Clinical genitourinary cancer最新文献

{"title":"Incidence and Survival of Patients With Prostate Cancer in North-Rhine Westphalia, Germany","authors":"Madeleine J. Karpinski MSc ,&nbsp;Kevin Claassen PhD ,&nbsp;Lennart Möller MSc ,&nbsp;Johannes Hüsing PhD ,&nbsp;Hiltraud Kajüter MSc ,&nbsp;Wolfgang P. Fendler MD ,&nbsp;Boris Hadaschik MD ,&nbsp;Andreas Stang MD","doi":"10.1016/j.clgc.2024.102289","DOIUrl":"10.1016/j.clgc.2024.102289","url":null,"abstract":"<div><h3>Introduction</h3><div>There is no organized prostate cancer screening in Germany. The aim of this study was to investigate the development of incidence and survival in patients with primary malignant tumors of the prostate in relation to changing recommendations of prostate-specific antigen (PSA) screening in guidelines.</div></div><div><h3>Methods</h3><div>Age-standardized incidence rates and 5-year relative survival (RS) (period approach) were calculated using data from the cancer registry North Rhine-Westphalia with the subset of the administrative district Münster respectively for the years 1992-2019. Analyses were stratified according to TNM classification.</div></div><div><h3>Results</h3><div>Until 2008 overall prostate cancer incidence increased, followed by a decrease up to 2017 and another increase thereafter. The same trend was observed in nonmetastatic but not in metastatic prostate cancer. Overall 5-year RS showed an increase of 10 percentage points up to period 2005-2009, followed by a constant RS. 5-year RS of patients with distant metastases remained constant from period 2000-2004 to 2015-2019, while 5-year RS with nonmetastatic prostate cancer and lymph node metastases increased slightly.</div></div><div><h3>Discussion</h3><div>Overall and nonmetastatic incidence rates reflect changes of recommendation in PSA screening guidelines from the United States. Accordingly, the increase in 5-year RS might be influenced by lead time bias. Incidence and survival of metastatic prostate cancer barely suggest any association with changing PSA screening recommendations.</div></div><div><h3>Conclusion</h3><div>Structured early detection of metastases with additionally applied diagnostic methods might improve 5-year RS rates of metastatic prostate cancer patients.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102289"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, Treatment, and Outcomes of Primary Urethral Cancer: A Multicenter Review Over Two Decades","authors":"Benjamin D. Hopkins ,&nbsp;David C. Qian ,&nbsp;Karen M. Xu ,&nbsp;Ashley McCook-Veal ,&nbsp;Jeffrey Switchenko ,&nbsp;Lindsey M. Hartsell ,&nbsp;Cara B. Cimmino ,&nbsp;Shreyas S. Joshi ,&nbsp;Vikram Narayan ,&nbsp;Viraj A. Master ,&nbsp;Bassel Nazha ,&nbsp;Bradley C. Carthon ,&nbsp;Mehmet A. Bilen ,&nbsp;Omer Kucuk ,&nbsp;Joseph W. Shelton ,&nbsp;Pretesh R. Patel ,&nbsp;Ashesh B. Jani ,&nbsp;Jill S. Remick ,&nbsp;Tony Y. Eng","doi":"10.1016/j.clgc.2024.102276","DOIUrl":"10.1016/j.clgc.2024.102276","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>Urethral cancers are uniquely complex and heterogeneous in their presentations and approaches to management.</div></span></li><li><span>•</span><span><div>Histology drives important differences in the behavior and treatment of urethral cancer.</div></span></li><li><span>•</span><span><div>The addition of brachytherapy to definitive external beam radiation results in superior locoregional disease control.</div></span></li><li><span>•</span><span><div>More than a third of the patients in our study required multimodality care, highlighting the importance of inter-disciplinary collaboration and comprehensive care in complex cases.</div></span></li></ul></div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102276"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world Evidence for Enfortumab Vedotin in Patients with Metastatic Urothelial Cancer: An Austrian Multicentre Study","authors":"Dora Niedersuess-Beke ,&nbsp;Karl Mayrhofer ,&nbsp;Johanna Krauter ,&nbsp;Susanne Schnabel ,&nbsp;Simon Peter Gampenrieder ,&nbsp;Jan Miechowiecki ,&nbsp;David Kiesl ,&nbsp;Ferdinand Luger ,&nbsp;Jakob Pfuner ,&nbsp;Clemens Wiesinger ,&nbsp;Sonia Vallet ,&nbsp;Haleh Andalibi ,&nbsp;Dominik Vais ,&nbsp;Andreas Banner ,&nbsp;Franz Stoiber ,&nbsp;Jasmin Spielgelberg ,&nbsp;Dominik Barth ,&nbsp;Thomas Bauernhofer ,&nbsp;Stefan Aufderklamm ,&nbsp;Sabine Weibrecht ,&nbsp;Renate Pichler","doi":"10.1016/j.clgc.2024.102278","DOIUrl":"10.1016/j.clgc.2024.102278","url":null,"abstract":"<div><h3>Aim</h3><div>Enfortumab vedotin (EV) represents a novel treatment for patients with locally advanced or metastatic urothelial carcinoma (la/mUC) refractory to platinum-based chemotherapy and PD(L)-1 containing therapies. Real-world data are crucial for informing health policy decisions and validating clinical trial findings.</div></div><div><h3>Methods</h3><div>We conducted a multicentre, retrospective real-world analysis comprising 128 patients with la/mUC from 16 Austrian centres treated with EV from April 2022 to April 2024, presenting the second largest real-world cohort to date. Data were analysed for efficacy and safety parameters.</div></div><div><h3>Results</h3><div>The median age was 69 years, the objective response rate 31% and the disease control rate 47%, with 9% of patients exhibiting a complete remission, 23% a partial remission and 16% a stable disease. After a median follow-up of 6.2 months, the median progression-free survival (mPFS) and the median overall survival (mOS) reached 4.8 and 10.75 months, respectively. Patients with good ECOG PS 0-1, metachronous metastatic disease and absence of liver metastases had significantly better OS. No difference in efficacy was observed in patients who received a reduced dose EV after experiencing adverse events. The safety profile was acceptable, showing grade ≥3 TRAEs in 25.8% of patients.</div></div><div><h3>Conclusion</h3><div>In our real-world population, the administration of EV was feasible and effective, with no new safety signals. Lower efficacy data compared to previous trials might be explained by the use in later therapy lines and in patients with poorer ECOG PS. Our data corroborate the efficacy and safety of EV monotherapy in later lines.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102278"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinicopathologic Study of 1598 Ultrasound-Guided Needle Prostate Biopsies and Trends in Prostate Cancer Over a 14-Year Period","authors":"Bahar Ebtehaj ,&nbsp;Mehdi Adhami ,&nbsp;Amir Javadi ,&nbsp;Fatemeh Hajmanoochehri","doi":"10.1016/j.clgc.2024.102272","DOIUrl":"10.1016/j.clgc.2024.102272","url":null,"abstract":"<div><h3>Background</h3><div>Prostate cancer manifests in various forms, ranging from occult and localized to metastatic disease. Analyzing prostate biopsies offers insights into histopathological characteristics, enhancing disease understanding and management.</div></div><div><h3>Methods</h3><div>This 14-year study reviewed ultrasound-guided needle prostate biopsies, collecting data via questionnaires and medical records, focusing on Gleason group, tumor involvement percentage, and predicted cancer stage. A comparative analysis across 2 distinct 7-year intervals was conducted. Statistical analyses included the Kolmogorov–Smirnov test, chi-square test, Fisher's exact test, and Analysis of Covariance, all performed using SPSS software.</div></div><div><h3>Results</h3><div>Among 1,598 biopsies, 624 cases of adenocarcinoma were identified. Malignancy incidence significantly correlated positively with age, prostate-specific antigen (PSA), and PSA density (PSAD), and inversely with prostate volume and the free-to-total PSA ratio (%fPSA). Notably, 30.8% of malignancies were classified as Gleason groups 4 or 5, displaying significantly higher PSA levels. Patients with prior transurethral resection of the prostate exhibited increased malignancy rates and higher Gleason groups. Diagnostic accuracy, measured by Area Under the Curve, was 0.719 for PSA, 0.730 for %fPSA, and 0.817 for PSAD. The later phase of the study showed higher cancer detection, lower PSA levels, and a greater incidence of higher Gleason groups despite a lower predicted stage.</div></div><div><h3>Conclusion</h3><div>The prevalence of higher Gleason groups was similar to other studies. PSAD demonstrated greater diagnostic reliability than PSA alone. Additionally, higher malignancy rates and Gleason groups were observed in patients with prior transurethral resection of the prostate. The increase in cancer detection rates during the second period likely indicates improved biopsy candidate selection.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102272"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cisplatin- or Carboplatin-Based Chemotherapy Plus Pembrolizumab in Advanced Urothelial Cancer: Exploratory Analysis From the Phase 3 KEYNOTE-361 Study","authors":"Thomas Powles ,&nbsp;Tibor Csőszi ,&nbsp;Yohann Loriot ,&nbsp;Nobuaki Matsubara ,&nbsp;Lajos Geczi ,&nbsp;Susanna Y-S Cheng ,&nbsp;Yves Fradet ,&nbsp;Ajjai Alva ,&nbsp;Stéphane Oudard ,&nbsp;Christof Vulsteke ,&nbsp;Rafael Morales-Barrera ,&nbsp;Aude Fléchon ,&nbsp;Seyda Gunduz ,&nbsp;Chih-Chin Liu ,&nbsp;Blanca Homet Moreno ,&nbsp;Abhishek Bavle ,&nbsp;Mustafa Özgüroğlu","doi":"10.1016/j.clgc.2024.102261","DOIUrl":"10.1016/j.clgc.2024.102261","url":null,"abstract":"<div><h3>Introduction</h3><div>KEYNOTE-361 evaluated first-line pembrolizumab with and without platinum-based chemotherapy versus chemotherapy alone in advanced or metastatic urothelial carcinoma. The primary end points of progression-free survival (PFS) or overall survival (OS) were not met. Exploratory analysis of efficacy by platinum agent (cisplatin or carboplatin) is reported.</div></div><div><h3>Patients and Methods</h3><div>Eligible patients were randomly assigned 1:1:1 to receive pembrolizumab 200 mg intravenously every 3 weeks for ≤35 cycles with or without chemotherapy (gemcitabine with investigator's choice of either cisplatin or carboplatin) or chemotherapy alone. This exploratory subset analysis evaluated PFS and objective response rate (ORR) per RECIST v1.1 by blinded independent central review and OS for cisplatin- or carboplatin-based chemotherapy with versus without pembrolizumab for patients assigned to chemotherapy-containing arms of KEYNOTE-361.</div></div><div><h3>Results</h3><div>Of 1010 patients enrolled, 703 were assigned to receive a chemotherapy-containing regimen (<em>n</em> = 312 cisplatin based; <em>n</em> = 391 carboplatin based). Median follow-up was 31.3 months. For cisplatin-based arms, with versus without pembrolizumab, median OS was 20.1 versus 16.4 months (HR 0.88, 95% CI, 0.67-1.15) and median PFS was 8.5 versus 7.1 months (HR 0.67, 0.51-0.89). ORR was 64.1% versus 48.7%, respectively. For carboplatin-based arms, with versus without pembrolizumab, median OS was 15.5 versus 12.3 months (HR 0.84, 95% CI, 0.67-1.06) and median PFS was 8.0 versus 6.7 months (HR 0.86, 0.68-1.09). ORR was 47.2% versus 41.8%, respectively. Among patients in the cisplatin-based versus carboplatin-based chemotherapy alone arms, 55.8% versus 41.8% received a subsequent antiprogrammed cell death protein 1/ligand 1 therapy. The addition of pembrolizumab did not significantly increase the incidence of adverse events reported.</div></div><div><h3>Conclusion</h3><div>Results suggest trends toward OS and PFS improvements with the addition of pembrolizumab to gemcitabine-platinum doublet over gemcitabine-platinum alone regardless of whether cisplatin or carboplatin was the chosen platinum agent. OS may have been influenced by active subsequent therapies.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102261"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Patterns and Attrition in Metastatic Renal Cell Carcinoma: Real-Life Experience from the Turkish Oncology Group Kidney Cancer Consortium (TKCC) Database","authors":"Hatice Bölek ,&nbsp;Elif Sertesen ,&nbsp;Omer Faruk Kuzu ,&nbsp;Deniz Tural ,&nbsp;Saadet Sim ,&nbsp;Mehmet Ali Nahit Şendur ,&nbsp;Gökhan Uçar ,&nbsp;Selver Işık ,&nbsp;Bekir Hacıoğlu ,&nbsp;İrfan Çiçin ,&nbsp;Çağatay Arslan ,&nbsp;Sema Sezgin Göksu ,&nbsp;Özlem Nuray Sever ,&nbsp;Cengiz Karaçin ,&nbsp;Nuri Karadurmuş ,&nbsp;Mustafa Özgüroğlu ,&nbsp;Emre Yekedüz ,&nbsp;Yüksel Ürün","doi":"10.1016/j.clgc.2024.102282","DOIUrl":"10.1016/j.clgc.2024.102282","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the rapid evolution in management of metastatic renal cell carcinoma (mRCC) over the past decade, challenges remain in accessing new therapies in some parts of the world. Despite therapeutic advancements, attrition rates remain persistently high. This study aims to assess the treatment patterns and attrition rates of patients with mRCC in oncology clinics across Turkey.</div></div><div><h3>Patients and Methods</h3><div>Patients diagnosed with mRCC between January 1, 2008, and December 31, 2022, with first-line systemic treatment data, were retrospectively evaluated using the Turkish Oncology Group Kidney Cancer Consortium (TKCC) Database.</div></div><div><h3>Results</h3><div>The final analysis included a total of 1126 patients. The percentages of patients treated in the 2nd, 3rd, 4th, and 5th lines of therapy were 62.8%, 27.4%, 8.9%, and 2.1%, respectively. The drugs that were most commonly used in the groups were tyrosine kinase inhibitors (TKIs) (52.2%) and interferon (IFN)-alpha (43.3%) for the first line, TKIs (66.3%) and immunotherapy (IO) monotherapy (25.9%) for the second line, TKI (41.4%) and mTOR inhibitors (28.8%) for the third line, TKI (44.4%) and mTOR inhibitors (29%) for the fourth line, and IO monotherapy (37.5%) and TKI (25%) for the fifth line. For the first-line treatment, the primary cause of attrition was disease progression (66.4%), followed by toxicity (16.5%), death (11.2%), and patient preference (5.9%). The primary reason for attrition across all treatment lines was disease progression. Over time, the use of TKIs in first-line treatment increased, while IFN-alpha usage declined. IOs began to be utilized in earlier lines, predominantly in second-line treatment, though use of IO-based combination therapies remains limited.</div></div><div><h3>Conclusion</h3><div>This study underscores that despite significant progress in therapeutic options, the adoption of novel agents remains slow, and attrition rates are still high. These findings indicate a disparity in systemic therapy compared to developed countries.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102282"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness Analysis of Lenvatinib plus Pembrolizumab or Everolimus as First-Line Treatment for Advanced Renal Cell Carcinoma","authors":"Huanrui Zheng ,&nbsp;Jin Zhou ,&nbsp;Yao Tong ,&nbsp;Jinhua Zhang","doi":"10.1016/j.clgc.2024.102264","DOIUrl":"10.1016/j.clgc.2024.102264","url":null,"abstract":"<div><h3>Background</h3><div>Recently, due to its promising efficacy against advanced renal cell carcinoma (RCC), the combination therapy with lenvatinib and pembrolizumab or everolimus has been approved as a first-line treatment for patients with advanced RCC in China and the United States. However, the high costs of combination therapies, especially of those new drugs, may limit their viability as clinical treatment options. Thus, our study aimed to evaluate the cost-effectiveness of using lenvatinib plus pembrolizumab or everolimus as a first-line treatment for patients with advanced RCC from the perspective of the Chinese healthcare system and US third-party payers.</div></div><div><h3>Methods</h3><div>We established a Markov model using TreeAge Pro 2022 software to estimate and compare the cost and effectiveness of the therapy with lenvatinib plus pembrolizumab or everolimus with those of sunitinib therapy for treating advanced RCC based on the clinical data derived from a phase III randomized controlled trial (CLEAR, ClinicalTrials.gov number NCT02811861). Transition probabilities and other data were calculated and obtained by using parametric survival modeling. The direct medical costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were used as economic indicators in this analysis. The robustness of the model was assessed by performing one-way and probability sensitivity analyses (PSA).</div></div><div><h3>Results</h3><div>Among the 3 treatment strategies, the sunitinib 1 was the least expensive option. All ICERs were far higher than the thresholds of $38,024 and $100,000 selected for China and the United States, respectively. The ICERs of the therapy with lenvatinib plus pembrolizumab versus sunitinib therapy were 106,749.06 US$/QALY and $414,672.19 US$/QALY in China and the United States, respectively. Thus, among these 2, the former strategy was less cost-effective than the latter. In addition, the ICERs of the lenvatinib plus everolimus treatment vs. sunitinib treatment were $44,353.18 US$/QALY and $292,653.10 US$/QALY in China and the United States, respectively. Thus, among these 2 strategies, the former was less cost-effective than the latter. The total cost of the lenvatinib plus everolimus treatment strategy was lower than that of lenvatinib plus pembrolizumab; however, the former treatment was less effective than the latter.</div></div><div><h3>Conclusion</h3><div>The treatment with lenvatinib plus pembrolizumab or everolimus is less cost-effective than the sunitinib treatment for patients with advanced RCC in China and the United States.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102264"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Disparities in Inpatient Palliative Care Use in Metastatic Renal Cell Carcinoma Patients Receiving Critical Care Therapy","authors":"Carolin Siech ,&nbsp;Simone Morra ,&nbsp;Lukas Scheipner ,&nbsp;Andrea Baudo ,&nbsp;Mario de Angelis ,&nbsp;Letizia Maria Ippolita Jannello ,&nbsp;Nawar Touma ,&nbsp;Jordan A. Goyal ,&nbsp;Zhe Tian ,&nbsp;Fred Saad ,&nbsp;Shahrokh F. Shariat ,&nbsp;Nicola Longo ,&nbsp;Luca Carmignani ,&nbsp;Ottavio de Cobelli ,&nbsp;Sascha Ahyai ,&nbsp;Alberto Briganti ,&nbsp;Cristina Cano Garcia ,&nbsp;Luis A. Kluth ,&nbsp;Felix K.H. Chun ,&nbsp;Pierre I. Karakiewicz","doi":"10.1016/j.clgc.2024.102269","DOIUrl":"10.1016/j.clgc.2024.102269","url":null,"abstract":"<div><h3>Purpose</h3><div>Temporal trends in and predictors of inpatient palliative care use in patients with metastatic renal cell carcinoma (mRCC) undergoing critical care therapy are unknown.</div></div><div><h3>Methods</h3><div>Relying on the National Inpatient Sample (2008-2019), we identified mRCC patients undergoing critical care therapy, namely invasive mechanical ventilation, percutaneous endoscopic gastrostomy tube insertion, dialysis for acute kidney failure, total parenteral nutrition, or tracheostomy. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models addressed inpatient palliative care use.</div></div><div><h3>Results</h3><div>Of 3802 mRCC patients undergoing critical care therapy, 817 (21.5%) received inpatient palliative care. Overall, inpatient palliative care use increased from 4.9% to 31.5% between 2008 and 2019 (EAPC +9.2%). In subgroup analyses, the highest increase in inpatient palliative care use was observed in the Midwest (EAPC: +11.9%), in the South (EAPC +10.4%), and in teaching hospitals (EAPC +9.0%; all <em>P</em> ≤ .004). In logistic regression models, teaching hospital status (odds ratio [OR] 1.41) and contemporary year interval (OR 2.12; all <em>P</em> &lt; .001) independently predicted higher inpatient palliative care rates. Conversely, hospital admission in the Northeast (OR 0.53) or in the South (OR 0.79; all <em>P</em> ≤ .03) was associated with lower inpatient palliative care rates than in the West.</div></div><div><h3>Conclusion</h3><div>In mRCC patients, inpatient palliative care rates have improved over time, with the highest increase in hospitals in the Midwest and in the South. Moreover, admission to teaching hospitals or in the West is associated with higher inpatient palliative care rates. In consequence, regional disparities, as well as differences according to teaching hospital status represent targets to achieve comprehensive inpatient palliative care coverage in mRCC patients receiving critical care therapy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102269"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world Clinical Outcomes and Prognostic Factors in Neuroendocrine Prostate Cancer","authors":"Richard Gagnon ,&nbsp;Ealia Khosh Kish ,&nbsp;Sarah Cook ,&nbsp;Kosuke Takemura ,&nbsp;Brian Yu Chieh Cheng ,&nbsp;Kamiko Bressler ,&nbsp;Daniel Yick Chin Heng ,&nbsp;Nimira Alimohamed ,&nbsp;Dean Ruether ,&nbsp;Richard Marvin Lee-Ying ,&nbsp;Pinaki Bose ,&nbsp;Michael Paul Kolinsky ,&nbsp;Catalina Vasquez ,&nbsp;Divya Samuel ,&nbsp;John Lewis ,&nbsp;Rehan Faridi ,&nbsp;Minal Borkar ,&nbsp;Adrian Fairey ,&nbsp;Tarek Bismar ,&nbsp;Steven Yip","doi":"10.1016/j.clgc.2024.102274","DOIUrl":"10.1016/j.clgc.2024.102274","url":null,"abstract":"<div><h3>Background</h3><div>Neuroendocrine prostate cancer (NEPC) encompasses pure NEPC and tumors with mixed adenocarcinoma and neuroendocrine histology. While NEPC is thought to confer a poor prognosis, outcome data are sparse, making risk stratification and treatment decisions difficult for clinicians.</div></div><div><h3>Methods</h3><div>This retrospective study identified patients with morphological and/or immunohistochemical NEPC features on pathological review of high-grade prostate cancer cases. Median overall survival (OS) was calculated by stage and castration sensitivity. Prognostic factors were assessed via multivariate analysis. OS and progression-free survival on first-line metastatic systemic treatment were also evaluated.</div></div><div><h3>Results</h3><div>Of 135 NEPC cases, 25.9% had NEPC documented in the original pathological report. Mixed pathology was found in 91.9% of cases. Median OS from NEPC diagnosis was 59.2, 42.3, 14.3, 17.6 and 9.6 months for localized, nonmetastatic castration-sensitive, nonmetastatic castration-resistant, metastatic castration-sensitive and metastatic castration-resistant prostate cancer, respectively. Anemia (hazard ratio [HR]: 1.66; 95% CI 1.05-2.16; <em>P = .</em>031) and elevated neutrophil-lymphocyte ratio (NLR) (HR: 1.51; 95% CI 1.01-2.52; <em>P = .</em>045), were associated with increased risk of death on multivariate analysis. 67 patients received first-line metastatic treatment beyond androgen deprivation, with a median progression-free survival of 5.2 months and OS of 15 months. Of these, 50.7% received more than 1 line of systemic treatment.</div></div><div><h3>Conclusion</h3><div>We observed underdiagnosis of NEPC in pathology specimens. NEPC is associated with poorer prognosis than would be expected in pure adenocarcinoma populations, with rapid progression on first-line metastatic treatment and sharp drop-off between subsequent treatment lines. Anemia and elevated NLR were associated with poor survival.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102274"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of Prognostic Model for Metastatic Castration-Resistant Prostate Cancer Patients Treated With First-Line Abiraterone or Enzalutamide","authors":"Orazio Caffo ,&nbsp;Umberto Basso ,&nbsp;Carlo Cattrini ,&nbsp;Paola Ermacora ,&nbsp;Marco Maruzzo ,&nbsp;Martina Alberti ,&nbsp;Cecilia Anesi ,&nbsp;Davide Bimbatti ,&nbsp;Massimiliano Cani ,&nbsp;Veronica Crespi ,&nbsp;Giovanni Farinea ,&nbsp;Dzenete Kadrija ,&nbsp;Stefania Kinspergher ,&nbsp;Eleonora Lai ,&nbsp;Ludovica Lay ,&nbsp;Francesca Maines ,&nbsp;Alessia Mennitto ,&nbsp;Francesco Pierantoni ,&nbsp;Alessandro Samuelly ,&nbsp;Susanna Urban ,&nbsp;Antonello Veccia","doi":"10.1016/j.clgc.2024.102265","DOIUrl":"10.1016/j.clgc.2024.102265","url":null,"abstract":"<div><h3>Introduction</h3><div>Over the years, several prognostic models were developed in patients receiving chemotherapy for metastatic castration resistant prostate cancer (mCRPC), while data on androgen-receptor signaling inhibitors (ARSI) in a real-world setting are limited.</div></div><div><h3>Patients and methods</h3><div>We compared a consecutive series of 565 mCRPC patients receiving first-line ARSI at 4 high-volume Italian Centers (development set) to an external series of 180 patients receiving the same treatment at another Italian high-volume Center (training set), between 2011 and 2022.</div><div>Sixteen clinical and baseline laboratory variables were selected to develop a prognostic model. Patients were categorized into risk groups according to the number of independent factors positively associated with overall survival (OS).</div></div><div><h3>Results</h3><div>In the development cohort, after a median follow-up of 21.1 months, the median OS was 30.4 months (95% CI 27.5-33.4). At the multivariate analysis, 7 variables [age, prostate specific antigen (PSA) doubling time, baseline levels of hemoglobin, PSA, time to castration resistance, ECOG PS and bone metastases number) were included into the final model.</div><div>The median OS was 13.4, 25.7 and 46.4 months in poor (0-2 factors), intermediate (3-4 factors) and good (≥ 5 factors) prognosis group, respectively.</div><div>The application of the model to the validation set confirmed its ability to prognosticate for OS. The model c-indexes were 0.68 (95% CI 0.64-0.72) and 0.75 (95% CI 0.68-0.81) in the development and validation cohort, respectively.</div></div><div><h3>Conclusions</h3><div>Our model, based on clinical and laboratory variables readily assessable in clinical practice, might prognosticate the OS of mCRPC patients receiving first-line ARSI.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102265"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}