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Rezaee ME, Elias R, Li HL, Agrawal P, Pallauf M, Enikeev D, Ged Y, Eggener S, Singla N. Survival outcomes and molecular drivers of testicular cancer in hispanic men. Urol Oncol 2024:S1078-1439(24)00444-7. [PMID: 38821727 DOI: 10.1016/j.urolonc.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/04/2024] [Accepted: 04/26/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE To examine survival outcomes and molecular drivers in testis cancer among Hispanic men using a large national sample and molecular database. METHODS We reviewed the SEER registry for testicular cancer from 2000 to 2020. Cox proportional hazards models were used to examine the relationship between race/ethnicity and cancer-specific survival (CSS) by tumor type (seminoma vs. nonseminomatous germ cell tumors [NSGCT]). All models were adjusted for demographic, socioeconomic, and treatment variables. We accessed somatic mutations for testicular cancers through AACR Project GENIE v13.1 and compared mutational frequencies by ethnicity. RESULTS Our cohort consisted of 43,709 patients (23.3% Hispanic) with median follow-up 106 months (interquartile range: 45-172). Compared to Non-Hispanic Whites (NWH), Hispanics presented at a younger age but with more advanced disease. Hispanics experienced worse CSS for NSGCT (HR 1.7, 95% CI: 1.5-2.0, P < 0.01) but not seminoma. Somatic mutation data was available for 699 patients. KIT and KRAS mutations occurred in 24.2% and 16.9% of seminoma patients (n = 178), respectively. TP53 and KRAS mutations occurred in 12.1% and 7.9% of NSGCT patients (n = 521), respectively. No differences in mutational frequencies were observed between ethnic groups. There was significant heterogeneity in primary ancestral group for Hispanic patients with available data (n = 53); 14 (26.4%) patients had primary Native American ancestry and 30 (56.6%) had primary European ancestry. CONCLUSIONS Cancer-specific survival is worse for Hispanic men with non-seminoma of the testicle. Somatic mutation analysis suggests no differences by ethnicity, though genetic ancestry is heterogeneous among patients identifying as Hispanic.
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Affiliation(s)
- Michael E Rezaee
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roy Elias
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Howard L Li
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pranjal Agrawal
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maximilian Pallauf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, University of Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yasser Ged
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Ríos-Rodríguez JA, Montalvo-Casimiro M, Álvarez-López DI, Reynoso-Noverón N, Cuevas-Estrada B, Mendoza-Pérez J, Jiménez-Ríos MA, Wegman-Ostrosky T, Salcedo-Tello P, Scavuzzo A, Castro-Hernández C, Herrera LA, González-Barrios R. Understanding Sociodemographic Factors among Hispanics Through a Population-Based Study on Testicular Cancer in Mexico. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01859-0. [PMID: 37962789 DOI: 10.1007/s40615-023-01859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
Testicular cancer (TCa) is a rare malignancy affecting young men worldwide. Sociodemographic factors, especially socioeconomic level (SEL) and healthcare access, seem to impact TCa incidence and outcomes, particularly among Hispanic populations. However, limited research has explored these variables in Hispanic groups. This study aimed to investigate sociodemographic and clinical factors in Mexico and their role in health disparities among Hispanic TCa patients. We retrospectively analyzed 244 Mexican TCa cases between 2007 and 2020 of a representative cohort with diverse social backgrounds from a national reference cancer center. Logistic regression identified risk factors for fatality: non-seminoma histology, advanced stage, and lower education levels. Age showed a significant trend as a risk factor. Patient delay and healthcare distance lacked significant associations. Inadequate treatment response and chemotherapy resistance were more likely in advanced stages, while higher education positively impacted treatment response. Cox regression highlighted non-seminoma histology, below-median SEL, higher education, and advanced-stage survival rates. Survival disparities emerged based on tumor histology and patient SEL. This research underscores the importance of comprehensive approaches that integrate sociodemographic, biological, and environmental factors to address health disparities improving outcomes through personalized interventions in Hispanic individuals with TCa.
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Affiliation(s)
- Juan Alberto Ríos-Rodríguez
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Monterrey, 64710, México
| | - Michel Montalvo-Casimiro
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
| | - Diego Ivar Álvarez-López
- Unidad de Epidemiología en Cáncer, Instituto Nacional de Cancerología, Mexico City, 14080, México
| | - Nancy Reynoso-Noverón
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
- Unidad de Epidemiología en Cáncer, Instituto Nacional de Cancerología, Mexico City, 14080, México
| | - Berenice Cuevas-Estrada
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
| | - Julia Mendoza-Pérez
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Miguel A Jiménez-Ríos
- Departamento de Urología, Instituto Nacional de Cancerología, Mexico City, 14080, México
| | - Talia Wegman-Ostrosky
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
| | - Pamela Salcedo-Tello
- Departamento de Bioquímica, Facultad de Medicina, UNAM, Mexico City, 04510, México
| | - Anna Scavuzzo
- Departamento de Urología, Instituto Nacional de Cancerología, Mexico City, 14080, México
| | - Clementina Castro-Hernández
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
| | - Luis A Herrera
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México.
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Monterrey, 64710, México.
| | - Rodrigo González-Barrios
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México.
- Departamento de Biología Celular, Facultad de Ciencias, UNAM, Mexico City, 04510, México.
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Bastos DA, Gongora ABL, Dzik C, Jardim DL, Piva M, Carcano FM, Bertollo G, Trindade K, Fontes MS, Soares A, Reinert T, De Cassia Costamilan R, Villarroel RU, Watarai G, Gazola AA, Preto DDA, Mutti H, Bonalumi Dos Santos M, Mariano RC, Binotto M, Carvalho MM, Oliveira VPDC, Gomes R, Rebelatto TF, Schutz FA, Smaletz O, Fay AP. Multicenter Database of Patients with Germ-Cell Tumors: A Latin American Cooperative Oncology Group Registry (LACOG 0515). Clin Genitourin Cancer 2022; 21:e104-e113. [PMID: 36509612 DOI: 10.1016/j.clgc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Germ-cell tumors (GCTs) are the most common malignancy in young men. There is a paucity of data on GCTs in developing countries. LACOG 0515 study aimed to evaluate clinical characteristics and treatment outcomes in patients with GCTs from Brazilian cancer centers. MATERIALS AND METHODS This is a retrospective cohort study evaluating male patients diagnosed with GCTs from 2000 to 2018 in 13 Brazilian hospitals. We described baseline characteristics, progression-free survival (PFS), and overall survival (OS). RESULTS A total of 1232 patients were included, with a median age of 30 years. Histology was seminoma in 47.1% and non-seminoma GCT (NSGCT) in 52.9%. The primary tumor site was testis in 96.5%. At diagnosis, clinical stage I was present in 68.1% and 34.7% and clinical stages IS/II/III in 31.9% and 65.2% of patients with seminoma and NSCGT, respectively. Following orchiectomy, 55.2% of patients with clinical stage I were managed with surveillance. The 5-year disease-free survival rates among patients with stage I were 98.0% in seminoma and 92.3% in NSGCT, with 5-year OS of 99.6% and 97.6%, respectively. Among patients with advanced disease (IS, II, and III), the 5-year PFS were 88.7% in seminoma and 68.7% in NSGCT, with 5y-OS of 97.6% and 82.8%, respectively. CONCLUSION This is the largest Brazilian cohort of GCTs. Our results show a high rate of adjuvant chemotherapy in patients with clinical stage I. Although our data demonstrate slightly inferior PFS compared with the International Germ Cell Cancer Collaborative Group and other contemporary series, the OS rates were similar.
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Affiliation(s)
- Diogo A Bastos
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Aline Bobato Lara Gongora
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil
| | - Carlos Dzik
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Denis Leonardo Jardim
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | - Karine Trindade
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Oncocentro, Fortaleza, Brazil
| | | | - Andrey Soares
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil; Centro Paulista de Oncologia/Oncoclínicas- São Paulo, São Paulo, Brazil
| | - Tomas Reinert
- Centro de Pesquisa da Serra Gaúcha (CEPESG), Caxias Do Sul, Brazil
| | | | | | - Gabriel Watarai
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Antonia Angeli Gazola
- Hospital São Lucas PUC-RS, Porto Alegre, Brazil; PUC-RS School of Medicine, Porto Alegre, Brazil
| | | | - Haila Mutti
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Monique Binotto
- Centro de Pesquisa da Serra Gaúcha (CEPESG), Caxias Do Sul, Brazil
| | | | | | - Rafaela Gomes
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | | | | | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andre P Fay
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital São Lucas PUC-RS, Porto Alegre, Brazil; PUC-RS School of Medicine, Porto Alegre, Brazil
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Bhambhvani HP, Peterson DJ, Sheth KR. Sociodemographic factors associated with Wilms tumor treatment and survival: a population-based study. Int Urol Nephrol 2022; 54:3055-3062. [PMID: 36069962 DOI: 10.1007/s11255-022-03343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Though Wilms tumor (WT) is one of the most common malignancies in children, there is a paucity of epidemiologic studies exploring sociodemographic disparities in treatment and survival. Here, we leveraged a national cancer registry to examine sociodemographic factors associated with receipt of adjuvant therapy, either chemotherapy or radiation, as well as overall survival among pediatric patients with WT. MATERIALS AND METHODS Within the Surveillance Epidemiology and End Results database (2000-2016), we identified 2043 patients (≤ 20 years of age) with unilateral WT. Multivariable logistic regression and Cox proportional hazard models were constructed to examine the association of sociodemographic factors with, respectively, adjuvant chemotherapy/radiotherapy and overall survival (OS). RESULTS Patients in the lowest SES quintile (OR 0.56, 95% CI 0.33-0.93, p = 0.03) were less likely to receive chemotherapy as compared to those in the highest SES quintile, though this association did not persist in sensitivity analyses including only patients at least 2 years of age and patients with regional/distant disease. In addition, female patients were more likely to receive chemotherapy (OR 1.46, 95% CI 1.08-1.97, p = 0.02) than male patients. Age, race, year of diagnosis, insurance status, and tumor laterality were not associated with receipt of chemotherapy. No sociodemographic variables were associated with receipt of radiotherapy. Lastly, as compared to Non-Hispanic-White patients, Hispanic patients had worse OS (HR 1.59, 95% CI 1.08-2.35, p = 0.02); no other sociodemographic variables were associated with OS. CONCLUSIONS This study suggests multilevel sociodemographic disparities involving ethnicity and SES in WT treatment and survival.
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Affiliation(s)
- Hriday P Bhambhvani
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Starr 9, New York, NY, 10065, USA.
| | - Dylan J Peterson
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Kunj R Sheth
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
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Predictive factors of diagnostic delay and effect on treatment patterns in testicular germ cell tumor patients. Urol Oncol 2022; 40:201.e1-201.e7. [DOI: 10.1016/j.urolonc.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/28/2022] [Accepted: 02/26/2022] [Indexed: 11/21/2022]
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Survival of nonseminomatous germ cell tumors in pediatric patients and young adults – A stage group stratified analysis. Urol Oncol 2022; 40:169.e1-169.e12. [PMID: 35144865 PMCID: PMC8960351 DOI: 10.1016/j.urolonc.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/28/2021] [Accepted: 12/15/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Testicular germ cell tumors, particularly nonseminomatous germ cell tumors (NSGCT), comprise the most common solid malignancy in male children and younger adults. While these patients experience excellent survival outcomes, few studies have characterized their survival by age. Thus, we aimed to characterize the relative survival of NSGCT by age, stratifying patients by stage group. METHODS Using the Surveillance Epidemiology and End Results (SEER) database, we divided patients with NSGCT into pediatric patients and adolescents (<19 years), young adults (19-30 years), and older adults (>30 years). Survival analysis, using Cox proportional hazards models and Kaplan Meier curves, described overall and cancer-specific survival (CSS) of each age category for Stage I-III NSGCT by stage group. RESULTS A total of 14,786 patients met inclusion criteria and comprised the age groups <19 years (N=1,287), 19 to 30 years (N=7,729), and >30 years (N=5,770). Stage group distribution at presentation was similar between each group. Survival analysis demonstrated no differences in cancer-specific survival (CSS) among Stage I or II NSGCT. However, among Stage III tumors, multivariable models noted worse CSS in patients >30 years (HR=3.35 (95%CI: 1.45-7.73), P=0.005) and those 19-30 years (HR=2.28 (95%CI: 0.99-5.21), P=0.053) compared to pediatric and adolescent patients. CONCLUSIONS Younger NSGCT patients experience excellent oncologic outcomes compared to their older counterparts. These survival differences by age group are largely driven by differential survival among Stage III neoplasms. Furthermore, our report lends additional evidence that age is an important prognostic factor in advanced NSGCT, including pediatric and adolescent patients.
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Dieckmann KP, Pokrivcak T, Geczi L, Niehaus D, Dralle-Filiz I, Matthies C, Dienes T, Zschäbitz S, Paffenholz P, Gschliesser T, Pichler R, Mego M, Bader P, Zengerling F, Heinzelbecker J, Krausewitz P, Krege S, Aurilio G, Aksoy C, Hentrich M, Seidel C, Törzsök P, Nestler T, Majewski M, Hiester A, Buchler T, Vallet S, Studentova H, Schönburg S, Niedersüß-Beke D, Ring J, Trenti E, Heidenreich A, Wülfing C, Isbarn H, Pichlmeier U, Pichler M. Single-course bleomycin, etoposide, and cisplatin (1xBEP) as adjuvant treatment in testicular nonseminoma clinical stage 1: outcome, safety, and risk factors for relapse in a population-based study. Ther Adv Med Oncol 2022; 14:17588359221086813. [PMID: 35386956 PMCID: PMC8977693 DOI: 10.1177/17588359221086813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Clinical stage 1 (CS1) nonseminomatous (NS) germ cell tumors involve a 30% probability of relapse upon surveillance. Adjuvant chemotherapy with one course of bleomycin, etoposide, and cisplatin (1xBEP) can reduce this risk to <5%. However, 1xBEP results are based solely on five controlled trials from high-volume centers. We analyzed the outcome in a real-life population. Patients and Methods: In a multicentric international study, 423 NS CS1 patients receiving 1xBEP were retrospectively evaluated. Median follow-up was 37 (range, 6–89) months. Primary end points were relapse-free and overall survival evaluated after 5 years. We also looked at associations of relapse with clinico-pathological factors using stratified Kaplan–Meier methods and Cox regression models. Treatment modality and outcome of recurrences were analyzed descriptively. Results: The 5-year relapse-free survival rate was 96.2%. Thirteen patients (3.1%; 95% confidence interval, 1.65–5.04%) relapsed after a median time of 13 months, of which 10 were salvaged (77%). Relapses were mostly confined to retroperitoneal nodes. Three patients succumbed, two to disease progression and one to toxicity of chemotherapy. Pathological stage >pT2 was significantly associated with relapse rate. Conclusion: The relapse rate of 3.1% found in this population of NS CS1 patients treated with 1xBEP at the routine care level was not inferior to the median rate of 2.3% reported from a meta-analysis of controlled trials. Also, the cure rate of relapses of 77% is consistent with the previously reported rate of 80%. This study clearly shows that the 1xBEP regimen represents a safe treatment for NS CS1 patients.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763 Hamburg, Germany
- Department of Urology, Albertinen-Krankenhaus, Hamburg, Germany
| | - Tomas Pokrivcak
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Lajos Geczi
- National Institute of Oncology, Budapest, Hungary
| | - David Niehaus
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Tamas Dienes
- National Institute of Oncology, Budapest, Hungary
| | - Stefanie Zschäbitz
- Department of Medical Oncology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Pia Bader
- Department of Urology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Julia Heinzelbecker
- Department of Urology and Pediatric Urology, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Philipp Krausewitz
- Department of Urology and Pediatric Urology, Universitätsklinikum Bonn, Bonn, Germany
| | - Susanne Krege
- Department of Urology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Gaetano Aurilio
- Medical Oncology Division of Urogenital and Head and Neck Tumours, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Cem Aksoy
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Péter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | | | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tomas Buchler
- Department of Oncology, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Sonia Vallet
- Department of Internal Medicine II, Universitätsklinikum Krems, Krems, AustriaDepartment of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Hana Studentova
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Sandra Schönburg
- Department of Urology, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | | | - Julia Ring
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Emanuela Trenti
- Department of Urology, Central Hospital Bolzano, Bolzano, Italy
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Hendrik Isbarn
- Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Pichler
- Division of Oncology, Medical University of Graz, Graz, Austria
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Patel AM, Ali O, Kainthla R, Rizvi SM, Awan FT, Patel T, Pan E, Maher E, Desai NB, Timmerman R, Kumar KA, Ramakrishnan Geethakumari P. Primary central nervous system lymphoma: a real-world comparison of therapy access and outcomes by hospital setting. Neurooncol Pract 2022; 9:183-192. [PMID: 35601974 PMCID: PMC9113306 DOI: 10.1093/nop/npab066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background This study analyzes sociodemographic barriers for primary CNS lymphoma (PCNSL) treatment and outcomes at a public safety-net hospital versus a private tertiary academic institution. We hypothesized that these barriers would lead to access disparities and poorer outcomes in the safety-net population. Methods We reviewed records of PCNSL patients from 2007-2020 (n = 95) at a public safety-net hospital (n = 33) and a private academic center (n = 62) staffed by the same university. Demographics, treatment patterns, and outcomes were analyzed. Results Patients at the safety-net hospital were significantly younger, more commonly Black or Hispanic, and had a higher prevalence of HIV/AIDS. They were significantly less likely to receive induction chemotherapy (67% vs 86%, P = .003) or consolidation autologous stem cell transplantation (0% vs. 47%, P = .001), but received more whole-brain radiation therapy (35% vs 16%, P = .001). Younger age and receiving any consolidation therapy were associated with improved progression-free (PFS, P = .001) and overall survival (OS, P = .001). Hospital location had no statistical impact on PFS (P = .725) or OS (P = .226) on an age-adjusted analysis. Conclusions Our study shows significant differences in treatment patterns for PCNSL between a public safety-net hospital and an academic cancer center. A significant survival difference was not demonstrated, which is likely multifactorial, but likely was positively impacted by the shared multidisciplinary care delivery between the institutions. As personalized therapies for PCNSL are being developed, equitable access including clinical trials should be advocated for resource-limited settings.
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Affiliation(s)
- Akshat M Patel
- Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Omer Ali
- Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Radhika Kainthla
- Division of Hematology/Oncology, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Syed M Rizvi
- Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Farrukh T Awan
- Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Toral Patel
- Department of Neurosurgery, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Edward Pan
- Department of Neurology, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Elizabeth Maher
- Department of Neurology, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kiran A Kumar
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Praveen Ramakrishnan Geethakumari
- Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Corresponding Author: Praveen Ramakrishnan Geethakumari, MD, MS, Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390, USA ()
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Patel AM, Howard JM, Bagrodia A. Re: Anthony Emmanuel, Abi Kanthabalan, Cameron Alexander, et al. Expedited Radical Orchidectomy for Testicular Cancer: Compromising Fertility Outcomes Without Oncological Benefit? Eur Urol. In press. https://doi.org/10.1016/j.eururo.2021.08.025. Eur Urol 2021; 81:e50. [PMID: 34872784 DOI: 10.1016/j.eururo.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Akshat M Patel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jeffrey M Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego Health, San Diego, CA, USA
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10
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Howard JM, Patel A, Bagrodia A. Reply. Urology 2021; 163:126-131. [PMID: 34343562 DOI: 10.1016/j.urology.2021.05.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/05/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare pre-orchiectomy sperm cryopreservation use in testicular cancer patients at a private tertiary care academic center and an affiliated public safety-net hospital. METHODS This was a retrospective cohort study of patients who underwent radical orchiectomy for testicular cancer at a private tertiary-care hospital, which cared primarily for patients with private health insurance, and at a public "safety-net" facility, which cared for patients regardless of insurance status. Clinical and demographic predictors of cryopreservation use prior to orchiectomy were determined by chart review. RESULTS A total of 201 patients formed the study cohort, 106 (53%) at the safety-net hospital and 95 (47%) at the private hospital. Safety net patients were more likely to be non-White (82% vs 15%, p < 0.001), uninsured (80% vs 12%, p < 0.001), Spanish speaking (38% vs 5.6%, p < 0.001), and to reside in areas in the bottom quartile of income (41% vs 5.6%, p < 0.001). On multivariable analysis, treatment at the private tertiary care center was strongly associated with use of cryopreservation (OR 5.60, 95% CI 1.74 - 20.4, p = 0.005, though the effects of specific demographic factors could not be elucidated due to collinearity. CONCLUSIONS Among patients with testicular cancer, disparities exist in use of sperm cryopreservation between the private and safety-net settings. Barriers to the use of cryopreservation in the safety-net population should be sought and addressed.
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Affiliation(s)
- Jeffrey M Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Akshat Patel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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11
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Bhanvadia RR, Baky FJ, Lafin JT, Bagrodia A. How can we mitigate treatment-associated morbidity in patients with germ cell tumors? Expert Rev Anticancer Ther 2021; 21:805-807. [PMID: 34006160 DOI: 10.1080/14737140.2021.1932473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Fady J Baky
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - John T Lafin
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
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12
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Baky FJ, Bhanvadia RR, Badia RR, Woldu S, Bagrodia A. Encouraging Outcomes Allow Patient-Guided Treatment Strategies for Stage I Pure Testicular Teratoma. Ann Surg Oncol 2021; 28:3465-3467. [PMID: 33754225 DOI: 10.1245/s10434-021-09700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Fady J Baky
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Raj R Bhanvadia
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rohit R Badia
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon Woldu
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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13
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Rovito MJ, Craycraft M, Talton W, Maresca M. So, now what?: Reflections on socioeconomic factors, testicular cancer, and health care accessibility. Cancer 2021; 127:1345-1346. [PMID: 33595835 DOI: 10.1002/cncr.33375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/03/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Michael J Rovito
- Testicular Cancer Research Collaborative, Department of Health Sciences, University of Central Florida, Orlando, Florida
| | | | - Walker Talton
- Testicular Cancer Research Collaborative, Department of Health Sciences, University of Central Florida, Orlando, Florida
| | - Michael Maresca
- Testicular Cancer Research Collaborative, Department of Health Sciences, University of Central Florida, Orlando, Florida
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Chertack N, Baky F, Woldu S, Bagrodia A. Reply to So, now what?: Reflections on socioeconomic factors, testicular cancer, and health care accessibility. Cancer 2021; 127:1347-1348. [PMID: 33595851 DOI: 10.1002/cncr.33374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Nathan Chertack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fady Baky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Bhambhvani HP, Greenberg DR, Kasman AM, DeRouen MC, Cheng I, Eisenberg ML, Shah SA. Racial and socioeconomic disparities in retroperitoneal lymph node dissection and survival in nonseminomatous germ cell tumor: A population-based study. Urol Oncol 2021; 39:197.e1-197.e8. [PMID: 33423934 DOI: 10.1016/j.urolonc.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Though testicular cancer is the most common cancer in young men, there is a paucity of epidemiologic studies examining sociodemographic disparities in adjuvant therapy and outcomes. We examined the associations of sociodemographic factors with retroperitoneal lymph node dissection (RPLND) and survival among patients with nonseminomatous germ cell tumors (NSGCTs). METHODS Within the Surveillance Epidemiology and End Results database (2005-2015), we identified 8,573 patients with nonseminomatous germ cell tumors. Multivariable logistic regression and Fine-Gray competing-risks regression models were constructed to examine the association of sociodemographic factors (neighborhood SES (nSES), race, and insurance) with, respectively, adjuvant RPLND within 1 year of diagnosis and cancer-specific mortality. RESULTS Patients in the lowest nSES quintile (OR 0.59, 95% CI = 0.40-0.88, P = 0.01) and Black patients (OR 0.41, 95% CI = 0.15-1.00, P= 0.058) with stage II disease were less likely to receive RPLND compared to those in the highest quintile and White patients, respectively. Stage III patients with Medicaid (OR 0.64, 95% CI = 0.46-0.89, P= 0.009) or without insurance (OR 0.46, 95% CI = 0.27-0.76, P= 0.003) were less likely to receive RPLND compared to patients with private insurance. Lowest quintile nSES patients of all disease stages and Black patients with stage I disease (HR = 2.64, 95% CI = 1.12-6.20, P = 0.026) or stage II disease (HR=4.93, 95% CI = 1.48-16.44, P = 0.009) had higher risks of cancer-specific mortality compared to highest quintile nSES and White patients, respectively. CONCLUSIONS This national study found multilevel, stage-specific sociodemographic disparities in receipt of RPLND and survival.
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Affiliation(s)
| | | | - Alex M Kasman
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Mindy C DeRouen
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; UCSF Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Iona Cheng
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; UCSF Department of Epidemiology and Biostatistics, San Francisco, CA
| | | | - Sumit A Shah
- Division of Oncology, Stanford University Medical Center, Stanford, CA
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