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Hellenthal N, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Bolenz C, Remzi M, Weizer A, Zigeuner R, Koppie TM. Adjuvant chemotherapy for high-risk upper tract urothelial carcinoma: Results from the Upper Tract Urothelial Carcinoma Collaboration. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5075 Background: There is relatively little literature regarding the use of adjuvant chemotherapy following radical nephroureterectomy in the management of patients with upper tract urothelial carcinoma (UTUC). Our goal was to determine the incidence of receipt of adjuvant chemotherapy in high-risk patients and the ensuing effect on overall- and cancer-specific survival. Methods: Using an international collaborative database, we identified 1390 patients who underwent nephroureterectomy for non-metastatic UTUC between the years of 1992 and 2006. Of these, 542 (39%) patients were classified as high-risk (pT3N0, pT4N0, and/or lymph node positive). These patients were separated into two groups—those who did and did not receive adjuvant chemotherapy—and were stratified by gender, age group, performance status, tumor grade and stage. Cox proportional hazard modeling and Kaplan-Meier analyses were used to determine overall- and cancer-specific survival amongst the cohorts. Results: Of the high-risk patients, 121 (22%) received adjuvant chemotherapy. Adjuvant chemotherapy was more commonly administered in the context of increased tumor grade and stage (p < 0.001). Median survival in the entire cohort was 24 months (range 0–231 months). There was no significant difference in overall- or cancer-specific survival between those who did and did not receive adjuvant chemotherapy; however age, performance status, tumor grade, and tumor stage were significant predictors of both overall and cancer-specific survival. Conclusions: Adjuvant chemotherapy is infrequently utilized in the treatment of patients with high-risk UTUC after nephroureterectomy. Despite this, it appears that adjuvant chemotherapy confers minimal impact on overall- or cancer-specific survival in this group. No significant financial relationships to disclose.
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Affiliation(s)
- N. Hellenthal
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - S. F. Shariat
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - V. Margulis
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - P. I. Karakiewicz
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - M. Roscigno
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - C. Bolenz
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - M. Remzi
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - A. Weizer
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - R. Zigeuner
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - T. M. Koppie
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
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Keegan KA, Hellenthal NJ, Chamie K, Koppie TM. Histopathology in surgically treated renal cell carcinoma: Is there a survival difference when stratified by stage? J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5089 Background: The impact of renal cell carcinoma histopathology (RCC) on survival has been conflicting and limited to retrospective institutional studies. Therefore, we sought to determine the role of RCC histopathology on stage-specific survival rates in a population-based cohort. Methods: We utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results database and identified 21,258 patients who underwent partial or radical nephrectomy for RCC between 1996 and 2004. Patients were stratified based on histopathologic diagnosis (clear cell, papillary, chromophobe, sarcomatoid, and collecting duct) and pathologic stage. We performed Cox-proportional hazard modeling and Kaplan-Meier survival analyses to determine overall- and cancer-specific survival. Results: Using univariate analysis, histopathology significantly impacted overall- and cancer-specific survival (p< 0.001). Specifically, patients with papillary and chromophobe variants had lower stage disease at the time of surgery and had improved survival compared to clear cell subtypes, (HR: 0.50; 95% CI, 0.42–0.60 and HR: 0.31; 95% CI, 0.22–0.44, respectively). When controlled for stage, improved outcomes for chromophobe and papillary histologies persisted, although it did not achieve statistical significance at all stages. On the other hand, patients with sarcomatoid disease were more likely to present with high stage disease and invariably had worse survival compared to clear cell carcinoma (HR: 8.74; 95%, CI 7.70–9.91). When controlled for stage, this difference achieved statistical significance across all stages (p< 0.001). Conclusions: Histopathologic subtype in patients with RCC does predict overall- and cancer-specific survival. Patients with sarcomatoid RCC, even those presenting with low-stage disease, have poor survival. These findings may give further value to recent data suggesting the increased utility of percutaneous renal biopsy and its potential impact on management. [Table: see text] No significant financial relationships to disclose.
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Chamie K, Ghosh PM, Koppie TM, Romero V, Troppmann C, deVere White RW. The effect of sirolimus on prostate-specific antigen (PSA) levels in male renal transplant recipients without prostate cancer. Am J Transplant 2008; 8:2668-73. [PMID: 18853950 PMCID: PMC4376320 DOI: 10.1111/j.1600-6143.2008.02430.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [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] [Indexed: 01/25/2023]
Abstract
In kidney recipients, the immunosuppressant sirolimus has been associated with a decreased incidence of de novo posttransplant malignancies (including prostate cancer). But the effect of sirolimus on the prostate-specific antigen (PSA) blood level, an important prostate cancer screening tool, remains unknown. We studied male kidney recipients >50 years old (transplanted from January 1994 to December 2006) without clinical evidence for prostate cancer. Pre- and posttransplant PSA levels were analyzed for 97 recipients (n = 19 on sirolimus, n = 78 on tacrolimus [control group]). Pretransplant PSA was similar for sirolimus versus tacrolimus recipients (mean, 1.8 versus 1.7 ng/mL, p = 0.89), but posttransplant PSA was significantly lower for recipients on sirolimus (mean, 0.9 versus 1.9 ng/mL, respectively, p < 0.001). The mean difference between pretransplant and posttransplant PSA was -0.9 ng/mL (50.0%, p = 0.006) for the sirolimus group versus +0.2 ng/mL (+11.8%, p = 0.24) for the tacrolimus group. By multivariate analysis, only pretransplant PSA and immunosuppression with sirolimus independently impacted posttransplant PSA. Our data strongly suggest that sirolimus is associated with a significant PSA decrease in kidney recipients. Future studies must investigate the clinical implications of our findings for the use of PSA for prostate cancer screening in male kidney recipients on sirolimus.
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Affiliation(s)
- K. Chamie
- Department of Urology, University of California, Davis, Sacramento, CA
| | - P. M. Ghosh
- Department of Urology, University of California, Davis, Sacramento, CA
- VA Northern California Health Care System, Sacramento, CA
| | - T. M. Koppie
- Department of Urology, University of California, Davis, Sacramento, CA
- VA Northern California Health Care System, Sacramento, CA
| | - V. Romero
- Department of Urology, University of California, Davis, Sacramento, CA
| | - C. Troppmann
- Department of Surgery, University of California, Davis, Sacramento, CA
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Koppie TM, Grossfeld GD, Miller D, Yu J, Stier D, Broering JM, Lubeck D, Henning JM, Flanders SC, Carroll PR. Patterns of treatment of patients with prostate cancer initially managed with surveillance: results from The CaPSURE database. Cancer of the Prostate Strategic Urological Research Endeavor. J Urol 2000; 164:81-8. [PMID: 10840429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE We determined the demographic and clinical profile of men who elect surveillance as the initial management of prostate cancer as well as the incidence and predictors of secondary treatment of these patients. MATERIALS AND METHODS The Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE) is a national disease registry of patients with various stages and treatments of prostate cancer. Using this database of 4,458 men we identified 329 (8.2%) who elected surveillance as the initial management of prostate cancer. Patients choosing watchful waiting were compared to other CaPSURE participants using the chi-square test. The likelihood of treatment initiation in the watchful waiting group was calculated using the Kaplan-Meier method. After adjusting for patient age, race, prostate specific antigen (PSA) at diagnosis, clinical T stage and total Gleason score the Cox proportional hazards regression model was used to determine significant predictors of treatment initiation. RESULTS Compared with others in the database, patients on watchful waiting were more likely to be 75 years old or older (51% versus 16%, p <0.001), white (93% versus 85%, p <0.001), and have lower serum PSA (p <0.001), organ confined disease (97% versus 88%, p <0.001) and a total Gleason score of 7 or less (97% versus 88%, p <0.001). In the watchful waiting group there was a 52% likelihood of treatment initiation within 5 years of the diagnosis. Significant predictors of secondary treatment were age younger than 65 years and elevated serum PSA at diagnosis. Neither race, extraprostatic stage cT3 disease nor higher total Gleason score was a significant predictor of treatment. CONCLUSIONS Men who elect initial watchful waiting for prostate cancer tend to be older, have lower serum PSA and more favorable disease characteristics than those who seek treatment. PSA at diagnosis is the dominant factor for predicting secondary treatment.
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Affiliation(s)
- T M Koppie
- Department of Urology, Center for Urologic Outcomes, University of California-San Francisco, San Francisco, California, USA
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