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1.
Urology ; 182: 175-180, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37730166

ABSTRACT

OBJECTIVE: To explore the effect of Agent Orange (AO) exposure on bladder cancer (BCa) outcomes in patients receiving Bacillus Calmette-Guérin (BCG) for non-muscle invasive BCa (NMIBC). METHODS: We retrospectively examined the association between AO exposure in patients with NMIBC in national veterans affairs databases who were being treated with BCG. Patients were diagnosed with NMIBC from 2000 to 2010 with follow-up through 2018. Clinical, pathological, and demographic variables were compared by AO exposure. Associations of AO exposure with recurrence, progression, and cancer-specific survival were performed using Cox proportional hazard models after inverse propensity score weighting and competing risks adjustments. We also assessed the association of AO exposure on grade and stage via multivariable logistic regression models. RESULTS: A total of 7651 patients were identified of which 753 (9.8%) were exposed to AO. The median follow-up time was 130 months. The AO-exposed patients were younger (age 61 vs 71 years, P <.001), but had similar Charlson comorbidity scores and stage/grade distribution as the non-AO exposed patients. AO exposure was not associated with higher grade or stage. In our Cox multivariable analyses, AO exposure was not associated with worse recurrence (hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.72-1.10, P = .29), progression (HR 1.08, 95% CI 0.86-1.36, P = .51), or cancer-specific survival (HR 1.31, 95% CI 0.92-1.87, P = .13). CONCLUSION: AO exposure was not associated with worse oncologic outcomes in patients receiving BCG for NMIBC. While this is reassuring, additional research is needed in other patient populations and disease states to determine if the effect is consistent.


Subject(s)
Agent Orange , Non-Muscle Invasive Bladder Neoplasms , Urinary Bladder Neoplasms , Humans , Middle Aged , Adjuvants, Immunologic/therapeutic use , Administration, Intravesical , Agent Orange/therapeutic use , BCG Vaccine/adverse effects , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local/drug therapy , Non-Muscle Invasive Bladder Neoplasms/complications , Non-Muscle Invasive Bladder Neoplasms/therapy , Retrospective Studies , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/therapy , Aged
3.
Abdom Radiol (NY) ; 47(6): 2230-2237, 2022 06.
Article in English | MEDLINE | ID: mdl-35238963

ABSTRACT

OBJECTIVE: To compare image quality and radiation dose between single-bolus 2-phase and split-bolus 1-phase CT Urography (CTU) performed immediately after microwave ablation (MWA) of clinically localized T1 (cT1) RCC. METHODS: Forty-two consecutive patients (30 M, mean age 67.5 ± 9.0) with cT1 RCC were treated with MWA from 7/2013 to 12/2013 at two academic quaternary-care institutions. Renal parenchymal enhancement, collecting system opacification and distention and size-specific dose estimate (SSDE) were quantified and image quality subjectively assessed on single-bolus 2-phase versus split-bolus 1-phase CTU. Kruskal-Wallis and Pearson's Chi-squared tests were performed to assess differences in continuous and categorical variables, respectively. Two-sample T test with equal variances was used to determine differences in quantitative and qualitative image data. RESULTS: Median tumor diameter was larger [2.9 cm (IQR 1.7-5.3) vs 3.6 cm (IQR 1.7-5.7), p = 0.01] in the split-bolus cohort. Mean abdominal girth (p = 0.20) was similar. Number of antennas used and unenhanced CTs obtained before and during MWA were similar (p = 0.11-0.32). Renal pelvis opacification (2.5 vs 3.5, p < 0.001) and distention (4 mm vs 8 mm, p < 0.001) were improved and renal enhancement (Right: 127 HU vs 177 HU, p = 0.001; Left: 124 HU vs 185 HU, p < 0.001) was higher for the split-bolus CTU. Image quality was superior for split-bolus CTU (3.2 vs 4.0, p = 0.004). Mean SSDE for the split-bolus CTU was significantly lower [163.9 mGy (SD ± 73.9) vs 36.3 mGy (SD ± 7.7), p < 0.001]. CONCLUSION: Split-bolus CTU immediately after MWA of cT1 RCC offers higher image quality, improved opacification/distention of the collecting system and renal parenchymal enhancement at a lower radiation dose.


Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Radiation Exposure , Aged , Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/surgery , Contrast Media , Female , Humans , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/surgery , Male , Microwaves/therapeutic use , Middle Aged , Tomography, X-Ray Computed/methods , Urography/methods
4.
Mol Oncol ; 15(9): 2330-2344, 2021 09.
Article in English | MEDLINE | ID: mdl-33604999

ABSTRACT

Although therapeutic options for patients with advanced renal cell carcinoma (RCC) have increased in the past decade, no biomarkers are yet available for patient stratification or evaluation of therapy resistance. Given the dynamic and heterogeneous nature of clear cell RCC (ccRCC), tumor biopsies provide limited clinical utility, but liquid biopsies could overcome these limitations. Prior liquid biopsy approaches have lacked clinically relevant detection rates for patients with ccRCC. This study employed ccRCC-specific markers, CAIX and CAXII, to identify circulating tumor cells (CTC) from patients with metastatic ccRCC. Distinct subtypes of ccRCC CTCs were evaluated for PD-L1 and HLA-I expression and correlated with patient response to therapy. CTC enumeration and expression of PD-L1 and HLA-I correlated with disease progression and treatment response, respectively. Longitudinal evaluation of a subset of patients demonstrated potential for CTC enumeration to serve as a pharmacodynamic biomarker. Further evaluation of phenotypic heterogeneity among CTCs is needed to better understand the clinical utility of this new biomarker.


Subject(s)
Carcinoma, Renal Cell/diagnosis , Kidney Neoplasms/diagnosis , Neoplastic Cells, Circulating , Adult , Aged , B7-H1 Antigen/blood , Biomarkers, Tumor/blood , Carcinoma, Renal Cell/blood , Carcinoma, Renal Cell/pathology , Cell Line, Tumor , Female , Histocompatibility Antigens Class I/blood , Humans , Kidney Neoplasms/blood , Kidney Neoplasms/pathology , Liquid Biopsy , Male , Middle Aged , Neoplasm Metastasis
5.
Curr Urol Rep ; 18(7): 48, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28589399

ABSTRACT

PURPOSE OF REVIEW: This manuscript reviews contemporary literature regarding prostate cancer active surveillance (AS) protocols as well as other tools that may guide the management of biopsy frequency and assess the possibility of progression in low-risk prostate cancer. RECENT FINDINGS: There is no consensus regarding the timing of surveillance biopsies; however, an immediate repeat biopsy within 12 months of diagnosis for patients considering AS confirms patients who have favorable risk disease yet also identifies patients who were undersampled initially. Studies regarding multiparametric MRI, nomograms, and biomarkers show promise in risk stratifying and counseling patients during AS. Further studies are needed to determine if these supplemental tests can decrease the frequency of surveillance biopsies. An immediate re-biopsy can help to reduce the risk of missing clinically significant disease. Other clinical tools, including mpMRI, exist that can be used as an adjunct to counsel patients and guide a personalized discussion regarding the frequency of surveillance biopsies.


Subject(s)
Biopsy, Large-Core Needle/methods , Prostatic Neoplasms/pathology , Watchful Waiting/methods , Disease Progression , Humans , Magnetic Resonance Imaging , Male , Nomograms , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/therapy , Time Factors
6.
Abdom Radiol (NY) ; 41(4): 617-9, 2016 04.
Article in English | MEDLINE | ID: mdl-27112777

ABSTRACT

Contemporary approaches to cancer therapy have moved away from a one-size-fits-all model. Precision treatments are based on patients and their individual tumor characteristics. In general, incidental renal masses fall into three categories: aggressive cancers, indolent cancers, and benign tumors. Treatments may include surgery, thermal ablation, or observation. Choosing the best treatment based solely on radiologic information is uninformed and unnecessary, and may lead to overtreatment of benign tumors or inappropriate treatment of aggressive tumors. Percutaneous biopsy is a safe and effective tool that provides prognostic information about unknown masses to guide treatment decision making. The first step for improving personalized treatments for small renal masses is clear: increase utilization of pretreatment renal mass biopsy.


Subject(s)
Carcinoma, Renal Cell/pathology , Image-Guided Biopsy , Kidney Neoplasms/pathology , Ablation Techniques , Carcinoma, Renal Cell/surgery , Diagnosis, Differential , Humans , Incidental Findings , Kidney Neoplasms/surgery
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