1
|
Psutka SP, Veleber S, Siman J, Holt SK, Jannat S, Wright JL, Lin DW, Gore JL, Schade GR, Annen Z, Greenlee H. Phase 1/2 Randomized Clinical Trial of In-clinic acupuncture Prior to Bacillus Calmette-Guérin in Patients with High-risk Non-muscle-invasive Bladder Cancer. Eur Urol Oncol 2024:S2588-9311(24)00091-9. [PMID: 38653622 DOI: 10.1016/j.euo.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/01/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Treatment-related dose-limiting dysuria and irritative bladder symptoms are common in patients receiving intravesical bacillus Calmette-Guérin (BCG) to treat non-muscle-invasive bladder cancer (NMIBC). Acupuncture has been shown to reduce pain and urinary urgency/frequency in other patient populations. OBJECTIVE To evaluate the feasibility, safety, and tolerability of weekly in-clinic preprocedural acupuncture among patients receiving induction BCG. DESIGN, SETTING, AND PARTICIPANTS Patients with high-risk NMIBC undergoing induction BCG were randomized 2:1 to a standardized acupuncture protocol (acupuncture) versus the standard-of-care control arm. INTERVENTION In-office acupuncture prior to each BCG instillation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Feasibility was assessed via recruitment, retention, and intervention adherence. Acupuncture safety and tolerability were assessed via physician-reported Common Terminology Criteria for Adverse Events version 5.0 and adverse events (AEs). Secondary endpoints included BCG treatment adherence, patient-reported BCG-related toxicity, and bladder cancer-specific and generic (European Organisation for Research and Treatment of Cancer [EORTC]-QLQ-NMIBC-24 and EORTC-QLQ-NMIBC-C30) quality of life (QOL). Subjective assessments of acupuncture acceptability were performed through patient surveys. RESULTS AND LIMITATIONS A total of 43 individuals were randomized 2:1 to the acupuncture (n = 28) versus control (n = 15) group. The median age was 70.3 yr, and 76% were male. Week 7 follow-up surveys were completed by 93%; six participants withdrew early due to disease progression, refractory gross hematuria, or preference. Acupuncture was delivered successfully prior to each BCG treatment, with no acupuncture-related AEs or interruptions to induction BCG. BCG-attributed AEs were reported by 91% acupuncture and 100% control individuals, including pain (28% vs 43%, p = 0.34) and urinary symptoms (62% vs 79%, p = 0.31). Comparing acupuncture patients with controls, change in QOL over the study period demonstrated greater improvements in median urinary symptoms (9.5, interquartile range [IQR] 0.0-19.0 vs 0.0, IQR -14.3 to 7.1; p = 0.02) among patients in the acupuncture arm. Of the acupuncture patients, 96% reported that acupuncture was "very/extremely helpful," and 91% would recommend acupuncture to other patients. Limitations include modest sample size and single-institution design. CONCLUSIONS Acupuncture prior to induction BCG treatments is feasible and safe. In this phase 1/2 trial, improved urinary function scores were observed among patients undergoing acupuncture. Patients receiving acupuncture reported high degrees of satisfaction with treatments. PATIENT SUMMARY We evaluated the safety and feasibility of delivering acupuncture in a urology clinic prior to weekly intravesical bladder cancer treatments with bacillus Calmette-Guérin (BCG) in a randomized controlled trial. We found that acupuncture could be delivered safely prior to weekly BCG instillations and that the use of acupuncture was associated with high patient satisfaction and a decrease in patient-reported urinary symptoms compared with usual care.
Collapse
Affiliation(s)
- Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Susan Veleber
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Jonathan Siman
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Samia Jannat
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - George R Schade
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Zachary Annen
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Heather Greenlee
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| |
Collapse
|
2
|
Nicaise EH, Schmeusser BN, Ali A, Midenberg E, Palacios AR, Hartsoe B, Kearns E, Ambadi S, Patil DH, Joshi SS, Narayan VM, Psutka SP, Nazha B, Brown JT, Ogan K, Bilen MA, Master VA. Linear Muscle Segmentation for Metastatic Renal Cell Carcinoma: Changes in Clinic-Friendly Estimation Predict Survival Following Cytoreductive Nephrectomy. Clin Genitourin Cancer 2024:102056. [PMID: 38443295 DOI: 10.1016/j.clgc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Baseline sarcopenia and postoperative changes in muscle mass are independently associated with overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) undergoing cytoreductive nephrectomy (CN). Here we examine the relationships between preoperative (baseline), postoperative changes in muscle quantity, and survival outcomes following CN as determined by linear segmentation, a clinic-friendly tool that rapidly estimates muscle mass. MATERIALS AND METHODS Our nephrectomy database was reviewed for patients with metastatic disease who underwent CN for RCC. Linear segmentation of the bilateral psoas/paraspinal muscles was completed for baseline imaging within 60 days of surgery and imaging 30 to 365 days postoperatively. Kruskal-Wallis for numerical and Fisher's exact test for categorical variables were used to test for differences between groups according to percent change in linear muscle index (LMI, cm2/m2). Multivariable Cox proportional hazards models evaluated associations between LMI percent change and cancer-specific (CSM) and all-cause mortality (ACM). Kaplan Meier curves estimated cancer-specific (CSS) and overall survival (OS). RESULTS From 2004-2020, 205 patients were included of whom 52 demonstrated stable LMI (25.4%; LMI change < 5% [0Δ]), 60 increase (29.3%; LMI +5% [+Δ]), and 92 decrease (44.9%; LMI -5% [-Δ]). Median time from baseline imaging to surgery was 18 days, and time from surgery to postoperative imaging was 133 days. Median CSS and OS were highest among patients with 0Δ LMI (CSS: 133.6 [0Δ] vs. 61.9 [+Δ] vs. 37.4 [-Δ] months; P = .0018 || OS: 67.2 [0Δ] vs. 54.8 [+Δ] vs. 29.5 [-Δ] months; P = .0007). Stable LMI was a protective factor for CSM (HR 0.48; P = .024) and ACM (HR 0.59; P = .040) on multivariable analysis. DISCUSSION Change in muscle mass after CN, as measured by the linear muscle segmentation technique, is independently associated with OS and CSS in patients following CN. Of note, lack of change was associated with longer survival.
Collapse
Affiliation(s)
- Edouard H Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Adil Ali
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Eric Midenberg
- Department of Urology, University of Louisville, Louisville, KY
| | | | - Blaise Hartsoe
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Ethan Kearns
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Sriram Ambadi
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Shreyas S Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Vikram M Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Bassel Nazha
- Department of Hematology & Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Jacqueline T Brown
- Department of Hematology & Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Mehmet A Bilen
- Department of Hematology & Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
| |
Collapse
|
3
|
Lotan Y, Agarwal P, Black P, Dickstein R, Kamat AM, Lee B, Narayan VM, Porten S, Psutka SP, Smith AK, Svatek RS, Williams SB, Woldu S. Standardization of the evaluation and surveillance of patients with BCG unresponsive high grade non-muscle invasive bladder cancer clinical trials. Urol Oncol 2024:S1078-1439(24)00020-6. [PMID: 38307803 DOI: 10.1016/j.urolonc.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
There are multiple ongoing and planned clinical trials that are evaluating novel therapies to treat patients with BCG-unresponsive high grade nonmuscle invasive bladder cancer (NMIBC). Importantly, there is considerable variation in surveillance strategies between these clinical trials, specifically with regards to the use of advanced imaging, enhanced cystoscopy, and mandatory biopsies, which could impact landmark efficacy assessments of investigational agents. To present guideline recommendations for the standardization of cystoscopic evaluation, surveillance, and efficacy assessments for patients with BCG-unresponsive NMIBC participating in clinical trials. On September 29, 2023 at the annual meeting of the International Bladder Cancer Network, a breakout session was convened, during which representatives from various disciplines discussed potential guidance statements with opportunity for discussion and comment. A set of statements regarding use of white light and enhanced cystoscopy were developed to help guide a pragmatic approach to surveillance and efficacy assessments of patients in clinical trials. The use of "for cause" and "mandatory" biopsies was also addressed. A standard approach to evaluation of patients within the context of clinical trials is necessary to accurately assess the efficacy of novel agents, especially within single arm trials that lack an appropriate comparator. Additionally, the utilization and timing of mandatory biopsies is critical, as these biopsies may impact both disease evaluations and the determination of duration of response.
Collapse
Affiliation(s)
- Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX.
| | | | - Peter Black
- Department of Urologic Sciences, University of British Columbia
| | - Rian Dickstein
- Department of Surgery-Urology, University of Maryland BWMC
| | - Ashish M Kamat
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Byron Lee
- Department of Urology, Glickman Urological and Kidney Institute
| | | | - Sima Porten
- Department of Urology, University of California, San Francisco
| | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center
| | | | - Robert S Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio
| | - Stephen B Williams
- Division of Urology, Department of Surgery, University of Texas, Medical Branch Health System
| | - Solomon Woldu
- University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
4
|
Wu Z, Chen H, Chen Q, Ge S, Yu N, Campi R, Gómez Rivas J, Autorino R, Rouprêt M, Psutka SP, Mehrazin R, Porpiglia F, Bensalah K, Black PC, Mir MC, Minervini A, Djaladat H, Margulis V, Bertolo R, Caliò A, Carbonara U, Amparore D, Borregales LD, Ciccarese C, Diana P, Erdem S, Marandino L, Marchioni M, Muselaers CHJ, Palumbo C, Pavan N, Pecoraro A, Roussel E, Warren H, Pandolfo SD, Chen R, Zhou W, Zhai W, He M, Li Y, Han B, Wan J, Zeng X, Yan J, Fu Y, Ji C, Fan X, Zhang G, Zhao C, Jing T, Wang A, Feng C, Zhao H, Sun D, Wang L, Tai S, Zhang C, Chen S, Liu Y, Xu Z, Wang H, Gao J, Wang F, Cheng J, Miao H, Rao Q, Wang J, Xu N, Wang G, Liang C, Liu Z, Xia D, Jiang J, Zu X, Chen M, Guo H, Qin W, Wang Z, Xue W, Shi B, Zhou X, Wang S, Zheng J, Ge J, Feng X, Li M, Chen C, Qu L, Wang L. Prognostic Significance of Grade Discrepancy Between Primary Tumor and Venous Thrombus in Nonmetastatic Clear-cell Renal Cell Carcinoma: Analysis of the REMEMBER Registry and Implications for Adjuvant Therapy. Eur Urol Oncol 2024; 7:112-121. [PMID: 37468393 DOI: 10.1016/j.euo.2023.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Further stratification of the risk of recurrence of clear-cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) will facilitate selection of candidates for adjuvant therapy. OBJECTIVE To assess the impact of tumor grade discrepancy (GD) between the primary tumor (PT) and VTT in nonmetastatic ccRCC on disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). DESIGN, SETTING, AND PARTICIPANTS This was a retrospective analysis of a multi-institutional nationwide data set for patients with pT3N0M0 ccRCC who underwent radical nephrectomy and thrombectomy. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS Pathology slides were centrally reviewed. GD, a bidirectional variable (upgrading or downgrading), was numerically defined as the VTT grade minus the PT grade. Multivariable models were built to predict DFS, OS, and CSS. RESULTS AND LIMITATIONS We analyzed data for 604 patients with median follow-up of 42 mo (excluding events). Tumor GD between VTT and PT was observed for 47% (285/604) of the patients and was an independent risk factor with incremental value in predicting the outcomes of interest (all p < 0.05). Incorporation of tumor GD significantly improved the performance of the ECOG-ACRIN 2805 (ASSURE) model. A GD-based model (PT grade, GD, pT stage, PT sarcomatoid features, fat invasion, and VTT consistency) had a c index of 0.72 for DFS. The hazard ratios were 8.0 for GD = +2 (p < 0.001), 1.9 for GD = +1 (p < 0.001), 0.57 for GD = -1 (p = 0.001), and 0.22 for GD = -2 (p = 0.003) versus GD = 0 as the reference. According to model-converted risk scores, DFS, OS, and CSS significantly differed between subgroups with low, intermediate, and high risk (all p < 0.001). CONCLUSIONS Routine reporting of VTT upgrading or downgrading in relation to the PT and use of our GD-based nomograms can facilitate more informed treatment decisions by tailoring strategies to an individual patient's risk of progression. PATIENT SUMMARY We developed a tool to improve patient counseling and guide decision-making on other therapies in addition to surgery for patients with the clear-cell type of kidney cancer and tumor invasion of a vein.
Collapse
Affiliation(s)
- Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China; European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands.
| | - Hui Chen
- Department of Pathology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
| | - Qi Chen
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Silun Ge
- Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Nengwang Yu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, China
| | - Riccardo Campi
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Juan Gómez Rivas
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Morgan Rouprêt
- Department of Urology, GRC No. 5, Predictive ONCO-URO, Hospital Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Peter C Black
- Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria C Mir
- Department of Urology; Hospital Universitario La Ribera; Valencia, Spain
| | - Andrea Minervini
- Departments of Urology and Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Hooman Djaladat
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Riccardo Bertolo
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Urology Unit, San Carlo di Nancy Hospital, Rome, Italy
| | - Anna Caliò
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Umberto Carbonara
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Daniele Amparore
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Leonardo D Borregales
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA
| | - Chiara Ciccarese
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pietro Diana
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Selcuk Erdem
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urologic Oncology, Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Laura Marandino
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michele Marchioni
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Medical, Oral and Biotechnological Sciences, Urology Unit, University G. d'Annunzio, Chieti, Italy
| | - Constantijn H J Muselaers
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlotta Palumbo
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Nicola Pavan
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Urology Clinic, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Angela Pecoraro
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Eduard Roussel
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Hannah Warren
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Surgery and Interventional Science, University College London, London, UK
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Rui Chen
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wenquan Zhou
- Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
| | - Wei Zhai
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Miaoxia He
- Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yaoming Li
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Han
- Department of Pathology, Qilu Hospital, Shandong University, Jinan, China
| | - Jie Wan
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junan Yan
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yao Fu
- Department of Pathology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
| | - Changwei Ji
- Department of Urology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
| | - Xiang Fan
- Department of Pathology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Guangyuan Zhang
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Cheng Zhao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Taile Jing
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Anbang Wang
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Chenchen Feng
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongwei Zhao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Di Sun
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Liang Wang
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Sheng Tai
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shaohao Chen
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yixun Liu
- Department of Urology, Anhui Provincial Hospital/The First Hospital of the University of Science and Technology of China, Hefei, China
| | - Zhipeng Xu
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haifeng Wang
- Department of Urology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Jinli Gao
- Department of Pathology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Fubo Wang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
| | - Jiwen Cheng
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - He Miao
- Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Qiu Rao
- Department of Pathology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
| | - Jianning Wang
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ning Xu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhiyu Liu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dan Xia
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Jiang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhe Wang
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiaojun Zhou
- Department of Pathology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhua Zheng
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jingping Ge
- Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
| | - Xiang Feng
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
| | - Minming Li
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China.
| | - Cheng Chen
- Department of Medical Oncology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
| | - Le Qu
- Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
| |
Collapse
|
5
|
Ghoreifi A, Vaishampayan U, Yin M, Psutka SP, Djaladat H. Immune Checkpoint Inhibitor Therapy Before Nephrectomy for Locally Advanced and Metastatic Renal Cell Carcinoma: A Review. JAMA Oncol 2024; 10:240-248. [PMID: 38095885 DOI: 10.1001/jamaoncol.2023.5269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Importance The therapeutic landscape of advanced renal cell carcinoma (RCC) has rapidly evolved in the past 2 decades, with the advent of cytokines therapy followed by targeted therapies and novel immune checkpoint inhibitors (ICI). This article aims to review the current evidence and ongoing trials of neoadjuvant or prenephrectomy ICI therapy in patients with locally advanced and metastatic RCC. Observations A literature search was performed using the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and PubMed as well as relevant medical society meetings for English-language studies, articles, and abstracts published before January 31, 2023. Currently, level I evidence supports the use of ICI-based combination therapy as the first-line treatment of patients with metastatic RCC with the potential option of deferred nephrectomy in those who respond to treatment. Nevertheless, limited prospective data are available regarding the role and outcomes of nephrectomy (cytoreductive or consolidative) in conjunction with ICI therapy in both metastatic and locally advanced RCC. Although data from retrospective case series confirmed the feasibility and safety of deferred nephrectomy in this setting, the sequence of nephrectomy and whether it should be considered in patients with metastatic RCC is a common clinical dilemma. However, although neoadjuvant targeted therapy for nonmetastatic RCCs has been associated with some advantages yet not accepted as a standard, current data from a phase 3 randomized clinical trial failed to demonstrate the oncologic benefit of neoadjuvant nivolumab for locally advanced RCC. Conclusion and Relevance The findings of this review suggest that ICI-based combination therapy is the standard of care as the first-line treatment of patients with metastatic RCC. However, the role of neoadjuvant ICIs in locally advanced RCC is an active area of investigation. Deferred nephrectomy after ICI-based immunotherapy for metastatic RCC is feasible and safe yet should be performed in high-volume health centers by experienced surgeons. The multidisciplinary and careful approach is critical for treatment decisions.
Collapse
Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, Norris Cancer Center, University of Southern California, Los Angeles
| | - Ulka Vaishampayan
- Division of Hematology and Oncology, University of Michigan, Ann Arbor
| | - Ming Yin
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University College of Medicine, Columbus
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle
| | - Hooman Djaladat
- Institute of Urology, Norris Cancer Center, University of Southern California, Los Angeles
| |
Collapse
|
6
|
Hunter H, Bennington-McKay N, Sher J, Psutka SP, Lin C. Emerging Role of Mobile Applications and Wearable Devices for Prehabilitation in Urologic Oncology. Eur Urol Focus 2024; 10:20-22. [PMID: 37923631 DOI: 10.1016/j.euf.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
Treatment for urologic cancers often includes major oncologic procedures and surgeries with a risk of complications, especially in older and frail patients. The aim of prehabilitation programs is to optimize perioperative functional status in the hope of improving postoperative outcomes and preventing deconditioning. Mobile applications (mHealth) and wearable devices are being integrated into home-based prehabilitation programs. These not only encourage physical activity but also monitor health data in the perioperative period. This narrative review highlights current uses and the future role of mHealth and wearable devices for prehabilitation in patients with urologic cancers, particularly in the preoperative setting. PATIENT SUMMARY: Prehabilitation programs can help patients in preparing for surgery and improve their postoperative recovery. Mobile apps and wearable devices can play a role in home-based programs. We review the use of these tools for patients for whom surgery for a urological cancer is planned.
Collapse
Affiliation(s)
- Hanna Hunter
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
| | | | - Jessica Sher
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Cindy Lin
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; The Sports Institute at UW Medicine, Department of Neurological Surgery, Seattle, WA, USA
| |
Collapse
|
7
|
Psutka SP. Prehabilitation: A multidimensional adjunct to comprehensive personalized oncologic care. But, can we make it pragmatic? Eur Urol Focus 2024; 10:1-3. [PMID: 38365529 DOI: 10.1016/j.euf.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| |
Collapse
|
8
|
Schmeusser BN, Biermann H, Nicaise EH, Ali AA, Patil DH, Midenberg E, Helman T, Armas-Phan M, Nabavizadeh R, Joshi SS, Narayan VM, Bilen MA, Psutka SP, Ogan K, Master VA. Creatinine to Cystatin-C Ratio in Renal Cell Carcinoma: A Clinically Pragmatic Prognostic Factor and Sarcopenia Biomarker. Oncologist 2023; 28:e1219-e1229. [PMID: 37540787 PMCID: PMC10712910 DOI: 10.1093/oncolo/oyad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/07/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Low creatinine to cystatin-C ratio (Cr/Cys-C) may be a biomarker for low-muscle mass. Furthermore, low Cr/Cys-C is associated with decreased overall survival (OS), but to date, has not been examined in patients with renal cell carcinoma (RCC). Our objective is to evaluate associations between low Cr/Cys-C ratio and OS and recurrence-free survival (RFS) in patients with RCC treated with nephrectomy. METHODS We performed a retrospective review of patients with RCC treated with nephrectomy. Patients with end-stage renal disease and less than 1-year follow up were excluded. Cr/Cys-C was dichotomized at the median for the cohort (low vs. high). OS and RFS for patients with high versus low Cr/Cys-C were estimated with the Kaplan-Meier method, and associations with the outcomes of interest were modeled using Cox proportional Hazards models. Associations between Cr/Cys-C and skeletal muscle mass were assessed with correlations and logistic regression. RESULTS A total of 255 patients were analyzed, with a median age of 64. Median (IQR) Cr/Cys-C was 1 (0.8-1.2). Low Cr/Cys-C was associated with age, female sex, Eastern Cooperative Oncology Group Performance Status ≥1, TNM stage, and tumor size. Kaplan-Meier and Cox regression analysis demonstrated an association between low Cr/Cys-C and decreased OS (HR = 2.97, 95%CI, 1.12-7.90, P =0.029) and RFS (HR = 3.31, 95%CI, 1.26-8.66, P = .015). Furthermore, a low Cr/Cys-C indicated a 2-3 increase in risk of radiographic sarcopenia. CONCLUSIONS Lower Cr/Cys-C is associated with inferior oncologic outcomes in RCC and, pending validation, may have utility as a serum biomarker for the presence of sarcopenia in patients with RCC treated with nephrectomy.
Collapse
Affiliation(s)
| | - Henry Biermann
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edouard H Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adil A Ali
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric Midenberg
- Department of Urology, University of Louisville, Louisville, KY, USA
| | - Talia Helman
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Manuel Armas-Phan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
- Department of Urology, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
9
|
Kamat AM, Apolo AB, Babjuk M, Bivalacqua TJ, Black PC, Buckley R, Campbell MT, Compérat E, Efstathiou JA, Grivas P, Gupta S, Kurtz NJ, Lamm D, Lerner SP, Li R, McConkey DJ, Palou Redorta J, Powles T, Psutka SP, Shore N, Steinberg GD, Sylvester R, Witjes JA, Galsky MD. Definitions, End Points, and Clinical Trial Designs for Bladder Cancer: Recommendations From the Society for Immunotherapy of Cancer and the International Bladder Cancer Group. J Clin Oncol 2023; 41:5437-5447. [PMID: 37793077 DOI: 10.1200/jco.23.00307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/10/2023] [Accepted: 08/12/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE There is a significant unmet need for new and efficacious therapies in urothelial cancer (UC). To provide recommendations on appropriate clinical trial designs across disease settings in UC, the Society for Immunotherapy of Cancer (SITC) and the International Bladder Cancer Group (IBCG) convened a multidisciplinary, international consensus panel. METHODS Through open communication and scientific debate in small- and whole-group settings, surveying, and responses to clinical questionnaires, the consensus panel developed recommendations on optimal definitions of the disease state, end points, trial design, evaluations, sample size calculations, and pathology considerations for definitive studies in low- and intermediate-risk nonmuscle-invasive bladder cancer (NMIBC), high-risk NMIBC, muscle-invasive bladder cancer in the neoadjuvant and adjuvant settings, and metastatic UC. The expert panel also solicited input on the recommendations through presentations and public discussion during an open session at the 2021 Bladder Cancer Advocacy Network (BCAN) Think Tank (held virtually). RESULTS The consensus panel developed a set of stage-specific bladder cancer clinical trial design recommendations, which are summarized in the table that accompanies this text. CONCLUSION These recommendations developed by the SITC-IBCG Bladder Cancer Clinical Trial Design consensus panel will encourage uniformity among studies and facilitate drug development in this disease.
Collapse
Affiliation(s)
- Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrea B Apolo
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD
| | - Marek Babjuk
- Department of Urology, Teaching Hospital Motol, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Trinity J Bivalacqua
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C Black
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Roger Buckley
- Department of Urology, North York General Hospital, Toronto, Ontario, Canada
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Shilpa Gupta
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Neil J Kurtz
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | - Donald Lamm
- Patient Advocate, Bladder Cancer Advocacy Network (BCAN), Bethesda, MD
| | | | - Roger Li
- Scott Department of Urology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX
| | - David J McConkey
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL
| | - Joan Palou Redorta
- Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD
| | - Thomas Powles
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Neal Shore
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | | | | |
Collapse
|
10
|
Mertens LS, Psutka SP, Mir MC. Bladder cancer oligometastases - definition and treatment. Nat Rev Urol 2023; 20:701-702. [PMID: 37591959 DOI: 10.1038/s41585-023-00815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands.
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Maria Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| |
Collapse
|
11
|
Koehne EL, Psutka SP. Adding Stereotactic Radiation to the Multidisciplinary Armamentarium for Localized Renal Cell Carcinoma: Ready for Primetime? : An Editorial Regarding a Recent 5-Year Efficacy and Safety Report of a Multicenter Cohort of Primary RCC Patients Treated with SABR. Ann Surg Oncol 2023; 30:6947-6949. [PMID: 37335349 DOI: 10.1245/s10434-023-13755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Elizabeth L Koehne
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| |
Collapse
|
12
|
Mistry NA, Sweis J, Ofori B, McKoy JM, Langford A, Psutka SP, Perazza E, Raman JD, Murphy AB. Engaging disparities in prostate cancer: Piloting an interactive, virtual workshop to educate providers on shared decision-making for underserved populations. Urol Oncol 2023; 41:430.e1-430.e7. [PMID: 37453812 DOI: 10.1016/j.urolonc.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is an approach to patient-centered care that is strongly recommended when counseling patients for screening and treatment of prostate cancer. However, providers report lack of comfort with SDM and particularly in disparate populations. We report our experience designing and piloting an online workshop to educate practicing urologists on SDM in diverse populations. Our objective was to create a valued interactive SDM workshop to help urologists learn to lead SDM discussions with men form underserved populations. Therefore, we tested the hypothesis that urologists would agree or strongly agree that we met our learning objectives on postcourse survey. MATERIALS AND METHODS With the support of the American Urologic Association, we developed a case-based workshop with interactive role-playing to demonstrate and teach integration of SDM into clinical care. Cases were centered around screening and treatment decisions for localized prostate cancer in diverse patients. Brief surveys were used to track success with learning objectives and urologists' satisfaction with the workshop. RESULTS The session included 14 participants from 6 countries. A postworkshop survey indicated that 100% of respondents (8 of 8) "strongly agreed" that the activity met learning objectives, and 100% rated the session as "good" (1), "very good" (1), or "excellent" (6). Participants' knowledge also improved on shared decision-making concepts and the knowledge was maintained one month after the workshop. CONCLUSION We successfully created and piloted an interactive online workshop to improve urologists' comfort using shared decision-making in caring for diverse patient populations. The course met its objectives and participant feedback for the course was positive. Sharing this process and framework for development of this intervention may inform future workshops that can be applied to medical students, residents, and providers.
Collapse
Affiliation(s)
- Neil A Mistry
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jamila Sweis
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bernice Ofori
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Aisha Langford
- Department of Population Health, NYU Langone Health, New York, NY
| | - Sarah P Psutka
- Department of Urology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | - Elizabeth Perazza
- Department of Surgery, Urology Service, Veterans Administration Caribbean Healthcare System, San Juan, PR
| | - Jay D Raman
- Department of Urology, Penn State Health, Hershey, PA
| | - Adam B Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.
| |
Collapse
|
13
|
Lui A, Zeng J, Chen J, Weg ES, Ellis W, Psutka SP, Nyame YA, Yezefski T, Lin D, Schade G, Liao JJ. Proton Radiation Therapy for Stage IIA/IIB Testicular Seminoma. Int J Radiat Oncol Biol Phys 2023; 117:e411-e412. [PMID: 37785363 DOI: 10.1016/j.ijrobp.2023.06.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Testicular seminoma affects young men and is associated with very favorable prognosis. The evolution in treatment paradigm has focused on minimizing acute and especially late toxicities. Following orchiectomy, while surveillance is favored in Stage I patients, radiotherapy (RT) is a standard treatment option for de novo or relapsed stage IIA or select non-bulky stage IIB disease. Despite low doses, standard RT fields to paraaortic and pelvic lymphatics using x-rays exposes a large volume of uninvolved normal tissue/viscera to excess dose. This young patient population is especially vulnerable to risks of late RT toxicities including secondary malignancy. Proton beam therapy (PBT) has dosimetric advantage over x-ray-based RT due to lack of exit dose, and comparative dosimetric/modeling studies show significant sparing of uninvolved abdominal/pelvic organs. However, there is scant reported clinical data at this time for PBT. We review our early institutional outcomes with PBT for testicular seminoma. MATERIALS/METHODS Single institution retrospective review from a tertiary care center of patients treated with PBT from 2013-2022 for testicular seminoma. Recurrence free (RFS) and overall survival (OS) were calculated from the completion of PBT. Toxicities were graded (Gr) using CTCAE v5.0. RESULTS Four patients underwent PBT, median age 39 (range 36-47). All were Stage I at diagnosis (pT1b n = 3; pT2 n = 1) and were treated for recurrent stage II disease (IIA n = 3; IIB n = 1) at a median of 34 months from orchiectomy (range 3 - 74 months). Nodal extent included 2 with multiple paraaortic nodes, 1 with solitary paraaortic node and 1 with solitary pelvic node. PBT was delivered with pencil-beam scanning, treating paraaortic + ipsilateral pelvic fields (20 Gy in 10 fractions), then sequential boost to involved nodes (10 -16 Gy in 5-8 fractions). Typically, PA or posterior oblique fields were used to minimize dose to out-of-field abdominal/pelvic viscera. Treatment was well tolerated with minimal acute toxicities: fatigue Gr 1 (n = 3), nausea Gr 1 (n = 3). No Gr 2 or higher acute toxicities or significant late toxicities were observed. At median follow up of 30 months (range 3 - 54), no recurrences were observed, and RFS and OS were 100%. Two patients are without evidence of disease > 4 years post-treatment. CONCLUSION In this case series, PBT for retroperitoneal and pelvic metastases in Stage IIA/IIB testicular seminoma was associated with oncologic efficacy with minimal toxicity. PBT reduces unnecessary dose to abdominal/pelvic organs compared to x-ray techniques, which is advantageous in young patients who have anticipated long-term survival. This is one of the few series reporting clinical outcomes of PBT in the management of seminoma. Randomized comparisons with x-ray approaches are impractical given the relatively low volume of patients receiving RT in modern seminoma management, so it is essential to report and track longitudinal outcomes across institutions to validate this approach.
Collapse
Affiliation(s)
- A Lui
- University of Washington School of Medicine, Seattle, WA
| | - J Zeng
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - J Chen
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - E S Weg
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - W Ellis
- University of Washington, Seattle, WA
| | - S P Psutka
- University of Washington School of Medicine, Seattle, WA
| | - Y A Nyame
- University of Washington, Seattle, WA
| | | | - D Lin
- University of Washington, Seattle, WA
| | - G Schade
- University of Washington, Seattle, WA
| | - J J Liao
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| |
Collapse
|
14
|
Carson DS, Weiss T, Zhang LX, Psutka SP. Surgical Management of Localized Disease and Small Renal Masses. Hematol Oncol Clin North Am 2023; 37:877-892. [PMID: 37330345 DOI: 10.1016/j.hoc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The incidence of renal cancer has increased over the past several decades, but mortality has declined. This is thought to be related in part to earlier detection of renal masses which portend excellent 5-year survival rates. Management of small renal masses and localized disease include both nonsurgical and surgical options. The choice of intervention is ultimately based on comprehensive evaluation and shared decision-making. This article provides a comprehensive review of the current surgical management options for localized renal cancer.
Collapse
Affiliation(s)
- Daniel S Carson
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Tova Weiss
- Department of Urology, University of Washington, Seattle, WA, USA
| | | | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Harborview Medical Center, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195, USA.
| |
Collapse
|
15
|
Sekar RR, Diamantopoulos LN, Bakaloudi DR, Khaki AR, Grivas P, Winters BR, Vakar-Lopez F, Tretiakova MS, Psutka SP, Holt SK, Gore JL, Lin DW, Schade GR, Hsieh AC, Lee JK, Yezefski T, Schweizer MT, Cheng HH, Yu EY, True LD, Montgomery RB, Wright JL. Sarcomatoid Urothelial Carcinoma Is Associated With Limited Response to Neoadjuvant Chemotherapy and Poor Oncologic Outcomes After Radical Cystectomy. Clin Genitourin Cancer 2023; 21:507.e1-507.e14. [PMID: 37150667 PMCID: PMC10621753 DOI: 10.1016/j.clgc.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION To examine oncologic outcomes and response to neoadjuvant chemotherapy (NAC) in patients with sarcomatoid urothelial carcinoma (SUC) treated with radical cystectomy (RC). MATERIALS AND METHODS We retrospectively queried our institutional database (2003-18) and Surveillance, Epidemiology, and End Results (SEER)-Medicare (2004-2015) for patients with cT2-4, N0-2, M0 SUC and conventional UC (CUC) treated with RC. Clinicopathologic characteristics were described using descriptive statistics (t test, χ2-test and log-rank-test for group comparison). Overall (OS) and recurrence-free-survival (RFS) after RC were estimated with the Kaplan Meier method and associations with OS were evaluated with Cox proportional hazards models. RESULTS We identified 38 patients with SUC and 287 patients with CUC in our database, and 190 patients with SUC in SEER-Medicare. In the institutional cohort, patients with SUC versus CUC had higher rates of pT3/4 stage (66% vs. 35%, P < 0.001), lower rates of ypT0N0 (6% vs. 35%, P = .02), and worse median OS (17.5 vs. 120 months, P < .001). Further, patients with SUC in the institutional versus SEER-Medicare cohort had similar median OS (17.5 vs. 21 months). In both cohorts, OS was comparable between patients with SUC undergoing NAC+RC vs. RC alone (17.5 vs. 18.4 months, P = .98, institutional cohort; 24 vs. 20 months, P = .56, SEER cohort). In Cox proportional hazards models for the institutional RC cohort, SUC was independently associated with worse OS (HR 2.3, CI 1.4-3.8, P = .001). CONCLUSION SUC demonstrates poor pathologic response to NAC and worse OS compared with CUC, with no OS benefit associated with NAC. A unique pattern of rapid abdominopelvic cystic recurrence was identified.
Collapse
Affiliation(s)
- Rishi R Sekar
- Department of Urology, University of Michigan, Ann Arbor, MI.
| | | | - Dimitra R Bakaloudi
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Ali R Khaki
- Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Brian R Winters
- Department of Urology, Kaiser Permanente Washington, Bellevue, Washington
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Maria S Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Sarah P Psutka
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - John L Gore
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - George R Schade
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Andrew C Hsieh
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - John K Lee
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Todd Yezefski
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Lawrence D True
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - R Bruce Montgomery
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Jonathan L Wright
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
16
|
Kwok C, Khorasanchi A, Psutka SP, Hinkley M, Dason S, Sundi D, Yang Y, Yang Y, Verschraegen C, Gross EE, Orcutt D, Yin M. Salvage lenvatinib/everolimus combination therapy after immune checkpoint inhibitor and VEGFR tyrosine kinase inhibitor for metastatic renal cell carcinoma. Front Oncol 2023; 13:1231831. [PMID: 37576889 PMCID: PMC10412983 DOI: 10.3389/fonc.2023.1231831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background The optimal treatment for metastatic renal cell carcinoma (mRCC) patients who have progressed after both immune checkpoint inhibitor (ICI) and VEGFR tyrosine kinase inhibitor (TKI) remains uncertain. Lenvatinib and everolimus (LE) are frequently used in combination as salvage therapy because of their different antitumor mechanisms, but efficacy and toxicity data in this setting are lacking. Methods We retrospectively reviewed charts from two academic centers for 71 adult mRCC patients who received LE after prior ICI and TKI exposure. We evaluated patient demographics, histology, International mRCC Database Consortium (IMDC) risk group, treatment history, and toxicity details. Outcomes of interest included objective response rate (ORR), time to treatment failure (TTF), overall survival (OS), ≥grade 3 toxicities, and schedule or dosage changes, which were evaluated using descriptive statistics, chi-square test, Cox proportional hazards model, and the Kaplan-Meier method. Results The median age was 64 (range 31-84). Most patients had clear cell histology (84.5%) and had undergone nephrectomy (80.3%). IMDC risks were favorable (19.7%), intermediate (int) (66.2%), poor (11.3%), and unknown (2.8%). The average ORR was 26.8%, while the median TTF was 5.5 months (95% confidence interval [CI], 3.5-7.6) and the median OS was 9 months (95% CI, 7.6-12.9). Intermediate and poor IMDC risks were independently associated with a significantly worse TTF compared to favorable risk (hazard ratio (HR), 3.03, 95% CI, 1.18-7.79), as was ≥4L treatment vs. 2L/3L treatment (HR, 2.02, 95% CI, 1.08-3.8). Of the 71 patients, 57.7% had ≥grade 3 adverse events, 60% had treatment interruption, 44.3% had dose reduction, and 21% stopped treatment due to intolerance. Conclusions LE therapy is feasible but has modest efficacies following ICI/TKI treatment. Patients with favorable risk or treated earlier may have a better treatment response. These observations need to be confirmed in prospective studies.
Collapse
Affiliation(s)
- Christopher Kwok
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Adam Khorasanchi
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Sarah P. Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Megan Hinkley
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Shawn Dason
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Debasish Sundi
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Yuanquan Yang
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Yajing Yang
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Claire Verschraegen
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Evan E. Gross
- The University of Washington School of Medicine, Seattle, WA, United States
| | - Delaney Orcutt
- The University of Washington School of Medicine, Seattle, WA, United States
| | - Ming Yin
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| |
Collapse
|
17
|
Barbour AB, Kirste S, Grosu AL, Siva S, Louie AV, Onishi H, Swaminath A, Teh BS, Psutka SP, Weg ES, Chen JJ, Zeng J, Gore JL, Hall E, Liao JJ, Correa RJM, Lo SS. The Judicious Use of Stereotactic Ablative Radiotherapy in the Primary Management of Localized Renal Cell Carcinoma. Cancers (Basel) 2023; 15:3672. [PMID: 37509333 PMCID: PMC10377531 DOI: 10.3390/cancers15143672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Localized renal cell carcinoma is primarily managed surgically, but this disease commonly presents in highly comorbid patients who are poor operative candidates. Less invasive techniques, such as cryoablation and radiofrequency ablation, are effective, but require percutaneous or laparoscopic access, while generally being limited to cT1a tumors without proximity to the renal pelvis or ureter. Active surveillance is another management option for small renal masses, but many patients desire treatment or are poor candidates for active surveillance. For poor surgical candidates, a growing body of evidence supports stereotactic ablative radiotherapy (SABR) as a safe and effective non-invasive treatment modality. For example, a recent multi-institution individual patient data meta-analysis of 190 patients managed with SABR estimated a 5.5% five-year cumulative incidence of local failure with one patient experiencing grade 4 toxicity, and no other grade ≥3 toxic events. Here, we discuss the recent developments in SABR for the management of localized renal cell carcinoma, highlighting key concepts of appropriate patient selection, treatment design, treatment delivery, and response assessment.
Collapse
Affiliation(s)
- Andrew B Barbour
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, 79085 Freiburg, Germany
| | - Anca-Liga Grosu
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, 79085 Freiburg, Germany
| | - Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Center, University of Melbourne, Parkville, VIC 3052, Australia
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Hiroshi Onishi
- Department of Radiology, School of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Anand Swaminath
- Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Bin S Teh
- Department of Radiation Oncology, Cancer Center and Research Institute, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Emily S Weg
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Jonathan J Chen
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - John L Gore
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Evan Hall
- Department of Medical Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Jay J Liao
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Rohann J M Correa
- Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| |
Collapse
|
18
|
Coleman JA, Clark PE, Bixler BR, Buckley DI, Chang SS, Chou R, Hoffman-Censits J, Kulkarni GS, Matin SF, Pierorazio PM, Potretzke AM, Psutka SP, Raman JD, Smith AB, Smith L. Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline. J Urol 2023; 209:1071-1081. [PMID: 37096584 DOI: 10.1097/ju.0000000000003480] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE The purpose of this guideline is to provide a useful reference on the effective evidence-based diagnoses and management of non-metastatic upper tract urothelial carcinoma (UTUC). MATERIALS/METHODS The Pacific Northwest Evidence-based Practice Center of Oregon Health & Science University (OHSU) team conducted searches in Ovid MEDLINE (1946 to March 3rd, 2022), Cochrane Central Register of Controlled Trials (through January 2022), and Cochrane Database of Systematic Reviews (through January 2022). The searches were updated August 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (Table 1).[Table: see text]Results:This Guideline provides updated, evidence-based recommendations regarding diagnosis and management of non-metastatic UTUC including risk stratification, surveillance and survivorship. Treatments discussed include kidney sparing management, surgical management, lymph node dissection (LND), neoadjuvant/adjuvant chemotherapy and immunotherapy. CONCLUSION This standardized guideline seeks to improve clinicians' ability to evaluate and treat patients with UTUC based on available evidence. Future studies will be essential to further support these statements for improving patient care. Updates will occur as the knowledge regarding disease biology, clinical behavior and new therapeutic options develop.
Collapse
Affiliation(s)
| | - Peter E Clark
- Department of Urology, Atrium Health, Charlotte, North Carolina
| | | | - David I Buckley
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Sam S Chang
- Department of Urology, Vanderbilt Health, Nashville, Tennessee
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | | | - Girish S Kulkarni
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, Texas
| | | | | | - Sarah P Psutka
- Department of Urology, University of Washington Medicine, Seattle, Washington
| | - Jay D Raman
- Division of Urology, Penn State Health, Hershey, Pennsylvania
| | - Angela B Smith
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | |
Collapse
|
19
|
Schmeusser BN, Midenberg E, Palacios AR, Ali AA, Patil DH, Higgins M, Nabavizadeh R, Croll B, Williams M, Sheehy J, Zheng B, Narayan VM, Joshi SS, Ogan K, Psutka SP, Bilen MA, Master VA. Low Skeletal Muscle as a Risk Factor for Worse Survival in Nonmetastatic Renal Cell Carcinoma with Venous Tumor Thrombus. Clin Genitourin Cancer 2023:S1558-7673(23)00092-7. [PMID: 37210313 DOI: 10.1016/j.clgc.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) with tumor thrombosis often requires nephrectomy and tumor thrombectomy. As an extensive and potentially morbid operation, patient preoperative functional reserve and body composition is an important consideration. Sarcopenia is a risk factor for increased postoperative complications, systemic therapy toxicity, and death solid organ tumors, including RCC. The influence of sarcopenia in RCC patients with tumor thrombus is not well defined. This study evaluates the prognostic ability of sarcopenia regarding surgical outcomes and complications in patients undergoing surgery for RCC with tumor thrombus. METHODS We retrospectively analyzed patients with nonmetastatic RCC and tumor thrombus undergoing radical nephrectomy and tumor thrombectomy. Skeletal muscle index (SMI; cm2/m2) was measured on preoperative CT/MRI. Sarcopenia was defined using body mass index- and sex-stratified thresholds optimally fit via a receiver-operating characteristic analysis for survival. Associations between preoperative sarcopenia and overall (OS), cancer-specific survival (CSS), and 90-day major complications were determined using multivariable analysis. RESULTS 115 patients were analyzed, with median (IQR) age and body mass index of 69 (56-72) and 28.6 kg/m2 (23.6-32.9), respectively. 96 (83.4%) of the cohort had ccRCC. Sarcopenia was associated with shorter median OS (P = .0017) and CSS (P = .0019) in Kaplan-Meier analysis. In multivariable analysis, preoperative sarcopenia was prognostic of shorter OS (HR = 3.38, 95% confidence interval [CI] 1.61-7.09) and CSS (HR = 5.15, 95% CI 1.46-18.18). Notably, 1 unit increases in SMI were associated with improved OS (HR = 0.97, 95% CI 0.94-0.999) but not CSS (HR = 0.95, 95% CI 0.90-1.01). No significant relationship between preoperative sarcopenia and 90-day major surgical complications was observed in this cohort (HR = 2.04, 95% CI 0.65-6.42). CONCLUSION Preoperative sarcopenia was associated with decreased OS and CSS in patients surgically managed for nonmetastatic RCC and VTT, however, was not predictive of 90-day major postoperative complications. Body composition analysis has prognostic utility for patients with nonmetastatic RCC and venous tumor thrombus undergoing surgery.
Collapse
Affiliation(s)
| | - Eric Midenberg
- Department of Urology, University of Louisville School of Medicine, Louisville, KY
| | - Arnold R Palacios
- Department of Urology, Creighton University School of Medicine, Omaha, NE
| | - Adil A Ali
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Michelle Higgins
- Department of Urology, Emory University School of Medicine, Atlanta, GA; The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Benjamin Croll
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Milton Williams
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - John Sheehy
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Bill Zheng
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Vikram M Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Shreyas S Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
| |
Collapse
|
20
|
Schmeusser BN, Ali AA, Fintelmann FJ, Garcia JM, Williams GR, Master VA, Psutka SP. Imaging Techniques to Determine Degree of Sarcopenia and Systemic Inflammation in Advanced Renal Cell Carcinoma. Curr Urol Rep 2023:10.1007/s11934-023-01157-6. [PMID: 37036632 DOI: 10.1007/s11934-023-01157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an up-to-date understanding regarding the literature on sarcopenia and inflammation as prognostic factors in the context of renal cell carcinoma (RCC). RECENT FINDINGS Sarcopenia is increasingly recognized as a prognostic factor in RCC. Emerging literature suggests monitoring quantity of muscle on successive imaging and examining muscle density may be additionally informative. Inflammation has prognostic ability in RCC and is also considered a key contributor to development and progression of both RCC and sarcopenia. Recent studies suggest these two prognostic factors together may provide additional prognostic ability when used in combination. Ongoing developments include quality control regarding sarcopenia research and imaging, improving understanding of muscle loss mechanisms, and enhancing clinical incorporation of sarcopenia via improving imaging analysis practicality (i.e., artificial intelligence) and feasible biomarkers. Sarcopenia and systemic inflammation are complementary prognostic factors for adverse outcomes in patients with RCC. Further study on high-quality sarcopenia assessment standardization and expedited sarcopenia assessment is desired for eventual routine clinical incorporation of these prognostic factors.
Collapse
Affiliation(s)
- Benjamin N Schmeusser
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite 1400, Atlanta, GA, 30322, USA
| | - Adil A Ali
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite 1400, Atlanta, GA, 30322, USA
| | | | - Jose M Garcia
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Alabama, USA
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite 1400, Atlanta, GA, 30322, USA.
- Winship Cancer Institute, Emory University, Atlanta, GA, USA.
| | - Sarah P Psutka
- Department of Urology, University of Washington, 1959 NE Pacific Stree, Box 356510, Seattle, WA, 98195, USA.
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA.
| |
Collapse
|
21
|
Bergerot CD, Malhotra J, Bergerot P, Philip EJ, Castro DV, Hsu J, Mota ACDA, Cardoso de Azeredo A, Neto JNDM, Hutson T, Grünwald V, Bex A, Psutka SP, Rini B, Plimack ER, Master V, Albiges L, Choueiri TK, Pal S, Powles T. Patients' Perceptions Regarding the Relevance of Items Contained in the Functional Assessment of Cancer Therapy Kidney Symptom Index-19. Oncologist 2023:7077455. [PMID: 36917626 DOI: 10.1093/oncolo/oyad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND There is a lack of consensus regarding the optimal method of assessing health-related quality of life (HR-QOL) among patients with metastatic renal cell carcinoma (mRCC). This study explored the perceived relevance of items that make up the Functional Assessment of Cancer Therapy Kidney Symptom Index-19 (FKSI-19), as judged by patients with mRCC. METHODS This was a multinational cross-sectional survey. Eligible patients responded to a questionnaire composed of 18 items that assessed the perceived relevance of each item in the FKSI-19 questionnaire. Open-ended questions assessed additional issues deemed relevant by patients. Responses were grouped as relevant (scores 2-5) or nonrelevant (score 1). Descriptive statistics were collated, and open-ended questions were analyzed and categorized into descriptive categories. Spearman correlation statistics were used to test the association between relevance and clinical characteristics. RESULTS A total of 151 patients were included (gender: 78.1 M, 21.9F; median age: 64; treatment: 38.4 immunotherapy, 29.8 targeted therapy, 13.9 immuno-TKI combination therapy) in the study. The most relevant questions evaluated fatigue (77.5), lack of energy (72.2), and worry that their condition will get worse (71.5). Most patients rated blood in urine (15.2), fevers (16.6), and lack of appetite (23.2) as least relevant. Qualitative analysis of open-ended questions revealed several themes, including emotional and physical symptoms, ability to live independently, effectiveness of treatment, family, spirituality, and financial toxicity. CONCLUSION There is a need to refine widely used HR-QOL measures that are employed among patients diagnosed with mRCC treated with contemporary therapies. Guidance was provided for the inclusion of more relevant items to patients' cancer journey.
Collapse
Affiliation(s)
| | - Jasnoor Malhotra
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Paulo Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasília, DF, Brazil
| | - Errol J Philip
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniela V Castro
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | | | | | - Thomas Hutson
- Urologic Oncology Program, Texas Oncology at Baylor Sammons Cancer Center, Dallas, TX, USA
| | - Viktor Grünwald
- Clinic for Medical Oncology, Clinic for Urology, University Hospital Essen, Essen, Alemanha, Germany
| | - Axel Bex
- UCL Division of Surgical and Interventional Science, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sarah P Psutka
- Urology Clinic, University of Washington, Seattle, WA, USA
| | - Brian Rini
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Elizabeth R Plimack
- Department of Hematology/Oncology and Chief, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Viraj Master
- Department of Urology, Emory University Hospital, Atlanta, GA, USA
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy Institute, Paris, France
| | - Toni K Choueiri
- Lank Center for Genitourinary (GU) Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sumanta Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Thomas Powles
- Barts Cancer Centre, Barts Cancer Centre at St. Bartholomew's Hospital, London, UK
| |
Collapse
|
22
|
Yoo JH, Hussey D, Gross E, Psutka SP, Tykodi SS, Thompson JA, Hall ET. Clinical outcomes of patients with metastatic renal cell carcinoma who discontinued nivolumab +/- ipilimumab therapy electively or due to toxicity. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
625 Background: Immune checkpoint inhibitor (ICI) based regimens are the standard of care for patients with metastatic renal cell carcinoma (mRCC). In other tumor types such as melanoma, there is evidence that cancer control can persist long after discontinuation of ICI therapy. Outcomes after ICI discontinuation for mRCC are less characterized. Our aim is to characterize the durability of treatment response in mRCC patients who discontinued ICI therapy electively or due to toxicity. Methods: We identified patients with mRCC who responded to nivolumab +/- ipilimumab and then discontinued ICI therapy either for elective reasons or due to toxicity. Patients who discontinued therapy due to progressive disease or who died within 3 months of their last ICI dose were excluded. Complete response (CR) duration was calculated from last ICI dose to the most recent documentation of CR status. Time to progression was defined as the time from last ICI dose to documentation of disease progression or initiation of next-line therapy. Durability of treatment response was calculated from the date of last ICI dose to the most recent follow up date at which sustained response was noted. Results: We identified a total of 56 patients treated with nivolumab +/- ipilimumab therapy who discontinued treatment for toxicity (n=30) or for elective reasons (n=26) and achieved CR or partial response/stable disease (PR/SD). Of the entire cohort, 19 patients (34%) achieved CR, and the majority (95%) were still alive and disease-free with a median follow up of 906 days (range 86-2143 days). Among all patients who discontinued treatment with best response of PR/SD, 49% experienced disease progression, with a median progression-free survival of 382 days (range 77-1267). 42% of patients who stopped ICI electively achieved CR and all (100%) were still alive with sustained CR (median follow-up = 735 days) at data collection. Among those with best response of PR/SD after elective discontinuation, about half (53%) maintained disease control while the rest had disease progression or death (47%). Conclusions: Patients with mRCC who achieve CR with nivolumab +/- ipilimumab and then subsequently discontinue therapy for reasons other than disease progression have excellent long-term cancer outcomes. Recurrence and subsequent progression are rare in this group. These results are similar to the durability of ICI treatment response observed in complete responders in melanoma. Outcomes were less favorable for patients who obtained PR/SD as best response prior to ICI discontinuation, although some patients had ongoing and durable cancer control for up to several years. More research is indicated to ascertain which disease/patient features predict long-term disease control after ICI discontinuation in patients who respond favorably to ICI therapy.
Collapse
Affiliation(s)
| | - Duncan Hussey
- University of Washington Department of Medicine, Seattle, WA
| | - Evan Gross
- University of Washington School of Medicine, Seattle, WA
| | - Sarah P. Psutka
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Scott S. Tykodi
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John A. Thompson
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Evan Thomas Hall
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| |
Collapse
|
23
|
Schmeusser B, Midenberg E, Palacios AR, Vettikattu N, Patil DH, Nabavizadeh R, Medline A, Higgins M, Psutka SP, Ogan K, Master VA. Prognostic utility of linear segmentation in nonmetastatic renal cell carcinoma: Correlation of overall survival with muscle mass. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
617 Background: In renal cell carcinoma (RCC) and other solid organ malignancies, sarcopenia has been associated with decreased survival and increased perioperative complications. Traditional body composition analysis is an expensive and time extensive process. As a modifiable risk factor, more clinic friendly methods to identify patients with low muscle composition is of interest. Linear segmentation on routine imaging has been proposed as a fast, reliable and reproducible alternative. This study assesses the prognostic ability of linear segmentation in patients with nonmetastatic RCC. Methods: Patients that underwent nephrectomy for nonmetastatic RCC from 2005-2021 at an academic referral center were identified. Linear segmentation of the bilateral psoas/paraspinal muscles was completed on preoperative imaging obtained within 60 days of surgery. Cox proportional-hazards analysis was used to determine association between total muscle index and overall survival. Results: 532 (388 clear cell) patients were analyzed and a median total muscle index was 28.6 (25.8-32.5) for women and 33.3 (29.1-36.9) for men. As a binary variable, lower total muscle index was significantly associated with decreased survival in both the full (HR=1.96, 95% CI 1.32-2.90, p<0.001) and clear cell only cohorts (HR=1.78, 95% CI 1.08-2.75, p=0.022). As a continuous variable, unit increases in total muscle index were significantly associated with improved survival in the full cohort (HR=0.95, 95% CI 0.92-0.99, p=0.006) and the clear cell only cohort (HR=0.95, 95% CI 0.92-0.99, p=0.016). Conclusions: Assessment of muscle composition via linear segmentation on routinely obtained preoperative imaging is a clinically feasible technique with prognostic utility in patients with localized RCC. In this cohort of patients with nonmetastatic RCC, linear segmentation demonstrated significant associations with overall survival as a binary and continuous variable. This simplified technique may allow for routine inclusion of body composition into clinical decision making. [Table: see text]
Collapse
Affiliation(s)
| | - Eric Midenberg
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Michelle Higgins
- Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD
| | - Sarah P. Psutka
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | |
Collapse
|
24
|
Psutka SP, Cutie C, Bhanvadia SK, Keegan KA, Crist W, Tian SK, Maffeo J, Raybold B, Kashmer M, Hasan M, Li X, Beeharry N, Thomas S, Tian H, Powles T. SunRISe-4: TAR-200 plus cetrelimab or cetrelimab alone as neoadjuvant therapy in patients with muscle-invasive bladder cancer (MIBC) who are ineligible for or refuse neoadjuvant platinum-based chemotherapy. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.tps584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
TPS584 Background: Standard of care for patients (pts) with MIBC is radical cystectomy (RC) with neoadjuvant systemic platinum-based chemotherapy (PBC); however, systemic chemotherapy is associated with significant toxicity. TAR-200 is an intravesical drug delivery system that provides local continuous gemcitabine release within the bladder. SunRISe-4 (NCT04919512) is an open-label, multicenter, randomized phase 2 study designed to assess the efficacy and safety of neoadjuvant TAR-200 + systemic cetrelimab (CET [anti–programmed death-1 antibody]) vs neoadjuvant CET alone in pts with MIBC scheduled for RC who are ineligible for or refuse neoadjuvant PBC. Methods: Eligibility criteria: age ≥18 years, Eastern Cooperative Oncology Group performance status of 0 or 1, histologically confirmed cT2-T4a MIBC with absence of nodal or metastatic disease at screening, and residual intravesical tumor volume of ≤3 cm prior to randomization. Pts will be stratified by completeness of transurethral resection of bladder tumor (TURBT; visibly complete vs incomplete and ≤3 cm) and tumor stage (cT2 vs cT3-4a) at initial diagnosis. Pts (N≈160) will be randomized 5:3 to receive TAR-200 + CET (Cohort 1, n≈100) or CET alone (Cohort 2, n≈60). In Cohort 1, TAR-200 (225 mg gemcitabine) will be placed intravesically at the initial treatment visit; TAR-200 will be removed and replaced over a 12-week period. In both cohorts, CET will be serially dosed intravenously over the same timeframe. Primary disease assessments include axial imaging (at screening and Week 6), centralized review of TURBT (initial diagnostic TURBT or debulking TURBT for pts with lesions >3 cm after initial TURBT) as well as RC and nodal tissue specimens. After RC, all pts will have follow-up visits from Weeks 4 to 108 post RC (end of study). The primary outcome measure is the pathologic complete response rate at time of RC. Secondary outcome measures include safety, tolerability, and recurrence-free survival (per Response Evaluation Criteria in Solid Tumors 1.1 or histologic evidence). Exploratory outcome measures include patient-reported cancer-related quality of life (Functional Assessment of Cancer Therapy–Bladder questionnaire) and pathologic overall response rate at RC. Overall survival and time to symptomatic progression, pharmacokinetics, biomarker analysis, and immunogenicity will also be evaluated. As of September 12, 2022, 2 of 160 planned pts have been enrolled and randomized, and recruitment is ongoing at ≈95 sites. Clinical trial information: NCT04919512 .
Collapse
Affiliation(s)
- Sarah P. Psutka
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | | | - Wendy Crist
- Janssen Research & Development, Spring House, PA
| | | | - John Maffeo
- Janssen Research & Development, Lexington, MA
| | | | | | | | - Xiang Li
- Janssen Research & Development, Spring House, PA
| | | | - Shibu Thomas
- Janssen Research & Development, Spring House, PA
| | - Hui Tian
- Janssen Research & Development, Spring House, PA
| | - Thomas Powles
- Barts Cancer Centre, London, UK; The Royal Free London NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
25
|
Garg H, Mansour AM, Psutka SP, Kim SP, Porter J, Gaspard CS, Dursun F, Pruthi DK, Wang H, Kaushik D. Robotic retroperitoneal lymph node dissection: A systematic review and meta-analysis of perioperative outcomes. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
420 Background: Retroperitoneal lymph node dissection (RPLND) forms an integral part of the management of testis cancer. Robotic RPLND (R-RPLND) is a minimally invasive treatment option for this disease. This systematic review assessed the safety and feasibility of R-RPLND and compared the perioperative outcomes of R-RPLND with open RPLND (O-RPLND). Methods: The PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND. Results: The search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4,224 patients (single-arm studies, n=461; comparative studies, n=3,763). Of 461 patients in the single-arm studies, 271 underwent primary R-RPLND and 190 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175-540 minutes and the major complication rate was 3.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134-550 min and the major complication rate was 8.4%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 8.9% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, p=0.0001) and a lower complication rate (18.5% vs 7.8%, p=0.002; Table). Conclusions: R-RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated. [Table: see text]
Collapse
Affiliation(s)
| | | | - Sarah P. Psutka
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Garg H, Mansour AM, Psutka SP, Kim SP, Porter J, Gaspard CS, Dursun F, Pruthi DK, Wang H, Kaushik D. Robot-assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes. BJU Int 2023. [PMID: 36754376 DOI: 10.1111/bju.15986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open RPLND (O-RPLND), as RPLND forms an integral part of the management of testis cancer and R-RPLND is a minimally invasive treatment option for this disease. MATERIALS AND METHODS The PubMed® , Scopus® , Cochrane Central Register of Controlled Trials, and Web of Science™ databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND. RESULTS The search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4222 patients (single-arm studies, n = 459; comparative studies, n = 3763). Of 459 patients in the single-arm studies, 271 underwent primary R-RPLND and 188 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175 to 540 min and the major complication rate was 4.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134 to 550 min and the major complication rate was 8.5%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 9.0% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, P < 0.001) and a lower complication rate (18.5% vs 7.8%, P = 0.002). CONCLUSION Robot-assisted RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated.
Collapse
Affiliation(s)
- Harshit Garg
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Simon P Kim
- Division of Urology, University of Colorado-Denver, Denver, CO, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, WA, USA
| | | | - Furkan Dursun
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Deepak K Pruthi
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| |
Collapse
|
27
|
Antonelli L, Sebro K, Lahmar A, Black PC, Ghodoussipour S, Hamilton-Reeves JM, Shah J, Bente Thoft J, Lerner SP, Llorente C, Lucca I, Preston MA, Psutka SP, Sfakianos JP, Vahr Lauridsen S, Williams SB, Catto J, Djaladat H, Kassouf W, Loftus K, Daneshmand S, Fankhauser CD. Association Between Antibiotic Prophylaxis Before Cystectomy or Stent Removal and Infection Complications: A Systematic Review. Eur Urol Focus 2023:S2405-4569(23)00028-7. [PMID: 36710211 DOI: 10.1016/j.euf.2023.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/24/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
CONTEXT Patients undergoing radical cystectomy frequently suffer from infectious complications, including urinary tract infections (UTIs) and surgical site infections (SSIs) leading to emergency department visits, hospital readmission, and added cost. OBJECTIVE To summarize the literature regarding perioperative antibiotic prophylaxis, ureteric stent usage, and prevalence of infectious complications after cystectomy. EVIDENCE ACQUISITION A systematic review of PubMed/Medline, EMBASE, Cochrane Library, and reference lists was conducted. EVIDENCE SYNTHESIS We identified 20 reports including a total of 55 306 patients. The median rates of any infection, UTIs, SSIs, and bacteremia were 40%, 20%, 11%, and 6%, respectively. Perioperative antibiotic prophylaxis differed substantially between reports. Perioperative antibiotics were used only during surgery in one study but were continued over several days after surgery in all other studies. Empirical use of antibiotics for 1-3 d after surgery was described in 12 studies, 3-10 d in two studies, and >10 d in four studies. Time to stent removal ranged from 4 to 25 d after cystectomy. Prophylactic antibiotics were used before stent removal in nine of 20 studies; two of these studies used targeted antibiotics based on urine cultures from the ureteric stents, and the other seven studies used a single shot or 2 d of empirical antibiotics. Studies with any prophylactic antibiotic before stent removal found a lower median percentage of positive blood cultures after stent removal than studies without prophylactic antibiotics before stent removal (2% vs 9%). CONCLUSIONS We confirmed a high proportion of infectious complications after cystectomy, and a heterogeneous pattern of choice and duration of antibiotics during and after surgery or stent removal. These findings highlight a need for further studies and support quality prospective trials. PATIENT SUMMARY In this review, we observed wide variability in the use of antibiotics before or after surgical removal of the bladder.
Collapse
Affiliation(s)
- Luca Antonelli
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland; Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Kirby Sebro
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Abdelilah Lahmar
- Medicine, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Peter C Black
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Jay Shah
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Seth Paul Lerner
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Carlos Llorente
- Department of Urology and Research Unit, Hospital Universitario Fundación Alcorcon, Alcorcón, Madrid, Spain
| | - Ilaria Lucca
- Department of Urology, CHUV, Lausanne, Switzerland
| | - Mark A Preston
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark; WHO-CC, Parker Institute Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
| | - Stephen B Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Hooman Djaladat
- Institute of Urology, Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Wassim Kassouf
- Department of Surgery (Urology), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Katherine Loftus
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY, USA
| | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christian D Fankhauser
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland.
| |
Collapse
|
28
|
Gross EE, Li M, Yin M, Orcutt D, Hussey D, Trott E, Holt SK, Dwyer ER, Kramer J, Oliva K, Gore JL, Schade GR, Lin DW, Tykodi SS, Hall ET, Thompson JA, Parikh A, Yang Y, Collier KA, Miah A, Mori-Vogt S, Hinkley M, Mortazavi A, Monk P, Folefac E, Clinton SK, Psutka SP. A multicenter study assessing survival in patients with metastatic renal cell carcinoma receiving immune checkpoint inhibitor therapy with and without cytoreductive nephrectomy. Urol Oncol 2023; 41:51.e25-51.e31. [PMID: 36441070 PMCID: PMC10938342 DOI: 10.1016/j.urolonc.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/01/2022] [Accepted: 08/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cytoreductive nephrectomy (CN) for the treatment of metastatic renal cell carcinoma (mRCC) was called into question following the publication of the CARMENA trial. While previous retrospective studies have supported CN alongside targeted therapies, there is minimal research establishing its role in conjunction with immune checkpoint inhibitor (ICI) therapy. OBJECTIVE To evaluate the association between CN and oncological outcomes in patients with mRCC treated with immunotherapy. MATERIALS AND METHODS A multicenter retrospective cohort study of patients diagnosed with mRCC between 2000 and 2020 who were treated at the Seattle Cancer Care Alliance and The Ohio State University and who were treated with ICI systemic therapy (ST) at any point in their disease course. Overall survival (OS) was estimated using Kaplan Meier analyses. Multivariable Cox proportional hazards models evaluated associations with mortality. RESULTS The study cohort consisted of 367 patients (CN+ST n = 232, ST alone n = 135). Among patients undergoing CN, 30 were deferred. Median survivor follow-up was 28.4 months. ICI therapy was first-line in 28.1%, second-line in 17.4%, and third or subsequent line (3L+) in 54.5% of patients. Overall, patients who underwent CN+ST had longer median OS (56.3 months IQR 50.2-79.8) compared to the ST alone group (19.1 months IQR 12.8-23.8). Multivariable analyses demonstrated a 67% reduction in risk of all-cause mortality in patients who received CN+ST vs. ST alone (P < 0.0001). Similar results were noted when first-line ICI therapy recipients were examined as a subgroup. Upfront and deferred CN did not demonstrate significant differences in OS. CONCLUSIONS CN was independently associated with longer OS in patients with mRCC treated with ICI in any line of therapy. Our data support consideration of CN in well selected patients with mRCC undergoing treatment with ICI.
Collapse
Affiliation(s)
- Evan E Gross
- The University of Washington School of Medicine, Seattle, WA
| | - Mingjia Li
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital Columbus, OH
| | - Ming Yin
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Delaney Orcutt
- The University of Washington School of Medicine, Seattle, WA
| | - Duncan Hussey
- The University of Washington School of Medicine, Seattle, WA
| | - Elliot Trott
- The University of Washington School of Medicine, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Erin R Dwyer
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Joel Kramer
- The University of Washington School of Medicine, Seattle, WA
| | - Kaylee Oliva
- The University of Washington School of Medicine, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - George R Schade
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Scott S Tykodi
- Department of Medicine, Division of Medical Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evan T Hall
- Department of Medicine, Division of Medical Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John A Thompson
- Department of Medicine, Division of Medical Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Anish Parikh
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital Columbus, OH
| | - Yuanquan Yang
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital Columbus, OH
| | - Katharine A Collier
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Abdul Miah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Sherry Mori-Vogt
- Department of Pharmacy, The Ohio State University James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | - Megan Hinkley
- Department of Pharmacy, The Ohio State University James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | - Amir Mortazavi
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Paul Monk
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital Columbus, OH
| | - Edmund Folefac
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Steven K Clinton
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA.
| |
Collapse
|
29
|
Midenberg E, Higgins MI, Schmeusser BN, Patil DH, Zaldumbide J, Martini DJ, Steele S, Williams M, Nabavizadeh R, Psutka SP, Ogan K, Bilen MA, Master VA. Prognostic Value of Sarcopenia and Albumin in the Surgical Management of Localized Renal Cell Carcinoma. Urol Oncol 2023; 41:50.e19-50.e26. [PMID: 36280529 DOI: 10.1016/j.urolonc.2022.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/27/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION A universally accepted model for preoperative surgical risk stratification in localized RCC patients undergoing nephrectomy is currently lacking. Both the evaluation of body composition and nutritional status has demonstrated prognostic value for patients with cancer. This study aims to investigate the potential associations between sarcopenia and hypoalbuminemia and survival outcomes in patients with localized kidney cancer treated with partial or radical nephrectomy. MATERIALS AND METHODS We retrospectively analyzed 473 patients with localized RCC managed with radical and partial nephrectomy. Skeletal muscle index (SMI) was measured from preoperative CT and MRI. Sarcopenic criteria were created using BMI- and sex-stratified thresholds. Relationships between sarcopenia and hypoalbuminemia (Albumin <3.5 g/dL) with overall (OS), recurrence-free (RFS), and cancer-specific survival (CSS) were determined using multivariable and Kaplan-Meier analysis. RESULTS Of the 473 patients, 42.5% were sarcopenic and 24.5% had hypoalbuminemia. Sarcopenia was significantly associated with shorter OS (HR=1.51, 95% CI 1.07-2.13), however, was nonsignificant in the RFS (HR = 1.33, 95% CI 0.88-2.03) and CSS (HR=1.66, 95% CI 0.96-2.87) models. Hypoalbuminemia predicted shorter OS (HR=1.76, 95% CI 1.22-2.55), RFS (HR=1.86, 95% CI 1.19-2.89), and CSS (HR=1.82, 95% CI 1.03-3.22). Patients were then stratified into low, medium, and high-risk groups based on the severity of sarcopenia and hypoalbuminemia. Risk groups demonstrated an increasing association with shorter OS (all p<0.05). Reduced RFS was observed in the medium risk-hypoalbuminemia (HR=2.18, 95% CI 1.16-4.09) and high-risk groups (HR=2.42, 95% CI 1.34-4.39). Shorter CSS was observed in the medium risk-hypoalbuminemia (HR=2.31, 95% CI 1.00-5.30) and high-risk groups (HR=2.98, 95% CI 1.34-6.61). CONCLUSION Localized RCC patients with combined preoperative sarcopenia and hypoalbuminemia displayed a two to a three-fold reduction in OS, RFS, and CSS after nephrectomy. These data have implications for guiding prognostication and treatment election in localized RCC patients undergoing extirpative surgery.
Collapse
Affiliation(s)
- Eric Midenberg
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Joel Zaldumbide
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Dylan J Martini
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sean Steele
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Milton Williams
- Department of Urology, University of Alabama, Birmingham, AL
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA; Seattle Cancer Care Alliance
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA.
| |
Collapse
|
30
|
Psutka SP, Veleber S, Siman J, Jannat S, Holt S, Wright JL, Greenlee H. Effects of acupuncture to decrease adverse events in patients with high-risk non-muscle invasive bladder cancer receiving induction intravesical BCG therapy: Study protocol for a randomized, controlled pilot and feasibility study. Contemp Clin Trials Commun 2022; 30:101044. [PMID: 36561732 PMCID: PMC9763430 DOI: 10.1016/j.conctc.2022.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/14/2022] [Accepted: 11/27/2022] [Indexed: 12/07/2022] Open
Abstract
Background Treatment-related serious adverse events (SAEs) are common in patients receiving intravesical Bacillus Calmette-Guerin (BCG) for the treatment of high-risk nonmuscle-invasive bladder cancer (NMIBC). Here we describe the protocol of a randomized, attention/waitlist-controlled feasibility pilot study testing the use of acupuncture to decrease SAEs and treatment interruptions in this population. The primary objectives are to evaluate the feasibility and efficacy of conducting pre-procedure acupuncture in a Urology Clinic. Methods A total of 45 patients will be recruited and randomized in a 2:1 ratio (treatment arm: attention/waitlist control). Eligibility criteria include 1) age 18 years or older, 2) English-speaking, 3) high-risk NMIBC, 4) no acupuncture in the previous 3 months, and 5) willing and able to participate in trial activities. Patients in the treatment arm will receive acupuncture prior to weekly BCG for a total of six weeks. Methods were developed to train and monitor research acupuncturists and included online and in-person training, study manuals, and monthly meetings throughout the study period. Feasibility assessments include evaluation of the recruitment, retention and protocol adherence to acupuncture treatment, and measurement of CTCAE v5.0 adverse events specific to acupuncture, and clinic staff surveys regarding the intervention impact on clinic workflow. Efficacy measures will be compared between treatment and control groups including: EORTC-QLQ-NMIBC-24, EORTC-QLQ-C30, CTCAE v5.0, medication journal, healthcare utilization, current use of complementary, alternative, and integrative therapies, and acupuncture expectancy and treatment preference. Trial results will inform the design of a multi-center trial to expand testing of the protocol to a larger patient cohort.
Collapse
Affiliation(s)
- Sarah P. Psutka
- Department of Urology, University of Washington School of Medicine, United States,Corresponding author. 1959 NE Pacific Street, Box 356510, Seattle, WA, 98195, United States.
| | - Susan Veleber
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, United States,Division of Public Health Sciences, Fred Hutchinson Cancer Center, United States
| | - Jonathan Siman
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, United States,Division of Public Health Sciences, Fred Hutchinson Cancer Center, United States
| | - Samia Jannat
- Department of Urology, University of Washington School of Medicine, United States
| | - Sarah Holt
- Department of Urology, University of Washington School of Medicine, United States,Clinical Research Division, Fred Hutchinson Cancer Center, United States
| | - Jonathan L. Wright
- Department of Urology, University of Washington School of Medicine, United States,Division of Public Health Sciences, Fred Hutchinson Cancer Center, United States,Clinical Research Division, Fred Hutchinson Cancer Center, United States
| | - Heather Greenlee
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, United States,Division of Public Health Sciences, Fred Hutchinson Cancer Center, United States,Clinical Research Division, Fred Hutchinson Cancer Center, United States,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, United States
| |
Collapse
|
31
|
Lobo N, Afferi L, Moschini M, Mostafid H, Porten S, Psutka SP, Gupta S, Smith AB, Williams SB, Lotan Y. Epidemiology, Screening, and Prevention of Bladder Cancer. Eur Urol Oncol 2022; 5:628-639. [PMID: 36333236 DOI: 10.1016/j.euo.2022.10.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/09/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
CONTEXT Bladder cancer (BC) represents a significant health problem due to the potential morbidity and mortality associated with disease burden, which has remained largely unaltered over time. OBJECTIVE To provide an expert collaborative review and describe the incidence, prevalence, and mortality of BC and to evaluate current evidence for BC screening and prevention. EVIDENCE ACQUISITION Data on the estimated incidence and mortality of BC for 2020 in 185 countries were derived from the International Agency for Research on Cancer GLOBOCAN database. A review of English-language articles published over the past 5 yr was conducted using PubMed/MEDLINE to identify risk factors in addition to contemporary evidence on BC screening and prevention. EVIDENCE SYNTHESIS BC is the tenth most common cancer worldwide, with 573 278 cases in 2020. BC incidence is approximately fourfold higher in men than women. Tobacco smoking remains the principal risk factor, accounting for approximately 50% of cases. There is insufficient evidence to recommend routine BC screening. However, targeted screening of high-risk individuals (defined according to smoking history or occupational exposure) may reduce BC mortality and should be the focus of prospective randomized trials. In terms of disease prevention, smoking cessation represents the most important intervention, followed by a reduction in exposure to occupational and environmental carcinogens. CONCLUSIONS BC confers a significant disease burden. An understanding of BC epidemiology and risk factors provides an optimal foundation for disease prevention and the care of affected patients. PATIENT SUMMARY Bladder cancer is the tenth most common cancer worldwide and is approximately four times more common among men than among women. The main risk factors are tobacco smoking, followed by exposure to carcinogens in the workplace or the environment. Routine screening is not currently recommended, but may be beneficial in individuals at high risk, such as heavy smokers. Primary prevention is extremely important, and smoking cessation represents the most important action for reducing bladder cancer cases and deaths.
Collapse
Affiliation(s)
- Niyati Lobo
- Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Marco Moschini
- Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Sima Porten
- University of California-San Francisco, San Francisco, CA, USA
| | - Sarah P Psutka
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Angela B Smith
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Yair Lotan
- University of Texas Southwestern Medical Centre, Dallas, TX, USA.
| |
Collapse
|
32
|
Schmeusser BN, Midenberg E, Palacios AR, Vettikattu N, Patil DH, Medline A, Higgins M, Armas-Phan M, Nabavizadeh R, Joshi SS, Narayan VM, Psutka SP, Ogan K, Bilen MA, Master VA. Clinic friendly estimation of muscle composition: Preoperative linear segmentation shows overall survival correlated with muscle mass in patients with nonmetastatic renal cell carcinoma. Front Oncol 2022; 12:1068357. [PMID: 36505878 PMCID: PMC9732562 DOI: 10.3389/fonc.2022.1068357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/04/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Sarcopenia is associated with decreased survival and increased complications in patients with renal cell carcinoma. Readily identifying patients with low muscle composition that may experience worse outcomes or would benefit from preoperative intervention is of clinical interest. Traditional body composition analysis methods are resource intensive; therefore, linear segmentation with routine imaging has been proposed as a clinically practical alternative. This study assesses linear segmentation's prognostic utility in nonmetastatic renal cell carcinoma. Materials and Methods A single institution retrospective analysis of patients that underwent nephrectomy for nonmetastatic renal cell carcinoma from 2005-2021 was conducted. Linear segmentation of the bilateral psoas/paraspinal muscles was completed on preoperative imaging. Total muscle area and total muscle index associations with overall survival were determined by multivariable analysis. Results 532 (388 clear cell) patients were analyzed, with median (IQR) total muscle index of 28.6cm2/m2 (25.8-32.5) for women and 33.3cm2/m2 (29.1-36.9) for men. Low total muscle index was associated with decreased survival (HR=1.96, 95% CI 1.32-2.90, p<0.001). Graded increases in total muscle index were associated with better survival (HR=0.95, 95% CI 0.92-0.99, p=0.006). Conclusions Linear segmentation, a clinically feasible technique to assess muscle composition, has prognostic utility in patients with localized renal cell carcinoma, allowing for incorporation of muscle composition analysis into clinical decision-making. Muscle mass determined by linear segmentation was associated with overall survival in patients with nonmetastatic renal cell carcinoma.
Collapse
Affiliation(s)
- Benjamin N. Schmeusser
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States,*Correspondence: Viraj A. Master, ; Benjamin N. Schmeusser,
| | - Eric Midenberg
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States,Department of Urology, University of Louisville, Louisville, KY, United States
| | - Arnold R. Palacios
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States,Department of Urology, Creighton University, Omaha, NE, United States
| | - Nikhil Vettikattu
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Dattatraya H. Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Alexandra Medline
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States,Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michelle Higgins
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States,Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Manuel Armas-Phan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States,Department of Urology, Mayo Clinic, Rochester MN, United States
| | - Shreyas S. Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Vikram M. Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah P. Psutka
- Department of Urology, University of Washington, Seattle, WA, United States,Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, United States
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mehmet A. Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States,*Correspondence: Viraj A. Master, ; Benjamin N. Schmeusser,
| |
Collapse
|
33
|
Bukavina L, Bensalah K, Bray F, Carlo M, Challacombe B, Karam JA, Kassouf W, Mitchell T, Montironi R, O'Brien T, Panebianco V, Scelo G, Shuch B, van Poppel H, Blosser CD, Psutka SP. Epidemiology of Renal Cell Carcinoma: 2022 Update. Eur Urol 2022; 82:529-542. [PMID: 36100483 DOI: 10.1016/j.eururo.2022.08.019] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/27/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT International variations in the rates of kidney cancer (KC) are considerable. An understanding of the risk factors for KC development is necessary to generate opportunities to reduce its incidence through prevention and surveillance. OBJECTIVE To retrieve and summarize global incidence and mortality rates of KC and risk factors associated with its development, and to describe known familial syndromes and genetic alterations that represent biologic risk factors. EVIDENCE ACQUISITION A systematic review was conducted via Medline (PubMed) and Scopus to include meta-analyses, reviews, and original studies regarding renal cell carcinoma, epidemiology, and risk factors. EVIDENCE SYNTHESIS Our narrative review provides a detailed analysis of KC incidence and mortality, with significant variations across time, geography, and sex. In particular, while KC incidence has continued to increase, mortality models have leveled off. Among the many risk factors, hypertension, obesity, and smoking are the most well established. The emergence of new genetic data coupled with observational data allows for integrated management and surveillance strategies for KC care. CONCLUSIONS KC incidence and mortality rates vary significantly by geography, sex, and age. Associations of the development of KC with modifiable and fixed risk factors such as obesity, hypertension, smoking, and chronic kidney disease (CKD)/end-stage kidney disease (ESKD) are well described. Recent advances in the genetic characterization of these cancers have led to a better understanding of the germline and somatic mutations that predispose patients to KC development, with potential for identification of therapeutic targets that may improve outcomes for these at-risk patients. PATIENT SUMMARY We reviewed evidence on the occurrence of kidney cancer (KC) around the world. Currently, the main avoidable causes are smoking, obesity, and high blood pressure. Although other risk factors also contribute, prevention and treatment of these three factors provide the best opportunities to reduce the risk of developing KC at present.
Collapse
Affiliation(s)
- Laura Bukavina
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA; University Hospitals Cleveland Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Maria Carlo
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ben Challacombe
- Department of Urology, Guy's and St. Thomas Hospitals, London, UK
| | - Jose A Karam
- Departments of Urology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wassim Kassouf
- Division of Adult Urology, McGill University, Montreal, Canada
| | - Thomas Mitchell
- Department of Urology, Wellcome Sanger Institute, Cambridge, UK
| | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, Polytechnic University of the Marche Region, Ancona, Italy
| | - Tim O'Brien
- Department of Urology, Guy's and St. Thomas Hospitals, London, UK
| | | | | | - Brian Shuch
- Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Hein van Poppel
- Department of Urology, Catholic University of Leuven, Leuven, Belgium
| | - Christopher D Blosser
- Department of Medicine, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Sarah P Psutka
- Department of Medicine, University of Washington and Seattle Children's Hospital, Seattle, WA, USA.
| |
Collapse
|
34
|
Schmeusser B, Patil DH, Midenberg E, Higgins MI, Zaldumbide J, Martini DJ, Steele S, Williams M, Nabavizadeh R, Psutka SP, Ogan K, Bilen MA, Master VA. Data Regarding Covariates Significantly Associated with Sarcopenia and Varying Albumin Statuses in Patients with Renal Cell Carcinoma. Data Brief 2022; 45:108724. [DOI: 10.1016/j.dib.2022.108724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
|
35
|
Burg ML, Sholklapper T, Kohli P, Kaneko M, Maria Autran A, Teoh J, Murphy DG, Samplasky M, Psutka SP, Loeb S, Ribal MJ, Cacciamani GE. Gender Disparities Among Editorial Boards of International Urology Journals. Eur Urol Focus 2022; 8:1840-1846. [PMID: 35504837 DOI: 10.1016/j.euf.2022.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Gender composition among surgical academic leadership, including academic medical journals, disproportionately favors men and may inadvertently introduce a bias. An understanding of the factors associated with gender representation among urologic journals may aid in prioritizing an equitable balance. OBJECTIVE To evaluate female representation on editorial boards of pre-eminent international urologic journals. DESIGN, SETTING, AND PARTICIPANTS The names and position descriptions of urologic journal leadership appointees were collected in October 2021. Gender was assessed using gender-api.com or through personal title, as available. Journal characteristics were summarized using SCImago, a bibliometric indicator database extracted from Scopus journal data. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A multivariate logistic regression analysis was performed to describe associations between SCImago Journal Rank (SJR) quartile and geographic region with female gender representation. Quartile 1 (Q1) was considered the top quartile and Q4 the bottom quartile concordant with journal impact factor. RESULTS AND LIMITATIONS A total of 105 urology-focused journals were identified with 5989 total editorial board members, including 877 (14.6%) female, 5112 (85.4%) male, and two nonbinary persons. Female representation differed significantly by journal leadership position, SJR quartile, and geographic region. On the multivariate analysis of overall female representation, Q1 journals had higher odds of female representation than Q2 and Q3 journals, and had no significant difference from Q4 journals. Additionally, compared with Western Europe, North American journals had 78% higher odds while Asiatic journals had 50% lower odds of female representation. This study is limited by the inability to account for outside factors that lead to invitation or acceptance of journal leadership positions. CONCLUSIONS Contemporary female leadership at urology journals is about six times less common than male leadership across all journals, although trends in their proportion were noted when assessed by journal quartile and region. Addressing this gender imbalance represents an important step toward achieving gender equity in the field of urology. PATIENT SUMMARY In this study, we looked at the gender balance of academic journal leaders who serve as gatekeepers for sharing urologic research with the public. We found that the most prestigious journals and those in western countries tended to have the highest female representation. We hope that these findings help the academic community recognize and improve gender representation.
Collapse
Affiliation(s)
- Madeleine L Burg
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tamir Sholklapper
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Priya Kohli
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Masatomo Kaneko
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ana Maria Autran
- Oficina de Investigacion CAU (Confederacion Americana de Urologia), Madrid, Spain
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Mary Samplasky
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Stacy Loeb
- Departments of Urology and Population Health, New York University Langone Health, New York, NY, USA; Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Maria J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Giovanni E Cacciamani
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; European Association of Urology - Young Academic Urologist (EAU-YAU), Arnhem, The Netherlands.
| |
Collapse
|
36
|
Wu Z, Li M, Wang L, Paul A, Raman JD, Necchi A, Psutka SP, Buonerba C, Zargar H, Black PC, Derweesh IH, Mir MC, Uzzo RG, Pandolfo SD, Autorino R, DI Lorenzo G. Neoadjuvant systemic therapy in patients undergoing nephroureterectomy for urothelial cancer: a multidisciplinary systematic review and critical analysis. Minerva Urol Nephrol 2022; 74:518-527. [PMID: 35383431 DOI: 10.23736/s2724-6051.22.04659-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The benefit of neoadjuvant systemic therapy (NAST) is not yet supported by randomized controlled trials in upper tract urothelial carcinoma (UTUC), but the evidence is increasing. This narrative systematic review was conducted to evaluate the available evidence on the role of NAST in patients undergoing radical nephroureterectomy (RNU) for UTUC. EVIDENCE ACQUISITION We searched for all relevant articles or conference abstracts published and indexed in PubMed, Embase, and Scopus on July 19, 2021. The study was reported according to the PRISMA criteria and designed within the PICOS framework. We included studies comparing patients with non-metastatic UTUC who received neoadjuvant chemotherapy (NAC) or immunotherapy (NAI) with patients who underwent definitive surgery alone or surgery plus adjuvant systemic therapy. Prospective uncontrolled studies were also included. EVIDENCE SYNTHESIS We identified 27 reports (NAC, N.=24 and NAI, N.=3) published between 2010 and 2021. Twenty of the 24 studies on NAC were retrospective comparative analyses, whereas the remaining four were prospective single-arm studies. One of the three NAI studies exclusively enrolled patients with UTUC. NAC was associated with improved survival and better pathological response relative to surgery alone, but there was no clear advantage when compared to surgery plus adjuvant chemotherapy. Overall, the drug-induced toxicity and risk of disease progression were acceptable but the inherent bias across study designs, inadequate reporting and heterogeneous definition of primary outcomes render it difficult to synthesize results, compare centers, and inform practice. CONCLUSIONS The current level of evidence supporting NAST for UTUC is relatively low and the inability to predict responsiveness and thereby pinpoint the optimal candidates remains a major challenge. There is a need to compare NAST to adjuvant therapies using clearly defined primary endpoints as minimum reporting standards developed by a multidisciplinary team.
Collapse
Affiliation(s)
- Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Mingmin Li
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China -
| | - Asit Paul
- Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, VCU Health, Richmond, VA, USA
| | - Jay D Raman
- Department of Urology, Penn State Health, Hershey, PA, USA
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Sarah P Psutka
- Department of Urology, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Carlo Buonerba
- Department of Oncology and Hematology, Regional Reference Center for Rare Tumors, University of Naples Federico II, Naples, Italy
| | - Homayoun Zargar
- Unit of Surgery, Department of Urology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Peter C Black
- Department of Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Maria C Mir
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain
| | - Robert G Uzzo
- Division of Urological Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | | | - Giuseppe DI Lorenzo
- Unit Oncology, Andrea Tortora Hospital, ASL Salerno, Pagani, Salerno, Italy.,Vincenzo Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| |
Collapse
|
37
|
Tan WS, Steinberg G, Witjes JA, Li R, Shariat SF, Roupret M, Babjuk M, Bivalacqua TJ, Psutka SP, Williams SB, Cookson MS, Palou J, Kamat AM. Intermediate-risk Non-muscle-invasive Bladder Cancer: Updated Consensus Definition and Management Recommendations from the International Bladder Cancer Group. Eur Urol Oncol 2022; 5:505-516. [PMID: 35718695 DOI: 10.1016/j.euo.2022.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
CONTEXT Intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease. OBJECTIVE To update the International Bladder Cancer Group (IBCG) guidance and provide practical recommendations on IR NMIBC management. EVIDENCE ACQUISITION A collaborative review of published randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidance on IR NMIBC published before January 2022 was undertaken using PubMed/Medline. EVIDENCE SYNTHESIS Variation exists between guidelines in defining IR NMIBC. The IBCG recommends defining IR NMIBC as any TaLG tumor that is either recurrent or multifocal or has size ≥3 cm, OR any T1LG tumor. If the 3 tier grading system is used, than any TaG2 tumor would also be considered IR diease regardless of whether new diagnosis or recurrent. Accurate grading and staging of tumor, particularly in ruling out HG/G3 disease and/or carcinoma in situ, are crucial. The IBCG recommends that management of IR NMIBC should be further based on the following risk factors: multifocal tumor (more than one), early recurrence (<1 yr), frequent recurrence (>1/yr), tumor size (≥3 cm), and failure of prior intravesical treatment. Patients with no risk factors are best managed by one dose of postoperative intravesical chemotherapy. Patients with one to two risk factors should be offered additional adjuvant induction intravesical chemotherapy (or bacillus Calmette-Guérin (BCG) if prior chemotherapy has been used). Patients with three or more risk factors should be offered induction plus 1-yr maintenance BCG. Where BCG is not available or recurrent disease following BCG is present, alternative intravesical treatments such as chemotherapy (single agent, combination, or chemohyperthermia) or a clinical trial are recommended. CONCLUSIONS Standardizing the definition of IR NMIBC is critical for appropriate management of patients and for allowing a comparison of outcomes across clinical trials. The IBCG recommends defining IR NMIBC as any TaLG tumor that is either recurrent or multifocal or ≥3 cm, OR any T1LG tumor. If the 3 tier grading system is used, than any TaG2 tumor would also be considered IR disease regardless of whether new diagnosis or recurrent. Adjunctive management should then be based on established risk factors. PATIENT SUMMARY Standardizing the definition of intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC), which is a heterogeneous disease, is critical for appropriate management of patients. The International Bladder Cancer Group recommends classification of IR NMIBC tumors and personalized management based on the following risk factors: multifocal tumor (more than one), early recurrence (<1 yr), frequent recurrence (>1/yr), tumor size (≥3 cm), and previous intravesical treatment.
Collapse
Affiliation(s)
- Wei Shen Tan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals, London, UK
| | - Gary Steinberg
- Department of Urology, New York University, New York City, NY, USA
| | - J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Morgan Roupret
- Urology, GRC n°5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Trinity J Bivalacqua
- Department of Urology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Michael S Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center & The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
38
|
Kirk PS, Wang A, Raskolnikov D, Psutka SP, Gore JL, Nyame YA, Kelly J, Wright JL. Naloxegol versus Alvimopan for Enhancing Postoperative Recovery following Radical Cystectomy for Bladder Cancer. Urol Pract 2022; 9:364-370. [PMID: 37145718 DOI: 10.1097/upj.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION µ-Opioid-receptor antagonists are a standard component of enhanced recovery after surgery (ERAS) pathways following radical cystectomy (RC) as they reduce ileus and shorten length of stay (LOS). Prior studies have used alvimopan; however, naloxegol is a less expensive medication in the same class. We compared differences in postoperative outcomes between patients receiving alvimopan or naloxegol following RC. METHODS We retrospectively reviewed all patients undergoing RC over 20 months at an academic center during which standard practice transitioned from using alvimopan to naloxegol, while maintaining all other components of our ERAS pathway. We utilized bivariate comparisons as well as negative binomial and logistic regression to compare return of bowel function, rates of ileus and LOS following RC. RESULTS Of 117 eligible patients, 59 (50%) received alvimopan and 58 (50%) received naloxegol. There were no differences in baseline clinical, demographic or perioperative factors. Median postoperative LOS was 6 days in each group (p=0.3). Time to flatus (2 versus 2 days, p=0.2) and ileus (14% versus 17%, p=0.6) were similar between the alvimopan and naloxegol groups, respectively. In multivariable models controlling for patient and surgical factors, µ-opioid antagonist agent was associated with neither LOS nor ileus. Cost difference was -$344.20/day, equivalent to a $2,065.20 savings over a 6-day hospital stay with naloxegol. CONCLUSIONS In patients undergoing RC managed with a standard ERAS pathway, there were no differences in postoperative recovery based on the use of alvimopan versus naloxegol. Substitution of naloxegol for alvimopan may allow for significant cost savings without compromising outcomes.
Collapse
Affiliation(s)
- Peter S Kirk
- Department of Urology, University of Washington, Seattle, Washington
| | - Austin Wang
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Dima Raskolnikov
- Department of Urology, University of Washington, Seattle, Washington
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington, Seattle, Washington
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Janet Kelly
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
| |
Collapse
|
39
|
Garg H, Psutka SP, Hakimi AA, Kim HL, Mansour AM, Pruthi D, Liss MA, Wang H, Gaspard CS, Ramamurthy C, Svatek RS, Kaushik D. A Decade of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy: A Systematic Review and Meta-Analysis of Perioperative Outcomes. J Urol 2022; 208:542-560. [PMID: 35762219 PMCID: PMC10663084 DOI: 10.1097/ju.0000000000002829] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Open radical nephrectomy with inferior vena cava thrombectomy (O-CT) is standard management for renal cell carcinoma with inferior vena cava thrombus. First reported a decade ago, robotic-assisted radical nephrectomy with inferior vena cava thrombectomy (R-CT) is a minimally invasive option for this disease. We aimed to perform a systematic review to assess the safety and feasibility of R-CT in terms of perioperative outcomes and compare the outcomes between R-CT and O-CT. MATERIALS AND METHODS The PubMed®, Scopus®, Cochrane Central Register of Controlled Trials and Web of ScienceTM databases were searched using the free-text and MeSH terms "renal cell carcinoma," "inferior vena cava," "thrombosis" or "thrombus," "robot" and "thrombectomy." Studies reporting perioperative outcomes of R-CT and studies comparing R-CT with O-CT were included. The review was done in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS The search retrieved 28 articles describing R-CT, including 7 comparative studies. This systematic review included 1,375 patients, out of which 329 patients were in single-arm studies and 1,046 patients were in comparative studies. Of the 329 patients who underwent R-CT, 14.7% were level I, 60.9% level II, 20.4% level III and 2.5% level IV thrombus. Operative time ranged from 150 to 530 minutes; blood transfusion was administered in 38.2% (126). The overall complication rate was 30.3% (99). R-CT, in comparison to O-CT, was associated with a lower blood transfusion rate (18.4% vs 64.3%, p=0.002) and a lower complication rate (14.5% vs 36.7%, p=0.005). Major complication and 30-day mortality rates were similar in both groups. CONCLUSIONS R-CT has acceptable perioperative outcomes in carefully selected patients. Compared with O-CT, R-CT is associated with a lower blood transfusion rate and fewer overall complications. In experienced hands with carefully selected patients, R-CT is feasible and safe, with acceptable outcomes; however, selection bias limits definitive inference of these results, and optimal patient selection criteria remain to be described.
Collapse
Affiliation(s)
- Harshit Garg
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Sarah P. Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Abraham Ari Hakimi
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Hyung L. Kim
- Department of Surgery/Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ahmed M. Mansour
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Deepak Pruthi
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Michael A. Liss
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | | | - Chethan Ramamurthy
- Department of Medical Oncology, Mays Cancer Centre, San Antonio, TX, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| |
Collapse
|
40
|
Prunty M, Rhodes S, Sun H, Psutka SP, Mishra K, Kutikov A, Chen D, Ponsky L, Calaway A, Bukavina L. Redefining the Gender Gap in Urology Authorship: An 18-Year Publication Analysis. Eur Urol Focus 2022; 8:1512-1519. [PMID: 34975008 DOI: 10.1016/j.euf.2021.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/08/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Academic authorship is a critical productivity metric used for academic promotion. OBJECTIVE To characterize temporal changes in female representation in academic authorship in ten primary urology journals as the complement of female urologists is increasing. DESIGN, SETTING, AND PARTICIPANTS Publication records were retrieved from 2002 to 2020 for the ten urology journals with the highest impact factor. The names of all authors were gathered and gender was inferred using first names. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Trends in first and last/senior authorship by gender were evaluated overall, within journals, and by geographic region. RESULTS A total of 59,375 articles were analyzed, of which 94.1% had gender information for the first author and 94.2% had gender information for the last author. The percentage of overall female authors increased positively from 17.2% (95% highest density interval [HDI] 12.9-21.4%) in 2002 to 27.2% (HDI 21.7-33.6%; p < 0.01) in 2020. Overall female first authorship increased from 15.2% (95% HDI 11.0-19.5%) to 28.5% (95% HDI 21.8-35.6%; p < 0.01). There was also significant growth for female senior authors from 10.4% (95% HDI 7.6-13.5%) to 18.6% (95% HDI 13.6-23.8%; p < 0.01). Assessment of journal-specific changes revealed that Neurourology and Urodynamics (12.6%, 95% HDI 9.9-15.1%) and The Journal of Sexual Medicine (16.2%, 95% HDI 13.6-19.0%) had significantly higher growth in female authorship when compared to Journal of Endourology (7.2%, 95% HDI 5.5-8.7%) and Urologic Oncology (4.5%, 95% HDI 2.0-6.8%; p < 0.05). CONCLUSIONS Although overall female authorship increased between 2002 and 2020, women remain underrepresented in urology authorship. The percentage of females in senior (last) author positions is less than the percentage of females in first author positions. Journal-specific differences can probably be attributed to gender-based differences in subspecialized fields. PATIENT SUMMARY In this study, we characterized the underrepresentation of women as authors in urology journals and analyzed the change in female authorship for ten academic urology journals over the course of 18 years. Although the proportion of female authors has increased over that time, the percentage of females in senior authorship roles is less than the percentage of females in first author positions.
Collapse
Affiliation(s)
- Megan Prunty
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Stephen Rhodes
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Helen Sun
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Kirtishri Mishra
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Alexander Kutikov
- Fox Chase Cancer Center, Division of Urologic Oncology, Philadelphia, PA, USA
| | - David Chen
- Fox Chase Cancer Center, Division of Urologic Oncology, Philadelphia, PA, USA
| | - Lee Ponsky
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Adam Calaway
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Laura Bukavina
- Fox Chase Cancer Center, Division of Urologic Oncology, Philadelphia, PA, USA
| |
Collapse
|
41
|
Midenberg E, Patil D, Medline A, Higgins M, Williams M, Psutka SP, Ogan K, Bilen MA, Master VA. MP47-14 THE ROLE OF COMBINED SARCOPENIA AND ALBUMIN IN THE SURGICAL PROGNOSTICATION OF LOCALLY ADVANCED RENAL CELL CARCINOMA WITH VENOUS TUMOR THROMBUS. J Urol 2022. [DOI: 10.1097/ju.0000000000002618.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Isali I, McClellan P, Calaway A, Prunty M, Abbosh P, Mishra K, Ponsky L, Markt S, Psutka SP, Bukavina L. Gene network profiling in muscle-invasive bladder cancer: A systematic review and meta-analysis. Urol Oncol 2022; 40:197.e11-197.e23. [PMID: 35039218 PMCID: PMC10123538 DOI: 10.1016/j.urolonc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/17/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Determining meta-analysis of transcriptional profiling of muscle-invasive bladder cancer (MIBC) through Gene Expression Omnibus (GEO) datasets has not been investigated. This study aims to define gene expression profiles in MIBC and to identify potential candidate genes and pathways. OBJECTIVES To review and evaluate gene expression studies in MIBC through publicly available RNA sequencing (RNA-Seq) and microarray data in order to identify potential prognostic and therapeutic targets for MIBC. METHODS A systematic literature search of the Ovid MEDLINE, PubMed, and Wiley Cochrane Central Register of Controlled Trials databases was performed using the terms "gene," "gene expression," and "bladder cancer" January 1, 1990 through March 2021 focused on populations with MIBC. RESULTS In the final analysis, GEO datasets were included. Fixed effect model was employed in the meta-analysis. Gene networking connections and gene-set functional analyses of the identified genes as differentially expressed in MIBC were performed using ImaGEO and GeneMANIA software. A heatmap for the upregulated and downregulated genes was generated along with the correlated pathways. CONCLUSION A total of 9 genes were reported in this analysis. Six genes were reported as upregulated (ProTα, SPINT1, UBE2E1, RAB25, KPNB1, HDAC1) and 3 genes as downregulated (NUP188, IPO13, NUP124). Genes were found to be involved in "ubiquitin mediated proteolysis," "protein processing in endoplasmic reticulum," "transcriptional misregulation in cancer," and "RNA transport" pathways.
Collapse
Affiliation(s)
- Ilaha Isali
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Phillip McClellan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Adam Calaway
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH
| | - Megan Prunty
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Phillip Abbosh
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Kirtishri Mishra
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Lee Ponsky
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH
| | - Sarah Markt
- Department of Population and Quantitative Health Science, Case Western Reserve School of Medicine, Cleveland, OH
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Laura Bukavina
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH.
| |
Collapse
|
43
|
Hogan ME, Psutka SP, Liu YJ, Tretiakova MS. Shapeshifters in Pathology: Paratesticular Solitary Fibrous Tumor Mimicking Leiomyoma. Int J Surg Pathol 2022; 30:921-925. [PMID: 35404164 DOI: 10.1177/10668969221091585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solitary fibrous tumors are mesenchymal fibroblastic tumors that were originally described as intrathoracic lesions but have since been found to occur in many other locations. They may rarely occur as paratesticular masses. Here we present a peculiar case of a solitary fibrous tumor arising in the paratesticular region and exhibiting leiomyoma-like morphology. Confirmation of the tumor as a solitary fibrous tumor was achieved by RNA sequencing showing NAB2::STAT6 fusion. Possible explanations for the unusual tumor morphology include entrapment of normal smooth muscle elements and tumor differentiation into smooth muscle type cells.
Collapse
Affiliation(s)
- Matthew E Hogan
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, Washington, USA
| | - Sarah P Psutka
- Department of Urology, 7284University of Washington, Seattle, Washington, USA
| | - Yajuan J Liu
- 12353University of Washington School of Medicine, Seattle, Washington, USA
| | - Maria S Tretiakova
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, Washington, USA
| |
Collapse
|
44
|
Yang Y, Psutka SP, Parikh AB, Li M, Collier K, Miah A, Mori SV, Hinkley M, Tykodi SS, Hall E, Thompson JA, Yin M. Combining immune checkpoint inhibition plus tyrosine kinase inhibition as first and subsequent treatments for metastatic renal cell carcinoma. Cancer Med 2022; 11:3106-3114. [PMID: 35304832 PMCID: PMC9385597 DOI: 10.1002/cam4.4679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 12/14/2022] Open
Abstract
Background Immune checkpoint inhibitor/tyrosine kinase inhibitor (ICI/TKI) combinations are a new standard of care for the initial treatment of metastatic renal cell carcinoma (mRCC). Their efficacy and toxicity beyond the first‐line setting remain poorly defined. Methods We retrospectively reviewed charts for 85 adults with mRCC of any histology receiving combination of ICI/TKI in any line of treatment at two academic centers as of 05/01/2020. We collected clinical, pathological, and treatment‐related variables. Outcomes including objective response rate (ORR), progression‐free survival (PFS), and toxicity were analyzed via descriptive statistics and the Kaplan–Meier method. Results Patients received pembrolizumab, nivolumab, avelumab, or nivolumab–ipilimumab, with concurrent use of sunitinib, axitinib, pazopanib, lenvatinib, or cabozantinib. Thirty‐three patients received first‐line ICI/TKI therapy, while 52 received ≥ second‐line ICI/TKI. The efficacy of ICI/TKI therapy decreased with increasing lines of treatment (ORR: 56.7%, 37.5%, 21.4%, and 21%; median PFS [mPFS]: 15.2, 14.2, 10.1, and 6.8 months, for first, second, third, and ≥ fourth line therapy, respectively). In the ≥ second‐line setting, ICI/TKI was most useful in patients who received ICI only, with an ORR of 50% and a mPFS of 9.1 months. Efficacy was limited in patients who received both TKI and ICI previously, with an ORR of 20% and a mPFS of 5.5 months. Overall, ≥ second‐line ICI/TKI was tolerable with 25 of 52 (52%) patients developing grade ≥3 adverse events. Conclusions ICI/TKI combination therapy is feasible and safe beyond the first‐line setting. Prior treatment history appears to impact efficacy but has a lesser effect on safety/tolerability.
Collapse
Affiliation(s)
- Yuanquan Yang
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, Ohio, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anish B Parikh
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, Ohio, USA
| | - Mingjia Li
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, Ohio, USA
| | - Katharine Collier
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, Ohio, USA
| | - Abdul Miah
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, Ohio, USA
| | - Sherry V Mori
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Megan Hinkley
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Scott S Tykodi
- Division of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Evan Hall
- Division of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - John A Thompson
- Division of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Ming Yin
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, Ohio, USA
| |
Collapse
|
45
|
Khan AI, Psutka SP, Patil DH, Hong G, Williams MA, Bilen MA, Sekhar A, Kissick HT, Narayan VM, Joshi SS, Ogan K, Master VA. Sarcopenia and systemic inflammation are associated with decreased survival after cytoreductive nephrectomy for metastatic renal cell carcinoma. Cancer 2022; 128:2073-2084. [PMID: 35285950 DOI: 10.1002/cncr.34174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study was aimed at assessing the associations of sarcopenia, muscle density, adiposity, and inflammation with overall survival (OS) after cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma. METHODS In all, 158 patients undergoing CN from 2001 to 2014 had digitized preoperative imaging for tissue segmentation via Slice-O-Matic software (version 5.0) at the mid-L3 level. The skeletal muscle index was calculated with the skeletal muscle area (cm2 ) normalized for height (m2 ), and the skeletal muscle density (SMD) was calculated with average Hounsfield units. Adiposity was measured with the cross-sectional area (cm2 ) of visceral, subcutaneous, and intramuscular adiposity compartments and was similarly normalized for height. The average fat density was obtained in Hounsfield units. OS was estimated with the Kaplan-Meier method. Associations between body composition, inflammation metrics, and relevant clinicopathology and OS were assessed with univariable and multivariate Cox analyses. RESULTS Seventy-six of the 158 patients (48%) were sarcopenic. Sarcopenia was associated with elevated neutrophil to lymphocyte ratios (NLRs; P = .02), increased age (P = .001), lower body mass indices (P = .009), greater modified Motzer scores (P = .019), and lower SMD (P = .006). The median OS was 15.0 and 29.4 months for sarcopenic and nonsarcopenic patients, respectively (P = .04). Elevated inflammation (NLR or C-reactive protein), in addition to sarcopenia, was independently associated with OS, with an elevated NLR ≥ 3.5 and sarcopenia associated with the poorest OS at 10.2 months. No associations were observed between measurements of muscle density or adiposity and OS. CONCLUSIONS Sarcopenia and measures of high systemic inflammation are additively associated with inferior OS after CN and may be of use in preoperative risk stratification. LAY SUMMARY Body composition and sarcopenia (a deficiency in skeletal musculature) have been shown to affect outcomes in cancer. We found that sarcopenic patients had poor survival in comparison with nonsarcopenic patients in the setting of metastatic renal cell carcinoma (mRCC). Patients with both elevated inflammation and sarcopenia had the poorest survival. Sarcopenia is an objective measure of nutrition that can assist in therapeutic counseling and decision-making for individualized treatment in mRCC.
Collapse
Affiliation(s)
- Amir Ishaq Khan
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Gordon Hong
- Northeast Ohio Medical University, Rootstown, Ohio
| | - Milton A Williams
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Aarti Sekhar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Haydn T Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Vikram M Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Shreyas S Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
46
|
Greer MD, Schaub SK, Bowen SR, Liao JJ, Russell K, Chen JJ, Weg ES, Meyer J, Alving T, Schade GR, Gore JL, Psutka SP, Montgomery RB, Schweizer M, Yu EY, Grivas P, Wright JL, Zeng J. A Prospective Study of a Resorbable Intravesical Fiducial Marker for Bladder Cancer Radiation Therapy. Adv Radiat Oncol 2022; 7:100858. [PMID: 35387424 PMCID: PMC8977855 DOI: 10.1016/j.adro.2021.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/15/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose We conducted a prospective pilot study to evaluate safety and feasibility of TraceIT, a resorbable radiopaque hydrogel, to improve image guidance for bladder cancer radiation therapy (RT). Methods and Materials Patients with muscle invasive bladder cancer receiving definitive RT were eligible. TraceIT was injected intravesically around the tumor bed during maximal transurethral resection of bladder tumor. The primary endpoint was the difference between radiation treatment planning margin on daily cone beam computed tomography based on alignment to TraceIT versus standard-of-care pelvic bone anatomy. The Van Herk margin formula was used to determine the optimal planning target volume margin. TraceIT visibility, recurrence rates, and survival were estimated by Kaplan-Meier method. Toxicity was measured by Common Terminology Criteria for Adverse Events version 4.03. Results The trial was fully accrued and 15 patients were analyzed. TraceIT was injected in 4 sites/patient (range, 4-6). Overall, 94% (95% confidence interval [CI], 90%-98%) of injection sites were radiographically visible at RT initiation versus 71% (95% CI, 62%-81%) at RT completion. The median duration of radiographic visibility for injection sites was 106 days (95% CI, 104-113). Most patients were treated with a standard split-course approach with initial pelvic radiation fields, then midcourse repeat transurethral resection of bladder tumor followed by bladder tumor bed boost fields, and 14/15 received concurrent chemotherapy. Alignment to fiducials could allow for reduced planning target volume margins (0.67 vs 1.56 cm) for the initial phase of RT, but not for the boost (1.01 vs 0.96 cm). This allowed for improved target coverage (D95% 80%-83% to 91%-94%) for 2 patients retrospectively planned with both volumetric-modulated arc therapy and 3-dimensional conformal RT. At median follow-up of 22 months, no acute or late complications attributable to TraceIT placement occurred. No patients required salvage cystectomy. Conclusions TraceIT intravesical fiducial placement is safe and feasible and may facilitate tumor bed delineation and targeting in patients undergoing RT for localized muscle invasive bladder cancer. Improved image guided treatment may facilitate strategies to improve local control and minimize toxicity.
Collapse
Affiliation(s)
| | | | - Stephen R. Bowen
- Radiation Oncology and
- Radiology, University of Washington, Seattle, Washington
| | | | | | | | | | | | - Tristan Alving
- Department of Urology, University of Washington, Seattle, Washington
| | - George R. Schade
- Department of Urology, University of Washington, Seattle, Washington
| | - John L. Gore
- Department of Urology, University of Washington, Seattle, Washington
| | - Sarah P. Psutka
- Department of Urology, University of Washington, Seattle, Washington
| | - Robert B. Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
| | - Michael Schweizer
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
| | - Evan Y. Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
| | | | - Jing Zeng
- Radiation Oncology and
- Corresponding author: Jing Zeng, MD
| |
Collapse
|
47
|
Midenberg E, Patil DH, Medline A, Higgins M, Williams M, Nazha B, Brown JT, Ogan K, Psutka SP, Bilen MA, Master VA. The prognostic role of sarcopenia and albumin in locally advanced renal cell carcinoma with IVC tumor thrombus. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
387 Background: Indicators of body composition and nutritional status, such as lumbar skeletal muscle index (SMI, cm2/m2) and hypoalbuminemia, are associated with adverse outcomes following surgery for localized renal cell carcinoma (RCC) but have yet to be described in patients with RCC and venous tumor thrombus. We hypothesize that preoperative sarcopenia, a severe deficit in lean muscle mass, and hypoalbuminemia will be associated with decreased overall survival (OS) and cancer specific survival (CSS) in nonmetastatic RCC patients undergoing radical nephrectomy and tumor thrombectomy. Methods: We retrospectively analyzed 103 nonmetastatic RCC patients who underwent radical nephrectomy and tumor thrombectomy from 2005 to 2020. Optimally fit BMI (kg/m2) and sex-stratified sarcopenia thresholds were calculated (BMI<30: SMI<47 for males, SMI<38 for females; BMI≥30: SMI<54 for males, SMI<47 for females). Sarcopenia and albumin risk groups were created based on their individual hazard ratios on univariable analysis and defined as low-risk (non-sarcopenic, normal albumin), medium-risk (non-sarcopenic, hypoalbuminemia), high-risk (sarcopenic, normal albumin), and very high-risk (sarcopenic, hypoalbuminemia). Associations between independent and combined sarcopenia and hypoalbuminemia (albumin<3.5 g/dL) with OS and CSS were evaluated using multivariable and Kaplan-Meier analyses. Results: Prevalence of sarcopenia and hypoalbuminemia were 51.2% and 44.7%, respectively. Median follow up time was 24.8 months and median time from preoperative imaging to surgery was 21 days. Sarcopenia was an independent predictor of OS (p=0.003) and CSS (p=0.006) whereas hypoalbuminemia was not (OS: p=0.096; CSS: p=0.718). When analyzing sarcopenia and albumin in combination, the high and very high-risk groups were significantly associated with decreased OS (high-risk: p=0.011; very high-risk: p<0.001) and CSS (high-risk: p=0.011; very high-risk: p=0.017). Kaplan-Meier curves showed a stepwise decline in median OS (p=0.0071) and CSS (p=0.0068) times with increasing risk. Conclusions: Simultaneous sarcopenia and hypoalbuminemia were associated with nearly a seven-fold decrease in OS and CSS in patients undergoing surgery for nonmetastatic RCC with IVC tumor thrombus.[Table: see text]
Collapse
Affiliation(s)
| | | | | | - Michelle Higgins
- Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD
| | | | - Bassel Nazha
- Emory University Department of Hematology and Medical Oncology, Atlanta, GA
| | - Jacqueline T Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Emory University School of Medicine Winship Cancer Institute, Atlanta, GA
| | | | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | | |
Collapse
|
48
|
Maldonado R, Fintelmann FJ, Marquardt JP, O'Malley RB, Holt SK, Ngo S, Diamantopoulos LN, Laidlaw G, Schade GR, Lin DW, Wright JL, Gore JL, Nyame YA, Grivas P, Yu EY, Montgomery RB, Hsieh AC, Yezefski T, Schweizer MT, Psutka SP. Changes in body composition during neoadjuvant platinum-based chemotherapy associations prior to radical cystectomy: Implications for chemotherapy-associated adverse events and oncologic outcomes. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
476 Background: Low skeletal muscle index (SMI) is associated with an increased risk of mortality in muscle-invasive bladder cancer (MIBC) and chemotherapy-related adverse events (AE) across numerous other malignancies. Small case series suggest neoadjuvant chemotherapy (NAC) is associated with a significant decline in SMI in patients with MIBC. However, limited data exists regarding changes in fat mass during NAC. Herein, we examine changes in SMI, visceral fat index (VFI), and subcutaneous fat index (SFI) in patients receiving NAC for MIBC before radical cystectomy (RC). We describe associations between body composition changes and NAC-associated AE and all-cause mortality (ACM) in patients with MIBC. Methods: Retrospective review of patients with MIBC (≥pT2 N0/x/1 M0) who received NAC (2006-2019). Patients with digitized abdominal computed tomography scans (CT) within 75 days prior (T1) and 75 days following completion (T2) of NAC were included. We segmented and calculated the indices (cm2/m2) for SMI, VFI, and SFI at the third lumbar vertebra level at T1 and T2 using validated methodology. Associations with AE during NAC and ACM were evaluated with multivariate logistic regression and Cox proportional hazards models. Results: Included 170 patients, median age 63 years receiving a median of 4 (IQR 3-5) cycles of Gemcitabine/Cisplatin (52%), MVAC (28%), or other NAC (20%). Absolute and relative changes in SMI, VFI, and SFI over a median of 112 days (IQR 94-146) between measurements are presented in the Table. 117 (69%) patients experienced grade ≥3 chemotherapy-related AE. No associations between baseline body composition or change in body composition during NAC with chemotherapy-related AE. T1 SMI (HR: 0.98; 0.97-0.99, p = 0.008), as well as T2 SMI (HR: 0.98; 0.96-0.99, p = 0.003), T2 VFI (HR: 0.99; 0.99-1.0, p = 0.05) and T2 SFI (HR: 0.99; 0.98-1.0, P = 0.03) were associated with ACM after adjusting for age, clinical T and N stage, and performance status. Conclusions: Patients undergoing NAC prior to RC experienced a 6.4% decrease in SMI and a 5.2% decrease in VFI during an average of 112 days. Chemotherapy-related AE were not associated with a change in body composition. Baseline SMI and T2 SMI, SFI, and VFI were associated with ACM on multivariable analysis. Future work is needed to understand the mechanisms underpinning such changes and the extent to which potentially detrimental changes in body composition may be mitigated before surgery.[Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jonathan L. Wright
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | | | - Yaw A. Nyame
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Petros Grivas
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | |
Collapse
|
49
|
Panian J, Saidian A, Hakimi K, Ajmera A, Barata PC, Berg SA, Chang SL, Choueiri TK, Dzimitrowicz HE, Emamekhoo H, Gross E, Kilari D, Lam ET, Lashgari I, Psutka SP, Thapa B, Weise N, Zhang T, Derweesh I, McKay RR. Pathologic outcomes at cytoreductive nephrectomy (CN) following immunotherapy (IO) for patients with advanced renal cell carcinoma (RCC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
334 Background: IO, either as combination therapy in the frontline or monotherapy in the second line, has improved outcomes for patients with advanced RCC. With the movement away from upfront CN, limited data are available on the outcomes of patients who receive IO with delayed CN. In this study, we characterized the pathologic and survival outcomes for patients who received IO followed by CN. Methods: We conducted a multi-center, retrospective analysis of patients with advanced/metastatic RCC having received IO combination or monotherapy followed by CN. An IRB-approved and HIPAA-compliant registry was used to collect data from the electronic medical record. Our primary endpoint was the degree of pathologic downstaging comparing baseline clinical T stage to pathologic T stage following IO. Secondary endpoints included investigator assessed response using RECIST principals, progression-free survival (PFS), and overall survival (OS). Results: We identified53 patients with advanced RCC across 9 institutions who were eligible for the study. The median age was 63 years, 72% were white, and 60% were male. 81% of patients had clear cell histology, 11% had sarcomatoid differentiation, and 75% presented with de novo metastatic disease. Baseline IMDC risk is as follows: 4% favorable, 55% intermediate, and 26% poor risk with 15% unknown. 23% had bone metastases and 23% had liver metastases at baseline. Lines of therapy prior to CN was 1 line in 74% of patients, 2 lines in 25%, and 3 lines in 2%. For the line of IO therapy immediately preceding CN, 49% received nivolumab+ipilimumab, 30% received IO monotherapy, and 21% received combination IO/VEGF therapy. The median duration of therapy prior to surgery was 11.3 months (range 0.38-47.8). 28% of patients discontinued treatment after CN for observation. Best overall response prior to CN was stable disease in 25% of patients, partial response in 60%, and progressive disease in 4% with 11% unknown. Following receipt of IO-based treatment, 38% of patients exhibited downstaging from the baseline clinical T stage to the CN pathological T stage (Table). 11% of patients had no residual disease at CN. For pathologic outcomes, 85% of patients had negative margins, 75% had necrosis present, and the median tumor size at CN was 6.5 cm. The median PFS was 11.3 months and median OS was 25.7 months for the overall cohort. Conclusions: IO-based strategies demonstrate efficacy in the renal primary in patients with advanced RCC. T stage downstaging was demonstrated in 38% of patients with 11% having a complete pathologic response in the renal primary following IO administration. Biomarker studies on baseline and CN tissue will further elucidate molecular predictors of response and resistance to IO therapy.[Table: see text]
Collapse
Affiliation(s)
- Justine Panian
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | - Ava Saidian
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | | | - Archana Ajmera
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | | | | | - Steven Lee Chang
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
| | | | - Hamid Emamekhoo
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Evan Gross
- University of Washington School of Medicine, Seattle, WA
| | - Deepak Kilari
- Department of Medicine, Froedtert Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Elaine Tat Lam
- University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO
| | - Isabel Lashgari
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | | | - Bicky Thapa
- Department of Medicine, Cleveland Clinic, Cleveland, OH
| | - Nicole Weise
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | - Tian Zhang
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Ithaar Derweesh
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | | |
Collapse
|
50
|
Saidian A, Hakimi K, Panian J, Ajmera A, Barata PC, Berg SA, Chang SL, Choueiri TK, Dzimitrowicz HE, Emamekhoo H, Gross E, Kilari D, Lam ET, Nonato T, Psutka SP, Thapa B, Weise N, Zhang T, McKay RR, Derweesh I. Impact of neoadjuvant immune checkpoint inhibitor therapy on primary tumor size and complexity: Correlation with surgical quality and short term oncological outcomes. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
390 Background:The concept of primary systemic therapy has gained increasing traction in the management of metastatic and locally advanced Renal Cell Carcinoma (RCC). Most series have evaluated the use of tyrosine-kinase inhibitors, however, with the emergence of immune checkpoint inhibitor therapy as first line agents in advanced RCC, further assessment of efficacy is warranted. We examined the effects of immunotherapy (IO) combinations on the primary tumor and consequent surgical quality and short-term oncological outcomes. Methods: We conducted a multi-center, retrospective analysis of patients with advanced/metastatic RCC having received IO followed by Radical (RN) or partial nephrectomy (PN). Primary outcome was achievement of Bifecta (composite outcome of complete resection and no 30-day post-operative complications). Predictors for achievement of Bifecta were assessed with logistic regression multivariable analysis. Secondary outcomes were change in maximal tumor dimension, RENAL nephrometry score and disease progression. Kaplan-Meier analysis was used to assess progression-free survival (PFS) for Bifecta and non-Bifecta patients. Results: We identified 52 patients with advanced RCC across 9 institutions who were eligible. The median age was 63 years and 60.4% were males. Median tumor size at diagnosis was 9.3 cm. 19.6% had T4 disease and 75% had AJCC Stage IV disease. IO treatment resulted in significant reductions in median tumor size (-25.4%; 9.7 cm vs. 7.3cm p = 0.0129) and RENAL nephrometry score (9 to 8, p = 0.032). 43 (83%) of patients underwent RN and (9) 17% had PN. Median tumor size was smaller for PN (8 vs. 4.1 cm, p < 0.001), and 30 day complication rates were higher (p = 0.024). Bifecta was achieved in 39 patients [33/42 (78.6%) RN and 6/9 (67%) PN, p = 0.264). Predictors for achievement of Bifecta were younger age (OR 1.06, p = 0.01), increasing reduction in tumor size (OR 1.187, p < 0.001), and shorter time between therapy and surgery (OR 1.07, p < 0.001). Kaplan-Meier analysis demonstrated longer median time to progression in the Bifecta-positive group compared to patients who failed to achieve Bifecta (75 vs. 30 months, p = 0.04). Conclusions: Pre-surgical therapy resulted in tumor size and complexity reduction. Tumor size reduction was predictive for achievement of Bifecta, which was associated with improved short term oncological outcomes. To our knowledge, this is the first series evaluating the effect of neoadjuvant systemic therapy on the primary tumor prior to surgical intervention.
Collapse
Affiliation(s)
- Ava Saidian
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | | | - Justine Panian
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | - Archana Ajmera
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | | | | | - Steven Lee Chang
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
| | | | - Hamid Emamekhoo
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Evan Gross
- University of Washington School of Medicine, Seattle, WA
| | - Deepak Kilari
- Department of Medicine, Froedtert Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Elaine Tat Lam
- University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO
| | - Taylor Nonato
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | | | - Bicky Thapa
- Department of Medicine, Cleveland Clinic, Cleveland, OH
| | - Nicole Weise
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| | - Tian Zhang
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | | | - Ithaar Derweesh
- University of California San Diego, Moores Cancer Center, La Jolla, CA
| |
Collapse
|