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1.
Victor S. Chen Robert Abouassaly Christopher M. Gonzalez Alexander Kutikov Marc C. Smaldone Neal J. Meropol Sarah P. Psutka Stephen B. Williams Rebecca O’Malley Hillary M. Sedlacek Simon P. Kim 《Urologic oncology》2017,35(11):662.e17-662.e21
Objective
To assess the relationship of race and margin status among patients undergoing robotic partial nephrectomy (RPN) for T1 renal tumors from a contemporary population-based cohort.Methods
Using the National Cancer Database, we identified patients with localized renal cell carcinoma (RCC) (clinical T1N0M0) who underwent RPN from 2010 to 2013. The primary outcome was positive surgical margins (PSM). Multivariable logistic regression analyses were used to assess the association between race and PSM adjusting for patient clinicopathologic and hospital factors.Results
Among 12,515 patients undergoing RPN in our cohort, 8.3% had PSM (n = 1,045). When compared to white patients undergoing RPN for T1 RCC with PSM (7.9%), we observed a higher proportion of PSM among African American (AA) (10.8%; P = 0.005) and Hispanic/Latino patients (8.8%; P = 0.005), respectively. On multivariable analysis, AA patients had higher odds of PSM compared to white patients (odds ratio = 1.40; P = 0.008). Other factors associated with higher odds of PSM were treatment at nonacademic centers relative to academic centers (10.4% vs. 6.9%; odds ratio = 1.57; P<0.001).Conclusions
In this contemporary population-based cohort, AA patients undergoing RPN for localized RCC tumors are at higher risk for PSM. These results suggest potential differences in quality of care and patient selection of RPN by race. 相似文献2.
Arjun Sivaraman Rafael Sanchez-Salas Dominique Prapotnich Kaixin Yu Fabien Olivier Fernando P. Secin Eric Barret Marc Galiano François Rozet Xavier Cathelineau 《Urologic oncology》2017,35(4):149.e1-149.e6
Background and objective
The primary objective was to evaluate the learning curve of minimally invasive radical prostatectomy (MIRP) in our institution and analyze the salient learning curve transition points regarding oncological outcomes.Methods
Clinical, pathologic, and oncological outcome data were collected from our prospectively collected MIRP database to estimate positive surgical margin (PSM) and biochemical recurrence (BCR) trends during a 15-year period from 1998 to 2013. All the radical prostatectomies (laparoscopic prostatectomy [LRP]/robot-assisted laparoscopic radical prostatectomy [RARP]) were performed by 9 surgeons. PSM was defined as presence of cancer cells at inked margins. BCR was defined as serum prostate-specific antigen >0.2 ng/ml and rising or start of secondary therapy. Surgical learning curve was assessed with the application of Kaplan-Meier curves, Cox regression model, cumulative summation, and logistic model to define the “transition point” of surgical improvement.Results
We identified 5,547 patients with localized prostate cancer treated with MIRP (3,846 LRP and 1,701 RARP). Patient characteristics of LRP and RARP were similar. The overall risk of PSM in LRP was 25%, 20%, and 17% for the first 50, 50 to 350, and>350 cases, respectively. For the same population, the 5-year BCR rate decreased from 30% to 16.7%. RARP started 3 years after the LRP program (after approximately 250 LRP). The PSM rate for RARP decreased from 21.8% to 20.4% and the corresponding 5-year BCR rate decreased from 17.6% to 7.9%. The cumulative summation analysis showed significantly lower PSM and BCR at 2 years occurred at the transition point of 350 cases for LRP and 100 cases for RARP. In multivariable analysis, predictors of BCR were prostate-specific antigen, Gleason score, extraprostatic disease, seminal vesicle invasion, and number of operations (P<0.05). Patients harboring PSM showed higher BCR risk (23% vs. 8%, P< 0.05).Conclusions
Learning curve trends in our large, single-center experience show correlation between surgical experience and oncological outcomes in MIRP. Significant reduction in PSM and BCR risk at 2 years is noted after the initial 350 cases and 100 cases of LRP and RARP, respectively. 相似文献3.
Michael J. Metcalfe Marc C. Smaldone Daniel W. Lin Ana M. Aparicio Brian F. Chapin 《Urologic oncology》2017,35(4):125-134
Context
Recent demonstration of efficacy with the use of chemohormonal therapy for men with metastatic prostate cancer (mPCa) has expanded the therapeutic options for these patients. Furthermore, multimodal therapy to treat systemic disease in the context of locoregional control has gained increasing interest. Concomitantly, the role of radical prostatectomy (RP) in multimodal treatment for locally advanced prostate cancer is expanding. As a result, there is interest in investigating the potential benefit of cytoreductive RP in mPCa.Objective
To review the literature regarding the role of cytoreductive prostatectomy in the setting of mPCa.Evidence acquisition
MEDLINE and PubMed electronic databases were queried for English language articles related to patients with mPCa who underwent RP from January 1990 to June 2016. Key words used in our search included cytoreductive prostatectomy, radical prostatectomy, and metastatic prostate cancer. Preclinical, retrospective, and prospective studies were included.Evidence synthesis
There are no published randomized control trials examining the role of cytoreduction in mPCa. Local symptoms are high in mPCa and often provide a necessity for palliative procedures with the impact on oncologic outcomes being uncertain. Recently, preclinical and retrospective population-based data suggest a benefit from treatment of the primary tumor in metastatic disease. Potential mechanisms mediating this benefit include prevention of symptomatic local progression and modulation of disease biology, resulting in an improvement in progression-free and overall survival. Current literature supports the feasibility of cytoreductive prostatectomy as it is associated with acceptable side effects that are comparable to RP for high-risk localized disease. In aggregate, these data compel prospective evaluation of the hypothesis that cytoreductive prostatectomy improves the outcome of men with mPCa.Conclusions
Cytoreductive prostatectomy in mPCa is a feasible procedure that may improve outcomes for men when combined with multimodal management. Preclinical, translational, and retrospective evidence supports local therapy for metastatic disease. However, currently, evidence is limited and is subject to bias. The results of ongoing prospective randomized trials are required before incorporating this therapeutic strategy into clinical practice. 相似文献4.
Nicola Fossati Martina Sofia Rossi Vito Cucchiara Giorgio Gandaglia Paolo Dell’Oglio Marco Moschini Nazareno Suardi Federico Dehò Francesco Montorsi Riccardo Schiavina Alexandre Mottrie Alberto Briganti 《Urologic oncology》2017,35(4):150.e9-150.e15
Objective
To test the prognostic role of treatment delay in patients affected by prostate cancer (PCa).Materials and methods
The study included 2,653 patients treated with radical prostatectomy (RP) at a single institution between 2006 and 2011. The evaluated outcomes were biochemical recurrence (BCR) and clinical recurrence (CR). Multivariable Cox regression analysis was used to test the association between time from diagnosis to RP and oncological outcomes. Nonparametric curve fitting methods were used to graphically explore the relationship between time from diagnosis to RP and oncological outcomes. Sensitivity analyses were repeated in the subgroups of low-, intermediate-, and high-risk patients.Results
At median follow-up of 56 months (interquartile range: 26, 92), 283 patients experienced BCR, and 84 patients developed CR. Median time from PCa diagnosis to surgery was 2.8 months (interquartile range: 1.6, 4.7). At multivariable Cox regression analysis, time from biopsy to RP was significantly associated with an increased risk of BCR (hazard ratio = 1.02, P = 0.0005) and CR (hazard ratio = 1.03, P = 0.0002). Using Nonparametric curve fitting methods, a significant increased risk of BCR and CR after approximately 18 months was observed. However, when sensitivity analyses were repeated according to risk groups, this effect was maintained in high-risk patients only, and such time interval was reduced to 12 months.Conclusions
Despite the overall trend on higher rate of cancer relapse after RP, the effect of treatment delay from biopsy to RP was significantly evident in high-risk patients only. Even in high-risk patients surgical treatment can be postponed safely, but not beyond the 12-month landmark. 相似文献5.
Daniel C. Parker Elizabeth Handorf Marc C. Smaldone Robert G. Uzzo Henry Pitt Adam C. Reese 《Urologic oncology》2017,35(12):670.e1-670.e6
Purpose
Racial disparities in complication rates have been demonstrated for a variety of surgical procedures. We hypothesized that African American (AA) patients experience higher postoperative complication rates than whites following urologic oncology procedures.Materials and methods
Patients in American College of Surgeons National Surgical Quality Improvement Program who underwent radical prostatectomy (RP), radical or partial nephrectomy (RN/PN), and radical cystectomy (RC) between 2005 and 2013 were included. Complications were grouped as minor (Clavien I–II), major (Clavien III–IV), or death (Clavien V). A 30-day complication rates and disparities in preoperative comorbidity burden were compared by race. After adjustment for comorbidity burden, multivariable logistic regression was performed to test the association between race and risk of complication.Results
Of 38,642 patients included in the analysis, 90% were white and 10% were AA. In unadjusted analysis, there were no significant differences in complication rates between AA and white patients for any Clavien grade in the procedures queried (RP: P = 0.07; RN/PN: P = 0.70; RC: P = 0.12). After controlling for a higher comorbidity burden among AA patients, AA race was again not independently associated with 30-day postoperative complications for RP (odds ratio [OR] = 1.08, 95% CI: 0.92–1.29), RN/PN (OR = 0.98, 95% CI: 0.84–1.13), or RC (OR = 1.10, 95% CI: 0.84–1.43).Conclusion
Despite a higher comorbidity burden, AA patients in American College of Surgeons National Surgical Quality Improvement Program are not at increased risk of 30-day postoperative complications following major urologic cancer surgery. These findings suggest that comorbidity burden, as opposed to race, is most strongly associated with the risk of postoperative complications. To minimize perioperative risk, clinicians should strive to preoperatively optimize medical comorbidities in all patients undergoing urologic cancer surgery. 相似文献6.
Satya R. Khare Armen Aprikian Peter Black Normand Blais Chris Booth Fadi Brimo Joseph Chin Peter Chung Darrel Drachenberg Libni Eapen Adrian Fairey Neil Fleshner Yves Fradet Geoffrey Gotto Jonathan Izawa Michael Jewett Girish Kulkarni Louis Lacombe Wassim Kassouf 《Urologic oncology》2017,35(6):328-334
Background
Survival in patients with bladder cancer has only moderately improved over the past 2 decades. A potential reason for this is nonadherence to clinical guidelines and best practice, leading to wide variations in care. Common quality indicators (QIs) are needed to quantify adherence to best practice and provide data for benchmarking and quality improvement.Objective
To produce an evidence- and consensus-based list of QIs for the management of bladder cancer.Methods
A modified Delphi method was used to develop the indicator list. Candidate indicators were extracted from the literature and rated by a 27-member Canadian expert panel in several rounds until consensus was reached on the final list of indicators. In rounds with numeric ratings, a frequency analysis was performed.Results
A total of 86 indicators were rated, 52 extracted from the literature and 34 suggested by the panel. After iterative rounds of ratings and discussion, a final list of 60 QIs spanning several disciplines and phases of the cancer care continuum was developed.Conclusions
This is the first study to comprehensively produce common QIs representing structure, process, and outcome measures in bladder cancer management. Though developed in Canada, these indicators can be used in other countries with slight modifications to track performance and improve care. 相似文献7.
Hung-Jui Tan Timothy J. Daskivich Joseph D. Shirk Christopher P. Filson Mark S. Litwin Jim C. Hu 《Urologic oncology》2017,35(4):153.e7-153.e14
Introduction
The long-term benefits of nephron-sparing surgery for kidney cancer depend on patient health. Accordingly, we examined whether receipt of partial nephrectomy varied with baseline comorbidity or functionality among older adults with stage I kidney cancer.Materials and methods
Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 to 2009, we identified patients treated with partial or radical nephrectomy for stage I kidney cancer. We examined treatment trends according to baseline comorbidity, function, and relevant health conditions. We then estimated the probability of partial nephrectomy using multivariable, mixed-effects models adjusting for patient, surgeon, and hospital characteristics.Results
Overall, 2,956 of 11,678 patients (25.3%) underwent treatment with partial nephrectomy. Receipt of partial nephrectomy was associated with younger age, male sex, higher socioeconomic position, smaller tumor size, and treatment by a high-volume provider, cancer center, or academic institution (P<0.001). During the study period, utilization increased significantly (P<0.001) but did not differ according to comorbidity or patient function. Adjusting for patient, surgeon, and hospital characteristics, the probability of partial nephrectomy by comorbidity and function categories remained within a narrow range from 19.6% to 22.8%. Only preexisting kidney disease appeared to be linked to partial nephrectomy usage (odds ratio = 1.49, 95% CI: 1.33–1.66).Conclusion
With the exception of kidney disease, the increasing use of partial nephrectomy did not vary with respect to health status. As the potential benefits of partial nephrectomy differ according to a patient?s underlying health, selection tools and algorithms that match treatment to patient comorbidity or function may be needed to optimize kidney cancer care in the United States. 相似文献8.
Ying-Chu Lin Tzyh-Chyuan Hour Yu-Chieh Tsai Shu-Pin Huang Wen-Jeng Wu Chung-Hsin Chen Yeong-Shiau Pu Shiu-Dong Chung Chao-Yuan Huang 《Urologic oncology》2017,35(9):543.e7-543.e16
Objective
Our aims were to investigate the correlations between polymorphisms in the cell cycle regulatory genes (aurora kinase A [AURKA], survivin, p21, and p53) and UC risk and prognosis.Patients and methods
This study recruited 185 patients with UTUC, 46 patients with bladder cancer, and 188 hospital controls. Demographic data and possible confounding factors were collected using a standardized questionnaire. Genotyping was determined by real-time polymerase chain reaction and TaqMan probe methods.Results
Compared to the UTUC group, the control group had significantly more alcohol drinkers and coffee drinkers but not cigarette smokers. Statistical analyses showed that UTUC risk correlated with AURKA rs2273535 (adjusted odds ratio = 2.51, 95% CI = 1.07–6.15) and with survivin rs9904341 (adjusted odds ratio = 1.82, 95% CI = 1.03–3.26) polymorphisms but not with p21 and p53 polymorphisms. The bladder cancer risk showed no significant correlations with the 4 polymorphisms. In both the UTUC and UC groups, disease-free survival and overall survival were significantly longer in patients with the rs1801270CC genotype compared to those with CA+AA genotypes. Poor prognosis did not correlate with polymorphisms in AURKA, survivin, and p53 genes.Conclusion
These results suggest that cell cycle regulatory gene polymorphisms rs2273535 and rs9904341 may contribute to UTUC susceptibility; gene polymorphism rs1801270 may contribute to prognosis of UTUC and prognosis of UC. The p53 polymorphisms may not correlate with UTUC susceptibility and prognosis of UTUC or UC. Further well-designed, large-scale studies are needed to clarify these findings. 相似文献9.
Isaiah Levy Mark Finkelstein Khawaja Hassan Bilal Michael Palese 《Urologic oncology》2017,35(6):425-431
Objective
To determine the effect of frailty on patient outcomes including any complication, Clavien-Dindo IV (CDIV) (intensive care unit-level) complications, and 30-day mortality for robotic-assisted radical prostatectomies (RARP) patients in comparison to other predictive indices using the modified frailty index (mFI).Material and methods
Patients undergoing RARP from 2008 to 2014 for a prostate cancer–related diagnosis were queried using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The mFI was developed using the Canadian Study of Health and Aging Frailty Index as a model. The mFI was compared with other associative indices such as the American Society of Anesthesiology (ASA) classification and the Charlson comorbidity index (CCI). Rates of CDIV complications and 30-day mortality were analyzed based on mFI score using SAS version 9.22.Results
A total of 23,104 patients undergoing RARP were queried. RARP patients with the highest frailty score (≥3) had an adjusted odds for CDIV complications of Odds ratio of 12.107 (CI: 2.800–52.351, P< 0.005) in comparison with nonfrail RARP patients. These odds were higher than the ASA and Charlson comorbidity index. Additionally, a variable combining mFI and ASA had fair sensitivity and specificity for predicting 30-day mortality in RARP patients (C-statistic = 0.7097, P<0.0001).Conclusion
Increasing mFI scores are associated with worsening outcomes for patients undergoing RARP. A combined mFI and ASA variable can be used to predict 30-day mortality for RARP patients better than mFI or ASA alone. 相似文献10.
Yash S. Khandwala In Gab Jeong Jae Heon Kim Deok Hyun Han Shufeng Li Ye Wang Steven L. Chang Benjamin I. Chung 《Urologic oncology》2017,35(12):672.e7-672.e13
Purpose
Partial nephrectomy (PN) remains underutilized within the United States and few reports have attempted to explain this trend. The aim of this study is to evaluate the nationwide incidence of unsuccessful PN and factors that predict its occurrence.Methods
Using the Premier Healthcare Database, we retrospectively analyzed a weighted sample of 66,432 patients undergoing curative surgery for renal mass between 2003 and 2015. PN intent was denoted by presence of insurance claims for the administration of mannitol. Unsuccessful PN was defined as an event in which patients were administered mannitol but received radical nephrectomy. A multivariate logistic regression model was generated to identify factors predicting unsuccessful PN.Results
Overall rates of unsuccessful PN declined from 33.5% to 14.5% since 2003. Conversion to radical nephrectomy occurred most frequently during laparoscopic (34.7%) and least frequently during robotic approach (13.6%). There was significant difference in the rate of unsuccessful PN between very high and very low volume surgeons (open: 39.4% vs. 13.3%, laparoscopic: 51.2% vs. 32.2%, and robot assisted: 27.1% vs. 9.4%, all P<0.001). After adjustment for patient- and hospital-related factors, surgical approach (laparoscopic vs. open, odds ratio = 1.74, 95% CI: 1.31–2.30, P<0.001) and annual surgeon volume (very high vs. very low, odds ratio = 0.27, 95% CI: 0.21–0.34 P<0.001) were associated with unsuccessful PN.Conclusions
Although the rate of unsuccessful PN appears to be declining, it still remains common for low volume surgeons and with the laparoscopic surgical approach. Further evaluation of its effect on health care outcomes is necessary. 相似文献11.
Introduction
The role of percutaneous biopsy to characterize large, locally advanced and metastatic primary renal tumors has not been well described. The goal of this article is to describe the potential advantages of biopsy for preoperative evaluation of patients with large renal tumors and advanced disease.Methods
Literature was reviewed for percutaneous biopsy and for locally advanced and metastatic renal tumors.Results
Multiple studies have confirmed that percutaneous biopsy is safe, and the cost is minimal relative to the cost of surgical operation. Biopsy of large masses should obtain multiple core samples from several sites with tumors to decrease error from sampling heterogeneous tumors.Conclusions
Potential advantages of biopsy for large renal masses include identification of patients for retroperitoneal lymph node dissection who may have occult lymph node metastasis. In patients with metastatic renal cell carcinoma, biopsy characterizes tumors for patients who may not benefit from cytoreductive surgical operation. The role of biopsy is likely to expand in the future with the development of advanced molecular tools for risk stratification. 相似文献12.
Background and objective
Erectile dysfunction is one of the complications occurring after radical prostatectomy (RP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVB).We evaluated the significance of NVB area on functional outcomes after RP.Materials and methods
Preoperative magnetic resonance imaging was performed on 141 patients who underwent bilateral, nerve-sparing, robot-assisted RP for clinically localized prostate cancer (clinically T2N0M0 on magnetic resonance imaging) and were evaluated at least 12 months after surgery. NVB area was measured as a region of interest that coincided with the outline of the maximum area of the posterolateral region of the prostate on T2-weighted axial imaging. Factors associated with functional outcomes were evaluated using logistic regression analysis.Results
Of 141 patients, 36 patients (25.5%) had no preoperative potency (group 1), 66 patients (46.8%) recovered potency (group 2), and 39 patients (27.7%) did not recover potency (group 3). Although the mean age of the entire cohort was 65.4 years, the mean age of group 1 was greater than groups 2 and 3 (P = 0.001). The NVB area of group 2 was larger than those of groups 1 and 3 (P = 0.001). Potency evaluations involved 105 patients (74.5%; groups 2 and 3), and patients with pre-existing erectile dysfunction were excluded. The median time to potency recovery was 3.0 months after surgery. The multivariable analysis revealed that the NVB area was the only significant factor predictive of potency recovery.Conclusions
The NVB area in the posterolateral region of the prostate is an independent factor for predicting potency recovery. The degree of postoperative erectile function can be predicted based on the preoperative NVB area. 相似文献13.
Randi H. Goldman Ruth E. Tuomala Joan M. Bengtson Amy R. Stagg 《Journal of Surgical Education》2017,74(1):68-73
Objective
Assessment tools that accrue data for the Accreditation Council for Graduate Medical Education Milestones must evaluate residents across multiple dimensions, including medical knowledge, procedural skills, teaching, and professionalism. Our objectives were to: (1) develop an assessment tool to evaluate resident performance in accordance with the Milestones and (2) review trends in resident achievements during the inaugural year of Milestone implementation.Design
A novel venue and postgraduate year (PGY) specific assessment tool was built, tested, and implemented for both operating room and labor and delivery “venues.” Resident development of competence and independence was captured over time. To account for variable rotation schedules, the year was divided into thirds and compared using two-tailed Fisher’s exact test.Setting
Brigham and Women’s and Massachusetts General Hospitals, Boston MA.Participants
Faculty evaluators and obstetrics and gynecology residents.Results
A total of 822 assessments of 44 residents were completed between 9/2014 and 6/2015. The percentage of labor and delivery tasks completed “independently” increased monotonically across the start of all years: 8.4% for PGY-1, 60.3% for PGY-2, 73.7% for PGY-3, and 87.5% for PGY-4. Assessments of PGY-1 residents demonstrated a significant shift toward “with minimal supervision” and “independent” for the management of normal labor (p = 0.03). PGY-3 residents demonstrated an increase in “able to be primary surgeon” in the operating room, from 36% of the time in the first 2/3 of the year, to 62.3% in the last 1/3 (p < 0.01).Conclusion
Assessment tools developed to assist with Milestone assignments capture the growth of residents over time and demonstrate quantifiable differences in achievements between PGY classes. These tools will allow for targeted teaching opportunities for both individual residents and residency programs. 相似文献14.
Ejaculatory frequency and the risk of aggressive prostate cancer: Findings from a case-control study
Nathan P. Papa Robert J. MacInnis Dallas R. English Damien Bolton Ian D. Davis Nathan Lawrentschuk Jeremy L. Millar John Pedersen Gianluca Severi Melissa C. Southey John L. Hopper Graham G. Giles 《Urologic oncology》2017,35(8):530.e7-530.e13
Objectives
Recent literature reports inverse associations with ejaculator frequency and prostate cancer (PC). We sought to explore the relationship between ejaculatory frequency from ages 20 to 50 and subsequent development of aggressive PC.Material and methods
We conducted a case-control study sampling 2,141 men from private urology practices in Victoria, Australia. Cases were defined as men with high grade or high stage PC and controls being biopsy negative men. Ejaculation frequency recalled at age decades 20, 30, and 40 second was assessed by questionnaire. Unconditional multivariable logistic regression models were used to generate odds ratios (ORs).Results
An inverse association with ejaculatory frequency at age 30 to 39 was observed (OR per 5-unit increase per week = 0.83, 95% CI: 0.72–0.96) but not at ages 20 to 29 (OR = 1.01, 95% CI: 0.89–1.14) or ages 40 to 49 (OR = 0.95, 95% CI: 0.81–1.12). This result differed between men with new sexual partners after age 30 (OR = 0.77, P = 0.009) and those with no new partners (OR = 0.97, P = 0.8) though the test for a difference between these estimates was not significant (P = 0.11).Conclusion
We found only weak evidence of an inverse association between ejaculatory frequency in the fourth decade of life and advanced PC, which was not significantly modified by number of new sexual partners. No relationship was found for ejaculatory frequency in the third and fifth decades of life. 相似文献15.
Thenappan Chandrasekar Zachary Klaassen Hanan Goldberg Girish S. Kulkarni Robert J. Hamilton Neil E. Fleshner 《Urologic oncology》2017,35(11):661.e7-661.e14
Objective
To assess the patterns and predictors of metastatic disease in renal cell carcinoma (RCC) at the time of diagnosis in a contemporary series.Methods
The Surveillance, Epidemiology, and End Results database was queried for all patients with kidney RCC from 2010 to 2013 (N = 50,815). Distribution and predictors of distant metastases at diagnosis were assessed. Multivariate logistic regression hazard analyses were performed to determine covariates associated with the likelihood of having metastases at diagnosis, whereas competing risks regression analysis was used to assess predictors of cancer-specific mortality (CSM) in patients with metastatic disease.Results
Lung (7.73%) and bone (5.17%) metastases were the most common. The strongest predictors of metastatic disease were disease-specific factors, such as clinical T-stage (cT4 vs. cT1; odds ratio = 43.08; P<0.01) and higher Fuhrman grade (FG4 vs. FG1; odds ratio = 5.09; P<0.01). Papillary RCC and chromophobe RCC were associated with localized disease at the time of diagnosis. For CSM, the presence of brain and liver metastases were associated with worse CSM than lung or bone metastases. Although patient factors did not contribute to the presence of metastases at diagnosis, lower socioeconomic status and being widowed/divorced predicted worse CSM.Conclusion
Understanding the distribution of distant metastases and associated CSM is important to counseling patients with newly diagnosed metastatic RCC. Although pathologic factors drive the presence of metastases at diagnosis, health care deficits in treatment remain. 相似文献16.
Mohammad Rashid Siddiqui Campbell Grant Thomas Sanford Piyush K. Agarwal 《Urologic oncology》2017,35(8):516-527
Background
The treatment options for non–muscle invasive bladder cancer (NMIBC) remain limited. Bacillus Calmette-Guerin (BCG) was the last major breakthrough in bladder cancer therapy almost 4 decades ago. There have been improvements in the understanding of immune therapies and cancer biology, leading to the development of novel agents. This has led to many clinical trials that are currently underway to find the next generation of therapies for NMIBC.Method
We reviewed clinicaltrials.org and pubmed.gov to find the recently completed and ongoing clinical trials in NIMBC. Included in this review are clinical trials that are currently active and trials that were completed in and after 2014.Result
Many trials with BCG-naive and BCG-unresponsive/recurrent/refractory/failure patients with NMIBC are either currently underway or have been recently completed. A wide variety of novel therapeutic agents are being investigated that range from cytotoxic agents to immunomodulatory agents to targeted molecular therapies. Other approaches include cancer vaccines, gene therapies, and chemoradiation potentiation agents. Novel drug-delivery methods are also being tested.Conclusion
This comprehensive update of current trials provides researchers an overview of the current clinical trial landscape for patients with NMIBC. 相似文献17.
Daniel C. Wang Kyle Plante Telisa Stewart Dongliang Wang Margaret Formica Michael Daugherty Gennady Bratslavsky 《Urologic oncology》2017,35(11):660.e9-660.e15
Purpose
There is a paucity of data comparing effects of partial nephrectomy (PN) vs. radical nephrectomy (RN) on overall survival in young patients. In this study, the National Cancer Database was used to evaluate the survival outcomes of those treated with PN and RN, and influence of comorbidities on surgical treatment (PN vs. RN) in young patients while accounting for Charlson-Deyo Comorbidity Score (CDCS).Materials and methods
Patients between 20 and 44 years old (n = 9,849) surgically treated for pT1a renal cell carcinoma between 2004 and 2013 were identified from the National Cancer Database. Kaplan-Meier log-rank analysis and Cox proportional hazards model were performed to compare overall survival and calculate the hazard ratio between those undergoing RN and PN. Binary logistic regression was used to calculate odds ratios for receiving RN compared to PN. The effect measures in all models were adjusted for potential confounding factors.Results
After adjusting for comorbidities, PN offered an overall survival advantage over RN (P<0.001, hazard ratio = 0.464, 95% CI: 0.359–0.601) at a mean follow-up of 48.4 months (0–130.96), including young patients with no comorbidities (P<0.001). Compared to those with a CDCS = 0, patients were more likely to be treated with RN if they had a CDCS>1 (odds ratios = 2.049, 95% CI: 1.527–2.750).Conclusions
Young patients treated with PN demonstrate an overall survival advantage. This survival advantage is observed after an early follow-up even in those without comorbidities. It is still not clear if the survival advantage seen is due to treatment itself or selection bias. 相似文献18.
Daniel N. Costa Fernando U. Kay Ivan Pedrosa Lauren Kolski Yair Lotan Claus G. Roehrborn Brad Hornberger Yin Xi Franto Francis Neil M. Rofsky 《Urologic oncology》2017,35(4):149.e15-149.e21
Background
Targeted prostate biopsies are changing the landscape of prostate cancer (PCa) diagnosis with the degree of suspicion on multiparametric magnetic resonance imaging (mpMRI) being a strong predictor of targeted biopsy outcome. Data regarding the rate and potential causes of false-negative magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion–targeted biopsy in patients with highly suspicious mpMRI findings are lacking.Objectives
To determine the rate of clinically significant PCa detection in repeat targeted biopsy or surgery in patients with highly suspicious mpMRI findings and in an initial negative MRI-TRUS fusion–targeted biopsy.Materials and methods
In this single-center, retrospective study of prospectively generated data, men with highly suspicious lesions (Likert 5 score) on mpMRI and an initial negative MRI-TRUS fusion–targeted biopsy were reviewed. The rate of PCa detection in a subsequent MRI-TRUS fusion–targeted biopsy or radical prostatectomy was determined. Tumors in the intermediate- and high-risk groups according to the National Comprehensive Cancer Network criteria were considered clinically significant.Results
A total of 32 men with 38 Likert 5 lesions were identified. Repeat targeted biopsy or surgery detected cancer in 42% (16/38) of the Likert 5 lesions with initial negative targeted biopsy. Most of these cancers were intermediate- (69%; 11/16) or high-risk (25%; 4/16) tumors.Conclusion
A negative round of targeted biopsies does not exclude clinically significant PCa in men with highly suspicious mpMRI findings. Patients with imaging-pathology disagreement should be carefully reviewed and considered for repeat biopsy or for strict surveillance. 相似文献19.
20.
Taha Reşid Özdemir Adnan Şimşir Hüseyin Onay İbrahim Cüreklibatır Ferda Özkınay Haluk Akın 《Urologic oncology》2017,35(10):607.e15-607.e24