Optic gliomas. A reanalysis of the University of California, San Francisco experience

Thirty-eight cases of optic gliomas seen at the University of California, San Francisco, were reviewed. Two patients died in the postoperative period and were excluded from the follow-up analysis. Twenty-nine cases (76%) involved the optic chiasm, nine (24%) cases were confined to one optic nerve. Most tumors were slow growing and progressive although there were three cases of adult chiasmal gliomas which exhibited unusually aggressive behavior. The three cases are presented in detail. After a mean follow-up period of 9.4 years, the 10-year overall actuarial survival was 87%. Relapse-free survival was 55% at 10 years. Chiasmal tumors had a poorer prognosis compared to optic nerve tumors with 56% of chiasmal tumors recurring versus 22% of optic nerve tumors. Radiotherapy was beneficial in chiasmal gliomas, initially improving vision in 35% (6/17) and decreasing recurrence from 86% (6/7) without radiation therapy to 45% (9/20) with radiation therapy. Optic gliomas are not benign, self-limiting lesions, and therefore require treatment. Radiotherapy is effective in chiasmal gliomas and should be used early in the management of these tumors. No advantage to radiotherapy could be demonstrated for optic nerve gliomas, although the number of these cases analyzed was small.     

Treatment results and prognostic factors of advanced T3--4 laryngeal carcinoma: the University of California, San Francisco (UCSF) and Stanford University Hospital (SUH) experience

To review the UCSF-SUH experience in the treatment of advanced T3–4 laryngeal carcinoma and to evaluate the different factors affecting locoregional control and survival.

We reviewed the records of 223 patients treated for T3–4 squamous cell carcinoma of the larynx between October 1, 1957, and December 1, 1999. There were 187 men and 36 women, with a median age of 60 years (range, 28–85 years). The primary site was glottic in 122 and supraglottic in 101 patients. We retrospectively staged the patients according to the 1997 AJCC staging system. One hundred and twenty-seven patients had T3 lesions, and 96 had T4 lesions; 132 had N0, 29 had N1, 45 had N2, and 17 had N3 disease. The overall stage was III in 93 and IV in 130 patients. Seventy-nine patients had cartilage involvement, and 144 did not. Surgery was the primary treatment modality in 161 patients, of which 134 had postoperative radiotherapy (RT), 11 had preoperative RT, 7 had surgery followed by RT and chemotherapy (CT), and 9 had surgery alone. Forty-one patients had RT alone, and 21 had CT with RT. Locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank statistics were employed to identify significant prognostic factors for OS and LRC.

The median follow-up was 41 months (range, 2–367 months) for all patients and 78 months (range, 6–332 months) for alive patients. The LRC rate was 69% at 5 years and 68% at 10 years. Eighty-four patients relapsed, of which 53 were locoregional failures. Significant prognostic factors for LRC on univariate analysis were primary site, N stage, overall stage, the lowest hemoglobin (Hgb) level during RT, and treatment modality. Favorable prognostic factors for LRC on multivariate analysis were lower N stage and primary surgery. The overall survival rate was 48% at 5 years and 34% at 10 years. Significant prognostic factors for OS on univariate analysis were: primary site, age, overall stage, T stage, N stage, lowest Hgb level during RT, and treatment modality. Favorable prognostic factors for OS on multivariate analysis were lower N stage and higher Hgb level during RT.

Lower N-stage was a favorable prognostic factor for LRC and OS. Hgb levels ≥ 12.5 g/dL during RT was a favorable prognostic factor for OS. Surgery was a favorable prognostic factor for LRC but did not impact on OS. Correcting the Hbg level before and during treatment should be investigated in future clinical trials as a way of improving therapeutic outcome in patients with advanced laryngeal carcinomas.     

Dietary and tobacco risk factors for adult onset glioma in the San Francisco Bay Area (California, USA)

The roles of diet and tobacco in the etiology of primary brain cancer are controversial. In this report, we compare dietary and cigarette smoking histories among 434 adults newly diagnosed with glioma in the San Francisco Bay Area (California, USA) between 1991 and 1994 with frequency age, gender, and ethnicity-matched population-based controls. Data were obtained on use of vitamin supplements and mean weekly consumption of each of 24 food groups. Adjusted for age, family income, and education, for both men and women, cases had higher mean weekly consumption of cured meats and other cured foods, lower consumption of high vitamin A and C fruits and vegetables, and higher average intakes of beer and other alcohol than controls. Men with brain cancer were twice as likely as control men to report high consumption of cured foods and low consumption of foods rich in vitamin C (odds ratio [OR]=2.0, 95 percent confidence interval [CI]=1.2-3.5). This association was less pronounced and not statistically significant in women (OR=1.5, CI=0.8-2.7). Similarly, men with brain cancer were twice as likely as controls to have high nitrite and low vitamin C consumption. Among men only, cases were 1.8 times more likely than controls to report smoking unfiltered cigarettes (CI=0.9-3.4). Moreover, among smokers, cases smoked unfiltered cigarettes almost twice as long as controls (P=0.04) and cases' average total pack-years also significantly exceeded controls. Although these findings support the hypothesis that N-nitroso compounds might be a factor in adult glioma, they are compatible with other dietary hypotheses. In particular, these results also favor the hypothesis that total body burden of oxidants may play a role in brain cancer causation.     

Hepatitis B and Liver Cancer Knowledge and Preventive Practices among Asian Americans in the San Francisco Bay Area,California

Chronic hepatitis B virus (HBV) infection causes liver cancer and disproportionately affects the Asiancommunity in the U.S. In order to advance HBV and liver cancer awareness and prevention, it is important toidentify existing gaps in knowledge and preventive practices among Asian Americans. Therefore, the authorsadministered a written questionnaire to 199 adults in the Asian-American community of the San Francisco BayArea, California. Although the majority of adults had at least a college education, knowledge regarding HBVtransmission, prevention, symptoms, risks, and occurrence was low. Fewer than 60% reported having been testedfor HBV, only 31% reported having been vaccinated against HBV, and only 44% reported having had theirchildren vaccinated. Asians, especially those born in China or Southeast Asia, had significantly poorer knowledgeregarding HBV and liver cancer than non-Asians. Those with higher knowledge levels were significantly morelikely to have been tested for HBV and to have had their children vaccinated. Younger adults, women, Caucasians,more highly educated individuals, those not born in China or Hong Kong, and those with a personal or familyhistory of liver disease were more likely to have taken preventive action against HBV. Our results suggest thatHBV and liver cancer knowledge among Asian Americans, especially Chinese Americans, is poor, and that betterknowledge is associated with increased preventive practices. Thus, there is a need for increased HBV educationand improved community-based interventions to prevent HBV-related liver disease in the high-risk Asian-Americancommunity.     

Dietary Phytoestrogen, Serum Enterolactone and Risk of Prostate Cancer: The Cancer Prostate Sweden Study (Sweden)

Objective

Based on evidence that phytoestrogens may protect against prostate cancer, we evaluated the associations between serum enterolactone concentration or dietary phytoestrogen intake and risk of prostate cancer.

Methods

In our Swedish population-based case-control study, questionnaire-data were available for 1,499 prostate cancer cases and 1,130 controls, with serum enterolactone levels in a sub-group of 209 cases and 214 controls. Unconditional logistic regression was performed to estimate multivariate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with risk of prostate cancer.

Results

High intake of food items rich in phytoestrogens was associated with a decreased risk of prostate cancer. The OR comparing the highest to the lowest quartile of intake was 0.74 (95% CI: 0.57–0.95; p-value for trend: 0.01). In contrast, we found no association between dietary intake of total or individual lignans or isoflavonoids and risk of prostate cancer. Intermediate serum levels of enterolactone were associated with a decreased risk of prostate cancer. The ORs comparing increasing quartiles of serum enterolactone concentration to the lowest quartile were, respectively, 0.28 (95% CI: 0.15–0.55), 0.63 (95% CI: 0.35–1.14) and 0.74 (95% CI: 0.41–1.32).

Conclusions

Our results support the hypothesis that certain foods high in phytoestrogens are associated with a lower risk of prostate cancer.     

Impact of Advanced External Beam Radiotherapy on Second Haematological Cancer Risk in Prostate Cancer Survivors

AimsExternal beam radiotherapy (EBRT) for prostate cancer (PCa) has rapidly advanced over the years. Advanced techniques with altered dose distributions may have an impact on second haematological cancer (SHC) risks. We assessed SHC risk after EBRT for PCa and explored whether this risk has changed over the years.Materials and methodsPatients diagnosed with a T1-T3 PCa between 1990 and 2015 were selected from the Netherlands Cancer Registry. Patients treated with EBRT were assigned to EBRT eras based on the date of diagnosis. These eras represented two-dimensional radiotherapy (2D-RT; 1991–1996), three-dimensional conformal radiotherapy (3D-CRT; 1998–2005) or advanced EBRT (2008–2015). Standardised incidence ratios (SIR) and absolute excess risks (AER) were calculated overall and by EBRT era. Sub-hazard ratios (sHRs) were calculated for the comparison of EBRT versus radical prostatectomy and active surveillance.ResultsPCa patients with EBRT as the primary treatment (n = 37 762) had an increased risk of developing a SHC (SIR = 1.20; 95% confidence interval 1.13–1.28) compared with the Dutch male general population. Estimated risks were highest for the 2D-RT era (SIR = 1.32; 95% confidence interval 1.14–1.67) compared with the 3D-CRT era (SIR = 1.16; 95% confidence interval 1.05–1.27) and the advanced EBRT era (SIR = 1.21; 95% confidence interval 1.07–1.36). AER were limited, with about five to six extra cases per 10 000 person-years. Relative risk analysis (EBRT versus radical prostatectomy/active surveillance) showed significant elevation with EBRT versus active surveillance (sHR = 1.17; 95% confidence interval 1.03–1.33; P = 0.017), but not for EBRT versus radical prostatectomy (sHR = 1.08; 95% confidence interval 0.94–1.23; P = 0.281).ConclusionIncreased SHC risks after EBRT for PCa cancer were observed for all EBRT eras compared with the general Dutch male population. Excess risks for EBRT versus other PCa treatment groups were found for only EBRT versus active surveillance.     

Development of Japanese version of the UCLA Prostate Cancer Index: a pilot validation study

Methods: The Japanese version (version 1.2) of the UCLA PCI was developed through a process of translation, back-translation, and refinement after interviewing patients. Reliability and validity were examined for 125 Japanese patients with localized prostate cancer. The patients simultaneously responded to the Japanese version of the RAND 36-Item Health Survey (SF-36) and five representative questions from the International Index of Erectile Function (IIEF). Results: Internal consistency reliability was very high for both urinary and sexual function scales, and lower for bowel function. The test-retest reliability of the urinary and sexual function scales and the urinary bother scales was stable, while that of the bowel function and bother scales was relatively unstable. Sexual function scores did not correlate highly with sexual bother scores. Furthermore, poor sexual function and bother had little association with the SF-36 scores. Missing data as to urinary and bowel function/bother scales were minimal (0.8%–2.4%), while those for sexual function and bother were relatively high (4.8%–11.2%). Conclusions: The results of this pilot study, together with the previous American study, suggest ethnic or cultural difference in how impaired sexual function is integrated into overall QOL. A future cross-cultural comparative study using the UCLA PCI and SF-36 will provide useful information about the influence of cultural or ethnic differences on health-related QOL in prostate cancer patients. Received: February 4, 2002 / Accepted: July 12, 2002 Acknowledgments We thank Dr. Christopher Holms for back-translation of the Japanese version of the UCLA PCI. This work was supported by a Grant-in-Aid for Cancer Research from the Ministry of Health, Welfare, and Labor of Japan (11–10). Correspondence to:Y. Kakehi     

Prospective validation of the NCI Breast Cancer Risk Assessment Tool (Gail Model) on 40,000 Australian women

Background

There is a growing interest in delivering more personalised, risk-based breast cancer screening protocols. This requires population-level validation of practical models that can stratify women into breast cancer risk groups. Few studies have evaluated the Gail model (NCI Breast Cancer Risk Assessment Tool) in a population screening setting; we validated this tool in a large, screened population.

Methods

We used data from 40,158 women aged 50–69?years (via the lifepool cohort) participating in Australia’s BreastScreen programme. We investigated the association between Gail scores and future invasive breast cancer, comparing observed and expected outcomes by Gail score ranked groups. We also used machine learning to rank Gail model input variables by importance and then assessed the incremental benefit in risk prediction obtained by adding variables in order of diminishing importance.

Results

Over a median of 4.3?years, the Gail model predicted 612 invasive breast cancers compared with 564 observed cancers (expected/observed (E/O)?=?1.09, 95% confidence interval (CI) 1.00–1.18). There was good agreement across decile groups of Gail scores (χ²?=?7.1, p?=?0.6) although there was some overestimation of cancer risk in the top decile of our study group (E/O?=?1.65, 95% CI 1.33–2.07). Women in the highest quintile (Q5) of Gail scores had a 2.28-fold increased risk of breast cancer (95% CI 1.73–3.02, p?<?0.0001) compared with the lowest quintile (Q1). Compared with the median quintile, women in Q5 had a 34% increased risk (95% CI 1.06–1.70, p?=?0.014) and those in Q1 had a 41% reduced risk (95% CI 0.44–0.79, p?<?0.0001). Similar patterns were observed separately for women aged 50–59 and 60–69?years. The model’s overall discrimination was modest (area under the curve (AUC) 0.59, 95% CI 0.56–0.61). A reduced Gail model excluding information on ethnicity and hyperplasia was comparable to the full Gail model in terms of correctly stratifying women into risk groups.

Conclusions

This study confirms that the Gail model (or a reduced model excluding information on hyperplasia and ethnicity) can effectively stratify a screened population aged 50–69 years according to the risk of future invasive breast cancer. This information has the potential to enable more personalised, risk-based screening strategies that aim to improve the balance of the benefits and harms of screening.

     

Combining the Prostate Cancer Risk Index (PRIX) with the Presence of Secondary Circulating Prostate Cells to Predict the Risk of Biochemical Failure after Radical Prostatectomy for Prostate Cancer

Introduction: The use of pre- and post-surgery variables has been used to create nomograms in order to identifypatients at high risk of treatment failure. The PRIX nomogram is one such device; we compare the PRIX nomogramwith the presence of secondary circulating prostate cells to predict those men who will undergo treatment failure.Methods and Patients: Men who underwent radical prostatectomy for prostate cancer entered the study. The PRIXscore was calculated from the total serum PSA pre-surgery, the biopsy Gleason score and clinical stage. Circulatingprostate cells were detected from venous blood one month after surgery, using differential gel centrifugation and standardimmunocytochemistry with anti-PSA. A test was considered positive when 1 CPC/blood sample was detected. Patientswere followed up for five years and biochemical failure was defined as a serum PSA >0.2ng/ml. Kaplan-Meier andCox proportional models were used to calculate survival curves. Results: 321 men participated, of whom 131 (40.8%)underwent biochemical failure within 5 years. A higher PRIX score was associated with increased failure risk, as wasthe presence of CPCs. The predictive power of CPCs was significantly higher than the PRIX score. Combining thetwo methods, for equal PRIX scores, scores but CPC positive had a worse biochemical failure free survival than menwith high PRIX scores but CPC negative. For men with PRIX scores of ≥4 the use of CPC detection did not aid in theclinical decision making process. For those with PRIX scores of 0 and 1, CPC detection identified men with a high riskof treatment failure. Conclusions: The combined PRIX/CPC score improved the predictive values of men at high riskof biochemical failure. Both are simple systems that could be incorporated in a general hospital. Further multicenterstudies are warranted to confirm these results.     

Cancer incidence trends in white women of the San Francisco Bay Area

The 10% increase in the incidence of all cancer observed in the total white population of the San Francisco Bay Area during 1970-75 is mostly due to the 19% increase in cancer among white females. The latter is largely a result of increased incidence of cancer of the corpus uteri, breast, and lung, and of malignant melanoma. Cancer of these four sites constitutes 85% of the increase in white women. The rise in uterine corpus cancer is limited to women over 50 years of age. An incidence peak in 1974 of breast cancer was followed by a substantial decrease in 1975. The 50% rise in female lung cancer is an extension of the increase that began in 1965. The almost 70% increase in melanoma among women since 1975 accompanies a comparable increase in melanoma among males after a decade of stable incidence rates.     

Evaluation of Biochemical Recurrence-free Survival after Radical Prostatectomy by Cancer of the Prostate Risk Assessment Post-Surgical (CAPRA-S) Score

Background: The cancer of the prostate risk assessment (CAPRA) score has been defined to predict prostatecancer recurrence based on the pre-clinical data, then pathological data have also been incorporated. Thus,CAPRA post-surgical (CAPRA-S) score has been developed based on six criteria (prostate specific antigen(PSA) at diagnosis, pathological Gleason score, and information on surgical margin, seminal vesicle invasion,extracapsular extension and lymph node involvement) for the prediction of post-surgical recurrences. In thepresent study, biochemical recurrence (BCR)-free probabilities after open retropubic radical prostatectomy (RP)were evaluated by the CAPRA-S scoring system and its three-risk level model. Materials and Methods: CAPRA-Sscores (0-12) of our 240 radical prostatectomies performed between January 2000-May 2011 were calculated.Patients were distributed into CAPRA-S score groups and also into three-risk groups as low, intermediate andhigh. BCR-free probabilities were assessed and compared using Kaplan-Meier analysis and Cox proportionalhazards regression. Ability of CAPRA-S in BCR detection was evaluated by concordance index (c-index). Results:BCR was present in 41 of total 240 patients (17.1%) and the mean follow-up time was 51.7 ± 33.0 months. MeanBCR-free survival time was 98.3 months (95% CI: 92.3-104.2). Of the patients in low, intermediate and highrisk groups, 5.4%, 22.0% and 58.8% had BCR, respectively and the difference among the three groups wassignificant (P = 0.0001). C-indices of CAPRA-S score and three-risk groups for detecting BCR-free probabilitiesin 5-yr were 0.87 and 0.81, respectively. Conclusions: Both CAPRA-S score and its three-risk level model wellpredicted BCR after RP with high c-index levels in our center. Therefore, it is a clinically reliable post-operativerisk stratifier and disease recurrence predictor for prostate cancer.     

The Cancer of the Prostate Risk Assessment (CAPRA) in patients treated with external beam radiation therapy: Evaluation and optimization in patients at higher risk of relapse

Background

The Cancer of the Prostate Risk Assessment (CAPRA) was developed to predict freedom from biochemical failure (FFBF) following radical prostatectomy (RP). Its utility following external beam radiation therapy (EBRT) has not been externally evaluated.

Methods

A retrospective study of 612 patients treated with dose-escalated EBRT at the University of Michigan Medical Center.

Results

Compared to the derivation cohort, EBRT treated patients had higher-risk disease (28% with CAPRA of 6-10 vs. 5%, respectively). A total of 114 patients (19%) had BF with 5-year BF ranging from 7% with CAPRA 0-3 to 35% with CAPRA 7-10. For RT patients the risk of BF at 5-year was similar to 4 surgical cohorts for CAPRA scores 0-2 but lower for all CAPRA scores ? 3. The difference favoring RT increased with increasing CAPRA score reaching a 27-50% absolute improved at 5-years for CAPRA scores of 6-10. On multivariate analysis each CAPRA point increased the risk of BF (p < 0.0001) while Gleason pattern 5 in the biopsy also increased BF (p = 0.01) and long-term androgen deprivation therapy (ADT) significantly reduced the risk of BF (p = 0.015).

Conclusions

Compared to surgical series the risk of BF was lower with dose-escalated EBRT with the greatest difference at the highest CAPRA scores.     

Antihypertensive Drug Use and The Risk of Prostate Cancer (Canada)

PURPOSE: To verify if exposure to antihypertensive drugs was associated to prostate cancer (PC) risk. METHODS: We conducted a matched case-control study using record linkage between two population-based databases. We defined exposure as a binary variable and in terms of timing and cumulative duration of use. We controlled for detection bias and Aspirin use. RESULTS: Among the 2221 cases and 11,105 controls, use of any antihypertensive agent was associated with an adjusted relative risk of PC of 0.98 (CI, 0.88-1.08). Of the different classes of antihypertensives, only beta-blockers (BBs) were associated with a reduction in PC risk (OR = 0.86, CI = 0.77-0.96). In those who cumulated < 1, 1-4, and > or = 4 years of BB use, the risk was 0.89 (0.75-1.05), 0.91 (0.75-1.09), and 0.82 (0.69-0.96), respectively. Also, subjects with > or = 4 years of alpha-blocker (ABs) use had a non-significant 25% reduction in PC risk. CONCLUSIONS: Our results suggest that BBs and long-term use of ABs may prevent PC whereas calcium channel blockers or angiotensin-converting enzyme inhibitors do not influence PC risk.     

Regular Use of Aspirin and Prostate Cancer Risk (United States)

It has been hypothesized that aspirin and other nonsteroidal anti-inflammatory drugs can decrease the risk of developing prostate and other cancers, although observational studies have not been very conclusive. The current study examined the effects of regular aspirin use on prostate cancer risk in 1,029 patients with primary, incident cancer of the prostate and 1,029 hospital controls frequency-matched to cases by 5-year age group and period of questionnaire completion. Patients who reported use of aspirin for at least once a week for at least 6 months were classified as regular users, with others classified as non-users. Results indicate that regular aspirin use may not be associated with decreased prostate cancer risk [odds ratio (OR) 1.05, 95% confidence interval (CI) 0.89–1.25], frequency of use (OR for at least seven/week 0.91, 95% CI 0.73–1.13), duration of use (OR for at least 10 years of use 1.17 95% CI 0.93–1.46) or tablet years (defined as tablets per day x years of use). A similar lack of association was observed when analyses were performed examining stage of the cancer. These data suggest that aspirin use may not be associated with reduced risk of prostate cancer.     

多因素分析中老年前列腺癌根治术后尿失禁的危险因素

目的:多因素分析中老年前列腺癌根治术后尿失禁的危险因素。方法:选择我院于2015年1月至2018年12月期间收治的中老年前列腺癌根治术患者100例作为研究对象,观察术后尿失禁发生情况。采用多因素Logistic分析影响中老年前列腺癌根治术后尿失禁的危险因素。结果:中老年前列腺癌根治术患者100例中,发生术后尿失禁31例,发生率为31.00%。经单因素分析结果表明,不同BMI、吸烟史、饮酒史、合并高血压、合并糖尿病、合并冠心病、前列腺手术史和手术时间与术后尿失禁发生率比较差异无统计学意义（P＞0.05）;年龄＞60岁者术后尿失禁发生率高于年龄≤60岁,术前尿失禁者术后尿失禁发生率高于术前无尿失禁者,术中无保护尿控神经者术后尿失禁发生率高于术后保护尿控神经术者,膀胱功能失代偿者术后尿失禁发生率高于代偿者,差异有统计学意义（P＜0.05）。将上述单因素分析差异有统计学意义的纳入多因素Logistic分析表明,年龄＞60岁、术前尿失禁、术中无保护尿控神经和膀胱功能失代偿为影响术后尿失禁危险因素。结论:多因素分析中老年前列腺癌根治术后尿失禁的危险因素,为年龄、术前尿失禁、术中保护尿控神经和膀胱功能失代偿,需采取针对性预防措施降低术后尿失禁发生。