The association of anxiety and depression with perioperative and oncologic outcomes among patients with clear cell renal cell carcinoma undergoing nephrectomy.

OBJECTIVES: Anxiety and depression have been associated with inferior overall survival for several malignancies, including metastatic renal cell carcinoma (RCC). However, there is minimal data evaluating this association for localized RCC. We evaluated the association of anxiety or depression with survival in patients with surgically treated localized clear cell RCC (ccRCC). PATIENTS AND METHODS: We reviewed our institutional nephrectomy registry of 1,990 adults who underwent radical or partial nephrectomy for unilateral, sporadic, nonmetastatic ccRCC between 1995 and 2011. Baseline anxiety and depression were identified using ICD-9 codes. Associations of anxiety or depression with 30-day complications and oncologic outcomes were evaluated using Cox proportional hazards models as well as adjustment for propensity score (PS) quintile and re-weighting by stabilized inverse probability weights. RESULTS: A total of 197 (10%) patients were identified with a diagnosis of anxiety or depression. Median follow-up among survivors was 10.0 (IQR 7.3-13.6) years, during which time 864 patients died, including 363 from RCC. After PS adjustment, clinical and pathologic features were well balanced between groups. Patients with anxiety or depression had increased overall 30-day complications compared to those without (17% vs. 11%, P = 0.011). No significant differences were noted in time to local ipsilateral recurrence (P = 0.54), distant metastases (P = 0.96), or death from RCC (P = 0.42) between patients with vs. without anxiety or depression, while patients with anxiety or depression trended toward worse overall survival (hazard ratio 1.29, 95%CI 0.98-1.69, P = 0.065). CONCLUSIONS: Neither anxiety nor depression were significantly associated with oncologic outcomes among patients who underwent surgery for localized ccRCC. The trend toward worse overall survival among patients with anxiety or depression warrants further investigation.

Single-dose perioperative mitomycin-C versus thiotepa for low-grade noninvasive bladder cancer.

INTRODUCTION: Mitomycin-C (MMC) and thiotepa are intravesical agents effective in reducing the recurrence of low-grade noninvasive bladder cancer when instilled perioperatively. No studies have compared these agents as a single-dose perioperative instillation. This study tests whether there is a difference in recurrence-free survival in patients with low-grade noninvasive bladder cancer who received intravesical MMC versus thiotepa. MATERIALS AND METHODS: A retrospective review was performed of patients who underwent cystoscopic excision of a bladder mass identified as a small, low-grade, treatment-naïve, noninvasive, wild-type urothelial carcinoma of the bladder and who received either intravesical thiotepa (30 mg/15 cc) or MMC (40 mg/20 cc) between January 1, 2002, and January 1, 2016. Data were collected for demographic characteristics, comorbid conditions, operative information, surveillance, and recurrence. The primary outcome was disease-free survival. Cohorts were compared via the doubly robust estimation approach, which used logistic regression to model the probability of recurrence. RESULTS: Of 154 total patients, 84 received intravesical MMC; 70, thiotepa. No statistical differences were shown between groups for age, sex, race, body mass index, smoking status, or baseline comorbid conditions; mass size, tumor multifocality, or tumor grade; and unadjusted recurrence rates (MMC, 36.0%; thiotepa, 46.0%; p = .33) at similar median follow up (MMC, 20.4; thiotepa, 22.8 months; p = .46). The robust logistic regression analysis yielded no differences in recurrence rates between MMC and thiotepa (OR, 0.65 [95% CI, 0.33-1.31]; p = .23). No episodes of myelosuppression or frozen pelvis were identified. CONCLUSIONS: As single-dose perioperative agents, both thiotepa and MMC were associated with similar recurrence-free survival rates.