Improvement In Cancer-specific Survival Research Articles

Role of neoadjuvant chemotherapy in patients with locally advanced and clinically positive nodes Upper Tract Urothelial Carcinoma treated with Nephroureterectomy: real-world data from the ROBUUST 2.0 Registry.

To assess the impact of neoadjuvant and adjuvant chemotherapy on survival outcomes, within a large multicenter cohort of Upper tract urothelial carcinoma patients treated with Nephroureterectomy. A multicenter retrospective analysis utilizing the Robotic surgery for Upper Tract Urothelial Cancer Study registry was performed. Baseline, preoperative, perioperative, and pathologic variables of three groups of patients receiving surgery only, neoadjuvant or adjuvant chemotherapy were compared. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests. The impact of perioperative chemotherapy on survival outcomes was assessed with the Kaplan Meier method. Univariable and multivariable Cox regression analyses were performed to identify predictors of survival. Overall, 1,994 patients were included. Overall and Clavien grade ≥3 complications rates were comparable among the three subgroups (p = 0.65 and p = 0.92). At Kaplan Meier analysis, neoadjuvant chemotherapy significantly improved cancer-specific survival (p = 0.03) and overall survival (p = 0.03) probabilities of patients with cT ≥ 3 tumors and of those with positive cN (p = 0.03 and p = 0.02). On multivariable analysis, neoadjuvant chemotherapy was independently associated with an improvement of cancer-specific survival in cT ≥ 3 patients (HR 0.44; p = 0.04), and of both cancer-specific survival (HR 0.50; p = 0.03) and overall survival (HR 0.53; p = 0.02) probabilities in positive cN patients. This large multicenter retrospective analysis suggests significant survival benefit in Upper tract urothelial carcinoma patients with either locally advanced or clinically positive nodes disease receiving neoadjuvant chemotherapy. These findings can be regarded as "hypothesis generating", stimulating future trials focusing on such advanced stages.

P16 status or response to induction chemotherapy, which predicts survival outcomes in Chinese oropharyngeal cancer treated with definitive radiotherapy?

PurposeTo identify whether p16 status or response to induction chemotherapy (IC) predicts the radiotherapy (RT) response and survival outcomes in Chinese oropharyngeal squamous cell carcinoma (OPSCC). MethodsA total of 211 patients, including 128 p16-positive and 83 p16-negative were analyzed. All patients underwent IC followed by definitive RT or concurrent chemoradiotherapy (CCRT). Propensity score matching (PSM) was used to eliminate the baseline variations. ResultsAge, sex, smoking history, alcohol history, and primary site were unbalanced between different p16 status subgroups. Before PSM, the objective response rates to IC between p16-positive and p16-negative groups were 80.5 % and 85.5 % (p = 0.344). After RT, the complete response (CR) rates were 73.4 % and 66.3 %, respectively (p = 0.264). IC-sensitive (IC-s) subgroups had a higher percentage of RT-CR rate than the IC-resistant (IC-r) subgroups in both p16-positive and p16-negative patients. IC-s showed significant improvement in cancer-specific survival (CSS) (92.9 % vs. 53.6 %, p < 0.0001), progression-free survival (PFS) (p < 0.0001), locoregional relapse-free survival (LRFS) (p < 0.0001) and distant metastasis-free survival (DMFS) (p = 0.025). After PSM, the CR rates among different p16 groups remained comparable following RT (71.2 % vs. 65.8 %, p = 0.476). Before or after PSM, CSS, PFS, LRFS, and DMFS were similar between different p16 status either in IC-s or IC-r subgroups (p > 0.05). IC-r was independently associated with shorter PFS (HR = 2.661, p = 0.002) and LRFS (HR = 2.876, p = 0.002; HR = 2.78, p = 0.018). ConclusionsResponse to IC is an important predictor of prognosis in Chinese OPSCC treated with definitive RT. Poor response to IC is associated with unsatisfactory outcomes either in p16-positive or p16-negative OPSCC.

Demographic and clinical factors associated with cardiovascular events in elderly long-term survivors of breast cancer.

e24105 Background: Improvements in cancer-specific survival have led to a growing appreciation for non-cancer drivers of mortality, particularly cardiovascular disease (CVD), in long-term cancer survivors. However, studies of population-level, non-oncologic outcomes in long-term survivors as a function of treatment exposures remain limited. Our aim is to evaluate the risk of developing cardiovascular disease (CVD) based on demographic and clinical characteristics in long-term breast cancer survivors, defined as those alive five years after diagnosis. Methods: We conducted a SEER-Medicare retrospective study of patients over age 65 with non-metastatic breast cancer, treated with curative intent surgery, diagnosed between 2003-2011, and enrolled in fee-for-service Medicare. CVD events were defined by the presence of any claims corresponding to stroke, heart failure, myocardial infarction, or cardiomyopathy beginning at 5 years after initial diagnosis and extending through year 10. Chi-squared tests were used to examine associations between demographic and clinical characteristics and CVD status. LASSO regularization was used for variable selection in a cox-proportional hazards model using 10-fold cross validation showing CVD hazard ratios stratified by diagnosis year. Results: 43,347 patients met inclusion criteria, of which 5,444 had a diagnosis of CVD between five years after diagnosis and last follow-up. Compared to patients without evidence of CVD, patients experiencing CVD were more likely to be older, Black, live in impoverished neighborhoods, have stage III (vs. I or II) disease, and have been diagnosed during the latter part of the study period (2009-2011 vs. 2003-2008). Variables included in the model following the LASSO regularization process were age at diagnosis, race/ethnicity, % with poverty, metropolitan residence, cancer stage at diagnosis, receipt of radiation therapy, and diagnosis year. Age, race/ethnicity, and cancer stage at diagnosis were significant predictors of developing CVD during years 5-10 after an initial cancer diagnosis (P &lt; 0.001). Risk of developing CVD increased with age and was associated with a threefold higher risk in women over age 85. Non-Hispanic Black patients were at the highest risk across race/ethnicity groups (HR: 1.48, 95% CI: 1.34 – 1.65), and patients with a stage III diagnosis were at the highest risk by stage (ref Stage I; HR: 1.56, 95% CI: 1.41 - 1.72). Those diagnosed in 2009-2011 were at higher risk of developing CVD than in earlier years (ref 2003-2005; HR: 1.67, 95% CI: 1.56 – 1.79). Conclusions: Age, race, poverty, and cancer stage at diagnosis were associated with increased risk of developing CVD in long-term breast cancer survivors. Patients with elevated non-oncologic risks may benefit from increased participation by primary care as a component of effective cancer survivorship.

Disparities in survival improvement for U.S. childhood and adolescent cancer between 1995 and 2019: An analysis of population-based data

BackgroundAlthough treatment advances have increased childhood and adolescent cancer survival, whether patient subgroups have benefited equally from these improvements is unclear. MethodsData on 42,865 malignant primary cancers diagnosed between 1995 and 2019 in individuals ≤ 19 years were obtained from 12 Surveillance, Epidemiology, and End Results registries. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for cancer-specific mortality by age group (0–14 and 15–19 years), sex, and race/ethnicity were estimated using flexible parametric models with a restricted cubic spline function in each of the periods: 2000–2004, 2005–2009, 2010–2014 and 2015–2019, versus 1995–1999. Interactions between diagnosis period and age group (children 0–14 and adolescents 15–19 years at diagnosis), sex, and race/ethnicity were assessed using likelihood ratio tests. Five-year cancer-specific survival rates for each diagnosis period were further predicted. ResultsCompared with the 1995–1999 cohort, the risk of dying from all cancers combined decreased in subgroups defined by age, sex and race/ethnicity with HRs ranging from 0.50 to 0.68 for the 2015–2019 comparison. HRs were more variable by cancer subtype. There were no statistically significant interactions by age group (Pinteraction=0.05) or sex (Pinteraction=0.71). Despite non-significant differences in cancer-specific survival improvement across different races and ethnicities (Pinteraction=0.33) over the study period, minorities consistently experienced inferior survival compared with non-Hispanic Whites. ConclusionsThe substantial improvements in cancer-specific survival for childhood and adolescent cancer did not differ significantly by different age, sex, and race/ethnicity groups. However, persistent gaps in survival between minorities and non-Hispanic Whites are noteworthy.

Abstract 4691: Spatially resolved transcriptomics deconvolutes histological prognostic subgroups in patients with colorectal cancer and synchronous liver metastases

Abstract Patients demonstrating strong immune responses to primary colorectal cancer (CRC) have a survival benefit following surgery, while those with predominantly stromal microenvironments do poorly. Biomarkers to identify patients with colorectal cancer liver metastases (CRLM) who have good prognosis following surgery for oligometastatic disease remain elusive. The aim of this study was to determine the practical application of a simple histological assessment of immune cell infiltration and stromal content in predicting outcome following synchronous resection of primary CRC and CRLM, and to interrogate the underlying functional biology that drives disease progression. Patients undergoing synchronous resection of primary CRC and CRLM underwent detailed histological assessment, panel genomic and bulk transcriptomic assessment, immunohistochemistry (IHC) and GeoMx Spatial Transcriptomics (ST) analysis. Integration with genomic features, pathway enrichment analysis and immune deconvolution were performed. High-immune metastases were associated with improved cancer specific survival (HR, 0.36, P=0.01). Bulk transcriptomic analysis was confounded by stromal content but ST demonstrated that the invasive edge of the metastases of long-term survivors was characterized by adaptive immune cell populations enriched for Type II Interferon signaling (NES=-2.05 P.Adj&amp;lt;0.005) and MHC-Class II Antigen Presentation (NES=-2.09 P.Adj&amp;lt;0.005). In contrast, patients with poor prognosis demonstrated increased abundance of regulatory T-cells and neutrophils with enrichment of Notch (NES=2.2 P.Adj=0.022) and TGF-β (NES=2.2 P.Adj=0.02) signaling pathways at the metastatic tumor center. In summary, histological assessment can stratify outcome in patients undergoing synchronous resection of CRLM and ST analysis has revealed significant intra-tumoral and inter-lesional heterogeneity with underlying transcriptomic programs identified in driving each phenotype. Citation Format: Colin S. Wood, Kathryn A. Pennel, Holly Leslie, Assya Legrini, Andrew J. Cameron, Paul Horgan, Joanne Edwards, Colin W. Steele, Nigel B. Jamieson. Spatially resolved transcriptomics deconvolutes histological prognostic subgroups in patients with colorectal cancer and synchronous liver metastases. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4691.

Association of Antibiotic Receipt With Survival Among Patients With Metastatic Pancreatic Ductal Adenocarcinoma Receiving Chemotherapy

The prognosis for patients with metastatic pancreatic ductal adenocarcinoma (PDAC) is dismal, due in part to chemoresistance. Bacteria-mediated mechanisms of chemoresistance suggest a potential role for antibiotics in modulating response to chemotherapy. To evaluate whether use of peritreatment antibiotics is associated with survival among patients with metastatic PDAC treated with first-line gemcitabine or fluorouracil chemotherapy. Using the population-based Surveillance, Epidemiology, and End Results-Medicare linked database, this retrospective cohort study analyzed data for patients diagnosed with PDAC between January 1, 2007, and December 31, 2017. Data analysis was conducted between September 1, 2021, and January 15, 2023. The population-based sample included 3850 patients with primary metastatic PDAC treated with first-line gemcitabine or fluorouracil chemotherapy. Patients who received antibiotics were matched based on propensity scores to patients who did not receive antibiotics. Receipt of 5 or more days of oral antibiotics or 1 injectable antibiotic in the month before or after beginning first-line chemotherapy. Overall survival and cancer-specific survival. The end of follow-up was December 31, 2019, for overall survival and December 31, 2018, for cancer-specific survival. Of the 3850 patients treated with first-line gemcitabine (3150 [81.8%]) or fluorouracil (700 [18.2%]), 2178 (56.6%) received antibiotics. The mean (SD) age at diagnosis was 74.2 (5.8) years and patients were predominantly women (2102 [54.6%]), White (3396 [88.2%]), and from metropolitan areas (3393 [88.1%]) in the northeastern or western US (2952 [76.7%]). In total, 1672 propensity-matched pairs were analyzed. Antibiotic receipt was associated with an 11% improvement in overall survival (hazard ratio [HR], 0.89; 95% CI, 0.83-0.96; P = .003) and a 16% improvement in cancer-specific survival (HR, 0.84; 95% CI, 0.77-0.92; P < .001) among patients treated with gemcitabine. In contrast, there was no association between antibiotic receipt and overall survival (HR, 1.08; 95% CI, 0.90-1.29; P = .41) or cancer-specific survival (HR, 1.12; 95% CI, 0.90-1.36; P = .29) among patients treated with fluorouracil. In a subgroup of gemcitabine-treated patients who received antibiotics, nonpenicillin β-lactams were associated with an 11% survival benefit (HR, 0.89; 95% CI, 0.81-0.97; P = .01). In this cohort study, receipt of perichemotherapy antibiotics was associated with improved survival among patients treated with gemcitabine, but not fluorouracil, suggesting that antibiotics may modulate bacteria-mediated gemcitabine resistance and have the potential to improve PDAC outcomes.

Lack of Adherence to Guideline-Based Imaging Before Subsequent Radiation in Patients with Non-Small Cell Lung Cancer: Impact on Patient Outcomes.

Lung cancer is the leading cause of cancer death within the United States, yet prior studies have shown a lack of adherence to imaging and treatment guidelines in patients with lung cancer. This study evaluated the use of 18F-FDG PET/CT imaging before subsequent radiation therapy (RT) in patients with non-small cell lung cancer (NSCLC), as recommended by National Comprehensive Cancer Network guidelines, and whether the use of this imaging modality impacts cancer-specific survival. Methods: This was a retrospective study of the National Cancer Institute's Surveillance, Epidemiology, and End Results program of Medicare-linked data in patients with NSCLC. Hazard ratios and 95% CIs for overall and cancer-specific survival were estimated for patients diagnosed between 2006 and 2015 who underwent either 18F-FDG PET/CT-based or CT-based imaging before subsequent RT. Results: Significant improvement in cancer-specific survival was found in patients who underwent 18F-FDG PET/CT imaging before subsequent RT, compared with those who underwent CT (hazard ratio, 1.43 [95% CI, 1.32-1.55; P < 0.0001]). Although the National Comprehensive Cancer Network recommends 18F-FDG PET/CT before subsequent RT, 43.6% of patients were imaged with CT alone. Conclusion: Many patients with NSCLC are not being imaged according to national guidelines before subsequent RT, and this omission is associated with a lower cancer-specific survival.

MP24-05 OUTCOMES OF PARTIAL NEPHRECTOMY FOR NON-METASTATIC cT2 RENAL TUMORS: RESULTS FROM A CANADIAN MULTI-INSTITUTIONAL COLLABORATIVE

You have accessJournal of UrologyCME1 May 2022MP24-05 OUTCOMES OF PARTIAL NEPHRECTOMY FOR NON-METASTATIC cT2 RENAL TUMORS: RESULTS FROM A CANADIAN MULTI-INSTITUTIONAL COLLABORATIVE Rahul Bansal, Ryan Sun, Frederic Pouliot, Ranjeeta Mallick, Simon Tanguay, Darrel Drachenberg, Richard Rendon, Alan So, Luke Lavallee, Antonio Finelli, Lucas Dean, Anil Kapoor, Bimal Bhindi, Lori Wood, Naveen Basappa, and Rodney Breau Rahul BansalRahul Bansal More articles by this author , Ryan SunRyan Sun More articles by this author , Frederic PouliotFrederic Pouliot More articles by this author , Ranjeeta MallickRanjeeta Mallick More articles by this author , Simon TanguaySimon Tanguay More articles by this author , Darrel DrachenbergDarrel Drachenberg More articles by this author , Richard RendonRichard Rendon More articles by this author , Alan SoAlan So More articles by this author , Luke LavalleeLuke Lavallee More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Lucas DeanLucas Dean More articles by this author , Anil KapoorAnil Kapoor More articles by this author , Bimal BhindiBimal Bhindi More articles by this author , Lori WoodLori Wood More articles by this author , Naveen BasappaNaveen Basappa More articles by this author , and Rodney BreauRodney Breau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The role of PN is not well defined for cT2 renal cell carcinoma (RCC) as compared to radical nephrectomy (RN). The aim of this study was to examine oncological outcomes of PN as compared to RN for non-metastatic cT2 RCC. METHODS: The Canadian Kidney Cancer information system was used to define patients who underwent surgery for non-metastatic cT2 RCC from January 2011 to October 2021. Patients with clear-cell, papillary, and chromophobe RCC were included. Other histology, multiple tumours, and hereditary RCC syndrome patients were excluded. Each PN patient was individually matched to RN up to 1:4 depending on availability of patients based on tumor size (±1 cm), histology, grade (clear cell and papillary), and necrosis (clear cell). Matched patients were analyzed as clusters. RESULTS: A total of 1347 patients were identified, and 42 PN patients met study criteria who were then matched to 145 RN patients. Both groups had similar age, gender, smoking status, BMI, Charlson comorbidity index score, symptoms at presentation, baseline eGFR, hemoglobin and pathological characteristics. PN patients had smaller tumors (7.6 cm [IQR 7.2, 9.2] vs. (8.5 cm [IQR 7.6, 10.3], p=0.048), had higher likelihood of undergoing open surgery (75% vs. 30% p <0.0001), less likely received adrenalectomy (0 vs. 21%, p=0.0001) and had higher likelihood of positive surgical margin (PSM) (10% vs. 1%, p=0.025). Median follow up was not significantly different in either group (3.7yrs [IQR 1.1, 5.4] in PN vs. 2.8yrs [IQR 1.2, 5.6] in RN, p=0.79). During the follow up period, PN patients had higher risk of local recurrence (HR 4.38 95% CI 1.51-12.71) and lower risk of metastasis (HR 0.39; 95% CI 0.16-0.95), improved cancer specific survival (HR 0.65; 95% CI 0.22-1.87) and overall survival (HR 0.47; 0.17-1.27) as compared to RN (Fig. 1). CONCLUSIONS: In this multi-institutional Canadian cohort of patients with non-metastatic cT2 RCC undergoing surgery, PN was associated with higher likelihood of PSM and local recurrence as compared to RN and lower risk of distant metastasis, cancer related death or death from any cause. Despite individual patient matching, there is likely unadjusted selection bias resulting in superior cancer survival associated with PN. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e394 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rahul Bansal More articles by this author Ryan Sun More articles by this author Frederic Pouliot More articles by this author Ranjeeta Mallick More articles by this author Simon Tanguay More articles by this author Darrel Drachenberg More articles by this author Richard Rendon More articles by this author Alan So More articles by this author Luke Lavallee More articles by this author Antonio Finelli More articles by this author Lucas Dean More articles by this author Anil Kapoor More articles by this author Bimal Bhindi More articles by this author Lori Wood More articles by this author Naveen Basappa More articles by this author Rodney Breau More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effect of Intravesical Chemotherapy on the Survival of Patients with Non-Muscle-Invasive Bladder Cancer Undergoing Transurethral Resection: A Retrospective Cohort Study Among Older Adults

Background: The average age of diagnosis for bladder cancer is 73 and about 75 percent of all bladder cancers are non-muscle invasive at initial diagnosis. It is recommended that non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by chemotherapy. However, there is no large-scale study from real-world databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT. This study aimed to investigate the effects of chemotherapy on survival among older NMIBC patients with TURBT. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), we performed analyses of cancer-specific mortality and overall mortality comparing chemotherapy versus no chemotherapy after TURBT. Coarsened exact matching was performed to balance the baseline patient characteristics. Cox proportional hazards and Kaplan-Meir analyses were used to evaluate survival outcomes. Results: A total of 3,222 matched patients with 1,611 in each arm (chemotherapy and no chemotherapy) were included in our study. After adjusting for covariates, multivariable Cox regression analyses show chemotherapy was associated with lower cancer-specific mortality (HR 0.63; 95% CI 0.42-0.94; p value 0.024). However, chemotherapy did not have any effect on overall mortality (HR 0.84; 95% CI 0.65-1.07; p value 0.159). The Kaplan-Meier curves show the protective effects of chemotherapy on cancer specific survival (p=0.032), but not on overall survival (p=0.34). Conclusion: Chemotherapy improved cancer specific survival among older patients with non-muscle invasive bladder cancer undergoing TURBT surgery, but it had no effect on overall survival. There is a need for more granular level real-world data on chemotherapy regimens and dosage to effectively investigate the effects of chemotherapy on the survival of older patients with NMIBC that have undergone TURBT.

A pilot study of physical activity in newly diagnosed elderly patients with multiple myeloma.

e20027 Background: Compared to a baseline normative population, patients with multiple myeloma (MM) have decreased physical function[1]. Studies have revealed that sarcopenia[2, 3], decreased performance status[4], and poor performance on biometric testing[3, 5] predicts worse survival in patients with advanced, incurable malignancies. Physical activity (PA) has been shown to mitigate these effects and in some cases improve cancer specific survival [6-9]. However, there is a need for further research in this area for patients with hematologic malignancies. Here in we describe the results of a pilot study to assess a physical activity intervention in elderly patients with newly diagnosed multiple myeloma. Methods: We designed a single arm, feasibility study utilizing physical and behavioral therapy interventions to help participants adhere to a prescribed exercise program. Eligible patients (age ≥65 years old) were recruited from the multiple myeloma treatment clinic. Baseline, 3-month and 6-month assessments occurred. The intervention included both text messaging and video visits with behavioral coaches and physical therapists to monitor activity levels, review and modify exercise plans, , and enhance motivation and self-efficacy. Our primary aim was to establish the feasibility of recruitment, enrollment, and adherence of the exercise intervention. Our secondary objective was to evaluate changes in fitness (6 minute walk test, grip strength, and the Short Physical Performance Battery). Results: Between 11/18/2019-03/04/2020, 9 participants enrolled on the study (goal of 20). New enrollment was halted due to the COVID-19 pandemic. Median age of the participants was 70 (range 65-86). Six (67%) were female. Eight participants (89%) completed the 6-month intervention. Participants completed 97.8% of the scheduled visits. At 3 and 6 months there was a mean change of moderate/vigorous activity of 26.0% (SD 89.6%) and -0.5% (SD 56.4%) respectively. At 3 and 6 months there was a mean change in step count per day of -5.1% (SD 25.3%) and -1.3% (SD 32.2%) respectively. Overall fitness was preserved over the 6-month period. Conclusions: Prior to COVID-19 pandemic, the study was on track to meet feasibility endpoints of recruitment, enrollment, and retention. The primary endpoint of increasing physical activity was not met. However, adults in our region experienced a 20-30% reduction in physical activity during the pandemic [10]. In the target population, reductions in the absence of intervention may have been even greater, given their pronounced vulnerability to COVID-19 complications. Thus, the true benefits of the intervention may have been difficult to detect during this period. Lack of a control arm is a limiting factor in making further conclusions about the potential benefits of our intervention.

Comparative effectiveness of posttreatment imaging modalities for Medicare patients with advanced head and neck cancer.

Persistent controversy exists with regard to how and when patients with head and neck cancer should undergo imaging after definitive therapy. The current study was conducted to evaluate whether the type of imaging modality used in posttreatment imaging impacts cancer-specific survival for patients with advanced head and neck squamous cell carcinoma. A retrospective study of National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program-Medicare-linked data in patients with an advanced stage of the 3 most common head and neck malignancies (oral cavity, oropharynx, and larynx) was conducted. Hazard ratios and 95% CIs for cancer-specific survival were estimated for patients diagnosed with any of these cancers between 2006 and 2015. Significant improvement with regard to cancer-specific survival was observed among patients with American Joint Committee on Cancer stage III and stage IVA laryngeal cancer who underwent positron emission tomography (PET) and/or computed tomography (CT) imaging during the first 6 months after receipt of definitive treatment (hazard ratio, 0.517; 95% CI, 0.33-0.811) compared with those who underwent CT. There was a trend toward an improvement in cancer-specific survival among patients with oral cavity or oropharyngeal malignancies who underwent PET/CT imaging, but it did not reach statistical significance. Compared with CT imaging, posttreatment imaging with PET was associated with improved survival in patients with advanced laryngeal carcinoma.

MP72-10 THE OUTCOME OF PATIENTS WITH HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER IN SWEDEN

You have accessJournal of UrologyBladder Cancer: Non-invasive III (MP72)1 Apr 2020MP72-10 THE OUTCOME OF PATIENTS WITH HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER IN SWEDEN Eugen Wang*, Ulf Larsson, Truls Gårdmark, and Per-Uno Malmström Eugen Wang*Eugen Wang* More articles by this author , Ulf LarssonUlf Larsson More articles by this author , Truls GårdmarkTruls Gårdmark More articles by this author , and Per-Uno MalmströmPer-Uno Malmström More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000952.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: At the time of bladder cancer detection, about 2/3 are non-muscle invasive bladder cancer (NMIBC). The high-risk NMIBC tumor types (TaG3, T1G2,T1G3 or/and Tis) present an increased risk of progression to deep-growing cancer and metastasis. Our aim was to identify this group of patients in the Bladder Cancer Data Base Sweden (BladderBaSe) and analyze the cancer specific survival after different managements. METHODS: BladderBaSe was created in 2015. This database links information from the Swedish National Register of Urinary Bladder Cancer (SNRUBC) from 1997 to 2014, with a number of national health care and demographic registers through the use of the personal identification numbers. The national register has detailed data on 97% of the bladder cancer cases diagnosed in Sweden. In 1997-2014 in Sweden, a total of 26808 patients were diangosed with NMIBC, of whom 10209 were high-risk cancer with median age 71 and 80 % male. 5660 patients were treated with TURBT only, 3862 had inital Bacillus Calmette-Guérin (BCG). Radical cystectomy was performed in 687 patients initially while 399 had delayed cystectomy after BCG. RESULTS: Characteristics of patients with high risk NMIBC is shown in table 1. During the follow-up 5 years, the cancer specific survival chance was higher for the BCG group (85 %) than it was for the initial radical cystectomy (75 %) or TURBT only group (65 %). (Fig.1). In a Cox proportional hazards model younger patients, lower cancer stage, initial treatment with BCG and treatment in high volume university hospital was associated with better survival. CONCLUSIONS: Initial BCG installation with or without delayed cystectomy improved cancer specific survival more than initial cystectomy in high-grade T1 bladder cancer in this population registry. However selection criteria could be a cause for confounding and will be further studied. Source of Funding: Schmekel fund in Urological research © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1077-e1077 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugen Wang* More articles by this author Ulf Larsson More articles by this author Truls Gårdmark More articles by this author Per-Uno Malmström More articles by this author Expand All Advertisement PDF downloadLoading ...

Survival benefit of nephron-sparing surgery for patients with pT1b renal cell carcinoma: A population-based study.

The use of partial nephrectomy (PN) to treat patients with large renal cell carcinoma (RCC) remains controversial, particularly among elderly patients. The present study compared the improvement in cancer-specific survival (CSS) in patients with pT1b RCC who underwent either PN or radical nephrectomy (RN) and investigated the effects of age and sex on CSS. A total of 20,343 patients were identified in the Surveillance, Epidemiology and End Results database. Kaplan-Meier curves and Cox regression analysis were used to compare the CSS of patients who received PN vs. those who received RN. In total, 5,375 (26.42%) and 14,968 (73.58%) patients with pT1b RCC received PN and RN, respectively. Kaplan-Meier and Cox regression analysis indicated that PN resulted in an improved CSS compared with RN (P<0.001). In addition, PN was observed to be beneficial in male (P<0.001) and female patients <75 years of age. However, it was not beneficial for female patients of ≥75 years of age (P=0.197). These preliminary results warrant further investigation in clinical trials.

Survival outcomes of radical prostatectomy vs. external beam radiation therapy in prostate cancer patients with Gleason Score 9-10 at biopsy: A population-based analysis

PurposeGleason Score (GS) 9-10 prostate cancer is associated with particularly adverse oncological outcomes and the optimal treatment is unknown. Therefore, cancer-specific mortality (CSM) rates after radical prostatectomy (RP) ± adjuvant radiation therapy (aRT) vs. external beam radiation therapy (EBRT) were tested. MethodsWithin the Surveillance, Epidemiology, and End Results database (2004–2015), 17,897 clinically localized prostate cancer patients with biopsy GS 9-10 were identified who either received RP ± aRT or EBRT. Temporal trends, cumulative incidence plots and multivariable competing-risks regression analyses were used after propensity score matching. Sensitivity analyses were performed according to primary treatment type (RP only vs. EBRT). ResultsOf all, 8,890 (49.7%) underwent EBRT vs. 9,007 (50.3%) underwent RP. Of those, 2,584 (28.7%) received aRT. No significant change in treatment assignment was recorded over time. In cumulative incidence smoothed plots, 10 year CSM rates were 19.9% vs. 19.6% (P = 0.3) and 10 year other-cause mortalityrates were 11.5% vs. 31.2%, respectively, in RP vs. EBRT patients (P < 0.001). In multivariable competing-risks regression analyses, RP did not reach independent predictor status of lower CSM (hazard ratio (HR): 0.93, P = 0.2). In sensitivity analyses within RP only vs. EBRT patients, RP represented an independent predictor of lower CSM (HR: 0.76, P < 0.001). ConclusionsIn biopsy GS 9-10 patients, no CSM differences were observed after RP ± aRT vs. EBRT. However, in patients in whom RP did not have to be combined with aRT, RP seems to be associated with a minor improvement in cancer-specific survival compared to EBRT. This applied to the majority of GS 9-10 RP patients.

Evaluation of the prognostic role of co-morbidities on disease outcome in renal cell carcinoma patients.

Co-morbidities may induce local and systemic tumor progression of renal cell carcinoma (RCC); however, the prognostic impact of co-morbidities has not yet been well characterized. RCC patients (n = 2206) surgically treated at three academic institutions in the US and Europe were included in the analysis. Presence of diabetes mellitus, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, coronary heart disease, and hypothyroidism were investigated for their association with clinicopathological features and cancer-specific survival. Hypertension was associated with less advanced T stages (p = 0.025), a lower risk of lymph-node (p = 0.026) and distant metastases (p = 0.001), and improved cancer specific survival in univariable analysis (HR 0.81 95% CI 0.69-0.96, p = 0.013). However, hypertension was not an independent prognostic factor after adjustment for TNM stages, grading, and ECOG performance status (HR 0.95, 95% CI 0.80-1.12; p = 0.530). A correlation between the use of concomitant anti-hypertensive medications and improved survival outcome was not identified. All other investigated co-morbidities did not show significant associations with clinicopathological features or cancer-specific survival. Although the investigated co-morbidities are capable or inducing pathophysiological changes that are predisposing factors for tumor progression, none is an independent prognostic factor in patients with RCC.

Complete Surgical Metastasectomy of Renal Cell Carcinoma in the Post-Cytokine Era.

Data supporting complete metastasectomy of metastatic renal cell carcinoma were derived primarily from the era of cytokine therapy. Whether complete metastasectomy remains beneficial in patients who receive more recently approved systemic therapies has not been well studied. The objective of this study was to examine survival outcomes among patients treated with complete metastasectomy in the era of targeted therapy and checkpoint blockade availability. We queried our institutional nephrectomy registry and identified 586 patients who underwent partial or radical nephrectomy of unilateral, sporadic renal cell carcinoma with a first occurrence of metastasis between 2006 and 2017. Of these patients 158 were treated with complete metastasectomy. Associations of complete metastasectomy with cancer specific and overall survival were assessed using Cox proportional hazards models. Median followup after the diagnosis of metastasis was 3.9 years, during which 403 patients died, including 345 of renal cell carcinoma. Of the patients treated with complete metastasectomy 147 (93%) did not receive any systemic treatment of the index metastatic lesion(s). Two-year cancer specific survival was significantly greater in patients with vs without complete metastasectomy (84% vs 54%, p <0.001). After adjusting for age, gender, and the timing, number and location of metastases complete metastasectomy was associated with a significantly reduced likelihood of death from renal cell carcinoma (HR 0.47, 95% CI 0.34-0.65, p <0.001). Complete surgical resection of metastases of renal cell carcinoma was associated with improved cancer specific survival in the post-cytokine era. It may be considered in appropriate patients after a process of shared decision making.

Primary site surgery for elderly patients with distant metastatic pancreatic neuroendocrine tumor: to do or not to do?

ObjectiveTo investigate the effect of primary site surgery (PSS) on elderly patients (≥65 years) with pancreatic neuroendocrine tumor (pNET) distant metastasis.Patients and methodsWe reviewed Surveillance Epidemiology and the End Results database for elderly patients with distant pNET from 1973 to 2015. The variables and survival outcomes of patients with PSS were compared with that of patients with no PSS. After propensity score matching, the survival outcome was compared again between the two groups. Multivariable Cox proportional hazard model was used to identify variables associated with cancer-specific and overall survival. Four sub-groups were divided according to the age and differentiation: 1) age 65–74 years+ well or moderately differentiated; 2) age ≥75 years+ well or moderately differentiated; 3) age 65–74 years+ poorly differentiated or undifferentiated; and 4) age ≥75 years+ poorly differentiated or undifferentiated. Cancer-specific survival was compared between the patients with and without PSS in the above each group.ResultsA total of 210 elderly patients with distant pNET were finally confirmed. Of which, 148 patients did not undergo PSS, while 62 patients underwent PSS. Being female (p=0.049), locating on body/tail of pancreas (p=0.006), and well or moderately differentiated (p=0.032) were more likely received PSS. The patients underwent PSS had better survival outcomes both before and after propensity score matching. Multivariable Cox proportional hazard analysis proves PSS and higher histological grade to be protective and risk factors. PSS may improve cancer specific survival in patients of group 1), and no improvement was observed in patients of the other three sub-groups.ConclusionNot all elderly patients with pNET distant metastasis could benefit from PSS. Patients aged 65–74 years with well or moderately differentiated may benefit from primary lesion surgery, but should be evaluated carefully. Prospective randomized controlled trials are worth performing.

Impact of therapeutic modalities on disease-specific survival in older adults with glioblastoma: A single-institution retrospective cohort study.

The standard first-line therapy for glioblastoma consists of maximal surgical resection, followed by concurrent chemoradiotherapy. Optimal management for older glioblastoma patients is unknown as they have not been extensively studied in clinical trials. We report data from a series of 156 consecutive glioblastoma patients treated at our institution from 2007 to 2017. Compared to glioblastoma patients aged 70 or less, the patients older than 70 were less likely to undergo surgical resection (34% vs. 64%; p = 0.0003), be treated with adjuvant chemotherapy (37% vs. 59%; p = 0.01) or radiation therapy (36% vs. 56%; p = 0.03). Disease-specific survival was significantly shorter in this age group (4.7 vs. 15.3 months; p = 0.002). Nonetheless, when older patients did undergo surgery or chemotherapy, the proportional improvement in cancer-specific survival was similar to the one recorded in younger patients, which is concordant with the findings of other published reports. A multidisciplinary input from neurosurgeons, medical and radiation oncologists, oncology pharmacists and geriatricians remain paramount for the optimal management of glioblastoma in patients older than 70.

Effect of centralization on complex surgical care: A population-based case study of radical cystectomy.

We sought to determine whether non-mandated or passive centralization of radical cystectomy (RC) to higher-volume centers leads to enhanced processes of care and outcomes. This is a population-based, retrospective, cohort study that used the Ontario Cancer Registry (OCR) to identify all incident patients who underwent RC from 1994-2013. Electronic records of treatment were linked to OCR; pathology records were obtained for all cases and reviewed by a team of trained data abstractors. The primary objective was to describe annual provider RC volumes. Secondary objectives included investigating process and outcome measures. For the 5574 patients identified, the mean annual surgeon volume and hospital volume of RC from 1994-2008 was 4.5 (95% confidence interval [CI] 4.4-4.7) and 12.2 (95% CI 11.8-12.5), respectively. From 2009-2013, these volumes significantly increased to 6.8 (95% CI 6.5-7. 1) and 16.4 (95% CI 15.8-16.9). Process variables improved over time, including the use of neoadjuvant chemotherapy. Over the study period, there was a substantial improvement in cancer-specific survival (CSS): hazard ratio (HR) 0.60 (95% CI 0.53-0.67) for 2009-2013. During the most recent era, there was still evidence of a provider volume effect on both process measures and CSS. There has been recent passive centralization of RC to higher-volume providers in the province of Ontario, with measurable improvements in processes of quality care. Although centralization was also associated with improvement in CSS, in the most recent era, there continues to be low-volume providers with a residual volume-outcome effect.

Generalisability of Common Oncology Clinical Trial Eligibility Criteria in the Real World

AimsStrict oncology clinical trial eligibility criteria can contribute to low accrual and result in poorly generalisable study findings. Using common eligibility criteria, we sought to (i) determine how many patients would be eligible versus ineligible and (ii) describe real-world patterns of treatments and outcomes between those considered trial eligible and ineligible. Materials and methodsThe Alberta Cancer Registry was used to assemble a population-based cohort of patients diagnosed with 11 common malignancies between 2004 and 2015. We considered age >75 years, anaemia, comorbid conditions (heart disease, uncontrolled diabetes, kidney disease, liver disease) and history of a prior malignancy or immunosuppression to be exclusion criteria. Logistic regression was used to characterise the likelihood of receiving treatment. Cox regression models were constructed to determine cancer-specific and overall survival. ResultsWe identified 125 316 cancer patients, of whom 53% were men; the median age was 66 (interquartile range 48–84) years. Approximately 38% of patients were considered trial ineligible. The most common reasons for ineligibility were advanced age (24%) and heart disease (16%). In this ineligible group, 12, 47 and 19% still underwent chemotherapy, surgery and radiotherapy, respectively. Compared with ineligible patients, eligible patients were more likely to undergo chemotherapy (odds ratio 1.98, 95% confidence interval 1.89–2.07, P < 0.0001), surgery (odds ratio 1.39, 95% confidence interval 1.32–1.46, P < 0.0001) and radiotherapy (odds ratio 1.46, 95% confidence interval 1.4–1.52, P < 0.0001). Compared with ineligible patients who did not receive treatment, those considered ineligible but who still received treatment experienced improved cancer-specific survival (hazard ratio 0.75, 95% confidence interval 0.74–0.77, P < 0.0001) and overall survival (hazard ratio 0.89, 95% confidence interval 0.87–0.90, P < 0.0001). ConclusionsA significant proportion of real-world patients are unable to participate in clinical trials due to stringent exclusion criteria, but many still receive treatment in routine practice. The eligibility criteria of oncology clinical trials should be broadened.