Urologic Oncology-seminars and Original Investigations最新文献

{"title":"TESTICULAR CANCER MALPRACTICE TRENDS","authors":"Adri Durant,&nbsp;Connor Mayes,&nbsp;Mark Tyson","doi":"10.1016/j.urolonc.2024.12.080","DOIUrl":"10.1016/j.urolonc.2024.12.080","url":null,"abstract":"<div><h3>Introduction</h3><div>Medical and surgical advancements have been made in testicular cancer management over the past 50 years. The evolution of practice standards is expected to provide patients benefits in quality of life and oncologic outcomes, but changes in care standards can introduce potential opportunities for increased malpractice claims against providers. We seek to evaluate the frequency and causation of malpractice claims as well as temporal trends in testicular cancer management.</div></div><div><h3>Methods</h3><div>The Google Scholar Case Law database, an open access database of state and federal case law as well as trial court cases, was evaluated for litigation related to testicular cancer malpractice in the United States. A query of the following terms from January 1, 1975, to January 1, 2024, was completed: “testicular cancer” OR “testis cancer” AND “malpractice.”</div></div><div><h3>Results</h3><div>Of 102 lawsuits initially screened, 24 were identified after duplicates were excluded and cases irrelevant to malpractice litigation in testicular cancer patients (Figure 1). Most cases were related to delays in diagnosis or treatment (n = 21, 87.5%). Two cases (8.3%) were in response to complications from radiation treatment, and one case (4.2%) was a suit in response to the loss of semen specimen for fertility preservation after testicular cancer diagnosis (Figure 2). No malpractice claims were filed in response to surveillance practices or surgical techniques utilized for retroperitoneal lymph node dissection. Defendants involved in testicular cancer malpractice cases were most commonly healthcare centers, including VA hospitals, prison healthcare systems, private hospitals, or medical groups (n = 16, 67%).</div></div><div><h3>Conclusions</h3><div>The present study emphasizes the importance of early detection and diagnosis of testicular cancer, as this was the primary cause of malpractice lawsuits. Importantly, changes in the management of testicular cancer to limit the morbidity of testicular cancer treatment have not increased the risk of malpractice claims.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 32"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510054","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":"Impact of smoking exposure on disease progression in high risk and very high-risk nonmuscle invasive bladder cancer patients undergoing BCG therapy","authors":"Roberto Contieri Ph.D. ,&nbsp;Francesco Claps Ph.D. ,&nbsp;Rodolfo Hurle Ph.D. ,&nbsp;Nicolò Maria Buffi Ph.D. ,&nbsp;Giovanni Lughezzani ,&nbsp;Massimo Lazzeri Ph.D. ,&nbsp;Achille Aveta Ph.D. ,&nbsp;Savio Pandolfo Ph.D. ,&nbsp;Francesco Porpiglia ,&nbsp;Cristian Fiori ,&nbsp;Biagio Barone Ph.D. ,&nbsp;Felice Crocetto Ph.D. ,&nbsp;Pasquale Ditonno ,&nbsp;Giuseppe Lucarelli ,&nbsp;Francesco Lasorsa M.D. ,&nbsp;Gian Maria Busetto Ph.D. ,&nbsp;Ugo Falagario Ph.D. ,&nbsp;Francesco Del Giudice Ph.D. ,&nbsp;Martina Maggi M.D. ,&nbsp;Francesco Cantiello Ph.D. ,&nbsp;Matteo Ferro","doi":"10.1016/j.urolonc.2024.11.015","DOIUrl":"10.1016/j.urolonc.2024.11.015","url":null,"abstract":"<div><h3>Introduction</h3><div>The nonmuscle invasive bladder cancer treated with BCG instillations in patients who smoke could potentially lead to poorer oncological results in the light of the new EAU risk groups classification for NMIBC that did not include BCG treated patients or smoking status.</div></div><div><h3>Patient and Methods</h3><div>Outcomes from 1313 patients with nonmuscle invasive bladder cancer treated with TURBT, re-TURBT and BCG instillations at 13 academic hospital centers, since 2002, has been included in this retrospective study. The study variables, including cumulative smoking exposure have been analyzed. A multivariable Cox proportional hazard model was used to assess associations between smoking variables and disease progression and repeated in the EAU high risk and very high-risk group. The statistical significance threshold was set at 0.05, and the statistical analysis was performed using Stata/SE version 17 (StataCorp, College Station, TX, USA).</div></div><div><h3>Results</h3><div>Cox regression analysis revealed in 1313 patients diagnosed with T1G3 NMIBC that patients with a history of heavy and long-term smoking faced a more than twofold increased risk of disease progression compared to nonsmoker patients (HR 2.35; 95% CI: 1.7-3.2; <em>P</em> &lt; 0.01) and a significantly poorer PFS for patients with a history of heavy long-term smoke exposure (<em>P</em> &lt; 0.01). Patients with heavy long-term smoking exposure according to the EAU21 high-risk group had a PFS comparable to very high-risk patients and high-risk patients with heavy long-term smoking exposure showed a higher risk of progression when compared to the high-risk group (HR 1.4; 95% CI: 1.3-1.6; <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>This study adds valuable information on the relationship between smoking and the progression of NMIBC and BCG therapy. The findings emphasize the need for healthcare providers to consider a patient's smoking history when managing NMIBC and express the need for individualized smoking cessation counseling and individualized treatment approach.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 189.e1-189.e8"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822734","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":"Impact of race and payor status on patterns of utilization of partial and radical nephrectomy in patients with renal cell carcinoma in California","authors":"Regina Barragan-Carrillo M.D. ,&nbsp;Nicholas Salgia B.Sc. ,&nbsp;Karyn S. Eilber M.D. ,&nbsp;Sumanta K. Pal M.D. ,&nbsp;Kai Dallas M.D. ,&nbsp;Maria T. Bourlon M.D., M.Sc.","doi":"10.1016/j.urolonc.2024.11.026","DOIUrl":"10.1016/j.urolonc.2024.11.026","url":null,"abstract":"<div><h3>Background</h3><div>Prospective trials have shown similar outcomes with partial nephrectomy (PN) in patients with localized renal cell carcinoma (RCC), and multiple studies suggest increasing the use of the technique. We hypothesize that patients who stem from minority groups, as well as Medicare and Medical, have less access to this specialized procedure and, therefore, have a higher rate of radical nephrectomy (RN).</div></div><div><h3>Methods</h3><div>We interrogated the California Office of Statewide Health Planning and Development (OSHPD) database, which collects information from all inpatient admissions, emergency room visits and inpatient/outpatient procedures in the state. All patients undergoing nephrectomy for RCC were identified from 2012 to 2018 using CPT and ICD-9/10 codes to identify patients with RCC undergoing RN and PN. Variables of interest included patient demographics, comorbidities, payor status and type of institution where the surgery was performed. We performed univariate and multivariable analysis to explore associations between patient factors and type of nephrectomy performed.</div></div><div><h3>Results</h3><div>In total, 31,093 patients who had undergone a nephrectomy in the study period were identified. Overall, most were 57% male, with a mean age of 58 years. PN and RN were performed in 15,840 (50.9%) and 15,253 (49.1%) patients, respectively. PN rates differed according to race/ ethnicity, as it was performed in 8576 (53.1%) White, 1124 (55.3%) Black, 1286 (46.0%) Asian, 4107 (47.5%) Hispanic and 747 (50.5%) other race patients (<em>P</em> &lt; 0.001). Use of PN also differed among patients based on payor status, with 6800 (56.4%) private, 5,036 (43.9%) Medicare, 1,817 (38.3%) Medical, and 2,187 (77.7%) other insurance patients (<em>P</em> &lt; 0.001). On multivariate analysis controlling for age, gender, comorbidities, and frailty, race was independently associated with the type of nephrectomy, but payor was not.</div></div><div><h3>Conclusions</h3><div>Our study confirms that race and payor status may have an influence on the utilization of partial versus status radical nephrectomy, with the highest rate of partial nephrectomies among Black patients and those with private insurance. Although there are multiple potential confounders (e.g., latency of diagnosis and resulting tumor size/complexity), it is possible access to care is a driver of this phenomenon.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 193.e1-193.e5"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865619","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":"CO-DELIVERY OF SIAPE1 AND MELATONIN BY 125I-LOADED PSMA-TARGETED NANOPARTICLES FOR THE TREATMENT OF PROSTATE CANCER","authors":"Ying Liu,&nbsp;Zhen-Duo Shi,&nbsp;Lin Hao,&nbsp;Yang Dong,&nbsp;Kun Pang,&nbsp;Xiao Hu,&nbsp;Cong-Hui Han","doi":"10.1016/j.urolonc.2024.12.076","DOIUrl":"10.1016/j.urolonc.2024.12.076","url":null,"abstract":"<div><h3>Introduction</h3><div><strong>Background:</strong> Both apurinic/apyrimidinic endodeoxyribonuclease 1 (APE1) inhibition and melatonin suppress prostate cancer (PCa) growth.</div></div><div><h3>Objective</h3><div>This study evaluated the therapeutic efficiency of self-assembled and prostate-specific membrane antigen (PSMA)-targeted nanocarrier loading ¹²⁵I radioactive particles and encapsulat-ing siRNA targeting APE1 (siAPE1) and melatonin for PCa.</div></div><div><h3>Methods</h3><div>The linear polyarginine R12 polypeptide was prepared using Fmoc-Arg-Pbf-OH. The PSMA-targeted polymer was synthesized by conjugating azide-modified R12 peptide to PSMA monoclonal antibody (mAb). Before experiments, the PSMA-R12 nanocarrier was installed with melatonin and siAPE1, which were subsequently labeled by ¹²⁵I radioactive particles. In vitro bio-compatibility and cytotoxicity of nanocomposites were examined in LNCaP cells and in vivo bio-distribution and pharmacokinetics were determined using PCa tumor-bearing mice.</div></div><div><h3>Results</h3><div>PSMA-R12 nanocarrier was ∼120 nm in size and was increased to ∼150 nm by melatonin encapsulation. PSMA-R12 nanoparticles had efficient loading capacities of siAPE1, melatonin, and ¹²⁵I particles. The co-delivery of melatonin and siAPE1 by PSMA-R12-¹²⁵I showed synergis-tic effects on suppressing LNCaP cell proliferation and Bcl-2 expression and promoting cell apop-tosis and caspase-3 expression. Pharmacokinetics analysis showed that Mel@PSMA-R12-¹²⁵I particles had high uptake activity in the liver, spleen, kidney, intestine, and tumor, and were accumu-lated in the tumor sites within the first 8 h p.i., but was rapidly cleared from all the tested organs at 24 h p.i. Administration of nanoparticles to PCa tumors in vivo showed that Mel@PSMA-R12-¹²⁵I/siAPE1 had high efficiency in suppressing PCa tumor growth.</div></div><div><h3>Conclusions</h3><div>The PSMA-targeted nanocarrier encapsulating siAPE1 and melatonin is a promising therapeutic strategy for PCa and can provide a theoretical basis for patent applications.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 30"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509786","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":"EXPANDING THE ROLE FOR (P)REHABILITATION FOR PATIENTS WITH TESTICULAR CANCER","authors":"Logan Briggs,&nbsp;Sarah Psutka,&nbsp;Khalid Alkhatib,&nbsp;Adri Durant,&nbsp;Phillip Pierorazio,&nbsp;Hider Abdul-Muhsin,&nbsp;Mark Tyson,&nbsp;Quoc-Dien Trinh,&nbsp;Sara Parke","doi":"10.1016/j.urolonc.2024.12.093","DOIUrl":"10.1016/j.urolonc.2024.12.093","url":null,"abstract":"<div><h3>Introduction</h3><div>Few data exist on best practices for provision of nutrition, exercise, and psychologic support to testicular cancer (TC) patients and their caregivers. We aim to summarize the extant literature and identify gaps.</div></div><div><h3>Methods</h3><div>We performed a scoping review including randomized controlled trials (RCTs) including patients with TC or their caregivers in a program with (p)rehabilitation, exercise, psychologic support, or nutrition components. Recorded were statistically significant positive (SS+) and negative (SS-) results and nonsignificant differences (NSD).</div></div><div><h3>Results</h3><div>The systematic search yielded 10,968 records, and included were 14 unique RCTs, encompassing 1729 unique subjects, 250 of which were TC patients/survivors, and 0 of which were caregivers. Overall, 9/14 RCTs (64%) yielded ≥1 SS+ while four demonstrated NSD, and 2 demonstrated one SS- each. Of 3 RCTs evaluating bimodal exercise and psychologic support, 3 yielded ≥1 SS+, compared with 3/4 providing unimodal psychologic support, 0/1 providing unimodal nutritional support, and 3/6 interventions providing unimodal exercise programs, though two demonstrated negative associations (increased thrombotic events and fatigue). Table 1 demonstrates characteristics of included RCTs, while Figure 2 is an alluvial diagram depicting the types of interventions emplyed by included RCTs along with outcomes affected.</div></div><div><h3>Conclusions</h3><div>Over half of RCTs on TC (p) rehabilitation demonstrate efficacy for ≥1 outcome of interest. Such interventions are safe, with positive findings outweighing the two RCTs with SS- findings. There is particularly strong evidence to support exercise improving fatigue, cardiovascular risk profile, and physical performance measures including VO2 max, muscle strength, etc. as well as psychologic support programs to improve fatigue and mental health. A paucity of data exists in this space and further work is needed.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 37"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509799","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":"METABOLIC, CARDIAC, AND BONE HEALTH TESTING IN PROSTATE CANCER PATIENTS ON ANDROGEN DEPRIVATION THERAPY: A POPULATION-BASED ASSESSMENT OF ADHERENCE TO THERAPEUTIC MONITORING GUIDELINES","authors":"Ahmad Mousa,&nbsp;David-Dan Nguyen,&nbsp;Aly-Khan Lalani,&nbsp;Raj Satkunasivam,&nbsp;Khatereh Aminoltejari,&nbsp;Amanda Hird,&nbsp;Soumyajit Roy,&nbsp;Scott C. Morgan,&nbsp;Shawn Malone,&nbsp;Andrea Kokorovic,&nbsp;Luke T. Lavallée,&nbsp;Melissa Huynh,&nbsp;Bobby Shayegan,&nbsp;Di Maria Jiang,&nbsp;Geofrey Gotto,&nbsp;Rodney H. Breau,&nbsp;Girish S. Kulkarni,&nbsp;Alexandre Zlotta,&nbsp;Christopher JD Wallis","doi":"10.1016/j.urolonc.2024.12.017","DOIUrl":"10.1016/j.urolonc.2024.12.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Androgen deprivation therapy (ADT) remains a cornerstone in treatment for patients with advanced prostate cancer. ADT is associated with several adverse effects including osteoporosis, metabolic syndrome, and cardiovascular events, leading to guidelines recommending routine testing to monitor for these toxicities. There is a lack of data assessing adherence to these recommendations.</div></div><div><h3>Methods</h3><div>We conducted an observational, retrospective cohort study utilizing administrative data sources in Ontario, Canada between 2008-2021. We identified all men receiving ADT for prostate cancer. The primary outcomes were use of lipids, dysglycemia (glucose), bone health serum and bone density testing between 6 weeks preceding and 1 year following initiation of ADT. Secondary outcomes included predictors of adherence to testing.</div></div><div><h3>Results</h3><div>We examined 29,097 patients of whom 52.8% were prescribed ADT by Urologists, 37.9% by Radiation Oncologists, 2.8% by Medical Oncologists, and 2.4% by other physicians. Adherence to guidelines was generally low: only 21.3% of patients received a bone density scan, 41.2% underwent bone-health-related serum tests, 51.3% had a lipid profile completed, and 65.9% underwent dysglycemia testing within 1 year of diagnosis. Overall, only 11.9% of patients received all the recommended investigations. Adherence to testing did not appear to improve over time (2008-2021) or with the publication of guidelines. Patient (age) and physician (specialty) factors showed important associations with adherence to testing. ADT prescription by a Medical Oncologist was associated with a lower likelihood of undergoing screening tests for plasma glucose (RR 0.78, 95% CI 0.64-0.96, p=0.02), lipids (RR 0.65, 95% CI 0.58-0.80, p=&lt;0.01) and bone density (RR 0.62, 95% CI 0.43-0.89, p=0.009) within a year when compared to prescription by Urologists. Increasing patient age was associated with lower adherence to screening guidelines for lipids (RR 0.26, 95% CI 0.12-0.62, p=0.002) and bone health (RR 0.37, 95% CI 0.17-0.83, p=0.016).</div></div><div><h3>Conclusions</h3><div>Most patients receiving ADT for prostate cancer do not receive recommended testing to monitor for treatment-related toxicity. Further study is required to identify and address barriers to therapeutic monitoring of men on ADT and reduce treatment-associated adverse events.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 6"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509848","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":"EVALUATION OF RESPONSE TO 177LU-PSMA-617 BY SITE SPECIFIC DISEASE IN METASTATIC CASTRATE-RESISTANT PROSTATE CANCER","authors":"Mohamed E. Ahmed,&nbsp;Giuseppe Reitano,&nbsp;Ahmed Mahmoud,&nbsp;Umar Ghaffar,&nbsp;Ayse Tuba Kendi,&nbsp;R. Jeffrey Karnes,&nbsp;Eugene Kwon,&nbsp;Jack Andrews","doi":"10.1016/j.urolonc.2024.12.070","DOIUrl":"10.1016/j.urolonc.2024.12.070","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2022, the FDA approved ¹⁷⁷Lu-PSMA as a promising drug for metastatic castrate-resistant prostate cancer (mCRPC) after the VISION trial. Since then, multiple studies have tried to evaluate the response to ¹⁷⁷Lu-PSMA; however, few studies have described the response depending on the site of disease progression. In our study, we aim to assess the response to ¹⁷⁷Lu-PSMA according to the metastasis sites.</div></div><div><h3>Methods</h3><div>We queried retrospectively 273 patients who have been treated with ¹⁷⁷Lu-PSMA at Mayo Clinic between April 2022 and September 2023; out of those, we identified 76 (28%) patients who presented with either bone only or lymph node (LN) only disease. Trained research personnel recorded clinicopathological variables; in addition, follow-up imaging and clinical documentation were used to record the treatment outcomes. Chi-square and Kruskal-Wallis tests were used to compare between nominal and continuous variables, respectively.</div></div><div><h3>Results</h3><div>After the identification of 76 patients, we classified them into two groups according to the site of disease progression: pure bone disease (52 patients, 68%) and pure lymph node disease (24 patients, 32%) without any other sites of disease progression, and both had the same volume of disease. The bone group had a high median initial Gleason score (p=0.0192) and PSA levels (p=0.158) prior to the start of the ¹⁷⁷Lu-PSMA cycles compared with the LN group. With a median follow-up time of 10.2 (IQR: 8.6–11.5) months from the first ¹⁷⁷Lu-PSMA cycle, the post-treatment PSA kinetics did not differ significantly between the two groups; however, patients with LN disease showed a durable response in terms of decreased post-treatment SUVmax of the lesions (p=0.0299) and less radiographic disease progression (p=0.0011) compared with the bone group.</div></div><div><h3>Conclusions</h3><div>With the limited options for mCRPC patients after receiving several lines of treatment, the ¹⁷⁷Lu-PSMA offers an excellent alternative according to the VISION trial; however, the evaluation of its effect in real-world data is still under investigation. In our study, we found that patients who were treated with ¹⁷⁷Lu-PSMA and had LN only disease showed a durable response compared with those with bone only disease. Further prospective studies to validate our findings are warranted.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 28"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509871","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":"PATIENT SUPPORT NEEDS AND COPING MECHANISMS FOR CLINICAL T1 RENAL MASS DECISION-MAKING","authors":"Katherine Poulos,&nbsp;Allison Lazard,&nbsp;Lixin Song,&nbsp;Kathryn Hacker Gessner,&nbsp;Deborah Usinger,&nbsp;Randall Teal,&nbsp;Debra Gottsleben,&nbsp;Amir Feinberg,&nbsp;Gianpaolo Carpinito,&nbsp;Marc Bjurlin,&nbsp;Eric Wallen,&nbsp;David Johnson,&nbsp;Mathew Raynor,&nbsp;Hung-Jui Tan","doi":"10.1016/j.urolonc.2024.12.060","DOIUrl":"10.1016/j.urolonc.2024.12.060","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Decision-making for T1 renal masses has become increasingly complex as more management options have become available. Most patients experience decisional conflict at some point in their decision-making process due to fear, uncertainty, and lack of understanding. Furthermore, decisional conflict may prompt patients to undergo a treatment that does not necessarily align with their priorities or values. For medical decisions, patients have a variety of unique support needs that impact their decision-making process, preferences, and treatment choice. To better support these patient needs, we sought to characterize support needs and coping mechanisms for patients presenting for small renal masses (SRM).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Forty patients previously enrolled onto the GRADE-SRM study, a prospective clinical trial examining cancer genomics and the impact of renal mass biopsy on decision-making, were recruited to participate in a follow-up qualitative study. Participants were purposely sampled based on high (21) vs. low (19) decisional conflict scores as well as diverse support needs and coping strategies. Trained qualitative researchers conducted semi-structured interviews asking participants questions related to decision-making support needs including factors that impacted their decision-making preferences and coping strategies. Qualitative researchers then conducted a coding-based thematic analysis to define pertinent themes regarding patient support needs that impact decision-making. Further post hoc analysis was conducted to synthesize and describe support needs and coping mechanisms across the cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among the 40 interview participants, the mean age was 65.1, with 58% male and 72.5% White. A primary focus on either preparation/process or health outcomes tended to drive individual support needs. A focus on process entailed steps in management and the overall journey while a focus on outcomes encompassed impact on survival or other health effects. Patient support needs fell into three main categories that were identified in post hoc analysis: informational, emotional, and instrumental support. Within each category, patients desired support from both their healthcare team and personal support system. Informational supports included medical counseling from their urologist and advice externally. Patients required emotional support from both medical and social sources but mainly desired instrumental support from their social network. Patients described coping mechanisms employed from diagnosis through treatment. These fell into four categories: relying on faith, controlling outlook, depending on external support, and trusting in their urologist.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients display a diverse range of support needs and coping strategies during the process of diagnosis and decision-making for clinical T1 renal masses that we can overwhelmingly categori","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 24"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509957","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":"RACIAL DIFFERENCES IN SURVIVAL FOR LOCALLY ADVANCED RENAL CELL CARCINOMA","authors":"MS Kanumuambidi IV MPH, Jean-pierre (Trey),&nbsp;Dmitry Tumin,&nbsp;Michael Blute Jr","doi":"10.1016/j.urolonc.2024.12.054","DOIUrl":"10.1016/j.urolonc.2024.12.054","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Previous studies have established African Americans with renal cell carcinoma (RCC) have aggressive tumors and worse outcomes compared to other races. The impact of racial differences on locally advanced tumors (specifically tumor thrombus) and metastatic RCC (mRCC) remains unclear. We aim to evaluate survival outcomes among different racial groups in a population of RCC tumor thrombus patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective study, approved by the IRB with a consent waiver, analyzed patients aged 40-80 with primary (RCC) and tumor thrombus who underwent nephrectomy between 2010 and 2015 using the National Cancer Database (NCDB). The study focused on patients with RCC and tumor thrombus to assess survival differences between racial backgrounds. Demographic covariates included age, sex, and race and ethnicity (non-Hispanic White, non-Hispanic African American, Hispanic, or none of the above). Clinical covariates included stage, grade, subtype, tumor thrombus level, type of surgery, comorbidities, hospital type, and patient residence.&lt;/div&gt;&lt;div&gt;The data were analyzed with statistical tests including Kruskal-Wallis, Chi-square, and log-rank tests to compare results by race/ethnicity. Survival outcomes were assessed with Kaplan-Meier curves, and multivariable analyses employed Cox proportional hazards regression and multinomial logistic regression. All analyses were conducted using Stata/SE 18.0, with significance set at P&lt;0.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We identified 11,520 patients, aged 40-80, with the diagnosis of renal cell carcinoma (RCC) and tumor thrombus who underwent surgery from 2010-2015. Among them, 83% were non-Hispanic White, 6% non-Hispanic African American, 7% Hispanic, and 3% other races.&lt;/div&gt;&lt;div&gt;Mortality rates were 55% overall and 82% in metastatic RCC (mRCC) cases. The study population included 2,429 mRCC patients. Survival analysis showed African Americans had lower survival compared to Caucasians in both the overall and mRCC cohorts. Multivariable analysis confirmed higher mortality for African Americans ( HR: 1.22 overall with P&lt;0.001; 1.24 in mRCC with p=0.019).&lt;/div&gt;&lt;div&gt;Overall, 5-year survival rates according to the presence of tumor thrombus did not differ among higher levels between Caucasians and African Americans for level I-III 39% and 46%, p=0.21; and Level IV 39% and 39%, p=0.39, respectively. There was a survival advantage for Level 0 tumor thrombus among the Caucasian population, p&lt;0.001 Log-rank test.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;African American patients diagnosed with RCC and tumor thrombus face a 22% higher risk hazard of mortality compared to non-Hispanic white patients. They often present with more locally advanced and mRCC. The mortality risk hazard for metastatic RCC is increased by 24% compared to Caucasians. The results underscore the demographic impact of race on disease severity and support clinical consideration ","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 21"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510050","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 survival and economic burden among patients with locally advanced or metastatic urothelial carcinoma in the United States","authors":"Ronald C. Chen M.D., M.P.H. ,&nbsp;Rupali Fuldeore M.S. ,&nbsp;Alexandra Greatsinger M.P.H. ,&nbsp;Zsolt Hepp Pharm.D., M.S. ,&nbsp;Qing Liu Ph.D. ,&nbsp;Phoebe Wright Pharm.D., M.S. ,&nbsp;Bin Xie Ph.D. ,&nbsp;Hongbo Yang Ph.D. ,&nbsp;Christopher Young Ph.D. ,&nbsp;Adina Zhang M.S. ,&nbsp;Lisa Mucha Ph.D.","doi":"10.1016/j.urolonc.2024.11.010","DOIUrl":"10.1016/j.urolonc.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Given the changing treatment landscape for locally advanced or metastatic urothelial carcinoma (la/mUC), this study aimed to describe real-world treatments, overall survival (OS), health care resource utilization (HCRU), and costs among US patients with la/mUC receiving first-line therapy.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted using 100% Medicare claims data (2015–2020). Patients with la/mUC were selected; initiation of first-line therapy was the index date. Treatments and OS were assessed during follow-up (index date to the earliest of end of data availability, health plan coverage, or death). All-cause HCRU and costs (2021 USD) were assessed during the first-line treatment period (index date to the earliest of first-line discontinuation, switch to second-line therapy, end of follow-up, or death). Outpatient pharmacy costs were not included. All-cause OS from start of first-line therapy was estimated using the Kaplan–Meier approach. The HCRU, cost, and OS analyses were stratified by 3 index treatment groups—platinum-based chemotherapy, non–platinum-based chemotherapy, and programmed cell death protein 1/ligand 1 (PD-1/L1) inhibitor monotherapy—and adjusted for baseline characteristics.</div></div><div><h3>Results</h3><div>Of 9,939 patients included, 77.1% were men and mean age was 76 years. In total, 5,050 (50.8%) received platinum-based chemotherapy, 1,361 (13.7%) received non–platinum-based chemotherapy, and 3,242 (32.6%) received PD-1/L1 inhibitor monotherapy for first-line la/mUC. Median OS was 12.9, 12.9 (<em>P</em> = 0.960), and 9.0 months (<em>P</em> &lt; 0.001) with platinum-based chemotherapy (reference), non–platinum-based chemotherapy, and PD-1/L1 inhibitor monotherapy, respectively. Most (&gt; 99%) patients had ≥ 1 outpatient visit during the treatment period; mean number of visits per patient was 13.1 with platinum-based chemotherapy, 10.5 with non–platinum-based chemotherapy, and 18.3 with PD-1/L1 inhibitor monotherapy. In general, HCRU was significantly lower for patients receiving PD-1/L1 inhibitor monotherapy versus platinum-based chemotherapy. However, costs were significantly higher with PD-1/L1 inhibitor monotherapy versus platinum-based chemotherapy. Mean total monthly cost per patient was $10,285 for platinum-based chemotherapy, $8,982 for non–platinum-based chemotherapy, and $18,147 for PD-1/L1 inhibitor monotherapy.</div></div><div><h3>Conclusions</h3><div>From 2015 to 2020, patients with la/mUC had substantial HCRU and costs and short survival, regardless of first-line treatment. More effective therapies were needed to prolong survival and reduce the economic burden of la/mUC.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 189.e9-189.e18"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829947","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}