1
|
de Angelis M, Baudo A, Siech C, Jannello LMI, Di Bello F, Goyal JA, Tian Z, Longo N, de Cobelli O, Chun FKH, Saad F, Shariat SF, Carmignani L, Gandaglia G, Moschini M, Montorsi F, Briganti A, Karakiewicz PI. The effect of race/ethnicity on cancer-specific mortality after trimodal therapy. J Racial Ethn Health Disparities 2025; 12:1416-1422. [PMID: 38509444 DOI: 10.1007/s40615-024-01973-7] [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: 01/02/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Trimodal therapy (TMT) is the most validated bladder-sparing treatment for organ-confined urothelial carcinoma of the urinary bladder (OC UCUB, namely cT2N0M0). However, it is unknown if barriers to the use of TMT or cancer-specific mortality (CSM) differences exist according to race/ethnicity. We addressed this knowledge gap. MATERIAL AND METHODS Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified OC UCUB patients aged from 18 to 85 treated with radical cystectomy (RC) or TMT. Temporal trends described TMT versus RC use over time. Subsequently, in the subgroup of TMT-treated patients, survival analyses consisting of Kaplan-Meier plots and multivariable Cox regression (MCR) models addressed CSM according to race/ethnicity. RESULTS Among 19,501 assessable patients, 15,336 (79%) underwent RC versus 4165 TMT (21%). Overall, of all races/ethnicities, 16,245 (83.3%) were White Americans, 1215 (6.3%) Hispanics, 1160 (5.9%) African Americans, and 881 (4.5%) Asian/Pacific Islanders. Among TMT-treated patients, 3460 (83.1%) were White Americans, 298 (7.1%) African Americans, 218 (5.3%) Hispanics, and 189 (4.5%) Asian/Pacific Islanders. The lowest rate of TMT use relative to RC and TMT patients was recorded in Hispanics (17.9%). Over time, TMT use increased in White Americans (EAPC: + 4.5%, p = 0.001) and Asians/Pacific Islanders (EAPC: + 5.2%, p = 0.003), but not in others. Kaplan-Meier analyses showed median CSM of 49 months, 41 months, and 34 months and not reached in White Americans, Hispanics, African Americans, and Asian/Pacific Islanders, respectively (p = 0.02). In MCR models, two race/ethnicity subgroups independently predicted either worse (African Americans, HR: 1.20, p = 0.02) or better CSM (Asian/Pacific Islanders, HR: 0.75, p = 0.02). CONCLUSION Race/ethnicity affects both access to TMT (lower access in Hispanics) as well as survival after TMT (better in Asians/Pacific Islanders and worse in African Americans).
Collapse
Affiliation(s)
- Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Letizia Maria Ippolita Jannello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Francesco Di Bello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Jordan A Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Felix K H Chun
- Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Giorgio Gandaglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| |
Collapse
|
2
|
Deng Q, Li S, Zhang Y, Jia Y, Yang Y. Development and validation of interpretable machine learning models to predict distant metastasis and prognosis of muscle-invasive bladder cancer patients. Sci Rep 2025; 15:11795. [PMID: 40189676 PMCID: PMC11973202 DOI: 10.1038/s41598-025-96089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 03/26/2025] [Indexed: 04/09/2025] Open
Abstract
Muscle-Invasive Bladder Cancer (MIBC) is a more aggressive disease than non-muscle-invasive bladder cancer (NMIBC), with greater chances of metastasis. We sought to develop machine learning (ML) models to predict metastasis and prognosis in MIBC patients. Clinical data of MIBC cases from 2000 to 2020 were sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Clinical variables used to predict DM were identified through univariate and multivariate logistic regression, and Recursive Feature Elimination (RFE). Thirteen ML models predicting DM were evaluated based on AUC, PRAUC, accuracy, sensitivity, specificity, precision, cross-entropy, Brier score, balanced accuracy, and F-beta score. SHapley Additive exPlanations (SHAP) framework helped interpret the best model. Additionally, we utilized ML algorithm combinations to predict prognosis in MIBC patients with metastasis. A total of 43,951 T2-T4 MIBC patients aged over 18 years old from the SEER database were enrolled consecutively. Nine clinical variables were selected to predict DM. The CatBoost model was identified as the optimal predictor, with AUC values of 0.956 [0.933, 0.969] for the training set, 0.882 [0.857, 0.919] for the internal test set, and 0.839 [0.723, 0.936] for the external test set. The model achieved an accuracy of 0.875 [0.854, 0.896], sensitivity of 0.869 [0.851, 0.889], specificity of 0.883 [0.823, 0.912], and precision of 0.917 [0.885, 0.944]. SHAP analysis revealed that tumor size was the most influential factor in predicting distant metastasis. For prognosis, the "RSF + Enet[alpha = 0.8]" model emerged as the top performer, with C-index values of 0.683 in training, 0.688 in the internal test, and 0.666 in the external test sets. Our ML models provide high accuracy and dependability, delivering refined, individualized predictions for metastasis risk and prognosis in MIBC patients.
Collapse
Affiliation(s)
- Qian Deng
- Luoyang Central Hospital Affiliated of Zhengzhou University, Henan, China
| | - Shan Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxiang Zhang
- Department of Urology Surgery, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China
| | - Yuanyuan Jia
- Department of Oncology, Huai'an Second People's Hospital, Affiliated to Xuzhou Medical University, Huai'an, Jiangsu, China.
| | - Yanhui Yang
- Department of Emergency Surgery (Trauma Center), The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China.
| |
Collapse
|
3
|
Zhao H, Lin N, Ho VWS, Liu K, Chen X, Wu H, Chiu PK, Huang L, Dantes Z, Wong K, Chau H, Ko IC, Wong CH, Leung DK, Yuen SK, Wu D, Ding X, Ng CF, Teoh JY. Patient-Derived Bladder Cancer Organoids as a Valuable Tool for Understanding Tumor Biology and Developing Personalized Treatment. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2025; 12:e2414558. [PMID: 39921252 PMCID: PMC11967763 DOI: 10.1002/advs.202414558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 01/15/2025] [Indexed: 02/10/2025]
Abstract
Bladder cancer (BC) is a heterogeneous disease with high recurrence rates and variable treatment responses. To address these clinical challenges, the world's first bladder cancer patient-derived organoids (PDOs) biobank is established based on an Asian population. Thirty-six BC-PDOs are generated from 56 patients and demonstrated that the BC-PDOs can replicate the histological and genomic features of parental tumors. Drug screening tests are conducted with a broad spectrum of conventional chemotherapeutic and targeted therapy drugs and identified differential drug sensitivities among the BC-PDOs. These in vitro results are consistently supported by the PDO xenograft animal studies and patients' clinical treatment outcomes, thereby verifying the predictive power of PDOs for drug responses in BC patients. By analyzing the genetic profiles of the PDOs, specific driver genes that correlate with drug sensitivity to two stand-of-care chemotherapeutics, cisplatin, and gemcitabine, are identified. Additionally, the practicality of PDOs in investigating the tumor microenvironment has been demonstrated. This study underscores the utility of PDOs in advancing the understanding of bladder cancer and the development of personalized therapeutic strategies. The BC-PDOs biobank provides an ideal preclinical platform for supporting the development of personalized treatment strategies for BC patients. This study also provides insights into the potential mechanisms of drug resistance, paves the way for subsequent region-specific research, and demonstrates the possibility of using PDO-related models to direct future research in developing drugs targeting tumor microenvironments.
Collapse
Affiliation(s)
- Hongda Zhao
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong999077China
| | - Na Lin
- Department of Biomedical SciencesFaculty of Health SciencesUniversity of MacauTaipaMacaoSAR999078China
| | - Vincy Wing Sze Ho
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong999077China
| | - Kang Liu
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong999077China
| | - Xuan Chen
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong999077China
| | - Hongwei Wu
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong999077China
| | - Peter Ka‐Fung Chiu
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
| | - Linda Huang
- Invitrocue Hong Kong LtdHong KongSAR999077China
| | | | - Ka‐Leung Wong
- Department of Applied Biology and Chemical TechnologyThe Hong Kong Polytechnic UniversityHong Kong999077China
| | - Ho‐Fai Chau
- Department of Applied Biology and Chemical TechnologyThe Hong Kong Polytechnic UniversityHong Kong999077China
| | - Ivan Ching‐Ho Ko
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
| | - Chris Ho‐Ming Wong
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
| | - David Ka‐Wai Leung
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
| | - Steffi Kar‐Kei Yuen
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
| | - Dinglan Wu
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
| | - Xiaofan Ding
- Department of Biomedical SciencesFaculty of Health SciencesUniversity of MacauTaipaMacaoSAR999078China
| | - Chi Fai Ng
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
| | - Jeremy Yuen‐Chun Teoh
- S.H. Ho Urology CentreDepartment of SurgeryThe Chinese University of Hong KongHong Kong999077China
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong999077China
- Department of UrologyMedical University of ViennaVienna1090Austria
| |
Collapse
|
4
|
Sanjida S, Garvey G, Bainbridge R, Diaz A, Barzi F, Holzapfel S, Chen MY, Collin H, Fatima Y, Hou XY, Ward J. Prevalence of surgery in Indigenous people with cancer: a systematic review and meta-analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2025; 57:101527. [PMID: 40225852 PMCID: PMC11992426 DOI: 10.1016/j.lanwpc.2025.101527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/02/2025] [Accepted: 03/04/2025] [Indexed: 04/15/2025]
Abstract
Background As cancer incidence increases globally, so does the prevalence of cancer among Indigenous peoples. Indigenous peoples face significant barriers to healthcare, including access to and uptake of surgery. To date, the synthesis of access to and uptake of surgery for Indigenous peoples living with cancer has not yet been reported. Methods We conducted a systematic literature review and meta-analysis of access to and uptake of surgery for Indigenous peoples in Canada, Australia, New Zealand, and the United States. Five databases were searched to identify studies of Indigenous adults with cancer and those who received surgery. The Joanna Briggs Institute critical appraisal tools were used to assess the quality and inclusion of articles. Random effect meta-analyses were conducted to estimate the pooled prevalence of surgery in Indigenous people with cancer. Findings Of the 52 studies in the systematic review, 38 were included in the meta-analysis. The pooled prevalence of surgery in Indigenous people with cancer was 56.2% (95% confidence interval (CI): 45.4-66.7%), including 42.8% (95% CI: 36.3-49.5%) in the Native Hawaiian population, 44.5% (95% CI: 38.7-50.3%) in the Inuit and 51.5% (95%CI: 36.8-65.9%) in Aboriginal and Torres Strait Islander people. Overall, Indigenous people received marginally less cancer surgery than non-Indigenous people (3%, 95% CI: 0-6%). Indigenous people were 15% (95% CI: 6-23%) less likely to receive surgery than non-Indigenous people for respiratory cancers. Remoteness, travel distance, financial barriers, and long waiting times to receive surgery were factors cited as contributing to lower access to surgery for Indigenous people compared to non-Indigenous people. Interpretation Efforts to improve access and use of cancer services and surgery for Indigenous peoples should be multilevel to address individual factors, health services and systems, and structural barriers. These determinants need to be addressed to expedite optimal care for Indigenous peoples, especially those living in outer metropolitan areas. Funding The Research Alliance for Urban Goori Health (RAUGH) funded this project. GG was funded by an NHMRC Investigator Grant (#1176651).
Collapse
Affiliation(s)
- Saira Sanjida
- Poche Centre for Indigenous Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Queensland, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Queensland, Australia
| | - Roxanne Bainbridge
- Indigenous Future Centre, Faculty of Business, Economics and Law, The University of Queensland, Queensland, Australia
| | - Abbey Diaz
- School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Queensland, Australia
- Yardhura Walani National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, The Australian National University, Australian Capital Territory, Australia
| | - Federica Barzi
- Poche Centre for Indigenous Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Queensland, Australia
| | - Sherry Holzapfel
- Aboriginal and Torres Strait Islander Health, Metro North Hospital and Health Service, Queensland, Australia
| | - Michael Y. Chen
- School of Medicine, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Queensland, Australia
| | - Harry Collin
- Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - Yaqoot Fatima
- Thompson Institute, University of the Sunshine Coast, Queensland, Australia
| | - Xiang-Yu Hou
- Broken Hill University Department of Rural Health, The University of Sydney, New South Wales, Australia
| | - James Ward
- Poche Centre for Indigenous Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Queensland, Australia
| |
Collapse
|
5
|
Rajpurohit M, Golzy M, Chen NW, Murray KS, Rosen G. Relationship Among Body Mass Index, Survival, Cancer Treatment and Health-Related Quality of Life Among Older Patients with Bladder Cancer. Cancers (Basel) 2025; 17:1200. [PMID: 40227765 PMCID: PMC11988038 DOI: 10.3390/cancers17071200] [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: 02/25/2025] [Revised: 03/26/2025] [Accepted: 03/30/2025] [Indexed: 04/15/2025] Open
Abstract
BACKGROUND The relationship between body composition and bladder cancer outcomes is complex. While a higher body mass index (BMI) has been associated with an increased risk of bladder cancer development, its impact on survival outcomes is less clear. This study aimed to explore the association between BMI, survival, health-related quality of life, and the performance of ADLs in a cohort of older patients with bladder cancer. METHODS Data were obtained from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey, including patients diagnosed with bladder cancer who had recorded BMI values. Analysis of variance was used to assess the association between BMI categories and patient demographics as well as cancer/treatment characteristics. Generalized linear models examined the impact of BMI on health-related quality of life, as measured by the physical and mental component summary scores when controlling for confounding variables. Kaplan-Meier survival curves across BMI categories were compared using log-rank tests. RESULTS The final cohort consisted of 8013 patients (age ≥ 65) with a mean age of 77.7 ± 7.1 years, the majority of whom were White (85.6%) and male (74.8%). We observed no significant association between BMI and cancer/treatment characteristics. The severely obese subgroup had the highest rate of disability in performing ADLs (18.3%) followed by the underweight subgroup (10.3%). Overweight patients exhibited the highest physical and mental component summary scores, indicating better health-related quality of life. BMI was a significant predictor of overall survival, with overweight, obese, and severely obese patients demonstrating improved survival compared to those with healthy or underweight BMI. These findings remained statistically significant in multivariable analysis. CONCLUSIONS Our findings suggest a dual role of BMI in older patients with bladder cancer: higher BMI provides a survival advantage and, to an extent, a QoL advantage. At the same time, severe obesity did lead to the lowest QoL despite improved survival outcomes. These results underscore the complex interplay between BMI, survival, and QoL in this bladder cancer population.
Collapse
Affiliation(s)
- Mitesh Rajpurohit
- Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri at Columbia, Columbia, MO 65201, USA; (M.R.); (N.-W.C.)
| | - Mojgan Golzy
- Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri at Columbia, Columbia, MO 65201, USA; (M.R.); (N.-W.C.)
| | - Nai-Wei Chen
- Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri at Columbia, Columbia, MO 65201, USA; (M.R.); (N.-W.C.)
| | - Katie S. Murray
- Department of Urology, NYU-Langone Health, New York, NY 10016, USA;
| | - Geoffrey Rosen
- Department of Urology, Oregon Health & Science University, Portland, OR 97201, USA;
- Division of Urology, Department of Surgery, VA Portland Health Care, Portland, OR 97239, USA
| |
Collapse
|
6
|
Avudaiappan AP, Prabhakar P, Fleischmann B, Rubens M, Garje R, Ozambela M, Gomez C, Manoharan M. Survival analysis comparing bladder preservation techniques in octogenarians with muscle-invasive bladder cancer. Transl Androl Urol 2025; 14:280-288. [PMID: 40114843 PMCID: PMC11921227 DOI: 10.21037/tau-24-602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 02/06/2025] [Indexed: 03/22/2025] Open
Abstract
Background The gold standard treatment for localized muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy with radical cystectomy (RC). Guidelines suggest concurrent chemoradiation (CRT) could be considered as an alternative, and partial cystectomy (PC) may be considered in carefully selected individuals. The bladder preservation strategies are gaining popularity, and due to the concerns about morbidity associated with RC and limited life expectancy, the octogenarian population is exploring strategies that help preserve bladder function. Hence, it is crucial to understand the outcome of various bladder preservation strategies. Using the National Cancer Database (NCDB), we compared the overall survival (OS) of octogenarians treated with PC and CRT. Methods We retrospectively evaluated the octogenarians with localized MIBC (cT2N0M0) ≤5 cm and urothelial histology between 2004 and 2018. Our analytic cohorts were the PC cohort, which included patients who underwent PC, and the CRT cohort, which included patients who received chemotherapy and radiotherapy within a 90-day timeframe. After propensity-matching with race and ethnicity, gender, facility type, median income, comorbidity index, and tumor grade, we compared the OS between PC and CRT cohorts. Results A total of 1,038 were octogenarians who met our selection criteria. Among them, 248 (23.8%) underwent PC, and 790 (76.2%) received CRT. In the PC cohort, tumors were located predominantly in the dome (34.3%) and anterior wall (10.5%), while in the CRT cohort, tumors were in the trigone (8.4%), lateral (22.0%) and posterior walls (10.6%). The median OS for the matched PC and CRT cohort was 38.3 and 32.9 months, respectively (P=0.66). Multivariate Cox regression showed no difference in survival hazards between PC and CRT [hazard ratio =1.07 (95% confidence interval: 0.82-1.39)] (P=0.63). Conclusions Our study comparing PC and CRT in octogenarians with T2 ≤5 cm tumors showed that PC had comparable OS to CRT. Therefore, PC can be considered a viable option in carefully selected octogenarians.
Collapse
Affiliation(s)
| | - Pushan Prabhakar
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Benjamin Fleischmann
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Muni Rubens
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Rohan Garje
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Manuel Ozambela
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Christopher Gomez
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Murugesan Manoharan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| |
Collapse
|
7
|
Puri D, Pandit K, Choi N, Rose BS, McKay RR, Bagrodia A. Striving for Equity: Examining Health Disparities in Urologic Oncology. Cancers (Basel) 2024; 16:3559. [PMID: 39518000 PMCID: PMC11544812 DOI: 10.3390/cancers16213559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 10/03/2024] [Accepted: 10/08/2024] [Indexed: 11/16/2024] Open
Abstract
Health disparities in urologic oncology, particularly in prostate, bladder, kidney, and testicular cancers, significantly impact patient outcomes across different demographic groups. This narrative review aims to investigate the extent and drivers of these disparities, focusing on the influence of race, socioeconomic status, and geographic location on diagnosis, treatment, and survival outcomes. We conducted a comprehensive review of the existing literature and analyzed data from national cancer databases to identify patterns of inequity. Our findings reveal that minority populations, individuals with lower socioeconomic status, and those residing in underserved areas are less likely to receive timely and guideline-based care, leading to worse outcomes. This review underscores the urgent need for targeted interventions, including policy reforms, health system restructuring, enhanced community outreach, and increased funding for disparity-focused research, to ensure equitable access to high-quality oncologic care. Addressing these disparities is crucial for improving cancer outcomes and achieving health equity in urologic oncology.
Collapse
Affiliation(s)
- Dhruv Puri
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA 92121, USA; (D.P.); (K.P.); (N.C.)
| | - Kshitij Pandit
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA 92121, USA; (D.P.); (K.P.); (N.C.)
| | - Noah Choi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA 92121, USA; (D.P.); (K.P.); (N.C.)
| | - Brent S. Rose
- Department of Radiation Oncology, UC San Diego School of Medicine, La Jolla, CA 92121, USA;
| | - Rana R. McKay
- Department of Medicine, Division of Hematology/Oncology, UC San Diego School of Medicine, La Jolla, CA 92121, USA;
| | - Aditya Bagrodia
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA 92121, USA; (D.P.); (K.P.); (N.C.)
| |
Collapse
|
8
|
Barsouk A, Elghawy O, Yang A, Sussman JH, Mamtani R, Mei L. Meta-Analysis of Age, Sex, and Race Disparities in the Era of Contemporary Urothelial Carcinoma Treatment. Cancers (Basel) 2024; 16:3338. [PMID: 39409958 PMCID: PMC11476295 DOI: 10.3390/cancers16193338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND Urothelial carcinoma (UC) is one of the most common cancers diagnosed worldwide. However, minority populations, such as female, elder, and Black patients, may have disparate outcomes and are commonly neglected in randomized prospective trials. This review aims to study the relationship between age, sex, and race on urothelial cancer prognosis, particularly focusing on contemporary therapy and its effect on overall survival. METHODS Phase III prospective trials since 2016 of immune checkpoint inhibitors, antibody-drug conjugates, or targeted therapies in urothelial carcinoma were identified from PubMed. Trials that did not report on survival by race, sex, or age distribution were excluded, and remaining trials (n = 17) were compared by subgroup. RESULTS Women were reported to have inferior OS on investigational agents compared to men in 9/17 trials. In a meta-analysis, women had inferior OS to men (OR 0.89 [95% CI: 0.78-0.99]; p = 0.04). Asian/Pacific Islander patients had inferior outcomes to White patients on investigational agents in 3/5 trials. In a meta-analysis, OS was not significant by race (OR 1.18 [0.90-1.46], p = 0.38). Black patients composed <2% of all trial patients, and no subgroup data were reported. Both 65 (n = 7) and 75 (n = 2) were reported as age cut-offs in trial subgroups, and survival data were mixed. CONCLUSIONS Women in UC trials may have inferior survival outcomes to men. Racial diversity was poor and thus limited any conclusions on survival disparities.
Collapse
Affiliation(s)
- Adam Barsouk
- Abramson Cancer Center, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Omar Elghawy
- Abramson Cancer Center, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Austin Yang
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Jonathan H. Sussman
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
- Graduate Group in Genomics and Computational Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ronac Mamtani
- Abramson Cancer Center, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Lin Mei
- Abramson Cancer Center, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| |
Collapse
|
9
|
Shin YS, Han K, Lee J, Han HH, Jang WS, Kim GM, Heo JE. Lymphatic embolization for early post-operative lymphatic leakage after radical cystectomy for bladder cancer. PLoS One 2024; 19:e0305240. [PMID: 39316604 PMCID: PMC11421775 DOI: 10.1371/journal.pone.0305240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 09/08/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Although radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard treatment of muscle invasive bladder cancer, it may cause lymphatic leakage. Recent studies describe lymphatic embolization (LE) as an option to manage post-operative lymphatic leakage. Hence, this study evaluated the outcome of LE in patients receiving RC and analyzed factors associated with outcomes. METHODS This was a retrospective analysis of patients who underwent LE after RC for bladder cancer between August 2017 and June 2023. The data was assessed for analysis at January 2024. The patients were divided into a clinical success group and a clinical failure group. Clinical failure was defined as the following: 1) those who required drainage catheter placement >7 days after LE, 2) those who needed re-intervention before catheter removal, and 3) those who experienced adverse events associated with LE. Logistic regression analysis was performed to identify the factors associated with outcomes of LE. KEY FINDINGS AND LIMITATIONS We analyzed 45 patients who underwent LE after RC. Twenty-eight (62.2%) patients were identified as clinically successful. Four patients required re-embolization, but none required more than two sessions of intervention. Three patients experienced lymphatic complications after LE. In multivariable analysis, maximal daily drainage volume of >1,000 mL/day (odds ratio [OR] = 4.729, 95% confidence interval [CI]: 1.018-21.974, p = 0.047) and diabetes mellitus (DM) (OR = 4.571, 95% CI: 1.128-18.510, p = 0.033) were factors associated with LE outcome. CONCLUSIONS AND CLINICAL IMPLICATIONS Our results suggest LE as a potentially effective procedure for controlling post-operative lymphatic leaks after RC, with few minor side effects. Patients exceeding a daily drainage of 1,000mL/day or with a medical history of DM have a higher risk for re-intervention and clinical failure after LE.
Collapse
Affiliation(s)
- Yoo Sub Shin
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongsoo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
10
|
Pon Avudaiappan A, Prabhakar P, Lusnia C, Ganiyani MA, Rubens M, Garje R, Eldefrawy A, Manoharan M. A comparative study of survival outcomes between partial and radical cystectomy in octogenarians with muscle-invasive bladder cancer. Transl Androl Urol 2024; 13:1486-1497. [PMID: 39280660 PMCID: PMC11399040 DOI: 10.21037/tau-24-139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/23/2024] [Indexed: 09/18/2024] Open
Abstract
Background Neoadjuvant chemotherapy with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). Due to the concern about morbidity associated with RC, the elderly population considers bladder preservation alternatives. Guidelines suggest partial cystectomy (PC) can be considered a viable option in carefully selected individuals. We used the National Cancer Database (NCDB) to compare the overall survival (OS) among octogenarians treated with PC and RC. Methods Using NCDB, we retrospectively evaluated individuals aged 80 years and above diagnosed with localized MIBC (cT2-4aN0M0) with tumor size less than 5 cm and urothelial histology between 2004 and 2018. Our primary cohort was divided into the RC cohort, which included patients who underwent RC with or without chemotherapy/radiotherapy, and the PC cohort, which included those who underwent PC. After propensity-matching, we compared the OS. Results Of 94,104 patients with MIBC, 2,528 octogenarians met our selection criteria. Among them, 313 were treated with PC, and 2,215 were treated with RC. A total of 151 (48.2%) PC patients had pelvic lymph node dissection, while 1,967 (88.8%) RC patients had lymph node dissection (P<0.001). The OS for matched PC and RC was 33.4 and 29.9 months, respectively (P=0.68). In T2 tumors, the OS for PC and RC was 37 and 33.5 months, respectively (P=0.52); for T3 tumors, the OS was 22.3 and 24.4 months, respectively (P=0.98). Conclusions Our study compared PC and RC in octogenarians with localized MIBC and observed that PC is safe and not inferior to RC in carefully selected octogenarians. The role of PC needs further exploration by comparing or integrating with strategies like concurrent chemoradiation to improve the oncological and survival outcomes.
Collapse
Affiliation(s)
- Arjun Pon Avudaiappan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Pushan Prabhakar
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Ciara Lusnia
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | | | - Muni Rubens
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Rohan Garje
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Ahmed Eldefrawy
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Murugesan Manoharan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| |
Collapse
|
11
|
de Angelis M, Jannello LMI, Siech C, Di Bello F, Peñaranda NR, Goyal JA, Tian Z, Longo N, de Cobelli O, Chun FKH, Puliatti S, Saad F, Shariat SF, Gandaglia G, Moschini M, Montorsi F, Briganti A, Karakiewicz PI. Race/Ethnicity Affects Access and Survival Differences After Neoadjuvant or Adjuvant Chemotherapy at Radical Cystectomy in Urothelial Carcinoma Patients. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02131-9. [PMID: 39160435 DOI: 10.1007/s40615-024-02131-9] [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: 06/18/2024] [Revised: 07/29/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION It is unknown whether race/ethnicity affects access and/or survival after neoadjuvant (NAC) or adjuvant chemotherapy (ADJ) at radical cystectomy (RC). We addressed these knowledge gaps. MATERIAL AND METHODS Within the Surveillance, Epidemiology, and End Results database (2007-2020), we identified NAC candidates (T2-T4N0M0) and ADJ candidates (T3-T4 and/or N1-3). We focused on the four most prevalent race/ethnicities: Caucasians, Hispanics, African American (AA), and Asian/Pacific Islanders (API). Multivariable logistic regression models (MLR) tested access to NAC and ADJ. Subsequently, within NAC-exposed patients, survival analyses consisting of Kaplan-Meier plots and multivariable Cox regression models addressed CSM according to race/ethnicity were fitted. We repeated the same methodology in ADJ-exposed patients. RESULTS In 6418 NAC candidates, NAC was administered in 1011 (19.0%) Caucasians, 88 (21.0%) Hispanics, 65 (17.0%) AA, and 53 (18.0%) API. In MLR, AA exhibited lower access rates to NAC (OR 0.83, p = 0.04). In NAC-exposed patients, AA independently predicted higher CSM (HR 1.3, p < 0.001) and API independently predicted lower CSM (HR 0.83, p = 0.03). Similarly, in 5195 ADJ candidates, ADJ was administered to 1387 (33.0%) Caucasians, 100 (28.0%) Hispanics, 105 (29.0%) AA, and 90 (37.0%) API. In MLR, AA (OR 68, p = 0.003) and Hispanics (OR 0.69, p = 0.004) exhibited lower access rates to ADJ. In ADJ-exposed patients, AA independently predicted lower CSM (HR 1.32, p < 0.001), while API showed better CSM (HR 0.82, p = 0.01). CONCLUSION Relative to Caucasians, AA are less likely to receive either NAC or ADJ. Moreover, relative to Caucasians, AA exhibit higher CSM even when treated with either NAC or ADJ.
Collapse
Affiliation(s)
- Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Letizia Maria Ippolita Jannello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Francesco Di Bello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Natali Rodriguez Peñaranda
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Jordan A Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Felix K H Chun
- Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Giorgio Gandaglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| |
Collapse
|
12
|
Avudaiappan AP, Prabhakar P, Sandman MS, Rubens M, Garje R, Eldefrawy A, Manoharan M. Pathological response and survival outcomes after neoadjuvant chemotherapy with radical cystectomy in octogenarians for muscle-invasive bladder cancer: an observational database study. BMC Urol 2024; 24:150. [PMID: 39049001 PMCID: PMC11267756 DOI: 10.1186/s12894-024-01548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). In recent years, octogenarians have been undergoing RC uneventfully, but studies showed older adults receive NAC less often. We studied the utilization and effect of RC with or without NAC in octogenarians and compared survival outcomes between responders and non-responders. METHODS In our retrospective study using the National Cancer Database (NCDB), we identified octogenarians with MIBC and urothelial histology who underwent RC with or without NAC between 2004 and 2018. The NAC cohort included patients who underwent RC with NAC, and the non-NAC cohort included those with or without adjuvant chemotherapy. The NAC cohort was subcategorized into responders and non-responders based on surgical pathology. Patients with comorbidity index > 1 were not included, thereby excluding patients with possible renal impairment. After propensity-matching, we compared the overall survival (OS) between NAC and non-NAC cohorts and responders and non-responders. RESULTS 33924 patients underwent RC, and 3056 octogenarians met our selection. Among them, 396 received NAC, and 2660 did not receive NAC. Among those who received NAC, 112(28.3%) experienced downstaging, and 223(56.4%) exhibited upstaging or no change (p < 0.001). After propensity-matching, the median OS of the NAC and non-NAC cohorts were 51.6 months and 31.3 months, respectively (p<0.001). Similarly, the median OS of responders and non-responders were 89.4 months and 26.5 months, respectively(p < 0.0001). CONCLUSION In our study, we observed that NAC with RC for MIBC may help to improve OS among healthy octogenarians. Similarly, responders had better OS than non-responders.
Collapse
Affiliation(s)
- Arjun Pon Avudaiappan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Pushan Prabhakar
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
| | - Mayer Simcha Sandman
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Muni Rubens
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
| | - Rohan Garje
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
| | - Ahmed Eldefrawy
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Murugesan Manoharan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| |
Collapse
|
13
|
Ghali F, Holt SK, Koehne EL, Chen JJ, Weg ES, Liao JJ, Zeng J, Grivas P, Hawley JE, Hsieh AC, Montgomery RB, Wright JL. Patterns of chemotherapy use with primary radiotherapy for localized bladder cancer in patients 65 or older. Front Oncol 2024; 14:1341655. [PMID: 38812783 PMCID: PMC11133586 DOI: 10.3389/fonc.2024.1341655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/08/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Bladder preservation with concurrent chemoradiotherapy after maximum transurethral resection of bladder tumor is an alternative to radical cystectomy in select patients with muscle invasive bladder cancer (MIBC). Concurrent administration of radio-sensitizing chemotherapy and radiation therapy (RT) has been shown to have superior disease control compared with RT alone and can often be administered with modest added toxicity. We sought to describe national patterns of chemotherapy use. Methods The linked surveillance, epidemiology, and end results (SEER)-Medicare database was used to identify patients with cT2-4, N0/X, M0/X BC who received radiation between 2004 and 2018. Data on demographics, clinicopathologic factors, therapy and outcomes were extracted. Concurrent utilization of chemotherapy with RT was also identified (CRT). Multivariate logistic regression (MVA) models were used to explore factors associated with receipt of chemotherapy and overall survival (OS). Results 2190 patients met inclusion criteria. Of these, 850 (38.8%) received no chemotherapy. Among those receiving chemotherapy, the most frequent regimens were single agent carboplatin, cisplatin, or gemcitabine. Factors that were independently associated with decreased likelihood of chemotherapy use were increasing age (OR 0.93, CI 0.92 - 0.95), Hispanic race (compared with White, OR 0.62, CI 0.39 - 0.99), cT3 or T4 (compared with cT2, OR 0.70, CI 0.55 - 0.90), and lower National Cancer Institute comorbidity index (OR 0.60, CI 0.51 - 0.70) (p < 0.05). Variables independently associated with increased likelihood of receipt of chemotherapy were married status (OR 1.28, CI 1.06 - 1.54), higher socioeconomic status (OR 1.31, CI 1.06 - 1.64), and later year of diagnosis (OR 1.09, CI 1.06 - 1.12). Receipt of concurrent chemotherapy with RT was associated with superior OS compared with RT alone. Conclusion Over a third of patients >/65 years old receiving curative-intent RT for MIBC do not receive concurrent chemotherapy. Considering the improvement in oncologic outcomes with CRT over RT alone and more options, such as low dose gemcitabine which can be administered with modest toxicity, efforts are needed to identify barriers to utilization and increase the use of radio-sensitizing chemotherapy.
Collapse
Affiliation(s)
- Fady Ghali
- Department of Urology, Yale School of Medicine, New Haven, CT, United States
| | - Sarah K. Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States
| | - Elizabeth L. Koehne
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States
| | - Jonathan J. Chen
- Division of Radiation Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Emily S. Weg
- Division of Radiation Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Jay J. Liao
- Division of Radiation Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Jing Zeng
- Division of Radiation Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Petros Grivas
- Division of Hematology Oncology, Department of Medicine, University of Washington School of medicine, Seattle, WA, United States
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Jessica E. Hawley
- Division of Hematology Oncology, Department of Medicine, University of Washington School of medicine, Seattle, WA, United States
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Andrew C. Hsieh
- Division of Hematology Oncology, Department of Medicine, University of Washington School of medicine, Seattle, WA, United States
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Robert Bruce Montgomery
- Division of Hematology Oncology, Department of Medicine, University of Washington School of medicine, Seattle, WA, United States
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Jonathan L. Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| |
Collapse
|
14
|
Djatisoesanto W, Azmi YA, Yatindra IBGTY. The relationship between income, health insurance, and employment status as prognostic indicators of bladder cancer: A survival analysis. Arch Ital Urol Androl 2024; 96:12305. [PMID: 38451257 DOI: 10.4081/aiua.2024.12305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/10/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Bladder cancer (BC) is one of the health problems. Socioeconomic status (SES) may correlate with patient treatment, possibly impacting patient prognosis. This study aimed to determine the relationship between income, health insurance, and employment status as prognostic indicators of BC. METHODS A retrospective observational study for patients diagnosed with BC in a hospital during the 5-year period between January 2019 and December 2023. Kaplan-Meier test analysis was used to generate overall survival curves stratified by income, employment status, and health insurance. Multivariate Cox proportional-hazards regression was used to identify factors associated with worse overall survival. RESULTS The results of the analysis on 219 patients showed no difference in patient survival based on income (p>0.05), while employment status and health insurance showed significant difference in patient survival (p<0.05). Moreover, there were 99 (45.2%) patients died, with the average patient being 58 years old and dominant in male patients. CONCLUSIONS Prevention of poor outcomes in patients needs to pay attention to certain characteristics, particularly for the loweconomic patients without appropriate national health insurance coverage.
Collapse
Affiliation(s)
- Wahjoe Djatisoesanto
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Yufi Aulia Azmi
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | | |
Collapse
|
15
|
Xia Y, Liu X, Ma B, Huang T, Xu D, Zhao C. Development and validation of a novel nomogram model for predicting the survival of patients with T2-4a, N0-x, M0 bladder cancer: a retrospective cohort study. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2023; 11:500-515. [PMID: 38148935 PMCID: PMC10749381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Recent developments in bladder cancer treatment strategies have significantly improved the prognosis of clinically curable muscle invasive bladder cancer (MIBC) patients. Here, the prognostic factors of T2-4a, N0-x, M0 MIBC patients were investigated using the Surveillance, Epidemiology, and End Results (SEER) database and a novel nomogram model was established for prognosis prediction. METHODS The data of 7,292 patients with T2-4a, N0-x, M0 MIBC were retrieved from the SEER database (2000-2020) and randomly classified into a training set (n = 5,106) and validation set (n = 2,188). Kaplan-Meier analysis was used to calculate cancer-specific survival (CSS) and overall survival (OS) rates of patients, and differences between survival curves were analyzed using the log-rank test. Cox regression analysis was used to screen and incorporate patient prognosis-affecting independent risk factors into the nomogram model. Consistency index (C-index) values and areas under the time-dependent receiver operating characteristic curve (AUC) were used to evaluate the discriminatory ability, and the calibration curve was used to assess the calibration of the model. Its predictive performance and American Joint Committee on Cancer (AJCC) stage were compared using decision curve analysis (DCA). RESULTS The 1-, 3-, and 5-year CSS and OS rates of patients with T2-4a, N0-x, M0 MIBC were 76.9%, 56.0%, and 49.9%, respectively, and 71.3%, 47.9%, and 39.5%, respectively. Cox regression analysis showed that age, marital status, race, pathological type, tumor size, AJCC stage, T stage, N stage, surgery of primary tumor, regional lymph node dissection, radiation, and chemotherapy were independent prognostic risk factors of both CSS and OS (P < 0.05). The C-index and AUC of the nomogram model constructed based on the training and validation sets were both > 0.7, and calibration curves for predicting the 1-, 3-, and 5-year survival were consistent with the ideal curve. The nomogram model showed a higher net benefit with DCA than AJCC stage analysis. CONCLUSION The nomogram model could accurately predict the prognosis of patients with T2-4a, N0-x, M0 MIBC. It may help clinicians perform personalized prognosis evaluations and formulate treatment plans.
Collapse
Affiliation(s)
- Yu Xia
- Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Xi Liu
- Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Binbin Ma
- Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Tao Huang
- Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of MedicineShanghai, China
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Chenhui Zhao
- Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of MedicineShanghai, China
| |
Collapse
|
16
|
Liu Y, Zhao YC, Lu Y, Goodarz D, Gershman B. The role of smoking in explaining racial/ethnic disparities in bladder cancer incidence in the United States. Urol Oncol 2023; 41:389.e1-389.e6. [PMID: 36849327 DOI: 10.1016/j.urolonc.2023.01.025] [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: 12/05/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Smoking is the most important modifiable risk factor for bladder cancer (BC), with the odds of developing BC among current and former smokers 3 times higher than never-smokers. We hypothesized that the observed disparities in BC incidence may be partially attributable to differences in smoking prevalence. We examined the attributable risk of BC related to smoking according to race/ethnicity and sex. MATERIAL AND METHODS We used data from SEER and the Behavioral Risk Factor Surveillance System to estimate BC cases that would have been prevented if current and former smokers had never smoked to calculate the Population Attributable Fractions, stratified by sex and race/ethnicity. SDs of BC incidences across racial/ethnic groups before and after smoking elimination were calculated to estimate disparities. RESULTS A total of 25,747 cases of BC were analyzed from 21 registries in 2018. By removing smoking, 10,176 cases (40%) would have been eliminated. Smoking was associated with a higher proportion of BC cases among males (42%) than females (36%). Across racial/ethnic groups, smoking contributed to the highest proportion of BC cases among American Indian/Alaska Natives (AI/AN) (43%) and Whites (36%) for females, and highest among AI/ANs (47%) and Blacks (44%) for males. Removing smoking, the SD of BC incidence across racial/ethnic groups was reduced for females (39%) and males (44%). CONCLUSION Approximately 40% of cases of BC in the United States are attributable to smoking, with the highest proportion in AI/ANs for both males and females, and the lowest in Hispanics for females and Asians and Pacific Islanders for males. Smoking contributes to almost half of racial/ethnic disparities in BC incidence in the United States. Accordingly, health policy to encourage smoking cessation among racial-ethnic minorities may substantially reduce inequalities in BC incidence.
Collapse
Affiliation(s)
- Yuchen Liu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Yu Chen Zhao
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yujia Lu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Danaei Goodarz
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
| |
Collapse
|
17
|
Wu R, Teng X, Song Q, Chen S, Wang L, Liao J, Zou C. Single-cell RNA sequencing reveals sexual diversity in the human bladder and its prospective impacts on bladder cancer and urinary tract infection. BMC Med Genomics 2023; 16:122. [PMID: 37277784 DOI: 10.1186/s12920-023-01535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Some bladder-related diseases, such as bladder urinary tract infection (UTI) and bladder cancer (BCa), have significant six differences in incidence and prognosis. However, the molecular mechanisms underlying these sex differences are still not fully understood. Understanding the sex-biased differences in gene expression in normal bladder cells can help resolve these problems. METHODS We first collected published single-cell RNA sequencing (scRNA-seq) data of normal human bladders from females and males to map the bladder transcriptomic landscape. Then, Gene Ontology (GO) analysis and gene set enrichment analysis (GSEA) were used to determine the significant pathways that changed in the specific cell populations. The Monocle2 package was performed to reconstruct the differentiation trajectories of fibroblasts. In addition, the scMetabolism package was used to analyze the metabolic activity at the single-cell level, and the SCENIC package was used to analyze the regulatory network. RESULTS In total, 27,437 cells passed stringent quality control, and eight main cell types in human bladder were identified according to classical markers. Sex-based differential gene expression profiles were mainly observed in human bladder urothelial cells, fibroblasts, B cells, and T cells. We found that urothelial cells in males demonstrated a higher growth rate. Moreover, female fibroblasts produced more extracellular matrix, including seven collagen genes that may mediate BCa progression. Furthermore, the results showed that B cells in female bladders exhibited more B-cell activated signals and a higher expression of immunoglobulin genes. We also found that T cells in female bladders exhibited more T-cell activated signals. These different biological functions and properties of these cell populations may correlate with sex differences in UTI and BCa, and result in different disease processes and outcomes. CONCLUSIONS Our study provides reasonable insights for further studies of sex-based physiological and pathological disparities in the human bladder, which will contribute to the understanding of epidemiological differences in UTI and BCa.
Collapse
Affiliation(s)
- Ribao Wu
- Center for Translational Medicine, Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Institute of Neuroscience and Guangxi Key Laboratory of Brain Science, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiahong Teng
- School of International Education, Guangxi Medical University, Nanning, Guangxi, China
| | - Qiong Song
- Center for Translational Medicine, Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Institute of Neuroscience and Guangxi Key Laboratory of Brain Science, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Shuai Chen
- Center for Translational Medicine, Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Institute of Neuroscience and Guangxi Key Laboratory of Brain Science, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Lihui Wang
- Center for Translational Medicine, Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Institute of Neuroscience and Guangxi Key Laboratory of Brain Science, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Jinling Liao
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Chunlin Zou
- Center for Translational Medicine, Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Institute of Neuroscience and Guangxi Key Laboratory of Brain Science, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, China.
| |
Collapse
|
18
|
Mar N, Zakharia Y, Falcon A, Morales-Barrera R, Mellado B, Duran I, Oh DY, Williamson SK, Gajate P, Arkenau HT, Jones RJ, Teo MY, Turan T, McLaughlin RT, Peltier HM, Chong E, Atluri H, Dean JP, Castellano D. Results from a Phase 1b/2 Study of Ibrutinib Combination Therapy in Advanced Urothelial Carcinoma. Cancers (Basel) 2023; 15:2978. [PMID: 37296940 PMCID: PMC10251876 DOI: 10.3390/cancers15112978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Ibrutinib is a first-in-class Bruton's tyrosine kinase inhibitor approved for the treatment of various B-cell malignancies and chronic graft-versus-host disease. We evaluated the safety and efficacy of ibrutinib, alone or combined with standard-of-care regimens, in adults with advanced urothelial carcinoma (UC). Once-daily ibrutinib was administered orally at 840 mg (single-agent or with paclitaxel) or at 560 mg (with pembrolizumab). Phase 1b determined the recommended phase 2 dose (RP2D) of ibrutinib, and phase 2 assessed progression-free survival (PFS), overall response rate (ORR), and safety. Thirty-five, eighteen, and fifty-nine patients received ibrutinib, ibrutinib plus pembrolizumab, and ibrutinib plus paclitaxel at the RP2D, respectively. Safety profiles were consistent with those of the individual agents. The best-confirmed ORRs were 7% (two partial responses) with single-agent ibrutinib and 36% (five partial responses) with ibrutinib plus pembrolizumab. Median PFS was 4.1 months (range, 1.0-37.4+) with ibrutinib plus paclitaxel. The best-confirmed ORR was 26% (two complete responses). In previously treated patients with UC, ORR was higher with ibrutinib plus pembrolizumab than with either agent alone (historical data in the intent-to-treat population). ORR with ibrutinib plus paclitaxel was greater than historical values for single-agent paclitaxel or ibrutinib. These data warrant further evaluation of ibrutinib combinations in UC.
Collapse
Affiliation(s)
- Nataliya Mar
- Division of Hematology/Oncology, University of California Irvine, Orange, CA 92868, USA
| | - Yousef Zakharia
- Division of Hematology/Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | | | - Rafael Morales-Barrera
- Vall d’Hebron Institute of Oncology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Begona Mellado
- Medical Oncology Department, Hospital Clínic i Provincial de Barcelona, Institut D’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Ignacio Duran
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), 39011 Santander, Spain
| | - Do-Youn Oh
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Graduate School, Seoul 03080, Republic of Korea
| | | | - Pablo Gajate
- Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute United Kingdom (SCRI-UK) and University College London Cancer Institute, London W1G 6AD, UK
| | - Robert J. Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow G12 0YN, UK
| | - Min Yuen Teo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Tolga Turan
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA 94080, USA
| | | | - Hillary M. Peltier
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA 94080, USA
| | - Elizabeth Chong
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA 94080, USA
| | - Harisha Atluri
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA 94080, USA
| | - James P. Dean
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA 94080, USA
| | | |
Collapse
|
19
|
An MH, Kim MS, Kim C, Noh TI, Joo KJ, Lee DH, Yi KH, Kwak JW, Hwang TH, Park RW, Kang SH. Association of 5α-Reductase Inhibitor Prescription With Bladder Cancer Progression in Males in South Korea. JAMA Netw Open 2023; 6:e2313667. [PMID: 37191958 DOI: 10.1001/jamanetworkopen.2023.13667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Importance The antiandrogenic effect of the 5α-reductase inhibitor (5-ARI) has been investigated for its role in preventing male-predominant cancers. Although 5-ARI has been widely associated with prostate cancer, its association with urothelial bladder cancer (BC), another cancer experienced predominantly by males, has been less explored. Objective To assess the association between 5-ARI prescription prior to BC diagnosis and reduced risk of BC progression. Design, Setting, and Participants This cohort study analyzed patient claims data from the Korean National Health Insurance Service database. The nationwide cohort included all male patients with BC diagnosis in this database from January 1, 2008, to December 31, 2019. Propensity score matching was conducted to balance the covariates between 2 treatment groups: α-blocker only group and 5-ARI plus α-blocker group. Data were analyzed from April 2021 to March 2023. Exposure Newly dispensed prescriptions of 5-ARIs at least 12 months prior to cohort entry (BC diagnosis), with a minimum of 2 prescriptions filled. Main Outcomes and Measures The primary outcomes were the risks of bladder instillation and radical cystectomy, and the secondary outcome was all-cause mortality. To compare the risk of outcomes, the hazard ratio (HR) was estimated using a Cox proportional hazards regression model and difference in restricted mean survival time analysis. Results The study cohort initially included 22 845 males with BC. After propensity score matching, 5300 patients each were assigned to the α-blocker only group (mean [SD] age, 68.3 [8.8] years) and 5-ARI plus α-blocker group (mean [SD] age, 67.8 [8.6] years). Compared with the α-blocker only group, the 5-ARI plus α-blocker group had a lower risk of mortality (adjusted HR [AHR], 0.83; 95% CI, 0.75-0.91), bladder instillation (crude HR, 0.84; 95% CI, 0.77-0.92), and radical cystectomy (AHR, 0.74; 95% CI, 0.62-0.88). The differences in restricted mean survival time were 92.6 (95% CI, 25.7-159.4) days for all-cause mortality, 88.1 (95% CI, 25.2-150.9) days for bladder instillation, and 68.0 (95% CI, 31.6-104.3) days for radical cystectomy. The incidence rates per 1000 person-years were 85.59 (95% CI, 80.53-90.88) for bladder instillation and 19.57 (95% CI, 17.41-21.91) for radical cystectomy in the α-blocker only group and 66.43 (95% CI, 62.22-70.84) for bladder instillation and 13.56 (95% CI, 11.86-15.45) for radical cystectomy in the 5-ARI plus α-blocker group. Conclusions and relevance Results of this study suggest an association between prediagnostic prescription of 5-ARI and reduced risk of BC progression.
Collapse
Affiliation(s)
- Min Ho An
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Department of Medical Sciences, Graduate School of Ajou University, Suwon, Korea
| | - Min Seo Kim
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Tae Il Noh
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kwan Joong Joo
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Dong Hun Lee
- Department of Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | | | - Tae-Ho Hwang
- Department of Pharmacology, Pusan National University, School of Medicine, Yangsan, Korea
- Gene and Cell Therapy Research Center for Vessel-Associated Diseases, School of Medicine, Pusan National University, Yangsan, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Seok Ho Kang
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
20
|
Bogumil D, Cortessis VK, Wilkens LR, Le Marchand L, Haiman CA, Maskarinec G, Setiawan VW. Interethnic Differences in Bladder Cancer Incidence and the Association between Type 2 Diabetes and Bladder Cancer in the Multiethnic Cohort Study. CANCER RESEARCH COMMUNICATIONS 2023; 3:755-762. [PMID: 37377897 PMCID: PMC10153456 DOI: 10.1158/2767-9764.crc-22-0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/11/2022] [Accepted: 04/04/2023] [Indexed: 06/29/2023]
Abstract
Background Research on the association between type 2 diabetes (T2D) and bladder cancer (BCA) risk among non-European ancestry populations is sparse to nonexistent, and most prior studies rely on a single baseline assessment of T2D status. Methods We estimated the T2D-BCA association using the Multiethnic Cohort Study of 185,059 men and women in California and Hawaii. Participants were African American, European American, Japanese American, Latin American, and Native Hawaiian, ages 45-75 years at enrollment (1993-1996). T2D was assessed by self-report at baseline, follow-up surveys, and Medicare claims. Cases were identified using Surveillance, Epidemiology and End Results Program cancer registries through 2016. Associations were estimated by race/ethnicity using Cox proportional hazards regression. Adjusted attributable fractions (AAF) and cumulative absolute risk of bladder cancer were estimated across groups. Results Over an average 19.7 years of follow-up 1,890 incident bladder cancer cases were diagnosed. Time-varying T2D was associated with bladder cancer in the multiethnic sample (HR = 1.17; 95% confidence interval, 1.05-1.30); however, the HR did not differ by race/ethnicity (P = 0.85). The AAF was 4.2% in the multiethnic sample and largest among Native Hawaiians (9.8%). Absolute risk of bladder cancer among European Americans without T2D was higher than all other groups with T2D. Conclusion T2D is significantly associated with bladder cancer risk in a multiethnic sample. Significance Those with T2D have higher incidence of bladder cancer, regardless of racial/ethnic group. Reducing T2D prevalence could substantially lower bladder cancer incidence among Native Hawaiians due to T2D being more common in this group. High absolute risk of bladder cancer among European Americans, regardless of T2D status, indicates that elevated bladder cancer risk in this group may be due to factors other than T2D. Future studies must explore reasons for this difference in incidence.
Collapse
Affiliation(s)
- David Bogumil
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Victoria K. Cortessis
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Lynne R. Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Christopher A. Haiman
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
- Center for Genetic Epidemiology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | | | - Veronica Wendy Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
- Center for Genetic Epidemiology, Keck School of Medicine of University of Southern California, Los Angeles, California
| |
Collapse
|
21
|
Nath G, Coursey A, Ekong J, Rastegari E, Sengupta S, Dag AZ, Delen D. Determining the temporal factors of survival associated with brain and nervous system cancer patients: A hybrid machine learning methodology. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2023. [DOI: 10.1080/20479700.2023.2196101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Affiliation(s)
- Gopal Nath
- Department of Mathematics and Statistics, Murray State University, Murray, KY, USA
| | - Austin Coursey
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Joseph Ekong
- Department of Industrial Engineering, Western New England University, Springfield, MA, USA
| | - Elham Rastegari
- Department of Business, Intelligence and Analytics, Creighton University, Omaha, NE, USA
| | - Saptarshi Sengupta
- Department of Computer Science, San José State University, San José, CA, USA
| | - Asli Z. Dag
- Heider College of Business, Creighton University, Omaha, NE, USA
| | - Dursun Delen
- Spears School of Business, Oklahoma State University, Stillwater, OK, USA
- Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, Turkey
| |
Collapse
|
22
|
Shu TD, Schumacher FR, Conroy B, Ponsky L, Mahran A, Bukavina L, Calaway A, Markt SC. Disparities in cause-specific mortality by race and sex among bladder cancer patients from the SEER database. Cancer Causes Control 2023; 34:521-531. [PMID: 36882598 DOI: 10.1007/s10552-023-01679-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Previous literature shows that more bladder cancer patients overall die from causes other than the primary malignancy. Given known disparities in bladder cancer outcomes by race and sex, we aimed to characterize differences in cause-specific mortality for bladder cancer patients by these demographics. METHODS We identified 215,252 bladder cancer patients diagnosed with bladder cancer from 2000 to 2017 in the SEER 18 database. We calculated cumulative incidence of death from seven causes (bladder cancer, COPD, diabetes, heart disease, external, other cancer, other) to assess differences in cause-specific mortality between race and sex subgroups. We used multivariable Cox proportional hazards regression and Fine-Gray competing risk models to compare risk of bladder cancer-specific mortality between race and sex subgroups overall and stratified by cancer stage. RESULTS 17% of patients died from bladder cancer (n = 36,923), 30% died from other causes (n = 65,076), and 53% were alive (n = 113,253). Among those who died, the most common cause of death was bladder cancer, followed by other cancer and diseases of the heart. All race-sex subgroups were more likely than white men to die from bladder cancer. Compared to white men, white women (HR: 1.20, 95% CI: 1.17-1.23) and Black women (HR: 1.57, 95% CI: 1.49-1.66) had a higher risk of dying from bladder cancer, overall and stratified by stage. CONCLUSION Among bladder cancer patients, death from other causes especially other cancer and heart disease contributed a large proportion of mortality. We found differences in cause-specific mortality by race-sex subgroups, with Black women having a particularly high risk of dying from bladder cancer.
Collapse
Affiliation(s)
- Timothy D Shu
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Fredrick R Schumacher
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Britt Conroy
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee Ponsky
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amr Mahran
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Laura Bukavina
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Adam Calaway
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah C Markt
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
23
|
Krampe NA, Oerline MK, Asplin JR, Hsi RS, Crivelli JJ, Shahinian VB, Hollingsworth JM. Potential for Urolithiasis-related Research Using the Novel Medicare-Litholink Database. UROLOGY PRACTICE 2023; 10:147-152. [PMID: 37103409 PMCID: PMC10140542 DOI: 10.1097/upj.0000000000000378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/18/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION To overcome the data availability hurdle of observational studies on urolithiasis, we linked claims data with 24-hour urine results from a large cohort of adults with urolithiasis. This database contains the sample size, clinical granularity, and long-term follow-up needed to study urolithiasis on a broad level. METHODS We identified adults enrolled in Medicare with urolithiasis who had a 24-hour urine collection processed by Litholink (2011 to 2016). We created a linkage of their collections results and paid Medicare claims. We characterized them across a variety of sociodemographic and clinical factors. We measured frequencies of prescription fills for medications used to prevent stone recurrence, as well as frequencies of symptomatic stone events, among these patients. RESULTS In total, there were 11,460 patients who performed 18,922 urine collections in the Medicare-Litholink cohort. The majority were male (57%), White (93.2%), and lived in a metropolitan county (51.5%). Results from their initial urine collections revealed abnormal pH to be the most common abnormality (77.2%), followed by low volume (63.8%), hypocitraturia (45.6%), hyperoxaluria (31.1%), hypercalciuria (28.4%), and hyperuricosuria (11.8%). Seventeen percent had prescription fills for alkali monotherapy, and 7.6% had prescription fills for thiazide diuretic monotherapy. Symptomatic stone events occurred in 23.1% at 2 years of follow-up. CONCLUSIONS We successfully linked Medicare claims with results from 24-hour urine collections performed by adults that were processed by Litholink. The resulting database is a unique resource for future studies on the clinical effectiveness of stone prevention strategies and urolithiasis more broadly.
Collapse
Affiliation(s)
- Noah A. Krampe
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Mary K. Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - John R. Asplin
- Litholink Corporation, Laboratory Corporation of America Holdings, Itasca, Il
| | - Ryan S. Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph J. Crivelli
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Vahakn B. Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - John M. Hollingsworth
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| |
Collapse
|
24
|
Lin W, Pan X, Zhang C, Ye B, Song J. Impact of Age at Diagnosis of Bladder Cancer on Survival: A Surveillance, Epidemiology, and End Results-Based Study 2004-2015. Cancer Control 2023; 30:10732748231152322. [PMID: 36662642 PMCID: PMC9903028 DOI: 10.1177/10732748231152322] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND An older age contributes to the development of bladder cancer. However, the relationship between advanced age at the diagnosis and prognosis of bladder cancer has been few reported. This study aimed to determine the effect of age on survival in bladder cancer with different subgroups. METHODS 117,275 patients with bladder cancer, identified from the Surveillance, Epidemiology, and End Results database during 2004-2015 in America, were divided into 4 age groups (≤54, 55 to 64, 65 to 74, and ≥75 years). Multivariable Cox proportional-hazards model and competing risk model were conducted according to different age groups. Heat maps were plotted to show the impact of age on survival in subgroups classified by other clinicopathological variables. Moreover, restricted cubic spline was used to model the association between age and the risk of death. RESULTS Patients aged ≥75 years had shorter overall survival in comparison with those aged ≤54 years (hazard ratio [HR] = 5.36, 95% confidence interval [CI] = 5.13-5.59). Compared with patients aged ≤54 years, patients older than 75 years experienced a decreased rate of bladder cancer-specific survival (subdistribution HR = 2.15, 95% CI = 2.04-2.25). Heat maps also showed that older ages were associated with worse overall cumulative mortality and bladder cancer-specific cumulative mortality. Similarly, restricted cubic spline verified the impact of age on survival of bladder cancer. CONCLUSIONS Age at diagnosis of bladder cancer was found to be a significant predictor for the worse overall survival and bladder cancer-specific survival even in an era with more effective therapies. Exploring the reasons why older age contributes to poor outcomes for bladder cancer will be the focus of future research.
Collapse
Affiliation(s)
- Wu Lin
- Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P.R. China
| | - Xuming Pan
- Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P.R. China
| | - Chun Zhang
- Department of General Surgery, Hospital of Traditional Chinese Medicine of Songyang, Lishui, P.R. China
| | - Bochun Ye
- Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P.R. China
| | - Jia Song
- Department of General Practice, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P.R. China,Jia Song, Department of General Practice, The Second Affiliate Hospital of Zhejiang Chinese Medical University, 318 Chaowang Road, Gongshu District, Hangzhou 310053, China.
| |
Collapse
|
25
|
Hu B, Chen R, Chen G, Zheng P, Fu B. Prognostic nomogram for estimating survival in patients with resected muscle-invasive bladder cancer receiving chemotherapy. Front Surg 2023; 10:1121184. [PMID: 36911611 PMCID: PMC9998492 DOI: 10.3389/fsurg.2023.1121184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
Background Chemotherapy has been proven to bring survival benefit in patients with resected muscle-invasive bladder cancer (MIBC), which is increasingly recommended. Our objective was to establish an effective model for estimating the overall survival (OS) and cancer-specific survival (CSS) in these patients. Methods 2,030 patients diagnosed with resected MIBC receiving chemotherapy were acquired from the Surveillance, Epidemiology, and End Result (SEER) database, which were randomized 7:3 into a primary set (1,421 patients) and an internal validation set (609 patients). Significant predictors for OS and CSS were identified by Cox regression models, which were then utilized to develop prognostic nomogram. The performance of the model was assessed by utilizing calibration, area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). Results Six independent prognostic factors, including age, race, histology, T stage, N stage and regional nodes examined, made up the nomogram. The AUCs of the primary cohort was 0.751 and 0.753 for 3- and 5- year OS and 0.751 and 0.754 for 3-and 5- year CSS, respectively. The calibration plots proved the nomograms' satisfactory discrimination. The results of DCA manifested that our models had an excellent clinical applicability. In addition, a risk stratification system was established according to the nomogram' risk score. Obvious difference was found in different groups (P < 0.001). Conclusion The established prediction nomogram provides a simple-to-use tool for estimating the survival probability of resected MIBC patients treated with chemotherapy, which can assist clinicians make individualized treatment plans.
Collapse
Affiliation(s)
- Bing Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ru Chen
- Department of Urology, The First Hospital of Putian City, Putian, China
| | - Guoxian Chen
- Department of Urology, The First Hospital of Putian City, Putian, China
| | - Ping Zheng
- Department of Urology, Shangrao municipa0000l Hospital, Shangrao, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
26
|
Duggan B, O’Rourke D, Anderson N, Reid CN, Watt J, O’Kane H, Boyd R, Curry D, Evans M, Stevenson M, Kurth MJ, Lamont JV, Fitzgerald P, Ruddock MW. Biomarkers to assess the risk of bladder cancer in patients presenting with haematuria are gender-specific. Front Oncol 2022; 12:1009014. [PMID: 36212463 PMCID: PMC9539269 DOI: 10.3389/fonc.2022.1009014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Haematuria is a common red flag symptom of urinary tract cancer. Bladder cancer (BC) is the most common cancer to present with haematuria. Women presenting with haematuria are often underdiagnosed. Currently, no gender-specific tests are utilized in clinical practice. Considerable healthcare resources are needed to investigate causes of haematuria and this study was set up to help identify markers of BC. The aim of the study was to define biomarker algorithms in haematuria patients using an expanded panel of biomarkers to diagnose BC and investigate if the algorithms are gender-specific. Materials and Methods A total of n=675 patients with a history of haematuria were recruited from Northern Ireland hospitals. Patients were collected on a 2:1 ratio, non-BC (control) n=474: BC n=201. A detailed clinical history, urine and blood samples were collected. Biomarkers, known to be involved in the pathobiology underlying bladder carcinogenesis were investigated. Biomarkers differentially expressed between groups were investigated using Wilcoxon rank sum and linear regression. Results Biomarkers were gender specific. Two biomarker-algorithms were identified to triage haematuria patients; male - u_NSE, s_PAI-1/tPA, u_midkine, u_NGAL, u_MMP-9/TIMP-1 and s_prolactin (u=urine; s=serum); sensitivity 71.8%, specificity 72.8%; AUROC 0.795; and female urine biomarkers - IL-12p70, IL-13, midkine and clusterin; sensitivity 83.7%, specificity 79.7%; AUROC 0.865. Addition of the clinical variable infection to both algorithms increased both AUROC to 0.822 (DeLong p=0.014) and to 0.923 (DeLong p=0.004) for males and females, respectively. Combining clinical risk factors with biomarker algorithms would enable application of the algorithms to triage haematuria patients. Conclusion Using gender-specific biomarker algorithms in combination with clinical risks that are associated with BC would allow clinicians to better manage haematuria patients and potentially reduce underdiagnosis in females. In this study, we demonstrate, for the first time, that blood and urine biomarkers are gender-specific when assessing risk of BC in patients who present with blood in their urine. Combining biomarker data with clinical factors could improve triage when referring patients for further investigations.
Collapse
Affiliation(s)
- Brian Duggan
- South Eastern Health and Social Care Trust, Ulster Hospital Dundonald, Belfast, United Kingdom
| | - Declan O’Rourke
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - Neil Anderson
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - Cherith N. Reid
- Randox Laboratories Ltd, Randox Science Park, Antrim, United Kingdom
| | - Joanne Watt
- Randox Laboratories Ltd, Randox Science Park, Antrim, United Kingdom
| | - Hugh O’Kane
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - Ruth Boyd
- Northern Ireland Clinical Trials Network, Belfast City Hospital, Belfast, United Kingdom
| | - David Curry
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - Mark Evans
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - Michael Stevenson
- Department of Epidemiology and Public Health, Queens University Belfast, Belfast, United Kingdom
| | - Mary Jo Kurth
- Randox Laboratories Ltd, Randox Science Park, Antrim, United Kingdom
| | - John V. Lamont
- Randox Laboratories Ltd, Randox Science Park, Antrim, United Kingdom
| | - Peter Fitzgerald
- Randox Laboratories Ltd, Randox Science Park, Antrim, United Kingdom
| | - Mark W. Ruddock
- Randox Laboratories Ltd, Randox Science Park, Antrim, United Kingdom
| |
Collapse
|
27
|
Pattenden T, Samaranayake D, Morton A, Thangasamy I. Bladder cancer in Aboriginal and Torres Strait Islander people living in Australia: a scoping review protocol. BMJ Open 2022; 12:e059144. [PMID: 35387834 PMCID: PMC8987786 DOI: 10.1136/bmjopen-2021-059144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Bladder cancer is the third most common urological malignancy affecting Australians, with key modifiable risk factors. Aboriginal and Torres Strait Islander people suffer from a higher prevalence of cancer-modifiable risk factors, are diagnosed with bladder cancer at a younger age, and have poorer survival rates compared with the general population. A comprehensive overview of the state of current knowledge on bladder cancer in this population is required. METHODS AND ANALYSIS A search of MEDLINE, CINAHL, EMBASE and Web of Science databases, along with appropriate grey literature sources will be conducted between the 1 April 2022 and 30 April 2022. The reference lists of all included studies will be reviewed for additional appropriate sources. The national bladder cancer dataset compiled by the Australian Institute of Health and Welfare will also be included as a source. All relevant sources meeting inclusion criteria, published in English, from inception onwards will be included. Dual independent screening of titles and abstracts prior to full-text review will be undertaken for all identified results during the initial searches. Preliminary findings will be reviewed with stakeholders, to seek culturally appropriate feedback on the implications of the results. Results will be reported in tabular form, accompanied by a narrative synthesis with comparisons to the wider bladder cancer population. ETHICS AND DISSEMINATION Ethics review will not be required, as only publicly available data will be analysed. Findings from the scoping review will be published in a peer-reviewed journal and presented at scientific meetings to stakeholders.
Collapse
Affiliation(s)
- Trent Pattenden
- Urology Department, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Dhanika Samaranayake
- Urology Department, Ipswich Hospital, Ipswich, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Morton
- Urology Department, Ipswich Hospital, Ipswich, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Isaac Thangasamy
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Urology Research Group, Nepean Hospital, Penrith, New South Wales, Australia
| |
Collapse
|
28
|
Wang SS, Zhai GQ, Chen G, Huang ZG, He RQ, Huang SN, Liu JL, Cheng JW, Yan HB, Dang YW, Li SH. Decreased expression of transcription factor Homeobox A11 and its potential target genes in bladder cancer. Pathol Res Pract 2022; 233:153847. [DOI: 10.1016/j.prp.2022.153847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
|
29
|
Wang W, Liu J, Liu L. Development and Validation of a Prognostic Model for Predicting Overall Survival in Patients With Bladder Cancer: A SEER-Based Study. Front Oncol 2021; 11:692728. [PMID: 34222021 PMCID: PMC8247910 DOI: 10.3389/fonc.2021.692728] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To establish a prognostic model for Bladder cancer (BLCA) based on demographic information, the American Joint Commission on Cancer (AJCC) 7th staging system, and additional treatment using the surveillance, epidemiology, and end results (SEER) database. METHODS Cases with BLCA diagnosed from 2010-2015 were collected from the SEER database, while patient records with incomplete information on pre-specified variables were excluded. All eligible cases were included in the full analysis set, which was then split into training set and test set with a 1:1 ratio. Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors for overall survival (OS) in BLCA patients. With selected independent prognosticators, a nomogram was mapped to predict OS for BLCA. The nomogram was evaluated using receiver operating characteristic (ROC) analysis and calibration plot in both the training and test sets. The area under curve [AUC] of the nomogram was calculated and compared with clinicopathological indicators using the full analysis set. Statistical analyses were conducted using the R software, where P-value <0.05 was considered significant. RESULTS The results indicated that age, race, sex, marital status, histology, tumor-node-metastasis (TNM) stages based on the AJCC 7th edition, and additional chemotherapy were independent prognostic factors for OS in patients with BLCA. Patients receiving chemotherapy tend to have better survival outcomes than those without. The proposed nomogram showed decent classification (AUCs >0.8) and prediction accuracy in both the training and test sets. Additionally, the AUC of the nomogram was observed to be better than that of conventional clinical indicators. CONCLUSIONS The proposed nomogram incorporated independent prognostic factors including age, race, sex, marital status, histology, tumor-node-metastasis (TNM) stages, and additional chemotherapy. Patients with BLCA benefit from chemotherapy on overall survival. The nomogram-based prognostic model could predict overall survival for patients with BLCA with accurate stratification, which is superior to clinicopathological factors.
Collapse
Affiliation(s)
- Wei Wang
- Institute of Military Hospital Management, The Chinese PLA General Hospital, Beijing, China
- Department of Rehabilitation Medicine, Qingdao Special Servicemen Recuperation Center of People’s Liberation Army (PLA) Navy, Qingdao, China
| | - Jianchao Liu
- Institute of Military Hospital Management, The Chinese PLA General Hospital, Beijing, China
| | - Lihua Liu
- Institute of Military Hospital Management, The Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
30
|
Duorui N, Shi B, Zhang T, Chen C, Fang C, Yue Z, Wu P, Wu Z, Huang X, Li M. The contemporary trend in worsening prognosis of pancreatic acinar cell carcinoma: A population-based study. PLoS One 2020; 15:e0243164. [PMID: 33332471 PMCID: PMC7746196 DOI: 10.1371/journal.pone.0243164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary acinar cell carcinoma (ACC) is a rare exocrine tumor of the pancreas with unclear clinical characteristics. Our goal was to determine the incidence and update the clinical characteristics and outcomes of ACC. METHODS Through the Surveillance, Epidemiology, and End Results (SEER) database, we identified 252 patients with the latest diagnosis of ACC (2004-2016). The age-adjusted incidence (AAI) was calculated using the SEER*Stat Software version 8.3.6. The Kaplan-Meier method was used to draw survival curves and differences among them were compared by the log-rank test. Cox proportional hazards models were used to evaluate factors that had independent predictive effects on the overall survival. RESULTS The AAI of pancreatic ACC was on the rise with the mean age at diagnosis of 63.79±14.79 years. Most patients (15.9%) had poorer differentiated tumors. The patients presented with distant stage were 54.4% compared with 53.1% between 1988 and 2003. The 1-, 2-, and 5-years survival rates for pancreatic ACC patients were 53.5%, 34.6%,17.5%, respectively (compared with 78.5%, 67.0%, and 42.8%, between 1988 and 2003). The multivariate COX analysis showed that the patient's age, surgery, chemotherapy, and summary stage, but not marital status were independent prognosis factors for ACC. CONCLUSIONS Pancreatic ACC is a highly malignant tumor with an increasing incidence in recent years. The rate of distant metastasis is increasing and the survival rate is worse than in the past, suggesting that it may require more aggressive treatment and follow-up. Surgery, radiotherapy, and chemotherapy are all effective treatments, but prospective studies are still needed to verify them.
Collapse
Affiliation(s)
- Nie Duorui
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Bin Shi
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Tao Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Chuyao Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Chongkai Fang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhijun Yue
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Peng Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhiming Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xuewu Huang
- Cancer center, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Meng Li
- Department of Oncology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| |
Collapse
|
31
|
Guo B, Liu M. Survival differences by ethnicity among patients diagnosed with bladder cancer. J Transl Med 2020; 18:486. [PMID: 33317562 PMCID: PMC7737256 DOI: 10.1186/s12967-020-02668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/04/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Boda Guo
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking, Union Medical College, Beijing, 100730, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Graduate School of Peking, Union Medical College, Beijing, 100730, China.
| |
Collapse
|
32
|
Wang C, Yuan X, Zuo J. Individualized Prediction of Overall Survival for Primary Intramedullary Spinal Cord Grade II/III Ependymoma. World Neurosurg 2020; 143:e149-e156. [PMID: 32683000 DOI: 10.1016/j.wneu.2020.07.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this study was to develop and validate a nomogram to predict overall survival (OS) for adult patients with primary intramedullary spinal cord grade II/III ependymoma (PISCGE). We also elucidated the effectiveness of postoperative radiotherapy for this disease. METHODS Clinical data of patients with PISCGE between 1988 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) registry database. The independent prognostic factors were identified using univariate and multivariate Cox analyses. The nomogram was established from the results of the multivariate Cox analysis. We also use some methods to verify the superiority of the prediction model. The effectiveness of postoperative radiotherapy for PISCGE was assessed through coarsened exact matching and survival analyses. RESULTS Multivariate Cox analysis revealed that sex, age, surgical treatment, tumor grade, and marital status were independent prognostic factors of OS. The nomogram model was established based on these factors and validated internally. Calibration plots based on bootstrap resampling validation showed good consistency between the nomogram prediction and actual observation. This model also exhibited favorable discrimination characteristics. A risk classification system based on a nomogram was established to promote risk stratification of PISCGE and optimize clinical management. Moreover, we found no association between radiation treatment and the OS for these patients (P > 0.05). CONCLUSIONS We built the first nomogram model and risk classification system for PISCGE patients. Our model accurately estimated the individual OS probability of these patients, and proposes different treatment approaches for patients based on the risk classification system. Furthermore, from our findings, radiotherapy confers no survival advantage to these patients.
Collapse
Affiliation(s)
- Chengwei Wang
- Department of Othopedics, Huangshi Central Hospital, Affiliated Hospital Polytechnic University, Huangshi, China.
| | - Xiang Yuan
- Department of Othopedics, Huangshi Central Hospital, Affiliated Hospital Polytechnic University, Huangshi, China
| | - Jian Zuo
- Department of Othopedics, Huangshi Central Hospital, Affiliated Hospital Polytechnic University, Huangshi, China
| |
Collapse
|
33
|
Nishida Y, Hamada S, Kawai A, Kunisada T, Ogose A, Matsumoto Y, Ae K, Toguchida J, Ozaki T, Hirakawa A, Motoi T, Sakai T, Kobayashi E, Gokita T, Okamoto T, Matsunobu T, Shimizu K, Koike H. Risk factors of local recurrence after surgery in extraabdominal desmoid-type fibromatosis: A multicenter study in Japan. Cancer Sci 2020; 111:2935-2942. [PMID: 32539220 PMCID: PMC7419055 DOI: 10.1111/cas.14528] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023] Open
Abstract
This study was undertaken to clarify the risk factors, including the mutation status of CTNNB1, for the local recurrence after surgery of the rare disease desmoid‐type fibromatosis. It was designed as a multiinstitutional joint research project with 7 major centers in Japan participating. The committee members of 7 major medical centers specializing in bone and soft tissue tumors formed this study group to develop clinical care guidelines. Of 196 cases with specimens and medical records collected from the 7 institutions, 88 surgically treated ones were analyzed regarding clinicopathologic prognostic factors including CTNNB1 mutation status. Excluding R2 cases (n = 3), 5‐year local recurrence‐free survival (LRFS) was 52.9%. No case had received pre‐ or postoperative radiotherapy. Univariate analysis revealed that extremity location (P < .001) and larger size (8 cm or more, P = .036) were significant adverse risk factors for LRFS. Multivariate analysis indicated that extremity location (P < .001) was a significantly adverse factor in addition to recurrent tumor (P = .041), S45F mutation (P = .028), and R1 surgical margin (P = .039). Preoperative drug treatment, including nonsteroidal antiinflammatory drugs, did not reduce the incidence of local recurrence (P = .199). This is the first study to analyze the factors correlating with outcomes of surgical treatment, including CTNNB1 mutation status, in a relatively large number of cases from an Asian country. Tumor location was found to be the most influential prognostic factor for local recurrence, similar to the results from Europe and North America. The development of more sensitive method(s) for determination of CTNNB1 mutation is a priority for future study.
Collapse
Affiliation(s)
- Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Hospital, Nagoya, Japan.,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Hamada
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshiyuki Kunisada
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akira Ogose
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | | | - Keisuke Ae
- Department of Orthopedic Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Junya Toguchida
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Motoi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomohisa Sakai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tabu Gokita
- Department of Orthopedic Surgery, Saitama Cancer Center, Saitama, Japan
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoya Matsunobu
- Department of Orthopedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Koki Shimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Koike
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|