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Teo MY, Bambury RM, Zabor EC, Jordan E, Al-Ahmadie H, Boyd ME, Bouvier N, Mullane SA, Cha EK, Roper N, Ostrovnaya I, Hyman DM, Bochner BH, Arcila ME, Solit DB, Berger MF, Bajorin DF, Bellmunt J, Iyer G, Rosenberg JE. Commentary on "DNA damage response and repair gene alterations are associated with improved survival in patients with platinum-treated advanced urothelial carcinoma.". Urol Oncol 2018; 36:345-346. [PMID: 29859727 DOI: 10.1016/j.urolonc.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Platinum-based chemotherapy remains the standard treatment for advanced urothelial carcinoma by inducing DNA damage. We hypothesize that somatic alterations in DNA damage response and repair (DDR) genes are associated with improved sensitivity to platinum-based chemotherapy. EXPERIMENTAL DESIGN Patients with diagnosis of locally advanced and metastatic urothelial carcinoma treated with platinum-based chemotherapy who had exon sequencing with the Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) assay were identified. Patients were dichotomized based on the presence/absence of alterations in a panel of 34 DDR genes. DDR alteration status was correlated with clinical outcomes and disease features. RESULTS One hundred patients were identified, of which 47 harbored alterations in DDR genes. Patients with DDR alterations had improved progression-free survival (9.3 vs. 6.0 months, log-rank P = 0.007) and overall survival (23.7 vs. 13.0 months, log-rank P = 0.006). DDR alterations were also associated with higher number mutations and copy-number alterations. A trend toward positive correlation between DDR status and nodal metastases and inverse correlation with visceral metastases were observed. Different DDR pathways also suggested variable effect on clinical outcomes. CONCLUSIONS Somatic DDR alteration is associated with improved clinical outcomes in platinum-treated patients with advanced urothelial carcinoma. Once validated, it can improve patient selection for clinical practice and future study enrollment.
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Xylinas E, Cha EK, Sun M, Rink M, Trinh QD, Novara G, Green DA, Pycha A, Fradet Y, Daneshmand S, Svatek RS, Fritsche HM, Kassouf W, Scherr DS, Faison T, Crivelli JJ, Tagawa ST, Zerbib M, Karakiewicz PI, Shariat SF. Risk stratification of pT1-3N0 patients after radical cystectomy for adjuvant chemotherapy counselling. Br J Cancer 2013; 107:1826-32. [PMID: 23169335 PMCID: PMC3504939 DOI: 10.1038/bjc.2012.464] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In pT1-T3N0 urothelial carcinoma of the bladder (UCB) patients, multi-modal therapy is inconsistently recommended. The aim of the study was to develop a prognostic tool to help decision-making regarding adjuvant therapy. METHODS We included 2145 patients with pT1-3N0 UCB after radical cystectomy (RC), naive of neoadjuvant or adjuvant therapy. The cohort was randomly split into development cohort based on the US patients (n=1067) and validation cohort based on the Europe patients (n=1078). Predictive accuracy was quantified using the concordance index. RESULTS With a median follow-up of 45 months, 5-year recurrence-free and cancer-specific survival estimates were 68% and 73%, respectively. pT-stage, ge, lymphovascular invasion, and positive margin were significantly associated with both disease recurrence and cancer-specific mortality (P-values ≤ 0.005). The accuracies of the multivariable models at 2, 5, and 7 years for predicting disease recurrence were 67.4%, 65%, and 64.4%, respectively. Accuracies at 2, 5, and 7 years for predicting cancer-specific mortality were 69.3%, 66.4%, and 65.5%, respectively. We developed competing-risk, conditional probability nomograms. External validation revealed minor overestimation. CONCLUSION Despite RC, a significant number of patients with pT1-3N0 UCB experience disease recurrence and ultimately die of UCB. We developed and externally validated competing-risk, conditional probability post-RC nomograms for prediction of disease recurrence and cancer-specific mortality.
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Affiliation(s)
- E Xylinas
- Department of Urology, Weill Cornell Medical College, Starr 900, 525 East 68th Street, Box 94, New York, NY 10065, USA
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Cha EK, Tirsar L, Shariat SF, Christos PJ, Mazumdar M, Hennenlotter J, Schwentner C, Mian C, Lodde M, Schmitz-Drager BJ. Use of immunocytology to predict bladder cancer presence in patients with asymptomatic hematuria. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
242 Background: The uCyt immunocytology assay detects cellular biomarkers for bladder cancer (BCa) in exfoliated urothelial cells. We assessed the performance of uCy for detecting BCa in patients undergoing initial evaluation for asymptomatic hematuria. Methods: Data from 1,182 subjects without a history of BCa undergoing evaluation for hematuria were collected at three centers: EuromedClinic/Urologie24, University of Tübingen, and Central Hospital of Bolzano. All subjects underwent standard workup (i.e., voided cytology, upper tract imaging, and cystoscopy) and immunocytology. Results: Overall, 245 subjects had BCa (20.7%). The sensitivity/specificity/negative predictive value for uCyt and cytology were 82.4%/86.6%/95.0% and 46.5%/94.9%/87.2%, respectively. uCyt (OR 18.3, p<0.001) and cytology (OR 2.9, p<0.001) were associated with BCa in a multivariable analysis. The base model (age, gender, smoking status, type of hematuria) predicted BCa with an accuracy of 74.1%. Addition of cytology to the base model improved predictive accuracy (PA) to 83.5% (p<0.001), while addition of uCyt to the base model improved PA to 90.1% (p<0.001). Addition of uCyt to Model 1 significantly improved PA (+7.6%, p<0.001), but addition of cytology to Model 2 did not (+1.0%, p=0.057). uCyt performed equally well in patients with microscopic and gross hematuria (OR 30 vs. 27), while cytology did not (OR 18 vs. 12). Conclusions: uCyt is a strong, independent predictor of BCa in patients with hematuria; it outperforms cytology. uCyt may help with patient counseling, quality of care optimization (referral prioritization), and possibly sparing unnecessary hematuria workup in patients at extremely low risk of BCa. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- E. K. Cha
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - L. Tirsar
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - S. F. Shariat
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - P. J. Christos
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - M. Mazumdar
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - J. Hennenlotter
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - C. Schwentner
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - C. Mian
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - M. Lodde
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
| | - B. J. Schmitz-Drager
- Weill Cornell Medical College, New York, NY; EuromedClinic, Furth, Germany; University of Tuebingen, Tuebingen, Germany; Central Hospital of Bolzano, Bolzano, Italy
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Abstract
OBJECTIVE We studied delayed or residual manifestations of penetrating cardiac injury in patients to determine the incidence, type, management, and outcome. BACKGROUND Penetrating cardiac injury is associated with a high mortality despite improvement in management in recent years. Secondary lesions that are usually not looked for at the time of initial surgery are diagnosed and repaired postoperatively. DESIGN Retrospective study. SETTING The study was conducted at a major urban trauma center. PATIENTS Forty-eight survivors of 71 penetrating cardiac injuries were treated during a 10-year period from 1980 to 1990. RESULTS Delayed sequelae were diagnosed in 11 patients (23%) during the postoperative period. There were five ventricular septal defects, two aortic valvular injuries, one atrial septal defect, two conduction defects, and one tricuspid valvular lesion. All lesions were repaired electively with 100% survival. CONCLUSION We found residual or delayed sequelae in 23% of our patients. Close follow-up and utilization of diagnostic studies, including two-dimensional echocardiography during the early postoperative period, can identify late sequelae and allow elective repair.
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Affiliation(s)
- E K Cha
- Department of Surgery, Wayne State University, Grace Hospital, Detroit, Mich
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