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Westhofen T, Buchner A, Lennartz S, Rodler S, Eismann L, Aydogdu C, Askari-Motlagh D, Berg E, Feyerabend E, Kazmierczak P, Jokisch F, Becker A, Stief CG, Kretschmer A. Optimizing risk stratification for intermediate-risk prostate cancer - the prognostic value of baseline health-related quality of life. World J Urol 2024; 42:585. [PMID: 39427278 PMCID: PMC11491415 DOI: 10.1007/s00345-024-05298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 09/24/2024] [Indexed: 10/22/2024] Open
Abstract
OBJECTIVE To investigate the prognostic value of baseline health-related quality of life (HRQOL) for patients with intermediate-risk localized prostate cancer (IR-PCa) undergoing radical prostatectomy (RP). METHODS 4780 patients with IR-PCa according to NCCN risk stratification were identified from a prospectively maintained database. All patients were treated with RP and had prospectively assessed baseline HRQOL. Main outcomes were oncologic endpoints metastasis-free survival (MFS); biochemical recurrence free survival (BRFS) and overall survival (OS). Multivariable Cox regression models assessed prognostic significance of baseline global health status (GHS) on survival outcomes. Harrell's discrimination C-index was applied to calculate the predictive accuracy of the model. Decision curve analysis (DCA) tested the clinical net benefit associated with adding the GHS domain to our multivariable model (p < 0.05). RESULTS Median follow-up was 51 months. Multivariable analysis confirmed baseline GHS as an independent predictor for increased MFS (HR 0.976, 95%CI 0.96-0.99; p < 0.001), increased BRFS (HR 0.993, 95%CI 0.99-1.00; p = 0.027) and increased OS (HR 0.969, 95%CI 0.95-0.99; p = 0.002), indicating a relative risk reduction of 2.4% for MFS, 0.7% for BRFS and 3.1% for OS per 1-point increase of baseline GHS. Baseline HRQOL improved discrimination in predicting MFS, BRFS and OS. DCA revealed a net benefit over all threshold probabilities. CONCLUSIONS We found baseline HRQOL to substantially improve risk stratification for the heterogeneous cohort of IR-PCa. Baseline HRQOL accurately predicts increased MFS, BRFS and OS. Our findings therefore support the role of preoperative HRQOL as an adjunct to established prognosticators for IR-PCa, potentially facilitating guidance of therapy.
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Affiliation(s)
- Thilo Westhofen
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Severin Rodler
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Lennert Eismann
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Can Aydogdu
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Darjusch Askari-Motlagh
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Elena Berg
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Enya Feyerabend
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Philipp Kazmierczak
- Institute for Diagnostic and Interventional Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Armin Becker
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Fukushima T, Suzuki K, Tanaka T, Okayama T, Inoue J, Morishita S, Nakano J. Global quality of life and mortality risk in patients with cancer: a systematic review and meta-analysis. Qual Life Res 2024; 33:2631-2643. [PMID: 38811448 DOI: 10.1007/s11136-024-03691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE This systematic review and meta-analysis aimed to examine the impact of global quality of life (QOL) on mortality risk in patients with cancer, considering cancer type and timepoint of QOL assessment. METHODS A systematic search was conducted using Cumulated Index to Nursing and Allied Health Literature, PubMed/MEDLINE, and Scopus databases from inception to December 2022. Observational studies that assessed QOL and examined mortality risk in patients with cancer were extracted. Subgroup analyses were performed for cancer types and timepoints of QOL assessment. RESULTS Overall, global QOL was significantly associated with mortality risk (hazard ratio: 1.06, 95% confidence interval: 1.05-1.07; p < 0.00001). A subgroup analysis based on cancer type demonstrated that lung, head and neck, breast, esophagus, colon, prostate, hematologic, liver, gynecologic, stomach, brain, bladder, bone and soft tissue, and mixed type cancers were significantly associated with mortality risk; however, melanoma and pancreatic cancer were not significantly associated with mortality risk. Additionally, global QOL was associated with mortality risk at all timepoints (pretreatment, posttreatment, and palliative phase); pretreatment QOL had the largest impact, followed by posttreatment QOL. CONCLUSION These findings provide evidence that QOL is associated with mortality risk in patients with cancer at any timepoint. These results indicate the importance of evaluating the QOL and supportive interventions to improve QOL in any phase.
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Affiliation(s)
- Takuya Fukushima
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Katsuyoshi Suzuki
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Tanaka
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Junichiro Inoue
- Division of Rehabilitation Medicine, Kobe University Hospital International Clinical Cancer Research Center, Kobe, Japan
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Science, Fukushima Medical University, Fukushima, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
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Mastroianni R, Iannuzzi A, Ragusa A, Tuderti G, Ferriero M, Anceschi U, Bove AM, Brassetti A, Misuraca L, D’Annunzio S, Guaglianone S, Papalia R, Simone G. Health Related Quality of Life in Patients with Bladder Cancer Receiving a Radical Cystectomy. Cancers (Basel) 2023; 15:5830. [PMID: 38136375 PMCID: PMC10741964 DOI: 10.3390/cancers15245830] [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: 11/08/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Radical Cystectomy (RC) and Urinary Diversion (UD) is a complex surgery associated with a significant impact on health-related quality of life (HRQoL). However, HRQoL assessment is too often overlooked, with survival and complications being the most commonly investigated outcomes. This study aimed to identify the most impaired HRQoL features in patients receiving RC, compared to a healthy population (HP) control, as well as patients' recovery after surgery, differentiating between patients receiving ORC and RARC. Patients with Bca, who were candidates for RC with curative intent, were enrolled in the "BCa cohort". HRQoL outcomes were collected with an EORTC QLQ-C30 questionnaire. These were collected at baseline, and then at 6-, 12- and 24 mo after surgery in the BCa cohorts, and at baseline in the HP cohort. A 1:1 propensity score matched (PSM)-analysis, adjusted for age, Charlson Comorbidity Index (CCI) and smoking history, was performed. Between January 2018 and February 2023, a total of 418 patients were enrolled in the study, 116 and 302 in the BCa and HP cohorts, respectively. After applying the 1:1 propensity scored match (PSM) analysis, two homogeneous cohorts were selected, including 85 patients in each group. Baseline HRQoL assessment showed a significant impairment in terms of emotional and cognitive functioning, appetite loss and financial difficulties for the BCa cohort. Among secondary outcomes, we investigated patients' recovery after RC and UD, comparing HRQoL outcome questionnaires between the HP and BCa cohorts at 6-, 12- and 24 mo after surgery, and a subgroup analysis was performed differentiating between patients receiving ORC and RARC with totally intracorporeal UD. Interestingly, ORC compared to RARC provided a major impact on HRQoL recovery across the early, mid and long term. In particular, the ORC cohort experienced a major impairment in terms of symptoms scales items such as fatigue, nausea and vomiting, pain and appetite loss. Consequently, comparing ORC and RARC vs. HP reported a major HRQoL impairment in the ORC cohort, possibly defining a benefit of RARC in early, mid- and long-term recovery. To conclude, this study confirmed the undeniable impact of RC on HRQoL. Interestingly, we highlighted the benefit of RARC in early, mid- and long-term recovery, expressed as less impairment of symptoms scales.
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Affiliation(s)
- Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.I.); (A.R.); (R.P.)
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.I.); (A.R.); (R.P.)
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Mariaconsiglia Ferriero
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Simone D’Annunzio
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Salvatore Guaglianone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.I.); (A.R.); (R.P.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
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Papadimitriou MA, Levis P, Kotronopoulos G, Stravodimos K, Avgeris M, Scorilas A. Preoperative Cell-Free DNA (cfDNA) in Muscle-Invasive Bladder Cancer Treatment Outcome. Clin Chem 2023; 69:399-410. [PMID: 36738246 DOI: 10.1093/clinchem/hvac218] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/22/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tumor heterogeneity and lack of personalized prognosis leads to bladder cancer (BlCa) patients' lifelong surveillance with invasive interventions, highlighting the need for modern minimally invasive tools for disease management. Herein, we have evaluated the clinical utility of preoperative serum cell-free DNA (cfDNA) in ameliorating patients' risk-stratification and prognosis. METHODS cfDNA was purified from 190 preoperative BlCa patients and 26 healthy individuals' serum samples and quantified by 2 assays: an in-house quantitative real-time PCR (qPCR) assay using LEP as reference control and a direct fluorometric assay using Qubit HS dsDNA. Capillary electrophoresis was performed in 31 samples for cfDNA fragment profiling. Tumor relapse/progression and metastasis/death were used as clinical endpoints for non-muscle-invasive bladder cancer and muscle-invasive bladder cancer (MIBC), respectively. RESULTS cfDNA profiling by capillary electrophoresis highlighted that total and fragment-related cfDNA levels were significantly increased in BlCa and associated with advance disease stages. Evaluation of cfDNA levels by both Qubit/qPCR displayed highly consistent results (rs = 0.960; P < 0.001). Higher cfDNA was correlated with MIBC and stronger risk for early metastasis (Qubit:hazard ratio [HR] = 3.016, P = 0.009; qPCR:HR = 2.918, P = 0.004) and poor survival (Qubit:HR = 1.898, P = 0.042; qPCR:HR = 1.888, P = 0.026) of MIBC patients. Multivariate cfDNA-fitted models led to superior risk stratification and net benefit for MIBC prognosis compared to disease established markers. CONCLUSIONS Elevated preoperative cfDNA levels are strongly associated with higher risk for short-term metastasis and poor outcome of MIBC, supporting modern noninvasive disease prognosis and management.
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Affiliation(s)
- Maria-Alexandra Papadimitriou
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Levis
- First Department of Urology, "Laiko" General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Kotronopoulos
- First Department of Urology, "Laiko" General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Stravodimos
- First Department of Urology, "Laiko" General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Margaritis Avgeris
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece.,Laboratory of Clinical Biochemistry - Molecular Diagnostics, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
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Renner S, Loussikian P, Foulquié P, Arnould B, Marrel A, Barbier V, Mebarki A, Schück S, Bharmal M. Perceived Unmet Needs in Patients and Caregivers Living With Advanced Bladder Cancer: An Infodemiology Study Using Data From Social Media in the United States (Preprint). JMIR Cancer 2022; 8:e37518. [PMID: 36125861 PMCID: PMC9533198 DOI: 10.2196/37518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Locally advanced or metastatic bladder cancer (BC), which is generally termed advanced BC (aBC), has a very poor prognosis, and in addition to its physical symptoms, it is associated with emotional and social challenges. However, few studies have assessed the unmet needs and burden of aBC from patient and caregiver perspectives. Infodemiology, that is, epidemiology based on internet health-related content, can help obtain more insights on patients’ and caregivers’ experiences with aBC. Objective The study aimed to identify the main discussion themes and the unmet needs of patients with aBC and their caregivers through a mixed methods analysis of social media posts. Methods Social media posts were collected between January 2015 and April 2021 from US geolocalized sites using specific keywords for aBC. Automatic natural language processing (regular expressions and machine learning) methods were used to filter out irrelevant content and identify verbatim posts from patients and caregivers. The verbatim posts were analyzed to identify main discussion themes using biterm topic modeling. Difficulties or unmet needs were further explored using qualitative research methods by 2 independent annotators until saturation of concepts. Results A total of 688 posts from 262 patients and 1214 posts from 679 caregivers discussing aBC were identified. Analysis of 340 randomly selected patient posts and 423 randomly selected caregiver posts uncovered 33 unique unmet need categories among patients and 36 among caregivers. The main unmet patient needs were related to challenges regarding adverse events (AEs; 28/95, 29%) and the psychological impact of aBC (20/95, 21%). Other patient unmet needs identified were prognosis or diagnosis errors (9/95, 9%) and the need for better management of aBC symptoms (9/95, 9%). The main unmet caregiver needs were related to the psychological impacts of aBC (46/177, 26.0%), the need for support groups and to share experiences between peers (28/177, 15.8%), and the fear and management of patient AEs (22/177, 12.4%). Conclusions The combination of manual and automatic methods allowed the extraction and analysis of several hundreds of social media posts from patients with aBC and their caregivers. The results highlighted the emotional burden of cancer for both patients and caregivers. Additional studies on patients with aBC and their caregivers are required to quantitatively explore the impact of this disease on quality of life.
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