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Cirulli GO, Corsi N, Rakic I, Stephens A, Chiarelli G, Finati M, Davis M, Tinsley S, Sood A, Buffi N, Lughezzani G, Carrieri G, Salonia A, Briganti A, Montorsi F, Rogers C, Abdollah F. Impact of lymphovascular invasion on survival in surgically treated upper tract urothelial carcinoma: a nationwide analysis. BJU Int 2024; 133:555-563. [PMID: 38097533 DOI: 10.1111/bju.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES To assess the prognostic ability of lymphovascular invasion (LVI) in upper tract urothelial carcinoma (UTUC) as a predictor of overall survival (OS) using a large North American cohort. PATIENTS AND METHODS Our cohort included 5940 patients with clinical M0 UTUC who underwent a radical nephroureterectomy (RNU), between 2010 and 2016, within the National Cancer Database. The main variable of interest was LVI status, and its interaction with pathological nodal (pN) status. Kaplan-Meier curves were used to depict the OS also stratifying patients on LVI status. Cox regression analysis tested the impact of LVI status on OS after accounting for the available covariates. RESULTS The median (interquartile range [IQR]) age at diagnosis was 71 (63-78) years and most patients had pathological T1 stage disease (48.6%). Nodal status was pN0, pN1 and pNx in 45.8%, 6.3% and 47.9%, respectively. Overall, 22.1% had LVI. The median (IQR) follow-up time was 32.6 (16.0-53.3) months. At the 5-year postoperative follow-up, the estimated OS rate was 28% in patients with LVI vs 66% in those without LVI (P < 0.001). When patients were stratified based on nodal status those rates were 32% vs 68% in pN0 patients (P < 0.001), 23% vs 30% in pN1 patients (P = 0.8), and 28% vs 65% in pNx patients (P < 0.001). On multivariable analysis, the presence of LVI was associated with less favourable OS (hazard ratio 1.79, 95% confidence interval 1.60-1.99; P < 0.001). CONCLUSION Our study assessed the impact of LVI on OS in patients with UTUC in a large North American nationwide cohort. Our series, as the largest to date, indicate that LVI is associated with less favourable survival outcomes in patients with UTUC after RNU, and this variable could be used in counselling patients about their prognosis and might be a useful tool for future trials to risk-stratify patients.
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Affiliation(s)
- Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicholas Corsi
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Ivan Rakic
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Matthew Davis
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Shane Tinsley
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Akshay Sood
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Andrea Salonia
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
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Dalela D, Corsi NJ, Bronkema C, Sood A, Arora S, Majdalany SE, Butaney M, Jamil M, Li P, Palma-Zamora I, Rakic N, Kovacevic N, Jeong W, Menon M, Rogers CG, Schonberg MA, Abdollah F. Prostate Specific Antigen Screening on a Nationwide Level: Featuring the Contribution of Race and Life Expectancy in Decision Making. Clin Genitourin Cancer 2024; 22:269-280.e2. [PMID: 38233279 DOI: 10.1016/j.clgc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Estimation of life expectancy (LE) is important for the relative benefit of prostate specific antigen (PSA) screening. Limited data exists regarding screening for Black men with extended LE. The aim of the current study was to assess temporal trends in screening in United States (US) Black men with limited vs. extended LE, using a nationally representative dataset. MATERIALS AND METHODS Using the National Health Institution Survey (NHIS) 2000 to 2018, men aged ≥40 without prior history of prostate cancer (PCa) who underwent PSA screening in the last 12 months were stratified into limited LE (ie, LE <15 years) and extended LE (ie, LE≥15 years) using the validated Schonberg index. LE-stratified temporal trends in PSA screening were analyzed for all men, and then in Black men. Weighted multivariable analyses and dominance analyses identified the predictors of PSA screening. RESULTS PSA screening declined over the study period both for all eligible men with limited and extended LE, particularly between NHIS 2008 and 2013 (27.9%-20.7% in the extended). Screening increased significantly in Black men with extended LE (17.6% in 2010-25.7% in 2018). However, LE was not an independent predictor of screening in the Black cohort. Prior recipient of colonoscopy (55%-57%) and visit to health care provider (24%-32%) were the most important determinants for screening. CONCLUSION For US men with extended LE, only 1 in 4 receive PSA screening, with a decline over the study-period. Screening rates increased for Black men. However, these changes were not driven by LE consideration itself, but participation in other screenings and access to a provider.
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Affiliation(s)
- Deepansh Dalela
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; University of Texas Southwestern Medical Center, Dallas, TX; Wayne State University School of Medicine, Detroit, MI
| | - Nicholas J Corsi
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; University of Texas Southwestern Medical Center, Dallas, TX; Wayne State University School of Medicine, Detroit, MI
| | - Chandler Bronkema
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sohrab Arora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Sami E Majdalany
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Marcus Jamil
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Pin Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Mi
| | - Isaac Palma-Zamora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Nikola Rakic
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Natalija Kovacevic
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Mara A Schonberg
- Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI.
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3
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Corsi NJ, Stephens A, Finati M, Malchow T, Morrison C, Davis M, Hares K, Corsi MP, Arora S, Chiarelli G, Cirulli GO, Autorino R, Sood A, Rogers C, Abdollah F. Testing the external validity of the POUT III trial (adjuvant platnium-based chemotherapy in upper tract urothelial carcinoma) in a North American cohort. Urol Oncol 2024:S1078-1439(24)00051-6. [PMID: 38522975 DOI: 10.1016/j.urolonc.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The European POUT III randomized controlled trial provided level-one evidence that adjuvant platinum-based chemotherapy is the standard of care following nephroureterectomy (RNU) for locally invasive or node-positive upper tract urothelial carcinoma. We aim to assess this European randomized controlled trial's generalizability (external validity) to a North American cohort, using a nationwide database. MATERIALS AND METHODS To compare trial patients with those seen in real-world practice, we simulated the trial inclusion criteria using data from the National Cancer Database (NCDB). We identified patients with histologically confirmed transitional cell carcinoma who underwent RNU. The available demographic characteristics of the NCDB cohort were compared with the POUT III trial cohort using Chi-squared test. RESULTS The NCDB cohort (n = 3,380) had a significantly higher proportion of older patients (age ≥ 80: 23.5% vs. 5%), and more males (68% vs. 56.2%) than the POUT cohort (Table 1, both p < 0.001). Additionally, the rate of advanced nodal disease was higher in the NCDB (N1 9.6%, N2 9.3%) than in the POUT (N1 6%, N2 3%) cohort (p < 0.001). A more extensive lymph node dissection was performed in NCDB vs. POUT patients (node≥10 10.9% vs. 3%, p < 0.001). Sensitivity analysis removing all subjects with a Charlson Comorbidity Index > 0 did not change the significance of any results. CONCLUSIONS While the primary disease stage was similar, the rate of advanced nodal disease was significantly higher in NCDB, which might be explained partially by the more extensive lymph node dissection performed in the latter. These differences warrant caution when applying the POUT III findings to North American patients.
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Affiliation(s)
- Nicholas James Corsi
- Wayne State University School of Medicine, Detroit, MI; University of Texas Southwestern Medical Center, Dallas, TX
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Marco Finati
- Vattikuti Center for Outcomes Research, Analytics, and Evaluation, Detroit, MI; Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Taylor Malchow
- Wright State University Boonshoft School of Medicine, Dayton, OH
| | | | - Matthew Davis
- Vattikuti Center for Outcomes Research, Analytics, and Evaluation, Detroit, MI
| | - Keinnan Hares
- Wayne State University School of Medicine, Detroit, MI
| | | | - Sohrab Arora
- Vattikuti Center for Outcomes Research, Analytics, and Evaluation, Detroit, MI
| | - Giuseppe Chiarelli
- Vattikuti Center for Outcomes Research, Analytics, and Evaluation, Detroit, MI; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Vattikuti Center for Outcomes Research, Analytics, and Evaluation, Detroit, MI; Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Craig Rogers
- Vattikuti Center for Outcomes Research, Analytics, and Evaluation, Detroit, MI
| | - Firas Abdollah
- Vattikuti Center for Outcomes Research, Analytics, and Evaluation, Detroit, MI.
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Posada JM, Yakirevich E, Kamat AM, Sood A, Jacob JM, Bratslavsky G, Grivas P, Spiess PE, Li R, Necchi A, Mega AE, Golijanin DJ, Pavlick D, Huang RSP, Lin D, Danziger N, Sokol ES, Sivakumar S, Ross JS, Cheng L. Characterizing the Genomic Landscape of the Micropapillary Subtype of Urothelial Carcinoma of the Bladder Harboring Activating Extracellular Mutations of ERBB2. Mod Pathol 2024; 37:100424. [PMID: 38219954 DOI: 10.1016/j.modpat.2024.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/02/2023] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
The micropapillary subtype of urothelial carcinoma (MPUC) of the bladder is a very aggressive histological variant of urothelial bladder cancer (UBC). A high frequency of MPUC contains activating mutations in the extracellular domain (ECD) of ERBB2. We sought to further characterize ERBB2 ECD-mutated MPUC to identify additional genomic alterations that have been associated with tumor progression and therapeutic response. In total, 5,485 cases of archived formalin-fixed, paraffin-embedded UBC underwent comprehensive genomic profiling to identify ERBB2 ECD-mutated MPUC and evaluate the frequencies of genomic co-alterations. We identified 219 cases of UBC with ERBB2 ECD mutations (74% S310F and 26% S310Y), of which 63 (28.8%) were MPUC. Genomic analysis revealed that TERT, TP53, and ARID1A were the most common co-altered genes in ERBB2-mutant MPUC (82.5%, 58.7%, and 39.7%, respectively) and did not differ from ERBB2-mutant non-MPUC (86.5%, 51.9%, and 35.3%). The main differences between ERBB2 ECD-mutated MPUC compared with non-MPUC were KMT2D, RB1, and MTAP alterations. KMT2D and RB1 are tumor-suppressor genes. KMT2D frequency was significantly decreased in ERBB2 ECD-mutated MPUC (6.3%) in contrast to non-MPUC (27.6%; P < .001). RB1 mutations were more frequent in ERBB2 ECD-mutated MPUC (33.3%) than in non-MPUC (17.3%; P = .012). Finally, MTAP loss, an emerging biomarker for new synthetic lethality-based anticancer drugs, was less frequent in ERBB2 ECD-mutated MPUC (11.1%) than in non-MPUC (26.9%; P = .018). Characterizing the genomic landscape of MPUC may not only improve our fundamental knowledge about this aggressive morphological variant of UBC but also has the potential to identify possible prognostic and predictive biomarkers that may drive tumor progression and dictate treatment response to therapeutic approaches.
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Affiliation(s)
- Jessica M Posada
- Department of Pathology and Laboratory Medicine, The Warren Albert Medical School of Brown University, Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, Rhode Island; Laboratory of Systems Cancer Biology, The Rockefeller University, New York, New York
| | - Evgeny Yakirevich
- Department of Pathology and Laboratory Medicine, The Warren Albert Medical School of Brown University, Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, Rhode Island
| | - Ashish M Kamat
- Department of Urology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Akshay Sood
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Petros Grivas
- Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Roger Li
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Andrea Necchi
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Anthony E Mega
- Division of Hematology and Oncology, The Warren Alpert Medical School of Brown University, Lifespan Cancer Institute, Providence, Rhode Island
| | - Dragan J Golijanin
- Division of Urology, Department of Surgery, Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Dean Pavlick
- Foundation Medicine Inc., Cambridge, Massachusetts
| | | | - Douglas Lin
- Foundation Medicine Inc., Cambridge, Massachusetts
| | | | | | | | - Jeffrey S Ross
- Upstate Medical University, Syracuse, New York; Foundation Medicine Inc., Cambridge, Massachusetts.
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, The Warren Albert Medical School of Brown University, Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, Rhode Island.
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Sood A, Zhang LT, Keeley J, Butaney M, Stricker M, Andrews JR, Grauer R, Peabody JO, Rogers CG, Menon M, Abdollah F. Optimizing anti-androgen treatment use among men with pathologic lymph-node positive prostate cancer treated with radical prostatectomy: the importance of postoperative PSA kinetics. Prostate Cancer Prostatic Dis 2024; 27:58-64. [PMID: 35794359 DOI: 10.1038/s41391-022-00572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/09/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Optimal postsurgical management of prostate cancer (PCa) patients with nodal metastasis at the time of radical prostatectomy remains unclear. We sought to examine the role of postoperative PSA kinetics and pathologic tumor characteristics in guiding additional hormonal therapy use in pN1 men. METHODS In total, 297 pN1 PCa patients treated with radical prostatectomy and ePLND between 2002 and 2018 were identified within our prospectively maintained institutional cancer data-registry. Following surgery, these patients were managed with either immediate androgen deprivation therapy (iADT) or observation with deferred ADT (dADT). The former was defined as ADT given within ≤6 months of surgery and the latter as >6 months. The primary outcome was metastasis. Regression-tree analysis was used to stratify patients into novel risk-groups based on post-prostatectomy tumor characteristics and PSA kinetics and the corresponding metastasis risk. Multivariable Cox regression analyses tested the impact of iADT versus observation ± dADT on metastasis, cancer-specific mortality, and overall mortality within each risk-group separately. RESULTS The median follow-up was 6.1 years (IQR 3.2-9.0). Regression-tree analysis stratified patients into 3 novel risk-groups (Harrell's C-index 0.79) based on PSA-nadir and time to biochemical failure: group 1 (low-risk) included patients with time to biochemical recurrence >6 months (n = 115), while groups 2 and 3 included patients with biochemical failure within ≤6 months with a postoperative PSA-nadir <1.05 ng/mL (group 2 [intermediate-risk], n = 125) or ≥1.05 ng/mL (group 3 [high-risk], n = 57), respectively. No other patient or tumor characteristics were significant for risk stratification. Within each risk-group, the 10-year metastasis-free survival rates with iADT versus observation ± dADT use were: group 1, 100% versus 95.4% (Log-rank p = 0.738), group 2, 80.6% versus 53.5% (Log-rank p = 0.016), and group 3, 41.5% versus 0% (Log-rank p = 0.015), respectively. Adjusted Cox regression analyses confirmed the benefit of iADT utilization in reducing metastasis in group 2 (p = 0.029) and group 3 (p = 0.008) patients, with no benefit for group 1 patients (p = 0.918). Similar results were noted for cancer-specific and overall mortality. CONCLUSIONS Following radical prostatectomy, early postoperative PSA kinetics may provide valuable information for guiding the timing of ADT initiation-this may reduce over- and undertreatment of pN1 PCa men.
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Affiliation(s)
- Akshay Sood
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Lawrence T Zhang
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Jacob Keeley
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Maxwell Stricker
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jack R Andrews
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James O Peabody
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Craig G Rogers
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Mani Menon
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Firas Abdollah
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
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Biney IN, Ari A, Barjaktarevic IZ, Carlin B, Christiani DC, Cochran L, Drummond MB, Johnson K, Kealing D, Kuehl PJ, Li J, Mahler DA, Martinez S, Ohar J, Radonovich LJ, Sood A, Suggett J, Tal-Singer R, Tashkin D, Yates J, Cambridge L, Dailey PA, Mannino DM, Dhand R. Guidance on Mitigating the Risk of Transmitting Respiratory Infections During Nebulization by the COPD Foundation Nebulizer Consortium. Chest 2024; 165:653-668. [PMID: 37977263 DOI: 10.1016/j.chest.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Nebulizers are used commonly for inhaled drug delivery. Because they deliver medication through aerosol generation, clarification is needed on what constitutes safe aerosol delivery in infectious respiratory disease settings. The COVID-19 pandemic highlighted the importance of understanding the safety and potential risks of aerosol-generating procedures. However, evidence supporting the increased risk of disease transmission with nebulized treatments is inconclusive, and inconsistent guidelines and differing opinions have left uncertainty regarding their use. Many clinicians opt for alternative devices, but this practice could impact outcomes negatively, especially for patients who may not derive full treatment benefit from handheld inhalers. Therefore, it is prudent to develop strategies that can be used during nebulized treatment to minimize the emission of fugitive aerosols, these comprising bioaerosols exhaled by infected individuals and medical aerosols generated by the device that also may be contaminated. This is particularly relevant for patient care in the context of a highly transmissible virus. RESEARCH QUESTION How can potential risks of infections during nebulization be mitigated? STUDY DESIGN AND METHODS The COPD Foundation Nebulizer Consortium (CNC) was formed in 2020 to address uncertainties surrounding administration of nebulized medication. The CNC is an international, multidisciplinary collaboration of patient advocates, pulmonary physicians, critical care physicians, respiratory therapists, clinical scientists, and pharmacists from research centers, medical centers, professional societies, industry, and government agencies. The CNC developed this expert guidance to inform the safe use of nebulized therapies for patients and providers and to answer key questions surrounding medication delivery with nebulizers during pandemics or when exposure to common respiratory pathogens is anticipated. RESULTS CNC members reviewed literature and guidelines regarding nebulization and developed two sets of guidance statements: one for the health care setting and one for the home environment. INTERPRETATION Future studies need to explore the risk of disease transmission with fugitive aerosols associated with different nebulizer types in real patient care situations and to evaluate the effectiveness of mitigation strategies.
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Affiliation(s)
- Isaac N Biney
- University Pulmonary and Critical Care, The University of Tennessee Graduate School of Medicine, Knoxville, TN.
| | - Arzu Ari
- Department of Respiratory Care and Texas State Sleep Center, Texas State University, Round Rock, TX
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles Health Sciences, Los Angeles, CA; Division of Liver and Pancreas Transplantation, David Geffen School of Medicine, University of California Los Angeles Health Sciences, Los Angeles, CA
| | - Brian Carlin
- Sleep Medicine and Lung Health Consultants LLC, Pittsburgh, PA
| | - David C Christiani
- Harvard T.H. Chan School of Public Health, Harvard Medical School, Cambridge, MA; Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, MA
| | | | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Jie Li
- Rush University, Chicago, IL
| | - Donald A Mahler
- Geisel School of Medicine at Dartmouth, Hanover, NH; Valley Regional Hospital, Claremont, NH
| | | | - Jill Ohar
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
| | - Akshay Sood
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | | | | | - Donald Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles Health Sciences, Los Angeles, CA
| | | | - Lisa Cambridge
- Medical Science & Pharmaceutical Alliances, PARI, Inc., Midlothian, VA
| | | | | | - Rajiv Dhand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Tennessee Graduate School of Medicine, Knoxville, TN
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7
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Chiarelli G, Davis M, Stephens A, Cirulli GO, Finati M, Corsi NJ, Sood A, Tinsley S, Carrieri G, Briganti A, Montorsi F, Lughezzani G, Buffi N, Rogers C, Abdollah F. Comparison of patient background between a real-world North American cohort and the Göteborg-2 trial. Int J Urol 2024. [PMID: 38334296 DOI: 10.1111/iju.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To analyze the generalizability of the Göteborg-2 findings to a North American cohort. METHODS We replicated the Göteborg-2 inclusion criteria in our Henry Ford Health (HFH) cohort, by identifying all patients 50-60 years old who had a PSA test from 2013 to 2018. The first PSA within the study period was considered PSA at entry, and included in the analysis. Chi-square test was used to compare categorical variables between the Göteborg-2 and HFH cohort, with a particular focus on Black men, who were also analyzed separately. RESULTS The HFH patients included in the cohort were 49 456, of which 8562 were Black. In patients within the entire HFH cohort, HFH Black cohort, Göteborg Reference cohort, and Göteborg Experimental cohort, the rate of PSA ≥3 ng/mL was, respectively, 6.8%, 10.2%, 6.8%, and 6.6%. The rate of biopsy performed was, respectively, 1.8%, 4.1%, 5.8%, and 2.5%. PCa was found in, respectively, 1.4%, 3.0%, 2.3%, and 1.5%; Gleason score 3 + 3 in, respectively, 0.5%, 0.8%, 1.2%, and 0.6%; Gleason score > 3 + 3 in, respectively, 0.9%, 2.2%, 1.1%, and 0.9%. CONCLUSIONS Our cohort had a lower biopsy rate and a lower incidence of non-csPCa diagnosis than both Göteborg cohorts, while still maintaining the same incidence of csPCa. This implies that the benefits of reducing non-csPCa diagnosis, as observed in the Experimental Göteborg cohort, are not necessarily replicable in U.S. "real-world practice" patients. Also noteworthy, we had a significantly higher percentage of Black men, who showed more aggressive disease.
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Affiliation(s)
- Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Matthew Davis
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Nicholas J Corsi
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Shane Tinsley
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
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Sood A, Rudzinski JK, Labbate CV, Hensley PJ, Bree KK, Guo CC, Alhalabi O, Campbell MT, Siefker-Radtke AO, Navai N, Dinney CPN, Gao J, Kamat AM. Long-Term Oncological Outcomes in Patients Diagnosed With Nonmetastatic Plasmacytoid Variant of Bladder Cancer: A 20-Year University of Texas MD Anderson Cancer Center Experience. J Urol 2024; 211:241-255. [PMID: 37922370 DOI: 10.1097/ju.0000000000003778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 10/30/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE The treated natural history of nonmetastatic plasmacytoid variant of bladder cancer (PV-BCa) is poorly understood owing to its rarity. We sought to examine the disease recurrence and metastasis patterns in this select group of patients in order to identify opportunities for intervention. MATERIALS AND METHODS We conducted a natural language processing algorithm-augmented retrospective chart review of 56 consecutive patients who were treated with curative intent for nonmetastatic PV-BCa at our institution between 1998 and 2018. Kaplan-Meier and multivariable Cox regression methods were used for survival analyses. RESULTS The stage at presentation was: ≤ cT2N0 in 22 (39.3%), cT3N0 in 15 (26.8%), cT4N0 in 13 (23.2%), and ≥ cN1 in 6 patients (10.7%). Forty-nine patients (87.5%) received chemotherapy, and 42 (75%) were able to undergo the planned surgery. Notably, only 4 patients (7.2%) had pT0 stage, while 22 (52.4%) had pN+ disease at the time of surgery. At 36-month follow-up, 28.4% of patients (95% CI: 22.1%-34.5%) were alive and 22.2% (95% CI: 16.1%-28.5%) were free of metastatic disease. The benefit of surgical extirpation was stage specific: successful completion of surgery was associated with improved metastasis-free survival (at 36 months 32.4% vs 0%, log-rank P < .001) in patients with localized or locally advanced disease (≤cT2N0/cT3N0); however, in patients with regionally advanced disease (cT4N0/≥cN1), consolidative surgery following chemotherapy was not associated with improved metastasis-free survival (12.5% vs 10% at 36 months, log-rank P = .49). The median time to metastasis from primary treatment end was 6.5 months (IQR: 2.9-14.7). The predominant site of recurrence/metastasis was the peritoneum (76.1%), either in isolation or along with extraperitoneal lesions. Salvage immunotherapy in these patients significantly reduced the risk of death (HR = 0.11, P = .001). CONCLUSIONS PV-BCa is a disease with high lethality. Despite multimodal treatment, a vast majority of patients develop atypical intraperitoneal metastasis soon after therapy and rapidly succumb to it. Clinical trials evaluating utility of hyperthermic intraperitoneal chemotherapy and/or immunotherapy may be warranted in this high-risk population.
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Affiliation(s)
- Akshay Sood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jan K Rudzinski
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Craig V Labbate
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick J Hensley
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Bree
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Omar Alhalabi
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew T Campbell
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arlene O Siefker-Radtke
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neema Navai
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Colin P N Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianjun Gao
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Arora S, Chen I, Bronkema C, Chiarelli G, Finati M, Cirulli GO, Majdalany SE, Rakic I, Sood A, Trinh QD, Rogers CG, Peabody JO, Menon M, Abdollah F. Admission Rates, Healthcare Utilization, and Inpatient Cost of Radiation Cystitis in the United States. Urology 2024; 184:94-100. [PMID: 38160761 DOI: 10.1016/j.urology.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To assess the incidence, cumulative healthcare burden, and financial impact of inpatient admissions for radiation cystitis (RC), while exploring practice differences in RC management between teaching and nonteaching hospitals. METHODS We focused on 19,613 patients with a diagnosis of RC within the National Inpatient Sample (NIS) from 2008 to 2014. ICD-9 diagnosis and procedure codes were used. Complex-survey procedures were used to study the descriptive characteristics of RC patients and the procedures received during admission, stratified by hospital teaching status. Inflation-adjusted cost and cumulative annual cost were calculated for the study period. Multivariable logistic regression was used to study the impact of teaching status on the high total cost of admission. RESULTS Median age was 76 (interquartile range 67-82) years. Most of the patients were males (73%; P < .001). 59,571 (61%) patients received at least one procedure, of which, 24,816 (25.5%) received more than one procedure. Median length of stay was 5days (interquartile range 2-9). Female patients and patients with a higher comorbidity score were more frequently treated at teaching hospitals. A higher proportion of patients received a procedure at a teaching hospital (64% vs 59%; P < .001). The inflation-adjusted cost was 9207 USD and was higher in teaching hospitals. The cumulative cost of inpatient treatment of RC was 63.5 million USD per year and 952.2 million USD over the study period. CONCLUSION The incidence of RC-associated admissions is rising in the US. This disease is a major burden to US healthcare. The awareness of the inpatient economic burden and healthcare utilization associated with RC may have funding implications.
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Affiliation(s)
- Sohrab Arora
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Irene Chen
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Chandler Bronkema
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Sami E Majdalany
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Ivan Rakic
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | | | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Craig G Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - James O Peabody
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Mani Menon
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI.
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Sood A, Kishan AU, Evans CP, Feng FY, Morgan TM, Murphy DG, Padhani AR, Pinto P, Van der Poel HG, Tilki D, Briganti A, Abdollah F. The Impact of Positron Emission Tomography Imaging and Tumor Molecular Profiling on Risk Stratification, Treatment Choice, and Oncological Outcomes of Patients with Primary or Relapsed Prostate Cancer: An International Collaborative Review of the Existing Literature. Eur Urol Oncol 2024; 7:27-43. [PMID: 37423774 DOI: 10.1016/j.euo.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/06/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
CONTEXT The clinical introduction of next-generation imaging methods and molecular biomarkers ("radiogenomics") has revolutionized the field of prostate cancer (PCa). While the clinical validity of these tests has thoroughly been vetted, their clinical utility remains a matter of investigation. OBJECTIVE To systematically review the evidence to date on the impact of positron emission tomography (PET) imaging and tissue-based prognostic biomarkers, including Decipher, Prolaris, and Oncotype Dx, on the risk stratification, treatment choice, and oncological outcomes of men with newly diagnosed PCa or those with biochemical failure (BCF). EVIDENCE ACQUISITION We performed a quantitative systematic review of the literature using the MEDLINE, EMBASE, and Web of Science databases (2010-2022) following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines. The validated Quality Assessment of Diagnostic Accuracy Studies 2 scoring system was used to assess the risk of bias. EVIDENCE SYNTHESIS A total of 148 studies (130 on PET and 18 on biomarkers) were included. In the primary PCa setting, prostate-specific membrane antigen (PSMA) PET imaging was not useful in improving T staging, moderately useful in improving N staging, but consistently useful in improving M staging in patients with National Comprehensive Cancer Network (NCCN) unfavorable intermediate- to very-high-risk PCa. Its use led to a management change in 20-30% of patients. However, the effect of these treatment changes on survival outcomes was not clear. Similarly, biomarkers in the pretherapy primary PCa setting increased and decreased the risk, respectively, in 7-30% and 32-36% of NCCN low-risk and 31-65% and 4-15% of NCCN favorable intermediate-risk patients being considered for active surveillance. A change in management was noted in up to 65% of patients, with the change being in line with the molecular risk-based reclassification, but again, the impact of these changes on survival outcomes remained unclear. Notably, in the postsurgical primary PCa setting, biomarker-guided adjuvant radiation therapy (RT) was associated with improved oncological control: Δ↓ 2-yr BCF by 22% (level 2b). In the BCF setting, the data were more mature. PSMA PET was consistently useful in improving disease localization-Δ↑ detection for T, N, and M staging was 13-32%, 19-58%, and 9-29%, respectively. Between 29% and 73% of patients had a change in management. Most importantly, these management changes were associated with improved survival outcomes in three trials: Δ↑ 4-yr disease-free survival by 24.3%, Δ↑ 6-mo metastasis-free survival (MFS) by 46.7%, and Δ↑ androgen deprivation therapy-free survival by 8 mo in patients who received PET-concordant RT (level 1b-2b). Biomarker testing in these patients also appeared to be helpful in risk stratifying and guiding the use of early salvage RT (sRT) and concomitant hormonal therapy. Patients with high-genomic-risk scores benefitted from treatment intensification: Δ↑ 8-yr MFS by 20% with the use of early sRT and Δ↑ 12-yr MFS by 11.2% with the use of hormonal therapy alongside early sRT, while low-genomic-risk score patients did equally well with initial conservative management (level 3). CONCLUSIONS Both PSMA PET imaging and tumor molecular profiling provide actionable information in the management of men with primary PCa and those with BCF. Emerging data suggest that radiogenomics-guided treatments translate into direct survival benefits for patients, however, additional prospective data are awaited. PATIENT SUMMARY In this review, we evaluated the utility of prostate-specific membrane antigen positron emission tomography and tumor molecular profiling in guiding the care of men with prostate cancer (PCa). We found that these tests augmented risk stratification, altered management, and improved cancer control in men with a new diagnosis of PCa or for those experiencing a relapse.
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Affiliation(s)
- Akshay Sood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Amar U Kishan
- Department of Radiation Oncology and Urology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher P Evans
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Declan G Murphy
- Department of Genitourinary Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henk G Van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - 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
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
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Lobo N, Duan Z, Sood A, Tan WS, Grajales V, Contieri R, Lindskrog SV, Dyrskjøt L, Zhao H, Giordano SH, Williams SB, Bree KK, Kamat AM. Association of Age with Non-muscle-invasive Bladder Cancer: Unearthing a Biological Basis for Epidemiological Disparities? Eur Urol Oncol 2024:S2588-9311(24)00036-1. [PMID: 38302322 DOI: 10.1016/j.euo.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Age disparity in patients with non-muscle-invasive bladder cancer (NMIBC) exists. Whether this is due to differences in adequate cancer care or tumour biology is unclear. OBJECTIVE To investigate age disparities in NMIBC using the Surveillance, Epidemiology, and End Results (SEER)-Medicare and UROMOL datasets. DESIGN, SETTING, AND PARTICIPANTS The SEER-Medicare data were used to identify patients with clinical stage Ta, Tis, and T1 NMIBC between 2005 and 2017 (n = 32 225). Using the UROMOL cohort (n = 834), age disparities across transcriptomic, genomic, and spatial proteomic domains were assessed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS For the SEER-Medicare data, multivariable competing-risk regression was used to examine the association between age and recurrence, progression, and bladder cancer-specific mortality (BCSM). For the UROMOL cohort, multivariable general linear model and multinomial logistic regression were performed to evaluate the association between age and tumour biology. RESULTS AND LIMITATIONS An analysis of the SEER-Medicare cohort revealed 5-yr recurrence rates of 55.2%, 57.4%, and 58.9%; 5-yr progression rates of 25.6%, 29.2%, and 36.9%; and 5-yr BCSM rates of 3.9%, 5.8%, and 11.8% in patients aged 66-70, 71-80, and ≥81 yr, respectively. After multivariable adjustment, age ≥81 yr was associated with a higher risk of recurrence (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03-1.12; p = 0.001), progression (HR 1.32, p < 0.001), and BCSM (HR 2.58, p < 0.001). UROMOL2021 transcriptomic class 2a was most frequently observed in patients with advanced age (34.0% in ≥76 yr vs 21.6% in ≤65 yr; p = 0.004), a finding confirmed on multivariable analysis (risk ratio [RR] 3.86, p = 0.002). UROMOL2021 genomic class 3 was observed more frequently in patients aged ≥76 yr (4.9% vs 24.2%; p = 0.001). Limitations include the definitions used for recurrence and progression, which may lead to under- or overestimation of true rates. CONCLUSIONS Among SEER-Medicare patients with NMIBC, advanced age is associated with inferior oncological outcomes. These results reflect age-related molecular biological differences observed across transcriptomic and genomic domains, providing further evidence that innate tumour biology contributes to observed disparities in NMIBC outcomes. PATIENT SUMMARY Older patients with non-muscle-invasive bladder cancer have worse oncological outcomes than younger patients. Some of this age disparity may be due to differences in tumour biology.
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Affiliation(s)
- Niyati Lobo
- Department of Urology, Royal Free London NHS Trust, London, UK; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhigang Duan
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sia V Lindskrog
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hui Zhao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen B Williams
- Department of Urology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kelly K Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Soller B, Myers O, Sood A. Transfer of Knowledge on Pneumoconiosis Care Among Rural-Based Members of a Digital Community of Practice: Cross-Sectional Study. JMIR Form Res 2024; 8:e52414. [PMID: 38265861 PMCID: PMC10851115 DOI: 10.2196/52414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Given the re-emergence of coal workers' pneumoconiosis in Appalachia and Mountain West United States, there is a tremendous need to train rural professionals in its multidisciplinary management. Since 2016, the Miners' Wellness TeleECHO (Extension for Community Health Outcomes) Program held by the University of New Mexico, Albuquerque, and Miners' Colfax Medical Center, Raton, New Mexico, provides structured longitudinal multidisciplinary telementoring to diverse professionals taking care of miners by creating a digital community of practice. Program sessions emphasize active learning through discussion, rather than didactic training. Professional stakeholder groups include respiratory therapists, home health professionals, benefits counselors, lawyers or attorneys, clinicians, and others. Rural-urban differences in knowledge transfer in such a community of practice, however, remain unknown. OBJECTIVE We aim to evaluate the role of the rurality of the patient or client base in the transfer of knowledge to professionals caring for miners using the digital community of practice approach. METHODS This is a cross-sectional study of 70 professionals participating in the Miners' Wellness TeleECHO Program between 2018 and 2019. Drawing insights from social network analysis, we examined the association between the rurality of participants' patient or client base and their self-reported receipt of knowledge. Our focal independent variable was the respondent's self-reported percentage of patients or clients who reside in rural areas. We measured knowledge transfer sources by asking participants if they received knowledge regarding the care of miners during and outside of TeleECHO sessions from each of the other participants. Our dependent variables included the number of knowledge sources, number of cross-stakeholder knowledge sources, number of same stakeholder knowledge sources, and range and heterogeneity of knowledge sources. RESULTS Respondents, on average, identified 4.46 (SD 3.16) unique knowledge sources within the community, with a greater number of cross-stakeholder knowledge sources (2.80) than same stakeholder knowledge sources (1.72). The mean knowledge source range was 2.50 (SD 1.29), indicating that, on average, respondents received knowledge sources from roughly half of the 5 stakeholder groups. Finally, the mean heterogeneity of knowledge sources, which can range between 0 and 0.80, was near the midpoint of the scale at 0.44 (SD 0.30). Multivariable analyses revealed that as the rurality of patient or client bases increased, participants reported more knowledge sources overall, more knowledge sources from outside of their stakeholder groups, a higher knowledge source range, and greater heterogeneity of knowledge sources (P<.05 for all comparisons). CONCLUSIONS Our findings suggest that participants who serve rural areas especially benefit from knowledge transfer within the TeleECHO community of practice. Additionally, the knowledge they receive comes from diverse information sources, emphasizing its multidisciplinary nature. Our results underscore the capacity of the TeleECHO model to leverage technology to promote rural health equity for miners.
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Affiliation(s)
- Brian Soller
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, MD, United States
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Akshay Sood
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
- Miners Colfax Medical Center, Raton, NM, United States
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Contieri R, Grajales V, Tan WS, Martini A, Sood A, Hensley P, Bree K, Lobo N, Nogueras-Gonzalez GM, Guo CC, Navai N, Dinney CP, Kamat AM. Impact of age >70 years on oncological outcomes in patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette-Guérin. BJU Int 2024; 133:63-70. [PMID: 37442564 PMCID: PMC10787034 DOI: 10.1111/bju.16127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To evaluate the impact of age on oncological outcomes in a large contemporary cohort of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette-Guérin (BCG). PATIENTS AND METHODS We performed an Institutional Review Board-approved retrospective study analysing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Adequate BCG was defined as per United States Food and Drug Administration (FDA) guidelines as being receipt of at least five of six induction BCG instillations with a minimum of two additional doses (of planned maintenance or of re-induction) of BCG instillations within a span of 6 months. The study's primary outcome was to determine if age >70 years was associated with progression to MIBC cancer or distant metastasis. The cumulative incidence method and the competing-risk regression analyses were used to investigate the association of advanced age (>70 years) with progression, high-grade (HG) recurrence and cancer-specific mortality (CSM). RESULTS Overall, data from 632 patients were analysed: 355 patients (56.2%) were aged ≤70 years and 277 (43.8%) were >70 years. Age >70 years did not adversely affect either cumulative incidence of progression or HG recurrence (P = 0.067 and P = 0.644, respectively). On competing-risk regression analyses, age >70 years did not emerge as an independent predictor of progression or HG recurrence (sub-standardised hazard ratio [SHR] 1.57, 95% confidence interval [CI] 0.87-2.81, P = 0.134; and SHR 1.05, 95% CI 0.77-1.44, P = 0.749). Not unexpectedly, patients in the older group did have higher overall mortality (P < 0.001) but not CSM (P = 0.057). CONCLUSION Age >70 years was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. BCG should not be withheld from older patients seeking for bladder sparing options.
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Affiliation(s)
- Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Humanitas University, Milan, Italy
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alberto Martini
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick Hensley
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Kelly Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Niyati Lobo
- Department of Urology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Charles C Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sood A, Grauer R, Diaz-Insua M, Tewari AK, Hemal AK, Shrivastava A, Peabody JO, Jeong W, Abdollah F, Rudzinski JK, Andrews JR, Gorin MA, Bhandari M, Menon M. 15-year biochemical failure, metastasis, salvage therapy, and cancer-specific and overall survival rates in men treated with robotic radical prostatectomy for PSA-screen detected prostate cancer. Prostate Cancer Prostatic Dis 2023; 26:778-786. [PMID: 37142635 DOI: 10.1038/s41391-023-00674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND An informed decision regarding a treatment option requires data on its long-term efficacy and side-effect profile. While the side-effects of robotic radical prostatectomy have been well-quantified, the data on its long-term efficacy are lacking. We here provide 15-year oncological outcomes of clinically-localized prostate cancer (CLPCa) patients treated with robot-assisted laparoscopic prostatectomy (RALP). METHODS We treated 1,807 men with CLPCa with RALP between 2001 and 2005 and prospectively collected follow-up data through 2020. We examined the rates of biochemical failure (BCF), metastatic progression, secondary therapy use, PCa-specific mortality (PCSM), and overall survival (OS) using Kaplan-Meier and competing-risk cumulative incidence methods as appropriate. RESULTS The median follow-up was 14.1 years. Six hundred eight and 312 men had D'Amico intermediate- and high-risk disease, respectively. Overall, the 15-year rates of BCF, metastasis, secondary therapy use, PCSM, and OS were 28.1%, 4.0%, 16.3%, 2.5%, and 82.1%, respectively. The rates of oncologic failure increased with increasing D'Amico (preoperative) and Diaz (postoperative) risk scores - BCF, metastasis, and PCSM rates in D'Amico low-, intermediate-, and high-risk groups at 15-years were 15.2%, 38.3%, and 44.1% [BCF], 1.1%, 4.1%, and 13.0% [metastasis], and 0.5%, 3.4%, and 6.6% [PCSM], respectively, and in Diaz risk groups 1, 2, 3, 4, and 5 were 5.5%, 20.6%, 41.8%, 66.9%, and 89.2% [BCF], 0%, 0.5%, 3.2%, 20.5%, and 60.0% [metastasis], and 0%, 0.8%, 0.6%, 13.5%, and 37.5% [PCSM], respectively. The OS rates in D'Amico low-to-high and Diaz 1-to-5 risk groups at 15-years were 85.9%, 78.6%, and 75.2%, and 89.4%, 83.2%, 80.6%, 67.2%, and 23.4%, respectively. CONCLUSIONS Men diagnosed with clinically-localized prostate cancer in the contemporaneous PSA-screening era and treated with RALP achieve durable long-term oncological control. The data reported here (in a risk-stratified manner) represent the longest follow-up after robotic radical prostatectomy, and as such, should be of value when counseling patients regarding expected oncologic outcomes from RALP.
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Affiliation(s)
- Akshay Sood
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mireya Diaz-Insua
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | | | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Firas Abdollah
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jan K Rudzinski
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack R Andrews
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Mani Menon
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Busby D, Rich JM, Grauer R, Kaufmann B, Pandav K, Sood A, Tewari AK, Menon M, Patel HD, Gorin MA. Biopsy and Erectile Functional Outcomes of Partial Prostate Ablation: A Systematic Review and Meta-analysis of Prospective Studies. Urology 2023; 182:14-26. [PMID: 37774854 DOI: 10.1016/j.urology.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/24/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To provide a systematic summary of prospectively performed studies evaluating ablative therapies for the treatment of prostate cancer (PCa) that included protocol-mandated assessment of (1) residual disease by post-treatment biopsy and/or (2) erectile functional outcomes. MATERIALS AND METHODS We performed a comprehensive literature search in September 2022. Studies were evaluated according to a predefined and registered plan in PROSPERO (CRD42022302777). Only prospective trials with protocol-mandated post-treatment prostate biopsies or functional assessments were included. Targeted focal therapy was the only ablation pattern with sufficient data to perform meta-analyses (29 studies, 1079 patients). RESULTS At baseline, 65.0% of patients treated with targeted focal therapy harbored grade group (GG) ≥2 PCa. One year after treatment, in-field treatment failure with ≥GG1 and ≥GG2 PCa occurred in 25.7% (range 11.1%-66.7%) and 8.8% (range 0%-27.8%) of men, respectively. In patients that received whole-gland biopsies 1year after ablation, residual ≥GG1 and ≥GG2 PCa was detected anywhere in the prostate in 43.7% (range 19.4%-71.7%) and 13.0% (range 0%-35.9%) of men. Erectile function was negatively affected by treatment, but 78.7% were potent 1year after targeted focal therapy (7 studies, 197 patients), and the average decrease in erectile function scores was 8.8% at 1year (21 studies, 760 patients). CONCLUSION Though long-term data after targeted focal therapy are limited, oncologic and treatment failure occurred in 13% and 9% (≥GG2 at 6-12months after treatment). Most men were able to maintain potency. This work can help benchmark new techniques and power future trials.
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Affiliation(s)
- Dallin Busby
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY; Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Jordan M Rich
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Ralph Grauer
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Basil Kaufmann
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY; Department of Urology, University Hospital of Zurich, Zurich, Switzerland
| | - Krunal Pandav
- Department of Biomedical Engineering, Emory University, Atlanta, GA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ashutosh K Tewari
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Mani Menon
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Hiten D Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
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16
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Duncan CJR, Kaemingk M, Li WH, Andorf MB, Bartnik AC, Galdi A, Gordon M, Pennington CA, Bazarov IV, Zeng HJ, Liu F, Luo D, Sood A, Lindenberg AM, Tate MW, Muller DA, Thom-Levy J, Gruner SM, Maxson JM. Multi-scale time-resolved electron diffraction: A case study in moiré materials. Ultramicroscopy 2023; 253:113771. [PMID: 37301082 DOI: 10.1016/j.ultramic.2023.113771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/09/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
Ultrafast-optical-pump - structural-probe measurements, including ultrafast electron and x-ray scattering, provide direct experimental access to the fundamental timescales of atomic motion, and are thus foundational techniques for studying matter out of equilibrium. High-performance detectors are needed in scattering experiments to obtain maximum scientific value from every probe particle. We deploy a hybrid pixel array direct electron detector to perform ultrafast electron diffraction experiments on a WSe2/MoSe2 2D heterobilayer, resolving the weak features of diffuse scattering and moiré superlattice structure without saturating the zero order peak. Enabled by the detector's high frame rate, we show that a chopping technique provides diffraction difference images with signal-to-noise at the shot noise limit. Finally, we demonstrate that a fast detector frame rate coupled with a high repetition rate probe can provide continuous time resolution from femtoseconds to seconds, enabling us to perform a scanning ultrafast electron diffraction experiment that maps thermal transport in WSe2/MoSe2 and resolves distinct diffusion mechanisms in space and time.
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Affiliation(s)
- C J R Duncan
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA.
| | - M Kaemingk
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA
| | - W H Li
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA
| | - M B Andorf
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA
| | - A C Bartnik
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA
| | - A Galdi
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA
| | - M Gordon
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA
| | - C A Pennington
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA
| | - I V Bazarov
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA
| | - H J Zeng
- Department of Chemistry, Stanford University, Stanford, CA 94305, USA
| | - F Liu
- Department of Chemistry, Stanford University, Stanford, CA 94305, USA
| | - D Luo
- SLAC National Accelerator Laboratory, Menlo Park, CA 94205, USA
| | - A Sood
- Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08540, USA; Princeton Materials Institute, Princeton University, Princeton, NJ 08540, USA
| | - A M Lindenberg
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
| | - M W Tate
- Laboratory of Atomic and Solid State Physics, Cornell University, Ithaca, NY 14853, USA
| | - D A Muller
- Kavli Institute at Cornell for Nanoscale Science, Ithaca, NY 14853, USA; School of Applied and Engineering Physics, Cornell University, Ithaca, NY 14853, USA
| | - J Thom-Levy
- Laboratory for Elementary-Particle Physics, Cornell University, Ithaca, NY 14853, USA
| | - S M Gruner
- Laboratory of Atomic and Solid State Physics, Cornell University, Ithaca, NY 14853, USA; Kavli Institute at Cornell for Nanoscale Science, Ithaca, NY 14853, USA
| | - J M Maxson
- Cornell Laboratory for Accelerator-Based Sciences and Education, Cornell University, Ithaca, NY 14850, USA.
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17
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Soller B, Martinez JM, Rishel Brakey H, Mickel N, Sood A. Navigating Barriers and Challenges to Achieving Critical Career Milestones Among Faculty Mentees. Chron Mentor Coach 2023; 7:207-212. [PMID: 38187469 PMCID: PMC10768922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
For faculty members, job satisfaction, compensation, and career advancement hinge on achieving 'critical' career milestones (e.g., external funding, tenure). Faculty face unique barriers to achieving career milestones (Bagley et al., 2018), and therefore must employ tailored strategies to overcome challenges. The current project extends research on barriers to career milestones (Soller et al., 2022) to examine strategies faculty employ to overcome barriers in the pursuit of critical career milestones. Thirty-seven faculty members participated across eight US academic institutions, including 22 under-represented minorities in science (URM-S; women or racial/ ethnic minorities). Respondents identified critical career milestones they achieved or will pursue within the next 24 months and then discussed strategies used and suggestions for achieving milestones during semi-structured qualitative interviews. The research team conducted a thematic, qualitative, descriptive analysis of qualitative data using NVivo software in a systematic, interactive, team-based process. Four key strategies emerged for navigating barriers in the pursuit of critical career milestones: 1) Careful engagement of mentors and allies; 2) Collaborate and network; 3) Set boundaries and prioritize; and 4) Reflect on values and use personal strengths. Administrators should aim to remove structural barriers, particularly those that reduce equity (Davis et al., 2022). Identifying strategies that faculty employ to overcome challenges can enhance mentoring by helping mentors understand how mentees overcome unique challenges, particularly those that are not easily addressed through structural interventions.
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Affiliation(s)
- B Soller
- University of Maryland-Baltimore County, University of New Mexico, University of Oklahoma
| | - J M Martinez
- University of Maryland-Baltimore County, University of New Mexico, University of Oklahoma
| | - H Rishel Brakey
- University of Maryland-Baltimore County, University of New Mexico, University of Oklahoma
| | - N Mickel
- University of Maryland-Baltimore County, University of New Mexico, University of Oklahoma
| | - A Sood
- University of Maryland-Baltimore County, University of New Mexico, University of Oklahoma
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18
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Nina G, Myers O, Rishel Brakey H, Sood A. Why Faculty Leaders Leave a School of Medicine? Chron Mentor Coach 2023; 7:394-400. [PMID: 38187468 PMCID: PMC10768927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Faculty attrition at academic health centers (AHCs) is significant at about 11% nationally, with one in five physicians intending to leave, and replacement costs averaging $500,000 per physician. Attrition among AHC faculty leaders is inadequately studied. This study compares reasons to leave between exiting faculty leaders and faculty non-leaders at the University of New Mexico School of Medicine (UNM SOM). The SOM deans interview all exiting faculty using a structured exit survey. 329 faculty non-leaders and 58 faculty leaders left UNM SOM between July 2017 and June 2022. Distributions of each variable were analyzed for statistically significant differences between the two groups using Fisher's 2-sided exact test. Text comments by leaders were analyzed qualitatively for content using a team-based, iterative process. As compared to non-leaders, exiting faculty leaders were more likely to be professors (51.7% vs 16.7%, p<0.001), and hold tenure (32.8% vs. 12.2%, p=0.001). Faculty leaders were more likely than non-leaders to cite high-level leadership as a reason to leave (41.4% vs. 24.3% p=0.01) and better leadership as a critical issue in development and retention (51.7% vs. 36.8% p=0.04). Qualitative analyses of textual leader comments showed a similar distribution of themes as the quantitative variables when examining open text related to the survey questions related to reasons to leave and the most critical issues. In addition, when asked what would need to change for them to return, qualitative data showed open-ended responses by exiting faculty leaders were twice as frequent to include leadership comments than those by non-leaders (34.2% vs. 16.2%). Exiting faculty leaders disproportionately cite high-level leadership as a reason to leave. The mediatory factors for this association are not known. Investigations to determine the causes for the study findings, and data-driven intervention strategies to retain faculty leaders at SOMs are needed.
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Myers O, Vick K, Greenberg N, Sood A. Faculty Retention at a School of Medicine, 2010-2022. Chron Mentor Coach 2023; 7:388-393. [PMID: 38187463 PMCID: PMC10768923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Faculty retention at academic health centers is a concern with about one-fifth of physicians reporting intentions to leave. We studied factors affecting faculty at risk for attrition, defined as women, racial/ethnic underrepresented minorities (URM), and clinical faculty. Identification of factors predicting retention of at-risk faculty may help mentors and minority-serving institutions devise novel targeted retention strategies. Our study site was a minority-serving institution in a majority-minority state in the US Southwest where at-risk faculty constitute the majority group. Faculty characteristics and departure dates were extracted from an institutional database maintained by the University of New Mexico (UNM) School of Medicine (SOM) for 2,427 participants employed from July 2009 through June 2022. Annual attrition rates and relative risk (RR) of attrition were estimated by discrete-time hazard rate models assuming a Poisson distribution. The overall annual attrition rate was 11.5%, which projects to 50% attrition in 6.0 years. Time to 50% attrition was 4.6 years for assistant professors, 8.9 years for associate professors 7.2 years for full professors. Faculty with a PhD degree had lower attrition (7.2%, RR=0.69, 95% CI 0.60, 0.79) compared to faculty with an MD degree (10.5%) in adjusted analyses. Clinician educators had a higher attrition rate (8.9%) compared to tenure track (6.4%, RRtenure track=0.72, 95% CI 0.61, 0.85). Black faculty had a higher risk of attrition compared to White faculty (RR=1.56, 95% CI 1.09, 2.25), and non-Hispanic White faculty had a lower risk of attrition (RR=0.83, 95% CI 0.71, 0.98). Annual attrition rates increased over the study period with most of the increase before about 2016. We did not detect significant differences in attrition due to sex or URM status.
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Shore X, Soller B, Mickel N, Wiskur B, Morales D, Dominguez N, Tigges B, Helitzer D, Myers O, Sood A. Gender Differences in Self-reported Faculty Developmental Networks. Chron Mentor Coach 2023; 7:445-452. [PMID: 38187464 PMCID: PMC10768926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Scholars have long recognized gender variation in social relationship dynamics. However, how gender shapes developmental networking relationships for career advancement, particularly among university faculty members, is understudied. This area of research is important since women comprise an increasing proportion of faculty and yet report receiving less mentoring and lower career satisfaction, productivity, and advancement than their male counterparts. This cross-sectional study assessed gender differences in self-reported dimensions of faculty participants' developmental networks by collecting information on relationships with developers, who are people who have taken concerted action and offered professional and personal guidance to help participants advance in their careers over the past year. The investigators used egocentric network data from an electronically administered Mentoring Network Questionnaire collected from 159 faculty involved in a mentoring intervention during the pandemic. Faculty were from multiple Southwest and Mountain West institutions. Statistical analyses were performed using the Chi-squared test, Wilcoxon rank-sum test, and unadjusted multilevel regression. Female faculty chose developers of lower gender diversity than male faculty (p=0.01). Compared to male faculty, female faculty reported receiving more psychosocial support from individual developers (p=0.03). Female faculty members' developers were more often characterized as friends and less often described as sponsors and allies than male faculty, based on relative levels of career and psychosocial support that individual developers provided (p<0.001). No gender differences were found in other network characteristics. Female faculty build developmental networks that have different factors compared to male faculty. Greater levels of psychosocial support and fewer allies and sponsors for female faculty may have long-term implications for differential career advancement for women vs. men in academic careers. Strategies to enhance networking should address gender differences and include a structured framework for assessing network gaps.
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Affiliation(s)
- X Shore
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Soller
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - N Mickel
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Wiskur
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - D Morales
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - N Dominguez
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Tigges
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - D Helitzer
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - O Myers
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - A Sood
- University of New Mexico-Health Sciences Center, University of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
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21
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Tigges B, Myers O, Mickel N, Dominguez N, Helitzer D, Sood A. Inter-Rater Reliability of the Mentor Behavioral Interaction Rubric. Chron Mentor Coach 2023; 7:466-471. [PMID: 38187466 PMCID: PMC10768924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
An objective assessment of a mentor's behavioral skills is needed to assess the effectiveness of mentor training interventions in academic settings. The Mentor Behavioral Interaction (MBI) Rubric is a newly developed, content-valid, observational measure of a mentor's behavioral skill during single-episode interactions with a mentee. The purpose of this study was to assess the inter-rater reliability (IRR) of the MBI Rubric when used to assess video-recorded mentor-mentee interactions. Three of a pool of four faculty raters with expertise in mentor training synchronously rated 26 videos of mentor-mentee interactions using structured guidelines. The MBI Rubric includes six items (Part 1), each with ratings on a 3- or 4-point scale, and ten yes/no items (Part 2) that characterize the content of the interaction. After initial individual ratings were completed, the three raters met, reviewed disagreements, and reached decisions about final item scores by either consensus or majority vote. Mean total Part 1 scores ranged between 1.42-2.69. IRRs ranged from good (Part 1 IRR=0.67) to excellent (Part 2 IRR=0.83). No training effects were observed, with no decrease (i.e., showing less variability) in inter-rater standard deviations over time. Rater effects in initial individual scoring were observed, with a significant difference between one vs. the other three raters on Part 1 individual scores, with no effects for Part 2 scores. Raters tended to score lower on initial individual scores than the final score for both Part 1 and 2. The MBI Rubric is the first observational measure to assess single episodes of video-recorded mentor-mentee interactions and has demonstrated content validity, and now inter-rater reliability. It may be used in parallel with other instruments to measure the efficacy of mentor training. Limitations include possible ceiling effects, and resource-intensive administration in terms of rater expertise and time. Future work will assess the responsiveness of the Rubric to change in mentor skill and construct validity.
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Affiliation(s)
- B Tigges
- University of New Mexico Health Sciences Center, University of Oklahoma Health Sciences Center, University of New Mexico, Arizona State University
| | - O Myers
- University of New Mexico Health Sciences Center, University of Oklahoma Health Sciences Center, University of New Mexico, Arizona State University
| | - N Mickel
- University of New Mexico Health Sciences Center, University of Oklahoma Health Sciences Center, University of New Mexico, Arizona State University
| | - N Dominguez
- University of New Mexico Health Sciences Center, University of Oklahoma Health Sciences Center, University of New Mexico, Arizona State University
| | - D Helitzer
- University of New Mexico Health Sciences Center, University of Oklahoma Health Sciences Center, University of New Mexico, Arizona State University
| | - A Sood
- University of New Mexico Health Sciences Center, University of Oklahoma Health Sciences Center, University of New Mexico, Arizona State University
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Shore XW, Soller B, Mickel N, Wiskur B, Morales D, Arora S, Dominguez N, Tigges B, Helitzer D, Myers O, Sood A. Curriculum-based Faculty Training in Networking: Knowledge and Self-efficacy Outcomes. Chron Mentor Coach 2023; 7:453-458. [PMID: 38187462 PMCID: PMC10768928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Although the advantages of developmental networks are well-known, most faculty do not know how to participate in such networks actively. Additionally, institutions face challenges in teaching faculty the best practices of networking. This deficiency constitutes a critical gap in the literature, which may slow career advancement for faculty, particularly from underrepresented groups. The study's purpose was to examine the effectiveness of a curriculum-based faculty training in developmental networks, utilizing the Extension for Community Health Outcomes (ECHO) platform. In this pre-post study, 33 faculty members participated in the intervention utilizing eight modules involving four competencies. Each module followed a standard format, including a short didactic, two facilitated case study discussions based on real-life scenarios, and self-reading of selected literature. Outcomes included (i) change in knowledge scores obtained from two questions per module and (ii) self-efficacy scores measured on a scale of 0-100. Paired student's t-test and mixed model regression analyses were used. A significant increase in knowledge score was documented using mixed model regression for 4 of the eight modules (mean change score 0.4-0.8, p≤0.03 for all analyses). The proportion of faculty participants reporting correct knowledge items for all modules increased from 49.8% (pre) to 64.3% (post), which was statistically significant (p<0.001). Significant increases in paired self-efficacy scores were reported for each of the eight modules (mean change score 17-37, p<0.05 for all analyses). This study highlights the importance of curriculum-based training in networking. Participants showed a significant increase in pre-post networking self-efficacy and knowledge scores. Our ECHO-based curriculum, facilitator training, and manual enable easy implementation in other institutions, ensuring scalability and adaptability. Our analysis provides the evidence basis for examining the impact of a developmental network intervention in enhancing individual career networks.
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Affiliation(s)
- X W Shore
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Soller
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - N Mickel
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Wiskur
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - D Morales
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - S Arora
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - N Dominguez
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Tigges
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - D Helitzer
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - O Myers
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - A Sood
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
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Vick K, Rodriguez-Esparza A, Melendres-Groves L, Shore X, Sigl D, Sood A. Inequity Analysis in Faculty Recognition Awards at a School of Medicine. Chron Mentor Coach 2023; 7:404-408. [PMID: 38187465 PMCID: PMC10768925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
As part of developmental networks, sponsors help provide recognition and visibility opportunities to their faculty protégés. Recognition awards given to the School of Medicine (SOM) faculty are an important mechanism for acknowledging what is valued in academic medicine. Beyond their impact on individual careers, awards help define the culture and climate of an organization. The literature suggests inequities in recognition awards for women and racial/ethnic underrepresented minority faculty. The study's purpose was to examine the characteristics of the awardees relative to the SOM faculty in a minority-serving institution in a minority-majority state. In this observational cross-sectional study, 47 SOM faculty were recognized between 2000-2023 as Regents' Lecturers (9), Regents' Professors (20), Community Engagement Awardees (5), and Gold-headed Cane Awardees (13). SOM sought nominations which a search committee competitively reviewed. Award recipients were characterized by their department, rank, academic track, degree, country of origin, sex, and race/ethnicity, and were compared to all SOM faculty. Male faculty were more likely than women faculty to receive an award (p=0.04). Faculty with tenure, Ph.D. degree, or Professor rank were more likely to receive an award than their counterparts (p<0.001, all analyses). Faculty in basic and diagnostic specialties were more likely to receive an award than medical or surgical specialties (p<0.001). Although rates of awards for racial/ethnic URM faculty were about half that of non-URM faculty, this difference did not reach statistical significance (p=0.14). In addition to demonstrating sex-related inequity in awards, recognized faculty are traditionally associated with the scholarship of discovery compared to other models of scholarship or clinical activity. Sponsors should promote women, physicians, and clinician educators for recognition awards to advance their academic careers. SOM leaders need to examine award criteria and processes to ensure recognition of the diversity of talents and achievements that are critical to the future of academic medicine.
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Affiliation(s)
- K Vick
- University of New Mexico School of Medicine
| | | | | | - X Shore
- University of New Mexico School of Medicine
| | - D Sigl
- University of New Mexico School of Medicine
| | - A Sood
- University of New Mexico School of Medicine
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Tigges B, Soller B, Myers O, Shore X, Mickel N, Dominguez N, Wiskur B, Helitzer D, Sood A. Mentoring Network Questionnaire Support Scales Reliable and Valid with University Faculty. Chron Mentor Coach 2023; 7:459-465. [PMID: 38187467 PMCID: PMC10768921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
The Developmental Network Questionnaire (DNQ) is used in business to self-assess relationships with developers, or people who support one's career. The Mentoring Network Questionnaire (MNQ) is an online modification of the DNQ and includes two scales that rate developer's contributions to career or psychosocial help. The psychometrics of these scales for different populations are unreported. This study analyzed the construct validity and reliability of the two scales measuring support provided by developers of university faculty. Mentors and mentees (G=156) from multiple Southwestern and Mountain West universities rated 741 developers on the MNQ's five-item career- and psychosocial-support scales. Participants responded on a seven-point scale ranging from "never, not at all" to "to the maximum extent possible." Multilevel confirmatory factor analysis (MCFA) using Mplus and the multi-level reliability coefficient omega assessed construct validity and internal consistency reliability, respectively. Results supported the validity of two latent constructs of career- and psychosocial support, each measured by the established five-item scale: Comparative fit index (CFI)=.93, Tucker-Lewis Index (TLI)=.91, root mean square error of approximation (RMSEA)=.06, standardized root mean square residual (SRMR): W=.09, B=.10. The measurement model was improved when the "removes barriers" item was removed from the career-support scale (CFI=.96, TLI=.95, RMSEA=.05, SRMR: W=.06 B=.09. Factor loadings at both the within- and between-levels were strong and statistically significant. Reliability omegas ranged from .85 to .92. Career and psychosocial support provided to university faculty by developers in their networks may be validly and reliably measured at both the within- and between-levels by a modified four-item career support scale and the original five-item psychosocial support scale from the DNQ and the modified MNQ. Limitations include reduced statistical power due to small sample size and lack of testing at the university level. Future work will assess the responsiveness of these scales to measuring change over time in the amount of support provided.
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Affiliation(s)
- B Tigges
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
| | - B Soller
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
| | - O Myers
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
| | - X Shore
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
| | - N Mickel
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
| | - N Dominguez
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
| | - B Wiskur
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
| | - D Helitzer
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
| | - A Sood
- University of New Mexico-Health Sciences Center, University of Oklahoma-Health Sciences Center, University of New Mexico-Central Campus, Arizona State University
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Davis M, Stephens A, Butaney M, Morrison C, Corsi N, Sood A, Levin AM, Cole A, Trinh QD, Rogers C, Abdollah F. Trends in Prostate Cancer Screening in the Pre- and Peri-COVID-19 Pandemic Period. Urol Pract 2023; 10:631-637. [PMID: 37647197 DOI: 10.1097/upj.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION This study sought to examine PSA testing rates before, early in, and later in the COVID-19 pandemic. METHODS Our cohort included test results from men >45 years who received PSA testing at least once at our institution from November 2018 to September 2021 and were alive at the end of that period. Monthly trends were evaluated for 3 periods: pre-COVID (November 2018-February 2020), early-COVID (March-May 2020), and late-COVID (June 2020-September 2021). Univariable and multivariable analysis tested the impact of these periods on PSA testing rate, after accounting for available confounders. All analyses were stratified by prostate cancer diagnosis status. RESULTS A total of 141,777 PSA tests met inclusion criteria. The monthly number of tests in men without prostate cancer declined from 3,669 pre-COVID to 1,760 early-COVID (52% decrease; P = .0086) before increasing to 4,171 (14% increase from pre-COVID; P < .0001) late-COVID. The monthly average of first-time tests declined from 805 pre-COVID to 315 early-COVID (61% decrease; P = .008) before rebounding to 795 (1% decrease from pre-COVID; P = .7) late-COVID. The monthly number of tests in prostate cancer patients declined from 343 pre-COVID to 195 early-COVID (43% decrease; P = .008) before partially rebounding to 313 (9% decrease; P = .03) late-COVID. These differences remained within multivariable models. CONCLUSIONS A number of men have forgone first-time PSA testing opportunities following the COVID-19 outbreak; thus, early cancer diagnoses in some individuals might have been missed. Likewise, many prostate cancer patients have forgone follow-up in the late-COVID period, which might compromise their oncologic outcomes.
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Affiliation(s)
- Matthew Davis
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Mohit Butaney
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Chase Morrison
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Nicholas Corsi
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | | | - Albert M Levin
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | | | | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
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Jiang M, Hu CJ, Rowe CL, Kang H, Gong X, Dagucon CP, Wang J, Lin Y, Sood A, Guo Y, Zhu Y, Alexis NE, Gilliland FD, Belinsky SA, Yu X, Leng S. Application of artificial intelligence in quantifying lung deposition dose of black carbon in people with exposure to ambient combustion particles. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00607-0. [PMID: 37848612 PMCID: PMC11021374 DOI: 10.1038/s41370-023-00607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Understanding lung deposition dose of black carbon is critical to fully reconcile epidemiological evidence of combustion particles induced health effects and inform the development of air quality metrics concerning black carbon. Macrophage carbon load (MaCL) is a novel cytology method that quantifies lung deposition dose of black carbon, however it has limited feasibility in large-scale epidemiological study due to the labor-intensive manual counting. OBJECTIVE To assess the association between MaCL and episodic elevation of combustion particles; to develop artificial intelligence based counting algorithm for MaCL assay. METHODS Sputum slides were collected during episodic elevation of ambient PM2.5 (n = 49, daily PM2.5 > 10 µg/m3 for over 2 weeks due to wildfire smoke intrusion in summer and local wood burning in winter) and low PM2.5 period (n = 39, 30-day average PM2.5 < 4 µg/m3) from the Lovelace Smokers cohort. RESULTS Over 98% individual carbon particles in macrophages had diameter <1 µm. MaCL levels scored manually were highly responsive to episodic elevation of ambient PM2.5 and also correlated with lung injury biomarker, plasma CC16. The association with CC16 became more robust when the assessment focused on macrophages with higher carbon load. A Machine-Learning algorithm for Engulfed cArbon Particles (MacLEAP) was developed based on the Mask Region-based Convolutional Neural Network. MacLEAP algorithm yielded excellent correlations with manual counting for number and area of the particles. The algorithm produced associations with ambient PM2.5 and plasma CC16 that were nearly identical in magnitude to those obtained through manual counting. IMPACT STATEMENT Understanding lung black carbon deposition is crucial for comprehending health effects of combustion particles. We developed "Machine-Learning algorithm for Engulfed cArbon Particles (MacLEAP)", the first artificial intelligence algorithm for quantifying airway macrophage black carbon. Our study bolstered the algorithm with more training images and its first use in air pollution epidemiology. We revealed macrophage carbon load as a sensitive biomarker for heightened ambient combustion particles due to wildfires and residential wood burning.
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Affiliation(s)
- Menghui Jiang
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Chelin Jamie Hu
- College of Nursing, University of New Mexico College of Nursing, Albuquerque, NM, USA
| | - Cassie L Rowe
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Huining Kang
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Xi Gong
- Department of Geography & Environmental Studies, University of New Mexico, Albuquerque, NM, USA
| | | | - Jialiang Wang
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Yan Lin
- Department of Geography & Environmental Studies, University of New Mexico, Albuquerque, NM, USA
| | - Akshay Sood
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
- Miners Colfax Medical Center, Raton, NM, USA
| | - Yan Guo
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Yiliang Zhu
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Neil E Alexis
- Center for Environmental Medicine Asthma and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Frank D Gilliland
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steven A Belinsky
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Lung Cancer Program, Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Xiaozhong Yu
- College of Nursing, University of New Mexico College of Nursing, Albuquerque, NM, USA.
| | - Shuguang Leng
- School of Medicine, University of New Mexico, Albuquerque, NM, USA.
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
- Lung Cancer Program, Lovelace Biomedical Research Institute, Albuquerque, NM, USA.
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Rakic I, Rakic N, Stephens A, Corsi N, Davis M, Tinsley S, Butaney M, Arora S, Sood A, Autorino R, Rogers C, Abdollah F. Assessing the impact of lymphovascular invasion on overall survival in surgically treated renal cell carcinoma patients: A nationwide cohort analysis. Urol Oncol 2023; 41:435.e1-435.e9. [PMID: 37625905 DOI: 10.1016/j.urolonc.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Lymph-vascular invasion (LVI) is recognized as an adverse pathological feature in patients with renal cell carcinoma (RCC). However, its impact on overall survival (OS) is not clear and scarcely addressed in the literature. We aimed to assess the prognostic ability of LVI as a predictor of OS in RCC patients using a large, North American cohort. METHODS We included 95,783 cM0 RCC patients, diagnosed between 2010 and 2015, who underwent partial or radical nephrectomy within the National Cancer Database. Kaplan-Meier curves and log-rank tests were used to depict and compare survival curves. Cox regression analysis tested the impact of LVI on OS, after adjusting for all available confounders. RESULTS Mean age (SD) was 59 (12), and most patients had pT1 stage (72.2%). Nodal status was pN0, pN1, and pNx, in 14.5%, 2.3%, and 83.3%, respectively. Overall, 9.0% of patients had LVI. The mean (SD) follow-up of the cohort was 39 months (24). At 5 years, OS was 65% in patients with LVI vs. 86% in patients without LVI (p<.0001). When patients were stratified based on nodal stage, these rates were 64% vs. 78% in pN0 patients, 31% vs. 41% in pN1 patients, and 69% vs. 87% in pNx patients (all P < 0.001). On multivariable analysis, and in comparison to patients without LVI, those with LVI had 1.37- (P < 0.001), 1.18- (P = 0.068), and 1.53-fold (P < 0.001) greater risk of death, when also harboring pN0, pN1, and pNx disease, respectively. CONCLUSIONS Our findings are the first, to our best knowledge, to illustrate the clear detrimental impact of LVI on OS in surgically treated RCC patients. These findings might be useful in postoperative patient counseling and need to be accounted for when designing future clinical trials.
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Affiliation(s)
- Ivan Rakic
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Nikola Rakic
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Alex Stephens
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Nicholas Corsi
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Matt Davis
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | | | - Mohit Butaney
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Sohrab Arora
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Craig Rogers
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Firas Abdollah
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
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Dalela D, Malchow T, Butaney M, Majdalany S, Corsi NJ, Rakic I, Sood A, Rogers C, Abdollah F. Temporal and Racial Trends in Prostate-specific Antigen Screening for U.S. Men With a Family History of Prostate Cancer. Urol Pract 2023; 10:484-492. [PMID: 37347799 DOI: 10.1097/upj.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/08/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Limited data exist on trends in PSA screening in men with a family history of prostate cancer. The aims of our study were to (1) study age-stratified temporal trends in PSA screening from 2000-2018 for men with a family history of prostate cancer and Black men with a family history of prostate cancer, and (2) identify determinants associated with receipt of PSA screening in the aforementioned groups. METHODS We identified men aged ≥40 years without a prior history of prostate cancer using data from National Health Interview Survey 2000-2018 who self-reported PSA testing in the last 12 months. Age-stratified temporal trends and weighted multivariable logistic regression analyses were assessed. RESULTS PSA screening increased for men with a family history of prostate cancer between National Health Interview Survey 2000 (28.9%) and 2005 (41.9%), with stable rates for the following years. Black men with a family history of prostate cancer showed no significant change in PSA screening rates regardless of age. Controlling for sociodemographics and access to health care provider, younger age (40-54) and later survey years (2013-2018) were associated with a lower likelihood of PSA screening overall and for Black men, but not for those with a positive family history. CONCLUSIONS Data from a nationally representative study of U.S. men indicated that the annual PSA screening rates for men with a family history of prostate cancer was higher than reported for the overall male population. We believe this represents the first study on trends and determinants of PSA screening in U.S. men with a family history of prostate cancer.
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Affiliation(s)
- Deepansh Dalela
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | | | - Mohit Butaney
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Sami Majdalany
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Nicholas J Corsi
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Ivan Rakic
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Akshay Sood
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Craig Rogers
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
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Modonutti D, Majdalany SE, Butaney M, Davis MJ, Corsi N, Sood A, Trinh QD, Cole AP, Rogers CG, Novara G, Abdollah F. Conditional survival does not improve over time in metastatic castration-resistant prostate cancer patients undergoing docetaxel. Prostate 2023; 83:1238-1246. [PMID: 37290911 DOI: 10.1002/pros.24583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/13/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the conditional overall survival (OS) of metastatic castration-resistant prostate cancer (mCRPC) patients receiving docetaxel chemotherapy. METHODS We used deidentified patient-level data from the Prostate Cancer DREAM Challenge database and the control arm of the ENTHUSE 14 trial. We identified 2158 chemonaïve mCRPC patients undergoing docetaxel chemotherapy in the five randomized clinical trials. The 6-month conditional OS was calculated at times 0, 6, 12, 18, and 24 months from randomization. Survival curves of each group were compared using the log-rank test. Patients were then stratified into low- and high-risk groups based on the median predicted value of our recently published nomogram predicting OS in mCRPC patients. RESULTS Nearly half (45%) of the study population was aged between 65 and 74 years. Median interquartile range prostate-specific antigen for the overall cohort was 83.2 (29.6-243) ng/mL, and 59% of patients had bone metastasis with or without lymph node involvement. The 6-month conditional survival rates at 0, 6, 12, 18, and 24 months for the entire cohort were 93% (95% confidence interval [CI]: 92-94), 82% (95% CI: 81-84), 76% (95% CI: 73-78), 75% (95% CI: 71-78), and 71% (95% CI: 65-76). These rates were, respectively, 96% (95% CI: 95-97), 92% (95% CI: 90-93), 84% (95% CI: 81-87), 81% (95% CI: 77-85), and 79% (95% CI: 72-84) in the low-risk group and 89% (95% CI: 87-91), 73% (95% CI: 70-76), 65% (95% CI: 60-69), 64% (95% CI: 58-70), and 58% (95% CI: 47-67) in the high-risk group. CONCLUSION The conditional OS for patients undergoing docetaxel chemotherapy tends to plateau over time, with the main drop in conditional OS happening during the first year from initiating docetaxel treatment. That is the longer a patient survives, the more likely they are to survive further. This prognostic information could be a useful tool for a more accurate tailoring of both follow-up and therapies. PATIENT SUMMARY In this report, we looked at the future survival in months of patients with metastatic castration resistant prostate cancer on chemotherapy who have already survived a certain period. We found that the longer time that a patient survives, the more likely they will continue to survive. We conclude that this information will help physicians tailor follow-ups and treatments for patients for a more accurate personalized medicine.
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Affiliation(s)
- Daniele Modonutti
- Department of Urology, Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
- Department of Surgery, Oncology and Gastroenterology-Urology, University Hospital of Padova, Padova, Italy
| | - Sami E Majdalany
- Department of Urology, Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohit Butaney
- Department of Urology, Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Matthew J Davis
- Department of Urology, Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Nicholas Corsi
- Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Akshay Sood
- Department of Urology, Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander P Cole
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Craig G Rogers
- Department of Urology, Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology-Urology, University Hospital of Padova, Padova, Italy
| | - Firas Abdollah
- Department of Urology, Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
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DiPalma AD, Sood A, Lehman D. Comment on "Analyzing various factors in the association between olfaction and perceived nasal patency" by Chao et al. including reply. Rhinology 2023; 61:383-384. [PMID: 37334677 DOI: 10.4193/rhin23.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Affiliation(s)
- A D DiPalma
- Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - A Sood
- Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - D Lehman
- Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
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Andrews JR, Sood A, Chapin BF. Point-Counterpoint: Staging Prostate-specific Membrane Antigen Positron Emission Tomography/Computerized Tomography for Detecting Clinically Node Positive Prostate Cancer. J Urol 2023; 210:242-243. [PMID: 37194136 DOI: 10.1097/ju.0000000000003495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Jack R Andrews
- Department of Urology, MD Anderson, Houston, Texas
- Department of Urology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Akshay Sood
- Department of Urology, MD Anderson, Houston, Texas
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Malchow T, Corsi NJ, Majdalany SE, Piontkowski AJ, Corsi MP, Friedman B, Butaney M, Rakic I, Arora S, Jamil M, Dalela D, Brodowsky E, Sood A, Ginsburg KB, Rogers C, Atiemo H, Abdollah F. Who Is Shaping the Future of Academic Urology? A Descriptive Analysis of Residency Program Directors. Urology 2023; 178:17-20. [PMID: 37209882 DOI: 10.1016/j.urology.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To characterize the demographics, educational background, and scholarly characteristics of current urology residency program directors (PDs). METHODS Urology programs were identified by the listing on the "Accredited US Urology Programs" section of American Urological Association website as of October 2021. Demographics and academic data were collected via publicly available department website and Google search engine. Metrics obtained included years of service as PD from time of appointment, sex, medical school/residency/fellowship, all-time H-index, dual degrees obtained, and professorial ranking. RESULTS One hundred and forty-seven accredited urological residencies were reviewed; every PD was included. The majority were male (78%) and fellowship trained (68%). Women represented only 22% of PDs. The median active time served as PD, as of 11/2021, was 4years (IQR: 2-7). Forty (28%) were faculty at the same program they completed their residency. The median all-time H-index was 12 (IQR: 7-19; range 1-61). Twelve PDs also served as chair of their department. CONCLUSION The vast majority of PDs are male, fellowship trained, and have served for less than 5years. Future studies are necessary to follow the trends of representation in leaders of urology residency programs.
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Affiliation(s)
- Taylor Malchow
- Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Nicholas J Corsi
- Wayne State University School of Medicine, Detroit, MI; University of Texas Southwestern Medical Center, Dallas, TX
| | - Sami E Majdalany
- Vattikuti Center for Outcomes Research Analytics and Evaluation, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | | | | | - Brett Friedman
- Department of Urology, The University of Texas Rio Grande Valley, Edinburgh, TX
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Ivan Rakic
- Wayne State University School of Medicine, Detroit, MI
| | - Sohrab Arora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Marcus Jamil
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Deepansh Dalela
- University of Texas Southwestern Medical Center, Dallas, TX; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Emily Brodowsky
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Akshay Sood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Urology, The Ohio State University, Columbus, OH
| | | | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Humphrey Atiemo
- Vattikuti Center for Outcomes Research Analytics and Evaluation, Detroit, MI
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
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de la Hoz RE, Shapiro M, Nolan A, Sood A, Lucchini RG, Cone JE, Celedón JC. Association of World Trade Center (WTC) Occupational Exposure Intensity with Chronic Obstructive Pulmonary Disease (COPD) and Asthma COPD Overlap (ACO). Lung 2023; 201:325-334. [PMID: 37468611 PMCID: PMC10763856 DOI: 10.1007/s00408-023-00636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Reported associations between World Trade Center (WTC) occupational exposure and chronic obstructive pulmonary disease (COPD) or asthma COPD overlap (ACO) have been inconsistent. Using spirometric case definitions, we examined that association in the largest WTC occupational surveillance cohort. METHODS We examined the relation between early arrival at the 2001 WTC disaster site (when dust and fumes exposures were most intense) and COPD and ACO in workers with at least one good quality spirometry with bronchodilator response testing between 2002 and 2019, and no physician-diagnosed COPD before 9/11/2001. COPD was defined spirometrically as fixed airflow obstruction and ACO as airflow obstruction plus an increase of ≥ 400 ml in FEV1 after bronchodilator administration. We used a nested 1:4 case-control design matching on age, sex and height using incidence density sampling. RESULTS Of the 17,928 study participants, most were male (85.3%) and overweight or obese (84.9%). Further, 504 (2.8%) and 244 (1.4%) study participants met the COPD and ACO spirometric case definitions, respectively. In multivariable analyses adjusted for smoking, occupation, cohort entry period, high peripheral blood eosinophil count and other covariates, early arrival at the WTC site was associated with both COPD (adjusted odds ratio [ORadj] = 1.34, 95% confidence interval [CI] 1.01-1.78) and ACO (ORadj = 1.55, 95%CI 1.04-2.32). CONCLUSION In this cohort of WTC workers, WTC exposure intensity was associated with spirometrically defined COPD and ACO. Our findings suggest that early arrival to the WTC site is a risk factor for the development of COPD or of fixed airway obstruction in workers with pre-existing asthma.
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Affiliation(s)
- Rafael E de la Hoz
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, WTC HP CCE Box 1059, New York, NY, 10029, USA.
| | - Moshe Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Nolan
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Akshay Sood
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Roberto G Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, WTC Health Registry, New York, NY, USA
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
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Greenberg J, Sood A, Guzman-Gomez A, Kulshrestha K, Kennedy J, Winlaw D, Morales D, Zafar F. A Potential Underutilized Donor Pool Exists for Infant Heart Transplant Candidates. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Sood A, Qualls C, Murata A, Kroth PJ, Mao J, Schade DS, Murata G. Potential for repurposing oral hypertension/diabetes drugs to decrease asthma risk in obesity. J Asthma 2023; 60:802-810. [PMID: 35796615 DOI: 10.1080/02770903.2022.2097919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Risk for asthma in the overweight/obese may be mediated by adiponectin and peroxisome proliferator activated receptor pathways and may be reduced by the use of oral drugs impacting these pathways, such as angiotensin converting enzyme inhibitors (ACE-I), thiazolidinediones (TZD), and angiotensin receptor blockers (ARB). Our study objective was to determine whether ACE-I, TZD, and/or ARB use in overweight/obese adults with diabetes mellitus and/or hypertension is associated with a lower risk for incident asthma. METHODS Using an existing cohort of American veterans, we performed a longitudinal data analysis over 15 years. Exposure was defined by the prescription pickup of ACE-I, TZD, and/or ARB for at least 4 weeks. The outcome, time until new-onset of clinician-diagnosed asthma, was studied using survival analysis. The propensity scoring method controlled for treatment selection bias. RESULTS 2.83 million eligible veterans, including 77,278 with incident asthma, were studied. As compared to those unexposed, the use of ACE-I alone, TZD alone, or their combinations were each associated with decreased risk for incident asthma (hazard ratios of 0.88, 0.74, and 0.20, respectively; p < 0.001 for all analyses in the fully adjusted statistical models). TZD lowered the risk among racial/ethnic minority subjects more than among White participants (p < 0.001). On the other hand, ARB use alone or in combination with TZD was associated with a higher risk for incident asthma. CONCLUSIONS Use of ACE-I and/or TZD was associated with a lower risk for incident asthma in overweight/obese patients with diabetes mellitus and/or hypertension.
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Affiliation(s)
- Akshay Sood
- Pulmonary, Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, United States
| | - Clifford Qualls
- Office of Research, New Mexico Veterans Administration Medical Center, Albuquerque, United States
| | - Allison Murata
- Office of Research, New Mexico Veterans Administration Medical Center, Albuquerque, United States
| | - Phillip J Kroth
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, United States
| | - Jenny Mao
- Pulmonary, Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, United States
| | - David S Schade
- Internal Medicine, University of New Mexico, Albuquerque, United States
| | - Glen Murata
- Office of Research, New Mexico Veterans Administration Medical Center, Albuquerque, United States
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Erdei E, Zhou X, Shuey C, Ass'ad N, Page K, Gore B, Zhu C, Kanda D, Luo L, Sood A, Zychowski KE. Serum autoantibodies and exploratory molecular pathways in rural miners: A pilot study. J Transl Autoimmun 2023; 6:100197. [PMID: 36942097 PMCID: PMC10023988 DOI: 10.1016/j.jtauto.2023.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction The Southwestern United States (SWUS) has an extensive history of coal and metal mining, including uranium (U) mining. Lung diseases, including but not limited to, lung cancer and pulmonary fibrosis, have been studied extensively in miners due to occupational, dust-related exposures. However, high-throughput autoimmune biomarkers are largely understudied in miners, despite the fact that ore miners, such as U-miners, are at an increased risk for the development of autoimmune diseases such as systemic sclerosis and systemic lupus erythematosus (SLE). Additionally, there are current gaps in knowledge regarding which signaling pathways may play a role in occupational exposure-associated autoimmunity. Methods Most current and former miners in the SWUS live close to their previous workplaces, in remote areas, with limited access to healthcare. In this pilot study, by leveraging a mobile clinical platform for patient care and clinical outreach, we recruited 44 miners who self-identified as either U (n = 10) or non-U miners (n = 34) and received health screenings. Serum IgG and IgM autoantibodies against 128 antigens were assessed using a high-throughput molecular technique, as a preliminary health screening opportunity. Results Even when adjusting for age as a covariate, there was a significant (p < 0.05) association between self-reported U-mining exposure and biomarkers including IgM alpha-actinin, histones H2B, and H4, myeloperoxidase (MPO) and myelin basic protein. However, adjusting for age did not result in significant associations for IgG autoantibody production in U-miners. Bioinformatic pathway analysis revealed several altered signaling pathways between IgM and IgG autoantibodies among both U and non-U miners. Conclusions Further research is warranted regarding the mechanistic connection between U-exposure and autoantibody development, especially regarding histone-related alterations and IgM autoantibody production.
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Affiliation(s)
- Esther Erdei
- College of Pharmacy, University of New Mexico- Health Sciences Center, 905 Vassar Drive NE, Albuquerque, NM, 87106, USA
| | - Xixi Zhou
- College of Pharmacy, University of New Mexico- Health Sciences Center, 905 Vassar Drive NE, Albuquerque, NM, 87106, USA
| | - Chris Shuey
- Southwest Research and Information Center, 105 Stanford Drive SE, Albuquerque, NM, 87106, USA
| | - Nour Ass'ad
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
| | - Bobbi Gore
- Miners' Colfax Medical Center, 203 Hospital Drive, Raton, NM, 87740, USA
| | - Chengsong Zhu
- Department of Immunology and Microarray Core, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Deborah Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Li Luo
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Akshay Sood
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
- Miners' Colfax Medical Center, 203 Hospital Drive, Raton, NM, 87740, USA
| | - Katherine E. Zychowski
- College of Nursing, University of New Mexico- Health Sciences Center, 2502 Marble Ave NE, Albuquerque, NM, 87131, USA
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Arora S, Bronkema C, Majdalany SE, Corsi N, Rakic I, Piontkowski A, Sood A, Davis MJ, Modonutti D, Novara G, Rogers CG, Abdollah F. Impact of preexisting opioid dependence on morbidity, length of stay, and inpatient cost of urological oncological surgery. World J Urol 2023; 41:1025-1031. [PMID: 36754878 DOI: 10.1007/s00345-023-04306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVES To determine the incidence of preexisting opioid dependence in patients undergoing elective urological oncological surgery. In addition, to quantify the impact of preexisting opioid dependence on outcomes and cost of common urologic oncological procedures at a national level in the USA. METHODS We used the National Inpatient Sample (NIS) to study 1,609,948 admissions for elective partial/radical nephrectomy, radical prostatectomy, and cystectomy procedures. Trends of preexisting opioid dependence were studied over 2003-2014. We use multivariable-adjusted analysis to compare opioid-dependent patients to those without opioid dependence (reference group) in terms of outcomes, namely major complications, length of stay (LOS), and total cost. RESULTS The incidence of opioid dependence steadily increased from 0.6 per 1000 patients in 2003 to 2 per 1000 in 2014. Opioid-dependent patients had a significantly higher rate of major complications (18 vs 10%; p < 0.001) and longer LOS (4 days (IQR 2-7) vs 2 days (IQR 1-4); p < 0.001), when compared to the non-opioid-dependent counterparts. Opioid dependence also increased the overall cost by 48% (adjusted median cost $18,290 [IQR 12,549-27,715] vs. $12,383 [IQR 9225-17,494] in non-opioid-dependent, p < 0.001). Multivariable analysis confirmed the independent association of preexisting opioid dependence with major complications, length of stay in 4th quartile, and total cost in 4th quartile. CONCLUSIONS The incidence of preexisting opioid dependence before elective urological oncology is increasing and is associated with adverse outcomes after surgery. There is a need to further understand the challenges associated with opioid dependence before surgery and identify and optimize these patients to improve outcomes.
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Affiliation(s)
- Sohrab Arora
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.,Vattikuti Urology Institute, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA
| | - Chandler Bronkema
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Sami E Majdalany
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Nicholas Corsi
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - Ivan Rakic
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - Austin Piontkowski
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - Akshay Sood
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.,Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew J Davis
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Daniele Modonutti
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.,Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padua, Italy
| | - Giacomo Novara
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padua, Italy
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA
| | - Firas Abdollah
- Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA. .,Vattikuti Urology Institute, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA. .,Wayne State University School of Medicine, Detroit, MI, USA.
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Brady PD, Six-Means A, Sood A, Durante J, Day P, Gimpel N, Stone K. Empowering youth aging out of foster care: a needs assessment to improve transitions to independent living. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Davis M, Stephens A, Morrison C, Majdalany S, Affas R, Arora S, Corsi N, Rakic I, Sood A, Rogers C, Abdollah F. Racial disparities in future development of lethal prostate cancer based on PSA levels in midlife. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01236-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Hensley PJ, Duan Z, Bree K, Sood A, Zhao H, Lobo N, Contieri R, Campbell MT, Guo CC, Navai N, Williams SB, Dinney CP, Kamat AM. Competing mortality risk from second primary malignancy in bladder cancer patients following radical cystectomy: Implications for survivorship. Urol Oncol 2023; 41:108.e11-108.e17. [PMID: 36404232 DOI: 10.1016/j.urolonc.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/16/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Muscle-invasive bladder cancer (BC) often occurs in patients with competing mortality risks, while also being associated with the highest rate of second primary nonurothelial cancers (SNUC) of all solid malignancies. We investigated the incidence, risk factors, and timing of SNUC as a competing mortality risk factor in patients with BC who were treated with curative intent radical cystectomy (RC). METHODS We performed a retrospective cohort study assessing patients who underwent RC for cT2-4 N0M0 BC from January 1, 2005 to December 31, 2018 at a single, high volume tertiary care referral center. The Fine-Gray multivariable regression model was used to evaluate predictive factors for SNUC. Cumulative incidence of mortality (CIM) was estimated with modified Kaplan-Meier analysis. RESULTS The median follow-up time for the 693 patients who underwent RC was 3.7 years (interquartile range [IQR] 1.9-5.9 years). SNUC developed in 85 (12.3%) patients at a median 3.0 years post-RC (IQR 1.2-5.5 years). On multivariable analysis, the only significant predictor for developing SNUC was freedom from BC recurrence or metastasis (HR 1.54, 95% CI 1.12-1.76, P = 0.019). The most common SNUCs were primary lung cancer (24, 3.2% of cohort) and colon cancer (9, 1.3% of cohort). BC surveillance imaging diagnosed SNUC in 35/52 (67.3%) patients with solid-organ visceral primaries. The overall mortality rate for any SNUC was 38.8%, with the 3 most lethal cancer types being pancreatic, lung, and colon (62.5%, 54.2%, and 44.4% mortality, respectively). The incidence of SNUC uniformly increased postoperatively, with a cumulative incidence of 22.1% (95% CI, 16.8-27.9%) at 12-years post-RC. 163 patients (23.5%) died from BC, 33 patients (4.8%) died from SNUC, and 94 patients (13.6%) died from other causes. While the CIM for BC plateaued around 5-years post-RC at 24%, the incidence of other-cause mortality uniformly rose throughout the postoperative period. By post-RC year 9 there was no significant difference in CIM between BC (CIM 27.2%, 95% CI, 23.5-31.1%) and other-causes (CIM 20.0%, 95% CI, 15.8-24.6%). CONCLUSIONS The cumulative incidence of SNUC at 12-years post-RC was 22%, with the majority identified on BC surveillance imaging. While BC mortality plateaued around 5-years post-RC, mortality related to SNUC or other causes rose steadily in the postoperative period. These data have clinical significance with regards to patient counseling, survivorship and oncologic surveillance in the highly comorbid muscle-invasive BC population.
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Affiliation(s)
- Patrick J Hensley
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhigang Duan
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Zhao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Niyati Lobo
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles C Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen B Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
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Davis M, Stephens A, Morrison C, Majdalany S, Affas R, Arora S, Corsi N, Rakic I, Sood A, Rogers C, Abdollah F. Baseline PSA levels in midlife & future development of lethal prostate cancer: A diverse North American cohort analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Rakic I, Davis M, Corsi N, Stephens A, Arora S, Rakic N, Morrison C, Malchow T, Affas R, Sood A, Rogers C, Abdollah F. Evaluating the role of lymphvascular invasion as an indicator for adverse outcomes for patients with upper tract urothelial carcinoma and its histological subtypes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Corsi N, Stephens A, Malchow T, Piontkowski A, Corsi M, Davis M, Arora S, Rakic I, Morrison C, Autorino R, Sood A, Rogers C, Abdollah F. Testing the external validity of the pout III trial (adjuvant platnium-based chemotherapy in upper tract urothelial carcinoma) in a North American cohort. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Brodowsky EC, Sood A, Butaney M, Majdalany SE, Stephens A, Corsi N, Piontkowski AJ, Rakic I, Jamil M, Dalela D, Peabody JO, Rogers CG, Abdollah F. Time to second biochemical recurrence as a prognostic indicator in postprostatectomy patients who undergo salvage radiation therapy: An RTOG 9601 based post hoc analysis. Prostate 2023; 83:64-70. [PMID: 36120850 DOI: 10.1002/pros.24436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVE The prognostic significance of a "second" biochemical recurrence (sBCR) after salvage radiation therapy (sRT) with/without hormonal therapy following primary radical prostatectomy in men with prostate cancer has not been examined. We hypothesized that a shorter time to sBCR will be associated with worse cancer control outcomes. METHODS The RTOG 9601 study included 760 patients with tumor stage pT2/T3, pN0, who had either persistently elevated prostate-specific antigen (PSA) postradical prostatectomy or developed subsequent biochemical recurrence with PSA levels between 0.2 and 4.0 ng/ml. All patients received sRT (with or without 2 years of Bicalutamide) from 1998 to 2015. For our study, we focused on 421 patients who had sBCR after sRT-which was defined as a PSA increase of at least 0.3 ng/ml over the first nadir. Patients were divided into two categories: early sBCR (n = 210) and late sBCR (n = 211) using median time to sBCR (3.51 years). All patients who experienced sBCR received salvage hormonal therapy. Competing-risk analysis was used to examine the impact of early versus late sBCR on prostate cancer specific mortality (CSM), after accounting for available covariates. RESULTS The majority of patients were age 60 years or older (75.8%), had pT3 disease (74.8%), and Gleason score 7 (75.2%). Overall, 13.8% had persistent PSA initially after surgery. At 10 years, starting at the time of sBCR, CSM rate was 31.3% in the early sBCR group versus 20.0% in the late sBCR group. In competing-risk analysis, time to sBCR was an independent predictor of CSM, where patients with early sBCR had 1.7-fold higher CSM risk (p = 0.026) than their counterparts with late sBCR. CONCLUSIONS Time to sBCR after sRT (with or without concomitant Bicalutamide) is a significant predictor of CSM following initial radical prostatectomy. This information can be used to guide subsequent treatments, and to counsel patients.
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Affiliation(s)
- Emily Chan Brodowsky
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Akshay Sood
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohit Butaney
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sami E Majdalany
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
| | - Alex Stephens
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
| | - Nicholas Corsi
- Division of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Austin J Piontkowski
- Division of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Ivan Rakic
- Division of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Marcus Jamil
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Deepansh Dalela
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - James O Peabody
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Craig G Rogers
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Firas Abdollah
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
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Meek PM, Schmiege SJ, Sood A, Petersen H, Vazquez-Guillamet R, Irshad H, McDonald J, Tesfaigzi Y. Testing of a novel questionnaire of Household Exposure to Wood Smoke. PLOS Glob Public Health 2023; 3:e0001500. [PMID: 36963064 PMCID: PMC10022189 DOI: 10.1371/journal.pgph.0001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/22/2022] [Indexed: 01/26/2023]
Abstract
Household air pollution from wood smoke (WS), contributes to adverse health effects in both low- and high-income countries. However, measurement of WS exposure has been limited to expensive in-home monitoring and lengthy face-to-face interviews. This paper reports on the development and testing of a novel, self-report nine-item measure of WS exposure, called the Household Exposure to Wood Smoke (HEWS). A sample of 149 individuals using household wood stoves for heating from western states in the U.S., completed the HEWS during the winter months (November to March) of 2013 through 2016 with 30 subjects having in-home particle monitoring. Hard copy or online surveys were completed. Cronbach's alpha (α), intraclass correlations (ICC), exploratory factor analysis (EFA) and tests of associations were done to evaluate reliability and validity of the HEWS. Based on initial analysis, only 9 of the 12 items were retained and entered in the EFA. The EFA did not support a unitary scale as the 9 items demonstrated a 3-factor solution (WS exposure duration, proximity, and intensity) with Cronbach's α of 0.79, 0.91, and 0.62, respectively. ICC was 0.86 of the combined items with single items ranging from 0.46 to 0.95. WS intensity was associated with symptoms and levoglucosan levels, while WS duration was associated with stove and flume maintenance. The three-dimensional HEWS demonstrated internal consistency and test-retest reliability, structural validity, and initial criterion and construct validity.
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Affiliation(s)
- Paula M Meek
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
| | - Sarah J Schmiege
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Akshay Sood
- Department of Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Hans Petersen
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, United States of America
| | - Rodrigo Vazquez-Guillamet
- John T. Milliken Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Hammad Irshad
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, United States of America
| | - Jacob McDonald
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, United States of America
| | - Yohannes Tesfaigzi
- Department of Medicine, Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, United States of America
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Corsi NJ, Messing EM, Sood A, Keeley J, Bronkema C, Rakic N, Jamil M, Dalela D, Arora S, Piontkowski AJ, Majdalany SE, Butaney M, Rakic I, Li P, Menon M, Rogers CG, Abdollah F. Risk-Based Assessment Of the Impact Of Intravesical Therapy on Recurrence-Free Survival Rate Following Resection of Suspected Low-grade, Non-muscle-invasive Bladder Cancer (NMIBC): A Southwest Oncology Groups (SWOG) S0337 Posthoc Analysis. Clin Genitourin Cancer 2022; 20:e498-e505. [PMID: 35871040 DOI: 10.1016/j.clgc.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/03/2022] [Accepted: 06/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Nonmuscle invasive bladder cancer (NMIBC) has an elevated risk of recurrence, and immediate postresection intravesical instillation of chemotherapy (IVC) significantly reduces the risk of recurrence. Questions remain about which subpopulation may maximally benefit from IVC. Our aim was to develop risk groups based on recurrence risk in NMIBC, and then evaluate the impact of a single, postoperative instillation of IVC on the subsequent risk of recurrence for each risk group. MATERIAL AND METHODS Using the SWOG S0337 trial cohort, we performed a posthoc analysis of 345 patients who were diagnosed with suspected low-grade NMIBC, underwent transurethral resection of the bladder tumor (TURBT), and received post-operative IVC (gemcitabine vs. saline). Using regression tree analysis, the regression tree stratified patients based on their risk of recurrence into low-risk - single tumor and aged < 57 years, intermediate-risk - single tumor and aged ≥ 57 years, and high-risk - multiple tumors. We used Cox proportional hazard models to test the impact of recurrence-free rate, and after adjustment to available covariates. RESULTS Median age of the cohort was 66.5 (IQR: 59.7-75.8 years) with 85% of patients being males. Median overall follow-up time was 3.07 years (IQR: 0.75-4.01 years). When testing the impact of treatment in each risk group separately, we found that patients in the intermediate-risk treated with gemcitabine had a 24-month recurrence free rate of 77% (95% CI: 68%-86%) vs. 59% (95% CI: 49%-70%) in the saline group. This survival difference was confirmed on multivariable analysis (hazard ratio: 0.39, 95% CI: 23%-66%, P < 0.001). This group represented 53% of our cohort. Conversely, we did not observe a significant difference in recurrence-free survival among patients in the low- (P = 0.7) and high-risk (P = 0.4) groups. CONCLUSION Our findings indicate that older patients with a single tumor of suspected low-grade NMIBC at TURBT maximally benefit from immediate postresection IVC (gemcitabine).
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Affiliation(s)
- Nicholas J Corsi
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | | | - Akshay Sood
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jacob Keeley
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Chandler Bronkema
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nikola Rakic
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Department of Urology, Baylor College of Medicine, Houston, TX
| | - Marcus Jamil
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Deepansh Dalela
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Sohrab Arora
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Austin J Piontkowski
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Sami E Majdalany
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Mohit Butaney
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Ivan Rakic
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Pin Li
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Mani Menon
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Craig G Rogers
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Firas Abdollah
- Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
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Myers O, Sood A, Dominguez N, Helitzer D, Tigges B. Organizations' Mentoring Culture is Associated With Mentoring Climate and Involvement. Chron Mentor Coach 2022; 6:598-603. [PMID: 36713785 PMCID: PMC9880803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Organizational culture is the shared, often unspoken, basic values, beliefs, and assumptions. Underlying culture influences organizational climate, the observable policies, practices, and procedures that faculty experience. Yet little is known about mentoring culture and climate in higher education. The purpose of this study was to a) conduct a psychometric evaluation of the 4-item Organizational Culture Mentoring Values (OCuM-V) scale and b) determine if organizational culture, operationalized as values related to mentoring, is associated with organizational mentoring climate (OMC) and involvement with mentoring. 298 [55 under-represented minority (URM)] faculty from University of New Mexico and Arizona State University completed a cross-sectional survey, including the OCuM-V scale and the 15-item OMC Availability (OMCA) scale. Items for both scales were rated No (1), Don't know (0), or Yes (1). Faculty reported if they were being mentored or providing mentoring. Exploratory factor analysis (EFA) and Cronbach's alpha were used for scale evaluation. Spearman correlation and logistic regression were used to assess OCuM-V association with climate and mentoring involvement, respectively. Overall, 24% of faculty were being mentored (27% for URM), and 43% were mentoring (38% for URM). OCuM-V items loaded on a single factor in EFA (Cronbach's alpha=0.84 for all; 0.88 for URM). OCuM-V was positively correlated with OMCA (including institutional expectations, mentor-mentee relationships, and resources subscales) for both all and URM faculty (r>0.4 p<.001 for all). Greater OCuM-V was associated with an increased odds of being mentored (OR=1.75±1.19-2.61) and providing mentoring (OR=1.83±1.30-2.58). Mentoring culture is associated with mentoring climate. Faculty who perceive stronger OCuM-V report a stronger OMC (available structure, programs/activities, policies/guidelines) and are being mentored or providing mentoring more often. Limitations include a small sample size for the URM group and cross-sectional data collection. Organizational leaders should explicitly promote values related to mentoring to strengthen both mentoring culture and climate at their institutions.
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Greenberg N, Myers O, Magdaleno Y, Sood A. The Pandemic Effect on Faculty Attrition at a School of Medicine. Chron Mentor Coach 2022; 6:604-609. [PMID: 36713786 PMCID: PMC9880763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mentors at Academic Health Centers (AHC) are challenged by mentee attrition, with one in five physicians reporting an intent to leave in 2020. AHCs struggle with physician replacement costs, which are exorbitant. Data-driven efforts to mitigate attrition during the pandemic require an understanding of reasons to leave. This study compares characteristics of exiting faculty at the University of New Mexico School of Medicine (UNM SOM) two years before to two years after April 1, 2020. Demographic and reason to leave variables from exit interviews of 168 faculty that left UNM SOM between April 2018-to-March 2020 and 151 faculty that left between April 2020-to-March 2022 were compared. Exiting faculty were stratified into those resigning vs. retiring. Distributions of each variable were analyzed for statistically significant differences using a chi-square or Fisher's 2-sided exact test. The pandemic was associated with an approximately three-fold higher proportion of retirement contributing to total attrition than before (25.8% vs. 8.9%; p<0.001). Among those who resigned, the pandemic was associated with a higher proportion of physicians than before (84.3% vs. 72.8%; p=0.03). Hispanic faculty may be more likely to resign during the pandemic than before (p=0.06). Those who resigned during the pandemic may be significantly less likely to cite "inadequate adherence to FTE" or a "challenging work environment" (p= 0.048 and 0.053 respectively) but more likely to cite personal family matters (p=0.06) as reasons to leave than before the pandemic. The increased proportion of retirees during the pandemic presents challenges for AHCs by exacerbating the current shortage of mentors while providing leadership opportunities for those retained. Mentors need to be aware of the top reasons for faculty leaving (which have not materially changed during the pandemic): challenging work environment, personal/family matters, inadequate work-life balance, greater career opportunities, and inadequate salary.
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Magdaleno Y, Rishel Brakey H, Greenberg N, Myers O, Sood A. A Qualitative Review of Comments by Faculty Who Cite Work-Life Balance as a Reason to Leave. Chron Mentor Coach 2022; 6:587-593. [PMID: 36778791 PMCID: PMC9910626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Despite growing evidence for the need for work-life balance (WLB) for faculty at academic health centers, mentors frequently do not know how to advise their mentees on this topic. WLB impacts job satisfaction and intent to stay, and physicians are particularly at risk. In this study, we explored exit survey comments of faculty of the University of New Mexico School of Medicine citing work-life balance as a reason to leave (WLB-ARTL). Between July 2017 and December 2020, 59 faculty provided open-ended survey responses related to reasons for leaving, what they liked and disliked about being faculty, mentorship, and more. Using a qualitative descriptive design, we analyzed open-ended responses using a systematic, iterative, thematic approach via NVIVO software. We classified themes using Shanafelt's drivers of engagement and burnout: workload/job demands; efficiency/ resources; meaning in work; culture/values; control/flexibility; social support/community at work; and work-life integration. While there were numerous quotes across all themes, we chose to summarize emergent codes with the most faculty representation and those that can most easily be addressed through mentorship: career development, culture and people, and hours and schedule (related to themes of meaning in work, culture and values, community at work, work-life integration, and control and flexibility). To improve faculty retention, institutional leaders should focus on developing mentors' career coaching and mentoring skills. Additional focus should be placed on training mentors to discuss and address WLB among their faculty mentees.
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Soller B, Martinez J, Rishel Brakey H, Dominguez N, Tigges B, Sood A. Barriers and Challenges for Career Milestones Among Faculty Mentees. Chron Mentor Coach 2022; 6:830-837. [PMID: 36743999 PMCID: PMC9894121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
'Critical' career milestones for faculty (e.g., tenure, securing grant funding) relate to career advancement, job satisfaction, service/leadership, scholarship/research, clinical or teaching activities, professionalism, compensation, and work-life balance. However, barriers and challenges to these milestones encountered by junior faculty have been inadequately studied, particularly those affecting underrepresented minorities in science (URM-S). Additionally, little is known about how barriers and challenges to career milestones have changed during the COVID-19 pandemic for URM-S and non-URM faculty mentees in science. In this study, we conducted semi-structured interviews with 31 faculty mentees from four academic institutions (located in New Mexico, Arizona, Idaho, and Hawaii), including 22 URM-S (women or racial/ethnic). Respondents were given examples of 'critical' career milestones and were asked to identify and discuss barriers and challenges that they have encountered or expect to encounter while working toward achieving these milestones. We performed thematic descriptive analysis using NVivo software in an iterative, team-based process. Our preliminary analysis identified five key themes that illustrate barriers and challenges encountered: Job and career development, Discrimination and a lack of workplace diversity; Lack of interpersonal relationships and inadequate social support at the workplace; Personal and family matters; and Unique COVID-19-related issues. COVID-19 barriers and challenges were related to online curriculum creation and administration, interpersonal relationship development, inadequate training/service/conference opportunities, and disruptions in childcare and schooling. Although COVID-19 helped create new barriers and challenges for junior faculty mentees, traditional barriers and challenges for 'critical' career milestones continue to be reported among our respondents. URM-S respondents also identified discrimination and diversity-related barriers and challenges. Subsequent interviews will focus on 12-month and 24-month follow-ups and provide additional insight into the unique challenges and barriers to 'critical' career milestones that URM and non-URM faculty in science have encountered during the unique historical context of the COVID-19 pandemic.
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