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1.
Minerva Urol Nefrol ; 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31487976

RESUMO

BACKGROUND: Local tumor ablation (LTA) and non-interventional management (NIM) emerged as alternative management options for T1a renal cell carcinoma (RCC). We investigated trends and cancer-specific mortality (CSM) after LTA and NIM, compared to partial nephrectomy (PN). METHODS: Within the Surveillance, Epidemiology, and End Results database (2004-2015), T1a RCC patients treated with PN, LTA or NIM were identified. Estimated annual proportion change methodology (EAPC), 1:1 ratio propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (CRR) were used to compare LTA vs PN and NIM vs PN. Subgroup analyses focused on patients <65 and ≥65years. RESULTS: Overall 4,524 patients underwent LTA vs 1,654 NIM vs 25,435 PN. Annuals rates increased for NIM (EAPC: +3.3%, p<0.001), but not for either LTA or PN. After PS-matching in multivariable CCR, LTA (HR 1.9, p<0.001) and NIM (HR 3.0, p<0.001) showed worse 5-year CSM, relative to PN. In subgroup analyses, LTA showed no CSM disadvantage relative to PN in younger patients (HR 2.0, p=0.07). In older patients 1.64-fold CSM increase was recorded. Conversely, NIM younger (HR 3.1, p=0.001) and older (HR 3.1, p<0.001) patients exhibited higher CSM relative to PN. CONCLUSIONS: In T1a RCC patients, NIM rates showed a modest but significant increase, while LTA and PN rates remained stable. In survival analyses, LTA exhibited higher CSM rates only for elderly patients. Conversely, NIM exhibited higher CSM rates in both younger and older patients.

2.
Int Urol Nephrol ; 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31468289

RESUMO

PURPOSE: We tested the effect of marital status on cytoreductive nephrectomy, metastasectomy, and systemic therapy rates, as well as on cancer-specific mortality (CSM) in patients with metastatic clear cell renal carcinoma (mccRCC). METHODS: Within the Surveillance, Epidemiology and End Results database (2004-2015), we identified 6975 patients (4806 men and 2169 women) with metastatic clear cell renal carcinoma. Temporal trend analyses, logistic regression models, cumulative incidence plots, and competing-risk regression models were used. RESULTS: Overall, 1450 men and 1018 women were unmarried (30.2% and 47.0%, respectively). In men, unmarried status was an independent predictor of lower cytoreductive nephrectomy rate (OR: 0.54), lower metastasectomy rate (OR: 0.70), and lower systemic therapy rate (OR: 0.70). Conversely, in women, unmarried status was an independent predictor of lower cytoreductive nephrectomy rate (OR: 0.63) and of lower systemic therapy rate (OR: 0.80), but not of lower metastasectomy rate (OR: 0.83; p = 0.12). In multivariable competing-risk regression analyses, unmarried status was an independent predictor of higher CSM in men (HR: 1.15), but not in women (HR 0.97, p = 0.6). CONCLUSIONS: Unmarried men are at higher risk of not benefiting of cytoreductive nephrectomy, metastasectomy, or systemic therapy than their married counterparts. Unmarried women are at higher risk of not benefiting of cytoreductive nephrectomy or systemic therapy. These gender-related differences cumulate in higher CSM in unmarried men, but not in unmarried women.

3.
World J Urol ; 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31463562

RESUMO

BACKGROUND: The International Germ Cell Consensus Classification (IGCCC) is the recommended stratification scheme for newly diagnosed metastatic seminoma (mSGCT) and non-seminoma germ cell tumor (mNSGCT) patients. However, a contemporary North-American population-based validation has never been completed and represented our focus. MATERIALS AND METHODS: We identified mSGCT and mNSGCT patients within the SEER database (2004-2015). The IGCCC criteria were used for stratification into prognostic groups. Kaplan-Meier (KM) derived actuarial 5-year overall survival (OS) rates were calculated. In addition, cumulative incidence plots tested cancer-specific (CSM) and other-cause mortality (OCM) rates. RESULTS: Of 321 mSGCT patients, 190 (59.2%) and 131 (40.8%), respectively, fulfilled good and intermediate prognosis criteria. Of 803 mNSGCT patients, 209 (26.1%), 100 (12.4%), and 494 (61.5%), respectively, fulfilled good, intermediate, and poor prognosis criteria. In mSGCT patients, actuarial KM derived 5-year OS was 87% and 78% for, respectively, good and intermediate prognosis groups (p = 0.02). In cumulative incidence analyses, statistically significant differences were recorded for CSM but not for OCM between good versus intermediate prognosis groups. In mNSGCT patients, actuarial KM derived 5-year OS was 89%, 75% and 60% for, respectively, good, intermediate, and poor prognosis groups (p < 0.001). In cumulative incidence analyses, statistically significant differences were recorded for both CSM and OCM between good, intermediate, and poor prognosis groups. CONCLUSIONS: Our findings represent the first population-based validation of the IGCCC in contemporary North-American mSGCT and mNSGCT patients. The recorded OM rates closely replicate those of the original publication, except for better survival of poor prognosis mNSGCT patients.

4.
Anticancer Res ; 39(8): 4357-4361, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366530

RESUMO

AIM: This study analyzed the effect of metastasectomy on overall mortality (OM) and perioperative outcomes in patients with metastatic renal cell carcinoma (mRCC) treated exclusively with targeted therapy. MATERIALS AND METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database (2006-2015), Kaplan-Meier analyses and multivariable Cox regression models tested for OM. Using the National Inpatient Sample (NIS) database (2006-2015), complication rates and in-hospital mortality were evaluated. RESULTS: Within the SEER database, 437 (12.2%) out of 3,654 patients underwent metastasectomy. Metastasectomy was associated with lower OM risk (median survival 11 vs. 9 months, hazard ratio=0.83; p=0.002). Within the NIS database, 351 such patients were identified. Complications and in-hospital mortality were 55.0% and 4.6%, respectively. CONCLUSION: Metastasectomy in patients with mRCC treated exclusively with targeted therapy is associated with lower OM risk, however, based on short duration of expected survival. Complications and in-hospital mortality rates are not negligible.


Assuntos
Carcinoma de Células Renais/cirurgia , Metastasectomia/efeitos adversos , Terapia de Alvo Molecular , Metástase Neoplásica , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Nefrectomia , Modelos de Riscos Proporcionais
5.
Artigo em Inglês | MEDLINE | ID: mdl-31416752

RESUMO

BACKGROUND: We examined the changes over time in other-cause mortality (OCM) rates in patients with clinically localized prostate cancer (PCa) as an indicator of patient selection. PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (1987-2011), we identified patients with PCa treated with either radical prostatectomy (RP) (n = 230,969; 62.8%) or external beam radiation therapy (EBRT) (n = 136,915; 37.2%). Temporal trends and multivariable Cox regression analyses assessed OCM at 5 years using stratification according to year of diagnosis (1987-1991 vs. 1992-1996 vs. 1997-2001 vs. 2002-2006 vs. 2007-2011), age group, and ethnicity. RESULTS: In patients who had undergone RP, the OCM rates at 5 years of follow-up decreased over time from 7.9% to 2.4% (slope, -0.25%/year) versus from 15.2% to 9.9% after EBRT (slope, -0.29%/year). The greatest decrease in 5-year OCM rates over time was recorded in patients ≥ 75 years (16.0%-12.0%; slope, -0.25%/year), followed by younger age categories (70-74 years, -0.21%/year; 65-69 years, -0.17%/year; 60-64 years, -0.10%/year; < 60 years, -0.07%/year), as well as in African-American men (11.0%-5.1%; slope, -0.32%/year), followed by Caucasian (7.6%-3.4%; slope, -0.21%/year) and Hispanic men (7.0%-3.1%; slope, -0.20%/year; all P < .001), as corroborated in multivariable Cox regression models. CONCLUSIONS: OCM rates were highest in oldest individuals and in African-American men. In both groups, an important 5-year OCM reduction over the 25-year study span was recorded. Nonetheless, these 2 patient groups may still represent the ideal target for better patient selection based on OCM considerations, because their most recent OCM rates exceeded those of, respectively, younger and Caucasian patients.

6.
Eur Urol Oncol ; 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-31411975

RESUMO

BACKGROUND: Prostate cancer (PCa) staging is crucial in clinical decision making and treatment assignment. OBJECTIVE: To develop a predictive tool that is capable of predicting the probability of metastases at initial PCa diagnosis. DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology, and End Results database (2010-2014), we identified patients with newly diagnosed PCa and available clinical tumor stage, prostatic-specific antigen value (PSA), and Gleason grade group (GGG), and with or without metastases. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We relied on PSA, clinical tumor stages, and GGG to discriminate between M1 and M0 patients. Patients were randomly divided according to the registry of origin between development (n=102469) and validation (n=98755) cohorts. Logistic regression modeling coefficients were used to devise a lookup table to discriminate between M0 and M1 stages. Receiver operating characteristic-derived area under the curve was tested for model accuracy, within the validation cohort. A total of 2000 bootstrap resamples were applied to 95% confidence intervals (CIs). Decision curve analysis (DCA) and calibration plots were used to test the performance of the lookup table. RESULTS AND LIMITATIONS: Of 201224 patients, 3.5% harbored metastatic PCa (mPCa). PSA >40ng/ml, GGG5, and GGG4, in that order, represented the strongest predictors of mPCa. Overall, PSA, clinical tumor stage, and GGG were 94.3% (95% CI: 94.2-94.3%) accurate in predicting the probability of mPCa, in the external validation cohort. Up to 39.4% probability of mPCa, the model demonstrated accurate predictions in the calibration plot. In DCA, a net benefit was recorded up to a threshold probability of approximately 54%. CONCLUSIONS: The proposed lookup table for the prediction of the probability of mPCa may represent a useful clinical tool based on its high accuracy, excellent calibration, and robust nature of predictions. PATIENT SUMMARY: Our study provides a highly accurate lookup table for the prediction of the probability of metastatic prostate cancer patients. This clinical tool can be useful in staging decisions.

7.
Eur Urol Oncol ; 2(5): 541-548, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31411992

RESUMO

BACKGROUND: Radical prostatectomy (RP) may occasionally be performed in patients with metastatic prostate cancer (mPCa). However, the role of lymph node dissection (LND) for such cases is unknown. OBJECTIVE: To test the contemporary effect of LND at RP on cancer-specific mortality (CSM), overall mortality (OM), and early postoperative outcomes compared with no LND in mPCa patients. DESIGN, SETTING, AND PARTICIPANTS: We identified surgically treated mPCa patients within the Surveillance, Epidemiology, and End Result (SEER) database (2004-2014) and the Nationwide Inpatient Sample (NIS) database (2004-2013). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In the SEER-based analyses, Kaplan-Meier plots and multivariable Cox regression models (CRMs) were used after inverse probability of treatment weighting (IPTW) adjustment. In the NIS-based analyses, multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used after IPTW and adjustment for clustering. RESULTS AND LIMITATIONS: Within the SEER database, 199 (60.3%) of 330 mPCa patients treated with RP underwent LND. After IPTW, multivariable CRMs showed lower CSM (hazard ratio [HR]: 0.52, confidence interval [CI]: 0.31-0.87; p=0.01) and OM (HR: 0.38, CI: 0.24-0.60; p<0.001) rates after LND at RP in patients. Within the NIS database, 1186 (71.3%) of 1663 mPCa patients treated with RP underwent LND. After IPTW, MLR models showed higher rates of transfusions (odds ratio [OR]: 1.54, CI: 1.03-2.30; p=0.03) after LND versus no LND. No difference was observed in overall complications (OR: 1.04, CI: 0.77-1.41, p=0.7). In MPR, LND at RP did not affect the length of stay (OR: 1.05, CI: 0.97-1.14, p=0.2). CONCLUSIONS: We are the first to demonstrate that LND at RP is associated with lower CSM and OM in the setting of mPCa, but not with higher rates of perioperative complications. PATIENT SUMMARY: Lymph node dissection might further improve the survival benefit of radical prostatectomy in metastatic prostate cancer patients. In consequence, lymph node dissection at radical prostatectomy should strongly be considered in the metastatic setting.

8.
Can Urol Assoc J ; 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-31364976

RESUMO

INTRODUCTION: Current prostate cancer (PC) guidelines primarily focus on localized or metastatic PC. A multidisciplinary genitourinary oncology panel determined that additional guidance focusing on monitoring and management of biochemical recurrence (BCR) following radical therapy and non-metastatic castration-resistant prostate cancer (nmCRPC) was warranted. METHODS: The most up-to-date national and international guidelines, consensus statements, and emerging phase 3 trials were identified and used to inform development of algorithms by a multidisciplinary genitourinary oncology panel outlining optimal monitoring and treatment for patients with non-metastatic PC. RESULTS: A total of eight major national and international guidelines/consensus statements published since 2015 and three phase 3 trials were identified. Working group discussions among the multidisciplinary genitourinary oncology panel led to the development of two algorithms: the first addressing management of patients with BCR following radical therapy (post-BCR), and the second addressing management of nmCRPC. The post-BCR algorithm suggests consideration of early salvage treatment in select patients, and provides guidance regarding observation vs. intermittent or continuous androgen-deprivation therapy (ADT). The nmCRPC algorithm suggests continued ADT and monitoring for all patients, with consideration of treatment with apalutamide or enzalutamide for patients with high-risk disease (prostate-specific antigen [PSA] doubling time of ≤10 months). CONCLUSIONS: Two treatment algorithms have been developed to guide the management of non-metastatic PC, and should be considered in the context of local guidelines and practice patterns.

9.
Artigo em Inglês | MEDLINE | ID: mdl-31378580

RESUMO

BACKGROUND: We comprehensively tested contemporary incidence and mortality rates in patients with germ cell tumor of the testis (GCTT). MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2004-2015), statistical analyses included estimated annual percentage changes, multivariable logistic regression (MLR) models, Kaplan-Meier curves, and multivariable Cox regression (MCR) models. RESULTS: Of 13,114 GCTT patients, 7954 (60.6%) harbored seminoma germ cell tumors of the testis (SGCTT) and 5160 (39.4%) non-SGCTT (NSGCTT). Relative to SGCTT, NSGCTT patients harbored more advanced stage (for stage III 824 [16.0%] vs. 279 patients [3.5%]; P < .001). In MLR, higher rates of stage II/III affected those with never-married status (odds ratio [OR], 1.6; P < .001) and African American ethnicity (OR, 1.5; P = .005) for SGCTT and never-married (OR, 1.3; P = .002) and Hispanic ethnicity (OR, 1.3; P < .001) for NSGCTT. Significant differences in 5-year cancer-specific mortality (CSM) distinguished SGCTT (stage I: 0.4; stage II: 3.4; stage III: 11.4%; P < .001) from NSGCTT (stage I: 1.6; stage II: 2.5; stage III: 22.2%; P < .001). In MCR, unmarried status independently predicted higher CSM for SGCTT (hazard ratio [HR], 2.1; P = .007) and NSGCTT (HR, 1.9; P < .001). CONCLUSION: Stage I and stage III NSGCTT survival is worse, than for SGCTT. Never-married, Hispanic, and African American individuals are at higher risk of more advanced stage and/or CSM in SGCTT and NSGCTT.

10.
Artigo em Inglês | MEDLINE | ID: mdl-31375352

RESUMO

INTRODUCTION: Cytoreductive radical prostatectomy (CRP) may offer a survival advantage, according to several retrospective analyses. However, no direct comparisons are available regarding the type of surgical approach (open vs. robotic) in the metastatic setting. To address intraoperative and postoperative complications of robotically assisted CRP relative to open CRP in patients with metastatic prostate cancer. PATIENTS AND METHODS: Within the National Inpatient Sample database (2008-2013), we identified patients with metastatic prostate cancer who underwent robotically assisted versus open CRP. Multivariable logistic regression, multivariable Poisson regression models, and linear regression models were used. RESULTS: Of 874 patients who underwent CRP, 412 (47.1%) versus 462 (52.9%) underwent open versus robotically assisted CRP, respectively. Between 2008 and 2013, robotically assisted CRP rates increased from 7.6% to 50.0% (P = .5). In multivariable logistic regression models, robotically assisted CRP resulted in lower rates of overall (odds ratio [OR], 0.42; P < .001), miscellaneous medical (OR, 0.47; P = .02), and miscellaneous surgical complications (OR, 0.40; P = .04), as well as in lower rates of blood transfusions (OR, 0.19; P < .001). In multivariable Poisson regression models, robotically assisted CRP was associated with shorter stay (OR, 0.72; P < .001) and higher total hospital charges ($2483 more for each robotic surgery; P < .001). Similar results were recorded after adjustment for clustering. CONCLUSION: The intraoperative and postoperative complications associated with robotically assisted CRP are lower than those of open CRP. Similarly, robotically assisted CRP is associated with shorter stay. Conversely, an increase in total hospital charges is associated with robotically assisted CRP. Nonetheless, the complication profile of robotically assisted CRP validates its safety and feasibility.

11.
J Geriatr Oncol ; 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257163

RESUMO

OBJECTIVES: Historical data showed worse perioperative outcomes after cytoreductive nephrectomy (CN) in older patients. Additionally, the CARMENA trial questioned the survival benefit of cytoreductive CN. We reassessed complication, failure to rescue (FTR) and mortality rates after CN in a contemporary cohort of older patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS: From National Inpatient Sample (NIS) database (2008-2015), mRCC patients treated with CN were abstracted. Univariable and multivariable logistic regression models tested for the relationship between age (≤55 vs. 56-70 vs ≥71 years), Charlson Comorbidity Index (CCI) and modified Frailty Index (mFI) categories and complications, FTR and in-hospital mortality. All models were clustered, weighted and adjusted for all available patient and hospital characteristics. RESULTS: Of 3644 mRCC patients treated with CN, 924 (25.4%) were ≥ 71 years old, 435 (11.9%) had CCI ≥ 2 and 749 (20.6%) were frail. In multivariable logistic regression models, age ≥ 71 (odds ratio [OR] 1.4, p < .001), CCI ≥ 2 (OR 1.88, p < .001) and frail status (OR 1.91, p < .001) were independent predictors of overall complications. Age ≥ 71 was also an independent predictor of FTR (OR 2.27, p = .04), but not of in-hospital mortality. Both CCI and mFI were not significantly associated with either FTR or in-hospital mortality. CONCLUSION: Older patients with mRCC are more likely to experience higher rates of overall complications, FTR and in-hospital mortality following CN. These results highlight the importance of rigorous selection criteria for older surgical candidates. Moreover, timely recognition and rapid response to complications are particularly critical in this population.

12.
PLoS Med ; 16(7): e1002847, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31265453

RESUMO

BACKGROUND: The identification of patients with high-risk prostate cancer (PC) is a major challenge for clinicians, and the improvement of current prognostic parameters is an unmet clinical need. We and others have identified an association between the nuclear localization of NF-κB p65 and biochemical recurrence (BCR) in PC in small and/or single-centre cohorts of patients. METHODS AND FINDINGS: In this study, we accessed 2 different multi-centre tissue microarrays (TMAs) representing cohorts of patients (Test-TMA and Validation-TMA series) of the Canadian Prostate Cancer Biomarker Network (CPCBN) to validate the association between p65 nuclear frequency and PC outcomes. Immunohistochemical staining of p65 was performed on the Test-TMA and Validation-TMA series, which include PC tissues from patients treated by first-line radical prostatectomy (n = 250 and n = 1,262, respectively). Two independent observers evaluated the p65 nuclear frequency in digital images of cancer tissue and benign adjacent gland tissue. Kaplan-Meier curves coupled with a log-rank test and univariate and multivariate Cox regression models were used for statistical analyses of continuous values and dichotomized data (cutoff of 3%). Multivariate analysis of the Validation-TMA cohort showed that p65 nuclear frequency in cancer cells was an independent predictor of BCR using continuous (hazard ratio [HR] 1.02 [95% CI 1.00-1.03], p = 0.004) and dichotomized data (HR 1.33 [95% CI 1.09-1.62], p = 0.005). Using a cutoff of 3%, we found that this biomarker was also associated with the development of bone metastases (HR 1.82 [95% CI 1.05-3.16], p = 0.033) and PC-specific mortality (HR 2.63 [95% CI 1.30-5.31], p = 0.004), independent of clinical parameters. BCR-free survival, bone-metastasis-free survival, and PC-specific survival were shorter for patients with higher p65 nuclear frequency (p < 0.005). As the small cores on TMAs are a limitation of the study, a backward validation of whole PC tissue section will be necessary for the implementation of p65 nuclear frequency as a PC biomarker in the clinical workflow. CONCLUSIONS: We report the first study using the pan-Canadian multi-centre cohorts of CPCBN and validate the association between increased frequency of nuclear p65 frequency and a risk of disease progression.

13.
Urol Oncol ; 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31296422

RESUMO

OBJECTIVES: We studied the effect of conditional survival on 5-year cancer-specific mortality (CSM) probability in a contemporary North-American population-based nonmetastatic urothelial carcinoma of urinary bladder cohort treated with radical cystectomy. METHODS AND MATERIALS: Within the SEER database (2004-2015), we identified pTa/pTis/pT1N0 high grade, pT2 to pT4N0 and pTanyN1-3 patients treated with radical cystectomy for nonmetastatic urothelial carcinoma of urinary bladder. Conditional 5-year CSM-free estimates were assessed after event-free follow-up duration. Multivariable Cox regression models predicted CSM according to event-free follow-up duration. RESULTS: According to T and N stages, 1,079 (7.9%) pTa/pTis/pT1N0, 5,058 (37.2%) pT2N0, 2,865 (21.1%) pT3N0, 1,211 pT4N0 (8.9%) and 3,382 (24.9%) pTanyN1-3 patients were included. Conditional CSM-free estimates increased from 90.1 to 91.8%, 80.6 to 92.5%, 62.5 to 90.7%, 53.1 to 84.5%, and 37.5 to 84.0% after 5 years of event-free follow-up, in respectively pTa/pTis/pT1N0, pT2N0, pT3N0, pT4N0, and pTanyN1-3 patients. Attrition due to mortality was highest in pTanyN1-3 cohort and lowest in pTa/pTis/pT1N0. In Multivariable Cox regression analyses, pT2N0 (hazard ratio [HR] 1.9 P< 0.001), pT3N0 (HR 4.3 P< 0.001), pT4N0 (HR 5.8 P< 0.001) and pTanyN1-3 (HR 9.1 P< 0.001) were independent predictors of higher CSM at baseline, relative to pTa/pTis/pT1N0. A decrease in all conditional HRs to nonsignificant levels was recorded at 60 months for pT4N0 and pTanyN1-3 and at 48 months for pT2N0 and pT3N0. CONCLUSIONS CONDITIONAL SURVIVAL: showed a direct relationship between event-free follow-up duration and survival probability. Conditional CSM-free estimates increased in proportion with event-free follow-up but also resulted in equally proportional increase in attrition rates.

14.
World J Urol ; 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31297629

RESUMO

PURPOSE: To test the conditional survival that examined the effect of event-free survival on cancer-specific mortality after primary tumour excision (PTE) in patients with squamous cell carcinoma of the penis (SCCP). MATERIALS AND METHODS: Within the SEER database (1998-2015), 2282 stage I-III SCCP patients were identified. Conditional survival estimates were used to calculate cancer-specific mortality (CSM) after event-free survival intervals of 1, 2, 3, and 5 years. Multivariable Cox regression models predicted CSM according to event-free survival. RESULTS: After PTE, 5-year CSM-free rate was 78.0% and increased to 84.6%, 88.1%, 92.0%, and 94.2% in patients who survived ≥ 1, ≥ 2, ≥ 3, and ≥ 5 years. After stratification according to tumour characteristics, 5-year CSM-free rates increased from 85.9 to 95.4%, 79.0 to 97.1%, 78.9 to 90.0%, and from 54.5 to 86.0% in those survived ≥ 5 years, respectively, in T1N0, T2N0, T3N0, and N1-2 patients. In multivariable analyses, T2N0 [hazard ratio (HR) 1.68; p value < 0.001], T3N0 (HR 1.94; p value 0.001), and N1-2 (HR 6.61; p value < 0.001) were independent predictors of higher CSM rate at baseline, relative to T1N0. A decrease in all HRs was assessed over time in patients who survived. Attrition due to CSM was highest in N1-2 cohort and lowest in T1N0. CONCLUSIONS: Conditional survival models showed a direct relationship between event-free survival duration and subsequent CSM in SCCP patients. Even patients with non-organ-confined disease may achieve survival probabilities similar to those with organ-confined disease after at least 5 years of event-free survival since PTE.

15.
Artigo em Inglês | MEDLINE | ID: mdl-31311763

RESUMO

BACKGROUND: Radium-223 is approved by the US Food and Drug Administration and European Medicines Agency for the treatment of metastatic castration-resistant prostate cancer (mCRPC). There are currently no markers for selecting patients most likely to complete radium-223 treatment. PATIENTS AND METHODS: In this phase IIIb, international, single-arm study, patients received radium-223, 55 kBq/kg, every 4 weeks for ≤6 cycles. Primary end points were safety and overall survival. In post hoc analyses patients were grouped according to number of radium-223 injections received (1-4 or 5-6). Associations between baseline covariates and number of injections were investigated. RESULTS: Of 696 eligible patients, 473 (68%) had received 5 to 6 radium-223 injections and 223 (32%) 1 to 4 injections. Patients with less pain (moderate-severe vs. none-mild, odds ratio [OR], 0.41; P < .0001), lower Eastern Cooperative Oncology Group performance status (≥2 vs. 0-1, OR, 0.51; P = .0074), lower prostate-specific antigen level (>141 µg/L vs. ≤141 µg/L, OR, 0.40; P < .0001), and higher hemoglobin level (<10 g/dL vs. ≥10 g/dL, OR, 0.50; P = .0206) were more likely to receive 5 to 6 than 1 to 4 injections. Median overall survival was not reached and was 6.3 months (95% confidence interval, 5.4-7.4) in patients who had received 5 to 6 and 1 to 4 radium-223 injections, respectively. Adverse events were less common in patients who received 5 to 6 than 1 to 4 injections; anemia was reported in 87 (18%) and 64 (29%) patients, respectively. CONCLUSION: Patients with less advanced mCRPC are more likely to receive 5 to 6 radium-223 injections and to achieve better overall survival. Consideration of baseline and disease characteristics is recommended before initiation of radium-223 treatment.

17.
Minerva Urol Nefrol ; 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31353876

RESUMO

INTRODUCTION: In the last years, there have been significant developments in the therapeutic armamentarium of mCRPC. New evidence shows that the addition of bone- targeted agents (BTA) to "life-prolonging agents" result in improved clinical benefit. This review aims to give an overview of data for the use of BTAs in a new era of metastatic castration-resistant prostate cancer (mCRPC) where new agents are used in daily practice. EVIDENCE ACQUISITION: A non-systematic review of the literature was performed combining the keywords: "castration-resistant prostate cancer" and "bone-targeted therapy". The primary objective was to provide a critical assessment of data for the use of BTAs in mCRPC, and the secondary objective was to assess novel targeted therapy. EVIDENCE SYNTHESIS: Zoledronic acid and denosumab have shown to be effective in reducing the risk of SREs in patients with mCRPC. The point at which treatment with bisphosphonates or denosumab should be initiated during PCa evolution has yet to be determined. The EMA has restricted the usage of Ra-223 to patients who have had two previous treatments for mCRPC to the bone or who cannot receive other treatments. Ra-223 should only be used as monotherapy or in combination with ADT for the treatment of mCRPC, symptomatic bone metastases and without visceral metastases. With recent developments in PSMA-targeted radiopharmaceuticals, PSMA RLT agents are now under investigation for the treatment of mCRPC. CONCLUSIONS: Reducing skeletal-related morbidity remains a crucial goal of palliative life-extending therapy in mCRPC. New data about dosing schedules and combinations of different treatments will continue to refine the optimal strategy for incorporating BTAs into the new treatment paradigms for PCa. Novel molecules such as PSMA-targeted small molecules promise theranostic agents in the management of PCa patients.

18.
Urology ; 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31336110

RESUMO

OBJECTIVE: To test the effect of obesity (body mass index ≥30 kg/m2) on perioperative outcomes and total hospital charges at robot-assisted vs open radical prostatectomy (RARP vs ORP). METHODS: Within the National Inpatient Sample database (2008-2015), we identified obese vs nonobese RARP and ORP patients. Estimated annual percent changes, multivariable logistic regression and linear regression models were used. All models were adjusted for clustering and weighted. RESULTS: Of all, 53,626 (60%) underwent RARP vs 35,757 (40%) underwent ORP. At RARP, 8.6% were obese vs 6.9% at ORP. RARP rate increased significantly over time (12.5%-81.5%). Obesity rate increased significantly over time at both, RARP (5.1%-10.5%) and ORP (5.4%-10.7%). In multivariable logistic regression models, obesity predicted 5 of 11 unfavourable perioperative complications at RARP (odds ratio: 1.6-1.8) and 9 of 11 at ORP (odds ratio: 1.3-2.8). In linear regression models, obesity significantly added to total hospital charges at RARP (740$) and ORP (312$). CONCLUSION: Obesity may predispose to higher rates of adverse outcomes at RP. Its effect varies according to surgical approach.

19.
Urol Oncol ; 37(9): 578.e11-578.e19, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31296420

RESUMO

INTRODUCTION: We analyzed adherence rates to contemporary guidelines regarding inguinal lymph node dissection (ILND) for squamous cell carcinoma of the penis, as well as ILND association with cancer specific mortality (CSM), and complication rates. MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results and the National Inpatient Sample databases, 943 and 317 nonmetastatic penile cancer patients (1998-2015) were respectively identified. Multivariable analyses focused on ILND rates, CSM, and complication rates. Inverse probability of treatment weighting adjustment was used in CSM analyses. RESULTS: Within the Surveillance, Epidemiology, and End Results database, ILND was performed in 233 (24.7%) patients. ILND rates did not vary over time (P = 0.2). In the overall cohort (n = 943), ILND was an independent predictor of lower CSM (hazards ratio [HR]: 0.42; P < 0.001). In Multivariable CSM analyses stratified according to N-stage, ILND was associated with lower CSM in N1 (HR: 0.25; P < 0.001) and N2-3 (HR: 0.42; P = 0.01), but not in N0 patients. Within the National Inpatient Sample database, presence of LN invasion (LNI) was associated with longer hospitalization (odds ratio: 1.27, P = 0.01), but not with higher complications or in-hospital mortality. CONCLUSIONS: The adherence to guidelines for ILND was low (24.7%), and did not change over time. Nonetheless, a CSM benefit related to ILND was observed in N1, N2, and N3 patients. Complication rates and in-hospital mortality did not differ according to LNI. However, hospital stay may be longer in LNI patients. Finally, it should be noted that lack of distinction between clinical and pathological N-stage represents an important limitation.

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