Difference In Cancer-specific Survival Research Articles

Impact of radiotherapy on second primary lung cancer incidence and survival in esophageal cancer survivors

Esophageal cancer, ranked as the seventh most common cancer globally, encompasses squamous cell carcinoma and adenocarcinoma. Despite advancements in treatment modalities like surgery, chemotherapy, radiotherapy, and immunotherapy, radiotherapy, while crucial for enhancing local control and survival, poses risks for long-term side effects and the development of second primary malignancies (SPM), notably Second primary lung cancer (SPLC). This study aims to analyze the incidence of second primary lung cancer (SPLC) among esophageal cancer survivors, with a focus on the influence of radiotherapy, analyze variations across different demographic and clinical subgroups, and assess patient survival outcomes. Using data from the Surveillance, epidemiology, and end results (SEER) program on 56,493 esophageal cancer patients (2000–2020), we compared SPLC incidence in those with and without prior radiotherapy. We applied a competing risks framework, propensity score matching (PSM), and survival analyses to assess SPLC risk and radiotherapy’s impact. The study showed that patients treated with radiotherapy have a significantly higher long-term risk of SPLC compared to those without it. Radiotherapy significantly raised SPLC risk (HR 1.41, 95% CI 1.06–1.88), with higher SIRs particularly in younger patients and females. Post-PSM, there were significant differences in cancer-specific survival between esophageal cancer survivors with post-radiotherapy SPLC and those with only primary lung cancer. This cohort study shows that radiotherapy in esophageal cancer survivors increases SPLC risk but does not worsen survival compared to those with OPLC, highlighting the need for long-term monitoring and management.

Local Excision Versus Radical Resection for Grade 2 Rectal Neuroendocrine Tumors: A Multicenter Propensity Score-Matched Analysis.

Studies on grade 2 rectal neuroendocrine tumors are limited, and the optimal treatment for these tumors is not well established. We aimed to compare the oncologic results of local excision versus radical resection for the treatment of grade 2 rectal neuroendocrine tumors. Retrospective multicenter propensity score-matched study to minimize heterogeneity between groups and focus on the differences between surgery strategies. Seventeen large-scale Chinese medical centers participated in this study. A total of 144 patients with pathologically confirmed grade 2 rectal neuroendocrine tumors were retrospectively analyzed. Cancer-specific survival and relapse-free survival were assessed to compare surgery strategies. A total of 144 patients with grade 2 rectal neuroendocrine tumors were enrolled in this study. Twenty-seven patients underwent endoscopic resection, 55 underwent transanal excision, 50 underwent radical resection, and 12 underwent palliative surgery or biopsy for distant metastasis. Of the 50 patients who underwent radical resection, 30 (60.0%) had clinically positive lymph nodes on the basis of the histopathology results. The optimal cutoff value for tumor size to predict cancer-specific survival was 1.5 cm. In patients with grade 2 rectal neuroendocrine tumors of ≤1.5-cm size, there were no significant differences in cancer-specific survival and relapse-free survival between local excision and radical resection groups ( p > 0.05). In patients with grade 2 rectal neuroendocrine tumors of >1.5-cm size, relapse-free survival was significantly lower in the local excision group than in the radical resection group ( p = 0.04). The nature of retrospective reviews and a relatively short follow-up period are limitations of this study. Grade 2 rectal neuroendocrine tumors have a nonnegligible rate of lymph node metastasis. Local excision is a feasible choice for tumors of ≤1.5 cm size without metastasis, whereas radical resection is more beneficial in those of >1.5 cm size. See Video Abstract . ANTECEDENTES:Los estudios sobre los tumores neuroendocrinos rectales de grado 2 son limitados y el tratamiento óptimo para estos tumores no está bien establecido.OBJETIVO:Comparar los resultados oncológicos de la escisión local versus la resección radical para el tratamiento de tumores neuroendocrinos rectales grado 2.DISEÑO:Estudio multicéntrico retrospectivo emparejado por puntuación de propensión para minimizar la heterogeneidad entre grupos y centrarse en la diferencia entre estrategias quirúrgicas.ESCENARIO:Diecisiete centros médicos chinos de gran tamaño participaron en este estudio.PACIENTES:Se analizaron retrospectivamente un total de 144 pacientes con tumores neuroendocrinos rectales grado 2 patológicamente confirmados.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluaron la supervivencia específica del cáncer y la supervivencia libre de recaída para comparar las estrategias quirúrgicas.RESULTADOS:En este estudio se inscribieron un total de 144 pacientes con tumores neuroendocrinos rectales grado 2. Veintisiete pacientes se sometieron a resección endoscópica, 55 a escisión transanal, 50 a resección radical y 12 a cirugía paliativa o biopsia por metástasis a distancia. De los 50 pacientes que se sometieron a resección radical, 30 (60,0%) tenían ganglios linfáticos clínicamente positivos según los resultados histopatológicos. El valor de corte óptimo para el tamaño del tumor para predecir la supervivencia específica del cáncer fue de 1,5 cm. En pacientes con tumores neuroendocrinos rectales grado 2 ≤ 1,5 cm, no hubo diferencias significativas en la supervivencia específica del cáncer y la supervivencia libre de recaída entre los grupos de escisión local y resección radical ( p >0,05). En pacientes con tumores neuroendocrinos rectales grado 2 > 1,5 cm, la supervivencia libre de recaída fue significativamente menor en el grupo de escisión local que en el grupo de resección radical ( p = 0,04).LIMITACIONES:La naturaleza de la revisión retrospectiva y el período de seguimiento relativamente corto son limitaciones de este estudio.CONCLUSIONES:Los tumores neuroendocrinos rectales grado 2 tienen una tasa no despreciable de metástasis en los ganglios linfáticos. La escisión local es una opción factible para tumores ≤ 1,5 cm sin metástasis, mientras que la resección radical es más beneficiosa en aquellos > 1,5 cm. (Traducción-Dr. Felipe Bellolio ).

Functional Impact of Neuro-Vascular Bundle Preservation in High Risk Prostate Cancer without Compromising Oncological Outcomes: A Propensity-Modelled Analysis.

Nerve sparing (NS) is a surgical technique to optimize functional outcomes of radical prostatectomy (RP). However, it is not recommended in high risk (HR) cases because of the risk of a positive surgical margin that may increase the risk of cancer recurrence. In the last two decades there has been a change of perspective to the effect that in well-selected cases NS could be an oncologically safe option with better functional outcomes. Therefore, we aim to compare the functional outcomes and oncological safety of NS during RP in men with HR disease. A total of 1340 patients were included in this analysis, of which 12% (n = 158) underwent non-NSRP and 39% (n = 516) and 50% (n = 666) uni- and bilateral NSRP, respectively. We calculated a propensity score and used inverse probability of treatment weighting (IPTW) to balance the baseline characteristics of Pca patients undergoing non-NSRP and those having uni- and bilateral NSRP, respectively. NS improved functional outcomes; after IPTW, only 3% of patients having non-NSRP reached complete erectile function recovery (without erectile aid) at 24 months, whereas 22% reached erectile function recovery (with erectile aid), while 87% were continent. Unilateral NS increased the probability of functional recovery in all outcomes (OR 1.1 or 1.2, respectively), bilateral NS slightly more so (OR 1.1 to 1.4). NSRP did not impact the risk of any recurrence (HR 0.99, 95%CI 0.73-1.34, p = 0.09), and there was no difference in survival for men who underwent NSRP (HR 0.65, 95%CI 0.39-1.08). There was no difference in cancer-specific survival (0.56, 95%CI 0.29-1.11). Our study found that NSRP significantly improved functional outcomes and can be safely performed in carefully selected patients with HR-PCa without compromising long term oncological outcomes.

IDH1-mutated Crohn's disease-associated small bowel adenocarcinomas: Distinctive pathological features and association with MGMT methylation and serrated-type dysplasia.

Patients with Crohn's disease (CrD) have an elevated risk for the development of small bowel adenocarcinomas (SBAs). Actionable isocitrate dehydrogenase 1 (IDH1) mutations have been reported to be more frequent in CrD-SBAs than in sporadic SBAs. The present study aimed to investigate the clinicopathological and immunophenotypical features, as well as methylation profiles, of IDH1-mutated CrD-SBAs. An international multicentre series of surgically resected CrD-SBAs was tested for IDH1 mutation. Clinicopathological features, immunophenotypical marker expression and O6-methylguanine-DNA methyltransferase (MGMT) and long interspersed nuclear element-1 (LINE-1) methylation were compared between IDH1-mutated and IDH1 wild-type CrD-SBAs. Ten (20%) of the 49 CrD-SBAs examined harboured an IDH1 mutation and all the mutated cancers harboured the R132C variant. Compared to IDH1 wild-type cases, IDH1-mutated CrD-SBAs showed significantly lower rates of cytokeratin 7 expression (P = 0.005) and higher rates of p53 overexpression (P = 0.012) and MGMT methylation (P = 0.012). All three dysplastic growths associated with IDH1-mutated SBAs harboured the same IDH1 variant (R132C) of the corresponding invasive cancer, and all were of non-conventional subtype (two serrated dysplastic lesions and one goblet cell-deficient dysplasia). In particular, non-conventional serrated dysplasia was significantly associated with IDH1-mutated CrD-SBAs (P = 0.029). No significant cancer-specific survival difference between IDH1-mutated CrD-SBA patients and IDH1 wild-type CrD-SBA patients was found (hazard ratio = 0.55, 95% confidence interval = 0.16-1.89; P = 0.313). IDH1-mutated CrD-SBAs, which represent approximately one-fifth of total cases, are characterised by distinctive immunophenotypical features and methylation profiles, with potential therapeutic implications. Moreover, IDH1-mutated non-conventional, serrated dysplasia is likely to represent a precursor lesion to such CrD-SBAs.

Administration of Enfortumab Vedotin after Immune-Checkpoint Inhibitor and the Prognosis in Japanese Metastatic Urothelial Carcinoma: A Large Database Study on Enfortumab Vedotin in Metastatic Urothelial Carcinoma.

Enfortumab vedotin shows promise as a targeted therapy for advanced urothelial carcinoma, particularly in patients who have previously received platinum-based chemotherapy and an immune-checkpoint inhibitor. The EV-301 phase III trial demonstrated significantly improved overall survival and response rates compared to standard chemotherapy. However, more data, especially from larger real-world studies, are needed to further assess its effectiveness in Japanese patients. A total of 6007 urothelial cancer patients inducted with pembrolizumab as a second-line treatment were analyzed. Among them, 563 patients received enfortumab vedotin after pembrolizumab, while 443 patients received docetaxel or paclitaxel after pembrolizumab, and all were included in the study for efficacy as a life prolonging agent. The enfortumab vedotin group showed a longer overall survival than the paclitaxel/docetaxel group (p = 0.013, HR: 0.71). In multivariate analysis, enfortumab vedotin induction was the independent risk factor for overall survival (p = 0.013, HR: 0.70). There were no significant differences in cancer-specific survival. Enfortumab vedotin prolonged the overall survival for Japanese advanced or metastatic urothelial carcinoma patients compared to paclitaxel or docetaxel after pembrolizumab treatment.

Effect of type of definitive treatment on race-based differences in prostate cancer-specific survival.

Racial and ethnic disparities in prostate cancer (PCa)mortality are partially mediated by inequities in quality of care. Intermediate- and high-risk PCa can be treated with either surgery or radiation, therefore we designed a study to assess the magnitude of race-based differences in cancer-specific survival between these two treatment modalities. Non-HispanicBlack (NHB)and non-HispanicWhite (NHW)men with localized intermediate- and high-risk PCa, treated with surgery or radiation between 2004 and 2015 in the Surveillance, Epidemiologyand End Results database were included in the study and followed until December 2018. Unadjusted and adjusted survival analyses were employed to compare cancer-specific survival by race and treatment modality. A model with an interaction term between race and treatment was used to assess whether the type of treatment amplified or attenuated the effect of race/ethnicity on prostate cancer-specific mortality (PCSM). 15,178 (20.1%) NHB and 60,225 (79.9%) NHW men were included in the study. NHB men had a higher cumulative incidence of PCSM (p = 0.005) and were significantly more likely to be treated with radiation than NHW men (aOR: 1.89, 95% CI: 1.81-1.97,p < 0.001). In the adjusted models, NHB men were significantly more likely to die from PCa compared withNHW men (aHR: 1.18,95% CI:1.03-1.35, p = 0.014), and radiation was associated with a significantly higher odds of PCSM (aHR: 2.10,95% CI:1.85-2.38, p < 0.001) compared with surgery. Finally, the interaction between race and treatment on PCSM was not significant, meaning that no race-based differences in PCSM were found within each treatment modality. NHB men with intermediate- and high-risk PCa had a higher rate of PCSM than NWH men in a large national cancer registry, though NHB and NHW men managed with the same treatment achieved similar PCa survival outcomes. The higher tendency for NHB men to receive radiation was similar in magnitude to the difference in cancer survival between racial and ethnic groups.

MP77-17 EFFECT OF TYPE OF DEFINITIVE TREATMENT ON RACE-BASED DIFFERENCES IN PROSTATE CANCER-SPECIFIC SURVIVAL

You have accessJournal of UrologyCME1 Apr 2023MP77-17 EFFECT OF TYPE OF DEFINITIVE TREATMENT ON RACE-BASED DIFFERENCES IN PROSTATE CANCER-SPECIFIC SURVIVAL Nicola Frego, Muhieddine Labban, Benjamin V. Stone, Mara Koelker, Khalid Alkhatib, Dejan K. Filipas, Edoardo Beatrici, Giovanni Lughezzani, Nicolò Maria Buffi, Stuart R. Lipsitz, Joel S. Weissman, Sean A. Fletcher, Adam S. Kibel, Quoc-Dien Trinh, and Alexander P. Cole Nicola FregoNicola Frego More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Benjamin V. StoneBenjamin V. Stone More articles by this author , Mara KoelkerMara Koelker More articles by this author , Khalid AlkhatibKhalid Alkhatib More articles by this author , Dejan K. FilipasDejan K. Filipas More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Joel S. WeissmanJoel S. Weissman More articles by this author , Sean A. FletcherSean A. Fletcher More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Alexander P. ColeAlexander P. Cole More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Racial and ethnic disparities in prostate cancer (PCa) mortality are partially mediated by inequities in quality of care. Intermediate- and high-risk PCa can be treated with either surgery or radiation. We sought to assess the magnitude of race-based differences in cancer-specific survival between these treatment modalities. METHODS: NHB and non-Hispanic White (NHW) men with localized intermediate- and high-risk PCa, treated with surgery or radiation between 2004 and 2015 in the Surveillance, Epidemiology and End Results database were included in the study. Follow up was to December 2018. Unadjusted Kaplan-Meier curves and adjusted Fine-Gray competing-risks regression analyses with other cause of death as competing event, were employed to compare cancer-specific survival by race and treatment modality. A model with an interaction term between race and treatment was used to assess whether the type of treatment amplified or attenuated the effect of race on prostate cancer-specific mortality (PCSM). RESULTS: 15,178 (20,1%) NHB and 60,225 (79.9%) NHW men were included in the study. NHB men had a higher cumulative incidence of PCSM (p=0.005 by log-rank test) and were significantly less likely to be treated with surgery than NHW men (aOR:0.53, 95%CIs:0.51–0.55, p<0.001). In the adjusted models, NHB men were not significantly more likely to die for PCa compared to NHW men (aHR:1.11, 95%CIs:0.97-1.27, p=0.123); while radiation was associated with a significantly higher odds of PCSM (aHR:2.03, 95%CIs:1.79-2.31, p<0.001) compared to surgery. Finally, the interaction between race and treatment on PCSM was not significant (pint=0.073), meaning that no race-based differences in PCSM were found within each treatment modality. Indeed, we found no significant difference in PCSM when comparing NHB vs. NHW men treated with surgery (aHR:1.25, 95%CIs:0.97–1.63, p=0.086) or radiation (aHR:0.95, 95%CI:0.82–1.11, p=056). CONCLUSIONS: NHB and NHW men managed with the same treatment achieved similar PCa survival outcomes in a large national cancer registry. The higher tendency for NHB men to receive radiation was similar in magnitude to the difference in cancer survival between racial and ethnic groups. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1109 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicola Frego More articles by this author Muhieddine Labban More articles by this author Benjamin V. Stone More articles by this author Mara Koelker More articles by this author Khalid Alkhatib More articles by this author Dejan K. Filipas More articles by this author Edoardo Beatrici More articles by this author Giovanni Lughezzani More articles by this author Nicolò Maria Buffi More articles by this author Stuart R. Lipsitz More articles by this author Joel S. Weissman More articles by this author Sean A. Fletcher More articles by this author Adam S. Kibel More articles by this author Quoc-Dien Trinh More articles by this author Alexander P. Cole More articles by this author Expand All Advertisement PDF downloadLoading ...

Novel diagnostic biomarkers of T cell-mediated tumor killing characteristics for early-stage triple negative breast cancer: A SEER analysis and molecular portraits.

The primary objective was to investigate the epidemiology, molecular characteristics, and clinical survival to identify potential transcriptome biomarkers to promote early diagnosis and screening of triple-negative breast cancer patients. Early-stage triple-negative breast cancer patients (E-TNBC) and late-stage triple-negative breast cancer patients (L-TNBC) were identified from the Surveillance, Epidemiology, and End Results database from 2010 to 2019. The difference in cancer specific survival (CSS) and overall survival (OS) between E-TNBC and L-TNBC was analyzed via a Kaplan-Meier plotter. 118 triple-negative breast cancer samples and 114 normal samples with the RNA sequencing expression data were selected from the cohort of TCGA breast cancer from UCSC Xena Database. The study involved 13,690 patients with L-TNBC and 44,994 patients with E-TNBC. L-TNBC patients were more frequently to be ≤ 60 years old (54.9% vs 52.2%), multiple primary site (44.0% vs 30.1%), and were more likely to receive radiotherapy (49.6% vs 47.4%) and chemotherapy (81.1% vs 72.1%), while L-TNBC patients were less likely to be white (68.7% vs 73.0%), married or with domestic partner (46.7% vs 54.7%), poorly differentiated grade (54.0% vs 61.9%), < 3 months from diagnosis to treatment (91.6% vs 96.4%), and were less likely to receive surgery (72.3% vs 95.4%). Stage-stratified survival analysis revealed that the prognosis of L-TNBC was worse when compared to E-TNBC, Kaplan-Meier analysis demonstrated that there were striking differences in OS and CSS between E-TNBC and L-TNBC. In the multivariable regression models, L-TNBC was the single highest risk factor, with a death risk that was 4.741 and 6.074 times higher than E-TNBC in terms of OS and CSS, respectively. The results also showed that treatment with surgery, radiation, or chemotherapy was effective for a better prognosis. Transcriptome analyses revealed that the top 5 upregulated genes in L-TNBC were, respectively, ISX, ALOX15B, MADCAM1, TP63, and ARG1 compared with E-TNBC. And the top 5 downregulated genes were, respectively, CTAG1B, CT45A1, MAGEC2, TFF2, and TNFRSF11B. The L-TNBC exhibited a lower rate of survival than E-TNBC, and the 2 groups differed in terms of transcriptome characteristics. To date, the diagnostic value of T cell-mediated tumor killing portraits on E-TNBC may not be completely recognized.

Pathological and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses.

We evaluated oncologic risks in a large cohort of patients with radiographic cystic renal masses who underwent active surveillance or intervention. A single-institutional database of 4,340 kidney lesions managed with either active surveillance or intervention between 2000-2020 was queried for radiographically cystic renal masses. Association of radiographic tumor characteristics and high-grade pathology was evaluated. We identified 387 radiographically confirmed cystic lesions in 367 patients. Of these, 247 were resected (n=240) or ablated (n=7; n=247, 203 immediate vs 44 delayed intervention). Pathologically, 23% (n=56) demonstrated high-grade pathology. Cystic features were explicitly described by pathology in only 18% (n=33) of all lesions and in 7% (n=4) of high-grade lesions. Of the intervention cohort, African American race, male gender, and Bosniak score were associated with high-grade pathology (P < .05). On active surveillance (n=184), Bosniak IV lesions demonstrated faster growth rates than IIF and III lesions (2.7 vs 0.6 and 0.5 mm/y, P ≤ .001); however, growth rates were not associated with high-grade pathology (P = .5). No difference in cancer-specific survival was identified when comparing intervention vs active surveillance at 5 years (99% vs 100%, P = .2). No difference in recurrence was observed between immediate intervention vs delayed intervention (P > .9). A disconnect between "cystic" designation on imaging and pathology exists for renal lesions. Over 80% of radiographic Bosniak cystic lesions are not described as "cystic" on pathology reports. More than 1 in 5 resected cystic renal lesions demonstrated high-grade disease. Despite this finding, judiciously managed active surveillance ± delayed intervention is a safe and effective management option for most radiographic cystic renal masses.

Recursive Partitioning Analysis to Define Prognostic Groups Using a Large Single Institution Experience of Multimodality Radiation Therapy for Bladder Cancer

<h3>Purpose/Objective(s)</h3> We analyzed a cohort of patients who received definitive trimodality therapy (TMT) for bladder cancer at a single high-volume institution. We hypothesized that a recursive partitioning analysis (RPA) including patient and tumor characteristics would allow stratification of patients into clinically meaningful prognostic groups for local recurrence. <h3>Materials/Methods</h3> A retrospective cohort analysis was performed for bladder cancer patients treated with definitive radiation or chemoradiation therapy from 2006 to 2021 at our institution. We assessed overall and disease-free survival for the cohort and as a function of clinical and pathologic features. We performed an RPA for multivariate decision tree analysis to associate outcomes with individual clinical and pathologic variables. <h3>Results</h3> 175 patients were identified who were treated with definitive radiation (28%) or chemoradiation (72%) and had adequate follow-up data for analysis. Median follow up time was 23 months (Median age=78 [IQR 71-84], 77% male). While Grade 1-2 toxicities were common, Grade ≥3 toxicities were rare and there were no treatment related deaths. Cumulative 2yr and 5yr CSS were 79% and 61%, respectively. Radical cystectomy (RCx) eligible patients (35%) had a significantly longer OS after bladder sparing therapy compared to RCx ineligible patients (5y OS 54% vs 29%, Log-Rank p=0.003), however no difference in cancer specific survival was seen between groups (5y CSS 61% vs 58%, Log-Rank p = 0.851). Tumor size greater than 5cm did not correlate with risk of recurrence (Log-Rank p=0.194). The most common site of recurrence in the cohort was distant (35%), followed by locoregional (19%) and bladder only (6%). Nine patients (5%) underwent salvage cystectomy (7 for invasive local recurrence) after initial definitive radiation therapy. Using RPA and decision tree analysis, the presence of CIS and older age at treatment were the strongest predictors of local recurrence. The RPA results confirmed no significant association between tumor size and risk of local recurrence. <h3>Conclusion</h3> Multimodality bladder preservation had CSS comparable to modern surgical series and high rates of functional organ preservation. Cystectomy candidacy was a strong predictor of overall survival but not cancer specific survival, suggesting group level mismatches in competing risks of death. Extensive CIS was associated with increased risk of local failure, but tumor size may not be a reliable predictor of treatment response. RPA prognostic groups were generated which may be used to guide clinical decision making and improve patient selection for bladder preservation.

Persistent racial and ethnic inequities in cancer-specific mortality of head and neck cancers by human papillomavirus infection.

148 Background: Overlapping racial and ethnic disparities exist in the prevalence of risk factors that drive the prognosis of head and neck cancers in the US, including the use of tobacco products, socioeconomic status and human papillomavirus (HPV) infection. Our objective was to describe inequities in cancer-specific survival among patients diagnosed with head and neck cancers by HPV status and racial/ethnic group. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology and End Results Head and Neck with HPV Status Database. Patients diagnosed with first primary cancers of the hypopharynx, nasopharynx, oropharynx, pharyngeal tonsil, other pharyngeal, soft palate and tongue base between 2010 and 2016 were included, and information on clinical and demographic characteristics including tumor information, cancer-directed treatment, area-level socioeconomic status and HPV status were collected from population-based cancer registry data. Estimates of 5-year cancer-specific survival were calculated using the Kaplan-Meier method, and multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for racial/ethnic inequities in survival stratified by HPV status. Results: Among 15,393 patients diagnosed with head and neck cancer with documented HPV status, the median age was 59 years (interquartile range 53-66) and 10,457 (68%) were HPV+. Compared to patients diagnosed with HPV- head and neck cancers, a higher proportion of patients with HPV+ head and neck cancers were male (87% vs. 77%), diagnosed at stage IV (75% vs. 66%) and non-Hispanic White (84% vs. 68%%); and a lower proportion of HPV+ patients were non-Hispanic Black (6% vs. 13%) and uninsured or had Medicaid coverage (13% vs. 25%). Overall, 5-year cancer-specific survival was higher among HPV+ patients (82%) than among HPV- patients (62%), with a wider disparity observed among Black head and neck cancer patients (HPV+ 74%, HPV- 44%). In multivariable models, significant differences in cancer-specific survival were found across racial/ethnic groups and HPV status (P-interaction: 0.045). Compared to White patients, persistent inequities in cancer-specific survival were observed among Black HPV+ (HR 1.49, 95% CI 1.19-1.87) and HPV- (HR 1.42, 95% CI 1.21-1.66); and among Latinx HPV+ patients (HR 1.32, 95% CI 1.03-1.69). Conclusions: In this population-based study of patients with head and neck cancers, significant disparities in cancer-specific survival were observed that differed by both race/ethnicity and HPV status. The complex inequities in outcomes of head and cancers likely reflect the clinical impacts of socioeconomic and demographic risk factors in addition to HPV-related dysregulation of tumor metabolism and the immune microenvironment.

Sex differences in cancer-specific survival for locally advanced esophageal cancer after neoadjuvant chemoradiotherapy: A population-based analysis.

ObjectiveNeoadjuvant chemoradiotherapy (nCRT) is the recommended standard treatment for locally advanced esophageal cancer (LA-EC). This study aimed to determine whether sex makes a difference in cancer-specific survival (CSS) and construct a novel nomogram model to predict CSS for LA-EC after nCRT based on the SEER database.MethodsPatients coded by 04–15 were identified from the SEER database. Patients with systemic treatment and radiotherapy before surgery were defined as nCRT. We further divided this population into a training group and a verification group at a ratio of 7:3. Univariate and multivariate cox analyses were applied to determine the prognostic risk factors based on the training cohort, and then the Nomogram model was established. The area under the curve (AUC) was used to evaluate the predictive ability of the model. We used the calibration curve to evaluate the consistency between the predicted status and actual status and decision curve analysis (DCA) to evaluate the clinical value. We used X-tile software to determine the best cut-off value of nomogram scores and divided the population into low-risk, medium-risk, and high-risk groups, and Kaplan-Meier analysis was applied to compare the CSS.ResultsA total of 2096 LA-EC patients were included for further analysis, with 1,540 in the training cohort and 656 in the validation group. Male (HR: 1.29, 95% CI, 1.04 −1.58), T stage, N stage, and M stage were identified as independent risk factors of CSS based on the training cohort. A Nomogram model was constructed to predict the 3-, 5- and 7-years CSS. ROC curve and AUC confirmed that this nomogram has median discrimination ability. The calibration curve showed good agreement between predicted status and actual status. The DCA curves confirmed the clinical value. Kaplan-Meier analysis indicated that patients in the high-risk subgroup had poorer CSS in both the training cohort and validation cohort (P < 0.001).ConclusionMale patients had poorer CSS in LA-EC patients after nCRT. A nomogram model composed of sex, T stage, N stage, and M stage was constructed to identify the high-risk population and provide a personalized follow-up plan.

Cancer-specific survival after diagnosis in men versus women: A pan-cancer analysis.

Comprehensive understanding of cancer‐specific survival differences in gender is critical for cancer prevention and treatment. Based on the Surveillance Epidemiology and End Results database, we included data from the most prevalent cancers (lung, esophageal, liver, pancreatic, stomach, colorectal, kidney, and bladder cancer). Cox proportional hazards regression models were constructed to estimate hazard ratios, simultaneously adjusting for demographic, clinical, and treatment factors. Overall, male patients had a worse cancer‐specific survival than female patients. After adjustment for cancer prevalence with 1:1 matching, gender remained a significant factor in cancer‐specific survival. Among the included cancer types, female patients showed survival benefit in lung, liver, colorectal, pancreatic, stomach, and esophageal cancer, and male patients showed better survival in bladder cancer. Except for kidney cancer, the gender disparity was consistent between cancer patients with nonmetastatic and metastatic disease. Overall, gender appears to be a significant factor influencing cancer‐specific survival, and the prognosis of female patients is better than male patients in most cancers. This work might inspire the development of strategies for gender‐specific precision cancer prevention and treatment.

A promising Prognostic risk model for advanced renal cell carcinoma (RCC) with immune-related genes

BackgroundRenal cell carcinoma (RCC) is a third most common tumor of the urinary system. Nowadays, Immunotherapy is a hot topic in the treatment of solid tumors, especially for those tumors with pre-activated immune state.MethodsIn this study, we downloaded genomic and clinical data of RCC samples from The Cancer Genome Atlas (TCGA) database. Four immune-related genetic signatures were used to predict the prognosis of RCC by Cox regression analysis. Then we established a prognostic risk model consisting of the genes most related to prognosis from four signatures to value prognosis of the RCC samples via Kaplan–Meier (KM) survival analysis. An independent data from International Cancer Genome Consortium (ICGC) database were used to test the predictive stability of the model. Furthermore, we performed landscape analysis to assess the difference of gene mutant in the RCC samples from TCGA. Finally, we explored the correlation between the selected genes and the level of tumor immune infiltration via Tumor Immune Estimation Resource (TIMER) platform.ResultsWe used four genetic signatures to construct prognostic risk models respectively and found that each of the models could divide the RCC samples into high- and low-risk groups with significantly different prognosis, especially in advanced RCC. A comprehensive prognostic risk model was constructed by 8 candidate genes from four signatures (HLA-B, HLA-A, HLA-DRA, IDO1, TAGAP, CIITA, PRF1 and CD8B) dividing the advanced RCC samples from TCGA database into high-risk and low-risk groups with a significant difference in cancer-specific survival (CSS). The stability of the model was verified by independent data from ICGC database. And the classification efficiency of the model was stable for the samples from different subgroups. Landscape analysis showed that mutation ratios of some genes were different between two risk groups. In addition, the expression levels of the selected genes were significantly correlated with the infiltration degree of immune cells in the advanced RCC.ConclusionsSum up, eight immune-related genes were screened in our study to construct prognostic risk model with great predictive value for the prognosis of advanced RCC, and the genes were associated with infiltrating immune cells in tumors which have potential to conduct personalized treatment for advanced RCC.

PD33-03 IS ANGIOTENSIN SYSTEM INHIBITOR USE ASSOCIATED WITH IMPROVED OUTCOMES IN PATIENTS WITH LOCALIZED CLEAR CELL RCC?

You have accessJournal of UrologyCME1 May 2022PD33-03 IS ANGIOTENSIN SYSTEM INHIBITOR USE ASSOCIATED WITH IMPROVED OUTCOMES IN PATIENTS WITH LOCALIZED CLEAR CELL RCC? Paige Nichols, Andrew Zganjar, Christine Lohse, Sounak Gupta, John Cheville, Cameron Britton, Aaron Potretzke, Stephen Boorjian, Houston Thompson, Bradley Leibovich, and Vidit Sharma Paige NicholsPaige Nichols More articles by this author , Andrew ZganjarAndrew Zganjar More articles by this author , Christine LohseChristine Lohse More articles by this author , Sounak GuptaSounak Gupta More articles by this author , John ChevilleJohn Cheville More articles by this author , Cameron BrittonCameron Britton More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Houston ThompsonHouston Thompson More articles by this author , Bradley LeibovichBradley Leibovich More articles by this author , and Vidit SharmaVidit Sharma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002584.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preclinical studies demonstrate VEGF expression is regulated by angiotensin II. Increased angiotensin II receptor expression in clear cell renal cell carcinoma (ccRCC) may be associated with higher tumor grade and poorer survival. It is unknown if angiotensin system inhibitors, in the form of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are associated with improved outcomes for hypertensive patients with ccRCC. METHODS: A large nephrectomy registry was queried to identify adults treated with radical or partial nephrectomy for localized ccRCC from 2005-2012. Patients were divided into three groups: (1) patients without HTN, (2) patients with HTN but not treated with ACEIs or ARBs, and (3) patients with HTN treated with ACEIs or ARBs. The primary outcome of disease progression-free survival (PFS) and secondary outcomes of cancer-specific survival and CKD stage PFS were estimated using the Kaplan-Meier method. Associations with disease progression, death from RCC, and CKD stage progression were evaluated using multivariable Cox models. We adjusted for a disease progression score and a death from RCC score in the multivariable models for disease progression and death from RCC, respectively. RESULTS: Among 1,203 patients, there were 432 (36%), 359 (30%), and 412 (34%) in groups 1, 2, and 3, respectively, with a median follow-up of 10.1 (IQR 7.9-12.5) years. Disease PFS for the three groups is shown in Figure 1. On multivariable analysis, group 3 was associated with improved disease PFS compared to group 2 (HR 0.76, 95% CI 0.57-1.00, p=0.05) but not group 1 (HR 0.89, 95% CI 0.68-1.17, p=0.40). A subset multivariable analysis of group 3 treated with ACEIs alone relative to group 2 demonstrated improved disease PFS (HR 0.68, 95% CI 0.49-0.93, p=0.02). There were no significant differences between groups for either cancer specific survival or CKD stage PFS on multivariable analysis. CONCLUSIONS: The use of ACEIs or ARBs is associated with improved disease PFS in patients with HTN and localized ccRCC after radical or partial nephrectomy. No appreciable differences in cancer specific survival or CKD stage PFS were identified. Further studies are warranted to validate this finding and elucidate underlying mechanisms of angiotensin blockade in ccRCC patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e553 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paige Nichols More articles by this author Andrew Zganjar More articles by this author Christine Lohse More articles by this author Sounak Gupta More articles by this author John Cheville More articles by this author Cameron Britton More articles by this author Aaron Potretzke More articles by this author Stephen Boorjian More articles by this author Houston Thompson More articles by this author Bradley Leibovich More articles by this author Vidit Sharma More articles by this author Expand All Advertisement PDF DownloadLoading ...

Association of microsatellite instability (MSI) status with the 5-year outcome and genetic ancestry in a large Brazilian cohort of colorectal cancer.

Colorectal cancer (CRC) has a high incidence and mortality worldwide. Microsatellite instability (MSI) is crucial in CRC, with distinct molecular and clinicopathological features in patients. Nowadays, it is a predictive marker for immunotherapy. We proposed to evaluate the 5-year outcome of MSI status in 1002 Brazilian CRC, and associate it with genetic ancestry, molecular and clinicopathological features. MSI evaluation was performed using molecular markers. MSI+ tumors were analyzed for alterations in 23 MSI-targeted genes. Genetic ancestry was evaluated using an Ancestry-Informative markers panel. MSI status was analyzed in relation to CRC specific survival and other clinical and genetic variables. MSI+ status was observed in 10.5% of cases. MSI+ status was significantly associated with the anatomic site right colon, mucinous histological type, clinical stage II, histological grade III/undifferentiated, no recurrence of disease, and live cases without cancer. No association of MSI status with genetic ancestry components was observed. MSI-targeted genes analyses showed the most frequently altered genes: ATM, EGFR, MRE11, ROCK1, and TGFBRII. There was a statistically significant difference in cancer-specific survival between cases according to MSI status. This study constitutes the most comprehensive analyses of the MSI impact on the Brazilian CRC. MSI+ frequency in Brazilian CRC agreed with the literature and was associated with several clinicopathological features related with less aggressive tumors, independently of their genetic ancestry.

Survival of nonseminomatous germ cell tumors in pediatric patients and young adults - A stage group stratified analysis.

Testicular germ cell tumors, particularly nonseminomatous germ cell tumors (NSGCT), comprise the most common solid malignancy in male children and younger adults. While these patients experience excellent survival outcomes, few studies have characterized their survival by age. Thus, we aimed to characterize the relative survival of NSGCT by age, stratifying patients by stage group. Using the Surveillance Epidemiology and End Results (SEER) database, we divided patients with NSGCT into pediatric patients and adolescents (<19 years), young adults (19-30 years), and older adults (>30 years). Survival analysis, using Cox proportional hazards models and Kaplan Meier curves, described overall and cancer-specific survival (CSS) of each age category for Stage I-III NSGCT by stage group. A total of 14,786 patients met inclusion criteria and comprised the age groups <19 years (N=1,287), 19 to 30 years (N=7,729), and >30 years (N=5,770). Stage group distribution at presentation was similar between each group. Survival analysis demonstrated no differences in cancer-specific survival (CSS) among Stage I or II NSGCT. However, among Stage III tumors, multivariable models noted worse CSS in patients >30 years (HR=3.35 (95%CI: 1.45-7.73), P=0.005) and those 19-30 years (HR=2.28 (95%CI: 0.99-5.21), P=0.053) compared to pediatric and adolescent patients. Younger NSGCT patients experience excellent oncologic outcomes compared to their older counterparts. These survival differences by age group are largely driven by differential survival among Stage III neoplasms. Furthermore, our report lends additional evidence that age is an important prognostic factor in advanced NSGCT, including pediatric and adolescent patients.

Get insight into the cause of death distribution and epidemiology of penile squamous cell carcinoma: Apopulation-based study.

BackgroundPenile squamous cell carcinoma (PSCC) survival had no significant improvement since 1990 in the United States. This study aims to get insight into the changing trend and distribution of death causes of PSCC. The epidemiology of PSCC is also investigated.MethodsThe Surveillance, Epidemiology, and End Results (SEER) (1992–2018) database is utilized to get patients diagnosed with penile squamous cell carcinoma. The trend of incidence, distribution of age, changing trend and distribution of death cause, and survival outcome are analyzed for all PSCC patients and each race.ResultsThree thousand four hundred and twenty‐three male patients with PSCC are enrolled in our study. The age‐adjusted incidence rate of the white has a slight increase (Annual percent change [APC] = 0.647%). American Indian/Alaska Native men have the highest average annual incidence, while Asian /Pacific Islander men have the lowest. PSCC patients aged 70–80 are the most common, and patients over 80 years have the highest 3‐year (50%) and 5‐year (63.93%) mortality rate. Non‐cancer disease, especially circulatory system disease, is the most common cause of death, whereas the proportion of patients who died of PSCC significantly increased from 21.17% (1992–2001) to 41.3% (2012–2017) in PSCC patients (p < 0.001). These results have not changed significantly when we only focus on primary PSCC without previous malignant tumors. Hispanics are shown better overall survival than non‐Hispanic White and non‐ Hispanic Black men. (p < 0.001) No statistical differences in cancer‐specific survival are observed (p = 0.15).ConclusionThe current study provides essential initial data regarding the presentation and clinical outcomes of PSCC patients. Notably, non‐cancer disease, especially circulatory system disease, is the more common cause of death than PSCC. However, the proportion of patients who died of penile squamous cell carcinoma has a relatively significant increase in recent years. The increasing trends in the advanced stage of PSCC patients might account for this change.

The obesity paradox in patients with colorectal cancer: a systematic review and meta-analysis.

Obesity is widely regarded as an established risk factor for colorectal cancer (CRC). However, recent studies have shown that lower mortality and better cancer-specific survival were observed in CRC patients with elevated body mass index (BMI), an example of the obesity paradox, which is the inverse correlation between obesity and mortality in some populations. The aim of this systematic review and meta-analysis was to investigate the association between BMI and CRC outcomes. PubMed, Web of Science, MEDLINE, the Cochrane Library, and Embase databases were searched for relevant articles published from inception to December 31, 2020. Studies comparing the prognosis of CRC patients with obesity or overweight with that of normal-weight CRC patients were eligible. Data were extracted by 2 reviewers independently; differences were resolved by a third reviewer. BMI was classified according to WHO categories. To assess the prognostic effects of different BMI categories in CRC patients, hazard ratios and 95%CIs of overall survival, disease-free survival, and cancer-specific survival were extracted from included articles. Sixteen studies (55 391 patients in total) were included. Higher BMI was significantly associated with more favorable CRC outcomes. Compared with normal-weight patients, underweight patients had worse overall survival (HR = 1.26; 95%CI, 1.15-1.37) and disease-free survival (HR = 1.19; 95%CI, 1.11-1.27, while patients with overweight had better overall survival (HR = 0.92; 95%CI, 0.86-0.99), disease-free survival (HR = 0.96; 95%CI, 0.93-1.00), and cancer-specific survival (HR = 0.86; 95%CI, 0.76-0.98). Patients with morbid obesity had worse overall survival (HR = 1.12; 95%CI, 1.02-1.22) and disease-free survival (HR = 1.15; 95%CI, 1.07-1.24) than normal-weight patients. There was no significant difference in cancer-specific survival between patients with obesity (HR = 0.94; 95%CI, 0.76-1.16) and patients with normal weight, nor between patients with underweight and patients with normal weight (HR = 1.14; 95%CI, 0.82-1.58). CRC patients with a higher BMI appear to have reduced mortality compared with normal-weight CRC patients, even though higher BMI/obesity is an established determinant for the development of CRC. PROSPERO registration no. CRD42020202320.

Predicting factor analysis of postoperative complications after robot-assisted radical cystectomy: Multicenter KORARC database study.

To evaluate postoperative complications following robot-assisted radical cystectomy in patients diagnosed with bladder cancer and reveal if there are predictors for postoperative complications. Prospectively collected medical records of 730 robot-assisted radical cystectomy patients between 2007/04 and 2019/05 in 13 tertiary referral centers were reviewed. Perioperative outcomes were compared between two groups by postoperative complications (complication vs non-complication). We assessed recurrence-free survival, cancer-specific survival, and overall survival between groups. Regression analyses were implemented to identify factors associated with postoperative complications. Any total and high-grade complication (Clavien-Dindo grade ≥3) rates were 57.8% and 21.1%, respectively. Patients in complication group had significantly higher proportion of diabetes mellitus (P = 0.048), chronic kidney disease (P = 0.011), dyslipidemia (P < 0.001), longer operation time (P = 0.001), more estimated blood loss (P = 0.001), and larger intraoperative fluid volume (P < 0.001). There was a significant difference in cancer-specific survival (log-rank P = 0.038, median cancer-specific survival: both groups not reached). Dyslipidemia (odds ratio 2.59, P = 0.002) and intraoperative fluid volume (odds ratio 1.0002, P = 0.040) were significantly associated with high-grade postoperative complications. Diabetes mellitus (odds ratio 1.97, P = 0.028), chronic kidney disease (odds ratio 1.89, P = 0.046), dyslipidemia (odds ratio 5.94, P = 0.007), and intraoperative fluid volume (odds ratio 1.0002, P = 0.009) were significantly associated with any postoperative complications. Patients with diabetes mellitus, chronic kidney disease, dyslipidemia, or a relatively large intraoperatively infused fluid volume are more likely to develop postoperative complications. Patients with postoperative complications might have a possibility of lower cancer-specific survival rate.