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1.
India Anderson-Carter Natasza Posielski Jinn-ing Liou Tariq A. Khemees Tracy M. Downs E. Jason Abel David F. Jarrard Kyle A. Richards 《Urologic oncology》2019,37(2):130-137
Background
Statins are thought to possess antineoplastic properties related to their effect on cell proliferation and steroidogenesis. Progression to castrate resistant prostate cancer (CaP) includes de-regulation of androgen synthesis suggesting a role for statins in this setting. Our goal was to assess the role of statin use on oncologic outcomes in patients with advanced CaP being treated with androgen deprivation therapy (ADT).Methods
The national VA database was used to identify all men diagnosed with CaP who were treated with ADT for at least 6 months between 2000 and 2008 with follow-up through May 2016. Our cohort was stratified based on statin use of at least 6 months duration during the same time. Multivariable Cox proportional hazards analyses with inverse propensity score weighted (IPSW) adjustment were calculated to assess for primary outcomes of CaP-specific survival (CSS), overall survival (OS) and skeletal related events (SREs).Results
A total of 87,346 patients on ADT were included in the study cohort, 53,360 patients used statins and 33,986 did not. Statin users were younger in age (median 73 vs. 76, P < 0.001), more likely to have a higher Charlson comorbidity index (CCI) >3 (3.1% vs. 2.5%, P < 0.001) and more likely to have a high grade (Gleason score 8–10) cancer (12.3% vs. 10.9%, P < 0.001). Statin users had longer OS (median 6.5 vs. 4.0 years P < 0.001) and decreased death from CaP (5-year CSS 94.0% vs. 87.3%, P < 0.001). Statin use was also associated with longer time to a SRE (median 5.9 vs. 3.7 years, P < 0.001). On multivariable Cox proportional hazards analysis with inverse propensity score weighted, statin use was an independent predictor of improved OS (hazard ratio [HR] 0.66, confidence interval [CI] 0.63–0.68; P < 0.001), CSS (HR 0.56, 95% CI 0.53–0.60; P < 0.001), and SREs (HR 0.64, 95%CI 0.59–0.71; P < 0.001) when controlling for age, race, Charlson comorbidity index, prostate-specific antigen, and Gleason score.Conclusion
The use of statins in men on ADT for CaP is associated with improved CSS and OS. Statins are inexpensive, well-tolerated medications that offer a promising adjunct to ADT, but require further prospective studies. 相似文献2.
Philipp Gild Stephanie A. Wankowicz Akshay Sood Nicolas von Landenberg David F. Friedlander Shaheen Alanee Felix K.H. Chun Margit Fisch Mani Menon Quoc-Dien Trinh Joaquim Bellmunt Firas Abdollah 《Urologic oncology》2018,36(10):469.e1-469.e11
Objectives
To examine the impact of race on quality of care and overall survival (OS) among patients with muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC) in the U.S.Materials & Methods
Our cohort consisted of 12,652 patients receiving RC for MIBC within the National Cancer Database from 2004 to 2012. Patients were stratified by race (Black non-Hispanic vs. White non-Hispanic) and imbalances in patient characteristics mitigated using propensity score weighting. Logistic and Cox regressions examined the impact of race on quality of care metrics (receipt of pelvic lymph node dissection (PLND), lymph node count, hospital volume, length of stay, delay of treatment) and on OS. The difference in OS was expressed as Delta, and stratified by facility-type, hospital volume, and region.Results
Blacks were less likely to receive PLND (odds ratio [OR] 0.70, 95% confidence interval [CI]: 0.55–0.91), or to have a greater number of lymph nodes removed (OR 0.76, 95%CI: 0.64–0.90). They exhibited greater length of stay (OR 1.34, 95%CI: 1.13–1.59), and delay of RC among recipients of neoadjuvant chemotherapy (OR 2.59, 95%CI: 1.77–3.85) (all P ≤ 0.001). Notably, utilization of neoadjuvant chemotherapy in advanced disease stages was more common in blacks (OR 2.82, 95%CI: 1.93–4.13, P < 0.001). Additionally, Black race was associated with inferior OS (Hazard ratio 0.87, 95%CI: 0.79–0.97, P < 0.014). Disparities in OS varied based on facility type and geographical region, but not hospital volume. Specifically, Blacks had worse OS when treated in a community cancer program (Delta 0.42, 95%CI: 0.28–0.57,P < 0.001), or within New England/Middle Atlantic region (Delta 0.16, 95% CI: 0.07–0.24,P < 0.001).Conclusion
Black race is an independent predictor of inferior quality of care and OS in patients undergoing RC for MIBC. Survival disparities vary based on geographical region and facility type. Notably, the OS disparity appears to have narrowed in comparison to previous studies. 相似文献3.
Amirali Salmasi Izak Faiena Jason Wu Anthony E. Sisk Ankush Sachveda Jacob J. Vandel Karim Chamie Leonard S. Marks Robert E. Reiter 《Urologic oncology》2018,36(9):401.e19-401.e25
Background
In the era of increasing scrutiny of delivery of quality care, efforts to decrease surgical overtreatment of insignificant prostate cancer (iCaP) continue.Objective
To quantify the incidence of surgical overtreatment over time among a contemporary series of men diagnosed with CaP.Methods
We retrospectively reviewed the medical records and pathologic specimens for men with CaP who underwent radical prostatectomy between January 2009 and December 2016 at a tertiary referral center. Overtreatment, defined as presence of iCaP in radical prostatectomy specimens, was the primary endpoint. iCaP was defined as a tumor of Gleason score no more than 6 and a tumor diameter ≤10mm (volume <0.5 cc). Independent predictors of iCaP were determined using a multivariable model.Results
A total of 1,283 men were eligible for analysis. Overtreatment was found in 86 (6.7%) patients. The frequency of overtreatment significantly decreased from 15% (24/165) in 2009 to 3% (4/134) of patients in 2016 (P < 0.001). In the multivariable analysis, prostate-specific antigen density ≥0.15 vs. <0.15 (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.15–0.64, P < 0.01), biopsy Gleason score 3+4 vs. 3+3 (OR 0.15, 95% CI 0.08–0.29, P < 0.01), African American vs. White ethnicity (OR 0.13, 95% CI 0.02–0.96, P = 0.045), and year of surgery (OR 0.88, 95% CI 0.77–0.99, P = 0.03) remained significant predictors of iCaP at surgery. Over the years of study, the odds of overtreatment decreased by 12% annually (OR 0.88, 95 CI 0.77–0.99, P = 0.03). At the same time, the pathological evidence of advanced disease at surgery (≥T3a with/without lymph node involvement) remained unchanged.Comment
Surgical overtreatment of CaP has declined to a rate of approximately 3% at this tertiary referral center; further decline is likely. The decline probably has a multifactorial explanation: decreased rate of overdiagnosis, better patient selection for surgery, or change in the referral pattern. 相似文献4.
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5.
Mihai Dorin Vartolomei David D&#x;Andrea Daher C. Chade Francesco Soria Shoji Kimura Beat Foerster Mohammad Abufaraj Romain Mathieu Marco Moschini Morgan Rouprêt Alberto Briganti Pierre I. Karakiewicz Shahrokh F. Shariat 《Urologic oncology》2019,37(2):123-129
Background
Serum cholinesterase (ChE) a serine hydrolase that catalyses the hydrolysis of esters of choline, is involved in cellular proliferation and differentiation, therefore affecting carcinogenesis. The aim of this study was to understand the prognostic role of preoperative serum ChE in patients with radiation-recurrent prostate cancer (CaP) treated with salvage radical prostatectomy (SRP).Material and methods
This retrospective study included 214 patients with radiation-recurrent CaP treated with SRP from January 2007 to December 2015 at 5 academic centers. Patients were considered with abnormal/decreased ChE levels if <5 kU/l. Biochemical recurrence-free and metastases-free (MFS) survival analyses were performed.Results
Median serum ChE level was 6.9 (interquartile range) 6–7.7) kU/l. Serum ChE level (<5 kU/l) was decreased in 25 (11.7%) patients. Decreased serum ChE level was associated with lower body mass index (P = 0.006) and metastasis to lymph nodes (P = 0.004). In multivariable analysis, continuous ChE was an independent predictor of MFS (hazard ratio [HR] 0.48, confidence interval [CI] 0.33–0.71, P < 0.001), overall survival (HR 0.68, CI 0.48–0.96, P = 0.03) and cancer-specific survival (HR 0.41, CI 0.2–0.84, P = 0.01). Serum ChE improved the C-index (by 2.54%) to 87.8% for prediction of overall survival and (by 3%) to 92% for prediction of MFS.Conclusion
Preoperative serum ChE is associated with the development of metastasis in patients with radiation-recurrent CaP who underwent SRP. The biological underpinning of this association with the biological and clinical aggressiveness of CaP needs to be further elucidated. 相似文献6.
Alessandro Morlacco Fabrizio Dal Moro Laureano J. Rangel Rachel E. Carlson Phillip J. Schulte Karnes R. Jeffrey 《Urologic oncology》2018,36(12):528.e1-528.e6
Purpose
The associations between metabolic syndrome (MetS) and prostate cancer (CaP) outcomes following radical prostatectomy (RP) are not clear. This study aims to understand the role of MetS in influencing oncological outcomes at RP.Materials and methods
Patients who underwent RP for CaP at our institution from 2000 to 2010 were identified; MetS prior to RP was ascertained with a modified version of the IDF-AHA/NHLBI using ICD-9 codes. Histopathological outcomes included surgical margins, pathological stage, and Gleason score (GS) upgrading. Long-term outcomes included biochemical recurrence (BCR), local recurrence, systemic progression, and CaP-specific mortality. Multivariable adjusted logistic regression and Cox proportional hazards regression assessed the association between MetS status and histopathological and long-term outcomes, respectively.Results
Of 8,504 RP patients, 1,054 (12.4%) had MetS at the time of RP. MetS patients were older, had higher biopsy GS, but lower pre-op prostatic specific antigen (PSA), higher pathological GS, and larger prostate volume. Adjusted logistic regression suggested an association between MetS and positive margins (odds ratio [OR] = 1.22, P?=?0.025) and GS upgrading (OR?=?1.28, P?=?0.002). There was evidence of an increased risk of local recurrence (hazard ratio [HR] = 1.33, P?=?0.037) and CaP-specific mortality (HR?=?1.58, P < 0.001) for MetS patients. There was no evidence to suggest an association with BCR or systemic progression.Conclusion
Men with MetS are at higher risk of GS upgrade and positive surgical margins at surgery, local recurrence, and CaP-specific mortality. Pathological stage, BCR, and systemic progression were not associated with MetS. Our data may be useful in patients’ counseling, especially when active surveillance is an option. 相似文献7.
Kosuke Takemura Hiroshi Fukushima Masaya Ito Madoka Kataoka Yasukazu Nakanishi Kazumasa Sakamoto Hiroaki Suzuki Ken-ichi Tobisu Fumitaka Koga 《Urologic oncology》2019,37(2):108-115
Objectives
Serum γ-glutamyltransferase (GGT) is reportedly associated with prognosis in patients with various malignancies. However, the prognostic role of GGT is unknown among patients with advanced urothelial carcinoma (aUC). This study was designed to examine the prognostic role of serum GGT in patients with aUC.Materials and methods
Charts of 125 consecutive aUC patients (inoperable cT4 and/or metastasis to lymph nodes/distant organs) managed at a single cancer center between 2004 and 2016 were retrospectively reviewed. Variables collected included age, sex, body mass index, Karnofsky performance status, primary site, clinical tumor stage, lymph node/visceral metastasis, hepatic comorbidities, the presence of curative treatment before the diagnosis of aUC, white blood cell count, neutrophil-to-lymphocyte ratio, hemoglobin, albumin, lactate dehydrogenase, alkaline phosphatase, GGT, C-reactive protein, and treatments given after the diagnosis of aUC. Associations of variables with overall survival (OS) were analyzed using the Cox proportional hazard model.Results
Serum GGT was elevated (≥60 U/l) at the diagnosis of aUC in 16 patients (13%). During follow-up period (median 12.1 months), 101 patients died (2-year OS rate, 32%). Patients with elevated GGT at the diagnosis of aUC had a significantly poorer prognosis than those with normal GGT with respective 2-year OS rates of 0% and 37% (P < 0.001). On multivariate analysis, elevated GGT was a significant and independent risk factor for shorter OS (hazard ratio, HR?=?2.97; P < 0.001) as were poorer Karnofsky performance status (HR?=?3.47; P < 0.001), elevated lactate dehydrogenase (HR?=?1.86; P?=?0.033), advanced age (HR?=?1.82; P?=?0.013), elevated neutrophil-to-lymphocyte ratio (HR?=?1.80; P?=?0.015), elevated C-reactive protein (HR?=?1.73; P?=?0.018), the absence of systemic chemotherapy (HR?=?1.71; P?=?0.035), and primary site of upper urinary tract (HR?=?1.71; P?=?0.014) in descending order by HR. The prognostic significance of elevated GGT was also observed in a subset of 101 patients who had been diagnosed with aUC at their first presentation.Conclusion
The present study for the first time demonstrated that elevated serum GGT was an independent adverse prognostic factor in aUC patients. 相似文献8.
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9.
Ketan K. Badani Balaji N. Reddy Eric J. Moskowitz David J. Paulucci Alp Tuna Beksac Alberto Martini Michael J. Whalen Douglas W. Skarecky Linda My Huynh Thomas E. Ahlering 《Urologic oncology》2018,36(6):310.e1-310.e6
Objectives
Seminal vesicle invasion (SVI) is a risk factor for poor oncologic outcome in patients with prostate cancer. Modifications to the pelvic lymph node dissection (PLND) during radical prostatectomy (RP) have been reported to have a therapeutic benefit. The present study is the first to determine if lymph node yield (LNY) is associated with a lower risk of biochemical recurrence (BCR) for men with SVI.Methods
A total of 220 patients from 2 high-volume institutions who underwent RP without adjuvant treatment between 1990 and 2015 and had prostate cancer with SVI (i.e., pT3b) were identified, and 21 patients did not undergo lymph node dissection. BCR was defined as a postoperative PSA>0.2 ng/mL, or use of salvage androgen deprivation therapy (ADT) or radiation. Multivariable Cox proportional hazards models were used to determine whether LNY was predictive of BCR, controlling for PSA, pathologic Gleason Score, pathologic lymph node status, NCCN risk category, etc. The Kaplan-Meier method was used to determine 3-year freedom from BCR.Results
Median number of lymph nodes sampled were 7 (IQR: 3–12; range: 0–35) and 90.5% underwent PLND. The estimated 3-year BCR rate was 43.9%. Results from multivariable analysis demonstrated that LNY was not significantly associated with risk of BCR overall (HR = 1.00, 95% CI: 0.98–1.03; P = 0.848) for pN0 (HR = 0.99, 95% CI: 0.97–1.03; P = 0.916) or pN1 patients (HR = 0.96, 95% CI: 0.88–1.06; P = 0.468). Overall, PSA (HR = 1.02, P<0.001) and biopsy Gleason sum ≥ 8 (HR = 1.81, P = 0.001) were associated with an increased risk of BCR, and increasing LNY increased the likelihood of detecting>2 positive lymph nodes (OR = 1.27, 95% CI: 1.06–1.65, P = 0.023).Conclusion
Seminal vesicle invasion is associated with an increased risk of BCR at 3 years, primarily due to pathologic Gleason score and PSA. Although greater lymph node yield is diagnostic and facilitates more accurate pathologic staging, our data do not show a therapeutic benefit in reducing BCR. 相似文献10.
Misop Han Bruce J. Trock Alan W. Partin Elizabeth B. Humphreys Trinity J. Bivalacqua Thomas J. Guzzo Patrick C. Walsh 《BJU international》2010,106(11):1612-1617
Study Type – Prognosis (case series)Level of Evidence 4
PURPOSE
Erectile dysfunction (ED) and cardiovascular disease (CVD) share etiology and pathophysiology. The underlying pathology for preoperative ED may adversely affect survival following radical prostatectomy (RP). We examined the association between preoperative ED and survival following RP.MATERIALS AND METHODS
Between 1983 and 2000, a single surgeon performed RP on 2511 men, with preoperative ED (ED group, n= 231, 9.2%) or without ED (No ED group, n= 2280, 90.8%). We retrospectively analysed their CVD‐specific survival (CVDSS), prostate cancer‐specific survival (PCSS), non‐PCSS (NPCSS) and overall survival (OS) from time of surgery.RESULTS
With median follow‐up of 13 years after RP, 449 men (18%) died (140 from prostate cancer, 309 from other causes). Kaplan–Meier analyses demonstrated significant differences in CVDSS (P < 0.001), NPCSS (P < 0.001) and OS (P < 0.001), but not in PCSS (P= 0.12), between the ED group vs No ED group. In univariate proportional hazards analyses, preoperative ED was associated with a significant decrease in OS, hazard ratio (HR), 1.71 (95% CI, 1.34–2.23), P < 0.001. However, in multivariable analyses, the association of ED with survival became non‐significant (HR, 1.25 (95% CI, 0.97–1.66), P= 0.111) after adjusting for other prognostic factors, such as age, preoperative prostate‐specific antigen (PSA) level, Gleason score, pathologic stage, body mass index and Charlson Comorbidity Index.CONCLUSIONS
Preoperative ED is associated with decreased overall survival and survival from causes other than prostate cancer following RP. However, preoperative ED was not an independent predictor of overall survival after adjusting for other predictors of survival. Urologists should carefully assess pretreatment ED status to enhance appropriate treatment recommendation for men with prostate cancer. 相似文献11.
Soroush T. Bazargani Thomas G. Clifford Hooman Djaladat Anne K. Schuckman Kevin Wayne Gus Miranda Jie Cai Sarmad Sadeghi Tanya Dorff David I Quinn Siamak Daneshmand 《Urologic oncology》2019,37(1):1-11
Introduction and Objectives
We previously reported that elevated precystectomy serum levels of epithelial tumor markers predict worse oncological outcome in patients with invasive bladder cancer (BC). Herein, we evaluated the effect of neoadjuvant chemotherapy (NAC) on elevated tumor marker levels and their association with oncological outcomes.Methods
Under IRB approval, serum levels of Carbohydrate Antigen 125 (CA-125), Carbohydrate Antigen 19-9 (CA 19-9) and Carcinoembryonic Antigen (CEA) were prospectively measured in 480 patients with invasive BC from August 2011 through December 2016. In the subgroup undergoing NAC, markers were measured prior to the first and after the last cycle of chemotherapy (prior to cystectomy).Results
Three hundred and thirty-seven patients were eligible for the study, with a median age was 71 years (range 34–93) and 81% (272) male. Elevated precystectomy level of any tumor markers (31% of patients) was independently associated with worse recurrence-free survival (hazard ratio [HR]?=?2.81; P < 0.001) and overall survival (HR?=?3.97; P < 0.001). One hundred and twenty-five (37%) patients underwent NAC, of whom 59 had a complete tumor marker profile and 30 (51%) had an elevated pre-NAC tumor marker. Following completion of chemotherapy, 10/30 (33%) patients normalized their tumor markers, while 20/30 (67%) had one or more persistently elevated markers. There was no difference in clinical or pathological stage between groups (P = 0.54 and P = 0.09, respectively). Further analysis showed a significantly lower rate and longer median time to recurrence/progression in the responder group (50% in responders vs. 90% in nonresponders at a median time of 22 vs. 4.8 months, respectively; P = 0.015). There was also significant difference in mortality rates and median overall survival between the study groups (30% in responders vs. 70% in nonresponders at a median time of 27.3 vs. 11.6 months respectively; P = 0.037). Two of the three patients that died in the normalized tumor marker group had tumor marker relapse at recurrence prior to their death.Conclusions
To our knowledge, this is the first study showing tumor marker response to NAC. Patients with persistently elevated markers following NAC have a very poor prognosis following cystectomy, which may help identifying chemotherapy-resistant tumors. A larger, controlled study with longer follow up is needed to determine their role in predicting survival. 相似文献12.
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13.
Objectives
To assess the relationship between nodal disease burden and overall survival (OS) among patients with lymph node (LN) metastases from renal cell carcinoma (RCC)Methods
The National Cancer Data Base was used to identify 2,975 patients with RCC who were treated with radical nephrectomy and were found to have regional LN metastases. Associations between the number of positive and negative LN removed and OS were assessed using Cox proportional hazards regression. The median follow-up time among survivors was 3.6years.Results
The median number of positive LN was 1 (interquartile range 1–3). A higher number of positive LN was associated with higher all-cause mortality on multivariable analysis (HR 1.06 per 1 positive LN, 95% CI 1.04, 1.07, P < 0.001). Conversely, higher negative LN counts were associated with better OS (HR 0.97 per 1 negative LN, 95% CI 0.96, 0.99, P < 0.001). The adjusted probability of a patient with 1 LN removed that was positive surviving at least 2 years was 56%, a figure that increased to 64% when 1 out of 10 LN removed was positive and decreased to 38% when 10 out of 10 LN removed were positive.Conclusions
Ours is the first study to show that differences in nodal disease burden translate into clinically significant differences in survival among patients with LN metastases from RCC. 相似文献14.
Raisa S. Pompe Sami-Ramzi Leyh-Bannurah Felix Preisser Georg Salomon Markus Graefen Hartwig Huland Pierre I. Karakiewicz Derya Tilki 《Urologic oncology》2018,36(12):527.e21-527.e28
Objectives
To examine oncological, surgical, and functional outcomes of radical prostatectomy (RP) in patients with history of transurethral resection of the prostate (TUR-P).Materials and methods
Retrospective analysis of 18,681 RP-patients including 470 patients with previous TUR-P at a single institution (2002–2015). Kaplan-Meier as well as multivariable Cox and logistic regression analyses compared surgical, oncological, and functional outcomes between TUR-P and non-TUR-P patients after propensity score matching (nearest neighbor in a 1:3 fashion).Results
After propensity score adjustment, pathological and surgical results were similar between both groups. Specifically, rates of positive surgical margins and nerve-sparing (NS) procedure did not differ between groups (positive surgical margins: 18.5% vs. 17.2%, P = 0.7; nerve-sparing: 89.4% vs. 91.6%, P = 0.5). In addition, there was no difference in mean operating room time (185 vs. 184 minutes, P = 0.6), blood loss (710 vs. 666 ml, P = 0.1), and catheterization time (12 days, P = 0.3). In multivariable analyses, TUR-P patients did not exhibit higher risk of biochemical recurrence, metastatic progression, or mortality (all P > 0.05). However, TUR-P patients exhibited higher risk for urinary incontinence at third month (OR: 1.47; 95% confidence interval [CI] 1.01–2.12, P?=?0.04) and first year (OR: 2.06; 95% CI 1.23–3.42, P?=?0.006) and worse 1-year erectile function recovery (OR: 0.48; 95% CI 0.27–0.86, P?=?0.02).Conclusions
This large series of TUR-P RP patients demonstrated that RP could be safely performed in patients with history of TUR-P without compromising oncological results. However, functional outcomes were worse for patients with previous TUR-P. 相似文献15.
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16.
Y. Ayar A. Ersoy G. Ocakoglu A. Yildiz A. Oruc H. Soyak M. Calapkulu A.B. Sahin N. Bolca Topal E. Okeer B. Coskun O. Kaygisiz Y. Kordan H. Vuruskan 《Transplantation proceedings》2017,49(2):270-277
Aim
The aim of this study was to evaluate risk factors affecting graft and patient survival after transplantation from deceased donors.Methods
We retrospectively analyzed the outcomes of 186 transplantations from deceased donors performed at our center between 2006 and 2014. The recipients were divided into two groups: Group I (141 recipients without graft loss) and Group II (45 recipients with graft loss). Kaplan-Meier, log-rank test, and Cox proportional hazard regressions were used.Results
The characteristics of both groups were similar except renal resistive index at the last follow-ups. When graft survival and mortality at the first, third, and fifth years were analyzed, tacrolimus (Tac)-based regimens were superior to cyclosporine (CsA)-based regimens (P < .001). Risk factors associated with graft survival at the first year included cardiac cause of death (versus cerebrovascular accident [CVA]; hazard ratio [HR], 6.36; 95% confidence interval [CI], 1.84–22.05; P = .004), older transplant age (HR, 1.05; 95% CI, 1.02–1.08; P < .001), and high serum creatinine level at 6 months post-transplantation (HR, 1.74; 95% CI, 1.48–2.03; P < .001), whereas younger donor age decreased risk (HR, 0.97; 95% CI, 0.95–1.00; P = .019). Also, the Tac-based regimen had a 3.63-fold (95% CI, 1.47–8.97; P = .005) lower risk factor than the CsA-based regimen, and 2.93-fold (95% CI, 1.13–7.63; P = .027) than other regimens without calcineurin inhibitors. When graft survival at 3 years was analyzed, diabetes mellitus was lower than idiopathic causes and pyelonephritis (P = .035). In Cox regression analysis at year 3, older transplantation age (HR, 1.20; 95% CI, 1.04–1.39; P = .014) and serum creatinine level at month 6 post-transplantation (HR, 1.65; 95% CI, 1.42–1.90; P < .001) were significant risk factors for graft survival. Hemodialysis (HD) plus peritoneal dialysis (PD) treatment was 2.22-fold (95% CI, 1.08–4.58; P = .03) risk factor than only HD before transplantation. When graft survival and mortality at year 5 were analyzed, diabetes mellitus was lower compared with all other diseases. In Cox regression analysis at year 5, younger donor age (HR, 0.73; 95% CI, 0.62–0.86; P < .001) was protective for graft survival, whereas older transplantation age (HR, 1.40; 95% CI, 1.20–1.64; P < .001) and serum creatinine level at month 6 of post-transplantation (HR, 1.39; 95% CI, 1.19–1.61; P < .001) were significant risk factors. PD increased 3.32 (95% CI, 1.28–8.61; P = .014) times the risk than HD. In Cox regression analysis at year 1, cardiac cause of death (versus CVA; HR, 5.28; 95% CI, 1.37–20.31; P = .016), CsA-based regimen (versus Tac; HR, 4.95; 95% CI, 1.78–13.78; P = .002), HD plus PD treatment (versus alone HD; HR, 3.26; 95% CI, 1.28–8.30; P = .013), older transplantation age (HR, 1.08; 95% CI, 1.04–1.11; P < .001), serum creatinine level at month 6 post-transplantation (HR, 1.34; 95% CI, 1.11–1.62; P = .003), and low HLA mismatches (HR, 1.67; 95% CI 1.01–2.70; P = .044) were risk factors for mortality. At year 3, CsA-based regimen (versus Tac; HR, 3.54; 95% CI, 1.32–9.47; P = .012), PD (versus HD; HR, 5.04; 95% CI, 1.41–18.05; P = .013), HD plus PD treatment (versus alone HD; HR, 3.51; 95% CI, 1.37–9.04; P = .009), and older transplantation age (HR, 1.27; 95% CI 1.05–1.53; P = .015) were risk factors for mortality. At year 5, older age at transplantation (HR, 1.47; 95% CI, 1.23–1.77; P < .001), PD (versus HD; HR, 9.21; 95% CI, 3.09–27.45; P < .001), and CsA-based regimen (versus Tac; HR, 2.75; 95% CI, 1.04–7.23; P = .041) were risk factors for mortality, whereas younger donor age decreased risk (HR, 0.71; 95% CI, 0.56–0.86; P < .001).Conclusion
Death of donor with cardiac cause, CsA-based immunosuppressive regimen, donor age, serum creatinine level at month 6 post-transplantation, and renal replacement therapy before transplantation affected mortality and graft survival in deceased donors. 相似文献17.
Vincenza Conteduca Orazio Caffo Luca Galli Antonio Maugeri Emanuela Scarpi Francesca Maines Vincenzo Emanuele Chiuri Cristian Lolli Stefania Kinspergher Giuseppe Schepisi Matteo Santoni Daniele Santini Lucia Fratino Salvatore Luca Burgio Samanta Salvi Cecilia Menna Ugo De Giorgi 《Urologic oncology》2018,36(5):240.e1-240.e11
Background
Metabolic syndrome (MS) and inflammation (INF) alterations are among the factors involved in cancer progression. The study aimed to assess the relationship between MS and INF and its effect on progression-free/overall survival (PFS/OS) in metastatic castration-resistant prostate cancer (mCRPC) treaed with abiraterone or enzalutamide.Methods
We, retrospectively, evaluated patients with mCRPC in 7 Italian Institutes between March 2011 and October 2016. MS was defined by modified adult treatment panel-III criteria. INF was characterized by at least one of these criteria: neutrophil to lymphocyte ratio ≥ 3, elevated erythrocyte sedimentation rate or C-reactive protein.Results
Eighty-three of 551 (15.1%) patients met MS criteria at baseline and 34 (6.2%) during treatment. MS patients (MS+) presented a greater INF profile compared to MS? (P<0.0001). Median PFS was 3.7 for MS+ vs. 8.7 months for MS? (hazard ratio [HR] = 2.77; 95% CI: 2.12–3.61; P<0.0001). Median OS was 6.9 and 19 months in MS+ and MS?, respectively (HR = 3.43; 95% CI: 2.56–4.58; P<0.0001). We also demonstrated INF led to shorter PFS and OS (4.5 vs. 8.5 months, HR = 1.48, 95% CI: 1.15–1.90, P = 0.002, and 11.2 vs. 18.8 months, HR =1.66, 95% CI: 1.26–2.18, P = 0.0003, respectively). The combination of MS with INF provided the identification of high-risk prognostic group (MS+/INF+ vs. MS?/INF?) with worse PFS (3.7 vs. 9 months, HR = 2.7, 95% CI: 1.88–3.89, P<0.0001) and OS (6.3 vs. 20.4 months, HR = 4.04, 95% CI: 2.75–5.93, P<0.0001). Multivariable analysis confirmed that MS was independently associated with PFS (HR = 2.07; 95% CI: 1.03–4.18; P = 0.041) and OS (HR = 4.87; 95% CI: 2.36–10.03; P<0.0001). The absence of INF as an independent predictor of survival underlined the correlation between MS/INF.Conclusions
Pretreatment identification of MS and INF alterations might represent an available and easy tool for better prognostication of patients with mCRPC. A prospective evaluation is warranted. 相似文献18.
Brian F. Dinerman Francesca Khani Ron Golan Adrien N. Bernstein Michael F. Cosiano Daniel J. Margolis Jim C. Hu 《Urologic oncology》2017,35(12):673.e9-673.e14
Purpose
The degree to which intraductal carcinoma of the prostate (IDC-P) affects clinical course remains poorly understood owing to small sample sizes from single-center studies. We sought to determine prognostic factors and outcomes associated with IDC-P in radical prostatectomy (RP) specimens.Materials and methods
This is a retrospective study of RP during 2004 to 2013 using Surveillance, Epidemiology, and End Results to compare IDC-P with non-IDC-P. The effect of IDC-P on overall and disease-specific survival was assessed using Cox regression with a median follow-up of 4.8 years (interquartile range [IQR]: 2.6–7.0 y; P = 0.01). Median prostate-specific antigen at diagnosis in IDC-P vs. non-IDC-P was similar (P = 0.23) at 6.2 (IQR: 4.6–13.0) vs. 6.1 ng/ml (IQR: 4.6–9.8).Results
We identified 159,777 RP from 2004 to 2013, and 242 (0.002%) had IDC-P pathologic features. IDC-P was associated with a greater likelihood of extraprostatic stage, pT3/T4, 45.9% vs. 21.6% (P<0.001), higher grade, GS≥ 7, 79.3% vs. 62.7% (P<0.001), lymph node metastases, 5.8% vs. 2.4% (P<0.001), and positive surgical margins, 25.6% vs. 19.5% (P = 0.02). IDC-P was associated with a 3-fold increase in prostate cancer-specific mortality relative to non-IDC-P (hazard ratio = 3.0, 95% CI: 1.5–5.7; P<0.01). Limitations include retrospective design and potential underreporting of IDC-P that leads to underestimation of the true effect size.Conclusions
The significance of IDC-P features has been recently recognized by the World Health Organization and it is associated with high-grade, extraprostatic features, and worse prostate cancer-specific mortality. Understanding its prognostic significance better guides adjuvant therapies and clinical trials. 相似文献19.
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20.
Se Young Choi Jeman Ryu Dalsan You In Gab Jeong Jun Hyuk Hong Hanjong Ahn Choung-Soo Kim 《Urologic oncology》2018,36(9):401.e11-401.e18