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Narayan VM, Boorjian SA, Alemozaffar M, Konety BR, Shore ND, Gomella LG, Kamat AM, Bivalacqua TJ, Montgomery JS, Lerner SP, Busby JE, Poch M, Crispen PL, Steinberg GD, Schuckman AK, Downs TM, Mashni J, Lane BR, Bratslavsky G, Karsh LI, Woods ME, Brown G, Canter D, Luchey A, Lotan Y, Inman BA, Williams MB, Cookson MS, Chang SS, Sankin AI, O'Donnell MA, Sawutz D, Philipson R, Parker NR, Yla-Herttuala S, Rehm D, Jakobsen JS, Juul K, Dinney CPN. Efficacy of Intravesical Nadofaragene Firadenovec for Patients with BCG-Unresponsive Non-muscle Invasive Bladder Cancer: 5 Year Follow-Up from a Phase 3 Trial. J Urol 2024:101097JU0000000000004020. [PMID: 38704840 DOI: 10.1097/ju.0000000000004020] [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: 03/08/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Nadofaragene firadenovec-vncg is a non-replicating adenoviral vector-based gene therapy for BCG-unresponsive carcinoma in situ (CIS) with/without HG Ta/T1). We report outcomes following 5 years of planned follow-up. METHODS This open-label phase 3 trial (NCT02773849) enrolled patients with BCG-unresponsive NMIBC in 2 cohorts: CIS ± Ta/T1 (CIS; n = 107) and Ta/T1 without CIS (Ta/T1 cohort; n = 50). Patients received 75 mL (3 × 1011 vp/mL) of Nadofaragene firadenovec intravesically once every 3 months with cystoscopy and cytology assessments, with continued treatment offered to those remaining high-grade recurrence free (HGRF). RESULTS One hundred fifty-seven patients were enrolled from 33 US sites (n = 151 included in efficacy analyses). Median follow-up was 50.8 months (IQR 39.1-60.0), with 27% receiving ≥ 5 instillations and 7.6% receiving treatment for ≥ 57 months. 5.8% (95% CI 2.2-12.2) of patients with CIS and 15% (95% CI 6.1-27.8) of patients with HG Ta/T1 were HGRF at month 57. Kaplan-Meier (KM)-estimated HGRF survival at 57 months was 13% (95% CI 6.9-21.5) and 33% (95% CI 19.5-46.6) in the CIS and Ta/T1 cohorts, respectively. Cystectomy-free survival at month 60 was 49% (95% CI 40.0-57.1): 43% (95% CI 32.2-53.7) in the CIS cohort and 59% (95% CI 43.1-71.4) in the Ta/T1 cohort. Overall survival at 60 months was 80% (71.0, 86.0): 76% (64.6-84.5) and 86% (70.9-93.5) in the CIS and Ta/T1 cohorts, respectively. Only 5 patients (4 with CIS and 1 with Ta/T1) experienced clinical progression to muscle-invasive disease. CONCLUSIONS At 60 months, Nadofaragene firadenovec-vncg allowed bladder preservation in nearly half of the patients and proved to be a safe option for BCG-unresponsive NMIBC.
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Affiliation(s)
- Vikram M Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Badrinath R Konety
- Department of Urology, University of Minnesota and Allina Health Cancer Institute, Minneapolis, Minnesota
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina
| | - Leonard G Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Seth P Lerner
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Joseph E Busby
- Cancer Centers of the Carolinas, Greenville Hospital System, Greenville, South Carolina
| | - Michael Poch
- Department of GU Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Paul L Crispen
- Department of Urology, University of Florida, Gainesville, Florida
| | | | - Anne K Schuckman
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Tracy M Downs
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | | | - Brian R Lane
- Division of Urology, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | | | | | - Michael E Woods
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | | | | | - Adam Luchey
- West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brant A Inman
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | | | - Michael S Cookson
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | - Nigel R Parker
- AI Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Seppo Yla-Herttuala
- AI Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Dorte Rehm
- Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | | | | | - Colin P N Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Moreno CS, Winham CL, Alemozaffar M, Klein ER, Lawal IO, Abiodun-Ojo OA, Patil D, Barwick BG, Huang Y, Schuster DM, Sanda MG, Osunkoya AO. Integrated Genomic Analysis of Primary Prostate Tumor Foci and Corresponding Lymph Node Metastases Identifies Mutations and Pathways Associated with Metastasis. Cancers (Basel) 2023; 15:5671. [PMID: 38067373 PMCID: PMC10705102 DOI: 10.3390/cancers15235671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 02/12/2024] Open
Abstract
Prostate cancer is a highly heterogeneous disease and mortality is mainly due to metastases but the initial steps of metastasis have not been well characterized. We have performed integrative whole exome sequencing and transcriptome analysis of primary prostate tumor foci and corresponding lymph node metastases (LNM) from 43 patients enrolled in clinical trial. We present evidence that, while there are some cases of clonally independent primary tumor foci, 87% of primary tumor foci and metastases are descended from a common ancestor. We demonstrate that genes related to oxidative phosphorylation are upregulated in LNM and in African-American patients relative to White patients. We further show that mutations in TP53, FLT4, EYA1, NCOR2, CSMD3, and PCDH15 are enriched in prostate cancer metastases. These findings were validated in a meta-analysis of 3929 primary tumors and 2721 metastases and reveal a pattern of molecular alterations underlying the pathology of metastatic prostate cancer. We show that LNM contain multiple subclones that are already present in primary tumor foci. We observed enrichment of mutations in several genes including understudied genes such as EYA1, CSMD3, FLT4, NCOR2, and PCDH15 and found that mutations in EYA1 and CSMD3 are associated with a poor outcome in prostate cancer.
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Affiliation(s)
- Carlos S. Moreno
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (C.L.W.); (A.O.O.)
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
| | - Cynthia L. Winham
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (C.L.W.); (A.O.O.)
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University, Atlanta, GA 30322, USA (D.P.); (M.G.S.)
| | - Emma R. Klein
- Emory College of Arts and Sciences, Atlanta, GA 30322, USA
| | - Ismaheel O. Lawal
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA (O.A.A.-O.); (D.M.S.)
| | - Olayinka A. Abiodun-Ojo
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA (O.A.A.-O.); (D.M.S.)
| | - Dattatraya Patil
- Department of Urology, Emory University, Atlanta, GA 30322, USA (D.P.); (M.G.S.)
| | - Benjamin G. Barwick
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA 30322, USA
| | - Yijian Huang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA 30322, USA;
| | - David M. Schuster
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA (O.A.A.-O.); (D.M.S.)
| | - Martin G. Sanda
- Department of Urology, Emory University, Atlanta, GA 30322, USA (D.P.); (M.G.S.)
| | - Adeboye O. Osunkoya
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (C.L.W.); (A.O.O.)
- Department of Urology, Emory University, Atlanta, GA 30322, USA (D.P.); (M.G.S.)
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Daneshmand S, Cary C, Masterson T, Einhorn L, Adra N, Boorjian SA, Kollmannsberger C, Schuckman A, So A, Black P, Bagrodia A, Skinner E, Alemozaffar M, Brand T, Eggener S, Pierorazio P, Stratton K, Nappi L, Nichols C, Luo C, Li M, Hu B. Surgery in Early Metastatic Seminoma: A Phase II Trial of Retroperitoneal Lymph Node Dissection for Testicular Seminoma With Limited Retroperitoneal Lymphadenopathy. J Clin Oncol 2023; 41:3009-3018. [PMID: 36913642 DOI: 10.1200/jco.22.00624] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 01/31/2023] [Indexed: 03/15/2023] Open
Abstract
PURPOSE The long-term toxicities of chemotherapy and radiotherapy can represent a significant burden to testicular cancer survivors. Retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors with minimal late morbidity although little data exist on its efficacy in early metastatic seminoma. Surgery in early metastatic seminoma is a prospective phase II single-arm, multi-institutional trial of RPLND as first-line treatment for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy. PATIENTS AND METHODS Twelve sites in the United States and Canada prospectively enrolled adult patients with testicular seminoma and isolated retroperitoneal lymphadenopathy (1-3 cm). Open RPLND was performed by certified surgeons with a primary end point of 2-year recurrence-free survival (RFS). Complication rates, pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed. RESULTS A total of 55 patients were enrolled, with a median (IQR) largest clinical lymph node size of 1.6 cm (1.3-1.9). RPLND pathology demonstrated a median (IQR) largest lymph node size of 2.3 cm (0.9-3.5); nine patients (16%) were pN0, 12 (22%) pN1, 31 (56%) pN2, and 3 (5%) pN3. One patient received adjuvant chemotherapy. With a median (IQR) follow-up of 33 months (12.0-61.6), 12 patients experienced recurrence, with a 2-year RFS of 81% and a recurrence rate of 22%. Of the patients who experienced recurrence, 10 were treated with chemotherapy and two underwent additional surgery. At last follow-up, all patients who experienced a recurrence were disease-free and the 2-year overall survival was 100%. Four patients (7%) experienced short-term complications, and four patients experienced long-term complications including incisional hernia (1) and anejaculation (3). CONCLUSION RPLND is a treatment option for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy and is associated with low long-term morbidity.
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Affiliation(s)
- Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Clint Cary
- Department of Urology, Indiana University, Indianapolis, IN
| | | | - Lawrence Einhorn
- Division of Hematology & Medical Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Division of Hematology & Medical Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Anne Schuckman
- Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Alan So
- Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Peter Black
- Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eila Skinner
- Department of Urology, Stanford University, Stanford, CA
| | | | - Timothy Brand
- Department of Urology, Madigan Army Medical Center, Tacoma, WA
| | - Scott Eggener
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - Phillip Pierorazio
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MA
| | - Kelly Stratton
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Lucia Nappi
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Craig Nichols
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Chunqiao Luo
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Ming Li
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Brian Hu
- Department of Urology, Loma Linda University, Loma Linda, CA
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Heidenreich A, Ladi Seyedian S, Alsyouf M, Hu B, Cary C, Masterson T, Einhorn L, Adra N, Boorjian S, Schuckman A, Bagrodia A, Kollmannsberger C, So A, Black P, Skinner E, Alemozaffar M, Brand T, Eggener S, Pierorazio P, Pierorazio K, Nappi L, Nichols C, Daneshmand S. Surgical and oncologic outcomes of surgery in early metastatic seminoma: Multi-institutional retrospective study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00795-9] [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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Prokhnevska N, Cardenas MA, Valanparambil RM, Sobierajska E, Barwick BG, Jansen C, Reyes Moon A, Gregorova P, delBalzo L, Greenwald R, Bilen MA, Alemozaffar M, Joshi S, Cimmino C, Larsen C, Master V, Sanda M, Kissick H. CD8 + T cell activation in cancer comprises an initial activation phase in lymph nodes followed by effector differentiation within the tumor. Immunity 2023; 56:107-124.e5. [PMID: 36580918 DOI: 10.1016/j.immuni.2022.12.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 77.0] [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: 04/23/2022] [Revised: 09/11/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022]
Abstract
Improvements in tumor immunotherapies depend on better understanding of the anti-tumor T cell response. By studying human tumor-draining lymph nodes (TDLNs), we found that activated CD8+ T cells in TDLNs shared functional, transcriptional, and epigenetic traits with TCF1+ stem-like cells in the tumor. The phenotype and TCR overlap suggested that these TDLN cells were precursors to tumor-resident stem-like CD8+ T cells. Murine tumor models revealed that tumor-specific CD8+ T cells were activated in TDLNs but lacked an effector phenotype. These stem-like cells migrated into the tumor, where additional co-stimulation from antigen-presenting cells drove effector differentiation. This model of CD8+ T cell activation in response to cancer is different from that of canonical CD8+ T cell activation to acute viruses, and it proposes two stages of tumor-specific CD8+ T cell activation: initial activation in TDLNs and subsequent effector program acquisition within the tumor after additional co-stimulation.
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Affiliation(s)
| | - Maria A Cardenas
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rajesh M Valanparambil
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA; Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Ewelina Sobierajska
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin G Barwick
- Winship Cancer Institute of Emory University, Atlanta, GA, USA; Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Caroline Jansen
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Adriana Reyes Moon
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Petra Gregorova
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Luke delBalzo
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel Greenwald
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA; Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Shreyas Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Cara Cimmino
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Christian Larsen
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA, USA; Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Martin Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Haydn Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA; Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA.
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6
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Nabavizadeh R, Lee G, Bobrek K, Patil D, Alemozaffar M, Moreno C, Master VA. Utility of ultrasonography in preoperative assessment of tumor thrombi in kidney cancer. Can J Urol 2022; 29:11300-11306. [PMID: 36245200] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION This study examined the clinical accuracy of ultrasonography compared to magnetic resonance imaging (MRI) and intraoperative findings for evaluation of tumor thrombi level in patients with renal cell carcinoma. MATERIALS AND METHODS We retrospectively identified 38 patients at our institution who underwent both ultrasonography and MRI before undergoing open radical nephrectomy with tumor thrombectomy between 2010 and 2019. We compared tumor thrombus level findings of both ultrasonography and MRI, as well as the diagnostic accuracy of each to intraoperative findings. Agreement between ultrasonography, MRI, and surgery was tested with kappa. Logistic regression models identified factors that predict a mismatched thrombus level between an imaging modality and surgical findings. RESULTS AND CONCLUSIONS Tumor thrombus levels determined by ultrasonography matched with MRI in 26 (68.4%) cases. Compared to operative findings, ultrasonography accurately identified the cephalad extent of thrombi in 30 (79.0%) cases, under-staged five (13.2%) cases, and over-staged three (7.9%). Magnetic resonance imaging agreed with operative findings in 30 (79.0%) cases, under-staged five (13.2%) and over-staged three (7.9%) cases. On univariable regression assessment, M1 stage was predictive of a mismatched result between MRI and surgery (OR: 6.0, 95% CI: 1.02-35.3, p = 0.047), but this association did not hold-up in a multivariable model. Ultrasonography and magnetic resonance imaging identified the preoperative tumor thrombus level at a rate of 79%. Ultrasonography is an effective preoperative imaging modality for evaluating tumor thrombi associated with kidney cancer, notably as an adjunct to magnetic resonance imaging.
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Affiliation(s)
- Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Grace Lee
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katherine Bobrek
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehrdad Alemozaffar
- Department of Urology, Kaiser Permanente Orange County, Orange County, California, USA
| | - Courtney Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Ghodoussipour S, Ahmadi N, Goh A, Alemozaffar M, Nabavizadeh R, Gallucci M, Simone G, Tuderti G, Gill I, Desai M, Zhao LC, Aron M. Robotic Repair of Ureteroenteric Stricture Following Radical Cystectomy: A Multi-Institutional Experience. Urology 2022; 161:125-130. [PMID: 35007620 PMCID: PMC9982748 DOI: 10.1016/j.urology.2021.11.020] [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: 09/09/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the safety, feasibility and durability of robotic reimplantation of ureteroenteric stricture after radical cystectomy. MATERIALS AND METHODS A retrospective multi-institutional review was performed for all patients undergoing robotic repair of ureteroenteric stricture from January 2010 to January 2019. Functional outcomes and complications were followed and data were analyzed with SPSS statistical software. RESULTS A total of 46 patients and 58 renal units were identified, of which 15 had right sided, 19 left sided and 12 patients had bilateral strictures. Presentation of stricture was asymptomatic in 14 (30.4%) patients. Symptomatic presentations included infection in 22 (47.8%), worsening renal function in 11 (23.9%) and pain in 3 (6.5%) patients. Median time from cystectomy to diagnosis of stricture was 5 months (1-40). Median stricture length was 1.5 cm (range 0.5-10). All strictures were of benign etiology except for 4 (6.9%), which were due to malignancy. Overall, 49 (84.5%) ureters underwent primary re-implantation, while 9 (15.5%) required Boari-like advancement flaps prior to re-implantation. Median operative time was 190 min (range 45-540) with median estimated blood loss of 50 mL (range 25-2000) and median length of stay of 2 days (range 1-33, IQR 2-4). Seven (15.2%) patients experienced complications; 3 (6.5%) were low grade and 4 (8.7%) high grade. With median follow up of 18 months (range 1-51) the stricture recurrence rate was 8.6%. CONCLUSION Robotic reimplantation of ureteroenteric strictures following radical cystectomy is safe and feasible in experienced centers with high success rates.
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Affiliation(s)
- Saum Ghodoussipour
- Rutgers Robert Wood Johnson Medical School and Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Alvin Goh
- Methodist Hospital, Houston, Texas, USA,Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | | | | | | | | - Inderbir Gill
- USC Institute of Urology, Los Angeles, California, USA
| | - Mihir Desai
- USC Institute of Urology, Los Angeles, California, USA
| | - Lee C. Zhao
- New York University Langone Health, New York, USA
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8
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Mitra AP, Narayan VM, Mokkapati S, Miest T, Boorjian SA, Alemozaffar M, Konety BR, Shore ND, Gomella LG, Kamat AM, Bivalacqua TJ, Montgomery JS, Lerner SP, Busby JE, Poch M, Crispen PL, Steinberg GD, Schuckman AK, Downs TM, Svatek RS, Mashni J, Lane BR, Guzzo TJ, Bratslavsky G, Karsh LI, Woods ME, Brown GA, Canter D, Luchey A, Lotan Y, Krupski T, Inman BA, Williams MB, Cookson MS, Keegan KA, Andriole GL, Sankin AI, Boyd A, O’Donnell MA, Philipson R, Ylä-Herttuala S, Sawutz D, Parker NR, McConkey DJ, Dinney CP. Antiadenovirus Antibodies Predict Response Durability to Nadofaragene Firadenovec Therapy in BCG-unresponsive Non-muscle-invasive Bladder Cancer: Secondary Analysis of a Phase 3 Clinical Trial. Eur Urol 2022; 81:223-228. [PMID: 34933753 PMCID: PMC8891058 DOI: 10.1016/j.eururo.2021.12.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/04/2021] [Accepted: 12/02/2021] [Indexed: 01/09/2023]
Abstract
A recent phase 3 trial of intravesical nadofaragene firadenovec reported a promising complete response rate for patients with bacillus Calmette-Guérin-unresponsive non-muscle-invasive bladder cancer. This study examined the ability of antiadenovirus antibody levels to predict the durability of therapeutic response to nadofaragene firadenovec. A standardized and validated quantitative assay was used to prospectively assess baseline and post-treatment serum antibody levels among 91 patients from the phase 3 trial, of whom 47 (52%) were high-grade recurrence free at 12 mo (responders). While baseline titers did not predict treatment response, 3-mo titer >800 was associated with a higher likelihood of durable response (p = 0.026). Peak post-treatment titers >800 were noted in 42 (89%) responders versus 26 (59%) nonresponders (p = 0.001; assay sensitivity, 89%; negative predictive value, 78%). Moreover, 22 (47%) responders compared with eight (18%) nonresponders had a combination of peak post-treatment titers >800 and peak antibody fold change >8 (p = 0.004; assay specificity, 82%; positive predictive value, 73%). A majority of responders continued to have post-treatment antibody titers >800 after the first 6 mo of therapy. In conclusion, serum antiadenovirus antibody quantification may serve as a novel predictive marker for nadofaragene firadenovec response durability. Future studies will focus on large-scale validation and clinical utility of the assay. PATIENT SUMMARY: This study reports on a planned secondary analysis of a phase 3 multicenter clinical trial that established the benefit of nadofaragene firadenovec, a novel intravesical gene therapeutic, for the treatment of patients with bacillus Calmette-Guérin (BCG)-unresponsive high-risk non-muscle-invasive bladder cancer. Prospective assessment of serum anti-human adenovirus type-5 antibody levels of patients in this trial indicated that a combination of post-treatment titers and fold change from baseline can predict treatment efficacy. While this merits additional validation, our findings suggest that serum antiadenovirus antibody levels can serve as an important predictive marker for the durability of therapeutic response to nadofaragene firadenovec.
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Affiliation(s)
- Anirban P. Mitra
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vikram M. Narayan
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharada Mokkapati
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tanner Miest
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Neal D. Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Leonard G. Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashish M. Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Trinity J. Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | - Seth P. Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - J. Erik Busby
- Department of Surgery, Prisma Health, University of South Carolina School of Medicine at Greenville, Greenville, SC, USA
| | - Michael Poch
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Paul L. Crispen
- Department of Urology, University of Florida, Gainesville, FL, USA
| | - Gary D. Steinberg
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Anne K. Schuckman
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Tracy M. Downs
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Joseph Mashni
- Department of Surgical Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Brian R. Lane
- Division of Urology, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Thomas J. Guzzo
- Division of Urology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Adam Luchey
- Department of Urology, West Virginia University Cancer Institute, Morgantown, WV, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracey Krupski
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Brant A. Inman
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA
| | | | - Michael S. Cookson
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kirk A. Keegan
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald L. Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Alexander I. Sankin
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Seppo Ylä-Herttuala
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Nigel R. Parker
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - David J. McConkey
- Department of Urology, Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Colin P.N. Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,Corresponding author. Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030, USA. Tel. +1-713-792-3250; Fax: +1-713-794-4824, (C.P.N. Dinney)
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9
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Daneshmand S, Cary C, Masterson TA, Einhorn L, Boorjian SA, Kollmannsberger CK, Schuckman AK, So A, Black PC, Bagrodia A, Skinner EC, Alemozaffar M, Brand TC, Eggener SE, Pierorazio PM, Stratton KL, Nappi L, Nichols CR, Hu B. SEMS trial: Result of a prospective, multi-institutional phase II clinical trial of surgery in early metastatic seminoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.375] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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
375 Background: Chemotherapy or radiotherapy are standard treatments for stage II seminoma, though they are associated with significant long-term treatment-related toxicities. Retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors but little data exists on its efficacy as a front-line treatment in early metastatic (stage II) seminoma. This is a single-arm, multi-institutional (NCT02537548), phase II study of retroperitoneal lymph node dissection (RLND) as first-line treatment for testicular seminoma with isolated retroperitoneal disease. Methods: Twelve sites in the United States and Canada prospectively enrolled patients (16 years of age) with testicular seminoma and isolated retroperitoneal lymphadenopathy between 1-3 cm in size. Patients were excluded if they received prior therapy (except orchiectomy) for testicular cancer. Open, modified-template RPLND was performed by qualified surgeons with a primary endpoint of 2-year recurrence-free survival. Data on complication rates (short and long-term), pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed. Results: A total of 55 patients were enrolled and underwent RPLND. Fourteen patients had initial stage I disease who developed isolated retroperitoneal relapse while 41 patients had clinical stage IIA-B at presentation. With a median follow-up of 24 months (8-52 months), there were a total of 10 recurrences. The overall recurrence rate was 18% with a median time to recurrence of 8 months. Of the recurrences, 8 underwent chemotherapy (6 BEP X 3, 1 EP X 4, 1 carbo/etoposide) and 2 underwent additional surgery. The two-year recurrence free survival was 87% and the overall survival was 100%. There were 7 (13%) patients who experienced short-term complications within 1 year of RPLND. Of these, 5 (9%) were classified as Clavien Dindo I-II and 2 (3.6%) were classified as Clavien Dindo III. No patients have reported long-term complications. Conclusions: This trial establishes RPLND as a therapeutic option as a first-line treatment in early metastatic seminoma. The surgery offers cancer control rates similar to those seen in non-seminomatous germ cell tumors. Clinical trial information: NCT02537548.
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Affiliation(s)
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Lawrence Einhorn
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | - Anne K. Schuckman
- USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Alan So
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Peter C. Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | - Phillip M. Pierorazio
- James Buchanan Brady Urological Institute, Dept. of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Lucia Nappi
- Vancouver Prostate Centre, University of British Columbia, Vnacouver, BC, Canada
| | | | - Brian Hu
- Loma Linda University, Loma Linda, CA
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10
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Boorjian SA, Alemozaffar M, Konety BR, Shore ND, Gomella LG, Kamat AM, Bivalacqua TJ, Montgomery JS, Lerner SP, Busby JE, Poch M, Crispen PL, Steinberg GD, Schuckman AK, Downs TM, Svatek RS, Mashni J, Lane BR, Guzzo TJ, Bratslavsky G, Karsh LI, Woods ME, Brown G, Canter D, Luchey A, Lotan Y, Krupski T, Inman BA, Williams MB, Cookson MS, Keegan KA, Andriole GL, Sankin AI, Boyd A, O'Donnell MA, Sawutz D, Philipson R, Coll R, Narayan VM, Treasure FP, Yla-Herttuala S, Parker NR, Dinney CPN. Intravesical nadofaragene firadenovec gene therapy for BCG-unresponsive non-muscle-invasive bladder cancer: a single-arm, open-label, repeat-dose clinical trial. Lancet Oncol 2021; 22:107-117. [PMID: 33253641 PMCID: PMC7988888 DOI: 10.1016/s1470-2045(20)30540-4] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND BCG is the most effective therapy for high-risk non-muscle-invasive bladder cancer. Nadofaragene firadenovec (also known as rAd-IFNa/Syn3) is a replication-deficient recombinant adenovirus that delivers human interferon alfa-2b cDNA into the bladder epithelium, and a novel intravesical therapy for BCG-unresponsive non-muscle-invasive bladder cancer. We aimed to evaluate its efficacy in patients with BCG-unresponsive non-muscle-invasive bladder cancer. METHODS In this phase 3, multicentre, open-label, repeat-dose study done in 33 centres (hospitals and clinics) in the USA, we recruited patients aged 18 years or older, with BCG-unresponsive non-muscle-invasive bladder cancer and an Eastern Cooperative Oncology Group status of 2 or less. Patients were excluded if they had upper urinary tract disease, urothelial carcinoma within the prostatic urethra, lymphovascular invasion, micropapillary disease, or hydronephrosis. Eligible patients received a single intravesical 75 mL dose of nadofaragene firadenovec (3 × 1011 viral particles per mL). Repeat dosing at months 3, 6, and 9 was done in the absence of high-grade recurrence. The primary endpoint was complete response at any time in patients with carcinoma in situ (with or without a high-grade Ta or T1 tumour). The null hypothesis specified a complete response rate of less than 27% in this cohort. Efficacy analyses were done on the per-protocol population, to include only patients strictly meeting the BCG-unresponsive definition. Safety analyses were done in all patients who received at least one dose of treatment. The study is ongoing, with a planned 4-year treatment and monitoring phase. This study is registered with ClinicalTrials.gov, NCT02773849. FINDINGS Between Sept 19, 2016, and May 24, 2019, 198 patients were assessed for eligibility. 41 patients were excluded, and 157 were enrolled and received at least one dose of the study drug. Six patients did not meet the definition of BCG-unresponsive non-muscle-invasive bladder cancer and were therefore excluded from efficacy analyses; the remaining 151 patients were included in the per-protocol efficacy analyses. 55 (53·4%) of 103 patients with carcinoma in situ (with or without a high-grade Ta or T1 tumour) had a complete response within 3 months of the first dose and this response was maintained in 25 (45·5%) of 55 patients at 12 months. Micturition urgency was the most common grade 3-4 study drug-related adverse event (two [1%] of 157 patients, both grade 3), and there were no treatment-related deaths. INTERPRETATION Intravesical nadofaragene firadenovec was efficacious, with a favourable benefit:risk ratio, in patients with BCG-unresponsive non-muscle-invasive bladder cancer. This represents a novel treatment option in a therapeutically challenging disease state. FUNDING FKD Therapies Oy.
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Affiliation(s)
| | | | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Leonard G Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Seth P Lerner
- Scott Department of Urology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Joseph E Busby
- Cancer Centers of the Carolinas, Greenville Hospital System, Greenville, SC, USA
| | - Michael Poch
- Department of GU Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Paul L Crispen
- Department of Urology, University of Florida, Gainesville, FL, USA
| | - Gary D Steinberg
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Anne K Schuckman
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Tracy M Downs
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Brian R Lane
- Division of Urology, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Thomas J Guzzo
- Division of Urology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Michael E Woods
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Adam Luchey
- West Virginia University Cancer Institute, Morgantown, WV, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracey Krupski
- Department of Urology, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Brant A Inman
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Michael S Cookson
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kirk A Keegan
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald L Andriole
- Washington University School of Medicine in St Louis, St Louis, MO, USA
| | | | | | | | | | | | | | - Vikram M Narayan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Seppo Yla-Herttuala
- AI Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Nigel R Parker
- AI Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Colin P N Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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11
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Nabavizadeh R, Alemozaffar M. Robotic reconstruction of left common iliac vein. Urology Video Journal 2020. [DOI: 10.1016/j.urolvj.2020.100045] [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: 11/28/2022] Open
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12
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Kagan J, Alemozaffar M, Carthon B, Osunkoya AO. Surgical Pathology Findings in Patients Who Have Undergone Radical Cystectomy/Cystoprostatectomy With Extended Versus Standard Lymph Node Dissection for Urothelial Carcinoma of the Bladder: A Contemporary Analysis. Int J Surg Pathol 2020; 29:150-154. [PMID: 32573301 DOI: 10.1177/1066896920937072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radical cystectomy/cystoprostatectomy with pelvic lymph node dissection (with or without neoadjuvant chemotherapy) is the gold standard in the management of patients with urothelial carcinoma (UCa) with muscularis propria (detrusor muscle) invasion. However, it remains controversial how extensive the lymph node dissection should be. In this article, we analyzed the clinicopathologic findings in patients who had radical cystectomy/cystoprostatectomy with extended versus standard lymph node dissection. A search was made through our Urologic Pathology files for radical cystectomy/cystoprostatectomy cases with extended and standard lymph node dissection for UCa. A total of 264 cases were included in the study (218 cystoprostatectomy and 46 cystectomy specimens). Mean patients age was 68 years (range = 32-92 years). Patients in all stage categories had more extended lymph node dissection performed compared with standard lymph node dissection: pT0 (20 vs 7), pTis (40 vs 12), pTa (8 vs 4), pT1 (27 vs 5), pT2 (39 vs 8), pT3 (51 vs 17), and pT4 (18 vs 8). In cases with neoadjuvant therapy there was a 19% lymph node positivity rate compared with a 24% positivity rate in those with no presurgical therapy. The only cases categorized as pT2 and below with positive lymph node metastasis were those that had extended lymph node dissection performed. Positive lymph nodes were more frequently detected in cases that had extended lymph node dissection. More than 35% of the positive lymph nodes were in nonregional distribution. Extended lymph node dissection should be considered in patients with UCa even in the low stage or post-neoadjuvant chemotherapy setting.
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Affiliation(s)
| | | | | | - Adeboye O Osunkoya
- 1371Emory University, Atlanta, GA, USA.,Veterans Affairs Medical Center, Decatur, GA, USA
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13
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Patil D, Le TL, Bens KB, Alemozaffar M, Lay A, Pattaras J, Filson CP, Ogan K, Bilen MA, Master VA. Dynamic Evaluation of the Modified Glasgow Prognostic Scale in Patients With Resected, Localized Clear Cell Renal Cell Carcinoma. Urology 2020; 141:101-107. [PMID: 32294483 DOI: 10.1016/j.urology.2020.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the relationship between dynamic changes in the modified Glasgow Prognostic Scale (mGPS) and postnephrectomy survival among localized clear cell renal cell carcinoma (ccRCC) patients. METHODS We retrospectively identified patients who underwent nephrectomy for localized ccRCC with preoperative mGPS = 0 from 2005 to 2018. The primary exposure of interest was ΔmGPS between 2 points - 60 days prior to surgery and 1 year after surgery. We assessed the relationship between ΔmGPS and survival outcomes. Kaplan-Meier curves were generated to determine survival estimates and Cox proportional hazards models were fit to estimate hazard ratios (HRs). Multivariable models were constructed using both ΔmGPS and clinical variables known to be associated with differences in survival. RESULTS We identified 313 patients for our analytic cohort with a median follow-up time of 20.2 months. Thirty-seven (11.9%) patients died and 39 (12.54%) showed recurrence during follow-up. Two hundred sixty-three (84.6%) patients had unchanged mGPS before and after surgery, while 48 (15.4%) patients showed an increase in postoperative mGPS from preoperative mGPS. Compared to patients with unchanged mGPS, patients with a higher postoperative mGPS had an increased risk of death (HR = 3.05 [1.39-6.68], P = .005) and recurrence (HR = 2.98 [1.34-6.64], P = .008). CONCLUSION Patients with an increase in mGPS following nephrectomy for ccRCC were more likely to die and experience cancer recurrence. Assessing dynamic changes in this cheap, validated, and reproducible test may be useful in identifying patients at higher risk for more aggressive disease or for counseling patients regarding risk of cancer recurrence.
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Affiliation(s)
| | - Thien-Linh Le
- Department of Urology, Emory University, Atlanta, GA
| | | | - Mehrdad Alemozaffar
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Aaron Lay
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - John Pattaras
- Department of Urology, Emory University, Atlanta, GA
| | - Christopher P Filson
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA.
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14
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Shabto JM, Martini DJ, Liu Y, Ravindranathan D, Brown J, Hitron EE, Russler GA, Caulfield S, Kissick H, Alemozaffar M, Ogan K, Harris WB, Master VA, Kucuk O, Carthon BC, Bilen MA. Novel risk group stratification for metastatic urothelial cancer patients treated with immune checkpoint inhibitors. Cancer Med 2020; 9:2752-2760. [PMID: 32100417 PMCID: PMC7163104 DOI: 10.1002/cam4.2932] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We developed a novel risk scoring system for urothelial cancer (UC) patients receiving immune checkpoint inhibitors (ICI). METHODS We conducted a retrospective review of 67 UC patients treated with ICI at Winship Cancer Institute of Emory University from 2015 to 2018. Using stepwise variable selection in Cox proportional hazard model and Sullivan's weighting schema, baseline platelet-to-lymphocyte ratio (PLR), presence of liver metastasis, baseline albumin, and baseline Eastern Cooperative Oncology Group performance status (ECOG PS) were used for risk scoring. Patients were categorized into good risk (risk score 0-1), intermediate risk (risk score 2-3), and poor risk (risk score 4-6). Univariable (UVA) and multivariable analysis (MVA) and Kaplan-Meier method were used to assess overall survival (OS) and progression free survival (PFS). RESULTS The Emory Risk Scoring System had C-statistics of 0.74 (Standard Error = 0.047) in predicting OS and 0.70 (Standard Error = 0.043) in predicting PFS. Compared to good risk patients, poor risk patients had significantly shorter OS and PFS in both UVA and MVA (all P < .001), and intermediate risk patients had significantly shorter OS and PFS in both UVA and MVA (all P < .03). CONCLUSIONS Risk scoring using baseline PLR, presence of liver metastasis, baseline albumin, and baseline ECOG PS may effectively predict OS and PFS in UC patients receiving ICI.
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Affiliation(s)
- Julie M Shabto
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Deepak Ravindranathan
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Medicine, Emory University, Atlanta, GA, USA
| | - Jacqueline Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Emilie E Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Greta A Russler
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sarah Caulfield
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, USA
| | - Haydn Kissick
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehrdad Alemozaffar
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Ogan
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Wayne B Harris
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
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15
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Jansen CS, Prokhnevska N, Master VA, Sanda MG, Carlisle JW, Bilen MA, Cardenas M, Wilkinson S, Lake R, Sowalsky AG, Valanparambil RM, Hudson WH, McGuire D, Melnick K, Khan AI, Kim K, Chang YM, Kim A, Filson CP, Alemozaffar M, Osunkoya AO, Mullane P, Ellis C, Akondy R, Im SJ, Kamphorst AO, Reyes A, Liu Y, Kissick H. An intra-tumoral niche maintains and differentiates stem-like CD8 T cells. Nature 2019; 576:465-470. [PMID: 31827286 DOI: 10.1038/s41586-019-1836-5] [Citation(s) in RCA: 442] [Impact Index Per Article: 88.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 11/13/2019] [Indexed: 02/07/2023]
Abstract
Tumour-infiltrating lymphocytes are associated with a survival benefit in several tumour types and with the response to immunotherapy1-8. However, the reason some tumours have high CD8 T cell infiltration while others do not remains unclear. Here we investigate the requirements for maintaining a CD8 T cell response against human cancer. We find that CD8 T cells within tumours consist of distinct populations of terminally differentiated and stem-like cells. On proliferation, stem-like CD8 T cells give rise to more terminally differentiated, effector-molecule-expressing daughter cells. For many T cells to infiltrate the tumour, it is critical that this effector differentiation process occur. In addition, we show that these stem-like T cells reside in dense antigen-presenting-cell niches within the tumour, and that tumours that fail to form these structures are not extensively infiltrated by T cells. Patients with progressive disease lack these immune niches, suggesting that niche breakdown may be a key mechanism of immune escape.
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Affiliation(s)
- Caroline S Jansen
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Jennifer W Carlisle
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Cardenas
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott Wilkinson
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Ross Lake
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Adam G Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Rajesh M Valanparambil
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - William H Hudson
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald McGuire
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - Kevin Melnick
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amir I Khan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kyu Kim
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yun Min Chang
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Alice Kim
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Adeboye O Osunkoya
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick Mullane
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Carla Ellis
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rama Akondy
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - Se Jin Im
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - Alice O Kamphorst
- Department of Oncological Sciences, Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Adriana Reyes
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Haydn Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA. .,Winship Cancer Institute of Emory University, Atlanta, GA, USA. .,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA. .,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA.
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Alemozaffar M, Ogan K, Filson CP, Patil D, Lee G, Canter DJ, Hong G, Master VA. A randomized, controlled trial for transurethral treatment of bladder tumors using PlasmaButton vaporization electrode or monopolar loop electrocautery. Can J Urol 2019; 26:9908-9915. [PMID: 31629439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The use of an electrocautery device (monopolar loop) for patients undergoing transurethral resection of bladder tumors (TURBT) is standard of care. The aim of this study is to establish non-inferiority of complication rates for a bipolar energy device, the PK PlasmaButton (PK Button), when compared to the monopolar loop. MATERIALS AND METHODS Seventy-eight subjects (41 monopolar loop and 37 PK Button), were enrolled in a single-center, prospective, randomized study with cystoscopically detected bladder tumors that were judged endoscopically resectable with only one trip into the operating room. Intra and postoperative data on complication rates, operative time, catheterization time and disease recurrence rates at 3 month follow up were collected. RESULTS Overall complication rates after TURBT with the monopolar loop or PK Button were similar, (56% versus 38% respectively, p = 0.107), however there were more bladder perforations in the monopolar loop arm compared to the PK Button arm (12.2% versus 0%, respectively, p = 0.028). There was no difference in overall operative time (p = 0.170), catheterization time (p = 0.709) and disease recurrence (p = 0.199). CONCLUSION The results of this study demonstrated no difference between the monopolar loop and PK Button in regard to overall complications; however, there was a higher rate of bladder perforation with monopolar TURBT. PK Button vaporization for bladder tumors represents a promising alternative to traditional monopolar TURBT without compromising short term (3 month) cancer recurrence rates.
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Affiliation(s)
- Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
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17
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Gutierrez CM, Alemozaffar M, Osunkoya AO. Invasive high-grade urothelial carcinoma of the bladder, renal pelvis, ureter, and prostatic urethra arising in a background of urothelial carcinoma with an inverted growth pattern: a contemporary clinicopathological analysis of 91 cases. Hum Pathol 2019; 92:18-24. [DOI: 10.1016/j.humpath.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
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18
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Abiodun-Ojo OA, Akintayo AA, Akin-Akintayo OO, Tade FI, Nieh PT, Master VA, Alemozaffar M, Osunkoya AO, Goodman MM, Fei B, Schuster DM. 18F-Fluciclovine Parameters on Targeted Prostate Biopsy Associated with True Positivity in Recurrent Prostate Cancer. J Nucl Med 2019; 60:1531-1536. [PMID: 30954940 DOI: 10.2967/jnumed.119.227033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/05/2019] [Accepted: 03/29/2019] [Indexed: 11/16/2022] Open
Abstract
We evaluated 18F-fluciclovine uptake parameters that correlate with true positivity for local recurrence in non-prostatectomy-treated patients. Methods: Twenty-one patients (prostate-specific antigen level, 7.4 ± 6.8 ng/mL) with biochemical recurrence after nonprostatectomy local therapy (radiotherapy and cryotherapy) underwent dual-time-point 18F-fluciclovine (364.1 ± 37.7 MBq) PET/CT from pelvis to diaphragm. Prostatic uptake over background was delineated and coregistered to a prostate-biopsy-planning ultrasound. Transrectal biopsies of 18F-fluciclovine-defined targets were completed using a 3-dimensional visualization and navigation platform. Histologic analyses of lesions were completed. Lesion characteristics including SUVmax, target-to-background ratio (TBR), uptake pattern, and subjective reader's suspicion level were compared between true-positive (malignant) and false-positive (benign) lesions. Univariate analysis was used to determine the association between PET and histologic findings. Receiver-operating-characteristic curves were plotted to determine discriminatory cutoffs for TBR. Statistical significance was set at a P value of less than 0.05. Results: Fifty lesions were identified in 21 patients on PET. Seventeen of 50 (34.0%) targeted lesions in 10 of 21 patients were positive for malignancy. True-positive lesions had a significantly higher SUVmax (6.62 ± 1.70 vs. 4.92 ± 1.27), marrow TBR (2.57 ± 0.81 vs. 1.69 ± 0.51), and blood-pool TBR (4.10 ± 1.17 vs. 2.99 ± 1.01) than false-positive lesions at the early time point (P < 0.01) and remained significant at the delayed time point, except for blood-pool TBR. Focal uptake (odds ratio, 12.07; 95% confidence interval, 2.98-48.80; P < 0.01) and subjective highest suspicion level (odds ratio, 10.91; 95% confidence interval, 1.19-99.69; P = 0.03) correlated with true positivity. Using the receiver-operating-characteristic curve, optimal cutoffs for marrow TBR were 1.9 (area under the curve, 0.82) and 1.8 (area under the curve, 0.85) at early and delayed imaging, respectively. With these cutoffs, 15 of 17 malignant lesions were identified at both time points; however, fewer false-positive lesions were detected at the delayed time point (5/33) than at the early time point (11/33). Conclusion: True positivity of 18F-fluciclovine-targeted prostate biopsy in non-prostatectomy-treated patients correlates with focal uptake, TBR (blood pool and marrow), and subjective highest suspicion level. A marrow TBR of 1.9 at the early time point and 1.8 at the delayed time point had optimal discriminating capabilities. Despite the relatively low intraprostate positive predictive value (34.0%) with 18F-fluciclovine, application of these parameters to interpretative criteria may improve true positivity in the treated prostate.
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Affiliation(s)
- Olayinka A Abiodun-Ojo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Akinyemi A Akintayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Oladunni O Akin-Akintayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Funmilayo I Tade
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Peter T Nieh
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Adeboye O Osunkoya
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mark M Goodman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Emory University Center for Systems Imaging, Atlanta, Georgia
| | - Baowei Fei
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Bioengineering, Erick Josson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, Texas; and.,Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David M Schuster
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Alemozaffar M, Nam CS, Said MA, Patil D, Carney KJ, David S, Master VA. Avoiding the Need for Bowel Anastomosis during Pelvic Exenteration-Urinary Sigmoid or Descending Colon Conduit-Short and Long Term Complications. Urology 2019; 129:228-233. [PMID: 30922975 DOI: 10.1016/j.urology.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/11/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To educate surgeons of distal colon urinary diversion as an alternative to ileal conduit. To assess perioperative outcomes of distal colon conduit in pelvic exenteration including conduit-related, gastrointestinal, infectious, metabolic, and wound complications within 30 days, 31-89 days, and greater than 90 days from the time of surgery. MATERIALS AND METHODS Forty-one patients who underwent distal colon urinary diversion for malignancy, fistula, or neurogenic bladder were identified in our IRB approved database from 1/2007 to 7/2017. RESULTS Twenty-six (63.4%) were male with mean age of 54.1 years. Complications were stratified by early (≤30 days), intermediate (31-89 days), and late (≥90 days). Within 30 days, 2 (4.9%) had partial small bowel obstructions requiring nasogastric tube (NGT) placement and total parenteral nutrition (TPN); 8 (19.5%) prolonged ileus with 6 (14.6%) requiring TPN and 5 (12.2%) requiring NGT placement; 1 (2.4%) enterocutaneous fistula; 1 (2.4%) conduit hemorrhage, 10 (24.4%) treated urinary tract infections (UTIs). Between 31 and 89 days, 1 patient (2.4%) had urinary conduit leak and 3 (7.3%) treated UTIs. At ≥90 days, 2 (4.9%) had partial small bowel obstructions requiring NGT placement, 4 (9.8%) ureterocolonic strictures and 1 (2.4%) parastomal hernia, 3 (7.3%) treated UTIs. Readmission rate in ≤30 days was 10 (24.4%), 31-89 days was 13 (31.7%), and 90+ days was 16 (39%). Long-term metabolic complications at ≥90 days included 16 (39%) with hypokalemia, 10 (24.4%) with hyperchloremia, and 14 (34.1%) with metabolic acidosis. CONCLUSION Distal colon urinary conduit is a relatively safe and feasible option and obviates the need for small bowel anastomosis and possible associated complications.
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Affiliation(s)
- Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Catherine S Nam
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
| | - Mohammed A Said
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - K Jeff Carney
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Sam David
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
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Shabto JM, Martini DJ, Liu Y, Ravindranathan D, Kline MR, Hitron E, Russler G, Caulfield S, Kissick H, Alemozaffar M, Ogan K, Harris W, Kucuk O, Carthon BC, Master VA, Bilen MA. Inflammatory markers at baseline (C1) and cycle 3 (C3) and their association with clinical outcomes in urothelial cancer patients (pts) treated with immunotherapy (IO). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.390] [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
390 Background: Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have been explored as biomarkers for response to IO. We investigated the association between these biomarkers and clinical outcomes in urothelial cancer pts treated with IO. Methods: We conducted a retrospective review of 67 urothelial cancer pts treated with PD-1 or PD-L1 inhibitors at Winship Cancer Institute from 2015-2018. Overall survival (OS) and progression free survival (PFS) were measured from first dose of IO to date of death or hospice referral and clinical or radiographic progression, respectively. MLR, NLR, and PLR were collected at C1 and C3. The nonlinear relationship between log-transformed biomarkers and OS or PFS was examined by martingale residual plot and optimal cutoff (OC) values were determined. Multivariable analysis (MVA) used Cox proportional hazard model. Results: OC for C1 and C3 NLR, MLR, and PLR were 2.06 and 1.42, -0.331 and -0.153, and 5.7 and 5.6, respectively. Pts with C1 NLR and PLR above OC had worse OS and shorter PFS (all p<0.05) (Table). High C3 MLR portended shorter OS and PFS. NLR, MLR and PLR were highly correlated (Pearson correlation coefficients ≥ 0.67, p<0.0001). Conclusions: High NLR, MLR, and PLR at C1 and at C3 are associated with worse clinical outcomes in this cohort. These values warrant a larger study for validation. MVA† of MLR, NLR, and PLR at C1 and at C3 with OS and PFS. [Table: see text]
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Affiliation(s)
- Julie M. Shabto
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | | | - Meredith R Kline
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Greta Russler
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Sarah Caulfield
- Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA
| | - Haydn Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Wayne Harris
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA
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Shabto JM, Martini DJ, Liu Y, Ravindranathan D, Kline MR, Hitron E, Russler G, Caulfield S, Kissick H, Alemozaffar M, Ogan K, Harris W, Master VA, Kucuk O, Carthon BC, Bilen MA. Sites of metastases (mets) and their association with clinical outcomes (CO) in urothelial cancer patients (pts) treated with immunotherapy (IO). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
473 Background: Several IO agents have been approved for treatment of advanced urothelial cancer pts. We investigated the association between sites of mets and CO in urothelial cancer pts treated with IO in the real world setting. Methods: We performed a retrospective review of 67 urothelial cancer pts treated with PD-1 or PD-L1 inhibitors at Winship Cancer Institute from 2015-2018. Overall survival (OS) and progression free survival (PFS) were measured from first dose of IO to date of death or hospice referral and radiographic or clinical progression, respectively. Sites of mets were collected from radiology and clinic notes at baseline. Univariate analysis (UVA) and multivariable analysis (MVA) used Cox proportional hazard. Results: The median age was 70 and most (79.1%) were men. Pts had mets to sites such as lymph node (73.1%), bone (29.9%), liver (20.9%), lung (31.3%), and brain (1.5%). Pts with bone or liver mets had significantly shorter OS and PFS in UVA. Pts with bone mets also had significantly shorter OS and PFS in MVA (Table). The median OS of pts with bone mets was 2.2 months (12-month survival=28.0%), while those without bone mets had a median OS of 21.9 months (12-month survival=52.5%) per Kaplan-Meier estimation. The median OS of pts with liver mets was 2.2 months (12-month survival=28.6%), while those without liver mets had a median OS of 12.8 months (12-month survival=50.1%) per Kaplan-Meier estimation. Conclusions: Bone and liver mets are poor prognostic factors in urothelial cancer pts receiving IO in the real world setting. These findings should be validated in a larger study. [Table: see text]
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Affiliation(s)
- Julie M. Shabto
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | | | - Meredith R Kline
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Greta Russler
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Sarah Caulfield
- Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA
| | - Haydn Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Wayne Harris
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, GA
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Shabto JM, Martini DJ, Liu Y, Ravindranathan D, Kline MR, Hitron E, Russler G, Caulfield S, Kissick H, Alemozaffar M, Ogan K, Harris W, Master VA, Carthon BC, Kucuk O, Bilen MA. Association between immune-related adverse events (irAEs) and clinical outcomes (CO) in advanced urothelial cancer patients (pts) treated with immunotherapy (IO). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
472 Background: The increasing use of IO agents in the treatment of urothelial cancer has revealed irAEs during therapy. We investigated whether there is an association between treatment-related irAEs and CO in urothelial cancer pts treated with IO. Methods: We performed a retrospective analysis of 67 urothelial cancer pts treated with PD-1/PD-L1 inhibitors at Winship Cancer Institute from 2015-2018. Overall survival (OS) and progression free survival (PFS) were calculated from first IO dose to date of death or hospice referral and clinical or radiographic progression, respectively. Objective response (OR) was defined as partial or complete response per RECISTv1.1. Treatment-related irAEs were determined from clinic notes. The univariate association between irAE and clinical outcomes was generated using chi-square test and Fisher’s exact test. Results: The median age was 70 and 79.1% were men. 41.8% of pts had received 2 or more prior lines of therapy. Nine pts (13.4%) experienced irAEs including infusion reactions, rashes, and joint pain. Median follow-up from date of first dose of IO was 15 months (95% CI: 11-18 months). The overall death rate for pts who experienced irAE was 0%, while it was 62% for pts who did not experience irAE ( p<0.001) (Table). Conclusions: Experiencing irAEs was associated with lower death rate and progression rate and higher rate of OR in this cohort. These findings should be validated in a larger study. Univariate association of irAEs with CO. [Table: see text]
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Affiliation(s)
- Julie M. Shabto
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | | | - Meredith R Kline
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Greta Russler
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Sarah Caulfield
- Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA
| | - Haydn Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Wayne Harris
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, GA
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Henry M, Taylor M, Kim F, Pattaras JG, Alemozaffar M, Master V, Filson CP. Lymphadenectomy for High-Risk Prostate Cancer Patients: What Is Going on in Georgia? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.579] [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: 11/28/2022]
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Taylor M, Henry M, Kim F, Master V, Alemozaffar M, Pattaras J, Filson C. PD52-08 RISING PREVALENCE OF NODE-POSTIVE PROSTATE CANCER AMONG MEN TREATED WITH RADICAL PROSTATECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alemozaffar M. V05-04 ROBOTIC REPAIR OF LEFT URETERO-NEOBLADDER ANASTOMOTIC STRICTURE FOLLOWING PRIOR ROBOTIC RADICAL CYSTECTOMY AND INTRACORPOREAL NEOBLADDER DIVERSION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nam C, Alemozaffar M, Said M, Patil D, Master V. MP49-15 AVOIDING THE NEED FOR BOWEL ANASTOMOSIS DURING PELVIC EXENTERATION - URINARY SIGMOID CONDUIT - SHORT AND LONG TERM COMPLICATIONS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alemozaffar M. V05-05 ROBOTIC ANTERIOR EXENTERATION IN FEMALES– TIPS AND TRICKS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Patil DH, Anastasiades EN, Torlak M, Lay A, Alemozaffar M, Pattaras J, Kucuk O, Carthon BC, Bilen MA, Ogan K, Master VA. Evaluation of serial measurements of C-reactive protein: Albumin ratio in patients with clear cell renal cell carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.695] [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
695 Background: Sequential measurements of prognostic markers is an important protocol for accurate prediction of clinical outcomes in clear cell RCC. We propose that change in value of C-Reactive Protein to albumin ratio before and after surgery would be a good prognostic indicator for assessment of overall survival and risk stratification in clear cell RCC. Methods: Patients that underwent nephrectomy for clear cell RCC between 2007 and 2016 were followed up with CRP-Albumin measurements for 3 post-op visits (1, 3, 6 months). All measurements between post-op day 1 to 21 were excluded from analysis owing to possible confounding effect due to surgical stress. We assessed if change in CRP-Albumin ratio from pre-operative level is associated with any patient and tumor characteristics by fitting linear regression generalized estimating equations models to account for correlation in repeated measures. Average change in level for each post-op visit was used to stratify for an eventual end of follow-up outcome. Results: 302 clear cell RCC patients were treated with nephrectomy with mean age at surgery was 59.9±11 years, and mean BMI of 30.1± 6.6. 103 patients had at least 2 time-points available after surgery. Table 1 depicts mean CRP-Albumin ratio with 95% CI for each visit stratified with vital status. A linear GEE model fitted for baseline factors affecting change in ratio , identified t-stage, Fuhrman nuclear grade, gender, and BMI as significantly associated (p < 0.05). Conclusions: Serial measurement of CRP/Albumin ratio is useful factor for personalized risk-stratification for prognosticating overall survival as well as recurrence in patients with clear cell RCC. Significant effect of T-stage, tumor grade, and BMI depicts close relationship of CA-ratio and established risk predictors. [Table: see text]
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Affiliation(s)
| | | | | | - Aaron Lay
- Emory University School of Medicine, Atlanta, GA
| | | | - John Pattaras
- Emory University Winship Cancer Institute, Atlanta, GA
| | - Omer Kucuk
- Emory University Winship Cancer Institute, Atlanta, GA
| | | | | | - Kenneth Ogan
- Emory University School of Medicine Winship Cancer Institute, Atlanta Veterans Affairs Medical Center, Atlanta, GA
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Patil DH, Williams S, Torlak M, Alemozaffar M, Lay A, Pattaras J, Kucuk O, Carthon BC, Bilen MA, Ogan K, Master VA. Evaluation of preoperative C-reactive protein: Albumin ratio in patients with clear cell renal cell carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.690] [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
690 Background: Multiple inflammatory markers have been evaluated in predicting preoperative risk in patient’s undergoing curative nephrectomy for Clear cell renal cell carcinoma. We propose that ratio of C-Reactive Protein to albumin (CA-ratio) would prove to be a good prognostic indicator for assessment of overall survival and comparable to established nomograms in clear call RCC. Methods: Patients that underwent nephrectomy for localized clear cell RCC between 2007 and 2016 were retrospectively identified. The optimal threshold for individual biomarkers among the panel was determined using grid search methodology, receiver operating characteristic (ROC) analysis, and sensitivity-specificity trade-off analysis. Prognostic value of CA-ratio was analyzed using the Kaplan-Meier method and Cox proportional regression models. ROC and chi-square analyses were performed to compare the predictive ability of CA-ratio to SSIGN, and UISS. Results: Among the 433 clear cell RCC patients treated with nephrectomy, mean age at surgery was 58.4±12, and mean BMI was 30.6±6.8. 158 (36.5%) had CA-ratio < 0.1, while 164 (37.9%) were between 0.1-0.2, and 111 (25.6%) were 0.2+. Pathological T-stage was distributed as follows: T1: 294 (67.9%), T2: 29 (6.7%), T3: 106 (24.5%), and T4: 4 (0.9%). Overall, 60 (13.9%) patients died before end of the follow-up. Area under the curve (AUC) for CA-ratio was 0.72, comparable to SSIGN (AUC 0.73, p = 0.12). On multivariate COX proportional hazards analysis, patients with ratio 0.2 or more were more likely to die compared to patients with ratio < 0.1 [HR:3.45 95%CI:1.68-7.10, p = < 0.001], while adjusting for T-stage, grade, necrosis, and age. Conclusions: CA-ratio is an cost-effective , independent and significant predictor of overall survival in clear cell RCC with accuracy at least as good as other established prognostic tools including SSIGN and UISS. [Table: see text]
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Affiliation(s)
| | | | | | | | - Aaron Lay
- Emory University School of Medicine, Atlanta, GA
| | - John Pattaras
- Emory University Winship Cancer Institute, Atlanta, GA
| | - Omer Kucuk
- Emory University Winship Cancer Institute, Atlanta, GA
| | | | | | - Kenneth Ogan
- Emory University School of Medicine Winship Cancer Institute, Atlanta Veterans Affairs Medical Center, Atlanta, GA
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Chopra S, Liu J, Alemozaffar M, Nichols PW, Aron M, Weisenberger DJ, Collings CK, Syan S, Hu B, Desai M, Aron M, Duddalwar V, Gill I, Liang G, Siegmund KD. Improving needle biopsy accuracy in small renal mass using tumor-specific DNA methylation markers. Oncotarget 2018; 8:5439-5448. [PMID: 27690297 PMCID: PMC5354921 DOI: 10.18632/oncotarget.12276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/20/2016] [Indexed: 01/17/2023] Open
Abstract
Purpose The clinical management of small renal masses (SRMs) is challenging since the current methods for distinguishing between benign masses and malignant renal cell carcinomas (RCCs) are frequently inaccurate or inconclusive. In addition, renal cancer subtypes also have different treatments and outcomes. High false negative rates increase the risk of cancer progression and indeterminate diagnoses result in unnecessary and potentially morbid surgical procedures. Experimental Design We built a predictive classification model for kidney tumors using 697 DNA methylation profiles from six different subgroups: clear cell, papillary and chromophobe RCC, benign angiomylolipomas, oncocytomas, and normal kidney tissues. Furthermore, the DNA methylation-dependent classifier has been validated in 272 ex vivo needle biopsy samples from 100 renal masses (71% SRMs). Results In general, the results were highly reproducible (89%, n=70) in predicting identical malignant subtypes from biopsies. Overall, 98% of adjacent-normals (n=102) were correctly classified as normal, while 92% of tumors (n=71) were correctly classified malignant and 86% of benign (n=29) were correctly classified benign by this classification model. Conclusions Overall, this study provides molecular-based support for using routine needle biopsies to determine tumor classification of SRMs and support the clinical decision-making.
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Affiliation(s)
- Sameer Chopra
- Department of Urology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jie Liu
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mehrdad Alemozaffar
- Department of Urology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Peter W Nichols
- Department of Pathology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- Department of Pathology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Weisenberger
- Department of Biochemistry and Molecular Biology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Clayton K Collings
- Department of Urology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sumeet Syan
- Department of Urology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Hu
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Mihir Desai
- Department of Urology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- Department of Urology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vinay Duddalwar
- Department of Radiology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- Department of Urology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gangning Liang
- Department of Urology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kimberly D Siegmund
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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31
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Patel AP, Melnick K, Sekar R, Patil D, Pattaras JG, Alemozaffar M, Filson CP, Nieh PT, Ogan K, Master VA. Relationship Between Preoperative C-Reactive Protein and Fuhrman Nuclear Grade in Stage T1 Renal Cell Carcinoma: A Short-Term Update. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.482] [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: 11/16/2022]
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32
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Sekar RR, Patil D, Baum Y, Pearl J, Bausum A, Bilen MA, Kucuk O, Harris WB, Carthon BC, Alemozaffar M, Filson CP, Pattaras JG, Nieh PT, Ogan K, Master VA. A novel preoperative inflammatory marker prognostic score in patients with localized and metastatic renal cell carcinoma. Asian J Urol 2017; 4:230-238. [PMID: 29387555 PMCID: PMC5773049 DOI: 10.1016/j.ajur.2017.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/10/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022] Open
Abstract
Objective Several inflammatory markers have been studied as potential biomarkers in renal cell carcinoma (RCC), however few reports have analyzed their prognostic value in aggregate and in non-clear cell histologies. We hypothesize that a combination of specific inflammatory markers into an RCC Inflammatory Score (RISK) could serve as a rigorous prognostic indicator of overall survival (OS) in patients with clear cell and non-clear cell RCC. Methods Combination of preoperative C-reactive protein (CRP), albumin, erythrocyte sedimentation rate (ESR), corrected calcium, and aspartate transaminase to alanine transaminase (AST/ALT) ratio was used to develop RISK. RISK was developed using grid-search methodology, receiver-operating-characteristic (ROC) analysis, and sensitivity-specificity trade-off analysis. Prognostic value of RISK was analyzed using the Kaplan–Meier method and Cox proportional regression models. Predictive accuracy was compared with RISK to Size, Size, Grade, and Necrosis (SSIGN) score, University of California-LOS Angeles (UCLA) Integrated Staging System (UISS), and Leibovich Prognosis Score (LPS). Results Among 391 RCC patients treated with nephrectomy, area under the curve (AUC) for RISK was 0.783, which was comparable to SSIGN (AUC 0.776, p = 0.82) and UISS (AUC 0.809, p = 0.317). Among patients with localized disease, AUC for RISK and LPS was 0.742 and 0.706, respectively (p = 0.456). On multivariate analysis, we observed a step-wise statistically significant inverse relationship between increasing RISK group and OS (all p < 0.001). Conclusion RISK is an independent and significant predictor of OS for patients treated with nephrectomy for clear cell and non-clear cell RCC, with accuracy comparable to other histopathological prognostic tools.
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Affiliation(s)
- Rishi R Sekar
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yoram Baum
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Pearl
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna Bausum
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, USA
| | - Wayne B Harris
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, USA.,The Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, USA.,The Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, GA, USA
| | - John G Pattaras
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter T Nieh
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, USA
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Hou R, Alemozaffar M, Yang B, Sands JM, Kong X, Chen G. Identification of a Novel UT-B Urea Transporter in Human Urothelial Cancer. Front Physiol 2017; 8:245. [PMID: 28503151 PMCID: PMC5409228 DOI: 10.3389/fphys.2017.00245] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/07/2017] [Indexed: 02/01/2023] Open
Abstract
The urea transporter UT-B is widely expressed and has been studied in erythrocyte, kidney, brain and intestines. Interestingly, UT-B gene has been found more abundant in bladder than any other tissue. Recently, gene analyses demonstrate that SLC14A1 (UT-B) gene mutations are associated with bladder cancer, suggesting that urea transporter UT-B may play an important role in bladder carcinogenesis. In this study, we examined UT-B expression in bladder cancer with human primary bladder cancer tissues and cancer derived cell lines. Human UT-B has two isoforms. We found that normal bladder expresses long form of UT-B2 but was lost in 8 of 24 (33%) or significantly downregulated in 16 of 24 (67%) of primary bladder cancer patients. In contrast, the short form of UT-B1 lacking exon 3 was detected in 20 bladder cancer samples. Surprisingly, a 24-nt in-frame deletion in exon 4 in UT-B1 (UT-B1Δ24) was identified in 11 of 20 (55%) bladder tumors. This deletion caused a functional defect of UT-B1. Immunohistochemistry revealed that UT-B protein levels were significantly decreased in bladder cancers. Western blot analysis showed a weak UT-B band of 40 kDa in some tumors, consistent with UT-B1 gene expression detected by RT-PCR. Interestingly, bladder cancer associate UT-B1Δ24 was barely sialylated, reflecting impaired glycosylation of UT-B1 in bladder tumors. In conclusion, SLC14A1 gene and UT-B protein expression are significantly changed in bladder cancers. The aberrant UT-B expression may promote bladder cancer development or facilitate carcinogenesis induced by other carcinogens.
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Affiliation(s)
- Ruida Hou
- Department of Urology, China-Japan Union Hospital, Jilin UniversityChangchun, China.,Department of Physiology, Emory University School of MedicineAtlanta, GA, USA
| | | | - Baoxue Yang
- Department of Pharmacology, School of Basic Medical Sciences, Peking UniversityBeijing, China
| | - Jeff M Sands
- Department of Physiology, Emory University School of MedicineAtlanta, GA, USA.,Renal Division Department of Medicine, Emory University School of MedicineAtlanta, GA, USA
| | - Xiangbo Kong
- Department of Urology, China-Japan Union Hospital, Jilin UniversityChangchun, China
| | - Guangping Chen
- Department of Physiology, Emory University School of MedicineAtlanta, GA, USA.,Renal Division Department of Medicine, Emory University School of MedicineAtlanta, GA, USA
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34
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Gilbert K, Lorentz A, Patil D, Alemozaffar M, Filson C. MP21-09 PROLONGED LENGTH OF STAY NOT ASSOCIATED WITH DECREASED HOSPITAL READMISSIONS FOLLOWING UNCOMPLICATED HOSPITALIZATION AFTER RADICAL CYSTECTOMY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Alemozaffar M. V10-07 ROBOTIC REPAIR OF RIGHT URETERO-ILEAL ANASTOMOTIC STRICTURE FOLLOWING PRIOR ROBOTIC RADICAL CYSTECTOMY AND INTRACORPOREAL CONDUIT DIVERSION. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Gerhard RS, Patil D, Liu Y, Ogan K, Alemozaffar M, Jani AB, Kucuk ON, Master VA, Gillespie TW, Filson CP. Treatment of men with high-risk prostate cancer based on race, insurance coverage, and access to advanced technology. Urol Oncol 2017; 35:250-256. [PMID: 28089387 DOI: 10.1016/j.urolonc.2016.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 10/03/2016] [Revised: 11/29/2016] [Accepted: 12/06/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE We characterized factors related to nondefinitive management (NDM) of patients with high-risk prostate cancer and assessed impact from race, insurance status, and facility-level volume of technologically advanced prostate cancer treatments (i.e., intensity-modulated radiation therapy, robotic-assisted laparoscopic radical prostatectomy) on this outcome. METHODS We identified men with high-risk localized prostate cancer (based on D׳Amico criteria) in the National Cancer Database (2010-2012). Primary outcome was NDM (i.e., delayed/no treatment with prostatectomy/radiation therapy or androgen-deprivation monotherapy). Treating facilities were classified by quartiles of proportions of patients treated with advanced technology. Multivariable regression estimated odds of primary outcome based on race, insurance status, and facility-level technology use, and evaluated for interactions between these covariates. RESULTS Among 60,300 patients, 9,265 (15.4%) received NDM. This was more common among non-White men (P<0.001), Medicaid/uninsured patients (P<0.001), and those managed at facilities in the lowest quartile of technology use (25.1% vs. 11.0% highest, P<0.001). Though NDM was common among non-White men with Medicaid/no insurance treated at low-technology centers (43% vs. 10% White, private/Medicare, high-tech facility; adjusted odds ratios = 7.18, P<0.001), this was less likely if this group was managed at a high-tech hospital (22% vs. 43% low-tech, P<0.001). CONCLUSIONS Technology use at a facility correlates with high-quality prostate cancer care and is associated with diminished disparities based on insurance status and patient race. More research is required to characterize other facility-level factors explaining these findings.
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Affiliation(s)
| | | | - Yuan Liu
- Winship Cancer Institute, Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University, Atlanta, GA
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ashesh B Jani
- Winship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Omer N Kucuk
- Winship Cancer Institute, Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA
| | - Theresa W Gillespie
- Winship Cancer Institute, Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA; Department of Surgery, Emory University, Atlanta, GA
| | - Christopher P Filson
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA; Atlanta Veterans Administration Medical Center, Decatur, GA.
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Mundbjerg K, Chopra S, Alemozaffar M, Duymich C, Lakshminarasimhan R, Nichols PW, Aron M, Siegmund KD, Ukimura O, Aron M, Stern M, Gill P, Carpten JD, Ørntoft TF, Sørensen KD, Weisenberger DJ, Jones PA, Duddalwar V, Gill I, Liang G. Identifying aggressive prostate cancer foci using a DNA methylation classifier. Genome Biol 2017; 18:3. [PMID: 28081708 PMCID: PMC5234101 DOI: 10.1186/s13059-016-1129-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/08/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Slow-growing prostate cancer (PC) can be aggressive in a subset of cases. Therefore, prognostic tools to guide clinical decision-making and avoid overtreatment of indolent PC and undertreatment of aggressive disease are urgently needed. PC has a propensity to be multifocal with several different cancerous foci per gland. RESULTS Here, we have taken advantage of the multifocal propensity of PC and categorized aggressiveness of individual PC foci based on DNA methylation patterns in primary PC foci and matched lymph node metastases. In a set of 14 patients, we demonstrate that over half of the cases have multiple epigenetically distinct subclones and determine the primary subclone from which the metastatic lesion(s) originated. Furthermore, we develop an aggressiveness classifier consisting of 25 DNA methylation probes to determine aggressive and non-aggressive subclones. Upon validation of the classifier in an independent cohort, the predicted aggressive tumors are significantly associated with the presence of lymph node metastases and invasive tumor stages. CONCLUSIONS Overall, this study provides molecular-based support for determining PC aggressiveness with the potential to impact clinical decision-making, such as targeted biopsy approaches for early diagnosis and active surveillance, in addition to focal therapy.
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Affiliation(s)
- Kamilla Mundbjerg
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Sameer Chopra
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Mehrdad Alemozaffar
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Christopher Duymich
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ranjani Lakshminarasimhan
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Peter W Nichols
- Department of Pathology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Manju Aron
- Department of Pathology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Kimberly D Siegmund
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Osamu Ukimura
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Monish Aron
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Mariana Stern
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Parkash Gill
- Department of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - John D Carpten
- Department of Translational Genomics, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Torben F Ørntoft
- Department of Molecular Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Karina D Sørensen
- Department of Molecular Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Daniel J Weisenberger
- Department of Biochemistry and Molecular Biology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Peter A Jones
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA.,Van Andel Research Institute, Grand Rapids, MI, 49503, USA
| | - Vinay Duddalwar
- Department of Radiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Inderbir Gill
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Gangning Liang
- USC Institute of Urology and the Catherine & Joseph Aresty Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA.
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38
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Pearl JA, Patil D, Filson CP, Arya S, Alemozaffar M, Master VA, Ogan K. Patient Frailty and Discharge Disposition Following Radical Cystectomy. Clin Genitourin Cancer 2017; 15:e615-e621. [PMID: 28139446 DOI: 10.1016/j.clgc.2016.12.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/03/2016] [Accepted: 12/10/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with bladder cancer who are treated with cystectomy are at high risk for complications and prolonged length of stay. This population tends to be of advanced age with underlying comorbidities, and thus more likely to have decreased physiologic reserve (ie, frailty). Our objective was to evaluate the relationship between frailty and discharge disposition for patients with bladder cancer treated with cystectomy. MATERIALS AND METHODS Using data from the National Surgical Quality Improvement Program, we identified patients with bladder cancer undergoing cystectomy (2011-2014). Our exposure of interest was frailty, based on the 11-point modified Frailty Index (mFI). Patients were deemed robust (mFI = 0), pre-frail (mFI = 0.09-0.18), or frail (mFI ≥ 0.27). Our outcome of interest was discharge disposition defined as home, skilled nursing facility, and rehabilitation dichotomized as home versus non-home for multivariable logistic regression analysis. We then generated predicted probabilities of non-home discharge based on frailty and in-hospital complications. RESULTS Among 4330 patients treated with radical cystectomy, 32.8% were robust, 65.1% were pre-frail, and 2.2% were frail. Overall, 86.2% were discharged home, 4.4% to a rehabilitation facility, and 9.4% to a skilled nursing facility. Frail patients were more likely to be discharged to non-home care (vs. robust, odds ratio, 2.33; 95% confidence interval, 1.34-4.03), which was independent of whether they experienced a major complication prior to discharge. CONCLUSION Frailty is a significant predictor of non-home discharge following radical cystectomy. This finding was independent of inpatient complications. These data will assist providers in setting patient expectations and have important implications for allocating postoperative resources.
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Affiliation(s)
- Jeffrey A Pearl
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA
| | - Shipra Arya
- Department of Vascular Surgery, Emory University School of Medicine, Atlanta, GA
| | | | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
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Jegadeesh N, Liu Y, Zhang C, Zhong J, Cassidy RJ, Gillespie T, Kucuk O, Rossi P, Master VA, Alemozaffar M, Jani AB. The role of adjuvant radiotherapy in pathologically lymph node-positive prostate cancer. Cancer 2016; 123:512-520. [DOI: 10.1002/cncr.30373] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Naresh Jegadeesh
- Department of Radiation Oncology; Emory University; Atlanta Georgia
| | - Yuan Liu
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Biostatistics and Bioinformatics; Emory University; Atlanta Georgia
- Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Chao Zhang
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Biostatistics and Bioinformatics; Emory University; Atlanta Georgia
- Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Jim Zhong
- Department of Radiation Oncology; Emory University; Atlanta Georgia
- Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Richard J. Cassidy
- Department of Radiation Oncology; Emory University; Atlanta Georgia
- Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Theresa Gillespie
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Surgery; Emory University; Atlanta Georgia
| | - Omer Kucuk
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Medical Oncology; Emory University; Atlanta Georgia
| | - Peter Rossi
- Department of Radiation Oncology; Emory University; Atlanta Georgia
- Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Viraj A. Master
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Medical Oncology; Emory University; Atlanta Georgia
| | - Mehrdad Alemozaffar
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Urology; Emory University; Atlanta Georgia
| | - Ashesh B. Jani
- Department of Radiation Oncology; Emory University; Atlanta Georgia
- Winship Cancer Institute; Emory University; Atlanta Georgia
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Pearl J, Patil D, Arya S, Alemozaffar M, Master VA, Ogan K. Patient Frailty and Discharge Disposition after Radical Cystectomy. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.352] [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: 10/20/2022]
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Broggi MS, Patil D, Baum Y, Nieh PT, Alemozaffar M, Pattaras JG, Ogan K, Master VA. Author Reply. Urology 2016; 96:105. [DOI: 10.1016/j.urology.2016.05.066] [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: 11/26/2022]
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Broggi MS, Patil D, Baum Y, Nieh PT, Alemozaffar M, Pattaras JG, Ogan K, Master VA. Onodera's Prognostic Nutritional Index as an Independent Prognostic Factor in Clear Cell Renal Cell Carcinoma. Urology 2016; 96:99-105. [PMID: 27431662 DOI: 10.1016/j.urology.2016.05.064] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/27/2016] [Accepted: 05/03/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the relationship between the Onodera Prognostic Nutritional Index (OPNI) and overall survival, as well as recurrence-free survival, in clear cell renal cell carcinoma (ccRCC) patients following nephrectomy. MATERIALS AND METHODS Three hundred forty-one patients who underwent nephrectomy for ccRCC were analyzed. The optimum OPNI cutoff score of 44.7 was determined by receiver operating characteristic analysis and patients were placed in either the low or high OPNI group, with OPNI values of ≤44.7 and ≥44.8, respectively. Kaplan-Meier analysis was performed to evaluate the univariate impact of the OPNI groups on overall survival and recurrence-free survival. OPNI's association with overall survival and recurrence-free survival, with adjustments for other patient and tumor qualities, was assessed with univariate and multivariate Cox regression analysis. RESULTS Median (95% CI) overall survival times for the low and high OPNI groups were 21.1 months and 37.9 months, respectively. OPNI was determined to be an independent prognostic factor in multivariate analysis, and after controlling for patient and tumor characteristics, the low OPNI group experienced a 1.67-fold (hazard ratio: 1.67, 95% confidence interval: 1.05-2.68) increased risk of overall mortality. CONCLUSION Preoperative OPNI is a valuable independent prognostic indicator of overall survival and recurrence-free survival in patients with ccRCC following nephrectomy.
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Affiliation(s)
- Matthew S Broggi
- Department of Urology, Emory Winship Cancer Institute, Emory University, Atlanta, GA
| | - Dattatraya Patil
- Department of Urology, Emory Winship Cancer Institute, Emory University, Atlanta, GA
| | - Yoram Baum
- Department of Urology, Emory Winship Cancer Institute, Emory University, Atlanta, GA
| | - Peter T Nieh
- Department of Urology, Emory Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mehrdad Alemozaffar
- Department of Urology, Emory Winship Cancer Institute, Emory University, Atlanta, GA
| | - John G Pattaras
- Department of Urology, Emory Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory Winship Cancer Institute, Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory Winship Cancer Institute, Emory University, Atlanta, GA.
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Abstract
Introduction: The role and extent of extended pelvic lymph node dissection (ePLND) during radical prostatectomy (RP) for prostate cancer patients remains unclear. Materials and Methods: A PubMed literature search was performed for studies reporting on treatment regimens and outcomes in patients with prostate cancer treated by RP and extended lymph node dissection between 1999 and 2013. Results: Studies have shown that RP can improve progression-free and overall survival in patients with lymph node-positive prostate cancer. While this finding requires further validation, it does allow urologists to question the former treatment paradigm of aborting surgery when lymph node invasion from prostate cancer occurred, especially in patients with limited lymph node tumor infiltration. Studies show that intermediate- and high-risk patients should undergo ePLND up to the common iliac arteries in order to improve nodal staging. Conclusions: Evidence from the literature suggests that RP with ePLND improves survival in lymph node-positive prostate cancer. While studies have shown promising results, further improvements and understanding of the surgical technique and post-operative treatment are required to improve treatment for prostate cancer patients with lymph node involvement.
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Affiliation(s)
- Sameer Chopra
- Department of Urology, Catherine and Joseph Aresty USC, Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mehrdad Alemozaffar
- Department of Urology, Catherine and Joseph Aresty USC, Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- Department of Urology, Catherine and Joseph Aresty USC, Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- Department of Urology, Catherine and Joseph Aresty USC, Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Gakis G, Schubert T, Alemozaffar M, Bellmunt J, Bochner BH, Boorjian SA, Daneshmand S, Huang WC, Kondo T, Konety BR, Laguna MP, Matin SF, Siefker-Radtke AO, Shariat SF, Stenzl A. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease. World J Urol 2016; 35:327-335. [DOI: 10.1007/s00345-016-1819-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 12/11/2022] Open
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Pearl J, Patil D, Arya S, Alemozaffar M, Master V, Ogan K. MP06-12 FRAIL PATIENTS ARE LESS LIKELY TO BE DISCHARGED TO HOME AFTER CYSTECTOMY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Alemozaffar M, Filson CP, Master VA. The importance of surgical margins in renal cell and urothelial carcinomas. J Surg Oncol 2016; 113:316-22. [DOI: 10.1002/jso.24121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/20/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Christopher P. Filson
- Department of Urology; Emory University; Atlanta Georgia
- Atlanta Veterans Affairs Medical Center; Decatur Georgia
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Jegadeesh N, Liu Y, Zhang C, Zhong J, Gillespie TW, Kucuk O, Rossi PJ, Master VA, Alemozaffar M, Jani AB. The role of adjuvant radiotherapy in pathologically node positive prostate cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.28] [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
28 Background: The postoperative management of prostate cancer with regional lymph nodal involvement (LNI) is controversial. Prospective evidence to guide the role of radiotherapy (RT) in this setting does not exist. Randomized studies demonstrate an improvement in disease-related outcomes with adjuvant RT in high-risk patients without LNI following prostatectomy (RP). Retrospective evidence supports the selective use of RT with LNI following extended pelvic lymph node dissection. It is unclear if this experience is generalizable to practice in the United States where extended dissection is uncommon. We sought to identify patients with LNI who may derive a survival benefit following adjuvant RT. Methods: The National Cancer Data Base was queried for M0 patients with prostate adenocarcinoma who underwent RP with pathologic LNI. Adjvuant RT was defined as delivered within 6 months following RP. Kaplan-Meier, log-rank test, and multivariable Cox proportional hazards regression were performed with overall survival (OS) as the primary outcome. Propensity score matching (PSM) was employed to further reduce treatment selection bias. Results: 7,902 patients diagnosed between 2003-2011 were eligible for analysis; 1,439 (18.2%) received RT. RT was more frequently employed in patients with lower Charlson-Deyo Comorbidity Score, higher T stage, <5 nodes examined, ≥50% nodal positivity ratio, Gleason 8-10, ≥20 PSA, positive surgical margin, and <65 years of age (all p < 0.05). Five year OS was 87.6% vs. 85% in those receiving RT vs. not (p = 0.075). With androgen deprivation (ADT) (n = 3,265), 5-year OS was 87.2% vs. 82.7% in those receiving RT vs. not (p = 0.004). In multivariable analysis, the use of RT was independently associated with improved OS (HR 0.73, 95% CI 0.59-0.89, p = 0.002). 894 remained in each cohort following PSM. In this analysis, RT remained associated with OS (HR 0.66, 95% CI 0.51-0.85, p = 0.002). Conclusions: Adjuvant RT was associated with improved OS following RP in patients with LNI in this large generalizable retrospective analysis. This effect appears stronger in those receiving ADT. This series is the largest describing adjuvant RT in this population. In the absence of prospective evidence, these results may help guide therapy in this setting.
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Affiliation(s)
- Naresh Jegadeesh
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Yuan Liu
- Department of Biostatistics of Emory University, Atlanta, GA
| | - Chao Zhang
- Department of Biostatistics of Emory University, Atlanta, GA
| | - Jim Zhong
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Omer Kucuk
- Department of Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Peter John Rossi
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Viraj A. Master
- Emory University School of Medicine, Department of Urology, Winship Cancer Institute, Atlanta, GA
| | - Mehrdad Alemozaffar
- Emory University School of Medicine, Department of Urology, Winship Cancer Institute, Atlanta, GA
| | - Ashesh B. Jani
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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Sekar RR, Patil D, Pearl J, Baum Y, Alemozaffar M, Filson CP, Ogan K, Master VA. The relationship between preoperative c-reactive protein and Fuhrman nuclear grade in stage T1 renal cell carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.593] [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
593 Background: In an era of active surveillance for small renal masses (SRMs), non-invasive predictors of tumor aggressiveness may be helpful in identifying high-risk patients for surgical intervention. In this study, we evaluate the predictive value of preoperative C-reactive protein (CRP) on Furhman Nuclear Grade (FNG) in patients with stage T1 renal cell carcinoma (RCC). Methods: Patients who underwent nephrectomy for stage T1 RCC with documented preoperative CRP within 15 days of surgery were included in the study. Surgical pathology reports were used to determine TNM stage and FNG. Receiver operating characteristic (ROC) analysis, sensitivity-specificity analysis, and Youden index were used to determine the optimal threshold of preoperative CRP in predicting FNG 4 disease versus FNG 1-3 disease. Logistic regression analysis was then performed to assess the significance and independence of preoperative CRP in predicting FNG 4 disease. Results: 351 patients were included in the study. On ROC analysis, area under the curve (AUC) was 0.7576. The optimal threshold of preoperative CRP was determined to be 4.8 mg/dL. On univariate and multivariate analysis, CRP ≥ 4.8 mg/dL was found to be a significant and independent predictor of FNG 4 disease (log-rank, p=0.014, p=0.006, respectively). Conclusions: Our data show that preoperative CRP ≥ 4.8 mg/dL is a significant and independent predictor of FNG 4 disease in patients with stage T1 RCC. These findings suggest that a standardized and cost-effective preoperative laboratory value can provide crucial prognostic information in patients undergoing active surveillance for SRMs, allowing for improved patient selection for definitive surgical therapy. [Table: see text]
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Affiliation(s)
| | - Dattatraya Patil
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Jeff Pearl
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Yoram Baum
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Mehrdad Alemozaffar
- Emory University School of Medicine, Department of Urology, Winship Cancer Institute, Atlanta, GA
| | - Christopher Paul Filson
- Emory University School of Medicine, Department of Urology, Atlanta VA Medical Center, Atlanta, GA
| | - Kenneth Ogan
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Viraj A. Master
- Emory University School of Medicine, Department of Urology, Winship Cancer Institute, Atlanta, GA
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Sekar RR, Patil D, Pearl J, Baum Y, Kucuk O, Harris WB, Carthon BC, Alemozaffar M, Filson CP, Ogan K, Master VA. A novel preoperative inflammatory marker prognostic score in patients with clear cell renal cell carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.566] [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
566 Background: Several inflammatory markers have been singularly studied as potential biomarkers in clear cell renal cell carcinoma (RCC), however few reports have analyzed their prognostic value in aggregate. We hypothesize that a combination of preoperative C-Reactive Protein (CRP), albumin, Erythrocyte Sedimentation Rate (ESR), corrected calcium, and AST/ALT ratio into a RCC Inflammatory Score (RISC) could serve as a rigorous prognostic indicator in patients with clear cell RCC. Methods: Patients that underwent nephrectomy for localized clear cell RCC were queried from our nephrectomy database. The optimal threshold for individual biomarkers was determined using grid search methodology, receiver operating characteristic (ROC) analysis, and sensitivity-specificity trade-off analysis. The final score, RISC, was the sum of all points accrued from each biomarker (Table). ROC and chi-square analysis was performed to compare the prognostic ability of RISC to SSIGN and UISS. Impact on overall survival was analyzed with multivariate logistic regression analysis. Results: 280 patients were included in the study. Area under the curve (AUC) for RISC, SSIGN and UISS was 0.77, 0.78, and 0.81, respectively. Chi-square analysis of AUCs revealed no statistically significant difference between RISC, SSIGN, and UISS (p= 0.975 and p =0.299, respectively). On multivariate analysis, after adjusting for confounding variables, each unit increase in RISC was associated with a 31% increase in mortality (HR=1.31, 95%CI 1.13-1.50, p<0.001). Conclusions: RISC is an independent and significant predictor of overall survival in clear cell RCC with accuracy at least as good as other established prognostic tools. Notably, RISC is composed of standardized laboratory markers easily and cost-effectively obtained preoperatively, allowing crucial prognostic information to be integrated into medical decision making prior to surgery. [Table: see text]
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Affiliation(s)
| | - Dattatraya Patil
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Jeff Pearl
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Yoram Baum
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Omer Kucuk
- Emory University School of Medicine, Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, GA
| | - Wayne B. Harris
- Emory University School of Medicine, Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, GA
| | - Bradley Curtis Carthon
- Emory University School of Medicine, Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, GA
| | - Mehrdad Alemozaffar
- Emory University School of Medicine, Department of Urology, Winship Cancer Institute, Atlanta, GA
| | - Christopher Paul Filson
- Emory University School of Medicine, Department of Urology, Atlanta VA Medical Center, Atlanta, GA
| | - Kenneth Ogan
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Viraj A. Master
- Emory University School of Medicine, Department of Urology, Winship Cancer Institute, Atlanta, GA
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50
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Sekar RR, Patil D, Pearl J, Baum Y, Kucuk O, Harris WB, Carthon B, Alemozaffar M, Filson CP, Ogan K, Master VA. A novel preoperative inflammatory marker prognostic score in patients with clear cell and non-clear cell renal cell carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.530] [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
530 Background: Several inflammatory markers have been studied as potential biomarkers in clear cell renal cell carcinoma (RCC), however few reports have analyzed their prognostic value in aggregate and in non-clear cell histologies. We hypothesize that a combination of preoperative C-Reactive Protein (CRP), albumin, Erythrocyte Sedimentation Rate (ESR), corrected calcium, and AST/ALT ratio into a RCC Inflammatory Score (RISC) could serve as a rigorous prognostic indicator in patients with clear cell and non-clear cell RCC. Methods: Patients that underwent nephrectomy for localized RCC were queried from our nephrectomy database. The optimal threshold for individual biomarkers was determined using grid search methodology, receiver operating characteristic (ROC) analysis, and sensitivity-specificity trade-off analysis. The final score, RISC, was the sum of points accrued from each biomarker (Table). ROC and chi-square analysis was performed to compare the prognostic ability of RISC to SSIGN and UISS. Impact on overall survival was analyzed with multivariate logistic regression analysis. Results: 391 patients were included in the study. Area under the curve (AUC) for RISC, SSIGN, and UISS was 0.78, 0.78, and 0.81, respectively. Chi-square analysis of AUCs revealed no statistically significant difference between RISC, SSIGN, and UISS (p= 0.820, and p =0.317, respectively). On multivariate analysis, after adjusting for confounding variables, each unit increase in RISC was associated with a 32% increase in mortality (HR=1.32, 95%CI 1.17-1.49, p<0.001). Conclusions: RISC is an independent and significant predictor of overall survival in clear cell and non-clear cell RCC with accuracy at least as good as other established prognostic tools. Notably, RISC is composed of standardized preoperative laboratory markers, allowing crucial prognostic information to be integrated into medical decision making prior to surgery. [Table: see text]
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Affiliation(s)
| | - Dattatraya Patil
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Jeff Pearl
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Yoram Baum
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Omer Kucuk
- Emory University School of Medicine, Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, GA
| | - Wayne B. Harris
- Emory University School of Medicine, Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, GA
| | - Bradley Carthon
- Emory University School of Medicine, Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, GA
| | - Mehrdad Alemozaffar
- Emory University School of Medicine, Department of Urology, Winship Cancer Institute, Atlanta, GA
| | - Christopher Paul Filson
- Emory University School of Medicine, Department of Urology, Atlanta VA Medical Center, Atlanta, GA
| | - Kenneth Ogan
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | - Viraj A. Master
- Emory University School of Medicine, Department of Urology, Winship Cancer Institute, Atlanta, GA
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