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Hu J, Gu H, Zhang D, Wen M, Yan Z, Song B, Xie C. Establishment and validation of a nomogram for predicting overall survival of upper-tract urothelial carcinoma with bone metastasis: a population-based study. BMC Urol 2024; 24:100. [PMID: 38689213 PMCID: PMC11059636 DOI: 10.1186/s12894-024-01488-7] [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: 12/14/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Bone metastasis (BM) carries a poor prognosis for patients with upper-tract urothelial carcinoma (UTUC). This study aims to identify survival predictors and develop a prognostic nomogram for overall survival (OS) in UTUC patients with BM. METHODS The Surveillance, Epidemiology, and End Results database was used to select patients with UTUC between 2010 and 2019. The chi-square test was used to assess the baseline differences between the groups. Kaplan-Meier analysis was employed to assess OS. Univariate and multivariate analyses were conducted to identify prognostic factors for nomogram establishment. An independent cohort was used for external validation of the nomogram. The discrimination and calibration of the nomogram were evaluated using concordance index (C-index), area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). All statistical analyses were performed using SPSS 23.0 and R software 4.2.2. RESULTS The mean OS for UTUC patients with BM was 10 months (95% CI: 8.17 to 11.84), with 6-month OS, 1-year OS, and 3-year OS rates of 41%, 21%, and 3%, respectively. Multi-organ metastases (HR = 2.21, 95% CI: 1.66 to 2.95, P < 0.001), surgery (HR = 0.72, 95% CI: 0.56 to 0.91, P = 0.007), and chemotherapy (HR = 0.37, 95% CI: 0.3 to 0.46, P < 0.001) were identified as independent prognostic factors. The C-index was 0.725 for the training cohort and 0.854 for the validation cohort, and all AUC values were > 0.679. The calibration curve and DCA curve showed the accuracy and practicality of the nomogram. CONCLUSIONS The OS of UTUC patients with BM was poor. Multi-organ metastases was a risk factor for OS, while surgery and chemotherapy were protective factors. Our nomogram was developed and validated to assist clinicians in evaluating the OS of UTUC patients with BM.
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Affiliation(s)
- Jiasheng Hu
- Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo, China
- Ningbo Clinical Research Center for Urological Disease, Ningbo, China
| | - Haowen Gu
- Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Dongxu Zhang
- Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo, China
- Ningbo Clinical Research Center for Urological Disease, Ningbo, China
| | - Min Wen
- Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo, China
- Ningbo Clinical Research Center for Urological Disease, Ningbo, China
| | - Zejun Yan
- Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo, China
- Ningbo Clinical Research Center for Urological Disease, Ningbo, China
| | - Baiyang Song
- Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo, China.
| | - Chengxin Xie
- Shandong First Medical University, Jinan, 250021, China.
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
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Labidi S, Meti N, Barua R, Li M, Riromar J, Jiang DM, Fallah-Rad N, Sridhar SS, Del Rincon SV, Pezo RC, Ferrario C, Cheng S, Sacher AG, Rose AAN. Clinical variables associated with immune checkpoint inhibitor outcomes in patients with metastatic urothelial carcinoma: a multicentre retrospective cohort study. BMJ Open 2024; 14:e081480. [PMID: 38553056 PMCID: PMC10982788 DOI: 10.1136/bmjopen-2023-081480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Immune checkpoint inhibitors (ICIs) are indicated for metastatic urothelial cancer (mUC), but predictive and prognostic factors are lacking. We investigated clinical variables associated with ICI outcomes. METHODS We performed a multicentre retrospective cohort study of 135 patients who received ICI for mUC, 2016-2021, at three Canadian centres. Clinical characteristics, body mass index (BMI), metastatic sites, neutrophil-to-lymphocyte ratio (NLR), response and survival were abstracted from chart review. RESULTS We identified 135 patients and 62% had received ICI as a second-line or later treatment for mUC. A BMI ≥25 was significantly correlated to a higher overall response rate (ORR) (45.4% vs 16.3%, p value=0.020). Patients with BMI ≥30 experienced longer median overall survival (OS) of 24.8 vs 14.4 for 25≤BMI<30 and 8.5 months for BMI <25 (p value=0.012). The ORR was lower in the presence of bone metastases (16% vs 41%, p value=0.006) and liver metastases (16% vs 39%, p value=0.013). Metastatic lymph nodes were correlated with higher ORR (40% vs 20%, p value=0.032). The median OS for bone metastases was 7.3 versus 18 months (p value <0.001). Patients with liver metastases had a median OS of 8.6 versus 15 months (p value=0.006). No difference for lymph nodes metastases (13.5 vs 12.7 months, p value=0.175) was found. NLR ≥4 had worse OS (8.2 vs 17.7 months, p value=0.0001). In multivariate analysis, BMI ≥30, bone metastases, NLR ≥4, performance status ≥2 and line of ICI ≥2 were independent factors for OS. CONCLUSIONS Our data identified BMI and bone metastases as novel clinical biomarkers that were independently associated with ICI outcomes in mUC. External and prospective validation are warranted.
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Affiliation(s)
- Soumaya Labidi
- Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
| | - Nicholas Meti
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
- St Mary Hospital, Montreal, Quebec, Canada
| | - Reeta Barua
- Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | - Mengqi Li
- Lady Davis Institute for Medical Research, Montreal, Québec, Canada
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jamila Riromar
- National Oncology Center, The Royal Hospital, Seeb, Muscat, Oman
| | - Di Maria Jiang
- Medical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Nazanin Fallah-Rad
- Medical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Medical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Sonia V Del Rincon
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Montreal, Québec, Canada
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rossanna C Pezo
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Cristiano Ferrario
- Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
| | - Susanna Cheng
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Adrian G Sacher
- Medical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - April A N Rose
- Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Montreal, Québec, Canada
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Lei M, Wu B, Zhang Z, Qin Y, Cao X, Cao Y, Liu B, Su X, Liu Y. A Web-Based Calculator to Predict Early Death Among Patients With Bone Metastasis Using Machine Learning Techniques: Development and Validation Study. J Med Internet Res 2023; 25:e47590. [PMID: 37870889 PMCID: PMC10628690 DOI: 10.2196/47590] [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: 03/25/2023] [Revised: 07/05/2023] [Accepted: 08/24/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Patients with bone metastasis often experience a significantly limited survival time, and a life expectancy of <3 months is generally regarded as a contraindication for extensive invasive surgeries. In this context, the accurate prediction of survival becomes very important since it serves as a crucial guide in making clinical decisions. OBJECTIVE This study aimed to develop a machine learning-based web calculator that can provide an accurate assessment of the likelihood of early death among patients with bone metastasis. METHODS This study analyzed a large cohort of 118,227 patients diagnosed with bone metastasis between 2010 and 2019 using the data obtained from a national cancer database. The entire cohort of patients was randomly split 9:1 into a training group (n=106,492) and a validation group (n=11,735). Six approaches-logistic regression, extreme gradient boosting machine, decision tree, random forest, neural network, and gradient boosting machine-were implemented in this study. The performance of these approaches was evaluated using 11 measures, and each approach was ranked based on its performance in each measure. Patients (n=332) from a teaching hospital were used as the external validation group, and external validation was performed using the optimal model. RESULTS In the entire cohort, a substantial proportion of patients (43,305/118,227, 36.63%) experienced early death. Among the different approaches evaluated, the gradient boosting machine exhibited the highest score of prediction performance (54 points), followed by the neural network (52 points) and extreme gradient boosting machine (50 points). The gradient boosting machine demonstrated a favorable discrimination ability, with an area under the curve of 0.858 (95% CI 0.851-0.865). In addition, the calibration slope was 1.02, and the intercept-in-large value was -0.02, indicating good calibration of the model. Patients were divided into 2 risk groups using a threshold of 37% based on the gradient boosting machine. Patients in the high-risk group (3105/4315, 71.96%) were found to be 4.5 times more likely to experience early death compared with those in the low-risk group (1159/7420, 15.62%). External validation of the model demonstrated a high area under the curve of 0.847 (95% CI 0.798-0.895), indicating its robust performance. The model developed by the gradient boosting machine has been deployed on the internet as a calculator. CONCLUSIONS This study develops a machine learning-based calculator to assess the probability of early death among patients with bone metastasis. The calculator has the potential to guide clinical decision-making and improve the care of patients with bone metastasis by identifying those at a higher risk of early death.
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Affiliation(s)
- Mingxing Lei
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
- Chinese PLA Medical School, Beijing, China
| | - Bing Wu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhicheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yong Qin
- Department of Joint and Sports Medicine Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuyong Cao
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yuncen Cao
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Baoge Liu
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiuyun Su
- Intelligent Medical Innovation institute, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Yaosheng Liu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- Department of Orthopedics, The Fifth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, PLA General Hospital, Beijing, China
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Buharov AV, Kurilchik AA, Barashev AA, Derzhavin VA, Yadrina AV, Erin DA, Elkhov DO, Aliev MD, Kaprin AD. Development of a prognostic model in patients with metastatic bone lesions to choose surgical treatment: retrospective study. JOURNAL OF MODERN ONCOLOGY 2023. [DOI: 10.26442/18151434.2022.3.201865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Choosing surgical management for patients with metastatic bone lesions is one of the essential problems of modern oncology. Surgical interventions are aimed at palliative treatment in most patients with metastatic skeletal lesions. However, curative resections with reconstruction and plasty steps may be considered in selected cases of a solitary metastatic lesion. The life expectancy prognosis based on the histological structure of the tumor is a significant and decisive factor in choosing the appropriate surgery.
Aim. To develop a prognostic model for choosing surgical treatment for metastatic bone lesions.
Materials and methods. Treatment analysis of 715 patients with a history of surgery for metastatic bone lesions of various localizations is presented. A total of 780 surgical interventions were performed. Surgeries for the complications of bone metastases were mainly performed on the spine (48.5% of all surgeries), followed by long bones with 247 (35%) surgeries, pelvic bones with 81 (11%) interventions, and the chest wall with 40 (5.5%) surgeries.
Results. The most unfavorable prognostic factors in patients with metastatic bone lesions are the histological type of the primary tumor of the rapid growth group (risk ratio [RR]=5.11), visceral metastases (RR=3.1), Charlson Comorbidity Index over 10 (RR=3.07) and presence of critical laboratory abnormalities (RR=2.91), as they have the highest rates of impact on survival (over 2.9).
Conclusion. The developed 14-point mathematical score of life expectancy prognosis, which includes five oncological and four clinical factors, defines with an accuracy of 91% the risk groups of good (estimated life expectancy over one year), moderate (6 to 12 months), and poor (less than six months) prognosis in patients with metastatic bone lesions.
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Cui Y, Shi X, Wang S, Qin Y, Wang B, Che X, Lei M. Machine learning approaches for prediction of early death among lung cancer patients with bone metastases using routine clinical characteristics: An analysis of 19,887 patients. Front Public Health 2022; 10:1019168. [PMID: 36276398 PMCID: PMC9583680 DOI: 10.3389/fpubh.2022.1019168] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/20/2022] [Indexed: 01/28/2023] Open
Abstract
Purpose Bone is one of the most common sites for the spread of malignant tumors. Patients with bone metastases whose prognosis was shorter than 3 months (early death) were considered as surgical contraindications. However, the information currently available in the literature limits our capacity to assess the risk likelihood of 3 month mortality. As a result, the study's objective is to create an accurate prediction model utilizing machine-learning techniques to predict 3 month mortality specifically among lung cancer patients with bone metastases according to easily available clinical data. Methods This study enrolled 19,887 lung cancer patients with bone metastases between 2010 and 2018 from a large oncologic database in the United States. According to a ratio of 8:2, the entire patient cohort was randomly assigned to a training (n = 15881, 80%) and validation (n = 4,006, 20%) group. In the training group, prediction models were trained and optimized using six approaches, including logistic regression, XGBoosting machine, random forest, neural network, gradient boosting machine, and decision tree. There were 13 metrics, including the Brier score, calibration slope, intercept-in-large, area under the curve (AUC), and sensitivity, used to assess the model's prediction performance in the validation group. In each metric, the best prediction effectiveness was assigned six points, while the worst was given one point. The model with the highest sum score of the 13 measures was optimal. The model's explainability was performed using the local interpretable model-agnostic explanation (LIME) according to the optimal model. Predictor importance was assessed using H2O automatic machine learning. Risk stratification was also evaluated based on the optimal threshold. Results Among all recruited patients, the 3 month mortality was 48.5%. Twelve variables, including age, primary site, histology, race, sex, tumor (T) stage, node (N) stage, brain metastasis, liver metastasis, cancer-directed surgery, radiation, and chemotherapy, were significantly associated with 3 month mortality based on multivariate analysis, and these variables were included for developing prediction models. With the highest sum score of all the measurements, the gradient boosting machine approach outperformed all the other models (62 points), followed by the XGBooting machine approach (59 points) and logistic regression (53). The area under the curve (AUC) was 0.820 (95% confident interval [CI]: 0.807-0.833), 0.820 (95% CI: 0.807-0.833), and 0.815 (95% CI: 0.801-0.828), respectively, calibration slope was 0.97, 0.95, and 0.96, respectively, and accuracy was all 0.772. Explainability of models was conducted to rank the predictors and visualize their contributions to an individual's mortality outcome. The top four important predictors in the population according to H2O automatic machine learning were chemotherapy, followed by liver metastasis, radiation, and brain metastasis. Compared to patients in the low-risk group, patients in the high-risk group were more than three times the odds of dying within 3 months (P < 0.001). Conclusions Using machine learning techniques, this study offers a number of models, and the optimal model is found after thoroughly assessing and contrasting the prediction performance of each model. The optimal model can be a pragmatic risk prediction tool and is capable of identifying lung cancer patients with bone metastases who are at high risk for 3 month mortality, informing risk counseling, and aiding clinical treatment decision-making. It is better advised for patients in the high-risk group to have radiotherapy alone, the best supportive care, or minimally invasive procedures like cementoplasty.
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Affiliation(s)
- Yunpeng Cui
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China
| | - Xuedong Shi
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China,*Correspondence: Xuedong Shi
| | - Shengjie Wang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Yong Qin
- Department of Joint and Sports Medicine Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China,Yong Qin
| | - Bailin Wang
- Department of Thoracic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Xiaotong Che
- Department of Evaluation Office, Hainan Cancer Hospital, Haikou, China
| | - Mingxing Lei
- Department of Orthopedic Surgery, Hainan Hospital of PLA General Hospital, Sanya, China,Chinese PLA Medical School, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China,Mingxing Lei
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The Prediction of Survival after Surgical Management of Bone Metastases of the Extremities—A Comparison of Prognostic Models. Curr Oncol 2022; 29:4703-4716. [PMID: 35877233 PMCID: PMC9320475 DOI: 10.3390/curroncol29070373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/19/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Individualized survival prognostic models for symptomatic patients with appendicular metastatic bone disease are key to guiding clinical decision-making for the orthopedic surgeon. Several prognostic models have been developed in recent years; however, most orthopedic surgeons have not incorporated these models into routine practice. This is possibly due to uncertainty concerning their accuracy and the lack of comparison publications and recommendations. Our aim was to conduct a review and quality assessment of these models. A computerized literature search in MEDLINE, EMBASE and PubMed up to February 2022 was done, using keywords: “Bone metastasis”, “survival”, “extremity” and “prognosis”. We evaluated each model’s performance, assessing the estimated discriminative power and calibration accuracy for the analyzed patients. We included 11 studies out of the 1779 citations initially retrieved. The 11 studies included seven different models for estimating survival. Among externally validated survival prediction scores, PATHFx 3.0, 2013-SPRING and potentially Optimodel were found to be the best models in terms of performance. Currently, it is still a challenge to recommend any of the models as the standard for predicting survival for these patients. However, some models show better performance status and other quality characteristics. We recommend future, large, multicenter, prospective studies to compare between PATHfx 3.0, SPRING 2013 and OptiModel using the same external validation dataset.
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Shimizu T, Miyake M, Nishimura N, Inoue K, Fujii K, Iemura Y, Ichikawa K, Omori C, Tomizawa M, Maesaka F, Oda Y, Miyamoto T, Sakamoto K, Kiba K, Tanaka M, Oyama N, Okajima E, Fujimoto K, Hori S, Morizawa Y, Gotoh D, Nakai Y, Torimoto K, Tanaka N, Fujimoto K. Organ-Specific and Mixed Responses to Pembrolizumab in Patients with Unresectable or Metastatic Urothelial Carcinoma: A Multicenter Retrospective Study. Cancers (Basel) 2022; 14:cancers14071735. [PMID: 35406508 PMCID: PMC8997142 DOI: 10.3390/cancers14071735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate the organ-specific response and clinical outcomes of mixed responses (MRs) to immune checkpoint inhibitors (ICIs) for unresectable or metastatic urothelial carcinoma (ur/mUC), we retrospectively analyzed 136 patients who received pembrolizumab. The total objective response rate (ORR) and organ-specific ORR were determined for each lesion according to the Response Evaluation Criteria in Solid Tumors version 1.1 as follows: (i) complete response (CR), (ii) partial response (PR), (iii) stable disease (SD), and (iv) progressive disease (PD). Most of the organ-specific ORR was 30−40%, but bone metastasis was only 5%. There was a significant difference in overall survival (OS) between responders and non-responders with locally advanced lesions and lymph node, lung, or liver metastases (HR 9.02 (3.63−22.4) p < 0.0001; HR 3.63 (1.97−6.69), p < 0.0001; HR 2.75 (1.35−5.59), p = 0.0053; and HR 3.17 (1.00−10.0), p = 0.049, respectively). MR was defined as occurring when PD happened in one lesion plus either CR or PR occurred in another lesion simultaneously, and 12 cases were applicable. MR was significantly associated with a poorer prognosis than that of the responder group (CR or PR; HR 0.09 (0.02−0.35), p = 0.004). Patients with bone metastases benefitted less. Care may be needed to treat patients with MR as well as patients with pure PD. Further studies should be conducted in the future.
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Affiliation(s)
- Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
- Correspondence: ; Tel.: +81-744-22-3051; Fax: +81-744-22-9282
| | - Nobutaka Nishimura
- Department of Urology, Okanami General Hospital, Iga 518-0842, Japan; (N.N.); (K.F.)
| | - Kuniaki Inoue
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Koyo Fujii
- Department of Urology, Osaka Gyoumeikan Hospital, Osaka 554-0012, Japan;
| | - Yusuke Iemura
- Department of Urology, Hirao Hospital, Kashihara 634-0076, Japan;
| | - Kazuki Ichikawa
- Department of Urology, Takai Hospital, Tenri 632-0372, Japan;
| | - Chihiro Omori
- Department of Urology, Nara Prefecture General Medical Center, Nara 630-8581, Japan;
| | - Mitsuru Tomizawa
- Department of Urology, Yamato Takada Municipal Hospital, Yamato Takada 635-8501, Japan;
| | - Fumisato Maesaka
- Department of Urology, Nara City Hospital, Nara 630-8305, Japan; (F.M.); (E.O.)
| | - Yuki Oda
- Department of Urology, Nara Prefecture Seiwa Medical Center, Ikoma 636-0802, Japan; (Y.O.); (N.O.)
| | - Tatsuki Miyamoto
- Department of Urology, Hoshigaoka Medical Center, Hirakata 573-8511, Japan;
| | - Keiichi Sakamoto
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Keisuke Kiba
- Department of Urology, Kindai University Nara Hospital, Ikoma 630-0293, Japan;
| | - Masahiro Tanaka
- Department of Urology, Osaka Kaisei Hospital, Osaka 532-0003, Japan;
| | - Nobuo Oyama
- Department of Urology, Nara Prefecture Seiwa Medical Center, Ikoma 636-0802, Japan; (Y.O.); (N.O.)
| | - Eijiro Okajima
- Department of Urology, Nara City Hospital, Nara 630-8305, Japan; (F.M.); (E.O.)
| | - Ken Fujimoto
- Department of Urology, Okanami General Hospital, Iga 518-0842, Japan; (N.N.); (K.F.)
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Nobumichi Tanaka
- Department of Brachytherapy, Nara Medical University, Kashihara 634-8522, Japan;
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
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