European urology oncology最新文献

{"title":"Time to Refine Prostate Cancer Epidemiology: Defining New Endpoints for Effective Screening and Causal Epidemiological Studies","authors":"Olivier Cussenot , Morgan Rouprêt , Shahrokh F. Shariat","doi":"10.1016/j.euo.2024.12.004","DOIUrl":"10.1016/j.euo.2024.12.004","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 7-8"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment-free Survival After First-line Therapies for Metastatic Renal Cell Carcinoma: An International Metastatic Renal Cell Carcinoma Database Consortium Analysis","authors":"Mehul Gupta ,&nbsp;Connor Wells ,&nbsp;Meredith M. Regan ,&nbsp;Wanling Xie ,&nbsp;Vishal Navani ,&nbsp;Renee Maria Saliby ,&nbsp;Naveen S. Basappa ,&nbsp;Frede Donskov ,&nbsp;Takeshi Yuasa ,&nbsp;Kosuke Takemura ,&nbsp;Christian K. Kollmannsberger ,&nbsp;Megan Crumbaker ,&nbsp;Aly-Khan A. Lalani ,&nbsp;Thomas Powles ,&nbsp;Hedyeh Ebrahimi ,&nbsp;Rana R. McKay ,&nbsp;Jae-Lyun Lee ,&nbsp;Ravindran Kanesvaran ,&nbsp;Toni K. Choueiri ,&nbsp;Daniel Y.C. Heng","doi":"10.1016/j.euo.2024.12.011","DOIUrl":"10.1016/j.euo.2024.12.011","url":null,"abstract":"<div><h3>Background and objective</h3><div>Patients receiving immune checkpoint blockade (ICB) therapy may experience periods of prolonged disease control without a need for systemic therapy. Treatment-free survival (TFS) is an important measure for this period, but no data are available for patients with metastatic renal cell carcinoma (mRCC) starting first-line agents. Our aim was to analyze TFS outcomes for patients with mRCC starting first-line therapy.</div></div><div><h3>Methods</h3><div>We analyzed data for patients with mRCC starting first-line systemic therapy with VEGFR-targeted monotherapy, an ICB + VEGFR combination, or an ICB doublet from February 1, 2014 to February 1, 2023 from the multicenter International Metastatic RCC Database Consortium (IMDC) database. We estimated 36-mo TFS as the difference in restricted mean survival time between (1) the time to first-line therapy discontinuation and (2) the time to subsequent systemic therapy initiation.</div></div><div><h3>Key findings and limitations</h3><div>The study population included 3758 patients receiving either first-line VEGFR monotherapy (<em>n</em> = 2635), an ICB + VEGFR combination (<em>n</em> = 354), or doublet ICB (<em>n</em> = 769) were included. For the IMDC favorable-risk cohort, the 36-mo TFS estimate was 3.1 mo (95% confidence interval [CI] 1.5–4.6) for the VEGFR monotherapy group and 3.7 mo (95% CI 0.2–7.2) for the ICB + VEGFR group. For the IMDC intermediate-/poor-risk cohort, TFS was 2.1 mo (95% CI 1.4–2.8) for the VEGFR monotherapy group, 3.7 mo (95% CI 1.0–6.4) for the ICB + VEGFR group, and 5.3 mo (95% CI 3.8–6.8) for ICB doublet group. Limitations include the retrospective design and an inability to quantify time spent with adverse events.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our study demonstrates that patients with IMDC intermediate or poor risk treated with ICB doublet therapy experienced longer TFS than those treated with VEGFR monotherapy in the first-line setting. These results emphasize the utility of TFS as an informative endpoint and provide survival estimates to inform decision-making in mRCC.</div></div><div><h3>Patient summary</h3><div>For patients with metastatic kidney cancer, we compared the survival time free from a second treatment line for different first-line treatment options. The results show that the time free from second-line treatment was longer when first-line treatment was with a combination of two immunotherapy drugs (ipilimumab and nivolumab) in comparison to other treatment options.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 171-178"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Twins in Urological Oncology: Precise Treatment Planning via Complex Modeling","authors":"Enrico Checcucci ,&nbsp;Christoph Oing ,&nbsp;Daniele Amparore ,&nbsp;Francesco Porpiglia ,&nbsp;Pasquale Rescigno","doi":"10.1016/j.euo.2024.10.005","DOIUrl":"10.1016/j.euo.2024.10.005","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 1-4"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hall of Fame","authors":"","doi":"10.1016/S2588-9311(25)00034-3","DOIUrl":"10.1016/S2588-9311(25)00034-3","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Page viii"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hematuria Cancer Risk Score with Ultrasound Informs Cystoscopy Use in Patients with Hematuria","authors":"Wei Shen Tan ,&nbsp;Amar Ahmad ,&nbsp;Yin Zhou ,&nbsp;Arjun Nathan ,&nbsp;Ayodeji Ogunbo ,&nbsp;Olayinka Gbolahan ,&nbsp;Neha Kallam ,&nbsp;Rebecca Smith ,&nbsp;Maen Khalifeh ,&nbsp;Wei Phin Tan ,&nbsp;Daniel Cohen ,&nbsp;Dimitrios Volanis ,&nbsp;Fiona M. Walter ,&nbsp;Peter Sasieni ,&nbsp;Ashish M. Kamat ,&nbsp;John D. Kelly","doi":"10.1016/j.euo.2024.05.005","DOIUrl":"10.1016/j.euo.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Hematuria is a cardinal symptom of urinary tract cancer and would require further investigations.</div></div><div><h3>Objective</h3><div>To determine the ability of renal bladder ultrasound (RBUS) with the Hematuria Cancer Risk Score (HCRS) to inform cystoscopy use in patients with hematuria.</div></div><div><h3>Design, setting, and participants</h3><div>The development cohort comprised 1984 patients with hematuria from 40 UK hospitals (DETECT 1; ClinicalTrials.gov: NCT02676180) who received RBUS. An independent validation cohort comprised 500 consecutive patients referred to secondary care for a suspicion of bladder cancer.</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>Sensitivity and true negative of the HCRS and RBUS were assessed.</div></div><div><h3>Results and limitations</h3><div>A total of 134 (7%) and 36 (8%) patients in the development and validation cohorts, respectively, had a diagnosis of urinary tract cancer. Validation of the HCRS achieves good discrimination with an area under the receiver operating characteristic curve of 0.727 (95% confidence interval 0.648–0.800) in the validation cohort with sensitivity of 95% for the identification of cancer. Utilizing the cutoff of 4.500 derived from the HCRS in combination with RBUS in the development cohort, 680 (34%) patients would have been spared cystoscopy at the cost of missing a G1 Ta bladder cancer and a urinary tract cancer patient, while 117 (25%) patients would have avoided cystoscopy at the cost of missing a single patient of G1 Ta bladder cancer with sensitivity for the identification of cancer of 97% in the validation cohort.</div></div><div><h3>Conclusions</h3><div>The HCRS with RBUS offers good discriminatory ability in identifying patients who would benefit from cystoscopy, sparing selected patient cohorts from an invasive procedure.</div></div><div><h3>Patient summary</h3><div>The hematuria cancer risk score with renal bladder ultrasound allows for the triage of patients with hematuria who would benefit from visual examination of the bladder (cystoscopy). This resulted in 25% of patients safely omitting cystoscopy, which is an invasive procedure, and would lead to health care cost savings.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 87-93"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consistencies in Follow-up After Radical Cystectomy for Bladder Cancer: A Framework Based on Expert Practices Collaboratively Developed by the European Association of Urology Bladder Cancer Guideline Panels","authors":"Laura S. Mertens ,&nbsp;Harman Maxim Bruins ,&nbsp;Roberto Contieri ,&nbsp;Marek Babjuk ,&nbsp;Bhavan P. Rai ,&nbsp;Albert Carrión Puig ,&nbsp;Jose Luis Dominguez Escrig ,&nbsp;Paolo Gontero ,&nbsp;Antoine G. van der Heijden ,&nbsp;Fredrik Liedberg ,&nbsp;Alberto Martini ,&nbsp;Alexandra Masson-Lecomte ,&nbsp;Richard P. Meijer ,&nbsp;Hugh Mostafid ,&nbsp;Yann Neuzillet ,&nbsp;Benjamin Pradere ,&nbsp;John Redlef ,&nbsp;Bas W.G. van Rhijn ,&nbsp;Matthieu Rouanne ,&nbsp;Morgan Rouprêt ,&nbsp;J. Alfred Witjes","doi":"10.1016/j.euo.2024.05.010","DOIUrl":"10.1016/j.euo.2024.05.010","url":null,"abstract":"<div><h3>Background and objective</h3><div>There is no standardized regimen for follow-up after radical cystectomy (RC) for bladder cancer (BC). To address this gap, we conducted a multicenter study involving urologist members from the European Association of Urology (EAU) bladder cancer guideline panels. Our objective was to identify consistent post-RC follow-up strategies and develop a practice-based framework based on expert opinion.</div></div><div><h3>Methods</h3><div>We surveyed 27 urologist members of the EAU guideline panels for non–muscle-invasive bladder cancer and muscle-invasive and metastatic bladder cancer using a pre-tested questionnaire with dichotomous responses. The survey inquired about follow-up strategies after RC and the use of risk-adapted strategies. Consistency was defined as &gt;75% affirmative responses for follow-up practices commencing 3 mo after RC. Descriptive statistics were used for analysis.</div></div><div><h3>Key findings and limitations</h3><div>We received responses from 96% of the panel members, who provided data from 21 European hospitals. Risk-adapted follow-up is used in 53% of hospitals, with uniform criteria for high-risk (at least ≥pT3 or pN+) and low-risk ([y]pT0/a/1N0) cases. In the absence of agreement for risk-based follow up, a non-risk-adapted framework for follow-up was developed. Higher conformity was observed within the initial 3 yr, followed by a decline in subsequent follow-up. Follow-up was most frequent during the first year, including patient assessments, physical examinations, and laboratory tests. Computed tomography of the chest and abdomen/pelvis was the most common imaging modality, initially at least biannually, and then annually from years 2 to 5. There was a lack of consistency for continuing follow-up beyond 10 yr after RC.</div></div><div><h3>Conclusions and clinical implications</h3><div>This practice-based post-RC follow-up framework developed by EAU bladder cancer experts may serve as a valuable guide for urologists in the absence of prospective randomized studies.</div></div><div><h3>Patient summary</h3><div>We asked urologists from the EAU bladder cancer guideline panels about their patient follow-up after surgical removal of the bladder for bladder cancer. We found that although urologists have varying approaches, there are also common follow-up practices across the panel. We created a practical follow-up framework that could be useful for urologists in their day-to-day practice.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 105-110"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deintensification of Treatment for Low-grade Bladder Tumors: A Collaborative Review by the International Bladder Cancer Group (IBCG)","authors":"Roberto Contieri ,&nbsp;Mark S. Soloway ,&nbsp;Paolo Gontero ,&nbsp;Harry Herr ,&nbsp;Wassim Kassouf ,&nbsp;Laura S. Mertens ,&nbsp;Marco Moschini ,&nbsp;Michael O’Donnell ,&nbsp;Joan Palou ,&nbsp;Sarah P. Psutka ,&nbsp;Morgan Rouprêt ,&nbsp;Jeremy Y.C. Teoh ,&nbsp;Ashish M. Kamat","doi":"10.1016/j.euo.2024.08.001","DOIUrl":"10.1016/j.euo.2024.08.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>Management of low-grade (LG) urothelium-confined (Ta stage) non–muscle-invasive bladder cancer (NMIBC) poses a distinct therapeutic challenge. Transurethral resection of bladder tumor (TURBT), the standard treatment, frequently has to be repeated because of high tumor recurrence rates. This places a considerable strain on both patients and health care infrastructure, underscoring the need for alternative management approaches. Herein, the IBCG (International Bladder Cancer Group), conducted a review to explore the efficacy and safety of deintensified treatment strategies for recurrent LG Ta NMIBC.</div></div><div><h3>Methods</h3><div>We conducted a collaborative review of relevant literature in the PubMed/MEDLINE and Cochrane CENTRAL databases. Our focus was on high-quality evidence, including randomized controlled trials, systematic reviews, and meta-analyses. We also reviewed guidelines published by prominent urological associations.</div></div><div><h3>Key findings and limitations</h3><div>Active surveillance, chemoablation, and office fulguration are valid treatment options for recurrent LG Ta NMIBC. These deintensified approaches offer several advantages over TURBT: lower complication rates, less morbidity, lower health care costs, and better quality of life for patients. Importantly, these benefits are achieved without compromising oncological safety.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our review demonstrates that less intensive treatment strategies for recurrent LG Ta NMIBC are both feasible and valuable. The IBCG recommends use of these approaches for carefully selected patients to help lower health care costs and enhance patients’ quality of life.</div></div><div><h3>Patient summary</h3><div>We reviewed studies on less invasive management options for low-grade noninvasive bladder cancer, including active surveillance, chemical ablation, and heat treatment. Recent results confirm that these less intense treatment options can reduce the treatment burden and costs for patients and preserve their quality of life without negatively affecting cancer control outcomes.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 179-189"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Pathologist and Artificial Intelligence–based Grading for Prediction of Metastatic Outcomes After Radical Prostatectomy","authors":"Lia D. Oliveira ,&nbsp;Jiayun Lu ,&nbsp;Eric Erak ,&nbsp;Adrianna A. Mendes ,&nbsp;Oluwademilade Dairo ,&nbsp;Onur Ertunc ,&nbsp;Ibrahim Kulac ,&nbsp;Javier A. Baena-Del Valle ,&nbsp;Tracy Jones ,&nbsp;Jessica L. Hicks ,&nbsp;Stephanie Glavaris ,&nbsp;Gunes Guner ,&nbsp;Igor D. Vidal ,&nbsp;Bruce J. Trock ,&nbsp;Uttara Joshi ,&nbsp;Chaith Kondragunta ,&nbsp;Saikiran Bonthu ,&nbsp;Corinne Joshu ,&nbsp;Nitin Singhal ,&nbsp;Angelo M. De Marzo ,&nbsp;Tamara L. Lotan","doi":"10.1016/j.euo.2024.08.004","DOIUrl":"10.1016/j.euo.2024.08.004","url":null,"abstract":"<div><div>Gleason grade group (GG) is the most powerful prognostic variable in localized prostate cancer; however, interobserver variability remains a challenge. Artificial intelligence algorithms applied to histopathologic images standardize grading, but most have been tested only for agreement with pathologist GG, without assessment of performance with respect to oncologic outcomes. We compared deep learning–based and pathologist-based GGs for an association with metastatic outcome in three surgical cohorts comprising 777 unique patients. A digitized whole slide image of the representative hematoxylin and eosin–stained slide of the dominant tumor nodule was assigned a GG by an artificial intelligence–based grading algorithm and was compared with the GG assigned by a contemporary pathologist or the original pathologist-assigned GG for the entire prostatectomy. Harrell’s C-indices based on Cox models for time to metastasis were compared. In a combined analysis of all cohorts, the C-index for the artificial intelligence–assigned GG was 0.77 (95% confidence interval [CI]: 0.73–0.81), compared with 0.77 (95% CI: 0.73–0.81) for the pathologist-assigned GG. By comparison, the original pathologist-assigned GG for the entire case had a C-index of 0.78 (95% CI: 0.73–0.82).</div></div><div><h3>Patient summary</h3><div>Artificial intelligence–enabled prostate cancer grading on a single slide was comparable with pathologist grading for predicting metastatic outcome in men treated by radical prostatectomy, enabling equal access to expert grading in lower resource settings.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 9-13"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Related to Urinary Tract Infections Is Associated with Delayed Diagnosis of Urinary Bladder Cancer: A Nationwide Population-based Study","authors":"Fredrik Liedberg ,&nbsp;Truls Gårdmark ,&nbsp;Oskar Hagberg ,&nbsp;Firas Aljabery ,&nbsp;Viveka Ströck ,&nbsp;Abolfazl Hosseini ,&nbsp;Per-Uno Malmström ,&nbsp;Karin Söderkvist ,&nbsp;Anders Ullén ,&nbsp;Tomas Jerlström ,&nbsp;Staffan Jahnson ,&nbsp;Lars Holmberg ,&nbsp;Christel Häggström","doi":"10.1016/j.euo.2024.07.008","DOIUrl":"10.1016/j.euo.2024.07.008","url":null,"abstract":"<div><h3>Background and objective</h3><div>It has been suggested that urinary tract infections (UTIs) are associated with delayed diagnosis of bladder cancer (BC). Our aim was to investigate prediagnostic treatments related to UTI and the relation to BC diagnostic delay, reflected by advanced disease at diagnosis.</div></div><div><h3>Methods</h3><div>We used data from the BladderBaSe 2.0 with data of treatments related to UTI up to 3 yr before BC diagnosis (2008–2019) for BC patients in comparison to a matched reference population. We investigated the association between UTI treatments and more advanced disease at diagnosis in the BC cohort. We used generalized ordered logistic regression to calculate odds ratios (ORs) for more advanced disease as an ordered outcome: non–muscle-invasive BC (NMIBC), muscle-invasive BC (MIBC), and metastatic BC (MBC).</div></div><div><h3>Key findings and limitations</h3><div>The study population included 29 921 BC patients and 149 467 matched reference subjects. The proportions of individuals receiving UTI treatment were higher in the patient groups than in the corresponding reference groups, with the greatest differences observed for the MIBC and MBC subgroups. The OR for the risk of more advanced disease (MIBC or MBC) with at least one UTI treatment versus none was 1.28 (95% confidence interval [CI] 1.19–1.37) for men and 1.42 (95 % CI 1.27–1.58) for women. The association to risk of more advanced disease increased with the number of UTI treatments for both sexes.</div></div><div><h3>Conclusions and clinical implications</h3><div>Further studies on the effects of treatments related to UTI in combination with other factors are needed to identify reasons for possible delays in the BC diagnostic pathway.</div></div><div><h3>Patient summary</h3><div>We found that for patients with bladder cancer, previous antibiotic treatment for a urinary tract infection was linked to more advanced disease at diagnosis. Further studies are needed to identify reasons for possible delays in the diagnosis of bladder cancer.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 119-125"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported Quality of Life and Survival Outcomes in Prostate Cancer: Analysis of the ECOG-ACRIN E3805 Chemohormonal Androgen Ablation Randomized Trial (CHAARTED)","authors":"Daniel Sentana-Lledo ,&nbsp;Xiangying Chu ,&nbsp;David F. Jarrard ,&nbsp;Michael A. Carducci ,&nbsp;Robert S. DiPaola ,&nbsp;Lynn I. Wagner ,&nbsp;David Cella ,&nbsp;Christopher J. Sweeney ,&nbsp;Alicia K. Morgans","doi":"10.1016/j.euo.2024.04.010","DOIUrl":"10.1016/j.euo.2024.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Chemohormonal therapy with androgen deprivation therapy and docetaxel (ADT + D) improves overall survival (OS) and quality of life (QOL) at 12 mo versus androgen deprivation therapy (ADT) alone in men with metastatic hormone-sensitive prostate cancer (mHSPC). However, the prognostic role of QOL is unknown in this population.</div></div><div><h3>Objective</h3><div>To study the relationship between QOL, disease characteristics, and OS in men with mHSPC.</div></div><div><h3>Design, setting, and participants</h3><div>In this exploratory post hoc analysis, 790 patients with mHSPC completed the QOL instruments Functional Assessment of Cancer Therapy—Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT-F), and Brief Pain Inventory (BPI).</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>Log-rank test and Cox proportional hazard models tested the association between QOL and OS by clinical and disease characteristics.</div></div><div><h3>Results and limitations</h3><div>Baseline higher FACT-P trended toward improved survival after accounting for clinical variables (hazard ratio [HR] 0.80 [0.62, 1.04], <em>p</em> = 0.09), while higher 3-mo FACT-P was independently associated with better survival (HR 0.76 [0.58, 1.0], <em>p</em> = 0.05). Patients with the poorest QOL (bottom quartile) at baseline and 3 mo had longer survival if they received ADT + D rather than ADT alone (median OS 45.2 vs 34.4 mo, HR 0.75 [0.53, 1.05], <em>p</em> = 0.09, and 48.3 vs 29.3 mo, HR 0.69 [0.48, 0.99], <em>p</em> = 0.05 respectively). In contrast, patients with the best QOL (top quartile) at baseline and 3 mo had comparable survival irrespective of whether or not docetaxel was added (median OS 72.1 vs 51.7 mo, HR 0.92 [0.63, 1.36], <em>p</em> = 0.69, and 69.9 vs 68.9 mo, HR 1.11 [0.73, 1.67], <em>p</em> = 0.63, respectively). Survival was linked with baseline FACIT-F (HR 0.76 [0.57, 1.0], <em>p</em> = 0.05), but not BPI (HR 0.98 [0.75, 1.28], <em>p</em> = 0.90).</div></div><div><h3>Conclusions</h3><div>Three-month QOL had a stronger independent association with survival. The most symptomatic patients had longer survival with the addition of docetaxel; conversely, the least symptomatic patients did not appear to benefit. Consideration of QOL may enhance decision-making and patient selection when choosing chemohormonal treatment in mHSPC.</div></div><div><h3>Patient summary</h3><div>Quality of life independently forecasted the survival of men with metastatic hormone-sensitive prostate cancer in the CHAARTED study. Close tracking of quality of life could help patients and clinicians make decisions about the appropriate treatment in this setting.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 29-37"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}