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McFadden J, Tachibana I, Adra N, Collins K, Cary C, Koch M, Kaimakliotis H, Masterson TA, Rice KR. Impact of variant histology on upstaging and survival in patients with nonmuscle invasive bladder cancer undergoing radical cystectomy. Urol Oncol 2024; 42:69.e11-69.e16. [PMID: 38267301 DOI: 10.1016/j.urolonc.2023.12.008] [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] [Received: 06/28/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Variant histology (VH) of urothelial carcinoma is uncommon and frequently presents at the muscle-invasive stage. VH is considering a significant risk factor for progression among patients with nonmuscle invasive bladder cancer (NMIBC). While there is some debate, expert opinion is generally that upfront radical cystectomy (RC) should be consider for these patients. Limited data exists to support this position. In this study, we sought to examine the rate of upstaging and overall survival for patients with VH NMIBC against patients with pure urothelial NMIBC who underwent RC, to help clarify the optimal treatment strategy for these patients. METHODS The institutional REDCap database was utilized to identify all patients with T1 and Ta bladder cancer that underwent RC over the study period (2004-2022). Matched-pair analysis was performed between patients with VH and pure urothelial NMIBC; 42 pairs were matched on prior intravesical therapy, presence of muscularis propria on transurethral resection of bladder tumor (TURBT), any carcinoma in situ presence on prior TURBTs, and final tumor staging on TURBT. The primary outcomes of interest were pathologic tumor upstaging rate at RC and overall survival. Secondary outcomes of interest included association of demographic or pretreatment variables with upstaging, and upstaging rates for specific variant histologies. RESULTS Patients with VH NMIBC undergoing RC were upstaged at a significantly higher rate than a matched cohort of patients with pure urothelial NMIBC (73.8% vs. 52.4%, P = 0.0244) and among those upstaged, had significantly higher rates of pT3 to pT4 (54.7% vs. 23.8%, P = 0.0088). Rate of node positivity at RC for VH NMIBC was also higher compared to pure urothelial NMIBC (40.5% vs. 21.4%, P = 0.0389). Among histologic variants, patients with plasmacytoid and sarcomatoid subtypes demonstrated the highest rates of upstaging; differences were not statistically significant. The overall median survival was 28.4 months for patients with VH after RC compared to 155.1 months for patients with pure urothelial NMIBC (P = 0.009). CONCLUSION Patients with VH NMIBC undergoing RC are at significantly higher risk of upstaging at RC when compared to patients with pure urothelial NMIBC and have worse overall survival. While this study supports the concept of an aggressive treatment approach for patients with VH NMIBC, improvements in understanding of the disease are necessary to improve outcomes.
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Affiliation(s)
- J McFadden
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - I Tachibana
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - N Adra
- Department of Medicine, Division of Hematology/Oncology, Indiana University Hospital, Indianapolis, IN
| | - K Collins
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN
| | - C Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - M Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - H Kaimakliotis
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - T A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - K R Rice
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Tachibana I, Alabd A, Whaley RD, McFadden J, Piroozi A, Hassoun R, Kern SQ, King J, Adra N, Rice KR, Foster RS, Einhorn LH, Cary C, Masterson TA. Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for seminoma: Limitations of surgical intervention after first-line chemotherapy. Urol Oncol 2023; 41:394.e1-394.e6. [PMID: 37543446 DOI: 10.1016/j.urolonc.2023.06.019] [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] [Received: 04/09/2023] [Revised: 05/30/2023] [Accepted: 06/26/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Patients with relapsed seminoma after first-line chemotherapy can be treated with salvage chemotherapy or postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). Based on prior experience, surgical management can have worse efficacy and increased morbidity compared to nonseminomatous germ cell tumor. Our aim was to characterize the surgical efficacy and difficulty in highly selected patients with residual disease after first-line chemotherapy. MATERIALS AND METHODS The Indiana University testis cancer database was queried to identify men who underwent PC-RPLND for seminoma between January 2011 and December 2021. Included patients underwent first-line chemotherapy and had evidence of retroperitoneal disease progression. RESULTS We identified 889 patients that underwent PC-RPLND, of which only 14 patients were operated on for seminoma. One patient was excluded for lack of follow-up. Out of 13 patients, only 3 patients were disease free with surgery only. Median follow up time was 29.9 months (interquartile ranges : 22.6-53.7). Two patients died of disease. The remaining 8 patients were treated successfully with salvage chemotherapy. During PC-RPLND, 4 patients required nephrectomy, 1 patient required an aortic graft, 2 patients required a partial ureterectomy, and 3 patients required partial or complete caval resection. CONCLUSION The decision between salvage chemotherapy and PC-RPLND as second-line therapy can be challenging. Salvage chemotherapy is effective but is associated with short and long-term morbidity. Surgical efficacy in this setting seems to be limited, but careful selection of patients may lead to surgical success without affecting the ability to receive any systemic salvage therapies if necessary or causing life-threating morbidity.
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Affiliation(s)
- Isamu Tachibana
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - Andre Alabd
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Rumeal D Whaley
- Department of Pathology, Indiana University, Indianapolis, IN
| | - Jacob McFadden
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Alex Piroozi
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Rebecca Hassoun
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Sean Q Kern
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Jennifer King
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Kevin R Rice
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Lawrence H Einhorn
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Tachibana I, Alabd A, Tong Y, Piroozi A, Mahmoud M, Kern SQ, Masterson TA, Adra N, Foster RS, Hanna NH, Einhorn LH, Cary C. Primary Retroperitoneal Lymph Node Dissection for Stage II Seminoma: Is Surgery the New Path Forward? J Clin Oncol 2023; 41:3930-3938. [PMID: 36730902 DOI: 10.1200/jco.22.01822] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/18/2022] [Accepted: 12/29/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE On the basis of National Comprehensive Cancer Network guidelines, clinical stage (CS) II seminoma is treated with radiotherapy or chemotherapy. Primary retroperitoneal lymph node dissection (RPLND) demonstrated recent success as first-line therapy for RP-only disease. Our aim was to confirm surgical efficacy and evaluate recurrences after primary RPLND for CS IIA/IIB seminoma to determine if various clinical factors could predict recurrences. PATIENTS AND METHODS Patients who underwent primary RPLND for seminoma from 2014 to 2021 were identified. All patients had at least 6 months of follow-up. Nineteen patients were part of a clinical trial. Patients receiving adjuvant chemotherapy were excluded from Kaplan-Meier recurrence-free survival (RFS) analysis. RESULTS We identified 67 patients who underwent RPLND for RP-only seminoma. One patient had pN0 disease. Median follow-up time after RPLND was 22.4 months (interquartile range, 12.3-36.1 months) and 11 patients were found to have a recurrence. The 2-year RFS for RPLND-only patients without adjuvant chemotherapy was 80.2%. Patients who developed RP disease for a period > 12 months had the lowest chance of recurrence, with a 2-year RFS of 92.2%. Seven initial CS II patients were on surveillance for 3-12 months before surgery and no patients experienced recurrence. Pathologic nodal stage and high-risk factors such as tumor size > 4 cm or rete testis invasion of the orchiectomy specimen did not affect recurrence. CONCLUSION CS II seminoma can be treated with surgery to avoid rigors of chemotherapy or radiotherapy. Patients with delayed development of CS II disease (> 12 months) had the best surgical results. Patients may present with borderline CS II disease, and careful surveillance may avoid overtreatment. Further study on patient selection and extent of dissection remains uncertain and warrants further investigation.
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Affiliation(s)
- Isamu Tachibana
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Andre Alabd
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Yan Tong
- Department of Statistics, Indiana University, Indianapolis, IN
| | - Alex Piroozi
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Mohammad Mahmoud
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Sean Q Kern
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Nasser H Hanna
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Lawrence H Einhorn
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Tachibana I, Kern SQ, Douglawi A, Tong Y, Mahmoud M, Masterson TA, Adra N, Foster RS, Einhorn LH, Cary C. Primary Retroperitoneal Lymph Node Dissection for Patients With Pathologic Stage II Nonseminomatous Germ Cell Tumor-N1, N2, and N3 Disease: Is Adjuvant Chemotherapy Necessary? J Clin Oncol 2022; 40:3762-3769. [PMID: 35675585 DOI: 10.1200/jco.22.00118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/19/2022] [Revised: 02/22/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE According to National Comprehensive Cancer Network guidelines, adjuvant chemotherapy (AC) has been advocated after primary retroperitoneal lymph node dissection (RPLND) to reduce the risk of relapse in pathologic nodal (pN) stage pN2 or pN3, whereas surveillance is preferred for pN1. We sought to explore the oncologic efficacy of primary RPLND alone for pathologic stage II in nonseminomatous germ cell tumors (NSGCTs) to reduce overtreatment with chemotherapy. METHODS Patients with pathologic stage II NSGCT after primary RPLND between 2007 and 2017 were identified. Patients were excluded for elevated preoperative serum tumor markers, receipt of AC, or if pure teratoma or primitive neuroectodermal tumor elements were found in the retroperitoneal pathology. RESULTS We identified 117 patients with active NSGCT in the retroperitoneum after primary RPLND. We excluded seven patients who lacked meaningful follow-up and 13 patients who received AC. There were 97 patients treated with RPLND alone: 41 pN1, 46 pN2, and 10 pN3. In total, 77 of 97 patients had not recurred after a median follow-up time of 52 months. The 2-year recurrence-free survival (RFS) was 80.3%, and the 5-year RFS was 79%. No differences in RFS were noted among nodal stage-pN1, pN2, and pN3-on Kaplan-Meier analysis. Lymphovascular invasion in the orchiectomy specimen, a high-risk pathologic feature, was also predictive of recurrence after primary RPLND. All 20 patients who recurred were treated with first-line chemotherapy and remained continuously disease free. CONCLUSION Most men with pathologic stage II disease treated with surgery alone in our series never experienced a recurrence. We did not observe a difference in recurrences between patients with pN1 and pN2. The recommendation for AC for pN2 disease may be overtreatment in most patients.
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Affiliation(s)
- Isamu Tachibana
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Sean Q Kern
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Antoin Douglawi
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Yan Tong
- Department of Statistics, Indiana University, Indianapolis, IN
| | - Mohammad Mahmoud
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Department of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Lawrence H Einhorn
- Department of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Tachibana I, Alabd A, Piroozi A, Mahmoud M, Kern S, Tong Y, Masterson TA, Adra N, Foster R, Hanna NH, Einhorn LH, Cary C. Oncologic outcomes of primary retroperitoneal lymph node dissection (RPLND) for stage II seminoma: Indiana University experience. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17012] [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
e17012 Background: Stage II seminoma is typically treated with radiotherapy or chemotherapy based on NCCN guidelines. Primary RPLND has demonstrated efficacy as first-line therapy for retroperitoneal (RP)-only disease. Our aim was to study recurrences of patients undergoing primary RPLND for Stage IIa or IIb seminoma to identify clinicopathologic factors affecting outcomes. Methods: Using our prospectively maintained database, we identified patients that had primary RPLND for seminoma from 2014-2021. All patients had at least 6 months of follow up. Patients were clinical stage IIa or IIb at the time of surgery and underwent open RPLND. We used Kaplan-Meier analysis for recurrence free survival (RFS) and compared clinicopathologic factors. Results: We identified 67 patients that underwent RPLND for RP only seminoma. Table shows the clinical characteristics of patients experiencing recurrences (median follow up - 22.4 months) and excludes 2 patients that had adjuvant chemotherapy. The 2-year RFS rate was 80.2%. Eleven patients (16.4%) experienced recurrences. Kaplan Meier analysis demonstrated improved survival in patients that had an RPLND after 12 months of surveillance (p = 0.02). Fifty-six patients were presumably cured with surgery alone at time of last follow-up. No patients died of testis cancer. One patient had a recurrence within the surgical field. Two patients had contralateral recurrences that may have been cured with bilateral RP template dissection. Seven patients that had a bilateral template dissection had disease on the contralateral side, of which 4 patients had visible nodes on pre-operative scans. In total, 9 out of 67 patients had disease on the contralateral side suggesting that bilateral RP template could confer higher cure rates. Recurrences were successfully treated with BEPx3 (9 pts), Redo RPLND then BEPx3 (1 pt), BEPx3 then High Dose chemotherapy (1 pt), and EPx4 (1 pt). Conclusions: Primary RPLND for low volume RP disease is effective with over 80% chance of surgical cure. Recurrences were cured almost exclusively with induction chemotherapy. Patients with delayed RP only recurrences had improved surgical success. Further investigation in larger trials may help standardize bilateral templates in seminoma and surveillance protocols in the post-operative setting. [Table: see text]
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Affiliation(s)
| | | | | | | | - Sean Kern
- Indiana University, Indianapolis, IN
| | - Yan Tong
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Nabil Adra
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
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Patel HV, Srivastava A, Kim S, Patel HD, Pierorazio PM, Bagrodia A, Masterson TA, Ghodoussipour SB, Kim IY, Singer EA, Jang TL. Association of Lymph Node Count and Survival after Primary Retroperitoneal Lymphadenectomy for Nonseminomatous Testicular Cancer. J Urol 2022; 207:1057-1066. [DOI: 10.1097/ju.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hiren V. Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sinae Kim
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, New Jersey
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Hiten D. Patel
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Phillip M. Pierorazio
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Timothy A. Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Saum B. Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Isaac Y. Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Thomas L. Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Calaway AC, Kern SQ, Crook D, Tong Y, Masterson TA, Adra N, Einhorn LH, Foster RS, Cary C. Percentage of Teratoma in Orchiectomy and Risk of Retroperitoneal Teratoma at the Time of Postchemotherapy Retroperitoneal Lymph Node Dissection in Germ Cell Tumors. J Urol 2021; 206:1430-1437. [PMID: 34288715 DOI: 10.1097/ju.0000000000001960] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
PURPOSE Presence of teratoma in the orchiectomy and residual retroperitoneal mass size are known predictors of finding teratoma during postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). We sought to determine if the percentage of teratoma in the orchiectomy specimen could better stratify the risk of teratoma in the retroperitoneum. MATERIALS AND METHODS The Indiana University Testis Cancer Database was reviewed to identify patients who underwent PC-RPLND for nonseminomatous germ cell tumors from 2010 to 2018. A logistic regression model was fit to predict the presence of retroperitoneal teratoma using teratoma and yolk sac tumor in the orchiectomy, residual mass size and log transformed values of prechemotherapy alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin. The study cohort was split into 60% training and 40% validation sets using 200 bootstraps. A predictive nomogram was developed for predicting teratoma in the retroperitoneum. RESULTS A total of 422 men were included. Presence of teratoma in the orchiectomy (OR 1.02, p <0.001), residual mass size (OR 1.16, p <0.001) and log transformed prechemotherapy AFP (OR 1.12, p=0.002) were predictive factors for having teratoma in the retroperitoneum. The C-statistic using this model demonstrated a predictive ability of 0.77. Training set C-statistic was 0.78 compared to 0.75 for the validation set. A nomogram was developed to aid in clinical utility. CONCLUSIONS The model better predicts patients at higher risk for teratoma in the retroperitoneum following chemotherapy, which can aid in a more informed referral for surgical resection.
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Affiliation(s)
- Adam C Calaway
- University Hospitals/Case Western Reserve University, Cleveland, Ohio
| | - Sean Q Kern
- Department of Urology, School of Medicine, Indiana University,Indianapolis, Indiana
| | - David Crook
- Department of Urology, School of Medicine, Indiana University,Indianapolis, Indiana
| | - Yan Tong
- Department of Biostatistics, Indiana University,Indianapolis, Indiana
| | - Timothy A Masterson
- Department of Urology, School of Medicine, Indiana University,Indianapolis, Indiana
| | - Nabil Adra
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University,Indianapolis, Indiana
| | - Lawrence H Einhorn
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University,Indianapolis, Indiana
| | - Richard S Foster
- Department of Urology, School of Medicine, Indiana University,Indianapolis, Indiana
| | - Clint Cary
- Department of Urology, School of Medicine, Indiana University,Indianapolis, Indiana
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Tachibana I, Calaway AC, Abedali Z, Szymanski KM, Mellon MJ, Masterson TA, Cary C, Kaimakliotis HZ, Boris RS. Definitive surgical therapy for refractory radiation cystitis: Evaluating effectiveness, tolerability, and extent of surgical approach. Urol Oncol 2021; 39:789.e1-789.e7. [PMID: 34247908 DOI: 10.1016/j.urolonc.2021.05.038] [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] [Received: 01/13/2021] [Revised: 05/06/2021] [Accepted: 05/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE The management of severe symptoms secondary to radiation changes to the bladder can be difficult. Many patients often endure costly procedures, hospitalizations, transfusions, and physician visits for intractable symptoms. Our aim was to evaluate the short-term efficacy and feasibility of urinary diversion in patients with severe, debilitating symptoms related to radiation cystitis by focusing on perioperative data examining surgical feasibility and assess for any improvement in the number of procedures, transfusions, hospitalizations, and office visits required. METHODS With IRB approval, we queried our institutional database for patients with a diagnosis code of radiation cystitis who underwent urinary diversion with or without bladder removal from 2011 to 2018. We reviewed institutional and regional record to assess pre, peri and postoperative outcomes, including rates of surgical procedures, hospitalizations, transfusions and clinic visits, in the year before and after treatment. Non-parametric statistics and linear regression were used. RESULTS Of the 286 patients with radiation cystitis, 45 patients underwent definitive urinary diversion - 31 with concomitant cystectomy and 14 with diversion alone. Analysis of perioperative variables such as estimated blood loss, surgical time, post-operative hospital stay or complication rates were similar to our experience with cystectomy in non-radiated patients. With a mean follow up of 14.6 months, we found that the number of procedures, hospitalizations and transfusions objectively improved following radical surgery. Office visits, however, did not seem to be impacted by performing urinary diversion. There were no significant differences in post-operative benefits between patients that received a concomitant cystectomy and those that only underwent diversion. CONCLUSION Patients suffering from severe refractory symptomatic radiation cystitis may be best treated with a radical surgical approach. Definitive urinary diversion with or without cystectomy can lower burden of disease by reducing the need for additional procedures, hospitalizations, and blood transfusions on short term follow-up.
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Affiliation(s)
- Isamu Tachibana
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive RT 473, Indianapolis, IN 46202.
| | - Adam C Calaway
- Department of Urology, Case Western Reserve University School of Medicine, 11100 Euclid Ave Cleveland, OH 44106
| | - Zain Abedali
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive RT 473, Indianapolis, IN 46202
| | - Konrad M Szymanski
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive RT 473, Indianapolis, IN 46202
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive RT 473, Indianapolis, IN 46202
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive RT 473, Indianapolis, IN 46202.
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive RT 473, Indianapolis, IN 46202
| | - Hristos Z Kaimakliotis
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive RT 473, Indianapolis, IN 46202
| | - Ronald S Boris
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive RT 473, Indianapolis, IN 46202
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Masterson TA, Tagawa ST. A 25-year perspective on advances in an understanding of the biology, evaluation, treatment and future directions/challenges of penile cancer. Urol Oncol 2021; 39:569-576. [PMID: 34219002 DOI: 10.1016/j.urolonc.2021.05.021] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
Squamous cell carcinoma of the penis (SCCP) is uncommon in some countries (including the U.S.), but is an important malignancy elsewhere. As a rare disease, progress has been slow compared to more common tumor types discussed in this anniversary issue and most often limited to single-center or retrospective datasets. In this section we describe developments leading to the current standard approach with current research questions.
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Affiliation(s)
- Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Scott T Tagawa
- Division of Hematology & Medical Oncology, Department of Medicine and Department of Urology, Weill Cornell Medicine, New York, NY.
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Kern SQ, Speir RW, Tong Y, Kaimakliotis H, Masterson TA, Bihrle R, Foster R, Koch MO, Cary C. AUTHOR REPLY. Urology 2021; 152:189. [PMID: 34112344 DOI: 10.1016/j.urology.2020.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sean Q Kern
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - Ryan W Speir
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, IN
| | | | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Michael O Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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11
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Richardson NH, Althouse SK, Ashkar R, Cary C, Masterson TA, Foster R, Hanna NH, Einhorn LH, Adra N. Late relapse of germ cell tumors: Detection and treatment outcomes. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5007] [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
5007 Background: Late relapse (LR) of germ cell tumors (GCT) is defined as relapsed disease > 2 years from initial treatment. LR remains a challenge both for optimal screening methods and treatment. We report the method of detection, treatments received, and outcomes in patients with LR GCT. Methods: The prospectively maintained Indiana University testicular cancer database was queried identifying 2712 pts with GCT treated at Indiana University from January 2000 to January 2019. Method of detection of LR was recorded along with site, treatment received, chemo-naive vs chemo-exposed LR, and survival outcomes. Results: 90 pts with LR were identified. Median age at LR was 35.2 yr (range, 19.2-56.8). Primary tumor site was testis in 88 (98%), retroperitoneum in 1 (1%), and mediastinum in 1 (1%). Chemo-exposed accounted for 42 (47%) and chemo-naïve for 48 (53%) of cases. Table compares clinical characteristics and survival outcomes of chemo-exposed vs. chemo-naïve late relapse. 62% of chemo-exposed LR were diagnosed with elevated AFP. For the 42 chemo-exposed LR pts, 2-yr PFS based on treatment: surgery vs. chemo vs surgery+chemo was 48% vs 10% vs 45% (p = 0.105). For the 48 chemo-naïve LR pts, 2-yr PFS based on treatment: surgery vs. chemo vs. surgery+chemo was 100% vs 74% vs 37% (p = 0.004). Next generation sequencing was available for 9 patients. No actionable findings were found. Tumor mutational burden was low in all patients where genomic testing was available. Conclusions: Most pts with chemo-exposed LR will be diagnosed with an elevated AFP. GCT pts require lifetime follow-up with annual physical exam and tumor markers. Surgical resection, when feasible, remains our preferred treatment for chemo-exposed LR as chemotherapy alone offers only brief responses. Pts with chemo-naïve LR have more chemo-sensitive biology.[Table: see text]
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Affiliation(s)
| | - Sandra K. Althouse
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Ryan Ashkar
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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12
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Wei C, Cary C, Masterson TA, Foster R, Ashkar R, Adra N, Hanna NH, Einhorn LH. Adjuvant chemotherapy with CAV/IE for malignant transformation of teratoma to primitive neuroectodermal tumor (PNET): An institutional analysis from Indiana University. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5026] [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
5026 Background: Malignant transformation of teratoma to PNET has an aggressive disease biology and generally poor outcomes when metastasis occurs. The optimal management of patients (pts) with PNET who have complete surgical extirpation is unknown. Most pts who are monitored with surveillance will relapse. We report results from pts with metastatic PNET who had complete surgical resection to NED status followed by adjuvant chemotherapy, most commonly cyclophosphamide + doxorubicin + vincristine alternating with ifosfamide + etoposide (CAV/IE) for 4 cycles. Methods: We reviewed records for pts with histologically confirmed malignant transformation of teratoma at Indiana University from 1990 to 2020. We identified 13 pts with PNET who underwent resection of metastatic disease to NED status followed by treatment with adjuvant chemotherapy, most commonly CAV/IE comprising of cyclophosphamide (1200 mg/m2), doxorubicin (75 mg/m2), and vincristine (2 mg/m2) alternating with ifosfamide (1.8 g/m2) plus etoposide (100 mg/m2). Treatment was delivered every 3 weeks for 4 cycles or until unacceptable toxicity. Results: Thirteen pts with metastatic PNET resected to NED status and received adjuvant chemotherapy were identified. Median age at diagnosis was 29 (range, 20 to 55). Primary tumor site was testis in 11 pts, retroperitoneum in 1 pt, and mediastinum in 1 pt. Metastasis site was retroperitoneal lymph nodes in 11 pts, mediastinal lymph nodes in 1 pt, and local mediastinal recurrence in 1 pt. After resection to NED status, all 13 pts were treated with adjuvant chemotherapy: 11 pts were treated with CAV/IE and 2 received etoposide-ifosfamide-cisplatin (VIP) x 2. Among the 11 pts who received CAV/IE: 3 pts received < 4 cycles due to toxicity and 8 completed 4 cycles. With a median follow-up of 16.3 months, 3 of 13 pts relapsed (23%) and 10 of 13 remained continuously disease free (77%). Of those who relapsed, median time to relapse was 9.3 months, 2 remained alive with disease at follow up and one patient died of disease progression. Conclusions: Adjuvant CAV/IE improves the outcomes of pts with malignant transformation of teratoma to PNET and who had resection of metastasis to NED status. Most pts who received adjuvant therapy remain continuously disease-free in comparison to historically high relapse rates in pts with resected PNET monitored with surveillance.
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Affiliation(s)
- Cynthia Wei
- Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Ryan Ashkar
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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13
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King J, Althouse SK, Cary C, Masterson TA, Foster R, Ashkar R, Hanna NH, Einhorn LH, Adra N. Surveillance after complete response in patients with metastatic non-seminomatous germ-cell tumor (NSGCT). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5018] [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
5018 Background: The optimal management of patients (pts) with complete response (CR) after first-line chemotherapy remains unsettled with guidelines recommending either surveillance or retroperitoneal LN dissection (RPLND). We present long-term outcomes from a large dataset of pts managed with surveillance after achieving CR to first-line chemotherapy. Methods: The prospectively maintained Indiana University testicular cancer database was queried for pts with metastatic NSGCT treated between 1990-2017 who achieved a CR after first-line chemotherapy. CR was defined as normalization of tumor markers (AFP+hCG) and no residual mass > 1cm. Kaplan-Meier methods were used to analyze progression-free survival (PFS) and overall survival (OS). Results: 388 pts met eligibility and were included in this analysis. Median age at diagnosis was 28.4 (range, 13-61.5). Primary site was testis in 385 pts (99%). Primary tumor predominant histology was embryonal ca (241), mixed (61), seminoma (31), yolk sac tumor (20), choriocarcinoma (10), and teratoma (14). 126 pts (32.5%) had teratoma in the primary tumor. Metastasis sites were retroperitoneum (295), mediastinal LN (15), pulmonary (149), liver (15), bone (7), and brain (6). IGCCCG risk was good in 325, intermediate in 25, and poor in 32 pts. Pre-chemotherapy retroperitoneal LN size was available in 232 pts: < 3cm in 170 and ≥3cm in 62. Median pre-chemo AFP was 10.7 (1-31,000) and hCG was 16.5 (0-595,930). First-line chemo was BEPx3 in 274, BEPx4 in 30, other regimens in 82 pts. With a median follow-up of 3.9 yrs, 34 pts (8.8%) progressed. At most recent follow-up, 363 (93.6%) pts were alive with no evidence of disease and 10 pts (2.6%) died of their disease. The estimated 2-yr PFS was 90.1% (95% CI: 86.2-93%) and 2-yr OS was 97.8% (95% CI: 95.2-99%). The estimated 2-yr PFS by IGCCCG risk category was 90.4% for good vs 90.4% for intermediate vs 86.5% for poor risk (p = 0.23), and the estimated 2-yr OS was 98.6% for good vs 95.5% for intermediate vs 92.9% for poor risk disease respectively (p = 0.002). For the 34 pts who progressed on surveillance, 16 (4%) progressed in the retroperitoneum only. 3 pts had malignant transformation of teratoma to PNET, adenocarcinoma, or other elements. 11 of progressed pts were treated with surgery, 12 were treated with salvage chemo, and 11 were treated with surgery+chemo. At most recent follow up, 21 of progressed pts had NED, 10 had died of disease, and 3 were lost to follow up. Conclusions: Pts with metastatic NSGCT who achieve CR after first-line chemotherapy can be safely observed with surveillance. Most pts who relapse can be salvaged with surgery and/or chemotherapy.
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Affiliation(s)
- Jennifer King
- Indiana University School of Medicine, Indianapolis, IN
| | - Sandra K. Althouse
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Ryan Ashkar
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Masterson TA, Tagawa ST. A 25-year review of advances in testicular cancer: Perspectives on evaluation, treatment, and future directions/challenges. Urol Oncol 2021; 39:561-568. [PMID: 33853746 DOI: 10.1016/j.urolonc.2021.02.028] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
The year 2020 will be remembered for a number of different events, both good and bad. For the journal Urologic Oncology, Seminars and Original Investigations, this year represents the 25th anniversary of its inception and 1st publication. Under the encouragement of Editor-in-Chief Dr. Michael Droller, the collective editorial board has put together a reflection of the progresses made among the spectrum of genitourinary cancers across the entirety of therapeutic disciplines. In this review, we discuss the advances achieved in our knowledge and understanding of testicular germ cell tumors since 1995, and the challenges that lie ahead.
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Affiliation(s)
- Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - Scott T Tagawa
- Division of Medical Oncology, Department of Medicine and Department of Urology, Weill Cornell University Medicine, New York, NY
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15
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Steward JE, Kern SQ, Cheng L, Boris RS, Tong Y, Bahler CD, Masterson TA, Cary KC, Kaimakliotis H, Gardner T, Sundaram CP. Clear cell papillary renal cell carcinoma: Characteristics and survival outcomes from a large single institutional series. Urol Oncol 2021; 39:370.e21-370.e25. [PMID: 33771410 DOI: 10.1016/j.urolonc.2021.02.003] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the clinical characteristics and survival outcomes of a large clear cell papillary renal cell carcinoma cohort. METHODS AND MATERIALS A retrospective review of patients with clear cell papillary renal cell carcinoma at a single academic center was performed after Institutional Review Board approval. Patients underwent either partial or radical nephrectomy from September 2009 to July 2019. Demographic and clinical characteristics, recurrence, and cancer specific and overall survival were reported. RESULTS A total of 90 patients were included in the study. Median follow up was 26.5 months. Median age was 61 (range 27 to 87). 47.8% of patients were African American. 26.7% of patients had end stage renal disease. 37.8% had multifocal renal tumors. 48.9% underwent partial nephrectomy, while the remainder underwent radical nephrectomy. 43.3% underwent an open surgical approach, 40.0% a robotic approach, and 16.7% a laparoscopic approach. Pathologic stage included T1a (90.0%), T1b (1.1%), and T2b (8.9%). Fuhrman grades 1-3 were present in 18.9%, 77.8%, and 3.3% of patients, respectively. There were no cancer specific deaths. There was one local recurrence and no metastases. The overall survival at a median follow up of 26.5 months was 92.1% (95% confidence interval 83.1%-96.4%). CONCLUSIONS Clear cell papillary renal cell carcinoma typically presents at a low stage and grade and has favorable survival outcomes. A nephron-sparing approach to treatment should be considered when feasible due to the tumor's indolent nature and propensity towards multifocality.
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Affiliation(s)
- James E Steward
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean Q Kern
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, IN, USA
| | - Ronald S Boris
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, IN, USA
| | - Clint D Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hristos Kaimakliotis
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas Gardner
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
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16
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Akel R, Anouti B, Kern S, Cary C, Masterson TA, Jacob JM, Bratslavsky G, Danziger N, Pavlick D, Hanna NH, Einhorn LH, Ross JS, Adra N. Comprehensive genomic profiling (CGP) in patients with relapsed/refractory germ cell tumors (GCT). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.388] [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
388 Background: Understanding the genetic alterations in patients with relapsed/refractory GCT (rrGCT) could delineate the pathogenesis of cisplatin resistance. Our study uses CGP to characterize genomic alterations (GA) in refractory GCT and correlate with clinical outcomes. Methods: 432 patients with rrGCT were seen at Indiana University between Jan 2016 to Sep 2019 of whom 52 patients underwent CGP using a hybrid-capture based commercial assay to evaluate all classes of GA. Tumor mutational burden (TMB) was determined on 1.1 Mbp of sequenced DNA and reported as mutations/Mb and microsatellite instability (MSI) was determined on 114 loci. PDL1 expression was determined by IHC (DAKO 22C3 antibody). Results: All patients relapsed after first-line cisplatin-based combination chemotherapy. Median age at diagnosis was 33 (range 15-68). Primary site of GCT was testicular in 85% and mediastinum in 8%. 6 patients had pure seminoma and 46 had non-seminoma. Platinum refractory disease, defined as serologic or radiographic progression within 4 weeks of first-line chemotherapy comprised 23% of patients. The primary tumor was used for sequencing in 6 cases (12%) and non-primary tumor metastatic site (lymph node, lung, liver, brain, omentum) in 46 cases (88%). The most common GA in the entire cohort were FGF6 (27%), FGF23 (27%), KDM5A (27%), CCND2 (27%), KRAS (18%), TP53 (14%), KIT (8%), APC (8%), ZNF217 (6%), MUTYH (6%), AURKA (6%), NRAS (6%), EGFR (6%), CTNNB1 (6%), GNAS (6%). Most common alterations for testicular primary tumors were FGF6, FGF23, KDM5A, CCND2, KRAS, TP53, KIT. For non-testicular primary GCT, most common GA were APC, TP53, EGFR. Most common GA for non-seminoma were FGF6, FGF23, KDM5A, CCND2, KRAS, TP53, APC. Most common GA for pure seminoma was KIT. Potentially targetable genomic alterations were found in 17 patients (33%). 10 of 17 patients (59%) tested had PDL1 score ≥1% and 3 patients had PDL1 ≥50%. Median TMB was 3.5 mutations/MB. There were 4 patients (8%) with TMB ≥ 10 mutations/Mb and 2 patients (4%) with TMB ≥ 20 mutations/Mb. 1 of 48 patients (2%) evaluated for MSI had MSI-High status. Isochromosome 12p was detected in the majority of samples where it was tested. Outcomes with GA-directed therapy will be presented at the conference. Conclusions: CGP can reveal potential therapeutic targets in patients with rrGCT including EGFR, ERBB3, KIT, and MET. Consistent with reported clinical trials in rrGCT, biomarkers predicting response to immune checkpoint blockade are uncommon with most patients having low TMB, absence of MSI-H status, and low expression of PDL1.
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Affiliation(s)
- Reem Akel
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Bilal Anouti
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Sean Kern
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Clint Cary
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Daneshmand S, Cary C, Masterson TA, Einhorn L, Boorjian SA, Kollmannsberger CK, Schuckman AK, So A, Black PC, Bagrodia A, Skinner EC, Alemozaffar M, Brand TC, Eggener SE, Pierorazio PM, Stratton KL, Nappi L, Nichols CR, Hu B. SEMS trial: Result of a prospective, multi-institutional phase II clinical trial of surgery in early metastatic seminoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.375] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
375 Background: Chemotherapy or radiotherapy are standard treatments for stage II seminoma, though they are associated with significant long-term treatment-related toxicities. Retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors but little data exists on its efficacy as a front-line treatment in early metastatic (stage II) seminoma. This is a single-arm, multi-institutional (NCT02537548), phase II study of retroperitoneal lymph node dissection (RLND) as first-line treatment for testicular seminoma with isolated retroperitoneal disease. Methods: Twelve sites in the United States and Canada prospectively enrolled patients (16 years of age) with testicular seminoma and isolated retroperitoneal lymphadenopathy between 1-3 cm in size. Patients were excluded if they received prior therapy (except orchiectomy) for testicular cancer. Open, modified-template RPLND was performed by qualified surgeons with a primary endpoint of 2-year recurrence-free survival. Data on complication rates (short and long-term), pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed. Results: A total of 55 patients were enrolled and underwent RPLND. Fourteen patients had initial stage I disease who developed isolated retroperitoneal relapse while 41 patients had clinical stage IIA-B at presentation. With a median follow-up of 24 months (8-52 months), there were a total of 10 recurrences. The overall recurrence rate was 18% with a median time to recurrence of 8 months. Of the recurrences, 8 underwent chemotherapy (6 BEP X 3, 1 EP X 4, 1 carbo/etoposide) and 2 underwent additional surgery. The two-year recurrence free survival was 87% and the overall survival was 100%. There were 7 (13%) patients who experienced short-term complications within 1 year of RPLND. Of these, 5 (9%) were classified as Clavien Dindo I-II and 2 (3.6%) were classified as Clavien Dindo III. No patients have reported long-term complications. Conclusions: This trial establishes RPLND as a therapeutic option as a first-line treatment in early metastatic seminoma. The surgery offers cancer control rates similar to those seen in non-seminomatous germ cell tumors. Clinical trial information: NCT02537548.
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Affiliation(s)
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Lawrence Einhorn
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | - Anne K. Schuckman
- USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Alan So
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Peter C. Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | - Phillip M. Pierorazio
- James Buchanan Brady Urological Institute, Dept. of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Lucia Nappi
- Vancouver Prostate Centre, University of British Columbia, Vnacouver, BC, Canada
| | | | - Brian Hu
- Loma Linda University, Loma Linda, CA
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Ashkar R, Althouse SK, Cary C, Masterson TA, Foster R, Hanna NH, Einhorn LH, Adra N. Prediction model for brain metastasis (BM) in patients with metastatic germ-cell tumors (mGCT) accounting for size of pulmonary metastases. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.378] [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
378 Background: BM is an independent adverse prognostic factor that can lead to treatment complications and failure in pts with mGCT. We aimed to establish an effective and practical BM prediction model accounting for size of pulmonary metastases. Methods: 2,291 consecutive pts with mGCT treated at Indiana University between January 1990 and September 2017 were identified. Pts were divided into 2 categories: BM present (N=154) and BM absent (N=2137). Kaplan-Meier methods were used to analyze progression free survival (PFS) and overall survival (OS). Logistic regression was used to determine a predictive model for whether BM was present. The data was separated 50/50 into training and validation datasets with equal numbers of events in each. Size of pulmonary metastases were calculated based on the sum of long axis diameter of pulmonary metastases for each patient and were divided into <3cm vs. ≥3cm. Results: Baseline characteristics for 2 groups are listed in the table below. 2-yr PFS and OS for pts with vs without BM: 17% vs 65% (p<0.001) and 62% vs 91% (p<0.001) respectively. Among the 154 pts with BM, 64 (42%) had radiation only (whole-brain radiotherapy or gamma knife), 22 (14%) had BM-surgery only, 14 (9%) had both radiation and BM-surgery. 54 pts (35%) did not receive local therapy for BM. A stepwise selection was used to determine the best model with p<0.15 as the entry and staying criteria. The model with the largest ROC AUC was used moving forward. The model was tested in the validation dataset. A model was generated including age at diagnosis≥40 (1 point), pre-chemotherapy hCG≥5000 (1 point), presence of bone metastases (1 point), choriocarcinoma predominant histology (2 points), and presence of pulmonary metastases size <3 cm (2 points) or ≥3 cm (3 points). Patients with 0 points had a 0.6% probability of having BM, 1 point → 1.4%, 2 points → 3.5%, 3 points → 8.2%, 4 points → 18.3%, 5 points → 36%, 6 points → 58%, 7 points → 78%, and 8 points → 90%. Conclusions: The prediction model developed in this study demonstrated discrimination capability of predicting BM occurrence in mGCT and can be used by clinicians to identify high-risk pts. [Table: see text]
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Affiliation(s)
- Ryan Ashkar
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Sandra K. Althouse
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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19
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Cheng L, Davidson DD, Montironi R, Wang M, Lopez-Beltran A, Masterson TA, Albany C, Zhang S. Fluorescence In Situ Hybridization (FISH) Detection of Chromosomal 12p Anomalies in Testicular Germ Cell Tumors. Methods Mol Biol 2021; 2195:49-63. [PMID: 32852756 DOI: 10.1007/978-1-0716-0860-9_4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gains of genetic material or internal rearrangements of chromosome 12p, including 12p overrepresentation or isochromosome 12p [i(12p)], are observed in virtually all germ cell tumors (GCT), in all histologic subtypes, and from various body locations. The chromosomal region involved in these alterations contains the growth and survival promoting oncogene KRAS (12p12.1). Gains or rearrangements of 12p characterize GCT from in situ to chemoresistant stages. Fluorescence in situ hybridization (FISH) detection of chromosome 12p anomalies is a sensitive and specific test for the diagnosis of germ cell tumors. Here we provide a detailed protocol for FISH detection of isochromosome 12p and chromosome 12p overrepresentation. The method is helpful for diagnosis of germ cell origin, and for selection of patients who may benefit from cisplatin-based chemotherapy.
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Affiliation(s)
- Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Darrell D Davidson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rodolfo Montironi
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy
| | - Mingsheng Wang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Pathology and Surgery, Faculty of Medicine, University of Cordoba, Cordoba, Spain
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Costantine Albany
- Department of Medicine, Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Shaobo Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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20
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Masterson TA, Cary C, Foster RS. Lessons learned from 40 years of managing chylous ascites following RPLND. Urol Oncol 2021; 39:1-2. [PMID: 38571278 DOI: 10.1016/j.urolonc.2020.09.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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21
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Abedali ZA, Monn MF, Cleveland BE, Sulek J, Bahler CD, Koch MO, Bihrle R, Masterson TA, Gardner TA, Boris RS, Sundaram CP. Robotic and open partial nephrectomy for tumors in a solitary kidney. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415819890474] [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: 11/15/2022]
Abstract
Introduction and objective: Traditionally, patients with renal masses in solitary kidneys were managed with an open partial nephrectomy. With improving techniques, robotic-assisted partial nephrectomy in the setting of a solitary kidney is increasingly utilized. The objective of this study was to compare open partial nephrectomy and robotic-assisted partial nephrectomy outcomes in solitary kidney patients. Methods: A retrospective study of 536 total patients who underwent partial nephrectomy between 2004–2016 was performed. Of these patients, 23 had a renal mass in a solitary kidney. Patient demographics, perioperative values, and surgical outcomes were analyzed using descriptive statistics to compare open partial nephrectomy to robotic-assisted partial nephrectomy. Results: Of the 23 patients in the cohort, 52% ( n=12) underwent open partial nephrectomy and 48% ( n=11) underwent robotic-assisted partial nephrectomy. Patient characteristics were not significantly different. The mean (standard deviation) nephrometry score was 6.9 (1.8) for open partial nephrectomy and 6.1 (1.9) for robotic-assisted partial nephrectomy ( p=0.290). The mean (standard deviation) pre-operative creatinine was 1.2 (0.3) in open partial nephrectomy and 1.5 (0.4) in robotic-assisted partial nephrectomy, which did not reach statistical significance ( p=0.110). No difference in postoperative kidney function, Clavien grade 3 or higher complication rate, blood loss, or hospitalization length was noted. Conclusion: Although traditionally patients with a tumor in a solitary kidney are counseled to undergo open partial nephrectomy, robotic-assisted partial nephrectomy is a safe alternative with no decrease in postoperative renal function when compared with a similar cohort of patients undergoing open partial nephrectomy in a solitary kidney. Level of evidence: Level II
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Affiliation(s)
| | | | | | - Jay Sulek
- Indiana University School of Medicine, USA
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Speir RW, Barboza MP, Calaway A, Masterson TA, Cary C, Koch M, Bihrle R, Cheng L, Adra N, Kaimakliotis H. Role of Neoadjuvant Chemotherapy in Squamous Variant Histology in Urothelial Bladder Cancer: Does Presence and Percentage Matter? Clin Genitourin Cancer 2020; 19:47-52. [PMID: 32711961 DOI: 10.1016/j.clgc.2020.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/02/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of neoadjuvant chemotherapy (NACT) on squamous variant (SV) bladder cancer by investigating patients presenting with SV histology at the time of transurethral resection (TUR), stratified by their receipt of NACT. MATERIALS AND METHODS The records of 71 patients with muscle-invasive bladder cancer and SV in the TUR specimen who underwent cystectomy between 2008 and 2018 were reviewed. Our primary outcome was pathologic response at time of cystectomy. Secondary outcomes included recurrence-free survival and overall survival stratified by receipt of NACT. A subgroup analysis was then conducted on the patients with defined SV% on TUR stratified by % involvement (< 50% SV vs. ≥ 50% SV). RESULTS The median age of the NACT and no-NACT groups was 60.2 and 70 years, respectively (P = .003). The complete response rate at cystectomy was 60% versus 13.7% for the NACT and no-NACT groups, respectively (P < .001). The non-organ-confined disease rate at time of radical cystectomy was 35% for the NACT group and 68.6% for the no-NACT group (P = .01). The NACT group had fewer recurrences than the no-NACT group (10% vs 47.1%; P = .003). In the subgroup analysis, the lower rate of non-organ-confined disease persisted for the patients who underwent NACT at the lower SV percentage but failed to remain significant at greater percentage involvement. This was also true for overall survival. CONCLUSIONS The effect of NACT in variant histology bladder cancer is variable. In patients with SV, these results favor the recommendation in favor of NACT administration, particularly when the primary tumor has < 50% involvement by the variant histology.
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Affiliation(s)
- Ryan W Speir
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | | | - Adam Calaway
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Michael Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Rick Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Liang Cheng
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Akel R, Anouti B, Kern S, Cary C, Masterson TA, Jacob JM, Bratslavsky G, Danziger N, Pavlick D, Hanna NH, Einhorn LH, Ross JS, Adra N. Comprehensive genomic profiling (CGP) in patients with relapsed/refractory germ cell tumors (GCT). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17053] [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: 11/20/2022] Open
Abstract
e17053 Background: Understanding the genetic alterations in patients with relapsed/refractory GCT (rrGCT) could delineate the pathogenesis of cisplatin resistance. Our study uses CGP to characterize genomic alterations (GA) in refractory GCT and correlate with clinical outcomes. Methods: 432 patients with rrGCT were seen at Indiana University between Jan 2016 to Sep 2019 of whom 52 patients underwent CGP using a hybrid-capture based commercial assay to evaluate all classes of GA. Tumor mutational burden (TMB) was determined on 1.1 Mbp of sequenced DNA and reported as mutations/Mb and microsatellite instability (MSI) was determined on 114 loci. PDL1 expression was determined by IHC (DAKO 22C3 antibody). Results: All patients relapsed after first-line cisplatin-based combination chemotherapy. Median age at diagnosis was 33 (range 15-68). Primary site of GCT was testicular in 85% and mediastinum in 8%. 6 patients had pure seminoma and 46 had non-seminoma. Platinum refractory disease, defined as serologic or radiographic progression within 4 weeks of first-line chemotherapy comprised 23% of patients. The primary tumor was used for sequencing in 6 cases (12%) and non-primary tumor metastatic site (lymph node, lung, liver, brain, omentum) in 46 cases (88%). The most common GA in the entire cohort were FGF6 (27%), FGF23 (27%), KDM5A (27%), CCND2 (27%), KRAS (18%), TP53 (14%), KIT (8%), APC (8%), ZNF217 (6%), MUTYH (6%), AURKA (6%), NRAS (6%), EGFR (6%), CTNNB1 (6%), GNAS (6%). Most common alterations for testicular primary tumors were FGF6, FGF23, KDM5A, CCND2, KRAS, TP53, KIT. For non-testicular primary GCT, most common GA were APC, TP53, EGFR. Most common GA for non-seminoma were FGF6, FGF23, KDM5A, CCND2, KRAS, TP53, APC. Most common GA for pure seminoma was KIT. Potentially targetable genomic alterations were found in 17 patients (33%). 10 of 17 patients (59%) tested had PDL1 score ≥1% and 3 patients had PDL1 ≥50%. Median TMB was 3.5 mutations/MB. There were 4 patients (8%) with TMB ≥ 10 mutations/Mb and 2 patients (4%) with TMB ≥ 20 mutations/Mb. 1 of 48 patients (2%) evaluated for MSI had MSI-High status. Isochromosome 12p was detected in the majority of samples where it was tested. Outcomes with GA-directed therapy will be presented at the conference. Conclusions: CGP can reveal potential therapeutic targets in patients with rrGCT including EGFR, ERBB3, KIT, and MET. Consistent with reported clinical trials in rrGCT, biomarkers predicting response to immune checkpoint blockade are uncommon with most patients having low TMB, absence of MSI-H status, and low expression of PDL1.
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Affiliation(s)
- Reem Akel
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Bilal Anouti
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Sean Kern
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Clint Cary
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Ashkar R, Althouse SK, Cary C, Masterson TA, Foster R, Hanna NH, Einhorn LH, Adra N. Model to predict brain metastasis (BM) in patients with metastatic germ-cell tumors (mGCT). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5057] [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
5057 Background: BM is an independent adverse prognostic factor that can lead to treatment complications and failure in pts with mGCT. We aimed to establish an effective and practical model for prediction of BM in mGCT. Methods: 2,256 consecutive pts with mGCT treated at Indiana University between January 1990 and September 2017 were identified. Pts were divided into 2 categories: BM present (N = 144) and BM absent (N = 2112). Kaplan-Meier methods were used to analyze progression free survival (PFS) and overall survival (OS). Logistic regression was used to determine a predictive model for whether BM was present. The data was separated 50/50 into training and validation datasets with equal numbers of events in each. Results: Baseline characteristics for 2 groups are listed in Table. 2-yr PFS and OS for pts with vs without BM: 17% vs 66% (p < 0.001) and 62% vs 91% (p < 0.001) respectively. Among the 144 pts with BM, 64 (44%) had radiation only (whole-brain radiotherapy or gamma knife), 21 (15%) had BM-surgery only, 14 (10%) had both radiation and BM-surgery. 45 pts (31%) did not receive local therapy for BM. A stepwise selection was used to determine the best model with p < 0.15 as the entry and staying criteria. The model with the largest ROC AUC was used moving forward. The model was tested in the validation dataset. A model was generated including age at diagnosis≥40 (1 point), presence of pulmonary metastases (3 points), bone metastasis (1 point), pre-chemotherapy hCG≥5000 (1 point), and choriocarcinoma predominant histology (1 point). Patients with 0 points had a 0.4% probability of BM, 1 point: 1%, 2 points: 2.6%, 3 points: 7%, 4 points: 16%, 5 points: 32%, 6 points: 56%, and 7 points: 77%. Details regarding analysis in training and validation datasets will be presented. Conclusions: The prediction model developed in this study demonstrated discrimination capability of predicting BM occurrence and can be used by clinicians to identify high-risk pts. [Table: see text]
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Affiliation(s)
- Ryan Ashkar
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Sandra K. Althouse
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Kaimakliotis HZ, Adra N, Kelly WK, Trabulsi EJ, Lauer RC, Picus J, Smith ZL, Walling R, Masterson TA, Calaway AC, Koch MO, Sonderman E, Fu P, Goolamier G, Eitman C, Ponsky LE, Hoimes CJ. Phase II neoadjuvant (N-) gemcitabine (G) and pembrolizumab (P) for locally advanced urothelial cancer (laUC): Interim results from the cisplatin (C)-ineligible cohort of GU14-188. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5019 Background: Patients (pts) with laUC who are C-ineligible have inferior survival compared to counterparts who receive C based N-therapy and have a pathologic response at radical cystectomy (RC). Cohort 2 (C2) of the GU14-188 trial is designed to assess the tolerability and efficacy of N- G and P in laUC pts who are C-ineligible. Methods: Eligible pts for C2 were surgical candidates and C-ineligible with cT2-4aN0M0 bladder UC or mixed histology. Enrollment followed a Simon 2-stage design for H0 of interval futility which was rejected at stage 1, and fully enrolled. Pts were treated with N- G (1000mg/m2) on days 1, 8, and 15 of a 28 day cycle (cy) for a total of 3 cy, and overlapped with P 200mg every 3wks starting on cy 1 day 8 x 5 doses. Minimum criteria for evaluation of safety: 1 dose of P, and for efficacy: 2 doses P and RC. The primary endpoint of pathologic muscle invasive response rate (PaIR, ≤pT1N0) was assessed at RC and designed for 86% power, 4% significance to detect PaIR difference from 18 to 40%. Molecular subtyping is planned. Results: 37 pts were enrolled to C2 with a median (mdn) age of 72, 70% male, 55% > cT2. C-ineligibility was due to renal function (49%), hearing (30%), neuropathy (12%). Mdn per-pt doses given (intended) for P:5(5) and G:9(9). The PaIR was 51.6% (95%CI 0.35, 0.68), P0 (ypT0N0) rate of 45.2%, and neither correlated with baseline PD-L1 score. Downstage to PaIR occurred in 57% of pts with cT2, and 47% of > cT2. Mdn time to RC from last dose was 5.6wks. Six were not included in the primary analysis: 3 (8.1%) did not have RC due to progression (RFS censored), 2 did not receive required protocol therapy, and 1 withdrew consent. At mdn follow up of 10.8mo (4-24), the estimated 12mo RFS, OS, and DSS is 74.9%, 93.8%, and 100%, respectively. Treatment related AE included grade (gr) 3/4 neutropenia (24%), anemia (13%), and platelets (5%). There were no gr 4 non-heme AE, and of 14 (36%) pts with gr 3, 12 did not preclude RC. Of these, there were 4 gr 3 investigator assessed immune related adverse events (IAirAE) of pneumonitis (5%), colitis (3%), and AST elevation (3%). Though IAirAE improved, protocol therapy was discontinued in 3 pts: 2 did not have RC due to progression. Conclusion: N- G with P in C-ineligible pts with laUC is feasible with manageable toxicity, and has a pathologic downstage rate comparable to standard of care in the C-eligible population. G and P warrants further study with component contribution as a C- free N- option in laUC. Clinical trial information: NCT02365766 .
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Affiliation(s)
| | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - William Kevin Kelly
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Edouard John Trabulsi
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Richard C. Lauer
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Joel Picus
- Washington University in St. Louis School of Medicine, St. Louis, MO
| | | | | | | | - Adam C Calaway
- Seidman Cancer Center at University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Elizabeth Sonderman
- Seidman Cancer Center at University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Pingfu Fu
- Department of Population and Quantitative Health Science, Case Western Reserve University, Cleveland, OH
| | | | - Cheryl Eitman
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Lee Evan Ponsky
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
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Abedali ZA, Monn MF, Huddleston P, Cleveland BE, Sulek J, Bahler CD, Foster RS, Koch MO, Mellon MJ, Kaimakliotis HZ, Cary C, Bihrle R, Gardner TA, Masterson TA, Boris RS, Sundaram CP. Robotic and open partial nephrectomy for intermediate and high complexity tumors: a matched-pairs comparison of surgical outcomes at a single institution. Scand J Urol 2020; 54:313-317. [PMID: 32401119 DOI: 10.1080/21681805.2020.1765017] [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: 10/24/2022]
Abstract
Objective: To compare peri-operative factors and renal function following open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) for intermediate and high complexity tumors when controlling for tumor and patient complexity.Methods: A retrospective review of 222 patients undergoing partial nephrectomy was performed. Patients with intermediate (nephrometry score NS 7-9) or high (NS 10-12) complexity tumors were matched 2:1 for RPN:OPN using NS, Charlson Comorbidity Index (CCI), and BMI. Patient demographics, peri-operative values, renal function, and complication rates were analyzed and compared.Results: Seventy-four OPN patients were matched to 148 RPN patients with no difference in patient demographics. Estimated blood loss in OPN patients was significantly higher (368.5 vs 210.5 mL, p < 0.001) as was transfusion rate (17% vs 1.6%, p < 0.001). Warm ischemia time was longer in OPN (25.5 vs 19.7 min, p = 0.001) while operative time was reduced (200.5 vs 226.5 min, p = 0.010). RPN patients had significantly shorter hospitalizations (5.3 vs 3.0 days, p < 0.001). GFR decrease after one month was not statistically significant (12.9 vs 6.6 ml/min, p = 0.130). Clavien III-V complications incidence was higher for OPN compared to RPN although not significantly (20.3% vs 10.8%, p = 0.055).Conclusion: When matching for tumor and patient complexity, RPN patients had fewer high grade post-operative complications, decreased blood loss, and shorter hospitalizations. RPN is a safe option for patients with intermediate and high complexity tumors.
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Affiliation(s)
- Zain A Abedali
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick Huddleston
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent E Cleveland
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jay Sulek
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clinton D Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael O Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas A Gardner
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ronald S Boris
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Taza F, Chovanec M, Snavely A, Hanna NH, Cary C, Masterson TA, Foster RS, Einhorn LH, Albany C, Adra N. Prognostic Value of Teratoma in Primary Tumor and Postchemotherapy Retroperitoneal Lymph Node Dissection Specimens in Patients With Metastatic Germ Cell Tumor. J Clin Oncol 2020; 38:1338-1345. [PMID: 32134699 PMCID: PMC7840096 DOI: 10.1200/jco.19.02569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Presence of teratoma in patients with metastatic testicular germ cell tumor (GCT) is of unknown prognostic significance. We report survival outcomes of patients with or without teratoma in primary tumor and postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) specimen and assess impact on prognosis. PATIENTS AND METHODS Patients with metastatic nonseminomatous GCT (NSGCT) who were evaluated at Indiana University between 1990 and 2016 and had primary testicular tumor specimen from orchiectomy (ORCH) were included. All patients were treated with cisplatin-based combination chemotherapy. The cohort was divided into 2 groups according to presence or absence of teratoma in ORCH specimen. Survival data were correlated with histopathologic findings. Differences in progression-free (PFS) and overall survival (OS) were evaluated using log-rank tests and Cox proportional hazards models to adjust for known adverse prognostic factors. RESULTS We identified 1,224 consecutive patients evaluated at Indiana University between 1990 and 2016 who met inclusion criteria. Median age was 27 years (range, 13-71 years); 689 patients had teratoma in ORCH specimen, and 535 did not. With median follow-up of 2.3 years, 5-year PFS was 61.9% (95% CI, 57.1% to 66.2%) for those with teratoma versus 63.1% (95% CI, 58.0% to 67.8%) for those without (P = .66); 5-year OS was 82.2% (95% CI, 77.9% to 85.8%) versus 81.4% (95% CI, 76.5% to 85.3%; P = .91), respectively. A total of 473 patients underwent PC-RPLND; 5-year PFS for patients with pure teratoma in PC-RPLND specimen versus necrosis only was 65.9% versus 79.1% (P = .06), and 5-year OS was 90.3% versus 93.4% (P = .21), respectively. CONCLUSION Presence of teratoma in ORCH and PC-RPLND specimens was not a prognostic factor in this large retrospective study of patients with NSGCT.
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Affiliation(s)
- Fadi Taza
- Division of Hematology and Medical Oncology, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Michal Chovanec
- Division of Hematology and Medical Oncology, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Anna Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Nasser H. Hanna
- Division of Hematology and Medical Oncology, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | | | - Richard S. Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Lawrence H. Einhorn
- Division of Hematology and Medical Oncology, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Costantine Albany
- Division of Hematology and Medical Oncology, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Division of Hematology and Medical Oncology, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
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Nappi L, Thi M, Adra N, Leao RRN, Eigl BJ, Chi KN, Gleave M, So A, Black PC, Hamilton RJ, Daneshmand S, Cary C, Masterson TA, Einhorn LH, Nichols CR, Kollmannsberger CK. Expression of circulating miR375 and miR371 to differentiate teratoma and viable germ cell tumor in patients with post-chemotherapy residual disease. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.414] [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
414 Background: Viable germ cell tumors (vGCT) express high levels of certain circulating microRNAs, including miR-371a-3p (miR371) that has shown high specificity and sensitivity. However, neither tissue nor serum/plasma from patients with only teratoma are miR371 positive. miR375 is overexpressed in teratoma tissue, but detectability in blood is unknown. Methods: miR371 and miR375 expression was analyzed in 100 patients with various stages and histology of GCT. miR375 expression in teratoma was validated in patients with post-chemotherapy pathologically confirmed teratoma (PCPCT). The miRNAs expression was assessed by RT-PCR and quantified by ΔΔCT method. The optimal cut-off for miR375 expression was estimated by Youden index ( > 20). Spike-in cel-miR-39-3p, miR-451 and miR-30b-5p were used as internal controls. Sensitivity, specificity, AUC of the ROC of miR375 in detecting teratoma was analyzed. Results: In the discovery cohort miR371 and miR375 were measured in 62 pts: 27 CSI NED, 15 chemo-naïve metastatic seminoma and 20 with PCPCT. miR375 was over-expressed in pts with teratoma compared to CSI and seminoma pts (p = 0.002), while miR371 was expressed in the seminoma pts and undetectable in the PCPCT and CSI pts (p < 0.001). In the post-chemotherapy setting, 38 pts were analyzed: 21 PCPCT, 6 vGCT and 11 complete remission (CR). Also in this cohort, miR375 was over-expressed in pts with teratoma compared to the pts presenting vGCT and post-chemotherapy CR (p = 0.01), while miR371 was detectable only in the pts with vGCT (p < 0.001). Overall, sensitivity and specificity of miR375 in identifying teratoma were 78% and 80%, respectively; the AUC was 0.7 (95% CI: 0.5490-0.8186; p < 0.01). Conclusions: Pts with residual post-chemotherapy teratoma present higher plasma levels of miR375 compared to pts with vGCT in whom miR375 is low but miR371 is expressed at high levels. The simultaneous evaluation of miR371 and miR375 may be clinically useful to predict the histology of the GCT components in pts with post-chemotherapy residual disease to inform the best therapeutic options (surgery or chemotherapy). Further validation within larger studies is warranted.
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Affiliation(s)
- Lucia Nappi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Marisa Thi
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | - Bernhard J. Eigl
- Department of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC, Canada
| | - Kim N. Chi
- BC Cancer and Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Martin Gleave
- The Vancouver Prostate Centre and Department of Urologic Sciences, Vancouver, BC, Canada
| | - Alan So
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Peter C. Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Robert James Hamilton
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Craig R. Nichols
- Testicular Cancer Commons and SWOG Group Chair's Office, Portland, OR
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Calaway AC, Foster RS, Tong Y, Masterson TA, Bihrle R, Cary C. Improving postoperative quality of care in germ cell tumor patients: Does scheduled alvimopan, acetaminophen, and gabapentin improve short-term clinical outcomes after retroperitoneal lymph node dissection? Urol Oncol 2020; 38:305-312. [PMID: 32001197 DOI: 10.1016/j.urolonc.2019.12.016] [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: 05/29/2019] [Revised: 11/18/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION To determine the benefits of alvimopan and multimodal pain management strategies in men undergoing retroperitoneal lymph node dissection for testicular cancer. METHODS A retrospective cohort study was completed in men undergoing retroperitoneal lymph node dissection from January 2017 to May 2018. Patients were placed into the 3-drug, 2-drug, and control cohorts as a result of a prospectively determined protocol during the study period. Men in the 3-drug group were managed using alvimopan 12 mg PO the morning of surgery then BID until bowel movement, gabapentin 300 mg daily, and acetaminophen 1,000 mg q6H. The 2-drug group was managed with the above regimen excluding alvimopan. Controls were treated per our standard perioperative pathway. Primary outcomes were length of stay, IV narcotic consumption, bowel movement during hospitalization, and time to bowel movement and assessed in multivariate models controlling for operative time, concomitant surgery, chemotherapy receipt, and residual mass size. RESULTS One-hundred and fifty-two consecutive patients underwent RPLND (42 3-drug, 38 2-drug, and 72 controls). Multivariable models indicated that the 3-drug (IRR 0.89, P < 0.0001) and 2-drug group (IRR 0.87, P = 0.0209) had shorter hospital stays than controls. Men in the 3-drug group required less narcotic pain medication than the 2-drug (β -8.16, P = 0.0405) and the control (β -8.16, P = 0.0302) group. Men receiving alvimopan (3-drug) were almost 6 times more likely than the 2-drug group (odds ratio 5.94, P < 0.0001) and 4 times more likely than the control group (odds ratio 3.86, P = 0.0017) to have a bowel movement during hospitalization. Men in the 3-drug group had the quickest return of bowel movements. CONCLUSIONS Multimodal pain management improves length of stay in men undergoing retroperitoneal lymph node dissection for testis cancer. The addition of alvimopan allows for quicker return of bowel movements and reduces overall narcotic requirements.
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Affiliation(s)
- Adam C Calaway
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Yan Tong
- Department of Biostatistics, Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Abstract
The purpose of this review is to present a comprehensive and updated review of the literature and summary of the indications, risks and outcomes related to salvage, desperation and late relapse surgery for advanced testicular cancer. After completing a thorough review of the current literature, this review has attempted to provide an overview of the indications for salvage, desperation and late relapse retroperitoneal lymph node dissection (RPLND) followed by a summary of the histopathologic and clinical outcomes regarding each. Recent literature, combined with a significant contribution from historical studies suggest that while testicular cancer is a relatively uncommon malignancy overall, it represents the most common solid organ malignancy for young men. Although a significant number of men are cured with a combination of first-line treatments, the remaining men are a diverse and often challenging cohort who require the benefit of expertise to improve their outcomes. The role of surgical strategies in the salvage, desperation and late relapse settings is unquestionable, although the most important question remains who will benefit. This often requires a multi-disciplinary approach at centers specializing in this disease process in order to recognize who should get surgery, what surgery to do and how to minimize the potential morbidity associated with the operation.
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Affiliation(s)
- Ryan W Speir
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Calaway AC, Einhorn LH, Masterson TA, Foster RS, Cary C. Adverse Surgical Outcomes Associated with Robotic Retroperitoneal Lymph Node Dissection Among Patients with Testicular Cancer. Eur Urol 2019; 76:607-609. [PMID: 31174891 DOI: 10.1016/j.eururo.2019.05.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 03/04/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Abstract
Surgery for metastatic testicular disease has been an essential factor in the long-term cure rates for men with testicular germ cell tumors. Robotic approaches to retroperitoneal lymph node dissection (R-RPLND) have been proposed as an alternative to open surgery with few if any adverse events reported. We report the clinical course for five recent patients referred to our center for recurrences after R-RPLND, focusing on recurrence patterns, treatment burden, and treatment-related morbidity and mortality. The median time to recurrence after R-RPLND was 259d. The recurrence patterns after R-RPLND were aberrant from our past experience in managing recurrences after open RPLND. One man experienced an in-field recurrence located in close proximitry to an undivided lumbar vessel. Four patients had out-of-field recurrence in abnormal locations: pericolic space invading the sigmoid colon, peritoneal carcinomatosis with a perinephric mass, large-volume liver lesions with suprahilar disease extending into the retrocrural space, and lymph nodes in the celiac axis. The treatment burden was high: the five men were subjected to 12 different chemotherapy regimens and three underwent additional surgeries. Three patients developed significant cisplatin-induced toxicity. One patient died due to progression of testicular cancer after failing all chemotherapy and surgical options. PATIENT SUMMARY: We report our initial experience in managing patients with testicular cancer referred to our institution after robotic retroperitoneal lymph node dissection (RPLND). We found that the recurrences were highly variable and in unusual locations and were associated with a high treatment burden. We conclude that further investigation into the safety and long-term oncologic efficacy of robotic RPLND is necessary before widespread implementation.
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Affiliation(s)
- Adam C Calaway
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Lawrence H Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Adra N, Althouse SK, Liu H, Abonour R, Abu Zaid MI, Cary C, Masterson TA, Foster R, Albany C, Hanna NH, Einhorn LH. Prognostic value of serum tumor marker (STM) rate of decline during high-dose chemotherapy (HDCT) and peripheral-blood stem-cell transplant (PBSCT) for relapsed germ-cell tumors (rGCT). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16044] [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
e16044 Background: Rate of STM decline is prognostic in patients (pts) with metastatic GCT receiving first-line chemotherapy. We investigated the prognostic value of STM decline in pts with rGCT treated with HDCT and PBSCT. Methods: 444 consecutive pts with rGCT were treated with HDCT and PBSCT at Indiana University between 2004-2018. All pts were planned for 2 consecutive HDCT courses. Pts with elevated STM (AFP > 25 and/or hCG > 4.9) were included in this analysis. Slope and half-life (T1/2) were calculated for weekly AFP and hCG values during HDCT starting with peak value during days 1-7 to avoid interference from lysis. T1/2 AFP≤7 days and hCG≤3 days were categorized as satisfactory (SAT); normalization within 7 days was also considered SAT regardless of T1/2. Pts with elevated AFP and hCG must have adequate decline in both to be SAT. Progression-free (PFS) and overall survival (OS) were compared for SAT vs unsatisfactory (UNSAT) using log-rank test and analyzed using Kaplan-Meier methods. Results: 2-yr PFS for pts with elevated STM at initiation of HDCT (N = 335) was inferior to pts with normal STM (N = 109) [49% vs. 89%; p < 0.001]. Among the 335 pts with elevated STM, 300 had non-seminoma and 35 had seminoma. Median age was 31 (range, 17-58). Primary site: testis (285), mediastinum (25), and retroperitoneum/other (25). Metastatic sites included retroperitoneum (267), lung (226), liver (81), brain (76), and bone (21). At initiation of HDCT, 73 pts had elevated AFP only, 215 had elevated hCG only, and 47 had elevated both AFP and hCG. Median AFP 9 (1-21,347) and hCG 115 (1-178,140). 307 pts (92%) completed 2 planned cycles of HDCT. Overall, 45/335 pts had SAT decline (13 for AFP; 29 for hCG; 3 for both). Pts with SAT STM decline had superior outcomes compared to UNSAT: 2-yr PFS 71% vs 46% (p = 0.004) and 2-yr OS 77% vs 52% (p = 0.004). When evaluating each STM separately, SAT decline in hCG had superior outcomes vs UNSAT: 2-yr PFS 76% vs 47% (p = 0.002). There was statistically non-significant difference in outcomes for AFP: 2-yr PFS 50% vs 43% (p = 0.55). Conclusions: SAT rate of STM decline predicts superior outcomes in pts with rGCT undergoing HDCT and PBSCT. Although UNSAT STM decline does not preclude long-term remissions, these pts are at higher risk of relapse and death.
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Affiliation(s)
- Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Sandra K. Althouse
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Hao Liu
- Indiana University Simon Cancer Center, Indianapolis, IN
| | - Rafat Abonour
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Costantine Albany
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Albany C, Adra N, Snavely AC, Cary C, Masterson TA, Foster RS, Kesler K, Ulbright TM, Cheng L, Chovanec M, Taza F, Ku K, Brames MJ, Hanna NH, Einhorn LH. Multidisciplinary clinic approach improves overall survival outcomes of patients with metastatic germ-cell tumors. Ann Oncol 2019; 29:341-346. [PMID: 29140422 DOI: 10.1093/annonc/mdx731] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background To report our experience utilizing a multidisciplinary clinic (MDC) at Indiana University (IU) since the publication of the International Germ Cell Cancer Collaborative Group (IGCCCG), and to compare our overall survival (OS) to that of the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program. Patients and methods We conducted a retrospective analysis of all patients with metastatic germ-cell tumor (GCT) seen at IU from 1998 to 2014. A total of 1611 consecutive patients were identified, of whom 704 patients received an initial evaluation by our MDC (including medical oncology, pathology, urology and thoracic surgery) and started first-line chemotherapy at IU. These 704 patients were eligible for analysis. All patients in this cohort were treated with cisplatin-etoposide-based combination chemotherapy. We compared the progression-free survival (PFS) and OS of patients treated at IU with that of the published IGCCCG cohort. OS of the IU testis cancer primary cohort (n = 622) was further compared with the SEER data of 1283 patients labeled with 'distant' disease. The Kaplan-Meier method was used to estimate PFS and OS. Results With a median follow-up of 4.4 years, patients with good, intermediate, and poor risk disease by IGCCCG criteria treated at IU had 5-year PFS of 90%, 84%, and 54% and 5-year OS of 97%, 92%, and 73%, respectively. The 5-year PFS for all patients in the IU cohort was 79% [95% confidence interval (CI) 76% to 82%]. The 5-year OS for the IU cohort was 90% (95% CI 87% to 92%). IU testis cohort had 5-year OS 94% (95% CI 91% to 96%) versus 75% (95% CI 73% to 78%) for the SEER 'distant' cohort between 2000 and 2014, P-value <0.0001. Conclusion The MDC approach to GCT at high-volume cancer center associated with improved OS outcomes in this contemporary dataset. OS is significantly higher in the IU cohort compared with the IGCCCG and SEER 'distant' cohort.
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Affiliation(s)
- C Albany
- Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
| | - N Adra
- Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - A C Snavely
- PDstat, Chapel Hill, Indiana University School of Medicine, Indianapolis, USA
| | - C Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
| | - T A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
| | - R S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
| | - K Kesler
- Thoracic Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - T M Ulbright
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - L Cheng
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - M Chovanec
- Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA; 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, USA; National Cancer Institute, Bratislava, Slovakia, USA
| | - F Taza
- Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - K Ku
- Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA; Division of Hematology & Medical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - M J Brames
- Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - N H Hanna
- Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - L H Einhorn
- Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
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Calaway AC, Tachibana I, Masterson TA, Foster RS, Einhorn LH, Cary C. Oncologic Outcomes Following Surgical Management of Clinical Stage II Sex Cord Stromal Tumors. Urology 2019; 127:74-79. [PMID: 30807775 DOI: 10.1016/j.urology.2019.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/09/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the clinical history of patients with clinical stage II sex cord stromal tumors who underwent retroperitoneal lymph node dissection (RPLND) at our institution. METHODS Our prospectively maintained testicular cancer database was queried to identify patients who presented with or developed clinical stage II sex cord stromal tumors and underwent RPLND at our institution between 1980 and 2018. Demographic, clinical, and pathologic characteristics were reviewed. Kaplan-Meier curves were graphed to assess recurrence-free and overall survival. RESULTS Fourteen patients were included in the study with a median age of 44.2years. Four patients presented with clinical stage II disease and 10 patients developed metastatic disease during follow-up of initial clinical stage I disease with a median time to metastasis of 2.7years (range: 0.4-19.5 years). Of the 10 patients with orchiectomy pathology data available, all patients had at least 1 risk factor on testis pathology (mean: 2.9 risk factors). Nine patients received treatment prior to referral to our institution. All patients recurred post-RPLND at Indiana University. Median recurrence-free survival was 9.8 months. Twelve patients died of disease with a median overall survival of 14.4 months. CONCLUSION Metastatic sex cord stromal tumors are rare and are more resistant to standard treatment modalities than metastatic germ cell tumors. Patients presenting with sex cord stromal tumors should consider prophylactic primary RPLND in the setting of 1 or more pathologic predictor of malignancy.
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Affiliation(s)
- Adam C Calaway
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN.
| | - Isamu Tachibana
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Timothy A Masterson
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Richard S Foster
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Lawrence H Einhorn
- Indiana University School of Medicine, Department of Oncology, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
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Calaway AC, Foster RS, Adra N, Masterson TA, Albany C, Hanna NH, Einhorn LH, Cary C. Risk of Bleomycin-Related Pulmonary Toxicities and Operative Morbidity After Postchemotherapy Retroperitoneal Lymph Node Dissection in Patients With Good-Risk Germ Cell Tumors. J Clin Oncol 2018; 36:2950-2954. [DOI: 10.1200/jco.18.00431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Three cycles of bleomycin, etoposide, and cisplatin (BEP × 3) or four cycles of etoposide and cisplatin (EP × 4) are first-line chemotherapy regimens for men with International Germ Cell Cancer Collaborative Group (IGCCCG) good-risk germ cell tumors (GCTs). We determined whether inclusion of bleomycin affected pulmonary and operative morbidity after postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). Patients and Methods We queried our database to identify IGCCCG good-risk patients who received BEP × 3 or EP × 4 induction chemotherapy before PC-RPLND from 2006 to 2016. Patients who received combination regimens were excluded. The primary outcomes of interest were pulmonary morbidity (prolonged intubation, reintubation, supplemental oxygen use, intensive care unit stay) and operative morbidity (operative time, length of stay, concomitant procedures, estimated blood loss). Results We analyzed 234 patients (191 BEP × 3 v 43 EP × 4). All patients were extubated immediately after the operation. None were reintubated or discharged on oxygen. Two patients in each cohort required an intensive care unit stay for nonpulmonary reasons. Patients treated with BEP required shorter use of supplemental oxygen (0.99 v 1.63 days; P = .005). No significant differences were found in preoperative mass size ( P = .42) or concomitant surgeries ( P = .58). Operative time was significantly shorter (131 v 170 minutes; P < .01), and estimated blood loss was considerably less (194 v 226 mL; P < .01) in patients treated with BEP. Length of stay was shorter in patients treated with BEP (3.3 v 3.9 days; P < .01). Conclusion In a modern surgical cohort, the inclusion of bleomycin does not seem to influence pulmonary morbidity, operative difficulty, or nonpulmonary postoperative complications after PC-RPLND in men with IGCCCG good-risk GST.
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Affiliation(s)
- Adam C. Calaway
- All authors: Indiana University School of Medicine, Indianapolis, IN
| | - Richard S. Foster
- All authors: Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- All authors: Indiana University School of Medicine, Indianapolis, IN
| | | | - Costa Albany
- All authors: Indiana University School of Medicine, Indianapolis, IN
| | - Nassar H. Hanna
- All authors: Indiana University School of Medicine, Indianapolis, IN
| | | | - Clint Cary
- All authors: Indiana University School of Medicine, Indianapolis, IN
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Bungart BL, Lan L, Wang P, Li R, Koch MO, Cheng L, Masterson TA, Dundar M, Cheng JX. Photoacoustic tomography of intact human prostates and vascular texture analysis identify prostate cancer biopsy targets. Photoacoustics 2018; 11:46-55. [PMID: 30109195 PMCID: PMC6088561 DOI: 10.1016/j.pacs.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/24/2018] [Accepted: 07/26/2018] [Indexed: 05/05/2023]
Abstract
Prostate cancer is poorly visualized on ultrasonography (US) so that current biopsy requires either a templated technique or guidance after fusion of US with magnetic resonance imaging. Here we determined the ability for photoacoustic tomography (PAT) and US followed by texture-based image processing to identify prostate biopsy targets. K-means clustering feature learning and testing was performed on separate datasets comprised of 1064 and 1197 nm PAT and US images of intact, ex vivo human prostates. 1197 nm PAT was found to not contribute to the feature learning, and thus, only 1064 nm PAT and US images were used for final feature testing. Biopsy targets, determined by the tumor-assigned pixels' center of mass, located 100% of the primary lesions and 67% of the secondary lesions. In conclusion, 1064 nm PAT and US texture-based feature analysis provided successful prostate biopsy targets.
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Affiliation(s)
- Brittani L. Bungart
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- Medical Scientist Training Program, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lu Lan
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Pu Wang
- Vibronix Inc., West Lafayette, IN, USA
| | - Rui Li
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- Vibronix Inc., West Lafayette, IN, USA
| | - Michael O. Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy A. Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Murat Dundar
- Computer and Information Science Department, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Ji-Xin Cheng
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
- Department of Electrical and Computer Engineering, Boston University, Boston, MA, USA
- Corresponding author at: Boston University Photonics Center, Boston University, 8 St. Mary’s Street, Boston, MA, 02215, USA.
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Thomas DE, Kaimakliotis HZ, Rice KR, Pereira JA, Johnston P, Moore ML, Reed A, Cregar DM, Franklin C, Loman RL, Koch MO, Bihrle R, Foster RS, Masterson TA, Gardner TA, Sundaram CP, Powell CR, Beck S, Grignon DJ, Cheng L, Albany C, Hahn NM. Commentary on "Prognostic effect of carcinoma in situ in muscle-invasive urothelial carcinoma patients receiving neoadjuvant chemotherapy.". Urol Oncol 2018; 36:345. [PMID: 29880459 DOI: 10.1016/j.urolonc.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carcinoma in situ (CIS) is a poor prognostic finding in urothelial carcinoma. However, its significance in muscle-invasive urothelial carcinoma (MIUC) treated with neoadjuvant chemotherapy (NAC) is uncertain. We assessed the effect of CIS found in pretreatment transurethral resection of bladder tumor (TURBT) biopsies on the pathologic and clinical outcomes. MATERIALS AND METHODS Subjects with MIUC treated with NAC before cystectomy were identified. The pathologic complete response (pCR) rates stratified by TURBT CIS status were compared. The secondary analyses included tumor response, progression-free survival (PFS), overall survival (OS), and an exploratory post hoc analysis of patients with pathologic CIS only (pTisN0) at cystectomy. RESULTS A total of 137 patients with MIUC were identified. TURBT CIS was noted in 30.7% of the patients. The absence of TURBT CIS was associated with a significantly increased pCR rate (23.2% vs. 9.5%; odds ratio = 4.08; 95% CI: 1.19-13.98; P = 0.025). Stage pTisN0 disease was observed in 19.0% of the TURBT CIS patients. TURBT CIS status did not significantly affect the PFS or OS outcomes. Post hoc analysis of the pTisN0 patients revealed prolonged median PFS (104.5 vs. 139.9 months; P = 0.055) and OS (104.5 vs. 152.3 months; P = 0.091) outcomes similar to those for the pCR patients. CONCLUSION The absence of CIS on pretreatment TURBT in patients with MIUC undergoing NAC was associated with increased pCR rates, with no observed differences in PFS or OS. Isolated CIS at cystectomy was frequently observed, with lengthy PFS and OS durations similar to those for pCR patients. Further studies aimed at understanding the biology and clinical effect of CIS in MIUC are warranted.
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Taza F, Chovanec M, Snavely A, Adra N, Hanna NH, Cary C, Masterson TA, Einhorn LH, Albany C. Retroperitoneal cancer viability after postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in good risk germ cell tumors (GCTs). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4551] [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: 11/20/2022] Open
Affiliation(s)
- Fadi Taza
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, IN
| | - Michal Chovanec
- Comenius University and National Cancer Institute, Bratislava, Slovakia
| | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Costantine Albany
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Taza F, Chovanec M, Snavely A, Adra N, Hanna NH, Cary C, Masterson TA, Einhorn LH, Albany C. The prognostic value of teratoma in the primary tumor and postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) specimens in patients with germ cell tumors (GCTs). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4553] [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: 11/20/2022] Open
Affiliation(s)
- Fadi Taza
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, IN
| | - Michal Chovanec
- Comenius University and National Cancer Institute, Bratislava, Slovakia
| | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Costantine Albany
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Cary C, Kalra M, Menendez AG, Masterson TA, Foster R, Einhorn LH. A pilot study to assess the accuracy of “intuition” in analyzing post chemotherapy (chemo) residual retroperitoneal (RP) masses in patients (pts) with non seminomatous germ cell tumor (NSCGCT). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Clint Cary
- Indiana University School of Medicine, Indianapolis, IN
| | - Maitri Kalra
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Shum CF, Bahler CD, Cary C, Masterson TA, Boris RS, Gardner TA, Kaimakliotis HZ, Foster RS, Bihrle R, Koch MO, Slaven JE, Sundaram CP. Preoperative Nomograms for Predicting Renal Function at 1 Year After Partial Nephrectomy. J Endourol 2018; 31:711-718. [PMID: 28443676 DOI: 10.1089/end.2017.0184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 01/11/2023] Open
Abstract
INTRODUCTION Partial nephrectomy (PN) reduces the risk of postoperative chronic renal insufficiency (CRI). However, some patients still develop CRI after PN, and may eventually require dialysis. Being able to predict renal function before PN helps in counseling patients and managing expectations. We aimed to construct nomograms that predict estimated glomerular filtration rates (eGFRs), defined by the modification of diet in renal disease (MDRD) and the chronic kidney disease epidemiology collaboration (CKD-EPI) formulae, at 1 year after PN, using only preoperative covariates as predictors. PATIENTS AND METHODS We identified patients who underwent PN in our institution between 2004 and 2016, with known postoperative serum creatinine levels at 1 year. The preoperative covariates included patients' demographics, chronic comorbid conditions, tumor characteristics, and preoperative renal status. The endpoints were eGFRs at 1 year after PN, calculated using the MDRD and the CKD-EPI formulae. We first identified preoperative covariates with significant associations with the endpoints by Pearson correlation and independent samples t-test. Suitable covariates were then included in two multivariate linear regression models, for constructing and internally validating two nomograms. RESULTS 461 patients were eligible for analysis. The percentage of patients with eGFR below 60 mL/min/1.73 m2 increased from 25% before PN to 35% at 1 year after PN. We included age, gender, African American race, body mass index, preoperative creatinine level, ipsilateral renal volume, solitary kidney status, tumor diameter, hypertension, diabetes, ischemic heart disease, and previous stroke in the multivariate linear regression models for nomogram construction. Internal validation showed bootstrap-corrected coefficients of determination of 0.61 and 0.70, for predicting eGFRs defined by the MDRD and CKD-EPI formulae, respectively. CONCLUSIONS We constructed and internally validated two nomograms to predict eGFRs at 1 year after PN, using only preoperative covariates as predictors.
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Affiliation(s)
- Cheuk Fan Shum
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Clinton D Bahler
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Clint Cary
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Timothy A Masterson
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Ronald S Boris
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Thomas A Gardner
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | | | - Richard S Foster
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Richard Bihrle
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Michael O Koch
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - James E Slaven
- 2 Department of Biostatistics, Indiana University School of Medicine , Indianapolis, Indiana
| | - Chandru P Sundaram
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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Cary C, Jacob JM, Albany C, Masterson TA, Hanna NH, Einhorn LH, Foster RS. Long-Term Survival of Good-Risk Germ Cell Tumor Patients After Postchemotherapy Retroperitoneal Lymph Node Dissection: A Comparison of BEP × 3 vs. EP × 4 and Treating Institution. Clin Genitourin Cancer 2017; 16:e307-e313. [PMID: 29104087 DOI: 10.1016/j.clgc.2017.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/03/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with International Germ Cell Cancer Collaborative Group (IGCCCG) good-risk testicular cancer might receive either 4 cycles of etoposide and cisplatin (EP × 4) or 3 cycles of bleomycin, etoposide, and cisplatin (BEP × 3). We sought to examine differences in survival after retroperitoneal lymph node dissection (PC-RPLND) between patients who received EP × 4 compared with BEP × 3. PATIENTS AND METHODS The Indiana University Testis Cancer database was queried to identify IGCCCG good-risk PC-RPLND patients who received either EP × 4 or BEP × 3 induction chemotherapy. The primary outcome was overall survival (OS). Kaplan-Meier plots were generated for the EP × 4 and BEP × 3 groups and compared using the log rank test. Cox regression analysis was used to determine risk of mortality. RESULTS A total of 223 patients met inclusion criteria between 1985 and 2011. Induction chemotherapy consisted of EP × 4 in 45 (20%) patients and BEP × 3 in 178 (80%). Most patients (78%) received their chemotherapy at outside institutions and were subsequently referred for PC-RPLND. The location of treating institution did not influence outcomes significantly when similar chemotherapy regimens were compared in this good-risk cohort. The 10-year OS for the EP × 4 and BEP × 3 groups were 91% and 98%, respectively (log rank P < .01). The adjusted risk of death in the EP × 4 group showed a nonsignificant trend of 3 times greater compared with the BEP × 3 group (hazard ratio, 3.1; 95% confidence interval, 0.8-12.0; P = .10). CONCLUSION The regimen of BEP × 3 resulted in a trend toward improved survival, however, this did not reach statistical significance. The location of treating institution seems less important in this risk group of patients.
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Affiliation(s)
- Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
| | - Joseph M Jacob
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Costantine Albany
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Nasser H Hanna
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN
| | - Lawrence H Einhorn
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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43
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Abel EJ, Masterson TA, Karam JA, Master VA, Margulis V, Hutchinson R, Lorentz CA, Bloom E, Bauman TM, Wood CG, Blute ML. Predictive Nomogram for Recurrence following Surgery for Nonmetastatic Renal Cell Cancer with Tumor Thrombus. J Urol 2017; 198:810-816. [DOI: 10.1016/j.juro.2017.04.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- E. Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Timothy A. Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jose A. Karam
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryan Hutchinson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - C. Adam Lorentz
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Evan Bloom
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tyler M. Bauman
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher G. Wood
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Michael L. Blute
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Abstract
Penile cancer is a rare neoplasm representing less than 1% of all malignancies in the USA and Europe but is a significant public health hazard in the developing world. Male neonatal circumcision has been associated with a dramatic decrease in penile cancer rates with countries such as Israel, where circumcision is widely performed, having the lowest incidence in the world at <0.1% of malignancies. Many risk factors have been identified for penile cancer including phimosis, lack of circumcision, obesity, lichen sclerosis, chronic inflammation, smoking, UVA phototherapy, socioeconomic status, human papillomavirus (HPV) infection and immune compromised states. The relationship between these factors and invasive disease varies and continues to be investigated. Our objective was to present a contemporary overview of the epidemiology and risk factors for invasive penile cancer.
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Affiliation(s)
- Antoin Douglawi
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Harari SE, Sassoon DJ, Priemer DS, Jacob JM, Eble JN, Caliò A, Grignon DJ, Idrees M, Albany C, Masterson TA, Hanna NH, Foster RS, Ulbright TM, Einhorn LH, Cheng L. Testicular cancer: The usage of central review for pathology diagnosis of orchiectomy specimens. Urol Oncol 2017. [PMID: 28647396 DOI: 10.1016/j.urolonc.2017.05.018] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Radical orchiectomy specimens present a unique set of challenges for pathology assessment owing to their rarity and complexity. This study compares second opinion pathology reports generated at a single, large academic institution to primary reports from outside hospitals. METHODS A database search was conducted for orchiectomy cases that were sent to our institution for management of testicular cancer from 2014 to 2015. Cases sent for consultation without a finalized diagnosis from the outside hospitals were excluded. A total of 221 consecutive cases were evaluated for comparison of final diagnoses between the outside institution and central pathology review. RESULTS This study revealed significant discrepancy involving multiple parameters between original and second opinion pathology reports. Of 221 cases of germ cell tumors assessed, 31% showed some discrepancy of histologic subtype. Overall, reporting of lymphovascular invasion changed in 22% of cases; of those, initially called positive 23% were changed to negative and of those initially called negative 12% were changed to positive. Although the overall discrepancy for spermatic cord invasion was 9%, an initial positive diagnosis was negated 35% of the time. The pathologic stage was altered in 23% of cases, mostly secondary to differences interpreting lymphovascular and spermatic cord invasion. CONCLUSION Pathologists evaluating orchiectomy specimens should be aware of the major pitfalls in classification and staging, many of which may affect patient management.
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Affiliation(s)
- Saul E Harari
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Daniel J Sassoon
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
| | - David S Priemer
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Joseph M Jacob
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - John N Eble
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Anna Caliò
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - David J Grignon
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Mohammed Idrees
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Costantine Albany
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Nasser H Hanna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Thomas M Ulbright
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Lawrence H Einhorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
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46
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Affiliation(s)
- Joel Sheinfeld
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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47
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Cho JS, Kaimakliotis HZ, Cary C, Masterson TA, Beck S, Foster R. Modified retroperitoneal lymph node dissection for post-chemotherapy residual tumour: a long-term update. BJU Int 2017; 120:104-108. [DOI: 10.1111/bju.13844] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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)
- Jane S. Cho
- Department of Urology; Indiana University School of Medicine; Indianapolis IN USA
| | | | - Clint Cary
- Department of Urology; Indiana University School of Medicine; Indianapolis IN USA
| | - Timothy A. Masterson
- Department of Urology; Indiana University School of Medicine; Indianapolis IN USA
| | - Stephen Beck
- Department of Urology; Southern Illinois University School of Medicine; Springfield IL USA
| | - Richard Foster
- Department of Urology; Indiana University School of Medicine; Indianapolis IN USA
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48
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Jacob JM, Mehan R, Beck SD, Cary C, Masterson TA, Bihrle R, Foster RS. Management of Pelvic Metastases in Patients With Testicular Cancer. Urology 2017; 102:159-163. [DOI: 10.1016/j.urology.2016.08.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022]
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Hahn NM, Bivalacqua TJ, Ross AE, Netto GJ, Baras A, Park JC, Chapman C, Masterson TA, Koch MO, Bihrle R, Foster RS, Gardner TA, Cheng L, Jones DR, McElyea K, Sandusky GE, Breen T, Liu Z, Albany C, Moore ML, Loman RL, Reed A, Turner SA, De Abreu FB, Gallagher T, Tsongalis GJ, Plimack ER, Greenberg RE, Geynisman DM. A Phase II Trial of Dovitinib in BCG-Unresponsive Urothelial Carcinoma with FGFR3 Mutations or Overexpression: Hoosier Cancer Research Network Trial HCRN 12-157. Clin Cancer Res 2016; 23:3003-3011. [PMID: 27932416 DOI: 10.1158/1078-0432.ccr-16-2267] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022]
Abstract
Purpose: To assess the clinical and pharmacodynamic activity of dovitinib in a treatment-resistant, molecularly enriched non-muscle-invasive urothelial carcinoma of the bladder (NMIUC) population.Experimental Design: A multi-site pilot phase II trial was conducted. Key eligibility criteria included the following: Bacillus Calmette-Guerin (BCG)-unresponsive NMIUC (>2 prior intravesical regimens) with increased phosphorylated FGFR3 (pFGFR3) expression by centrally analyzed immunohistochemistry (IHC+) or FGFR3 mutations (Mut+) assessed in a CLIA-licensed laboratory. Patients received oral dovitinib 500 mg daily (5 days on/2 days off). The primary endpoint was 6-month TURBT-confirmed complete response (CR) rate.Results: Between 11/2013 and 10/2014, 13 patients enrolled (10 IHC+ Mut-, 3 IHC+ Mut+). Accrual ended prematurely due to cessation of dovitinib clinical development. Demographics included the following: median age 70 years; 85% male; carcinoma in situ (CIS; 3 patients), Ta/T1 (8 patients), and Ta/T1 + CIS (2 patients); median prior regimens 3. Toxicity was frequent with all patients experiencing at least one grade 3-4 event. Six-month CR rate was 8% (0% in IHC+ Mut-; 33% in IHC+ Mut+). The primary endpoint was not met. Pharmacodynamically active (94-5,812 nmol/L) dovitinib concentrations in urothelial tissue were observed in all evaluable patients. Reductions in pFGFR3 IHC staining were observed post-dovitinib treatment.Conclusions: Dovitinib consistently achieved biologically active concentrations within the urothelium and demonstrated pharmacodynamic pFGFR3 inhibition. These results support systemic administration as a viable approach to clinical trials in patients with NMIUC. Long-term dovitinib administration was not feasible due to frequent toxicity. Absent clinical activity suggests that patient selection by pFGFR3 IHC alone does not enrich for response to FGFR3 kinase inhibitors in urothelial carcinoma. Clin Cancer Res; 23(12); 3003-11. ©2016 AACR.
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Affiliation(s)
- Noah M Hahn
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland. .,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Trinity J Bivalacqua
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Ashley E Ross
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - George J Netto
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Alex Baras
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Jong Chul Park
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Carolyn Chapman
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Timothy A Masterson
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Michael O Koch
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Richard Bihrle
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Richard S Foster
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Thomas A Gardner
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - David R Jones
- Department of Clinical Pharmacology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Kyle McElyea
- Department of Pathology and Laboratory Medicine, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - George E Sandusky
- Department of Pathology and Laboratory Medicine, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Timothy Breen
- Hoosier Cancer Research Network, Indianapolis, Indiana
| | - Ziyue Liu
- Indiana University Department of Biostatistics, Schools of Public Health and Medicine, Indianapolis, Indiana
| | - Costantine Albany
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Marietta L Moore
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Rhoda L Loman
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Angela Reed
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Scott A Turner
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Francine B De Abreu
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Torrey Gallagher
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Gregory J Tsongalis
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Elizabeth R Plimack
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Daniel M Geynisman
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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50
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Thomas DE, Kaimakliotis HZ, Rice KR, Pereira JA, Johnston P, Moore ML, Reed A, Cregar DM, Franklin C, Loman RL, Koch MO, Bihrle R, Foster RS, Masterson TA, Gardner TA, Sundaram CP, Powell CR, Beck SDW, Grignon DJ, Cheng L, Albany C, Hahn NM. Prognostic Effect of Carcinoma In Situ in Muscle-invasive Urothelial Carcinoma Patients Receiving Neoadjuvant Chemotherapy. Clin Genitourin Cancer 2016; 15:479-486. [PMID: 28040424 DOI: 10.1016/j.clgc.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/28/2016] [Revised: 11/16/2016] [Accepted: 11/20/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Carcinoma in situ (CIS) is a poor prognostic finding in urothelial carcinoma. However, its significance in muscle-invasive urothelial carcinoma (MIUC) treated with neoadjuvant chemotherapy (NAC) is uncertain. We assessed the effect of CIS found in pretreatment transurethral resection of bladder tumor (TURBT) biopsies on the pathologic and clinical outcomes. MATERIALS AND METHODS Subjects with MIUC treated with NAC before cystectomy were identified. The pathologic complete response (pCR) rates stratified by TURBT CIS status were compared. The secondary analyses included tumor response, progression-free survival (PFS), overall survival (OS), and an exploratory post hoc analysis of patients with pathologic CIS only (pTisN0) at cystectomy. RESULTS A total of 137 patients with MIUC were identified. TURBT CIS was noted in 30.7% of the patients. The absence of TURBT CIS was associated with a significantly increased pCR rate (23.2% vs. 9.5%; odds ratio, 4.08; 95% confidence interval, 1.19-13.98; P = .025). Stage pTisN0 disease was observed in 19.0% of the TURBT CIS patients. TURBT CIS status did not significantly affect the PFS or OS outcomes. Post hoc analysis of the pTisN0 patients revealed prolonged median PFS (104.5 vs. 139.9 months; P = .055) and OS (104.5 vs. 152.3 months; P = .091) outcomes similar to those for the pCR patients. CONCLUSION The absence of CIS on pretreatment TURBT in patients with MIUC undergoing NAC was associated with increased pCR rates, with no observed differences in PFS or OS. Isolated CIS at cystectomy was frequently observed, with lengthy PFS and OS durations similar to those for pCR patients. Further studies aimed at understanding the biology and clinical effect of CIS in MIUC are warranted.
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Affiliation(s)
- Derek E Thomas
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Hristos Z Kaimakliotis
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Kevin R Rice
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Jose A Pereira
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Paul Johnston
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Marietta L Moore
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Angela Reed
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Dylan M Cregar
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Cindy Franklin
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Rhoda L Loman
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Michael O Koch
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Bihrle
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard S Foster
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy A Masterson
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Thomas A Gardner
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Chandru P Sundaram
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Charles R Powell
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Stephen D W Beck
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - David J Grignon
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Liang Cheng
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Costantine Albany
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Noah M Hahn
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD.
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