Clinical characteristics and survival outcomes of elderly patients with de novo metastatic germ cell tumors

OBJECTIVES

To determine the outcomes for elderly patients with de novo metastatic germ cell tumors and the influence of patient age on adherence to standard chemotherapy.

METHODS

A total of 150 patients who were initially diagnosed with metastatic germ cell tumors and treated at our institution between 2007 and 2021 were included. Patients were classified according to three age groups: aged <40, 40-49, and ≥50 years. Clinicopathological features, adherence to standard first-line chemotherapy, overall survival, and disease-free survival were compared between these groups. We also analyzed the outcomes of patients who received low-intensity induction chemotherapy due to adverse events and/or comorbidities.

RESULTS

There was no significant difference in any of the survival outcomes and in the rate of adherence to standard first-line chemotherapy between the three age groups, although elderly patients with intermediate/poor prognosis group tended to receive less-intense chemotherapies. The rate of febrile neutropenia as a chemotherapy-related adverse event was significantly higher in patients aged ≥50 years. No statistical significance in survival outcomes was detected between the group of patients who received relatively low-intensity induction chemotherapy and those who received adequately intensive planned chemotherapy.

CONCLUSIONS

The adherence rate of standard fist-line chemotherapy of elderly patients is almost comparable to that of younger patients, although some adverse events should be carefully managed. Even elderly patients with metastatic germ cell tumors can aim for equivalently good survival outcome like younger populations, with effort to adhere to standard chemotherapy.

Significant reduction in burden of metastatic disease by intermittent docetaxel therapy in a patient with castration-resistant prostate cancer

Intermittent docetaxel therapy (IDT) is rarely used nowadays as a treatment option for men with metastatic castration-resistant prostate cancer (mCRPC) because of the widespread availability of androgen receptor axis-targeted therapy, which is less toxic. Therefore, there is limited information available on whether IDT has a clinical benefit in the treatment of men with mCRPC. This report describes the case of a 66-year-old man with a diagnosis of cT2N1M0 prostate cancer who underwent neoadjuvant combined androgen blockade and whole-pelvis radiation therapy. However, the tumor had progressed to mCRPC with metastasis to the bladder and a left pelvic lymph node within 2 years. Docetaxel had been administered as first-line chemotherapy, and the patient achieved a complete response in terms of the bladder metastasis. Docetaxel was stopped after 15 cycles. When a durable response had been maintained for more than 2 years, during which only androgen deprivation therapy was administered, the patient was switched to observation only. However, his prostate-specific antigen level gradually increased. Abiraterone was started as second-line therapy, during which there was a rapid increase in the PSA level. Computed tomography revealed further enlargement of the left pelvic lymph node, bladder metastasis, metastasis to the left common iliac lymph nodes, and several disseminated nodules around the bladder. Docetaxel was reintroduced as IDT for third-line therapy, and a complete response was achieved for all metastases, with the exception of the metastasis in the left pelvic lymph node. Thus far, the patient has survived for more than 7 years after starting docetaxel as first-line therapy for mCRPC. IDT is potentially useful in a subgroup of patients with mCRPC and could achieve long-term survival. Comprehensive genomic profiling may help physicians to select patients with mCRPC who are more likely to benefit from docetaxel than other systemic therapy.

Comparison of therapeutic features and oncologic outcome in patients with pN1 prostate cancer among robot-assisted, laparoscopic, or open radical prostatectomy

OBJECTIVES

To compare the therapeutic features and oncological outcomes of robot-assisted radical prostatectomy (RARP) with those of open radical prostatectomy (ORP) or laparoscopic radical prostatectomy (LRP) in lymph node (LN) positive prostate cancer patients in a retrospective observational multi-institutional study.

PATIENTS AND METHODS

We evaluated the clinical results of 561 patients across 33 institutions who underwent RARP, LRP, or ORP and who were diagnosed with LN-positive prostate cancer during RP with pelvic LN dissection (PLND). We determined the following survival outcomes: metastasis-free survival, overall survival, cancer-specific survival, and biochemical recurrence-free survival. The Kaplan-Meier method, log-rank test, and Cox proportional hazards regression model were used to evaluate the effect of treatment on oncological outcomes. Statistical significance was set at P < 0.05.

RESULTS

There was no significant difference for any of the survival outcomes between the three surgical groups. However, RARP achieved a greater LN yield compared to that of ORP or LRP. When the extent of PLND was limited to the obturator LNs, the number of removed LNs (RLNs) was comparable between the three surgical groups. However, higher numbers of RLNs were achieved with RARP compared to the number of RLNs with ORP (P < 0.001) when PLND was extended to the external and/or internal iliac LNs.

CONCLUSION

RARP, LRP, and ORP provided equal surgical outcomes for pN1 prostate cancer, and the prognosis was relatively good for all procedures. Increased numbers of RLNs may not necessarily affect the oncological outcome.

Bladder metastasis without hematuria, following radiation therapy for lung adenocarcinoma

Bladder metastasis from lung adenocarcinoma is extremely rare. Unlike primary bladder urothelial tumors, the initial symptoms of this disease vary, and include pelvic pain, dysuria, and hematuria. There are few reports on cases without microscopic hematuria. An 86-year-old woman with a previous history of radiation therapy for lung adenocarcinoma complained of urinary frequency. A urinalysis was negative for hematuria and pyuria; thus, overactive bladder was suspected. However, the patient’s symptom worsened considerably, and cystoscopy revealed bladder tumor. Transurethral resection of the bladder tumor was performed. Based on the histological, immunohistochemical examination and clinical history, the final pathological diagnosis was bladder metastasis from lung adenocarcinoma. The patient died 19 days after the operation due to severe disease progression. In this rare case, a patient with bladder metastasis from lung adenocarcinoma did not show microscopic hematuria. Cystoscopy and computed tomography helped to make a rapid and accurate diagnosis.

Physical and Psychological Effects of Gender-Affirming Hormonal Treatment Using Intramuscular Testosterone Enanthate in Japanese Transgender Men

INTRODUCTION

The evidence on gender-affirming hormonal treatment (HT) for transgender persons is still insufficient.

AIM

To characterize the physical and psychological effects of HT using testosterone enanthate in transgender men, and to validate the safety of this treatment.

METHODS

A total of 85 Japanese transgender men who were followed up for at least 1 year at our gender clinic from 2004 to 2017 were included in this study. All self-reported effects that they recognized and regularly acquired laboratory data were investigated after initiation of HT.

MAIN OUTCOME MEASURE

HT mainly using testosterone enanthate 250 mg every 2 weeks caused the most desired physical effects to appear promptly and effectively, whereas small but not negligible numbers of undesired physical and psychological effects were also confirmed.

RESULTS

The initial dose of testosterone enanthate was 250 mg for 72 (84.7%) subjects, and the injection interval was maintained every 2 weeks for 70 (82.3%). Most physical effects appeared within 6 months. A deepened voice (87.1%), cessation of menses (78.8%), acne (69.4%), and facial (52.9%)/body (37.6%) hair growth occurred within 3 months. Although recognition of psychological effects was rare, emotional instability (9.4%) and increased libido (7.1%) appeared in the relatively early phase after beginning HT. The mean values for red blood cells, hemoglobin, uric acid, and alkaline phosphatase were significantly increased for 2 year. During the observation period, there were no life-threatening adverse effects in any subjects.

CONCLUSION

The present HT strategy is effective and safe for Japanese transgender men. The information from self-reported effects and objective data from blood tests can help both physicians and transgender men to understand testosterone HT. Kirisawa T, Ichihara K, Sakai Y, et al. Physical and Psychological Effects of Gender-Affirming Hormonal Treatment Using Intramuscular Testosterone Enanthate in Japanese Transgender Men. Sex Med 2021;9:100306.

[An analysis of nutritional status and pulmonary hypertension in patients with sequela of pulmonary tuberculosis and chronic obstructive pulmonary disease]

The prognostic value of hypercapnia and/or pulmonary hypertension differs in patients with sequela of pulmonary tuberculosis (TBseq) and those with chronic obstructive pulmonary disease (COPD) who are receiving home oxygen therapy (HOT). In an attempt to identify the factors, if any, that might explain this difference, we first compared nutritional status, respiratory function test results, dyspnea indexes, and other data for hypercapnic patients (PaCO2 > or = 45 Torr) and normocapnic patients (PaCO2 < 45 Torr) receiving HOT. Second, we examined the relationship between the degree of pulmonary hypertension and several respiratory function parameters for patients in each disease category. In 44 patients with TBseq, nutritional status estimated by body mass index and serum albumin was significantly better in the hypercapnic patients than in the normocapnic patients. However, this difference was not observed in 37 patients with COPD. In 30 patients with TBseq, the degree of pulmonary hypertension correlated significantly only with PaO2; in 32 patients with COPD, however, significant correlations were observed not only with PaO2 but also with PaCO2, %VC, and FEV1. These differences distinguishing groups of patients with the 2 diseases may provide an explanatory basis for the difference in prognostic value of hypercapnia and/or pulmonary hypertension in patients receiving HOT.

[A case of primary endobronchial mucosa-associated lymphoid tissue lymphoma with middle lobe atelectasis]

A 60-year-old woman was admitted for evaluation of an abnormal shadow in her chest X-ray. A chest roentgenogram revealed middle lobe atelectasis and a tomogram showed masses mainly in the right intermediate bronchus. In bronchoscopy, the bronchus was severely narrowed by irregularly surfaced masses. Microscopic examinations of transbronchial biopsy specimen showed the mucosal and submucosal tissue diffusedly infiltrated mainly by lymphocytes composed of small lymphocytes, centrocyte-like cells and monocytoid cells. The B-cell origin was suggested by a positive L-26 stain. Monoclonality of lymphocytes was proven by Southern blot analysis and in situ hybridization. The diagnosis was primary endobronchial lymphoma of mucosa-associated lymphoid tissue. The case was treated with chemotherapy protocol (CAMBO-VIP) and has been in complete remission for 20 months.

[Clinical experience of therapeutic use of cefmetazole (cefmetazon) or bronchopneumonia (author's transl)]

1. Therapeutic effects of cefmetazole (cefmetazon, CMZ) were examined in 22 cases of bronchopneumonia. 2. Among the 22 cases, 17 cases (77%) showed better response than 'effective'. However, 10 cases (91%) showed better response than 'effective' if a daily of 4 g (11 cases) was taken into consideration. 3. No particular symptomatic side effect of CMZ was shown. Abnormality in such laboratory tests as transaminase (1 case of GOT, and 2 cases of GPT) and 1 case of alkaline phosphatase were observed, and the abnormality was ascribable to CMZ administration.

Comparison between pulmonary emphysema and chronic bronchitis: an assessment by selective alveolo-bronchography

In order to elucidate the interrelationship between pulmonary emphysema and chronic bronchitis, 23 adult patients with chronic obstructive pulmonary disease were examined during life by selective alveolo-bronchography. They were classified according to radiologic criteria as centrilobular or panlobular emphysema or chronic bronchitis and according to clinical criteria as A, B or X types. A and B clinical types proposed by Burrows and Fletcher were almost in agreement respectively with emphysema and chronic bronchitis based on x-ray criteria. However, no correlation between A-type and panlobular emphysema or between B-type and centrilobular emphysema were observed. Centrilobular emphysema was diagnosed in 4 patients who had no history of findings of bronchitis. This suggests that inflammation of airways is not necessarily a cause of centrilobular emphysema. As a result, selective alveolo-bronchography was thought to be useful method to diagnose the type and severity of emphysema.