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Moran S, Cheng HH, Weg E, Kim EH, Chen DL, Iravani A, Ippolito JE. Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) of prostate cancer: current and emerging applications. Abdom Radiol (NY) 2024; 49:1288-1305. [PMID: 38386156 DOI: 10.1007/s00261-024-04188-w] [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: 02/11/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 02/23/2024]
Abstract
Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) is transforming the management of patients with prostate cancer. In appropriately selected patients, PSMA-PET offers superior sensitivity and specificity compared to conventional imaging (e.g., computed tomography and bone scintigraphy) as well as choline and fluciclovine PET, with the added benefit of consolidating bone and soft tissue evaluation into a single study. Despite being a newly available imaging tool, PSMA-PET has established indications, interpretation guidelines, and reporting criteria, which will be reviewed. The prostate cancer care team, from imaging specialists to those delivering treatment, should have knowledge of physiologic PSMA radiotracer uptake, patterns of disease spread, and the strengths and limitations of PSMA-PET. In this review, current and emerging applications of PSMA-PET, including appropriateness use criteria as well as image interpretation and pitfalls, will be provided with an emphasis on clinical implications.
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Affiliation(s)
- Shamus Moran
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Emily Weg
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Delphine L Chen
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Amir Iravani
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 4559 Scott Ave., Mail Stop Code: 8131, St. Louis, MO, 63110, USA.
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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Shaikh PA, Som A, Deych E, Deng AJ, Reimers MA, Baumann BC, Kim EH, Lenihan DJ, Zhang KW. Incidental Coronary Arterial Calcification for Cardiovascular Risk Assessment in Men With Prostate Cancer Undergoing PET/CT Imaging. Clin Genitourin Cancer 2024; 22:586-592. [PMID: 38369389 DOI: 10.1016/j.clgc.2024.01.014] [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: 03/03/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Cardiovascular (CV) disease is common among men with prostate cancer and the leading cause of death in this population. There is a need for CV risk assessment tools that can be easily implemented in the prostate cancer treatment setting. METHODS Consecutive patients who underwent positron emission tomography/computed tomography (PET/CT) for recurrent prostate cancer at a single institution from 2012 to 2017 were identified retrospectively. Clinical data and coronary calcification on nongated CT imaging were obtained. The primary outcome was major adverse CV event (MACE; myocardial infarction, coronary or peripheral revascularization, stroke, heart failure hospitalization, or all-cause mortality) occurring within 5 years of PET/CT. RESULTS Among 354 patients included in the study, there were 98 MACE events that occurred in 74 patients (21%). All-cause mortality was the most common MACE event (35%), followed by coronary revascularization/myocardial infarction (26%) and stroke (19%). Coronary calcification was predictive of MACE (HR = 1.9, 95% CI: 1.1-3.4, P = .03) using adjusted Kaplan-Meier analysis. As a comparator, the Framingham risk score was calculated for 198 patients (56%) with complete clinical and laboratory data available. In this subgroup, high baseline Framingham risk (corresponding to 10-year risk of CV disease > 20%) was not predictive of MACE. CONCLUSIONS MACE was common (21%) in men with recurrent prostate cancer undergoing PET/CT over 5 years of follow-up. Incidental coronary calcification on PET/CT was associated with increased risk of MACE and may have utility as a CV risk predictor that is feasible to implement among all prostate cancer providers.
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Affiliation(s)
- Preet A Shaikh
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Avira Som
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Elena Deych
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Alison J Deng
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Melissa A Reimers
- Division of Oncology, Section of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Eric H Kim
- Department of Urology, Washington University School of Medicine, St. Louis, MO
| | | | - Kathleen W Zhang
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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3
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Bhatt R, Mittauer DJ, Vetter JM, Barashi NS, McGinnis R, Sands KG, Chow AK, Kim EH. Comparing Bladder Neck Contracture Rate Between Robotic Intracorporeal and Extracorporeal Neobladder Construction. Cureus 2024; 16:e56825. [PMID: 38659512 PMCID: PMC11040430 DOI: 10.7759/cureus.56825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Robot-assisted radical cystectomy (RARC) has become more accessible to surgeons worldwide, and descriptions of intracorporeal urinary diversion techniques, such as orthotopic neobladder construction, have increased. In this study, we aim to compare the rate of bladder neck contracture (BNC) formation between RARC and two different urinary diversion techniques. We retrospectively reviewed our institutional database for patients with bladder cancer who underwent RARC with intracorporeal neobladder (ICNB) construction (n = 11) or extracorporeal neobladder (ECNB) construction (n = 11) between 2012 and 2020. BNC was defined by the need for an additional surgical procedure (e.g., dilatation, urethrotomy). Patients who underwent RARC with ICNB (n = 11) were compared to patients who underwent RARC with ECNB (n = 11) across patient characteristics and postoperative BNC formation rates. Kaplan-Meier curves were generated for freedom from BNC based on the neobladder approach and compared with the log-rank test. For patients who received an ECNB, 73% (8/11) developed a BNC; in comparison, none of the patients in the ICNB group experienced a BNC. Kaplan-Meier survival analysis demonstrates the ECNB group's median probability of freedom from BNC as 1.3 years, while the ICNB group was free of BNC over the study period (p < 0.001). RARC with ICNB creation demonstrated a significantly reduced BNC rate in contrast to RARC with ECNB construction. Longer-term follow-up is needed to assess the durability of this difference in BNC rates.
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Affiliation(s)
- Rohit Bhatt
- Department of Urology, University of California Irvine Health, Orange, USA
| | - Dylan J Mittauer
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Joel M Vetter
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Nimrod S Barashi
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Riley McGinnis
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Kenneth G Sands
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Alexander K Chow
- Department of Urology, Rush University Medical Center, Chicago, USA
| | - Eric H Kim
- Department of Urology, Washington University School of Medicine, St. Louis, USA
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Barashi NS, Li T, Angappulige DH, Zhang B, O’Gorman H, Nottingham CU, Shetty AS, Ippolito JE, Andriole GL, Mahajan NP, Kim EH, Mahajan K. Symptomatic Benign Prostatic Hyperplasia with Suppressed Epigenetic Regulator HOXB13 Shows a Lower Incidence of Prostate Cancer Development. Cancers (Basel) 2024; 16:213. [PMID: 38201640 PMCID: PMC10778073 DOI: 10.3390/cancers16010213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Our objective was to identify variations in gene expression that could help elucidate the pathways for the development of prostate cancer (PCa) in men with Benign Prostatic Hyperplasia (BPH). We included 98 men with BPH, a positive prostate MRI (Prostate Imaging Reporting and Data System; PIRADS ≥ 4), and a negative biopsy from November 2014 to January 2018. RNA sequencing (RNA-Seq) was performed on tissue cores from the MRI lesion and a geographically distant region (two regions per patient). All patients were followed for at least three years to identify who went on to develop PCa. We compared the gene expressions of those who did not develop PCa ("BPH-only") vs. those who did ("BPH/PCa"). Then, we identified the subset of men with BPH who had the highest American Urological Association (AUA) symptom scores ("symptomatic BPH") and compared their gene expression to the BPH/PCa group. At a median follow-up of 47.5 months, 15 men had developed PCa while 83 did not. We compared gene expressions of 14 men with symptomatic BPH (AUAss ≥ 18) vs. 15 with BPH/PCa. We found two clusters of genes, suggesting the two groups had distinctive molecular features. Differential analysis revealed genes that were upregulated in BPH-only and downregulated in BPH/PCa, and vice versa. Symptomatic BPH men had upregulation of T-cell activation markers (TCR, CD3, ZAP70, IL-2 and IFN-γ and chemokine receptors, CXCL9/10) expression. In contrast, men with BPH/PCa had upregulation of NKX3-1 and HOXB13 transcription factors associated with luminal epithelial progenitors but depleted of immune cells, suggesting a cell-autonomous role in immune evasion. Symptomatic BPH with immune-enriched landscapes may support anti-tumor immunity. RNA sequencing of benign prostate biopsy tissue showing upregulation of NKX3-1 and HOXB13 with the absence of T-cells might help in identifying men at higher risk of future PCa development, which may be useful in determining ongoing PCa screening.
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Affiliation(s)
- Nimrod S. Barashi
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA (E.H.K.)
| | - Tiandao Li
- Department of Developmental Biology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Duminduni H. Angappulige
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA (E.H.K.)
| | - Bo Zhang
- Department of Developmental Biology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Harry O’Gorman
- School of Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Charles U. Nottingham
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA (E.H.K.)
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Anup S. Shetty
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Joseph E. Ippolito
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA
- Department of Biochemistry and Molecular Biophysics, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Gerald L. Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA (E.H.K.)
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Nupam P. Mahajan
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA (E.H.K.)
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Eric H. Kim
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA (E.H.K.)
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kiran Mahajan
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA (E.H.K.)
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
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Khan S, Chang SH, Wang M, Kim EH, Schoen MW, Rocuskie-Marker C, Drake BF. Local Treatment and Treatment-Related Adverse Effects Among Patients With Advanced Prostate Cancer. JAMA Netw Open 2023; 6:e2348057. [PMID: 38109113 PMCID: PMC10728764 DOI: 10.1001/jamanetworkopen.2023.48057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
Importance Recent data suggest that local treatment with radical prostatectomy or radiation may improve survival outcomes in men with advanced prostate cancer. However, evidence is lacking on treatment-related adverse effects among men with advanced prostate cancer. Objective To assess the association of local treatment on treatment-related adverse effects among men diagnosed with advanced prostate cancer. Design, Setting, and Participants This cohort study assessed men diagnosed with advanced prostate cancer (defined as T4, N1, and/or M1 prostate cancer) between January 1, 1999, and December 31, 2013, with follow-up through December 31, 2021, who were treated at Veterans Health Administration medical centers. Exposure Local treatment with radical prostatectomy or radiation. Main Outcomes and Measures Main outcomes were treatment-related adverse effects, including constitutional, gastrointestinal, pain, sexual function, and urinary function conditions, at 3 intervals after initial treatment (≤1 year, >1 to ≤2 years, and >2 to ≤5 years) after initial treatment. Results This cohort study consisted of 5502 men (mean [SD] age, 68.7 [10.3] years) diagnosed with advanced prostate cancer. Of the cohort, 1705 men (31.0%) received local treatment. There was a high prevalence of adverse conditions in men receiving both local and nonlocal treatment, and these adverse conditions persisted for more than 2 years to 5 years or less after initial treatment. A total of 916 men (75.2%) with initial local treatment and 897 men (67.1%) with initial nonlocal treatment reported the presence of at least 1 adverse condition for more than 2 years to 5 years or less after initial treatment. In the first year, local treatment (vs nonlocal) was associated with adverse gastrointestinal (multivariable-adjusted odds ratio [AOR], 4.08; 95% CI, 3.06-5.45), pain (AOR, 1.57; 95% CI, 1.35-1.83), sexual (AOR, 2.96; 95% CI, 2.42-3.62), and urinary (AOR, 2.25; 95% CI, 1.90-2.66) conditions. Local treatment (without secondary treatment) remained significantly associated with adverse gastrointestinal (AOR, 2.39; 95% CI, 1.52-3.77), sexual (AOR, 3.36; 95% CI, 2.56-4.41), and urinary (AOR, 1.39; 95% CI, 1.09-1.78) conditions at more than 2 years to 5 years or less after treatment. Conclusions and Relevance In this cohort study of men with advanced prostate cancer, local treatment was associated with persistent treatment-related adverse effects across multiple domains. These results suggest that patients and clinicians should consider the adverse effects of local treatment when making treatment decisions in the setting of advanced prostate cancer.
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Affiliation(s)
- Saira Khan
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Mei Wang
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Eric H. Kim
- Division of Urologic Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Martin W. Schoen
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri
- Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | | | - Bettina F. Drake
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
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Andruska N, Waters MR, Fischer-Valuck BW, Smith ZL, Kim EH, Reimers M, Brenneman R, Gay HA, Patel SA, Michalski JM, Delacroix SE, Efstathiou JA, Baumann BC. Does Chemo-Radiotherapy Improve Survival Outcomes vs. Radiotherapy Alone for High-Grade cT1 Urothelial Carcinoma of the Bladder? Clin Genitourin Cancer 2023; 21:653-659.e1. [PMID: 37704483 DOI: 10.1016/j.clgc.2023.07.011] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Non-muscle invasive bladder cancer (non-MIBC) that is high-grade and confined to the lamina propria (HGT1) often has an aggressive clinical course. Currently, there is limited data on the comparative effectiveness of RT vs. CRT for HGT1 non-MIBC. We hypothesized that CRT would be associated with improved overall survival (OS) vs. RT in HGT1 bladder cancer. METHODS Patients diagnosed with HGT1 non-MIBC, and treated with transurethral resection of bladder tumor followed by either treatment with RT alone or CRT, were identified in the National Cancer Database. Inverse probability of treatment weighting (IPTW) was employed and weight-adjusted multivariable analysis (MVA) using Cox regression modeling was used to compare overall survival (OS) hazard ratios. OS was the primary endpoint, and was estimated using the Kaplan-Meier method and log-rank tests. RESULTS A total of 259 patients with HGT1 UC were treated with: (i) RT alone (n = 123) or (ii) CRT (n = 136). Propensity-weighted MVA showed that combined modality treatment with CRT was associated with improved OS relative to radiation alone (Hazard Ratio [HR]: 0.62, 95% Confidence Interval (95% CI): 0.44-0.88, P = .007). Four-year OS for the CRT vs. RT alone was 36% and 19%, respectively (log-rank P <.008). CONCLUSION For patients with HGT1 bladder cancer, concurrent CRT was associated with improved OS compared with radiation alone in a retrospective cohort. These results are hypothesis-generating. The NRG is currently developing a phase II randomized clinical trial comparing CRT to other novel, bladder preservation strategies.
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Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Michael R Waters
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | | | - Zachary L Smith
- Division of Urology, Washington University School of Medicine, St Louis, MO
| | - Eric H Kim
- Division of Urology, Washington University School of Medicine, St Louis, MO
| | - Melissa Reimers
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Sagar A Patel
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Scott E Delacroix
- Department of Urology, Louisiana State University School of Medicine, New Orleans, LA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Harvard University School of Medicine, Boston, MA
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO; Department of Radiation Oncology, Springfield Clinic, Springfield, IL.
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Tabei SS, Baas W, Brooks A, Kim EH, Smith Z, Murphy GP. Malignant priapism: case report and update on management protocols. Transl Androl Urol 2023; 12:1607-1613. [PMID: 37969781 PMCID: PMC10643380 DOI: 10.21037/tau-23-327] [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: 06/07/2023] [Accepted: 09/01/2023] [Indexed: 11/17/2023] Open
Abstract
Background Malignant priapism, a rare disease with only about 500 reported cases to date, consists of persistent erection secondary to invasion or metastasis of a primary neoplasm. While treatment guidelines for priapism in non-malignant cases have been established, there is currently no guideline for treating malignant priapism. Herein, we describe three cases of malignant priapism and suggest a step-by-step approach for clinical management. Case Description This study reports three cases of malignant priapism resulting from advanced genitourinary cancers. All patients experienced a sub-acute progression of penile pain and ultimately underwent palliative penectomy, resulting in sustained symptom relief. Conclusions Treatment of malignant priapism needs to be individualized to the needs of the patient. No matter the primary or secondary nature of the disease, current data suggest that malignant priapism is associated with poor outcomes and emphasis should be put on palliative care. Similar to previous cases, our cases died shortly after the diagnosis of malignant priapism. Conventional procedures such as shunting may not necessarily provide symptom relief in these patients. Although new radiation techniques have shown favorable outcomes, penectomy should be considered the last resort in clinical management. Revisions to the existing management guidelines for priapism are necessary to address its occurrence in malignant contexts.
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Affiliation(s)
- Seyed Sajjad Tabei
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Wesley Baas
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anthony Brooks
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Zachary Smith
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gregory P. Murphy
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Berry JM, Hill H, Vetter JM, Bhayani SB, Henning GM, Pickersgill NA, Sivaraman A, Figenshau RS, Kim EH. Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses. J Robot Surg 2023; 17:2149-2155. [PMID: 37256454 PMCID: PMC10230457 DOI: 10.1007/s11701-023-01637-4] [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: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4-6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.
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Affiliation(s)
- James M Berry
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
| | - Hayden Hill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Joel M Vetter
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Grant M Henning
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Nicholas A Pickersgill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Arjun Sivaraman
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - R Sherburne Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
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de Almeida S R, Thomas J, Mason MM, Becerra MF, Merhe A, Reis IM, Kwon D, Soodana‐Prakash N, Tewari A, Patel V, Wagaskar V, Konety B, Kasraeian A, Czarniecki S, Thoreson GR, Kim EH, Swain S, Parekh DJ, Punnen S. Optimum threshold of the 4Kscore for biopsy in men with negative or indeterminate multiparametric magnetic resonance imaging. BJUI Compass 2023; 4:591-596. [PMID: 37636212 PMCID: PMC10447206 DOI: 10.1002/bco2.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 08/29/2023] Open
Abstract
Objective The study aims to identify the optimal 4Kscore thresholds to determine the need for a prostate biopsy when multiparametric magnetic resonance imaging (MRI) (mpMRI) is negative or indeterminate. Materials and methods We analysed retrospective data from men in eight different institutions who underwent an mpMRI, 4Kscore and prostate biopsy for evaluation of prostate cancer. We selected men with a negative (PIRADS ≤2) or indeterminate (PIRADS 3) mpMRI. 4Kscore values were categorized into ranges of 1-7, 8-19, 20-32 and greater than 32. We evaluated the proportion of men with grade group 2 or higher (GG2+) cancer in groups defined by PIRADS and 4Kscore. We also evaluated the number of biopsies avoided and GG2+ cancer missed in each group reported depend on 4Kscore cutoff points. Results Among 1111 men who had an mpMRI, 4Kscore and biopsy, 625 of them had PIRADS ≤3 on mpMRI: 374 negative (PIRADS ≤2) and 251 indeterminate (PIRADS 3). In men with a negative mpMRI, we found a 4Kscore cut-point of 33 resulted in an increased risk of GG2+ cancer on biopsy. In patients with an equivocal lesion on mpMRI, men with a 4Kscore cutoff ≥8 had a greater risk of GG2+ cancer on biopsy. Decision curve analysis supported the proposed cut-points in each mpMRI group. Conclusions In men with negative and indeterminate mpMRI, we found the best 4Kscore threshold to determine the need for biopsy to be 33 and 8 respectively. Future prospective studies in independent populations are needed to confirm these findings.
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Affiliation(s)
- Ricardo de Almeida S
- Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Jamie Thomas
- Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | | | - Maria F. Becerra
- Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Ali Merhe
- Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Isildinha M. Reis
- Division of Biostatistics, Department of Public Health Sciences, School of MedicineUniversity of Miami MillerMiamiFloridaUSA
| | - Deukwoo Kwon
- Division of Biostatistics, Department of Public Health Sciences, School of MedicineUniversity of Miami MillerMiamiFloridaUSA
| | - Nachiketh Soodana‐Prakash
- Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Ashutosh Tewari
- Department of UrologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Vipul Patel
- Global Robotics Institute, Florida Hospital‐Celebration Health, College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Vinayak Wagaskar
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | | | | | - Stefan Czarniecki
- HIFU Clinic, Department of UrologySt. Elizabeth HospitalWarsawPoland
| | | | - Eric H. Kim
- School of MedicineWashington UniversitySt. LouisMissouriUSA
| | - Sanjaya Swain
- Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Dipen J. Parekh
- Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer CenterUniversity of MiamiMiamiFloridaUSA
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10
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Housten AJ, Rice HE, Chang SH, L'Hotta AJ, Kim EH, Drake BF, Wright-Jones R, Politi MC. Financial burden of men with localized prostate cancer: a process paper. Front Psychol 2023; 14:1176843. [PMID: 37476084 PMCID: PMC10354547 DOI: 10.3389/fpsyg.2023.1176843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Background Many individuals undergoing cancer treatment experience substantial financial hardship, often referred to as financial toxicity (FT). Those undergoing prostate cancer treatment may experience FT and its impact can exacerbate disparate health outcomes. Localized prostate cancer treatment options include: radiation, surgery, and/or active surveillance. Quality of life tradeoffs and costs differ between treatment options. In this project, our aim was to quantify direct healthcare costs to support patients and clinicians as they discuss prostate cancer treatment options. We provide the transparent steps to estimate healthcare costs associated with treatment for localized prostate cancer among the privately insured population using a large claims dataset. Methods To quantify the costs associated with their prostate cancer treatment, we used data from the Truven Health Analytics MarketScan Commercial Claims and Encounters, including MarketScan Medicaid, and peer reviewed literature. Strategies to estimate costs included: (1) identifying the problem, (2) engaging a multidisciplinary team, (3) reviewing the literature and identifying the database, (4) identifying outcomes, (5) defining the cohort, and (6) designing the analytic plan. The costs consist of patient, clinician, and system/facility costs, at 1-year, 3-years, and 5-years following diagnosis. Results We outline our specific strategies to estimate costs, including: defining complex research questions, defining the study population, defining initial prostate cancer treatment, linking facility and provider level related costs, and developing a shared understanding of definitions on our research team. Discussion and next steps Analyses are underway. We plan to include these costs in a prostate cancer patient decision aid alongside other clinical tradeoffs.
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Affiliation(s)
- Ashley J. Housten
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Hannah E. Rice
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Allison J. L'Hotta
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric H. Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Bettina F. Drake
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | | | - Mary C. Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
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11
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Lake BB, Menon R, Winfree S, Hu Q, Melo Ferreira R, Kalhor K, Barwinska D, Otto EA, Ferkowicz M, Diep D, Plongthongkum N, Knoten A, Urata S, Mariani LH, Naik AS, Eddy S, Zhang B, Wu Y, Salamon D, Williams JC, Wang X, Balderrama KS, Hoover PJ, Murray E, Marshall JL, Noel T, Vijayan A, Hartman A, Chen F, Waikar SS, Rosas SE, Wilson FP, Palevsky PM, Kiryluk K, Sedor JR, Toto RD, Parikh CR, Kim EH, Satija R, Greka A, Macosko EZ, Kharchenko PV, Gaut JP, Hodgin JB, Eadon MT, Dagher PC, El-Achkar TM, Zhang K, Kretzler M, Jain S. An atlas of healthy and injured cell states and niches in the human kidney. Nature 2023; 619:585-594. [PMID: 37468583 PMCID: PMC10356613 DOI: 10.1038/s41586-023-05769-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/30/2023] [Indexed: 07/21/2023]
Abstract
Understanding kidney disease relies on defining the complexity of cell types and states, their associated molecular profiles and interactions within tissue neighbourhoods1. Here we applied multiple single-cell and single-nucleus assays (>400,000 nuclei or cells) and spatial imaging technologies to a broad spectrum of healthy reference kidneys (45 donors) and diseased kidneys (48 patients). This has provided a high-resolution cellular atlas of 51 main cell types, which include rare and previously undescribed cell populations. The multi-omic approach provides detailed transcriptomic profiles, regulatory factors and spatial localizations spanning the entire kidney. We also define 28 cellular states across nephron segments and interstitium that were altered in kidney injury, encompassing cycling, adaptive (successful or maladaptive repair), transitioning and degenerative states. Molecular signatures permitted the localization of these states within injury neighbourhoods using spatial transcriptomics, while large-scale 3D imaging analysis (around 1.2 million neighbourhoods) provided corresponding linkages to active immune responses. These analyses defined biological pathways that are relevant to injury time-course and niches, including signatures underlying epithelial repair that predicted maladaptive states associated with a decline in kidney function. This integrated multimodal spatial cell atlas of healthy and diseased human kidneys represents a comprehensive benchmark of cellular states, neighbourhoods, outcome-associated signatures and publicly available interactive visualizations.
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Affiliation(s)
- Blue B Lake
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- San Diego Institute of Science, Altos Labs, San Diego, CA, USA
| | - Rajasree Menon
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Seth Winfree
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Qiwen Hu
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Ricardo Melo Ferreira
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kian Kalhor
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | - Daria Barwinska
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Edgar A Otto
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Michael Ferkowicz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dinh Diep
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- San Diego Institute of Science, Altos Labs, San Diego, CA, USA
| | - Nongluk Plongthongkum
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | - Amanda Knoten
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Sarah Urata
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | - Laura H Mariani
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Abhijit S Naik
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Sean Eddy
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Bo Zhang
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Yan Wu
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- San Diego Institute of Science, Altos Labs, San Diego, CA, USA
| | - Diane Salamon
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - James C Williams
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Xin Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | | | - Paul J Hoover
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Evan Murray
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Teia Noel
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Anitha Vijayan
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | | | - Fei Chen
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Francis P Wilson
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Paul M Palevsky
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - John R Sedor
- Lerner Research and Glickman Urology and Kidney Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Toto
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chirag R Parikh
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eric H Kim
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | | | - Anna Greka
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Peter V Kharchenko
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- San Diego Institute of Science, Altos Labs, San Diego, CA, USA
| | - Joseph P Gaut
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Jeffrey B Hodgin
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Michael T Eadon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Pierre C Dagher
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Tarek M El-Achkar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Kun Zhang
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA.
- San Diego Institute of Science, Altos Labs, San Diego, CA, USA.
| | - Matthias Kretzler
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA.
| | - Sanjay Jain
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA.
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
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12
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Shetty AS, Fraum TJ, Ballard DH, Hoegger MJ, Itani M, Rajput MZ, Lanier MH, Cusworth BM, Mehrsheikh AL, Cabrera-Lebron JA, Chu J, Cunningham CR, Hirschi RS, Mokkarala M, Unteriner JG, Kim EH, Siegel CL, Ludwig DR. Renal Mass Imaging with MRI Clear Cell Likelihood Score: A User's Guide. Radiographics 2023; 43:e220209. [PMID: 37319026 DOI: 10.1148/rg.220209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Small solid renal masses (SRMs) are frequently detected at imaging. Nearly 20% are benign, making careful evaluation with MRI an important consideration before deciding on management. Clear cell renal cell carcinoma (ccRCC) is the most common renal cell carcinoma subtype with potentially aggressive behavior. Thus, confident identification of ccRCC imaging features is a critical task for the radiologist. Imaging features distinguishing ccRCC from other benign and malignant renal masses are based on major features (T2 signal intensity, corticomedullary phase enhancement, and the presence of microscopic fat) and ancillary features (segmental enhancement inversion, arterial-to-delayed enhancement ratio, and diffusion restriction). The clear cell likelihood score (ccLS) system was recently devised to provide a standardized framework for categorizing SRMs, offering a Likert score of the likelihood of ccRCC ranging from 1 (very unlikely) to 5 (very likely). Alternative diagnoses based on imaging appearance are also suggested by the algorithm. Furthermore, the ccLS system aims to stratify which patients may or may not benefit from biopsy. The authors use case examples to guide the reader through the evaluation of major and ancillary MRI features of the ccLS algorithm for assigning a likelihood score to an SRM. The authors also discuss patient selection, imaging parameters, pitfalls, and areas for future development. The goal is for radiologists to be better equipped to guide management and improve shared decision making between the patient and treating physician. © RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Pedrosa in this issue.
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Affiliation(s)
- Anup S Shetty
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Tyler J Fraum
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mark J Hoegger
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mohamed Z Rajput
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Michael H Lanier
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Brian M Cusworth
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Amanda L Mehrsheikh
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jorge A Cabrera-Lebron
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jia Chu
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Christopher R Cunningham
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Ryan S Hirschi
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mahati Mokkarala
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jackson G Unteriner
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Eric H Kim
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Cary L Siegel
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Daniel R Ludwig
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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13
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Yang L, Harper A, Imm KR, Grubb RL, Kim EH, Colditz GA, Wolin KY, Kibel AS, Sutcliffe S. Association between Presurgical Weight Status and Urinary and Sexual Function in Prostate Cancer Patients Treated by Radical Prostatectomy: A Prospective Cohort Study. Urology 2023; 175:137-143. [PMID: 36841358 PMCID: PMC10239333 DOI: 10.1016/j.urology.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To prospectively examine the influence of weight status on urinary and sexual function in clinically localized prostate cancer patients treated by radical prostatectomy (RP). METHODS The Prostatectomy, Incontinence and Erectile dysfunction study recruited patients at 2 US institutions between 2011 and 2014. At baseline, height and weight were measured, and urinary and sexual function were collected by the modified Expanded Prostate Cancer Index Composite-50. This index was repeated at the 5-week, 6-month, and 12-month postsurgical assessments and compared to baseline using linear generalized estimating equations. Logistic equations were used to evaluate the likelihood of functional recovery at the 6- and 12-month assessments. RESULT Presurgery, nonobese patients (68.8% of 407 patients) had similar urinary function as those with obesity (P = .217), but better sexual function (P = .006). One year after surgery, 50.5% and 28.9% patients had recovered to baseline levels for urinary and sexual function, respectively. Recovery was not, however, uniform by obesity. Compared to those with obesity, nonobese patients had better urinary function at the 6- (P < .001) and 12-month postsurgical assessments (P = .011) and were more likely to recover their function by the 6-month assessment (OR = 2.55, 95% CI = 1.36-4.76). For sexual function, nonobese patients had better function at the 6- (P = .028) and 12-month (P = .051) assessments, but a similar likelihood of recovery 1-year postsurgery. CONCLUSION Nonobese prostate cancer patients had better and likely earlier recovery in urinary function postsurgery, and better sexual function both pre- and postsurgery. These findings support the potential for tailored presurgical counseling about RP side-effects and prehabilitation to improve these side-effects.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO.
| | - Andrew Harper
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Kellie R Imm
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert L Grubb
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Eric H Kim
- Division of Urological Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | | | - Adam S Kibel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Urology, Department of Surgery, Brigham & Women's Hospital, Boston, MA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
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14
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Chauhan PS, Shiang AL, Alahi I, Sundby RT, Feng W, Gungoren B, Nawaf C, Chen K, Babbra RK, Harris PK, Qaium F, Hatscher C, Antiporda A, Brunt L, Mayer LR, Shern JF, Baumann BC, Kim EH, Reimers MA, Smith ZL, Chaudhuri AA. Abstract 2219: Urine cell-free DNA multi-omics to detect molecular residual disease and predict survival in bladder cancer patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-2219] [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: 04/07/2023]
Abstract
Abstract
Background: Circulating cell-free tumor DNA (ctDNA) analysis for minimal residual disease (MRD) detection is transforming cancer care. However, the sensitivity of these approaches remains subpar and there is significant risk of false negative results. We analyzed the most proximal biofluid (urine) in localized muscle-invasive bladder cancer (MIBC) patients, and performed two orthogonal ctDNA analytical techniques, one focusing on driver mutation detection, and another focusing on genome-wide copy number alterations. The primary objective of this combinatorial approach was to sensitively detect ctDNA MRD, predict pathologic complete response (pCR), and improve patient risk-stratification.
Methods: Urine samples from 74 localized bladder cancer patients were collected preoperatively on the day of curative-intent radical cystectomy (RC) to assess urine tumor DNA (utDNA). We performed ultra-low pass whole genome sequencing (ULP-WGS) of urine cfDNA from all 74 patients as well as 15 healthy adults. Tumor fraction (TFx) level based on genome-wide copy number alterations was estimated using ichorCNA. Variant allele frequency (VAF) based on single-nucleotide variants (SNVs) was estimated by uCAPP-Seq. We also noninvasively inferred tumor mutation burden (iTMB). pCR was determined by surgical pathology. A random forest (RF) model with leave-one-out cross-validation (LOOCV) was utilized to predict disease status. Kaplan-Meier (KM) and Cox proportional hazards model survival analyses were performed to assess overall survival (OS) and progression-free survival (PFS).
Results: Our study cohort consisted of 74 patients, of which 58 (78%) harbored localized MIBC, and 16 (22%) harbored treatment-refractory high-risk localized NMIBC. Among MIBC patients, 64% (37/58) received neo-adjuvant chemotherapy. VAF, iTMB and TFx levels significantly predicted pCR status. Our RF model incorporating these three utDNA parameters achieved a sensitivity of 87%, a negative predictive value of 77%, and a positive predictive value of 65% for predicting residual disease. AUC for the model was 0.80 (p<0.0001). KM analysis revealed that both PFS (HR = 3.00, P = 0.01) and OS (HR = 4.81, P = 0.009) were significantly worse for patients predicted by the model to have residual disease. Univariate and multivariate Cox proportional hazards models confirmed the significance of our MRD predictions. Survival analyses performed on MIBC, neoadjuvant chemotherapy, and held-out validation subgroups corroborated these findings.
Conclusions: Integration of ULP-WGS with uCAPP-Seq enabled robust detection of residual urine tumor DNA with high sensitivity and predicted survival in localized bladder cancer patients. In the future, this type of multimodal urine-based genomic analysis may lead to more precise risk stratification and nonoperative clinical decision-making for bladder cancer patients.
Citation Format: Pradeep Singh Chauhan, Alexander L. Shiang, Irfan Alahi, R. Taylor Sundby, Wenjia Feng, Bilge Gungoren, Cayce Nawaf, Kevin Chen, Ramandeep K. Babbra, Peter K. Harris, Faridi Qaium, Casey Hatscher, Anna Antiporda, Lindsey Brunt, Lindsey R. Mayer, Jack F. Shern, Brian C. Baumann, Eric H. Kim, Melissa A. Reimers, Zachary L. Smith, Aadel A. Chaudhuri. Urine cell-free DNA multi-omics to detect molecular residual disease and predict survival in bladder cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2219.
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Affiliation(s)
| | | | - Irfan Alahi
- 1Washington University in St. Louis, St. Louis, MO
| | - R. Taylor Sundby
- 2Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Wenjia Feng
- 1Washington University in St. Louis, St. Louis, MO
| | | | - Cayce Nawaf
- 1Washington University in St. Louis, St. Louis, MO
| | - Kevin Chen
- 1Washington University in St. Louis, St. Louis, MO
| | - Ramandeep K. Babbra
- 4Wilmot Institute Cancer Center, University of Rochester Medical Center, Rochester, NY
| | | | - Faridi Qaium
- 1Washington University in St. Louis, St. Louis, MO
| | | | | | | | | | | | | | - Eric H. Kim
- 1Washington University in St. Louis, St. Louis, MO
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15
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Drake BF, Khan S, Wang M, Hicks V, Nichols K, Taylor M, Kim EH, Chang SH. Definitive treatment and risk of death among men diagnosed with metastatic prostate cancer at the Veterans Health Administration. Ann Epidemiol 2023; 79:24-31. [PMID: 36640917 DOI: 10.1016/j.annepidem.2023.01.004] [Citation(s) in RCA: 1] [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: 07/21/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess the potential survival benefit associated with receipt of definitive treatment (radical prostatectomy or radiation), compared to non-definitive treatment (hormonal therapy or chemotherapy) among men with metastatic prostate cancer. METHODS A cohort of men diagnosed with metastatic (T4/M1/N1 or T4/M1) prostate cancer from 1999 to 2013 in the Veterans Health Administration were identified and followed to December 28, 2014. All-cause and prostate cancer-specific mortality were evaluated at 10 years for the T4/M1/N1 cohort and 8 years for the T4/M1/ cohort. The association of definitive treatment (radical prostatectomy or radiation), compared to non-definitive (hormonal therapy or chemotherapy) with both all-cause and prostate cancer-specific mortality was assessed using inverse probability of treatment weighted (IPTW) multivariable survival analyses. RESULTS The cohort included 2919 with T4/M1/N1 disease and 1479 men with T4/M1 disease. Receipt of definitive treatment was associated with a reduced risk of 10-year all-cause (Hazard Ratio (HR): 0.61; 95% Confidence Interval (CI): 0.57-0.65) and prostate cancer-specific mortality (HR: 0.50; 95% CI: 0.46-0.55) among men diagnosed with T4/M1/N1 met-astatic disease. Definitive treatment was similarly associated with a reduced risk of all-cause (HR: 0.84; 95% CI: 0.77-0.91) and prostate cancer-specific (HR: 0.81; 95% CI: 0.73-0.90) mortality among men diagnosed with T4/M1 only metastatic disease. CONCLUSIONS Definitive treatment may improve survival in men diagnosed with metastatic prostate cancer.
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Affiliation(s)
- Bettina F Drake
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO.
| | - Saira Khan
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Mei Wang
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Veronica Hicks
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Kate Nichols
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO; Agendia, Inc, Irvine, CA
| | - Meghan Taylor
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO; Department of Behavioral Science and Health Education, College for Public Health and Social, Justice, Saint Louis University
| | - Eric H Kim
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Su-Hsin Chang
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
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16
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Nawaf CB, Peng B, Reimers MA, Weimholt C, Slane K, Oppelt PJ, Frankel J, Figenshau RS, Kim EH, Andriole GL, Fong L, Pachynski RK. A phase 2 study of ibrutinib as neoadjuvant therapy in patients with localized prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
387 Background: Treatment of localized prostate cancer (PCa) with surgery or radiotherapy remains suboptimal with failure rates of 35-40%. Bruton’s Tyrosine Kinase (BTK) is seen elevated in PCa tissues compared to normal prostate tissue. Malignant B-cell density has been correlated with higher risk of aggressive PCa and mitigating that through the BTK has been proposed in mouse models. Ibrutinib is a potent BTK inhibitor which targets B-cell signaling pathways, has an established safety profile, and has been shown to inhibit in vivo prostate tumor growth pre-clinically. Therefore, we hypothesized that ibrutinib will augment anti-tumor immune responses through inhibiting tumor-intrinsic growth via blocking BTK B-cell signaling pathways, while also inducing favorable T-cell profiles in localized PCa. Methods: We performed a neoadjuvant clinical trial (NCT02643667) studying ibrutinib in PCa. Eligible patients had localized PCa with no prior treatment, and deemed suitable for undergoing a radical prostatectomy. Patients received 840mg/day oral ibrutinib for 28 days followed by a radical prostatectomy 7-12 days later. Patients were assessed 4 weeks after surgery. The primary objectives are to assess safety of ibrutinib and characterize B and T cell infiltration. Correlative pre- and post- treatment tissue and blood samples were collected; BTK and PD-L1 expression in tumor and immune-infiltrating immune cells will be examined, and BCR and TCR clonality and diversity will be evaluated. Results: 22 patients were registered and underwent treatment to date. 4 patients had early termination of ibrutinib treatment with 3 due to adverse effects and 1 due to discovery of surgically unresectable disease. A total of 21 of 22 patients received radical prostatectomies. There were no intra-operative complications attributed to ibrutinib. The treatment was generally well tolerated with 7.1% grade 3 treatment related adverse effects. 2% experienced a grade 4 treatment adverse effects of hepatic dysfunction. The most common grade 1-2 adverse effects were diarrhea (8.2%), fatigue (7.1%), and anemia (6.1%). The median follow-up time was 23.9 months. Median overall survival and median failure free survival have not been reached and the two-year milestone is 100%. Sample collection is complete and immune correlative analyses are ongoing. Safety/tolerability, clinical outcomes, and preliminary correlative data will be reported. Conclusions: This is the first clinical trial of ibrutinib in PCa, and lays the foundation for larger future studies. Clinical trial information: NCT02643667 .
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Affiliation(s)
| | - Bo Peng
- Washington University School of Medicine, St. Louis, MO
| | | | - Cody Weimholt
- Washington University School of Medicine, St. Louis, MO
| | - Kathryn Slane
- Washington University School of Medicine, St. Louis, MO
| | | | - Jason Frankel
- Washington University School of Medicine, St. Louis, MO
| | | | - Eric H Kim
- Washington University School of Medicine, St. Louis, MO
| | | | - Lawrence Fong
- University of California, San Francisco, San Francisco, CA
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17
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Kim EH, Andriole GL. Should men undergo MRI before prostate biopsy - CON. Urol Oncol 2023; 41:92-95. [PMID: 34602360 DOI: 10.1016/j.urolonc.2021.08.006] [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: 05/18/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Prostate magnetic resonance imaging (MRI) is increasingly used prior to biopsy in response to the overdiagnosis and overtreatment of prostate cancer (CaP) associated with prostate-specific antigen (PSA) based screening. However, technical limitations in the conventional diffusion-weighted imaging (DWI) sequences as well as the high degree of radiologist-to-radiologist variability in interpreting prostate MRI result in inadequate accuracy. Specifically, the insufficient negative predictive value (NPV) of prostate MRI (76%-87%) does not allow biopsy to be omitted in the negative MRI setting. Additionally, the variable, and relatively low positive predictive value (PPV) of MRI (27%-44%) provides only an incremental improvement in risk prediction compared to readily available clinical tools such as the Prostate Cancer Prevention Trial risk calculator. This small benefit is likely confined to the minority of patients with positive MRI findings in a typically under-sampled region of the prostate (e.g., anterior lesions), which may be obviated by newer biopsy approaches and tools such as transperineal prostate biopsy and micro-ultrasound technology. With these considerations in mind, pre-biopsy prostate MRI in its current form is unlikely to provide a clinically significant benefit, and should not be considered as routine practice until its accuracy is sufficiently improved.
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Affiliation(s)
- Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Gerald L Andriole
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
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18
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Chauhan PS, Shiang A, Alahi I, Sundby RT, Feng W, Gungoren B, Nawaf C, Chen K, Babbra RK, Harris PK, Qaium F, Hatscher C, Antiporda A, Brunt L, Mayer LR, Shern JF, Baumann BC, Kim EH, Reimers MA, Smith ZL, Chaudhuri AA. Urine cell-free DNA multi-omics to detect MRD and predict survival in bladder cancer patients. NPJ Precis Oncol 2023; 7:6. [PMID: 36658307 PMCID: PMC9852243 DOI: 10.1038/s41698-022-00345-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023] Open
Abstract
Circulating tumor DNA (ctDNA) sensitivity remains subpar for molecular residual disease (MRD) detection in bladder cancer patients. To remedy this problem, we focused on the biofluid most proximal to the disease, urine, and analyzed urine tumor DNA in 74 localized bladder cancer patients. We integrated ultra-low-pass whole genome sequencing (ULP-WGS) with urine cancer personalized profiling by deep sequencing (uCAPP-Seq) to achieve sensitive MRD detection and predict overall survival. Variant allele frequency, inferred tumor mutational burden, and copy number-derived tumor fraction levels in urine cell-free DNA (cfDNA) significantly predicted pathologic complete response status, far better than plasma ctDNA was able to. A random forest model incorporating these urine cfDNA-derived factors with leave-one-out cross-validation was 87% sensitive for predicting residual disease in reference to gold-standard surgical pathology. Both progression-free survival (HR = 3.00, p = 0.01) and overall survival (HR = 4.81, p = 0.009) were dramatically worse by Kaplan-Meier analysis for patients predicted by the model to have MRD, which was corroborated by Cox regression analysis. Additional survival analyses performed on muscle-invasive, neoadjuvant chemotherapy, and held-out validation subgroups corroborated these findings. In summary, we profiled urine samples from 74 patients with localized bladder cancer and used urine cfDNA multi-omics to detect MRD sensitively and predict survival accurately.
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Affiliation(s)
- Pradeep S. Chauhan
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Alexander Shiang
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Irfan Alahi
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO USA
| | - R. Taylor Sundby
- grid.94365.3d0000 0001 2297 5165Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Wenjia Feng
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Bilge Gungoren
- grid.20861.3d0000000107068890Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA USA
| | - Cayce Nawaf
- grid.4367.60000 0001 2355 7002Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO USA
| | - Kevin Chen
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Ramandeep K. Babbra
- grid.412750.50000 0004 1936 9166Wilmot Institute Cancer Center, University of Rochester Medical Center, Rochester, NY USA
| | - Peter K. Harris
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Faridi Qaium
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Casey Hatscher
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Anna Antiporda
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Lindsey Brunt
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Lindsey R. Mayer
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Jack F. Shern
- grid.94365.3d0000 0001 2297 5165Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Brian C. Baumann
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO USA
| | - Eric H. Kim
- grid.4367.60000 0001 2355 7002Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO USA
| | - Melissa A. Reimers
- grid.4367.60000 0001 2355 7002Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
| | - Zachary L. Smith
- grid.4367.60000 0001 2355 7002Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO USA
| | - Aadel A. Chaudhuri
- grid.4367.60000 0001 2355 7002Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Genetics, Washington University School of Medicine, St. Louis, MO USA
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Balasubramanian S, Ronstrom C, Shiang A, Vetter JM, Sheets J, Palka J, Figenshau RS, Kim EH. Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy. World J Urol 2023; 41:35-41. [PMID: 36322183 PMCID: PMC9629187 DOI: 10.1007/s00345-022-04204-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/23/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The standard discharge pathway following robotic-assisted laparoscopic prostatectomy (RALP) involves overnight hospital admission. Models for same-day discharge (SDD) have been explored for multiport RALP, however, less is known regarding SDD for single-port RALP, especially in terms of patient experience. METHODS Patient enrollment, based on preoperative determination of potential SDD eligibility, commenced March 2020 and ended March 2021. Day-of-surgery criteria were utilized to determine which enrolled patients underwent SDD. Differences in preoperative characteristics and perioperative outcomes between patients undergoing SDD and patients undergoing standard discharge were evaluated. A prospectively administered questionnaire was designed to characterize patient-centered factors informing SDD perception. RESULTS Fifteen patients underwent SDD and 36 underwent standard discharge. Overall mean ± SD age and BMI were 63.6 ± 7.0 years and 29.7 ± 4.4 kg/m2, respectively. Mean operative time was shorter in the SDD cohort than the standard discharge cohort (188 min vs 217 min, p = 0.011). A higher proportion of cases that underwent SDD were performed using the Retzius-sparing approach, 80% (12/15) vs 33% (12/36) in the standard discharge cohort (p = 0.005). Rates of 90 day complication (p = 0.343), 90 day readmission (p = 0.144), and 90 day emergency department visits (p = 0.343) rates were all not significantly different between cohorts. Of questionnaire respondents undergoing standard discharge, 32% (8/25) cited pain as a reason for not undergoing SDD. CONCLUSIONS With comparable outcomes to the standard discharge pathway, SDD is safe and effective in single-port RALP. Post-operative pain and perceptions of distance are implicated as patient-centered barriers to SDD; proactive pain management and patient education strategies may facilitate SDD.
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Affiliation(s)
- Shiva Balasubramanian
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108 USA
| | - Carrie Ronstrom
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Alexander Shiang
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Joel M. Vetter
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Julia Sheets
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Joshua Palka
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - R. Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
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Balasubramanian S, Shiang A, Vetter JM, Henning GM, Figenshau RS, Kim EH. Comparison of Three Approaches to Single-Port Robot-Assisted Radical Prostatectomy: Our Institution's Initial Experience. J Endourol 2022; 36:1551-1558. [PMID: 36017625 PMCID: PMC9718430 DOI: 10.1089/end.2022.0330] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: We aimed to compare three robot-assisted radical prostatectomy (RARP) approaches-Retzius sparing (RS), extraperitoneal (EP), and transperitoneal (TP)-performed at our institution using the da Vinci® single-port (SP) platform (Intuitive Surgical, Sunnyvale, CA). Materials and Methods: We retrospectively reviewed the records of 101 patients who underwent SP-RARP at our institution and stratified them into three cohorts based on the RARP approach: RS (n = 32), EP (n = 30), and TP (n = 39). Data regarding preoperative patient characteristics, perioperative characteristics, oncologic outcomes, and early functional outcomes were collected. The Fisher's exact test and chi-square tests were utilized for categorical variables, and the Kruskal-Wallis test was utilized for numerical variables. Wilcoxon rank-sum tests were utilized for pairwise comparisons. A two-tailed p < 0.05 was considered significant. Results: All three cohorts were largely similar in terms of preoperative patient characteristics. Operative time was significantly different between cohorts (p < 0.001), with the RS approach having a faster mean operating time than the TP approach (208 ± 40 minutes vs 248 ± 36 minutes, p < 0.001). Clinically significant margin rates did not differ significantly between cohorts (p = 0.861). Postoperative continence differed significantly between cohorts (p < 0.001); higher continence rates were observed in RS vs EP-94% (30/32) vs 52% (15/29), respectively, p < 0.001. Return of erectile function also differed significantly between cohorts (p = <0.001); higher erectile function recovery rates were observed in RS vs EP-88% (28/32) vs 41% (11/27), respectively, p < 0.001-and in RS vs TP-88% (28/32) vs 60% (22/37), respectively, p = 0.014. Median (IQR) follow-up time was 150 (88-377) days. Conclusions: RS SP-RARP is associated with improved early functional outcomes when compared with both EP and TP approaches. These benefits are achieved while maintaining equivalent oncologic outcomes. Further research is needed to optimize the patient selection paradigm for the SP-RARP approach.
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Affiliation(s)
| | - Alexander Shiang
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel M. Vetter
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grant M. Henning
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - R. Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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21
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Sridaran D, Chouhan S, Mahajan K, Renganathan A, Weimholt C, Bhagwat S, Reimers M, Kim EH, Thakur MK, Saeed MA, Pachynski RK, Seeliger MA, Miller WT, Feng FY, Mahajan NP. Inhibiting ACK1-mediated phosphorylation of C-terminal Src kinase counteracts prostate cancer immune checkpoint blockade resistance. Nat Commun 2022; 13:6929. [PMID: 36376335 PMCID: PMC9663509 DOI: 10.1038/s41467-022-34724-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Solid tumours are highly refractory to immune checkpoint blockade (ICB) therapies due to the functional impairment of effector T cells and their inefficient trafficking to tumours. T-cell activation is negatively regulated by C-terminal Src kinase (CSK); however, the exact mechanism remains unknown. Here we show that the conserved oncogenic tyrosine kinase Activated CDC42 kinase 1 (ACK1) is able to phosphorylate CSK at Tyrosine 18 (pY18), which enhances CSK function, constraining T-cell activation. Mice deficient in the Tnk2 gene encoding Ack1, are characterized by diminished CSK Y18-phosphorylation and spontaneous activation of CD8+ and CD4+ T cells, resulting in inhibited growth of transplanted ICB-resistant tumours. Furthermore, ICB treatment of castration-resistant prostate cancer (CRPC) patients results in re-activation of ACK1/pY18-CSK signalling, confirming the involvement of this pathway in ICB insensitivity. An ACK1 small-molecule inhibitor, (R)-9b, recapitulates inhibition of ICB-resistant tumours, which provides evidence for ACK1 enzymatic activity playing a pivotal role in generating ICB resistance. Overall, our study identifies an important mechanism of ICB resistance and holds potential for expanding the scope of ICB therapy to tumours that are currently unresponsive.
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Affiliation(s)
- Dhivya Sridaran
- Department of Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Surbhi Chouhan
- Department of Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Kiran Mahajan
- Department of Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
- Siteman Cancer Center, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Arun Renganathan
- Department of Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Cody Weimholt
- Department of Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Oncology, Department of Medicine, Washington University at St Louis, St Louis, MO, 63110, USA
- Anatomic and Clinical Pathology, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Shambhavi Bhagwat
- Department of Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Melissa Reimers
- Siteman Cancer Center, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Oncology, Department of Medicine, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Eric H Kim
- Department of Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Manish K Thakur
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Muhammad A Saeed
- Siteman Cancer Center, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Russell K Pachynski
- Siteman Cancer Center, Washington University at St Louis, St Louis, MO, 63110, USA
- Division of Oncology, Department of Medicine, Washington University at St Louis, St Louis, MO, 63110, USA
| | - Markus A Seeliger
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY, 11794, USA
- Department of Physiology and Biophysics, School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
| | - W Todd Miller
- Department of Physiology and Biophysics, School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
- Department of Veterans Affairs Medical Center, Northport, NY, 11768, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, CA, USA
| | - Nupam P Mahajan
- Department of Surgery, Washington University at St Louis, St Louis, MO, 63110, USA.
- Division of Urologic Surgery, Washington University at St Louis, St Louis, MO, 63110, USA.
- Siteman Cancer Center, Washington University at St Louis, St Louis, MO, 63110, USA.
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22
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Shiang AL, Palka JK, Balasubramanian S, Figenshau RS, Smith ZL, Kim EH. Comparison of single-port and multi-port Retzius-sparing robot-assisted laparoscopic prostatectomy. J Robot Surg 2022; 17:835-840. [PMID: 36316538 PMCID: PMC9628306 DOI: 10.1007/s11701-022-01464-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
Dissemination of robotic surgical technology for robot-assisted laparoscopic prostatectomy (RALP) has yielded advancements including the Retzius-sparing (RS) approach and the single-port (SP) platform. The safety and feasibility of each individual advancement have been evaluated, yet there is a lack of literature comparing SP RS-RALP to conventional multi-port (MP) RS-RALP. All patients who underwent RS-RALP at our institution between January 2019 and February 2021 were retrospectively reviewed. Data regarding baseline patient and tumor characteristics, operative characteristics, and surgical outcomes were collected and analyzed using the Fisher's exact test and two-tailed unpaired t tests. 62 patients were evaluated: 31 received SP RS-RALP and 31 received MP RS-RALP. Differences in patient age, BMI, and initial PSA were not observed. Lower median lymph node yield (SP: 4 vs MP: 12, p < 0.01), lower estimated blood loss (SP: 111.2 vs. MP 157.8 mL, p < 0.01), shorter operative time (SP: 207.7 vs. MP: 255.9 min, p < 0.01) and decreased length of stay (SP: 0.39 vs. MP: 1.23 days, p < 0.01) were observed in the SP RS-RALP cohort. No differences in positive surgical margins, complications, or biochemical recurrence rates were observed. SP RS-RALP is non-inferior to MP RS-RALP in terms of both perioperative and early oncologic outcomes. Despite the small sample size, the SP platform is a safe and feasible option for RS-RALP and confers potential benefits in the form of shorter operative time and reduced length of stay.
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Affiliation(s)
- Alexander L. Shiang
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Joshua K. Palka
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Shiva Balasubramanian
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108 USA
| | - R. Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Zachary L. Smith
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
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23
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Nguyen DT, Yang W, Renganathan A, Weimholt C, Angappulige DH, Nguyen T, Sprung RW, Andriole GL, Kim EH, Mahajan NP, Mahajan K. Acetylated HOXB13 Regulated Super Enhancer Genes Define Therapeutic Vulnerabilities of Castration-Resistant Prostate Cancer. Clin Cancer Res 2022; 28:4131-4145. [PMID: 35849143 PMCID: PMC9481728 DOI: 10.1158/1078-0432.ccr-21-3603] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/01/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Androgen receptor (AR) antagonism is exacerbated by HOXB13 in castration-resistant prostate cancers (CRPC). However, it is unclear when and how HOXB13 primes CRPCs for AR antagonism. By mass-spectrometry analysis of CRPC extract, we uncovered a novel lysine 13 (K13) acetylation in HOXB13 mediated by CBP/p300. To determine whether acetylated K13-HOXB13 is a clinical biomarker of CRPC development, we characterized its role in prostate cancer biology. EXPERIMENTAL DESIGN We identified tumor-specific acK13-HOXB13 signal enriched super enhancer (SE)-regulated targets. We analyzed the effect of loss of HOXB13K13-acetylation on chromatin binding, SE proximal target gene expression, self-renewal, enzalutamide sensitivity, and CRPC tumor growth by employing isogenic parental and HOXB13K13A mutants. Finally, using primary human prostate organoids, we evaluated whether inhibiting an acK13-HOXB13 target, ACK1, with a selective inhibitor (R)-9b is superior to AR antagonists in inhibiting CRPC growth. RESULTS acK13-HOXB13 promotes increased expression of lineage (AR, HOXB13), prostate cancer diagnostic (FOLH1), CRPC-promoting (ACK1), and angiogenesis (VEGFA, Angiopoietins) genes early in prostate cancer development by establishing tumor-specific SEs. acK13-HOXB13 recruitment to key SE-regulated targets is insensitive to enzalutamide. ACK1 expression is significantly reduced in the loss of function HOXB13K13A mutant CRPCs. Consequently, HOXB13K13A mutants display reduced self-renewal, increased sensitivity to enzalutamide, and impaired xenograft tumor growth. Primary human prostate tumor organoids expressing HOXB13 are significantly resistant to AR antagonists but sensitive to (R)-9b. CONCLUSIONS In summary, acetylated HOXB13 is a biomarker of clinically significant prostate cancer. Importantly, PSMA-targeting agents and (R)-9b could be new therapeutic modalities to target HOXB13-ACK1 axis regulated prostate cancers.
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Affiliation(s)
- Duy T Nguyen
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.,Mayo Clinic Graduate School of Biomedical Science, College of Medicine & Science, Rochester, Minnesota
| | - Wei Yang
- Genome Technology Access Center, Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
| | - Arun Renganathan
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Cody Weimholt
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri
| | - Duminduni H Angappulige
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Thanh Nguyen
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.,Cancer and Cell Biology Graduate Program, Baylor College of Medicine, Houston, Texas
| | - Robert W Sprung
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | - Gerald L Andriole
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.,National Capital Region, Johns Hopkins Medicine, Sibley Memorial Hospital, Washington, District of Columbia.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Eric H Kim
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Nupam P Mahajan
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Kiran Mahajan
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
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24
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Baek JK, Kim HI, Kang MJ, Seon KE, Kim EH, Seo SK. Relationship between the type of hormone replacement therapy and incidence of breast cancer in Korea. Climacteric 2022; 25:516-522. [PMID: 35674251 DOI: 10.1080/13697137.2022.2077096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between hormone replacement therapy (HRT) types and breast cancer (BC) incidence in postmenopausal women in Korea. METHODS The nested case-control study used data from the National Health Insurance Service database. Among the women aged ≥50 years who menopaused between 2004 and 2007, BC incidence up to 2017 was analyzed in 36,446 women using or having used HRT for >1 year and in 36,446 women who did not use any HRT for more than 1 year. HRT types and duration were classified into three categories. RESULTS BC risk (BCR) decreased with tibolone use for all ages. With HRT initiation in women aged ≥50 years, BCR was lower with tibolone and estrogen-progestogen therapy. HRT for <3 years showed lower BCR with tibolone, while higher BCR was observed with estrogen-only therapy. BCR was lower in women of all ages on HRT for >5 years than in the control group. CONCLUSIONS For women in their 50s, tibolone use lowers BCR; for all ages, the use of any HRT for >5 years showed lower BCR in Korea. These divergent results from western countries could be associated with the specific characteristics of BC in Korea.
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Affiliation(s)
- J K Baek
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H I Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M J Kang
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - K E Seon
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - E H Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - S K Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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25
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Andruska N, Fischer-Valuck BW, Waters M, Diaz EJ, Agabalogun T, Kim EH, Smith ZL, Brenneman R, Gay HA, Andriole GL, Michalski JM, Baumann BC. Survival Outcomes in Men with Unfavorable Intermediate-Risk and High-Risk Prostate Cancer Treated with Prostate-Only versus Whole Pelvic Radiation Therapy. J Urol 2022; 207:1227-1235. [PMID: 35085038 PMCID: PMC9169570 DOI: 10.1097/ju.0000000000002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Men with unfavorable intermediate-risk (UIR-PCa) or high-risk prostate cancer (HR-PCa) are often treated with definitive external beam radiotherapy (EBRT) plus androgen deprivation therapy. Treatment is frequently intensified by electively treating the pelvic lymph nodes (LNs) with whole pelvis radiotherapy (WPRT), but practice patterns and the benefits of WPRT are not well defined. We hypothesized that men treated with WPRT would have improved overall survival (OS) relative to men treated with prostate-only radiotherapy. MATERIALS AND METHODS National Cancer Database records of men diagnosed between 2008-2015 with UIR-PCa or HR-PCa and treated with prostate EBRT±androgen deprivation therapy (72-86.4 Gy) with (15,175) or without (13,549) WPRT were reviewed. Risk of LN involvement was calculated using the Memorial Sloan Kettering Cancer Center nomogram. Measured confounders were balanced with inverse probability of treatment weighting and OS hazard ratios (HRs) were generated using multivariable Cox regression. RESULTS Of the men, 53% received WPRT. Every 1% increase in risk of LN involvement correlated with a 1% increase in risk of death (p <0.001). WPRT trended toward improved OS in all men with UIR-PCa and HR-PCa (HR: 0.95 [95% CI: 0.90-1.006], p=0.055). WPRT correlated with improved OS in men with Gleason 9 and 10 disease (HR: 0.87 [0.78-0.98], p=0.02) or risk of LN involvement ≥10% (HR: 0.93 [0.87-0.99], p=0.03). CONCLUSIONS Men with higher LN risk scores and Gleason grade benefited from WPRT. These results complement the recent POP-RT randomized trial in mostly positron emission tomography/computerized tomography-staged patients, demonstrating that a more heterogeneous population of men staged without functional imaging benefits from WPRT.
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Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | | | - Michael Waters
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Elizabeth Juarez Diaz
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Temitope Agabalogun
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Eric H. Kim
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Zachary L Smith
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Gerald L. Andriole
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA
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26
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Henning GM, Andriole GL, Kim EH. Liquid biomarkers for early detection of prostate cancer and summary of available data for their use in African-American men. Prostate Cancer Prostatic Dis 2022; 25:180-186. [PMID: 35246608 DOI: 10.1038/s41391-022-00507-8] [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: 09/01/2021] [Revised: 12/20/2021] [Accepted: 01/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Several liquid biomarker tests have been developed to account for the limitations of prostate specific antigen (PSA) screening prior to prostate biopsy. African ancestry is an established risk factor for prostate cancer (PCa) and must be particularly considered when evaluating patients with liquid biomarkers. While multiple tests have been developed over decades of exploration, recent advances can help patients and physicians incorporate data into a broader clinical context. METHODS We sought to review currently available liquid biomarker tests in a practical, clinically directed fashion with particular focus on performance in men with African ancestry. We reviewed discovery and validation studies and highlight important considerations for each test. RESULTS We discuss the advantages and limitations of percent free PSA, Prostate Health Index, Progensa® PCA3, ExoDx® Prostate Test, SelectMDx®, 4Kscore® Test, and Mi-Prostate Score and summarize salient studies on their use. A literature review of evidence specifically for men with African ancestry was conducted and available studies were summarized. CONCLUSIONS Liquid biomarkers can be useful tools for aiding in risk stratification prior to prostate biopsy. Use of such tests should be individualized based on a thorough knowledge of supporting evidence and the goals of the patient and physician. Further study should prioritize evaluation of such biomarkers in men with African ancestry.
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Affiliation(s)
- Grant M Henning
- Washington University School of Medicine, St. Louis, MO, USA.
| | | | - Eric H Kim
- Washington University School of Medicine, St. Louis, MO, USA
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27
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Chauhan PS, Shiang A, Chen K, Babbra R, Feng W, Szymanski JJ, Harris PK, Hatcher C, Roussin J, Basarabescu F, Brunt L, Mayer LR, Borkowski A, Maguire L, Baumann BC, Reimers MA, Kim EH, Arora VK, Smith ZL, Chaudhuri AA. Integrative analysis of urine cell-free DNA for the detection of residual disease in localized bladder cancer patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.559] [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
559 Background: We previously developed a liquid biopsy assay to measure urine tumor DNA (utDNA) levels based on detection of single nucleotide variants (SNVs) in urine cell-free DNA (cfDNA). Nonsilent SNV detection in urine from muscle-invasive bladder cancer (MIBC) patients prior to radical cystectomy (RC) was associated with pathologic residual disease and worse progression-free survival (Chauhan et al., PLOS Medicine, 2021). Given the multiple types of genomic alterations present in bladder cancer (BC), here we developed a multi-omics approach for estimating utDNA levels without restricting our approach to SNVs. We performed ultra-low pass whole genome sequencing (ULP-WGS) based copy number analysis and urine Cancer Personalized Profiling by deep Sequencing (uCAPP-Seq) of urine cell-free DNA to predict pathologic complete response (pCR) in localized BC patients. Methods: We acquired urine preoperatively from 65 BC patients (69% muscle-invasive) on the day of standard-of-care RC, and after neoadjuvant chemotherapy in 48% of patients. We performed ULP-WGS of urine cfDNA from all 65 BC patients and 11 healthy adults. utDNA levels based on genome-wide copy number alterations (CNAs) in urine cfDNA was estimated using ichorCNA. In order to derive a SNV-based utDNA level as well, uCAPP-Seq was applied to urine cfDNA samples derived from 42 patients using a 145 kb panel of 49 consensus driver genes commonly mutated in MIBC. Results: In our cohort of 65 BC patients, 55% of patients achieved pCR ( n = 36) while 45% had residual disease detected in their surgical sample (no pCR; n = 29). Comparing ULP-WGS-derived utDNA levels between the groups, patients with no pCR had significantly higher CNA-derived tumor fractions in urine compared to patients with pCR (median 8.9% vs 1.8%, p = 0.01) and healthy adults ( n = 11) (median 8.9% vs 0%, p = 0.006). Further analysis with uCAPP-Seq in 42 patients revealed that nonsilent SNV-based utDNA detection correlated significantly with the absence of pCR ( p < 0.001) with a sensitivity of 81% and specificity of 81%. Moreover, utDNA-positive patients exhibited significantly worse progression-free survival compared to utDNA-negative patients (HR = 7.4; 95% CI: 1.4–38.9; p = 0.02). Conclusions: Bladder cancer patients who did not attain a pCR at the time of RC had greater genome-wide copy number alterations and nonsilent single nucleotide variants in their urine cfDNA compared to patients with pCR. These results suggest that integrative multi-omics of urine derived from MIBC patients has potential real-world clinical impact for bladder-sparing approaches in select patients.
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Affiliation(s)
- Pradeep S. Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Alexander Shiang
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Kevin Chen
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Ramandeep Babbra
- Wilmot Institute Cancer Center, University of Rochester medical Center, Rochester, NY
| | - Wenjia Feng
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey J. Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Peter K. Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Casey Hatcher
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Jessica Roussin
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Franco Basarabescu
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Lindsey Brunt
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Lindsey R. Mayer
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Ariel Borkowski
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Lenon Maguire
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Brian C. Baumann
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Vivek K Arora
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Zachary L Smith
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Aadel A Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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Chauhan PS, Chen K, Babbra RK, Feng W, Pejovic N, Nallicheri A, Harris PK, Dienstbach K, Atkocius A, Maguire L, Qaium F, Szymanski JJ, Baumann BC, Ding L, Cao D, Reimers MA, Kim EH, Smith ZL, Arora VK, Chaudhuri AA. Correction: Urine tumor DNA detection of minimal residual disease in muscle-invasive bladder cancer treated with curative-intent radical cystectomy: A cohort study. PLoS Med 2021; 18:e1003876. [PMID: 34905549 PMCID: PMC8670709 DOI: 10.1371/journal.pmed.1003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1003732.].
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Ghildiyal R, Sawant M, Renganathan A, Mahajan K, Kim EH, Luo J, Dang HX, Maher CA, Feng FY, Mahajan NP. Loss of long non-coding RNA NXTAR in prostate cancer augments androgen receptor expression and enzalutamide resistance. Cancer Res 2021; 82:155-168. [PMID: 34740892 DOI: 10.1158/0008-5472.can-20-3845] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/19/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
Androgen receptor (AR) signaling continues to play a dominant role in all stages of prostate cancer (PC), including castration-resistant prostate cancers (CRPC) that have developed resistance to second-generation AR antagonists such as enzalutamide. In this study, we identified a long non-coding RNA (lncRNA), NXTAR (LOC105373241), that is located convergent with the AR gene and is repressed in human prostate tumors and cell lines. NXTAR bound upstream of the AR promoter and promoted EZH2 recruitment, causing significant loss of AR (and AR-V7) expression. Paradoxically, AR bound the NXTAR promoter, and inhibition of AR by the ACK1/TNK2 small molecule inhibitor (R)-9b excluded AR from the NXTAR promoter. The histone acetyltransferase GCN5 bound and deposited H3K14 acetylation marks, enhancing NXTAR expression. Application of an oligonucleotide derived from NXTAR exon 5 (NXTAR-N5) suppressed AR/AR-V7 expression and prostate cancer cell proliferation, indicating the translational relevance of the negative regulation of AR. In addition, pharmacological restoration of NXTAR using (R)-9b abrogated enzalutamide-resistant prostate xenograft tumor growth. Overall, this study uncovers a positive feedback loop, wherein NXTAR acts as a novel prostate tumor-suppressing lncRNA by inhibiting AR/AR-V7 expression, which in turn upregulates NXTAR levels, compromising enzalutamide-resistant prostate cancer. The restoration of NXTAR could serve as a new therapeutic modality for patients who have acquired resistance to second-generation AR antagonists.
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Affiliation(s)
| | | | | | | | - Eric H Kim
- Siteman Cancer Center, Moffitt Cancer Center
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine
| | - Ha X Dang
- Internal Medicine, Washington University in St. Louis
| | | | - Felix Y Feng
- Radiation Oncology, Helen Diller Comprehensive Cancer Center, University of California, San Francisco
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Sands KG, Figenshau RS, Vetter J, Paradis A, Pierce A, Kim EH, Du K, Chow A, Venkatesh R. Contemporary Pure Laparoscopic Vs Robot-Assisted Laparoscopic Radical Nephrectomy: Is the Transition Worth It? J Endourol 2021; 35:1526-1532. [PMID: 34121444 DOI: 10.1089/end.2021.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The proportion of robotic procedures continues to rise. The literature reinforces that robotic procedures take longer and are often more costly. We compared cost and perioperative outcomes of laparoscopic radical nephrectomy (LRN) and robot-assisted radical nephrectomy (RARN) at our high-volume center. Materials and Methods: We retrospectively reviewed our 2012-2015 data repository for patients undergoing RARN and LRN for a renal mass. Perioperative and oncologic outcomes were compared. We performed a multivariate analysis of operative time, estimated blood loss, length of stay (LOS), and overall and major 90-day complication rates while controlling for demographic data, Charlson comorbidity index (CCI), tumor size, and surgeon factors. We compared fixed, variable, and distinct procedural costs. Results: We identified 99 LRN and 95 RARN cases. There was no difference in demographic data, tumor size, preoperative renal function, and malignant histology. LRN patients had more comorbidities (49.5% vs 27.3% CCI 2+, p = 0.018). The mean preoperative glomerular filtration rate was higher in the robotic cohort (84.8 vs 75.1, p = 0.48). Mean operative time was 32.7 minutes longer (p = 0.002) and estimated blood loss 145 mL higher (p = 0.007) for the RARN cohort. There was no difference in mean LOS. Major and all 90-day complication rates were no different. The mean procedural cost for RARN was higher by $464 when controlling for operative time (p < 0.001). Fixed costs were not statistically different. Variable costs for RARN were estimated to be $2,310 higher (p = 0.045). Conclusions: Even with cost-conscious, experienced renal surgeons, RARN is associated with a longer procedure, higher supply costs, and higher hospitalization costs. There was no difference in positive surgical margin and complications. There were fewer 30-day readmissions for the RARN cohort, which may represent under-recognized cost savings. With fewer LRN cases in the United States each year, discussion to address cost is warranted. Without better outcomes for robotic surgery, a change in reimbursement to cover costs is unlikely to happen.
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Affiliation(s)
- Kenneth G Sands
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert S Figenshau
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alethea Paradis
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrew Pierce
- Barnes-Jewish Hospital, Supply Plus, St. Louis, Missouri, USA
| | - Eric H Kim
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kefu Du
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alexander Chow
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Chauhan PS, Chen K, Babbra RK, Feng W, Pejovic N, Nallicheri A, Harris PK, Dienstbach K, Atkocius A, Maguire L, Qaium F, Szymanski JJ, Baumann BC, Ding L, Cao D, Reimers MA, Kim EH, Smith ZL, Arora VK, Chaudhuri AA. Urine tumor DNA detection of minimal residual disease in muscle-invasive bladder cancer treated with curative-intent radical cystectomy: A cohort study. PLoS Med 2021; 18:e1003732. [PMID: 34464379 PMCID: PMC8407541 DOI: 10.1371/journal.pmed.1003732] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The standard of care treatment for muscle-invasive bladder cancer (MIBC) is radical cystectomy, which is typically preceded by neoadjuvant chemotherapy. However, the inability to assess minimal residual disease (MRD) noninvasively limits our ability to offer bladder-sparing treatment. Here, we sought to develop a liquid biopsy solution via urine tumor DNA (utDNA) analysis. METHODS AND FINDINGS We applied urine Cancer Personalized Profiling by Deep Sequencing (uCAPP-Seq), a targeted next-generation sequencing (NGS) method for detecting utDNA, to urine cell-free DNA (cfDNA) samples acquired between April 2019 and November 2020 on the day of curative-intent radical cystectomy from 42 patients with localized bladder cancer. The average age of patients was 69 years (range: 50 to 86), of whom 76% (32/42) were male, 64% (27/42) were smokers, and 76% (32/42) had a confirmed diagnosis of MIBC. Among MIBC patients, 59% (19/32) received neoadjuvant chemotherapy. utDNA variant calling was performed noninvasively without prior sequencing of tumor tissue. The overall utDNA level for each patient was represented by the non-silent mutation with the highest variant allele fraction after removing germline variants. Urine was similarly analyzed from 15 healthy adults. utDNA analysis revealed a median utDNA level of 0% in healthy adults and 2.4% in bladder cancer patients. When patients were classified as those who had residual disease detected in their surgical sample (n = 16) compared to those who achieved a pathologic complete response (pCR; n = 26), median utDNA levels were 4.3% vs. 0%, respectively (p = 0.002). Using an optimal utDNA threshold to define MRD detection, positive utDNA MRD detection was highly correlated with the absence of pCR (p < 0.001) with a sensitivity of 81% and specificity of 81%. Leave-one-out cross-validation applied to the prediction of pathologic response based on utDNA MRD detection in our cohort yielded a highly significant accuracy of 81% (p = 0.007). Moreover, utDNA MRD-positive patients exhibited significantly worse progression-free survival (PFS; HR = 7.4; 95% CI: 1.4-38.9; p = 0.02) compared to utDNA MRD-negative patients. Concordance between urine- and tumor-derived mutations, determined in 5 MIBC patients, was 85%. Tumor mutational burden (TMB) in utDNA MRD-positive patients was inferred from the number of non-silent mutations detected in urine cfDNA by applying a linear relationship derived from The Cancer Genome Atlas (TCGA) whole exome sequencing of 409 MIBC tumors. We suggest that about 58% of these patients with high inferred TMB might have been candidates for treatment with early immune checkpoint blockade. Study limitations included an analysis restricted only to single-nucleotide variants (SNVs), survival differences diminished by surgery, and a low number of DNA damage response (DRR) mutations detected after neoadjuvant chemotherapy at the MRD time point. CONCLUSIONS utDNA MRD detection prior to curative-intent radical cystectomy for bladder cancer correlated significantly with pathologic response, which may help select patients for bladder-sparing treatment. utDNA MRD detection also correlated significantly with PFS. Furthermore, utDNA can be used to noninvasively infer TMB, which could facilitate personalized immunotherapy for bladder cancer in the future.
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Affiliation(s)
- Pradeep S. Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Kevin Chen
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Ramandeep K. Babbra
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Wenjia Feng
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Nadja Pejovic
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Armaan Nallicheri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Peter K. Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Katherine Dienstbach
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Andrew Atkocius
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Lenon Maguire
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Faridi Qaium
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jeffrey J. Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Brian C. Baumann
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Li Ding
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Melissa A. Reimers
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Eric H. Kim
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Zachary L. Smith
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Vivek K. Arora
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Aadel A. Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
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Chen K, Chauhan PS, Babbra RK, Feng W, Harris PK, Dienstbach K, Atkocius A, Maguire L, Qaium F, Nallicheri A, Baumann BC, Reimers MA, Kim EH, Smith ZL, Arora VK, Chaudhuri AA. Abstract 547: Urine tumor DNA MRD detection and correlation with pathologic complete response in muscle-invasive bladder cancer treated with curative-intent radical cystectomy. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-547] [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: 11/16/2022]
Abstract
Abstract
Objective: Standard-of-care for muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy followed by radical cystectomy. The inability to assess molecular residual disease (MRD) noninvasively limits our ability to offer bladder-sparing treatment. We seek to develop a liquid biopsy solution via urine tumor DNA (utDNA) analysis.
Methods: We applied uCAPP-Seq, a targeted next-generation sequencing method for detecting utDNA, to urine cell-free DNA samples acquired on the day of curative-intent radical cystectomy from 42 patients with non-metastatic bladder cancer, 30 of whom had a confirmed diagnosis of MIBC and 19 of whom received neoadjuvant chemotherapy. utDNA mutational calling was performed noninvasively without tumor tissue sequencing knowledge. The overall utDNA level for each patient was represented by the non-silent mutation with the highest duplex-supported variant allele fraction after removing germline variants. Urine was similarly analyzed from 15 healthy donors. The concordance between urine cell-free DNA and tumor tissue was determined for a subset of patients. Tumor mutational burden (TMB) in utDNA MRD-positive patients was inferred from the number of mutations detected in urine cell-free DNA by applying a linear relationship derived from TCGA whole-exome sequencing of 409 MIBC tumors.
Results: utDNA analysis revealed a median utDNA level of 0% in healthy donors and 2.4% in non-metastatic bladder cancer patients. Concordance between urine- and tumor-derived mutations, determined in 5 MIBC patients, was 87%. When patients were classified as those who had residual disease detected in their surgical sample (n = 16) compared to those who achieved a pathologic complete response (n = 26), median utDNA levels were 4.3% vs. 0%, respectively (P = 0.002). The lack of utDNA MRD detection was highly correlated with pathologic complete response by Fisher's exact test (P = 0.0001) with Youden's index-determined sensitivity of 81% and specificity of 81%. Moreover, utDNA MRD-positive patients exhibited significantly worse progression-free survival compared to utDNA MRD-negative patients (HR = 7.2; P = 0.03) with a median follow-up time of 200 days. Leveraging data from TCGA, the median inferred TMB in utDNA MRD-positive patients was 198 mutations per exome. We suggest that 58% of these patients with inferred TMB ≥ this level might have been candidates for early immune checkpoint blockade.
Conclusion: The lack of utDNA MRD detection prior to curative-intent radical cystectomy for muscle-invasive bladder cancer correlated significantly with pathologic complete response. utDNA MRD detection status also correlated significantly with progression-free survival. Furthermore, utDNA results can be used to noninvasively infer TMB, which may facilitate the targeted use of adjuvant immunotherapy.
Citation Format: Kevin Chen, Pradeep S. Chauhan, Ramandeep K. Babbra, Wenjia Feng, Peter K. Harris, Katherine Dienstbach, Andrew Atkocius, Lenon Maguire, Faridi Qaium, Armaan Nallicheri, Brian C. Baumann, Melissa A. Reimers, Eric H. Kim, Zachary L. Smith, Vivek K. Arora, Aadel A. Chaudhuri. Urine tumor DNA MRD detection and correlation with pathologic complete response in muscle-invasive bladder cancer treated with curative-intent radical cystectomy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 547.
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Affiliation(s)
- Kevin Chen
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Wenjia Feng
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Lenon Maguire
- Washington University School of Medicine, St. Louis, MO
| | - Faridi Qaium
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Eric H. Kim
- Washington University School of Medicine, St. Louis, MO
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Iqbal U, Elsayed AS, Jing Z, Stoeckle M, Wijburg C, Wiklund P, Hosseini A, Dasgupta P, Khan MS, Hemal A, Kim EH, Wagner AA, Gaboardi F, Rha KH, Maatman T, Balbay D, Li Q, Hussein A, Guru KA. Upstaging and Survival Outcomes for Non-Muscle Invasive Bladder Cancer After Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. J Endourol 2021; 35:1541-1547. [PMID: 34139890 DOI: 10.1089/end.2021.0013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We sought to describe the incidence, risk factors, and survival outcomes associated with pathological upstaging from non-muscle invasive bladder cancer (NMIBC) to muscle invasive bladder cancer (MIBC) after robot-assisted radical cystectomy (RARC). METHODS We reviewed the International Robotic Cystectomy Consortium database between 2004 and 2020. Upstaging was defined as ≥pT2 or pN+ at final pathology from clinical <T2N0M0. Descriptive statistics were used to summarize data. Cochran-Armitage test was used to depict upstaging trend over time. Multivariate regression models were used to depict variables associated with upstaging. Kaplan Meier curves were used to describe disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). RESULTS 463 patients underwent RARC for NMIBC. Upstaging occurred in 145 (31%) patients. Upstaged patients were older (70 vs 67 years, p <0.01), more likely to have American Society of Anesthesiologists score (≥3) (55% vs 44%, p=0.04) and had higher rate of preoperative hydronephrosis (26% vs 10%, p <0.01). They were more likely to have positive surgical margins (10% vs 3%, p= 0.01), recurrences (28% vs 9%, p<0.01), and to receive adjuvant/salvage treatment (26% vs none, p <0.01). On multivariate analysis, upstaging was associated with older age (OR 1.04; CI 1.01-1.07, p<0.01), cT1 vs cTis (OR 4.25; CI 1.57-11.48, p <0.01), cT1 vs cTa (OR 2.92; CI 1.40-6.06, p<0.01), and preoperative hydronephrosis (OR 3.18; CI 1.60-6.32, p<0.01). Upstaged patients had worse 5-year RFS (53 % vs 85%, log rank p<0.01), DSS (66% vs 93%, log rank p<0.01), and OS (49% vs 74%, log rank p<0.01). The rate of upstaging did not significantly change over time (38% in 2004 to 27% in 2019, p=0.17). CONCLUSION Upstaging to MIBC occurred in a significant proportion of patients after RARC for NMIBC and was associated with worse survival outcomes. Older patients, those with cT1 disease and hydronephrosis were more likely to upstage.
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Affiliation(s)
- Umar Iqbal
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | - Ahmed S Elsayed
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States.,Cairo University Kasr Alainy Faculty of Medicine, 63527, Cairo, United States;
| | - Zhe Jing
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | - Michael Stoeckle
- Universitat des Saarlandes, 9379, Urologie, Saarbrucken, Germany;
| | | | | | - Abolfazl Hosseini
- Karolinska Institutet, Urology, 171 76 Stockholm, Stockholm, Sweden, 171 76 Stockhol;
| | - Prokar Dasgupta
- King's College London, 4616, MRC Centre for Transplantation, Guy's Hospital, London, United Kingdom of Great Britain and Northern Ireland, SE19RT.,Guy's and St Thomas' NHS Trust, Department of Urology, Guy's Hospital, London, United Kingdom of Great Britain and Northern Ireland, SE19RT;
| | | | - Ashok Hemal
- Wake Foresty University Baptist Medical Center, Urology, Medical Center Blvd, Winston-Salem, North Carolina, United States, 27157.,United States;
| | - Eric H Kim
- Washington University School of Medicine, Urology, 4960 Children's Place, Box 8242, St. Louis, Missouri, United States, 63110;
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center and Harvard Medical School, Urology, 330 Brookline Ave., Boston, Massachusetts, United States, 02215;
| | | | - Koon Ho Rha
- Severance Hospital, Yonsei University, Urology, Yonseiro 50-1, Seodaemun-gu, Seoul, Korea, Seoul, Korea (the Republic of);
| | - Thomas Maatman
- Metro Health: University of Michigan Health, Urological Surgery, Wyoming, Michigan, United States;
| | | | - Qiang Li
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | | | - Khurshid A Guru
- Roswell Park Cancer Insitute, Urologic Oncology, Elm and Carlton Streets, Buffalo, New York, United States, 14263.,Roswell Park Cancer Institute, Urologic Oncology, Elm and Carlton Streets, Buffalo, United States, 14263;
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Pickersgill NA, Raval NS, Kim EH, Black RG, Du K, Figenshau RS. Post-chemotherapy Laparoscopic Retroperitoneal Lymph Node Dissection for Mixed Malignant Germ Cell Testicular Tumors. Clin Genitourin Cancer 2021; 19:273.e1-273.e5. [PMID: 33139148 DOI: 10.1016/j.clgc.2020.09.003] [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] [Received: 06/05/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Retroperitoneal lymph node dissection (RPLND) is performed to treat residual disease following chemotherapy for stage II and III testicular cancer. Significant morbidity can be associated with open RPLND. As such, laparoscopic techniques have been demonstrated to be safe and effective in select cases. Outcomes following post-chemotherapy laparoscopic RPLND for mixed malignant germ cell testicular tumors (MMGCT) are limited in the literature. PATIENTS AND METHODS We performed a retrospective chart review for patients who underwent laparoscopic RPLND at our institution for MMGCT from May 2006 to October 2016. Patient clinical data and perioperative and oncologic outcomes were recorded. RESULTS Twenty-three patients underwent post-chemotherapy laparoscopic RPLND. Thirty-five percent (8/23) underwent bilateral template dissection, whereas 65% (15/23) underwent a modified unilateral template dissection. Robotic assistance was utilized in 22% (5/23) of cases. Bilateral template was inferior to unilateral template RPLND in operative time, estimated blood loss, open conversion rate, length of hospital stay, and complication rate. The mean follow-up was 35.1 months and 43.3 months for the bilateral and unilateral template groups, respectively. The mean lymph node yield and recurrence rate were similar between the 2 cohorts. One recurrence of mature teratoma was noted 67 months after unilateral laparoscopic RPLND. CONCLUSIONS In select patients, laparoscopic RPLND for stage II and III MMGCT is safe and effective in the post-chemotherapy setting. Bilateral template laparoscopic RPLND was associated with inferior perioperative outcomes, but similar oncologic outcomes compared with unilateral template. Patients requiring bilateral template RPLND should be considered for an open approach.
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Affiliation(s)
| | - Neel S Raval
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - River G Black
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Kefu Du
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - R Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
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Wahba BM, Chow AK, Du K, Sands KG, Paradis AG, Vetter JM, Venkatesh R, Kim EH, Bhayani SB, Figenshau RS. Positive Surgical Margins After Robot-Assisted Partial Nephrectomy Predict Long-Term Oncologic Outcomes for Clinically Localized Renal Masses. J Endourol 2021; 35:814-820. [PMID: 33267669 PMCID: PMC8252897 DOI: 10.1089/end.2020.0707] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: For patients with clinically localized renal masses, positive surgical margins (PSMs) after robotic partial nephrectomy (RPN) have been associated with a higher risk of disease recurrence, although some studies have challenged this conclusion. Owing to inconsistent reports and a lack of long-term robotic data, the clinical impact of PSM after RPN remains uncertain. We evaluate long-term (>6 years) survival outcomes after RPN in patients with clinically localized disease with respect to surgical margin status. Methods: We conducted a retrospective review of patients who underwent RPN for clinically localized renal masses from June 2007 to December 2012 at Washington University School of Medicine. Disease recurrence and overall survival (OS) were stratified on the presence or absence of PSM. The cohort was analyzed to identify patient- and tumor-specific characteristics associated with PSM. Results: We identified 374 RPNs performed from 2007 to 2012 with a mean follow-up time of 77.7 months (SD 32.2 months). PSM was identified in 12 (3.2%) patients. Patients with PSM were at 14-fold increased risk for recurrence with no difference in OS (p < 0.001, p = 0.130, respectively). Patients with PSM had higher incidence of chronic obstructive pulmonary disease (COPD) (25% vs 6.4%) and greater blood loss (425 mL vs 203 mL). Conclusion: With an extended follow-up period of 77 months after RPN, we found that PSM substantially increased the risk of recurrence without impacting OS. Our finding that PSM may occur more frequently in older patients with COPD must be confirmed in larger studies.
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Affiliation(s)
- B. Malik Wahba
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alexander K. Chow
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kefu Du
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kenneth G. Sands
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alethea G. Paradis
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joel M. Vetter
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Eric H. Kim
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sam B. Bhayani
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Chen K, Chauhan PS, Babbra RK, Feng W, Pejovic N, Nallicheri A, Harris PK, Dienstbach K, Atkocius A, Maguire L, Qaium F, Szymanski JJ, Baumann BC, Ding L, Cao D, Reimers MA, Kim EH, Smith ZL, Arora VK, Chaudhuri AA. Tracking minimal residual disease with urine tumor DNA in muscle-invasive bladder cancer after neoadjuvant chemotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16514] [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
e16514 Background: Standard-of-care for muscle-invasive bladder cancer (MIBC) consists of neoadjuvant chemotherapy (NAC) followed by radical cystectomy. The inability to noninvasively assess minimal residual disease (MRD) after NAC limits our ability to offer bladder-sparing treatment. We perform urine tumor DNA (utDNA) analysis to identify pathologic complete response (pCR) at the time of cystectomy in patients receiving NAC. Methods: We applied CAPP-Seq to urine cell-free DNA samples acquired on the day of radical cystectomy from 19 MIBC patients treated with NAC. utDNA variant-calling was performed without prior tumor mutational knowledge using a panel of 49 consensus driver genes mutated in MIBC. The utDNA level for each patient was represented by the duplex-supported non-silent driver mutation with the highest variant allele fraction (vAF) after removing germline variants. We also serially tracked utDNA variants in two patients before, during, and after NAC. Results: Comparing patients with residual disease detected in their cystectomy specimen ( n = 10) to those who achieved a pCR ( n = 9), median utDNA levels were 2.4% vs. 0%, respectively ( P = 0.006). Using an optimal utDNA threshold to define MRD detection, positive utDNA MRD was highly correlated with the absence of pCR ( P = 0.003). Analysis of two patients’ serial urine samples revealed utDNA dynamics that were consistent with treatment responses in real-time. In one patient who ultimately achieved a pCR, four non-silent driver mutations were detectable pre-NAC, including ERCC2 N238S (7.8% vAF) associated with increased chemosensitivity. One week after starting NAC, ERCC2 N238S increased by 1.6-fold in urine, as did PIK3CA E726K which increased by 8.4-fold. Four weeks post-NAC, however, all mutations previously detected in this patient’s urine became undetectable, consistent with the patient’s pCR and long-term disease-free survival. Conversely, another patient harbored two non-silent driver mutations in PLEKHS1 (1.9% vAF) and KMT2D (4.9% vAF) pre-NAC. One week after starting NAC, both mutations decreased dramatically by 8.0- and 4.3-fold, respectively. By three weeks post-NAC, however, these mutations progressively increased by 5.2-fold on average, which correlated with a lack of pCR as well as post-treatment disease progression. Two newly detected non-silent driver mutations in ARID1A and ERBB2 also emerged on NAC and persisted following completion of chemotherapy , likely reflecting the development of treatment resistance. Conclusions: utDNA MRD after NAC but before radical cystectomy for MIBC correlated significantly with pathologic response, which could help personalize patient selection for bladder-sparing treatments in the future. Serial monitoring of utDNA variants during NAC can reveal dynamic mutational changes that reflect real-time treatment responses as well as ultimate disease-free survival.
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Affiliation(s)
- Kevin Chen
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Pradeep S Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Ramandeep K Babbra
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Wenjia Feng
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Nadja Pejovic
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Armaan Nallicheri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Peter K Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Katherine Dienstbach
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Andrew Atkocius
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Lenon Maguire
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Faridi Qaium
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey J Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Brian C Baumann
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Li Ding
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Melissa Andrea Reimers
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Zachary L Smith
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Vivek K Arora
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Aadel A Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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Chow AK, Wahba BM, Phillips T, Sands KG, Vetter J, Venkatesh R, Kim EH, Bhayani SB, Figenshau RS. Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center. J Endourol 2021; 35:1639-1643. [PMID: 33820472 DOI: 10.1089/end.2020.0726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Herein we evaluate the incidence of incisional lumbodorsal hernia (ILDH) after retroperitoneal robotic partial nephrectomy (RRPN) and associated patient-specific and tumor-specific risk factors. Furthermore, we aim to evaluate the role of routine lumbodorsal fascial closure for the prevention of ILDH. Methodology: This is a retrospective review of our robotic partial nephrectomy database of all RRPNs performed at Washington University School of Medicine from 2000 to 2020. Postoperative imaging was reviewed for evidence of ILDH. A clinically significant hernia was defined as the protrusion of visceral organ(s) through the lumbodorsal fascia. Patient and tumor characteristics, and fascial closure techniques were analyzed to determine predictors of ILDH. Results: In total, 150 patients underwent RRPN between 2007 and 2020 with an average follow-up of 4.9 (1-37) months. Twelve (8%) ILDHs were identified. Ten (6.7%) patients had herniated retroperitoneal fat whereas 2 (1.3%) patients had herniated colon. All were asymptomatic and managed conservatively. On matched cohort comparison, patients with ILDH had larger tumors than patients without an incisional hernia (3.9 cm vs 2.8 cm, p = 0.029). In general, patient factors were no different between patients with and without ILDH. However, coronary artery disease (CAD) was more prevalent in patients with ILDH (33.3% vs 10.9%, p = 0.028). Patients with ILDH were more likely to have a port site extended for specimen extraction (66.7% vs 38.2%, p = 0.069). Lumbodorsal fascial closure and type of suture material were not associated with prevention of ILDH (p = 0.545, p = 0.637). Conclusion: The radiographic incidence of lumbar incisional hernias after RRPN without routine fascial closure of the extraction incision was 8%. All were asymptomatic and did not require surgical repair. Larger tumor size and CAD were associated with ILDH.
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Affiliation(s)
- Alexander K Chow
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brandon Malik Wahba
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tarik Phillips
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kenneth G Sands
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel Vetter
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert S Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Yang L, Lee JA, Heer E, Pernar C, Colditz GA, Pakpahan R, Imm KR, Kim EH, Grubb RL, Wolin KY, Kibel AS, Sutcliffe S. One-year urinary and sexual outcome trajectories among prostate cancer patients treated by radical prostatectomy: a prospective study. BMC Urol 2021; 21:81. [PMID: 34001094 PMCID: PMC8130427 DOI: 10.1186/s12894-021-00845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To examine one-year trajectories of urinary and sexual outcomes, and correlates of these trajectories, among prostate cancer patients treated by radical prostatectomy (RP). METHODS Study participants were recruited from 2011 to 2014 at two US institutions. Self-reported urinary and sexual outcomes were measured at baseline before surgery, and 5 weeks, 6 months and 12 months after surgery, using the modified Expanded Prostate Cancer Index Composite-50 (EPIC-50). Changes in EPIC-50 scores from baseline were categorized as improved (beyond baseline), maintained, or impaired (below baseline), using previously-reported minimum clinically important differences. RESULTS Of the 426 eligible participants who completed the baseline survey, 395 provided data on at least one EPIC-50 sub-scale at 5 weeks and 12 months, and were analyzed. Although all mean EPIC-50 scores declined markedly 5 weeks after surgery and then recovered to near (incontinence-related outcomes) or below (sexual outcomes) baseline levels by 12 months post-surgery, some men experienced improvement beyond their baseline levels on each sub-scale (3.3-51% depending on the sub-scale). Having benign prostatic hyperplasia (BPH) at baseline (prostate size ≥ 40 g; an International Prostate Symptom Index Score ≥ 8; or using BPH medications) was associated with post-surgical improvements in voiding dysfunction-related bother at 5 weeks (OR = 3.9, 95% CI: 2.1-7.2) and 12 months (OR = 3.3, 95% CI: 2.0-5.7); and in sexual bother at 5 weeks (OR = 5.7, 95% CI:1.7-19.3) and 12 months (OR = 3.0, 95% CI: 1.2-7.1). CONCLUSIONS Our findings provide additional support for considering baseline BPH symptoms when selecting the best therapy for early-stage prostate cancer.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, 5th Floor, Holy Cross Centre, Box ACB, 2210 - 2 St. SW, Calgary, AB T2S 3C3 Canada
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., 2nd floor, Rm. 208S, Campus Box 8100, St. Louis, MO 63110 USA
| | - Jung Ae Lee
- Agricultural Statistics Laboratory, University of Arkansas, Fayetteville, USA
| | - Emily Heer
- Department of Cancer Epidemiology and Prevention Research, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, 5th Floor, Holy Cross Centre, Box ACB, 2210 - 2 St. SW, Calgary, AB T2S 3C3 Canada
| | - Claire Pernar
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., 2nd floor, Rm. 208S, Campus Box 8100, St. Louis, MO 63110 USA
| | - Ratna Pakpahan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., 2nd floor, Rm. 208S, Campus Box 8100, St. Louis, MO 63110 USA
| | - Kellie R. Imm
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., 2nd floor, Rm. 208S, Campus Box 8100, St. Louis, MO 63110 USA
- Division of Health Behavior Research, Department of Preventive Medicine, Keck School of Medicine of the
University of Southern California, 2001 N Soto St., Los Angeles, CA 90032 USA
| | - Eric H. Kim
- Department of Cancer Epidemiology and Prevention Research, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, 5th Floor, Holy Cross Centre, Box ACB, 2210 - 2 St. SW, Calgary, AB T2S 3C3 Canada
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., 2nd floor, Rm. 208S, Campus Box 8100, St. Louis, MO 63110 USA
- Agricultural Statistics Laboratory, University of Arkansas, Fayetteville, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Division of Urological Surgery, Department of Surgery, Washington University School of Medicine, St Louis, USA
- Department of Urology, Medical University of South Carolina, Charleston, USA
- Coeus Health, Chicago, IL USA
- Division of Urology, Department of Surgery, Brigham and Women’s Hospital, Boston, USA
- Division of Health Behavior Research, Department of Preventive Medicine, Keck School of Medicine of the
University of Southern California, 2001 N Soto St., Los Angeles, CA 90032 USA
| | - Robert L. Grubb
- Division of Urological Surgery, Department of Surgery, Washington University School of Medicine, St Louis, USA
- Department of Urology, Medical University of South Carolina, Charleston, USA
| | | | - Adam S. Kibel
- Division of Urology, Department of Surgery, Brigham and Women’s Hospital, Boston, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., 2nd floor, Rm. 208S, Campus Box 8100, St. Louis, MO 63110 USA
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Gross JT, Vetter JM, Sands KG, Palka JK, Bhayani SB, Figenshau RS, Kim EH. Initial Experience with Single-Port Robot-Assisted Radical Cystectomy: Comparison of Perioperative Outcomes Between Single-Port and Conventional Multiport Approaches. J Endourol 2021; 35:1177-1183. [PMID: 33677991 DOI: 10.1089/end.2020.1227] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The surgical techniques and devices used to perform radical cystectomy have evolved significantly with the advent of laparoscopic and robotic methods. The da Vinci® Single-Port (SP) platform (Intuitive Surgical, Inc., Sunnyvale, CA) is an innovation that allows a surgeon to perform robot-assisted radical cystectomy (RARC) through a single incision. To determine if this new tool is comparable to its multiport (MP) predecessors, we reviewed a single-surgeon experience of SP RARC. Materials and Methods: We identified patients at our institution who underwent RARC between August 2017 and June 2020 by one surgeon at our institution (n = 64). Using propensity scoring analysis, patients whose procedure were performed with the SP platform (n = 12) were matched 1:2 to patients whose procedure was performed with the MP platform (n = 24). Univariable analysis was performed to identify differences in any perioperative outcome, including operative time, estimated blood loss (EBL), lymph node yield, 90-day complication/readmission rates, and positive surgical margin (PSM) rates. Results: Patients who had an SP RARC on average had a lower lymph node yield than those who had an MP RARC (11.9 vs 17.1, p = 0.0347). All other perioperative outcomes, including operative time, EBL, 90-day complication rates, 90-day readmission rates, and PSM rates, were not significantly different between the SP and MP RARC groups. Conclusions: Based on their perioperative outcomes, the SP platform is a feasible alternative to the MP platform when performing RARC. The SP's perioperative outcomes should continue to be evaluated as more SP RARCs are performed.
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Affiliation(s)
- James T Gross
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Joel M Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kenneth G Sands
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Joshua K Palka
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sam B Bhayani
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert S Figenshau
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Eric H Kim
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Pachynski RK, Kim EH, Miheecheva N, Kotlov N, Ramachandran A, Postovalova E, Galkin I, Svekolkin V, Lyu Y, Zou Q, Cao D, Gaut J, Ippolito JE, Bagaev A, Bruttan M, Gancharova O, Nomie K, Tsiper M, Andriole GL, Ataullakhanov R, Hsieh JJ. Single-cell Spatial Proteomic Revelations on the Multiparametric MRI Heterogeneity of Clinically Significant Prostate Cancer. Clin Cancer Res 2021; 27:3478-3490. [PMID: 33771855 DOI: 10.1158/1078-0432.ccr-20-4217] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/29/2020] [Revised: 01/08/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Multiparametric MRI (mpMRI) has become an indispensable radiographic tool in diagnosing prostate cancer. However, mpMRI fails to visualize approximately 15% of clinically significant prostate cancer (csPCa). The molecular, cellular, and spatial underpinnings of such radiographic heterogeneity in csPCa are unclear. EXPERIMENTAL DESIGN We examined tumor tissues from clinically matched patients with mpMRI-invisible and mpMRI-visible csPCa who underwent radical prostatectomy. Multiplex immunofluorescence single-cell spatial imaging and gene expression profiling were performed. Artificial intelligence-based analytic algorithms were developed to examine the tumor ecosystem and integrate with corresponding transcriptomics. RESULTS More complex and compact epithelial tumor architectures were found in mpMRI-visible than in mpMRI-invisible prostate cancer tumors. In contrast, similar stromal patterns were detected between mpMRI-invisible prostate cancer and normal prostate tissues. Furthermore, quantification of immune cell composition and tumor-immune interactions demonstrated a lack of immune cell infiltration in the malignant but not in the adjacent nonmalignant tissue compartments, irrespective of mpMRI visibility. No significant difference in immune profiles was detected between mpMRI-visible and mpMRI-invisible prostate cancer within our patient cohort, whereas expression profiling identified a 24-gene stromal signature enriched in mpMRI-invisible prostate cancer. Prostate cancer with strong stromal signature exhibited a favorable survival outcome within The Cancer Genome Atlas prostate cancer cohort. Notably, five recurrences in the 8 mpMRI-visible patients with csPCa and no recurrence in the 8 clinically matched patients with mpMRI-invisible csPCa occurred during the 5-year follow-up post-prostatectomy. CONCLUSIONS Our study identified distinct molecular, cellular, and structural characteristics associated with mpMRI-visible csPCa, whereas mpMRI-invisible tumors were similar to normal prostate tissue, likely contributing to mpMRI invisibility.
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Affiliation(s)
- Russell K Pachynski
- Molecular Oncology, Division of Oncology, Department of Medicine, Washington University, St Louis, Missouri
| | - Eric H Kim
- Division of Urological Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | | | | | - Akshaya Ramachandran
- Molecular Oncology, Division of Oncology, Department of Medicine, Washington University, St Louis, Missouri
| | | | - Ilia Galkin
- BostonGene Corporation, Waltham, Massachusetts
| | | | - Yang Lyu
- Molecular Oncology, Division of Oncology, Department of Medicine, Washington University, St Louis, Missouri
| | - Qiong Zou
- Department of Pathology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri
| | - Joseph Gaut
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri
| | | | | | | | | | | | | | - Gerald L Andriole
- Division of Urological Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | | | - James J Hsieh
- Molecular Oncology, Division of Oncology, Department of Medicine, Washington University, St Louis, Missouri.
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Chow AK, Wong R, Monda S, Bhatt R, Sands KG, Vetter J, Badhiwala N, DeClue A, Kim EH, Sivaraman A, Venkatesh R, Figenshau RS, Du K. Ex Vivo Porcine Model for Robot-Assisted Partial Nephrectomy Simulation at a High-Volume Tertiary Center: Resident Perception and Validation Assessment Using the Global Evaluative Assessment of Robotic Skills Tool. J Endourol 2021; 35:878-884. [PMID: 33261512 DOI: 10.1089/end.2020.0590] [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] [Indexed: 12/13/2022] Open
Abstract
Introduction: With increased demands on surgeon productivity and outcomes, residency robotics training increasingly relies on simulations. The objective of this study is to assess the validity and effectiveness of an ex vivo porcine training model as a useful tool to improve surgical skill and confidence with robot-assisted partial nephrectomy (RAPN) among urology residents. Methods: A 2.5 cm circular area of ex vivo porcine kidneys was marked as the area of the tumor. Tumor excision and renorrhaphy was performed by trainees using a da Vinci Si robot. All residents ranging from postgraduate year (PGY) 2 to 5 participated in four training sessions during the 2017 to 2018 academic year. Each session was videorecorded and scored using the global evaluative assessment of robotic skills (GEARS) by faculty members. Results: Twelve residents completed the program. Initial mean GEARS score was 16.7 and improved by +1.4 with each subsequent session (p = 0.008). Initial mean excision, renorrhaphy, and total times were 8.2, 13.9, and 22.1 minutes, which improved by 1.6, 2.0, and 3.6 minutes, respectively (all p < 0.001). Residents' confidence at performing RAPN and robotic surgery increased after completing the courses (p = 0.012 and p < 0.001, respectively). Overall, residents rated that this program has greatly contributed to their skill (4/5) and confidence (4.1/5) in robotic surgery. Conclusions: An ex vivo porcine simulation model for RAPN and robotic surgery provides measurable improvement in GEARS score and reduction in procedural time, although significant differences for all PGY levels need to be confirmed with larger study participation. Adoption of this simulation in a urology residency curriculum may improve residents' skill and confidence in robotic surgery.
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Affiliation(s)
- Alexander K Chow
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan Wong
- Department of Surgery, St. Louis University School of Medicine, St. Louis, Missouri, USA
| | - Steven Monda
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rohit Bhatt
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kenneth G Sands
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel Vetter
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Niraj Badhiwala
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angelia DeClue
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric H Kim
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arjun Sivaraman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kefu Du
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Henning GM, Kim EH. Predicting prostate cancer-specific mortality using SEER. Lancet Digit Health 2021; 3:e138-e139. [PMID: 33549514 DOI: 10.1016/s2589-7500(21)00020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Grant M Henning
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Eric H Kim
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
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Henning GM, Vetter JM, Sterling JA, Andriole GL, Kim IY, Kim EH. Factors associated with higher prostate biopsy yield: when is software-assisted fusion MRI-targeting necessary? Urol Oncol 2020; 39:234.e15-234.e19. [PMID: 33353869 DOI: 10.1016/j.urolonc.2020.11.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/10/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the addition of software-assisted fusion magnetic resonance imaging (MRI) targeted biopsy to systematic biopsy and determine clinical and imaging factors associated with improved prostate cancer (PCa) detection. METHODS We analyzed 454 patients who had prostate MRI and underwent combined systematic and software-assisted fusion MRI-targeted biopsy at 2 academic centers between July 2015 and December 2017. For our analysis, we compared the Gleason grade group of cores obtained systematically to cores obtained using MRI-targeting. Using multivariable analysis, we examined clinical and imaging factors associated with higher grade group disease in MRI-targeted cores. RESULTS Software assisted fusion MRI-targeted biopsy detected higher grade group disease in 18.3% of patients. Factors associated with higher grade group disease in MRI-targeted cores included anterior MRI lesion location (odds ratio [OR] 3.15, P< 0.01) and multiple lesions on MRI (OR 2.47, P = 0.01). Increasing prostate volume per cubic centimeter was noted to be negatively associated (OR 0.98, P = 0.02). Notably, factors not found to be associated with improved detection included PIRADS classification 5 compared to 3 (OR 2.47, P = 0.08), PIRADS classification 4 compared to 3 (OR 1.37, P = 0.50), previous negative biopsy (OR 1.48, P = 0.29), inclusion on an active surveillance protocol (OR 1.36, P = 0.48), transitional zone lesion location (OR 0.72, P = 0.45), and institution at which biopsy was performed (OR 1.81, P = 0.16). CONCLUSION Adding software-assisted fusion MRI-targeting to systematic prostate biopsy offers benefit for men with an anterior and multiple MRI lesions. In absence of these factors, systematic biopsy alone or with cognitive fusion may be considered.
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Affiliation(s)
| | - Joel M Vetter
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Isaac Y Kim
- Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric H Kim
- Washington University School of Medicine, St. Louis, MO
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Kim EH, Siegel BA, Teoh EJ, Andriole GL. Prostate cancer recurrence in patients with negative or equivocal conventional imaging: A role for 18F-fluciclovine-PET/CT in delineating sites of recurrence and identifying patients with oligometastatic disease. Urol Oncol 2020; 39:365.e9-365.e16. [PMID: 33160848 DOI: 10.1016/j.urolonc.2020.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite improvements in overall survival, biochemical recurrence of prostate cancer, characterized by rising prostate-specific antigen (PSA) levels after curative intent primary therapy, remains common. With the advent of highly sensitive molecular imaging, men with limited metastatic disease burden, or oligometastatic prostate cancer, are increasingly being identified. The LOCATE trial (NCT02680041) assessed the impact of positron emission tomography (PET) with 18F-fluciclovine on management of men with prostate cancer recurrence after curative intent primary therapy and negative/equivocal conventional imaging. Here, we use LOCATE data to characterize the sites of disease recurrence and explore the potential for 18F-fluciclovine-PET/CT to evaluate oligometastatic disease. METHODS Eligible men (≥18 years; prior curative intent treatment of prostate cancer; recurrence based on rising PSA; negative/equivocal conventional imaging) underwent 18F-fluciclovine-PET/CT according to standard protocols. The primary outcome measure of the LOCATE trial was a revised management plan post-scan. We performed a secondary analysis of the LOCATE imaging data to characterize anatomical sites of disease recurrence and to explore the potential for 18F-fluciclovine-PET/CT to evaluate oligometastatic disease. Imaging results were stratified by baseline PSA levels and prior treatment(s) and the Fisher exact test used to analyze differences between groups. Oligometastatic disease was defined as 1-5 extraprostatic lesions (≤3 lesions in any single organ system) plus negative prostate/bed imaging (as a surrogate for primary tumor control). RESULTS Of 213 enrolled patients, 164 (77%) had undergone prostatectomy as their initial treatment; their median PSA was 0.57ng/ml. For the 49 patients with an intact prostate, the median PSA was 5.5ng/ml. The overall 18F-fluciclovine-PET/CT detection rate was 57%. Detection rates were 84% in men with intact prostates and 49% in those who had undergone prostatectomy, with the difference being attributable to prostate/bed findings (71% vs. 18%, respectively). The detection rate in lymph nodes was 29% and in bone was 11%. In total, 53/213 (25%) had oligometastatic disease. Twenty (38%) oligometastatic patients had PSA ≤1.0 ng/ml. Forty-two (79%) experienced a change to their management plan following the scan, commonly to target a lesion identified by 18F-fluciclovine-PET/CT. The majority of management changes (74%) involved a new treatment modality; however, 10 patients (24%) experienced a modification of the existing plan for radiotherapy to incorporate a boost to an area guided by the 18F-fluciclovine-PET/CT results. CONCLUSION Even at low PSA levels, 18F-fluciclovine-PET/CT identified a diverse pattern of recurrence missed with conventional imaging. One-quarter of men had oligometastatic disease, raising the potential for 18F-fluciclovine-PET/CT to guide targeted treatment of oligometastases.
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Affiliation(s)
- Eric H Kim
- Division of Urologic Surgery, Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO,.
| | - Barry A Siegel
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Eugene J Teoh
- Blue Earth Diagnostics Ltd, the Oxford Science Park, Robert Robinson Avenue, Oxford OX4 4GA, UK
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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Zhao K, Kim EH, Vetter JM, Hsieh JJ, Venkatesh R, Bhayani SB, Figenshau RS. Laparoscopic cytoreductive nephrectomy is associated with significantly improved survival compared with open cytoreductive nephrectomy or targeted therapy alone. Mol Clin Oncol 2020; 13:71. [PMID: 33005405 DOI: 10.3892/mco.2020.2141] [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: 10/27/2019] [Accepted: 07/29/2020] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to compare the survival outcomes for patients with metastatic renal cell carcinoma (mRCC) who underwent laparoscopic cytoreductive nephrectomy (CN) vs. open CN vs. targeted therapy (TT) alone at our institution. A retrospective chart review was performed at our institution for patients who underwent CN prior to TT (laparoscopic, n=48; open, n=48) or who were deemed unfit for surgery and received TT alone (n=36), between January 2007 and December 2012. Kaplan-Meier estimated survival and Cox proportional hazards analyses were performed. Laparoscopic CN was associated with significantly longer survival compared with open CN or TT alone (median survival 24 vs. <12 months, respectively; P<0.01). On multivariate analysis, laparoscopic CN was an independent predictor of survival [hazard ratio (HR)=0.48, P<0.01), controlling for preoperative risk factors, while survival was similar between open CN and TT alone (HR=0.85, P=0.54). In our experience, laparoscopic CN appears to be a significant predictor of survival in mRCC. Selection bias of the surgeon for patients with improved survival may account for clinical variables that were otherwise difficult to quantify. For patients who were not candidates for laparoscopic CN, open CN did not confer a survival benefit over TT alone, while it was associated with increased morbidity.
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Affiliation(s)
- Kaidong Zhao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joel M Vetter
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - James J Hsieh
- Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ramakrishna Venkatesh
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sam B Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - R Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Kim EH, Cao D, Mahajan NP, Andriole GL, Mahajan K. ACK1-AR and AR-HOXB13 signaling axes: epigenetic regulation of lethal prostate cancers. NAR Cancer 2020; 2:zcaa018. [PMID: 32885168 PMCID: PMC7454006 DOI: 10.1093/narcan/zcaa018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/22/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022] Open
Abstract
The androgen receptor (AR) is a critical transcription factor in prostate cancer (PC) pathogenesis. Its activity in malignant cells is dependent on interactions with a diverse set of co-regulators. These interactions fluctuate depending on androgen availability. For example, the androgen depletion increases the dependence of castration-resistant PCs (CRPCs) on the ACK1 and HOXB13 cell survival pathways. Activated ACK1, an oncogenic tyrosine kinase, phosphorylates cytosolic and nuclear proteins, thereby avoiding the inhibitory growth consequences of androgen depletion. Notably, ACK1-mediated phosphorylation of histone H4, which leads to epigenetic upregulation of AR expression, has emerged as a critical mechanism of CRPC resistance to anti-androgens. This resistance can be targeted using the ACK1-selective small-molecule kinase inhibitor (R)- 9b. CRPCs also deploy the bromodomain and extra-terminal domain protein BRD4 to epigenetically increase HOXB13 gene expression, which in turn activates the MYC target genes AURKA/AURKB. HOXB13 also facilitates ligand-independent recruitment of the AR splice variant AR-V7 to chromatin, compensating for the loss of the chromatin remodeling protein, CHD1, and restricting expression of the mitosis control gene HSPB8. These studies highlight the crosstalk between AR-ACK1 and AR-HOXB13 pathways as key mediators of CRPC recurrence.
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Affiliation(s)
- Eric H Kim
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Dengfeng Cao
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Nupam P Mahajan
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Gerald L Andriole
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kiran Mahajan
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA
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Lee JS, Kim EH, Lee SH. Endoscopically assisted malarplasty: L-rotation technique. J Stomatol Oral Maxillofac Surg 2020; 122:229-234. [PMID: 32810601 DOI: 10.1016/j.jormas.2020.07.011] [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] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/21/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Endoscopically assisted malarplasty with a greenstick fracture is a method for preserving the body eminence and improving arch protrusion. However, this technique is inadequate when malar body reduction is required. To compensate for these limitations, we developed a new surgical technique using the endoscope to reduce body protrusion. MATERIAL AND METHODS We enrolled 261 patients who visited our clinic for zygoma reduction from January 2017 to December 2018. Their mean age was 31 (range 17-63) years. After a scalp incision, an incomplete osteotomy was created from the most prominent portion of the zygoma body to the zygomaticomaxillary suture line. A complete osteotomy was performed on the arch. These osteotomies resulted in an L-shaped zygoma segment after tapping the bone with a mallet. RESULTS Of the 261 patients who underwent our L-rotation technique, 242 also received a corticotomy. Of those patients, 15 underwent a different degree of zygoma reduction on both sides. A floating zygomatic segment occurred in four cases, although no further surgery was required. One patient's zygomatic segment dropped on one side, requiring rigid fixation through the intraoral approach. Most patients were satisfied and there were no specific complications. CONCLUSIONS Endoscopically assisted malarplasty using an L-rotation technique enables the protrusion of both the arch and body to be reduced. The zygoma reduction can be modified based on the location of the incomplete osteotomoy line and the number of corticotomies required.
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Affiliation(s)
- J S Lee
- Youtiful Vom Aesthetic Plastic Clinic, 326 Dosan-daero, Gangnam-gu, Seoul, Republic of Korea
| | - E H Kim
- Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Goyang-si, Gyeonggi-do, Republic of Korea
| | - S H Lee
- Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Goyang-si, Gyeonggi-do, Republic of Korea.
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Fischer-Valuck BW, Michalski JM, Harton JG, Birtle A, Christodouleas JP, Efstathiou JA, Arora VK, Kim EH, Knoche EM, Pachynski RK, Picus J, Rao YJ, Reimers M, Roth BJ, Sargos P, Smith ZL, Zaghloul MS, Gay HA, Patel SA, Baumann BC. Management of Muscle-Invasive Bladder Cancer During a Pandemic: Impact of Treatment Delay on Survival Outcomes for Patients Treated With Definitive Concurrent Chemoradiotherapy. Clin Genitourin Cancer 2020; 19:41-46.e1. [PMID: 33187904 PMCID: PMC7306737 DOI: 10.1016/j.clgc.2020.06.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/10/2023]
Abstract
Introduction During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making to ensure that the benefit of early intervention for muscle-invasive bladder cancer exceeds the risk of contracting COVID-19 in the clinical setting. It is unknown whether treatment delays for patients eligible for curative chemoradiation (CRT) compromise long-term outcomes. Patients and Methods We used the National Cancer Data Base to investigate whether there is an association between a ≥ 90-day delay from transurethral resection of bladder tumor (TURBT) in initiating CRT and overall survival. We included patients with cT2-4N0M0 muscle-invasive bladder cancer from 2004 to 2015 who underwent TURBT and curative-intent concurrent CRT. Patients were grouped on the basis of timing of CRT: ≤ 89 days after TURBT (earlier) vs. ≥ 90 and < 180 days after TURBT (delayed). Results A total of 1387 (87.5%) received earlier CRT (median, 45 days after TURBT; interquartile range, 34-59 days), and 197 (12.5%) received delayed CRT (median, 111 days after TURBT; interquartile range, 98-130 days). Median overall survival was 29.0 months (95% CI, 26.0-32.0) versus 27.0 months (95% CI, 19.75-34.24) for earlier and delayed CRT (P = .94). On multivariable analysis, delayed CRT was not associated with an overall survival difference (hazard ratio, 1.05; 95% CI, 0.87-1.27; P = .60). Conclusion Although these results are limited and require validation, short, strategic treatment delays during a pandemic can be considered on the basis of clinician judgment.
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Affiliation(s)
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Joanna G Harton
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Alison Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; University of Manchester, Manchester, UK
| | - John P Christodouleas
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Vivek K Arora
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Eric H Kim
- Division of Urology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Eric M Knoche
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Russell K Pachynski
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Joel Picus
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Yuan James Rao
- Department of Radiation Oncology, George Washington University, Washington D.C
| | - Melissa Reimers
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Bruce J Roth
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Paul Sargos
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada; Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Zachary L Smith
- Division of Urology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Mohamed S Zaghloul
- Radiation Oncology Department, Children's Cancer Hospital, Cairo, Egypt; Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Sagar A Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Pickersgill NA, Vetter JM, Kim EH, Cope SJ, Du K, Venkatesh R, Giardina JD, Saad NES, Bhayani SB, Figenshau RS. Ten-Year Experience with Percutaneous Cryoablation of Renal Tumors: Tumor Size Predicts Disease Progression. J Endourol 2020; 34:1211-1217. [PMID: 32292059 DOI: 10.1089/end.2019.0882] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/20/2023] Open
Abstract
Introduction: Percutaneous cryoablation (PCA) has emerged as an alternative to extirpative management of small renal masses (SRMs) in select patients, with a reduced risk of perioperative complications. Although disease recurrence is thought to occur in the early postoperative period, limited data on long-term oncologic outcomes have been published. We reviewed our 10-year experience with PCA for SRMs and assessed predictors of disease progression. Materials and Methods: We reviewed our prospectively maintained database of patients who underwent renal PCA from March 2005 to December 2015 (n = 308). Baseline patient and tumor variables were recorded, and postoperative cross-sectional imaging was examined for evidence of disease recurrence. Disease progression was defined as the presence of local recurrence or new lymphadenopathy/metastasis. Results: Mean patient age was 67.2 ± 11 years, mean tumor size was 2.7 ± 1.3 cm, and mean nephrometry score was 6.8 ± 1.7. At mean follow-up of 38 months, local recurrence and new lymphadenopathy/metastasis occurred in 10.1% (31/308) and 6.2% (19/308) of patients, respectively. Excluding patients with a solitary kidney and/or von Hippel-Lindau, local recurrence and new lymphadenopathy/metastasis occurred in 8.6% (23/268) and 1.9% (5/268) of cases, respectively. Kaplan-Meier estimated disease-free survival was 92.5% at 1 year, 89.3% at 2 years, and 86.7% at 3 years post-PCA. Increasing tumor size was a significant predictor of disease progression (hazard ratio 1.32 per 1-cm increase in size, p = 0.001). Conclusions: PCA is a viable treatment option for patients with SRMs. Increasing tumor size is a significant predictor of disease progression following PCA.
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Affiliation(s)
- Nicholas A Pickersgill
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel M Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric H Kim
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sky J Cope
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Kefu Du
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph Daniel Giardina
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nael E S Saad
- Division of Interventional Radiology, Department of Radiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sam B Bhayani
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert S Figenshau
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Salganik MJ, Lundberg I, Kindel AT, Ahearn CE, Al-Ghoneim K, Almaatouq A, Altschul DM, Brand JE, Carnegie NB, Compton RJ, Datta D, Davidson T, Filippova A, Gilroy C, Goode BJ, Jahani E, Kashyap R, Kirchner A, McKay S, Morgan AC, Pentland A, Polimis K, Raes L, Rigobon DE, Roberts CV, Stanescu DM, Suhara Y, Usmani A, Wang EH, Adem M, Alhajri A, AlShebli B, Amin R, Amos RB, Argyle LP, Baer-Bositis L, Büchi M, Chung BR, Eggert W, Faletto G, Fan Z, Freese J, Gadgil T, Gagné J, Gao Y, Halpern-Manners A, Hashim SP, Hausen S, He G, Higuera K, Hogan B, Horwitz IM, Hummel LM, Jain N, Jin K, Jurgens D, Kaminski P, Karapetyan A, Kim EH, Leizman B, Liu N, Möser M, Mack AE, Mahajan M, Mandell N, Marahrens H, Mercado-Garcia D, Mocz V, Mueller-Gastell K, Musse A, Niu Q, Nowak W, Omidvar H, Or A, Ouyang K, Pinto KM, Porter E, Porter KE, Qian C, Rauf T, Sargsyan A, Schaffner T, Schnabel L, Schonfeld B, Sender B, Tang JD, Tsurkov E, van Loon A, Varol O, Wang X, Wang Z, Wang J, Wang F, Weissman S, Whitaker K, Wolters MK, Woon WL, Wu J, Wu C, Yang K, Yin J, Zhao B, Zhu C, Brooks-Gunn J, Engelhardt BE, Hardt M, Knox D, Levy K, Narayanan A, Stewart BM, Watts DJ, McLanahan S. Measuring the predictability of life outcomes with a scientific mass collaboration. Proc Natl Acad Sci U S A 2020; 117:8398-8403. [PMID: 32229555 PMCID: PMC7165437 DOI: 10.1073/pnas.1915006117] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
How predictable are life trajectories? We investigated this question with a scientific mass collaboration using the common task method; 160 teams built predictive models for six life outcomes using data from the Fragile Families and Child Wellbeing Study, a high-quality birth cohort study. Despite using a rich dataset and applying machine-learning methods optimized for prediction, the best predictions were not very accurate and were only slightly better than those from a simple benchmark model. Within each outcome, prediction error was strongly associated with the family being predicted and weakly associated with the technique used to generate the prediction. Overall, these results suggest practical limits to the predictability of life outcomes in some settings and illustrate the value of mass collaborations in the social sciences.
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Affiliation(s)
| | - Ian Lundberg
- Department of Sociology, Princeton University, Princeton, NJ 08544
| | | | - Caitlin E Ahearn
- Department of Sociology, University of California, Los Angeles, CA 90095
| | | | - Abdullah Almaatouq
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02142
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Drew M Altschul
- Mental Health Data Science Scotland, Department of Psychology, The University of Edinburgh, Edinburgh EH8 9JZ, United Kingdom
| | - Jennie E Brand
- Department of Sociology, University of California, Los Angeles, CA 90095
- Department of Statistics, University of California, Los Angeles, CA 90095
| | | | - Ryan James Compton
- Human Computer Interaction Lab, University of California, Santa Cruz, CA 95064
| | - Debanjan Datta
- Discovery Analytics Center, Virginia Polytechnic Institute and State University, Arlington, VA 22203
| | - Thomas Davidson
- Department of Sociology, Cornell University, Ithaca, NY 14853
| | | | - Connor Gilroy
- Department of Sociology, University of Washington, Seattle, WA 98105
| | - Brian J Goode
- Social and Decision Analytics Laboratory, Fralin Life Sciences Institute, Virginia Polytechnic Institute and State University, Arlington, VA 22203
| | - Eaman Jahani
- Institute for Data, Systems and Society, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Ridhi Kashyap
- Department of Sociology, University of Oxford, Oxford OX1 1JD, United Kingdom
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford OX2 6PE, United Kingdom
| | - Antje Kirchner
- Program for Research in Survey Methodology, Survey Research Division, RTI International, Research Triangle Park, NC 27709
| | - Stephen McKay
- School of Social and Political Sciences, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom
| | - Allison C Morgan
- Department of Computer Science, University of Colorado, Boulder, CO 80309
| | - Alex Pentland
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Kivan Polimis
- Center for the Study of Demography and Ecology, University of Washington, Seattle, WA 98105
| | - Louis Raes
- Department of Economics, Tilburg School of Economics and Management, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Daniel E Rigobon
- Department of Operations Research and Financial Engineering, Princeton University, Princeton, NJ 08544
| | - Claudia V Roberts
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Diana M Stanescu
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Yoshihiko Suhara
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Adaner Usmani
- Department of Sociology, Harvard University, Cambridge, MA 02138
| | - Erik H Wang
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Muna Adem
- Department of Sociology, Indiana University, Bloomington, IN 47405
| | - Abdulla Alhajri
- Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Bedoor AlShebli
- Computational Social Science Lab, Social Science Division, New York University Abu Dhabi, 129188 Abu Dhabi, United Arab Emirates
| | - Redwane Amin
- Bendheim Center for Finance, Princeton University, Princeton, NJ 08544
| | - Ryan B Amos
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Lisa P Argyle
- Department of Political Science, Brigham Young University, Provo, UT 84602
| | | | - Moritz Büchi
- Department of Communication and Media Research, University of Zurich, Zurich, Switzerland, ZH-8050
| | - Bo-Ryehn Chung
- Center for Statistics & Machine Learning, Princeton University, Princeton, NJ 08544
| | - William Eggert
- Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08544
| | - Gregory Faletto
- Statistics Group, Department of Data Sciences and Operations, Marshall School of Business, University of Southern California, Los Angeles, CA 90089
| | - Zhilin Fan
- Department of Statistics, Columbia University, New York, NY 10027
| | - Jeremy Freese
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Tejomay Gadgil
- Center for Data Science, New York University, New York, NY 10011
| | - Josh Gagné
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Yue Gao
- Department of Industrial Engineering and Operations Research, Columbia University, New York, NY 10027
| | | | - Sonia P Hashim
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Sonia Hausen
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Guanhua He
- Department of Molecular Biology, Princeton University, Princeton, NJ 08544
| | - Kimberly Higuera
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Bernie Hogan
- Oxford Internet Institute, University of Oxford, Oxford OX1 3JS, United Kingdom
| | - Ilana M Horwitz
- Graduate School of Education, Stanford University, Stanford, CA, 94305
| | - Lisa M Hummel
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Naman Jain
- Department of Operations Research and Financial Engineering, Princeton University, Princeton, NJ 08544
| | - Kun Jin
- Department of Computer Science, Ohio State University, Columbus, OH 43210
| | - David Jurgens
- School of Information, University of Michigan, Ann Arbor, MI 48104
| | - Patrick Kaminski
- Department of Sociology, Indiana University, Bloomington, IN 47405
- Center for Complex Networks and Systems Research, Indiana University, Bloomington, IN 47405
| | - Areg Karapetyan
- Department of Computer Science, Masdar Institute, Khalifa University, 127788 Abu Dhabi, United Arab Emirates
- Research Institute for Mathematical Sciences, Kyoto University, Kyoto 606-8502, Japan
| | - E H Kim
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Ben Leizman
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Naijia Liu
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Malte Möser
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Andrew E Mack
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Mayank Mahajan
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Noah Mandell
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544
| | - Helge Marahrens
- Department of Sociology, Indiana University, Bloomington, IN 47405
| | | | - Viola Mocz
- Department of Neuroscience, Princeton University, Princeton, NJ 08544
| | | | - Ahmed Musse
- Department of Electrical Engineering, Princeton University, Princeton, NJ, 08544
| | - Qiankun Niu
- Bendheim Center for Finance, Princeton University, Princeton, NJ 08544
| | | | - Hamidreza Omidvar
- Department of Civil and Environmental Engineering, Princeton University, Princeton, NJ 08544
| | - Andrew Or
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Karen Ouyang
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Katy M Pinto
- Department of Sociology, California State University, Dominguez Hills, Carson, CA 90747
| | - Ethan Porter
- School of Media and Public Affairs, George Washington University, Washington, DC 20052
| | | | - Crystal Qian
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Tamkinat Rauf
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Anahit Sargsyan
- Social Science Division, New York University Abu Dhabi, 129188 Abu Dhabi, United Arab Emirates
| | - Thomas Schaffner
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Landon Schnabel
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Bryan Schonfeld
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Ben Sender
- Department of Economics, Princeton University, Princeton, NJ 08544
| | - Jonathan D Tang
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Emma Tsurkov
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Austin van Loon
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Onur Varol
- Center for Complex Network Research, Northeastern University Networks Science Institute, Boston, MA 02115
- Luddy School of Informatics, Computing, & Engineering, Indiana University, Bloomington, IN 47408
| | - Xiafei Wang
- School of Social Work, David B. Falk College of Sport and Human Dynamics, Syracuse University, NY 13244
| | - Zhi Wang
- Luddy School of Informatics, Computing, & Engineering, Indiana University, Bloomington, IN 47408
- School of Public Health, Indiana University, Bloomington, IN 47408
| | - Julia Wang
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Flora Wang
- Department of Economics, Princeton University, Princeton, NJ 08544
| | - Samantha Weissman
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Kirstie Whitaker
- The Alan Turing Institute, London NW1 2DB, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom
| | - Maria K Wolters
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, United Kingdom
| | - Wei Lee Woon
- Department of Marketplaces & Yield Data Science, Expedia Group, Seattle, WA 98119
| | - James Wu
- Department of the Applied Statistics, Social Science, and Humanities, New York University, New York, NY 10003
| | - Catherine Wu
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Kengran Yang
- Department of Civil and Environmental Engineering, Princeton University, Princeton, NJ 08544
| | - Jingwen Yin
- Department of Statistics, Columbia University, New York, NY 10027
| | - Bingyu Zhao
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, United Kingdom
| | - Chenyun Zhu
- Department of Statistics, Columbia University, New York, NY 10027
| | - Jeanne Brooks-Gunn
- Department of Human Development, Teachers College, Columbia University, New York, NY 10027
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Barbara E Engelhardt
- Department of Computer Science, Princeton University, Princeton, NJ 08544
- Center for Statistics & Machine Learning, Princeton University, Princeton, NJ 08544
| | - Moritz Hardt
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720
| | - Dean Knox
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Karen Levy
- Department of Information Science, Cornell University, Ithaca, NY 14853
| | - Arvind Narayanan
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | | | - Duncan J Watts
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA 19104
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA 19104
- Operations, Information and Decisions Department, University of Pennsylvania, Philadelphia, PA 19104
| | - Sara McLanahan
- Department of Sociology, Princeton University, Princeton, NJ 08544;
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