Worse Oncologic Outcomes Research Articles

Outcomes of laparoscopic radical hysterectomy in IA1- IB1 cervical cancer patients with low-risk: A multi-center retrospective study with 10 years’ experience (487)

<b>Objectives:</b> More evidence revealed that the oncological outcomes of open abdominal radical hysterectomy (OARH) were superior to those of laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer (CC). However, limited by the number of CC patients with IA and low-risk IB1, some aspects still needed more study to clarify. This retrospective study aimed to estimate the outcomes of LRH for IA1-IB1 cervical cancer patients with low- risk, which was defined as tumor <2cm, less than one-third stromal invasion, no lymphovascular space invasion (LVSI), no lymph node involvement. <b>Methods:</b> By carefully studying the results of the Laparoscopic Approach to Cervical Cancer (LACC) Trial, we were surprised to find that the number of early-stage CC patients with low risk was relatively insufficient. Therefore, we retrospectively reviewed the medical records to identify the low-risk patients with FIGO 2018 stage IA1, IA2, and IB1 cervical cancer and who received laparoscopic or abdominal radical hysterectomy from January 2010 to December 2020 at four hospitals. The Mann-Whitney U test and the Chi-square test were used for the comparison of categorical variables. Progression-free survival and overall survival were compared between matched groups using Kaplan-Meier survival analysis and log-rank tests, along with univariable and multivariable regression analysis. <b>Results:</b> Of 5360 patients selected, 1850 (35%) met the inclusion criteria for this study from January 2010 to December 2020. Of these, 1090 patients underwent open surgery, and 760 patients had laparoscopic surgery. In the entire cohort, the two groups were similar in regard to clinical characteristics, such as age, body mass index (BMI), FIGO stage, histologic type and grade, pelvic lymph nodes, positive margins, stromal invasion, LVSI, and adjuvant therapy. LRH had better outcomes compared with OARH in terms of blood loss, transfusion rates, and the length of hospital stay. And in the subgroup analysis, when it referred to those patients with low-risk factors (tumor <2cm, superficial stromal invasion, negative LVSI, and no lymph node involvement), the LRH group was equivalent to the OARH group with respect to both disease-free survival (DFS) and 5-year overall survival (OS) rates. What's more, when the tumor was >2cm or accompanied by other medium and high-risk factors, the LRH group showed a significantly shorter DFS and OS than OARH, which was consistent with the LACC Trial. <b>Conclusions:</b> Among FIGO 2018 stage IA1-IB1 CC patients with low- risk, tumor <2cm, superficial stromal invasion, negative LVSI, and no lymph node involvement, there was no detrimental effect on survival between LRH and OARH. And it also needed more prospective studies to explore the oncological outcomes of low-risk CC patients with stage IA1-IB1. Besides, LRH was closely associated with worse oncological outcomes than OARH in patients with risk factors.

Trends and characteristics of ovarian conservation at hysterectomy for young women with cervical cancer (463)

<b>Objectives:</b> The association between early surgical menopause and increased mortality has been well demonstrated. Prior studies have also demonstrated that ovarian conservation is not associated with worse oncologic outcomes in early-stage cervical cancer. This study examined the contemporary trends and characteristics of ovarian conservation at the time of hysterectomy in young women with cervical cancer. <b>Methods:</b> This is a retrospective observational cohort study examining the National Inpatient Sample. The study population was 4,900 women aged ≤50 with cervical cancer who had hysterectomy-based surgical treatment from October 2015 to December 2018. Exposure allocation was the adnexal procedure status (ovarian conservation vs bilateral adnexectomy). The main outcome measures were temporal trends of ovarian conservation over time and per patient age. A multivariable binary logistic regression model (conditional backward selection) was fitted to identify independent characteristics associated with ovarian conservation. <b>Results:</b> A total of 2,940 (60.0%) women underwent ovarian conservation at hysterectomy. The incidence of ovarian conservation increased from 54.7% in Q4/2015 to 64.4% in Q4/2018 (<i>p</i>=0.002). Ovarian conservation rates remained stable until age 37 years, ranging from 82.5% to 77.9% (<i>p</i>=0.502), after which time the rate sharply and significantly decreased from 77.9% to 28.7% (<i>p</i><0.001). In multivariable analysis, recent surgery remained an independent factor for ovarian conservation (adjusted-odds ratio per year-quar- ter: 1.03, 95% CI: 1.01-1.05). In addition, younger age, Hispanic race, self-pay, large hospital bed capacity, Southern region, and minimally invasive hysterectomy were independently associated with ovarian conservation (all, <i>p</i><0.05). <b>Conclusions:</b> Increasing rates of ovarian conservation at the time of hysterectomy in women undergoing surgical management of cervical cancer are encouraging; however, the marked decrease noted in patients in their mid-30s is striking and warrants further investigation.

Preprostatic lymph nodes in prostate cancer hot or not? Impact on oncological outcome after radical prostatectomy.

To assess the impact of preprostatic lymph node invasion on prostate cancer patients' outcome after radical prostatectomy. It is known that invasion of pelvic lymph nodes is associated with worse oncological outcome, but little is known about invasion of preprostatic lymph nodes. We hypothesized that positive preprostatic lymph nodes may not be as harmful as positive pelvic lymph nodes. A total of 11,107 consecutive patients treated for prostate cancer with radical prostatectomy between 2013 and 2017 were evaluated. 1575 (14.2%) had some type of lymph node invasion, 53 (0.5%) had only one positive preprostatic lymph node and 705 (6.3%) had only one positive pelvic lymph node. Median follow-up was 37.7months (interquartile range: 24.6-58.7months). Baseline characteristics of the overall cohort were not statistically significant between the preprostatic vs. pelvic lymph node invasion groups, except for robot-assisted operation (64.2 vs. 32.3%, p < 0.001) and count of removed lymph nodes (16 vs. 19, p < 0.001). There was no statistically significant difference in 3-years biochemical recurrence rate (56.2 vs. 65.8%, p = 0.5), 3-years metastases free survival rate (87.4 vs. 95.5%, p = 0.5) and overall cancer-specific mortality (1.9 vs 1.0%) between the two groups. Preprostatic lymph node invasion seems to have a similar harmful effect as pelvic lymph node invasion and thus, if detected, may alter treatment and follow-up strategy. Therefore, it is important to perform a histological analysis when removing the preprostatic tissue.

Prostate cancer upgrading and adverse pathology in Hispanic men undergoing radical prostatectomy.

Radical prostatectomy (RP) outcomes in Hispanic men with prostate cancer are not well-described. Prior studies showed varying results regarding the rate of upgrading and upstaging, and these studies included limited pathologic data and lack of central pathology review. We characterized the rate of upgrading, adverse pathology, and oncologic outcomes in Hispanics after prostatectomy using a large institutional database. We included Hispanic white (HW), non-Hispanic white (NHW), and black men who underwent (RP) between 2010 and 2021 at a single institution. We recorded differences in grade group between biopsy and prostatectomy and performed multivariable analyses for odds of upgrading and adverse pathologic findings. The primary outcome was rate of upgrading in HWs. Using a sub-cohort with follow-up data, we assessed race/ethnicity and upgrading as a predictor of biochemical recurrence (BCR)-free survival. Our cohort included 1877 men: 36.7% were NHW, 40.6% were HW, and 22.7% were black. Rates of upgrading were not different between NHW, NHW, and black men at 34.0, 33.8, and 37.3%, respectively (p = 0.4). In the multivariable analysis for upgrading, significant predictors for upgrading were older age (p = 0.002), higher PSA (p < 0.001), and lower prostate weight (p = 0.02), but race/ethnicity did not predict upgrading. In patients with available follow-up (1083, 58%), upgrading predicted worse BCR-free survival (HR 2.17, CI 1.46-3.22, p < 0.0001) but race/ethnicity did not. HW men undergoing RP had similar rates of upgrading and adverse pathologic outcomes as NHW men. Race/ethnicity does not independently predict upgrading or worse oncologic outcomes after RP.

Comparison of Oncologic Outcomes Between Incomplete Obstructive Colon Cancer and Non-Obstructive Colon Cancer by Tumor Location.

IntroductionObstruction in colon cancer is a well-known risk factor for worse oncologic outcomes. However, studies on differences in survival of patients with incomplete obstructive colon cancer (IOCC) by tumor location are insufficient. Thus, the aim of this study was to compare oncologic outcomes between IOCC and non-obstructive colon cancer (NOCC) according to tumor location.MethodsFrom January 2010 to December 2015, a total of 2,004 patients diagnosed with stage II or stage III colon adenocarcinoma who underwent elective colectomy were included (IOCC, n = 405; NOCC, n = 1,599). Incomplete obstruction was defined as a state in which colonoscopy could not pass through the cancer lesion but did not require emergent surgery, stent insertion, or stoma formation because the patient was asymptomatic without problem in bowel preparation. Kaplan–Meier method and log-rank tests were used to compare survival between IOCC and NOCC. Multivariable analysis was performed to determine which factors affected survivals.ResultsStage III IOCC patients showed significantly lower overall survival (OS) and recurrence-free survival (RFS). Stage II IOCC patients and stage III NOCC patients had similar survival curves. IOCC patients with tumors on the right side showed worse OS than other patients. In multivariable analysis, incomplete obstruction was an independent risk factor for worse OS and RFS in all stages. Tumor located at the right side in stage III was an independent risk factor for RFS (HR: 1.40, p = 0.030).ConclusionsPatients with IOCC showed significantly worse survival outcomes than those with NOCC. Stage II IOCC patients and stage III NOCC patients showed similar survival. Patients with stage III IOCC located at the right side showed significantly worse oncologic outcomes than those located at the left side. These results confirm that prognosis is different depending on the presence of incomplete obstruction and the location of the tumor, even in the same stage.

Is Gross Extrathyroidal Extension to Strap Muscles (T3b) Only a Risk Factor for Recurrence in Papillary Thyroid Carcinoma? A Propensity Score Matching Study.

Simple SummaryIn papillary thyroid carcinoma (PTC), staging classification of gross and minimal extrathyroidal extension (ETE) has been recently modified in the eighth edition of the American Joint Commission on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system. In this study, we compared the clinicopathological characteristics and recurrence rates between minimal and gross ETE. No significant differences in the recurrence and disease-free survival rates were found between the two groups. Whether gross ETE invading strap muscles (T3b) only could be a risk factor for recurrence in PTC remains questionable.The presence of extrathyroidal extension (ETE) is associated with locoregional recurrence and distant metastases in papillary thyroid carcinoma (PTC). This study was designed to compare the recurrence risk between minimal ETE (mETE) and gross ETE (gETE) in patients with PTC using propensity score matching. In this study, 4452 patients with PTC who underwent thyroid surgery in a single center were retrospectively analyzed, and clinicopathological characteristics were compared according to the ETE status. Disease-free survival (DFS) and recurrence risk were compared between mETE and gETE after propensity score matching. The mean follow-up duration was 122.7 ± 22.5 months. In multivariate analysis, both mETE and gETE were not associated with recurrence risk before propensity score matching (p = 0.154 and p = 0.072, respectively). After propensity score matching, no significant difference in recurrence rates was observed between the two groups (p = 0.668). DFS of the gETE group did not significantly differ from that of the mETE group (log-rank p = 0.531). This study revealed that both mETE and gETE are not independent risk factors for the risk of recurrence in PTC. Our findings suggest that gETE invading strap muscles only might not be associated with worse oncological outcomes in PTC.

MP47-08 SURGICAL DELAY AFTER BIOPSY AND RISK OF UPSTAGING FOR CLINICAL T1A RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022MP47-08 SURGICAL DELAY AFTER BIOPSY AND RISK OF UPSTAGING FOR CLINICAL T1A RENAL CELL CARCINOMA Leilei Xia, Ruchika Talwar, Raju Chelluri, Daniel Lee, and Thomas Guzzo Leilei XiaLeilei Xia More articles by this author , Ruchika TalwarRuchika Talwar More articles by this author , Raju ChelluriRaju Chelluri More articles by this author , Daniel LeeDaniel Lee More articles by this author , and Thomas GuzzoThomas Guzzo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal mass biopsy (RMB) has been increasingly used as the initial management of small renal masses. However, little is known about whether surgical delay after the positive biopsy results increases the risk of upstaging for small renal cell carcinomas (RCCs). METHODS: Patients with clinical T1aN0M0 RCCs (≤4cm) diagnosed between 2010 and 2016 who underwent RMB and then partial nephrectomy (PN) or radical nephrectomy (RN) were identified from the National Cancer Database (NCDB). Surgical delay time (SDT) was defined as days between RMB and definitive surgical resection (PN or RN). SDT was categorized into five groups: 1-30 days, 31-60 days, 61-90 days, 91-120 days, and 121-180 days. Upstaging to pT3a was used as the primary outcome of interest. Positive surgical margin (PSM) was used as a secondary outcome and analyses were restricted to PN cohort only. RESULTS: A total of 4,340 patients were included and 237 (5.5%) patients had pT3a upstaging. Of the 2,874 patients who had PN, PSM rate was 8.2%. pT3a upstaging and PSM rates stratified by SDT is shown in the Figure. Multivariable logistic regression showed that compared with SDT of 1-30 days, SDT of 31-60 days (odds ratio [OR]=1.04, P= 0.833), 61-90 days (OR=1.17, P= 0.481), and 91-120 days (OR=1.14, P= 0.631) were not associated with increased odds of pT3a upstaging. Patients with SDT of 121-180 days had a higher risk of pT3a upstaging (OR= 1.93, P=0.016). When STD was ≤ 120 days, multivariable logistic regression with SDT considered as a continuous variable showed increased SDT was also not associated with higher odds of pT3a upstaging (OR=1.002, P=0.461). In the PN cohort, multivariable logistic regressions showed no significant associations between SDT and PSM with SDT either considered as a categorical or continuous variable. CONCLUSIONS: In this NCDB study, increased SDT from RMB to definitive surgical resection of cT1aN0M0 RCCs was not associated with worse oncologic outcomes within 120 days after the RMB but patients with SDT > 120 days might have increased risk of upstaging. These findings have significant implications for patient counseling regarding active surveillance, RMB, and definitive surgical resection for small renal masses. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e812 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leilei Xia More articles by this author Ruchika Talwar More articles by this author Raju Chelluri More articles by this author Daniel Lee More articles by this author Thomas Guzzo More articles by this author Expand All Advertisement PDF DownloadLoading ...

Reduced Preoperative Glomerular Filtration Rate Is Associated With Adverse Postoperative Oncological Prognosis in Patients Undergoing Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Retrospective Cohort Study.

ObjectiveTo evaluate the association between perioperative estimated glomerular filtration rate (eGFR) and postoperative oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU),and to evaluate the effect of sex on this association.MethodsThe medical records of patients with UTUC who underwent RNU between January 2012 and December 2017 at our hospital were retrospectively reviewed. Patients were divided into three groups based on preoperative eGFRs: normal eGFR (>60 mL/min/1.73 m2; n = 179), moderately reduced eGFR (45–60 mL/min/1.73 m2; n = 45), and severely reduced eGFR (≤ 45 mL/min/1.73 m2; n = 36). Statistical analyses were performed to evaluate the prognostic impact of preoperative eGFR on prognosis.ResultsPatient mean age was 66.7 ± 9.6 years, and 47.9% were female. Multivariate regression analysis based on Cox proportional risk models and Kaplan-Meier survival rates showed that lower preoperative eGFR was associated with decreased OS, PFS, and CSS. In the adjusted Cox regression model, patients with normal and moderately reduced eGFRs had a decreased hazard for mortality, with adjusted hazard ratios of 0.13 [95% confidence interval (CI): 0.07–0.26] and 0.36 (95% CI: 0.18–0.73), respectively (P < 0.001). The smooth fitting curve suggested a linear relationship between eGFR and prognostic survival. Additionally, sensitivity subgroup analyses verified an inverse relationship between the reduced eGFR and OS. Women had a lower eGFR and worse oncological outcomes than men. A nomogram for OS was developed based on multivariate analysis with a C-index of 0.754 (95% CI: 0.728–0.779).ConclusionPreoperative renal insufficiency is strongly associated with a higher risk of cancer progression and a lower survival probability. It is important to identify preoperative renal insufficiency in patients with UTUC, particularly female patients.

Trends and characteristics of ovarian conservation at hysterectomy for young women with cervical cancer

ObjectiveThe association between early surgical menopause and increased mortality has been well demonstrated. Prior studies have also demonstrated that ovarian conservation is not associated with worse oncologic outcomes in early-stage cervical cancer. This study examined the contemporary trends and characteristics of ovarian conservation at time of hysterectomy in young women with cervical cancer. MethodsThis is a retrospective cohort study examining the National Inpatient Sample. The study population was 4900 women aged ≤50 years with cervical cancer who had hysterectomy-based surgical treatment from 10/2015 to 12/2018. The exposure allocation was the adnexal procedure status (ovarian conservation versus oophorectomy). The main outcome measures were temporal trends of ovarian conservation over time and per patient age. Multivariable binary logistic regression model was fitted to identify independent characteristics associated with ovarian conservation. A classification-tree was constructed by recursive partitioning analysis to examine the utilization patterns of ovarian conservation. ResultsA total of 2,940 (60.0%) women underwent ovarian conservation at hysterectomy. Ovarian conservation rates remained stable until age 37 years, ranging from 82.5% to 77.9% (P = 0.502), after which time the rate sharply and significantly decreased by 7.4% (95% confidence interval 5.4–9.3, P < 0.001) in one-year age increments from 77.9% at age 37 years to 28.7% at age 50 years. The rate of ovarian conservation increased from 54.7% in Q4/2015 to 64.4% in Q4/2018 (P = 0.002). In multivariable analysis, recent surgery remained an independent factor for ovarian conservation (adjusted-odds ratio per year-quarter 1.04, 95% confidence interval 1.03–1.06). A classification-tree model identified 24 unique patterns of ovarian conservation based on patient factor (age, race/ethnicity, primary expected payer, and year of surgery), surgical factor (minimally invasive hysterectomy), and facility factor (hospital bed capacity and region), ranging from <20% to 90% (absolute percentage difference, >80%). ConclusionIncreasing rates of ovarian conservation at the time of hysterectomy in women undergoing surgical management of cervical cancer is encouraging; however, the marked decrease noted in patients in their mid-30s as well as substantial variability in ovarian conservation based on patient, surgical, and hospital factors are striking and warrant further consideration in clinical practice guidelines.

Oncologic outcomes of organ-confined Gleason grade group 4-5 prostate cancer after radical prostatectomy.

Organ-confined prostate cancer (CaP) at radical prostatectomy (RP) is associated with good long-term outcomes. However, information for aggressive Gleason organ-confined CaP is scant. To investigate the impact of Gleason grade group (GG) 4-5 on long-term oncologic outcomes after RP. Within a high-volume center database we identified patients who harbored organ-confined CaP (pT2) at RP between 1992 and 2017. Only patients with negative surgical margins, without lymph node invasion and without neo- and/or adjuvant androgen deprivation therapy and/or adjuvant radiotherapy were included. Patients with GG1 were excluded. Kaplan-Meier analyses and Cox regression models tested the effect of GG4 and GG5 on biochemical recurrence-free (BFS), metastasis-free (MFS), overall survival (OS) and cancer-specific mortality (CSM) free survival. Of 10,855 identified pT2 patients, 0.1% (n=81) and 0.1% (n=114) harbored GG4 and GG5, respectively. At 10-years after RP, BFS, MFS, OS and CSM-free rates were 80.3 vs. 68.6 vs. 55.4% (P<0.001), 96.7 vs. 89.9. vs. 83.4% (P<0.001), 93.2 vs. 78.3 vs. 72.6% (P<0.001) and 99.3 vs. 98.0 vs. 82.7% (P<0.001) for GG2 and GG3 vs. GG4 vs. GG5, respectively. In multivariable Cox regression models, GG5 represented an independent predictor for biochemical recurrence (Hazard ratio [HR] 3.00, P<0.001), metastasis (HR 5.01, P<0.001), death (HR 2.72, P<0.01) and cancer-specific death (HR 30.1, P<0.001). Conversely, GG4 represented an independent predictor for death (HR 2.10, P=0.04) and cancer-specific death (HR 6.09, P=0.01) but not for biochemical recurrence and metastasis. GG4/5 in organ-confined CaP is rare. But its associated with worse oncologic outcomes after RP, namely biochemical recurrence, metastasis, death and cancer-specific death. Patients with organ-confined GG4/5 and negative margins should be closely followed and may be candidates for risk stratification by genomic markers.

Closed-Incision Negative-Pressure Wound Therapy after Resection of Soft-Tissue Tumors Reduces Wound Complications: Results of a Randomized Trial.

Wound healing after resection of large soft-tissue tumors is often impaired by large dead space and fluid collection. Recently, the authors were able to show an association of wound complications with worse oncologic outcome in soft-tissue sarcomas. The aim of the study was to examine the value of closed-incision negative pressure wound therapy on postoperative wound drainage and wound complications after soft-tissue tumor resection. Patients for whom resection is planned of a soft-tissue tumor larger than 10 cm in diameter of the extremities or the trunk were allocated randomly to one of two groups. After wound closure, patients in the study group received closed-incision negative-pressure wound therapy for a duration of 5 days, whereas those in the control group received regular dressings. The amount of drainage fluid, course of wound healing, length of hospital stay, and wound edge perfusion at postoperative day 5 measured by white-light infrared spectroscopy were compared. Sixty patients could be included in the study with even distribution to both study arms, meeting the goal. The postoperative course of wound drainage volume was significantly lower in the study group, and hospital stay was significantly shorter, with 9.1 ± 3.8 days versus 13.9 ± 11.8 days. The occurrence of wound complications was significantly lower in the study group on time-to-event analysis (one versus six). Tissue spectroscopy revealed a significantly higher oxygen saturation increase in the wound edge for the study group versus the control group. Closed-incision negative-pressure wound therapy should be considered for patients undergoing resection of large soft-tissue tumors. Therapeutic, II.

Mapping disadvantage: identifying inequities in functional outcomes for prostate cancer survivors based on geography

BackgroundProstate cancer is the most common internal malignancy in Australian men, and although most patients have good survival outcomes, treatment toxicities can impair function, leading to diminished quality of life for prostate cancer survivors. Socioeconomic disadvantage and geographical remoteness have been shown to be related to worse oncologic outcomes, and it is expected that they would similarly influence functional outcomes in prostate cancer.MethodsUsing data from the Victorian Prostate Cancer Outcomes Registry (n = 10,924), we investigated functional outcomes as measured by the Expanded Prostate Cancer Index Composite-26 (EPIC-26) following prostate cancer treatment, focusing on associations with socioeconomic status and geographical remoteness and controlling for clinicopathologic characteristics. A single composite score was developed from the five separate EPIC-26 domains for use in geo-mapping.ResultsA total of 7690 patients had complete EPIC-26 data, allowing mapping hotspots of poor function using our composite score. These hotspots were observed to relate to areas of socioeconomic disadvantage. Significant heterogeneity in outcomes was seen in urban areas, with hotspots of good and poor function. Both socioeconomic disadvantage and geographical remoteness were found to predict for worse functional outcomes, although only the former is significant on multivariate analysis.ConclusionsGeo-mapping of functional outcomes in prostate cancer has the potential to guide health care service provision and planning. A nuanced policy approach is required so as not to miss disadvantaged patients who live in urban areas. We have demonstrated the potential of geo-mapping to visualise population-level outcomes, potentially allowing targeted interventions to address inequities in quality of care.

Molecular Correlates of Venous Thromboembolism (VTE) in Ovarian Cancer.

Simple SummaryOvarian cancer is the most lethal form of gynecologic cancer. The prognosis is worse for patients with ovarian cancer who also develop a blood clot in their legs or lungs, known as a venous thromboembolism (VTE). Between 10-30% of women with ovarian cancer will develop a VTE but the mechanism behind this high incidence is not well understood. The aim of this study was to assess for the presence of tumor-specific molecular markers of VTE in order to better understand the relationship between ovarian cancer and VTE. We performed a comprehensive analysis assessing the proteomic and genomic profiles of 32 patients with ovarian cancer and identified that there are molecular differences in patients with a VTE compared to those without.Background: The incidence of venous thromboembolism (VTE) in patients with ovarian cancer is higher than most solid tumors, ranging between 10–30%, and a diagnosis of VTE in this patient population is associated with worse oncologic outcomes. The tumor-specific molecular factors that may lead to the development of VTE are not well understood. Objectives: The aim of this study was to identify molecular features present in ovarian tumors of patients with VTE compared to those without. Methods: We performed a multiplatform omics analysis incorporating RNA and DNA sequencing, quantitative proteomics, as well as immune cell profiling of high-grade serous ovarian carcinoma (HGSC) samples from a cohort of 32 patients with or without VTE. Results: Pathway analyses revealed upregulation of both inflammatory and coagulation pathways in the VTE group. While DNA whole-exome sequencing failed to identify significant coding alterations between the groups, the results of an integrated proteomic and RNA sequencing analysis indicated that there is a relationship between VTE and the expression of platelet-derived growth factor subunit B (PDGFB) and extracellular proteins in tumor cells, namely collagens, that are correlated with the formation of thrombosis. Conclusions: In this comprehensive analysis of HGSC tumor tissues from patients with and without VTE, we identified markers unique to the VTE group that could contribute to development of thrombosis. Our findings provide additional insights into the molecular alterations underlying the development of VTE in ovarian cancer patients and invite further investigation into potential predictive biomarkers of VTE in ovarian cancer.

The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma: A Retrospective Cohort Study.

BackgroundWe aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.Materials and MethodsWe retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan–Meier curve with a log-rank test.ResultsA total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan–Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).ConclusionUreter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.

Effect of reinforcement suture on anastomotic healing in rectal and sigmoid tumor resections, single-center experience: a retrospective case-controlled study.

Healing of colorectal anastomosis is burdened with a number of risk factors and the development of leak carries with it higher morbidity and mortality associated not only with worse quality of life but also worse oncological outcomes. The purpose of the study was an evaluation of the effect of reinforcement suture in the healing of stapler rectal anastomosis and risk factors for anastomotic leakage in mid, upper rectal and sigmoid tumors. A total of 357 patients who underwent curative resection for rectal or sigmoid tumor over 5 years were analyzed. Risk factors, baseline demographic and clinical data, and presence of leak were recorded. All statistical analyses were carried out at a significance level of P<0.05. One hundred fifty-one patients met the inclusion criteria for the study. The overall incidence of leak was 2.8% in the group with reinforcement suture and 6.3% in the group without reinforcement suture. Because of the low incidence of leak the results were not statistically significant. Further results also show that none of the monitored parameters (age, weight, body mass index, tumor distance, preoperative radiotherapy, tumor stage, type of surgery) were significant predictors of anastomotic leakage. Although the reinforcement suture is a safe and simple option for anastomosis protection after rectal or sigmoid resections, its statistical significance was not demonstrated in our study.

Assessment of travel distance for hyperthermic intraperitoneal chemotherapy in women with ovarian cancer

Objective (s)To evaluate travel distance in women with advanced or recurrent epithelial ovarian cancer (OC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) and the subsequent impact upon outcomes. MethodsAn IRB-approved single-institution prospective registry was queried for women with OC who underwent HIPEC from 1/1/2009–12/1/2020. Demographic, oncologic, and surgical data were recorded. The patient's home zip code was compared to the institutional zip code to determine travel distance using Google Maps. Patients were divided into three strata for analysis: 1) local: ≤50 miles, 2) regional: 51–99 miles, and 3) distant: ≥100 miles and univariate analysis was performed. ResultsOf 127 women, the median distance travelled was 57.0 miles (IQR: 20.6, 84.6). There were no significant differences in mild (28.3% vs. 26.3 vs. 24.1%), moderate (21.7% vs. 15.8% vs. 17.2%) or severe postoperative complications (11.7% vs. 5.3% vs. 17.2%) (p = 0.75) for local, regional and distant patients, respectively. There was no difference in progression-free survival (17.4 vs. 22.2 vs. 12.8 months, p > 0.05) or overall survival (57.3 vs. 61.6 vs. 29.2 months, p > 0.05) for local, regional or distant patients, respectively. ConclusionsThis study demonstrates that women with OC are willing to travel for HIPEC, with over 50% traveling > 50 miles. Our results suggest that women who travel for HIPEC procedures are not at increased risk for perioperative complications or worse oncologic outcomes than those local to HIPEC centers.

Surgical timing after preoperative chemotherapy is associated with oncologic outcomes in resectable colorectal liver metastases.

Preoperative chemotherapy (POC) is often employed for patients with resectable colorectal liver metastasis (CRLM). The time to resection (TTR) following the end of chemotherapy may impact oncologic outcomes; this phenomenon has not been studied in CRLM. We queried our institutional cancer database for patients with resected CRLM afterPOC from 2003 to 2019. TTR was calculated from date of last cytotoxic chemotherapy. Kaplan-Meier analysis and multivariable Cox proportional hazards modeling were used to analyze recurrence-free survival (RFS) and overall survival (OS). We identified n = 187 patients. One hundred twenty-four (66%) patients had a TTR of <2 months, while 63 (33%) had a TTR of ≥2 months. Median follow-up was 36 months. On Kaplan-Meier analysis, patients with TTR ≥ 2 months had shorter RFS (median 11 vs. 17 months, p = 0.002) and OS (median 44 vs. 62 months, p < 0.001). On multivariable analysis, TTR ≥ 2 months was independently associated with worse RFS (hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.06-2.22, p = 0.02) and OS (HR = 1.75, 95% CI = 1.11-2.77, p = 0.01). TTR ≥ 2 months followingPOCis independently associated with worse oncologic outcomes in patients with resectable CRLM. We therefore recommend consideration for hepatic resection of CRLM within this window whenever feasible.

Short-term Outcomes of Emergent Versus Elective Gastrectomy for Gastric Adenocarcinoma: A National Surgical Quality Improvement Program Study.

Gastric adenocarcinoma is a leading cause of cancer death worldwide and in the United States, and can present emergently with upper GI hemorrhage, obstruction, or perforation. Few large studies have examined how emergency surgery for gastric cancer affects patient outcomes. All patients from National Surgical Quality Improvement Program with gastric adenocarcinoma from 2005 to 2017 were examined retrospectively. Univariate and multivariate analysis of patient factors and perioperative outcomes was performed. P-values < .05 were significant. Of 4663 total patients, 115 had emergency surgery and 4548 had elective surgery. Emergency surgery patients were more likely to be non-white, underweight, higher ASA class, require a preoperative blood transfusion, and were less likely to be functionally independent. Multivariate analysis demonstrates an increased likelihood of unplanned intubation, prolonged ventilation, and deep vein thrombosis (DVT). There are no significant differences in mortality, reoperation, or infection when comparing emergent surgery for gastric cancer and elective surgery; however, there is an increased risk of reintubation, prolonged intubation, and DVT in patients undergoing emergent surgery. Patients requiring emergent surgery have more comorbidities, higher blood transfusion requirements, and worse preoperative functional status, and this study demonstrates that they also have worse perioperative outcomes. Previous studies have shown that long-term oncologic outcomes are worse for patients undergoing urgent surgery, and this study shows that perioperative outcomes are also somewhat worse. Thus, definitive surgery performed on a patient who presents emergently with gastric cancer should be considered but may come at the cost of increased perioperative respiratory complications, DVTs, and worse oncologic outcomes.

BCG efficacy in nonmuscle-invasive bladder cancer after prior radiation treatment for prostate cancer.

482 Background: Prostate radiotherapy is associated with worse oncologic outcomes in patients with bladder cancer. This is thought to be secondary to microvascular damage resulting in propagation of inflammation. There is sparse data on the effect of prior radiotherapy on the efficacy of intravesical Bacillus Calmette-Guerin (BCG) in patients with non-muscle invasive bladder cancer (NMIBC). We sought to evaluate BCG response and outcomes in NMIBC patients who have previously undergone prostate radiotherapy compared to patients with no prior history of pelvic radiotherapy. Methods: This is a retrospective cohort study that includes patients who received intravesical BCG for NMIBC at our institution from 2001 to 2019. Data were collected on patient and pathologic characteristics. Patients were stratified into three cohorts: prior radiotherapy (RT), radical prostatectomy (RP), and no prostate cancer (No PCa). Wilcoxon rank sum test and Chi-squared test were used for comparison between groups. The primary endpoints included recurrence at one-year, progression to MIBC and progression to metastatic disease. Results: In 199 total patients who underwent BCG for NMIBC, 23 had a prior history of radiotherapy treatment for prostate cancer, while 17 underwent prior radical prostatectomy. Overall, 41.2% of patients had recurrence at one year. There was no difference in recurrence at one year between the cohorts: 42.8% No PCa, 29.4% RP and 39.1% RT; p = 0.56. There was also no difference in progression to MIBC (6.9% No PCA, 0% RP, and 8.7% RT) or progression to metastatic disease (6.9% No PCA, 5.9% RP and 4.3% RT) with p = 0.50 and 0.89 respectively. Conclusions: The efficacy of intravesical BCG does not appear to be modified by prior radiation treatment for prostate cancer in patients with NMIBC.[Table: see text]

Impact of tumour stage on the surgical outcomes of scapular chondrosarcoma.

Chondrosarcomas are common primary bone tumours in adults, often affecting the flat bones. Oncologic outcomes are often tied to tumour grade; however, grade is only a factor in the aggressiveness of a tumor. Extracompartmental extension, or tumor stage, has been found to be predictive of a poor outcome in other flat bone chondrosarcomas; however, this relationship has not been identified in the scapula. The purpose of the current study was to analyze the impact of tumour stage on the outcome of patients with scapular chondrosarcoma. Thirty-nine patients (26 males:13 females) with a mean age of 46 ± 17 undergoing surgical resection of a scapular chondrosarcomas were reviewed. Most patients had grade 1 (n = 24) tumors, with 26 (67%) having extracompartmental extension. The mean follow-up was eightyears. The tenyear disease-specific survival was 77%. High-grade tumours (HR 18.15, p < 0.01) were associated with death due to disease. The tenyear local recurrence- and metastatic-free survival were 77% and 74%. Positive surgical margins (HR 8.85, p < 0.01) were associated with local recurrence, and local recurrence was associated with metastatic disease (HR3.37, p = 0.04). All disease recurrences and death due to disease occurred in patients with extracompartmental extension (p < 0.05). Extracompartmental extension was associated with a worse oncologic outcome in patients with scapular chondrosarcomas. Positive margins were associated with local recurrence, which was associated with metastatic disease; wide local excision with negative margins should be a goal for all patients, regardless of tumour grade.