Stage Ta Research Articles

Treatment of FIGO 2018 stage IIIC cervical cancer with different local tumor factors

BackgroundTo compare the oncological outcomes of patients with FIGO 2018 stage IIIC cervical cancer (CC) involving different local tumor factors who underwent abdominal radical hysterectomy (ARH), neoadjuvant chemotherapy and radical surgery (NACT), or radical chemoradiotherapy (R-CT).MethodsBased on tumor staging, patients with stage IIIC were divided into T1, T2a, T2b, and T3 groups. Kaplan–Meier and Cox proportional hazards regression analysis were used to compare their overall survival (OS) and disease-free survival (DFS) of 5 years.ResultsWe included 4,086 patients (1,117, 1,019, 869, and 1,081 in the T1, T2a, T2b, and T3 groups, respectively). In the T1 group, NACT was correlated with a decrease in OS (hazard ratio [HR] = 1.631, 95% confidence interval [CI]: 1.150–2.315, P = 0.006) and DFS (HR = 1.665, 95% CI: 1.255–2.182, P < 0.001) than ARH. ARH and NACT were not correlated with OS (P = 0.226 and P = 0.921) or DFS (P = 0.343 and P = 0.535) than R-CT. In the T2a group, NACT was correlated with a decrease in OS (HR = 1.454, 95% CI: 1.057–2.000, P = 0.021) and DFS (HR = 1.529, 95% CI: 1.185–1.974, P = 0.001) than ARH. ARH and NACT were not correlated with OS (P = 0.736 and P = 0.267) or DFS (P = 0.714 and P = 0.087) than R-CT. In the T2b group, NACT was correlated with a decrease in DFS (HR = 1.847, 95% CI: 1.347–2.532, P < 0.001) than R-CT nevertheless was not correlated with OS (P = 0.146); ARH was not correlated with OS (P = 0.056) and DFS (P = 0.676). In the T3 group, the OS rates of ARH (n = 10), NACT (n = 18), and R-CT (n = 1053) were 67.5%, 53.1%, and 64.7% (P = 0.941), and the DFS rates were 68.6%, 45.5%, and 61.1%, respectively (P = 0.761).ConclusionR-CT oncological outcomes were not entirely superior to those of NACT or ARH under different local tumor factors with stage IIIC. NACT is not suitable for stage T1, T2a, and T2b. Nevertheless ARH is potentially applicable to stage T1, T2a, T2b and T3. The results of stage T3 require confirmation through further research due to disparity in case numbers in each subgroup.

Primary Treatment for Clinically Early Cervical Cancer with Lymph Node Metastasis: Radical Surgery or Radiation?

To compare survival outcomes between primary radical surgery and primary radiation in early cervical cancer. Patient information was extracted from the Surveillance, Epidemiology, and Results database. Patients diagnosed with early cervical cancer of stage T1a, T1b, and T2a (American Joint Committee on Cancer, 7th edition) from 1998 to 2015 were included in this study after propensity score matching. Overall survival (OS) was analyzed using the Kaplan-Meier method. Among the 4964 patients included in the study, 1080 patients were identified as having positive lymph nodes (N1), and 3884 patients were identified as having negative lymph nodes (N0). Patients with primary surgery had significantly longer 5-year OS than those with primary radiotherapy in both the N1 group (P<0.001) and N0 group (P<0.001). In the subgroup analysis, similar results were found in patients with positive lymph nodes of stage T1a (100.0% vs. 61.1%), T1b (84.1% vs. 64.3%), and T2a (74.4% vs. 63.8%). In patients with T1b1 and T2a1, primary surgery resulted in longer OS than primary radiation, but not in patients with T1b2 and T2a2. In multivariate analysis, the primary treatment was identified as an independent prognostic factor in both N1 and N0 patients (HRN1=2.522, 95% CI=1.919-3.054, PN1<0.001; HRN0=1.895, 95% CI=1.689-2.126, PN0<0.001). In early cervical cancer stage T1a, T1b1, and T2a1, primary surgery may result in longer OS than primary radiation for patients with and without lymph node metastasis.

Comparison of prognostic and treatment between T1a and T1b glottic cancer: a propensity score-matched SEER database analysis.

The prognoses of T1a and T1b glottic cancers are still controversial. This study aimed to compare the prognosis difference between the two groups based on the population-based Surveillance, Epidemiology, and End Results database (SEER). Data for patients with T1a or T1b glottic cancers were extracted from the SEER database. The bias between T1a and T1b glottic cancers was minimized with Propensity Score Matching (PSM), and disease-specific survival (DSS) was analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards models. A total of 5,272 patients were extracted from the database, including 847 patients with T1b glottic cancer that were 1:1 propensity score-matched with patients with T1a glottic cancer. After propensity score-matching, there was no statistical difference in disease-specific survival between T1a and T1b patients, whilst survival was impaired by old age. However, on the multivariate analysis, the T1a stage was associated with improved DSS compared with the T1b stage. Our analysis showed that T1a glottic cancers didn't have a significantly better prognosis compared with T1b after PSM. However, the DSS of T1a patients is superior to that of T1b patients in multivariate analysis.

The prognostic nomogram for PSA-incongruent low-risk prostate cancer treated by radical prostatectomy.

To establish a prognostic nomogram for PSA-incongruent low-risk prostate cancer (PCa) patients (Gleason score 6 and clinical stage T2a) at diagnosis and treated with radical prostatectomy (RP), based on clinical and pathological metrics. In total, 217 patients diagnosed with PCa were included in this study. All patients had a Gleason score of 6 (GS6) in biopsy, had clinical T2a before surgery and were treated with RP. Biochemical progression-free survival (bPFS) was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were used to determine prognostic factors related to bPFS. A prognostic nomogram was established based on factors that were significant in the multivariate analyses. The median bPFS had a significant difference in the subgroup of PSA at diagnosis (' < 10ng/mL': 71.698 [67.549-75.847] vs '10-20ng/mL': 71.038 [66.220-75.857] vs ' ≥ 20ng/mL': 26.746 [12.384-41.108] months [Log Rank P < 0.001]), the subgroup of T stage upgrade (Negative: 70.016 [65.846-74.187] vs 'T2b/c': 69.183 [63.544-74.822] vs 'T3/4': 32.235 [11.877-52.593] months [Log Rank P < 0.001]) and the subgroup of Gleason score upgrade (Negative: 72.63 [69.096-76.163] vs '3 + 4': 68.393 [62.243-74.543] vs '4 + 3': 41.427 [27.517-55.336] vs ' ≥ 8': 28.291 [7.527-49.055] [Log Rank P < 0.001]). PSA at diagnoses (Hazard Ratio (HR) 1.027, 95% CI 1.015-1.039, P < 0.001), T stage upgrade (HR 2.116, 95% CI 1.083-4.133, P = 0.028), and Gleason score upgrade (HR 2.831, 95% CI 1.892-4.237, P < 0.001) were identified as independent predictors with significance in multivariable Cox regression analysis. A nomogram was established based on these three factors. Our study indicated that PSA-incongruent low-risk PCa patients (PSA with 10-20ng/mL) had a similar prognosis to those with real low-risk PCa (PSA < 10ng/mL) in the D' Amico criteria. We also established a nomogram based on three significant prognostic factors, including PSA at diagnosis, T stage upgrade, and Gleason score upgrade, which were associated with clinical outcomes in prostate cancer patients with GS6 and T2a after surgery.

V05-08 KIDNEY TUMORS WITH RENAL VEIN BRANCH EXTENSION: INITIAL EXPERIENCE ON T3A SUB CLASSIFICATION IN UPSTAGED T1A MASSES

You have accessJournal of UrologyCME1 Apr 2023V05-08 KIDNEY TUMORS WITH RENAL VEIN BRANCH EXTENSION: INITIAL EXPERIENCE ON T3A SUB CLASSIFICATION IN UPSTAGED T1A MASSES Laura Zuluaga, Burak Ucpinar, Kennedy Okhawere, Jordan Rich, Indu saini, Josh Levieddin, Antony Deluxe, and Ketan Badani Laura ZuluagaLaura Zuluaga More articles by this author , Burak UcpinarBurak Ucpinar More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Jordan RichJordan Rich More articles by this author , Indu saini Indu saini More articles by this author , Josh LevieddinJosh Levieddin More articles by this author , Antony DeluxeAntony Deluxe More articles by this author , and Ketan BadaniKetan Badani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Much has been written about the prognosis of Renal Cell Carcinoma (RCC) patients upstaged from cT1a to pT3a. However, the nature of the pT3a stage is diverse according to the current TNM (Tumor Node Metastasis) including perinephric fat invasion (PFI), renal sinus fat invasion (SFI), and renal vein branch extension (RVBE) and the prognosis of <4 cm tumors staged T3a due to the intraoperative finding of thrombus has never been explored. We aim to analyze the descriptive data in patients after Partial Nephrectomy (PN) with stage cT1a renal cell carcinoma (RCC) who were upstaged to stage T3a due to intraoperative finding of thrombus in the renal vein branches. METHODS: A retrospective descriptive analysis of our single center kidney cancer database was performed, which identified T1a RCC patients upstaged to T3a due to thrombotic intraoperative finding after PN between 2013 and 2022. Categorical variables were presented using frequency and percentage. Continuous variables presented with median and inter-quartile range. RESULTS: A total of 20 patients were included. Median age was 63.1±11.8. 11 (55%) were male, and 9 (45%) were female. The mean BMI was 28.2±4.1 and median Charlson Comorbidity Index was 4 (IQR: 3, 5). The median renal score was 7, the mean tumor size was 3.2±1.1 and 70% of tumors were left lateral tumors. Median operative time was 120 minutes (IQR 111, 138), and ischemia time was 10 minutes (IQR 11, 13). EBL was 50 ml (IQR 50, 75) and length of stay was 1 day (IQR 1, 1). Two (10%) patients had post-operative complications. Most common tumor histology was clear cell RCC (60%), and no patients had positive surgical margins. At the median follow-up of 11.4 (3.7, 36.2) months, no patient had experienced recurrence. CONCLUSIONS: No studies have described the recurrence characteristics of pT3a RCC with RVB. The treatment outcomes of patients with cT1a RCC upstaged to pT3a after PN remains controversial. Comparative studies are needed to provide conclusions on recurrence data and guidance in terms of follow-up and further treatment for these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e426 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Zuluaga More articles by this author Burak Ucpinar More articles by this author Kennedy Okhawere More articles by this author Jordan Rich More articles by this author Indu saini More articles by this author Josh Levieddin More articles by this author Antony Deluxe More articles by this author Ketan Badani More articles by this author Expand All Advertisement PDF downloadLoading ...

PD29-05 ASSOCIATION OF AGE WITH NON-MUSCLE INVASIVE BLADDER CANCER: A BIOLOGICAL BASIS FOR EPIDEMIOLOGICAL DISPARITIES?

You have accessJournal of UrologyCME1 Apr 2023PD29-05 ASSOCIATION OF AGE WITH NON-MUSCLE INVASIVE BLADDER CANCER: A BIOLOGICAL BASIS FOR EPIDEMIOLOGICAL DISPARITIES? Niyati Lobo, Akshay Sood, Zhigang Duan, Wei Shen Tan, Valentina Grajales, Sia Viborg Lindskrog, Lars Dyrskjøt, Aarhus, Denmark, Hui Zhao, Sharon Giordano, Stephen B. Williams, and Ashish M. Kamat Niyati LoboNiyati Lobo More articles by this author , Akshay SoodAkshay Sood More articles by this author , Zhigang DuanZhigang Duan More articles by this author , Wei Shen TanWei Shen Tan More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Sia Viborg LindskrogSia Viborg Lindskrog More articles by this author , Lars DyrskjøtLars Dyrskjøt More articles by this author , Aarhus Aarhus More articles by this author , Denmark Denmark More articles by this author , Hui ZhaoHui Zhao More articles by this author , Sharon GiordanoSharon Giordano More articles by this author , Stephen B. WilliamsStephen B. Williams More articles by this author , and Ashish M. KamatAshish M. Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003315.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Age disparity in patients with non-muscle-invasive bladder cancer (NMIBC) exists. Whether this is due to differences in cancer care or tumour biology is unclear. We sought to investigate age disparities in NMIBC using individual patient-level data from two cohorts: the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and the publicly available UROMOL dataset. METHODS: SEER-Medicare linked data was used to identify patients, aged ≥66 years, with clinical stage Ta, Tis and T1 NMIBC between 2005-2019 (n=32 225). Multivariable competing-risks Cox regression analyses were used to examine the association between age and recurrence (defined as receipt of TURBT ≥3 months after index diagnosis of NMIBC or progression), progression (defined as receipt of definitive treatment for bladder cancer) and bladder cancer-specific mortality rates after adjusting for demographic-, cancer- and treatment-related variables. Using the UROMOL cohort (n=834), age disparities across transcriptomic, genomic and spatial proteomic domains were assessed. Differences between groups were testing using Pearson’s Chi-square test or Fisher’s test for categorical variables. RESULTS: Analysis of the SEER-Medicare cohort revealed 10-year recurrence rates of 60.9%, 61.1% and 60.4% in patients aged 66-70 yrs, 71-80 yrs and ≥81 yrs, respectively; 10-year progression rates of 29.3%, 32.2% and 38.2%, respectively; and 10-year bladder-cancer specific mortality rates of 5.5%, 7.9% and 14.3%, respectively. Age ≥ 81 yrs was associated with a higher risk of progression (HR 1.32, 95% CI 1.25-1.40, p<0.001) and bladder cancer-specific mortality (HR 2.58, 95% CI 2.27-2.95, p<0.001). Analysis of UROMOL 2021 transcriptomic classes revealed that Class 2a was more frequently observed in older patients (34% in >75 yrs vs. 22% in ≤65 yrs; p=0.004). Compared to patients <65 yrs, those aged >75 yrs were more likely to have TP53 pathway change (54% vs. 38%; p=0.032). UROMOL genomic class 3 was more frequently observed in patients >75 yrs (42% vs. 24%; p=0.001), who also had higher amounts of altered genome (median: 337.7Mb vs. 168.2Mb; p<0.001). No significant differences were observed in immune cell infiltration scores between age groups. CONCLUSIONS: Among SEER-Medicare patients with NMIBC, advanced age is associated with higher risks of progression and bladder-cancer specific mortality. These results reflect age-related molecular biological differences observed across transcriptomic and genomic domains. Source of Funding: Niyati Lobo was supported by The Urology Foundation-Fulbright Scholar Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e826 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niyati Lobo More articles by this author Akshay Sood More articles by this author Zhigang Duan More articles by this author Wei Shen Tan More articles by this author Valentina Grajales More articles by this author Sia Viborg Lindskrog More articles by this author Lars Dyrskjøt More articles by this author Aarhus More articles by this author Denmark More articles by this author Hui Zhao More articles by this author Sharon Giordano More articles by this author Stephen B. Williams More articles by this author Ashish M. Kamat More articles by this author Expand All Advertisement PDF downloadLoading ...

Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up

Purpose: The aim of this study was to evaluate the 10-year oncological outcomes of bladder preservation with transurethral resection of bladder tumor (TURBT) and intravesical bacillus Calmette-Guérin (BCG) instillation in selected patients with superficial muscle-invasive bladder cancer (MIBC).Materials and Methods: Patients diagnosed with superficial MIBC (stage T2a) by TURBT between 2001 and 2009 were included. Cystectomy-free survival, recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox regression analysis was used to identify predictors of each type of survival.Results: Of 145 patients, 135 underwent bladder preservation and 10 underwent immediate radical cystectomy (RC). Among the latter, 9 patients showed downstaging. During a median follow-up of 132 months (interquartile range, 96–161 months), 13 patients underwent RC, with a 10-year cystectomy-free survival rate of 83.9%. Seventy patients (48.3%) had recurrence, and the 10-year RFS rate was 48.9%. Progression occurred in 12 patients (8.3%), with a 10-year PFS rate of 90.1%. Death occurred only in patients who exhibited progression; 5 patients (3.4%) died of bladder cancer, and the 10-year CSS rate was 96.5%. Tumors greater than 3 cm were associated with RC, and a high tumor grade predicted recurrence. RC was related to progression and cancer-specific mortality.Conclusions: Although high-grade tumors require careful follow-up, bladder preservation with TURBT and intravesical BCG instillation can enable the successful management of selected patients with stage T2a MIBC less than 3 cm, without carcinoma in situ or tumor-associated hydronephrosis, in a nonmetastatic setting.

Evaluation of the Anastomotic Leakage Following Linear Cutting Stapling Device Gastro-Jejunostomy

Background: The illness of gastric cancer (GC) is varied and complex. It poses a threat to the physical and psychological well-being of people, placing a heavy financial and health burden on both developed and developing nations. Objective: The objective is to evaluate the anastomotic leakage following linear cutting stapling device gastro-jejunostomy. Methodology: The study was a Prospective observational study which was conducted in Department of Surgery, Dhaka Medical college &amp; Hospital, over Six months period after approval of protocol using a semi-structured questionnaire through face to face interview. Data were analysed using a computer programme SPSS 23.0 version.Result: Total 20 patients were enrolled in this study with mean age of 57.60±6.83 years. About 60% of the respondents were male. The mean BMI of the respondents was 22.07±2.72. About 85% of the respondents had normal BMI and about 5% had DM, 10% had HTN and 5% had liver disease. Regarding tumor characteristics80% tumor location was in middle Also 50% had T1a stage followed by T1b (40%), T2 (10%) and T3 (0%) further 90% had N0 stage followed by N2 (5%) and N3 (5%). About 5% of the respondents had Anastomotic hemorrhage, Anastomotic leakage and needed blood transfusion respectively. Conclusion: As the overall rate of anastomotic leakage was 5% so it can be said that the rate is relatively low.

The use of laparoscopy for T4a and T4b colon cancer: are we playing with fire?

The laparoscopic approach for colon cancer has become widely accepted. However, its safety for T4 tumors, and particularly for T4b tumors when local invasion to adjacent structures occurs, remains controversial. This study aimed to compare short and long-term outcomes in patients undergoing laparoscopic vs. open resection for T4a and T4b colon cancers. A prospectively maintained, single-institution database was queried to identify patients with pathological stage T4a and T4b colon adenocarcinomas electively operated on between 2000 and 2012. Patients were divided into two groups based on the use of laparoscopy. Patient characteristics, perioperative, and oncologic outcomes were compared. One hundred and nineteen patients [41 laparoscopic (L), 78 open surgeries (O)] met the inclusion criteria. No difference was observed in age, gender, BMI, ASA, and procedure between groups. Tumors treated by L were smaller than O (p = 0.003). No difference was observed in morbidity, mortality, reoperation, or readmission between the groups. Length of hospital stay was shorter in L than O (6 vs. 9days, p = 0.005). Conversion to open was necessary in 22% of all T4 tumors laparoscopic cases. However, when tumors were subdivided by pT4 classification, conversion was necessary for 4 of 34 (12%) pT4a patients vs. 5 of 7 (71%) pT4b patients (p = 0.003). In the pT4b cohort (n = 37), more tumors were treated by the open approach (30 vs. 7). For pT4b tumors, the R0 resection rate was 94% (86% in L vs. 97% in O, p = 0.249). The use of laparoscopy did not impact overall survival, disease-free survival, cancer-specific survival, or tumor recurrence overall in all T4 or T4a and T4b tumors. Laparoscopic surgery can be safely performed in pT4 tumors with similar oncologic outcomes as compared to open surgery. However, for pT4b tumors, the conversion rate is very high. The open approach may be preferable.

A Randomized Feasibility Trial of Stereotactic Prostate Radiation Therapy With or Without Elective Nodal Irradiation in High-Risk Localized Prostate Cancer (SPORT Trial)

To establish the feasibility of a randomised clinical trial comparing stereotactic ablative radiotherapy (SABR) to the prostate-only (P-SABR) or to prostate plus pelvic lymph nodes (PPN-SABR) in patients with unfavourable intermediate- or high-risk localised prostate cancer and explore potential toxicity biomarkers. Thirty adult men with at least one of the following features; clinical MRI stage T3a N0 M0, Gleason score ≥ 7 (4+3), PSA > 20 ng/mL were randomised 1:1 to P-SABR or PPN-SABR. P-SABR patients received 36.25Gy/5 fractions/29 days, PPN-SABR patients also received 25Gy/5 fractions to pelvic nodes with the final cohort receiving a boost to the dominant intraprostatic lesion of 45-50 Gy. γH2AX foci numbers, citrulline levels and circulating lymphocyte counts were quantified. Acute toxicity information (CTCAE v4.03) was collected weekly at each treatment and at six weeks and three months. Physician-reported late RTOG toxicity was recorded from 90 days to 36 months post-completion of SABR. Patient-reported quality of life (EPIC and IPSS) scores were recorded with each toxicity timepoint. The target recruitment was achieved and treatment successfully delivered in all patients.0% and 6.7% (P-SABR) and 6.7% and 20.0% (PPN-SABR) experienced acute grade ≥ 2 gastrointestinal (GI) and genitourinary (GU) toxicity respectively. At 3 years, 6.7% and 6.7% (P-SABR) and 13.3% and 33.3% (PPN-SABR) had experienced late grade ≥ 2 GI and GU toxicity respectively. One patient (PPN-SABR) had late grade 3 GU toxicity (cystitis and haematuria), no other grade ≥ 3 toxicity was observed. 33.3% and 60% (P-SABR) and 64.3% and 92.9% (PPN-SABR) experienced a minimally clinically important change (MCIC) in late EPIC bowel and urinary summary scores respectively. γH2AX foci numbers at 1 hour post-first fraction were significantly higher in PPN-SABR arm compared to P-SABR arm (p=0.04). Patients with late grade ≥ 1 GI toxicity had significantly larger falls in circulating lymphocytes (12 weeks post-radiotherapy, p=0.01), and a trend towards higher γH2AX foci numbers (p=0.09), than patients with no late toxicity. Patients with late grade ≥ 1 bowel toxicity and late diarrhoea experienced greater falls in citrulline levels (p=0.05). A randomised trial comparing P-SABR to PPN-SABR is feasible with acceptable toxicity. Correlations of γH2AX foci, lymphocyte counts and citrulline levels with irradiated volume and toxicity suggest potential as predictive biomarkers. This study has informed a multicentre UK randomised phase III clinical trial.

Time Trends and Variation in the Use of Active Surveillance for Management of Low-risk Prostate Cancer in the US

Active surveillance (AS) is endorsed by clinical guidelines as the preferred management strategy for low-risk prostate cancer, but its use in contemporary clinical practice remains incompletely defined. To characterize trends over time and practice- and practitioner-level variation in the use of AS in a large, national disease registry. This retrospective analysis of a prospective cohort study included men with low-risk prostate cancer, defined as prostate-specific antigen (PSA) less than 10 ng/mL, Gleason grade group 1, and clinical stage T1c or T2a, newly diagnosed between January 1, 2014, and June 1, 2021. Patients were identified in the American Urological Association (AUA) Quality (AQUA) Registry, a large quality reporting registry including data from 1945 urology practitioners at 349 practices across 48 US states and territories, comprising more than 8.5 million unique patients. Data are collected automatically from electronic health record systems at participating practices. Exposures of interest included patient age, race, and PSA level, as well as urology practice and individual urology practitioners. The outcome of interest was the use of AS as primary treatment. Treatment was determined through analysis of electronic health record structured and unstructured clinical data and determination of surveillance based on follow-up testing with at least 1 PSA level remaining greater than 1.0 ng/mL. A total of 20 809 patients in AQUA were diagnosed with low-risk prostate cancer and had known primary treatment. The median age was 65 (IQR, 59-70) years; 31 (0.1%) were American Indian or Alaska Native; 148 (0.7%) were Asian or Pacific Islander; 1855 (8.9%) were Black; 8351 (40.1%) were White; 169 (0.8%) were of other race or ethnicity; and 10 255 (49.3%) were missing information on race or ethnicity. Rates of AS increased sharply and consistently from 26.5% in 2014 to 59.6% in 2021. However, use of AS varied from 4.0% to 78.0% at the urology practice level and from 0% to 100% at the practitioner level. On multivariable analysis, year of diagnosis was the variable most strongly associated with AS; age, race, and PSA value at diagnosis were all also associated with odds of surveillance. This cohort study of AS rates in the AQUA Registry found that national, community-based rates of AS have increased but remain suboptimal, and wide variation persists across practices and practitioners. Continued progress on this critical quality indicator is essential to minimize overtreatment of low-risk prostate cancer and by extension to improve the benefit-to-harm ratio of national prostate cancer early detection efforts.

Abstract P2-14-07: Omission of Sentinel Lymph Node Biopsy in Patients with Early Stage Breast Cancer: Looking Beyond the Choosing Wisely Guidelines for Age &amp;lt; 70

Abstract Background: The Surgical Society of Oncology Choosing Wisely Campaign for breast cancer advocates against the routine use of sentinel lymph node biopsy (SLNB) for women ≥ 70 years with early stage estrogen positive (ER+), clinically node negative (cN0) disease, given the low likelihood of axillary involvement and axillary recurrence risk, absence of survival benefit and greater reliance on genomic testing for therapeutic decisions. We hypothesize that this practice may be extended to a younger cohort of patients. In this proof-of-concept feasibility study, we first sought to determine the incidence of node positive (N+) disease in our health system using natural language understanding (NLU) technology to extract relevant data from the electronic medical record (EMR). NLU of the clinical narrative has been proven to aid clinical decision support by extracting relevant information and can populate clinical databases to facilitate optimal population management strategies. The advantage of NLU over a cancer registry is the speed and efficiency of data extraction for a large number of patients in real time, plus the capture of data points not conventionally included in a registry. Methods: All patients with early stage ER+, cN0 breast cancer who had SLNB from January 2015-December 2017 were identified in an integrated academic health network comprised of 15 hospitals in Western Pennsylvania. Patitent clinical data were abstracted from the EMR using Realyze Intelligence™ NLU technology. The Realyze NLU pipeline uses a combination of machine learning algorithms and standard terminologies to create a breast cancer patient model that includes genomic, phenotypic, and clinical data. The pipeline gathers information from all data sources – structured and unstructured – and normalizes the information to create a complete model of patient clinical criteria. Realyze Information Models use clinical data formatting flexible enough to represent clinical disorders on a concept level as well as the encounter, patient, and population levels. A breast cancer model with focus on the lymph node identification, pathological as well as clinical tumor and node classification were developed and mapped to standard terminology. A Semantic Reasoning layer is provided by different mechanisms including a rule-based layer to render answers to the questions posed in this hypothesis. NLU performance was validated by manually verifying key clinical variables (i.e., clinical stage, pathologic stage, and nodal positivity) on a subset of patients. Statistical analysis to determine any difference in N+ rates by age was performed using Chi-square testing with significance set at p &amp;lt; 0.05. Results: We identified 602 pts with early stage ER+, cN0 breast cancer over this period who underwent SLNB. Average age was 59.6 years old. As a whole group, there was an increase in N+ rates as the stage increased (Table 1). When comparing incidence of N+ disease stratified by age (&amp;lt; 70 or &amp;gt;70), there was no difference in N+ rates across all stages. In addition, equally low rates of SLN positivity were seen for patients specifically with stage T1a and T1b disease. Conclusions: These data suggest that the Choosing Wisely recommendation to omit SLNB may be extended to a younger cohort of pts with ER+, cN0 disease, specifically those with stage T1a or T1b tumors. With low rates of N+ disease, and less reliance on axillary stage for treatment decision making, the harms of surgical axillary staging may outweigh the benefits. Future validation is needed with a larger sample size. Table 1 Citation Format: Neil Carleton, Gilan Saadawi, Steffi Oesterreich, ADRIAN V. LEE, Emilia Diego. Omission of Sentinel Lymph Node Biopsy in Patients with Early Stage Breast Cancer: Looking Beyond the Choosing Wisely Guidelines for Age &amp;lt; 70 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-07.

Factors associated with pathological tumor stage and T3a upstage in clinical T1-2 renal cell carcinoma.

Considering the oncological outcomes, understanding the preoperative factors associated with and predicting advanced stage and T3a upstage will help in risk assessment and selection of the right treatment. Patients with postoperative pathology of Renal Cell Carcinoma (RCC) and stage T1-2 N0M0 were included in the study. Demographic and pathological characteristics of the patients, Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis- the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were recorded. Patients were classified according to T stage (T1-2 vs T3-4) and T3a upstage (T3a upstaged vs non-T3a upstaged). A total of 289 patients participated in the study when inclusion and exclusion criteria were applied. No difference was found between the groups in terms of age, gender, body mass index, laterality, ABO blood group, Rh positivity and comorbidities. According to multivariate analysis, PLR, AST/ALT, Fuhrman grade, open radical nephrectomy (RN) and Clear Cell pathological subtype were found to be significant-independent factors in predicting advanced stage (T3-4) and T3a upstage (P<0.05). It was found that higher PLR and AST/ALT ratios were associated with more advanced stage and postoperative T3a upstage in RCC patients. In addition, these patients more frequently had open RN and had higher Fuhrman grades, while the clear cell subtype was less common.

Association between multiple coagulation-related factors and lymph node metastasis in patients with gastric cancer: A retrospective cohort study.

Patients with tumors generally present with accompanying activation of the coagulation system, which may be related to tumor stage. To our knowledge, few studies have examined the activation of the coagulation system in reference to lymph node metastasis within gastric cancer. This study aimed to investigate the correlation between multiple coagulation-related factors and lymph node metastasis in patients with gastric cancer after excluding the influence of tumor T stage. We retrospectively evaluated the relationship between lymph node metastasis and coagulation-related factors in 516 patients with T4a stage gastric cancer. We further analyzed influencing factors for lymph node metastasis and verified the predictive value of maximum amplitude (MA, a parameter of thromboelastography which is widely used to assess the strength of platelet-fibrinogen interaction in forming clots) in reference to lymph node metastasis. Platelet counts (P=0.011), fibrinogen levels (P=0.002) and MA values (P=0.006) were statistically significantly higher in patients with T4a stage gastric cancer presenting with lymph node metastasis than in those without lymph node metastasis. Moreover, tumor N stage was statistically significantly and positively correlated with platelet count (P<0.001), fibrinogen level (P=0.003), MA value (P<0.001), and D-dimer level (P=0.010). The MA value was an independent factor for lymph node metastasis (β=0.098, 95% CI: 1.020-1.193, P=0.014) and tumor N stage (β=0.059, 95% CI: 0.015-0.104, P=0.009), and could be used to predict the presence of lymph node metastasis in patients with gastric cancer (sensitivity 0.477, specificity 0.783, P=0.006). The independent influencing factors for MA value mainly included platelet levels, fibrinogen levels, D-dimer and hemoglobin levels; we found no statistically significant correlations with tumor diameter, tumor area, and other evaluated factors. We conclude that MA value is an independent influencing factor for lymph node metastasis and tumor N stage in patients with T4a stage gastric cancer. The MA value has important value in predicting the presence or absence of lymph node metastasis in patients with gastric cancer. http://www.chictr.org.cn, identifier ChiCTR2200064936.

Comparative Study of Short-Term Efficacy and Safety of Mitomycin versus Lobaplatin for Hyperthermic Intraperitoneal Chemotherapy after Radical Surgery in Colorectal Cancer with High-Risk Factors for Peritoneal Carcinomatosis: A Propensity Score Matching Analysis.

The drug selection of radical surgery (RS), with hyperthermic intraperitoneal chemotherapy (HIPEC), in pT4 colorectal cancer (CRC) remains controversial. Adverse events after HIPEC were estimated by common terminology criteria for adverse events version 5.0. The efficacy was evaluated using overall survival (OS) and recurrence-free rate (RFR). Propensity score matching (PSM) was used to reduce the influence of confounders between Mitomycin and Lobaplatin groups. Of the 146 patients, from April 2020 to March 2021, 47 were managed with mitomycin and 99 with lobaplatin. There was no significant difference in the incidence of all adverse events between the two groups after PSM. OS and RFR were not significantly different between the two groups at 22 months (p = 0.410; p = 0.310). OS and RFR of the two groups also showed no significant difference for patients with T4a or T4b stage, tumor size < or ≥ 5 cm. Among patients with colon cancer, RFR at 22 months of the two groups was significantly different (100.0% vs. 63.2%, p = 0.028). In summary, the safety of mitomycin and lobaplatin for HIPEC was not different. Compared with lobaplatin, mitomycin for HIPEC after RS could benefit patients with colon cancer in RFR.

Prognosis of Primary Papillary Ta Grade 3 Bladder Cancer in the Non–muscle-invasive Spectrum

BackgroundTa grade 3 (G3) non–muscle-invasive bladder cancer (NMIBC) is a relatively rare diagnosis with an ambiguous character owing to the presence of an aggressive G3 component together with the lower malignant potential of the Ta component. The European Association of Urology (EAU) NMIBC guidelines recently changed the risk stratification for Ta G3 from high risk to intermediate, high, or very high risk. However, prognostic studies on Ta G3 carcinomas are limited and inconclusive. ObjectiveTo evaluate the prognostic value of categorizing Ta G3 compared to Ta G2 and T1 G3 carcinomas. Design, setting, and participantsIndividual patient data for 5170 primary Ta–T1 bladder tumors from 17 hospitals were analyzed. Transurethral resection of the tumor was performed between 1990 and 2018. Outcome measurements and statistical analysisTime to recurrence and time to progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox-regression models with interaction terms stratified by institution. Results and limitationsTa G3 represented 7.5% (387/5170) of Ta–T1 carcinomas of which 42% were classified as intermediate risk. Time to recurrence did not differ between Ta G3 and Ta G2 (p = 0.9) or T1 G3 (p = 0.4). Progression at 5 yr occurred for 3.6% (95% confidence interval [CI] 2.7–4.8%) of Ta G2, 13% (95% CI 9.3–17%) of Ta G3, and 20% (95% CI 17–23%) of T1 G3 carcinomas. Time to progression for Ta G3 was shorter than for Ta G2 (p < 0.001) and longer than for T1 G3 (p = 0.002). Patients with Ta G3 NMIBC with concomitant carcinoma in situ (CIS) had worse prognosis and a similar time to progression as for patients with T1 G3 NMIBC with CIS (p = 0.5). Multivariable analyses for recurrence and progression showed similar results. ConclusionsThe prognosis of Ta G3 tumors in terms of progression appears to be in between that of Ta G2 and T1 G3. However, patients with Ta G3 NMIBC with concomitant CIS have worse prognosis that is comparable to that of T1 G3 with CIS. Our results support the recent EAU NMIBC guideline changes for more refined risk stratification of Ta G3 tumors because many of these patients have better prognosis than previously thought. Patient summaryWe used data from 17 centers in Europe and Canada to assess the prognosis for patients with stage Ta grade 3 (G3) non–muscle-invasive bladder cancer (NMIBC). Time to cancer progression for Ta G3 cancer differed from both Ta G2 and T1 G3 tumors. Our results support the recent change in the European Association of Urology guidelines for more refined risk stratification of Ta G3 NMIBC because many patients with this tumor have better prognosis than previously thought.

Histopathologic features and parameters predicting recurrence potential of small renal masses

Abstract Background Small renal masses (SRMs) are defined as contrast-enhanced masses with a diameter of ≤4 cm, usually consistent with clinical stage T1a renal cell carcinoma (RCC). This study aimed to explore the histopathological features of a contemporary series of SRMs and investigate parameters that could predict their pathological nature, metastatic potential, and recurrence potential. Materials and methods Small renal masses were identified in 166 of 427 patients who underwent surgery for suspected RCC. The radical nephrectomy/partial nephrectomy ratio was 1:44, and autotransplantation was performed in a single case. Variables associated with metastatic recurrence of SRM were analyzed using χ2 and logistic regression models. Results Renal cell carcinoma was confirmed in 86% (n = 143) of cases, whereas benign tumors were present in 14% (n = 23) of cases. Seventeen percent of the RCC cases were high-grade (Fuhrman G3–4). Among SRMs with a diameter of &gt;2 cm, 71% were malignant. The mean ± standard deviation diameter of the removed SRMs was 28 ± 12 mm, significantly higher in the malignant SRMs group (31 ± 8 vs. 24 ± 9 mm) (p = 0.005). During follow-up, local recurrence was identified in 4 patients versus new distant metastasis in 11 patients. Metastatic lesions were detected in the lungs (1.8%), bone (1.2%), distant (1.9%) and regional lymph nodes (1.2%), liver (0.6%), and multiple organs (2.4%). Patients with malignant SRMs were significantly older than those with benign tumors (p = 0.036). The multivariate analysis identified tumor size, Fuhrman grade, stage, nodal and distant metastasis status, tumor localization, and treatment modality as characteristics significant for tumor recurrence. Conclusions The majority of treated neoplasms were malignant, but their incidence was low among SRMs with a diameter of &lt;2 cm. Our results emphasized the importance of histopathological features and treatment modalities in predicting malignant recurrence.

Survival benefit stratification of partial nephrectomy versus non-surgical treatment in elderly patients with T1a renal cell carcinoma.

Renal cell carcinoma (RCC) of stage T1a has been proven to be of low-grade malignancy and mostly affects elderly individuals with relatively limited life expectancy. However, research on the survival benefit of surgery relative to non-surgical treatment (NST) is limited. The aim of the study was to investigate the survival difference between partial nephrectomy (PN) and NST and to establish a benefit stratification model for elderly patients (≥70 years) diagnosed with T1a RCC. Patients diagnosed with non-metastatic T1a RCC who received PN or NST were identified from the SEER database during 2004-2015. Before survival analysis, propensity score matching (PSM) was performed. Overall survival (OS) was estimated by the Kaplan-Meier method, and subgroup analyses were used to identify favorable factors of PN. Independent factors of survival were recognized by multivariate Cox regression analysis. Patients diagnosed with non-metastatic T1a RCC who received PN or NST were identified from the SEER database during 2004-2015. Before survival analysis, propensity score matching (PSM) was performed. Overall survival (OS) was estimated by the Kaplan-Meier method, and subgroup analyses were used to identify favorable factors of PN. Independent factors of survival were recognized by multivariate Cox regression analysis. Our findings suggest that the survival benefit of PN could be stratified based on the clinical characteristics in patients with stage T1a RCC aged 70 years or older, which may help physicians and patients optimize clinical decisions.

Frequency and accuracy of intraoperative bone margin sampling for T4a cancers of the head and neck at the QEII Health Sciences Centre: a retrospective chart review

BackgroundStage T4a cancers are associated with a 5-year survival of 21.6–59.0%. Adequate resection of these tumors is a critical factor in maximizing survival. Tumors invading bone pose a unique challenge to intraoperative bone margin assessment. Due to processing limitations, there had been no formal standardized protocol for intraoperative bone sampling at the QEII Health Sciences Centre. These resections often involve extensive reconstruction, making salvage surgery difficult if positive margins are detected post-surgically. The purpose of this study was to assess the accuracy and frequency of intraoperative bone margin assessment during the study period and to determine survival and recurrence rates associated with positive final bone margins.MethodsA retrospective chart review was conducted including patients with stage T4a head and neck cancer involving bone that underwent primary surgical resection in Nova Scotia between 2009 and 2019. Eligible patients were identified through the Cancer Care Nova Scotia registry. Exclusion criteria included patients with stage T4a tumors involving bone that did not receive primary surgical treatment with curative intent and patients with stage T4a tumors that did not invade bone.ResultsOf 67 patients included, 50 were amenable to intraoperative bone margin sampling while 18 had intraoperative sampling. Four patients had positive intraoperative margins and one had final positive bone margins. The incidence of final bone margin positivity was 7.5%. Median survival following surgery was 4.56 years for patients with final negative bone margins (n = 62) and 3.98 years for patients with positive final bone margins (n = 5). All patients with final positive bone margins received adjuvant radiation therapy. Of patients with negative final bone margins, 16.1% received no adjuvant therapy, 61.3% received adjuvant radiation therapy and 21.0% received adjuvant chemoradiation therapy.ConclusionIntraoperative bone margin sampling occurred in 26.8% of all cases and 36.0% of amenable cases. Median survival of patients with positive final bone margins was 0.58 years lower than those with negative final bone margins, although this difference did not reach statistical significance. This will provide baseline data for comparison of the standardized intraoperative bone margin sampling protocol implemented at the QEII Health Sciences Centre.Graphical

Organ preservation surgery for laryngeal cancer in a trombone player

Introduction. Modern treatments for early glottic carcinoma achieve high rates of local control and long-term survival, but potential side effects of some of these treatments have a substantial impact on a patient?s quality of life. There is a small quantity of available scientific research on the effects of organ-preservation surgery on musicians, highlighting the challenge of balancing functional outcomes with their occupational demands. Case report. We present a successful surgical treatment of a mid-membranous left vocal fold squamous cell carcinoma (T1a stage) in a professional trombonist with a history of many years of smoking. Due to suboptimal exposure during initial microlaryngoscopy, open cordectomy was performed for tumor removal instead of transoral laser microsurgery. After the operation and the proper rehabilitation, the patient continued to play the brass instrument unhindered and managed to fulfill all the obligations of a professional musician in a national orchestra. Conclusion. Selecting a method for the treatment of glottic cancers in professional musicians who play brass instruments remains challenging due to limited literature and the potential harm to the ability of performance and the musician?s career. Partial open laryngectomies for laryngeal cancer treatment are shown to be feasible without compromising the musician?s performance.