Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Efficacy and safety of dose-dense gemcitabine and cisplatin as neoadjuvant chemotherapy for high-grade upper tract urothelial carcinoma (cT2-3N0M0).","authors":"Yuto Hattori, Akihiko Nagoshi, Tasuku Fujiwara, Takanari Kambe, Yuta Mine, Hidetoshi Kokubun, Yohei Abe, Masashi Kubota, Noboru Shibasaki, Mutsushi Kawakita, Toshinari Yamasaki","doi":"10.1016/j.urolonc.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.02.010","url":null,"abstract":"<p><strong>Purpose: </strong>Neoadjuvant chemotherapy for upper tract urothelial carcinoma has shown favorable results. However, few studies have been conducted on dose-dense regimens that have demonstrated superior efficacy in bladder cancer. We aimed to retrospectively evaluate the efficacy and safety of dose-dense gemcitabine and cisplatin as neoadjuvant chemotherapy for upper tract urothelial carcinoma.</p><p><strong>Materials and methods: </strong>Ninety-five patients who underwent radical nephroureterectomy for high-grade upper tract urothelial carcinoma (cT2-3N0M0) with dose-dense gemcitabine and cisplatin (n = 33) or without neoadjuvant chemotherapy (n = 62, Control) were included. Propensity score matching was performed based on the patient and tumor demographics. Efficacy was evaluated by the pathological response rate defined as pathological downstaging to ≤ pT1N0 and complete response (pT0N0). Progression-free survival, cancer-specific survival, and overall survival were estimated. All adverse events and postoperative complications were assessed.</p><p><strong>Results: </strong>Thirty-one matched patients were included in each cohort after adjusting for baseline propensity score matching. The pathological downstaging to ≤ pT1N0 rate of the neoadjuvant chemotherapy group was significantly higher than the Control group. The complete response rate was 6.5% in the neoadjuvant chemotherapy group; pT0N0 was not observed in the Control group. The 2-year progression-free survival and cancer-specific survival rates were significantly better in the neoadjuvant chemotherapy group. Of the 33 patients who received neoadjuvant chemotherapy, 7 severe adverse events (grade 3 or higher) were observed in 6 patients.</p><p><strong>Conclusions: </strong>Dose-dense gemcitabine and cisplatin showed a favorable pathological response and oncological outcome with good tolerability.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558009","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":"A PHASE 1B TRIAL OF MASOFANITEN (EPI-7386) IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER (MCRPC)","authors":"Andrew Laccetti,&nbsp;Nicholas Iannotti,&nbsp;Russell Pachynski,&nbsp;Bradley Carthon,&nbsp;Kim N. Chi,&nbsp;Matthew Smith,&nbsp;Fred Saad,&nbsp;Roberto Pili,&nbsp;Wilson Tu,&nbsp;Edmond M. Kwan,&nbsp;Alexander W. Wyatt,&nbsp;Karen Villaluna,&nbsp;Brett Younginger,&nbsp;Ronan Le Moigne,&nbsp;Alessandra Cesano","doi":"10.1016/j.urolonc.2024.12.005","DOIUrl":"10.1016/j.urolonc.2024.12.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Masofaniten (EPI-7386) is a next generation aniten, a novel class of compounds designed to inhibit androgen receptor (AR) activity by binding to the N-terminal domain. Preclinical data supports disruption of AR regulated gene transcription, even in the presence of resistance mechanisms including ligand-binding domain point mutations and truncated splice variants, as a strategy to inhibit prostate cancer growth. In the Phase 1a dose-escalation study (NCT04421222), treatment with EPI-7386 monotherapy was safe, well tolerated up to a daily dose of 1200 mg (600 mg BID), achieved target clinical exposures and showed preliminary signals of antitumor activity in heavily pretreated mCRPC. We report here the results of the Phase 1b dose expansion first-in-human trial of EPI-7386 in mCRPC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This Phase 1b, open-label, multicenter, dose expansion trial was designed to evaluate the safety, pharmacokinetics, pharmacodynamics, and antitumor activity of EPI-7386 in mCRPC patients (pts) progressing on standard of care treatment, including next generation antiandrogens. Two cohorts were tested, examining the 600 mg BID and 600 mg QD dosing regimens. Circulating Tumor DNA (ctDNA) samples were also collected in the study at baseline and at cycle 4 to characterize the tumor genomic profile and quantify molecular response.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;12 pts were enrolled in the 600 mg BID cohort (median follow up 12 months) and 12 in the 600 mg QD cohort (median follow up 8 months). Pts in both arms had a median of 2 (range 1-3) lines of prior therapy for mCRPC: 71% in both cohorts received abiraterone and at least one second generation AR inhibitor (enzalutamide, darolutamide or apalutamide). EPI-7386 was safe and well tolerated at both dosing schedules. The majority of related adverse events (AEs) were grade 1 (47%), and grade 2 (41%). AEs were consistent with AEs associated with second-generation antiandrogens (i.e. anemia, fatigue and hypertension), and no differences were observed between EPI-7386 600 mg QD and BID dosing. As expected, 600 mg BID dosing resulted in higher PK parameters at steady state, with a mean AUC&lt;sub&gt;0-24&lt;/sub&gt; of 357,000 hr*ng/mL and a mean C&lt;sub&gt;last&lt;/sub&gt; of 14,500 ng/mL, in comparison to a mean AUC&lt;sub&gt;0-24&lt;/sub&gt; of 246,000 hr*ng/mL and a mean C&lt;sub&gt;last&lt;/sub&gt; of 7,120 ng/mL for the 600 mg QD cohort. Both dosing regimens resulted in exposures in the range of those associated with antitumor activity in preclinical models. Evidence of antitumor activity was observed in ∼1/3 of the patients in both cohorts. Notably, genomic characterization of ctDNA samples showed, beside the expected alterations in the AR pathway (AR mutations, amplifications, structural rearrangements), additional molecular alterations associated with disease aggression and lineage plasticity (&lt;em&gt;P53&lt;/em&gt; mut, &lt;em&gt;PTEN&lt;/em&gt; deletion, &lt;em&gt;RB1&lt;/em&gt; deletion).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;di","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 1"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509347","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":"IDENTIFYING BARRIERS TO TIMELY FOLLOW-UP AFTER ELEVATED PSA SCREENING: A RETROSPECTIVE ANALYSIS OF A LARGE HEALTHCARE SYSTEM","authors":"Zhiyu (Jason) Qian,&nbsp;Yu-Jen Chen,&nbsp;Precious Precious Moman,&nbsp;Muhieddine Labban,&nbsp;Daniel Stelzl,&nbsp;Filippo Dagnin,&nbsp;Hanna Zurl,&nbsp;Danesha Daniels,&nbsp;Claudia Carranza,&nbsp;Kara L. Watts,&nbsp;Alexander P. Cole,&nbsp;Quoc-Dien Trinh","doi":"10.1016/j.urolonc.2024.12.025","DOIUrl":"10.1016/j.urolonc.2024.12.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Prostate cancer is the most common solid organ cancer and the second leading cause of cancer-related mortality among American men. Early detection and timely treatment are crucial for effective management. Despite updated guidelines from the United States Preventive Services Task Force in 2018 recommending shared decision-making for PSA screening in men aged 55-69 years, barriers to timely follow-up care persist. This study aims to examine elevated PSA follow-up within our healthcare system and identify barriers to timely diagnosis of prostate cancer.</div></div><div><h3>Methods</h3><div>We analyzed data from the Mass General Brigham's Enterprise Data Warehouse, focusing on patients with elevated PSA levels from 2018-2021. Timely follow-up was defined as having a urologist appointment, prostate biopsy, or prostate MRI within 6 months of diagnosis. The location of elevated PSA diagnosis was categorized as academic medical centers versus community sites. Univariable and multivariable analyses were conducted to identify factors impacting follow-up.</div></div><div><h3>Results</h3><div>Our cohort included 28,346 patients, with 50.30% receiving timely follow-up, 15.02% experiencing untimely follow-up, and 34.69% having no follow-up. Multivariable analysis showed that patients diagnosed at academic medical centers were more likely to receive follow-up care (OR=1.39, 95%CI 1.30-1.48). Sensitivity analysis incorporating two major community hospitals into the academic category revealed even higher odds of timely follow-up (OR=1.61, 95%CI 1.51-1.73).</div></div><div><h3>Conclusions</h3><div>Significant variation exists in follow-up rates between academic medical centers and community sites, underscoring the need for strategies to ensure timely and consistent prostate cancer follow-up care across all facilities. Addressing these disparities can enhance timely care delivery and improve patient outcomes.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 10"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509783","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":"PREDICTIVE VALUE OF PSA KINETICS ON RISK OF PROSTATE CANCER VERSUS INFLAMMATION IN AN AFRO-CARIBBEAN POPULATION: A SINGLE INSTITUTION BASED RETROSPECTIVE STUDY IN AFRO-CARIBBEAN POPULATION","authors":"Prashil Dave,&nbsp;Benjamin Prizer,&nbsp;David Musheyev,&nbsp;Eli Berglas,&nbsp;Nikeeta Mandhan,&nbsp;Parima Saxena,&nbsp;Luis Gonzalez Miranda,&nbsp;Sankalpa Pokhrel,&nbsp;Dedipya Bhamidipati,&nbsp;Areeba Zaman,&nbsp;Andrew Winer","doi":"10.1016/j.urolonc.2024.12.077","DOIUrl":"10.1016/j.urolonc.2024.12.077","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The change in Prostate Specific Antigen (PSA) over time, known as PSA velocity (PSAV), has been proposed as a measurement for improving the specificity of PSA monitoring for prostate cancer screening; however, its utility is controversial. Some studies use PSA doubling time (PSADT) as a readout of biochemical and clinical progression. Studies suggest that the validity of PSAV thresholds varies depending on the demographics of the patient population. Few studies investigate how PSAV and PSADT can be used to stratify prostate cancer risk in black populations. Black men have the highest incidence of prostate cancer out of any group in America. This retrospective study aims to compare PSAV and PSADT in patients who received prostate biopsy with pathology results of inflammation versus cancer to determine how PSAV and PSADT impact the risk of prostate cancer in a predominantly Afro-Caribbean patient population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Prostate biopsies from Kings County Hospital, Brooklyn, New York, from 01/2018 to 04/2024, were retrospectively reviewed and recorded in the REDcap database. Patients with three PSA values at least 18 months, with six months between each, were included. Pathology results were classified into cancer (N=155) and inflammation (N=70). The cancer cohort was stratified to adjust for treatment (N=126, 81%). PSAV calculation used untransformed PSA values that met the previously mentioned inclusion criteria. The cancer cohort (calculated before treatment, N=50) was compared to the inflammation group (N=64). PSA doubling times (at least two PSA values, three months apart) were also compared between the cancer cohort pre- and post-treatment (N = 68, 63) and the inflammation cohort pre- and post-biopsy (N = 34, 39) when PSAV could not be calculated. Odds ratio, sensitivity, and specificity were calculated using several PSAV and doubling time thresholds.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Increasing threshold PSAV increased specificity in identifying a cancer patient (Figure 1). However, returns were limited as using a PSAV threshold of 2.00 ng/mL/Yr, 16 of 50 (32%) cancer patients met the threshold. This contrasts with 36 of 50 patients (72%) who met the lowest threshold. 0.65 ng/mL/Yr yielded the highest odds ratio (OR = 3.97, 95% CI [1.81, 8.71]) amongst results where p &lt; 0.05. When comparing PSA doubling time using values of less than 6 and 10 months as thresholds between pre-treatment cancer and pre-biopsy groups, there were no significant findings. However, comparing post-treatment cancer cohort to post-biopsy inflammation, both a cutoff of 6 (OR = 3.33, 95% CI [1.44, 7.67]) and 10 months (OR = 3.44, 95% CI [1.49, 7.93]) showed similar significant findings (Table 1).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;PSAV has the potential to increase the specificity of PSA monitoring, particularly in black populations that have a high incidence of disease. Our data suggests that when take","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 30-31"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509787","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":"UTILITY OF TUMOR-INFORMED CIRCULATING TUMOR DNA (CTDNA) IN PATIENTS UNDERGOING RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER","authors":"Reuben Ben-David,&nbsp;Reza Mehrazin,&nbsp;Neeraja Tillu,&nbsp;Sarah Lidagoster,&nbsp;Matthew Galsky,&nbsp;Che-Kai Tsao,&nbsp;Kyrollis Attalla,&nbsp;Peter Wiklund,&nbsp;John Sfakianos","doi":"10.1016/j.urolonc.2024.12.084","DOIUrl":"10.1016/j.urolonc.2024.12.084","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Circulating tumor DNA (ctDNA) has been gaining popularity in directing and tailoring treatment modalities in solid cancers. ctDNA utility before and after diagnosis of testicular cancer has not yet been well-characterized. We seek to characterize the utility of ctDNA in correlation with pathologic and clinical features in patients with testicular cancer who underwent retroperitoneal lymph node dissection (RPLND).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Our single institution prospectively maintained database identified consecutive patients who underwent radical orchiectomy for germ cell tumor (GCT) between 2021 - 2023, included were patients who had prospectively collected ctDNA (Signatera&lt;sup&gt;TM&lt;/sup&gt;) analyses performed before and after RPLND. ctDNA signature was informed from the radical orchiectomy specimen in 9 patients and from the RPLND specimen in 8 patients (Figure 1). The informed signature was used throughout the patient's surveillance. Pre-RPLND ctDNA status was determined from blood drawn prior to surgery, and the post-RPLND minimal residual disease (MRD) window ctDNA status was determined from blood drawn after and within 90 days from RPLND. Study findings were reported using descriptive statistics. R programming language version 4.3.1 was used for all statistical analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Seventeen patients had 89 ctDNA analyses performed before and after RPLND. The median age was 31 (IQR 25-33). The median follow-up time was 11 months (IQR 7-13). The primary testicular pathology prior to RPLND was non-seminoma for 14 patients (82.3%), seminoma for 2 patients (11.7%), and one patient had primary retroperitoneal seminoma (5.8%). Nine patients underwent primary RPLND (53%), 6 underwent post-chemotherapy RPLND (PS-RPLND, 35%) and 2 patients had RPLND performed due to recurrence while on surveillance for clinical stage I (11.7%). Serum tumor markers (STM) were normal for all the patients prior to RPLND. Pre-RPLND ctDNA status was available for 13 patients, ctDNA was undetectable in 8 patients (5 had benign pathology and 3 had teratoma), and detectable in 5 patients (38%); among them, 4 had viable GCT and one had teratoma. Fourteen patients had ctDNA MRD window status available. Four had detectable ctDNA status (28.5), all of them had disease progression (100%) and received further chemotherapy after RPLND. Only 1 of the 4 patients had elevated STM after RPLND (25%). Ten patients (71.4%) had undetectable MRD ctDNA status, 9 patients (90%) are currently under surveillance without evidence of disease recurrence, and one patient received adjuvant chemotherapy after RPLND without evidence of disease recurrence, all had post-RPLND normal STM. Detectable pre-RPLND ctDNA signature was found only in 1 of 4 patients with teratoma on RPLND histology (25%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Detectable ctDNA status in the pre-RPLND status was associated with viable GCT on histology while havin","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 33"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509925","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":"TESTIS CANCER PRESENTATION, SURGICAL MANAGEMENT, AND MORTALITY ACROSS THE RURAL-URBAN CONTINUUM IN THE NATIONAL CANCER DATABASE (NCDB)","authors":"Devon M. Langston,&nbsp;Joemy Ramsay,&nbsp;Bogdana Schmidt","doi":"10.1016/j.urolonc.2024.12.085","DOIUrl":"10.1016/j.urolonc.2024.12.085","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Testicular neoplasms, though infrequent overall, are the most common tumors in men aged 20-40, with 95% classified as seminoma and non-seminomatous germ cell tumors. In the U.S., the incidence is approximately 1 per 250 males, showing a rise over recent decades, while mortality rates have decreased. For stage I or IIA nonseminomatous germ cell tumors, primary retroperitoneal lymph node dissection (RPLND) provides crucial therapeutic and diagnostic benefit due to the tumor's limited metastatic spread. Disparities persist in testicular cancer outcomes partly due to limited access to high volume specialty surgical care, and based on race and ethnicity with increased mortality noted for Hispanic men. This study aims to explore these disparities further by analyzing clinical outcomes, including presentation and surgical management, across rural and urban areas using the National Cancer Database (NCDB), to better understand how geographical factors influence testicular cancer outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Our retrospective study, utilizing the NCDB, explores disparities in testicular cancer outcomes among men diagnosed with seminoma (SGCT) and nonseminomatous germ cell tumors (NSGCT). Individuals were assigned to geographic areas using Rural-Urban continuum codes (RUCCs) for their county of residence at the time of diagnosis: large metropolitan (population ≥1 million), medium metropolitan (population 250,000-1 million), small metropolitan (population &lt;250,000), urban (population 2,500-&gt;20,000), and rural (population &lt;2,500). Univariate analysis examined sociodemographic, clinical, and treatment variables. Risk of mortality across the rural-urban continuum was assessed using multivariable Cox regression adjusted for age, pathologic stage, chemotherapy, radiation therapy, race, insurance, surgery type, and area of residence. Kaplan-Meier survival curves assessing mortality based on residence and distance from treating facility were also generated. We also assessed long-term survivorship by examining mortality from time of diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our cohort of 100,805 had a geographic breakdown of large- (N=55,910), medium- (N=22,089), small-metropolitan (N=9,804), urban (N=11,692), and rural (N=1,310). Disparities were observed including age at diagnosis (p=0.016), race/ethnicity, insurance coverage, educational attainment, and income (all with p&lt;0.001). Unadjusted Cox proportional hazards models reveal urban patients showed increased odds for RPLND overall (OR= 1.10 (1.04-1.17), p=0.002) and uninsured patients having the lowest odds overall for all stages (OR= 0.72 (0.65-0.80), p&lt;0.001). In multivariable models, distance to treating facility was positively associated with RPLND (OR= 1.10 (1.07-1.13), p&lt;0.001) and patients residing &gt;50 miles from their treatment facility showing the highest odds of RPLND (OR= 4.34 (4.12-4.57), p&lt;0.001). Residents of rural area","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 33-34"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509926","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":"HOSPITAL OUTCOMES AND HEALTHCARE BURDEN OF TESTICULAR CANCER: A RETROSPECTIVE ANALYSIS OF THE 2024 NATIONAL INPATIENT SAMPLE","authors":"Srinishant Rajarajan,&nbsp;Kalaivani Babu,&nbsp;Sruthi Ramanan,&nbsp;Nithya Ramesh,&nbsp;Asmi Chattaraj,&nbsp;Amit Correa","doi":"10.1016/j.urolonc.2024.12.090","DOIUrl":"10.1016/j.urolonc.2024.12.090","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Testicular cancer, although relatively rare, is the most common malignancy in young men aged 15 to 35 years. It accounts for approximately 1% of all male cancers but has a high survival rate if detected early. Testicular cancer can have significant implications for fertility and quality of life, making it a critical area of focus for public health and clinical research. Despite advancements in treatment, disparities in outcomes exist based on various demographic and hospital-related factors. This study aims to estimate the prevalence, mortality rate, hospital length of stay (LOS), and total hospitalization charges for patients with testicular cancer using the National Inpatient Sample (NIS) data from 2021.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective analysis using the NIS dataset, which included 6,666,752 observations. Testicular cancer cases were identified using the appropriate ICD-10 code. Survey procedures (svy) were utilized to account for the complex survey design of the NIS. The primary outcome of interest was in-hospital mortality, while secondary outcomes included hospital length of stay (LOS) and total hospitalization charges (TOTCHG). Descriptive statistics and regression analyses were performed to examine the associations between testicular cancer and these outcomes. Independent variables included age, gender, race, zip code income quartile, Charlson Comorbidity Index, weekend admission, hospital region, teaching status, and bed size.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The total number of testicular cancer cases was estimated to be 8,225 (95% CI: 7,434 - 9,016). The crude total of in-hospital deaths among testicular cancer patients was 265 (95% CI: 192 - 338), resulting in a mortality rate of 3.22% (95% CI: 2.45% - 4.23%). Adjusted logistic regression analysis revealed significant associations with the Charlson Comorbidity Index (Odds Ratio [OR] = 1.390, p &lt; 0.001) and hospital teaching status (OR = 0.468, p = 0.043), while patients identified as Asian/Pacific Islander had a significantly higher odds ratio (OR = 6.210, p = 0.004).&lt;/div&gt;&lt;div&gt;The mean LOS for testicular cancer patients was 6.44 days (95% CI: 6.07 - 6.82). Adjusted linear regression analysis showed that LOS was significantly associated with patients identified as Native American (Coefficient = 14.039, p = 0.041) and Charlson Comorbidity Index (Coefficient = 0.590, p &lt; 0.001). The mean total hospitalization charges for testicular cancer patients were $88,194 (95% CI: $80,853 - $95,536). Adjusted regression analysis identified significant associations with Charlson Comorbidity Index (Coefficient = $8,633, p &lt; 0.001), hospital region, teaching status (Coefficient = $19,921, p = 0.006), and hospital bed size (Coefficient for the largest bed size category = $19,562, p = 0.009).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study highlights the significant burden of testicular cancer in hospitalized patients, with","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 36"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509945","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":"DO THE METASTATIC PATTERNS OF SEMINOMA SUPPORT PRIMARY RPLND AS THE TREATMENT OF CHOICE IN STAGE II SEMINOMA COMPARED TO NON-SEMINOMA?","authors":"Khalid Y. Alkhatib,&nbsp;Roby Daniel,&nbsp;Sydney Chambule,&nbsp;Avanti Rangnekar,&nbsp;Yash Shah,&nbsp;Morgan A. Leff,&nbsp;Madhumita Parmar,&nbsp;Trinity J. Bivalacqua,&nbsp;Daniel J. Lee,&nbsp;Thomas J. Guzzo,&nbsp;Phillip M. Pierorazio","doi":"10.1016/j.urolonc.2024.12.092","DOIUrl":"10.1016/j.urolonc.2024.12.092","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary RPLND is one treatment modality for stage II seminoma germ cell tumor (SGCT) cases. In theory, the success of the procedure relies on having the disease confined within the dissected lymph nodes with no presence of any undetected organ metastatic disease outside the surgical margins. While SGCT characteristics and behavior have been well described in comparison to non-seminoma germ cell tumors (NSGCT), quantifying the probability and absolute causal effect of SGCT subtype in having advanced metastatic disease (i.e., Stage III) compared to NSGCT has not been described using large national dataset yet. Therefore, we aim to quantify and describe this relationship using the National Cancer Database (NCDB).</div></div><div><h3>Methods</h3><div>We utilized inverse propensity score weights (IPTW) calculated by age, primary tumor characteristics, patient sociodemographic, regional and facility level, and year of diagnosis to run a multivariable IPTW-weighted logistic regression model (MVA) for the outcome of stage III (vs. stage I/II) to estimate the odds ratio of SGCT presenting with stage III. Then, we utilized IPTW to estimate the absolute average causal effect of SGCT v.s. NSGCT in developing stage III in our balanced IPTW-matched study sample.</div></div><div><h3>Results</h3><div>We identified 62,329 testicular germ call cancer patients between 2004 and 2016 (details available in Table 1). Our IPTW-MVA showed that SGCT is significantly less likely to present with stage III disease compared to NSGCT after accounting for all available covariates (OR: 0.303, [95%CI; 0.278 – 0.330], p&lt;0.0001), based of the same model we estimated the mean causal effect of presenting as stage III to be significantly less likely in SGCT compared to NSGCT by 66.41% if all other patients parameters and variables were the same (- 62.41% [95%CI: - 65.00%, -59.82%], p&lt;0.0001).</div></div><div><h3>Conclusions</h3><div>Our results strongly validate the use of primary-RPLND in SGCT as opposed to NSGCT, as SGCT are 62.41% less likely to present with advanced stage given the same parameters in NSGCT. In addition torecent favorable clinical trial results, primary RPLND in carefully selected SGCT patients should be highly considered to avoid long-term complications associated with other treatment modalities.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 36-37"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509947","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":"WHAT CLINICAL FACTORS PREDICT OUTCOMES IN RECURRENT METASTATIC CASTRATE-SENSITIVE PROSTATE CANCER? RESULTS FROM THE SEARCH DATABASE","authors":"John Heard,&nbsp;Galen Cook-Weins,&nbsp;Martha K. Terris MD, FACS,&nbsp;Zach Klaassen MD,&nbsp;Christopher J. Kane MD,&nbsp;Lourdes Guerrios Rivera MD,&nbsp;Matthew R. Cooperberg MD, MPH,&nbsp;William J. Aronson MD,&nbsp;Christopher L. Amling MD, FACS,&nbsp;Stephen J. Freedland MD","doi":"10.1016/j.urolonc.2024.12.064","DOIUrl":"10.1016/j.urolonc.2024.12.064","url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately one third of patients with prostate cancer (PC) undergoing radical prostatectomy (RP) develop biochemical recurrence within 10 years. PC in these men is heterogenous, with most following an indolent course, however up to one third will progress to metastatic castrate sensitive disease (mCSPC). Patient and clinical factors associated with progression from non-metastatic PSA recurrence to mCRPC or death include increased age, shorter time from surgery to recurrence, higher Gleason grade (PC specific tumor grade), and shorter PSA doubling time (PSADT). The factors that influence disease progression once patients develop mCSPC are unknown.</div></div><div><h3>Methods</h3><div>After obtaining IRB approval, the SEARCH database was created by combining data on 9,928 patients who underwent RP from 1982 to 2020 at eight VA Medical Centers across the U.S. Patients with recurrent mCSPC after RP were selected for analysis. Those treated with preoperative ADT or radiation therapy were excluded, as were patients who developed CRPC prior to metastasis. Patients who received ADT more than 3 months prior to metastasis were excluded. Of the 278 men who met these criteria, 153 were excluded due to missing data. We used multivariable cox proportional hazards regression modeling to assess the association between clinical variables at the time of mCSPC and the primary outcome of overall mortality (OM).</div></div><div><h3>Results</h3><div>Of 125 patients with recurrent mCSPC, median age at metastasis was 70. Median time from surgery to metastasis was 61 months. During follow-up, 60 patients (48%) progressed to mCRPC while 56 (45%) died from PC and 81 (65%) died from any cause. Shorter PSADT was the only clinical or pathologic feature associated with progression to OM (HR = 0.98, p &lt; 0.0001). Patients were divided into groups based on PSADT widely used in non-metastatic biochemical recurrence (&lt;3, 3-8.9, &gt;9 months). On multivariable analysis, PSADT &lt;3 months and 3-8.9 months were associated with worse overall survival (OS) than PSADT &gt;9 months (Table 1). Median time to OS and 5-year OS rates were 93 months and 64% for PSADT &gt;9 months, 47 months and 41% for 3-8.9 months, and 25 months and 12% for &lt;3 months.</div></div><div><h3>Conclusions</h3><div>Outcomes for patients with recurrent mCSPC after RP were driven primarily by PSADT rather than other clinical features, including Gleason score. Our data demonstrates that patients with PSADT &lt; 9 months have rapidly progressive disease that warrants aggressive treatment and inclusion in clnical trials. In contrast, those with PSADT &gt; 9 months have a more indolent course despite the presence of metastases and may be candidates for deintensificaiton strategies.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 25-26"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509961","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":"QUALITY OF LIFE, DECISIONAL REGRET, AND FEAR OF RECURRENCE IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER MANAGED WITH SURVEILLANCE AFTER CLINICAL COMPLETE RESPONSE TO NEOADJUVANT CHEMOTHERAPY","authors":"Niccola B. Lynch,&nbsp;Emily Neckonoff,&nbsp;Ketty Bai,&nbsp;Caroline Laplaca,&nbsp;Srinath-Reddi Pingle,&nbsp;Benjamin I. Joffe,&nbsp;Karie D. Runcie,&nbsp;Alexander Z. Wei,&nbsp;Mark N. Stein,&nbsp;G. Joel Decastro,&nbsp;Christopher B. Anderson,&nbsp;James M. McKiernan,&nbsp;Andrew T. Lenis","doi":"10.1016/j.urolonc.2024.12.041","DOIUrl":"10.1016/j.urolonc.2024.12.041","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;While the standard-of-care for muscle-invasive bladder cancer (MIBC) includes radical cystectomy (RC) and urinary diversion, many patients are unfit or unwilling to undergo major surgery and instead opt for a bladder-sparing approach. Data regarding the safety and durability of surveillance in patients who achieve a clinical complete response (cCR) to neoadjuvant chemotherapy (NAC) is accumulating and encouraging. Despite this increasing interest from both patients and clinicians, there is limited data on the quality of life of cCR patients. In this study, we surveyed patients in our prospectively maintained clinical database who achieved cCR and were managed primarily with surveillance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We contacted all patients from our prospectively maintained cCR database for enrollment in our study. Consenting participants were emailed via Docusign three validated quality of life surveys, including the Bladder Cancer Index (BCI), the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), and the Decision Regret Scale. These surveys evaluate urinary function, bowel habits, sexual function, fear of cancer recurrence, and decisional regret. Survey responses were recorded in REDCap under a de-identified profile. Survey data was analyzed using descriptive statistics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;From a total of 61 patients in the cCR database, 33 patients were alive and available to participate. To date, 19 (58%) patients have completed the surveys. Patient demographics and disease characteristics are presented in Table 1. Of the 19 participants, 79% (15/19) had a native bladder, 5% (1/19) had a neobladder, 5% (1/19) had a continent catheterizable pouch, and 11% (2/19) had an ileal conduit. Of the cCR patients with durable response, 100% (15/15) had no decisional regret and 67% (10/15) had little to no fear of cancer recurrence. Conversely, in cCR patients with recurrence and subsequent RC, 25% (1/4) had significant decisional regret and 75% (3/4) had some fear of cancer recurrence. Of the durable response cCR patients, 93% (14/15) had no urinary bother while 50% (2/4) of the recurrence and subsequent RC patients had some urinary bother.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;As surveillance in patients with MIBC who achieve cCR after NAC becomes increasingly utilized, data on the implications of lifelong surveillance, frequent non-invasive recurrences, and the fear of cancer recurrence will be important to consider. In the data available at this time from our institutional cCR cohort, all patients with a durable response were free of decisional regret, nearly all (93%) had no urinary bother despite frequent interventions, and two thirds lacked fear of cancer recurrence. Study limitations include small sample size, response and selection bias given the survey format, and limited generalizability given patients were recruited from a single institution. Nevertheless, these results sugg","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 16"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510144","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}