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1.
Mihai Dorin Vartolomei Daniel Porav-Hodade Matteo Ferro Romain Mathieu Mohammad Abufaraj Beat Foerster Shoji Kimura Shahrokh F. Shariat 《Urologic oncology》2018,36(9):389-399
Objective
The aim of this study was to summarize and analyze the current evidence regarding the prognostic and predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients undergoing transurethral resection of bladder tumors (TURBT) for non–muscle-invasive bladder cancer (NMIBC).Material and methods
A systematic search of Web of Science, Medline/PubMed, Google Scholar, and Cochrane library was performed on the 1st of March, 2018. Studies were deemed eligible if they compared NMIBC patients with high vs. low NLR before TURBT to determine its value for prognosticating disease recurrence and progression using multivariable analysis. We performed a formal meta-analysis for both recurrence-free (RFS) and progression-free survival (PFS).Results
Six studies encompassing 2,298 patients (477 [20.7%] females) assessed the prognostic value of NLR in NMIBC patients treated with TURBT. NLR predicted worse RFS (pooled HR = 1.78; 95% CI: 1.32–2.4, P<0.001) and PFS (pooled HR = 2.14; 95% CI: 1.59–2.87, P<0.001). In 4 studies encompassing 599 patients, high pretreatment NLR was associated with decreased RFS (pooled HR = 2.31; 95% CI: 1.27–4.22, P = 0.006) and in 3 of them high pretreatment NLR was associated with decreased PFS (pooled HR = 2.54; 95% CI: 1.36–4.71, P = 0.003) in high-risk NMIBC patients treated with BCG.Conclusion
In this meta-analysis, peripheral blood levels of NLR were associated with an increased risk of disease recurrence and progression in patients who underwent TURBT for NMIBC. Furthermore, NLR was an independent predictor of disease recurrence and progression in NMIBC treated with BCG patients. NLR could be used to improve clinical decision-making regarding treatment and follow-up scheduling. 相似文献2.
Kyle Scarberry Nicholas G. Berger Kelly B. Scarberry Shree Agrawal John J. Francis Jessica M. Yih Christopher M. Gonzalez Robert Abouassaly 《Urologic oncology》2018,36(6):308.e11-308.e17
Objectives
Positive surgical margins (PSM) and lymph node yield (LNY) following radical cystectomy (RC) for urothelial carcinoma of the bladder affect survival. Variations in PSM or LNY at different care facilities are poorly described. We evaluated the relationship between hospital surgical volume and academic hospital status with these surgical outcomes and overall survival (OS).Methods and materials
Patients with nonmetastatic urothelial carcinoma of the bladder who underwent RC were identified from the National Cancer Database (2004–2013). Treatment centers were categorized as academic (ACC) and community cancer centers (CCC). Logistic regression was used to identify factors associated with PSM status and LNY, and a multivariate Cox proportional hazards model was used to determine factors associated with OS.Results
In our cohort, 39,274 patients underwent RC. A lower proportion of PSMs (10% vs.12%; P<0.001) and higher median LNY (14 vs. 8, P<0.001) was observed at ACCs compared to CCCs. On logistic regression, there were lower odds of PSM (OR = 0.89, 95% CI: 0.81–0.97) and higher odds of LNY ≥ 10 nodes (OR = 1.84, 95% CI: 1.74–1.96) among patients at ACCs compared to CCCs. Cox proportional hazards analysis demonstrated benefit to OS at high-volume centers (HR = 0.91, 95% CI: 0.87–0.95) but not based on ACC designation. The OS advantage at high-volume centers is attenuated (HR = 0.95, 95% CI: 0.91–0.99) by PSM status and LNY.Conclusions
ACCs demonstrate improved surgical outcomes following RC, and a survival advantage attributable to high surgical volume is identified. Centralization of care may lead to improved outcomes in this lethal malignancy. 相似文献3.
Jonathan Gelfond Osamah Al-Bayati Aashish Kabra Kevan Iffrig Dharam Kaushik Michael A. Liss 《Urologic oncology》2018,36(7):340.e1-340.e6
Introduction
Identify modifiable factors contributing to renal cell carcinoma in the PCLO to target disease prevention and reduce health care costs.Methods
The prostate, lung, colorectal, and ovarian database were queried for the primary outcome of kidney cancer. Demographics were investigated, specifically focusing on modifiable risk factors. Statistical analysis includes the Student t-test for continuous variables, chi-squared or Fisher’s exact tests for dichotomous and categorical variables for bivariate analysis. The Cox proportional hazards model was used in a multivariate time-to-event analysis.Results
We investigate existing data relating specifically to renal cancer. After missing data were excluded, we analyzed 149,683 subjects enrolled in the prostate, lung, colorectal, and ovarian trial and noted 0.5% (n = 748) subjects developed renal cancer. Age, male gender, body mass index, diabetes, and hypertension were all significant associated with renal cancer in bivariate analysis (P<0.05). Men have a significant increased risk of kidney cancer over women (hazard ratio [HR] = 1.85; 95% CI: 1.58–2.16; P<0.0001). Nonmodifiable risk factors that are associated with kidney cancer include age (HR = 1.05; 95% CI: 1.01; 1.05, P = 0.001). Modifiable risk factors include obesity measured by body mass index (HR = 1.05; 95% CI: 1.02–1.07; P<0.0001), hypertension (HR = 1.32; 95% CI: 1.13–1.54; P = 0.0004), and smoking in pack-years (HR = 1.04; 95% CI: 1.02–1.07; P = 0.0002).Conclusions
Obesity, hypertension, and smoking are the 3 modifiable risk factors that could aggressively be targeted to reduce renal cell carcinoma. 相似文献4.
Nawar Hanna Jeffrey J. Leow Maxine Sun David F. Friedlander Thomas Seisen Firas Abdollah Stuart R. Lipsitz Mani Menon Adam S. Kibel Joaquim Bellmunt Toni K. Choueiri Quoc-Dien Trinh 《Urologic oncology》2018,36(3):88.e1-88.e9
Objectives
Over the past decade, robot-assisted radical cystectomy (RARC) has gained traction as an alternative to the conventional open approach open radical cystectomy (ORC). However, the benefits of RARC over ORC remain unclear. Our objective was to conduct a comparative effectiveness analysis between RARC and ORC using data from the National Cancer Data Base.Materials and methods
Within the National Cancer Data Base, we identified patients with localized muscle-invasive bladder cancer who underwent RC between 2010 and 2013. Patients were stratified according to surgical approach: ORC vs. RARC. Intraoperative endpoints included: the presence of positive surgical margins, the performance of a pelvic lymph node dissection, and number of lymph nodes (LN) removed. Postoperative endpoints included: length of stay (LOS), 30- and 90-day postoperative mortality (POM) rates, 30-day readmission rate, and overall survival (OS). To minimize selection bias, observed differences in baseline characteristics between RARC vs. ORC patients were controlled for using weighted propensity scores. Binary endpoints and OS were assessed using propensity score-adjusted logistic and Cox regression analyses, respectively. POM was assessed using propensity score weighted Kaplan-Meier survival estimates at 30 and 90 days after RC.Results
Of 9,561 patients who underwent RC, 2,048 (21.4%) and 7,513 (78.6%) underwent RARC and ORC, respectively. The use of RARC increased over time, from 16.7% in 2010 to 25.3% in 2013. With regard to intraoperative outcomes, RARC was associated with equivalent rates of positive surgical margins (9.3% vs. 10.7%, odds ratio [OR] = 0.86, 95% CI: 0.72–1.03; P = 0.10), higher rates of pelvic lymph node dissection (96.4% vs. 92.0%, OR = 2.30, 95% CI: 1.67–3.16; P<0.001), higher median LN count (17 vs. 12, P<0.001), higher rates of LN count above the median (56.8% vs. 40.4%, OR = 1.94, 95% CI: 1.55–2.42, P<0.001). With regard to postoperative outcomes, receipt of RARC was associated with a shorter median LOS (7 vs. 8, P<0.001), and lower rates of pLOS (45.0% vs. 54.8%, OR = 0.68, 95% CI: 0.58–0.79; P<0.001). The 30- and 90-day POM rates were 2.8%, 6.7% for ORC, and 1.4%, 4.8% for RARC, respectively (hazard ratio [HR] = 0.48, 95% CI: 0.29–0.80, P = 0.005 and HR = 0.71, 95% CI: 0.54–0.93; P = 0.014). Finally, with a mean follow-up of 26.9 months, on IPTW-adjusted Cox regression analysis, RARC vs. ORC was associated with a benefit in OS (HR = 0.79, 95% CI: 0.71–0.88; P<0.001).Conclusions
Our large contemporary study found an increased adoption of RARC between 2010 and 2013, with more than 1 out of 4 patients undergoing RARC by the end of the study period. We found that RARC was associated with higher LN counts, shorter LOS, and lower POM. Our results allude to potential benefits of RARC while we wait for more definitive answers from randomized trials. 相似文献5.
《Urologic oncology》2020,38(1):2.e11-2.e17
ObjectiveDocetaxel-based chemotherapy remains the first-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC) in China. We have previously shown that time to nadir (TTN) of prostate-specific antigen (PSA) is an important prognostic factor in patients from a single center in Northwestern China. In this study, we performed a multicenter validation of the prognostic role of TTN in additional Chinese patients with mCRPC receiving docetaxel treatment.Materials and methodsThe data were gathered from 170 eligible Chinese patients who received docetaxel chemotherapy from January 2007 to October 2018 in 11 Chinese Prostate Cancer Consortium member hospitals in China. TTN was defined as the time from start of chemotherapy to the nadir of PSA level during the treatment. Multivariable Cox regression models and Kaplan-Meier analysis were used to predict overall survival (OS) and progression-free survival (PFS).ResultsPatients with a TTN ≥ 15 weeks had a longer OS and PFS compared to those with a TTN < 15 weeks (43 vs. 15 months, P < 0.001; 24 vs. 6 months, P < 0.001, respectively). In addition, Patients with a TTN ≥ 15 weeks and PSA nadir <4.55ng/ml were associated with longer OS than others (HR 0.093, 95% CI 0.044-0.188, P < 0.001; HR 4.002, 95% CI 1.890–8.856, P = 0.001, respectively) and TTN, PSA nadir, PSA baseline (optimal threshold 56.07 ng/ml), and PSA reduction (optimal threshold 50%) were associated with PFS (HR 0.238, 95% CI 0.149–0.382, P < 0.001; HR 1.676, 95% CI 1.033–2.722, P = 0.037; HR 1.770, 95% CI 1.134–2.763, P = 0.012; HR 0.573, 95% CI 0.428–0.756, P < 0.001; respectively). Furthermore, patients with a PSA nadir <4.55 ng/ml had longer OS and PFS compared to other patients when TTN was ≥15 weeks.ConclusionIn this multicenter validation study, TTN and PSA nadir remain important prognostic markers in predicting therapeutic outcomes in Chinese men who receive chemotherapy for mCRPC. 相似文献
6.
Hiroshi Fukushima Madoka Kataoka Yasukazu Nakanishi Kazumasa Sakamoto Kosuke Takemura Hiroaki Suzuki Masaya Ito Ken-ichi Tobisu Yasuhisa Fujii Fumitaka Koga 《Urologic oncology》2018,36(4):156.e9-156.e16
Objectives
Sarcopenia, decreased skeletal muscle mass (SMM), is an adverse prognostic factor in patients with advanced urothelial carcinoma (aUC). Given that SMM is variable depending on disease and patient conditions, changes in SMM over the course of treatments may be also prognostic. We investigated the prognostic role of posttherapeutic SMM recovery (PSR) in patients with aUC receiving first-line platinum-based chemotherapy.Materials and methods
This retrospective study included 72 consecutive patients with aUC receiving first-line platinum-based chemotherapy. Skeletal muscle index (SMI) was measured on computed tomography images taken before the initiation of and immediately after 2 cycles of chemotherapy. ΔSMI was calculated as [(posttherapeutic SMI ? pretherapeutic SMI)/pretherapeutic SMI] × 100, and PSR was defined as ΔSMI >0. Variables associated with progression-free survival (PFS) and overall survival (OS) were evaluated.Results
During the follow-up (median, 18 mo for survivors), 60 (83%) patients progressed (2-year PFS, 17%) and 55 (76%) died (2-year OS, 24%). ΔSMI was significantly associated with chemotherapy response (P = 0.012), and was an independent predictor for both PFS (hazard ratio [HR] = 0.94, P<0.001) and OS (HR = 0.93, P<0.001). A total of 15 (21%) patients with PSR demonstrated significantly longer PFS and OS than those without PSR (both P<0.001). On multivariate analysis, PSR was an independent favorable predictor for both PFS (HR = 0.24, P<0.001) and OS (HR = 0.21, P<0.001). Incorporation of PSR into the Bajorin's and Galsky's models improved their c-indices (0.611–0.650, and 0.690–0.708, respectively).Conclusions
PSR is a novel prognostic factor in patients with aUC receiving first-line platinum-based chemotherapy. 相似文献7.
Sarah Buelens Filip Poelaert Bert Dhondt Valérie Fonteyne Pieter De Visschere Piet Ost Sofie Verbeke Geert Villeirs Kathia De Man Sylvie Rottey Karel Decaestecker Nicolaas Lumen 《Urologic oncology》2018,36(4):158.e13-158.e20
Objectives
No uniformity exists in the definition of metastatic burden in metastatic hormone-naive prostate cancer (mHNPC) across clinical trials making their comparison challenging. We explored definition agreement and prognostic significance of bulky mHNPC according to the CHAARTED and LATITUDE trial.Materials and methods
Since 2014, 95 patients with newly diagnosed mHNPC were prospectively registered. For this study, they were categorized as having high-volume (HVD) vs. low-volume (LVD) and high-risk (HRD) vs. low-risk disease (LRD) according to the definition of CHAARTED and LATITUDE, respectively. Agreement was tested using Cohen’s κ coefficient. The Kaplan-Meier method was used to compare castration-resistant prostate cancer-free survival (CRPC-FS) and overall survival (OS). Prognostic significance was analyzed using Cox regression models.Results
In total, 44 (46%) and 46 (48%) patients showed HVD and HRD, respectively. Cohen’s κ coefficient was 0.83 indicating “almost perfect” agreement (P<0.001).Median CRPC-FS was 40 (95% CI: 25–55) vs. 11 months (95% CI: 8–14) for LVD and HVD (P = 0.001); 40 (95% CI: 27–53) vs. 11 months (95% CI: 8–14) for LRD and HRD (P<0.001), respectively. Median OS was not reached vs. 51 months (95% CI: 0–102) for LVD and HVD (P = 0.001); not reached vs. 51 months (95% CI: 2–100) for LRD and HRD (P = 0.003), respectively. The prognostic significance of both definitions remained significant in the multivariate model for CRPC-FS (P = 0.012 and P = 0.003).Conclusions
There is an excellent agreement between the definitions of bulky mHNPC in the CHAARTED and LATITUDE trial. Both definitions have significant prognostic value for predicting worse CRPC-FS and OS. 相似文献8.
DE Thomas HZ Kaimakliotis KR Rice JA Pereira P Johnston ML Moore A Reed DM Cregar C Franklin RL Loman MO Koch R Bihrle RS Foster TA Masterson TA Gardner CP Sundaram CR Powell SDW Beck NM. Hahn 《Urologic oncology》2018,36(7):345-346
Background
Carcinoma in situ (CIS) is a poor prognostic finding in urothelial carcinoma. However, its significance in muscle-invasive urothelial carcinoma (MIUC) treated with neoadjuvant chemotherapy (NAC) is uncertain. We assessed the effect of CIS found in pretreatment transurethral resection of bladder tumor (TURBT) biopsies on the pathologic and clinical outcomes.Materials and methods
Subjects with MIUC treated with NAC before cystectomy were identified. The pathologic complete response (pCR) rates stratified by TURBT CIS status were compared. The secondary analyses included tumor response, progression-free survival (PFS), overall survival (OS), and an exploratory post hoc analysis of patients with pathologic CIS only (pTisN0) at cystectomy.Results
A total of 137 patients with MIUC were identified. TURBT CIS was noted in 30.7% of the patients. The absence of TURBT CIS was associated with a significantly increased pCR rate (23.2% vs. 9.5%; odds ratio = 4.08; 95% CI: 1.19–13.98; P = 0.025). Stage pTisN0 disease was observed in 19.0% of the TURBT CIS patients. TURBT CIS status did not significantly affect the PFS or OS outcomes. Post hoc analysis of the pTisN0 patients revealed prolonged median PFS (104.5 vs. 139.9 months; P = 0.055) and OS (104.5 vs. 152.3 months; P = 0.091) outcomes similar to those for the pCR patients.Conclusion
The absence of CIS on pretreatment TURBT in patients with MIUC undergoing NAC was associated with increased pCR rates, with no observed differences in PFS or OS. Isolated CIS at cystectomy was frequently observed, with lengthy PFS and OS durations similar to those for pCR patients. Further studies aimed at understanding the biology and clinical effect of CIS in MIUC are warranted. 相似文献9.
Nirmish Singla Laura-Maria Krabbe Ahmet M. Aydin Vandana Panwar Solomon L. Woldu Yuval Freifeld Christopher G. Wood Jose A. Karam Alon Z. Weizer Jay D. Raman Mesut Remzi Nathalie Rioux-Leclercq Andrea Haitel Marco Roscigno Christian Bolenz Karim Bensalah Arthur I. Sagalowsky Shahrokh F. Shariat Vitaly Margulis 《Urologic oncology》2018,36(7):343.e1-343.e8
Purpose
Enhancer of zeste homolog 2 is a methyltransferase encoded by the EZH2 gene, whose role in upper tract urothelial carcinoma (UTUC) is poorly understood. We sought to evaluate the prognostic value of EZH2 expression in UTUC.Methods
We reviewed a multi-institutional cohort of patients who underwent radical nephroureterectomy for high-grade UTUC from 1990 to 2008. Immunohistochemistry for EZH2 was performed on tissue microarrays. Percentage of staining was evaluated, and the discriminative value of EZH2 was tested, with EZH2 positivity defined as>20% staining present. Clinicopathologic characteristics and oncologic outcomes (recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS)) were compared, stratified by EZH2 positivity. The prognostic role of EZH2 was assessed using Kaplan-Meier, univariate (UVA), and multivariate (MVA) Cox regression analyses. Significance was defined for P<0.05.Results
A total of 376 patients were included for analysis, with median follow-up 36.0 months. Overall, 78 (20.7%) were EZH2-positive. EZH2 expression was more often associated with ureteral location, lymphovascular invasion, sessile architecture, necrosis, and concomitant carcinoma in situ. On UVA, increased EZH2 expression was a significant predictor for inferior RFS (HR 1.63, P = 0.033), CSS (HR 2.03, P = 0.003), and OS (HR 2.11, P<0.001). On MVA EZH2 remained a significant predictor of worse CSS (HR 1.99 [95% CI: 1.21–3.27], P = 0.007) and OS (HR 1.54 [95% CI: 1.06–2.24], P = 0.024), while significance was lost for RFS.Conclusion
Increased EZH2 expression is associated with adverse pathologic features and inferior oncologic outcomes in patients with high-grade UTUC. The role of EZH2 biology in UTUC pathogenesis remains to be further elucidated. 相似文献10.
Daniel M. Tennenbaum Brandon J. Manley Emily Zabor Maria F. Becerra Maria I. Carlo Jozefina Casuscelli Almedina Redzematovic Nabeela Khan Maria E. Arcila Martin H. Voss Darren R. Feldman Robert J. Motzer Nicole E. Benfante Jonathan A. Coleman Paul Russo James J. Hsieh Abraham Ari Hakimi 《Urologic oncology》2017,35(8):532.e7-532.e13
Purpose
To establish prognostic genomic biomarkers for patients with metastatic clear cell renal cell carcinoma (ccRCC).Materials and methods
We identified 60 patients who presented with metastatic ccRCC at our institution between 2001 and 2015 and had genomic sequencing on their primary tumor. We pooled these patients with 107 other patients with the same inclusion criteria from three well-known public databases. Five commonly mutated genes were chosen for analysis: VHL, PBRM1, BAP1, SETD2, and KDM5C. Overall survival (OS) was estimated using the Kaplan-Meier method and the log-rank test was used for comparisons between groups.Results
Median OS in the cohort was 2.5 years. Higher Fuhrman grade was associated with decreased median OS (P<0.001). Mutations in SETD2 (P = 0.027) and KDM5C (P = 0.019) were associated with reduced risk of death (hazard ratio [HR] = 0.58 [95% CI: 0.35–0.94] and HR = 0.43 [95% CI: 0.22–0.85], respectively). BAP1 mutations (P = 0.008) were associated with increased risk of death (HR = 1.81 [95% CI: 1.16–2.83]). There were significantly more female patients with a BAP1 mutation than females in the overall cohort (P = 0.001).Conclusions
Mutations in BAP1 negatively affected OS, whereas SETD2 and KDM5C mutations were associated with prolonged OS in our pooled cohort of 167 patients with metastatic ccRCC. Our results expand upon efforts at understanding genomic biomarkers in localized disease. Those efforts set the stage for our novel investigation examining associations of select recurrent somatic mutations in stage IV patients with ccRCC. 相似文献11.
Adam B. Weiner Mary-Kate Keeter Adarsh Manjunath Joshua J. Meeks 《Urologic oncology》2018,36(5):237.e9-237.e17
Introduction
We sought to characterize national disparities in the diagnosis of advanced stage bladder cancer. Among patients with advanced disease, we explored disparities in overall survival, treatment, and time to treatment.Methods and materials
We queried the National Cancer Data Base for patients diagnosed with bladder urothelial carcinoma. We used multivariable logistic regression to assess the association between covariates and diagnosis of advanced disease (AJCC stage III–IV). We used Kaplan-Meier, log-rank, and Cox proportional analyses to evaluate disparities in overall survival for patients with advanced disease. Receipt of treatment and delays to treatment were compared between subgroups.Results
Among our cohort of 328,560 patients, 7.6% were diagnosed with advanced disease. Female sex, black race, Hispanic ethnicity, and living in a region of lower income and education were all associated with increased odds of advanced disease. Female sex (HR = 1.16; 95% CI: 1.12–1.20; P<0.001), black race (HR = 1.10; 95% CI: 1.04–1.18; P = 0.002), and lower regional income levels (fourth quartile compared to first: HR = 1.08; 95% CI: 1.02–1.16; P = 0.016) portended worse overall survival. Chemotherapy (HR = 0.55, 95% CI: 0.53–0.57; P<0.001) and radical cystectomy (HR = 0.61; 95% CI: 0.59–0.64, P<0.001) improved survival. Females, black patients, and patients from regions of lower income and education were less likely to receive treatment and less likely to receive treatment within 12 weeks of diagnosis.Conclusion
There are several disparities in the diagnosis and treatment of advanced bladder cancer. Overall survival for certain groups may benefit from earlier diagnosis and improved timely access to potentially life prolonging treatment. 相似文献12.
Mari Ohtaka Yasuhide Miyoshi Takashi Kawahara Shinji Ohtake Masato Yasui Koichi Uemura Shuko Yoneyama Yusuke Hattori Jun-ichi Teranishi Yumiko Yokomizo Hiroji Uemura Hiroshi Miyamoto Masahiro Yao 《Urologic oncology》2017,35(10):607.e9-607.e14
Objectives
Recent studies have demonstrated that up-front docetaxel combined with androgen deprivation therapy (ADT) prolongs survival in some patients with metastatic hormone-naïve prostate cancer (mHNPC). However, new biomarkers for selecting personalized treatment strategies for mHNPC are warranted. We evaluated the value of low-molecular-weight protein tyrosine phosphatase (LMW-PTP) expression as a prognosticator in men with mHNPC.Methods and materials
A total of 48 men with mHNPC diagnosed from 2003 to 2009 were enrolled in this study. Prostate cancer tissues obtained by needle biopsies were immunohistochemically stained for LMW-PTP. Correlations between LMW-PTP expression and clinicopathological characteristics were then assessed.Results
At the time of analysis, 29 (60.4%) patients were alive, whereas 15 (31.3%) and 4 (8.3%) died of prostate cancer and nonprostate cancer, respectively. Of these, 29 (60.4%) had low LMW-PTP expression and 19 (39.6%) had high expression. Median overall survival (OS) for patients with high LMW-PTP expression was not reached and that for patients with low LMW-PTP expression was 23.8 months. High LMW-PTP expression was significantly correlated with a shorter OS compared with low LMW-PTP expression (P = 0.01). Moreover, multivariate analysis showed that Gleason score (≥8 vs.≤7; HR = 5.8, 95% CI: 1.3–26.5, P = 0.02) and LMW-PTP expression (high vs. low; HR = 2.7, 95% CI: 1.0–7.2, P = 0.04) were independent prognostic factors for OS.Conclusions
LMW-PTP is a potential biomarker to predict OS in patients with mHNPC. 相似文献13.
Fan Zhang Yongpeng Xie Xin Ma Liangyou Gu Hongzhao Li Xintao Li Gang Guo Xu Zhang 《Urologic oncology》2019,37(3):184.e9-184.e17
Objectives
We aimed to explore the prognostic value of preoperative apolipoprotein B/apolipoprotein A1 (Apo B/A1) ratio in metastatic renal cell carcinoma (mRCC).Materials and methods
Between January 2006 and December 2016, patients with mRCC who underwent cytoreductive nephrectomy at the Chinese PLA General Hospital were enrolled. The clinical-pathological parameters were collected retrospectively, and the preoperative Apo B/A1 ratios of two different subgroups were compared. The cut-off value was determined with the receiver operating characteristic (ROC) curve. The value of preoperative Apo B/A1 ratio on oncological outcome was determined through Kaplan–Meier survival analysis and Cox regression analysis.Results
A total of 287 mRCC patients were enrolled in this study. The median postoperative follow-up time was 27.8 months (IQR, 12.5–58.6 months). The Apo B/A1 ratio was higher in the high Fuhrman grade (G3 and G4) group than that in the low Fuhrman grade (G1 and G2) group (P?=?0.010). The area under the curve values of the ROC curves were 0.613 for progression-free survival (PFS) (P?=?0.005) and 0.607 for overall survival (OS) (P?=?0.004). The optimal cut-off values of Apo B/A1 ratio were 0.977 for PFS and 0.847 for OS. A high preoperative Apo B/A1 ratio (PFS ≥ 0.977; OS ≥ 0.847) was significantly associated with poor PFS (P < 0.0001) and OS (P?=?0.0005). Cox regression analyses showed that the Apo B/A1 ratio is an independent prognostic factor for PFS (hazard ratio [HR]?=?3.131; 95% confidence interval [CI]?=?2.249–4.360; P < 0.001) and OS (HR?=?2.173; 95% CI?=?1.533–3.080; P < 0.001).Conclusion
Preoperative Apo B/A1 ratio is an independent prognostic factor for PFS and OS in patients with mRCC. Preoperative Apo B/A1 ratio can be useful in improving current prognostic evaluation and treatment decision for patients with mRCC. 相似文献14.
Kyrollis Attalla David J. Paulucci Kyle Blum Harry Anastos Kelvin A. Moses Ketan K. Badani Philippe E. Spiess John P. Sfakianos 《Urologic oncology》2018,36(1):14.e17-14.e24
Objectives
To evaluate whether socioeconomic factors affect pathologic stage, treatment delays, pathologic upstaging, and overall survival (OS) in patients with penile cancer (PC).Patients and methods
A total of 13,283 eligible patients diagnosed with PC from 1998 to 2012 were identified from the National Cancer Database. Socioeconomic, demographic and pathologic variables were used in multivariable regression models to identify predictors of pathologic T stage ≥2, pathologic lymph node positivity, cT to pT upstaging, treatment delays, and OS.Results
A 5-year OS was 61.5% with a median follow-up of 41.7 months. Pathologic T stage ≥2 was identified in 3,521 patients (27.2%), 1,173 (9.2%) had ≥pN1 and 388 (7.9%) experienced cT to pT upstaging. Variables associated with a higher likelihood of pathologic T stage ≥2 included no insurance (OR = 1.79, P<0.001), lower higher education based on zip code (OR = 1.13, P = 0.027), black race (OR = 1.17, P = 0.046) and Hispanic ethnicity (OR = 1.66, P<0.001). Patients with Hispanic ethnicity (OR = 1.46; P<0.001) or living in nonmetropolitan areas were more likely to have ≥pN1 (P = 0.001). Lack of insurance was associated with cT to pT upstaging (OR = 2.05, P = 0.001) as was living in an urban vs. metropolitan area (OR = 1.35, P = 0.031). In addition to TNM stage, black vs. white race (HR = 1.56, P<0.001), living in an urban vs. metropolitan area (hazard ratio [HR] = 1.18, P = 0.022), age (HR = 1.04, P<0.001) and Charlson score (HR = 1.49, P<0.001) were associated with lower OS.Conclusion
Socioeconomic variables including no insurance, lower education, race, Hispanic ethnicity, and nonmetropolitan residence were found to be poor prognostic factors. Increased educational awareness of this rare disease may help reduce delays in diagnosis, improve prognosis and ultimately prevent deaths among socioeconomically disadvantaged men with PC. 相似文献15.
16.
Alejandro Berlin Julio F. Castro-Mesta Laura Rodriguez-Romo David Hernandez-Barajas Juan F. González-Guerrero Iván A. Rodríguez-Fernández Galileo González-Conchas Adrian Verdines-Perez Francisco E. Vera-Badillo 《Urologic oncology》2017,35(8):499-506
Background
Ki-67 for quantifying tumor proliferation is widely used. In localized prostate cancer (PCa), despite a suggested predictive role of Ki-67 for outcomes after therapies, it has not been incorporated into clinical practice. Herein, we conduct a systematic review and meta-analysis of the literature reporting the association of Ki-67 and disease outcomes in PCa treated radically.Methods
Medline and EMBASE databases were searched without date or language restrictions, using “KI67” and “prostate cancer” MeSH terms. Studies reporting Ki-67 association with clinical outcomes (disease-free survival [DFS], biochemical failure-free survival, rate of distant metastases [DM], disease-specific survival [DSS], or overall survival [OS], or all of these) in patients with PCa managed actively were included, and relevant data extracted by 2 independent reviewers. Odds ratios (OR) were weighted and pooled in a meta-analysis using Mantel-Haenszel random-effect modeling.Results
Twenty-one studies comprising 5,419 patients met eligibility for analysis, and 67.6% of patients had low Ki-67. Mean Ki-67 was 6.14%. High Ki-67 was strongly associated with worse clinical outcomes. DFS was better in those patients with low Ki-67 at 5 and 10 years (OR = 0.32, 95% CI: 0.23–0.44, P<0.00001; OR = 0.31, 95% CI: 0.20–0.48, P<0.00001). Similarly, low Ki-67 was related to improved DSS at 5 and 10 years (OR = 0.15, 95% CI: 0.10–0.21, P<0.00001; OR = 0.16, 95% CI: 0.06–0.40, P<0.00001). Association between low Ki-67 scores with improved OS (OR = 0.47; 95% CI: 0.37–0.61; P<0.00001) and high Ki-67 scores with DM at 5 years (OR = 4.07; 95% CI: 2.52–6.58; P<0.00001) was consistently observed.Conclusions
High Ki-67 expression in localized PCa is a factor of poor prognosis for DSS, biochemical failure-free survival, DFS, DM, and OS after curative-intent treatments. Incorporation into clinical routine of this widely available and standardized biomarker should be strongly considered. 相似文献17.
João Lobo Ângelo Rodrigues Luís Antunes Inês Graça João Ramalho-Carvalho Filipa Quintela Vieira Ana Teresa Martins Jorge Oliveira Carmen Jerónimo Rui Henrique 《Urologic oncology》2018,36(4):161.e7-161.e17
Introduction
Overtreatment is a major concern in patients with prostate cancer (PCa). Prognostic biomarkers discriminating indolent from aggressive disease in prostate biopsy are urgently needed. We aimed to evaluate the prognostic value of Ki67, EZH2, LSD1, and SMYD3 immunoexpression in diagnostic biopsies from a cohort of PCa patients with long term follow-up.Materials and methods
A series of 189 consecutive prostate biopsies diagnosed with PCa (1997–2001) in a cancer center was included in the study, with follow-up last updated in November 2016. Biopsies were reviewed and graded according to 2016 WHO criteria. Immunohistochemistry was performed in the most representative block. Nuclear staining was assessed using digital image analysis. Study outcomes included disease-specific, disease-free, and progression-free survival. Statistical analysis was tabulated using SPSS version 22.0. Survival curves and hazard ratios (HRs) were estimated using Kaplan-Meyer and Cox-regression models, respectively. Statistical significance was set at P<0.05.Results
The proportion of patients who completed the study was 177/189 (94%). In univariable analysis, high Ki67, EZH2, and SMYD3 immunoexpression associated with significantly worse disease-specific survival (HR = 1.86, 95% CI: 1.05–3.29; HR = 1.87, 95% CI: 1.10–3.27; HR = 2.68, 95% CI: 1.02–7.92). In multivariable analysis, the 3 biomarkers displayed significantly worse DSS adjusted for CAPRA score (HR = 1.78, 95% CI: 1.01–3.16; HR = 1.93, 95% CI: 1.12–3.32; HR = 2.71, 95% CI: 1.04–7.10). Among patients with low/intermediate risk CAPRA score, high Ki67 immunoexpression identified those more prone to experience disease recurrence (HR = 9.20, 95% CI: 1.27–66.44) and progression (HR = 2.97, 95% CI: 1.05–8.43).Conclusions
High Ki67, EZH2, and SMYD3 immunoexpression, adjusted for standard clinicopathological parameters, independently predicts outcome in patients with PCa, at diagnosis. This might assist in discriminating indolent from aggressive PCa, improving treatment selection. 相似文献18.
Ross E. Krasnow Dayron Rodríguez Ramzy T. Nagle Matthew Mossanen Adam S. Kibel Steven L. Chang 《Urologic oncology》2018,36(11):500.e11-500.e19
Purpose
There is a known increased risk of second primary malignancy (SPM) in patients with prostate cancer (CaP) treated with radiotherapy (RT). It is unclear how age at diagnosis influences the risk of SPMs.Materials and methods
Using the 1973 to 2013 Surveillance, Epidemiology, and End Results Program, we studied the impact of age on SPMs (defined as a bladder or rectal tumor) after localized CaP treatment with radical prostatectomy (RP) or RT. SPM risk was compared using inverse probability of treatment weighting (IPTW)-adjusted cumulative incidence function and competing-risk proportional hazard models. Overall survival (OS) in patients with SPM was compared using Kaplan Meier and Cox regression analyses.Results
A total of 579,608 patients met inclusion criteria, and 51.8% of the cohort was treated with RT. The 10- and 20-year cumulative incidences of competing risk (IPTW adjusted) of SPMs were 1.9% (95%CI = 1.8–1.9%) and 3.6% (95%CI = 3.4–3.7%) after RP vs. 2.7% (95%CI = 2.6–2.8%) and 5.4%(95%CI = 5.3–5.6%) after RT. IPTW-adjusted competing risk hazard ratio (HR) of SPM after RT compared to RP was increased in the entire cohort (HR 1.46; 95%CI = 1.39–1.53, P < 0.001) and was highest in the youngest patients: Age <55 HR = 1.83 (95% confidence interval [CI] = 1.49–2.24, P<0.001), Age 55 to 64 HR = 1.66 (95%CI = 1.54–1.79, P < 0.001), Age 65–74 HR = 1.41 (95%CI = 1.33–1.48, P < 0.001), Age ≥75 HR = 1.14 (95%CI = 0.97–1.35, P = 0.112). At 10 years, SPM-specific mortality occurred in 28.9% of patients treated with RT, though OS with SPM was worse in the youngest patients: Age <55 HR = 1.88 (95%CI = 1.25–2.81, P = 0.002), Age 55–64 HR = 1.60 (95%CI = 1.42–1.81, P < 0.001), Age 65–74 HR = 1.40 (95%CI = 1.30–1.52, P < 0.001), Age ≥ 75 HR = 1.27 (95%CI = 1.06–1.53, P = 0.009). All of the age categories had similar median follow-up times.Conclusion
At 10 years there is a 1.8% increased incidence of SPM after RT compared to RP, of which <30% of RT-treated patients with an SPM die as a result of a SPM. However, the risk of SPMs was greatest among younger men treated with RT for localized CaP, and this relationship could not be explained solely by follow-up time, latency time, or life expectancy. An improved understanding of those at the highest risk of SPMs may help tailor treatment and surveillance strategies. 相似文献19.
Karim A. Touijer Robert Jeffery Karnes Niccolo Passoni Daniel D. Sjoberg Melissa Assel Nicola Fossati Giorgio Gandaglia James A. Eastham Peter T. Scardino Andrew Vickers Cesare Cozzarini Francesco Montorsi Alberto Briganti 《European urology》2018,73(6):890-896
Background
Optimal management of patients with lymph node metastasis (LNM) after radical prostatectomy (RP) remains undefined.Objective
We evaluated the association between three different management strategies and survival in prostate cancer with LNM after RP.Design, setting, and participants
We analyzed data of 1338 patients with LNM after RP from three tertiary care centers. Three hundred and eighty-seven patients (28%) were observed, 676 (49%) received lifelong adjuvant androgen deprivation therapy (ADT), and 325 (23%) received adjuvant external beam radiation therapy (EBRT) and ADT. Three hundred and sixty-eight men were followed for more than 10 yr.Outcome measurements and statistical analysis
Primary outcome measure was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS) and other-cause mortality. Kaplan-Meier methods were used to visualize OS for the three treatment groups. Cox proportional hazards regression was utilized to compare OS and CSS among the three groups.Results and limitations
ADT + EBRT was associated with better OS than ADT alone (hazard ratio [HR]: 0.46, 95% confidence interval [CI]: 0.32–0.66, p < 0.0001) or observation (HR: 0.41, 95% CI: 0.27–0.64, p < 0.0001). Higher-risk patients benefited more from ADT + EBRT than lower-risk patients. Ten-year mortality risk difference between ADT + EBRT, observation, or ADT alone ranged from 5% in low-risk patients to 40% in high-risk patients. Adjuvant ADT + EBRT was also associated with better CSS than observation or ADT alone (p < 0.0001), ADT had better CSS compared to observation (HR: 0.64, 95% CI: 0.43–0.95, p = 0.027). However, ADT was associated with an increased risk of other-cause mortality (HR: 3.05, 95% CI: 1.45–6.40, p = 0.003) compared with observation, resulting in similar OS between ADT and observation (HR: 0.90, 95% CI: 0.65–1.25, p = 0.5). While selection bias might remain, its effect would operate in the opposite direction to our findings.Conclusions
In men with LNM after RP, ADT + EBRT improved survival over either observation or adjuvant ADT alone. This survival benefit increases with higher-risk disease.Patient summary
Lymph node metastasis following radical prostatectomy is associated with poor survival outcomes. However, we found that adjuvant androgen deprivation therapy with external beam radiation therapy improved survival in these patients. 相似文献20.
Emily McCracken G. Craig Wood Wesley Prichard Bruce Bistrian Christopher Still Glenn Gerhard David Rolston Peter Benotti 《Surgery for obesity and related diseases》2018,14(7):902-909