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Monaghan TF, Robins DJ, Suss NR, Miller CD, Flores VX, Smith MT, Weiss JP, McNeil BK, Winer AG. Determinants of neoadjuvant chemotherapy for urothelial muscle-invasive bladder cancer: Does location matter? Int J Clin Pract 2021; 75:e14262. [PMID: 33887115 DOI: 10.1111/ijcp.14262] [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: 08/31/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Bladder cancer care has been increasingly concentrated in high-volume metropolitan medical centres (ie, "regionalisation" of care). We aimed to assess the potential role of geographic factors, including facility region and distance to treatment centre, as determinants of neoadjuvant chemotherapy (NAC) delivery in patients with non-metastatic urothelial muscle-invasive bladder cancer (MIBC) using nationally representative data from the United States. METHODS We queried the National Cancer Database to identify patients with cT2-cT4a, N0M0 urothelial MIBC who underwent radical cystectomy (RC) from 2006 to 2015. Patients who received radiation therapy, single-agent chemotherapy, adjuvant chemotherapy or systemic therapies other than multi-agent chemotherapy were excluded. Multivariate logistic regression analysis was performed to identify independent predictors of receiving NAC. RESULTS A total of 5986 patients met the criteria for inclusion, of whom 1788 (29.9%) received NAC and 4108 received RC alone. Younger age, increased Charlson-Deyo score, increased cT stage, increased annual income, increased distance from cancer treatment centre, treatment at an Academic Research Program or Integrated Network Cancer Program and a later year of diagnosis were independently predictive of NAC receipt. Older age, Medicare insurance and treatment in the East South Central or West South Central regions were independently associated with decreased odds of NAC receipt. CONCLUSIONS Distance to treatment centre and United States geographic region were found to affect the likelihood of NAC receipt independently of other established predictors of success in this quality-of-care metric. Access to transportation and related resources merits consideration as additional pertinent social determinants of health in bladder cancer care.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Dennis J Robins
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Nicholas R Suss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Connelly D Miller
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Viktor X Flores
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Matthew T Smith
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Brian K McNeil
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Andrew G Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
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2
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Wolff DT, Monaghan TF, Gordon DJ, Michelson KP, Jones T, Khargi R, Smith MT, Maffucci F, Kwun H, Suss NR, Winer AG. Racial Differences in Incident Genitourinary Cancer Cases Captured in the National Cancer Database. ACTA ACUST UNITED AC 2021; 57:medicina57070671. [PMID: 34209546 PMCID: PMC8303448 DOI: 10.3390/medicina57070671] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The National Cancer Database (NCDB) captures nearly 70% of all new cancer diagnoses in the United States, but there exists significant variation in this capture rate based on primary tumor location and other patient demographic factors. Prostate cancer has the lowest coverage rate of all major cancers, and other genitourinary malignancies likewise fall below the average NCDB case coverage rate. We aimed to explore NCDB coverage rates for patients with genitourinary cancers as a function of race. Materials and Methods: We compared the incidence of cancer cases in the NCDB with contemporary United States Cancer Statistics data. Results: Across all malignancies, American Indian/Alaskan Natives subjects demonstrated the lowest capture rates, and Asian/Pacific Islander subjects exhibited the second-lowest capture rates. Between White and Black subjects, capture rates were significantly higher for White subjects overall and for prostate cancer and kidney cancer in White males, but significantly higher for bladder cancer in Black versus White females. No significant differences were observed in coverage rates for kidney cancer in females, bladder cancer in males, penile cancer, or testicular cancer in White versus Black patients. Conclusions: Differential access to Commission on Cancer-accredited treatment facilities for racial minorities with genitourinary cancer constitutes a unique avenue for health equity research.
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Affiliation(s)
- Dylan T. Wolff
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Thomas F. Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence:
| | - Danielle J. Gordon
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Kyle P. Michelson
- Department of Urology, University of South Florida, Tampa, FL 33606, USA;
| | - Tashzna Jones
- Department of Urology, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - Raymond Khargi
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Matthew T. Smith
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Fenizia Maffucci
- Department of Urology, Temple University Hospital, Philadelphia, PA 19104, USA;
| | - Hyezo Kwun
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Nicholas R. Suss
- Department of Surgery, University of Chicago, Chicago, IL 60637, USA;
| | - Andrew G. Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
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Suss NR, Bruha MJ, Monaghan TF, Robins D, Flores V, Agudelo CW, Smith M, Hyacinthe L, McNeil BK, Weiss J, Winer A. Assessing the role of race in pathological upstaging of renal cell carcinoma: Results from the National Cancer Database. Int J Clin Pract 2021; 75:e13818. [PMID: 33159366 DOI: 10.1111/ijcp.13818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/20/2020] [Accepted: 11/02/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Pathologic upstaging in renal cell carcinoma (RCC) is common and confers a significant risk of poor surgical and survival outcomes. Preoperative predictors of upstaging are of great clinical relevance but empirical evidence specific to racial minorities remains scarce. METHODS National Cancer Database (NCDB) analysis of T3a-specific upstaging among White, African-American, Hispanic and Asian Pacific Islander (API) patients with AJCC cT1N0M0 RCC who underwent partial or radical nephrectomy between 2010 and 2015. Independent preoperative predictors of tumour upstaging were identified using multivariate logistic regression analyses. RESULTS A total of 81 002 patients met the criteria for inclusion (5.6% T3a-specific upstaging). Increased age, increased Charlson-Deyo comorbidity index, clinical stages cT1b and unspecified cT1, and increased Fuhrman nuclear grade were identified as independent risk factors for upstaging. Independent protective factors for upstaging were younger age, female sex, African-American race and papillary, chromophobe, and unspecified RCC histologic subtypes. Significant risk factors and protective factors within individual racial subgroups were highly consistent with those observed in the overall study sample. All independent factors identified on race-specific subgroup analyses were significant in the same direction relative to the overall study sample. Variables found to be non-significant in the overall study sample remained non-significant across all racial subgroup analyses. CONCLUSION The present study of nationally representative data found no clinically significant differences in upstaging risk across individual racial subgroups relative to the overall study sample. Preoperative factors that can be used to predict pT3a-specific tumour upstaging in CT1N0M0 RCC likely persist across different racial groups.
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Affiliation(s)
- Nicholas R Suss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew J Bruha
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Dennis Robins
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Viktor Flores
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Christina W Agudelo
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew Smith
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Llewellyn Hyacinthe
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Brian K McNeil
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Andrew Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Monaghan TF, Flores VX, Suss NR, Robins DJ, Smith MT, McNeil BK, Hyacinthe LM, Weiss JP, Winer AG. Determinants of adequate lymph node dissection following neoadjuvant chemotherapy in patients with urothelial muscle-invasive bladder cancer: results from the National Cancer Database. Int Urol Nephrol 2020; 53:235-239. [PMID: 32865771 DOI: 10.1007/s11255-020-02625-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Recent literature has separately identified multiple determinants of the use of neoadjuvant chemotherapy (NAC) and adherence to pelvic lymph node dissection (PLND) guidelines in the management of non-metastatic bladder cancer. However, such NAC/PLND analyses tend not to account for the other modality, despite the fact that NAC may impact the extent of dissectible lymph nodes. We aimed to determine the predictors of adequate PLND in patients with non-metastatic urothelial muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC) following receipt of NAC. METHODS We queried the National Cancer Database to identify patients from 2006-2015 with cT2-cT4a/N0M0 urothelial MIBC who underwent RC and were pre-treated with NAC. Multivariate logistic regression analysis was used to identify independent predictors of undergoing an adequate PLND (defined as > 8 nodes). RESULTS A total of 1518 patients met the criteria for inclusion (74.4% underwent adequate PLND). Adequate PLND was associated with treatment at an academic research facility (OR 2.762 [95% CI 2.119-3.599], p < 0.001). The likelihood of adequate PLND was significantly decreased in patients of older age (0.607 [0.441-0.835], p = 0.002 for age 70-79 years; 0.459 [0.245-0.860], p = 0.015 for age ≥ 80 years), a Charlson-Deyo score of 1 (0.722 [0.537-0.971], p = 0.031), and those who were uninsured (0.530 [0.292-0.964], p = 0.038). CONCLUSIONS Established predictors of PLND may not necessarily be generalizable to all patients undergoing treatment for bladder cancer. The interplay between PLND and NAC merits further study, particularly in view of recent literature calling into question the survival benefit of PLND in patients pre-treated with NAC.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA. .,Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA.
| | - Viktor X Flores
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.,Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Nicholas R Suss
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.,Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Dennis J Robins
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.,Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Matthew T Smith
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.,Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Brian K McNeil
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.,Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Llewellyn M Hyacinthe
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.,Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.,Department of Urology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Andrew G Winer
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.,Department of Urology, Kings County Hospital Center, Brooklyn, NY, USA
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5
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Epstein MR, Monaghan TF, Khusid JA, Suss NR, Agudelo CW, Michelson KP, Wu ZD, Gong F, Weiss JP. Comparison of nocturia etiology in black and white male patients. Can J Urol 2019; 26:9769-9773. [PMID: 31180307] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Much of what is known about the etiology of nocturia (i.e., nocturnal polyuria [NP], small bladder capacity [SBC], etc.) at the population level stems from the Krimpen study, which enrolled aging males from a homogenous municipality in the Netherlands. Given the higher prevalence of benign prostatic hyperplasia and overactive bladder in black versus white males in population research, we aim to test the hypothesis that black males seeking treatment for lower urinary tract symptoms (LUTS) are more likely to have nocturia owing to SBC. MATERIALS AND METHODS We retrospectively analyzed 24 hour frequency-volume charts (FVCs) completed by males seeking treatment for LUTS at a Veterans Affairs urology clinic from 2008-2016. Patients were included if they were ≥ 18 years, identified as either Caucasian or African American, and had a complete baseline FVC showing ≥ 1 nocturnal void. Patients were stratified by race and classified as having nocturia owing to SBC (defined by a maximum voided volume < 200 mL or a nocturnal bladder capacity index > 1.3); NP (defined by a nocturnal polyuria index > 0.33); 'mixed' (SBC + NP); or 'other' (neither SBC nor NP). RESULTS Between white and black patients, 28 (24%) versus 28 (26%) had NP, 32 (27%) versus 33 (30%) had SBC, and 35 (30%) versus 30 (28%) had mixed nocturia. Overall, there was no difference in distribution of underlying etiology by race (p = 0.51). CONCLUSIONS Our results demonstrate no difference in the etiology of nocturia between black and white males. Accordingly, race should not play a role in the evaluation of patients seeking treatment for nocturia.
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Affiliation(s)
- Matthew R Epstein
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York, USA
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6
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Monaghan TF, Bliwise DL, Suss NR, Epstein MR, Wu ZD, Michelson KP, Agudelo CW, Robins DJ, Wagg A, Weiss JP. Overnight Urge Perception in Nocturia Is Independent of Depression, PTSD, or Anxiety in a Male Veterans Administration Population. J Clin Sleep Med 2019; 15:615-621. [PMID: 30952224 DOI: 10.5664/jcsm.7726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/09/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The goal of this study was to compare the urge perception associated with nocturnal voiding at the time of voiding in individuals with and without depression, posttraumatic stress disorder (PTSD), or anxiety diagnoses to test the hypothesis that patients with such diagnoses are more likely to experience insomnia-driven convenience voiding during the sleep period. METHODS A database of voiding diaries with urge perception grades (UPGs) from 429 adult males seeking treatment for nocturia at a Veterans Affairs-based urology clinic was analyzed. The UPG categorizes perception for urinating from 0 (out of convenience) to 4 (desperate urge). Diaries completed by males age 18 years and older showing ≥ 2 nocturnal voids were included. Those included (n = 178) were divided into two cohorts based on the presence (n = 62) or absence (n = 116) of one or more previously established mental health diagnoses (depression, PTSD, or anxiety). The chi-square test was used to determine significance between groups. RESULTS Patients with a mental health diagnosis were more likely to report convenience voiding compared to those without depression, PTSD, or anxiety (14.5% versus 0.8%, P < .01). However, most voids in both groups were associated with the perception of urinary urgency. There were no differences in urinary volumes or hourly rates of urine production between the groups. CONCLUSIONS A relatively small subset of urology patients experience nocturnal voiding because they are awake for reasons other than the urge to void. Mental health factors had a substantial, albeit minimal, effect. Most nocturia reflects urgency to urinate rather than voiding by convenience.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Nicholas R Suss
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Matthew R Epstein
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Zhan D Wu
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Kyle P Michelson
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | | | - Dennis J Robins
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Adrian Wagg
- Department of Geriatric Medicine, University of Alberta, Edmonton, Canada
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
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Bleicher RJ, Chang C, Wang CE, Goldstein LJ, Kaufmann CS, Moran MS, Pollitt KA, Suss NR, Winchester DP, Tafra L, Yao K. Treatment delays from transfers of care and their impact on breast cancer quality measures. Breast Cancer Res Treat 2018; 173:603-617. [DOI: 10.1007/s10549-018-5046-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022]
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Benjamin AJ, Baker TB, Talamonti MS, Bodzin AS, Schneider AB, Winschester DJ, Roggin KK, Bentrem DJ, Suss NR, Baker MS. Liver transplant offers a survival benefit over margin negative resection in patients with small unifocal hepatocellular carcinoma and preserved liver function. Surgery 2018; 163:582-586. [PMID: 29370929 DOI: 10.1016/j.surg.2017.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies comparing orthotopic liver transplantation to margin negative resection for patients with small unifocal hepatocellular carcinoma have not controlled for degree of cirrhosis. METHODS The National Cancer Database was used to identify patients with preserved liver function (Model for End-stage Liver Disease score ≤12) who underwent orthotopic liver transplantation or margin negative resection for American Joint Committee on Cancer stage I hepatocellular carcinoma lesions <3 cm between 2010 and 2013. Multivariable and Cox regression adjusting for age, demographics, comorbid disease burden, Model for End-stage Liver Disease score, tumor size, and operation were used to compare overall survival between cohorts. RESULTS In the study, 241 (53%) patients underwent orthotopic liver transplantation. In addition, 219 (47%) underwent margin negative resection. On multivariable regression, patients having a Charlson comorbidity score ≥2 were more likely to undergo orthotopic liver transplantation, (odds ratio 1.94, P=.03). African American patients (odds ratio 0.44, P=.02), and patients of advanced age (odds ratio 0.92, P<.001) were more likely to undergo margin negative resection. Patients undergoing orthotopic liver transplantation had longer overall survival than those undergoing margin negative resection (median OS not reached versus 67.6 months, P<.001). Multivariable Cox regression identified surgical procedure as the only independent determinant of survival with margin negative resection conferring a nearly 3-fold increased risk of death (hazard ratio 2.86, P<.001). CONCLUSION Orthotopic liver transplantation offers a survival advantage relative to margin negative resection for patients with small unifocal hepatocellular carcinoma and preserved liver function.
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Affiliation(s)
| | - Talia B Baker
- Department of Surgery, University of Chicago, Chicago, IL
| | - Mark S Talamonti
- Department of Surgery, Northshore University HealthSystem, Evanston, IL
| | - Adam S Bodzin
- Department of Surgery, University of Chicago, Chicago, IL
| | | | | | - Kevin K Roggin
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Nicholas R Suss
- Department of Surgery, Northshore University HealthSystem, Evanston, IL
| | - Marshall S Baker
- Department of Surgery, Northshore University HealthSystem, Evanston, IL.
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Suss NR, Talamonti MS, Bryan DS, Wang CH, Kuchta KM, Stocker SJ, Bentrem DJ, Roggin KK, Winchester DJ, Marsh R, Prinz RA, Murad FM, Baker MS. Does adjuvant radiation provide any survival benefit after an R1 resections for pancreatic cancer? Surgery 2018; 163:1047-1052. [PMID: 29336810 DOI: 10.1016/j.surg.2017.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/04/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The benefit of adding external beam radiation to adjuvant chemotherapy in patients that have undergone a margin positive resection for early stage, pancreatic ductal adenocarcinoma has not been determined definitively. METHODS The National Cancer Data Base was queried to evaluate the utility of adjuvant radiation in patients with pathologic stage I-II pancreatic ductal adenocarcinoma who underwent upfront pancreatoduodenectomy with a positive margin (margin positive resection) between 2004 and 2013. RESULTS In the study, 1,392 patients met inclusion criteria, of whom 263 (18.9%) were lymph node-negative (pathologic stages IA, IB, IIA) and 1,129 (81.1%) were node-positive (pathologic stage IIB); 938 (67.4%) patients received adjuvant radiation and chemotherapy, while 454 (32.6%) received adjuvant chemotherapy alone. Cox modeling stratified by nodal status demonstrated the benefit of radiation to be statistically significant only in node positive patients (hazard ratio 0.81, 95% confidence interval, 0.71-0.93). Node-positive patients receiving adjuvant radiation and chemotherapy had an adjusted median survival of 17.5 months vs 15.2 months for those receiving adjuvant chemotherapy alone (P=.003). In patients who had negative nodes, there was no difference in overall survival with radiation (22.5 vs 23.6 months, P=.511). CONCLUSION Addition of radiation to adjuvant chemotherapy after a margin positive resection confers a survival benefit albeit limited (about 2 months) in patients with node-positive pancreatic head cancer. (Surgery 2017;160:XXX-XXX.).
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Affiliation(s)
- Nicholas R Suss
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States
| | - Mark S Talamonti
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States
| | - Darren S Bryan
- Department of Surgery, University of Chicago Medicine, Chicago, IL, United States
| | - Chi-Hsiung Wang
- Bioinformatics and Research Core, NorthShore University HealthSystem, Evanston, IL, United States
| | - Kristine M Kuchta
- Bioinformatics and Research Core, NorthShore University HealthSystem, Evanston, IL, United States
| | - Susan J Stocker
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States
| | - David J Bentrem
- Department of Surgery, Northwestern University, Chicago, IL, United States
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, IL, United States
| | - David J Winchester
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States
| | - Robert Marsh
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Richard A Prinz
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States
| | - Faris M Murad
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States
| | - Marshall S Baker
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States; Department of Surgery, University of Chicago Medicine, Chicago, IL, United States.
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10
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Liu JB, Baker TB, Suss NR, Talamonti MS, Roggin KK, Winchester DJ, Baker MS. Orthotopic liver transplantation provides a survival advantage compared with resection in patients with hepatocellular carcinoma and preserved liver function. Surgery 2017; 162:1032-1039. [DOI: 10.1016/j.surg.2017.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/07/2017] [Accepted: 07/14/2017] [Indexed: 01/27/2023]
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