Memorial Sloan-Kettering Cancer Center Score Research Articles

A non-invasive 25-Gene PLNM-Score urine test for detection of prostate cancer pelvic lymph node metastasis.

Prostate cancer patients with pelvic lymph node metastasis (PLNM) have poor prognosis. Based on EAU guidelines, patients with >5% risk of PLNM by nomograms often receive pelvic lymph node dissection (PLND) during prostatectomy. However, nomograms have limited accuracy, so large numbers of false positive patients receive unnecessary surgery with potentially serious side effects. It is important to accurately identify PLNM, yet current tests, including imaging tools are inaccurate. Therefore, we intended to develop a gene expression-based algorithm for detecting PLNM. An advanced random forest machine learning algorithm screening was conducted to develop a classifier for identifying PLNM using urine samples collected from a multi-center retrospective cohort (n = 413) as training set and validated in an independent multi-center prospective cohort (n = 243). Univariate and multivariate discriminant analyses were performed to measure the ability of the algorithm classifier to detect PLNM and compare it with the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram score. An algorithm named 25 G PLNM-Score was developed and found to accurately distinguish PLNM and non-PLNM with AUC of 0.93 (95% CI: 0.85-1.01) and 0.93 (95% CI: 0.87-0.99) in the retrospective and prospective urine cohorts respectively. Kaplan-Meier plots showed large and significant difference in biochemical recurrence-free survival and distant metastasis-free survival in the patients stratified by the 25 G PLNM-Score (log rank P < 0.001 and P < 0.0001, respectively). It spared 96% and 80% of unnecessary PLND with only 0.51% and 1% of PLNM missing in the retrospective and prospective cohorts respectively. In contrast, the MSKCC score only spared 15% of PLND with 0% of PLNM missing. The novel 25 G PLNM-Score is the first highly accurate and non-invasive machine learning algorithm-based urine test to identify PLNM before PLND, with potential clinical benefits of avoiding unnecessary PLND and improving treatment decision-making.

Relevance of different prognostic scores in primary CNS lymphoma in the era of intensified treatment regimens: A retrospective, multicenter analysis of 174 patients.

Treatment intensification (including consolidative high-dose chemotherapy with autologous stem cell transplantation [HDT-ASCT]) significantly improved outcome in primary central nervous system lymphoma (PCNSL) patients. We conducted a multicenter, retrospective analysis of newly diagnosed PCNSL patients, treated with intensified treatment regimens. The following scores were evaluated in terms of overall survival (OS) and progression-free survival (PFS): Memorial Sloan-Kettering Cancer Center (MSKCC), International Extranodal Lymphoma Study Group (IELSG), and three-factor (3F) prognostic score. Further, all scores were comparatively investigated for model quality and concordance. Altogether, 174 PCNSL patients were included. One hundred and five patients (60.3%) underwent HDT-ASCT. Two-year OS and 2-year PFS for the entire population were 73.3% and 48.5%, respectively. The MSKCC (p = .003) and 3F score (p < .001), but not the IELSG score (p = .06), had the discriminatory power to identify different risk groups for OS. In regard to concordance, the 3F score (C-index [0.71]) outperformed both the MSKCC (C-index [0.64]) and IELSG (C-index [0.53]) score. Moreover, the superiority of the 3F score was shown for PFS, successfully stratifying patients in three risk groups, which also resulted in the highest C-index (0.66). The comparative analysis of established PCNSL risk scores affirm the clinical utility of the 3F score stratifying the widest prognostic spectrum among PCNSL patients treated with intensified treatment approaches.

MP14-12 DISAGREEMENTS BETWEEN MEMORIAL SLOAN KETTERING CANCER CENTER (MSKCC) AND THE INTERNATIONAL METASTATIC RCC DATABASE CONSORTIUM (IMDC) PROGNOSTIC SCORE AND THEIR IMPACT ON SURVIVAL OUTCOMES IN CLEAR-CELL METASTATIC RENAL CELL CARCINOMA (mRCC) PATIENTS TREATED WITH TYROSINE-KINASE INHIBITORS (TKI)

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP14)1 Sep 2021MP14-12 DISAGREEMENTS BETWEEN MEMORIAL SLOAN KETTERING CANCER CENTER (MSKCC) AND THE INTERNATIONAL METASTATIC RCC DATABASE CONSORTIUM (IMDC) PROGNOSTIC SCORE AND THEIR IMPACT ON SURVIVAL OUTCOMES IN CLEAR-CELL METASTATIC RENAL CELL CARCINOMA (mRCC) PATIENTS TREATED WITH TYROSINE-KINASE INHIBITORS (TKI) Florian Janisch, Phillip Marks, Philipp Gild, Christian P. Meyer, Constantin Fühner, Roland Dahlem, Shahrokh F. Shariat, Margit Fisch, and Michael Rink Florian JanischFlorian Janisch More articles by this author , Phillip MarksPhillip Marks More articles by this author , Philipp GildPhilipp Gild More articles by this author , Christian P. MeyerChristian P. Meyer More articles by this author , Constantin FühnerConstantin Fühner More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Margit FischMargit Fisch More articles by this author , and Michael RinkMichael Rink More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001995.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clear-cell histology is the most common histologic subtype in patients with metastatic renal cell carcinoma (mRCC) in the tyrosine-kinase era. Treatment strategies are dependent on proper risk stratification. Differential risk stratification between the Memorial Sloan Kettering Cancer Center (MSKCC) and the International Metastatic RCC Database Consortium (IMDC) prognostic score complicates clinical decision-making. We aimed to assess the specifics and impact of disagreement between IMDC and MSKCC risk scores on survival outcomes in patients with clear-cell mRCC (ccmRCC) treated with TKIs METHODS: 215 patients with ccmRCC treated with TKIs were analyzed. Calculation of MSKCC and IMDC was performed based on clinical data and patients were grouped according to disagreement between the scores. Cohen’s kappa was used to assess overall agreement between the risk scores. We used descriptive analysis to assess differences between the two groups as well as Kaplan-Meier estimates to assess the association of disagreement on overall (OS) and progression-free survival (PFS) as primary co-endpoints. RESULTS: Overall, 169 (78.6%) of patients were in agreement between risk scores, with a Cohen’s kappa of 0.624 (p<0.01). 8 patients (22.4%) were upgraded to higher, and 38 patients (77.6%) were downgraded to a lower risk group from MSKCC to IMDC score. Neutrophil leucocyte serum levels were the most frequent score-relevant factors involved in upgrading in 7 patients (87.5%) and LDH serum levels were the most frequent reason for downgrading in 38 patients (100%), respectively. Patients with agreement in prognostic risk scores had significantly worse IMDC score groups (p<0.01), more frequently time to systematic therapy <1 year (p=0.03), and had more frequently a LDH ≤1.5 fold of the upper normal level (p≤0.01). There was no association between agreement of the scores and OS (HR: 0.94; 95%-CI=0.64-1.38; p=0.7) or PFS (HR: 1.20; 95%-CI=0.80-1.79; p=0.4) in univariable analyses. CONCLUSIONS: There was a moderate agreement between IMDC and MSKCC score groups ccmRCC patients treated with TKI. OS and PFS were not impacted by disagreement between the score. Despite the preferred role of the IMDC for risk stratification, results of studies using the MSKCC score can be used for comparison of results in research and the clinical setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e257-e258 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Florian Janisch More articles by this author Phillip Marks More articles by this author Philipp Gild More articles by this author Christian P. Meyer More articles by this author Constantin Fühner More articles by this author Roland Dahlem More articles by this author Shahrokh F. Shariat More articles by this author Margit Fisch More articles by this author Michael Rink More articles by this author Expand All Advertisement Loading ...

A Novel Prognostic Marker for Primary CNS Lymphoma: Lactate Dehydrogenase-to-Lymphocyte Ratio Improves Stratification of Patients Within the Low and Intermediate MSKCC Risk Groups.

BackgroundPrimary central nervous system lymphoma (PCNSL) is a highly aggressive and rare extranodal non-Hodgkin lymphoma (NHL). The MSKCC and the IELSG scores represent the most widely used prognostic models, but many changes have occurred in therapeutic protocols since their development. Moreover, many PCNSL patients cannot be classified using the IELSG score. We thus aimed to create a novel, effective and feasible prognostic model for PCNSL.MethodsWe included 248 PCNSL patients diagnosed with PCNSL. Our primary endpoint was the overall survival (OS) and we used the receiver operating characteristic (ROC) analysis to determine the optimal prognostic cut-off value for LLR (lactate dehydrogenase-to-lymphocyte ratio), neutrophil-to-lymphocyte ratio (NLR) and derived neutrophil-to-lymphocyte ratio (dNLR). Variable associated with OS were evaluated by univariate and multivariate analyses. 124 out of 248 patients were randomly selected as the internal validation cohort.ResultsBy univariate analysis, an age >60 years, Eastern Cooperative Oncology Group performance status (ECOG PS) >1, treatment with radiotherapy alone, high-risk groups of Memorial Sloan Kettering Cancer Center (MSKCC) score, NLR >4.74, dNLR >3.29, and LLR >166.8 were significantly associated with a worse OS. By multivariate analysis, the MSKCC score and LLR were confirmed as independent prognostic parameters for poorer OS. OS, however, was not significantly different between low- and intermediate-risk groups according to the MSKCC score, while LLR proved to be prognostically relevant and was thus used to develop a novel, effective three-tier PCNSL scoring system. Of 124 patients, 84 patients with survival data and LLR data were successfully validated by newly established PCNSL LLR scoring system.ConclusionsIn the present study, we demonstrate that a high LLR represents an independent unfavorable prognostic parameter in PCNSL patients which can be integrated into an effective prognostic model.

Prognostic role of hematologic parameters of metastatic renal cell carcinoma treated with sunitinib.

Hemochrome parameters at the diagnosis of metastatic renal cell carcinoma (mRCC) and the development of macrocytosis during sunitinib therapy are considered prognostic. To evaluate the prognostic role of hematologic parameters and macrocytosis in mRCC treated with sunitinib. We analyzed clinical data of 100 patients with mRCC treated with sunitinib as first-line therapy in a retrospective multicenter study. We calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) at baseline and erythrocyte mean corpuscular volume (MCV) during therapy. We considered the following cutoffs: NLR >3, PLR >150, LMR <3, and MCV >100 fl. Clinical data histology, prior nephrectomy, Fuhrman grading, metastatic sites, Memorial Sloan-Kettering Cancer Center score, and Heng score were collected. Overall survival (OS) and progression-free survival (PFS) were calculated. Univariate and multivariate analysis using Cox regression model with time-dependent (macrocytosis) covariate were applied. At the univariate analysis, low LMR was associated with shorter PFS and OS (p = 0.02 and p = 0.06, respectively). High PLR was associated with worse PFS (p = 0.005); median OS was 23 vs 28 months (p = 0.13). At the multivariate analysis, poor risk (Heng score), low LMR, and high PLR were associated with shorter PFS (hazard ratio 7.1, 1.5, and 2, respectively); poor PS and poor risk (Heng score) were related to worst OS. Macrocytosis was observed in 26 patients and was not prognostic of survival. In our cohort of patients with mRCC treated with sunitinib, low LMR (>3) and high PLR (>150) were associated with shorter PFS. Macrocytosis was not prognostic.

The Effect of Anastomotic Leakage on the Incidence and Severity of Low Anterior Resection Syndrome in Patients Undergoing Proctectomy: A Propensity Score Matching Analysis.

PurposeProctectomy for the treatment of rectal cancer results in inevitable changes to bowel habits. Symptoms such as fecal incontinence, constipation, and tenesmus are collectively referred to as low anterior resection syndrome (LARS). Among the several risk factors that cause LARS, anastomotic leakage (AL) is a strong risk factor for permanent stoma formation. Therefore, the purpose of this study was to investigate the relationship between the severity of LARS and AL in patients with rectal cancer based on the LARS score and the Memorial Sloan Kettering Cancer Center (MSKCC) defecation symptom questionnaires.MethodsWe retrospectively analyzed patients who underwent low anterior resection for rectal cancer since January 2010. Patients who completed the questionnaire were classified into the AL group and control group based on medical and imaging records. Major LARS and MSKCC scores were analyzed as primary endpoints.ResultsAmong the 179 patients included in this study, 37 were classified into the AL group. After propensity score matching, there were significant differences in the ratio of major LARS and MSKCC scores of the control group and AL group (ratio of major LARS: 11.1% and 37.8%, P < 0.001; MSKCC score: 67.29±10.4 and 56.49±7.2, respectively, P < 0.001). Univariate and multivariate analyses revealed that AL was an independent factor for major LARS occurrence and MSKCC score.ConclusionThis study showed that AL was a significant factor in the occurrence of major LARS and defecation symptoms after proctectomy.

Prognostic Role of Blood Markers in Primary Central Nervous System Lymphoma Patients Treated With High-Dose Methotrexate-Based Therapy.

Purpose: Primary central nervous system lymphoma (PCNSL) is a rare type of extra-nodal non-Hodgkin lymphoma, but the prognostic value of blood parameters indicating systemic inflammation and nutritional status remains unknown. We aim to explore the prognostic role of blood parameters in PCNSL.Methods: All PCNSL patients diagnosed at West China Hospital between February 2011 and February 2020 were retrospectively screened. For patients who were initially treated with high-dose methotrexate (HD-MTX)-based therapy, clinical data were collected. Survival analyses were performed using the Kaplan–Meier method and multivariable Cox proportional regression. The accuracies of different multivariate models were assessed by Harrell's C statistical analysis (C-index).Results: Sixty patients were included. Median overall survival (OS) was 4.8 ± 3.7 years, and median progression-free survival (PFS) was 1.9 ± 1.3 years. In the multivariate analysis, hemoglobin (Hb) (HR 3.940, p = 0.013), neutrophil–lymphocyte ratio (NLR) (HR 10.548, p = 0.034), and total bilirubin (TBIL) (HR 3.429, p = 0.004) had independent prognostic values for PFS, while lymphocyte–monocyte ratio (LMR) (HR 6.195, p = 0.039), systemic immune-inflammation index (SII) (HR 5.144, p = 0.012), and TBIL (HR 3.892, p = 0.009) were independently related to OS. The C-index of the Memorial Sloan-Kettering Cancer Center (MSKCC) score increased from 0.57 to 0.72 when SII and TBIL were combined.Conclusions: Our study indicated that pretreatment Hb, NLR, SII, LMR, and TBIL were convenient prognostic factors in PCNSL. Adding SII and TBIL to the MSKCC score can better predict the survival of PCNSL based on HD-MTX regimens.

Complete Blood Count Score Model Predicts Inferior Prognosis in Primary Central Nervous System Lymphoma.

BackgroundPrimary central nervous system lymphoma (PCNSL), an aggressive type of non-Hodgkin lymphoma, has a poor prognosis. Currently available prognostic scoring systems are inadequate. We therefore aimed to investigate the predictive values of complete blood counts (CBCs) in PCNSL.Materials and MethodsThe cohort of this retrospective study comprised 73 PCNSL patients. The predictive values of selected CBCs, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI), were analyzed.ResultsAges and Memorial Sloan Kettering Cancer Center (MSKCC) scores of PCNSL patients correlated with NLR, PLR, and SII values (p <0.05). Both age and MSKCC scores correlated with inferior progression-free survival (PFS) and overall survival (OS) (p <0.05). High NLR, PLR, SII, and SIRI were significant predictors of shorter PFS and OS (p <0.05). NLR, PLR, SII, and SIRI were integrated to generate a “CBC score” model that accurately stratified PCNSL patients into three risk groups. The median PFS for low-risk, intermediate-risk, and high-risk groups were 24 ((12.458–35.542), 17 (10.626–23.374), and 9 (8.893–19.107) months, respectively (p = 0.011), and the median OS were 33 (19.175–46.825), 18 (16.368–19.632), and 9 (6.521–11.479) months, respectively (p = 0.008). Multivariate Cox regression model showed that MSKCC score (hazard ratio (HR) = 3.791, p <0.001), PLR (HR = 1.003, p = 0.013), and CBC score (HR = 1.873, p = 0.011) were independent predictors for PFS, whereas MSKCC score (HR = 4.128, p <0.001), PLR (HR = 1.003, p = 0.005), and CBC score (HR = 1.907, p = 0.004) were independent predictors for OS.ConclusionThe CBC score model may be a promising predictive system for PCNSL patients.

Outcomes According to MSKCC Risk Score with Focus on the Intermediate-Risk Group in Metastatic Renal Cell Carcinoma Patients Treated with First-Line Sunitinib: A Retrospective Analysis of 2390 Patients.

Background: The Memorial Sloan–Kettering Cancer Center (MSKCC) prognostic model has been widely used for the prediction of the outcome of metastatic renal cell carcinoma (mRCC) patients treated with systemic therapies, however, data from large studies are limited. This study aimed at the evaluation of the impact of the MSKCC score on the outcomes in mRCC patients treated with first-line sunitinib, with a focus on the intermediate-risk group. Methods: Clinical data from 2390 mRCC patients were analysed retrospectively. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were analysed according to the MSKCC risk score. Results: ORR, median PFS, and OS for patients with one risk factor were 26.7%, 10.1, and 28.2 months versus 18.7%, 6.2, and 16.2 months, respectively, for those with two risk factors (ORR: p = 0.001, PFS: p < 0.001, OS: p < 0.001). ORR, median PFS, and OS were 33.0%, 17.0, and 44.7 months versus 24.1%, 9.0, and 24.1 months versus 13.4%, 4.5, and 9.5 months in the favourable-, intermediate-, and poor-risk groups, respectively (ORR: p < 0.001, PFS: p < 0.001, OS: p < 0.001). Conclusions: The results of the present retrospective study demonstrate the suitability of the MSKCC model in mRCC patients treated with first-line sunitinib and suggest different outcomes between patients with one or two risk factors.

Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: Comparative cross sectional study.

Despite acceptable oncologic outcomes of sphincter preserving surgeries for low rectal cancer, bowel dysfunction occurs. This study aimed to compare the oncologic and functional bowel outcomes between ultralow anterior resection (ULAR) and intersphincteric resection (ISR) for low rectal cancer. One hundred sixty-four patients who underwent ULAR with or without ISR for low rectal cancer between December 2010 and May 2018 were included. The Wexner and Memorial Sloan Kettering Cancer Center (MSKCC) scores were used to evaluate the bowel function of patients. Overall survival (OS) and disease-free survival (DFS) were compared between patients. The ISR group had higher incidence of major fecal incontinence than the ULAR group (75.9% vs 49.3%; P = .016). The median Wexner score decreased from 12 to 9 (P = .062) at 1-year follow-up. However, the frequency and urgency/soilage subscales of MSKCC score improved significantly in the ULAR group. ISR and follow-up interval less than 1-year significantly increased the major incontinence risk. The OS in the ULAR and ISR groups was 91.4% and 91.7%. Whereas the DFS in both groups was 79% and 79.2%, respectively. ULAR and ISR are comparable in oncologic outcomes. Severe bowel dysfunctions and major incontinence were noted in ISR group. Careful selection of patients is mandatory.

Pretreatment Hemoglobin as an Independent Prognostic Factor in Primary Central Nervous System Lymphomas.

Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal lymphoma. Despite established clinical prognostic scoring such as that of the Memorial Sloan Kettering Cancer Center (MSKCC) and the International Extranodal Lymphoma Study Group, outcome prediction needs to be improved. Several studies have indicated an association between changes in hematologic laboratory parameters with patient outcomes in PCNSL. We sought to assess the association between hematological parameters and overall survival (OS) in patients with PCNSL. Pretreatment blood tests were analyzed in patients with newly diagnosed PCNSL (n = 182), and we divided the analysis into two cohorts (A and B, both n = 91). OS was evaluated using the Cox proportional hazards models and log-rank test. Furthermore, the accuracy of the different multivariate models was assessed by Harrell's concordance index (C-index). Using prechemotherapy blood tests, anemia was found in 38 patients (41.8%) in cohort A and 34 patients (37.4%) in cohort B. In univariate analysis, anemia (<12 g/dL in women and <13 g/dL in men) was significantly associated with OS. None of the other blood tests parameters (neutrophils, lymphocyte, or platelets counts) or their ratios (neutrophil-to-lymphocyte ratio and neutrophil-to-platelets ratio) were associated with OS. In multivariate analysis, after adjusting by MSKCC score, anemia remained an independent prognostic factor. Interestingly, the prediction accuracy of OS using Harrell's C-index was similar using anemia or MSKCC (mean C-index, 0.6) and was increased to 0.67 when combining anemia and MSKCC. The presence of anemia was associated with poor prognosis in both cohorts of PCNSL. Validation of these results and biologic role of hemoglobin levels in PCNSL requires further investigation. The prediction of the outcome of primary central nervous system lymphoma (PCNSL) using the most frequently used scores (i.e., Memorial Sloan Kettering Cancer Center [MSKCC] or International Extranodal Lymphoma Study Group) needs to be improved. We analyzed a large cohort of PCNSL to dissect the potential prognostic value of blood tests in this rare entity. We found anemia as an independent predictor for overall survival in PCNSL. Interestingly, the accuracy to predict PCNSL outcome was improved using hemoglobin level. This improvement was additional to the currently used clinical score (i.e., MSKCC). Finally, none of the other blood tests parameters or their ratios had a prognostic impact in this study.

Systemic inflammation response index predicts prognosis in patients with clear cell renal cell carcinoma: a propensity score-matched analysis.

PurposeIn the present study, we aimed to evaluate the prognostic significance of the systemic inflammation response index (SIRI), which was defined based on peripheral blood counts of neutrophils, lymphocytes, and monocytes, in patients with localized or locally advanced clear cell renal cell carcinoma (CCRCC).Patients and methodsThe prognostic value of SIRI was evaluated in a primary cohort consisting of 414 patients with localized or locally advanced CCRCC and then further validated in an independent cohort composed of 168 patients.ResultsKaplan–Meier survival analyses of both cohorts revealed that CCRCC patients with high SIRI levels exhibited poorer overall survival (OS) and cancer-specific survival (CSS) compared with those with low SIRI levels. Furthermore, univariate and multivariate analyses identified SIRI as a significant independent predictor for both OS (HR: 4.853; 95% CI: 2.362–9.972; P<0.001) and CSS (HR: 5.913; 95% CI: 2.681–13.040; P<0.001). Following propensity score matching analysis, SIRI remained an excellent predictor for both OS and CSS. The area under the curve for SIRI was larger than that of the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and Memorial Sloan Kettering Cancer Center (MSKCC) prognostic score in both cohorts.ConclusionSIRI might be a better prognostic predictor than PLR, NLR, MLR, and MSKCC score in patients with localized or locally advanced CCRCC.Institutional review board approval number(2010) Scientific Research Project No. 39

Prognosis of renal cell carcinoma with bone metastases: Experience from a large cancer centre

BackgroundBone metastases (BMs) are associated with significant morbidity and shorter survival in renal cell carcinoma (RCC). Our purpose was to identify prognostic factors for overall survival (OS) in RCC patients with BMs. MethodsData from patients with BMs from RCC treated at Gustave Roussy between April 1992 and March 2016 were retrospectively collected. Age, sex, Eastern Cooperative Oncology Group-Performance Status, Memorial Sloan-Kettering Cancer Center (MSKCC) risk groups, histology, number and site of bone lesions, concomitant metastases (presence and sites), therapy for BMs (radical resection or palliative surgery, radiotherapy and other local and systemic treatments) and time from diagnosis to BMs were analysed. Synchronous solitary bone metastasis (SSBM) was defined as a single BM without concomitant visceral lesions at the initial diagnosis of RCC. OS was calculated from the date of BMs diagnosis to death or last follow-up using Kaplan–Maier method and modelled with Cox regression analysis. ResultsFrom 1750 patients with diagnosis of RCC followed at Gustave Roussy Cancer Campus, 300 patients with BMs were identified. Median time from diagnosis to BMs was 32.4 months (range 0–324 months). In 64 patients (21%), bone was the only metastatic site, and 22 patients (7%) had an SSBM and 236 patients (79%) had concomitant metastases in other sites. Median OS was 23.2 months (95% confidence interval 19.9–26.2). SSBM patients had better OS than those with concomitant metastases (40 vs 20 months; P < 0.001). At multivariate analysis, concomitant metastases remained predictor of poor prognosis, while MSKCC risk group, radical resection and SSBM were predictors of better OS. ConclusionsThis study suggests that MSKCC score, numbers of BMs and radical resection are important prognostic factors for RCC patients with BMs. Additionally, in the presence of solitary BM without concomitant metastases at the initial diagnosis of RCC, bone surgery should be considered to achieve local tumour control and likely increase OS.

Immediate Progressive Disease in Patients with Metastatic Renal Cell Carcinoma Treated with Nivolumab: a Multi-Institution Retrospective Study.

Investigations on rapid disease progression in patients with urologic malignancies treated with immune checkpoint inhibitors are currently lacking. The objective of this study was to assess cases of rapid disease progression/immediate development of progressive disease (immediate PD) in patients with pretreated metastatic renal cell carcinoma (mRCC) treated with nivolumab. Forty patients were retrospectively evaluated. Immediate PD within the initial two cycles of nivolumab therapy was clinically or objectively diagnosed. Clinical diagnosis was defined as an acceleration of symptoms directly caused by tumor growth or systematic worsening of the general condition, such as cachexia. Objective diagnosis was based on imaging evaluation using the Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Seven patients (17.5%) developed immediate PD. For these patients, the median time from the initiation of nivolumab treatment to PD was 14days; all seven patients subsequently died from the cancer. Progression-free survival (0.66 vs. 10.5months; p < 0.0001) and overall survival (1.41months vs. not reached; p < 0.0001) were significantly shorter in patients with immediate PD than in those without immediate PD. Further, female sex (p = 0.0434), poor Memorial Sloan Kettering Cancer Center (MSKCC) prognostic score (p = 0.0263), and shorter prior-line time to progression (p = 0.0218) were associated with immediate PD. The development of immediate PD in mRCC patients treated with nivolumab can severely worsen patient prognosis. Sex, MSKCC score, and prior-line time to progression may be involved in the development of immediate PD. Prospective studies are needed to further assess these findings.

Construction of a Preoperative Radiologic-Risk Signature for Predicting the Pathologic Status of Prostate Cancer at Radical Prostatectomy.

We developed a radiologic-risk signature (RRS) that serves as a surrogate for the pathologic status of prostate cancer (PCA) and investigated its ability to predict disease-free survival. This study included 631 patients with localized PCA who underwent prostatic multiparametric MRI before prostatectomy. Images from 426 training datasets were structurally interpreted and correlated to a postoperative Memorial Sloan Kettering Cancer Center (MSKCC) score by a stepwise partial least-squares regression analysis. The developed RRS, compared with a preoperative Kattan nomogram, was validated in a cohort of 205 patients with 3-year follow-up data after prostatectomy in terms of calibration, discrimination, and clinical usefulness. Statistical tests were performed by AUC analysis, Kaplan-Meier test, and decision curve analysis. The RRS, which consists of 12 preoperative variables, faithfully represented postoperative MSKCC score in 426 training (r = 0.75; p < 0.001) and 205 validation (r = 0.79; p < 0.001) datasets. For patients in the validation group, RRS showed better discriminative power (C-index, 0.859; 95% CI, 0.779-0.939; p = 0.013) than did the preoperative Kattan nomogram (C-index, 0.780; 95% CI, 0.701-0.859) for predicting 3-year biochemical recurrence and showed higher net benefits for a probability threshold of greater than 10%. Characteristics of RRS can faithfully represent the tumor pathologic status and predict accurately the disease postoperative outcome before prostatectomy.

MP66-19 PREDICTIVE VALUE OF INFLAMMATION-BASED PROGNOSTIC SCORES IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH CYTOREDUCTIVE NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II1 Apr 2018MP66-19 PREDICTIVE VALUE OF INFLAMMATION-BASED PROGNOSTIC SCORES IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH CYTOREDUCTIVE NEPHRECTOMY Hironori Fukuda, Toshio Takagi, Tsunenori Kondo, Kazuhiko Yoshida, Satoru Shimizu, and Kazunari Tanabe Hironori FukudaHironori Fukuda More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Satoru ShimizuSatoru Shimizu More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1891AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of the present study is to determine the most useful inflammation-based prognostic score for predicting survival in patients with metastatic renal cell carcinoma (mRCC) after cytoreductive nephrectomy (CN). METHODS We retrospectively analyzed the data of 152 patients who underwent CN for mRCC between 1986 and 2015. C-reactive protein (CRP), Glasgow prognostic score (GPS), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) were analyzed. Survival rates were compared using Cox proportional hazards regression models and predictive accuracy was evaluated using Harrell's concordance index (c-index). RESULTS Seven factors were significant predictors for survival in the multivariate analysis: age, Memorial Sloan-Kettering Cancer Center score, histology, sarcomatoid change, clinical nodal stage, brain metastasis, and liver metastasis (c-index 0.638). The c-index of these factors improved with the addition of an inflammation-based prognostic score: CRP (c-index: 0.672), GPS (c-index: 0.674), NLR (c-index: 0.685), LMR (c-index: 0.670), PLR (c-index: 0.666), SIRI (c-index: 0.652), and SII (c-index: 0.678). NLR provided the greatest improvement in the c-index. Additional multivariate analysis showed that NLR was an independent prognostic factor for survival rate (P < 0.0001). CONCLUSIONS NLR was most useful inflammation-based prognostic score for predicting survival in mRCC patients treated with CN. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e875-e876 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Hironori Fukuda More articles by this author Toshio Takagi More articles by this author Tsunenori Kondo More articles by this author Kazuhiko Yoshida More articles by this author Satoru Shimizu More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Assessment of bowel and anal sphincter function after neoadjuvant chemoradiotherapy in locally advanced rectal cancer.

To report long-term effects on anorectal function and bowel disorders and late toxicity rate of preoperative chemoradiotherapy in patients with locally advanced rectal cancer. Between 2000 and 2016, 201 patients treated with different neoadjuvant schedules of chemotherapy and radiotherapy doses were retrospectively analyzed. The Memorial Sloan-Kettering Cancer Center score was used for the evaluation of anal sphincter function. The median follow-up time was 68 months (interquartile range 35-113 months). Radical resection was performed in 188 (93.5%) patients with a pathologic complete response rate of 26.4%. Overall sphincter function resulted excellent in 105 (52.2%) patients, good in 13 (6.5%), fair in 10 (5.0%), and poor (incontinence) in 40 (19.9%), with a persistent stoma rate of 16.4%. A further evaluation on 194 patients showed an improvement of sphincter function after 2 years in 11.9% of them. Seventy-three patients presenting stoma or poor sphincter function were re-evaluated for quality of life (QoL) indexes. Twenty-one (29%), 19 (26%), and 24 (33%) of them declared some variations concerning well-being, fatigue, and ability to perform daily activities. The 5-year overall survival, disease-free survival, and local recurrence rates were 88.0% ± 2.6%, 86.3% ± 2.5%, and 94.6% ± 1.9%, respectively. In our study, neoadjuvant chemoradiotherapy was associated with good results in terms of sphincter function, late toxicities, and QoL indexes. A routine use of assessment scales could contribute to a better selection of patients with increased risk of developing functional disorders who could benefit from neoadjuvant therapy.

Predictive value of inflammation-based prognostic scores in patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy.

Inflammation-based prognostic scores are useful for predicting survival in various cancers. Here, we aimed to determine the most useful inflammation-based prognostic score for predicting survival in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy. We retrospectively analyzed the data of 152 patients who underwent cytoreductive nephrectomy for metastatic renal cell carcinoma between 1986 and 2015. In the multivariate stepwise analysis, the combination of age, Memorial Sloan-Kettering Cancer Center score, histology, sarcomatoid change, clinical nodal stage, brain metastasis, and liver metastasis was a significant predictor for survival (Harrell's concordance index [c-index]: 0.638). The c-index of the combination improved with the addition of an inflammation-based prognostic score: C-reactive protein (c-index: 0.672), Glasgow prognostic score (c-index: 0.674), neutrophil-to-lymphocyte ratio (c-index: 0.685), lymphocyte-to-monocyte ratio (c-index: 0.670), platelet-to-lymphocyte ratio (c-index: 0.666), systemic inflammation response index (c-index: 0.652), and systemic immune-inflammation index (c-index: 0.678). The neutrophil-to-lymphocyte ratio provided the greatest improvement in the c-index. Additional multivariate analysis showed that the neutrophil-to-lymphocyte ratio was an independent prognostic factor for survival (P < 0.0001). The neutrophil-to-lymphocyte ratio was the most useful inflammation-based prognostic score for predicting survival in patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy.

Evaluation of Memorial Sloan-Kettering Cancer Center and International Extranodal Lymphoma Study Group prognostic scoring systems to predict Overall Survival in intracranial Primary CNS lymphoma.

ObjectivesTo evaluate the validity of Memorial Sloan‐Kettering Cancer Center (MSKCC) and International Extranodal Lymphoma Study Group (IELSG) prognostic scoring systems for Overall Survival (OS) in intracranial Primary CNS lymphoma (PCNSL) of all patients diagnosed at a single center.Material and MethodsPretreatment clinical factors including tumor characteristics and histology, treatment, and survival of PCNSL patients with diagnostic biopsies over a 12‐year period (2003–2014) were retrieved from a prospective database at Oslo University Hospital.ResultsSeventy‐nine patients with intracranial PCNSL were identified. The female:male ratio was 1:1.63 and the median age was 65.3 years [range 18.9–80.7]. Involvement of deep brain structures was shown in 63 patients. Six patients were MSKCC risk group 1, 35 patients were in risk group 2, and 38 patients were in risk group 3. International Extranodal Lymphoma Study Group scores were <2 in 17 patients (22%). After a median follow‐up of 70.5 months, 55 patients were dead. Median OS was 16.4 months [range 0.2–157.7]. Age, sLDH by recursive partitioning analysis (RPA), Eastern Cooperative Oncology Group score (ECOG), lesion size, involvement of deep brain structures, IELSG score, and MSKCC score were significant factors for OS in univariate analysis. Multivariate analysis confirmed the significance of age (p < .05), sLDH by RPA (p < .005), ECOG (p < .05), and deep brain structure involvement (p < .05) for OS. The six‐tiered IELSG scores had to be dichotomized according to RPA analysis into <2 and ≥2 in order to have prognostic value. In contrast, when using the three‐tiered MSKCC, three distinct risk groups were identified.ConclusionsOur study failed to verify the IELSG, but validated the use of MSKCC for prognostication of OS in intracranial PCNSL.

Treatments, Outcomes, and Validity of Prognostic Scores in Patients With Sarcomatoid Renal Cell Carcinoma: A 20-Year Single-Institution Experience.

Metastatic renal cell carcinoma (RCC) with a sarcomatoid component is a rare disease associated with a poor prognosis. We report the outcomes of 47 patients with metastatic sarcomatoid RCC (SRCC) treated with different modalities including chemotherapy, tyrosine kinase inhibitors, or immunotherapy over 2 decades in a French cancer center. Furthermore, we assessed the validity of prognostic scores in this subset of RCC. Patients were retrospectively identified from the database of the pathology department of the University Hospital of Strasbourg. We enrolled all patients with RCC with a sarcomatoid component diagnosed between 1995 and 2016. Patients with nonmetastatic RCC were excluded. Recorded variables included: clinical stage, metastatic sites, pathologic stage, type of treatments, prognostic group, and survival data. The primary end point was overall survival. The institutional ethical committee approved the study protocol. Of 104 patients with SRCC, 47 patients with metastatic SRCC were included. The median age was 60 years (range, 41-77 years). Median length of follow-up was 34 months (range, 1-180 months). Fifty-five percent of patients had known metastases at diagnosis. Lung represented the first metastatic site (70%) followed by glandular (28%), bone (23%), liver (21%), and brain (6%). Fifteen percent of patients received immunotherapy including cytokine-based therapy (n= 7), or checkpoint inhibitors (n= 2). Moreover, 7 patients received chemotherapy. Five patients received no systemic treatment because of their poor performance status. Of 42 treated patients, 2 patients achieved complete response and 9 partial response (24%). Median overall survival was 13.3 months. International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center (MSKCC) prognostic groups were valid in this subset of SRCC patients. A sarcomatoid percentage cutoff of 30% had the strongest influence on overall survival. Despite the arrival of tyrosine kinase inhibitors 10 years ago, metastatic SRCC remains a disease of poor prognosis and difficult to treat. Chemotherapy regimen and targeted therapies showed little activity in SRCC. IMDC score is a relevant prognostic factor in SRCC patients. Additionally, the MSKCC score, the sarcomatoid percentage, the necrotic fraction, and the vascular invasion could prove useful in identifying patients with a more favorable prognosis. These findings could help toward better patient stratification in clinical trials. Prospective trials assessing new drugs including immune checkpoint inhibitors are currently ongoing to improve SRCC survival.