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Crispin-Rios Y, Faura-Gonzales M, Torres-Roman JS, Quispe-Vicuña C, Franco-Jimenez US, Valcarcel B, Stang A, McGlynn KA. Testicular cancer mortality in Latin America and the Caribbean: trend analysis from 1997 to 2019. BMC Cancer 2023; 23:1038. [PMID: 37884890 PMCID: PMC10605564 DOI: 10.1186/s12885-023-11511-z] [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: 07/11/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND In the last decades, an increasing incidence of testicular cancer has been observed in several countries worldwide. Although mortality rates have been variable in many countries, little information is available from Latin America and the Caribbean (LAC). Therefore, we examined mortality trends of testicular cancer in the last two decades. METHODS Age-standardized mortality rates (ASMR) of testicular cancer per 100,000 men-years were estimated using the World Health Organization mortality database from 1997 to 2019. We examined the mortality trends and computed annual percent change (APC) for all ages and the following age groups, 15-29, 30-44, 15-44, and ≥ 45 years. RESULTS Ten countries had mortality rates greater than 0.43 per 100,000 men, with the highest rates for Chile, Mexico, and Argentina. Significant increases in mortality rates were observed in Argentina, Brazil Colombia, and Mexico in all ages, and < 45 years, while Colombia, Ecuador, Mexico, and Peru reported significant downward trends in males aged ≥ 45 years. Only Chile showed significant decreases for all ages and age groups studied. CONCLUSION Mortality by testicular cancer increased among LAC countries in males of all ages and across age groups. A reduction in mortality rates was observed only in Chilean males of all ages and in men ≥ 45 years in several countries. Strengthening of early detection among symptomatic males may decrease the mortality by this neoplasm.
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Affiliation(s)
- Yuleizy Crispin-Rios
- Cancer Research Networking, Universidad Cientifica del Sur, Lima, Peru
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru
| | - Mariafe Faura-Gonzales
- Cancer Research Networking, Universidad Cientifica del Sur, Lima, Peru
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru
| | | | - Carlos Quispe-Vicuña
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Uriel S Franco-Jimenez
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Bryan Valcarcel
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru
| | - Andreas Stang
- Institut Für Medizinische InformatikBiometrie Und EpidemiologieUniversitätsklinikum Essen, Essen, Germany
- School of Public Health, Boston University, Boston, Mass, USA
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Yen TH, Wang SS, Yang CK, Lu K, Chen CS, Cheng CL, Hung SC, Chiu KY, Chen CP, Yang CR, Li JR. Risk analysis of subsequent therapies after first-line chemotherapy in advanced testicular cancer patients. J Chin Med Assoc 2023; 86:646-652. [PMID: 37191945 DOI: 10.1097/jcma.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Testicular cancer is the most common solid cancer diagnosed among young men. Despite good response to chemotherapy and a high survival rate, subsequent salvage therapies may still be required for some patients in advanced stages. The predictive and prognostic markers are crucial unmet needs. METHODS We retrospectively analyzed advanced testicular cancer patients who had received first-line chemotherapy between January 2002 and December 2020. The associations between baseline characteristics and clinical outcomes were evaluated. RESULTS Of the 68 included patients, the median age was 29 years. Among them, 40 patients received only first-line chemotherapy while the remaining 28 received subsequent chemotherapy or surgeries. Data reveal that 82.5% (33/40) of the patients in the chemotherapy-only group were recorded as a good prognostic risk using the International Germ Cell Cancer Collaborative Group classification when compared with 35.7% (10/28) in the second-line therapy group. In the chemotherapy-only group, 53.8% of patients were presented with lymph node metastasis compared with 78.6% in the second-line therapy group ( p = 0.068). Fifteen percent of patients (6/40) were recorded as S stage 2-3 in the chemotherapy-only group, whereas 85.2% (23/28) were recorded as such in the second-line therapy group ( p < 0.001). The 5-year overall survival estimation was 92.9% in the chemotherapy-only group and 77.3% in the second-line therapy group. Univariate analysis for overall survival revealed that those patients at the S 2-3 stage and those receiving second-line therapies showed a trend of having an increased death risk (hazard ratio [HR] = 8.26, 95% confidence interval (CI), 0.99-68.67, p = 0.051; HR = 7.76, 95% CI, 0.93-64.99, p = 0.059, respectively). The S 2-3 stage was also independently associated with the risk of subsequent therapy (HR = 33.13; 95% CI, 2.55-430.64, p = 0.007). CONCLUSION Our real-world data show the predictive role of serum tumor marker stage 2-3 to be associated with any subsequent therapies after first-line chemotherapy. This can facilitate clinical decision making during the testicular cancer treatment process.
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Affiliation(s)
- Tsung-Han Yen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan, ROC
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Kevin Lu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Chen-Li Cheng
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Sheng-Chun Hung
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Chun Pen Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chi-Rei Yang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Department of Nursing, Hung Kuang University, Taichung, Taiwan, ROC
- Division of Surgical Intensive Care Unit, Department of Intensive Care, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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3
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Lesko P, Chovanec M, Mego M. Biomarkers of disease recurrence in stage I testicular germ cell tumours. Nat Rev Urol 2022; 19:637-658. [PMID: 36028719 DOI: 10.1038/s41585-022-00624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/09/2022]
Abstract
Stage I testicular cancer is a disease restricted to the testicle. After orchiectomy, patients are considered to be without disease; however, the tumour is prone to relapse in ~4-50% of patients. Current predictive markers of relapse, which are tumour size and invasion to rete testis (in seminoma) or lymphovascular invasion (in non-seminoma), have limited clinical utility and are unable to correctly predict relapse in a substantial proportion of patients. Adjuvant therapeutic strategies based on available biomarkers can lead to overtreatment of 50-85% of patients. Discovery and implementation of novel biomarkers into treatment decision making will help to reduce the burden of adjuvant treatments and improve patient selection for adjuvant therapy.
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Affiliation(s)
- Peter Lesko
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia.
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Rovito MJ, Craycraft M, Adams WB, Maresca M, Saab MM, Cary C, Gooljar C, Martinez S, Abu Zanet R. A Cross-Sectional Analysis of Testicular Cancer Symptom Recognition and Stage of Diagnosis. Am J Mens Health 2022; 16:15579883221104900. [PMID: 35723132 PMCID: PMC9344164 DOI: 10.1177/15579883221104900] [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] [Indexed: 11/17/2022] Open
Abstract
There is a need to further explore the relationship between atypical symptom
reporting and stage diagnosis to help develop a clearer defined list of possible
testicular cancer (TC) symptoms that could assist physicians diagnose the
disease earlier. A cross-sectional study was employed to explore possible
associations between TC symptom presentation and stage of diagnosis. An original
40-item survey was distributed among 698 TC survivors to determine the potential
impact of several risk factors, experiences, and behaviors upon diagnosis. This
analysis aimed to explore how certain patient-driven experiences (e.g.,
symptoms, perceptions, and behaviors) could serve as catalysts for seeking
medical care for testicular health concerns. Experiencing hot flashes or having
no symptoms had a positive association with later-stage diagnosis while change
in shape had a significant negative association with later-stage diagnosis.
While the logistic regression model explained relatively low variance in the
data (R2 = .1415), it was statistically significant
(χ2p < .001). Pain (odds ratio [OR] = 1.6524,
p < .05), hot flashes (OR = 5.7893, p
< .01), and no symptoms experienced (OR = 12.4836, p <
.01) were all significant predictors of a more advanced stage diagnosis. The
concern around uncommon/atypical symptoms are that they are indistinct and do
not serve as clear signs that TC is present. However, perhaps in tandem with
other more overt symptoms, their discovery can serve in a more confirmatory role
for a suspect case. If observed with other uncommonly reported symptoms, these
uncommon symptoms could provide another pathway in the TC diagnostic process.
Clinical and patient education is warranted to increase awareness of uncommon TC
symptoms.
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Affiliation(s)
- Michael J Rovito
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | | | - Wesley B Adams
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Michael Maresca
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Clint Cary
- Health Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Chayna Gooljar
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Sydney Martinez
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Rama Abu Zanet
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
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5
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Huang MM, Cheaib JG, Su ZT, Biles MJ, Sharma R, Zhang A, Singla N, Bass EB, Pierorazio PM. Assessing quality of care in the diagnosis and treatment of early-stage testicular cancer: A critical review and summary. Urol Oncol 2021; 39:400-408. [PMID: 33642227 DOI: 10.1016/j.urolonc.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the current literature on quality of care in the diagnosis and management of early-stage testicular cancer. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies on quality of care in testicular cancer diagnosis and management from January 1980 to August 2018. Major overlapping themes related to quality of care in the diagnosis and management of TGCT were identified and evidence related to these themes were abstracted. EVIDENCE 62 studies were included in the review. A number of themes were identified including (1) trends in survival and outcomes, (2) management patterns, (3) adherence to evidence-based clinical guidelines, (4) delays in care, (5) treatment complications and toxicities, (6) sociodemographic factors, (7) volume of patients treated, (8) gaps in provider knowledge and medical errors, and (9) multidisciplinary approaches to care. EVIDENCE SUMMARY As survival for patients with testicular cancer improves, there has been a greater emphasis on other components of quality of care, such as reducing treatment toxicity and minimizing delays in diagnosis. Efforts to meet these goals include encouragement of adherence to evidence-based guidelines, greater utilization of surveillance, and promotion of multidisciplinary team-based care. Although outcomes have improved, social determinants of health, such as insurance status, race, and geographical residence all may influence survival and cancer-related outcomes. Additionally, qualitative review indicates patients who receive care at high-volume institutions appear to experience better outcomes than those treated at smaller centers. CONCLUSIONS As outcomes and survival improve for patients with testicular cancer, quality of care has become an important consideration. Future avenues of research on this topic include identifying an appropriate balance between centralization of care and expanding access to underserved areas, minimizing delays in care, ensuring greater adherence to clinical guidelines, and addressing sociodemographic and racial disparities in outcomes.
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Affiliation(s)
- Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritu Sharma
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allen Zhang
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric B Bass
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
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6
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Huang C, Long Q, Pan Y, Wu L, Wang X, Xu H, Zheng F. Lymph Node Ratio Rather Than Positive Lymph Node Counts Has Better Prognostic Value in Patients With Testicular Germ Cell Tumors. Technol Cancer Res Treat 2021; 20:1533033820979702. [PMID: 33455540 PMCID: PMC7816529 DOI: 10.1177/1533033820979702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Testicular cancer represents the most common malignancy in young adult men. In the current study, we sought to analyze and compare the prognostic value of lymph node ratio (LNR) as well as positive lymph node counts (LNC) to understand its clinical significance in testicular germ cell tumors. Methods: We employed eligibility criteria to recruit a total of 931 patients, with testicular cancer, from 2010 to 2015 from The Surveillance, Epidemiology, and End Results (SEER) database. We then used the X-Tile program to calculate LNR and LNC cutoff values and discriminate survival. We then calculated the overall and cancer specific survival rates and analyzed the association between LNR/LNC and clinical pathological characteristics using the χ2 test. Finally, we assessed the relationships between clinical pathological factors and patient survival using univariate Cox proportional hazard analysis. Results: Univariate analysis revealed a significant association between prognosis with age (HR, 5.169; 95% CI, 1.758-15.200; P = 0.003), AJCC stage (III vs I: HR, 9.298; 95% CI, 2.691-32.131; P < 0.001), M stage (HR, 7.897; 95% CI, 3.417-18.251; P < 0.001) and LNR (HR, 3.009; 95% CI, 1.275-7.098; P = 0.012). On the other hand, LNC (HR, 1.743; 95% CI, 0.687-4.420; P = 0.242) was not significantly associated with prognosis. Analysis of the association between LNR/LNC and clinical pathological characteristics showed that high LNR patients tended to have significantly larger tumor sizes (χ2 = 7.877, P = 0.005), as well as advanced T (χ2 = 13.195, P = 0.004), N ( χ2 = 86.775, P < 0.001), M (χ2 = 19.948, P < 0.001) and 7th AJCC (χ2 = 103.074, P < 0.001) stages. In addition, high LNC patients were significantly associated with T (χ2 = 8.799, P = 0.032), N (χ2 = 74.390, P < 0.001) and 7th AJCC (χ2 = 111.759, P < 0.001) stages. Conclusion: LNR was a better predictor for long-term prognosis and was closely associated with clinical pathological characteristics than LNC in patients with testicular germ cell tumors.
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Affiliation(s)
| | - Qian Long
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Yangxun Pan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Leilei Wu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xiaonan Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Hailin Xu
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fufu Zheng
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Fufu Zheng, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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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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Yao Y, Zhang C, Han B, Tang Y, Xiong Y, Wang S. [Shikonin induces cell death by inhibiting glycolysis in human testicular cancer I-10 and seminoma TCAM-2 cells]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1288-1294. [PMID: 32990238 DOI: 10.12122/j.issn.1673-4254.2020.09.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the pattern of shikonin-induced cell death in testicular cancer cell I-10 and seminoma TCAM-2 cells and explore the possible mechanism in light of mitochondrial function and glycolysis. METHODS I-10 cells treated with 0, 1.2, 1.4 and 1.6 μmol/L shikonin and TCAM-2 cells treated with 0, 0.5, 1 and 1.5 μmol/L shikonin were examined for mitochondrial membrane potential and production of reactive oxygen species (ROS) using JC-1 kit and ROS kit, respectively. The levels of intracellular lactic acid in the cells were detected using a lactic acid kit. The inhibitory effect of shikonin on the proliferation of the cells was assessed with MTT assay. The death patterns of the cells were observed by transmission electron microscopy, and annexin V-FITC/PI double staining was used to detect cell apoptosis. Western blotting was used to detect the relative expression levels of the apoptotic proteins Bax, Bcl-2, and cleaved caspase-3, the autophagy- related protein LC3B and glycolysis- related proteins PKM2, GLUT1 and HK2. RESULTS MTT assay showed that shikonin significantly inhibited the proliferation of I-10 and TCAM-2 cells in a time- and dose-dependent manner (P < 0.05). The IC50 values of shikonin in I-10 cells at 24, 48, and 72 h were 1.8, 1.36 and 1.16 μmol/L, as compared with 2.37, 0.8 and 0.41 μmol/L in TCAM-2 cells, respectively. Shikonin treatment significantly reduced mitochondrial membrane potential, increased ROS levels and lower the level of lactic acid in both I-10 and TCAM-2 cells (P < 0.05). Transmission electron microscopy and annexin V-FITC/PI double staining demonstrated that shikonin induced apoptosis and excessive autophagy in I-10 and TCAM-2 cells (P < 0.05). In both I-10 and TCAM cells, shikonin treatment significantly down- regulated the expressions of Bax, Bcl-2, cleaved caspase-3, PKM2, GLUT1 and HK2, and up-regulated the expression of autophagy-related protein LC3B (P < 0.05). CONCLUSIONS Shikonin can inhibit the proliferation, induce apoptosis and increase autophagy in both I-10 and TCAM-2 cells probably by affecting energy metabolism of the cells.
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Affiliation(s)
- Yue Yao
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Chong Zhang
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Bing Han
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Yurui Tang
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Yanjun Xiong
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Sheng Wang
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
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9
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Weiner AB, Jan S, Jain-Poster K, Ko OS, Desai AS, Kundu SD. Insurance coverage, stage at diagnosis, and time to treatment following dependent coverage and Medicaid expansion for men with testicular cancer. PLoS One 2020; 15:e0238813. [PMID: 32936794 PMCID: PMC7494102 DOI: 10.1371/journal.pone.0238813] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/23/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction We sought to assess the impact of Affordable Care Act Dependent Care Expansion (ACA-DCE), which allowed dependent coverage for adults aged 19–25, and Medicaid expansion on outcomes for men with testicular cancer. Methods Using a US-based cancer registry, we performed adjusted difference-in-difference (DID) analyses comparing outcomes between men aged 19–25 (n = 8,026) and 26–64 (n = 33,303) pre- (2007–2009) and post-ACA-DCE (2011–2016) and between men in states that expanded Medicaid (n = 2,296) to men in those that did not (n = 2,265)pre- (2011–2013) and post-Medicaid expansion (2015–2016). Results In ACA-DCE analysis, rates of uninsurance decreased (DID -5.64, 95% confidence interval [CI] -7.23 to -4.04%, p<0.001) among patients aged 19–25 relative to older patients aged 26–64. There was no significant DID in advanced stage at diagnosis (stage≥II; p = 0.6) or orchiectomy more than 14 days after diagnosis (p = 0.6). For patients who received chemotherapy or radiotherapy as their first course of treatment, treatment greater than 60 days after diagnosis decreased (DID -4.84%, 95% CI -8.22 to -1.45%, p = 0.005) among patients aged 19–25 relative to patients aged 26–64. In Medicaid expansion states, rates of uninsurance decreased (DID -4.20%, 95% CI -7.67 to -0.73%, p = 0.018) while patients receiving chemotherapy or radiotherapy greater than 60 days after diagnosis decreased (DID -8.76, 95% CI -17.13 to -0.38%, p = 0.040) compared to rates in non-expansion states. No significant DIDs were seen for stage (p = 0.8) or time to orchiectomy (p = 0.1). Conclusions Men with testicular cancer had lower uninsurance rates and decreased time to delivery of chemotherapy or radiotherapy following ACA-DCE and Medicaid expansions. Time to orchiectomy and stage at diagnosis did not change following either insurance expansion.
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Affiliation(s)
- Adam B. Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Stephen Jan
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Ketan Jain-Poster
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Oliver S. Ko
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Anuj S. Desai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Shilajit D. Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- * E-mail:
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10
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Li Y, Zhu MX, Zhang B. The impact of insurance status on the survival outcomes of patients with renal cell carcinoma. Transl Androl Urol 2020; 9:1678-1690. [PMID: 32944529 PMCID: PMC7475676 DOI: 10.21037/tau-20-1045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The impact of insurance status on renal cell carcinoma (RCC) patient survival is unclear. In this study, we investigated the effects of insurance status on the survival outcomes of RCC patients in the United States of America. Methods Data of patients diagnosed with RCC between 2007 and 2014 were obtained from the Surveillance, Epidemiology and End Results (SEER) database, a large national database including statistics on cancer patients. The Kaplan-Meier method and Cox regression analysis were used to determine the influence of insurance status on cancer-specific survival (CSS). Results A total of 30,951 eligible RCC patients were identified. Of these patients, 25,493 (82.37%) were insured, 3,959 (12.79%) had any Medicaid coverage, and 1,499 (4.84%) were uninsured. Kaplan-Meier analysis revealed that insurance status was associated with better CCS (P<0.001). The 5-year CSS rates of patients with insurance, any Medicaid, and no insurance were 88.3%, 82.6%, and 82.7%, respectively. Multivariate Cox regression analysis showed that patients with any Medicaid had poorer CSS than insured patients [hazard ratio (HR), 1.222; 95% confidence interval (CI), 1.100–1.357]. Stratified analysis revealed that at localized tumor stage and at regional tumor stage or among white patients, any Medicaid insurance was an independent predictor of an unfavorable survival outcome. Conclusions Among the RCC patients in this study, individuals with insurance experienced improved CSS while individuals with any Medicaid tended to suffer worse survival outcomes.
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Affiliation(s)
- Yan Li
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ming-Xi Zhu
- Department of Anatomy, School of Basic Medicine and Life Science, Hainan Medical University, Haikou, China
| | - Bing Zhang
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
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11
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Hsiang W, Han X, Jemal A, Nguyen KA, Shuch B, Park H, Yu JB, Gross CP, Davidoff AJ, Leapman MS. The Association Between the Affordable Care Act and Insurance Status, Stage and Treatment in Patients with Testicular Cancer. UROLOGY PRACTICE 2020; 7:252-258. [PMID: 34017908 PMCID: PMC8130174 DOI: 10.1097/upj.0000000000000109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to determine whether insurance expansions implemented through the Affordable Care Act (ACA) were associated with changes in coverage status, disease stage, and treatment of younger adults with testicular germ cell tumors (GCT). MATERIALS AND METHODS We identified men aged 18-64 diagnosed with testicular GCTs between 2010 and 2015 in the National Cancer Data Base. We defined time periods as: pre-ACA (2010-2013) and post-ACA (2014-2015) and used difference-in-differences (DID) modeling to examine associations between state Medicaid expansion status and changes in insurance, stage at diagnosis, and treatment. RESULTS Following the ACA, the proportion of patients with any health insurance increased 3.7% (95% CI 3-4.5) in Medicaid expansion states and 3.0% (95% CI 1.5-4.5) in non-expansion states, mainly by gaining Medicaid and private insurance, respectively. The largest increases occurred in low-income patients, where Medicaid expansion was associated with an adjusted increase of 14.5 percentage points (95% CI 7.2-21.8) in Medicaid coverage following the ACA. We did not observe reductions in late-stage diagnoses during the observation period. Changes in the proportion of patients receiving chemotherapy or radiation for advanced-stage cancers were ongoing prior to the ACA and differed between expansion and non-expansion states, limiting assessment of ACA-related effects on individual treatments. CONCLUSIONS Post-ACA, the proportion of newly diagnosed testicular cancer patients with health insurance increased, with the largest effects seen among lowest income individuals. Our findings that changes in practice preceded the ACA and differed by expansion status highlight the need for caution in assessing the legislation's impact.
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Affiliation(s)
| | - Xuesong Han
- Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Kevin A. Nguyen
- David Geffen School of Medicine, University of California Los Angeles
| | - Brian Shuch
- University of California Los Angeles, Department of Urology
| | - Henry Park
- Yale University School of Medicine, Department of Therapeutic Radiology
- Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center
| | - James B. Yu
- Yale University School of Medicine, Department of Therapeutic Radiology
- Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center
| | - Cary P. Gross
- Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center
- Yale University School of Medicine, Department of Medicine
| | - Amy J. Davidoff
- Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center
- Yale University School of Public Health
| | - Michael S. Leapman
- Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center
- Yale University School of Medicine, Department of Urology
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12
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Wang X, Ojha RP, Partap S, Johnson KJ. The effect of insurance status on overall survival among children and adolescents with cancer. Int J Epidemiol 2020; 49:1366-1377. [DOI: 10.1093/ije/dyaa079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Differences in access, delivery and utilisation of health care may impact childhood and adolescent cancer survival. We evaluated whether insurance coverage impacts survival among US children and adolescents with cancer diagnoses, overall and by age group, and explored potential mechanisms.
Methods
Data from 58 421 children (aged ≤14 years) and adolescents (15–19 years), diagnosed with cancer from 2004 to 2010, were obtained from the National Cancer Database. We examined associations between insurance status at initial diagnosis or treatment and diagnosis stage; any treatment received; and mortality using logistic regression, Cox proportional hazards (PH) regression, restricted mean survival time (RMST) and mediation analyses.
Results
Relative to privately insured individuals, the hazard of death (all-cause) was increased and survival months were decreased in those with Medicaid [hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.22 to 1.33; and −1.73 months, 95% CI: −2.07 to −1.38] and no insurance (HR = 1.32, 95% CI: 1.20 to 1.46; and −2.13 months, 95% CI: −2.91 to −1.34). The HR for Medicaid vs. private insurance was larger (pinteraction <0.001) in adolescents (HR = 1.52, 95% CI: 1.41 to 1.64) than children (HR = 1.16, 95% CI: 1.10 to 1.23). Despite statistical evidence of PH assumption violation, RMST results supported all interpretations. Earlier diagnosis for staged cancers in the Medicaid and uninsured populations accounted for an estimated 13% and 19% of the survival deficit, respectively, vs. the privately insured population. Any treatment received did not account for insurance-associated survival differences in children and adolescents with cancer.
Conclusions
Children and adolescents without private insurance had a higher risk of death and shorter survival within 5 years following cancer diagnosis. Additional research is needed to understand underlying mechanisms.
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Affiliation(s)
- Xiaoyan Wang
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Rohit P Ojha
- Center for Outcomes Research, JPS Health Network, Fort Worth, TX, USA
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sonia Partap
- Department of Neurology, Stanford University, Palo Alto, CA, USA
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Kimberly J Johnson
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
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13
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Wang Q, Zheng D, Chai D, Wu S, Wang X, Chen S, Wu L, Cao R, Tao Y. Primary testicular diffuse large B-cell lymphoma: Case series. Medicine (Baltimore) 2020; 99:e19463. [PMID: 32195944 PMCID: PMC7220436 DOI: 10.1097/md.0000000000019463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Primary testicular lymphoma (PTL) is a rare type of extranodal non-Hodgkin's lymphoma (NHL). Although data of PTL in patients with diffuse large B-cell lymphoma (DLBCL) are accumulating, there are still patients respond poorly to prognosis. PATIENT CONCERNS All patients had disease of the DLBCL subtype and those patients had primary involvement of the testis. In our studies, eleven patients had stage I/II disease, and 3 patients had advanced disease with B symptoms. Four patients exhibited a MYC+, BCL2+, and BCL6- expression pattern, 4 patients had a MYC+, BCL6+, and BCL2- expression pattern, and 3 patients had a MYC+, BCL2+, and BCL6+ expression pattern. Additionally, 43% (7/16) of PT-DLBCL patients had a germinal center B-cell-like (GCB) phenotype, while the others had a non-GCB phonotype. DIAGNOSES In our case, most patients presented with unilateral painless scrotal swelling and the enlargement of the testicles in the first examination. After hospitalization, all patients underwent preoperative imageological examination of the testis and epididymis and postoperative revealed that all patients were the diffuse infiltration of a large number of anomalous lymphocytes. In addition, no invasion of other sites was observed within 3 months after diagnosis. INTERVENTIONS AND OUTCOMES Underwent orchiectomy on the affected side was performed by urologists after all patients were diagnosed with PTL. Meanwhile, some patients received at least one course of chemotherapy, or received postoperative combined RT and chemotherapy. Because of it particularity, nineteen instances of lymph node region involvement were discovered in 12 patients since the operation. LESSONS PT-DLBCL has unique biological characteristics, and its treatment modalities are becoming increasingly standardized. In the future, systematic interventions need to be actively considered in the early stages of PTL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chemoradiotherapy/methods
- Germinal Center/pathology
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Non-Hodgkin/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Orchiectomy/methods
- Phenotype
- Prognosis
- Retrospective Studies
- Testicular Neoplasms/metabolism
- Testicular Neoplasms/pathology
- Testicular Neoplasms/therapy
- Testis/diagnostic imaging
- Testis/pathology
- Ultrasonography/methods
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Affiliation(s)
- Qi Wang
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Dafang Zheng
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Damin Chai
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Shiwu Wu
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Xiaolin Wang
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Shaonan Chen
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College
| | - Linhui Wu
- Research center of Clinical Laboratory Science, Bengbu Medical College, Bengbu, Anhui, China
| | - Ruoxue Cao
- Research center of Clinical Laboratory Science, Bengbu Medical College, Bengbu, Anhui, China
| | - Yisheng Tao
- Department of Pathology
- Department of Pathology, Bengbu Medical College
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14
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Rolevich A, Yaumenenka A, Borodin D, Semenov S, Artsiushkevich L, Polyakov S, Konoplia N, Krasny S. Trends in incidence, mortality and survival of testicular cancer patients in Belarus. Cent European J Urol 2019; 72:357-368. [PMID: 32015904 PMCID: PMC6979549 DOI: 10.5173/ceju.2019.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The objective of this study was to assess recent trends in incidence, mortality and relative survival (RS) in testicular cancer (TC) patients in Belarus and to provide international comparisons of our figures. MATERIAL AND METHODS We surveyed the Belarusian Cancer Registry for all male cases diagnosed with International Classification of Diseases for Oncology, third edition (ICD-O-3) topography code C62 between 1990 and 2015. Trends for incidence and mortality rates per 100,000 of the world standard population and annual percentage changes (APCs) were calculated. We also estimated the 1- and 5-year RS rates for the 1990-1998, 1999-2007 and 2008-2015 periods according to the Ederer II method. The RS estimates for the 2008-2015 period were age-standardized and compared with the published EUROCARE-5 data and SEER-18 database analysis. RESULTS A total of 2,500 and 2,439 cases were included into incidence and survival analyses, respectively. We found a significant increase in the TC age-standardized incidence rate (APC 2.6%) and a decline in the age-standardized mortality (APC -3.0%) over the study period. RS significantly increased in all patients` strata; a relative increase was more pronounced in advanced stages of seminoma and younger age groups. Nevertheless, the most recent figures of age-standardized RS including stage-specific estimates were generally worse than the European and SEER data. CONCLUSIONS We have found a significant increase in TC incidence in Belarus in recent years. Mortality has significantly declined with a corresponding increase in RS which, however, did not reach European or North American figures. Continued effort is required to improve the quality of management of TC patients in our country.
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Affiliation(s)
- Alexander Rolevich
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Alesia Yaumenenka
- Department of Cancer Control, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Denis Borodin
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Sviataslau Semenov
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Liudmila Artsiushkevich
- Department of Oncology and Hematology No. 4, Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Sergey Polyakov
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Natalia Konoplia
- Department of Oncology and Hematology No. 4, Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Sergei Krasny
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
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15
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Wang K, Chen Y, Zhao Z, Feng M, Zhang S. Identification of potential core genes and miRNAs in testicular seminoma via bioinformatics analysis. Mol Med Rep 2019; 20:4013-4022. [PMID: 31545448 PMCID: PMC6797975 DOI: 10.3892/mmr.2019.10684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/21/2019] [Indexed: 12/28/2022] Open
Abstract
Testicular seminoma is one of the most common tumours in the field of urology, and its aetiology is still unclear. The aim of the present study was to identify the factors responsible for the development of testicular cancer and to investigate whether mutations in these genes were primarily congenital or acquired. To identify the key genes and miRNAs linked to testicular seminoma, as well as their potential molecular mechanisms, the GSE15220, GSE1818 and GSE59520 microarray datasets were analysed. A total of 5,195 and 1,163 differentially expressed genes (DEGs) were identified after analysing the GSE15220 and GSE1818 datasets, respectively. Among them, 287 genes were common between the two datasets. Of these, 110 were upregulated and 177 were downregulated. Five differentially expressed microRNAs (miRs; DEMs) that were downregulated in seminoma were identified after analysing the GSE59520 dataset. Following protein-protein interaction network and Gene Ontology analysis, the five nodes with the highest degrees were screened as hub genes. Among them, the high expression of hub genes, such as protein tyrosine phosphatase receptor type C (PTPRC), was associated with worse overall survival. We also predicted the potential target genes of the DEMs. DNA topoisomerase II α (TOP2A), marker of proliferation Ki-67 (MKI67), PTPRC and ubiquitin conjugating enzyme E2 C were associated with the PI3K/AKT and Wnt/β-catenin signalling pathways. In addition, hsa-miR-650 and hsa-miR-665 were associated with the PI3K/AKT and Wnt/β-catenin signalling pathways. Additionally, TOP2A and MKI67 were strongly associated with the target genes hsa-miR-650 and hsa-miR-665, respectively. We proposed that the hub genes reported in the present study may have a certain impact on cellular proliferation and migration in testicular seminoma. The roles of these hub genes in seminoma may provide novel insight to improve the diagnosis and treatment of patients with seminoma.
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Affiliation(s)
- Kai Wang
- Guangdong Provincial Key Laboratory of Agro‑Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong 510642, P.R. China
| | - Yun Chen
- Guangdong Provincial Key Laboratory of Agro‑Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong 510642, P.R. China
| | - Zhihong Zhao
- Guangdong Provincial Key Laboratory of Agro‑Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong 510642, P.R. China
| | - Meiying Feng
- Guangdong Provincial Key Laboratory of Agro‑Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong 510642, P.R. China
| | - Shouquan Zhang
- Guangdong Provincial Key Laboratory of Agro‑Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong 510642, P.R. China
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16
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Wu J, Ye J, Wu W, Fang D, Wang K, Yang L, Jiang X, Wang Q, Li L. Racial disparities in young-onset patients with colorectal, breast and testicular cancer. J Cancer 2019; 10:5388-5396. [PMID: 31632483 PMCID: PMC6775692 DOI: 10.7150/jca.32435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/11/2019] [Indexed: 12/12/2022] Open
Abstract
Aims: Racial disparities in cancer mortality persist despite rapid developments in cancer treatment strategies. In recent decades, an increased frequency of patients with young-onset cancer has been reported. However, few studies have assessed racial disparities in clinical features and overall survival among young-onset patients with colorectal, breast, and testicular cancer. Therefore, we evaluated racial disparities in cancer mortality for these three cancer types. Methods: We extracted the data of eligible patients from the Surveillance, Epidemiology and End Results (SEER) database from 1973 to 2014. Overall and cancer-specific survival rates were compared among races using Kaplan-Meier curves. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and the association of race with survival was influenced by marital status, surgery and disease stage in Cox proportional hazard models. Results: We collected the data of 19,574 patients with colorectal cancer, 68,733 with breast cancer, and 26,410 with testicular cancer; all were aged 25-40 years. A higher proportion of Blacks presented with a distant stage at diagnosis compared to Whites and Others (colorectal cancer: 18.0%, 18.5% and 18.4%, respectively, P = 0.004; breast cancer: 3.5%, 6.3% and 4.0%, respectively, P < 0.001; testicular cancer: 6.9%, 10.8% and 8.6%, respectively, P < 0.001). Multivariate analysis showed that Blacks had the highest overall mortality rate (colorectal cancer, HR, 1.277, 95% CI: 1.198, 1.361, P < 0.001; breast cancer, HR, 1.471, 95% CI: 1.420, 1.525, P < 0.001; testicular cancer, HR, 1.887, 95% CI: 1.562, 2.281, P < 0.001). In stratified analyses, Unmarried Blacks had a higher mortality rates (colorectal cancer, HR, 1.318, 95% CI: 1.211, 1.435, P < 0.001; breast cancer, HR, 1.465, 95% CI: 1.394, 1.541, P < 0.001; testicular cancer, HR, 1.944, 95% CI: 1.544, 2.447, P < 0.001). Furthermore, Blacks with colorectal and breast cancer had a higher risk of mortality than Whites at every disease stage, with greatest disparities occurred among individuals at localized stage. The influence of racial disparities on survival was consistent among patients who accepted surgery, but was weak among those who did not undergo surgery for colorectal cancer (Blacks, HR, 1.027, 95% CI: 0.866, 1.219, P = 0.758; Others, HR, 0.919, 95% CI: 0.760, 1.112, P = 0.386) and testicular cancer (Blacks, HR, 1.039, 95% CI: 0.538, 2.007, P = 0.909; Others, HR, 0.772, 95% CI: 0.388, 1.533, P = 0.459). Conclusions: We demonstrated that Blacks had a worse prognosis for young-onset colorectal, breast, and testicular cancer. Marital status, cancer-directed surgery and disease stage may influence the association of race with the risk of mortality. Equal access to high-quality medical care among races, greater social support and comprehensive interventions are required. Moreover, further studies need to clarify the effects of biological properties like genetic differences between races on cancer patient survival.
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Affiliation(s)
- Jingjing Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jianzhong Ye
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenrui Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Daiqiong Fang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Kaicen Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Liya Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xianwan Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qiangqiang Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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17
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Ghandour R, Ashbrook C, Freifeld Y, Singla N, El-Asmar JM, Lotan Y, Margulis V, Eggener S, Woldu S, Bagrodia A. Nationwide Patterns of Care for Stage II Nonseminomatous Germ Cell Tumor of the Testicle. Eur Urol Oncol 2019; 3:198-206. [PMID: 31272940 DOI: 10.1016/j.euo.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Management strategies for advanced testicular cancer published from a few, high-volume clinical centers may not be generalizable. OBJECTIVE To discern treatment patterns for stage II nonseminomatous germ cell tumor (NSGCT) in a nationwide cancer registry. DESIGN, SETTING, AND PARTICIPANTS The National Cancer Database was queried for patients with a stage II NSGCT from 2004 to 2014. Patients were stratified by clinical nodal status: cN1/stage IIA, cN2/stage IIB, and cN3/stage IIIC. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression was performed to determine factors independently associated with primary retroperitoneal lymph node dissection (RPLND), primary chemotherapy, and postchemotherapy RPLND (PC-RPLND). RESULTS AND LIMITATIONS A total of 2203 patients (stages IIA, n=1060; IIB, n=869; and IIC, n=274) met the inclusion criteria. Overall, 83% of patients underwent primary chemotherapy, while 17% underwent primary RPLND. Stratified by stage, use of primary chemotherapy was 78%, 88%, and 86% for stages IIA, IIB, and IIC, respectively. Overall, 24% of patients underwent PC-RPLND. Factors independently associated with a lower likelihood of undergoing primary RPLND were a more recent diagnosis and a higher clinical nodal stage. Conversely, patients treated at high-volume facilities were more likely to receive primary RPLND. Factors associated with a higher likelihood of undergoing PC-RPLND included a higher clinical nodal stage, treatment at a high-volume center, and a greater distance of patient travel. Associations based on serum tumor markers could not be assessed. CONCLUSIONS For clinical stage II NSGCT, nationwide utilization of primary chemotherapy is increasing compared with RPLND and is the preferred therapy for more advanced nodal disease. Primary RPLND may be underutilized in stage IIA disease. Utilization of PC-RPLND is driven by nodal stage as well as accessibility of a high-volume center. PATIENT SUMMARY The use of primary retroperitoneal lymph node dissection (RPLND) in early nodal disease is declining, while upfront chemotherapy is increasingly utilized. Primary RPLND may identify patients who are actually pN0 and would not benefit from systemic chemotherapy. Primary RPLND and postchemotherapy RPLND are performed more frequently at centers of excellence.
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Affiliation(s)
- Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caleb Ashbrook
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott Eggener
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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18
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Pishgar F, Haj-Mirzaian A, Ebrahimi H, Saeedi Moghaddam S, Mohajer B, Nowroozi MR, Ayati M, Farzadfar F, Fitzmaurice C, Amini E. Global, regional and national burden of testicular cancer, 1990-2016: results from the Global Burden of Disease Study 2016. BJU Int 2019; 124:386-394. [PMID: 30953597 DOI: 10.1111/bju.14771] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To provide estimates of the global incidence, mortality and disability-adjusted life-years (DALYs) associated with testicular cancer (TCa) between 1990 and 2016, using findings from the Global Burden of Disease (GBD) 2016 study. MATERIALS AND METHODS For the GBD 2016 study, cancer registry data and a vital registration system were used to estimate TCa mortality. Mortality to incidence ratios were used to transform mortality estimates to incidence, and to estimate survival, which was then used to estimate 10-year prevalence. Prevalence was weighted using disability weights to estimate years lived with disability (YLDs). Age-specific mortality and a reference life expectancy were used to estimate years of life lost (YLLs). DALYs are the sum of YLDs and YLLs. RESULTS Global incidence of TCa showed a 1.80-fold increase from 37 231 (95% uncertainty interval [ UI] 36 116-38 515) in 1990 to 66 833 (95% UI 64 487-69 736) new cases in 2016. The age-standardized incidence rate also increased from 1.5 (95% UI 1.45-1.55) to 1.75 (95% UI 1.69-1.83) cases per 100 000. Deaths from TCa remained stable between 1990 and 2016 [1990: 8394 (95% UI 7980-8904), 2016: 8651 (95% UI 8292-9027)]. The TCa age-standardized death rate decreased between 1990 and 2016, from 0.39 (95% UI 0.37-0.41) to 0.25 (95% UI 0.24-0.26) per 100 000; however, the decreasing trend was not similar in all regions. Global TCa DALYs decreased by 2% and reached 391 816 (95% UI 372 360-412 031) DALYs in 2016. The age-standardized DALY rate also decreased globally between 1990 and 2016 (10.31 [95% UI 9.82-10.84]) per 100 000 in 2016). CONCLUSION Although the mortality rate for TCa has decreased over recent decades, large disparities still exist in TCa mortality, probably as a result of lack of access to healthcare and oncological treatment. Timely diagnosis of this cancer, by improving general awareness, should be prioritized. In addition, improving access to effective therapies and trained healthcare workforces in developing and under-developed areas could be the next milestones.
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Affiliation(s)
- Farhad Pishgar
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Arvin Haj-Mirzaian
- Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Hedyeh Ebrahimi
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohajer
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Ayati
- Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, Seattle, WA, USA.,Division of Haematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Erfan Amini
- Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Huang Y, Sheng H, Zhang J, Liu Q, Ye D, Shi G. Incorporating non-biological factors into the TNM staging system for better prognostication and decision-making in testicular cancer. World J Urol 2018; 37:2165-2173. [PMID: 30554272 DOI: 10.1007/s00345-018-2603-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We combined county-level socioeconomic status (SES), marital status and insurance status to introduce NBF-stage, which were further incorporated into the American Joint Committee on Cancer (AJCC) TNM staging system to generate an integrated staging system for better prognostication and decision-making for testicular cancer patients. METHODS 15,324 eligible patients diagnosed with primary testicular cancer between January 1, 2007 and December 31, 2015 were strictly selected from the Surveillance, Epidemiology, and End Results (SEER) database. Independent survival predictors were determined based on Cox proportional hazards model. The Kaplan-Meier survival curves were conducted to describe the difference in predicting survival probability and the Multivariate Cox proportion hazard regression analyses were established to compare the cancer-specific survival (CSS) and overall survival (OS) difference among NBF stages or NBF-TNM subgroups. RESULTS County-level SES, marital status and insurance status were independent prognostic non-biological factors (NBFs) in our study (P < 0.05). NBF-stage (combination of SES, marital status, and insurance status) was also an independent survival predictor in TC (P < 0.05). NBF1 patients had 167% increased risk of cancer-specific mortality (CSM) as compared to NBF0 patients in testicular cancer (P < 0.01). And NBF0 patients all had a better CSS as compared to NBF1 patients of the same TNM stage both in seminoma and non-seminomatous germ cell tumor (P < 0.05). CONCLUSIONS Incorporation of NBFs into AJCC TNM staging system in testicular cancer would potentially impact treatment decisions where treatments would not be rendered for a typically curable cancer with multi-modal therapy.
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Affiliation(s)
- Yongqiang Huang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Haoyue Sheng
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Junyu Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qi Liu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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20
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Woldu SL, Moore JA, Ci B, Freifeld Y, Clinton TN, Aydin AM, Singla N, Laura-Maria K, Hutchinson RC, Amatruda JF, Sagalowsky A, Lotan Y, Arriaga Y, Margulis V, Xie Y, Bagrodia A. Practice Patterns and Impact of Postchemotherapy Retroperitoneal Lymph Node Dissection on Testicular Cancer Outcomes. Eur Urol Oncol 2018; 1:242-251. [PMID: 31058267 PMCID: PMC6494089 DOI: 10.1016/j.euo.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Owing to surgical complexity and controversy regarding indications, there are wide practice variations in the use of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). Objective To evaluate patterns of PC-RPLND use in the USA and evaluate the association between PC-RPLND and survival in advanced nonseminomatous germ cell tumors (NSGCTs). Design setting and participants A retrospective, observational study using National Cancer Data Base (NCDB) data from 2004-2014 for 5062 men diagnosed with stage II/III NSGCT. Outcome measurements and statistical analysis In a comparative analysis based on receipt of PC-RPLND, the primary outcome of interest was factors associated with omission of PC-RPLND as explored via logistic regression. As a secondary outcome, we evaluated the association between PC-RPLND and overall survival (OS) via multivariable Cox regression and propensity score matching (PSM). Results and limitations Patients undergoing PC-RPLND were more likely to be younger, white, privately insured, and reside in more educated/wealthier regions (p < 0.001). Insurance status was independently associated with receipt of PC-RPLND; compared to patients with private insurance, those without insurance were significantly less likely to receive PC-RPLND (odds ratio 0.49; p < 0.001). After multivariate adjustment, age, comorbidity, non-private insurance, distance from hospital, clinical stage, and risk group were independently associated with all-cause mortality. In addition, omission of PC-RPLND remained associated with all-cause mortality (hazard ratio 1.98; p < 0.001). After PSM, the 5-yr OS was significantly lower among those not undergoing PC-RPLND (72% vs 77%; p = 0.007). Conclusions PC-RPLND represents a critical part of the multidisciplinary management of NSGCT. Patients with non-private insurance are less likely to undergo PC-RPLND, and omission of PC-RPLND is associated with lower OS. Patient summary We evaluated the practice patterns for advanced testicular cancer management and found that patients who did not undergo a postchemotherapy retroperitoneal lymph node dissection were more likely to have worse survival outcomes. Patients with unfavorable insurance were less likely to receive this surgical treatment.
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Affiliation(s)
- Solomon L. Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph A. Moore
- Department of Medicine, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bo Ci
- Department of Clinical Science, Division of Biomedical Informatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy N. Clinton
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ahmet M. Aydin
- Department of Urology, Hacettepe University, Ankara, Turkey
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Krabbe Laura-Maria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan C. Hutchinson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James F. Amatruda
- Department of Medicine and Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arthur Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yull Arriaga
- Department of Medicine, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yang Xie
- Department of Clinical Science, Division of Biomedical Informatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Adams WB, Rovito MJ, Craycraft M. The Connection Between Testicular Cancer, Minority Males, and Planned Parenthood. Am J Mens Health 2018; 12:1774-1783. [PMID: 30008248 PMCID: PMC6142153 DOI: 10.1177/1557988318786874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Testicular cancer (TCa) is the most prevalent neoplasm diagnosed in males aged 15-40 years. Lack of access to care is a key impediment to early-stage TCa diagnosis. Health equity concerns arise, however, as poor access largely manifests within underserved male populations, therefore, placing them at a higher risk to develop late-stage TCa. Planned Parenthood Federation of America (PPFA) offers a myriad of male reproductive/sexual health care options, including TCa screening and referral services. Therefore, expanding these amenities in traditionally underserved communities may address the concern of TCa screening opportunities. An ecological analysis was performed using data from the United States Cancer Statistics, American Community Survey, and PPFA databases to assess the impact of TCa upon minority males, identify associations between PPFA services and minority males, and provide future implications on the role PPFA may play in bridging health-care access gaps pertaining to TCa screenings. Results indicate that states with higher rates of poverty and uninsured individuals, as well as specifically Black/African American males, have lower TCa incidence and limited access to screening services. PPFA service presence and Black/African American, as well as uninsured, males had a negative association but revealed positive correlations with TCa incidence. Considering the emerging TCa outcome disparities among minority males, expanding PPFA men's health services is crucial in providing affordable options to help identify testicular abnormalities that are early stage or carcinoma in situ. Many at-risk males have limited means to obtain TCa screening services. Expanding this discussion could provide a foundation for future advocacy.
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Affiliation(s)
- Wesley B Adams
- 1 Behavioral Health Research Group, College of Health and Public Affairs, Department of Health Professions, University of Central Florida, Orlando, FL, USA
| | - Michael J Rovito
- 1 Behavioral Health Research Group, College of Health and Public Affairs, Department of Health Professions, University of Central Florida, Orlando, FL, USA
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22
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Chen Y, Lu J, Xia L, Xue D, Yu X, Shen D, Xu L, Li G. Testicular orphan receptor 4 promotes tumor progression and implies poor survival through AKT3 regulation in seminoma. Cancer Sci 2018; 109:384-394. [PMID: 29197138 PMCID: PMC5797821 DOI: 10.1111/cas.13461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/17/2017] [Accepted: 11/29/2017] [Indexed: 12/21/2022] Open
Abstract
Seminoma is the most common testicular germ cell tumor worldwide and mainly occurs in 15-35-year-old young men. Early studies have indicated that testicular nuclear receptor 4 (TR4) first cloned from testis is involved in the invasion and metastasis of several human tumors; however, little attention is paid to the function of TR4 in seminoma. Our immunohistochemical (IHC) staining results showed that patients with advanced stage tumors tended to have higher expression of TR4. Importantly, there was a significant association between elevated TR4 expression and reduced overall survival in seminoma patients. In vitro MTS, western blot and transwell assays, after manipulating TR4 expression in Tcam-2 cells, revealed that TR4 induced epithelial-to-mesenchymal transition (EMT) and promoted Tcam-2 cell proliferation and invasion. Mechanism dissection demonstrated that AKT3, a critical component in the signaling pathway, played a crucial role in mediating TR4-promoted Tcam-2 cell proliferation and invasion. We further revealed that TR4 modulated AKT3 at the transcriptional level via chromatin immunoprecipitation and luciferase assays. Meanwhile, addition of the AKT3 siRNA blocked the function of TR4. Overall, these findings first elucidate that TR4 is a novel prognostic marker and plays a critical role in the metastatic capacity of Tcam-2 cells by EMT regulation and, consequently, targeting TR4-AKT3 pathway may serve as a potential therapeutic approach for seminoma.
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Affiliation(s)
- Yuanlei Chen
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jieyang Lu
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liqun Xia
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dingwei Xue
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoming Yu
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danyang Shen
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liwei Xu
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gonghui Li
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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23
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Shin JY, Yoon JK, Shin AK, Blumenfeld P, Mai M, Diaz AZ. Association of Insurance and Community-Level Socioeconomic Status With Treatment and Outcome of Squamous Cell Carcinoma of the Pharynx. JAMA Otolaryngol Head Neck Surg 2017; 143:899-907. [PMID: 28662244 DOI: 10.1001/jamaoto.2017.0837] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Community-level socioeconomic status, particularly insurance status, is increasingly becoming important as a possible determinant in patient outcomes. Objective To determine the association of insurance and community-level socioeconomic status with outcome for patients with pharyngeal squamous cell carcinoma (SCC). Design, Setting, and Participants This study extracted data from more than 1500 Commission on Cancer-accredited facilities collected in the National Cancer Database. A total of 35 559 patients diagnosed with SCC of the pharynx from 2004 through 2013 were identified. The χ2 test, Kaplan-Meier method, and Cox regression models were used to analyze data from April 1, 2016, through April 16, 2017. Main Outcomes and Measures Overall survival was defined as time to death from the date of diagnosis. Results Among the 35 559 patients identified (75.6% men and 24.4% women; median age, 61 years [range, 18-90 years]), 15 146 (42.6%) had Medicare coverage; 13 061 (36.7%), private insurance; 4881 (13.7%), Medicaid coverage; and 2471 (6.9%), no insurance. Uninsured patients and Medicaid recipients were more likely to be younger, black, or Hispanic; to have lower median household income and lower educational attainment; to present with higher TNM stages of disease; and to start primary treatment at a later time from diagnosis. Those with private insurance (reference group) had significantly better overall survival than uninsured patients (hazard ratio [HR], 1.72; 95% CI, 1.59-1.87), Medicaid recipients (HR, 1.99; 95% CI, 1.88-2.12), or Medicare recipients (HR, 2.07; 95% CI, 1.99-2.16), as did those with median household income of at least $63 000 (reference) vs $48 000 to $62 999 (HR, 1.19; 95% CI, 1.13-1.26), $38 000 to $47 999 (HR, 1.31; 95% CI, 1.24-1.38), and less than $38 000 (HR, 1.51; 95% CI, 1.43-1.59). On multivariable analysis, insurance status and median household income remained independent prognostic factors for overall survival even after accounting for educational attainment, race, Charlson/Deyo comorbidity score, disease site, and TNM stage of disease. Conclusions and Relevance Insurance status and household income level are associated with outcome in patients with SCC of the pharynx. Those without insurance and with lower household income may significantly benefit from improving access to adequate, timely medical care. Additional investigations are necessary to develop targeted interventions to optimize access to standard medical treatments, adherence to physician management recommendations, and subsequently, prognosis in these patients at risk.
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Affiliation(s)
- Jacob Y Shin
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Ja Kyoung Yoon
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Aaron K Shin
- School of Dentistry, University of Michigan, Ann Arbor
| | - Philip Blumenfeld
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Miranda Mai
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Aidnag Z Diaz
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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24
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Chen Z, Gao W, Pu L, Zhang L, Han G, Zhu Q, Li X, Wu J, Wang X. Impact of insurance status on the survival of gallbladder cancer patients. Oncotarget 2017; 8:51663-51674. [PMID: 28881677 PMCID: PMC5584278 DOI: 10.18632/oncotarget.18381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/06/2017] [Indexed: 01/10/2023] Open
Abstract
The prognostic significance of insurance status has been investigated in many types of malignancies, however, its impact on gallbladder cancer is yet not known. The purpose of this study was to determine the relationship between insurance status and gallbladder cancer survival. We searched the Surveillance, Epidemiology, and End Results dataset, and identified 1,729 gallbladder cancer cases. Kaplan-Meier methods and multivariable Cox regression models were used to analyze survival outcomes and risk factors. We found that individuals who had non-Medicaid insurance were more likely to be male, older, from wealthier area, and better-educated. Insurance status was confirmed as an independent prognostic factor for gallbladder cancer patients. Stratified analysis revealed that the uninsured status independently predicted unfavorable survival outcome at localized tumor stage and in white individuals. To conclude, insurance status is an important predictive factor for gallbladder cancer, and uninsured individuals are at the highest risk of death.
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Affiliation(s)
- Zhiqiang Chen
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory on Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing, Jiangsu Province, China
| | - Wen Gao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Liyong Pu
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory on Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing, Jiangsu Province, China
| | - Long Zhang
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory on Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing, Jiangsu Province, China
| | - Guoyong Han
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory on Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing, Jiangsu Province, China
| | - Qin Zhu
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory on Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing, Jiangsu Province, China
| | - Xiangcheng Li
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory on Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing, Jiangsu Province, China
| | - Jindao Wu
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory on Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing, Jiangsu Province, China
| | - Xuehao Wang
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory on Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing, Jiangsu Province, China
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25
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Hsu CD, Wang X, Habif DV, Ma CX, Johnson KJ. Breast cancer stage variation and survival in association with insurance status and sociodemographic factors in US women 18 to 64 years old. Cancer 2017; 123:3125-3131. [DOI: 10.1002/cncr.30722] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/03/2017] [Accepted: 03/16/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Christine D. Hsu
- Brown School; Washington University in St. Louis; St. Louis Missouri
| | - Xiaoyan Wang
- Brown School; Washington University in St. Louis; St. Louis Missouri
| | - David V. Habif
- Brown School; Washington University in St. Louis; St. Louis Missouri
| | - Cynthia X. Ma
- Siteman Cancer Center; Washington University School of Medicine; St. Louis Missouri
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26
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Influence of insurance status and income in anaplastic astrocytoma: an analysis of 4325 patients. J Neurooncol 2016; 132:89-98. [PMID: 27864706 DOI: 10.1007/s11060-016-2339-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/12/2016] [Indexed: 10/20/2022]
Abstract
To determine the impact of insurance status and income for anaplastic astrocytoma (AA). Data were extracted from the National Cancer Data Base. Chi square test, Kaplan-Meier method, and Cox regression models were employed in SPSS 22.0 (Armonk, NY: IBM Corp.) for data analyses. 4325 patients with AA diagnosed from 2004 to 2013 were identified. 2781 (64.3%) had private insurance, 925 (21.4%) Medicare, 396 (9.2%) Medicaid, and 223 (5.2%) were uninsured. Those uninsured were more likely to be Black or Hispanic versus White or Asian (p < 0.001), have lower median income (p < 0.001), less educated (p < 0.001), and not receive adjuvant chemoradiation (p < 0.001). 1651 (38.2%) had income ≥$63,000, 1204 (27.8%) $48,000-$62,999, 889 (20.5%) $38,000-$47,999, and 581 (13.4%) had income <$38,000. Those with lower income were more likely to be Black or Hispanic versus White or Asian (p < 0.001), uninsured (p < 0.001), reside in a rural area (p < 0.001), less educated (p < 0.001), and not receive adjuvant chemoradiation (p < 0.001). Those with private insurance had significantly higher overall survival (OS) than those uninsured, on Medicaid, or on Medicare (p < 0.001). Those with income ≥$63,000 had significantly higher OS than those with lower income (p < 0.001). On multivariate analysis, age, insurance status, income, and adjuvant therapy were independent prognostic factors for OS. Being uninsured and having income <$38,000 were independent prognostic factors for worse OS in AA. Further investigations are warranted to help determine ways to ensure adequate medical care for those who may be socially disadvantaged so that outcome can be maximized for all patients regardless of socioeconomic status.
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27
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Markt SC, Lago-Hernandez CA, Miller RE, Mahal BA, Bernard B, Albiges L, Frazier LA, Beard CJ, Wright AA, Sweeney CJ. Insurance status and disparities in disease presentation, treatment, and outcomes for men with germ cell tumors. Cancer 2016; 122:3127-3135. [PMID: 27500561 DOI: 10.1002/cncr.30159] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND People aged 26 to 34 years represent the greatest proportion of the uninsured, and they have the highest incidence of testicular cancers. The aim of this study was to investigate the association between insurance status and cancer outcomes in men diagnosed with germ cell tumors. METHODS The Surveillance, Epidemiology, and End Results database was used to identify 10,211 men diagnosed with germ cell gonadal neoplasms from 2007 to 2011. Associations between insurance status and characteristics at diagnosis and receipt of treatment were examined with log-binomial regression. The association between insurance status and mortality was assessed with Cox proportional hazards regression. RESULTS Uninsured patients had an increased risk of metastatic disease at diagnosis (relative risk [RR], 1.26; 95% confidence interval [CI], 1.15-1.38) in comparison with insured patients, as did Medicaid patients (RR, 1.62; 95% CI, 1.51-1.74). Among men with metastatic disease, uninsured and Medicaid patients were more likely to be diagnosed with intermediate/poor-risk disease (RR for uninsured patients, 1.22; 95% CI, 1.04-1.44; RR for Medicaid patients, 1.39; 95% CI, 1.23-1.57) and were less likely to undergo lymph node dissection (RR for uninsured patients, 0.74; 95% CI, 0.57-0.94; RR for Medicaid patients, 0.76; 95% CI, 0.63-0.92) in comparison with insured patients. Men without insurance were more likely to die of their disease (hazard ratio [HR], 1.88; 95% CI, 1.29-2.75) in comparison with insured men, as were those with Medicaid (HR, 1.51; 95% CI, 1.08-2.10). CONCLUSIONS Patients without insurance and patients with Medicaid have an increased risk of presenting with advanced disease and dying of the disease in comparison with those who have insurance. Future studies should examine whether implementation of the Patient Protection and Affordable Care Act reduces these disparities. Cancer 2016;122:3127-35. © 2016 American Cancer Society.
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Affiliation(s)
- Sarah C Markt
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Carlos A Lago-Hernandez
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Rowan E Miller
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Brandon A Mahal
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Brandon Bernard
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Laurence Albiges
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | | | - Clair J Beard
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alexi A Wright
- Department of Medical Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christopher J Sweeney
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.
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Dupree JM. Editorial Comment. Urology 2016; 87:145. [PMID: 26832448 DOI: 10.1016/j.urology.2015.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- James M Dupree
- Divisions of Andrology and Health Services Research, University of Michigan, Ann Arbor, MI
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