Difference In Disease Recurrence Research Articles

Impact of cachexia on disease recurrence and survival outcomes in endometrial cancer patients

ObjectiveCancer cachexia is progressive weight loss due to muscle/adipose tissue wasting and inadequate intake that occurs in response to malignancy. It is an independent predictor of disease recurrence and reduced survival in several cancers. However, cachexia’s relationship with gynecologic malignancy outcomes has only been examined in small studies with limited follow-up and inconsistent definitions of cachexia. This study investigated the impact of cachexia on disease recurrence and overall survival in high-risk endometrial carcinoma patients. MethodsThis retrospective cohort study examined data from patients with high-risk non-metastatic primary endometrial carcinoma treated at a single institution from 2015 to 2020. Treatment for all subjects included total hysterectomy, surgical staging, pelvic external beam radiotherapy with or without adjuvant chemotherapy. Radiation planning CT datasets were used to measure skeletal musculature at the L3 vertebral level. Skeletal muscle index (SMI) was defined as total L3 skeletal muscle cross sectional area (cm2)/height2 (m2), and cachexia was defined based on SMI. Results55 patients were eligible for analysis. Several SMI thresholds were used to define cachexia, and analysis was performed for each definition. Kaplan-Meier and Cox-proportional hazards regression analysis yielded no significant reduction in overall survival (OS) or progression-free survival (PFS) in patients with cachexia, regardless of threshold chosen. However, 4 of 13 definitions of cachexia showed significantly improved OS in patients without cachexia, relative to those with cachexia. There were no significant differences in disease recurrence. ConclusionsCachexia as defined in this study was not associated with poor outcomes in endometrial carcinoma patients based on OS, PFS, or disease recurrence.

Pregnancy and the disease recurrence of patients previously treated for differentiated thyroid cancer: A systematic review and meta analysis.

Differentiated thyroid cancer (DTC) is commonly diagnosed in women of child-bearing age, but whether pregnancy influences the prognosis of DTC remains controversial. This study aimed to summarize existing evidence regarding the association of pregnancy with recurrence risk in patients previously treated for DTC. We searched PubMed, Embase, Web of Science, Cochrane, and Scopus based on the prespecified protocol registered at PROSPERO (CRD42022367896). After study selection, two researchers independently extracted data from the included studies. For quantitative data synthesis, we used random-effects meta-analysis models to pool the proportion of recurrence (for pregnant women only) and odds ratio (OR; comparing the risk of recurrence between the pregnancy group and the nonpregnancy group), respectively. Then we conducted subgroup analyses to explore whether risk of recurrence differed by response to therapy status or duration of follow-up time. We also assessed quality of the included studies. A total of ten studies were included. The sample size ranged from 8 to 235, with participants' age at pregnancy or delivery ranging from 28 to 35 years. The follow-up time varied from 0.1 to 36.0 years. The pooled proportion of recurrence in all pregnant patients was 0.13 (95% confidence intervals [CI]: 0.06-0.25; I2 : 0.58). Among six included studies reporting response to therapy status before pregnancy, we observed a trend for increasingly higher risk of recurrence from excellent, indeterminate, and biochemically incomplete to structurally incomplete response to therapy ( Ptrend <0.05). The pooled risk of recurrence in the pregnancy group showed no evidence of a significant difference from that in the nonpregnancy group (OR: 0.75; 95% CI: 0.45-1.23; I2 : 0). The difference in follow-up time (below/above five years) was not associated with either the proportion of recurrence in all pregnant patients ( P >0.05) or the OR of recurrence in studies with a comparison group ( P >0.05). Two included studies that focused on patients with distant metastasis also did not show a significant difference in disease recurrence between pregnancy and nonpregnancy groups (OR: 0.51 [95% CI: 0.14-1.87; I2 : 59%]). In general, pregnancy appears to have a minimal association with the disease recurrence of DTC with initial treatment. Clinicians should pay more attention to progression of DTC among pregnant women with biochemical and/or structural persistence. PROSPERO, https://www.crd.york.ac.uk/PROSPERO/ ; No. CRD42022367896.

Periprocedural management of sclerotherapy in patients with telangiectasias of the lower extremities

Objective — to reveal the effect of certain medicinal and non­medicinal factors that can be applied before and after the sclerotherapy procedure on the final result of the treatment. Materials and methods. The study included 104 patients aged 18 to 60 years who underwent sclerotherapy for the treatment of telangiectasias and reticular varicosities of the lower extremities. Patients were divided into subgroups depending on the appointment of phlebotonics and external means after the procedure. Results were evaluated 1, 3, and 6 months after treatment. Results and discussion. According to the self-assessment of patients, the best cosmetic result was achieved in the subgroup that used phlebotonics in combination with external therapy with heparin sodium gel, compared to the subgroups in which phlebotonics were not prescribed (p &lt; 0.01). In the subgroup where only phlebotonics were used, the result was also better compared to the subgroups in which phlebotonics were not prescribed (p = 0.03; p &lt; 0.01). Self-administration of sodium heparin gel did not provide a statistically significant improvement when comparing the subgroups (p = 0.26). No statistically significant difference in disease recurrence was found between the subgroups (p = 0.729). Conclusions. Ultrasound Doppler mapping with a detailed definition of the feeding sources of the reticular veins and telangiectasias allows determining the optimal stages of treatment to prevent the recurrence of the disease. The appointment of phlebotonics in the post­procedure period has a positive effect on the cosmetic result of sclerotherapy, especially in combination with external therapy with heparin sodium salt gel (p &lt; 0.01). The use of phlebotonics and gel with heparin sodium salt does not affect the number of relapses of the disease (p = 0,729), which is probably due to the technical impossibility of detecting feeding sources in the pre­procedural period.

Efficacy of Therapy vs Surveillance in Patients with Resected Early-Stage Intermediate to High-Risk Renal Cell Carcinoma

BACKGROUND: The historical standard of care for locally advanced renal cell carcinoma (RCC) is nephrectomy + active surveillance. Despite a high recurrence rate ( 40%), adjuvant therapy was previously not included in the standard of care. This review of adjuvant pharmacotherapy reflects conflicting results from multiple trials. OBJECTIVE: The objective of this review is to summarize the efficacy of therapy vs surveillance in resected early-stage intermediate to high-risk renal cell carcinoma. METHODS: We performed a systematic literature search using PubMed, EMBASE, and SCOPUS. Keywords such as “renal cell carcinoma”, “adjuvant therapy” and “nephrectomy” were used. In the literature search, 2,711 studies were identified and screened. RESULTS: We included a total of 21 publications. The most common histology seen in trials was clear cell carcinoma. A variety of interventions were reviewed including immunotherapy, medroxyprogesterone acetate, interferon alfa, and tyrosine kinase inhibitors. Most trials did not demonstrate a benefit in relapse-free survival (RPS) or overall survival (OS). Pembrolizumab demonstrated a significant difference in disease recurrence in the KEYNOTE-564 trial although median data was not reached. Blinded independent reviewers identified a benefit in disease-free survival (DFS) with Sunitinib in the S-TRAC trial. CONCLUSION: There was not a clear benefit in using adjuvant therapy broadly for resected locoregional RCC; however, further investigation should be done in the highest-risk group to elucidate potential benefit.

MP26-05 SINGLE-PORT VS. MULTIPORT PARTIAL NEPHRECTOMY: 6-MONTH INTERMEDIATE OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP26-05 SINGLE-PORT VS. MULTIPORT PARTIAL NEPHRECTOMY: 6-MONTH INTERMEDIATE OUTCOMES Jennifer L Nguyen, Teona Iarajuli, Katherine Kim, Jacquelyn Roth, Martin Malik, Allison Brown, Hunter Hasley, Simon Gelman, Mutahar Ahmed, and Michael Stifelman Jennifer L NguyenJennifer L Nguyen More articles by this author , Teona IarajuliTeona Iarajuli More articles by this author , Katherine KimKatherine Kim More articles by this author , Jacquelyn RothJacquelyn Roth More articles by this author , Martin MalikMartin Malik More articles by this author , Allison BrownAllison Brown More articles by this author , Hunter HasleyHunter Hasley More articles by this author , Simon GelmanSimon Gelman More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study aims to compare intermediate outcomes in patients following single port (SP) and multiport (MP) robotic-assisted partial nephrectomy (RAPN). METHODS: This prospective, single-center study involved patients who underwent SP or MP RAPN (based on surgeon preference), performed by two surgeons between 2017 and 2022, with at least 6 months of follow-up. Linear and logistic regression analyses were performed to estimate the difference in outcomes between SP and MP, adjusting for the operating surgeon. RESULTS: Overall, 48 patients underwent SP and 185 MP RAPN (20.6% vs. 79.4%) with minimum 6 month follow up. Table 1 summarizes demographics between the SP and MP cohorts and confirms no differences except for more females in the SP group. Table 2 summarizes the intermediate outcomes at 6 month follow up. There was no difference in disease recurrence or hernia incidence. There were significant differences in preservation of GFR (10.5, p = 0.004) despite similar changes in creatinine in the SP group. CONCLUSIONS: Based on our analyses, SP partial nephrectomy is an effective treatment with similar recurrence rates and hernia incidence at 6 months post surgery compared to MP . We did note an improvement in post op 6 month GFR for the SP group. The clinical significance of this is unclear as the change in creatinine was no different between the SP and MP groups. Larger multi-institutional studies are underway to evaluate if SP may have a protective effect on renal function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e353 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer L Nguyen More articles by this author Teona Iarajuli More articles by this author Katherine Kim More articles by this author Jacquelyn Roth More articles by this author Martin Malik More articles by this author Allison Brown More articles by this author Hunter Hasley More articles by this author Simon Gelman More articles by this author Mutahar Ahmed More articles by this author Michael Stifelman More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P3-05-27: The impact of co-existing ductal carcinoma in situ in invasive early hormone receptor positive breast cancer on the genomic and clinical risk of recurrence

Abstract Background: Invasive early breast cancer (IBC) often presents with a co-existing ductal carcinoma in situ (DCIS) component, while about 5% of the cases present with an extensive (&amp;gt;25%) intraductal component (EIC). The presence of a DCIS component was previously shown to be associated with favorable clinico-pathological characteristics and survival outcomes. However, the association between co-existing DCIS and genomic risk of recurrence is unclear. Methods: Patients with early hormone receptor positive (HR+) HER2neu-negative (HER2-) breast cancer and known OncotypeDX breast recurrence score (RS), who underwent breast surgery in our institute, were included. A natural language processing (NLP) algorithm was used to identify co-existence of extensive DCIS (DCIS-H) and non-extensive DCIS (DCIS-L) in surgical pathological reports. Genomic risk was determined using OncotypeDX RS, while clinical risk was calculated according to the MINDACT criteria, based on tumor size and grade. The genomic and clinical risks of DCIS-H, DCIS-L and pure IBC (No-DCIS) were compared. Results: A total of 45 (5%) DCIS-H cases, 468 (56%) DCIS-L cases and 328 (39%) No-DCIS cases were identified. DCIS-H cases presented with less aggressive clinico-pathological characteristics, such as lower proportions of histologic grade III (10% vs 26% vs 21%) and lower proportions of node-positive disease (13% vs 18% vs 21%), compared to DCIS-L and No-DCIS cases, respectively. The distribution of OncotypeDX RS significantly varied between the groups. DCIS-H tumors were less likely to have a high RS and more likely to have a low or intermediate RS compared to DCIS-L and No-DCIS tumors (High RS: 4% vs 20% vs 20%, Low + intermediate RS: 96% vs 80% vs 80%, respectively; p=0.04). Additionally, the proportions of high clinical risk cases were lower in the DCIS-H group compared to the DCIS-L and No-DCIS groups (42% vs 53% vs 50%, respectively; p=0.002). Based on genomic and clinical risk and current guidelines, we found that women presented with an extensive DCIS component (DCIS-H) had a lower probability of receiving an adjuvant chemotherapy recommendation compared to women presented with a non-extensive DCIS component (DCIS-L) or pure IBC (No-DCIS) (11% vs 29% vs 25%, respectively; p=.035). No differences in disease recurrence were detected between the groups. Conclusions: Co-existing extensive DCIS in invasive early HR+Her2- breast cancer is significantly correlated with lower genomic and clinical risk of recurrence and a smaller chance for chemotherapy recommendation. The rarity of this condition (5% of cases) limited our ability to detect differences in outcomes. These findings warrant future studies of the underlying genomic landscape of co-existing extensive DCIS. Citation Format: Yael Bar, Kfir Bar, Judith Ben- Dror, Didi Feldman, Meishar Shahoha, Ahuva Weiss-Meilik, Nachum Dershowitz, Wolf Ido, Amir Sonnenblick. The impact of co-existing ductal carcinoma in situ in invasive early hormone receptor positive breast cancer on the genomic and clinical risk of recurrence [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-27.

Stereotactic Body Radiotherapy (SBRT) in Very Limited-Stage Small Cell Lung Cancer (VLS-SCLC).

Small cell lung cancer (SCLC) is an aggressive neuroendocrine tumour with metastatic propensity. Stereotactic body radiation therapy (SBRT) is an emerging therapeutic option for SCLC, despite limited supporting evidence. By evaluating the use of SBRT in very limited stage (VLS) SCLC at our institution, we aimed to contribute to the existing knowledge in this area while establishing a basis for further research. We performed a retrospective review of all cases of VLS-SCLC treated with SBRT between 2013 and 2020. Baseline demographics, diagnostic, and treatment information were collected. The primary outcome was overall survival (OS). We identified 46 patients with pathologically confirmed VLS-SCLC; 25 were treated with SBRT, and the remainder received either surgery, conventional radiation therapy, chemotherapy, or palliative-intent therapy. After a median follow-up of 23.7 months, 44% of the patients had died; the median OS was of 24.4 months for the SBRT cohort and 67.0 months for the curative intent non-SBRT cohort. The difference in disease recurrence and survival between cohorts was underpowered and not statistically significant. Higher baseline ECOG and comorbidity was noted in the SBRT cohort.

Single-center experience of liver transplantation for perihilar cholangiocarcinoma.

Traditionally, curative resection was considered the cornerstone of treatment for perihilar cholangiocarcinoma. More recently, liver transplantation (LT) offered an alternative for patients with unresectable disease. The purpose of this study was to assess our experience with perihilar cholangiocarcinoma and LT. A perihilar cholangiocarcinoma protocol was commenced in 2006 whereby diagnosed patients were enrolled onto an institutional registry for LT consideration. Data on patient progression and oncologic outcomes were assessed. Fifty-eight patients were initially enrolled onto the protocol and 38 proceeded to LT following neoadjuvant chemoradiation (mean age 55.6±11.4 years). Mean time to LT was 3.7±2 months and, among those transplanted, 14 (37%) had underlying primary sclerosing cholangitis (PSC). Thirteen (34%) patients developed malignant recurrence and there were no differences in disease recurrence between PSC (n=3) and non-PSC (n=10) patients (p=0.32). Overall patient survival was 91%, 58% and 52% at 1-, 3- and 5-years corresponding with 81%, 52% and 46% graft survival, respectively. Rigorous patient selection and chemoradiation treatment algorithms can be highly effective in treating perihilar cholangiocarcinoma. For appropriately selected candidates, LT can provide a 52% 5-year survival for patients who would otherwise have no surgical treatment option.

Abstract P1-17-06: Impact of body mass index on the efficacy of aromatase inhibitors in patients with metastatic breast cancer

Abstract Background: Aromatase inhibitors (AIs) are part of standard endocrine therapy for hormone receptor (HR)-positive breast cancer (BC) and are used in both adjuvant and metastatic settings. Since AIs work by inhibiting the conversion of androgens to estrogen in peripheral adipose tissue, the higher levels of estrogen in obese patients may lead to incomplete inhibition by AIs and influence their efficacy. A retrospective analysis of the ABCSG-12 trial found that overweight premenopausal patients with early-stage BC treated with anastrozole had a 60% increased risk of disease recurrence and more than doubling in risk of death compared with normal weight patients on anastrozole. Similarly, an exploratory analysis from the ATAC trial found that in post-menopausal women with early-stage BC, overall recurrence rates were lower in patients randomized to anastrozole versus tamoxifen but in women with body mass index (BMI) &amp;gt; 30, there was no significant difference in disease recurrence between anastrozole and tamoxifen. While these findings raise concern for the efficacy of adjuvant AI therapy in obese patients with early-stage BC, this has not yet been demonstrated in the metastatic setting. The aim of this study was to determine the impact of BMI on efficacy of AIs in patients with metastatic HR-positive BC. Methods: We performed a retrospective chart review of all female patients with metastatic HR-positive BC on an AI in first- or second-line settings and seen at our academic institution between 2001-2020. The primary endpoint was progression-free survival (PFS), defined as the time from start of AI to disease progression or death from any cause. PFS was compared across BMI groups using Kaplan-Meier curves and log-rank tests. Cox proportional hazards regression model was used for univariate and multivariate analyses. Results: We identified 219 patients who had received an AI in the first- or second-line settings for metastatic HR-positive BC and with documented information on BMI. The median age was 59 with 45% of patients White, 29% African American, 16% Hispanic/Latino, 5.5% Asian and remainder other/unknown. 32% (71) had HER-2 positive disease. 82% (179) were on an AI in the first-line setting. Overall, 53% were on letrozole, 42% on anastrozole and 5.5% on exemestane. Of the 219 patients, 56% (123) had a low BMI (defined as &amp;lt; 27 kg/m2) and 44% (96) had a high BMI (≥ 27 kg/m2; based on the Breast Cancer Weight Loss [BWEL] trial). The median PFS was 21.9 months (95% CI, 14.5 to 28.4) in the low BMI group versus 20.2 months (95% CI, 14.3 to 27.5) in the high BMI group with no statistically significant difference (p =0.73). There were 8 (6.5%) deaths in the low BMI group and 7 (7.3%) deaths in the high BMI group. Multivariate cox regression model did not demonstrate any significant impact of BMI on PFS when adjusting for age, race/ethnicity, HER2 status, type of AI, line of therapy, drug partner and type of metastatic disease (HR =0.91, 95% CI =0.64 to 1.30, p =0.6 for high BMI group). Subgroup analysis of patients on an AI in the first line setting also did not show a significant difference in PFS with median PFS 19.3 and 18 months in the low and high BMI groups, respectively. Conclusions: In patients on an AI for metastatic HR-positive breast cancer, there was no statistically significant difference in PFS in patients with low versus high BMI. While BMI influences efficacy of AIs in the adjuvant setting, our results demonstrate that in the metastatic setting, BMI does not significantly impact the efficacy of AIs among our patient population. This discrepancy could be due to other differences in disease characteristics that make complete aromatase inhibition more important in the adjuvant setting when disease burden is the lowest. Additional larger studies are needed to confirm this finding. Citation Format: Rima Patel, Zhiqiang Li, Brittney S. Zimmerman, Marc Y. Fink, Jason D. Wells, Xiang Zhou, Kristin L. Ayers, Arielle Redfern, Scott Newman, Rong Chen, William K. Oh, Amy Tiersten. Impact of body mass index on the efficacy of aromatase inhibitors in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-17-06.

Statin use and patterns of breast cancer recurrence in the Malmö Diet and Cancer Study

BackgroundAccumulating evidence suggests that statins have a beneficial effect on breast cancer prognosis. Previous studies have reported a positive association between statin use and breast cancer survival; however, the relationship between statin use and patterns of breast cancer recurrence remains unclear. Patients and methodsWe identified all Malmö Diet and Cancer Study (MDCS) participants diagnosed with incident invasive breast cancer between 2005 and 2014. The follow-up period began at breast cancer diagnosis and continued until the first invasive breast cancer recurrence event, death, emigration or the end of the follow-up (June 8, 2020). We estimated incidence rates (IRs) of recurrence and fit Cox regression models to compute crude and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) for disease recurrence to compare post-diagnosis statin users with non-users. ResultsThe final study cohort consisted of 360 eligible patients with a median follow-up of 8.6 years. Overall, there were 71 recurrences in 2932 total person-years. According to statin use, there were 14 recurrences in 595 person-years among statin users, and 57 recurrences in 2337 person-years in non-users. Statin use was associated with a reduced risk of breast cancer recurrence (HRadj = 0.88 [95% CI: 0.82–0.96]). Regarding the pattern of recurrence, statin use was associated with a reduced risk of distant recurrence (HRadj = 0.86 [95% CI: 0.80–0.94]) but not loco-regional recurrence (HRadj = 0.97 [95% CI: 0.87–1.08]). ConclusionIn the MDCS, statin use was associated with a reduced risk of distant breast cancer recurrence, whereas no association between statin use and loco-regional breast cancer recurrence was found. This site-based difference in disease recurrence may be explained by statin's inhibition of epithelial-mesenchymal transition.

Pre- and postsurgical medical therapy for endometriosis surgery.

Pre- and postsurgical medical therapy for endometriosis surgery.

Segmental versus extended colectomy for tumours of the transverse colon: a systematic review and meta-analysis.

There is no consensus on the appropriate extent of oncological resection for tumours of the transverse colon. Concerns regarding tumour factors such as pattern of lymph node spread and technical factors such as anastomotic perfusion lead to a variety of procedures being performed. A comprehensive search for published studies examining outcomes following segmental versus extended colectomy for transverse colon tumours was performed adhering to PRISMA (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Random effects methods were used to combine data. Seven comparative series examining outcomes in 3395 patients were identified. Segmental colectomy results in shorter operating times (mean difference 15.80 min, 95% CI -20.98 to -10.62, P<0.001) and less ileus (OR 0.52, 95% CI 0.33-0.81, P=0.004). There was no difference in length of hospital stay (mean difference 1.53days, 95% CI -3.79 to 0.73, P=0.18). Extended colectomy results in a lower rate of anastomotic leak (OR 0.62, 95% CI 0.40-0.97, P=0.04). There are fewer nodes retrieved in segmental colectomy (mean difference 7.60 nodes, 95% CI -9.60 to -5.61, P<0.001) but no difference in disease recurrence (OR 0.88, 95% CI 0.59-1.34, P=0.56) or overall survival (OR 0.98, 95% CI 0.68-1.4, P=0.9). Available data are limited due to a lack of randomized controlled trials. However, based on current evidence, segmental resection for transverse colon tumours is associated with less ileus but lower lymph node yields and higher anastomotic leak rates. Length of stay is similar. Oncological outcomes are equivalent.

Can we treat bladder cancer with intravesical Bacillus Calmette-Guerin in patients with prior tuberculosis infection? A population-based cohort study

BackgroundIntravesical bacillus Calmette-Guerin (BCG) therapy is the treatment of choice for patients with T1 or high-grade superficial bladder cancer or those with carcinoma in situ after transurethral resection. A personal history of tuberculosis infection has been viewed as a relative contraindication for BCG therapy, because it may increase the risk of complications or decrease the treatment effectiveness. We determined the safety and efficacy of intravesical BCG treatment for patients with prior tuberculosis infection by analyzing the data obtained from the National Health Insurance Research Database in Taiwan.MethodsWe included patients who were newly diagnosed with bladder cancer from 2000 to 2009 and who received adjuvant intravesical BCG therapy within 3 months after the surgery. We excluded those who developed upper urinary tract cancer during the study period. Disease recurrence, disease progression, and major adverse effects were compared between patients with and without a prior diagnosis of tuberculosis infection until December 31, 2011.ResultsAmong the 3915 patients included, 187 (4.8%) had been previously diagnosed with tuberculosis infection. The proportion of men (84.0% versus 76.9%) and older patients was higher in the group with a prior tuberculosis infection than in those without a prior tuberculosis infection. Significant differences in disease recurrence (20.3% versus 22.8%; hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.63–1.21, p = 0.404) or disease progression (10.2% versus 12.8%, HR, 0.74; 95% CI, 0.46–1.17, p = 0.191) were not observed between the two groups. None of the patients with a prior tuberculosis infection had severe urinary tract infections, whereas four (0.1%) patients without such an infection developed severe urinary tract infections.ConclusionA prior tuberculosis infection did not affect the treatment efficacy or safety of intravesical BCG treatment. The efficacy and safety of intravesical BCG therapy are comparable between bladder cancer patients with and without prior tuberculosis infections.

Preoperative and Perioperative Analgesia/Anesthesia in Ovarian Cancer Patients: Correlation With Recurrence [36H

INTRODUCTION: Prior breast cancer studies demonstrated an association between beta blockers and nonsteroidal medication in disease-free survival, possibly due to immune interactions. This hypothesis-generating retrospective study evaluated the association between ovarian cancer recurrence and baseline medication use (aspirin, acetaminophen, nonsteroidals, beta blockers, or antidepressants) and the perioperative medication (Tylenol, NSAIDs and regional analgesia) administration. METHODS: After IRB approval, a retrospective chart review of an academic medical center’s pathology database and ovarian cancer registry was performed to evaluate medication administration and recurrence. RESULTS: 284 women with ovarian cancer were included (mean age 62 years). At point of last contact, 34.2% were alive without recurrence, 15.7% were alive with disease, 43.1% had died of disease, and 7% unknown. 61.2% had cancer recurrence. Mean time from surgery to recurrence was 23.7 months (4.4-132.5 +/- 20). There was no statistically significant difference in baseline use of beta blockers (P=.076), aspirin (P=.29), acetaminophen (P=.67), NSAIDs (P=.78) or anti-depressants (P=.96). There was no statistically significant difference between perioperative medication use and recurrence, regional anesthesia (P=.12), beta-blocker (P=.93), acetaminophen (P=.68), and nonsteroidals (P=.12). Women who recurred were older (59.5 vs 63.7 years, P&lt;.01) and had higher CA-125 (93.6% vs 6.4%, P&lt;.01) at diagnosis. Of the medications evaluated, antidepressants showed the only statistically significant difference in progression free survival (PFS), (70 vs 77 months, P=.008). CONCLUSION: Outside of the association of antidepressant use with worse PFS, there was no statistically significant difference in disease recurrence based on baseline or perioperative analgesic medication use.

Effects of high ligation of the inguinal or retroperitoneal varicoceles and microsurgical varicocele ligation on varicocele and its influence on sperm quality

Objective To investigate the therapeutic effect of varicocele treated with high ligation of the inguinal or retroperitoneal varicocele and microsurgical ligatures vein ligation. Methods A retrospective analysis of 90 patients with varicocele treated in our hospital from August 2015 to March 2018 was conducted. The patients were divided into three groups according to the different surgical methods. They were group A (surgical methods: High inguinal varicocele ligation), group B (surgical method: high retroperitoneal varicocele ligation) and group C (surgical method: microsurgical ligatures vein ligation), 30 cases in each group. The operative time, blood loss, postoperative day temperature, length of hospital stay, sperm quality, postoperative complications, and recurrence of the three groups were compared. Results The operation time of group C was significantly longer than that of group A and B, and the difference was statistically significant(P 0.05). One year after operation, the sperm quality indicators of the three groups were significantly higher than before surgery, and the difference was statistically significant (P<0.05). At the same time, the quality of each index in group C was significantly higher than that of group A and B(P<0.05). The group C of the 2 h incision pain was significantly better in group A and group B(P<0.05). The incidence of postoperative complications in group C was significantly lower than that in group A (40%) and group B (33.3%) (P<0.05). The difference in disease recurrence between the three groups was not statistically significant(P<0.05). Conclusions Microsurgical ligatures vein ligation for the treatment of varicocele compared to the inguinal or retroperitoneal varicocele ligation, its effect on improving sperm quality is better, the incidence of complications is low, the safety is higher , is worthy of further promotion of surgical methods. Key words: Varicocele; Groin; Peritoneum; Ligation; Spermatozoa

PD42-12 ONCOLOGICAL OUTCOMES OF UNFAVORABLE INTERMEDIATE-RISK IS COMPARABLE TO HIGH-RISK LOCALIZED PROSTATE CANCER IN PATIENTS TREATED WITH RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2018PD42-12 ONCOLOGICAL OUTCOMES OF UNFAVORABLE INTERMEDIATE-RISK IS COMPARABLE TO HIGH-RISK LOCALIZED PROSTATE CANCER IN PATIENTS TREATED WITH RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION Youness Ahallal, Davy Benarroche, Luis Felipe Snel Zanettini, Alexandre Colau, Clement Charbonnier, Jean-Francois Cote, and Bertrand Guillonneau Youness AhallalYouness Ahallal More articles by this author , Davy BenarrocheDavy Benarroche More articles by this author , Luis Felipe Snel ZanettiniLuis Felipe Snel Zanettini More articles by this author , Alexandre ColauAlexandre Colau More articles by this author , Clement CharbonnierClement Charbonnier More articles by this author , Jean-Francois CoteJean-Francois Cote More articles by this author , and Bertrand GuillonneauBertrand Guillonneau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1965AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with intermediate-risk prostate cancer (IR-PCa) are heterogeneous with highly variable prognoses. We have characterized an unfavorable subgroup of IR-PCa patients and aimed to compare their oncologic outcomes with those of patients harboring high-risk prostate cancer (HR-PCa) METHODS Between 2011 and 2016, 138 consecutive patients harboring IR-PCa according to the AUA risk groups were treated with radical prostatectomy and extended pelvic lymph node dissection (RP-ePLND) when the risk of lymph node involvement was higher than 2% according to the MSKCC nomogram. Of those, 91 patients who presented 4 out of 12 biopsy positive cores or higher were considered as unfavorable subgroup. Data were prospectively collected and extracted from our institutional database. Whithin the same period, 110 patients with HR-PCa were treated with RP-ePLND in our institution. Disease recurrence was defined as a serum PSA level of 0.2 ng/mL or higher with a confirmatory rise. The primary endpoint was biochemical recurrence-free survival and the secondary endpoints were metastasis-free survival, death due to prostate cancer and overall mortality. Statistical significance was set for p values <0.05. RESULTS Preoperative characteristics for patients with unfavorable IR-PCa and HR-PCa were respectively: median (interquartile range [IQR]) age was 65 (61-71) and 66 (61-70); median PSA was 8.6 (5.9-11.2) and 14.0 (4.7-27.7) ng/mL; prostate biopsy Gleason Score was 3 in five (3.3%) and four (4%) patients, 7 in 88 (96.7%) and 25 (23%) patients. Gleason score was 8 in 50 (45%), 9 in 10 (11%) HR-PCa patients and one HR-PCa patient had a Gleason score of 10. In patients with unfavorable IR-PCa and HR-PCa, respectively, 81 (89%) and 99 (90%) were disease-free after 18 (7.4-33.6) and 17.2 (5.3-31.7) months median (IQR) follow-up. When adjusted for pre-operative PSA, there was no significant difference in disease recurrence (hazard ratio [HR] 0.98 for HR-PCa vs IR-PCa; p=0.49). One (1.15%) and four (4.08%) patients developed subsequent metastases (HR 0.97 for HR-PCa vs IR-PCa; p=0.13), none of the patients died from prostate cancer and one patient died in each group from other causes. CONCLUSIONS The subgroup of unfavorable IR-PCa and HR-PCa patients had comparable oncological prognosis when treated with RP-ePLND. These results should be taken into account when counseling patients with such unfavorable IR-PCa characteristics who should be considered harboring a high-risk disease. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e819 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Youness Ahallal More articles by this author Davy Benarroche More articles by this author Luis Felipe Snel Zanettini More articles by this author Alexandre Colau More articles by this author Clement Charbonnier More articles by this author Jean-Francois Cote More articles by this author Bertrand Guillonneau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Extramammary Paget Disease of the Vulva: A Case Series Examining Treatment, Recurrence, and Malignant Transformation.

Extramammary Paget disease (EMPD) of the vulva is a rare lesion with a high recurrence rate ranging from 12% to 61%. The rate of underlying adenocarcinoma varies, but in the largest series was reported at 4%. Given the rarity of the disease there is a paucity of data to optimize treatment. This study aims to describe the management and recurrence patterns in a tertiary care setting and to offer suggestions for management in a modern-day setting. Patients with pathologically confirmed EMPD treated from 2000 to 2015 were retrospectively identified using an IRB approved database. Clinical data were abstracted from the electronic medical record. Pathology underwent central review. Forty-four patients met criteria and underwent central pathology review. Forty-two patients were treated with surgical excision. Alternative treatment modalities included Mohs surgery in 3 patients and medical therapy in 20 patients. The median number of surgical procedures was 1 and the number of procedures ranged from 1 to 16. Twenty-five patients (56.8%) had recurrent disease with a median of 2 (1-6) recurrences per patient. The median disease-free interval was 28.7 months with a median follow up of 45.8 months (1.2-178.9 months). Three patients (7%) had invasive cancer and 7 patients (16%) were diagnosed with a separate malignancy at or following diagnosis of EMPD. Despite radical resection, the majority of patients had positive margins and there was no significant difference in disease recurrence between simple and radical resection (P = 0.69). Patients with EMPD in this series have a high rate of recurrence. Many undergo multi-modal therapy often with multiple providers. However, patients experience relatively long disease-free intervals with a low rate of associated malignancy. We propose an algorithm for management that focuses on symptom control and minimizing morbidity of treatment intervention once invasive disease has been excluded.

Association Between Recurrence and Re-Excision for Close and Positive Margins Versus Observation in Patients with Benign Phyllodes Tumors.

Breast lesions not sampled prior to surgery or initially diagnosed as fibroepithelial lesions on core biopsy may have a diagnosis of phyllodes tumor (PT) on excision. Historically, re-excision for close or positive margins has been the standard of care. We examined the rate of re-excision for close or positive margins in patients with benign phyllodes and compared recurrence rates among those undergoing re-excision versus observation. We identified all patients with phyllodes tumor diagnosed between 2003 and 2013. Operative and surgical pathology reports were reviewed for clinical, pathologic, and follow-up data. Among 246 cases, 216 (88%) were benign PT and 30 (12%) borderline/malignant tumors. In the group of benign PT (n=216), margins were negative in 64 patients (29.6%), 50 (23%) were close, and 102 (47%) were positive. Of those with close margins, 22 (44%) underwent reexcision and residual benign PT was found in 2 (9%). In patients with positive margins, 45 (44%) had re-excision and residual benign PT was detected in 4 (8.8%). After a median follow-up of 35.5months, there were 4 (1.9%) recurrences among patients with benign PT. There was no difference in recurrence among patients who had re-excision for positive or close margins versus observation (p=0.7 and 0.21, respectively). Among patients with close or positive margins, there was no significant difference in disease recurrence between patients who underwent reexcision and those who were observed. Based on these results, it may be reasonable to manage these patients conservatively with close follow-up.

Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases: A Comprehensive Systematic Review and Meta-analysis

The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non-randomized studies with 4697 patients (LLR: 1809, OLR: 2888) were analyzed. There were higher rates of clear surgical margins (OR: 1.64, 95%CI: 1.32 to 2.05, p < 0.00001) in the LLR group, without significant differences in disease recurrence, 3- or 5-year overall survival(OS) and disease free survival(DFS) between the two approaches. LLR was associated with less intraoperative blood loss (WMD: −147.46 [−195.78 to −99.15] mL, P < 0.00001) and fewer blood transfusions (OR: 0.41 [0.30–0.58], P < 0.00001), but with longer operation time (WMD:14.44 [1.01 to 27.88] min, P < 0.00001) compared to OLR. Less overall morbidity (OR: 0.64 [0.55 to 0.75], p < 0.00001) and shorter postoperative hospital stay (WMD: −2.36 [−3.06 to −1.66] d, p < 0.00001) were observed for patients undergoing LLR, while there was no statistical difference in mortality. LLR appears to be a safe and feasible alternative to OLR in the treatment of CCLM in selected patients.

Adjuvant platinum-based chemotherapy for early stage cervical cancer.

This is the second updated version of the original Cochrane review published in the Cochrane Library 2009, Issue 3. Most women with early cervical cancer (stages I to IIA) are cured with surgery or radiotherapy, or both. We performed this review originally because it was unclear whether cisplatin-based chemotherapy after surgery, radiotherapy or both, in women with early stage disease with risk factors for recurrence, was associated with additional survival benefits or risks. To evaluate the effectiveness and safety of adjuvant platinum-based chemotherapy after radical hysterectomy, radiotherapy, or both in the treatment of early stage cervical cancer. For the original 2009 review, we searched the Cochrane Gynaecological Cancer Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library 2009, Issue 1), MEDLINE, Embase, LILACS, BIOLOGICAL ABSTRACTS and CancerLit, the National Research Register and Clinical Trials register, with no language restriction. We handsearched abstracts of scientific meetings and other relevant publications. We extended the database searches to November 2011 for the first update and to September 2016 for the second update. Randomised controlled trials (RCTs) comparing adjuvant cisplatin-based chemotherapy (after radical surgery, radiotherapy or both) with no adjuvant chemotherapy, in women with early stage cervical cancer (stage IA2-IIA) with at least one risk factor for recurrence. Two review authors extracted data independently. Meta-analysis was performed using a random-effects model, with death and disease progression as outcomes. For this second updated version we identified only one small trial reporting grade 4 toxicity results, without disease-free or overall survival data with a median follow-up of 16 months.From the first updated version, we identified three trials that were ongoing, and remain so in 2016.Four trials including 401 women with evaluable results with early cervical cancer were included in the meta-analyses. The median follow-up period in these trials ranged from 29 to 42 months. All women had undergone surgery first. Three trials compared chemotherapy combined with radiotherapy versus radiotherapy alone; and one trial compared chemotherapy followed by radiotherapy versus radiotherapy alone. It was not possible to perform subgroup analyses by stage or tumour size.Compared with adjuvant radiotherapy, chemotherapy combined with radiotherapy significantly reduced the risk of death (two trials, 297 women; hazard ratio (HR) = 0.56, 95% confidence interval (CI): 0.36 to 0.87) and disease progression (two trials, 297 women; HR = 0.47, 95% CI 0.30 to 0.74), with no heterogeneity between trials (I² = 0% for both meta-analyses). Acute grade 4 toxicity occurred significantly more frequently in the chemotherapy plus radiotherapy group than in the radiotherapy group (three trials, 321 women; risk ratio (RR) 6.26, 95% CI 2.50 to 15.67). We considered the evidence for all three outcomes to be of a moderate quality, using the GRADE approach due to small numbers and limited follow-up in the included studies. In addition, it was not possible to separate data for bulky early stage disease.In the one small trial that compared adjuvant chemotherapy followed by radiotherapy with adjuvant radiotherapy alone there was no difference in disease recurrence between the groups (one trial, 71 women; HR = 1.34; 95% CI 0.24 to 7.66) and overall survival was not reported. We considered this evidence to be of a low quality.No trials compared adjuvant platinum-based chemotherapy with no adjuvant chemotherapy after surgery for early cervical cancer with risk factors for recurrence. The addition of platinum-based chemotherapy to adjuvant radiotherapy (chemoradiation) may improve survival in women with early stage cervical cancer (IA2-IIA) and risk factors for recurrence. Adjuvant chemoradiation is associated with an increased risk of severe acute toxicity, although it is not clear whether this toxicity is significant in the long term due to a lack of long-term data. This evidence is limited by the small numbers and low to moderate methodological quality of the included studies. We await the results of three ongoing trials, which are likely to have an important impact on our confidence in this evidence.