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Xu H, Taylor-Cho IA, Sara Jiang X, Foo WC. Diagnostic accuracy and clinical impact of renal biopsy cytology. Diagn Cytopathol 2024; 52:505-510. [PMID: 38801188 DOI: 10.1002/dc.25357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The role of fine needle biopsy cytology in the workup of renal mass lesions remains controversial. With advances in imaging technology and clinical management for renal masses, a critical reevaluation of the role of renal biopsy is needed. This study was designed to provide a comprehensive evaluation of the performance and clinical impact of fine needle biopsy in patients with renal masses. METHODS A 5-year retrospective study of ultrasound or computer tomography (CT)-guided fine needle biopsies of renal masses diagnosed via cytopathology was conducted. Overall diagnostic rate, sensitivity, and diagnostic accuracy were calculated. Further analysis of the impact of fine needle biopsy cytology on clinical management was performed. RESULTS A total of 227 cases of fine-needle aspiration and/or biopsy (FNA/B) of renal masses were identified, including 76 with subsequent nephrectomies. Complications were rare (<1%). The diagnostic rate and sensitivity of FNA/B were 83.3% and 89.5%, respectively. Diagnostic accuracy was 98.7% at the major categorical level and 94.7% at the tumor subtype level. Subsequent clinical actions were associated with a definitive cytologic diagnosis of malignancy/neoplasia (p < .05) and were affected by tumor subtype (p < .05). CONCLUSION This study demonstrates that FNA/B of renal masses is a safe and reliable minimally invasive diagnostic tool with excellent accuracy in confirmation of malignancy and subclassification of tumors. Diagnoses made on FNA/B play a key role in guiding a personalized clinical treatment plan.
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Affiliation(s)
- Hongzhi Xu
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ian A Taylor-Cho
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Xiaoyin Sara Jiang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Wen-Chi Foo
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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2
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Yang YC, Wu JJ, Shi F, Ren QG, Jiang QJ, Guan S, Tang XQ, Meng XS. Sub-regional Radiomics Analysis for Predicting Metastasis Risk in Clear Cell Renal Cell Carcinoma: A Multicenter Retrospective Study. Acad Radiol 2024:S1076-6332(24)00569-5. [PMID: 39147643 DOI: 10.1016/j.acra.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
RATIONALE AND OBJECTIVES Clear cell renal cell carcinoma (ccRCC) is the most common malignant neoplasm affecting the kidney, exhibiting a dismal prognosis in metastatic instances. Elucidating the composition of ccRCC holds promise for the discovery of highly sensitive biomarkers. Our objective was to utilize habitat imaging techniques and integrate multimodal data to precisely predict the risk of metastasis, ultimately enabling early intervention and enhancing patient survival rates. MATERIAL AND METHODS A retrospective analysis was performed on a cohort of 263 patients with ccRCC from three hospitals between April 2013 and March 2021. Preoperative CT images, ultrasound images, and clinical data were comprehensively analyzed. Patients from two campuses of Qilu Hospital of Shandong University were assigned to the training dataset, while the third hospital served as the independent testing dataset. A robust consensus clustering method was used to classify the primary tumor space into distinct sub-regions (i.e., habitats) using contrast-enhanced CT images. Radiomic features were extracted from these tumor sub-regions and subsequently reduced to identify meaningful features for constructing a predictive model for ccRCC metastasis risk assessment. In addition, the potential value of radiomics in predicting ccRCC metastasis risk was explored by integrating ultrasound image features and clinical data to construct and compare alternative models. RESULTS In this study, we performed k-means clustering within the tumor region to generate three distinct tumor subregions. We quantified the Hounsfiled Unit (HU) value, volume fraction, and distribution of high- and low-risk groups in each subregion. Our investigation focused on 252 patients with Habitat1 + Habitat3 to assess the discriminative power of these two subregions. We then developed a risk prediction model for ccRCC metastasis risk classification based on radiomic features extracted from CT and ultrasound images, and clinical data. The Combined model and the CT_Habitat3 model showed AUC values of 0.935 [95%CI: 0.902-0.968] and 0.934 [95%CI: 0.902-0.966], respectively, in the training dataset, while in the independent testing dataset, they achieved AUC values of 0.891 [95%CI: 0.794-0.988] and 0.903 [95%CI: 0.819-0.987], respectively. CONCLUSION We have identified a non-invasive imaging predictor and the proposed sub-regional radiomics model can accurately predict the risk of metastasis in ccRCC. This predictive tool has potential for clinical application to refine individualized treatment strategies for patients with ccRCC.
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Affiliation(s)
- You Chang Yang
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong Province, China.
| | - Jiao Jiao Wu
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China.
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China.
| | - Qing Guo Ren
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong Province, China.
| | - Qing Jun Jiang
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong Province, China.
| | - Shuai Guan
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong Province, China.
| | - Xiao Qiang Tang
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.
| | - Xiang Shui Meng
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong Province, China.
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Pajunen H, Veitonmäki T, Huhtala H, Nikkola J, Pöyhönen A, Murtola T. Prognostic factors of renal cell cancer in elderly patients: a population-based cohort study. Sci Rep 2024; 14:6295. [PMID: 38491173 PMCID: PMC10942969 DOI: 10.1038/s41598-024-56835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
Mortality in renal cell cancer (RCC) is high in the elderly population. Comorbidities have a greater impact on overall prognosis of RCC among elderly patients than in younger patients. All new RCC cases were collected in people over 74 years of age between 1995 and 2018 from the Finnish cancer registry. The comorbidities were identified from the Care Registry for Healthcare. Charlson Comorbidity Index (CCI) was used to evaluate the risk of death based on comorbidities. The overall risk of death was analyzed using the Cox regression model. The risk for RCC death was analyzed using Fine and Gray regression analysis. Individual prognostic role of CCI components was evaluated by adding each component separately into the multivariable Fine and Gray regression model. Using the most prognostic comorbidities we constructed a nomogram to predict RCC mortality. Statistically significant prognostic factors of RCC death were tumor morphology (clear cell, papillary and chromophobe), sex, operative treatment, age, primary tumor extent and CCI. The strongest prognostic factors for overall mortality were tumor extent, tumor morphology and operative treatment. Among the components of CCI, the most important comorbidities predicting mortality were dementia, heart failure and kidney disease. The limitation of this study is that the comorbidities have only been recorded at inpatient and outpatient hospital contacts, which is why the prevalence of comorbidities is probably underestimated. In addition, physical performance status was not available from registry data, but it significantly affects the treatment decisions. RCC mortality is high in the elderly population. Among comorbidities, dementia and heart failure have the greatest impact on the prognosis. Curative treatment in selected elderly patients is efficient and should be considered in patients who can tolerate it and have only limited comorbidities.
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Affiliation(s)
- Heini Pajunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Thea Veitonmäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jussi Nikkola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Pöyhönen
- Center for Military Medicine, The Finnish Defense Forces, Helsinki, Finland
| | - Teemu Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Urology, TAYS Cancer Center, Tampere, Finland
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Wang M, Wittenberg S, Cher ML, Van Til M, Ferrante S, Mirza M, Johnson A, Semerjian A, George A, Rogers C, Wilder S, Sarle R, Ghani KR, Lane B, Ginsburg KB. Does Urologist-level Utilization of Active Surveillance for Low-risk Prostate Cancer Correspond with Utilization of Active Surveillance for Small Renal Masses? Eur Urol 2024; 85:101-104. [PMID: 37507241 DOI: 10.1016/j.eururo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Active surveillance (AS) for prostate cancer (CaP) or small renal masses (SRMs) helps in limiting the overtreatment of indolent malignancies. Implementation of AS for these conditions varies substantially across individual urologists. We examined the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry to assess for correlation of AS between patients with low-risk CaP and patients with SRM managed by individual urologists. We identified 27 urologists who treated at least ten patients with National Comprehensive Cancer Network low-risk CaP and ten patients with SRMs between 2017 and 2021. For surgeons in the lowest quartile of AS use for low-risk CaP (<74%), 21% of their patients with SRMs were managed with AS, in comparison to 74% of patients of surgeons in the highest quartile (>90%). There was a modest positive correlation between the surgeon-level risk-adjusted proportions of patients managed with AS for low-risk CaP and for SRMs (Pearson correlation coefficient 0.48). A surgeon's tendency to use AS to manage one low-risk malignancy corresponds to their use of AS for a second low-risk condition. By identifying and correcting structural issues associated with underutilization of AS, interventions aimed at increasing AS use may have effects that influence clinical tendencies across a variety of urologic conditions. PATIENT SUMMARY: The use of active surveillance (AS) for patients with low-risk prostate cancer or small kidney masses varies greatly among individual urologists. Urologists who use AS for low-risk prostate cancer were more likely to use AS for patients with small kidney masses, but there is room to improve the use of AS for both of these conditions.
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Affiliation(s)
- Michael Wang
- Department of Urology, Wayne State University, Detroit, MI, USA.
| | | | - Michael L Cher
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Monica Van Til
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Mahin Mirza
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anna Johnson
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Arvin George
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Health Systems, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health Systems, Detroit, MI, USA
| | - Richard Sarle
- Department of Urology, Sparrow Point Hospitals, Lansing, MI, USA
| | | | - Brian Lane
- Division of Urology, Corewell Health, Grand Rapids, MI, USA
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Kong J, Zou Y, Huang Y, Yao Y, Gan Q, Chen Z, Xie W, Fan X. Crafting and Authenticating Prognostic Nomograms for Overall and Cancer-specific Survival in Pediatric Small Renal Masses: A Comprehensive Two-Decade Cohort Study. Technol Cancer Res Treat 2024; 23:15330338241284845. [PMID: 39380441 PMCID: PMC11468340 DOI: 10.1177/15330338241284845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/25/2024] [Accepted: 08/30/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND The intricate task of diagnosing and managing small renal masses (SRMs) has become progressively convoluted within the realm of clinical practice. Contemporary clinical prediction instruments may succumb to a gradual decay in precision, coupled with an absence of unambiguous guidelines to navigate patient management. METHODS This investigation was devised to formulate and authenticate nomograms for the overall survival (OS) and cancer- specific survival (CSS) among patients afflicted with SRMs. The study encompassed a cohort of 2558 pediatric patients diagnosed with SRMs over the period of 2000 to 2019. Independent prognostic indicators for OS and CSS, encompassing historical staging, chemotherapy regimens, surgical interventions, and pathological classifications, were ascertained through the employment of multivariate Cox proportional hazards regression analysis and backward stepwise selection. RESULTS Through the utilization of multivariate Cox regression models, nomograms for OS and CSS were meticulously crafted, demonstrating commendable discrimination and calibration within the training set (OS C-index: 0.762, CSS C-index: 0.779). The validation set further corroborated the exemplary discrimination and calibration of the nomograms. Moreover, these nomograms adeptly differentiated between patient groups at elevated and diminished risk levels. CONCLUSION The nomograms delineated in this research provide propitious predictive accuracy for overall survival and cancer-specific survival in patients suffering from pediatric SRMs, thereby contributing to refined risk stratification and steering the optimal therapeutic course of action. The necessity for supplementary validation prevails before the translation of these findings into clinical practice.
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Affiliation(s)
- Jianqiu Kong
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong, P. R. China
| | - Yitong Zou
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong, P. R. China
| | - Yi Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong, P. R. China
| | - Yuhui Yao
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong, P. R. China
| | - Qinghua Gan
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong, P. R. China
| | - Zhijian Chen
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong, P. R. China
| | - Weibin Xie
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong, P. R. China
| | - Xinxiang Fan
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong, P. R. China
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Lehrer R, Cornelis F, Bernhard JC, Bigot P, Champy C, Bruyère F, Rouprêt M, Doumerc N, Bensalah CK, Olivier J, Audenet F, Tricard T, Parier B, Durand X, Durand M, Charles T, Branger N, Surlemont L, Xylinas E, Beauval JB, Barral M. Minimally invasive nephron-sparing treatments for T1 renal cell cancer in patients over 75 years: a comparison of outcomes after robot-assisted partial nephrectomy and percutaneous ablation. Eur Radiol 2023; 33:8426-8435. [PMID: 37466710 DOI: 10.1007/s00330-023-09975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To compare the oncological and perioperative outcomes of robot-assisted partial nephrectomy (RPN) and percutaneous thermal ablation (PTA) for treatment of T1 renal cell cancer (RCC) in patients older than 75 years. MATERIALS AND METHODS Retrospective national multicenter study included all patients older than 75 years treated for a T1 RCC by RPN or PTA between January 2010 and January 2021. Patients' characteristics, tumor data, and perioperative and oncological outcomes were compared. RESULTS A total of 205 patients for 209 procedures (143 RPN and 66 PTA) were included. In the PTA group, patients were older (80.4 ± 3.7 vs. 79 ± 3.7 years (p = 0.01)); frailer (ASA score (2.43 ± 0.6 vs. 2.17 ± 0.6 (p < 0.01)); and more frequently had a history of kidney surgery (16.7% [11/66] vs. 5.6% [8/143] (p = 0.01)) than in the RPN group. Tumors were larger in the RPN group (2.7 ± 0.7 vs. 3.2 ± 0.9 cm (p < 0.01)). Operation time, length of hospital stay, and increase of creatinine serum level were higher in RPN (respectively 92.1 ± 42.7 vs. 150.7 ± 61.3 min (p < 0.01); 1.7 ± 1.4 vs. 4.2 ± 3.4 days (p < 0.01); 1.9 ± 19.3% vs. 10.1 ± 23.7 (p = 0.03)). Disease-free survival and time to progression were similar (respectively, HR 2.2; 95% CI 0.88-5.5; p = 0.09; HR 2.1; 95% CI 0.86-5.2; p = 0.1). Overall survival was shorter for PTA that disappeared after Cox adjusting model (HR 3.3; 95% CI 0.87-12.72; p = 0.08). CONCLUSION Similar oncological outcomes are observed after PTA and RPN for T1 RCC in elderly patients. CLINICAL RELEVANCE STATEMENT Robot-assisted partial nephrectomy and percutaneous thermal ablation have similar oncological outcomes for T1a kidney cancer in patients over 75 years; however, operative time, decrease in renal function, and length of hospital stay were lower with ablation. KEY POINTS • After adjusting model for age and ASA score, similar oncological outcomes are observed after percutaneous thermal ablation and robot-assisted partial nephrectomy for T1 renal cell cancer in elderly patients. • Operation time, length of hospital stay, and increase of creatinine serum level were higher in the robot-assisted partial nephrectomy group.
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Affiliation(s)
- Raphaël Lehrer
- Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
- Department of Interventional Radiology, Sorbonne Université, Paris, France
| | - Francois Cornelis
- Radiology Department, Memorial Sloan Kettering Cancer Center, New York, USA
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
| | - Jean-Christophe Bernhard
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Bigot
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Angers University Hospital, Angers, France
| | - Cécile Champy
- Department of Urology, University Hospital Henri Mondor, AP-HP, Créteil, France
- INSERM, U1430, Henri Mondor University Hospital, AP-HP, 94000, Creteil, France
| | - Franck Bruyère
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Tours University Hospital, Tours, France
| | - Morgan Rouprêt
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Nicolas Doumerc
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, University Hospital Rangueil, Toulouse, France
| | - Charles-Karim Bensalah
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - François Audenet
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | - Bastien Parier
- Department of Urology, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Xavier Durand
- Department of Urology, Paris Saint-Joseph Hospital, Paris, France
| | - Matthieu Durand
- Department of Urology, Hôpital Pasteur 2, Nice, France
- INSERM U1081 - CNRS, UMR 7284, Université de Nice Côte d'Azur, Nice, France
| | - Thomas Charles
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - Nicolas Branger
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Louis Surlemont
- Department of Urology, Rouen University Hospital, Rouen, France
| | - Evanguelos Xylinas
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Jean-Baptiste Beauval
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Matthias Barral
- Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France.
- Department of Interventional Radiology, Sorbonne Université, Paris, France.
- Service d'Imagerie Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Sorbonne Université, AP-HP, 4 rue de la chine, 75020, Paris, France.
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Che WQ, Li YJ, Tsang CK, Wang YJ, Chen Z, Wang XY, Xu AD, Lyu J. How to use the Surveillance, Epidemiology, and End Results (SEER) data: research design and methodology. Mil Med Res 2023; 10:50. [PMID: 37899480 PMCID: PMC10614369 DOI: 10.1186/s40779-023-00488-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023] Open
Abstract
In the United States (US), the Surveillance, Epidemiology, and End Results (SEER) program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient survival data. This program aims to provide a database about cancer incidence and survival for studies of surveillance and the development of analytical and methodological tools in the cancer field. Currently, the SEER program covers approximately half of the total cancer patients in the US. A growing number of clinical studies have applied the SEER database in various aspects. However, the intrinsic features of the SEER database, such as the huge data volume and complexity of data types, have hindered its application. In this review, we provided a systematic overview of the commonly used methodologies and study designs for retrospective epidemiological research in order to illustrate the application of the SEER database. Therefore, the goal of this review is to assist researchers in the selection of appropriate methods and study designs for enhancing the robustness and reliability of clinical studies by mining the SEER database.
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Affiliation(s)
- Wen-Qiang Che
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
- Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Yuan-Jie Li
- Planning & Discipline Construction Office, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Chi-Kwan Tsang
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Yu-Jiao Wang
- Department of Pathology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Zheng Chen
- Department of Urology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Xiang-Yu Wang
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
| | - An-Ding Xu
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
| | - Jun Lyu
- Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, 510632, China.
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8
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Piccinelli ML, Barletta F, Tappero S, Cano Garcia C, Incesu RB, Morra S, Scheipner L, Tian Z, Luzzago S, Mistretta FA, Ferro M, Saad F, Shariat SF, Ahyai S, Longo N, Tilki D, Chun FKH, Terrone C, Briganti A, de Cobelli O, Musi G, Karakiewicz PI. Development and External Validation of a Novel Nomogram Predicting Cancer-specific Mortality-free Survival in Surgically Treated Papillary Renal Cell Carcinoma Patients. Eur Urol Focus 2023; 9:799-806. [PMID: 37024421 DOI: 10.1016/j.euf.2023.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Accurate prediction of cancer control outcomes in renal cell carcinoma (RCC) patients is important for counselling, follow-up planning, and selection of appropriate adjuvant trial designs. OBJECTIVE To develop and externally validate a novel contemporary population-based model for predicting cancer-specific mortality-free survival (CSM-FS) in surgically treated papillary RCC (papRCC) patients and to compare it with established risk categories (Leibovich 2018). DESIGN, SETTING, AND PARTICIPANTS Within the Surveillance, Epidemiology, and End Results database (2004-2019), we identified surgically treated papRCC patients (n = 3978). The population was randomly divided into development (50%, n = 1989) and external validation (50%, n = 1989) cohorts. Of the external validation cohort, 97% (n = 1930) of patients were included in a head-to-head comparison of the Leibovich 2018 risk categories addressing nonmetastatic patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Univariable Cox regression models tested the statistical significance in the prediction of CSM-FS. The most parsimonious model with the best validation metrics was selected as the multivariable nomogram. Accuracy, calibration, and decision curve analyses (DCAs) tested the Cox regression-based nomogram, as well as the Leibovich 2018 risk categories in the external validation cohort. RESULTS AND LIMITATIONS Age at diagnosis, grade, T stage, N stage, and M stage qualified for inclusion in the novel nomogram. In external validation, the accuracy of the novel nomogram was 0.83 at 5 yr and 0.80 at 10 yr. In nonmetastatic patients, 5- and 10-yr accuracy of the novel nomogram was 0.77 and 0.76, respectively. Conversely, 5- and 10-yr accuracy of the Leibovich 2018 risk categories was 0.70 and 0.66, respectively. The novel nomogram exhibited smaller departures from ideal predictions in calibration plots and higher net benefit in DCAs, when it was compared with the Leibovich 2018 risk categories. Limitations include the retrospective nature of the study, absence of a central pathological review, and inclusion of only North American patients. CONCLUSIONS The novel nomogram may represent a valuable clinical aid, when papRCC CSM-FS predictions are required. PATIENT SUMMARY We developed an accurate tool to predict death due to papillary kidney cancer in a North American population.
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Affiliation(s)
- Mattia Luca Piccinelli
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Francesco Barletta
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Cristina Cano Garcia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Reha-Baris Incesu
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Morra
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lukas Scheipner
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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9
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Zhan X, Chen T, Liu Y, Wan H, Liu X, Deng X, Fu B, Xiong J. Trends in cause of death among patients with renal cell carcinoma in the United States: a SEER-based study. BMC Public Health 2023; 23:770. [PMID: 37101189 PMCID: PMC10131378 DOI: 10.1186/s12889-023-15647-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) survival has improved due to recent developments in RCC treatment. Therefore, other co-morbid conditions may have a more critical role. This study aims to explore the common causes of death in patients with RCC to improve the management and survival of RCC. METHOD We used the Surveillance, Epidemiology, and End Results (SEER) (1992-2018) database to get patients with RCC. We calculated the percentage of total deaths of six kinds of the cause of death (COD) and the cumulative incidence of death for each selected cause over survival time. The joinpoint regression was utilized to present the trend of mortality rate by COD. RESULTS We enrolled 107,683 cases with RCC. RCC was the leading cause of death in patients with RCC [25376(48.3%)], followed by cardiovascular diseases [9023(17.2%)], other cancers [8003 (15.2%)], other non-cancer diseases [4195 (8%)], non-disease cause [4023 (7.7%)], and respiratory diseases [1934 (3.6%)]. The proportion of patients who died of RCC decreased gradually over survival time, and this value decreased from 69.71% in 1992-1996 to 38.96% in 2012-2018. The non-RCC cause mortality rate showed an increasing trend, whereas a slight decrease was observed in RCC specific mortality rate. The distribution of such conditions varied across different patient populations. CONCLUSION RCC was still the primary COD of patients with RCC. However, non-RCC cause death was increasingly important among RCC patients in recent two decades. Cardiovascular disease and other cancers were crucial co-morbidities that required significant attention in the management of RCC patients.
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Affiliation(s)
- Xiangpeng Zhan
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Tao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Ying Liu
- Department of Preventive Medicine, School of Public Health, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Hao Wan
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xinxi Deng
- Department of Urology, Jiu Jiang No.1 People's Hospital, Jiujiang, Jiangxi Province, China.
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.
| | - Jing Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.
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10
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Piccinelli ML, Morra S, Tappero S, Cano Garcia C, Barletta F, Incesu RB, Scheipner L, Baudo A, Tian Z, Luzzago S, Mistretta FA, Ferro M, Saad F, Shariat SF, Carmignani L, Ahyai S, Tilki D, Briganti A, Chun FKH, Terrone C, Longo N, de Cobelli O, Musi G, Karakiewicz PI. Critical Appraisal of Leibovich 2018 and GRANT Models for Prediction of Cancer-Specific Survival in Non-Metastatic Chromophobe Renal Cell Carcinoma. Cancers (Basel) 2023; 15:cancers15072155. [PMID: 37046815 PMCID: PMC10093654 DOI: 10.3390/cancers15072155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Within the Surveillance, Epidemiology, and End Results database (2000–2019), we identified 5522 unilateral surgically treated non-metastatic chromophobe kidney cancer (chRCC) patients. This population was randomly divided into development vs. external validation cohorts. In the development cohort, the original Leibovich 2018 and GRANT categories were applied to predict 5- and 10-year cancer-specific survival (CSS). Subsequently, a novel multivariable nomogram was developed. Accuracy, calibration and decision curve analyses (DCA) tested the Cox regression-based nomogram as well as the Leibovich 2018 and GRANT risk categories in the external validation cohort. The accuracy of the Leibovich 2018 and GRANT models was 0.65 and 0.64 at ten years, respectively. The novel prognostic nomogram had an accuracy of 0.78 at ten years. All models exhibited good calibration. In DCA, Leibovich 2018 outperformed the novel nomogram within selected ranges of threshold probabilities at ten years. Conversely, the novel nomogram outperformed Leibovich 2018 for other values of threshold probabilities. In summary, Leibovich 2018 and GRANT risk categories exhibited borderline low accuracy in predicting CSS in North American non-metastatic chRCC patients. Conversely, the novel nomogram exhibited higher accuracy. However, in DCA, all examined models exhibited limitations within specific threshold probability intervals. In consequence, all three examined models provide individual predictions that might be suboptimal and be affected by limitations determined by the natural history of chRCC, where few deaths occur within ten years from surgery. Further investigations regarding established and novel predictors of CSS and relying on large sample sizes with longer follow-up are needed to better stratify CSS in chRCC.
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Affiliation(s)
- Mattia Luca Piccinelli
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
- Department of Urology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Simone Morra
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
- Department of Urology, IRCCS Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16148 Genova, Italy
| | - Cristina Cano Garcia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany
| | - Francesco Barletta
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
- Division of Experimental Oncology, Unit of Urology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Reha-Baris Incesu
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Lukas Scheipner
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
- Department of Urology, Medical University of Graz, 8036 Graz, Austria
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
- Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Department of Urology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, 8036 Graz, Austria
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Urology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Alberto Briganti
- Division of Experimental Oncology, Unit of Urology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16148 Genova, Italy
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada
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11
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Shao IH, Peng PH, Wu HH, Chen JL, Lai JCY, Chang JS, Wu HT, Wu KJ, Pang ST, Hsu KW. RP11-367G18.1 V2 enhances clear cell renal cell carcinoma progression via induction of epithelial-mesenchymal transition. Cancer Med 2023; 12:9788-9801. [PMID: 36847128 PMCID: PMC10166984 DOI: 10.1002/cam4.5723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE Metastasis is the end stage of renal cell carcinoma (RCC), and clear cell renal cell carcinoma (ccRCC) is the most common malignant subtype. The hypoxic microenvironment is a common feature in ccRCC and plays an essential role in the regulation of epithelial-mesenchymal transition (EMT). Accumulating evidence manifests that long non-coding RNAs (lncRNAs) participate in RCC tumorigenesis and regulate hypoxia-induced EMT. Here, we identified a lncRNA RP11-367G18.1 induced by hypoxia, that was overexpressed in ccRCC tissues. METHODS A total of 216 specimens, including 149 ccRCC tumor samples and 67 related normal kidney parenchyma tissue samples, were collected. To investigate the biological fucntions of RP11.367G18.1 in ccRCC, migration, invasion, soft agar colony formation, xenograft tumorigenicity assays, and tail vein and orthotopic metastatic mouse models were performed. The relationship between RP11-367G18.1 and downstream signaling was analyzed utilizing reporter assay, RNA pull-down, chromatin immunopreciptation, and chromatin isolation by RNA purification assays. RESULTS Hypoxic conditions and overexpression of HIF-1α increased the level of RP11-367G18.1. RP11-367G18.1 induced EMT and enhanced cell migration and invasion through variant 2. Inhibition of RP11-367G18.1 variant 2 reversed hypoxia-induced EMT phenotypes. An in vivo study revealed that RP11-367G18.1 variant 2 was required for hypoxia-induced tumor growth and metastasis in ccRCC. Mechanistically, RP11-367G18.1 variant 2 interacted with p300 histone acetyltransferase to regulate lysine 16 acetylation on histone 4 (H4K16Ac), thus contributing to hypoxia-regulated gene expression. Clinically, RP11-367G18.1 variant 2 was upregulated in ccRCC tissues, particularly metastatic ccRCC tissues, and it is linked to poor overall survival. CONCLUSION These findings demonstrate the prognostic value and EMT-promoting role of RP11-367G18.1 and indicate that this lncRNA may provide a therapeutic target for ccRCC.
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Affiliation(s)
- I-Hung Shao
- Cancer Genome Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Hua Peng
- Cancer Genome Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Heng-Hsiung Wu
- Research Center for Cancer Biology, China Medical University, Taichung City, Taiwan.,Program for Cancer Biology and Drug Discovery, China Medical University, Taichung City, Taiwan.,Drug Development Center, China Medical University, Taichung City, Taiwan
| | - Ji-Lin Chen
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Jeng-Shou Chang
- Cancer Genome Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Han-Tsang Wu
- Cancer Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Kou-Juey Wu
- Cancer Genome Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan.,Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- Cancer Genome Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Wen Hsu
- Research Center for Cancer Biology, China Medical University, Taichung City, Taiwan.,Drug Development Center, China Medical University, Taichung City, Taiwan.,Institute of Translational Medicine and New Drug Development, China Medical University, Taichung City, Taiwan
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12
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Elgenidy A, Awad AK, Cheema HA, Shahid A, Kacimi SEO, Aly MG, Singla N, Afifi AM, Patel HD. Cause-specific mortality among patients with renal cell carcinoma in the United States from 2000 to 2018. Urol Oncol 2023; 41:209.e11-209.e20. [PMID: 36822993 DOI: 10.1016/j.urolonc.2023.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/25/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES There has been little focus on the non-cancer causes of death in patients with renal cell carcinoma (RCC). Therefore, we aimed to assess the frequency and risk of different causes of death, stratified by tumor stage, and demographics, after a diagnosis of RCC in the United States. MATERIALS AND METHODS Data on eligible patients with RCC from January 1, 2000, to December 31, 2018, in the United States were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Standardized mortality ratios for causes of death were calculated using the SEER*Stat software 8.3.9.2 for the overall population and stratified subgroups. RESULTS A total of 165,969 patients with RCC were included and 60,290 (36.3%) died during follow-up. The majority of deaths were due to kidney cancer (51.3%) but a significant proportion was non-cancer causes (37.6%). The proportion of deaths attributed to RCC decreased with increasing follow-up with non-cancer causes becoming dominant after the fifth year following RCC diagnosis. Overall, cardiovascular diseases and cerebrovascular diseases were the most common non-RCC-related causes of death. AJCC stage I and localized RCC had the most deaths attributed to non-cancerous causes (66.2% and 61.2%, respectively) while AJCC stage IV and distant RCC had the most deaths due to RCC (86.2% and 86.5%, respectively). CONCLUSION A large proportion of RCC patients die of non-cancerous causes especially early-stage patients and advanced-stage patients who survive >5 years. Coordination of multidisciplinary care with relevant specialists depending on the stage of the disease is needed to better prevent death overtime from non-cancer causes.
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Affiliation(s)
| | - Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | | | - Abia Shahid
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Mostafa G Aly
- Transplantation Immunology, Institute of Immunology, University Hospital Heidelberg, Germany; Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nirmish Singla
- The Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - Ahmed M Afifi
- Department of Gastroenterology, Hepatology and Nutrition Diseases, Texas University, MD Anderson Cancer Center, TX.
| | - Hiten D Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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13
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Buller DM, Antony M, Ristau BT. Adjuvant Therapy for High-Risk Localized Renal Cell Carcinoma: Current Landscape and Future Direction. Onco Targets Ther 2023; 16:49-64. [PMID: 36718243 PMCID: PMC9884052 DOI: 10.2147/ott.s393296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/15/2023] [Indexed: 01/25/2023] Open
Abstract
Locally and regionally advanced renal cell carcinoma (RCC) can recur at high rates even after visually complete resection of primary disease. Both targeted therapies and immunotherapies represent potential agents that might help reduce recurrence of RCC in these patients. This paper reviews the current body of evidence defining their potential impact and examines the large Phase III randomized clinical trials that have been performed to assess the safety and efficacy of these systemic therapies in the adjuvant setting. Given that the findings from these trials have been predominantly negative, this paper also explores the role of other potential adjuvant agents, including single and combination agent targeted therapies and immunotherapies, whose use is currently limited to metastatic RCC. Finally, the use of radiation therapy and the use of advanced imaging modalities in RCC are also considered.
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Affiliation(s)
| | - Maria Antony
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Benjamin T Ristau
- Division of Urology, UConn Health, Farmington, CT, USA,Correspondence: Benjamin T Ristau, Division of Urology, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, Tel +1 860 679 3438, Fax +1 860 679 6109, Email
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14
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Zhanghuang C, Wang J, Zhang Z, Yao Z, Ji F, Li L, Xie Y, Yang Z, Tang H, Zhang K, Wu C, Yan B. A nomogram for predicting cancer-specific survival and overall survival in elderly patients with nonmetastatic renal cell carcinoma. Front Surg 2023; 9:1018579. [PMID: 36684269 PMCID: PMC9852727 DOI: 10.3389/fsurg.2022.1018579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background Renal cell carcinoma (RCC) is a common malignant tumor in the elderly, with an increasing trend in recent years. We aimed to construct a nomogram of cancer-specific survival (CSS) and overall survival (OS) in elderly patients with nonmetastatic renal cell carcinoma (nmRCC). Methods Clinicopathological information was downloaded from the Surveillance, Epidemiology, and End Results (SEER) program in elderly patients with nmRCC from 2010 to 2015. All patients were randomly assigned to a training cohort (70%) or a validation cohort (30%). Univariate and multivariate Cox regression analyses were used to identify independent risk factors for patient outcomes in the training cohort. A nomogram was constructed based on these independent risk factors to predict the 1-, 3-, and 5-year CSS and OS in elderly patients with nmRCC. We used a range of methods to validate the accuracy and reliability of the model, including the calibration curve, consistency index (C-index), and the area under the receiver operating curve (AUC). Decision curve analysis (DCA) was used to test the clinical utility of the model. Results A total of 12,116 patients were enrolled in the study. Patients were randomly assigned to the training cohort (N = 8,514) and validation cohort (N = 3,602). In the training cohort, univariate and multivariate Cox regression analysis showed that age, marriage, tumor histological type, histological tumor grade, TN stage, tumor size, and surgery are independent risk factors for prognosis. A nomogram was constructed based on independent risk factors to predict CSS and OS at 1-, 3-, and 5- years in elderly patients with nmRCC. The C-index of the training and validation cohorts in CSS were 0.826 and 0.831; in OS, they were 0.733 and 0.734, respectively. The AUC results of the training and validation cohort were similar to the C-index. The calibration curve indicated that the observed value is highly consistent with the predicted value, meaning the model has good accuracy. DCA results suggest that the clinical significance of the nomogram is better than that of traditional TNM staging. Conclusions We built a nomogram prediction model to predict the 1-, 3- and 5-year CSS and OS of elderly nmRCC patients. This model has good accuracy and discrimination and can help doctors and patients make clinical decisions and active monitoring.
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Affiliation(s)
- Chenghao Zhanghuang
- Department of Urology, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China,Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China,Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Jinkui Wang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Zhaoxia Zhang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Zhigang Yao
- Department of Urology, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Fengming Ji
- Department of Urology, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Li Li
- Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children's Hospital, Children’s Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Zhen Yang
- Department of Oncology, Yunnan Children Solid Tumor Treatment Center, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Haoyu Tang
- Department of Urology, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Kun Zhang
- Department of Urology, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Chengchuang Wu
- Department of Urology, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Bing Yan
- Department of Urology, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China,Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Children’s Hospital Affiliated to Kunming Medical University, Kunming, China,Correspondence: Bing Yan
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Zhu D, Loloi J, Labagnara K, Schwartz D, Agalliu I, Fram EB, Sankin A, Aboumohamed A, Kovac E. Clinical Risk Factors Associated With Small Renal Mass Malignant Histology in a Multi-Ethnic Population Undergoing Partial Nephrectomy. Clin Genitourin Cancer 2022; 20:e465-e472. [PMID: 35768315 DOI: 10.1016/j.clgc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Small renal masses (SRMs) are often incidentally diagnosed, and a large proportion are malignant. However, there is a paucity of data describing predictors of malignancy in minority patients with SRMs. Thus, our goal was to examine clinical risk factors associated with SRM malignant histology in patients undergoing partial nephrectomy (PN) a diverse, urban academic center. MATERIALS AND METHODS Patients with a SRM undergoing PN at a single institution between 2010 to 2018 were reviewed. Demographic, clinical, and imaging characteristics were compared to pathology results. Logistic regression was used to examine associations between demographic/clinical variables for malignant and high-grade histology. RESULTS In total, 331 patients who underwent PN for SRM were included. Of those, 264 (79.8%) had malignant histology while 67 (20.2%) had benign histology. The proportions of men and of current smokers were significantly higher among patients with malignant histology. In multivariate models, non-Hispanic Black (NHB) patients had increased odds of having malignant histology (OR 2.46, 95% CI: 1.01-5.99, P = .048) and current smokers (OR = 4.02; 95% CI 1.14-14.18, P = .031). Hispanic patients had a 3-fold increased risk of high-grade RCC (OR 3.06, 95% CI: 1.19-7.87, P = 0.02) compared to Non-Hispanic White patients. CONCLUSION In our population, male sex, smoking, and NHB race/ethnicity was associated with an increased risk of malignancy in patients undergoing partial nephrectomy for SRM. Older age and Hispanic race/ethnicity were associated with high grade RCC. Our results suggest that urologists should exercise a higher level of vigilance in managing and treating SRM among NHB and Hispanic patients.
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Affiliation(s)
- Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Ilir Agalliu
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ethan B Fram
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Alex Sankin
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ahmed Aboumohamed
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Evan Kovac
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ; Cancer Institute of New Jersey, Newark, NJ.
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Peng FS, Wu WT, Zhang L, Shen JH, Yu DD, Mao LQ. Cause of death during upper tract urothelial carcinoma survivorship: A contemporary, population-based analysis. Front Oncol 2022; 12:948289. [PMID: 36387214 PMCID: PMC9650258 DOI: 10.3389/fonc.2022.948289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Very few studies have been published on the causes of death of upper tract urothelial carcinoma (UTUC). We sought to explore the mortality patterns of contemporary UTUC survivors. Methods We performed a retrospective cohort study involving patients with upper urinary tract carcinoma from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database (2000 and 2015). We used standardized mortality ratios (SMRs) to compare death rates among patients with UTUC in the general population and excess absolute risks (EARs) to quantify the disease-specific death burden. Results A total of 10,179 patients with UTUC, including 7,133 who died, were included in our study. In total, 302 (17.17%) patients with the localized disease died of UTUC; however, patients who died from other causes were 4.8 times more likely to die from UTUC (n = 1,457 [82.83%]). Cardiovascular disease was the most common non-cancer cause of death (n = 393 [22.34% of all deaths]); SMR, 1.22; 95% confidence intervals [CI], 1.1–1.35; EAR, 35.96). A total of 4,046 (69.99%) patients with regional stage died within their follow-up, 1,413 (34.92%) of whom died from UTUC and 1,082 (26.74%) of whom died from non-cancer causes. UTUC was the main cause of death (SMR, 242.48; 95% CI, 230–255.47; EAR, 542.47), followed by non-tumor causes (SMR, 1.18; 95% CI, 1.11–1.25; EAR, 63.74). Most patients (94.94%) with distant stage died within 3 years of initial diagnosis. Although UTUC was the leading cause of death (n = 721 [54.29%]), these patients also had a higher risk of death from non-cancer than the general population (SMR, 2.08; 95% CI, 1.67–2.56; EAR, 288.26). Conclusions Non-UTUC deaths accounted for 82.48% of UTUC survivors among those with localized disease. Patients with regional/distant stages were most likely to die of UTUC; however, there is an increased risk of dying from non-cancer causes that cannot be ignored. These data provide the latest and most comprehensive assessment of the causes of death in patients with UTUC.
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Affiliation(s)
- Fu-Sheng Peng
- Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Wan-Ting Wu
- Major of Clinical Medicine, Huzhou University, Huzhou, China
| | - Lu Zhang
- Major of Clinical Medicine, Huzhou University, Huzhou, China
| | - Jia-Hua Shen
- Department of Medical Insurance Fund Supervision Section, Huzhou Wu-xing District Medical Insurance Management Service Center, Huzhou, China
- *Correspondence: Li-Qi Mao, ; Dong-Dong Yu, ; Jia-Hua Shen,
| | - Dong-Dong Yu
- Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- *Correspondence: Li-Qi Mao, ; Dong-Dong Yu, ; Jia-Hua Shen,
| | - Li-Qi Mao
- Department of Gastroenterology, The First People‘s Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou, China
- *Correspondence: Li-Qi Mao, ; Dong-Dong Yu, ; Jia-Hua Shen,
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Tabourin T, Pinar U, Parra J, Vaessen C, Bensalah CK, Audenet F, Bigot P, Champy C, Olivier J, Bruyere F, Doumerc N, Paparel P, Parier B, Nouhaud FX, Durand X, Lang H, Branger N, Long JA, Durand M, Waeckel T, Charles T, Cussenot O, Xylinas E, Boissier R, Tambwe R, Patard JJ, Bernhard JC, Roupret M. Impact of Renal Cell Carcinoma Histological Variants on Recurrence After Partial Nephrectomy: A Multi-Institutional, Prospective Study (UROCCR Study 82). Ann Surg Oncol 2022; 29:7218-7228. [PMID: 35780452 DOI: 10.1245/s10434-022-12052-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/05/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prognostic impact of renal cell carcinoma (RCC) morphotype remains unclear in patients who undergo partial nephrectomy (PN). Our objective was to determine the risk factors for recurrence after PN, including RCC morphotype. METHODS Patients with RCC who had undergone PN were extracted from the prospective, national French database, UroCCR. Patients with genetic predisposition, bilateral or multiple tumours, and those who had undergone secondary totalization were excluded. Primary endpoint was 5-year, recurrence-free survival (RFS), and secondary endpoint was overall survival (OS). Risk factors for recurrence were assessed by multivariable Cox regression analysis. RESULTS Overall, 2,767 patients were included (70% male; median age: 61 years [interquartile range (IQR) 51-69]). Most (71.5%) of the PN procedures were robot-assisted. Overall, 2,573 (93.0%) patients were recurrence free, and 74 died (2.7%). Five-year RFS was 84.9% (IQR 82.4-87.4). A significant difference in RFS was observed between RCC morphotypes (p < 0.001). Surgical margins (hazard ratio [HR] = 2.0 [95% confidence interval (CI): 1.3-3.2], p < 0.01), pT stage >1 (HR = 2.6 [95% CI: 1.8-3.7], p < 0.01]) and Fuhrmann grade >2 (HR = 1.9 [95% CI: 1.4-2.6], p < 0.001) were risk factors for recurrence, whereas chromophobe subtype was a protective factor (HR = 0.08 [95% CI: 0.01-0.6], p = 0.02). Five-year OS was 94.0% [92.4-95.7], and there were no significant differences between RCC subgroups (p = 0.06). The main study limitation was its design (multicentre national database), which may be responsible for declarative bias. CONCLUSIONS Chromophobe morphotype was significantly associated with better RFS in RCC patients who underwent PN. Conversely, pT stage, Fuhrman group and positive surgical margins were risk factors for recurrence.
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Affiliation(s)
- Thomas Tabourin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Hôpital Pitié-Salpêtrière, Urology, F-75013, Paris, France
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Hôpital Pitié-Salpêtrière, Urology, F-75013, Paris, France
| | - Jerome Parra
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Hôpital Pitié-Salpêtrière, Urology, F-75013, Paris, France
| | - Christophe Vaessen
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Hôpital Pitié-Salpêtrière, Urology, F-75013, Paris, France
| | | | - Francois Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Pierre Bigot
- Department of Urology, University Hospital of Angers, Angers, France
| | - Cecile Champy
- Department of Urology, APHP, Henri Mondor University Hospital, Créteil, France
| | - Jonathan Olivier
- Department of Urology, University Hospital of Lille, Lille, France
| | - Franck Bruyere
- Department of Urology, University Hospital of Tours, Tours, France
| | - Nicolas Doumerc
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | - Philippe Paparel
- Department of Urology, University Hospital of Lyon, Lyon, France
| | - Bastien Parier
- APHP Department of Urology, Bicetre University Hospital, Paris Saclay University, Le Kremlin Bicetre, France
| | | | - Xavier Durand
- Department of Urology, Hospital Saint Joseph, Paris, France
| | - Herve Lang
- Department of Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Branger
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | | | - Matthieu Durand
- Department of Urology, University Hospital of Nice, Nice, France
| | - Thibaut Waeckel
- Department of Urology, University Hospital of Caen, Caen, France
| | - Thomas Charles
- Department of Urology, University Hospital of Poitiers, Poitiers, France
| | - Olivier Cussenot
- Sorbonne Université, GRC n°5, AP-HP, Tenon Hospital, 75020, Paris, France
| | - Evanguelos Xylinas
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Romain Boissier
- Department of Urology, University Hospital of Marseille, Marseille, France
| | - Ricky Tambwe
- Department of Urology, University Hospital of Reims, Reims, France
| | | | | | - Morgan Roupret
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Hôpital Pitié-Salpêtrière, Urology, F-75013, Paris, France.
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Xie R, Wu J, Shang B, Cao C, Bi X, Shi H, Shou J, Guan Y. Transmembrane Transporter Sema3D Serves as a Tumor Suppressor in Localized Clear Cell Renal Cell Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:3204189. [PMID: 35813868 PMCID: PMC9262505 DOI: 10.1155/2022/3204189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
Abstract
Background The transmembrane transporter Sema3D is a vital molecule involved in axon guidance and carcinogenesis of variant malignancies. However, the relationship between Sema3D and clear cell renal cell carcinoma (ccRCC) is barely reported and remains unclear. Methods Sema3D expression and the connection of clinical and histological characteristics were first analyzed with transcriptome data in the TCGA repository. We then located and examined the Sema3D expression in ccRCC patients by using immunofluorescence staining in the tissue microarray. The prognostic value of Sema3D in localized ccRCC was evaluated by Cox proportional hazard analysis. Functional and gene set enrichment analysis (GSEA), Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed to describe the potential mechanisms of Sema3D in ccRCC. Correlation analysis between Sema3D and tumor-infiltrating lymphocytes was calculated by ssGSEA. Results In 86 ccRCC patients, Sema3D mRNA and protein expression were downregulated in tumor tissues than the para-tumor tissues, and Sema3D was dominantly expressed in the extracellular space. Low expression of Sema3D was associated with advanced tumor stage, advanced histological grade, and poor prognosis in ccRCC. In the subgroup analysis of 81 localized ccRCC patients, Sema3D expression level was an independent protective prognostic factor for overall survival (OS) (HR = 0.125, p=0.043). Coagulation, complement, estrogen response, and KRAS signaling hallmark gene sets were identified as Sema3D-related signaling pathways. The expression level of Sema3D was significantly correlated with a high abundance of several immune cells (neutrophils, eosinophils, and T helper cells). Conclusions Transmembrane transporter Sema3D is an efficient prognostic biomarker for localized ccRCC patients, by playing the role of tumor suppressor in ccRCC. Sema3D can be a novel therapeutic target for ccRCC.
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Affiliation(s)
- Ruiyang Xie
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Jie Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Bingqing Shang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Chuanzhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Xingang Bi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Hongzhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Youyan Guan
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
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Zhu K, Chen Y, Guo R, Dai L, Wang J, Tang Y, Zhou S, Chen D, Huang S. Prognostic Factor Analysis and Model Construction of Triple-Negative Metaplastic Breast Carcinoma After Surgery. Front Oncol 2022; 12:924342. [PMID: 35814407 PMCID: PMC9261478 DOI: 10.3389/fonc.2022.924342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The study aimed to analyze the prognostic factors of patients with triple-negative (TN) metaplastic breast carcinoma (MpBC) after surgery and to construct a nomogram for forecasting the 3-, 5-, and 8-year overall survival (OS). Methods A total of 998 patients extracted from the Surveillance, Epidemiology, and End Results (SEER) database were assigned to either the training or validation group at random in a ratio of 7:3. The clinical characteristics of patients in the training and validation sets were compared, and multivariate Cox regression analysis was used to identify the independent risk variables for the OS of patients with TN MpBC after surgery. These selected parameters were estimated through the Kaplan–Meier (KM) curves using the log-rank test. The nomogram for predicting the OS was constructed and validated by performing the concordance index (C-index), receiver operating characteristics (ROC) curves with area under the receiver operating characteristic curves (AUC), calibration curves, and decision curve analyses (DCAs). Patients were then stratified as high-risk and low-risk, and KM curves were performed. Results Multivariate Cox regression analysis indicated that factors including age, marital status, clinical stage at diagnosis, chemotherapy, and regional node status were independent predictors of prognosis in patients with MpBC after surgery. Separate KM curves for the screened variables revealed the same statistical results as with Cox regression analysis. A prediction model was created and virtualized via nomogram based on these findings. For the training and validation cohorts, the C-index of the nomogram was 0.730 and 0.719, respectively. The AUC values of the 3-, 5-, and 8-year OS were 0.758, 0.757, and 0.785 in the training group, and 0.736, 0.735, and 0.736 for 3, 5, and 8 years in the validation group, respectively. The difference in the OS between the real observation and the forecast was quite constant according to the calibration curves. The generated clinical applicability of the nomogram was further demonstrated by the DCA analysis. In all the training and validation sets, the KM curves for the different risk subgroups revealed substantial differences in survival probabilities (P <0.001). Conclusion The study showed a nomogram that was built from a parametric survival model based on the SEER database, which can be used to make an accurate prediction of the prognosis of patients with TN MpBC after surgery.
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Affiliation(s)
| | | | | | | | | | | | | | - Dedian Chen
- *Correspondence: Sheng Huang, ; Dedian Chen,
| | - Sheng Huang
- *Correspondence: Sheng Huang, ; Dedian Chen,
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Yu DD, Chen WK, Wu CY, Wu WT, Xin X, Jiang YL, Li P, Zhang MH. Cause of Death During Renal Cell Carcinoma Survivorship: A Contemporary, Population-Based Analysis. Front Oncol 2022; 12:864132. [PMID: 35719910 PMCID: PMC9201523 DOI: 10.3389/fonc.2022.864132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background As the survival rates of patients with renal cell carcinoma (RCC) continue to increase, noncancer causes of death cannot be ignored. The cause-specific mortality in patients with RCC is not well understood. Objective Our study aimed to explore the mortality patterns of contemporary RCC survivors. Methods We performed a retrospective cohort study involving patients with RCC from the Surveillance, Epidemiology, and End Results (SEER) database. We used standardized mortality ratios (SMRs) to compare the death rates in patients with RCC with those in the general population. Results A total of 106,118 patients with RCC, including 39,630 who died (27%), were included in our study. Overall, compared with the general US population, noncancer SMRs were increased 1.25-fold (95% confidence intervals [CI], 1.22 to 1.27; observed, 11,235), 1.19-fold (95% CI, 1.14 to 1.24; observed, 2,014), and 2.24-fold (95% CI, 2.11 to 2.38; observed, 1,110) for stage I/II, III, and IV RCC, respectively. The proportion of noncancer causes of death increased with the extension of survival time. A total of 4,273 men with stage I/II disease (23.13%) died of RCC; however, patients who died from other causes were 3.2 times more likely to die from RCC (n = 14,203 [76.87%]). Heart disease was the most common noncancer cause of death (n = 3,718 [20.12%]; SMR, 1.23; 95% CI, 1.19–1.27). In patients with stage III disease, 3,912 (25.98%) died from RCC, and 2,014 (13.37%) died from noncancer causes. Most patients (94.99%) with stage IV RCC died within 5 years of initial diagnosis. Although RCC was the leading cause of death (n = 12,310 [84.65%]), patients with stage IV RCC also had a higher risk of noncancer death than the general population (2.24; 95% CI, 2.11–2.38). Conclusions Non-RCC death causes account for more than 3/4 of RCC survivors among patients with stage I/II disease. Patients with stage IV are most likely to die of RCC; however, there is an increased risk of dying from septicemia, and suicide cannot be ignored. These data provide the latest and most comprehensive assessment of the causes of death in patients with RCC.
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Affiliation(s)
- Dong-Dong Yu
- Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Wei-Kang Chen
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chen-Yu Wu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wan-Ting Wu
- Department of Clinical Medicine, Huzhou University, Huzhou, China
| | - Xiao Xin
- Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Yu-Li Jiang
- Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Peng Li
- Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Ming-Hua Zhang
- Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
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Michael J, Velazquez N, Renson A, Tan HJ, Rose TL, Osterman CK, Milowsky M, Kang SK, Huang WC, Bjurlin MA. Does histologic subtype impact overall survival in observed T1a kidney cancers compared with competing risks? Implications for biopsy as a risk stratification tool. Int J Urol 2022; 29:845-851. [PMID: 35474518 DOI: 10.1111/iju.14910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/10/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We sought to assess if adding a biopsy proven histologic subtype to a model that predicts overall survival that includes variables representing competing risks in observed, biopsy proven, T1a renal cell carcinomas, enhances the model's performance. METHODS The National Cancer Database was assessed (years 2004-2015) for patients with observed T1a renal cell carcinoma who had undergone renal mass biopsy. Kaplan-Meier curves were utilized to estimate overall survival stratified by histologic subtype. We utilized C-index from a Cox proportional hazards model to evaluate the impact of adding histologic subtypes to a model to predict overall survival for each stage. RESULTS Of 132 958 T1a renal masses identified, 1614 had biopsy proven histology and were managed non-operatively. Of those, 61% were clear cell, 33% papillary, and 6% chromophobe. Adjusted Kaplan-Meier curves demonstrated a difference in overall survival between histologic subtypes (P = 0.010) with greater median overall survival for patients with chromophobe (85.1 months, hazard rate 0.45, P = 0.005) compared to clear cell (64.8 months, reference group). Adding histology to a model with competing risks alone did not substantially improve model performance (C-index 0.65 vs 0.64 respectively). CONCLUSIONS Incorporation of histologic subtype into a risk stratification model to determine prognostic overall survival did not improve modeling of overall survival compared with variables representing competing risks in patients with T1a renal cell carcinoma managed with observation. These results suggest that performing renal mass biopsy in order to obtain tumor histology may have limited utility. Future studies should further investigate the overall utility of renal mass biopsy for observed T1a kidney cancers.
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Affiliation(s)
- Jamie Michael
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nermarie Velazquez
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York City, New York, USA
| | - Audrey Renson
- Department of Clinical Research, NYU Langone Hospital - Brooklyn, Brooklyn, New York, USA
| | - Hung-Jui Tan
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tracy L Rose
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chelsea K Osterman
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew Milowsky
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stella K Kang
- Department of Radiology, NYU Langone Health, New York City, New York, USA.,Department of Population Health, NYU School of Medicine, New York City, New York, USA
| | - William C Huang
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York City, New York, USA
| | - Marc A Bjurlin
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Numakura K, Nakai Y, Kojima T, Osawa T, Narita S, Nakayama M, Kitamura H, Nishiyama H, Shinohara N. Overview of clinical management for older patients with renal cell carcinoma. Jpn J Clin Oncol 2022; 52:665-681. [PMID: 35397166 DOI: 10.1093/jjco/hyac047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
The rapidly increasing pool of older patients being diagnosed with and surviving their cancer is creating many challenges. Regarding localized renal cell carcinoma, surgery is considered as gold standard treatment options even in older men, whereas active surveillance and ablation therapy are alternative options for a proportion of these patients. With regard to advanced disease, anti-vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) and immune check point inhibitor are standard treatment modalities, although treatment choice from multiple regimens and prevention of adverse events need to be considered. Better assessment techniques, such as comprehensive geriatric assessment to meet the unique needs of older patients, are a central focus in the delivery of high-quality geriatric oncology care. Through this process, shared decision-making should be adopted in clinical care to achieve optimal goals of care that reflect patient and caregiver hopes, needs and preferences. It is necessary to continue investigating oncological outcomes and complications associated with treatment in this population to ensure appropriate cancer care. In this narrative review, we completed a literature review of the various treatments for renal cell carcinoma in older patients that aimed to identify the current evidence related to the full range of the treatments including active surveillance, surgery, ablation therapy and systemic therapy. Prospectively designed studies and studies regarding geriatric assessment were preferentially added as references. Our goals were to summarize the real-world evidence and provide a decision framework that guides better cancer practices for older patients with renal cell carcinoma.
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Affiliation(s)
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Wang J, Zhanghuang C, Tan X, Mi T, Liu J, Jin L, Li M, Zhang Z, He D. Development and Validation of a Nomogram to Predict Distant Metastasis in Elderly Patients With Renal Cell Carcinoma. Front Public Health 2022; 9:831940. [PMID: 35155365 PMCID: PMC8831843 DOI: 10.3389/fpubh.2021.831940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/24/2021] [Indexed: 12/09/2022] Open
Abstract
BackgroundRenal cell carcinoma (RCC) is the most common renal malignant tumor in elderly patients. The prognosis of renal cell carcinoma with distant metastasis is poor. We aim to construct a nomogram to predict the risk of distant metastasis in elderly patients with RCC to help doctors and patients with early intervention and improve the survival rate.MethodsThe clinicopathological information of patients was downloaded from SEER to identify all elderly patients with RCC over 65 years old from 2010 to 2018. Univariate and multivariate logistic regression analyzed the training cohort's independent risk factors for distant metastasis. A nomogram was established to predict the distant metastasis of elderly patients with RCC based on these risk factors. We used the consistency index (C-index), calibration curve, and area under the receiver operating curve (AUC) to evaluate the accuracy and discrimination of the prediction model. Decision curve analysis (DCA) was used to assess the clinical application value of the model.ResultsA total of 36,365 elderly patients with RCC were included in the study. They were randomly divided into the training cohort (N = 25,321) and the validation cohort (N = 11,044). In the training cohort, univariate and multivariate logistic regression analysis suggested that race, tumor histological type, histological grade, T stage, N stage, tumor size, surgery, radiotherapy, and chemotherapy were independent risk factors for distant metastasis elderly patients with RCC. A nomogram was constructed to predict the risk of distant metastasis in elderly patients with RCC. The training and validation cohort's C-indexes are 0.949 and 0.954, respectively, indicating that the nomogram has excellent accuracy. AUC of the training and validation cohorts indicated excellent predictive ability. DCA suggested that the nomogram had a better clinical application value than the traditional TN staging.ConclusionThis study constructed a new nomogram to predict the risk of distant metastasis in elderly patients with RCC. The nomogram has excellent accuracy and reliability, which can help doctors and patients actively monitor and follow up patients to prevent distant metastasis of tumors.
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Affiliation(s)
- Jinkui Wang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chenghao Zhanghuang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Urology, Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Xiaojun Tan
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical University, Nanchong, China
| | - Tao Mi
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayan Liu
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Liming Jin
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Mujie Li
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhaoxia Zhang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Dawei He
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Dawei He
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Zhang T, Liu L, Qiu B. Development of a competing risk nomogram for the prediction of cause-specific mortality in patients with thymoma: a population-based analysis. J Thorac Dis 2022; 13:6838-6847. [PMID: 35070368 PMCID: PMC8743403 DOI: 10.21037/jtd-21-931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/09/2021] [Indexed: 11/07/2022]
Abstract
Background This study was developed to assess the odds of cause-specific mortality and other types of mortality in thymoma patients. In addition, these analyses were leveraged to develop a comprehensive competing risk model-based nomogram capable of predicting cause-specific mortality as a result of thymoma. Methods Thymoma patients included within the Surveillance, Epidemiology, and End Results (SEER) database from 2004–2016 were identified, and the odds of cause-specific mortality due to thymoma and other forms of mortality for these patients were estimated. In addition, Fine and Gray’s proportional subdistribution hazard model was constructed, and a competing risk nomogram was developed using this model that was capable of predicting the odds of 3-, 5-, and 10-year cause-specific mortality in thymoma patients. Results In total, 1,591 relevant cases in the SEER database were selected for analysis. In this patient cohort, the respective 5-year cumulative incidence rates for cause-specific mortality and mortality attributable to other causes were 12.4% and 8.2%. Variables significantly associated with cause-specific mortality included age, chemotherapy, surgery, and Masaoka stage. Additionally, the odds of other-cause-specific mortality rose with increasing patient age, and chemotherapy was correlated with other-cause-specific mortality. The competing risk nomogram that was developed exhibited good discriminative ability as a means of predicting cause-specific mortality, as evidenced by a concordance index (C-index) value of 0.84. Calibration curves further revealed excellent consistency between predicted and actual mortality when using this nomogram. Conclusions In summary, we herein assessed the odds of cause-specific and other-cause-specific mortality among thymoma patients, and we designed a novel nomogram capable of predicting cause-specific mortality for thymoma, providing a promising tool that may be of value in the context of individualized patient prognostic evaluation.
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Affiliation(s)
- Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lipin Liu
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Qiu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Psutka SP, Gulati R, Jewett MAS, Fadaak K, Finelli A, Legere L, Morgan TM, Pierorazio PM, Allaf ME, Herrin J, Lohse CM, Houston Thompson R, Boorjian SA, Atwell TD, Schmit GD, Costello BA, Shah ND, Leibovich BC. A Clinical Decision Aid to Support Personalized Treatment Selection for Patients with Clinical T1 Renal Masses: Results from a Multi-institutional Competing-risks Analysis. Eur Urol 2021; 81:576-585. [PMID: 34862099 DOI: 10.1016/j.eururo.2021.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/28/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Personalized treatment for clinical T1 renal cortical masses (RCMs) should take into account competing risks related to tumor and patient characteristics. OBJECTIVE To develop treatment-specific prediction models for cancer-specific mortality (CSM), other-cause mortality (OCM), and 90-d Clavien grade ≥3 complications across radical nephrectomy (RN), partial nephrectomy (PN), thermal ablation (TA), and active surveillance (AS). DESIGN, SETTING, AND PARTICIPANTS Pretreatment clinical and radiological features were collected for consecutive adult patients treated with initial RN, PN, TA, or AS for RCMs at four high-volume referral centers (2000-2019). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Prediction models used competing-risks regression for CSM and OCM and logistic regression for 90-d Clavien grade ≥3 complications. Performance was assessed using bootstrap validation. RESULTS AND LIMITATIONS The cohort comprised 5300 patients treated with RN (n = 1277), PN (n = 2967), TA (n = 476), or AS (n = 580). Over median follow-up of 5.2 yr (interquartile range 2.5-8.7), there were 117 CSM, 607 OCM, and 198 complication events. The C index for the predictive models was 0.80 for CSM, 0.77 for OCM, and 0.64 for complications. Predictions from the fitted models are provided in an online calculator (https://small-renal-mass-risk-calculator.fredhutch.org). To illustrate, a hypothetical 74-yr-old male with a 4.5-cm RCM, body mass index of 32 kg/m2, estimated glomerular filtration rate of 50 ml/min, Eastern Cooperative Oncology Group performance status of 3, and Charlson comorbidity index of 3 has predicted 5-yr CSM of 2.9-5.6% across treatments, but 5-yr OCM of 29% and risk of 90-d Clavien grade 3-5 complications of 1.9% for RN, 5.8% for PN, and 3.6% for TA. Limitations include selection bias, heterogeneity in practice across treatment sites and the study time period, and lack of control for surgeon/hospital volume. CONCLUSIONS We present a risk calculator incorporating pretreatment features to estimate treatment-specific competing risks of mortality and complications for use during shared decision-making and personalized treatment selection for RCMs. PATIENT SUMMARY We present a risk calculator that generates personalized estimates of the risks of death from cancer or other causes and of complications for surgical, ablation, and surveillance treatment options for patients with stage 1 kidney tumors.
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Affiliation(s)
- Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA.
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Kamel Fadaak
- Department of Urology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Antonio Finelli
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Laura Legere
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Phillip M Pierorazio
- Department of Urology, Brady Urological Institute, Department of Urology at Johns Hopkins, Baltimore, MD, USA
| | - Mohamad E Allaf
- Department of Urology, Brady Urological Institute, Department of Urology at Johns Hopkins, Baltimore, MD, USA
| | - Jeph Herrin
- Division of Cardiology, Yale School of Medicine, New Haven, CT, USA; Health Research & Educational Trust, Chicago, IL, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Grant D Schmit
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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The prognostic significance of controlling nutritional status (CONUT) score for surgically treated renal cell cancer and upper urinary tract urothelial cancer: a systematic review and meta-analysis. Eur J Clin Nutr 2021; 76:801-810. [PMID: 34815539 DOI: 10.1038/s41430-021-01014-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 02/05/2023]
Abstract
In order to evaluate the predictive effect of the controlled nutritional status (CONUT) score on the prognosis of patients with renal cell carcinoma (RCC) and upper urinary tract urothelial carcinoma (UTUC), a meta-analysis was performed. This systematic review has been registered on PROSPERO, the registration ID is CRD42021251879. A systematic search of the published literature using PubMed, Web of Science, Cochrane Library, EMBASE, and MEDLINE was performed. The fields of "renal cell cancer," "upper tract urothelial cancer," and "controlling nutritional status" and other fields were used as search terms. STATA 16 software was used to carry out data merging and statistical analysis of binary variables, Q test and χ2 tests were used to verify the heterogeneity between the included works of studies. Subgroup analysis and sensitivity analysis were used to explain the sources of heterogeneity between studies. Begg's test was used to assess publication bias between studies. From the first 542 studies retrieved, through strict inclusion and exclusion criteria, 7 studies finally met the requirements and were included in the meta-analysis. Pooled results indicated that high CONUT indicates worse over survival (OS) [HR = 1.70, 95% CI (1.43-2.03), P = 0.02], cancer-specific survival (CSS) [HR = 1.84, 95% CI (1.52-2.23), P = 0.01], recurrence-free survival (RFS) [HR = 1.60, 95% CI (1.26-2.03), P = 0.116], and disease-free survival (DFS) [HR = 1.47, 95% CI (1.20-1.81), P = 0.03]. Based on cancer type, cutoff value, region, and sample size, a subgroup analysis was performed. The results showed that OS and CSS were not affected by the above factors, and the high CONUT score before surgery predicted worse OS and CSS. In conclusion, this meta-analysis revealed that the preoperative CONUT score is a potential independent predictor of the postoperative prognosis of RCC/UTUC patients. A high CONUT predicts worse OS/CSS/DFS and RFS in patients.
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Disease Progression in Older Patients With Renal Tumor Assigned to an Active Surveillance Protocol. Clin Genitourin Cancer 2021; 20:e53-e60. [PMID: 34815184 DOI: 10.1016/j.clgc.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Active surveillance (AS) is a validated option for the treatment of small renal masses (SMRs), especially in older patients. This study investigates the oncologic outcomes and competitive mortality of older patients prospectively assigned to AS. METHODS We conducted a monocentric study on patients ≥75 years treated between 2011 and 2016 for a SMR. Treatment modalities, biopsy data, survivals (overall, specific, cancer progression) and delayed interventions were analyzed. RESULTS Overall, 106 patients (median age 80.5 years) were included, of which 41 were managed by AS during a follow-up of 3.4 years [0-7.1]. Seven patients (17%) had a primary biopsy with 3 confirmed renal cell carcinomas. Fourteen patients (34.1%) presented with progression (29.2% local; 4.9% metastatic), 8 (19.5%) requiring delayed interventions (75% ablative therapy and 25% radical nephrectomy). Overall survival (OS) was 68.3% and cancer specific survival was 95.1% during the study period. Competitive mortality was higher (84.6%) than cancer specific mortality (15.4%), P = .001. CONCLUSION The growth rate of progression including 4.9% metastatic progression underlines the value of AS compared to simple watchful surveillance in the treatment of SMRs in older patients. Of note, the higher competitive mortality confirm that AS should be preferred to active intervention at the beginning of the management.
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Hou Q, Yu X, Cheng Z, Han Z, Liu F, Dou J, Yu J, Liang P. Survival benefits analyses of T1a renal cell carcinoma patients treated with microwave ablation. Eur J Radiol 2021; 144:109951. [PMID: 34607288 DOI: 10.1016/j.ejrad.2021.109951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/26/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The individual decision-making reference of Microwave ablation (MWA) for T1a RCC treatment is not clear, and it may not benefit all the patients equally. Therefore, we quantitatively evaluated the distinct survival benefits of patients with T1a RCC stratified by survival predictors. MATERIALS AND METHODS A total of 237 patients with T1a RCC who underwent MWA over the last 16 years were retrospectively reviewed for survival benefit analysis. Cox proportional hazard models were used to control for the prognostic variables of OS, CSS, and PFS. Survival rates were calculated using the Kaplan-Meier method and compared by log-rank analysis. Linear extrapolation was used to compute median survival periods. RESULTS The OS benefit was significantly dependent on age (HR:2.499, 95% CI: 1.245-5.016, p = 0.010) and age-adjusted Charlson comorbidity index (CCI) score (HR:3.956, 95% CI, 1.409-11.110, p = 0.009). OS in patients aged <75 years or with an age-adjusted CCI score <7 was significantly prolonged (44.68, 65.55 months) compared to OS in patients aged ≥75 years or with CCI score ≥7 (p < 0.001 for both). PFS benefit was significantly dependent on age-adjusted CCI (HR:3.325, 95% CI, 1.390-7.956, p = 0.007), patient type (HR:0.4, 95% CI, 0.214-0.745, p = 0.004), and tumour growth pattern (HR:12.562, 95% CI, 1.552-101.696, p = 0.018). PFS in incipient patients was significantly prolonged (33.75 months) compared to that in the relapsed patients (p = 0.037). Patients with an age-adjusted CCI score <7 or without tumour protruding into the renal pelvis, lived free from recurrence or metastasis (55.69 or 101.61 months) longer than that in patients with an age-adjusted CCI score ≥7 or with tumour protruding into the renal pelvis (p < 0.01 for both). None of the variables was associated with CSS benefit. CONCLUSIONS The OS and PFS benefits from MWA were not equal for all T1a RCC patients. Age ≥75 years and age-adjusted CCI ≥ 7 significantly shortened OS. Age-adjusted CCI ≥ 7, relapsed RCC, and RCC protruding into the renal pelvis significantly shortened the PFS period. For a better survival prognosis, appropriate patient triage is still needed.
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Affiliation(s)
- Qidi Hou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China; Department of Clinical Laboratory, Institute of Laboratory Medicine, Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, School of Medical Technology, Guangdong Medical University, Dongguan 523808, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China.
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China.
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China.
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Fragkiadis E, Alamanis C, Constantinides CA, Mitropoulos D. Prediction of post radical nephrectomy complications based on patient comorbidity preoperatively. Arch Ital Urol Androl 2021; 93:251-254. [PMID: 34839625 DOI: 10.4081/aiua.2021.3.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Comorbidity along with tumor and patient characteristics is taken into account when deciding for the surgical treatment of renal cell carcinoma (RCC). Comorbidity has also been used as an independent predictive factor for postoperative complications of several major urological procedures including radical nephrectomy for RCC. The aim of the present study was to objectively evaluate the association between comorbidity and postoperative complications after radical nephrectomy for RCC, using standardized systems to grade both comorbidity and severity of postoperative complications. MATERIALS AND METHODS Clinicopathological data of 171 patients undergoing open radical nephrectomy for lesions suspected of RCC were prospectively recorded for a period of 3 years. Comorbidity was scored using the Charlson Comorbidity Index (CCI) while postoperative complications were graded according to the Clavien-Dindo system. RESULTS Patients were predominantly males (59.1%); their age ranged from 35 to 88 years (mean ± SD: 63.6 ± 11.9 yrs) with 50.8% of them being ≤ 65 yrs. CCI ranged from 0 to 8 with the majority (85.3%) scoring ≤ 2. The procedure was uncomplicated in 57.3% cases; 10 patients suffered major (grade III/IV) complications and 4 patients died within the 40 days postoperative period. CCI correlated with the manifestation of any postoperative complication, Clavien ≥ 1, OR (95% CI): 1.47 (1.09-1.96), p = 0.011 and the occurrence of severe complications, Clavien > 2. OR (95% CI): 1.29 (1.01-1.63), p = 0.038. CONCLUSIONS The present prospective study showed that considerable complications occur in patients with major comorbidities. CCI is easily calculated and should be incorporated in preoperative consultation especially in cases of elder patients with severe comorbidity and favorable tumor characteristics where less invasive interventions or even active surveillance could be applied.
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Yang C, Shuch B, Kluger HM, Serrano M, Kibel AS, Humphrey PA, Adeniran AJ. Adverse Histopathologic Characteristics in Small Papillary Renal Cell Carcinomas Have Minimal Impact on Prognosis. Am J Clin Pathol 2021; 156:550-558. [PMID: 34424955 DOI: 10.1093/ajcp/aqab015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Tumor size has long been used in the management decision-making of patients with renal masses. Active surveillance had recently gained traction in selected patients with tumor size of 4 cm or less. Adverse histopathologic characteristics in papillary renal cell carcinoma (PRCC) have been shown to correlate with worse prognosis. We aimed to study whether such features in small PRCCs provide additional prognostic information. METHODS Nephrectomies from our institution were collected and reviewed to evaluate for adverse histopathologic features. Clinical follow-up information was collected for all cases. Relationships between the variables were examined by Wilcoxon test and logistic regression. RESULTS We identified 291 consecutive cases of PRCC. Adverse tumor histopathologic characteristics were significantly related to size. In PRCCs with size greater than 4 cm, there were more cases with high World Health Organization/International Society of Urological Pathology grade and necrosis. Adverse histologic features are less commonly seen in small PRCC and are not associated with lower disease-free survival or disease-specific survival. CONCLUSIONS Identification of these features in small PRCCs (≤4 cm) through needle core biopsy examination would not provide additional prognostic information in patients for whom active surveillance is considered. Clinical and radiologic follow-up in patients with small renal masses that have a known histologic diagnosis of PRCC should be sufficient.
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Affiliation(s)
- Chen Yang
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Brian Shuch
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Harriet M Kluger
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | | | - Adam S Kibel
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Peter A Humphrey
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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Wang W, Chang G, Sun Y, Zhuo R, Li H, Hu Y, Ye C. Nomograms for Individualized Evaluation of Prognosis in Adrenocortical Carcinomas for the Elderly: A Population-Based Analysis. J INVEST SURG 2021; 35:1153-1160. [PMID: 34433351 DOI: 10.1080/08941939.2021.1968981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is extremely rare in elderly patients. Thus, this study aimed to identify the incidence rate and develop nomogram models for predicting survival in elderly ACC patients. METHODS Data of ACC patients aged >60 years from 1975 to 2016 were obtained from the Surveillance, Epidemiology, and End Results dataset. The national incidence rate was estimated, and survival was subjected to Kaplan-Meier analysis. A multivariate Cox regression model was used to identify predictors of survival. Nomograms were generated to predict survival, calibrated and internally validated. RESULTS We identified 583 cases. Univariate analysis showed that patients with younger age (≤67 years), female sex, lower tumor grade, surgical treatment performed, and earlier European Network for the Study of Adrenal Tumors (ENSAT) stage had a better survival (P < 0.05). In the Cox regression analysis, no surgery performed (hazard ratio [HR]: 3.544, 95% CI: 1.142-10.995, P = 0.029 for overall survival [OS]; HR: 3.230, 95% CI: 1.040-10.034, P = 0.043 for disease-specific survival [DSS]) and advanced ENSAT stage (HR: 3.328, 95% CI: 1.628-6.801, P = 0.001 for OS; HR: 3.701, 95% CI: 1.682-8.141, P = 0.001 for DSS) were associated with worse outcomes. Age, sex, histologic grade, surgical resection, radiotherapy, and ENSAT stage were included in the nomograms, with a C-index of 0.692 for OS and 0.694 for DSS, demonstrating a good accuracy in predicting survival. CONCLUSIONS This study is the largest review of ACC in elderly patients. We present nomograms to predict survival in elderly ACC patients using clinicopathologic data, which could aid in accurate clinical decision-making.
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Affiliation(s)
- Weixi Wang
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Guilin Chang
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Yan Sun
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Ran Zhuo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Huiting Li
- Department of Respiratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Hu
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Cong Ye
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Masic S, Strother M, Kidd LC, Egleston B, Braun A, Srivastava A, Smaldone M, Milestone B, Parsons R, Viterbo R, Greenberg R, Chen D, Kutikov A, Uzzo R. Feasibility and Outcomes of Renal Mass Biopsy for Anatomically Complex Renal Tumors. Urology 2021; 158:125-130. [PMID: 34380055 DOI: 10.1016/j.urology.2021.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the feasibility and outcomes of renal mass biopsies (RMB) of anatomically complex vs non-complex renal masses. METHODS Our institutional renal tumor database was queried for patients who underwent RMB between 2005 and 2019 and with available nephrometry score. Complex masses were: (1) small (<2 cm), (2) entirely endophytic (nephrometry E=3), (3) hilar (h) or (4) partially endophytic (E=2) and anterior. Demographic and pathologic data were compared. Biopsies were deemed adequate if they resulted in a diagnosis. Concordance with surgical pathology was assessed. These were both presented using proportions. Factors associated with biopsy outcomes were identified using multivariable logistic regression. RMB sensitivity and specificity were calculated using contingency methods. RESULTS A total of 306 RBMs were included, 179 complex and 127 non-complex. A total of 199 (65%) had an extirpative procedure. Complex lesions were less likely to have an adequate biopsy (89% vs 96%, P = .03), and to be concordant with final surgical pathology from an oncologic standpoint (89% vs 97%, P = .03). There was no significant difference in concordance of histology (76% vs 86%, P = .10) or grade (48 vs 51%, P = .66). On multivariable analyses, only male gender was associated with biopsy adequacy (OR 3.31, 95% CI 1.28-8.55, P = .01). Our overall sensitivity was 93%, specificity 93%, and accuracy 93%. There were no significant differences over time in biopsy outcomes during the study period. CONCLUSION RMB of complex lesions is associated with excellent diagnostic yield, albeit lower than non-complex lesions. RMB should not be deferred in cases of anatomically complex lesions where additional data could improve clinical decision-making.
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Affiliation(s)
- Selma Masic
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Marshall Strother
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Laura C Kidd
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Brian Egleston
- The Department of Biostatistics, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Avery Braun
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Abhishek Srivastava
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Marc Smaldone
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Barton Milestone
- The Department of Radiology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Rosaleen Parsons
- The Department of Radiology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Rosalia Viterbo
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Richard Greenberg
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - David Chen
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Alexander Kutikov
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA
| | - Robert Uzzo
- The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA.
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Courcier J, De La Taille A, Lassau N, Ingels A. Comorbidity and frailty assessment in renal cell carcinoma patients. World J Urol 2021; 39:2831-2841. [PMID: 33616708 DOI: 10.1007/s00345-021-03632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Renal cell carcinoma (RCC) incidence has considerably increased during the last decades without any real impact on age-standardized mortality. It questions the relevance of aggressive treatments carrying potential side effects. Conservative management should be considered for frail patients. Comorbidity and frailty assessment in RCC patients is paramount before engaging a treatment. METHODS Narrative, non-systematic review based on PubMed and EMBASE search with the terms "renal neoplasm", "elderly, frail", "comorbidities", "active surveillance", "metastatic". The selection was restricted to articles written in English. RESULTS Comorbidity and frailty assessment go along with the cancer-specific aggressivity and intervention risks assessment. In localized disease, several standardized algorithms offer patient health evaluation to define how suitable the patient would be for curative treatment. The pre-operative American Society of Anesthesiologists and the age-adjusted Charlson's scores are the most widely used. At the metastatic stage, drug combinations based on immunotherapies and targeted therapies improved cancer outcomes at the price of significant toxicities. Frail patients are not always suitable for such strategies. Commonly used scores like the International Metastatic RCC Database Consortium or Memorial Sloan Kettering Cancer Center integrate features to define patients' risk groups, more specifically the Karnofsky Performance Score is an easy way to document the frailty. CONCLUSIONS Comorbidity and frailty have to be assessed at any stage of the RCC disease based on a standardized scoring system to define the most suitable treatment strategy ranging from surveillance to aggressive treatment.
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Affiliation(s)
- Jean Courcier
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
| | - Alexandre De La Taille
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Nathalie Lassau
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
- Department of Imaging, Institut Gustave Roussy, Villejuif, France
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France.
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Su X, Hou NN, Yang LJ, Li PX, Yang XJ, Hou GD, Gao XL, Ma SJ, Guo F, Zhang R, Zhang WH, Qin WJ, Wang FL. The first competing risk survival nomogram in patients with papillary renal cell carcinoma. Sci Rep 2021; 11:11835. [PMID: 34088935 PMCID: PMC8178392 DOI: 10.1038/s41598-021-91217-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/24/2021] [Indexed: 01/15/2023] Open
Abstract
There is still a lack of competing risk analysis of patients with papillary renal cell carcinoma (pRCC) following surgery. We performed the cumulative incidence function (CIF) to estimate the absolute risks of cancer-specific mortality (CSM) and other-cause mortality (OCM) of pRCC over time, and constructed a nomogram predicting the probability of 2-, 3- and 5-year CSM based on competing risk regression. A total of 5993 pRCC patients who underwent nephrectomy between 2010 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The 2-, 3-, 5-year CSM rates were 3.2%, 4.4% and 6.5%, respectively, and that of OCM were 3.2%, 5.0% and 9.3%, respectively. The estimates of 5-year cumulative mortality were most pronounced among patients aged > 75 years in OCM (17.0%). On multivariable analyses, age, tumor grade, T stage, N stage, and with or without bone, liver and lung metastases were identified as independent predictors of CSM following surgery and were integrated to generate the nomogram. The nomogram achieved a satisfactory discrimination with the AUCt of 0.730 at 5-year, and the calibration curves presented impressive agreements. Taken together, age-related OCM is a significant portion of all-cause mortality in elderly patients and our nomogram can be used for decision-making and patient counselling.
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Affiliation(s)
- Xing Su
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Niu-Niu Hou
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Li-Jun Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Peng-Xiao Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiao-Jian Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Guang-Dong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xue-Lin Gao
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Shuai-Jun Ma
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Fan Guo
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Rui Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Wu-He Zhang
- Department of Urology, The 986th Hospital of Air Force, Xi'an, 710054, China
| | - Wei-Jun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Fu-Li Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
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Cui HW, Sullivan ME. Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices. Transl Androl Urol 2021; 10:2762-2786. [PMID: 34295761 PMCID: PMC8261444 DOI: 10.21037/tau-20-1295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022] Open
Abstract
The management trend of low-risk kidney cancer over the last decade has been from treatment with radical nephrectomy, to use of nephron sparing procedures of partial nephrectomy and ablation, as well as the option of active surveillance (AS). This narrative review aims to summarise the available guidelines related to AS and review the published descriptions of regional practices on the management of low-risk kidney cancer worldwide. A search of PubMed, Google Scholar and Cochrane Library databases for studies published 2010 to June 2020 identified 15 studies, performed between 2000 and 2019, which investigated 13 different cohorts of low-risk kidney cancer patients on AS. Although international guidelines show a level of agreement in their recommendation on how AS is conducted, in terms of patient selection, surveillance strategy and triggers for intervention, cohort studies show distinct differences in worldwide practice of AS. Prospective studies showed general agreement in their predefined selection criteria for entry into AS. Retrospective studies showed that patients who were older, with greater comorbidities, worse performance status and smaller tumours were more likely to be managed with AS. The rate of percutaneous renal mass biopsy varied between studies from 2% to 56%. The surveillance protocol was different across all studies in terms of recommended modality and frequency of imaging. Of the 6 studies which had set indications for intervention, these were broadly in agreement. Despite clear criteria for intervention, patient or surgeon preference was still the reason in 11–71% of cases of delayed intervention across 5 studies. This review shows that AS is being applied in a variety of centres worldwide and that key areas of patient selection criteria and surveillance strategy have large similarities. However, the rate of renal mass biopsy and of delayed intervention varies significantly between studies, suggesting the process of diagnosing malignant SRM and decision making whilst on AS are varying in practice. Further research is needed on the diagnosis and characterisation of incidentally found small renal masses (SRM), using imaging and histology, and the natural history of these SRM in order to develop evidence-based active surveillance protocols.
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Affiliation(s)
- Helen Wei Cui
- Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark Edward Sullivan
- Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Qi WX, Cao L, Xu C, Zhao S, Chen J. Established and Validated Novel Nomogram for Predicting Prognosis of Post-Mastectomy pN0-1 Breast Cancer without Adjuvant Radiotherapy. Cancer Manag Res 2021; 13:3517-3527. [PMID: 33935517 PMCID: PMC8079251 DOI: 10.2147/cmar.s292233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Aim To establish and validate a nomogram for predicting prognosis of breast cancer patients with pN0-1 who were treated with mastectomy and without adjuvant radiotherapy. Material and Methods The LASSO regression was performed to identify predictors of breast cancer-specific survival (BCSS), local regional recurrence (LRR) and distant metastasis (DM). Model performance was evaluated by the concordance index (C-index) and calibration plot. Results The 5-year BCSS, LRR and DM rates for the entire cohort were 98%, 2% and 4%, respectively. LASSO regression analysis found that pathological T stage, number of positive LN, grade and Ki-67 were significant predictors for both BCSS and DM-free survival, while number of resected LN and PR status were predictors for DM-free survival. In addition, number of positive LN was the only significant predictor for developing LRR. The C-indexes for the 5-year BCSS and DM nomograms were 0.81 and 0.78 in the training data set, 0.65 and 0.70 in the testing set and 0.72 and 0.69 in the external validation set, respectively. Conclusion Our prognostic nomograms accurately predict 5-year BCSS and DM-free survival in post-mastectomy breast cancer without adjuvant radiotherapy, which provides a useful tool to identify high-risk patients who could benefit from additional adjuvant therapy.
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Affiliation(s)
- Wei-Xiang Qi
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Cheng Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Shengguang Zhao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Wang Z, Wang J, Zhu Y, Liu C, Li X, Zeng X. Cause-Specific Mortality Among Survivors From T1N0M0 Renal Cell Carcinoma: A Registry-Based Cohort Study. Front Oncol 2021; 11:604724. [PMID: 33777747 PMCID: PMC7988093 DOI: 10.3389/fonc.2021.604724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Objective More T1N0M0 renal cell carcinoma (RCC) is detected and the prognosis has improved, but, the current focus on non-RCC-related mortality is superficial. We investigated cause-specific mortality and its temporal patterns after an RCC diagnosis. Methods In the Surveillance, Epidemiology, and End Results-18 database, patients with T1N0M0 RCC treated with partial nephrectomy (PN) or radical nephrectomy (RN) during 2000-15 were identified. Standardized mortality ratios (SMRs) for cause of death were calculated. Risk predictors for each cause-specific mortality were investigated using the Fine and Gray sub-distribution model. Results In all, 68,612 eligible patients were pooled. A total of 14,047 (20.5%) patients had died (cardiovascular disease [CVD], 28.3%; other non-cancer-related diseases, 20.3%; RCC, 18.7%; other cancer types, 16.3%; non-disease events, 16.1%) during follow-up. Heart disease, diabetes mellitus, and cerebrovascular disease were the primary causes of non-RCC-related mortality within 1 year after the diagnosis. The greatest proportion of death (39.0%) occurred within 1-5 years after the diagnosis, mostly due to RCC itself, followed by heart disease. However, >5 years after the diagnosis, heart disease became the leading cause of death. Compared with the general US population, a 21% (SMR, 1.21; 95%CI 1.19-1.23) increased risk of all-mortality was observed; RCC patients had a higher risk of heart disease-related death within 5-10 years (SMR, 1.10; 95%CI 1.04-1.17) and >10 years (1.12; 1.02-1.22) after the diagnosis. Older age and RN increased the death risk of CVD and RCC-specific mortality. Although a larger tumor diameter increased the risk of RCC-specific death, this was not a significant predictor for CVD. Moreover, for T1N0M0 RCC tumors of diameter >4 cm, there was no significant difference in CVD incidence for RN vs. PN. Conclusions RCC-specific mortality is a common challenge for the prognosis. Importantly, a large proportion and higher SMRs of other non-RCC-related diseases (especially CVD) should not be disregarded for the better holistic management of survivors of local RCC. Targeted prevention strategies for non-RCC-related death could lead to significant reductions in mortality for RCC survivors.
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Affiliation(s)
- Zhixian Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunpeng Zhu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Liu
- Department of General Medical, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyong Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology of Hubei Province, Wuhan, China
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Chandrasekar T, Boorjian SA, Capitanio U, Gershman B, Mir MC, Kutikov A. Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass. Eur Urol 2021; 80:575-588. [PMID: 33558091 DOI: 10.1016/j.eururo.2021.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. OBJECTIVE To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. CONCLUSIONS Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. PATIENT SUMMARY With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Michael J, Velazquez N, Renson A, Tan HJ, Rose TL, Osterman C, Milowsky M, Raynor M, Kang SK, Huang WC, Bjurlin MA. Overall Survival of Biopsy-confirmed T1B and T2A Kidney Cancers Managed With Observation: Prognostic Value of Tumor Histology. Clin Genitourin Cancer 2021; 19:280-287. [PMID: 33582101 DOI: 10.1016/j.clgc.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The natural history of T1b (4-7 cm) or T2a (> 7-10 cm) kidney cancers managed with observation is not well-understood. The aim of our study was to determine if the addition of histologic subtype to a predictive model of overall survival (OS) that includes covariates for competing risks in observed, biopsy-proven, T1b and T2a renal cell carcinomas (RCCs) improves the model's performance. MATERIALS AND METHODS We queried the National Cancer Database for patients with biopsy-proven stage T1b or T2a RCC and managed nonoperatively between 2004 and 2015. OS was estimated by Kaplan-Meier curves based on histologic subtype. The concordance index (c-index) from a Cox proportional hazards model was used to estimate the extent to which histologic subtypes predict survival for each stage when included in a model along with competing risks of age, gender, race/ethnicity, insurance status, area-level socioeconomic indicators, Charlson-Deyo index, and tumor grade. RESULTS A total of 937 patients (754 with T1b and 185 with T2a) with biopsy-proven RCC were identified. Kaplan-Meier analysis suggested differences in OS by histologic subtype where sarcomatoid, followed by clear cell, papillary, and chromophobe, had the highest mortality risk at 1, 3, and 5 years. However, there was marginal improvement in the multivariable model of OS using competing risks and histology (c-index, 0.64 and 0.697) compared with competing risks alone (c-index, 0.631 and 0.671) for T1b and T2a RCCs, respectively. CONCLUSIONS In patients with T1b or T2a RCC managed with observation, incorporation of histologic subtype into a risk-stratification model to determine prognostic OS did not improve modeling of OS compared with variables representing competing risks. Histologic subtype of observed T1b and T2a RCC appears to have prognostic OS value when not considering competing risks. These findings may impact the usefulness of renal biopsy to inform decision-making when managing patients with T1b and T2a renal tumors with observation.
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Affiliation(s)
- Jamie Michael
- School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Nermarie Velazquez
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York, NY
| | - Audrey Renson
- Department of Clinical Research, NYU Langone Hospital - Brooklyn, Brooklyn, NY
| | - Hung-Jui Tan
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Tracy L Rose
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Chelsea Osterman
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Matthew Milowsky
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Matt Raynor
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Stella K Kang
- Department of Radiology, NYU Langone Health, New York, NY; Department of Population Health, NYU School of Medicine, New York, NY
| | - William C Huang
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York, NY
| | - Marc A Bjurlin
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
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Mo X, Zhou M, Yan H, Chen X, Wang Y. Competing risk analysis of cardiovascular/cerebrovascular death in T1/2 kidney cancer: a SEER database analysis. BMC Cancer 2021; 21:13. [PMID: 33402111 PMCID: PMC7786899 DOI: 10.1186/s12885-020-07718-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/08/2020] [Indexed: 01/20/2023] Open
Abstract
Background Kidney cancer (KC) is associated with cardiovascular regulation disorder and easily leads to cardiovascular and cerebrovascular death (CCD), which is one of the major causes of death in patients with KC, especially those with T1/2 status. However, few studies have treated CCD as an independent outcome for analysis. We aimed to identify and evaluate the key factors associated with CCD in patients with T1/2 KC by competing risk analysis and compared these risk factors with those associated with kidney cancer-specific death (KCD) to offer some information for clinical management. Methods A total of 45,117 patients diagnosed with first primary KC in T1/2 status were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were divided into the CCD group (n = 3087), KCD group (n = 3212), other events group (n = 6312) or alive group (n = 32,506). Patients’ characteristics were estimated for their association with CCD or KCD by a competing risk model. Pearson’s correlation coefficient and variance inflation factor (VIF) were used to detect collinearity between variables. Factors significantly correlated with CCD or KCD were used to create forest plots to compare their differences. Results The competing risk analysis showed that age at diagnosis, race, AJCC T/N status, radiation therapy, chemotherapy and scope of lymph node represented different relationships to CCD than to KCD. In detail, age at diagnosis (over 74/1–50: HR = 9.525, 95% CI: 8.049–11.273), race (white/black: HR = 1.475, 95% CI: 1.334–1.632), AJCC T status (T2/T1: HR = 0.847, 95% CI: 0.758–0.946) and chemotherapy (received/unreceived: HR = 0.574, 95% CI: 0.347–0.949) were correlated significantly with CCD; age at diagnosis (over 74/1–50: HR = 3.205, 95% CI: 2.814–3.650), AJCC T/N status (T2/T1: HR = 2.259, 95% CI: 2.081–2.451 and N1/N0:HR = 3.347, 95% CI: 2.698–4.152), radiation therapy (received/unreceived: HR = 2.552, 95% CI: 1.946–3.346), chemotherapy (received/unreceived: HR = 2.896, 95% CI: 2.342–3.581) and scope of lymph nodes (1–3 regional lymph nodes removed/none: HR = 1.378, 95% CI: 1.206–1.575) were correlated significantly with KCD. Conclusions We found that age at diagnosis, race, AJCC T status and chemotherapy as the independent risk factors associated with CCD were different from those associated with KCD.
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Affiliation(s)
- Xiaofei Mo
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China
| | - Mingge Zhou
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China
| | - Hui Yan
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China
| | - Xueqin Chen
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China
| | - Yuetao Wang
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China. .,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, Jiangsu, China.
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Patel AK, Rogers CG, Johnson A, Noyes SL, Qi J, Miller D, Shervish E, Stockton B, Lane BR. Initial Observation of a Large Proportion of Patients Presenting with Clinical Stage T1 Renal Masses: Results from the MUSIC-KIDNEY Statewide Collaborative. EUR UROL SUPPL 2021; 23:13-19. [PMID: 34337485 PMCID: PMC8317780 DOI: 10.1016/j.euros.2020.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND While surgical excision remains the principal management strategy for clinical T1 renal masses (cT1RMs), the rates of noninterventional approaches are not well known. Most single-institution and population-based series suggest rates below 10%. OBJECTIVE To evaluate the use of observation for newly diagnosed cT1RM patients in academic and community-based practices across a statewide collaborative. DESIGN SETTING AND PARTICIPANTS The Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) commenced data collection in September 2017 by recording clinical, radiographic, pathologic, and short-term follow-up data for cT1RM patients at 13 diverse practices. Patients with complete data were assessed at >90 d after initial evaluation as to whether observation or treatment was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relationships with outcomes were analyzed using multivariable logistic regression, chi-square test, and Wilcoxon rank-sum test. RESULTS AND LIMITATIONS Out of 965 patients, observation was employed in 48% (n = 459), with practice-level rates ranging from 0% to 68%. Patients managed with observation (vs treatment) were significantly older (71.2 vs 62.8 yr, p < 0.0001) and had smaller tumors (2.3 vs 3.4 cm, p < 0.0001). Observation was used for 53.5% of cT1a renal masses, for 29.9% of cT1b renal masses, and for 42.5%, 53.7%, and 63.9% of radiographically solid, Bosniak III-IV cystic, and indeterminate cT1RMs, respectively. Factors significantly associated with observation in multivariable analysis included lesion type (Bosniak III-IV vs solid, p = 0.017), tumor stage (cT1a vs cT1b, p < 0.001), and higher age (p < 0.001). A short duration of follow-up limits the assessment of longer-term patient management. CONCLUSIONS Noninterventional management of cT1RMs is common across the MUSIC-KIDNEY collaborative, with wide variability across practices. Factors associated with observation were advanced age, smaller tumor size, and cystic tumor type. Durability of the initial decision for observation (delayed intervention vs active surveillance vs less active surveillance) will be a focus of subsequent study. PATIENT SUMMARY The Michigan Urological Surgery Improvement Collaborative: Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) quality improvement collaborative assessed the current utilization of initial observation of a renal mass ≤7 cm across a diverse group of urology practices and found it to be used in 48% of patients. We found that the factors predicting observation were advanced age, smaller tumor size, and cystic tumor type.
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Affiliation(s)
| | | | - Anna Johnson
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Ji Qi
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | - David Miller
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | - Brian R. Lane
- Spectrum Health Hospital System, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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Caruso AM, Ardisson KM, Ravishankar R, Malkowicz SB. A Shared Decision-Making Model for Management of Small Renal Masses: Optimizing the Patient Experience. KIDNEY CANCER 2020. [DOI: 10.3233/kca-200091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The finding of a small renal mass (SRM) on radiological imaging and the potential of a cancer diagnosis is anxiety provoking in most patients. The decision-making process often occurs in the absence of any framework regarding the nature and treatment outcomes. This project aimed to educate patients newly diagnosed with a SRM, implement a shared decision-making (SDM) model, and assess the educational attainment and effect on a SDM intervention. Methods: This project assessed the educational attainment and its effect on a SDM intervention using a pre-and post- intervention survey, an educational video [Urology Care Foundation, “What is a renal mass?], and a structured provider discussion. The survey incorporated eight knowledge questions and two questions which addressed anxiety related to diagnosis and confidence in decision-making. Results: Fifty surveys were completed. The post intervention score showed a significant increase in patient knowledge. Wilcoxon signed rank test (P = <0.001; 2.0; CI 95% (1.54–2.46)). Thirty-nine demonstrated improvement in knowledge with a mean of 2.0, 9 were unchanged and 2 decreased. Approximately 42% of patients reported a decrease in anxiety rating by a mean of 40%. When confidence in decision-making improved, it improved by a mean of 45%. Conclusions: A significant improvement in understanding of SRMs was demonstrated. This model showed improved knowledge, alleviation of anxiety and improved confidence and denotes the feasibility of implementing a SDM model in newly diagnosed patients. Results should encourage providers who aspire to incorporate a SDM as a Best Practice.
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Affiliation(s)
| | | | | | - S. Bruce Malkowicz
- Urologic Oncology Program, University of Pennsylvania, Philadelphia, PA, USA
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Zhang L, Hou G, Gao M, Zheng Y, Dun X, Hou N, Zheng W, Yan F, Lu J, Meng P, Ju D, Yuan J, Wei D, Zhu Z, Wang F, Yuan J. Novel survival nomograms for patients with lung metastatic clear cell renal cell carcinoma: A population-based study. Medicine (Baltimore) 2020; 99:e23465. [PMID: 33350729 PMCID: PMC7769336 DOI: 10.1097/md.0000000000023465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/02/2020] [Indexed: 01/04/2023] Open
Abstract
Survival heterogeneity is observed among renal cell carcinoma (RCC) patients with metastases in different organs. Moreover, almost all previous prognostic nomograms based on data from metastatic RCC patients did not take competing events, such as death from cerebrovascular and heart diseases, into account. We aimed to construct novel prognostic nomograms for patients with lung metastatic clear cell RCC (LMCCRCC).Data of 712 non-Hispanic white LMCCRCC patients registered in the Surveillance, Epidemiology, and End Results database were retrospectively analyzed. Nomograms for predicting overall survival (OS) and disease-specific survival (DSS) were established using the Cox approach and Fine and Gray approach, respectively, and their performances were assessed using the concordance index (C-index), calibration plots, and an independent cohort comprising 181 Hispanic patients.Sex, tumor grade, T stage, N stage, presence or absence of bone metastases, and presence or absence of brain metastases were independent predictors for both OS and DSS. Additionally, presence or absence of liver metastases was an independent predictor only for DSS. Meanwhile, age at diagnosis was independently associated with OS. The C-indexes of the nomograms were 0.702 for OS and 0.723 for DSS in internal validation. In external validation, the C-indexes were 0.700 for OS and 0.708 for DSS. Both internal and external calibration plots showed excellent consistency between the prediction and the observation.The current study developed a novel nomogram for predicting individual OS in LMCCRCC patients. Moreover, we constructed an effective competing risk nomogram for predicting their individual DSS for the first time.
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Affiliation(s)
- Lei Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Ming Gao
- Department of Andrology, Xi’an Daxing Hospital, Shaanxi University of Chinese Medicine
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Zheng
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Xinlong Dun
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Niuniu Hou
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Wanxiang Zheng
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Fei Yan
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Jun Lu
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Ping Meng
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Dongen Ju
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Jiarui Yuan
- St. George’ s University School of Medicine, Grenada, West Indies
| | - Di Wei
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Zheng Zhu
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Fuli Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University
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Patterns of surveillance intensity in kidney cancer. Int Urol Nephrol 2020; 53:447-453. [PMID: 33085053 DOI: 10.1007/s11255-020-02685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Surveillance guidelines for kidney cancer following surgery are heterogeneous, making it unclear what factors influence surveillance intensity in practice. Thus, we assessed the patterns of surveillance intensity in kidney cancer after primary surgery among patients ≥ 66 years. METHODS Non-metastatic kidney cancer patients after primary surgery (n = 2433) from 2007 to 2011 were identified in SEER-Medicare. Surveillance intensity was measured as the number of unique inpatient and outpatient claims made for kidney cancer starting 60 days after primary surgery. Multivariable linear regressions assessed relationships between patient factors and surveillance intensity (log-transformed). Parameters were reported using risk ratios (RRs). RESULTS Patients diagnosed in contemporary years experienced 10% more surveillance visits/12 months (RR 1.10 for every 1-year increase, 95% CI 1.07-1.13, p < 0.001). Compared to pT1 stage, patients with pT2-4 disease experienced 108% more surveillance visits/12 months (RR 2.08, 95% CI 1.90-2.27, p < 0.001). Both older age and living in a metro/urban area, as compared to a big metropolitan location, were associated with significantly fewer follow-up visits (10-year increase in age: RR 0.89, 95% CI 0.83-0.95, p < 0.001; metro/urban: RR 0.86, 95% CI 0.79-0.93, p < 0.001). Surgery type (radical, partial or ablation), gender, race and Charlson comorbidity score were not significantly associated with surveillance intensity. CONCLUSIONS Similar to guidelines, surveillance intensity in practice was associated with stage, but not with surgery type. Other factors such as diagnosis year, care location and patient age were associated with the amount of surveillance administered by the clinician. These additional influences are augmenting the heterogeneous delivery of kidney cancer surveillance care.
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Prognostic Factors in Patients with Rhabdomyosarcoma Using Competing-Risks Analysis: A Study of Cases in the SEER Database. JOURNAL OF ONCOLOGY 2020; 2020:2635486. [PMID: 33014049 PMCID: PMC7519458 DOI: 10.1155/2020/2635486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022]
Abstract
Background Rhabdomyosarcoma (RMS) is a rare malignant soft-tissue sarcoma characterized by a poor outcome and unclear prognostic factors. This study applied a competing-risks analysis using data from the Surveillance, Epidemiology, and End Results (SEER) database to RMS patients, with the aim of identifying more accurate prognostic factors. Methods Data of all patients with RMS during 1986–2015 were extracted from the SEER database. We used the competing-risks approach to calculate the cumulative incidence function (CIF) for death due to rhabdomyosarcoma (DTR) and death from other causes (DOC) at each time point. The Fine–Gray subdistribution proportional-hazards model was then applied in univariate and multivariate analyses to determine how the CIF differs between groups and to identify independent prognostic factors. The potential prognostic factors were analyzed using the competing-risks analysis methods in SAS and R statistical software. Results This study included 3399 patients with RMS. The 5-year cumulative incidence rates of DTR and DOC after an RMS diagnosis were 39.9% and 8.7%, respectively. The multivariate analysis indicated that age, year of diagnosis, race, primary site, historic stage, tumor size, histology subtype, and surgery status significantly affected the probability of DTR and were independent prognostic factors in patients with RMS. A nomogram model was constructed based on multivariate models for DTR and DOC. The performances of the two models were validated by calibration and discrimination, with C-index values of 0.758 and 0.670, respectively. Conclusions A prognostic nomogram model based on the competing-risks model has been established for predicting the probability of death in patients with RMS. This validated prognostic model may be useful when choosing treatment strategies and for predicting survival.
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Huynh MJ, Wang Y, Joshi M, Krasnow R, Yu AX, Mossanen M, Chung BI, Chang SL. Patient factors predict complications after partial nephrectomy: validation and calibration of the Preoperative Risk Evaluation for Partial Nephrectomy (PREP) score. BJU Int 2020; 127:369-374. [PMID: 32920933 DOI: 10.1111/bju.15240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To develop and validate the Preoperative Risk Evaluation for Partial Nephrectomy (PREP) score to predict the probability of major postoperative complications after partial nephrectomy (PN) based on patient comorbidities. PATIENTS AND METHODS The Premier Healthcare Database was used to identify patients who had undergone elective PN. Through review of International Classification of Diseases ninth revision codes, we identified patient comorbidities and major surgical complications (Clavien-Dindo Grade III-V). Multivariable logistic regression was used to identify predictors of major complications. We used half of the set as the training cohort to develop our risk score and the other half as a validation cohort. RESULTS From 2003 to 2015, 25 451 PNs were performed. The overall rate of major complications was 4.9%. The final risk score consisted of 10 predictors: age, sex, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, chronic kidney disease, diabetes, hypertension, obesity, and smoking. In the training cohort, the area under the receiver operating characteristic curve (AUC) was 0.75 (95% confidence interval [CI] 0.73-0.78), while the AUC for the validation cohort was 0.73 (95% CI 0.70-0.75). The predicted probabilities of major complication in the low- (≤10 points), intermediate- (11-20 points), high- (21-30 points), and very high-risk (>30 points) categories were 3% (95% CI 2.6-3.2), 8% (95% CI 7.2-9.2), 24% (95% CI 20.5-27.8), and 41% (95% CI 34.5-47.8), respectively. CONCLUSIONS We developed and validated the PREP score to predict the risk of complications after PN based on patient characteristics. Calculation of the PREP score can help providers select treatment options for patients with a cT1a renal mass and enhance the informed consent process for patients planning to undergo PN.
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Affiliation(s)
- Melissa J Huynh
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Ross Krasnow
- Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Alice X Yu
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
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Larcher A, Wallis CJ, Pavan N, Porpiglia F, Takagi T, Tanabe K, Rha KH, Raheem AA, Yang B, Zang C, Perdonà S, Quarto G, Maurer T, Amiel T, Schips L, Castellucci R, Crivellaro S, Dobbs R, Baiamonte G, Celia A, De Concilio B, Furlan M, Lima E, Linares E, Micali S, Amparore D, De Naeyer G, Trombetta C, Hampton LJ, Tracey A, Bindayi A, Antonelli A, Derweesh I, Mir C, Montorsi F, Mottrie A, Autorino R, Capitanio U. Outcomes of minimally invasive partial nephrectomy among very elderly patients: report from the RESURGE collaborative international database. Cent European J Urol 2020; 73:273-279. [PMID: 33133653 PMCID: PMC7587491 DOI: 10.5173/ceju.2020.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST] -4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
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Affiliation(s)
- Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Toshio Takagi
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Koon H. Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology, Tanta University, Tanta, Egypt; Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bo Yang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Chao Zang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Sisto Perdonà
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Giuseppe Quarto
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Tobias Maurer
- Department of Urology, Technical University, Munich, Germany
| | - Thomas Amiel
- Department of Urology, Technical University, Munich, Germany
| | - Luigi Schips
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Roberto Castellucci
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan Dobbs
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Gianfranco Baiamonte
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | - Maria Furlan
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Estevão Lima
- Department of CUF Urology and Service of Urology, Hospital of Braga, Braga, Portugal
| | | | - Salvatore Micali
- University of Modena and Reggio Emilia, Department of Urology, Modena, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Carlo Trombetta
- Department of Urology, University of Trieste, Trieste, Italy
| | | | | | - Ahmet Bindayi
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Carme Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
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Pecoraro A, Knipper S, Palumbo C, Rosiello G, Luzzago S, Tian Z, Shariat SF, Saad F, Briganti A, Fiori C, Porpiglia F, Karakiewicz PI. Assessment of other-cause mortality in localized renal cell carcinoma patients within 15 years: A population-based analysis. J Surg Oncol 2020; 122:1506-1513. [PMID: 32812284 DOI: 10.1002/jso.26149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Five-year other cause mortality (OCM) after nephrectomy for non-metastatic renal cell carcinoma (RCC) should be marginal in properly selected surgical candidates. We examined 5-year OCM rates as a quality of care indicator for patient selection. MATERIALS AND METHODS Within the Surveillance, Epidemiology, and End Results database (1997-2011), we identified 59267 RCC patients treated with either radical (n = 27 804, 46.9%) or partial nephrectomy (n = 31 463, 53.1%). Temporal trends and multivariable Cox regression analyses assessed 5-year OCM. Data were stratified according to age group, year of diagnosis, race, marital status, gender, and socio-economic status. The overall OCM rates for the entire cohort at 5 years of follow-up was 4.7% and decreased from 9.4% to 5.6% over the study span (-3.8%, P < .001). The greatest decrease in 5-year OCM rates over time was recorded in patients >70 years (17.0%-9.6%, slope, -0.6%/y), as well as in African-Americans (12.0-6.2%; slope, -0.3%/y) and in males (8.9%-4.7%; slope, -0.3%, all P < .001). CONCLUSIONS An important OCM decrease was recorded over the study span. Nonetheless, further improvement may be accomplished, especially in African-Americans, unmarried and older individuals, who exhibited higher OCM rates than others. These three groups may represent ideal targets for better patient selection based on OCM considerations.
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Affiliation(s)
- Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Department of Urology, University of Brescia, Brescia, Italy
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Department of Urology, San Raffaele Hospital, Milan, Italy
| | - Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Department of Urology, European Institute of Oncology, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | | | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | | | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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49
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Crispin-Ortuzar M, Gehrung M, Ursprung S, Gill AB, Warren AY, Beer L, Gallagher FA, Mitchell TJ, Mendichovszky IA, Priest AN, Stewart GD, Sala E, Markowetz F. Three-Dimensional Printed Molds for Image-Guided Surgical Biopsies: An Open Source Computational Platform. JCO Clin Cancer Inform 2020; 4:736-748. [PMID: 32804543 PMCID: PMC7469624 DOI: 10.1200/cci.20.00026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Spatial heterogeneity of tumors is a major challenge in precision oncology. The relationship between molecular and imaging heterogeneity is still poorly understood because it relies on the accurate coregistration of medical images and tissue biopsies. Tumor molds can guide the localization of biopsies, but their creation is time consuming, technologically challenging, and difficult to interface with routine clinical practice. These hurdles have so far hindered the progress in the area of multiscale integration of tumor heterogeneity data. METHODS We have developed an open-source computational framework to automatically produce patient-specific 3-dimensional-printed molds that can be used in the clinical setting. Our approach achieves accurate coregistration of sampling location between tissue and imaging, and integrates seamlessly with clinical, imaging, and pathology workflows. RESULTS We applied our framework to patients with renal cancer undergoing radical nephrectomy. We created personalized molds for 6 patients, obtaining Dice similarity coefficients between imaging and tissue sections ranging from 0.86 to 0.96 for tumor regions and between 0.70 and 0.76 for healthy kidneys. The framework required minimal manual intervention, producing the final mold design in just minutes, while automatically taking into account clinical considerations such as a preference for specific cutting planes. CONCLUSION Our work provides a robust and automated interface between imaging and tissue samples, enabling the development of clinical studies to probe tumor heterogeneity on multiple spatial scales.
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Affiliation(s)
- Mireia Crispin-Ortuzar
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Marcel Gehrung
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Stephan Ursprung
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Andrew B. Gill
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Anne Y. Warren
- Department of Histopathology, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Lucian Beer
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | | | - Thomas J. Mitchell
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Iosif A. Mendichovszky
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Andrew N. Priest
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Grant D. Stewart
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Evis Sala
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Florian Markowetz
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
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50
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Han D, Yang J, Xu F, Huang Q, Bai L, Wei YL, Kaaya RE, Wang S, Lyu J. Prognostic factors in patients with gallbladder adenocarcinoma identified using competing-risks analysis: A study of cases in the SEER database. Medicine (Baltimore) 2020; 99:e21322. [PMID: 32756116 PMCID: PMC7402769 DOI: 10.1097/md.0000000000021322] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A competing-risks model was developed in this study to identify the significant prognostic factors and evaluate the cumulative incidence of cause-specific death in gallbladder adenocarcinoma (GBAC), with the aim of providing guidance on effective clinical treatments.All patients with GBAC in the Surveillance, Epidemiology, and End Results (SEER) database during 1973 to 2015 were identified. The potential prognostic factors were identified using competing-risks analyses implemented using the R and SAS statistical software packages. We calculated the cumulative incidence function (CIF) for cause-specific death and death from other causes at each time point. The Fine-Gray proportional-subdistribution-hazards model was then applied in univariate and multivariate analyses to test the differences in CIF between different groups and identify independent prognostic factors.This study included 3836 eligible patients who had been enrolled from 2004 to 2015 in the SEER database. The univariate analysis indicated that age, race, AJCC stage, RS, tumor size, SEER historic stage, grade, surgery, radiotherapy, chemotherapy and adjuvant therapy (RCT, SRT, SCT and SRCT) were significant factors affecting the probability of death due to GBAC. The multivariate analysis indicated that age, race, AJCC stage, RS status, tumor size, grade and SRT were independent prognostic factors affecting GBAC cancer-specific death. A nomogram model was constructed based on multivariate models for death related to GBAC.We have constructed the first competing-risks nomogram for GBAC. The model was found to perform well. This novel validated prognostic model may facilitate the choosing of beneficial treatment strategies and help when predicting survival.
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Affiliation(s)
- Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi
| | - Jin Yang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan
| | - Ling Bai
- Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Yuan-long Wei
- Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Rahel Elishilia Kaaya
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi
| | - ShengPeng Wang
- Cardiovascular Research Center, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province
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