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Vitug C, Lajkosz K, Chavarriaga J, Llano A, Din S, Villegas E, Kuk C, Chan A, Gao B, Hemminki O, Kot D, Misurka J, van der Kwast TH, Wallis C, Jewett MAS, Soloway MS, Fleshner NE, Kulkarni GS, Zlotta AR. Long-term outcomes and cost savings of office fulguration of papillary Ta low-grade bladder cancer. BJU Int 2024; 133:289-296. [PMID: 38105525 DOI: 10.1111/bju.16269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To assess whether office-based fulguration (OF) under local anaesthesia for small, recurrent, pathological Ta low-grade (LG) non-muscle-invasive bladder cancer (NMIBC) is an effective alternative to transurethral resection of bladder tumour (TURBT), avoiding the costs and risks of procedure, and anesthesia. PATIENTS AND METHODS Of 521 patients with primary TaLG NMIBC, this retrospective study included 270 patients who underwent OF during follow-up for recurrent, small, papillary LG-appearing tumours at a university centre (University Health Network, University of Toronto, Canada). We assessed the cumulative incidence of cancer-specific mortality (CSM) and disease progression (to MIBC or metastases), as well as possible direct cost savings. RESULTS In the 270 patients with recurrent TaLG NMIBC treated with OF, the mean (sd) age was 64.9 (13.3) years, 70.8% were men, and 60.3% had single tumours. The mean (sd, range) number of OF procedures per patient was 3.1 (3.2, 1-22). The median (interquartile range) follow-up was 10.1 (5.8-16.2) years. Patients also underwent a mean (sd) of 3.6 (3.0) TURBTs during follow-up in case of numerous or bulkier recurrence. In all, 44.4% of patients never received intravesical therapy. The 10-year incidence of CSM and progression were 0% and 3.1% (95% confidence interval 0.8-5.4%), respectively. Direct cost savings in Ontario were estimated at $6994.14 (Canadian dollars) per patient over the study follow-up. CONCLUSIONS This study supports that properly selected patients with recurrent, apparent TaLG NMIBC can be safely managed with OF under local anaesthesia with occasional TURBT for larger or numerous recurrent tumours, without compromising long-term oncological outcomes. This approach could generate substantial cost-saving to healthcare systems, is patient-friendly, and could be adopted more widely.
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Affiliation(s)
- Christian Vitug
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Julian Chavarriaga
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Andres Llano
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Shayan Din
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Eunice Villegas
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Cynthia Kuk
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Amy Chan
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Bruce Gao
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Otto Hemminki
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Dhiral Kot
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Misurka
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | | | - Christopher Wallis
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Mark S Soloway
- Division of Urology, Memorial Physician Group, Memorial Healthcare System, Hollywood, FL, USA
| | - Neil E Fleshner
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
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Claps F, van de Kamp MW, Mayr R, Bostrom PJ, Shariat SF, Hippe K, Bertz S, Neuzillet Y, Sanders J, Otto W, van der Heijden MS, Jewett MAS, Stöhr R, Zlotta AR, Trombetta C, Eckstein M, Mertens LS, Burger M, Soorojebally Y, Wullich B, Bartoletti R, Radvanyi F, Pavan N, Sirab N, Mir MC, Pouessel D, van der Kwast TH, Hartmann A, Lotan Y, Bussani R, Allory Y, van Rhijn BWG. Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy. BJU Int 2023; 132:170-180. [PMID: 36748180 DOI: 10.1111/bju.15984] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC). MATERIALS AND METHODS We analysed a multi-institutional cohort of 1082 patients treated with upfront RC for cT1-4aN0M0 urothelial BCa at eight centres. Univariable and multivariable Cox' regression analyses were used to assess the effect of different VHs on DSS in overall cohort and three stage-based analyses. The stages were defined as 'organ-confined' (≤pT2N0), 'locally advanced' (pT3-4N0) and 'node-positive' (pTanyN1-3). RESULTS Overall, 784 patients (72.5%) had pure urothelial carcinoma (UC), while the remaining 298 (27.5%) harboured a VH. Squamous differentiation was the most common VH, observed in 166 patients (15.3%), followed by micropapillary (40 patients [3.7%]), sarcomatoid (29 patients [2.7%]), glandular (18 patients [1.7%]), lymphoepithelioma-like (14 patients [1.3%]), small-cell (13 patients [1.2%]), clear-cell (eight patients [0.7%]), nested (seven patients [0.6%]) and plasmacytoid VH (three patients [0.3%]). The median follow-up was 2.3 years. Overall, 534 (49.4%) disease-related deaths occurred. In uni- and multivariable analyses, plasmacytoid and small-cell VHs were associated with worse DSS in the overall cohort (both P = 0.04). In univariable analyses, sarcomatoid VH was significantly associated with worse DSS, while lymphoepithelioma-like VH had favourable DSS compared to pure UC. Clear-cell (P = 0.015) and small-cell (P = 0.011) VH were associated with worse DSS in the organ-confined and node-positive cohorts, respectively. CONCLUSIONS More than 25% of patients harboured a VH at time of RC. Compared to pure UC, clear-cell, plasmacytoid, small-cell and sarcomatoid VHs were associated with worse DSS, while lymphoepithelioma-like VH was characterized by a DSS benefit. Accurate pathological diagnosis of VHs may ensure tailored counselling to identify patients who require more intensive management.
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Affiliation(s)
- Francesco Claps
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Maaike W van de Kamp
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Roman Mayr
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Peter J Bostrom
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katrin Hippe
- Department of Pathology, University Medical Center - Regensburg, Regensburg, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yann Neuzillet
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Joyce Sanders
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Wolfgang Otto
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Michiel S van der Heijden
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Robert Stöhr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Alexandre R Zlotta
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Carlo Trombetta
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Maximilian Burger
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Yanish Soorojebally
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Bernd Wullich
- Department of Urology & Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Riccardo Bartoletti
- Unit of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - François Radvanyi
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Nicola Pavan
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nanour Sirab
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - M Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Damien Pouessel
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
- Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, Toulouse, France
| | - Theo H van der Kwast
- Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA
| | - Rossana Bussani
- Department of Pathology, University of Trieste, Trieste, Italy
| | - Yves Allory
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
- Department of Pathology, Institut Curie, Paris, France
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
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Zlotta AR, Ballas LK, Niemierko A, Lajkosz K, Kuk C, Miranda G, Drumm M, Mari A, Thio E, Fleshner NE, Kulkarni GS, Jewett MAS, Bristow RG, Catton C, Berlin A, Sridhar SS, Schuckman A, Feldman AS, Wszolek M, Dahl DM, Lee RJ, Saylor PJ, Michaelson MD, Miyamoto DT, Zietman A, Shipley W, Chung P, Daneshmand S, Efstathiou JA. Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis. Lancet Oncol 2023; 24:669-681. [PMID: 37187202 DOI: 10.1016/s1470-2045(23)00170-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Previous randomised controlled trials comparing bladder preservation with radical cystectomy for muscle-invasive bladder cancer closed due to insufficient accrual. Given that no further trials are foreseen, we aimed to use propensity scores to compare trimodality therapy (maximal transurethral resection of bladder tumour followed by concurrent chemoradiation) with radical cystectomy. METHODS This retrospective analysis included 722 patients with clinical stage T2-T4N0M0 muscle-invasive urothelial carcinoma of the bladder (440 underwent radical cystectomy, 282 received trimodality therapy) who would have been eligible for both approaches, treated at three university centres in the USA and Canada between Jan 1, 2005, and Dec 31, 2017. All patients had solitary tumours less than 7 cm, no or unilateral hydronephrosis, and no extensive or multifocal carcinoma in situ. The 440 cases of radical cystectomy represent 29% of all radical cystectomies performed during the study period at the contributing institutions. The primary endpoint was metastasis-free survival. Secondary endpoints included overall survival, cancer-specific survival, and disease-free survival. Differences in survival outcomes by treatment were analysed using propensity scores incorporated in propensity score matching (PSM) using logistic regression and 3:1 matching with replacement and inverse probability treatment weighting (IPTW). FINDINGS In the PSM analysis, the 3:1 matched cohort comprised 1119 patients (837 radical cystectomy, 282 trimodality therapy). After matching, age (71·4 years [IQR 66·0-77·1] for radical cystectomy vs 71·6 years [64·0-78·9] for trimodality therapy), sex (213 [25%] vs 68 [24%] female; 624 [75%] vs 214 [76%] male), cT2 stage (755 [90%] vs 255 [90%]), presence of hydronephrosis (97 [12%] vs 27 [10%]), and receipt of neoadjuvant or adjuvant chemotherapy (492 [59%] vs 159 [56%]) were similar between groups. Median follow-up was 4·38 years (IQR 1·6-6·7) versus 4·88 years (2·8-7·7), respectively. 5-year metastasis-free survival was 74% (95% CI 70-78) for radical cystectomy and 75% (70-80) for trimodality therapy with IPTW and 74% (70-77) and 74% (68-79) with PSM. There was no difference in metastasis-free survival either with IPTW (subdistribution hazard ratio [SHR] 0·89 [95% CI 0·67-1·20]; p=0·40) or PSM (SHR 0·93 [0·71-1·24]; p=0·64). 5-year cancer-specific survival for radical cystectomy versus trimodality therapy was 81% (95% CI 77-85) versus 84% (79-89) with IPTW and 83% (80-86) versus 85% (80-89) with PSM. 5-year disease-free survival was 73% (95% CI 69-77) versus 74% (69-79) with IPTW and 76% (72-80) versus 76% (71-81) with PSM. There were no differences in cancer-specific survival (IPTW: SHR 0·72 [95% CI 0·50-1·04]; p=0·071; PSM: SHR 0·73 [0·52-1·02]; p=0·057) and disease-free survival (IPTW: SHR 0·87 [0·65-1·16]; p=0·35; PSM: SHR 0·88 [0·67-1·16]; p=0·37) between radical cystectomy and trimodality therapy. Overall survival favoured trimodality therapy (IPTW: 66% [95% CI 61-71] vs 73% [68-78]; hazard ratio [HR] 0·70 [95% CI 0·53-0·92]; p=0·010; PSM: 72% [69-75] vs 77% [72-81]; HR 0·75 [0·58-0·97]; p=0·0078). Outcomes for radical cystectomy and trimodality therapy were not statistically different among centres for cancer-specific survival and metastasis-free survival (p=0·22-0·90). Salvage cystectomy was done in 38 (13%) trimodality therapy patients. Pathological stage in the 440 radical cystectomy patients was pT2 in 124 (28%), pT3-4 in 194 (44%), and 114 (26%) node positive. The median number of nodes removed was 39, the soft tissue positive margin rate was 1% (n=5), and the perioperative mortality rate was 2·5% (n=11). INTERPRETATION This multi-institutional study provides the best evidence to date showing similar oncological outcomes between radical cystectomy and trimodality therapy for select patients with muscle-invasive bladder cancer. These results support that trimodality therapy, in the setting of multidisciplinary shared decision making, should be offered to all suitable candidates with muscle-invasive bladder cancer and not only to patients with significant comorbidities for whom surgery is not an option. FUNDING Sinai Health Foundation, Princess Margaret Cancer Foundation, Massachusetts General Hospital.
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Affiliation(s)
- Alexandre R Zlotta
- Divisions of Urology and Surgical Oncology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, University of Toronto, Toronto, ON, Canada; Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Leslie K Ballas
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katherine Lajkosz
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cynthia Kuk
- Divisions of Urology and Surgical Oncology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, University of Toronto, Toronto, ON, Canada; Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gus Miranda
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Drumm
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Ethan Thio
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Neil E Fleshner
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Girish S Kulkarni
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert G Bristow
- Manchester Cancer Research Centre and University of Manchester, Manchester, UK
| | - Charles Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Srikala S Sridhar
- Department of Medical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anne Schuckman
- Aresty Department of Urology, Kenneth Norris Jr Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Wszolek
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard J Lee
- MGH Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip J Saylor
- MGH Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Dror Michaelson
- MGH Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David T Miyamoto
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William Shipley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Siamak Daneshmand
- Aresty Department of Urology, Kenneth Norris Jr Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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4
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Richard PO, Violette PD, Bhindi B, Breau RH, Gratton M, Jewett MAS, Kapoor A, Pouliot F, Leveridge M, So AI, Whelan TF, Rendon RA, Tanguay S, Finelli A. 2023 UPDATE - Canadian Urological Association guideline: Management of cystic renal lesions Prior to original publication (March 2017), this guideline underwent review by the CUA Guidelines Committee, CUA members at large, and the CUA Executive Board. The 2023 updates were app roved by the CUA Guidelines Committee and CUA Executive Board. Can Urol Assoc J 2023; 17:162-174. [PMID: 37310905 DOI: 10.5489/cuaj.8389] [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: 06/15/2023]
Affiliation(s)
- Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Bimal Bhindi
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON , Canada
| | - Matthieu Gratton
- Division of Urology, Department of Surgery, Université Laval, Quebec, QC, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON , Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery McMaster University, Hamilton, ON , Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Université Laval, Quebec, QC, Canada
| | - Michael Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON , Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Tom F Whelan
- Division of Urology, Department of Surgery, Saint John Regional Hospital, Dalhousie University, Saint John, NB, Canada
| | - Ricardo A Rendon
- Department of Urology, QEII Health Sciences Centre, Dalhousie University, Halifax, NS , Canada
| | - Simon Tanguay
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON , Canada
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Jewett MAS. Updated testicular cancer consensus guideline is a concise, balanced, and practical guide for clinicians. Can Urol Assoc J 2022; 16:174. [PMID: 35623008 DOI: 10.5489/cuaj.7948] [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: 11/19/2022]
Affiliation(s)
- Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Herrera-Caceres JO, Ajaj R, Leão R, Barello S, Rodriguez-Covarrubias F, Zequi SC, Maskens D, Giles RH, Lavallée LT, Jewett MAS. Patient-centered care can be improved by joint meetings between cancer patient group leaders and health care providers. Patient Educ Couns 2022; 105:786-787. [PMID: 34344571 DOI: 10.1016/j.pec.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/24/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Jaime O Herrera-Caceres
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Rand Ajaj
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Ricardo Leão
- Faculty of Medicine, University of Coimbra, CUF Coimbra Hospital, Portugal
| | - Serena Barello
- EngageMinds HUB, Consumer, Food & Health Engagement Research Center - Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Stenio C Zequi
- Urology Division A.C. Camargo Cancer Center, São Paulo, SP, Brazil; LARCG, Latin American Renal Cancer Group, Brazil; Medical Advisory Board -International Kidney Cancer Coalition, The Netherlands
| | - Deborah Maskens
- International Kidney Cancer Coalition (IKCC), Amsterdam, The Netherlands
| | - Rachel H Giles
- International Kidney Cancer Coalition (IKCC), Amsterdam, The Netherlands
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada; International Kidney Cancer Coalition (IKCC), Amsterdam, The Netherlands.
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Mertens LS, Claps F, Mayr R, Bostrom PJ, Shariat SF, Zwarthoff EC, Boormans JL, Abas C, van Leenders GJLH, Götz S, Hippe K, Bertz S, Neuzillet Y, Sanders J, Broeks A, Peters D, van der Heijden MS, Jewett MAS, Stöhr R, Zlotta AR, Eckstein M, Soorojebally Y, van der Schoot DKE, Wullich B, Burger M, Otto W, Radvanyi F, Sirab N, Pouessel D, van der Kwast TH, Hartmann A, Lotan Y, Allory Y, Zuiverloon TCM, van Rhijn BWG. Prognostic markers in invasive bladder cancer: FGFR3 mutation status versus P53 and KI-67 expression: a multi-center, multi-laboratory analysis in 1058 radical cystectomy patients. Urol Oncol 2021; 40:110.e1-110.e9. [PMID: 34906411 DOI: 10.1016/j.urolonc.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To determine the association between the FGFR3 mutation status and immuno-histochemistry (IHC) markers (p53 and Ki-67) in invasive bladder cancer (BC), and to analyze their prognostic value in a multicenter, multi-laboratory radical cystectomy (RC) cohort. PATIENTS AND METHODS We included 1058 cN0M0, chemotherapy-naive BC patients who underwent RC with pelvic lymph-node dissection at 8 hospitals. The specimens were reviewed by uro-pathologists. Mutations in the FGFR3 gene were examined using PCR-SNaPshot; p53 and Ki-67 expression were determined by standard IHC. FGFR3 mutation status as well as p53 (cut-off>10%) and Ki-67 (cut-off>20%) expression were correlated to clinicopathological parameters and disease specific survival (DSS). RESULTS pT-stage was <pT2 in 80, pT2 in 266, pT3 in 513 and pT4 in 199 patients, respectively. Cancer-positive nodes were found in 410 (39%) patients. An FGFR3 mutation was detected in 107 (10%) and aberrant p53 and Ki-67 expression in 718 (68%) and 581(55%) tumors, respectively. The FGFR3 mutation was associated with lower pT-stage (P<0.001), lower grade (P<0.001), pN0 (P=0.001) and prolonged DSS (P<0.001). Aberrant Ki-67 and p53 expression were associated with higher pT-stage and G3-tumors, but not with pN-stage or worse DSS, even if these IHC-biomarkers were combined (P=0.81). Significant predictors for DSS in multivariable analysis were pT-stage (HR1.5, 95%CI:1.3-1.6; P<0.001), lympho-vascular invasion (LVI) (HR1.4, 95%CI:1.2-1.7; P=0.001), pN-stage (HR1.9, 95%CI:1.6-2.4; P<0.001) and FGFR3 mutation status (HR1.6, 95%CI:1.1-2.2; P=0.011). CONCLUSION The FGFR3 mutation selectively identified patients with favorable BC at RC while p53 and Ki-67 were only associated with adverse tumor characteristics. Our results suggest that, besides tumor-stage, nodal-status and LVI, the oncogenic FGFR3 mutation may represent a valuable tool to guide adjuvant treatment and follow-up strategies after RC.
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Affiliation(s)
- Laura S Mertens
- Dept. Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Francesco Claps
- Dept. Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Roman Mayr
- Dept. Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Peter J Bostrom
- Dept. Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada; Dept. Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Shahrokh F Shariat
- Dept. Urology, University of Texas Southwestern Medical center, Dallas, TX
| | - Ellen C Zwarthoff
- Dept. of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Joost L Boormans
- Dept. Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Cheno Abas
- Dept. of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Geert J L H van Leenders
- Dept. of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Stefanie Götz
- Dept. Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Katrin Hippe
- Dept. Pathology, University Medical Center - Regensburg, Regensburg, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yann Neuzillet
- Dept. Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Institut Curie, CNRS, UMR144, Molecular Oncology team, PSL Research University, Paris, France; Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Joyce Sanders
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annegien Broeks
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Dennis Peters
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michiel S van der Heijden
- Dept. Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michael A S Jewett
- Dept. Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Robert Stöhr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Alexandre R Zlotta
- Dept. Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yanish Soorojebally
- Institut Curie, CNRS, UMR144, Molecular Oncology team, PSL Research University, Paris, France
| | | | - Bernd Wullich
- Dept. Urology & Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Maximilian Burger
- Dept. Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Wolfgang Otto
- Dept. Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - François Radvanyi
- Institut Curie, CNRS, UMR144, Molecular Oncology team, PSL Research University, Paris, France
| | - Nanour Sirab
- Institut Curie, CNRS, UMR144, Molecular Oncology team, PSL Research University, Paris, France
| | - Damien Pouessel
- Dept. Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, Toulouse, France
| | - Theo H van der Kwast
- Dept. Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yair Lotan
- Dept. Urology, University of Texas Southwestern Medical center, Dallas, TX
| | - Yves Allory
- Institut Curie, CNRS, UMR144, Molecular Oncology team, PSL Research University, Paris, France; Dept. Pathology, Institut Curie, Paris, France
| | - Tahlita C M Zuiverloon
- Dept. of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands; Dept. Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
| | - Bas W G van Rhijn
- Dept. Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Dept. Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany; Dept. Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
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8
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Psutka SP, Gulati R, Jewett MAS, Fadaak K, Finelli A, Legere L, Morgan TM, Pierorazio PM, Allaf ME, Herrin J, Lohse CM, Houston Thompson R, Boorjian SA, Atwell TD, Schmit GD, Costello BA, Shah ND, Leibovich BC. A Clinical Decision Aid to Support Personalized Treatment Selection for Patients with Clinical T1 Renal Masses: Results from a Multi-institutional Competing-risks Analysis. Eur Urol 2021; 81:576-585. [PMID: 34862099 DOI: 10.1016/j.eururo.2021.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 04/06/2021] [Revised: 09/28/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Personalized treatment for clinical T1 renal cortical masses (RCMs) should take into account competing risks related to tumor and patient characteristics. OBJECTIVE To develop treatment-specific prediction models for cancer-specific mortality (CSM), other-cause mortality (OCM), and 90-d Clavien grade ≥3 complications across radical nephrectomy (RN), partial nephrectomy (PN), thermal ablation (TA), and active surveillance (AS). DESIGN, SETTING, AND PARTICIPANTS Pretreatment clinical and radiological features were collected for consecutive adult patients treated with initial RN, PN, TA, or AS for RCMs at four high-volume referral centers (2000-2019). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Prediction models used competing-risks regression for CSM and OCM and logistic regression for 90-d Clavien grade ≥3 complications. Performance was assessed using bootstrap validation. RESULTS AND LIMITATIONS The cohort comprised 5300 patients treated with RN (n = 1277), PN (n = 2967), TA (n = 476), or AS (n = 580). Over median follow-up of 5.2 yr (interquartile range 2.5-8.7), there were 117 CSM, 607 OCM, and 198 complication events. The C index for the predictive models was 0.80 for CSM, 0.77 for OCM, and 0.64 for complications. Predictions from the fitted models are provided in an online calculator (https://small-renal-mass-risk-calculator.fredhutch.org). To illustrate, a hypothetical 74-yr-old male with a 4.5-cm RCM, body mass index of 32 kg/m2, estimated glomerular filtration rate of 50 ml/min, Eastern Cooperative Oncology Group performance status of 3, and Charlson comorbidity index of 3 has predicted 5-yr CSM of 2.9-5.6% across treatments, but 5-yr OCM of 29% and risk of 90-d Clavien grade 3-5 complications of 1.9% for RN, 5.8% for PN, and 3.6% for TA. Limitations include selection bias, heterogeneity in practice across treatment sites and the study time period, and lack of control for surgeon/hospital volume. CONCLUSIONS We present a risk calculator incorporating pretreatment features to estimate treatment-specific competing risks of mortality and complications for use during shared decision-making and personalized treatment selection for RCMs. PATIENT SUMMARY We present a risk calculator that generates personalized estimates of the risks of death from cancer or other causes and of complications for surgical, ablation, and surveillance treatment options for patients with stage 1 kidney tumors.
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Affiliation(s)
- Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA.
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Kamel Fadaak
- Department of Urology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Antonio Finelli
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Laura Legere
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Phillip M Pierorazio
- Department of Urology, Brady Urological Institute, Department of Urology at Johns Hopkins, Baltimore, MD, USA
| | - Mohamad E Allaf
- Department of Urology, Brady Urological Institute, Department of Urology at Johns Hopkins, Baltimore, MD, USA
| | - Jeph Herrin
- Division of Cardiology, Yale School of Medicine, New Haven, CT, USA; Health Research & Educational Trust, Chicago, IL, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Grant D Schmit
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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9
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Abstract
Clinical guidelines for guiding clinical decision-making must be trustworthy, especially when there is controversy or a shifting paradigm. In urology, the management of small renal masses is one area in which there is currently a paradigm shift towards active surveillance. A number of international guidelines address this paradigm shift to some extent, with varying degrees of rigor. To be trustworthy, guidelines should be developed by panels that include content experts - the traditional panel members - as well as methodologists with expertise in evidence interpretation, front-line clinicians who take care of the patients who constitute the target audience, and patient partners. At a minimum, panels should integrate four key concepts: (1) guidelines provide a systematic summary of evidence used to support answerable questions, including assessment of the quality of the evidence; (2) there is a clear and transparent link between the evidence and recommendations; (3) recommendations incorporate patient values and preferences; and (4) conflicts of interest are managed optimally. In this article we address several issues in four international guidelines, with an emphasis on guideline methods and implications for guidance statements. The strengths and limitations of available recommendations are reviewed and summarized with suggestions for improving the next iterations of guidelines on the management of small renal masses. PATIENT SUMMARY: Good clinical decision-making relies on trustworthy guidelines. We assessed four international guidelines on the management of small kidney tumors that illustrate some of the key issues in developing a trustworthy guideline. Patient values and preferences are under-represented in most clinical guidelines.
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Affiliation(s)
- Philippe D Violette
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Surgery, Woodstock General Hospital, Woodstock, Canada.
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, University Health Network and Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Patrick O Richard
- Department of Urology, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, Canada
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10
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Karam JA, Puligandla M, Flaherty KT, Uzzo RG, Matin SF, Pins MR, Wood CG, Kane C, Jewett MAS, Kim SE, Dutcher JP, DiPaola RS, Haas NB. Adjuvant therapy in patients with sarcomatoid renal cell carcinoma: post hoc analysis from Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) E2805. BJU Int 2021; 129:718-722. [PMID: 34480522 DOI: 10.1111/bju.15587] [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: 11/28/2022]
Abstract
OBJECTIVES To study the effects of adjuvant therapy in patients with sarcomatoid renal cell carcinoma (sRCC) enrolled in the randomised phase III clinical trial E2805. PATIENTS AND METHODS The original trial (E2805) was a randomised, double-blinded phase III clinical trial comparing outcomes in 1943 patients with RCC accrued between 2006 and 2010 and treated with up to 1 year of adjuvant placebo, sunitinib, or sorafenib. The present study analyses the cohort of patients with sRCC that participated in E2805. RESULTS A total of 171 patients (8.8%) had sarcomatoid features. Of these, 52 patients received sunitinib, 58 received sorafenib, and 61 received placebo. Most patients were pT3-4 (71.1%, 63.7%, and 70.5%, respectively); 17.3%, 19.0%, and 27.9% had pathologically positive lymph nodes; and 59.6%, 62.1%, and 62.3% of the patients were University of California Los Angeles (UCLA) Integrated Staging System (UISS) very-high risk. In 49% of patients with subsequent development of metastatic disease, recurrence occurred in the lung, followed by 30% in the lymph nodes, and 13% in the liver. There was a high local recurrence rate in the renal bed (16%, 29%, and 18%, respectively). The 5-year disease-free survival (DFS) rates were 33.6%, 36.0%, and 27.8%, for sunitinib, sorafenib and placebo, respectively (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.45-1.20 for sunitinib vs placebo, and HR 0.82, 95% CI 0.53-1.28 for sorafenib vs placebo). CONCLUSIONS Adjuvant therapy with sunitinib or sorafenib did not show an improvement in DFS or OS in patients with sRCC.
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Affiliation(s)
- Jose A Karam
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maneka Puligandla
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | | | - Surena F Matin
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | - Se Eun Kim
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | | | - Naomi B Haas
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Fox Chase Cancer Center, Philadelphia, PA, USA
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11
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Bratslavsky G, Mendhiratta N, Daneshvar M, Brugarolas J, Ball MW, Metwalli A, Nathanson KL, Pierorazio PM, Boris RS, Singer EA, Carlo MI, Daly MB, Henske EP, Hyatt C, Middleton L, Morris G, Jeong A, Narayan V, Rathmell WK, Vaishampayan U, Lee BH, Battle D, Hall MJ, Hafez K, Jewett MAS, Karamboulas C, Pal SK, Hakimi AA, Kutikov A, Iliopoulos O, Linehan WM, Jonasch E, Srinivasan R, Shuch B. Genetic risk assessment for hereditary renal cell carcinoma: Clinical consensus statement. Cancer 2021; 127:3957-3966. [PMID: 34343338 DOI: 10.1002/cncr.33679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/14/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Although renal cell carcinoma (RCC) is believed to have a strong hereditary component, there is a paucity of published guidelines for genetic risk assessment. A panel of experts was convened to gauge current opinions. METHODS A North American multidisciplinary panel with expertise in hereditary RCC, including urologists, medical oncologists, clinical geneticists, genetic counselors, and patient advocates, was convened. Before the summit, a modified Delphi methodology was used to generate, review, and curate a set of consensus questions regarding RCC genetic risk assessment. Uniform consensus was defined as ≥85% agreement on particular questions. RESULTS Thirty-three panelists, including urologists (n = 13), medical oncologists (n = 12), genetic counselors and clinical geneticists (n = 6), and patient advocates (n = 2), reviewed 53 curated consensus questions. Uniform consensus was achieved on 30 statements in specific areas that addressed for whom, what, when, and how genetic testing should be performed. Topics of consensus included the family history criteria, which should trigger further assessment, the need for risk assessment in those with bilateral or multifocal disease and/or specific histology, the utility of multigene panel testing, and acceptance of clinician-based counseling and testing by those who have experience with hereditary RCC. CONCLUSIONS In the first ever consensus panel on RCC genetic risk assessment, 30 consensus statements were reached. Areas that require further research and discussion were also identified, with a second future meeting planned. This consensus statement may provide further guidance for clinicians when considering RCC genetic risk assessment. LAY SUMMARY The contribution of germline genetics to the development of renal cell carcinoma (RCC) has long been recognized. However, there is a paucity of guidelines to define how and when genetic risk assessment should be performed for patients with known or suspected hereditary RCC. Without guidelines, clinicians struggle to define who requires further evaluation, when risk assessment or testing should be done, which genes should be considered, and how counseling and/or testing should be performed. To this end, a multidisciplinary panel of national experts was convened to gauge current opinion on genetic risk assessment in RCC and to enumerate a set of recommendations to guide clinicians when evaluating individuals with suspected hereditary kidney cancer.
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Affiliation(s)
- Gennady Bratslavsky
- Department of Urology, State University of New York (SUNY, Upstate Medical University, Syracuse, New York
| | - Neil Mendhiratta
- Department of Urology, University of California Los Angeles, Los Angeles, California
| | - Michael Daneshvar
- Department of Urology, State University of New York (SUNY, Upstate Medical University, Syracuse, New York.,Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - James Brugarolas
- Department of Medicine, Division of Hematology-Oncology, University of Texas (UT) Southwestern Medical Center, Dallas, Texas
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Adam Metwalli
- Department of Surgery, Division of Urology, Howard University Hospital, Washington, District of Columbia
| | - Katherine L Nathanson
- Division of Human Genetics and Translational Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Phillip M Pierorazio
- Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ronald S Boris
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Maria I Carlo
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth P Henske
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Colette Hyatt
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lindsay Middleton
- Department of Medicine, Division of Hematology-Oncology, University of Texas (UT) Southwestern Medical Center, Dallas, Texas
| | - Gloria Morris
- Department of Urology, State University of New York (SUNY, Upstate Medical University, Syracuse, New York
| | - Anhyo Jeong
- Department of Urology, University of California Los Angeles, Los Angeles, California
| | - Vivek Narayan
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ulka Vaishampayan
- Department of Oncology, Karmanos Cancer Center/Wayne State University, Detroit, Michigan
| | | | - Dena Battle
- The Kidney Cancer Research Alliance, Leesburg, Virginia
| | - Michael J Hall
- Department of Surgery, Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Khaled Hafez
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Christina Karamboulas
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Sumanta K Pal
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - A Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander Kutikov
- Department of Surgery, Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Othon Iliopoulos
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Brian Shuch
- Department of Urology, University of California Los Angeles, Los Angeles, California
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12
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Nason GJ, Rendon RA, Wood L, Huddart RA, Albers P, Einhorn LH, Nichols CR, Kollmannsberger C, Anson-Cartwright L, Warde P, Jewett MAS, Chung P, Bedard PL, Hansen AR, Hamilton RJ. Clinical dilemmas in local and regional testis cancer. Can Urol Assoc J 2020; 15:E58-E64. [PMID: 33007187 DOI: 10.5489/cuaj.6913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
At the Canadian Testis Cancer Workshop, the multidisciplinary management of testis cancer care was discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician's assistants, residents, fellows, nurses, patients, and patient advocacy group members.This review summarizes the discussion regarding clinical dilemmas in local and regional testis cancer. We present cases that highlight the need for a coordinated approach to individualize care. Overarching themes include the importance of a multidisciplinary approach to testis cancer, willingness to involve a high-volume experienced center, and given that the oncological outcomes are excellent, a reminder that clinical decisions need to prioritize selecting a strategy with the least treatment-related morbidity when safe.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Robert A Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Lawrence H Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig R Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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13
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Nason GJ, Jewett MAS, Bostrom PJ, Goldberg H, Hansen AR, Bedard PL, Sturgeon J, Warde P, Chung P, Anson-Cartwright L, Sweet J, Atenafu EG, O'Malley M, Hamilton RJ. Long-term Surveillance of Patients with Complete Response Following Chemotherapy for Metastatic Nonseminomatous Germ Cell Tumor. Eur Urol Oncol 2020; 4:289-296. [PMID: 32907779 DOI: 10.1016/j.euo.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/16/2019] [Revised: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is controversy regarding the management of patients with normal markers and residual masses (≤1 cm) after chemotherapy for nonseminomatous germ cell tumors (NSGCTs). OBJECTIVE To determine long-term outcomes of a surveillance strategy in such patients. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of our multidisciplinary testicular cancer database was performed. All patients who underwent primary chemotherapy for metastatic NSGCTs were identified between 1981 and 2016. A complete response (CR) was defined as normalization of serum tumor markers and a ≤1 cm residual mass in the largest axial dimension following chemotherapy. All such patients were surveilled. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome variables of interest were time to death, time to cancer-specific survival, and time to relapse. Overall survival and relapse-free survival were calculated using the Kaplan-Meier method, and the cumulative incidence of cause-specific survival rates was calculated using competing risk analysis. The impact of risk group and chemotherapy regimen on relapse-free survival was assessed using log-rank test. RESULTS AND LIMITATIONS During the study period, 1429 metastatic germ cell tumor patients were treated with primary chemotherapy. CR was achieved in 191 (18.5%) NSGCT patients. The median age at diagnosis was 27.4 yr, with a median follow-up of 81.1 mo. The majority had American Joint Committee on Cancer stage II at diagnosis (I: 23.8%; II: 49.2%; III: 27%) and International Germ Cell Cancer Collaborative Group good-risk disease (good: 78%; intermediate: 17.8%; poor: 4.2%). Of the 191 patients with a CR, 175 (91.6%) never relapsed and remain disease free. Sixteen (8.4%) patients relapsed after a median of 11.3 mo (range 1-332 mo), with over half (nine patients; 4.7%) relapsing in the retroperitoneum only and salvaged successfully with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) alone. Of these nine patients, only two (1%) had viable disease in the PC-RPLND specimen. The remaining seven patients had relapses outside the retroperitoneum and received salvage chemotherapy ± postchemotherapy resection. Overall, nine (4.7%) patients have died, but only four (2.1%) from testis cancer. CONCLUSIONS Our data, the largest series to date, confirm that surveillance is safe and effective for men who achieve a CR following chemotherapy for metastatic NSGCTs. PATIENT SUMMARY Surveillance is a safe strategy for patients who achieve a complete response following chemotherapy for metastatic testis cancer.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter J Bostrom
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hanan Goldberg
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jeremy Sturgeon
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Martin O'Malley
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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14
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van Rhijn BWG, Mertens LS, Mayr R, Bostrom PJ, Real FX, Zwarthoff EC, Boormans JL, Abas C, van Leenders GJLH, Götz S, Hippe K, Bertz S, Neuzillet Y, Sanders J, Broeks A, van der Heijden MS, Jewett MAS, Marquez M, Stoehr R, Zlotta AR, Eckstein M, Soorojebally Y, Roshani H, Burger M, Otto W, Radvanyi F, Sirab N, Pouessel D, Wullich B, van der Kwast TH, Malats N, Hartmann A, Allory Y, Zuiverloon TCM. FGFR3 Mutation Status and FGFR3 Expression in a Large Bladder Cancer Cohort Treated by Radical Cystectomy: Implications for Anti-FGFR3 Treatment? †. Eur Urol 2020; 78:682-687. [PMID: 32682615 DOI: 10.1016/j.eururo.2020.07.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 03/02/2020] [Accepted: 07/02/2020] [Indexed: 11/15/2022]
Abstract
Fibroblast growth factor receptor 3 (FGFR3) is an actionable target in bladder cancer (BC). FGFR3 mutations are common in noninvasive BC and associated with favorable BC prognosis. Overexpression was reported in up to 40% of FGFR3 wild-type muscle-invasive BC. We analyzed FGFR3 mutations, FGFR3, and p53 protein expression and assessed their prognostic value in a cohort of 1000 chemotherapy-naive radical cystectomy specimens. FGFR3 mutations were found in 11%, FGFR3 overexpression was found in 28%, and p53 overexpression was found in 69% of tumors. Among FGFR3 mutant tumors, 73% had FGFR3 overexpression versus 22% among FGFR3 wild-type tumors. FGFR3 mutations were significantly associated with lower pT stage, tumor grade, absence of carcinoma in situ, pN0, low-level p53, and longer disease-specific survival (DSS). FGFR3 overexpression was associated only with lower pT stage and tumor grade. Moreover, FGFR3 overexpression was not associated with DSS in patients with FGFR3 wild-type tumors. In conclusion, FGFR3 mutations identified patients with favorable BC at cystectomy. Our results suggest that FGFR3 mutations have a driver role and are functionally distinct from FGFR3 overexpression. Hence, patients with FGFR3 mutations would be more likely to benefit from anti-FGFR3 therapy. Ideally, further research is needed to test this hypothesis. PATIENT SUMMARY: Oncogenic fibroblast growth factor receptor 3 (FGFR3) mutations are very common in bladder cancer. In this report, we found that these FGFR3 mutations were associated with favorable features and prognosis of bladder cancer compared with patients with FGFR3 overexpressed tumors only. As a consequence, patients with FGFR3 mutant tumors would be more likely to benefit from anti-FGFR3 therapy than patients with FGFR3 protein overexpression only.
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Affiliation(s)
- Bas W G van Rhijn
- Departments of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany.
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Roman Mayr
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Peter J Bostrom
- Departments of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada; Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Francisco X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO) & CIBERONC, Madrid, Spain; Department of de Ciències Experimentals i de la Salut, University Pompeu Fabra, Barcelona, Spain
| | - Ellen C Zwarthoff
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Cheno Abas
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, Rotterdam, The Netherlands; Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Stefanie Götz
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Katrin Hippe
- Department of Pathology, University Medical Center-Regensburg, Regensburg, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nürnberg, Erlangen, Germany
| | - Yann Neuzillet
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Joyce Sanders
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annegien Broeks
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michiel S van der Heijden
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Mirari Marquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Robert Stoehr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nürnberg, Erlangen, Germany
| | - Alexandre R Zlotta
- Departments of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nürnberg, Erlangen, Germany
| | - Yanish Soorojebally
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Hossain Roshani
- Department of Urology, Haga Ziekenhuis, The Hague, The Netherlands
| | - Maximilian Burger
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Wolfgang Otto
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - François Radvanyi
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Nanor Sirab
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Damien Pouessel
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France; Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, Toulouse, France
| | - Bernd Wullich
- Department of Urology & Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nürnberg, Erlangen, Germany
| | - Theo H van der Kwast
- Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nürnberg, Erlangen, Germany
| | - Yves Allory
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France; Department of Pathology, Institut Curie, Paris, France
| | - Tahlita C M Zuiverloon
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, Rotterdam, The Netherlands; Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
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15
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Finelli A, Cheung DC, Al-Matar A, Evans AJ, Morash CG, Pautler SE, Siemens DR, Tanguay S, Rendon RA, Gleave ME, Drachenberg DE, Chin JL, Fleshner NE, Haider MA, Kachura JR, Sykes J, Jewett MAS. Small Renal Mass Surveillance: Histology-specific Growth Rates in a Biopsy-characterized Cohort. Eur Urol 2020; 78:460-467. [PMID: 32680677 DOI: 10.1016/j.eururo.2020.06.053] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 03/10/2020] [Accepted: 06/22/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Most reports of active surveillance (AS) of small renal masses (SRMs) lack biopsy confirmation, and therefore include benign tumors and different subtypes of renal cell carcinoma (RCC). OBJECTIVE We compared the growth rates and progression of different histologic subtypes of RCC SRMs (SRMRCC) in the largest cohort of patients with biopsy-characterized SRMs on AS. DESIGN, SETTING, AND PARTICIPANTS Data from patients in a multicenter Canadian trial and a Princess Margaret cohort were combined to include 136 biopsy-proven SRMRCC lesions managed by AS, with treatment deferred until progression or patient/surgeon decision. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Growth curves were estimated from serial tumor size measures. Tumor progression was defined by sustained size ≥4 cm or volume doubling within 1 yr. RESULTS AND LIMITATIONS Median follow-up for patients who remained on AS was 5.8 yr (interquartile range 3.4-7.5 yr). Clear cell RCC SRMs (SRMccRCC) grew faster than papillary type 1 SRMs (0.25 and 0.02 cm/yr on average, respectively, p = 0.0003). Overall, 60 SRMRCC lesions progressed: 49 (82%) by rapid growth (volume doubling), seven (12%) increasing to ≥4 cm, and four (6.7%) by both criteria. Six patients developed metastases, and all were of clear cell RCC histology. Limitations include the use of different imaging modalities and a lack of central imaging review. CONCLUSIONS Tumor growth varies between histologic subtypes of SRMRCC and among SRMccRCC, which likely reflects individual host and tumor biology. Without validated biomarkers that predict this variation, initial follow-up of histologically characterized SRMs can inform personalized treatment for patients on AS. PATIENT SUMMARY Many small kidney cancers are suitable for surveillance and can be monitored over time for change. We demonstrate that different types of kidney cancers grow at different rates and are at different risks of progression. These results may guide better personalized treatment.
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Affiliation(s)
- Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Douglas C Cheung
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ashraf Al-Matar
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew J Evans
- Department of Pathology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Christopher G Morash
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Stephen E Pautler
- Divisions of Urology and Surgical Oncology, Western University, London, ON, Canada
| | | | - Simon Tanguay
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Ricardo A Rendon
- Department of Urology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | - Martin E Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Darrel E Drachenberg
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Joseph L Chin
- Divisions of Urology and Surgical Oncology, Western University, London, ON, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Masoom A Haider
- Joint Department of Medical Imaging, Sinai Health System, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R Kachura
- Joint Department of Medical Imaging, Sinai Health System, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Sykes
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
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16
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Nason GJ, Morris J, Bhatt JR, Richard PO, Martin L, Ajib K, Tan GH, Jewett MAS, Jhaveri K, Zlotta AR, Lee JY, Perlis N, Hamilton RJ, Finelli A. Natural History of Renal Angiomyolipoma Favors Surveillance as an Initial Approach. Eur Urol Focus 2020; 7:582-588. [PMID: 32636160 DOI: 10.1016/j.euf.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/10/2020] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Traditionally, intervention was recommended for angiomyolipomas (AMLs) >4 cm due to the risk of catastrophic hemorrhage. OBJECTIVE To delineate the natural history of AMLs, including growth rates and need for intervention. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was performed of an AML series from 2002 to 2013, which have been followed prospectively until 2018. We defined lesion size by maximum axial diameter and categorized lesion size at baseline. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A total of 458 patients with 593 AMLs, with a median follow-up of 65.2 mo, were identified. At diagnosis, 534 (90.1%) lesions were ≤4 cm. Forty-three interventions were required for 34 (5.7%) AMLs: 30 were treated with embolization, seven surgery, two with radiofrequency ablation (RFA), three with mammalian target of rapamycin (mTOR) inhibitors, and one with nivolumab when epithelioid AML was confirmed. The median size at intervention was 4.9 cm (range 1.1-29 cm). RESULTS AND LIMITATIONS Most (94%) of the lesions grew slowly (growth rate of <0.25 cm/yr) during the period of observation. The number of AMLs <4 cm needed to treat (NNT) prophylactically to prevent one emergent bleed would have been 136 or that to prevent one blood transfusion would have been 205. The NNT (<4 cm) prophylactically to prevent one elective intervention would have been 82. On multivariate analysis, there were significant differences in intervention rates based on tuberous sclerosis complex, size at presentation, and clinical presentation. CONCLUSIONS This large single-institution updated series of renal AMLs demonstrates that early intervention is not required, regardless of the traditional 4 cm cut-off. The vast majority of AMLs are indolent lesions that are predominantly asymptomatic and slow growing. Follow-up should be no more frequent than annually. PATIENT SUMMARY The majority of angiomyolipomas (AMLs) are indolent, slow-growing lesions that do not require intervention, regardless of size at presentation. We suggest that surveillance is a safe initial approach for patients presenting with AMLs.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jonathan Morris
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jaimin R Bhatt
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada; Department of Urology, University Hospital Ayr, Ayr, Scotland, UK
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada; Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Lisa Martin
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Kartik Jhaveri
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada.
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17
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Nason GJ, Sweet J, Landoni L, Leao R, Anson-Cartwright L, Mok S, Guzylak V, D'Angelo A, Fang ZY, Geist I, Warde P, Jewett MAS, Hamilton RJ. Discrepancy in pathology reports upon second review of radical orchiectomy specimens for testicular germ cell tumors. Can Urol Assoc J 2020; 14:411-415. [PMID: 32574142 DOI: 10.5489/cuaj.6481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We sought to evaluate the discrepancies between primary pathology report and second pathology review of radical orchiectomy (RO) specimens. METHODS A retrospective review was performed of RO specimens from the Ontario Cancer Registry. All cases required both a primary pathology report and a second pathology review from another institution. Histopathological variables assessed included histological subtype and components of mixed germ cell tumor (GCT), pathological tumor (pT) stage, lymphovascular invasion (LVI), spermatic cord invasion, and surgical margin. RESULTS Between 1994 and 2015, 5048 ROs were performed with 2719 (53.9%) seminoma and 2029 (40.2%) non-seminoma. Of these, 519 (10.3%) received a second pathology review. There was concordance between primary pathology report and second pathology review in 326 (62.8%) cases. The most common discrepancies involved a change in pT stage (n=148, 28.5%), with upstaging in 83 (16%) and downstaging in 65 (12.5%) cases relative to the original pT stage. The second most common discrepancy regarded the reporting of LVI (n=121, 23.3%), with 62 (11.9%) reporting presence of LVI when the primary pathology report did not. Other discrepancies included a change in the histological subtype in 28 (5.4%) cases and spermatic cord margin status in five (9.6%) cases. CONCLUSIONS Only 10% of orchiectomy specimens underwent a second pathology review, with nearly 40% of reviews leading to a meaningful change in parameters. Such variation could lead to incorrect tumor staging, estimate of relapse risk, and inappropriate treatment decisions. Expert pathology review of RO specimens should be considered, as it has significant implications for decision-making.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lauren Landoni
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ricardo Leao
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Faculty of Medicine; University of Coimbra, Portugal; Clinical Academic Center of Coimbra, Portugal
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Spencer Mok
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vanessa Guzylak
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrea D'Angelo
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zhi Yi Fang
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ilana Geist
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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18
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McAlpine K, Breau RH, Stacey D, Knee C, Jewett MAS, Violette PD, Richard PO, Cagiannos I, Morash C, Lavallée LT. Shared decision-making for the management of small renal masses: Development and acceptability testing of a novel patient decision aid. Can Urol Assoc J 2020; 14:385-391. [PMID: 32574143 DOI: 10.5489/cuaj.6575] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Shared decision-making incorporates patients' values and preferences to achieve high-quality decisions. The objective of this study was to develop an acceptable patient decision aid to facilitate shared decision-making for the management of small renal masses (SRMs). METHODS The International Patient Decision Aids Standards were used to guide an evidence-based development process. Management options included active surveillance, thermal ablation, partial nephrectomy, and radical nephrectomy. A literature review was performed to provide incidence rates for outcomes of each option. Once a prototype was complete, alpha-testing was performed using a 10-question survey to assess acceptability with patients, patient advocates, urologists, and methodological experts. The primary outcome was acceptability of the decision aid. RESULTS A novel patient decision aid was created to facilitate shared decision-making for the management of SRMs. Acceptability testing was performed with 20 patients, 10 urologists, two patient advocates, and one methodological expert. Responders indicated the decision aid was appropriate in length (82%, 27/33), well-balanced (82%, 27/33), and had language that was easy to follow (94%, 31/33). All patient responders felt the decision aid would have been helpful during their consultation and would recommend the decision aid for future patients (100%, 20/20). Most urologists reported they intend to use the decision aid (90%, 9/10). CONCLUSIONS A novel patient decision aid was created to facilitate shared decision-making for management of SRMs. This clinical tool was acceptable with patients, patient advocates, and urologists and is freely available at: https://decisionaid.ohri.ca/decaids.html.
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Affiliation(s)
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Knee
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Philippe D Violette
- Departments of Health Research Methods Evidence and Impact and Surgery, McMaster University, Hamilton, ON, Canada
| | - Patrick O Richard
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Ilias Cagiannos
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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19
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Nason GJ, Chung P, Warde P, Huddart R, Albers P, Kollmannsberger C, Booth CM, Hansen AR, Bedard PL, Einhorn L, Nichols C, Rendon RA, Wood LA, Jewett MAS, Hamilton RJ. Controversies in the management of clinical stage 1 testis cancer. Can Urol Assoc J 2020; 14:E537-E542. [PMID: 32569575 DOI: 10.5489/cuaj.6722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In November 2018, The Canadian Testis Cancer Workshop was convened. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, nurses, patients and patient advocacy groups. One of the goals of the workshop was to discuss the challenging areas of testis cancer care where guidelines may not be specific. The objective was to distill through discussion around cases, expert approach to working through these challenges. Herein we present a summary of discussion from the workshop around controversies in the management of clinical stage 1 (CS1) disease. CS1 represents organ confined non-metastatic testis cancer that represents approximately 70-80% of men at presentation. Regardless of management, CS1 has an excellent prognosis. However, without adjuvant treatment, approximately 30% of CS1 nonseminomatous germ cell tumors (NSGCT) and 15% of CS1 seminoma relapse. The workshop reviewed that while surveillance has become the standard for the majority of patients with CS1 disease there remains debate in the management of patients at high-risk of relapse. The controversy in the management of CS1 testis cancer surrounds the optimal balance between the morbidity of overtreatment and the identification of patients who may derive most benefit from adjuvant treatment. The challenge lies in a shared decision process where discussion of options extends beyond the simple risk of relapse but to include the long-term toxicities of adjuvant treatments and the favorable cancer-specific survival.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Christopher M Booth
- Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lawrence Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori A Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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20
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Lilge L, Wu J, Xu Y, Manalac A, Molenhuis D, Schwiegelshohn F, Vesselov L, Embree W, Nesbit M, Betz V, Mandel A, Jewett MAS, Kulkarni GS. Minimal required PDT light dosimetry for nonmuscle invasive bladder cancer. J Biomed Opt 2020; 25:1-13. [PMID: 32529817 PMCID: PMC7289452 DOI: 10.1117/1.jbo.25.6.068001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/27/2020] [Indexed: 05/18/2023]
Abstract
SIGNIFICANCE Photodynamic therapy (PDT) could become a treatment option for nonmuscle invasive bladder cancer when the current high morbidity rate associated with red light PDT and variable PDT dose can be overcome through a combination of intravesical instillation of the photosensitizer and the use of green light creating a steep PDT dose gradient. AIM To determine how a high PDT selectivity can be maintained throughout the bladder wall considering other efficacy determining parameters, in particular, the average optical properties of the mucosal layer governing the fluence rate multiplication factor, as well as the bladder shape and the position of the emitter in relationship to the bladder wall. APPROACH We present three irradiance monitoring systems and evaluate their ability to enable selective bladder PDT considering previously determined photodynamic threshold values for the bladder cancer, mucosa and urothelium in a preclinical model, and the photosensitizer's specific uptake ratio. Monte Carlo-based light propagation simulations performed for six human bladders at the time of therapy for a range of tissue optical properties. The performance of one irradiance sensing device in a clinical phase 1B trial is presented to underline the impact of irradiance monitoring, and it is compared to the Monte Carlo-derived dose surface histogram. RESULTS Monte Carlo simulations showed that irradiance monitoring systems need to comprise at least three sensors. Light scattering inside the bladder void needs to be minimized to prevent increased heterogeneity of the irradiance. The dose surface histograms vary significantly depending on the bladder shape and bladder volume but are less dependent on tissue optical properties. CONCLUSIONS We demonstrate the need for adequate irradiance monitoring independent of a photosensitizer's specific uptake ratio.
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Affiliation(s)
- Lothar Lilge
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- University of Toronto, Department of Medical Biophysics, Toronto, Ontario, Canada
- Address all correspondence to Lothar Lilge, E-mail:
| | - Jenny Wu
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Yiwen Xu
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Angelica Manalac
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Daniel Molenhuis
- University of Toronto, Department of Medical Biophysics, Toronto, Ontario, Canada
| | - Fynn Schwiegelshohn
- University of Toronto, Department of Electrical and Computer Engineering, Toronto, Ontario, Canada
| | | | - Wayne Embree
- Theralase Technologies Inc., Toronto, Ontario, Canada
| | - Michael Nesbit
- University of Toronto, Division of Urology, Department of Surgery, Toronto, Ontario, Canada
| | - Vaughn Betz
- University of Toronto, Department of Electrical and Computer Engineering, Toronto, Ontario, Canada
| | - Arkady Mandel
- Theralase Technologies Inc., Toronto, Ontario, Canada
| | - Michael A. S. Jewett
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- University of Toronto, Division of Urology, Department of Surgery, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- University of Toronto, Division of Urology, Department of Surgery, Toronto, Ontario, Canada
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21
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Goldberg H, Ajaj R, Cáceres JOH, Berlin A, Chandrasekar T, Klaassen Z, Wallis CJD, Ahmad AE, Leao R, Petrella AR, Kachura JR, Fleshner N, Matthew A, Finelli A, Jewett MAS, Hamilton RJ. Psychological distress associated with active surveillance in patients younger than 70 with a small renal mass. Urol Oncol 2020; 38:603.e17-603.e25. [PMID: 32253117 DOI: 10.1016/j.urolonc.2020.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/28/2019] [Accepted: 02/11/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To compare the psychological distress throughout several predefined disease time points in patients younger than 70 with small renal masses (SRMs) treated with either active surveillance (AS) or ablative/surgical therapy. METHODS Using the Edmonton Symptom Assessment System - revised (ESAS-r) questionnaire, we focused on psychological distress symptoms in all consecutive patients with an SRM between 2014 and 2017. We further evaluated the psychological distress sub-score (PDSS) of ESAS-r, consisting of the sum scores of anxiety, depression, and well-being. PDSS of patients treated with AS or ablation/surgery were compared at 4 distinct time points (before and after diagnosis, after a biopsy is performed, and at last follow-up). Multivariable linear regression models were performed to assess factors associated with worse PDSS (1-point score increase). RESULTS We examined 477 patients, of whom 217 and 260 were treated with AS and surgery/ablation, respectively. Similar ESAS-r and PDSS scores were shown at all predefined disease time points except following an SRM biopsy and at last, follow-up, where AS-treated patients with a biopsy-proven malignancy had significantly worse PDSS (11.4 vs. 6.1, P = 0.035), and (13.2 vs. 5.4, P = 0.004), respectively. At last follow-up, multivariable linear models demonstrated that a biopsy-proven malignancy (B = 2.630, 95% CI 0.024-5.236, P = 0.048) and AS strategy (B = 6.499, 95% CI 2.340-10.658, P = 0.002) were associated with worse PDSS in all patients, and in those who underwent a biopsy, respectively. CONCLUSIONS Offering standardized psychological supportive care may be required for patients younger than 70 years on AS for SRM, especially for those with a biopsy-proven tumor.
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Affiliation(s)
- Hanan Goldberg
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Rami Ajaj
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jaime Omar Herrera Cáceres
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Techna Institute, University Health Network, Toronto, ON, Canada
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA; Georgia Cancer Center, Augusta, GA
| | - Christopher J D Wallis
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ardalan E Ahmad
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ricardo Leao
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anika R Petrella
- Departments of Surgery and Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R Kachura
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Neil Fleshner
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Matthew
- Departments of Surgery and Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
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22
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Wettstein MS, Naimark D, Hermanns T, Herrera-Caceres JO, Ahmad A, Jewett MAS, Kulkarni GS. Required efficacy for novel therapies in BCG-unresponsive non-muscle invasive bladder cancer: Do current recommendations really reflect clinically meaningful outcomes? Cancer Med 2020; 9:3287-3296. [PMID: 32163677 PMCID: PMC7221312 DOI: 10.1002/cam4.2980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/28/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 11/11/2022] Open
Abstract
Background Single‐arm trials are currently an accepted study design to investigate the efficacy of novel therapies (NT) in non‐muscle invasive bladder cancer (NMIBC) unresponsive to intravesical Bacillus Calmette‐Guérin (BCG) immunotherapy as randomized controlled trials are either unfeasible (comparator: early radical cystectomy; ERC), or unethical (comparator: placebo). To guide the design of such single‐arm trials, expert groups published recommendations for clinically meaningful outcomes. The aim of this study was to quantitatively verify the appropriateness of these recommendations. Methods We used a discrete event simulation framework in combination with a supercomputer to find the required efficacy at which a NT can compete with ERC when it comes to quality‐adjusted life expectancy (QALE). In total, 24 different efficacy thresholds (including the recommendations) were investigated. Results After ascertaining face validity with content experts, repeated verification, external validation, and calibration we considered our model valid. Both recommendations rarely showed an incremental benefit of the NT over ERC. In the most optimistic scenario, an increase in the IBCG recommendation by 10% and an increase in the FDA/AUA recommendation by 5% would yield results at which a NT could compete with ERC from a QALE perspective. Conclusions This simulation study demonstrated that the current recommendations regarding clinically meaningful outcomes for single‐arm trials evaluating the efficacy of NT in BCG‐unresponsive NMIBC may be too low. Based on our quantitative approach, we propose increasing these thresholds to at least 45%‐55% at 6 months and 35% at 18‐24 months (complete response rates/recurrence‐free survival) to promote the development of clinically truly meaningful NT.
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Affiliation(s)
- Marian S Wettstein
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - David Naimark
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Thomas Hermanns
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jaime O Herrera-Caceres
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ardalan Ahmad
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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23
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Nason GJ, Donahoe L, de Perrot M, Aditya I, Jewett MAS, Bedard PL, Hansen AR, Chung P, Warde P, Anson-Cartwright L, Sweet J, O'Malley M, Atenafu EG, Hamilton RJ. Simultaneous Vs Sequential Retroperitoneal, Thoracic and Cervical Resection of Post Chemotherapy Residual Masses in Patients With Metastatic Nonseminomatous Germ Cell Tumors of the Testis. Urology 2020; 138:69-76. [PMID: 32004556 DOI: 10.1016/j.urology.2019.12.032] [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: 10/25/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare a simultaneous vs sequential approach to residual post chemotherapy mass resections in metastatic testis cancer. METHODS A retrospective review was performed of patients who underwent retroperitoneal and thoracic/cervical resection of post chemotherapy residual masses between 2002 and 2018. Group 1: "Simultaneous" (Combined Retroperitoneal and Thoracic/Cervical resections on the same date); Group 2: "Sequential" (Retroperitoneal and Thoracic/Cervical resections at separate dates). RESULTS During the study period, 35 simultaneous and 17 sequential resections were performed. The median age at surgery was 28 years (Range 16-61). The median follow-up from last surgical procedure was 62.7 months (Range 0.4-194). Histology revealed teratoma in 38 (73.1%) patients, necrosis in 8 (15.4%) and viable tumor in 6 (11.5%). Discordant pathology findings between thoracic/cervical and abdominal resections were noted in 16 (30.8%) patients. No differences were observed between the simultaneous vs sequential groups in median operating time (585 minutes vs 545 minutes, P = .64), blood loss (1300 vs 1300 mls, P = .42), or length of stay (9 vs 11 days, P = .14). There was no difference between the 5-year (65.7% vs 68.6%) relapse-free survival between the 2 groups (P = .84) or the 5-year (88.6% vs 100%) overall and disease-specific survival (P = .25). CONCLUSION Simultaneous resection of retroperitoneal and thoracic/cervical post chemotherapy metastases is a feasible in some patients. It requires multidisciplinary collaboration and a longer primary procedure.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Ishan Aditya
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philip L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martin O'Malley
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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24
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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25
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Lewin J, Dufort P, Halankar J, O'Malley M, Jewett MAS, Hamilton RJ, Gupta A, Lorenzo A, Traubici J, Nayan M, Leão R, Warde P, Chung P, Anson Cartwright L, Sweet J, Hansen AR, Metser U, Bedard PL. Applying Radiomics to Predict Pathology of Postchemotherapy Retroperitoneal Nodal Masses in Germ Cell Tumors. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652572 PMCID: PMC6874033 DOI: 10.1200/cci.18.00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose After chemotherapy, approximately 50% of patients with metastatic testicular germ cell tumors (GCTs) who undergo retroperitoneal lymph node dissections (RPNLDs) for residual masses have fibrosis. Radiomics uses image processing techniques to extract quantitative textures/features from regions of interest (ROIs) to train a classifier that predicts outcomes. We hypothesized that radiomics would identify patients with a high likelihood of fibrosis who may avoid RPLND. Patients and Methods Patients with GCT who had an RPLND for nodal masses > 1 cm after first-line platinum chemotherapy were included. Preoperative contrast-enhanced axial computed tomography images of retroperitoneal ROIs were manually contoured. Radiomics features (n = 153) were used to train a radial basis function support vector machine classifier to discriminate between viable GCT/mature teratoma versus fibrosis. A nested 10-fold cross-validation protocol was used to determine classifier accuracy. Clinical variables/restricted size criteria were used to optimize the classifier. Results Seventy-seven patients with 102 ROIs were analyzed (GCT, 21; teratoma, 41; fibrosis, 40). The discriminative accuracy of radiomics to identify GCT/teratoma versus fibrosis was 72 ± 2.2% (area under the curve [AUC], 0.74 ± 0.028); sensitivity was 56.2 ± 15.0%, and specificity was 81.9 ± 9.0% (P = .001). No major predictive differences were identified when data were restricted by varying maximal axial diameters (AUC range, 0.58 ± 0.05 to 0.74 ± 0.03). The prediction algorithm using clinical variables alone identified an AUC of 0.76. When these variables were added to the radiomics signature, the best performing classifier was identified when axial masses were limited to diameter < 2 cm (accuracy, 88.2 ± 4.4; AUC, 0.80 ± 0.05; P = .02). Conclusion A predictive radiomics algorithm had a discriminative accuracy of 72% that improved to 88% when combined with clinical predictors. Additional independent validation is required to assess whether radiomics allows patients with a high predicted likelihood of fibrosis to avoid RPLND.
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Affiliation(s)
- Jeremy Lewin
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Dufort
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jaydeep Halankar
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin O'Malley
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abha Gupta
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Armando Lorenzo
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey Traubici
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Madhur Nayan
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ricardo Leão
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Padraig Warde
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Chung
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lynn Anson Cartwright
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joan Sweet
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ur Metser
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philippe L Bedard
- Jeremy Lewin, Padraig Warde, Peter Chung, Lynn Anson Cartwright, Joan Sweet, Aaron R. Hansen, and Philippe L. Bedard, Princess Margaret Cancer Centre; Michael A.S. Jewett, Robert J. Hamilton, Madhur Nayan, Ricardo Leão, Aaron R. Hansen, and Philippe L. Bedard, University of Toronto; Paul Dufort, Jaydeep Halankar, Martin O'Malley, and Ur Metser, University Health Network; and Abha Gupta, Armando Lorenzo, and Jeffrey Traubici, Hospital for Sick Children, Toronto, Ontario, Canada
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McAlpine K, Breau RH, Stacey D, Knee C, Jewett MAS, Cagiannos I, Morash C, Lavallée LT. Development and acceptability testing of a patient decision aid for individuals with localized renal masses considering surgical removal with partial or radical nephrectomy. Urol Oncol 2019; 37:811.e1-811.e7. [PMID: 31540831 DOI: 10.1016/j.urolonc.2019.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/08/2019] [Accepted: 08/19/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Patient decision aids are structured clinical tools that facilitate shared decision-making. In urology, the decision between partial and radical nephrectomy for a renal mass can be difficult. We sought to develop and evaluate a decision aid for patients with a localized renal mass considering surgery. This paper describes the development process and acceptability testing of our patient decision aid. MATERIAL AND METHODS A decision aid was systematically created using the International Patient Decision Aids Standards. Review of the literature identified evidence regarding patient-important outcomes of partial and radical nephrectomy. A mixed methods survey was designed to assess acceptability of the decision aid. Kidney cancer survivors, patient advocates, methodological experts, and urologists were recruited to evaluate the decision aid. The primary outcome was the acceptability of the decision aid reported by survey responders. RESULTS An evidence-based decision aid was created. Included benefits were overall survival, cancer-free survival, and length of hospital stay. Included harms were postoperative bleeding, urine leak, stage 3 renal failure, renal replacement therapy, and flank bulge. The decision aid met the International Patient Decision Aids Standards defining (6 of 6), certification (6 of 6), and quality criteria (21 of 23). Results of acceptability testing were highly favorable. Responders (n = 22) reported the decision aid had acceptable language (91%), an appropriate length (82%), and presented balanced options (91%). Nine of 11 urologists (82%) reported intended use with future patients. CONCLUSIONS A novel, evidence-based decision aid was created for patients with renal masses considering surgery. The decision aid is available at https://decisionaid.ohri.ca/AZsumm.php?ID=1913. A separate decision aid addressing the management of small renal masses is currently under development.
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Affiliation(s)
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Knee
- Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
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Correa AF, Jegede O, Haas NB, Flaherty KT, Pins MR, Messing EM, Manola J, Wood CG, Kane CJ, Jewett MAS, Dutcher JP, DiPaola RS, Carducci MA, Uzzo RG. Predicting Renal Cancer Recurrence: Defining Limitations of Existing Prognostic Models With Prospective Trial-Based Validation. J Clin Oncol 2019; 37:2062-2071. [PMID: 31216227 DOI: 10.1200/jco.19.00107] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To validate currently used recurrence prediction models for renal cell carcinoma (RCC) by using prospective data from the ASSURE (ECOG-ACRIN E2805; Adjuvant Sorafenib or Sunitinib for Unfavorable Renal Carcinoma) adjuvant trial. PATIENTS AND METHODS Eight RCC recurrence models (University of California at Los Angeles Integrated Staging System [UISS]; Stage, Size, Grade, and Necrosis [SSIGN]; Leibovich; Kattan; Memorial Sloan Kettering Cancer Center [MSKCC]; Yaycioglu; Karakiewicz; and Cindolo) were selected on the basis of their use in clinical practice and clinical trial designs. These models along with the TNM staging system were validated using 1,647 patients with resected localized high-grade or locally advanced disease (≥ pT1b grade 3 and 4/pTanyN1Mo) from the ASSURE cohort. The predictive performance of the model was quantified by assessing its discriminatory and calibration abilities. RESULTS Prospective validation of predictive and prognostic models for localized RCC showed a substantial decrease in each of the predictive abilities of the model compared with their original and externally validated discriminatory estimates. Among the models, the SSIGN score performed best (0.688; 95% CI, 0.686 to 0.689), and the UISS model performed worst (0.556; 95% CI, 0.555 to 0.557). Compared with the 2002 TNM staging system (C-index, 0.60), most models only marginally outperformed standard staging. Importantly, all models, including TNM, demonstrated statistically significant variability in their predictive ability over time and were most useful within the first 2 years after diagnosis. CONCLUSION In RCC, as in many other solid malignancies, clinicians rely on retrospective prediction tools to guide patient care and clinical trial selection and largely overestimate their predictive abilities. We used prospective collected adjuvant trial data to validate existing RCC prediction models and demonstrate a sharp decrease in the predictive ability of all models compared with their previous retrospective validations. Accordingly, we recommend prospective validation of any predictive model before implementing it into clinical practice and clinical trial design.
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Hamilton RJ, Jewett MAS, Warde P, Hansen A. Optimal Management of High-risk Stage I Nonseminomatous Germ Cell Tumor: Surveillance is the Preferred Option. Eur Urol Focus 2019; 5:702-703. [PMID: 31129064 DOI: 10.1016/j.euf.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/03/2019] [Indexed: 11/25/2022]
Abstract
At Princess Margaret, we recommend active surveillance for all patients with clinical stage I nonseminomatous germ cell tumor. Here we refute common arguments against surveillance and urge clinicians to engage in a shared decision-making process that goes beyond merely citing relapse rates for the different options.
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Affiliation(s)
- Robert J Hamilton
- Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and The University of Toronto, Toronto, Canada.
| | - Michael A S Jewett
- Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and The University of Toronto, Toronto, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Aaron Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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Goldberg H, Wong LM, Dickson B, Catton C, Yap SA, Alkasab T, Evans A, van der Kwast T, Jewett MAS, Hamilton RJ. Long-term oncological outcomes of patients with paratesticular sarcoma. BJU Int 2019; 124:801-810. [DOI: 10.1111/bju.14775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hanan Goldberg
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Lih-Ming Wong
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
- Department of Surgery; St. Vincent's Hospital Melbourne; University of Melbourne; Parkville Victoria Australia
| | - Brendan Dickson
- Department of Pathology and Laboratory Medicine; Mount Sinai Hospital, New York, NY, USA, and University of Toronto; Toronto ON Canada
| | - Charles Catton
- Department of Radiation Oncology; Princess Margaret Cancer Center; University Health Network; University of Toronto; Toronto ON Canada
| | - Stanley A. Yap
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
- Department of Urology; University of California Davis; Sacramento CA USA
| | - Thamir Alkasab
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Andrew Evans
- Department of Pathology; Toronto General Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Theodorus van der Kwast
- Department of Pathology; Toronto General Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Michael A. S. Jewett
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Robert J. Hamilton
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
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Hamilton RJ, Nayan M, Anson-Cartwright L, Atenafu EG, Bedard PL, Hansen A, Chung P, Warde P, Sweet J, O'Malley M, Sturgeon J, Jewett MAS. Treatment of Relapse of Clinical Stage I Nonseminomatous Germ Cell Tumors on Surveillance. J Clin Oncol 2019; 37:1919-1926. [PMID: 30802156 DOI: 10.1200/jco.18.01250] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Active surveillance (AS) for testicular nonseminomatous germ cell tumors (NSGCT) is widely used. Although there is no consensus for optimal treatment at relapse on surveillance, globally patients typically receive chemotherapy. We describe treatment of relapses in our non-risk-adapted NSGCT AS cohort and highlight selective use of primary retroperitoneal lymph node dissection (RPLND). METHODS From December 1980 to December 2015, 580 patients with clinical stage I NSGCT were treated with AS, and 162 subsequently relapsed. First-line treatment was based on relapse site and extent. Logistic regression was used to explore factors associated with need for multimodal therapy on AS relapse. RESULTS Median time to relapse was 7.4 months. The majority of relapses were confined to the retroperitoneum (66%). After relapse, first-line treatment was chemotherapy for 95 (58.6%) and RPLND for 62 (38.3%), and five patients (3.1%) underwent other therapy. In 103 (65.6%), only one modality of treatment was required: chemotherapy only in 58 of 95 (61%) and RPLND only in 45 of 62 (73%). Factors associated with multimodal relapse therapy were larger node size (odds ratio, 2.68; P = .045) in patients undergoing chemotherapy and elevated tumor markers (odds ratio, 6.05; P = .008) in patients undergoing RPLND. When RPLND was performed with normal markers, 82% required no further treatment. Second relapse occurred in 30 of 162 patients (18.5%). With median follow-up of 7.6 years, there were five deaths (3.1% of AS relapses, but 0.8% of whole AS cohort) from NSGCT or treatment complications. CONCLUSION The retroperitoneum is the most common site of relapse in clinical stage I NSGCT on AS. Most are cured by single-modality treatment. RPLND should be considered for relapsed patients, especially those with disease limited to the retroperitoneum and normal markers, as an option to avoid chemotherapy.
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Affiliation(s)
- Robert J Hamilton
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,2The University of Toronto, Toronto, Ontario, Canada
| | - Madhur Nayan
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,2The University of Toronto, Toronto, Ontario, Canada
| | - Lynn Anson-Cartwright
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,2The University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Philippe L Bedard
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Aaron Hansen
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter Chung
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Padraig Warde
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joan Sweet
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Martin O'Malley
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeremy Sturgeon
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael A S Jewett
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,2The University of Toronto, Toronto, Ontario, Canada
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Prendeville S, Richard PO, Jewett MAS, Kachura JR, Sweet JM, van der Kwast TH, Cheung CC, Finelli A, Evans AJ. Accuracy of renal tumour biopsy for the diagnosis and subtyping of papillary renal cell carcinoma: analysis of paired biopsy and nephrectomy specimens with focus on discordant cases. J Clin Pathol 2019; 72:363-367. [DOI: 10.1136/jclinpath-2018-205655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 01/20/2023]
Abstract
AimsRenal tumour biopsy (RTB) is increasingly recognised as a useful diagnostic tool in the management of small renal masses, particularly those that are incidentally found. Intratumoural heterogeneity with respect to morphology, grade and molecular features represents a frequently identified limitation to the use of RTB. While previous studies have evaluated pathological correlation between RTB and nephrectomy, no studies to date have focused specifically on the role of RTB for the diagnosis of papillary renal cell carcinoma (PRCC) and its further subclassification into clinically relevant subtypes.MethodsThis single-institution study evaluated 60 cases of PRCC for concordance between RTB and nephrectomy with respect to diagnosis, grading and subtyping (type 1/type 2).ResultsWe observed 93% concordance (55 of 59 evaluable cases) between RTB and nephrectomy for the diagnosis of PRCC, although seven tumours (12%) were undergraded on RTB. Subtyping of PRCC on RTB was concordant with nephrectomy in 89% of cases reported as type 1 PRCC on RTB (31/35), but only 40% of cases reported as type 2 PRCC on RTB (4/10). Morphological misclassification of PRCC on RTB was most likely to occur in tumours showing a solid growth pattern. Discordant PRCC subtyping most often occurred in tumours with eosinophilia/oncocytic change.ConclusionThere was good concordance between RTB and nephrectomy for the primary diagnosis of PRCC. Although further subtyping of PRCC can aid therapeutic stratification, this can be challenging on RTB and tumours with overlapping or ambiguous features are best reported as PRCC not otherwise specified pending development of more robust methods to facilitate definitive subclassification.
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Lavallée LT, Fitzpatrick R, Wood LA, Basiuk J, Knee C, Cnossen S, Mallick R, Witiuk K, Vanhuyse M, Tanguay S, Finelli A, Jewett MAS, Basappa N, Lattouf JB, Gotto GT, Al-Asaaed S, Bjarnason GA, Moore R, North S, Canil C, Pouliot F, Soulières D, Castonguay V, Kassouf W, Cagiannos I, Morash C, Breau RH. Development and Implementation of a Continuing Medical Education Program in Canada: Knowledge Translation for Renal Cell Carcinoma (KT4RCC). J Cancer Educ 2019; 34:14-18. [PMID: 28779441 DOI: 10.1007/s13187-017-1259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An in-person multidisciplinary continuing medical education (CME) program was designed to address previously identified knowledge gaps regarding quality indicators of care in kidney cancer. The objective of this study was to develop a CME program and determine if the program was effective for improving participant knowledge. CME programs for clinicians were delivered by local experts (uro-oncologist and medical oncologist) in four Canadian cities. Participants completed knowledge assessment tests pre-CME, immediately post-CME, and 3-month post-CME. Test questions were related to topics covered in the CME program including prognostic factors for advanced disease, surgery for advanced disease, indications for hereditary screening, systemic therapy, and management of small renal masses. Fifty-two participants attended the CME program and completed the pre- and immediate post-CME tests. Participants attended in Ottawa (14; 27%), Toronto (13; 25%), Québec City (18; 35%), and Montréal (7; 13%) and were staff urologists (21; 40%), staff medical oncologists (9; 17%), fellows (5; 10%), residents (16; 31%), and oncology nurses (1; 2%). The mean pre-CME test score was 61% and the mean post-CME test score was 70% (p = 0.003). Twenty-one participants (40%) completed the 3-month post-CME test. Of those that completed the post-test, scores remained 10% higher than the pre-test (p value 0.01). Variability in test scores was observed across sites and between French and English test versions. Urologists had the largest specialty-specific increase in knowledge at 13.8% (SD 24.2, p value 0.02). The kidney cancer CME program was moderately effective in improving provider knowledge regarding quality indicators of kidney cancer care. These findings support continued use of this CME program at other sites.
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Affiliation(s)
- Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Ryan Fitzpatrick
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Lori A Wood
- QEII Health Sciences Centre, Halifax, Canada
- Dalhousie University, Halifax, Canada
| | | | | | | | | | | | | | | | - Antonio Finelli
- University Health Network, Toronto, Canada
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Naveen Basappa
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Jean-Baptiste Lattouf
- Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Université de Montréal, Montreal, Canada
| | | | | | | | - Ronald Moore
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Scott North
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Christina Canil
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | | | - Denis Soulières
- Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- University of Ottawa, Ottawa, Canada.
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Goldberg H, Klaassen Z, Chandrasekar T, Fleshner N, Hamilton RJ, Jewett MAS. Germ Cell Testicular Tumors-Contemporary Diagnosis, Staging and Management of Localized and Advanced disease. Urology 2018; 125:8-19. [PMID: 30597167 DOI: 10.1016/j.urology.2018.12.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 01/15/2023]
Abstract
Germ cell testicular tumors are the most commonly diagnosed cancer in young men, with cure rates exceeding 95%. Clinical stage 1 disease is the most common manifestation, with radical orchiectomy curing the majority of Clinical stage 1 patients, making active surveillance the treatment of choice, with a cancer specific survival nearing 100% and low relapse rates. However, in metastatic disease, chemotherapy, radiotherapy, and surgery are curative options. Chemotherapy remains the mainstay of therapy for advanced disease with surgical management of residual disease. Patients with advanced disease should be treated in high volume experienced academic centers with multidisciplinary teams. Research exploring refinement of diagnosis and treatment, and lowering treatment burden is underway.
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Affiliation(s)
- Hanan Goldberg
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada.
| | - Zachary Klaassen
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Thenappan Chandrasekar
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Neil Fleshner
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Robert J Hamilton
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
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Chung P, O'Malley ME, Jewett MAS, Bedard PL, Panzarella T, Sturgeon J, Moore MJ, Hamilton R, Hansen AR, Anson-Cartwright L, Gospodarowicz M, Warde P. Detection of Relapse by Low-dose Computed Tomography During Surveillance in Stage I Testicular Germ Cell Tumours. Eur Urol Oncol 2018; 2:437-442. [PMID: 31277780 DOI: 10.1016/j.euo.2018.08.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/31/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Standard-dose computed tomography (SDCT) scans are associated with radiation exposure during stage I testicular cancer surveillance. OBJECTIVE To evaluate low-dose CT (LDCT) for clinical use. DESIGN, SETTING, AND PARTICIPANTS In this single-arm prospective study, patients on surveillance for stage I testicular germ cell tumour underwent SDCT and LDCT scans on their first visit after enrolment. The adequacy of LDCT image quality was assessed for subsequent use. Patients were followed with LDCT only and suspected relapse was confirmed by SDCT. OUTCOME MEASURES AND STATISTICAL ANALYSIS We assessed whether initial LDCT scans were of sufficient quality for routine clinical use. We compared mean differences in nodal size at relapse between LDCT and SDCT using a one-sample paired t test. The relapse free-rate was calculated using the Kaplan-Meier method. RESULTS AND LIMITATIONS Of 257 patients, one was excluded because of inadequate image quality. At median follow-up of 5.25 yr, 35 patients had relapsed, 33 with retroperitoneal lymphadenopathy. The 2- and 5-yr relapse-free rates were 89.5% and 85.3%, respectively. The mean size of retroperitoneal nodal relapse was 17.3 and 17.5mm on the short axis, 23.2 and 22.7mm on the long axis, and 26.1 and 26.7mm on craniocaudal length for LDCT and SDCT, respectively. The mean difference between LDCT and SDCT was 0.14mm (p=0.55) short axis, -0.54mm (p=0.092) long axis, and -0.51mm (p=0.086) length. A limitation was the lack of a control arm. CONCLUSIONS LDCT image quality was adequate for clinical use, and retroperitoneal nodal relapse was detected with minimal differences seen between LD and SDCT. LDCT can be safely adopted and will decrease overall radiation exposure in stage I germ cell tumour surveillance. PATIENT SUMMARY We studied the use of low-dose computed tomography scans for detecting testicular cancer recurrence in lymph nodes of the abdomen and pelvis and found that they were safe, effective and would potentially reduce overall X-ray exposure. This trial is registered at ClinicalTrials.gov as NCT03142802.
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Affiliation(s)
- Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - Martin E O'Malley
- University of Toronto, Toronto, Canada; Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Michael A S Jewett
- University of Toronto, Toronto, Canada; Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Philippe L Bedard
- University of Toronto, Toronto, Canada; Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Tony Panzarella
- University of Toronto, Toronto, Canada; Department of Medical Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jeremy Sturgeon
- University of Toronto, Toronto, Canada; Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Malcolm J Moore
- British Columbia Cancer Agency and University of British Columbia, Vancouver, Canada
| | - Robert Hamilton
- University of Toronto, Toronto, Canada; Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Aaron R Hansen
- University of Toronto, Toronto, Canada; Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Lynn Anson-Cartwright
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Mary Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada
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Organ M, MacDonald LP, Jewett MAS, Ajzenberg H, Almatar A, Abdolell M, Acker MR, Rendon R. Classification tree for the prediction of malignant disease and the prediction of non-diagnostic biopsies in patients with small renal masses. Can Urol Assoc J 2018; 13:115-119. [PMID: 30059288 DOI: 10.5489/cuaj.5196] [Citation(s) in RCA: 3] [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] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Preoperative prediction of benign vs. malignant small renal masses (SRMs) remains a challenge. This study: 1) validates our previously published classification tree (CT) with an external cohort; 2) creates a new CT with the combined cohort; and 3) evaluates the RENAL and PADUA scoring systems for prediction of malignancy. METHODS This study includes a total of 818 patients with renal masses; 395 underwent surgical resection and 423 underwent biopsy. A CT to predict benign disease was developed using patient and tumour characteristics from the 709 eligible participants. Our CT is based on four parameters: tumour volume, symptoms, gender, and symptomatology. CART modelling was also used to determine if RENAL and PADUA scoring could predict malignancy. RESULTS When externally validated with the surgical cohort, the predictive accuracy of the old CT dropped. However, by combining the cohorts and creating a new CT, the predictive accuracy increased from 74% to 87% (95% confidence interval 0.84-0.89). RENAL and PADUA score alone were not predictive of malignancy. One limitation was the lack of available histological data from the biopsy series. CONCLUSIONS The validated old CT and new combined-cohort CT have a predictive value greater than currently published nomograms and single-biopsy cohorts. Overall, RENAL and PADUA scores were not able to predict malignancy.
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Affiliation(s)
- Michael Organ
- Department of Urology, Memorial University, St. John's, NL, Canada
| | | | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Henry Ajzenberg
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Ashraf Almatar
- Department of Urology, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Mohamed Abdolell
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Matthew R Acker
- Department of Urology, Dalhousie University, Saint John, NB, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Herrera-Caceres JO, Finelli A, Jewett MAS. Renal tumor biopsy: indicators, technique, safety, accuracy results, and impact on treatment decision management. World J Urol 2018; 37:437-443. [DOI: 10.1007/s00345-018-2373-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/08/2018] [Indexed: 12/11/2022] Open
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Mir MC, Capitanio U, Bertolo R, Ouzaid I, Salagierski M, Kriegmair M, Volpe A, Jewett MAS, Kutikov A, Pierorazio PM. Role of Active Surveillance for Localized Small Renal Masses. Eur Urol Oncol 2018; 1:177-187. [PMID: 31102618 DOI: 10.1016/j.euo.2018.05.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 11/29/2022]
Abstract
CONTEXT Stage migration of organ-confined renal masses is occurring as a result of incidental diagnosis, especially in the elderly. Active surveillance (AS) is gaining clinical traction as a treatment alternative to surgery and focal therapy. OBJECTIVE To assess contemporary data and evaluate AS risk trade-offs in the treatment of organ-confined kidney cancer. EVIDENCE ACQUISITION A comprehensive search of the Embase, Medline and Cochrane databases was carried out. A systematic review of the role of AS for organ-confined renal masses was performed. A total of 28 studies were included in the systematic review. EVIDENCE SYNTHESIS The median linear tumor growth rate for clinically localized renal masses (CLRMs) was 0.37cm/yr (interquartile range 0.15-0.7), with 0.22cm/yr in the cT1a subgroup and 0.45cm/yr in the cT1b--2 subgroup. The metastatic progression rate was 1-6% and was similar for cT1a (1-6%) and cT1b (0-5%); other-cause mortality for patients with CLRMs was 0-45% (1-25% for cT1a vs 11-13% for cT1b-2); cancer-specific mortality ranged between 0% and 18%. According to the 2011 Oxford scale, AS as a treatment option for CLRMs remains supported by level 3 evidence. CONCLUSIONS Although no randomized clinical data are available, current data support oncologic safety for AS in the management of CLRMs, particularly for small renal masses and among elderly and/or comorbid patients. PATIENT SUMMARY In this review we looked at the outcomes for patients with small kidney masses managed with surveillance. We found that surveillance is a safe initial option for tumors of less than 2cm, especially in elderly and sick patients.
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Affiliation(s)
- Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano de Oncologia, Valencia, Spain.
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Bertolo
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Turin, Italy
| | - Idir Ouzaid
- Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France
| | | | | | - Alessandro Volpe
- Department of Urology, University of Novara, Maggiore della Carità Hospital, Novara, Italy
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Temple Health System, Philadelphia, PA, USA
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Nayan M, Jewett MAS, Finelli A. Uncoupling Diagnosis and Treatment of Incidentally Imaged Renal Masses. JAMA Intern Med 2018; 178:727-728. [PMID: 29801131 DOI: 10.1001/jamainternmed.2018.1180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Madhur Nayan
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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van de Putte EEF, Bosschieter J, van der Kwast TH, Bertz S, Denzinger S, Manach Q, Compérat EM, Boormans JL, Jewett MAS, Stoehr R, van Leenders GJLH, Nieuwenhuijzen JA, Zlotta AR, Hendricksen K, Rouprêt M, Otto W, Burger M, Hartmann A, van Rhijn BWG. The World Health Organization 1973 classification system for grade is an important prognosticator in T1 non-muscle-invasive bladder cancer. BJU Int 2018; 122:978-985. [PMID: 29637669 DOI: 10.1111/bju.14238] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the prognostic value of the World Health Organization (WHO) 1973 and 2004 classification systems for grade in T1 bladder cancer (T1-BC), as both are currently recommended in international guidelines. PATIENTS AND METHODS Three uro-pathologists re-revised slides of 601 primary (first diagnosis) T1-BCs, initially managed conservatively (bacille Calmette-Guérin) in four hospitals. Grade was defined according to WHO1973 (Grade 1-3) and WHO2004 (low-grade [LG] and high-grade [HG]). This resulted in a lack of Grade 1 tumours, 188 (31%) Grade 2, and 413 (69%) Grade 3 tumours. There were 47 LG (8%) vs 554 (92%) HG tumours. We determined the prognostic value for progression-free survival (PFS) and cancer-specific survival (CSS) in Cox-regression models and corrected for age, sex, multiplicity, size and concomitant carcinoma in situ. RESULTS At a median follow-up of 5.9 years, 148 patients showed progression and 94 died from BC. The WHO1973 Grade 3 was negatively associated with PFS (hazard ratio [HR] 2.1) and CSS (HR 3.4), whilst WHO2004 grade was not prognostic. On multivariable analysis, WHO1973 grade was the only prognostic factor for progression (HR 2.0). Grade 3 tumours (HR 3.0), older age (HR 1.03) and tumour size >3 cm (HR 1.8) were all independently associated with worse CSS. CONCLUSION The WHO1973 classification system for grade has strong prognostic value in T1-BC, compared to the WHO2004 system. Our present results suggest that WHO1973 grade cannot be replaced by the WHO2004 classification in non-muscle-invasive BC guidelines.
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Affiliation(s)
- Elisabeth E Fransen van de Putte
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Judith Bosschieter
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Theo H van der Kwast
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands.,Department of Pathology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Simone Bertz
- Department of Pathology, University of Erlangen, Erlangen, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Quentin Manach
- Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris, Paris, France
| | - Eva M Compérat
- Department of Pathology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris, Paris, France
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Michael A S Jewett
- Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Robert Stoehr
- Department of Pathology, University of Erlangen, Erlangen, Germany
| | | | | | - Alexandre R Zlotta
- Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.,Department of Urology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Kees Hendricksen
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris, Paris, France
| | - Wolfgang Otto
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Department of Pathology, University of Erlangen, Erlangen, Germany
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands.,Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.,Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
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Richard PO, Martin L, Lavallée LT, Violette PD, Komisarenko M, Evans AJ, Jain K, Jewett MAS, Finelli A. Identifying the use and barriers to the adoption of renal tumour biopsy in the management of small renal masses. Can Urol Assoc J 2018; 12:260-266. [PMID: 29629862 DOI: 10.5489/cuaj.5065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Renal tumour biopsies (RTBs) can provide the histology of small renal masses (SRMs) prior to treatment decision-making. However, many urologists are reluctant to use RTB as a standard of care. This study characterizes the current use of RTB in the management of SRMs and identifies barriers to a more widespread adoption. METHODS A web-based survey was sent to members of the Canadian and Quebec Urological Associations who had registered email address (n=767) in June 2016. The survey examined physicians' practice patterns, RTB use, and potential barriers to RTB. Chi-squared tests were used to assess for differences between respondents. RESULTS The response rate was 29% (n=223), of which 188 respondents were eligible. A minority of respondents (12%) perform RTB in >75% of cases, while 53% never perform or perform RTB in <25% of cases. Respondents with urological oncology fellowship training were more likely to request a biopsy than their colleagues without such training. The most frequent management-related reason for not using routine RTB was a belief that biopsy won't alter management, while the most frequent pathology-related reason was the risk of obtaining a false-negative or a non-diagnostic biopsy. CONCLUSIONS Adoption of RTBs remains low in Canada. Concerns about the accuracy of RTB and its ability to change clinical practice are the largest barriers to adoption. A knowledge translation strategy is needed to address these concerns. Future studies are also required in order to define where RTB is most valuable and how to best to implement it.
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Affiliation(s)
- Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de Recherche du CHUS and the University of Sherbrooke, Sherbrooke, QC, Canada
| | - Lisa Martin
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - Philippe D Violette
- Division of Urology, Department of Surgery, Woodstock General Hospital and Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Maria Komisarenko
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Andrew J Evans
- Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Kunal Jain
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
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Leão R, van Agthoven T, Figueiredo A, Jewett MAS, Fadaak K, Sweet J, Ahmad AE, Anson-Cartwright L, Chung P, Hansen A, Warde P, Castelo-Branco P, O'Malley M, Bedard PL, Looijenga LHJ, Hamilton RJ. Serum miRNA Predicts Viable Disease after Chemotherapy in Patients with Testicular Nonseminoma Germ Cell Tumor. J Urol 2018; 200:126-135. [PMID: 29474847 DOI: 10.1016/j.juro.2018.02.068] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Retroperitoneal lymph node dissection is recommended for residual masses greater than 1 cm after chemotherapy of nonseminomatous germ cell tumors. Currently there is no reliable predictor of post-chemotherapy retroperitoneal lymph node dissection histology. Up to 50% of patients harbor necrosis/fibrosis only so that a potentially morbid surgery has limited therapeutic value. In this study we evaluated the ability of defined serum miRNAs to predict residual viable nonseminomatous germ cell tumors after chemotherapy. MATERIALS AND METHODS Levels of serum miRNA, including miR-371a-3p, miR-373-3p and miR-367-3p, were measured using the ampTSmiR (amplification targeted serum miRNA) test in 82 patients, including 39 in cohort 1 and 43 in cohort 2, who were treated with orchiectomy, chemotherapy and post-chemotherapy retroperitoneal lymph node dissection. miRNA levels were compared to clinical characteristics and serum tumor markers, and correlated with the presence of viable germ cell tumor vs fibrosis/necrosis and teratoma. ROC analysis was done to determine miRNA discriminative capacity. RESULTS miRNA levels were significantly associated with disease extent at chemotherapy and they decreased significantly after chemotherapy. Conventional serum tumor marker levels were uninformative after chemotherapy. However, after chemotherapy miRNA levels remained elevated in patients harboring viable germ cell tumor in post-chemotherapy retroperitoneal lymph node dissection specimens. miR-371a-3p demonstrated the highest discriminative capacity for viable germ cell tumors (AUC 0.874, 95% CI 0.774-0.974, p <0.0001). Using an adapted hypothetical cutoff of 3 cm or less for surgical intervention miR-371a-3p correctly stratified all patients with viable residual retroperitoneal germ cell tumors with 100% sensitivity (p = 0.02). CONCLUSIONS Our study demonstrates for the first time the potential value of miR-371a-3p to predict viable germ cell tumors in residual masses after chemotherapy. Prospective studies are required to confirm clinical usefulness.
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Affiliation(s)
- Ricardo Leão
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ton van Agthoven
- Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kamel Fadaak
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joan Sweet
- Department of Pathology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ardalan E Ahmad
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lynn Anson-Cartwright
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Aaron Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Martin O'Malley
- Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Philippe L Bedard
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leendert H J Looijenga
- Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Robert J Hamilton
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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Leão R, Nayan M, Punjani N, Jewett MAS, Fadaak K, Garisto J, Lewin J, Atenafu EG, Sweet J, Anson-Cartwright L, Boström P, Chung P, Warde P, Bedard PL, Bagrodia A, Freifeld Y, Power N, Winquist E, Hamilton RJ. A New Model to Predict Benign Histology in Residual Retroperitoneal Masses After Chemotherapy in Nonseminoma. Eur Urol Focus 2018; 4:995-1001. [PMID: 29428550 DOI: 10.1016/j.euf.2018.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/17/2018] [Accepted: 01/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Postchemotherapy retroperitoneal lymph node dissection (pcRPLND) is indicated in testicular cancer patients with normalised or plateaued serum tumour markers and residual retroperitoneal lesions >1cm. Challenges remain in predicting postchemotherapy residual mass (pcRM) histology, which may lead to unnecessary surgery. OBJECTIVE To develop an accurate model to predict pcRM histology in patients with nonseminomatous germ cell tumours (NSGCTs). DESIGN, SETTING, AND PARTICIPANTS A retrospective review of 335 patients undergoing pcRPLND for metastatic NSGCTs to develop a model to predict benign histology in retroperitoneal pcRM. Our model was compared with others and externally validated. INTERVENTION Chemotherapy and pcRPLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic regression to evaluate the presence of benign histology, and fractional polynomials to allow for a nonlinear association between continuous variables and the outcome. The final Princess Margaret model (PMM) was selected based on the number of variables used, reliability, and discriminative capacity to predict benign pcRM. RESULTS AND LIMITATIONS PMM included the presence of teratoma in the orchiectomy, prechemotherapy α-fetoprotein, prechemotherapy mass size, and change in mass size during chemotherapy. Model specificity was 99.3%. Compared with Vergouwe et al's model, PMM had significantly better accuracy (C statistic 0.843 vs 0.783). PMM appropriately identified a larger number of patients for whom pcRPLND can safely be avoided (13.9% vs 0%). Validated in external cohorts, the model retained high discrimination (C statistic 0.88 and 0.80). Larger and prospective studies are needed to further validate this model. CONCLUSIONS Our clinical model, externally validated, showed improved discriminative ability in predicting pcRM histology when compared with other models. The higher accuracy and reduced number of variables make this a novel and appealing model to use for patient counselling and treatment strategies. PATIENT SUMMARY Princess Margaret model accurately predicted postchemotherapy benign histology. These results might have clinical impact by avoiding unnecessary retroperitoneal lymph node dissection and consequently changing the paradigm of advanced testicular cancer treatment.
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Affiliation(s)
- Ricardo Leão
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Madhur Nayan
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nahid Punjani
- Division of Urology, Western University and London Health Sciences Centre, London, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kamel Fadaak
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Juan Garisto
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jeremy Lewin
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aditya Bagrodia
- Division of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yuval Freifeld
- Division of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nicholas Power
- Division of Medical Oncology, Western University and London Health Sciences Centre, London, ON, Canada
| | - Eric Winquist
- Division of Urology, Western University and London Health Sciences Centre, London, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Lieng H, Warde P, Bedard P, Hamilton RJ, Hansen AR, Jewett MAS, O'malley M, Sweet J, Chung P. Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach. Can Urol Assoc J 2017; 12:59-66. [PMID: 29381453 DOI: 10.5489/cuaj.4531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Testicular seminoma most commonly affects young men and is associated with favourable prognosis. Various followup schedules and imaging protocols for testicular seminoma have been described without overall consensus. We reviewed the literature together with our experience at the Princess Margaret Cancer Centre and present an evidence-based followup approach for patients with stage I and II seminoma.
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Affiliation(s)
- Hester Lieng
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
| | - Philippe Bedard
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network and Department of Medicine, University of Toronto; Toronto, ON, Canada
| | - Robert J Hamilton
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network and Department of Medicine, University of Toronto; Toronto, ON, Canada
| | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Martin O'malley
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University of Toronto; Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
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Jones J, Bhatt J, Avery J, Laupacis A, Cowan K, Basappa N, Basiuk J, Canil C, Al-Asaaed S, Heng D, Wood L, Stacey D, Kollmannsberger C, Jewett MAS. The kidney cancer research priority-setting partnership: Identifying the top 10 research priorities as defined by patients, caregivers, and expert clinicians. Can Urol Assoc J 2017; 11:379-387. [PMID: 29106364 DOI: 10.5489/cuaj.4590] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It is critically important to define disease-specific research priorities to better allocate limited resources. There is growing recognition of the value of involving patients and caregivers, as well as expert clinicians in this process. To our knowledge, this has not been done this way for kidney cancer. Using the transparent and inclusive process established by the James Lind Alliance, the Kidney Cancer Research Network of Canada (KCRNC) sponsored a collaborative consensus-based priority-setting partnership (PSP) to identify research priorities in the management of kidney cancer. The final result was identification of 10 research priorities for kidney cancer, which are discussed in the context of current initiatives and gaps in knowledge. This process provided a systematic and effective way to collaboratively establish research priorities with patients, caregivers, and clinicians, and provides a valuable resource for researchers and funding agencies.
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Affiliation(s)
- Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jaimin Bhatt
- Departments of Surgery and Surgical Oncology (Division of Urology), Princess Margaret Cancer Centre, University Health Network, and the University of Toronto, Toronto, ON, Canada
| | - Jonathan Avery
- School of Rehabilitation Sciences, University of Ottawa, ON, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | | | - Naveen Basappa
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Joan Basiuk
- Kidney Cancer Research Network of Canada, University of Ottawa, Ottawa, ON, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Sohaib Al-Asaaed
- Department of Medical Oncology, Dr. H. Bliss Murphy Cancer Centre, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Daniel Heng
- Department of Medical Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary AB, Canada
| | - Lori Wood
- Division of Medical Oncology, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, School of Nursing and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christian Kollmannsberger
- Medical Oncology, University of British Columbia and Medical Oncology BC Cancer Agency, Vancouver, BC, Canada
| | - Michael A S Jewett
- Departments of Surgery and Surgical Oncology (Division of Urology), Princess Margaret Cancer Centre, University Health Network, and the University of Toronto, Toronto, ON, Canada
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45
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McGrath DM, Lee J, Foltz WD, Samavati N, van der Kwast T, Jewett MAS, Chung P, Ménard C, Brock KK. MR elastography to measure the effects of cancer and pathology fixation on prostate biomechanics, and comparison with T 1, T 2 and ADC. Phys Med Biol 2017; 62:1126-1148. [PMID: 28092638 DOI: 10.1088/1361-6560/aa52f4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
MRI is under evaluation for image-guided intervention for prostate cancer. The sensitivity and specificity of MRI parameters is determined via correlation with the gold-standard of histopathology. Whole-mount histopathology of prostatectomy specimens can be digitally registered to in vivo imaging for correlation. When biomechanical-based deformable registration is employed to account for deformation during histopathology processing, the ex vivo biomechanical properties are required. However, these properties are altered by pathology fixation, and vary with disease. Hence, this study employs magnetic resonance elastography (MRE) to measure ex vivo prostate biomechanical properties before and after fixation. A quasi-static MRE method was employed to measure high resolution maps of Young's modulus (E) before and after fixation of canine prostate and prostatectomy specimens (n = 4) from prostate cancer patients who had previously received radiation therapy. For comparison, T 1, T 2 and apparent diffusion coefficient (ADC) were measured in parallel. E (kPa) varied across clinical anatomy and for histopathology-identified tumor: peripheral zone: 99(±22), central gland: 48(±37), tumor: 85(±53), and increased consistently with fixation (factor of 11 ± 5; p < 0.02). T 2 decreased consistently with fixation, while changes in T 1 and ADC were more complex and inconsistent. The biomechanics of the clinical prostate specimens varied greatly with fixation, and to a lesser extent with disease and anatomy. The data obtained will improve the precision of prostate pathology correlation, leading to more accurate disease detection and targeting.
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Affiliation(s)
- Deirdre M McGrath
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario M5G 2M9, Canada
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46
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Reaume MN, Basappa NS, Wood L, Kapoor A, Bjarnason GA, Blais N, Breau RH, Canil C, Cheung P, Conter HJ, Hotte SJ, Jeldres C, Jewett MAS, Karakiewicz PI, Kollmannsberger C, Patenaude F, So A, Soulières D, Venner P, Violette P, Zalewski P, Chappell H, North SA. Management of advanced kidney cancer: Canadian Kidney Cancer Forum (CKCF) consensus update 2017. Can Urol Assoc J 2017; 11:310-320. [PMID: 29382441 DOI: 10.5489/cuaj.4769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M Neil Reaume
- Division of Medical Oncology, Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, ON, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - Lori Wood
- Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada.,The Kidney Cancer Research Network of Canada, Toronto, ON, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Normand Blais
- Division of Medical Oncology/Hematology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Rodney H Breau
- Clinical Epidemiology Program and Division of Urology, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, ON, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Claudio Jeldres
- Centre hospitalier de l'Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Pierre I Karakiewicz
- Service d'urologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre, and University of British Columbia, Vancouver, BC, Canada
| | - Francois Patenaude
- Department of Medicine, Hematology Service and Department of Oncology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Peter Venner
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Pawel Zalewski
- R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, ON, Canada
| | | | - Scott A North
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
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47
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Lawson KA, Saarela O, Liu Z, Lavallée LT, Breau RH, Wood L, Jewett MAS, Kapoor A, Tanguay S, Moore RB, Rendon R, Pouliot F, Black PC, Kawakami J, Drachenberg D, Finelli A. Benchmarking quality for renal cancer surgery: Canadian Kidney Cancer information system (CKCis) perspective. Can Urol Assoc J 2017; 11:232-237. [PMID: 28798821 DOI: 10.5489/cuaj.4397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION There is a lack of validated quality metrics to evaluate the care of patients receiving surgery for renal cell carcinoma (RCC). To address this, the Kidney Cancer Research Network of Canada defined a list of quality indicators (QI) to assess hospital-level performance. We have case-mix adjusted these QIs to benchmark RCC surgical care at Canadian academic centres. METHODS The Canadian Kidney Cancer information system (CKCis) was used to measure six QIs: laparoscopic approach proportion (LA), partial nephrectomy proportion (PN), partial nephrectomy in patients with chronic kidney disease (CKDPN), positive margin rate (PMR), partial nephrectomy complication rate (PNCx), and warm ischemia time (WIT). To benchmark performance, indirect standardization (observed-to-expected ratio) methodology was employed using multivariate regression models. RESULTS Multivariate models for LA, PN, and CKDPN demonstrated good discrimination and were used for benchmarking. National averages of 74% (70-78%), 73% (70-75%), and 70% (67-74%) for the LA, PN, and CKDPN QIs, respectively, were determined and used to benchmark individual hospital performance. Overall, three (23%), two (15%), and two (15%) hospitals performed below expected for LA, PN, and CKDPN, respectively. Hospital identity was an independent predictor of LA, PN, and CKDPN (p<0.001). CONCLUSIONS Significant variability between CKCis hospitals for three RCC surgical QIs exists. Using the CKCis infrastructure may provide a framework for institution-level audit feedback for quality improvement. Greater CKCis capture rates and further data supporting the construct validity of these QIs are required to extend the use of this dataset to real-world quality initiatives.
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Affiliation(s)
- Keith A Lawson
- Division of Urology, Princess Margaret Hospital, University of Toronto, Toronto, ON; Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Canada
| | - Zhihui Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON; Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON; Canada
| | - Lori Wood
- Division of Medical Oncology, Dalhousie University, Halifax, NS; Canada
| | - Michael A S Jewett
- Division of Urology, Princess Margaret Hospital, University of Toronto, Toronto, ON; Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON; Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC; Canada
| | - Ronald B Moore
- Division of Urology, University of Alberta, Edmonton, AB; Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS; Canada
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Jun Kawakami
- Division of Urology, University of Calgary, Calgary, AB; Canada
| | | | - Antonio Finelli
- Division of Urology, Princess Margaret Hospital, University of Toronto, Toronto, ON; Canada
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Bansal RK, Tanguay S, Finelli A, Rendon R, Moore RB, Breau RH, Lacombe L, Black PC, Kawakami J, Drachenberg D, Pautler S, Saarela O, Liu Z, Jewett MAS, Kapoor A. Positive surgical margins during partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer information system (CKCis) collaborative. Can Urol Assoc J 2017; 11:182-187. [PMID: 28652876 DOI: 10.5489/cuaj.4264] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to determine the incidence, risk factors, and prognosis for patients with positive surgical margin (PSM) during partial nephrectomy (PN) for renal cell carcinoma (RCC). METHODS From the Canadian Kidney Cancer information system (CKCis) database, a historical cohort of PN patients with PSM were identified and compared to negative surgical margin (NSM). Risk factors for PSM were examined through multivariable logistic regression. Kaplan-Meier curves were used to compare progression-free survival. RESULTS Of 1103 patients, 972 (88.1%), 71 (6.4%), and 60 (5.4%) had NSM, PSM, and unknown status, respectively. Median patient age and tumour size were 61 years and 3.0 cm for both groups. From multivariable analysis, pathological stage ≥T3 (odds ratio [OR] 2.51; 95% confidence interval [CI] 1.13-5.60) and Fuhrman grade 4 (OR 5.35; 95% CI 1.11-25.72) were associated with PSM, whereas age, operative technique, and tumour size were not. Forty-nine (5.0%) patients from the NSM cohort and seven (9.9%) from the PSM cohort had a local/systemic progression of disease (adjusted hazard ratio [HR] 1.4; 95% CI 0.6-3.6). There were three (0.3%) cancer-related deaths in the NSM group and none in the PSM group. After median followup of 19 (interquartile range [IQR] 5-42) and 15 (IQR 7-30) months, 855 (91.4%) and 61 (89.7%) patients were alive in the NSM and PSM groups, respectively. CONCLUSIONS PSM occurred in 6.4% of PNs performed for RCC in this pan-Canadian cohort. Higher stage and grade are associated with a higher risk of positive margin. The small association between a PSM and progression suggests that complete nephrectomy is not necessary in patients with a PSM. The main study limitations are lack of nephrometry score and possible reporting bias.
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Affiliation(s)
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Ricardo Rendon
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - Ronald B Moore
- Division of Urology, University of Alberta, Edmonton, AB
| | | | | | - Peter C Black
- Department of Urology, University of British Columbia, Vancouver, BC
| | - Jun Kawakami
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB
| | - Darrel Drachenberg
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB
| | - Stephen Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Western University, London, ON
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON; Canada
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Kulkarni GS, Hermanns T, Wei Y, Bhindi B, Satkunasivam R, Athanasopoulos P, Bostrom PJ, Kuk C, Li K, Templeton AJ, Sridhar SS, van der Kwast TH, Chung P, Bristow RG, Milosevic M, Warde P, Fleshner NE, Jewett MAS, Bashir S, Zlotta AR. Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic. J Clin Oncol 2017; 35:2299-2305. [PMID: 28410011 DOI: 10.1200/jco.2016.69.2327] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Multidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. Although radical cystectomy (RC) currently is viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapy-based, bladder-sparing trimodal therapy (TMT) that combines transurethral resection of bladder tumor, chemotherapy for radiation sensitization, and external beam radiotherapy has emerged as a valid treatment option. In the absence of randomized studies, this study compared the oncologic outcomes between patients treated with RC or TMT by using a propensity score matched-cohort analysis. Methods Data from patients treated in a multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2013 were reviewed retrospectively. Those who received TMT for MIBC were identified and matched (for sex, cT and cN stage, Eastern Cooperative Oncology Group status, Charlson comorbidity score, treatment date, age, carcinoma in situ status, and hydronephrosis) with propensity scores to patients who underwent RC. Overall survival and disease-specific survival (DSS) were assessed with Cox proportional hazards modeling and a competing risk analysis, respectively. Results A total of 112 patients with MIBC were included after matching (56 who had been treated with TMT, and 56 who underwent RC). The median age was 68.0 years, and 29.5% had stage cT3/cT4 disease. At a median follow-up of 4.51 years, there were 20 deaths (35.7%) in the RC group (13 as a result of BC) and 22 deaths (39.3%) in the TMT group (13 as a result of BC). The 5-year DSS rate was 73.2% and 76.6% in the RC and TMT groups, respectively ( P = .49). Salvage cystectomy was performed in 6 (10.7%) of 56 patients who received TMT. Conclusion In the setting of a MDBCC, TMT yielded survival outcomes similar to those of matched patients who underwent RC. Appropriately selected patients with MIBC should be offered the opportunity to discuss various treatment options, including organ-sparing TMT.
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Affiliation(s)
- Girish S Kulkarni
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Thomas Hermanns
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yanliang Wei
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bimal Bhindi
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Raj Satkunasivam
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Paul Athanasopoulos
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter J Bostrom
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cynthia Kuk
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kathy Li
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Arnoud J Templeton
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Srikala S Sridhar
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Theodorus H van der Kwast
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter Chung
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert G Bristow
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael Milosevic
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Neil E Fleshner
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shaheena Bashir
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada
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Richard PO, Violette PD, Jewett MAS, Pouliot F, Leveridge M, So A, Whelan TF, Rendon R, Finelli A. CUA guideline on the management of cystic renal lesions. Can Urol Assoc J 2017; 11:E66-E73. [PMID: 28360949 DOI: 10.5489/cuaj.4484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Université Laval, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Quebec City, QC, Canada
| | - Michael Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON, Canada
| | - Alan So
- Division of Urology, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Thomas F Whelan
- Division of Urology, Department of Surgery, Saint John Regional Hospital, Dalhousie University, Saint John, NB
| | - Ricardo Rendon
- Department of Urology, QEII Health Sciences Centre, Dalhousie University, Halifax, NS
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
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