Median Cancer-specific Survival Research Articles

Clinicopathologic, treatment and prognosis study of 46 Xp11.2 translocation/TFE3 gene fusion renal cell carcinomas

PurposeTo report the clinicopathological features and mid- to long-term oncologic results of Xp11.2 translocation/transcription factor E3 (TFE3) gene fusion renal cell carcinomas (Xp11.2 translocation RCCs) in a single large-volume centrecentre.MethodsClinical and follow-up data of 46 patients who were diagnosed with Xp11.2 translocation RCC and underwentunderwent surgical intervention were retrospectively reviewed.ResultForty-six Xp11.2 translocation RCC patients were identified from 4218 renal tumour patients who were underwentunderwent surgery in our centrecentre from Jan. 2014 to Apr. 2020. The incidence of Xp11.2 translocation RCCs in our centre was 1.09%. During a median follow-up period of 30.5 months, 4 patients died of the disease. The total median overall survival and cancer specific survival were 30.0 months and 24.0 months, respectively. The 1-year, 3-year and 5-year OS rates were 97.4%, 88.8%, and 88.8%, respectively. In multivariable analysis, displaying symptoms when diagnosed (p = 0.019), lymph node metastasis (p = 0.002) and distal metastasis (p = 0.020) were identified as risk factors for poor prognosis.ConclusionXp11.2 translocation RCC is a type of renal cell carcinoma with a relatively low incidence and various prognoses. Early-stage Xp11.2 translocation RCCs have a similar prognosis to most typical RCCs, but late-stage Xp11.2 translocation RCCs can lead to poor oncological outcomes.

Resection of the Primary Tumor Improves the Survival of Patients With Stage IV Gastric Neuroendocrine Carcinoma.

BackgroundThe prognostic prolongation effect of surgical resection in the management of gastric neuroendocrine carcinoma (GNEC) with distant metastases was still uncertain. The purpose of this study was to investigate the association of primary tumor resection (PTR) with outcomes in patients with stage IV GNEC.MethodsThis retrospective study analyzed patients with distant metastatic GNEC diagnosed between 2000 and 2018 and identified using the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into PTR and non-PTR groups. The stabilized inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. Overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method and log-rank test. Cox-regression analyses (uni- and multivariate) were performed to evaluate factors potentially influencing survival.ResultsA total of 126 patients with a median follow-up of 79 months were identified. Forty-four patients underwent PTR and 82 patients did not undergo surgery. After the IPTW approach, PTR improved the OS in patients with stage IV GNEC (median OS 12 vs. 6 months, P = 0.010). The 1- and 3-year OS for patients with or without PTR were 43.8% and 34.5%, and 27.9% and 6.5%, respectively. The median CSS was 12 months for patients undergoing PTR and 6 months for those who did not. The 1 and 3-year CSS for patients with or without PTR were 45.1% and 37.0%, and 27.9% and 6.5%, respectively. In IPTW-adjusted Cox proportional hazards regression analysis, PTR was recognized as an independent factor for improved survival after the occurrence of distant metastatic disease [OS: hazard ratio (HR) = 0.305; 95% confidence interval (CI): 0.196, 0.475; and CSS: HR = 0.278; 95% CI: 0.171, 0.452].ConclusionPTR for stage IV GNEC contributes to a better prognosis compared with non-surgery. This study supported the resection of the primary tumor in patients with distant metastatic GNEC.

Efficacy of percutaneous ethanol injection versus radiofrequency ablation for single hepatocellular carcinoma no larger than 5 cm.

ObjectiveTo compare the efficacy of percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC) of no larger than 5 cm.MethodsThe data used in this study were retrieved from the SEER database. In total, 3510 patients diagnosed with HCC of no larger than 5 cm who received PEI or RFA were included.ResultsThe median overall survival (mOS) and median cancer-specific survival (mCSS) of RFA-treated patients were not significantly longer than those of PEI-treated patients either before or after propensity score matching (PSM). The subgroup analysis showed that patients with HCC of no larger than 2 cm, HCC of larger than 2 cm, American Joint Committee on Cancer (AJCC) stage I and II, and AJCC stage III and IV who received RFA had mOS and mCSS similar to those of patients who received PEI after PSM. Multivariable regression analysis showed that PEI did not increase the all-cause mortality risk or cancer-specific mortality risk after PSM.ConclusionRFA is still the better choice for patients with a single HCC of no more than 5 cm. However, PEI might be a good choice for these patients who cannot be treated with RFA.

Incidence of Metastatic Renal Cell Carcinoma in Sulaimaniyah Government, Iraq

Renal cell carcinoma (RCC) has a well-known tendency to metastasize. Kidney Cancer (KC) has some histopathological subtypes; the most common one is clear cell renal cell carcinoma (ccRCC), which can spread to distant organs in the body like the lungs, brain, bone, and lymphatic system. Multiple RCC metastasis can be treated by complete surgical resection of all metastases if the patient is amenable for surgery, in spite that there is another option in the management of (metRCC) like chemotherapy, radiotherapy and immunotherapy. Full metastasectomy was related to a significant extension of median cancer-specific survival. Also, it is important during multiple metastasectomies; the surgical beds have free of tumours. Primary systemic therapy is targeted therapy (TT) that affect the vascular endothelial growth factor pathway, which improves progression-free survival and overall survival. The results of this study demonstrate that the incidence of metastasized RCC was 0.28 in 2017, which increased until in 2018, it became 0.92, which was the first pick. The second pick was in 2019, which was 1.26. After that, the incidence steadily decreased till 2020 and became 0.57 per 100,000 populations. Regarding types of operation and laterality, partial nephrectomy was done for (45%), radical nephrectomy for 52.5% and 2.5% were non operated, and (64.8%) of the primary tumour was right-sided, and 35.2% was left-sided. Regarding male gender 75 (61.5%) and female 47 (38.5%), non-symptomatic patients were 57.4% while 28.7% had flank pain history, 7.4% had gross hematuria, and 4.1% had back pain symptoms. Route of diagnosis only by ultrasound (US) in 86% and least diagnostic tool is magnetic resonance image (MRI) (0.8%). The most frequent (72.7%) histologic subtype was ccRCC. The most frequent site of distant metastasis was a respiratory system which was 9.8%, then 4.9% metastasized to the skeletal system. In contrast, connective tissue, the endocrine system, and the digestive system had the least common site (0.8%), 10.7% had metachronous, and 13.9% had synchronous metastasis, respectively. Regarding risk factors, 83.4% had a smoking history, the mean body mass index (BMI) was 27.3 kg/m2 , and 46.7% had ahypertension history. This study demonstrated the incidence of MetRCC in the Sulaimaniyah government. Finally, we concluded that the incidence of metastatic RCC increases annually, also synchronous metastasis has higher than metachronous metastasis. In contrast, metastatic RCC is more common in males than females, and most cases of RCC are diagnosed incidentally by a noninvasive imaging method, which was US.

Additional Postoperative Radiotherapy Prolonged the Survival of Patients with I-IIA Small Cell Lung Cancer: Analysis of the SEER Database.

Purpose Complete resection and adjuvant chemotherapy are recommended as the standard strategy for patients with stage I-IIA small cell lung cancer (SCLC). However, the role of additional postoperative radiotherapy (PORT) in treatment remains controversial. Methods Patients with stage I-IIA SCLC undergoing surgery and adjuvant chemotherapy were extracted from the Surveillance, Epidemiology, and End Results database. Stage I-IIA, defined as T1-2N0M0, was recalculated according to the 8th AJCC TNM staging system. Propensity score matching (PSM) was conducted to identify the therapeutic impact of PORT. Univariate Cox hazards regression and least absolute shrinkage and selection operator regression were utilized for primary screening of prognostic variables for I-IIA SCLC disease. A nomogram to predict overall survival (OS) was constructed based on the multivariate Cox proportional hazards model, evaluated with area under the curve, calibration curve, and decision curve analysis, and validated with bootstrap resampling. Results Our results demonstrated that compared with no PORT, PORT significantly prolonged the median OS (8.58 vs. 5.17 years, HR = 0.61 [0.39–0.96], P = 0.032) and median cancer-specific survival (11.33 vs. 8.08, HR = 0.47 [0.27–0.82], P = 0.0086) after PSM. The 5-year OS rate was 61.56% vs. 46.60%. Five variables including age at diagnosis, gender, T stage, surgical type, and PORT were elucidated to impact on prognosis and included in a nomogram to predict 3-/5-/10-year OS probability. The area under the curve values were 0.72, 0.71, and 0.81, respectively. The nomogram also exhibited satisfactory accuracy and clinical usefulness. Conclusion PORT was verified to improve the OS of patients with T1-2N0M0 SCLC after surgery and chemotherapy. A prognostic nomogram was developed and validated for OS prediction for these patients.

Treatment Patterns for Patients With Unresected Stage III NSCLC: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database.

BackgroundRecently, immunotherapy (IO) has shown striking survival improvement in unresectable stage III non-small cell lung cancer (NSCLC). However, the role of chemo-radiotherapy (CRT) for improvement in outcomes should not be disregarded. This study aimed to compare the treatment patterns and illustrate the impact of radiotherapy on the cancer-specific survival (CSS) and overall survival (OS) of patients with unresected locally advanced stage III NSCLC.MethodsWe retrospectively analyzed the data of patients with stage III NSCLC patients who did not undergo surgery from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database between 2001 and 2016, and three continuous years were regarded as one unit. Using the Kaplan-Meier method, we identified the CSS and OS. Then, a linear regression model was graphed to analyze the correlation between median survival of CSS or OS and calendar years in the radiotherapy alone, chemotherapy alone, and CRT groups.ResultsA total of 20986 patients were included in this study. In the overall cohort, CSS and OS improved consistently. To explore the reason for the improved survival, patients were divided into three different cohorts: radiotherapy alone, chemotherapy alone, and CRT. From 2001 to 2015, the median CSS improved persistently, 7, 8, 8, 9, and 11 months in the radiotherapy alone group and 12, 13, 15, 17, 19 months in the CRT group, but improvement in outcomes was less consistent in the chemotherapy alone group (10, 9, 11, 12, 12 months). To better visualize the correlation between CSS and calendar year, linear regression was performed, yielding r2 = 0.8032, P = 0.0395 for the radiotherapy alone group; r2 = 0.7206, P = 0.0689 for the chemotherapy alone group; and r2 = 0.9878, P = 0.0006 for the CRT group. Similar findings were observed in the OS data. In addition to this, we also analyzed different pathological types and also obtained the same results.ConclusionsThe survival of patients with unresectable stage III NSCLC has improved substantially, and the most pronounced and consistent improvements were observed in the CRT group. In addition to IO, radiotherapy played an essential role in the treatment of unresectable stage III NSCLC in the past years and should be considered in the design of clinical trials.

Survival outcomes of pulmonary metastasectomy in advanced melanoma patients: An inverse probability weighted analysis.

e21518 Background: Pulmonary metastasectomy (PM) is a commonly performed procedure for certain patients with lung metastasis. We aimed to estimate the effect of PM on the survival outcomes of advanced melanoma patients with lung metastasis. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) database for all adult patients with advanced melanoma (AYA site recode) with lung metastasis (Stage M1b according to AJCC 7th edition) who were diagnosed from 2010 to 2015. Patients with known liver, brain, or bone metastasis were excluded. Our primary outcomes were overall survival (OS) and cancer-specific survival (CSS) in months. We used Kaplan-Meier plots to compare survival outcomes between treatment groups. We adjusted for potential confounders including age, sex, marital status, primary tumor surgery, chemotherapy, and radiotherapy in a multivariate analysis. We carried out an inverse probability (IP)-weighted Cox regression in an attempt to eliminate the effect of nonrandomization when estimating the treatment effect of PM on OS and CSS. Results: We included 520 patients; 98 (18.8%) underwent PM and 422 (81.2%) did not. The sample median age was 71 (IQR: 61-80). T0 stage was prevalent in 179 (34.4%) and N0-1 in 302 (58.1%). Primary surgical resection was performed for 217 (41.7%) patients, 136 (26.2%) patients had undergone chemotherapy, and radiotherapy was administered in 64 (12.3%) patients. Patients who underwent PM had a higher median OS than patients who did not (43.0 months, 95% CI: 25.0-not reached vs. 13 months, 95% CI: 11-16). The median CSS in PM group patients was not reached (95% CI: 43.0-not reached), while it was 16 months (95% CI: 13-21) in non-PM patients. After multivariate adjustment, older age, being single, and not undergoing primary surgical resection, were all significant independent prognostic factors for worse OS and CSS. In contrast, sex and receipt of chemotherapy and/or radiotherapy did not affect either OS or CSS. PM group patients had a significant survival advantage than non-PM patients, in terms of OS and CSS (HR = 0.50, 95% CI: 0.37-0.67 and HR = 0.45, 95% CI: 0.32-0.63, respectively). On the IP-weighted Cox analysis, the survival benefits of PM were still significantly favorable for OS (IP-weighted HR = 0.42, 95% CI: 0.30-0.59) and CSS (IP-weighted HR = 0.38, 95% CI: 0.26-0.57). Conclusions: PM in a multimodality treatment setting resulted in a marked survival advantage for patients with advanced melanoma who had lung metastasis only. The management of such patients should be delicately individualized to optimize their survival outcomes.

Clinical and pathological prognostic factors in Merkel cell carcinoma.

e21574 Background: From 25 to 50% of radically resected Merkel Cell Carcinomas (MCCs) develop local or distant recurrence with a 5 year Overall Survival (OS) of 35% and 13%, respectively. Due to the rarity of the disease, there are limited data about clinical/histological risk factors related to patients (pts) prognosis. Methods: We retrospectively evaluated a series of 57 MCCs pts treated with surgical curative intent at two Italian Centres from 2000 to 2020. For 43 of them, archival histological material was retrieved for further analysis. The following clinical and histological data were analyzed and related to time to relapse (TTR), OS and cancer specific survival (CSS): gender, age, Charlson Comorbidity Index value, immunodepression, surgical margins, re-excision and/or radiotherapy (RT) in case of positive margins, stage, perineural/lymphovascular infiltration, presence of inflammatory infiltrate (tumoral infiltrating lymphocyte (TILs) (> 1 positive cell per high-power field) and its composition CD3+, CD4+ T and CD8+ T cells), positivity for MCC-polyomavirus (MCCpV), Ki67 index and PDL1 expression CPS. Results: Pts were mainly female (52%), median age was 75 years (49-99), 70% were immunocompetent and 51% presented T1 stage. All pts received surgery as main treatment approach; in case of positive margins, pts received re-excision or RT, when feasible. During a median follow-up of 37 months (1- 188), 40% had a locoregional or distant recurrence. Median TTR of relapsed pts was 3 months (1-88); median OS and CSS in the whole population was 117 months (1-188) and not reached, respectively. At univariate analysis, only male gender was associated with a higher risk of relapse (HR 1.6; 1.07-2.55; p 0.02). Older age (HR 1.09; 1.04-1.14, p < 0.001), T stage ≥2 (HR 4.79, 1.99-11.53, p < 0.001) and positive margins after re-excision (HR 17.49, 1.09-279.74, p 0.043) were associated with shorter OS and negatively related to CSS. Re-excision and/or RT in cases of positive margins at diagnosis improved OS (HR 0.154, 95% CI 0.028-0.851, p = 0.032) and CSS (HR 0.15; 0.02-0.85, p 0.03). MCCpV positivity (HR 0.23, 0.08-0.62, p 0.004), TILs (HR 0.30, 0.11-0.80, p 0.017), a moderate or high content of CD3+ T cells (HR 0.33, 0.119-0.968, p 0.04), CD8+ T cells (HR 0.35, 0.12-0.99, p 0.04), and PDL1 CPS > 1 (HR 0.26, 0.08-0.82, p 0.02) resulted in longer OS. The impact of MCCpV positivity (HR 0.27; 0.08-0.88 p 0.03) and high TILs (HR 0.31, 0.09-0.99, p 0.04) was also confirmed for CSS. Conclusions: In primarily surgically treated MCCs, female gender, younger age, low T stage, positivity for MCCpV and tumoral immune cells infiltration were associated with better prognosis, as well as an aggressive management comprising re-excision and/or RT in case of positive margins.

Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for patients with stage III-N2M0 non-small cell lung cancer (NSCLC): A population-based study.

8503 Background: Stage III-N2 non-small cell lung cancer (NSCLC) is a heterogeneous disease with controversial management options. Induction therapy as part of multimodal treatment is the standard of care for Stage III-N2 NSCLC. We aim to investigate the effect of adding radiotherapy to neoadjuvant chemotherapy on survival outcomes. Methods: All adult NSCLC patients diagnosed between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database using ICD-O-3 histologic type coding. Inclusion criteria involved stage III NSCLC patients with ipsilateral lymph node involvement (N2), of any T stage, and with no known distant metastasis (M0). Our main sub-cohorts were patients who either underwent chemoradiotherapy (CRT) or chemotherapy (CT) in neoadjuvant settings. Our primary outcomes were overall survival (OS) and cancer-specific survival (CSS) in months. Cox proportional hazards model was used to analyze the effect of each treatment modality on OS and CSS in univariate and multivariate fashions. Multivariate analysis was adjusted for age, sex, marital status, T stage, resected lymph node status, tumor histology, primary site, laterality, and surgical procedure. Inverse probability treatment weighting (IPTW) was applied to create weighted samples based on study covariates. Results: Our analysis included 1175 patients; 799 (68.0%) underwent neoadjuvant CRT and 376 (32.0%) underwent neoadjuvant CT. Sample median age was 63 (IQR:56-69) years. T2 stage was the most prevalent (N =561, 47.7%), followed by T4 (N=243, 20.7%), T1 (N=228, 19.4%), and T3 (N=143, 12.2%). The main tumor histology was non-squamous cell carcinoma in 773 (65.8%) patients. The upper lobe was the most common primary tumor site (N =788, 67.1%). Patients underwent lobectomy (N=917, 78.0%), pneumonectomy (N=184, 15.7%), or sub-lobar resection (N=69, 5.9%). Adding radiotherapy to chemotherapy showed a slightly higher median OS than chemotherapy alone in neoadjuvant settings (51 vs. 47 months, respectively), and a higher median CSS (75 vs. 59 months, respectively). However, these differences were not statistically significant for OS or CSS (HR = 1.08, 95% CI: 0.91-1.28 and HR = 1.04, 95% CI: 0.89-1.21, respectively). After adjustment, age, T3-T4 stage, non-squamous histology, lower lobe primary site, positive resected lymph nodes, and pneumonectomy were all significant independent predictors for worse OS and CSS. IPTW analysis showed no remarkable survival advantage for CRT patients (HR = 1.15, 95% CI: 0.95-1.40 and HR= 1.12, 95% CI: 0.90-1.39) for OS and CSS, respectively. Conclusions: Adding radiotherapy to neoadjuvant CT did not result in significant survival benefits. Multiple prognostic factors should be taken into consideration when identifying the optimal choice and sequence of multimodal treatment for stage III-N2M0 NSCLC patients.

Combination of docetaxel versus nonsteroidal antiandrogen with androgen deprivation therapy for high-volume metastatic hormone-sensitive prostate cancer: a propensity score-matched analysis

PurposeThe aim of this study was to investigate the oncologic efficacy of combining docetaxel with androgen deprivation therapy (ADT) versus nonsteroidal antiandrogen (NSAA) with ADT in patients with high-volume metastatic hormone-sensitive prostate cancer (mHSPC) with focus on the effect of sequential therapy in a real-world clinical practice setting.MethodsThe records of 382 patients who harbored high-volume mHSPC, based on the CHAARTED criteria, and had received ADT with either docetaxel (n = 92) or NSAA (bicalutamide) (n = 290) were retrospectively analyzed. The cohorts were matched by one-to-one propensity scores based on patient demographics. Overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), including time to castration-resistant prostate cancer (CRPC), and time to second-line progression (PFS2) were compared. 2nd-line PFS defined as the time from CRPC diagnosis to progression after second-line therapy was also compared.ResultsAfter matching, a total of 170 patients were retained: 85 patients treated with docetaxel + ADT and 85 patients treated with NSAA + ADT. The median OS and CSS for docetaxel + ADT versus NSAA + ADT were not reached (NR) vs. 49 months (p = 0.02) and NR vs. 55 months (p = 0.02), respectively. Median time to CRPC and PFS2 in patients treated with docetaxel + ADT was significantly longer compared to those treated with NSAA (22 vs. 12 months; p = 0.003 and, NR vs. 28 months; p < 0.001, respectively). There was no significant difference in 2nd-line PFS between the two groups.ConclusionsOur analysis suggested that ADT with docetaxel significantly prolonged OS and CSS owing to a better time to CRPC and PFS2 in comparison to NSAA + ADT in high-volume mHSPC.

Long-term effects of total vs. partial pancreatectomy among patients with pancreatic cancer: a population-based study.

BackgroundTotal pancreatectomy (TP) for pancreatic cancer (PC) has been limited historically for fear of elevated perioperative morbidity and mortality. With advances in perioperative care, TP may be an alternative option to partial pancreatectomy (PP). Limited evidence clarified the indication for these two procedures in PC patients, especially in patients with different tumor staging and location. Thus, this study aims to compare the outcomes after TP and PP for PCs of different T stages and locations.MethodsThe study identified 14,456 PC patients with potentially curable primary tumor (T1–3) who received TP or PP from the Surveillance, Epidemiology, and End Results (SEER) database during 2000 to 2016. Detailed clinical and tumor covariates were all collected. Overall survival (OS) and cancer-specific survival (CSS) were the primary endpoints of interest in this study. OS and CSS were compared between patients after TP and PP using log-rank analysis.ResultsFor all patients, except for tumor location, TP group was comparable to the PP group. OS and CSS of the TP group were worse than of the PP group (median OS: 19 vs. 20 months, P=0.0058; median CSS: 24 vs. 26 months, P=0.00098, respectively). In stratifying analyses, TP was significantly related to worse OS and CSS than PP in pancreatic head and neck cancer patients with T2-stage tumors (median OS: 18 vs. 19 months, P=0.0016; median CSS: 22 vs. 24 months, P=0.00055, respectively), whereas for patients with T1- or T3-stage pancreatic head and neck cancer as well as T1- to T3-stage pancreatic body and tail cancer or overlapping location cancer, OS and CSS of the two groups were similar (all P>0.05).ConclusionsCompared with PP, TP offered worse prognosis in pancreatic head and neck cancer patients with T2-stage tumors, furthermore, TP and PP achieved comparable prognosis in patients with T1- or T3-stage pancreatic head and neck cancer as well as T1- to T3-stage pancreatic body and tail cancer or overlapping location cancer.

PD13-09 TRENDS IN SURVIVAL FOR MEN WITH DE NOVO METASTATIC PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD13-09 TRENDS IN SURVIVAL FOR MEN WITH DE NOVO METASTATIC PROSTATE CANCER Nina Wyatt, and Christopher Filson Nina WyattNina Wyatt More articles by this author , and Christopher FilsonChristopher Filson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002545.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The USPSTF recommended against routine prostate cancer screening in 2008 (men >75 years) and 2011 (all men). After 2010, novel therapies were approved for men with metastatic prostate cancer, such as abiraterone. We examined the characteristics and survival of the men presenting with metastatic prostate cancer before and after those time periods. We hypothesized that men diagnosed more recently would have improved survival compared to men diagnosed long ago. METHODS: Using SEER cancer registry data, we identified men newly diagnosed with metastatic prostate cancer diagnosis from 2004–2018. Our outcome of interest was prostate cancer specific survival. Primary exposure was time period of diagnosis (2004–2008; 2009–2012; 2013–2016; 2017–2018). We evaluated factors including age, race/ethnicity, registry, and PSA level. We performed survival analysis to generate Kaplan-Meier curves for men eligible for at least 3 years follow up (diagnosed 2004–2016) (Figure). Multivariable Cox proportional hazard model provided adjusted estimates for cancer specific survival. RESULTS: Among 840,852 prostate cancer patients, 47,343 (5.6%) had metastatic disease. This proportion increased from 4.2% in 2004–2008 to 8.1% in 2017–2018 (p <0.001). Over time, a greater proportion of men with metastatic prostate cancer were Asian/Hispanic (16.0% in 2004–2008 to 17.7% in 2017–2018, p <0.001). Survival after 1 year was most common for men diagnosed in 2017–2018 (81.3% vs 67.9% alive in 2004–2008, p <0.001). Median cancer-specific survival was longest for men diagnosed from 2013–2016 (36 vs 31 months for 2004–2008, p <0.001). After adjusting for other factors, men diagnosed in 2013–2016 had 15% improved survival compared to those diagnosed earlier (vs 2004-2008; adjusted HR 0.85, 95% CI 0.82–0.88). CONCLUSIONS: Men presenting with metastatic prostate cancer in more recent years are living longer. More work will need to evaluate the relative contribution to this finding from therapeutic successes with novel systemic therapies, stage migration with adoption of PET scans, and the impact of earlier cancer detection with screening. Source of Funding: ACS MRSG 18-1-CPHPS © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e254 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nina Wyatt More articles by this author Christopher Filson More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP12-11 NEOADJUVANT THERAPY IN THE MANAGEMENT OF LOCAL RETROPERITONEAL RECURRENCE OF RENAL CELL CARCINOMA AFTER RADICAL NEPHRECTOMY

You have accessJournal of UrologyCME1 May 2022MP12-11 NEOADJUVANT THERAPY IN THE MANAGEMENT OF LOCAL RETROPERITONEAL RECURRENCE OF RENAL CELL CARCINOMA AFTER RADICAL NEPHRECTOMY Jiwei Huang, Yueming Wang, Cuijian Zhang, Xiaoyi Hu, Ping Wang, Guohai Shi, Jin Zhang, Wen Kong, Yonghui Chen, Yiran Huang, Dingwei Ye, Dan Xia, Jianming Guo, Zhisong He, and Wei Xue Jiwei HuangJiwei Huang More articles by this author , Yueming WangYueming Wang More articles by this author , Cuijian ZhangCuijian Zhang More articles by this author , Xiaoyi HuXiaoyi Hu More articles by this author , Ping WangPing Wang More articles by this author , Guohai ShiGuohai Shi More articles by this author , Jin ZhangJin Zhang More articles by this author , Wen KongWen Kong More articles by this author , Yonghui ChenYonghui Chen More articles by this author , Yiran HuangYiran Huang More articles by this author , Dingwei YeDingwei Ye More articles by this author , Dan XiaDan Xia More articles by this author , Jianming GuoJianming Guo More articles by this author , Zhisong HeZhisong He More articles by this author , and Wei XueWei Xue More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002534.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Local retroperitoneal recurrence (RPR) after radical nephrectomy (RN) is rare in patients with renal cell carcinoma (RCC); however, it is associated with poor prognosis and lacks standard treatment. This study aimed to assess oncological outcomes and prognostic factors of patients that underwent targeted therapy for RPR after RN, and to evaluate the role of neoadjuvant targeted therapy in this context. METHODS: This was a retrospective multi-center study of 85 patients with RPR treated with targeted therapy for RPR after RN (2008-2020). Clinical and pathological characteristics were reported using descriptive statistics. Cancer-specific survival (CSS) was examined using the Cox proportional hazards model. RESULTS: The median follow-up time was 50 months (95% confidence interval [CI]: 33.3-66.7) after the RPR diagnosis. The median CSS was 96 months in the neoadjuvant targeted therapy followed by surgical resection group and 42 months (95% CI: 28.8-55.2) in the targeted therapy alone group (P = 0.001). In multivariate analysis, International Metastatic RCC Database Consortium classification poor-risk, number of recurrence sites, and surgical resection were independent predictors of CSS. CONCLUSIONS: Neoadjuvant targeted therapy may increase the feasibility of tumor resection for RPR after RN. Patients who underwent surgical resection following neoadjuvant targeted therapy had better CSS than those treated with targeted therapy alone. Source of Funding: This study was supported by grants from the Natural Science Foundation of Shanghai (21ZR1438900), Incubating Program for Clinical Research and Innovation of Renji Hospital (PYXJS16-008 and PYIII20-07), and Basic Oncology Research Program from the Bethune Charitable Foundation (BCF-NH-ZL-20201119-024) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e171 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jiwei Huang More articles by this author Yueming Wang More articles by this author Cuijian Zhang More articles by this author Xiaoyi Hu More articles by this author Ping Wang More articles by this author Guohai Shi More articles by this author Jin Zhang More articles by this author Wen Kong More articles by this author Yonghui Chen More articles by this author Yiran Huang More articles by this author Dingwei Ye More articles by this author Dan Xia More articles by this author Jianming Guo More articles by this author Zhisong He More articles by this author Wei Xue More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP47-14 THE ROLE OF COMBINED SARCOPENIA AND ALBUMIN IN THE SURGICAL PROGNOSTICATION OF LOCALLY ADVANCED RENAL CELL CARCINOMA WITH VENOUS TUMOR THROMBUS

You have accessJournal of UrologyCME1 May 2022MP47-14 THE ROLE OF COMBINED SARCOPENIA AND ALBUMIN IN THE SURGICAL PROGNOSTICATION OF LOCALLY ADVANCED RENAL CELL CARCINOMA WITH VENOUS TUMOR THROMBUS Eric Midenberg, Dattatraya Patil, Alexandra Medline, Michelle Higgins, Milton Williams, Sarah P. Psutka, Kenneth Ogan, Mehmet A. Bilen, and Viraj A. Master Eric MidenbergEric Midenberg More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Alexandra MedlineAlexandra Medline More articles by this author , Michelle HigginsMichelle Higgins More articles by this author , Milton WilliamsMilton Williams More articles by this author , Sarah P. PsutkaSarah P. Psutka More articles by this author , Kenneth OganKenneth Ogan More articles by this author , Mehmet A. BilenMehmet A. Bilen More articles by this author , and Viraj A. MasterViraj A. Master More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Baseline evaluation of skeletal muscle index (SMI; cm2/m2) and serum albumin have demonstrated value in the preoperative risk assessment of patients with renal cell carcinoma (RCC). We hypothesize that sarcopenia, defined as a critical deficiency in skeletal muscle mass, and hypoalbuminemia will be associated with decreased overall survival (OS) and cancer specific survival (CSS) in nonmetastatic RCC patients undergoing radical nephrectomy and tumor thrombectomy. METHODS: We retrospectively analyzed 103 nonmetastatic RCC patients who underwent radical nephrectomy and tumor thrombectomy from 2005 to 2020. Optimally fit body mass index (BMI; kg/m2) and sex-stratified sarcopenia thresholds were calculated: BMI<30, SMI <47 for males and SMI <38 for females; BMI≥30, SMI<54 for males and SMI <47 for females. Sarcopenia and albumin risk groups were created based on their individual hazard ratios in univariable analysis and defined as low-risk (non-sarcopenic, normal albumin), medium-risk (hypoalbuminemia only), high-risk (sarcopenia only), and very high-risk (sarcopenia, hypoalbuminemia). Multivariable and Kaplan-Meier analyses were used to determine associations between independent and combined sarcopenia and hypoalbuminemia (albumin <3.5 g/dL) with OS and CSS. RESULTS: Preoperatively, 51.2% and 44.7% of our cohort had sarcopenia and hypoalbuminemia, respectively. In the independent multivariable analysis, sarcopenia was significantly associated with decreased OS (p=0.003) and CSS (p=0.006) whereas no relationship between hypoalbuminemia and OS and CSS was found (OS: p=0.096; CSS: p=0.718). In a separate model analyzing the combined sarcopenia and albumin risk groups, the high and very high-risk groups were significantly associated with decreased OS (high-risk: p=0.011; very high-risk: p <0.001) and CSS (high-risk: p=0.011; very high-risk: p=0.017). Kaplan-Meier curves showed a stepwise decline in median OS (p=0.007) and CSS (p=0.007) times with increasing risk. CONCLUSIONS: Simultaneous preoperative sarcopenia and hypoalbuminemia conveyed nearly a seven-fold decrease in OS and CSS in patients undergoing surgery for nonmetastatic RCC with venous tumor thrombus. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e815 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Midenberg More articles by this author Dattatraya Patil More articles by this author Alexandra Medline More articles by this author Michelle Higgins More articles by this author Milton Williams More articles by this author Sarah P. Psutka More articles by this author Kenneth Ogan More articles by this author Mehmet A. Bilen More articles by this author Viraj A. Master More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD59-09 OUTCOMES OF CYTOREDUCTIVE NEPHRECTOMY FOLLOWED BY ACTIVE SURVEILLANCE IN METASTATIC RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022PD59-09 OUTCOMES OF CYTOREDUCTIVE NEPHRECTOMY FOLLOWED BY ACTIVE SURVEILLANCE IN METASTATIC RENAL CELL CARCINOMA Sari Khaleel, Andrew Silagy, Cihan Duzgol, Ritesh Kotecha, Philip Rappold, Robert Motzer, Paul Russo, Jonathan Coleman, Martin Voss, and Ari Hakimi Sari KhaleelSari Khaleel More articles by this author , Andrew SilagyAndrew Silagy More articles by this author , Cihan DuzgolCihan Duzgol More articles by this author , Ritesh KotechaRitesh Kotecha More articles by this author , Philip RappoldPhilip Rappold More articles by this author , Robert MotzerRobert Motzer More articles by this author , Paul RussoPaul Russo More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Martin VossMartin Voss More articles by this author , and Ari HakimiAri Hakimi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002644.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cytoreductive nephrectomy (CRN) for management of metastatic renal cell carcinoma (mRCC) has been recently debated with the introduction of effective systemic therapy (ST) agents. However, these STs are not without significant side effects and morbidity, with current evidence supporting the continued utilization of CRN with active surveillance (CRN + AS) in properly selected patients. We retrospectively evaluated clinical outcomes of ST-naïve mRCC patients undergoing CRN followed by active surveillance (CRN+AS), subclassified into favorable- and unfavorable-risk based on prognostic criteria proposed by Rini et al (2016) for length of AS after CRN. METHODS: We searched our institutional mRCC database for ST-naïve patients undergoing CRN+AS between 1989-2020. We assessed intervention-free survival (IFS), overall survival (OS) and cancer-specific survival (CSS). Categorical and continuous outcomes were assessed using Chi-squared and Welch T-test, respectively. Cox proportional hazard regression (PHR) was used to model predictors against survival outcomes. Analyses were performed using R v4.0.4 (The R Foundation for Statistical Computing). RESULTS: Of 517 ST-naïve patients who underwent CRN, 414 (80%) had residual disease, followed by AS vs ST in 97 (23.4%) vs 295 (76.6%) patients. Patients managed with CRN+AS were older than CRN + ST patients (median age 59.7 vs 66.7 years, p < 0.001), but had no significant difference in stage or number of organ metastases. Median follow-up was 31.8 months (95% CI: 16.5 – 45.2). Median IFS was 11.6 months in the CRN+AS cohort, with 58 patients undergoing further ST/other interventions. Median OS and CSS were 52.3 and 56.5 months, respectively (Table 1). On Cox PHR, unfavorable Rini-risk was significantly associated with shorter IFS (HR 1.7; p=0.028), CSS (HR 2.1; p=0.03), but not OS (HR 1.74; p = 0.07) patients, adjusting for sarcomatoid histology and Charlson comorbidity index. CONCLUSIONS: In this retrospective study, mRCC patients selected for primary CRN+AS had median IFS of 11.6 months, supporting CRN+AS in well-selected patients, deferring the morbidity of additional ST. Prognostic criteria proposed by Rini et al for CRN+AS patients may aid in patient selection and management planning for these patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1022 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sari Khaleel More articles by this author Andrew Silagy More articles by this author Cihan Duzgol More articles by this author Ritesh Kotecha More articles by this author Philip Rappold More articles by this author Robert Motzer More articles by this author Paul Russo More articles by this author Jonathan Coleman More articles by this author Martin Voss More articles by this author Ari Hakimi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Treatment outcomes among patients with metastatic uveal melanoma: a retrospective monocentric study

Aim: to establish the dependence of cancer specific survival rate of patients with metastatic uveal melanoma on the treatment method, according to the Belarusian Cancer Registry. Material and methods. We analyzed the data of the Belarusian cancer registry and medical records of patients diagnosed with metastatic uveal melanoma in the period from 2006 to 2015. Treatment methods included chemotherapy, radiation therapy, surgical removal of metastases, immunotherapy with roncoleukin. Hepatotropic therapy included hepatic artery chemoembolization, radiofrequency ablation of metastatic foci, or liver resection. We analyzed cancer specific 1-, 3-, 5- and 10-year survival of patients in treatment groups. Results. The median cancer specific survival of patients who received only supportive care was 2.0 (95% CI 1.1–2.9) months, after any of the anticancer therapy methods application — 10.0 (95% CI 7.3–12.7) months. The median cancer specific survival in the chemotherapy group was 9.0 (95% CI 6.3–11.7) months, in the case of hepatotropic therapy — 20.0 (95% CI 10.9–29.1). The median cancer specific survival of patients receiving immunotherapy was 7.0 (95% CI 1.1–12.9), the survival plateau was reached after 48 months. Conclusion. Metastatic uveal melanoma is characterized by a poor prognosis, including during therapy. Both hepatotropic and systemic therapy have limited efficacy. Further study of the tumor biology and immune microenvironment is required in order to determine possible targets of exposure.

Interleukin-2 and Interferon-α for Advanced Renal Cell Carcinoma: Patient Outcomes, Sexual Dimorphism of Responses, and Multimodal Treatment Approaches over a 30-Year Period

Introduction: Cytokine-based immunotherapy (IT) has been the mainstay of systemic treatment of advanced renal cell carcinoma (RCC) from the late 1980s until 2007. With the introduction of immune checkpoint inhibitors, a renaissance of immune oncological approaches is rapidly unfolding. Materials and Methods: In the present study, we revisited survival outcomes, sexual dimorphism of treatment responses, and the relevance of multimodal treatment approaches over a 30-year period in 156 patients with advanced RCC treated with subcutaneous (s.c.) interleukin-2 (IL-2) and interferon-α (IFN-α) between 1990 and 2009. Results: The median progression-free survival following the first IT was 5.8 months with a wide range from 0 to 197 months. The median overall survival (OS) was 25.8 months and the median cancer-specific survival after tumor nephrectomy was 24.6 months. A group of 29 patients (18.6%) and 11 patients (7.1%) survived longer than 5 and 10 years after surgery, respectively. A difference in the 5-year OS rate between male and female patients was detected (men, 21.6%; women, 11.1%). However, no sex-specific survival advantage was observed after 10 years. Conclusions: We provide evidence that IT with s.c. IL-2 and IFN-α played a vital role in long-term survivors either by inducing lasting complete remissions or as part of multimodal approaches that allowed patients to survive until novel therapies became available. The implications for current immune oncological treatment approaches are being discussed.

Impact of Treatment Modalities on Prognosis in Patients With Renal Collecting Duct Carcinoma: A Population-Based Study

ObjectiveRenal collecting duct carcinoma (CDC) is an extremely rare disease with few studies, and the current understanding of its prognosis is limited. We used the Surveillance, Epidemiology, and End Results (SEER) registry data to explore the prognostic factors and effect of treatment modalities on the overall survival (OS) and cancer-specific survival (CSS) in patients with CDC.MethodsPatients’ information of CDCs diagnosed by pathological examination between 2000 and 2018 was extracted from the SEER database. The Kaplan–Meier method was used to calculate OS and CSS and log-rank tests to evaluate the differences in OS and CSS. The associations between clinicopathological variables and survival outcomes were assessed with the Cox proportional hazard model. A directed acyclic graph (DAG) was drawn to recognize confounding factors and to obtain the multivariable regression model, and the impact of surgery, radiotherapy, and chemotherapy on OS and CSS was analyzed, respectively.ResultsA total of 242 patients with CDC were enrolled. The median OS and CSS time were 17 and 21 months, respectively. The OS rates at 1, 2, and 5 years were 56.9%, 41.9%, and 30.0%, respectively, while the CSS rates at 1, 2, and 5 years were 60.1%, 47.5%, and 34.8%, respectively. Patients who had a large tumor size, poor pathological grade, and advanced TNM classification exhibited worse survival outcomes. Univariable and multivariable Cox regression analyses revealed that surgery, chemotherapy, T stage, N stage, and M stage were independent prognostic factors for OS and CSS. The DAG-guided multivariate Cox regression model revealed that surgery and chemotherapy improved OS and CSS.ConclusionsCDC is an exceedingly rare disease and has malignant behavior. Most patients have a high pathological grade and advanced TNM stage at diagnosis and exhibited poor survival. Resection of all visible tumors including metastatic lesions or chemotherapy can be beneficial to prognosis, while healthier benefits are less likely to receive radiotherapy. More relevant studies with larger samples are needed to verify the value of surgery and adjuvant therapy in the treatment of CDCs.

Elderly Patients with Nondistant Metastatic Pancreatic Head Adenocarcinoma Cannot Benefit from More Radical Surgery.

Background The incidence of pancreatic cancer continues to rise globally, with pancreatic head cancer accounting for nearly 60–70%. Pancreatic head cancer occurs mainly in people over the age of 60, and its morbidity and mortality increase with age. We investigated whether these elderly patients with nondistant metastases would benefit more from expanded pancreaticoduodenectomy (EPD) compared with standard pancreaticoduodenectomy (SPD). Methods 3317 elderly patients with pancreatic head cancer from the SEER database were included in the study based on the inclusion and exclusion criteria. These patients were divided into a nonsurgical group and surgical group (including EPD and SPD). Univariate and multivariate Cox proportional hazards models were applied to identify the independent risk factors for cancer-specific survival (CSS). The survival differences between the nonsurgical group and surgical group were compared. Propensity score matching (PSM) methods were applied to balance covariates and reduce the interference of confounding variables. The two groups of patients were matched in a 1 : 1 ratio, and the covariates between the two groups were compared to verify the matching validity. The survival difference in different groups was compared after the matching analysis. Results 3317 enrolled patients were divided into the surgical group (n = 984) and nonsurgical group (n = 2333). Before PSM, there were significant differences in overall survival (OS) and CSS between the nonsurgical group and surgical group (median OS: 8 months vs. 20 months, P < 0.001; median CSS: 8 months vs. 22 months, P < 0.001). The multivariate CSS Cox regression analysis demonstrated surgery is an independent risk factor. However, no significant differences were founded between the SPD and EPD groups (median OS: 20 months vs. 22 months, P=0.636; median CSS: 22 months vs. 22 months, P=0.270). After PSM, there were also no significant differences in OS and CSS between the SPD and EPD groups (median OS: 23 months vs. 18 months, P=0.415; median CSS: 26 months vs. 18 months, P=0.329). Conclusion This study uses PSM to evaluate the effects of EPD and SPD for elderly patients with nondistant metastatic pancreatic head adenocarcinoma. It found that surgery is an independent prognostic factor, but expanded surgery has no survival advantage for these patients, whereas SPD provides a better survival advantage than EPD. SPD is a reasonable treatment option for these patients.

Impact of the neutrophil-to-lymphocyte ratio as a surgical prognostic factor in renal cell carcinoma with inferior-vena-cava tumor thrombus

BackgroundThe aim of this study is to evaluate the efficacy of radical nephrectomy with thrombectomy and to identify the prognostic factors for patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus (IVCTT). The role of the neutrophil-to-lymphocyte ratio (NLR), which has been reported to be a useful prognostic predictor for various solid cancers, was also investigated. MethodsFifty-five patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy in our hospital were retrospectively analyzed. The relationship between clinical characteristics and surgical outcome was examined using the Kaplan–Meier method. Univariate and multivariate analyses were carried out to determine the prognostic factors. ResultsThe median follow-up time after surgery was 44.2 months. Twenty-seven patients died of RCC, and 4 died of other disease at last follow-up. There were no patients with postoperative pulmonary embolism (PE) or deaths from PE. The median cancer-specific survival (CSS) and overall survival (OS) were 81.0 (95% confidence interval [CI]: 42.0–103.2) and 69.0 (95% CI: 34.3–81.5) months, respectively. Significant prognostic factors for CSS were distant metastasis (p = 0.045) and NLR ≥ 2.9 (p = 0.009). The only independent predictor for OS was the NLR ≥ 2.9 (p = 0.034). ConclusionsA high preoperative NLR level was an independent poor prognostic factor influencing CSS and OS of patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy. The NLR may be an available biomarker that helps with preoperative risk stratification.