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MacArthur E, Long Roche K, Sakran J, Patel SH, Najjar P, Lu KH, Gornet M, Frost AS, Walrath M, Bauer T, Oh G, Stone R. Salpingectomy for ovarian cancer prevention: Video education for the surgeon. Gynecol Oncol Rep 2024; 53:101368. [PMID: 38584804 PMCID: PMC10997886 DOI: 10.1016/j.gore.2024.101368] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
Given the unremitting obstacles to effectively screen for and treat ovarian cancer (OC), prevention is a necessary countermeasure. The recent discovery of the fallopian tube as the origin of the most common and deadly type of OC, high grade serous cancer (HGSC), makes prevention through salpingectomy possible (Madsen et al., 2015). Opportunistic salpingectomy (OS) is the practice of removing the post-reproductive fallopian tubes at the time of other intraperitoneal surgery, or for sterilization in lieu of tubal ligation, to decrease OC risk (Falconer et al., 2015). The safety, effectiveness, and reach of OS as a primary prevention strategy depends on the knowledge mobilization of a standard surgical approach for surgeons (Hanley et al., 2017, Morelli et al., 2013). Resources for accomplishing this knowledge mobilization activity are needed. We therefore aim to create a peer-reviewed, publicly available surgical instructional video that facilitates standardization of the practice of salpingectomy for the purpose of OC prevention. Content creation was generated by a team of surgeon stakeholders, medical illustrators, instructional designers, and health education specialists. Expert gynecologic surgeons were filmed performing salpingectomy in order to build a video library. Accurate illustration and editing of live video footage was executed to support surgeons in visualizing key anatomic landmarks to ensure safe and complete fallopian tube excision. Review of eligibility criteria, fundamentals of preoperative counseling, and strategic and technical points were prioritized. This endeavor is strictly educational, with no commercial benefit. Publicly available, peer-reviewed surgical education tools will help us collaborate to safely and equitably expand OS within and beyond the current scope of surgical practice.
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Affiliation(s)
- Emily MacArthur
- The Kelly Gynecologic Oncology Service, Johns Hopkins University, United States
| | - Kara Long Roche
- Division of Gynecologic Oncology, Memorial Sloan Kettering, United States
| | - Joseph Sakran
- Division of Surgery-Acute Care and Adult Trauma, Johns Hopkins University, United States
| | - Sunil H. Patel
- Division of Urology and Oncology, Johns Hopkins University, United States
| | - Peter Najjar
- Division of Surgery-Colon and Rectal Surgery, Johns Hopkins University, United States
| | - Karen H. Lu
- Department of Gynecologic Oncology and Reproductive Medicine-The University of Texas MD Anderson, United States
| | - Megan Gornet
- Division of Gynecology and Obstetrics, Johns Hopkins University, United States
| | - Anja S. Frost
- Division of Gynecology and Obstetrics-Gynecologic Specialties, Johns Hopkins University, United States
| | - Meghan Walrath
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, United States
| | - Tom Bauer
- Patient and Family Education, Johns Hopkins Medicine, United States
| | - Gyyong Oh
- Medical Illustration, Johns Hopkins University, United States
| | - Rebecca Stone
- The Kelly Gynecologic Oncology Service, Johns Hopkins University, United States
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Patel SH, Gabrielson AT, Chan S, Schwartz D, Collins C, Singla N, Trock B, Bivalacqua TJ, Hahn N, Kates MR. A Phase II Trial of Intravesical Gemcitabine and Docetaxel in the Treatment of Bacillus Calmette-Guérin‒Naïve Nonmuscle-Invasive Urothelial Carcinoma of the Bladder. J Urol 2024:101097JU0000000000003977. [PMID: 38653234 DOI: 10.1097/ju.0000000000003977] [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: 12/23/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Combination intravesical gemcitabine and docetaxel (GemDoce) has demonstrated efficacy as second-line therapy for patients with bacillus Calmette-Guérin (BCG)‒unresponsive nonmuscle-invasive urothelial carcinoma of the bladder (NMIBC). In the context of widespread BCG shortages, we performed a phase 2 prospective trial to assess GemDoce for BCG-naïve NMIBC. MATERIALS AND METHODS This study is a prospective, single-arm, open-label phase 2 trial for patients with BCG-naïve high-risk NMIBC. Intravesical GemDoce was given weekly for 6 weeks as induction followed by monthly maintenance therapy for 2 years among responders. The primary end point was 3-month complete response, and key secondary end points included adverse events (AEs) and 12-month recurrence-free survival. RESULTS Twenty-five patients were enrolled between August 2020 and August 2022 with median follow-up of 19.6 months. The pretrial pathologic stages were high-grade (HG) T1 with carcinoma in situ (CIS; n = 7), HGT1 without CIS (n = 6), HGTa (n = 9), and CIS alone (n = 3). The 3-month complete response rate was 100% and recurrence-free survival at 12 months was 92%. Two patients with pretrial HGT1 had HGT1 recurrences at 9 and 12 months. No patients progressed to T2 disease, underwent radical cystectomy, or had any radiographic evidence of progressive disease. Grade 1 AEs were common (23/25 patients) including hematuria, urinary frequency, urgency, and fatigue. Five patients (20%) experienced a grade 3 AE including hematuria and UTI. CONCLUSIONS In this single-arm phase 2 trial, GemDoce was well tolerated with promising efficacy for patients with BCG-naïve high-risk NMIBC.
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Affiliation(s)
- Sunil H Patel
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew T Gabrielson
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sin Chan
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah Schwartz
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Connie Collins
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nirmish Singla
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruce Trock
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trinity J Bivalacqua
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noah Hahn
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Greenberg Bladder Cancer Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Max R Kates
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cheaib JG, Talwar R, Roberson DS, Alam R, Lee DJ, Gupta M, Patel SH, Singla N, Pavlovich CP, Patel HD, Pierorazio PM. Urologist-level variation in the management of T1a renal cell carcinoma: A population-based cohort study. Urol Oncol 2024; 42:71.e9-71.e18. [PMID: 38278631 DOI: 10.1016/j.urolonc.2024.01.011] [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: 10/21/2023] [Revised: 12/30/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVES Lack of strict indications in current guidelines have led to significant variation in management patterns of small renal masses. The impact of the urologist on the management approach for patients with small renal masses has not been explored previously. MATERIALS AND METHODS Using the linked Surveillance, Epidemiology, and End Results-Medicare database, patients aged ≥66 years diagnosed with small renal masses from January 1, 2004 to December 31, 2013 were identified and assigned to primary urologists. Mixed-effects logistic models were used to evaluate factors associated with different management approaches, estimate urologist-level probabilities of each approach, assess management variation, and determine urologist impact on choice of approach. RESULTS A total of 12,402 patients with 2,794 corresponding primary urologists were included in the study. At the individual urologist level, the estimated case-adjusted probability of different approaches varied markedly: nonsurgical management (mean, 12.8%; range, 4.9%-36.1%); thermal ablation (mean, 10.8%; range, 2.4%-66.3%); partial nephrectomy (mean, 30.1%; range, 10.1%-66.6%); and radical nephrectomy (mean, 40.4%; range, 17.7%-71.6%). Compared to patient and tumor characteristics, the primary urologist was a more influential measured factor, accounting for 13.6% (vs. 12.9%), 33.8% (vs. 2.1%), 15.1% (vs. 8.4%), and 13.5% (vs. 4.0%) of the variation in management choice for nonsurgical management, thermal ablation, partial nephrectomy, and radical nephrectomy, respectively. CONCLUSIONS Significant variation exists in the management of small renal masses and appears to be driven primarily by urologist preference and practice patterns. Our findings emphasize the need for unified guidance regarding management of these masses to reduce unwarranted variation in care.
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Affiliation(s)
- Joseph G Cheaib
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Ruchika Talwar
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel S Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ridwan Alam
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel J Lee
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mohit Gupta
- Department of Urology, MedStar Health-Georgetown University Hospital, Washington, DC
| | - Sunil H Patel
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nirmish Singla
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian P Pavlovich
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hiten D Patel
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phillip M Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Agrawal P, Rostom M, Alam R, Florissi I, Biles M, Rodriguez K, Hahn NM, Johnson BA, Matoso A, Smith A, Bivalacqua TJ, Kates M, Hoffman-Censits J, Patel SH. Clinicopathologic and Survival After Cystectomy Outcomes in Squamous Cell Carcinoma of the Bladder. Clin Genitourin Cancer 2023; 21:631-638.e1. [PMID: 37336703 DOI: 10.1016/j.clgc.2023.05.019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Squamous cell carcinoma of the bladder (SqCC) is a rare disease with limited management data. Thus, we sought to characterize the clinicopathologic and survival outcomes amongst patients with SqCC and explore the association of squamous differentiation within urothelial carcinoma (UC w/Squam), as compared to muscle invasive pure UC. METHODS We conducted a single-center retrospective cohort study of patients, stratified by histology, who underwent cystectomy for MIBC. Baseline clinicopathologic characteristics were compared, and overall survival was assessed using Kaplan-Meier method. RESULTS We identified 1,034 patients; 37 (3.58%) with SqCC histology, 908 (87.81%) with UC histology, and 89 (8.61%) with UC w/ Squam histology. Among SqCC patients, a higher proportion were Black and similarly a higher proportion were women; amongst patients with UC w/ Squam a higher proportion had lower BMI; and amongst patients with UC a higher proportion had lower clinical (c) T, cN, pathological (p) T, and pN stages. Patients presenting with UC were more likely to receive intravesical therapy; patients presenting with SqCC were less likely to receive neoadjuvant chemotherapy (NAC). Adjuvant chemotherapy rates were similar. With post-hoc Bonferroni analysis, overall survival, cancer-specific survival, and recurrence-free survival were significantly worse for the UC w/ Squam cohort. CONCLUSIONS UC w/ Squam histology was associated with worse survival outcomes after cystectomy for muscle invasive bladder cancer compared to UC. Our results suggest that UC w/ Squam is associated with more advanced disease compared to UC, warranting further prospective work on consideration of combination therapies for patients with this disease state.
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Affiliation(s)
- Pranjal Agrawal
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary Rostom
- Department of Urology, Desai Sethi Urology Institute, Miller School of Medicine, Miami, FL
| | - Ridwan Alam
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Isabella Florissi
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Biles
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katherine Rodriguez
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Noah M Hahn
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Burles A Johnson
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andres Matoso
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Armine Smith
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trinity J Bivalacqua
- Department of Urology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA
| | - Max Kates
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeannie Hoffman-Censits
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sunil H Patel
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
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Ding Y, Holmes J, Li B, Vargas CE, Vora SA, Wong WW, Fatyga M, Foote RL, Patel SH, Liu W. Patient-Specific 3D CT Images Reconstruction from 2D KV Images Via Vision Transformer-Based Deep-Learning. Int J Radiat Oncol Biol Phys 2023; 117:e660. [PMID: 37785958 DOI: 10.1016/j.ijrobp.2023.06.2095] [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) In some proton therapy facilities, patient alignment relies on two 2D orthogonal kV images, taken at fixed, oblique angles, as no 3D on-the-bed-imaging is available. The visibility of the tumor in kV images is limited since the patient's 3D anatomy is projected onto a 2D plane, especially when the tumor is behind a high-density structure such as bone. This can lead to a large patient setup error. A solution to this problem is to reconstruct the 3D CT image from the kV images obtained in the treatment position. MATERIALS/METHODS An asymmetric autoencoder-like network built with vision-transformer blocks was developed. The data was collected from a head and neck patient: 2 orthogonal kV images (1024X1024 voxels), 1 3D CT with padding (512X512X512) acquired from the in-room CT-on-rails before kVs were taken and 2 digitally-reconstructed-radiograph (DRR) images (512X512) based on the CT. We resampled kV images every 8 voxels and DRR and CT every 4 voxels, thus formed a dataset consisting of 262,144 samples, in which the images had a dimension of 128 for each direction. The value of each voxel in CT was normalized to range 0-1 with a uniform shift of 1000 and a denominator of 4000. For kV and DRR, we ranked all voxels value in an ascending order and normalized the values of the first 80% voxels to range 0-0.8 and the rest to range 0.8-1, thus yielding a quasi-Gaussian distribution, which was favorable by the deep neural networks. We further cropped kV and DRR images with a self-supervised bitmap based on the voxels' gradients. In training, both kV and DRR were utilized, and the encoder was encouraged to learn the same feature maps for kV images and its corresponding DRR images with mean-absolute-error (MAE) as the similarity loss. Then the decoder would reconstruct the 3D CT image from the feature maps of the kV images with the CT-on-rails as ground-truth (gCT) and MAE as the reconstruction loss. In testing, only independent kV images were used. The full-size synthetic CT (sCT) was achieved by concatenating the sCTs generated by the model according to their spatial information. The image quality of the sCT was evaluated using MAE and per-voxel-absolute-CT-number-difference volume histogram (CDVH). The proposed network was implemented with PyTorch deep learning library and both distributed data parallel (DDP) and automatic mixed precision (AMP) were applied to saving memory and accelerating the training speed. We used the AdamW optimizer with β1 = 0.9 and β2 = 0.999 and a cosine annealing learning rate scheduler with an initial learning of 1e-7 and 20 warm-up epochs. RESULTS The model achieved a MAE of <40HU and the CDVH showed that <5% of the voxels had a per-voxel-absolute-CT-number-difference larger than 185HU. The profile of a typical gCT slice and its corresponding sCT slice exhibited a high agreement, indicating the high similarity between the gCT and sCT. CONCLUSION A patient-specific vision-transformer-based network was developed and shown to be accurate and efficient to reconstruct 3D CT images from kV images.
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Affiliation(s)
- Y Ding
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - J Holmes
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - B Li
- Arizona State University, Tempe, AZ
| | - C E Vargas
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - S A Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - W W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - M Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - W Liu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
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Buckey CR, Armstrong M, Chitsazzadeh S, Hobbis D, Clouser EL, Patel SH, Smetanick J, Pettit J, Rong Y. A Free, Open-Source Toolkit to Produce 3D Bolus in the Clinic. Int J Radiat Oncol Biol Phys 2023; 117:e646. [PMID: 37785922 DOI: 10.1016/j.ijrobp.2023.06.2062] [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) Tissue-equivalent, tissue-approximating and tissue-replacing bolus materials have been in use for decades in radiotherapy. Most frequently these materials are applied to a patient's skin to bring the highest dose region towards the surface of the skin-which is the location of the target. These materials can be applied at the time of simulation and included in a planning CT scan, or can be added during the planning process and first physically applied at the time of treatment. One of the most widely adopted materials for bolus has been sheets of a commercially available proprietary synthetic gel, which is uniform in thickness, and has some ability to match the curvature of the patient's body. Recently investigators have worked to create boluses using 3D printing technology, including several commercially available offerings. We hypothesized that we could create a bespoke, 3D bolus solution, using a series of open-source and free software products. MATERIALS/METHODS For an anthropomorphic phantom, a radiation treatment plan representative of skin cancer treatment was designed, this included a superficial target. The DICOM CT and structure set were imported into 3D Slicer, which is a free, open-source software for visualization, processing, segmentation, and registration. Using 3D Slicer, the bolus structure was saved as an STL file. Meshmixer, a free software for working with triangle meshes, was used to complete a mold design, and the mold parts were then printed using a rigid filament on a 3D printer. The mold parts were glued together, and small spring clamps were used secure the walls to the shells to ensure mold integrity. The mold was then filled with a thinned and degassed silicone. After appropriate curing, demolding was completed by removing the clamps and separating the walls. After QA, the bolus was applied to the anthropomorphic phantom and CTs were taken to compare a commercial sheet bolus with the in-house 3D printed product. RESULTS The bolus made via the in-house 3D printing process fit even complicated patient geometries well, and had both an obvious visual/goodness of fit advantage over the commercial sheet bolus and a nuanced dosimetric improvement as the air gaps present in the commercial sheet bolus were not desirable nor reproducible. The overall in-house workflow was efficient, and clinically reasonable (an estimated time of 72 hours was presented to the physician team, but in testing less than 24 hours was needed from export to delivery of the finished product). CONCLUSION In this work we explored whether motivated groups and departments could produce dosimetrically accurate and clinically reasonable custom boluses for patients undergoing radiotherapy to a superficial area of the body, using a test case on an anthropomorphic phantom. We found that this was absolutely achievable and could be implemented with no funds spent on software or licenses. Provided that a 3D printer, filament and silicone are available, any thoughtful practice can join the bespoke-bolus-club.
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Ebner DK, Evans JM, Christensen B, Breinholt J, Gamez ME, Lester SC, Routman DM, Ma DJ, Price K, Dong H, Park SS, Chintakuntlawar AV, Neben-Wittich MA, McGee LA, Garces Y, Patel SH, Foote RL, Evans JD. Unique T-cell Sub-Population Shifts after SBPT and Nivolumab in Platinum Refractory HNC: Biomarker Correlates from ROR1771. Int J Radiat Oncol Biol Phys 2023; 117:e580. [PMID: 37785763 DOI: 10.1016/j.ijrobp.2023.06.1920] [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) ROR1771 was a clinical trial investigating the use of stereotactic body proton radiotherapy (SBPT) and nivolumab in recurrent platinum refractory head and neck squamous cell carcinoma (HNSCC). The planned analysis of T-cell subpopulation and biomarker response is herein presented. MATERIALS/METHODS Patients with metastatic histologically confirmed HNSCC from any primary site received 2 cycles of nivolumab followed by SBPT to 1-2 selected target lesion(s) (hilar/lung: 8 of 12 patients), followed by maintenance nivolumab. Peripheral blood mononuclear cells were isolated pre-/post-treatment. Flow cytometry identified T-cell subpopulations. Single Cell 5' Gene Expression (GEX) and V(D)J T Cell Receptor libraries were prepared using Single Cell Immune Profiling. Seurat (v4.1.1) was used to identify cell type clusters, and differential expression post-filtration was evaluated using the Wilcoxon Rank Sum test. RESULTS A total of 12 patients were eligible for analysis, with one alive at time of analysis, 52 months from start of treatment. Median overall survival here was 12.5 months vs. 7.5-months on CheckMate 141. SBPT ranged from 35-50 Gy. Sequential changes in T-cell populations from baseline were noted with initiation of nivolumab, driving decrease in tumor-reactive (TTR; CD11ahighPD1+CD8+), central memory (TCM; CCR7+CD45RA-), and effector T-cells (TEF; CCR7-CD45RA-). TTR and TCM increased following SBPT, with greatest increase (3.5x TTR and 5.2x TCM) in the surviving patient. An average of 68 genes with significant differential expression between timepoints (p<0.0001) demonstrated RNA gene expression changes across all cell subtypes, including ribosomal (RPL and RPS) genes, ACTB, FTL, MALAT1, and others. This averaged 113 genes across all timepoints in the surviving patient, with peak following nivolumab induction. On T-cell receptor (TCR) analysis of this patient, the predominant clonotype diversity changed substantially following nivolumab. Following SBPT, clonotype diversity again changed to include a milieu seen neither at baseline nor with nivolumab alone. These TCRs persisted for approximately 2 weeks following SBPT before returning to resemble the nivolumab-induced TCR diversity alone, coinciding with disease recurrence. CONCLUSION ROR1771 demonstrated overall survival favorably comparable to CheckMate 141. Biomarker analysis of peripheral blood samples demonstrated significant shifts in T-cell subpopulations and underlying gene expression to nivolumab and then to SBPT administration. SBPT to a target lesion changed TCR clonotypes within the peripheral blood beyond those seen with nivolumab administration, with fading of these TCR clonotypes coinciding with recurrence. SBPT in combination with nivolumab may drive systemic immunologic change above that induced by nivolumab alone and warrants further investigation.
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Affiliation(s)
- D K Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J M Evans
- Intermountain Precision Genomics, St George, UT
| | | | - J Breinholt
- Intermountain Precision Genomics, St George, UT
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN
| | - H Dong
- Department of Urology and Immunology, Mayo Clinic, Rochester, MN
| | - S S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - L A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - Y Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J D Evans
- Department of Radiation Oncology, Intermountain Healthcare, Murray, UT
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Malik RF, Berry R, Lau BD, Busireddy KR, Patel P, Patel SH, Fishman EK, Bivalacqua TJ, Johnson PT, Sedaghat F. Systematic Evaluation of Imaging Features of Early Bladder Cancer Using Computed Tomography Performed before Pathologic Diagnosis. Tomography 2023; 9:1734-1744. [PMID: 37736991 PMCID: PMC10514844 DOI: 10.3390/tomography9050138] [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: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Bladder cancer is the sixth most common malignancy in the United States (US). Despite its high prevalence and the significant potential benefits of early detection, no reliable, cost-effective screening algorithm exists for asymptomatic patients at risk. Nonetheless, reports of incidentally identified early bladder cancer on CT/MRI scans performed for other indications are emerging in the literature. This represents a new opportunity for early detection, with over 80 million CT scans performed in the US yearly, 40% of which are abdominopelvic CTs. This investigation aims to define the imaging features of early bladder cancer, with the mission of facilitating early diagnosis. METHODS Following IRB approval with a waiver of informed consent, a retrospective review was performed, identifying 624 patients with non-muscle-invasive bladder cancer diagnosed at Johns Hopkins Hospital between 2000 and 2019. Of these patients, 99 patients underwent pelvic CT within the 5 years preceding pathologic diagnosis. These imaging studies were reviewed retrospectively to evaluate for the presence and features of any focal bladder wall abnormality. RESULTS Median age at the time of pathologic diagnosis was 70 years (range: 51-88 years), and 82% (81/99) of patients were male. A total of 226 CT studies were reviewed. The number of studies per patient ranged from 1 to 33. Median time interval between all available imaging and pathologic diagnosis was 14 months. A total of 62% (141/226) of the scans reviewed were performed for indications other than suspected urinary tract cancer (UTC). A bladder wall mass was visualized in 67% (66/99) of patients and on 35% (78/226) of scans performed before diagnosis. The majority (84%, 67/80) of masses were intraluminal. Mean transverse long- and short-axis measurements were 24 mm and 17 mm, respectively, with long dimension measurements ranging between 5 and 59 mm. CONCLUSIONS Early bladder cancer was visualized on CT preceding pathologic diagnosis in more than 2/3 of patients, and the majority of scans were performed for indications other than suspected urinary tract cancer/UTC symptoms. These results suggest that cross-sectional imaging performed for other indications can serve as a resource for opportunistic bladder cancer screening, particularly in high-risk patients.
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Affiliation(s)
- Rubab F. Malik
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Renu Berry
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Brandyn D. Lau
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Kiran R. Busireddy
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Prasan Patel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Sunil H. Patel
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.H.P.)
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Trinity J. Bivalacqua
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.H.P.)
| | - Pamela T. Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
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9
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Patel SH, Gabrielson A, Collins C, Singla N, Bivalacqua T, Hahn NM, Kates MR. Intravesical gemcitabine and docetaxel in the treatment of BCG-naïve non–muscle invasive urothelial carcinoma of the bladder: Updates from a phase 2 trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.507] [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
507 Background: Combination intravesical Gemcitabine and Docetaxel (GEMDOCE) has demonstrated benefit for bacillus Calmette-Guérin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) in retrospective series and is now being widely utilized as salvage therapy. BCG therapy is fraught with frequent drug shortages and some patients are unable to tolerate BCG due to side effects. Given ongoing BCG shortages as well as the promising efficacy and tolerability of GEMDOCE as a salvage therapy, our objective was to investigate the safety and efficacy of intravesical GEMDOCE for high-risk (HR) BCG-naïve NMIBC in a prospective manner. Methods: This study is an IRB-approved prospective single-arm open-label phase II trial for patients with BCG-naïve HR NMIBC. Intravesical gemcitabine (1,000 mg)/docetaxel (40 mg) in 100mL normal saline is given weekly for 6 weeks as induction followed by monthly maintenance therapy for 2 years among responders. The primary endpoint was 3-month complete response (CR), defined as a negative bladder biopsy 6 weeks after induction treatment. Secondary endpoints included adverse events (AE) and 12-month CR. Results: To date, the study has fully accrued with 25 patients enrolled from July 2020-August 2022. The pre-trial pathologic stages in our cohort were as follows: HGT1 with CIS (n = 7), HGT1 without CIS (n = 6), HGTa (n = 9), and CIS alone (n = 3) (Table). All 25 patients who completed induction therapy demonstrated CR at 3 months. Eight out of 9 (89%) patients with at least 12 months of follow-up demonstrated continued CR. One patient with HGT1 + CIS on enrollment developed a recurrence at 9 months with HGTa. No enrolled patients have undergone radical cystectomy. Grade 1 AEs were common (19/25 patients, 76%) including hematuria, urinary frequency, urgency, and fatigue. Two patients (8%) experienced a Grade 3 AE including urinary retention and UTI requiring hospitalization and intravenous antibiotics. Conclusions: In this ongoing single-arm phase II trial, GEMDOCE appears to be well-tolerated with promising short-term efficacy for patients with BCG-naïve HR NMIBC. [Table: see text]
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Affiliation(s)
- Sunil H. Patel
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Gabrielson
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Connie Collins
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nirmish Singla
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trinity Bivalacqua
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Noah M. Hahn
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Max R. Kates
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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10
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Kemble JP, Winoker JS, Patel SH, Su ZT, Matlaga BR, Potretzke AM, Koo K. Environmental impact of single-use and reusable flexible cystoscopes. BJU Int 2022; 131:617-622. [PMID: 36515438 DOI: 10.1111/bju.15949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare the carbon footprint and environmental impact of single-use and reusable flexible cystoscopes. MATERIALS AND METHODS We analysed the expected clinical lifecycle of single-use (Ambu aScope™ 4 Cysto) and reusable (Olympus CYF-V2) flexible cystoscopes, from manufacture to disposal. Performance data on cumulative procedures between repairs and before decommissioning were derived from a high-volume multispecialty practice. We estimated carbon expenditures per-case using published data on endoscope manufacturing, energy consumption during transportation and reprocessing, and solid waste disposal. RESULTS A fleet of 16 reusable cystoscopes in service for up to 135 months averaged 207 cases between repairs and 3920 cases per lifecycle. Based on a manufacturing carbon footprint of 11.49 kg CO2 /kg device for reusable flexible endoscopes and 8.54 kg CO2 /kg device for single-use endoscopes, the per-case manufacturing cost was 1.37 kg CO2 for single-use devices and 0.0017 kg CO2 for reusable devices. The solid mass of single-use and reusable devices was 0.16 and 0.57 kg, respectively. For reusable devices, the energy consumption of reusable device reprocessing using an automated endoscope reprocessor was 0.20 kg CO2 , and per-case costs of device repackaging and repair were 0.005 and 0.02 kg CO2 , respectively. The total estimated per-case carbon footprint of single-use and reusable devices was 2.40 and 0.53 kg CO2 , respectively, favouring reusable devices. CONCLUSION In this lifecycle analysis, the environmental impact of reusable flexible cystoscopes is markedly less than single-use cystoscopes. The primary contributor to the per-case carbon cost of reusable devices is energy consumption of reprocessing.
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Affiliation(s)
| | | | - Sunil H Patel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhuo T Su
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian R Matlaga
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Meagher MF, Patil D, Saito K, Javier-Desloges JF, Bradshaw AW, Patel SH, Cotta BH, Yasuda Y, Eldefrawy A, Ghali F, Nasseri R, Wan F, Fujii Y, Master V, Derweesh IH. Disparities in Cancer Specific and Overall Survival Outcomes in African Americans With Renal Cell Carcinoma: Analysis From the International Marker Consortium for Renal Cancer (INMARC). Urology 2022; 163:164-176. [PMID: 34995562 DOI: 10.1016/j.urology.2021.12.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/20/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate association of African-American race and survival in Renal Cell Carcinoma (RCC). PATIENTS AND METHODS We queried the International Marker Consortium for Renal Cancer database for patients who underwent partial or radical (RN) nephrectomy. The cohort was divided into African American (AA) and non-African American (NAA) patients. Primary outcome was all-cause mortality. Secondary outcome was cancer-specific mortality. Multivariable Analysis and Kaplan-Meier Analysis were used to elucidate predictive factors and survival outcomes. RESULTS Three thousand eight hundred and ninety-three patients were analyzed (AA, n = 564/NAA, n = 3329). AA had greater Stage I (73.8% vs 63.9%, P <.001) and papillary RCC (29.8% vs 8.5%, P <.001). Multivariable Analysis revealed increasing age (HR = 1.03, P <.001), AA (HR = 1.24, P = .027), higher stage (HR = 1.30-3.19, P <.001), RN (HR = 2.45, P <.001), clear cell (HR = 1.23, P <.001), positive margin (HR = 1.34, P .004), and high-grade (HR = 1.58, P <.001) to be associated with worsened all-cause mortality. Increasing age (HR = 1.02, P <.001), AA (HR = 1.48, P = .025), RN (HR = 2.98, P <.001), high-grade (HR = 3.11, P <.001), and higher stage (HR = 3.03-13.2, P <.001) were predictive for cancer-specific mortality. Kaplan-Meier Analysis revealed worsened 5-year overall survival for AA in stage I (80% vs 88%, P = .001), stage III (26% vs 70%, P = .001), and stage IV (23% vs 44%, P = .009). Five-year cancer-specific survival was worse for AA in stage III (36% vs 81%, P <.001) and stage IV (30% vs 49%, P = .007). CONCLUSION Despite presenting with more indolent histology and lower stage, African-Americans were at greater risk for diminished survival, faring worse in overall survival for all stages and cancer-specific survival in for stage III/IV RCC. Further investigation into factors associated with these disparities is warranted.
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Affiliation(s)
| | | | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Bunkyo City, Tokyo, Japan
| | | | - Aaron W Bradshaw
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Sunil H Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Brittney H Cotta
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Bunkyo City, Tokyo, Japan
| | - Ahmed Eldefrawy
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Fady Ghali
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Ryan Nasseri
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Fang Wan
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo City, Tokyo, Japan
| | - Viraj Master
- Department of Urology, Emory University, Atlanta, GA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA.
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12
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Bhangoo RS, Cheng TW, Petersen MM, Thorpe CS, DeWees TA, Anderson JD, Vargas CE, Patel SH, Halyard MY, Schild SE, Wong WW. Radiation recall dermatitis: A review of the literature. Semin Oncol 2022; 49:152-159. [DOI: 10.1053/j.seminoncol.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2021] [Accepted: 04/01/2022] [Indexed: 12/28/2022]
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13
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Toide M, Saito K, Yasuda Y, Tanaka H, Fukuda S, Patil D, Cotta BH, Patel SH, Master V, Derweesh IH, Fujii Y. Prognostic significance of C-reactive protein in patients with non-metastatic papillary renal cell carcinoma: Results from the INternational Marker Consortium for Renal Cancer (INMARC) cohort. Clin Genitourin Cancer 2022; 20:e276-e282. [DOI: 10.1016/j.clgc.2022.03.004] [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: 01/18/2022] [Revised: 02/27/2022] [Accepted: 03/06/2022] [Indexed: 11/03/2022]
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14
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Alam R, Cheaib JG, Biles MJ, Winoker JS, Singla N, Bivalacqua T, Pierorazio PM, Kates MR, Patel SH. Survival outcomes comparing radical nephroureterectomy versus endoscopic treatment in solitary kidney patients diagnosed with upper tract urothelial carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.477] [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
477 Background: Solitary kidney patients who develop upper tract urothelial carcinoma (UTUC) present a significant management challenge. Radical nephroureterectomy (RNU) renders these patients anephric with a need for dialysis, which is associated with lower life expectancy and decreased quality of life. However, organ-sparing endoscopic treatment may result in undertreatment of the cancer process. We sought to compare survival outcomes between RNU and endoscopy in solitary kidney patients diagnosed with clinically localized UTUC. Methods: The Surveillance, Epidemiology, and End Results database was linked to Medicare records to identify patients diagnosed with UTUC through 2017. This data was then linked to the Medicare Provider Analysis and Review and National Claims History databases to identify patients with a solitary kidney. Only patients with an established diagnosis of solitary kidney prior to developing clinically node-negative and non-metastatic disease (cN0M0) UTUC were included. Patients were stratified by treatment with RNU versus endoscopy. Kaplan-Meier analysis was performed to estimate survival between the two groups. Results: A total of 2108 solitary kidney patients with cN0M0 UTUC were identified, with a median age of 75.3 years at diagnosis [IQR 69.3-81.1]. Median follow-up time was 2.8 years [IQR 1.7-4.4]. High-grade disease was present in 1531 patients (72.6%), of whom 1344 underwent RNU and 195 underwent endoscopy. Between the two treatments, there was no difference in either cancer-specific survival ( P=0.18) or overall survival ( P=0.10). When combining high- and low-grade UTUC patients, 1839 underwent RNU and 269 underwent endoscopy. Again, no difference was observed in cancer-specific survival ( P=0.31) or overall survival ( P=0.17). Patients with high-grade disease demonstrated higher rates of cancer-specific and overall mortality than those with low-grade disease (both P<0.001). Conclusions: Solitary kidney patients diagnosed with clinically localized UTUC demonstrate no difference in survival outcomes when comparing RNU to endoscopic treatment. This potentially suggests that, when weighed against the option of endoscopic treatment, the benefits of RNU in these patients may not outweigh the risks of becoming anephric and therefore dependent on dialysis.
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Affiliation(s)
- Ridwan Alam
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph G. Cheaib
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J. Biles
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jared S. Winoker
- The Smith Institute for Urology at Lenox Hill, Zucker School of Medicine at Northwell Health, New York City, NY
| | - Nirmish Singla
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trinity Bivalacqua
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Phillip M. Pierorazio
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Max R. Kates
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sunil H. Patel
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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15
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Drescher M, Patel SH, Alam R, De La Calle C, Yerrapragada A, Bettegowda C, Matoso A, Ged Y, Singla N. Characteristics and outcomes of patients managed with surgical resection of brain metastasis from renal cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.392] [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
392 Background: For patients with metastatic renal cell carcinoma (mRCC), the presence of brain metastases (BM) confers a poor prognosis compared with alternative metastatic sites. Being an uncommon site of spread, granular data regarding BM in RCC is relatively sparse. We retrospectively reviewed the clinical features and outcomes of patients with surgically-resected BM from mRCC at our institution. Methods: Patients with mRCC and BM were identified within our institutional experience. Clinical and treatment data was obtained from electronic records. A diagnosis of mRCC to the brain was determined by pathological confirmation obtained via metastasectomy or rarely biopsy. Baseline patient demographics, clinicopathological disease characteristics and survival data were extracted. Overall survival (OS) was calculated from the date of BM intervention using Kaplan–Meier methods. Results: 54 patients were identified with surgically resected BM. Median age at RCC diagnosis was 58 years (IQR 49-67) and most patients were male (n = 39, 73%). 30 patients (56%) presented with de novo metastatic disease without any prior localized treatment, and most developed or presented with multiple metastatic sites. The most common histologic subtype was clear cell carcinoma (n = 51, 94%) and high grade disease was common (n = 39, 73%). The initial treatment of BM for the majority of patients was with neurosurgical resection (94%) followed by post-operative stereotactic radiosurgery (SRS) (87%) and systemic therapy (75%). For patients receiving systemic therapy, most received multiple agents (median 2, range 1-5). 32% of patients had received systemic therapy prior to developing BM. 19 patients (35%) received immune-checkpoint inhibitors. The median overall survival for patients from the date of neurosurgical intervention was 14.5 months (95% CI 9.2- 25 months). Conclusions: We present a large institutional series of patients with BM from mRCC treated with surgical resection. While BM remains a poor prognostic factor in mRCC, surgical resection in selected patients remains a viable strategy. Comprehensive molecular profiling of BM and their corresponding primary RCC tumors will shed light on biological tropism of this phenomenon and underscore prognostic and therapeutic implications.[Table: see text]
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Affiliation(s)
| | - Sunil H. Patel
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ridwan Alam
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Chetan Bettegowda
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Cheaib JG, Patel SH, Alam R, Metcalf M, Trock B, Jing Y, Ged Y, Allaf M, Pierorazio P, Singla N. Racial differences in the natural history of small renal masses: A prospective registry study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.295] [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
295 Background: Patients with small renal masses (SRM) can be managed conservatively by active surveillance (AS) or active treatment. A subset of patients who elect for AS undergo delayed intervention, either due to progression or other factors. Using a large, prospective registry of patients with SRMs we characterize differences in SRM growth trajectories on AS and pathologic differences among resected SRMs between African Americans (AA) and Caucasians. Methods: We stratified patients enrolled in the prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry by race. DISSRM includes AS, primary intervention (PI), and delayed intervention (DI). The growth rate for patients who elected for AS was compared between AA and Caucasian patients. Pathologic features among patients who underwent PI or DI were compared by race. Results: We enrolled 745 patients in DISSRM who were either AA (n = 117, 15.7%) or Caucasian (n = 628 (84.3%)), with median follow-up of 3.3 years [IQR 1.5-6.6]. 410 patients elected for AS (84% Caucasian, 16% AA) and 401 opted for PI (n = 335) or DI (n = 66) (86% Caucasian, 14% AA). Within the AS cohort, no differences were seen in age, comorbidities, or tumor size, though Caucasians were more male-predominant (60.9% vs. 38.5%, p = 0.001), and body mass index was higher among AA (p = 0.03). Median overall growth rate for AA vs Caucasian was 0.04 cm/year [-0.03-0.3] vs 0.1 cm/year [0-0.33], p = 0.2 (Figure).In the DI arm, median time to intervention was 12.5 months, with HR (AA vs Caucasian) being 0.32 (0.13-0.82), p = 0.02. There were no differences in baseline clinical characteristics or tumor size in the DI or PI arm, however AA were more likely to undergo radical nephrectomy (24.6% vs. 10.4%, p = 0.01). pT stage and grade were similar between groups, and papillary histology was more common among AA (34.1% vs 19.9%, p = 0.007). There were 31 deaths among patients undergoing intervention, which was significantly worse for AA after multivariable adjustment (HR 2.51, p = 0.025). Conclusions: Using the largest prospective registry of SRM, we found the natural history of SRM on AS to be similar between AA and Caucasians. However, histology, surgical approach, and survival differed between groups, with worse OS among AA. Further socioeconomic and molecular analyses will help elucidate biological differences and identify strategies to improve outcomes among patients with SRM.
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Affiliation(s)
| | - Sunil H. Patel
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ridwan Alam
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Meredith Metcalf
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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17
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Wang S, Cheaib JG, Patel SH, Alam R, Metcalf M, Jing Y, Trock B, Allaf M, Ged Y, Pierorazio P, Singla N. Clinicopathologic and survival differences between African Americans and Caucasians with renal cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.296] [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
296 Background: The incidence of renal cell carcinoma (RCC) has gradually increased over the past decades, particularly among African Americans (AA). Lifestyle and other factors such as high blood pressure and tobacco exposure are associated with its incidence. We aim to compare differences in clinicopathologic characteristics and survival outcomes between AA and Caucasian patients undergoing nephrectomy for RCC. Methods: A retrospective single institutional analysis was performed on AA or Caucasian patients undergoing nephrectomy for RCC between 1996 and 2021. Baseline clinical and pathologic characteristics were compared by race. Survival outcomes, including cancer-specific survival (CSS) and overall survival (OS), were assessed by Kaplan-Meier methods and multivariable Cox regression analysis (MVA). Results: We included 2,439 patients (445 AA, 1987 Caucasians). AA patients were female-predominant compared to Caucasians (54.8% vs. 35.7%, p<0.01). AA patients were more likely to have a history of hypertension (44.0% vs. 40.3%, p<0.001) and diabetes (14.4% vs. 11.4%, p<0.001). Caucasian race was associated with higher pathologic stage (p<0.001), positive nodal status (3.8% vs. 1.1%, p=0.016), and metastatic disease at presentation (3.7% vs. 1.8%, p=0.042). AA had more papillary variant compared to Caucasians (36 v 15.7%, p<0.01). The 5-year CSS across all stages was better for AA vs. Caucasians (93.1% vs. 89.7%, p=0.01), but after adjusting for covariates, race was not significant for CSS on MVA (HR 0.89 (95% CI 0.57-1.38), p=0.8). Similar findings were seen in OS. We performed additional sub-analyses on patients with stage pT1a (n=665) and locally advanced (pT3-4, n=431) clear cell RCC. Among these sub-groups, no significant differences were seen by race. Conclusions: Within our institutional cohort, AA patients with RCC undergoing nephrectomy did not exhibit worse pathologic characteristics at presentation or inferior survival outcomes compared to their Caucasian counterparts. There were notable differences among baseline clinical characteristics and histology by race. Socioeconomic and molecular analyses will help elucidate biological differences and identify socially actionable strategies to improve outcomes among patients with RCC.
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Affiliation(s)
| | | | - Sunil H. Patel
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ridwan Alam
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Routman DM, Kumar S, Chera BS, Jethwa KR, Van Abel KM, Frechette K, DeWees T, Golafshar M, Garcia JJ, Price DL, Kasperbauer JL, Patel SH, Neben-Wittich MA, Laack NL, Chintakuntlawar AV, Price KA, Liu MC, Foote RL, Moore EJ, Gupta GP, Ma DJ. Detectable Post-operative Circulating Tumor Human Papillomavirus (HPV) DNA And Association with Recurrence in Patients with HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2022; 113:530-538. [PMID: 35157995 DOI: 10.1016/j.ijrobp.2022.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To determine the rate of detectability of ctHPVDNA after surgery but before adjuvant therapy in patients with HPV-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) and to investigate whether detectable ctHPVDNA at this time point may be associated with risk of recurrence. METHODS AND MATERIALS Prospectively collected samples from patients with OPSCC were examined in a blinded fashion using a multi-analyte PCR assay. 45 samples were collected from HPV(+)OPSCC patients pre-op (prior to any treatment), and 159 samples post-op (before or at the start of adjuvant RT). Samples were identified via the radiation oncology biobank or via participation in a clinical trial. RT consisted of 60 Gy +/- cisplatin or de-escalation (30 Gy to 36 Gy in 20 b.i.d. fractions + docetaxel). 32 patients had paired samples available pre and post-op for the primary analysis. Additional exploratory analyses including associations of patient and tumor characteristics with recurrence were assessed using Cox proportional hazards models for all 159 post-op samples.. Detectability of ctHPVDNA was compared across groups utilizing logistic regression. Estimates of recurrence free survival (RFS) were made using Kaplan-Meier (KM). RESULTS In a paired analysis of 32 pre and post-op timepoints, 94% of patients had detectable ctHPVDNA pre-op and 41% post-op. RFS at 18 months was 83% (95% CI: 47-95%) for patients with detectable post-op ctHPVDNA compared to 100% for patients with undetectable post-op ctHPVDNA (p=.094).In an exploratory analysis of non-paired post-op samples, ctHPVDNA was detectable in 26% (41 of 159) of patients (median of 22 days post-op). Age (1.06, p=0.025), LVSI (OR 3.17, p=0.011) and ENE (OR=5.67, p=0.001) were associated with detectable ctHPVDNA after surgery. Detectable post-op ctHPVDNA was significantly associated with RFS (p<0.001). CONCLUSION Amongst patients with detectable pre-op ctHPVDNA, a significant proportion have detectable post-op ctHPVDNA in paired post-op samples, collected prior to the initiation of adjuvant radiation therapy. Future prospective study is warranted to investigate the association of detectable post-op ctHPVDNA with recurrence, including in comparison to established clinical and pathologic risk factors.
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Affiliation(s)
- D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
| | - S Kumar
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - B S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - K R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - K M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - K Frechette
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - T DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix AZ, USA
| | - M Golafshar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix AZ, USA
| | - J J Garcia
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester MN, USA
| | - D L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - J L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix AZ, USA
| | | | - N L Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - K A Price
- Division of Medical Oncology, Mayo Clinic, Rochester MN, USA
| | - M C Liu
- Division of Medical Oncology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - E J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - G P Gupta
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Forbes ZR, Scro AK, Patel SH, Dourdeville KM, Prescott RL, Smolowitz RM. Fecal and cloacal microbiomes of cold-stunned loggerhead Caretta caretta, Kemp’s ridley Lepidochelys kempii, and green sea turtles Chelonia mydas. ENDANGER SPECIES RES 2022. [DOI: 10.3354/esr01220] [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: 12/14/2022] Open
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20
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Patel SH, Wang S, Metcalf MR, Gupta N, Gabrielson A, Lee E, Rostom M, Pierorazio P, Smith A, Hahn N, Schoenberg M, Kates M, Hoffman-Censits J, Bivalacqua TJ. Safety and Efficacy of Reproductive Organ-Sparing Radical Cystectomy in Women With Variant Histology and Advanced Stage. Clin Genitourin Cancer 2021; 20:60-68. [PMID: 34896022 DOI: 10.1016/j.clgc.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Muscle invasive bladder cancer surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine, ovarian, and vaginal preservation are utilized, but raise concerns regarding risk to oncologic control, especially in variant histopathology or advanced stage. MATERIALS AND METHODS A retrospective single institutional analysis identified radical cystectomies performed in women, including those with variant histology, which were defined as reproductive organ sparing (uterine, vaginal, and ovary sparing) or nonorgan sparing. The Kaplan-Meier method was used for recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in patients with advanced disease. RESULTS From 2000 to 2020, 289 women were identified, 188 underwent reproductive organ-sparing cystectomy. No statistical differences were noted for clinical parameters or presence of variant histology for organ-sparing (ROS) and nonorgan-sparing (non-ROS). Positive margin rates did not differ for ROS and non-ROS; 4.3% vs. 7.9%, P = .19, respectively. Median RFS was not statistically significantly different for ROS vs. non-ROS (26.1 vs. 15.3 months) P = .937 hazard ratio (HR) 1.024. CSS was not statistically different for ROS vs. non-ROS (36.3 vs. 28.6 months), P = .755 HR 0.9. OS was not statistically different for ROS vs. non-ROS (25.8 vs. 23.8 months), P = .5 HR = 1.178. Variant histology did not change survival (HR 1.1, P = .643). CONCLUSION In this analysis, ROS in women with advanced disease did not increase positive margin rates or decrease RFS, CSS, or OS compared to non-ROS. Variant histology did not decrease survival odds. Based on preoperative assessment and intraoperative findings, ROS in patients with variant histology and advanced disease should be considered.
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Affiliation(s)
- Sunil H Patel
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
| | - Shirley Wang
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Natasha Gupta
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Andrew Gabrielson
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Esther Lee
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Mary Rostom
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Phil Pierorazio
- Division of Urology, University of Pennsylvania, Philadelphia, PA
| | - Armine Smith
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Noah Hahn
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Urology, New York University, New York, NY
| | - Mark Schoenberg
- Department of Urology, Montefiore Medical Center, Einstein School of Medicine, Bronx, NY
| | - Max Kates
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Jean Hoffman-Censits
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Oncology, The Johns Hopkins School of Medicine, Baltimore, MD
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21
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Wang S, Metcalf M, Hoffman-Censits J, Bivalacqua T, Patel SH. Penile sarcomatoid urothelial carcinoma: A case report. Urol Case Rep 2021; 38:101706. [PMID: 34703768 PMCID: PMC8521450 DOI: 10.1016/j.eucr.2021.101706] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
A 74-year-old man with a penile mass was diagnosed with sarcomatoid urothelial carcinoma. Further workup did not show any other lesions or metastases. He was treated with a total penectomy, bilateral inguinal lymph node dissection, and pelvic lymphadenectomy. Following surgery, he received six cycles of cisplatin and gemcitabine. Sarcomatoid carcinoma and carcinosarcoma of the urethra are rare; six prior cases have been reported in the literature, with this being the first urothelial with sarcomatoid component. Survival in patients with sarcomatoid carcinoma or carcinosarcoma of the urinary tract is poor, with the limited data supporting a multimodal approach to improve survival.
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Affiliation(s)
- Shirley Wang
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Meredith Metcalf
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Jeannie Hoffman-Censits
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Trinity Bivalacqua
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Sunil H Patel
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
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22
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Patel HD, Patel SH, Blanco-Martinez E, Kuzbel J, Chen VS, Druck A, Koehne EL, Patel PM, Doshi CP, Hahn NM, Hoffman-Censits JH, Berg S, Bivalacqua TJ, Kates M, Quek ML. Four versus 3 Cycles of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Implications for Pathological Response and Survival. J Urol 2021; 207:77-85. [PMID: 34445890 DOI: 10.1097/ju.0000000000002189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/25/2022]
Abstract
PURPOSE The ideal number of neoadjuvant chemotherapy (NAC) cycles for muscle-invasive bladder cancer is uncertain with 3 to 4 representing the standard of care (SOC). We compared ypT0 rates and survival between patients receiving 4 versus 3 cycles of NAC with evaluation of chemotherapy-related toxicity for correlation with tumor chemosensitivity and pathological response. MATERIALS AND METHODS Patients receiving NAC followed by radical cystectomy for cT2-4N0M0 urothelial carcinoma from 2 institutions were included. Primary study groups included 4 cisplatin-based NAC cycles, 3 cisplatin-based NAC cycles, and nonSOC NAC (1-2 cycles or noncisplatin-based) to compare ypT0/≤ypT1 rates and survival. A cohort of patients not receiving NAC was included for pathological reference. RESULTS Of 693 total patients, 318 (45.9%) received NAC. ypT0 and ≤ypT1 rates were 42/157 (26.8%) and 86/157 (54.8%) for 4 cycles, 38/114 (33.3%) and 71/114 (62.3%) for 3 cycles, and 6/47 (12.8%) and 13/47 (27.7%) for nonSOC (p=0.03 and p <0.01, respectively). Pathological response appeared higher among patients receiving 3 cycles due to toxicity (ypT0: 29/77 [37.7%]; ≤ypT1: 51/77 [66.2%]) but did not reach statistical significance. Toxicities leading to treatment modifications were thrombocytopenia (32.1%), neutropenia (27.2%), renal insufficiency (22.2%), and constitutional symptoms (18.5%). NonSOC patients had lower Kaplan-Meier survival (cT2-cT4N0M0: log-rank p=0.07; cT2N0M0: log-rank p=0.02). There were no statistically significant differences in survival between 4 and 3 cycles (HR 1.00 [95% CI 0.57-1.74], p=0.99). CONCLUSIONS Patients completing 3 cycles of cisplatin-based NAC have similar pathologic response and short-term survival compared to 4 cycles. Further evaluation of patients experiencing toxicity as a potential marker of tumor chemosensitivity is needed.
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Affiliation(s)
- Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Sunil H Patel
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Jake Kuzbel
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Aleksander Druck
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Elizabeth L Koehne
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Parth M Patel
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Chirag P Doshi
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Noah M Hahn
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Jean H Hoffman-Censits
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Stephanie Berg
- Division of Hematology/Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Max Kates
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
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23
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Patel SH. Clinician's commentary: Atypia in urinary tract cytology specimens. Diagn Cytopathol 2021; 50:184-185. [PMID: 34411464 DOI: 10.1002/dc.24852] [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: 08/02/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/09/2022]
Abstract
At the 18th International Congress of Cytology in Paris in 2013, the "Paris Group" created standardized reporting system/criteria for urine cytopathology. This reporting system provided evidence-based criteria for all the urine cytopathologic diagnosis in aims to avoid atypia being used a "waste basket." The addition of standard classification system greatly helps minimizing atypia diagnosis; however, clinicians, specifically, urologist, are still left without a clear set of guidelines for how to approach atypia. Prospective collaborate work with cytopathologists and urologist can help solve the dreaded atypia cytology pathological report and provide a framework and guidelines on management, providing better care to our patients.
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Affiliation(s)
- Sunil H Patel
- Division of Urologic Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
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24
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Patel SH, Singla N, Pierorazio PM. Decision-making in active surveillance in kidney cancer: current trends and future urine and tissue markers. World J Urol 2021; 39:2869-2874. [PMID: 34370079 DOI: 10.1007/s00345-021-03786-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/02/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Surveillance for small renal masses is a growing choice of management amongst physicians and patients. These decisions, however, can be difficult as patient factors and tumor factors may blur the line between continued surveillance and intervention. Currently, there are no biomarkers that are readily available to aid in the decision making for patients with known renal cell carcinoma; however, many show promise. We herein review the literature of the adjunct tools that are currently available for decision making in small renal masses, but also new potential biomarkers that can potentially be of use.
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Affiliation(s)
- Sunil H Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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25
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Patel SH, Gallo K, Becker R, Borin J, Loeb S. Climate Change Impact of Virtual Urology Meetings. Eur Urol 2021; 80:121-122. [PMID: 33985798 DOI: 10.1016/j.eururo.2021.04.033] [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: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Sunil H Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA.
| | - Kelsey Gallo
- Department of Urology, University of California San Diego Health System, San Diego, CA, USA
| | - Russell Becker
- James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | - James Borin
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA
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26
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Patel SH, Singla N, Pierorazio PM. Contemporary Prognostic Model for Renal Cell Carcinoma: Is it Time for Biomarkers? Eur Urol 2021; 80:32-33. [PMID: 33934930 DOI: 10.1016/j.eururo.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Sunil H Patel
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Nirmish Singla
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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27
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Cotta BH, Meagher MF, Patil D, Saito K, Patel SH, Patel DN, Miller N, Dutt R, Keiner C, Bradshaw AW, Wan F, Eldefrawy A, Yasuda Y, Fujii Y, Master V, Derweesh IH. Elevated preoperative C-reactive protein is associated with renal functional decline and non-cancer mortality in surgically treated renal cell carcinoma: analysis from the INternational Marker Consortium for Renal Cancer (INMARC). BJU Int 2020; 127:311-317. [PMID: 32772468 DOI: 10.1111/bju.15200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/20/2023]
Abstract
OBJECTIVE To investigate association of preoperative C-reactive protein (CRP) and non-cancer mortality (NCM) in a cohort of patients undergoing surgery for localised renal cell carcinoma (RCC). PATIENTS AND METHODS Retrospective multicentre analysis of patients surgically treated for clinical Stage 1-2 RCC from 2006 to 2017, excluding all cases of cancer-specific mortality. Descriptive analyses were obtained between the pre-treatment normal-CRP (≤5 mg/L) and elevated-CRP (>5 mg/L) groups. The primary outcome was NCM. The secondary outcomes included progression to de novo chronic kidney disease Stages 3-4 (estimated glomerular filtration rate [eGFR] of <60, <45, and <30 mL/min/1.73 m2 ). Multivariable analyses (MVA) were performed to assess for risk factors associated with functional decline and NCM, and Kaplan-Meier analysis was used to obtain survival estimates for outcomes. RESULTS A total of 1987 patients who underwent radical or partial nephrectomy were analysed (normal-CRP group, n = 963; elevated-CRP group, n = 1024). Groups were similar in age (59 vs 60 years, P = 0.079). An elevated CRP was more frequent in males (36.8% vs 27.8%, P < 0.001), African-Americans (22.6% vs 2.9%, P < 0.001), and in those with a higher median body mass index (30 vs 25 kg/m2 , P < 0.001) and larger median tumour size (4.5 vs 3.3 cm, P < 0.001). On MVA, an elevated CRP was independently associated with development of de novo eGFR of <60 mL/min/1.73 m2 (hazard ratio [HR] 1.32, P = 0.015), <45 mL/min/1.73 m2 (HR 1.41, P = 0.023) and <30 mL/min/1.73 m2 (odds ratio 2.23, P < 0.001). The MVA for factors associated with NCM demonstrated increasing age (HR 1.06, P < 0.001), preoperative elevated CRP (HR 2.18, P < 0.001) and an eGFR of <45 mL/min/1.73 m2 (HR 1.16; P = 0.021) as independent risk factors. Kaplan-Meier analysis revealed significantly higher 5-year NCM in the elevated-CRP group vs the normal-CRP group (98% vs 80%, P < 0.001). CONCLUSIONS Pre-treatment elevated CRP was independently associated with both progressive renal functional decline and NCM in patients undergoing surgery for Stage 1-2 RCC. Patients with elevated CRP and Stage 1 and 2 RCC may be considered as having indication for nephron-sparing strategies, which may be prioritised if oncologically appropriate.
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Affiliation(s)
- Brittney H Cotta
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F Meagher
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Dattatraya Patil
- Department of Urology, Emory University Medical Center, Atlanta, GA, USA
| | | | - Sunil H Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Devin N Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Nathan Miller
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Raksha Dutt
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Cathrine Keiner
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron W Bradshaw
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Fang Wan
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Ahmed Eldefrawy
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | | | | | - Viraj Master
- Department of Urology, Emory University Medical Center, Atlanta, GA, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
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28
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Patel DN, Ghali F, Meagher MF, Javier-Desloges J, Patel SH, Soliman S, Hakimi K, Yuan J, Murphy J, Derweesh IH. Utilization of renal mass biopsy in patients with localized renal cell carcinoma: A population-based study utilizing the National Cancer Database. Urol Oncol 2020; 39:79.e1-79.e8. [PMID: 33160847 DOI: 10.1016/j.urolonc.2020.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/06/2020] [Revised: 09/02/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate trends and factors predicting use of renal mass biopsy (RMB) for localized Renal Cell Carcinoma in the United States (US) in the context of current guidelines recommendations. METHODS We queried the National Cancer Database for cT1-cT3N0M0 Renal Cell Carcinoma diagnosed between 2004 and 2015. Temporal trends of RMB were characterized based on tumor size, treatment (partial nephrectomy [PN], radical nephrectomy [RN], ablation, and no treatment), age and Charlson Comorbidity Index with slopes compared using analysis of variance. Multivariable analysis was used to determine factors associated with use of RMB. RESULTS Of 338,252 patients analyzed, 11.9% (40,276) underwent RMB. Use of RMB increased throughout the study period from 1,586 (7.6%) in 2004 to 5,629 (16.2%) in 2015 (P < 0.001). Use of RMB increased greatest for ablation (27 to 63%, P < 0.001) and tumors 2-4 cm (9 to 20%, P < 0.001). Multivariable analysis showed year of diagnosis (OR = 1.06; P < 0.001), higher education (OR = 1.09; P < 0.001) and insured status (OR = 1.23; P < 0.001) were associated with increased RMB. Compared to tumors ≤2 cm, tumors 2.1-4 cm (OR = 1.36; P=<0.001), 4.1-7 cm (OR = 1.18; P <0.001) and >7 cm (OR = 1.05; P = 0.03) were associated with higher rates of RMB. Compared to RN, PN was not associated with increased RMB (OR = 1.00; P = 0.92), while ablation (OR = 10.90; P < 0.001) and no surgical treatment (OR = 4.83; P < 0.001) were. CONCLUSION RMB utilization increased overall, with largest increase associated with ablation. Nonetheless, only two-thirds of patients underwent RMB with ablation, suggesting persistent underutilization. Rates of RMB for tumors ≤2 cm and in those undergoing no treatment increased less, suggesting less utilization for surveillance. However, rates for tumors >2-4 cm increased more, suggesting selective utilization of RMB to guide decision-making and risk stratification in small renal masses.
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Affiliation(s)
- Devin N Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Fady Ghali
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | | | | | - Sunil H Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Shady Soliman
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Julia Yuan
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - James Murphy
- Department of Radiation Oncology, UC San Diego School of Medicine, La Jolla, CA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA.
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Ryan ST, Patel DN, Ghali F, Patel SH, Sarkar R, Yim K, Eldefrawy A, Cotta BH, Bradshaw AW, Meagher MF, Hamilton ZA, Murphy JD, Derweesh IH. Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database. Minerva Urol Nephrol 2020; 73:233-244. [PMID: 32748614 DOI: 10.23736/s2724-6051.20.03728-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC). METHODS Retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage (pT1a, pT1b, pT2a, pT2b, and pT3a [upstaged]) and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Sub-analysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities. RESULTS We analyzed 42,113 PN (pT1a: 33,341 [79.2%]; pT1a, pT1b: 6689 [15.9%]; pT2a: 757 [1.8%]; pT2b: 165 [0.4%]; and pT3a: upstaged 1161 [2.8%]). PSM occurred in 6.7% (2823) (pT1a: 6.5%, pT1b: 6.3%, pT2a: 5.9%, pT2b: 6.1%, pT3a: 14.1%, P<0.001). On MVA, PSM was associated with 31% increase in ACM (HR 1.31, P<0.001), which persisted in CCI=0 sub-analysis (HR: 1.25, P<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, P<0.001), pT2 (86.7% vs. 82.5%, P=0.48), and upstaged pT3a (69% vs. 84.2%, P<0.001). CONCLUSIONS PSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in sub-analysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.
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Affiliation(s)
- Stephen T Ryan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Devin N Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Fady Ghali
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Sunil H Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Reith Sarkar
- Department of Radiation Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Kendrick Yim
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ahmed Eldefrawy
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Brittney H Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron W Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Zachary A Hamilton
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - James D Murphy
- Department of Radiation Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA -
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Ryan ST, Patel DN, Ghali F, Patel SH, Sarkar R, Yim K, Eldefrawy A, Cotta BH, Bradshaw AW, Meagher MF, Hamilton ZA, Murphy JD, Derweesh IH. Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database. Minerva Urol Nephrol 2020. [PMID: 32748614 DOI: 10.23736/s0393-2249.20.03728-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC). METHODS Retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage (pT1a, pT1b, pT2a, pT2b, and pT3a [upstaged]) and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Sub-analysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities. RESULTS We analyzed 42,113 PN (pT1a: 33,341 [79.2%]; pT1a, pT1b: 6689 [15.9%]; pT2a: 757 [1.8%]; pT2b: 165 [0.4%]; and pT3a: upstaged 1161 [2.8%]). PSM occurred in 6.7% (2823) (pT1a: 6.5%, pT1b: 6.3%, pT2a: 5.9%, pT2b: 6.1%, pT3a: 14.1%, P<0.001). On MVA, PSM was associated with 31% increase in ACM (HR 1.31, P<0.001), which persisted in CCI=0 sub-analysis (HR: 1.25, P<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, P<0.001), pT2 (86.7% vs. 82.5%, P=0.48), and upstaged pT3a (69% vs. 84.2%, P<0.001). CONCLUSIONS PSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in sub-analysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.
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Affiliation(s)
- Stephen T Ryan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Devin N Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Fady Ghali
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Sunil H Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Reith Sarkar
- Department of Radiation Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Kendrick Yim
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ahmed Eldefrawy
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Brittney H Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron W Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Zachary A Hamilton
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - James D Murphy
- Department of Radiation Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA -
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Sarkar RR, Patel SH, Parsons JK, Deka R, Kumar A, Einck JP, Mundt AJ, Kader AK, Kane CJ, Riviere P, McKay R, Murphy JD, Rose BS. Testosterone therapy does not increase the risks of prostate cancer recurrence or death after definitive treatment for localized disease. Prostate Cancer Prostatic Dis 2020; 23:689-695. [PMID: 32513967 DOI: 10.1038/s41391-020-0241-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/02/2020] [Accepted: 05/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The safety of testosterone therapy (TT) after definitive treatment for localized prostate cancer remains undefined. We analyzed the risks of biochemical recurrence and mortality in men receiving TT after treatment for localized prostate cancer. METHODS Cohort analysis using the national US Veterans Affairs Informatics and Computing Infrastructure. We identified 69,984 patients with localized prostate cancer diagnosed from 2001 to 2015 treated with surgery or radiation. We coded receipt of TT after treatment as a time-dependent covariate; used the National Death Index to identify cause of death; and defined biochemical recurrence as PSA > 0.2 ng/mL after surgery and nadir + 2 ng/mL after radiation. We analyzed recurrence and mortality using cumulative incidence curves, Fine-Gray competing risk regression, and Cox regression. RESULTS This cohort included 28,651 surgery patients and 41,333 radiation patients, of whom 469 (1.64%) and 543 (1.31%), respectively, received TT with a median follow-up of 6.95 years. Comparing testosterone users to nonusers, there were no between-group differences in biochemical recurrence, prostate cancer-specific mortality, or overall mortality after surgery [hazard ratios (HR): 1.07; HR: 0.72 (p = 0.43); and HR: 1.11 (p = 0.43), respectively] or radiation [HR: 1.07; HR: 1.02 (p = 0.95); and HR: 1.02 (p = 0.86), respectively]. Limitations included lack of detailed data on TT duration and serum testosterone concentrations. CONCLUSIONS In this multi-ethnic national cohort, TT did not increase the risks of biochemical recurrence or prostate cancer-specific or overall mortality after surgery or radiation. These data suggest that TT is safe in appropriate men after definitive treatment of localized prostate cancer.
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Affiliation(s)
- Reith R Sarkar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA
| | - Sunil H Patel
- Veteran Affairs Healthcare, San Diego, CA, USA.,Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Rishi Deka
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Abhishek Kumar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - A Karim Kader
- Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Christopher J Kane
- Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA
| | - Rana McKay
- Division of Hematology-Oncology, Department of Internal Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA.,Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA
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Darvishi P, Batchala PP, Patrie JT, Poisson LM, Lopes MB, Jain R, Fadul CE, Schiff D, Patel SH. Prognostic Value of Preoperative MRI Metrics for Diffuse Lower-Grade Glioma Molecular Subtypes. AJNR Am J Neuroradiol 2020; 41:815-821. [PMID: 32327434 DOI: 10.3174/ajnr.a6511] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/29/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Despite the improved prognostic relevance of the 2016 WHO molecular-based classification of lower-grade gliomas, variability in clinical outcome persists within existing molecular subtypes. Our aim was to determine prognostically significant metrics on preoperative MR imaging for lower-grade gliomas within currently defined molecular categories. MATERIALS AND METHODS We undertook a retrospective analysis of 306 patients with lower-grade gliomas accrued from an institutional data base and The Cancer Genome Atlas. Two neuroradiologists in consensus analyzed preoperative MRIs of each lower-grade glioma to determine the following: tumor size, tumor location, number of involved lobes, corpus callosum involvement, hydrocephalus, midline shift, eloquent cortex involvement, ependymal extension, margins, contrast enhancement, and necrosis. Adjusted hazard ratios determined the association between MR imaging metrics and overall survival per molecular subtype, after adjustment for patient age, patient sex, World Health Organization grade, and surgical resection status. RESULTS For isocitrate dehydrogenase (IDH) wild-type lower-grade gliomas, tumor size (hazard ratio, 3.82; 95% CI, 1.94-7.75; P < .001), number of involved lobes (hazard ratio, 1.70; 95% CI, 1.28-2.27; P < .001), hydrocephalus (hazard ratio, 4.43; 95% CI, 1.12-17.54; P = .034), midline shift (hazard ratio, 1.16; 95% CI, 1.03-1.30; P = .013), margins (P = .031), and contrast enhancement (hazard ratio, 0.34; 95% CI, 0.13-0.90; P = .030) were associated with overall survival. For IDH-mutant 1p/19q-codeleted lower-grade gliomas, tumor size (hazard ratio, 2.85; 95% CI, 1.06-7.70; P = .039) and ependymal extension (hazard ratio, 6.34; 95% CI, 1.07-37.59; P = .042) were associated with overall survival. CONCLUSIONS MR imaging metrics offers prognostic information for patients with lower-grade gliomas within molecularly defined classes, with the greatest prognostic value for IDH wild-type lower-grade gliomas.
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Affiliation(s)
- P Darvishi
- From the Departments of Radiology and Medical Imaging (P.D., P.P.B., S.H.P.)
| | - P P Batchala
- From the Departments of Radiology and Medical Imaging (P.D., P.P.B., S.H.P.)
| | | | - L M Poisson
- Department of Public Health (L.M.P.), Henry Ford Health System, Detroit, Michigan
| | - M-B Lopes
- Pathology, Divisions of Neuropathology and Molecular Diagnostics (M.-B.L.)
| | - R Jain
- Departments of Radiology (R.J.) and Neurosurgery (R.J.), New York University School of Medicine, New York, New York
| | - C E Fadul
- Division of Neuro-Oncology (C.E.F., D.S.), University of Virginia Health System, Charlottesville, Virginia
| | - D Schiff
- Division of Neuro-Oncology (C.E.F., D.S.), University of Virginia Health System, Charlottesville, Virginia
| | - S H Patel
- From the Departments of Radiology and Medical Imaging (P.D., P.P.B., S.H.P.)
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Patel SH, Panian J, Bree K, Derweesh I, Millard F, Randall J, Mckay R. Systemic Treatment of Bone Disease in Metastatic Urinary Malignancies. Eur Urol Focus 2020; 6:17-25. [PMID: 31255618 DOI: 10.1016/j.euf.2019.06.007] [Citation(s) in RCA: 2] [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: 03/22/2019] [Revised: 05/28/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Bone metastasis is a common site of metastatic disease in patients with genitourinary malignancies. Given that the presence of bone metastasis decreases survival and has a negative impact on quality of life impact, it is critical to optimize management of this patient population. OBJECTIVE To systematically review literature on the systemic treatment of bone metastasis in prostate cancer, renal cell carcinoma, urothelial carcinoma, and germ cell tumors. EVIDENCE ACQUISITION We performed a nonsystematic critical review of PubMed/Medline, clinicaltrials.gov, and the Cochrane Library from January 2001 to February 2019. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials, and selected based on reporting skeletal related events and symptomatic skeletal events for patients with urologic malignancies. EVIDENCE SYNTHESIS Skeletal metastases occur frequently in genitourinary malignancies, at rates around 80% for patients with metastatic prostate cancer and 30% for patients with metastatic renal cell and urothelial carcinoma, and are uncommon in patients with germ cell tumors. Skeletal related events and symptomatic skeletal events can occur in these patients. Optimization of bone health involves dietary and lifestyle modifications, and use of osteoclast-targeted agents in select individuals. Additionally, disease-modifying agents, such as radiopharmaceutical, immunotherapy, and cMET inhibitors, which have activity in the bone, have improved outcomes for patients, including skeletal-related events and symptomatic skeletal events. CONCLUSIONS While the presence of bone metastases is associated with increased mortality and worse outcomes in patients with genitourinary malignancies, strategies have been developed to improve quality of life and survival for patients with skeletal metastases. Future studies investigating novel therapeutic options and bone supporting agents are warranted to target this patient population. PATIENT SUMMARY In this report, we reviewed the current literature and recent clinical trials involving treatment of bone metastases in urinary cancers. The use of bone-targeting agents can improve outcomes for patients, and additional lifestyle modification can optimize bone health in this population.
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Fukushima H, Saito K, Yasuda Y, Tanaka H, Patil D, Cotta BH, Patel SH, Master VA, Derweesh IH, Fujii Y. Female Gender Predicts Favorable Prognosis in Patients With Non-metastatic Clear Cell Renal Cell Carcinoma Undergoing Curative Surgery: Results From the International Marker Consortium for Renal Cancer (INMARC). Clin Genitourin Cancer 2019; 18:111-116.e1. [PMID: 32001181 DOI: 10.1016/j.clgc.2019.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/06/2019] [Revised: 10/19/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is no clear consensus regarding gender differences in the prognosis of patients with clear-cell renal cell carcinoma (ccRCC). In the present study, we investigated the prognostic value of gender in patients with non-metastatic ccRCC undergoing curative surgery using the inverse probability of treatment weighting (IPTW) method to balance the difference in baseline factors between females and males. PATIENTS AND METHODS We retrospectively reviewed the International Marker Consortium for Renal Cancer (INMARC) dataset and included 2055 patients with cT1-4N0M0 ccRCC who underwent partial or radical nephrectomy. The IPTW method was used to adjust for baseline characteristics between females and males (age, race, surgery type, and pT stage), and the association of gender with recurrence-free survival (RFS) was evaluated. RESULTS During the follow-up (median, 30 months), 162 (8%) patients had disease recurrence (5-year RFS rate, 88%). Female gender (n = 712; 35%) was significantly associated with a lower Fuhrman grade (unweighted, P = .022; IPTW-weighted, P < .001). Females had significantly better RFS compared with males (unweighted, 5-year RFS rate, 92% vs. 87%; P = .005; IPTW-weighted, 5-year RFS rate, 92% vs. 86%; P = .002). IPTW-weighted multivariate analysis showed that female gender was an independent predictor for better RFS (hazard ratio, 0.59; P = .005) along with lower pT stage and lower Fuhrman grade. The prognostic significance of female gender was also observed in the unweighted multivariate analysis. CONCLUSION Female gender was significantly associated with a lower Fuhrman grade and better prognosis for patients with non-metastatic ccRCC undergoing curative surgery.
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Affiliation(s)
- Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Brittney H Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Sunil H Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Aliotta E, Nourzadeh H, Batchala PP, Schiff D, Lopes MB, Druzgal JT, Mukherjee S, Patel SH. Molecular Subtype Classification in Lower-Grade Glioma with Accelerated DTI. AJNR Am J Neuroradiol 2019; 40:1458-1463. [PMID: 31413006 DOI: 10.3174/ajnr.a6162] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Image-based classification of lower-grade glioma molecular subtypes has substantial prognostic value. Diffusion tensor imaging has shown promise in lower-grade glioma subtyping but currently requires lengthy, nonstandard acquisitions. Our goal was to investigate lower-grade glioma classification using a machine learning technique that estimates fractional anisotropy from accelerated diffusion MR imaging scans containing only 3 diffusion-encoding directions. MATERIALS AND METHODS Patients with lower-grade gliomas (n = 41) (World Health Organization grades II and III) with known isocitrate dehydrogenase (IDH) mutation and 1p/19q codeletion status were imaged preoperatively with DTI. Whole-tumor volumes were autodelineated using conventional anatomic MR imaging sequences. In addition to conventional ADC and fractional anisotropy reconstructions, fractional anisotropy estimates were computed from 3-direction DTI subsets using DiffNet, a neural network that directly computes fractional anisotropy from raw DTI data. Differences in whole-tumor ADC, fractional anisotropy, and estimated fractional anisotropy were assessed between IDH-wild-type and IDH-mutant lower-grade gliomas with and without 1p/19q codeletion. Multivariate classification models were developed using whole-tumor histogram and texture features from ADC, ADC + fractional anisotropy, and ADC + estimated fractional anisotropy to identify the added value provided by fractional anisotropy and estimated fractional anisotropy. RESULTS ADC (P = .008), fractional anisotropy (P < .001), and estimated fractional anisotropy (P < .001) significantly differed between IDH-wild-type and IDH-mutant lower-grade gliomas. ADC (P < .001) significantly differed between IDH-mutant gliomas with and without codeletion. ADC-only multivariate classification predicted IDH mutation status with an area under the curve of 0.81 and codeletion status with an area under the curve of 0.83. Performance improved to area under the curve = 0.90/0.94 for the ADC + fractional anisotropy classification and to area under the curve = 0.89/0.89 for the ADC + estimated fractional anisotropy classification. CONCLUSIONS Fractional anisotropy estimates made from accelerated 3-direction DTI scans add value in classifying lower-grade glioma molecular status.
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Affiliation(s)
- E Aliotta
- From the Departments of Radiation Oncology (E.A., H.N.)
| | - H Nourzadeh
- From the Departments of Radiation Oncology (E.A., H.N.)
| | | | | | - M B Lopes
- Pathology (Neuropathology) (M.B.L.), University of Virginia, Charlottesville, Virginia
| | | | | | - S H Patel
- Radiology (P.P.B., J.T.D., S.M., S.H.P.)
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Patel SH, Stanton CL, Miller SG, Patrie JT, Itri JN, Shepherd TM. Risk Factors for Perceptual-versus-Interpretative Errors in Diagnostic Neuroradiology. AJNR Am J Neuroradiol 2019; 40:1252-1256. [PMID: 31296527 DOI: 10.3174/ajnr.a6125] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/09/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diagnostic errors in radiology are classified as perception or interpretation errors. This study determined whether specific conditions differed when perception or interpretation errors occurred during neuroradiology image interpretation. MATERIALS AND METHODS In a sample of 254 clinical error cases in diagnostic neuroradiology, we classified errors as perception or interpretation errors, then characterized imaging technique, interpreting radiologist's experience, anatomic location of the abnormality, disease etiology, time of day, and day of the week. Interpretation and perception errors were compared with hours worked per shift, cases read per shift, average cases read per shift hour, and the order of case during the shift when the error occurred. RESULTS Perception and interpretation errors were 74.8% (n = 190) and 25.2% (n = 64) of errors, respectively. Logistic regression analyses showed that the odds of an interpretation error were 2 times greater (OR, 2.09; 95% CI, 1.05-4.15; P = .04) for neuroradiology attending physicians with ≤5 years of experience. Interpretation errors were more likely with MR imaging compared with CT (OR, 2.10; 95% CI, 1.09-4.01; P = .03). Infectious/inflammatory/autoimmune diseases were more frequently associated with interpretation errors (P = .04). Perception errors were associated with faster reading rates (6.01 versus 5.03 cases read per hour; P = .004) and occurred later during the shift (24th-versus-18th case; P = .04). CONCLUSIONS Among diagnostic neuroradiology error cases, interpretation-versus-perception errors are affected by the neuroradiologist's experience, technique, and the volume and rate of cases read. Recognition of these risk factors may help guide programs for error reduction in clinical neuroradiology services.
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Affiliation(s)
- S H Patel
- From the Departments of Radiology and Medical Imaging (S.H.P.)
| | - C L Stanton
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York
| | - S G Miller
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York
| | - J T Patrie
- Public Health Sciences (J.T.P.), University of Virginia Health System, Charlottesville, Virginia
| | - J N Itri
- Department of Radiology (J.N.I.), Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - T M Shepherd
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York.,Center for Advanced Imaging Innovation and Research (T.M.S.), New York, New York
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Patel SH, Bansal AG, Young EB, Batchala PP, Patrie JT, Lopes MB, Jain R, Fadul CE, Schiff D. Extent of Surgical Resection in Lower-Grade Gliomas: Differential Impact Based on Molecular Subtype. AJNR Am J Neuroradiol 2019; 40:1149-1155. [PMID: 31248860 DOI: 10.3174/ajnr.a6102] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/12/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffuse lower-grade gliomas are classified into prognostically meaningful molecular subtypes. We aimed to determine the impact of surgical resection on overall survival in lower-grade glioma molecular subtypes. MATERIALS AND METHODS For 172 patients with lower-grade gliomas (World Health Organization grade II or III), pre- and postsurgical glioma volumes were determined using a semiautomated segmentation software based on FLAIR or T2-weighted MR imaging sequences. The association of pre- and postsurgical glioma volume and the percentage of glioma resection with overall survival was determined for the entire cohort and separately for lower-grade glioma molecular subtypes based on isocitrate dehydrogenase (IDH) and 1p/19q status, after adjustment for age, sex, World Health Organization grade, chemotherapy administration, and radiation therapy administration. RESULTS For the entire cohort, postsurgical glioma volume (hazard ratio, 1.80; 95% CI, 1.18-2.75; P = .006) and the percentage of resection (hazard ratio, 3.22; 95% CI, 1.79-5.82; P < .001) were associated with overall survival. For IDH-mutant 1p/19q-codeleted oligodendrogliomas, the percentage of resection (hazard ratio, 6.69; 95% CI, 1.57-28.46; P = .01) was associated with overall survival. For IDH-mutant 1p/19q-noncodeleted astrocytomas, presurgical glioma volume (hazard ratio, 3.20; 95% CI, 1.22-8.39; P = .018), postsurgical glioma volume (hazard ratio, 2.33; 95% CI, 1.32-4.12; P = .004), and percentage of resection (hazard ratio, 4.34; 95% CI, 1.74-10.81; P = .002) were associated with overall survival. For IDH-wild-type lower-grade gliomas, pre-/postsurgical glioma volume and percentage of resection were not associated with overall survival. CONCLUSIONS The extent of surgical resection has a differential survival impact in patients with lower-grade gliomas based on their molecular subtype. IDH-mutant lower-grade gliomas benefit from a greater extent of surgical resection, with the strongest impact observed for IDH-mutant 1p/19q-noncodeleted astrocytomas.
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Affiliation(s)
- S H Patel
- From the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
| | - A G Bansal
- From the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
| | - E B Young
- From the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
| | - P P Batchala
- From the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
| | | | - M B Lopes
- Pathology (M.B.L.), Divisions of Neuropathology and Molecular Diagnostics
| | - R Jain
- Departments of Radiology (R.J.).,Neurosurgery (R.J.), New York University School of Medicine, New York, New York
| | - C E Fadul
- Division of Neuro-Oncology (C.E.F., D.S.), University of Virginia Health System, Charlottesville, Virginia
| | - D Schiff
- Division of Neuro-Oncology (C.E.F., D.S.), University of Virginia Health System, Charlottesville, Virginia
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Mogen JL, Block KT, Bansal NK, Patrie JT, Mukherjee S, Zan E, Hagiwara M, Fatterpekar GM, Patel SH. Dynamic Contrast-Enhanced MRI to Differentiate Parotid Neoplasms Using Golden-Angle Radial Sparse Parallel Imaging. AJNR Am J Neuroradiol 2019; 40:1029-1036. [PMID: 31048300 DOI: 10.3174/ajnr.a6055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/31/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Conventional imaging frequently shows overlapping features between benign and malignant parotid neoplasms. We investigated dynamic contrast-enhanced MR imaging using golden-angle radial sparse parallel imaging in differentiating parotid neoplasms. MATERIALS AND METHODS For this retrospective study, 41 consecutive parotid neoplasms were imaged with dynamic contrast-enhanced MR imaging with golden-angle radial sparse parallel imaging using 1-mm in-plane resolution. The temporal resolution was 3.4 seconds for 78.2 seconds and 8.8 seconds for the remaining acquisition. Three readers retrospectively and independently created and classified time-intensity curves as follows: 1) continuous wash-in; 2) rapid wash-in, subsequent plateau; and 3) rapid wash-in with washout. Additionally, time-intensity curve-derived semiquantitative metrics normalized to the ipsilateral common carotid artery were recorded. Diagnostic performance for the prediction of neoplasm type and malignancy was assessed. Subset multivariate analysis (n = 32) combined semiquantitative time-intensity curve metrics with ADC values. RESULTS Independent time-intensity curve classification of the 41 neoplasms produced moderate-to-substantial interreader agreement (κ = 0.50-0.79). The time-intensity curve classification threshold of ≥2 predicted malignancy with a positive predictive value of 56.0%-66.7%, and a negative predictive value of 92.0%-100%. The time-intensity curve classification threshold of <2 predicted pleomorphic adenoma with a positive predictive value of 87.0%-95.0% and a negative predictive value of 76.0%-95.0%. For all readers, type 2 and 3 curves were associated with malignant neoplasms (P < .001), and type 1 curves, with pleomorphic adenomas (P < .001). Semiquantitative analysis for malignancy prediction yielded an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.73-0.99). Combining time-to-maximum and ADC predicts pleomorphic adenoma better than either metric alone (P < .001). CONCLUSIONS Golden-angle radial sparse parallel MR imaging allows high spatial and temporal resolution permeability characterization of parotid neoplasms, with a high negative predictive value for malignancy prediction. Combining time-to-maximum and ADC improves pleomorphic adenoma prediction compared with either metric alone.
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Affiliation(s)
- J L Mogen
- From the Department of Radiology (J.L.M.), Tufts Medical Center, Boston, Massachusetts
| | - K T Block
- Department of Radiology (K.T.B., N.K.B., E.Z., M.H., G.M.F.), New York University Langone Medical Center, New York, New York
| | - N K Bansal
- Department of Radiology (K.T.B., N.K.B., E.Z., M.H., G.M.F.), New York University Langone Medical Center, New York, New York
| | - J T Patrie
- Division of Biostatistics and Epidemiology (J.T.P.), University of Virginia, Charlottesville, Virginia
| | - S Mukherjee
- Department of Radiology and Medical Imaging (S.M., S.H.P.), University of Virginia Health System, Charlottesville, Virginia
| | - E Zan
- From the Department of Radiology (J.L.M.), Tufts Medical Center, Boston, Massachusetts
| | - M Hagiwara
- Department of Radiology (K.T.B., N.K.B., E.Z., M.H., G.M.F.), New York University Langone Medical Center, New York, New York
| | - G M Fatterpekar
- Department of Radiology (K.T.B., N.K.B., E.Z., M.H., G.M.F.), New York University Langone Medical Center, New York, New York
| | - S H Patel
- Department of Radiology and Medical Imaging (S.M., S.H.P.), University of Virginia Health System, Charlottesville, Virginia.
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Berquist SW, Yim K, Ryan ST, Patel SH, Eldefrawy A, Cotta BH, Bradshaw AW, Meagher MF, Bindayi A, McKay RR, Autorino R, Staehler M, Derweesh IH. Systemic therapy in the management of localized and locally advanced renal cell carcinoma: Current state and future perspectives. Int J Urol 2019; 26:532-542. [DOI: 10.1111/iju.13943] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/17/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Sean W Berquist
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Kendrick Yim
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Stephen T Ryan
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Sunil H Patel
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Ahmed Eldefrawy
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Brittney H Cotta
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Aaron W Bradshaw
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Margaret F Meagher
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Ahmet Bindayi
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Rana R McKay
- Division of Medical Oncology UC San Diego School of Medicine La Jolla California USA
| | - Riccardo Autorino
- Division of Urology Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Michael Staehler
- Department of Urology Ludwig‐Maximilian University Munich Germany
| | - Ithaar H Derweesh
- Department of Urology UC San Diego School of Medicine La Jolla California USA
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Batchala PP, Muttikkal TJE, Donahue JH, Patrie JT, Schiff D, Fadul CE, Mrachek EK, Lopes MB, Jain R, Patel SH. Neuroimaging-Based Classification Algorithm for Predicting 1p/19q-Codeletion Status in IDH-Mutant Lower Grade Gliomas. AJNR Am J Neuroradiol 2019; 40:426-432. [PMID: 30705071 DOI: 10.3174/ajnr.a5957] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/12/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Isocitrate dehydrogenase (IDH)-mutant lower grade gliomas are classified as oligodendrogliomas or diffuse astrocytomas based on 1p/19q-codeletion status. We aimed to test and validate neuroradiologists' performances in predicting the codeletion status of IDH-mutant lower grade gliomas based on simple neuroimaging metrics. MATERIALS AND METHODS One hundred two IDH-mutant lower grade gliomas with preoperative MR imaging and known 1p/19q status from The Cancer Genome Atlas composed a training dataset. Two neuroradiologists in consensus analyzed the training dataset for various imaging features: tumor texture, margins, cortical infiltration, T2-FLAIR mismatch, tumor cyst, T2* susceptibility, hydrocephalus, midline shift, maximum dimension, primary lobe, necrosis, enhancement, edema, and gliomatosis. Statistical analysis of the training data produced a multivariate classification model for codeletion prediction based on a subset of MR imaging features and patient age. To validate the classification model, 2 different independent neuroradiologists analyzed a separate cohort of 106 institutional IDH-mutant lower grade gliomas. RESULTS Training dataset analysis produced a 2-step classification algorithm with 86.3% codeletion prediction accuracy, based on the following: 1) the presence of the T2-FLAIR mismatch sign, which was 100% predictive of noncodeleted lower grade gliomas, (n = 21); and 2) a logistic regression model based on texture, patient age, T2* susceptibility, primary lobe, and hydrocephalus. Independent validation of the classification algorithm rendered codeletion prediction accuracies of 81.1% and 79.2% in 2 independent readers. The metrics used in the algorithm were associated with moderate-substantial interreader agreement (κ = 0.56-0.79). CONCLUSIONS We have validated a classification algorithm based on simple, reproducible neuroimaging metrics and patient age that demonstrates a moderate prediction accuracy of 1p/19q-codeletion status among IDH-mutant lower grade gliomas.
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Affiliation(s)
- P P Batchala
- From the Department of Radiology and Medical Imaging (P.P.B., T.J.E.M., J.H.D., S.H.P.)
| | - T J E Muttikkal
- From the Department of Radiology and Medical Imaging (P.P.B., T.J.E.M., J.H.D., S.H.P.)
| | - J H Donahue
- From the Department of Radiology and Medical Imaging (P.P.B., T.J.E.M., J.H.D., S.H.P.)
| | - J T Patrie
- Department of Public Health Sciences (J.T.P.)
| | - D Schiff
- Division of Neuro-Oncology (D.S., C.E.F.)
| | - C E Fadul
- Division of Neuro-Oncology (D.S., C.E.F.)
| | - E K Mrachek
- Department of Pathology (E.K.M., M.-B.L.), Divisions of Neuropathology and Molecular Diagnostics, University of Virginia Health System, Charlottesville, Virginia
| | - M-B Lopes
- Department of Pathology (E.K.M., M.-B.L.), Divisions of Neuropathology and Molecular Diagnostics, University of Virginia Health System, Charlottesville, Virginia
| | - R Jain
- Departments of Radiology (R.J.)
- Neurosurgery (R.J.), New York University School of Medicine, New York, New York
| | - S H Patel
- From the Department of Radiology and Medical Imaging (P.P.B., T.J.E.M., J.H.D., S.H.P.)
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Unterberg SH, Patel SH, Fuller TW, Buckley JC. Robotic-assisted Proximal Perineal Urethroplasty: Improving Visualization and Ergonomics. Urology 2019; 125:230-233. [DOI: 10.1016/j.urology.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/24/2018] [Accepted: 11/03/2018] [Indexed: 01/23/2023]
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Maldonado MD, Batchala P, Ornan D, Fadul C, Schiff D, Itri JN, Jain R, Patel SH. Features of diffuse gliomas that are misdiagnosed on initial neuroimaging: a case control study. J Neurooncol 2018; 140:107-113. [PMID: 29959694 DOI: 10.1007/s11060-018-2939-9] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The neuroimaging diagnosis of diffuse gliomas can be challenging owing to their variable clinical and radiologic presentation. The purpose of this study was to identify factors that are associated with imaging errors in the diagnosis of diffuse gliomas. METHODS A retrospective case-control analysis was undertaken. 18 misdiagnosed diffuse gliomas on initial neuroimaging (cases) and 108 accurately diagnosed diffuse gliomas on initial neuroimaging (controls) were collected. Clinical, pathological, and imaging metrics were tabulated for each patient. The tabulated metrics were compared between cases and controls to determine factors associated with misdiagnosis. RESULTS Cases of misdiagnosed diffuse glioma (vs controls) were more likely to undergo initial triage as a stroke workup [OR 14.429 (95% CI 4.345, 47.915), p < 0.0001], were less likely to enhance [OR 0.283 (95% CI 0.098, 0.812), p = 0.02], were smaller (mean diameter 4.4 vs 6.0 cm, p = 0.0008), produced less midline shift (median midline shift 0.0 vs 2.0 mm, p = 0.003), were less likely to demonstrate necrosis [OR 0.156 (95% CI 0.034-0.713), p = 0.008], and were less likely to have IV contrast administered on the initial MRI [OR 0.100 (95% CI 0.020, 0.494), p = 0.008]. CONCLUSION Several clinical and radiologic metrics are associated with diffuse gliomas that are missed or misdiagnosed on the initial neuroimaging study. Knowledge of these associations may aid in avoiding misinterpretation and accurately diagnosing such cases in clinical practice.
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Affiliation(s)
- M D Maldonado
- Division of Neuroradiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - P Batchala
- Division of Neuroradiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - D Ornan
- Division of Neuroradiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - C Fadul
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
| | - D Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
| | - J N Itri
- Department of Radiology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - R Jain
- Department of Radiology, NYU School of Medicine, New York, NY, USA.,Department of Neurosurgery, NYU School of Medicine, New York, NY, USA
| | - S H Patel
- Division of Neuroradiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
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Hoch MJ, Patel SH, Jethanamest D, Win W, Fatterpekar GM, Roland JT, Hagiwara M. Head and Neck MRI Findings in CHARGE Syndrome. AJNR Am J Neuroradiol 2017; 38:2357-2363. [PMID: 28705814 DOI: 10.3174/ajnr.a5297] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 05/13/2017] [Indexed: 11/07/2022]
Abstract
Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and deafness (CHARGE) syndrome is a disorder with multiple congenital anomalies seen on imaging. A retrospective review of 10 patients with CHARGE syndrome who underwent MR imaging of the brain as part of a preoperative evaluation for cochlear implantation was conducted. Structural abnormalities of the entire MR imaging of the head were evaluated, including the auditory system, olfactory system, face, skull base, and central nervous system. The most frequent MR imaging findings included dysplasias of the semicircular canals and hypoplasia of the frontal lobe olfactory sulci. Less frequent findings included cleft lip/palate and coloboma. Our study uncovered new findings of a J-shaped sella, dorsal angulation of the clivus, and absent/atrophic parotid glands, not previously described in patients with CHARGE. Our results emphasize the utility of MR imaging in the diagnosis and management of patients with CHARGE syndrome.
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Affiliation(s)
- M J Hoch
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
| | - S H Patel
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
| | - D Jethanamest
- Department of Otolaryngology (D.J., J.T.R.), New York University Langone Medical Center, New York, New York
| | - W Win
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
| | - G M Fatterpekar
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
| | - J T Roland
- Department of Otolaryngology (D.J., J.T.R.), New York University Langone Medical Center, New York, New York
| | - M Hagiwara
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
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Raheem OA, Patel SH, Sisul D, Furnish TJ, Hsieh TC. The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis. Am J Mens Health 2016. [PMID: 28625114 PMCID: PMC5675327 DOI: 10.1177/1557988316672396] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Indexed: 11/17/2022] Open
Abstract
Chronic opioid therapy for pain management is known to induce several endocrine changes. The authors examined the effect of testosterone supplemental therapy (TST) in patients with chronic, noncancer pain undergoing opioid therapy. It was hypothesized that treatment of opioid-induced hypogonadism (OIH) can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center, Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean patient age (55 and 54.4, p = .4) and basic metabolic index (28.5 and 31.9, p = .07) in TST and non-TST groups, respectively. Mean follow-up total testosterone (ng/dL) was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups (p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group (p < .05). This study reports that treatment of OIH with TST can reduce opioid requirements in men with chronic pain as quantified by MED. It also confirms previous reports on the potential effects of OIH and that TST is effective in correcting opioid-induced endocrine abnormalities.
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Affiliation(s)
- Omer A Raheem
- 1 Department of Urology, University of California San Diego Health, San Diego, CA, USA
| | - Sunil H Patel
- 1 Department of Urology, University of California San Diego Health, San Diego, CA, USA
| | - David Sisul
- 1 Department of Urology, University of California San Diego Health, San Diego, CA, USA
| | - Tim J Furnish
- 2 Center for Pain Medicine, University of California San Diego Health system, San Diego, CA, USA
| | - Tung-Chin Hsieh
- 1 Department of Urology, University of California San Diego Health, San Diego, CA, USA
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Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, Buckley JC. Surgical management of traumatic penile amputation: a case report and review of the world literature. Sex Med 2015; 3:49-53. [PMID: 25844175 PMCID: PMC4380914 DOI: 10.1002/sm2.54] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION There is paucity of case reports that describe the successful reimplantation of a penis after amputation. We sought to report on self-inflicted penile amputation and comment on its surgical management and review current literature. AIM To report on self-inflicted penile amputation and comment on its surgical management and review current literature. METHODS A 19-year-old male with no prior medical history presented to our university-affiliated trauma center following sustaining a self-inflicted amputation of shaft penis secondary to severe methamphetamine-induced psychosis. He immediately underwent extensive reconstructive reimplantation of the penis performed jointly by plastics and urology teams reattaching all visible neurovascular bundles, urethra, and corporal and fascial layers. The patient was discharged with a suprapubic tube in place and a Foley catheter in place with well-healing tissue. MAIN OUTCOME MEASURES To review the current published literature and case reports on the management of penile amputation with particular emphasis its etiology, surgical repairs, potential complications and functional outcomes. RESULTS We report herein a case of a traumatic penile amputation and successful outcome of microscopic reimplantation and review of the published literature with particular comments on surgical managements. CONCLUSION We review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49-53.
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Affiliation(s)
- Omer A Raheem
- Department of Urology, University of San Diego Medical Center San Diego, CA, USA
| | - Hossein S Mirheydar
- Department of Urology, University of San Diego Medical Center San Diego, CA, USA
| | - Nishant D Patel
- Department of Urology, University of San Diego Medical Center San Diego, CA, USA
| | - Sunil H Patel
- Department of Urology, University of San Diego Medical Center San Diego, CA, USA
| | - Ahmed Suliman
- Division of Plastics Surgery, Department of Surgery, University of San Diego Medical Center San Diego, CA, USA
| | - Jill C Buckley
- Department of Urology, University of San Diego Medical Center San Diego, CA, USA
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Patel A, Pathak R, Deshpande V, Patel SH, Wickremesinghe PC, Vadada D. Radiofrequency ablation using BarRx for the endoscopic treatment of radiation proctopathy: a series of three cases. Clin Exp Gastroenterol 2014; 7:453-60. [PMID: 25525377 PMCID: PMC4266256 DOI: 10.2147/ceg.s66534] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Radiation proctopathy is a complication of pelvic radiotherapy, which occurs in patients treated for carcinoma of the prostate, rectum, urinary bladder, cervix, uterus, and testes. If it presents within 6 weeks to 9 months after therapy, it is called acute radiation proctitis/proctopathy (ARP), and if it occurs 9 months to a year after treatment, it is classified as chronic radiation proctitis/proctopathy (CRP). CRP occurs in 5%–20% of patients receiving pelvic radiation, depending on the radiation dose and the presence or absence of chemotherapy. In many cases, CRP resolves spontaneously, but in some, it can lead to persistent rectal bleeding. Other symptoms of CRP include diarrhea, mucoid discharge, urgency, tenesmus, rectal pain, and fecal incontinence. Despite the availability of several therapies, many patients fail to respond, and continue to suffer in their quality of life. Radiofrequency ablation (RFA) is a newer endoscopic technique that uses radiofrequency energy to ablate tissue. This is an emerging way to treat radiation proctopathy and other mucosal telangiectasia. We present three cases of radiation proctopathy treated with RFA at our institute and review the literature on treatment modalities for CRP. We were also able to find 16 other cases of CRP that used RFA, and review their literature as well as literature on other treatment modalities.
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Affiliation(s)
- Anish Patel
- Department of Gastrointestinal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Rahul Pathak
- Department of Gastrointestinal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Vrushak Deshpande
- Department of Gastrointestinal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Sunil H Patel
- Department of Gastrointestinal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | | | - Deepak Vadada
- Department of Gastrointestinal Medicine, Richmond University Medical Center, Staten Island, NY, USA
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Patel SH, Cunnane ME, Juliano AF, Vangel MG, Kazlas MA, Moonis G. Imaging appearance of the lateral rectus-superior rectus band in 100 consecutive patients without strabismus. AJNR Am J Neuroradiol 2014; 35:1830-5. [PMID: 24763418 DOI: 10.3174/ajnr.a3943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The lateral rectus-superior rectus band is an orbital connective tissue structure that has been implicated in a form of strabismus termed sagging eye syndrome. Our purpose was to define the normal MR imaging and CT appearance of this band in patients without strabismus. MATERIALS AND METHODS Orbital MR imaging and CT examinations in 100 consecutive patients without strabismus were evaluated. Readers graded the visibility of the lateral rectus-superior rectus band on coronal T1WI, coronal STIR, and coronal CT images. Readers determined whether the band demonstrated superotemporal bowing or any discontinuities and whether a distinct lateral levator aponeurosis was seen. Reader agreement was assessed by κ coefficients. Association between imaging metrics and patient age/sex was calculated by using the Fisher exact test. RESULTS The lateral rectus-superior rectus band was visible in 95% of coronal T1WI, 68% of coronal STIR sequences, and 70% of coronal CT scans. Ninety-five percent of these bands were seen as a continuous, arc-like structure extending from the superior rectus/levator palpebrae muscle complex to the lateral rectus muscle; 24% demonstrated superotemporal bowing; and in 82% of orbits, a distinct lateral levator aponeurosis was visible. Increasing patient age was negatively associated with lateral rectus-superior rectus band visibility (P=.03), positively associated with lateral rectus-superior rectus band superotemporal bowing (P=.03), and positively associated with lateral levator aponeurosis visibility (P=.01). CONCLUSIONS The lateral rectus-superior rectus band is visible in most patients without strabismus on coronal T1WI. The age effect with respect to its visibility and superotemporal bowing could represent age-related connective tissue degeneration.
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Affiliation(s)
- S H Patel
- From the Departments of Radiology (S.H.P., M.E.C., A.F.J., G.M.)
| | - M E Cunnane
- From the Departments of Radiology (S.H.P., M.E.C., A.F.J., G.M.)
| | - A F Juliano
- From the Departments of Radiology (S.H.P., M.E.C., A.F.J., G.M.)
| | - M G Vangel
- Biostatistics Center (M.G.V.), Massachusetts General Hospital, Boston, Massachusetts
| | - M A Kazlas
- Ophthalmology (M.A.K.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts Department of Ophthalmology (M.A.K.), Boston Children's Hospital, Boston, Massachusetts
| | - G Moonis
- From the Departments of Radiology (S.H.P., M.E.C., A.F.J., G.M.)
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Grimes DT, Riley KL, Field S, Patel SH, Keynton J, Hilton H, Greenfield A, Norris DP. Pkd1l1 as a molecular sensor of fluid flow during the breaking of left-right symmetry. Cilia 2012. [PMCID: PMC3555852 DOI: 10.1186/2046-2530-1-s1-p68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Patel MN, Patel SH, Chhasatia MR, Desai CR. DNA interactions and promotion in antibacterial activities of ciprofloxacin drug due to formation of mixed-ligand complexes of oxovanadium(IV). Nucleosides Nucleotides Nucleic Acids 2010; 29:200-15. [PMID: 20408051 DOI: 10.1080/15257771003705625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mixed-ligand complexes of oxovanadium(IV) of the type [VOAL]*2H(2)O [where A = ciprofloxacin and L = uninegative bidentate ligands] have been synthesized and characterized using infrared spectra, electronic spectra, magnetic measurements, elemental analyses, thermal investigation, and mass spectroscopy. Here, we tried to increase an antibacterial activity of ciprofloxacin drug due to formation of mixed-ligand complexes. The complexes were found to be more potent compare to some standard drugs, ligands and metal salt against selective gram(+ve) and gram(-ve) organisms. Binding of the complexes with DNA have been investigated by spectroscopic absorption titration and viscometric techniques. The mixed-ligand complexes show good binding ability. The cleavage efficacy has been determined using gel electrophoresis method and complexes were found to be more active compared to parental ligands and metal salt.
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Affiliation(s)
- M N Patel
- Department of Chemistry, Sardar Patel University, Vallabh Vidyanagar, Gujarat, India.
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Patel SH, Tsang J, Harbers G, Healy KE, Li S. Endothelial cell function on a poly(acrylamide-co-polyethylene acid) interpenetrating polymer network: cardiovascular applications. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:5040-3. [PMID: 17271449 DOI: 10.1109/iembs.2004.1404393] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hydrogel coatings have been widely researched as a nonfouling surface modification of materials for cardiovascular applications. In this study, we examined cell-surface interactions between a poly(acrylamide-copolyethylene glycol/acrylic acid) interpenetrating network (IPN) hydrogel and aortic endothelial cells (ECs). The IPN was covalently attached to polystyrene to form a nanometer scale thick hydrogel, and the IPN layer was activated by conjugation of the cell adhesion peptide Arg-Gly-Asp (RGD). On IPN surfaces lacking the RGD peptide, EC did not adhere and spread even after long-term incubation. The IPN was able to support greater EC adhesion and spreading with increasing RGD surface concentrations. Upon adequate adhesion and spreading, ECs migrated and proliferated at high rates regardless of the RGD surface concentration. These results suggest that this IPN can be used to promote endothelialization of vascular implants made of polymeric and metal materials for cardiovascular applications.
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Affiliation(s)
- S H Patel
- Department of Bioengineering, California University, Berkeley, CA, USA
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