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Schaeffer EM, Srinivas S, Adra N, An Y, Bitting R, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Karnes RJ, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Szmulewitz R, Teply BA, Tward J, Valicenti R, Wong JK, Snedeker J, Freedman-Cass DA. Prostate Cancer, Version 3.2024. J Natl Compr Canc Netw 2024; 22:140-150. [PMID: 38626801 DOI: 10.6004/jnccn.2024.0019] [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] [Indexed: 04/19/2024]
Abstract
The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. These NCCN Guidelines Insights summarize the panel's discussions for the 2024 update to the guidelines with regard to initial risk stratification, initial management of very-low-risk disease, and the treatment of nonmetastatic recurrence.
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Affiliation(s)
| | | | - Nabil Adra
- 3Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- 4Yale Cancer Center/Smilow Cancer Hospital
| | | | - Brian Chapin
- 6The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- 9UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 13Mass General Cancer Center
| | - Shilpa Gupta
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- 15Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- 16Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Tamara Lotan
- 20The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Todd Morgan
- 22University of Michigan Rogel Cancer Center
| | | | | | - Mack Roach
- 25UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- 27University of California San Francisco Patient Services Committee
| | - Ahmad Shabsigh
- 28The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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2
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Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, Bryce A, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Netto G, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Teply BA, Tward J, Valicenti R, Wong JK, Shead DA, Snedeker J, Freedman-Cass DA. Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:1067-1096. [PMID: 37856213 DOI: 10.6004/jnccn.2023.0050] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
The NCCN Guidelines for Prostate Cancer provide a framework on which to base decisions regarding the workup of patients with prostate cancer, risk stratification and management of localized disease, post-treatment monitoring, and treatment of recurrence and advanced disease. The Guidelines sections included in this article focus on the management of metastatic castration-sensitive disease, nonmetastatic castration-resistant prostate cancer (CRPC), and metastatic CRPC (mCRPC). Androgen deprivation therapy (ADT) with treatment intensification is strongly recommended for patients with metastatic castration-sensitive prostate cancer. For patients with nonmetastatic CRPC, ADT is continued with or without the addition of certain secondary hormone therapies depending on prostate-specific antigen doubling time. In the mCRPC setting, ADT is continued with the sequential addition of certain secondary hormone therapies, chemotherapies, immunotherapies, radiopharmaceuticals, and/or targeted therapies. The NCCN Prostate Cancer Panel emphasizes a shared decision-making approach in all disease settings based on patient preferences, prior treatment exposures, the presence or absence of visceral disease, symptoms, and potential side effects.
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Affiliation(s)
| | | | - Nabil Adra
- 3Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- 4Yale Cancer Center/Smilow Cancer Hospital
| | | | | | - Alan Bryce
- 7Mayo Clinic Comprehensive Cancer Center
| | - Brian Chapin
- 8The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- 11UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 10Dana-Farber/Brigham and Women's Cancer Center | Mass General Cancer Center
| | - Shilpa Gupta
- 15Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- 16Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- 17Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Tamara Lotan
- 20The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Todd Morgan
- 22University of Michigan Rogel Cancer Center
| | | | | | | | - Mack Roach
- 26UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- 28University of California San Francisco, Patient Services Committee Chair
| | - Ahmad Shabsigh
- 29The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- 15Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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3
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Feng BJ, Kohlmann W, Nix DA, Atkinson A, Boucher KM, Carroll C, Kolesar J, Singer EA, Edge SB, Sahu K, Sanchez A, Larson M, Churchman ML, Graham L, Carpten JD, Zakharia Y, Byrne L, Jain RK, Nepple KG, Shabsigh A, Chahoud J, Gupta S. Abstract 6074: Germline and somatic genomic profiling of urothelial carcinoma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-6074] [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: 04/07/2023]
Abstract
Abstract
Urothelial carcinoma (UC) presents most frequently as bladder cancer and is the most common cancer of the urinary system in the United States. UC relapse and progression are common and impose a significant negative impact on the lives of patients and healthcare resources. To elucidate the biological mechanisms of UC and find novel biomarkers, we analyzed the clinical and genomic data in the Oncology Research Information Exchange Network (ORIEN). We conducted gene-based and gene-set based association tests on rare germline variants comparing the exome sequencing of 336 UC patients and genome sequencing of 366 healthy controls (42 unrelated individuals from the Centre d'Etudes du Polymorphisme Humain [CEPH] families and 324 from the University of Utah Heritage 1000 [H1K] Projects). The analysis of loss-of-function (LoF) variants revealed that the forkhead box (FOX) J2 gene set was significantly associated with UC at the genome-wide level (Bonferroni-corrected p-value=0.01). Genes in this gene set contain a motif that matches the FOXJ2 transcription factor binding site. Firth-penalized Cox proportional hazard regression on overall survival identified LoF variants in genes down-regulated in naive CD8 T cells to be associated with worse prognosis (Bonferroni-corrected p-value=0.032, hazard ratio=28.2, and 95% confidence interval 6.66 to 119.0). In exome sequencing of tumor tissues, we searched for driver genes and pathways by testing for higher variant allelic fractions than the genome average. The tests yielded eleven genes with genome-wide significance (Table 1). By gene set analysis using the MSigDB Hallmark database, significant pathways included the P53 pathway (p<2 × 10−16), Wnt beta-catenin signaling (p<2 × 10−16), E2F targets (p=8 × 10−13), PI3K/AKT/mTOR signaling (4 × 10−7), and apoptosis (p=9 × 10−7). These results reveal the germline predisposition variants and somatic oncogenic drivers in UC and suggest immune evasion as a contributing factor for poor clinical outcomes in UC patients.
Table 1. Genes with high allelic fractions Gene P-value Number of Variants TP53 <2 × 10−16 203 RB1 2.42 × 10−16 67 ELF3 2.06 × 10−7 38 TSC1 4.05 × 10−7 32 KMT2D 7.59 × 10−7 91 ZFP36L1 8.80 × 10−7 33 CDKN1A 2.47 × 10−6 40 FGFR3 1.11 × 10−5 37 ARID1A 1.28 × 10−5 62 SMARCA4 1.53 × 10−5 17 PIK3CA 2.00 × 10−5 53
Citation Format: Bing-Jian Feng, Wendy Kohlmann, David A. Nix, Aaron Atkinson, Kenneth M. Boucher, Courtney Carroll, Jill Kolesar, Eric A. Singer, Stephen B. Edge, Kamal Sahu, Alejandro Sanchez, Mikaela Larson, Michelle L. Churchman, Laura Graham, John D. Carpten, Yousef Zakharia, Lindsey Byrne, Rohit K. Jain, Kenneth G. Nepple, Ahmad Shabsigh, Jad Chahoud, Sumati Gupta. Germline and somatic genomic profiling of urothelial carcinoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6074.
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Affiliation(s)
| | | | | | | | | | | | | | - Eric A. Singer
- 4Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Kamal Sahu
- 2Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | | | | | | | | | - Lindsey Byrne
- 10Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Ahmad Shabsigh
- 10Ohio State University Comprehensive Cancer Center, Columbus, OH
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Dason S, Sheetz T, Ray S, Zimmerman DE, Yin M, Folefac E, Mortazavi A, Gong M, Shabsigh A, Singer EA. Impact of systemic therapy (ST) on deferred cytoreductive nephrectomy (CN) perioperative outcomes: A National Surgical Quality Improvement Program (NSQIP) analysis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.650] [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: 03/18/2023] Open
Abstract
650 Background: Management of metastatic renal cell carcinoma (mRCC) is highly individualized and often involves cytoreductive nephrectomy (CN) and systemic therapy (ST). The optimal sequencing of CN and ST is uncertain. A difference in perioperative outcomes based on sequence of CN and ST could influence decision-making. We conducted this NSQIP analysis to assess whether preoperative systemic therapy adversely impacted perioperative outcomes in patients receiving deferred CN. Methods: This analysis was conducted using the American College of Surgeons NSQIP Participant Use Data File for years 2019 and 2020. These years were selected because data on receipt of preoperative therapy is only available since 2019. Inclusion criteria were i) CPT code consistent with nephrectomy, ii) urologist operating surgeon & iii) presence of disseminated cancer. All cases with ICD-10 diagnosis codes not consistent with mRCC were excluded. Groups were stratified by their receipt of preoperative systemic therapy within 90 days before CN and we assessed 46 preoperative and perioperative outcomes. Results: The study cohort included 505 patients with 115 (23%) who received preoperative ST. No differences were noted in perioperative outcomes (Table). Patients receiving preoperative ST were more likely to be on steroids (23% vs. 7%, p<0.01) and develop urinary tract infections (4.3% vs. 0.5%, p<0.01). There were no significant differences noted in other related variables like surgical site infections, wound dehiscence, sepsis, septic shock, pneumonia, cardiovascular complications, preoperative hypertension, or preoperative diabetes (p>0.05). Conclusions: Because preoperative ST did not have an appreciable impact on deferred CN perioperative outcomes, decision making for ST and CN sequencing should not be influenced by perioperative outcomes. Those who undergo deferred CN are unlikely to experience delayed time to surgery or perioperative complications from their ST. [Table: see text]
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Affiliation(s)
- Shawn Dason
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Tyler Sheetz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Shagnik Ray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Ming Yin
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Edmund Folefac
- The Ohio State University Comprehensive Cancer Center – James Cancer Hospital & Solove Research Institute, Columbus, OH
| | - Amir Mortazavi
- The Ohio State University Comprehensive Cancer Center, Division of Medical Oncology, Columbus, OH
| | - Michael Gong
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ahmad Shabsigh
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Eric A. Singer
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, Bryce A, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Netto G, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Teply BA, Tward J, Valicenti R, Wong JK, Berardi RA, Shead DA, Freedman-Cass DA. NCCN Guidelines® Insights: Prostate Cancer, Version 1.2023. J Natl Compr Canc Netw 2022; 20:1288-1298. [PMID: 36509074 DOI: 10.6004/jnccn.2022.0063] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The NCCN Guidelines for Prostate Cancer address staging and risk assessment after a prostate cancer diagnosis and include management options for localized, regional, recurrent, and metastatic disease. The NCCN Prostate Cancer Panel meets annually to reevaluate and update their recommendations based on new clinical data and input from within NCCN Member Institutions and from external entities. These NCCN Guidelines Insights summarizes much of the panel's discussions for the 4.2022 and 1.2023 updates to the guidelines regarding systemic therapy for metastatic prostate cancer.
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Affiliation(s)
| | | | - Nabil Adra
- 3Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- 4Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - Brian Chapin
- 8The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- 11UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 15Massachusetts General Hospital Cancer Center
| | - Shilpa Gupta
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- 17Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- 18Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Tamara Lotan
- 21The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Todd Morgan
- 23University of Michigan Rogel Cancer Center
| | | | | | | | - Mack Roach
- 27UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- 29University of California San Francisco Patient Services
| | - Ahmad Shabsigh
- 30The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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6
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Kohlmann W, Nix D, Atkinson A, Boucher KM, Kolesar J, Singer EA, Edge SB, Quintana B, Churchman ML, Feng B, Graham L, Carpten JD, Sanchez A, Zakharia Y, Byrne L, Jain RK, Nepple KG, Shabsigh A, Chahoud J, Gupta S. Inherited germline variants in urothelial cancer: A multicenter whole-exome sequencing analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.451] [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
451 Background: Outside of Lynch syndrome, few genetic factors have been associated with urothelial cancer (UC). This project seeks to describe the frequency of germline variants in a multi-center UC cohort. Methods: Patients diagnosed with UC from 1980 to 2019 and consented to the Total Cancer Care protocol by members of the Oncology Research Information Exchange Network (ORIEN) were included in the study. The ORIEN program includes a convenience sample of cases with both germline and tumor samples available, though this analysis was germline only. Whole exome sequencing data were analyzed using a GATK best practices for germline variant analysis. A series of quality control (allele frequency > = 0.3, read depth > = 20, genotype quality > = 20), annotation, functional impact (loss of function/splicing), and region (cancer predisposition genes/pathways) filters were applied to identify variants of significant consequence. Results: 348 exomes were evaluated. This identified 60 variants classified as pathogenic/likely pathogenic (P/LP) and 17 novel, high impact variants in genes associated with high, moderate, or recessively inherited cancer risk in 77 individuals (22.1%). 15 (4.5%) had P/LP variants in genes associated with a high or moderate cancer risk, and 10 (3%) of these variants were considered to be clinically actionable with associated with cancer screening, risk reduction or treatment recommendations. The high/moderate risk genes with P/LP variants included CHEK2 (n = 5), FANCM (n = 4), MSH6 (n = 2) and single cases of MSH2, BRCA2, ERCC3, and BRIP1. The average age of diagnosis in those with and without a high/moderate risk P/LP variant was 67.6 (57-80 yrs) and 68.9 (45-91 yrs). Family history of cancer was reported for 73% of those with a germline LP/PV and 60% of those without, but this trend was not significant (p =.44). Conclusions: Individuals with UC have a high frequency of germline variants that warrant further study for association with cancer risk. A smaller, but significant portion also carry germline variants that may be clinically relevant to them and/or family members. Currently UC is not included in genetic testing criteria. This study adds to the growing body of research indicating that diverse types of cancer patients harbor germline variants. Strategies for expanding testing should be considered.
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Affiliation(s)
- Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - David Nix
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aaron Atkinson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Branda Quintana
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Bingjian Feng
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Laura Graham
- Division of Medical Oncology, University of Colorado, Aurora, CO
| | | | | | | | | | | | | | | | | | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Venkatramani V, Reis IM, Gonzalgo ML, Castle EP, Woods ME, Svatek RS, Weizer AZ, Konety BR, Tollefson M, Krupski TL, Smith ND, Shabsigh A, Barocas DA, Quek ML, Dash A, Parekh DJ. Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2148329. [PMID: 35171260 PMCID: PMC8851298 DOI: 10.1001/jamanetworkopen.2021.48329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE No data exist on time to recovery of patient-reported and performance-related measures of functional independence after radical cystectomy (open or robotic). OBJECTIVE To determine recovery of functional independence after radical cystectomy and whether robot-assisted radical cystectomy (RARC) is associated with any advantage over open procedures. DESIGN, SETTING, AND PARTICIPANTS Data for this secondary analysis from the RAZOR (Randomized Open vs Robotic Cystectomy) trial were used. RAZOR was a phase 3 multicenter noninferiority trial across 15 academic medical centers in the US from July 1, 2011, to November 18, 2014, with a median follow-up of 2 years. Participants included the per-protocol population (n = 302). Data were analyzed from February 1, 2017, to May 1, 2021. INTERVENTIONS Robot-assisted radical cystectomy or open radical cystectomy (ORC). MAIN OUTCOMES AND MEASURES Patient-reported (activities of daily living [ADL] and independent ADL [iADL]) and performance-related (hand grip strength [HGS] and Timed Up & Go walking test [TUGWT]) measures of independence were assessed. Patterns of postoperative recovery for the entire cohort and comparisons between RARC and ORC were performed. Exploratory analyses to assess measures of independence across diversion type and to determine whether baseline impairments were associated with 90-day complications or 1-year mortality were performed. FINDINGS Of the 302 patients included in the analysis (254 men [84.1%]; mean [SD] age at consent, 68.0 [9.7] years), 150 underwent RARC and 152 underwent ORC. Baseline characteristics were similar in both groups. For the entire cohort, ADL, iADL, and TUGWT recovered to baseline by 3 postoperative months, whereas HGS recovered by 6 months. There was no difference between RARC and ORC for ADL, iADL, TUGWT, or HGS scores at any time. Activities of daily living recovered 1 month after RARC (mean estimated score, 7.7 [95% CI, 7.3-8.0]) vs 3 months after ORC (mean estimated score, 7.5 [95% CI, 7.2-7.8]). Hand grip strength recovered by 3 months after RARC (mean estimated HGS, 29.0 [95% CI, 26.3-31.7] kg) vs 6 months after ORC (mean estimated HGS, 31.2 [95% CI, 28.8-34.2] kg). In the RARC group, 32 of 90 patients (35.6%) showed a recovery in HGS at 3 months vs 32 of 88 (36.4%) in the ORC group (P = .91), indicating a rejection of the primary study hypothesis for HGS. Independent ADL and TUGWT recovered in 3 months for both approaches. Hand grip strength showed earlier recovery in patients undergoing continent urinary diversion (mean HGS at 3 months, 31.3 [95% CI, 27.7-34.8] vs 33.9 [95% CI, 30.5-37.3] at baseline; P = .09) than noncontinent urinary diversion (mean HGS at 6 months, 27.4 [95% CI, 24.9-30.0] vs 29.5 [95% CI, 27.2-31.9] kg at baseline; P = .02), with no differences in other parameters. Baseline impairments in any parameter were not associated with 90-day complications or 1-year mortality. CONCLUSIONS AND RELEVANCE The results of this secondary analysis suggest that patients require 3 to 6 months to recover baseline levels after radical cystectomy irrespective of surgical approach. These data will be invaluable in patient counseling and preparation. Hand grip strength and ADL tended to recover to baseline earlier after RARC; however, there was no difference in the percentage of patients recovering when compared with ORC. Further study is needed to assess the clinical significance of these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01157676.
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Affiliation(s)
- Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Isildinha M. Reis
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mark L. Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Erik P. Castle
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Michael E. Woods
- Department of Urology, University of North Carolina at Chapel Hill
| | - Robert S. Svatek
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio
| | - Alon Z. Weizer
- Department of Urology, University of Michigan, Ann Arbor
| | | | | | - Tracey L. Krupski
- Department of Urology, University of Virginia Health Science Center, Charlottesville
| | - Norm D. Smith
- Department of Urology, North Shore University Health System, Evanston, Illinois
| | | | - Daniel A. Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus L. Quek
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Atreya Dash
- Department of Urology, University of Washington, Seattle
| | - Dipen J. Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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8
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Sardana R, Parwani AV, Shabsigh A, Sheldon J. An unusual case of renal Ewing sarcoma: A case report and review of literature. Human Pathology: Case Reports 2021. [DOI: 10.1016/j.ehpc.2021.200537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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9
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Shabsigh A, Kleinmann N, Smith AB, Scherr D, Seltzer E, Schoenberg M, Lerner SP. Pharmacokinetics of UGN-101, a mitomycin-containing reverse thermal gel instilled via retrograde catheter for the treatment of low-grade upper tract urothelial carcinoma. Cancer Chemother Pharmacol 2021; 87:799-805. [PMID: 33677615 PMCID: PMC8110485 DOI: 10.1007/s00280-021-04246-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/05/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the pharmacokinetic properties of UGN-101, a mitomycin-containing reverse thermal gel used as primary chemoablative treatment for low-grade upper tract urothelial carcinoma (UTUC), in a subset of patients participating in a phase 3 clinical trial. METHODS Pharmacokinetic parameters (Cmax, Tmax, AUC(0-6), λz, t½, and AUCinf) were evaluated in six participants (male or female, ≥ 18 years) with biopsy-proven, low-grade UTUC who received the first of 6 once-weekly instillations of UGN-101 to the renal pelvis and calyces via retrograde ureteral catheter. Plasma samples were collected prior to instillation and 30 min, 1, 2, 3, 4, 5, and 6 h post-instillation. Safety was assessed by laboratory evaluations, physical exam, and adverse event monitoring. RESULTS The mean age of the six participants was 69 years; most were male (5/6) and Caucasian (5/6). Mean (SD) Cmax was 6.24 (4.11) ng/mL and mean Tmax was 1.79 (1.89) hours after instillation. Mean apparent t½ following instillation was 1.27 (0.63) hours. Mean total systemic exposure to mitomycin up to 6 h post-instillation was 20.30 (19.69) ng h/mL. At 6 h post-instillation, mitomycin plasma concentrations of 5/6 participants were < 2 ng/mL. There were no clinically important adverse events or changes in laboratory values in any participant after a single instillation of UGN-101. CONCLUSION The reverse thermal gel formulation of UGN-101 is associated with higher concentration and extended dwell time of mitomycin in contact with the urothelium of the upper urinary tract while limiting systemic absorption of mitomycin. REGISTRATION NCT02793128; registered June 8, 2016.
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Affiliation(s)
- Ahmad Shabsigh
- Department of Urology, The Ohio State University Comprehensive Cancer Center, 300 W 10th Ave, Columbus, OH, 43210, USA.
| | - Nir Kleinmann
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel
| | - Angela B Smith
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Douglas Scherr
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA
| | | | - Mark Schoenberg
- UroGen Pharma, New York, NY, USA
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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10
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Schaeffer E, Srinivas S, Antonarakis ES, Armstrong AJ, Bekelman JE, Cheng H, D’Amico AV, Davis BJ, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Horwitz EM, Ippolito JE, Kuettel MR, Lang JM, McKay R, McKenney J, Netto G, Penson DF, Pow-Sang JM, Reiter R, Richey S, Roach, III M, Rosenfeld S, Shabsigh A, Spratt DE, Teply BA, Tward J, Shead DA, Freedman-Cass DA. NCCN Guidelines Insights: Prostate Cancer, Version 1.2021. J Natl Compr Canc Netw 2021; 19:134-143. [DOI: 10.6004/jnccn.2021.0008] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Prostate Cancer address staging and risk assessment after a prostate cancer diagnosis and include management options for localized, regional, and metastatic disease. Recommendations for disease monitoring and treatment of recurrent disease are also included. The NCCN Prostate Cancer Panel meets annually to reevaluate and update their recommendations based on new clinical data and input from within NCCN Member Institutions and from external entities. This article summarizes the panel’s discussions for the 2021 update of the guidelines with regard to systemic therapy for metastatic castration-resistant prostate cancer.
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Affiliation(s)
- Edward Schaeffer
- 1Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Heather Cheng
- 6Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Anthony Victor D’Amico
- 7Dana-Farber/Brigham and Women’s Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | - Neil Desai
- 9UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 7Dana-Farber/Brigham and Women’s Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | - Joseph E. Ippolito
- 14Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Jesse McKenney
- 18Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Sylvia Richey
- 23St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Stan Rosenfeld
- 25University of California San Francisco Patient Services Committee Chair
| | - Ahmad Shabsigh
- 26The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Jonathan Tward
- 29Huntsman Cancer Institute at the University of Utah; and
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11
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Becerra MF, Venkatramani V, Reis IM, Soodana-Prakash N, Punnen S, Gonzalgo ML, Raolji S, Castle EP, Woods ME, Svatek RS, Weizer AZ, Konety BR, Tollefson M, Krupski TL, Smith ND, Shabsigh A, Barocas DA, Quek ML, Dash A, Parekh DJ. Health Related Quality of Life of Patients with Bladder Cancer in the RAZOR Trial: A Multi-Institutional Randomized Trial Comparing Robot versus Open Radical Cystectomy. J Urol 2020; 204:450-459. [DOI: 10.1097/ju.0000000000001029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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)
- Maria F. Becerra
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Isildinha M. Reis
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Mark L. Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Shyamal Raolji
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Michael E. Woods
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert S. Svatek
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alon Z. Weizer
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Tracey L. Krupski
- Department of Urology, University of Virginia Health Science Center, Charlottesville, Virginia
| | - Norm D. Smith
- Department of Urology, University of Chicago, Chicago, Illinois
| | - Ahmad Shabsigh
- Department of Urology, Ohio State University, Columbus, Ohio
| | - Daniel A. Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus L. Quek
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Atreya Dash
- Department of Urology, University of Washington, Seattle, Washington
| | - Dipen J. Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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12
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Mohler JL, Antonarakis ES, Armstrong AJ, D'Amico AV, Davis BJ, Dorff T, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Hurwitz M, Ippolito JE, Kane CJ, Kuettel MR, Lang JM, McKenney J, Netto G, Penson DF, Plimack ER, Pow-Sang JM, Pugh TJ, Richey S, Roach M, Rosenfeld S, Schaeffer E, Shabsigh A, Small EJ, Spratt DE, Srinivas S, Tward J, Shead DA, Freedman-Cass DA. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:479-505. [PMID: 31085757 DOI: 10.6004/jnccn.2019.0023] [Citation(s) in RCA: 814] [Impact Index Per Article: 203.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The NCCN Guidelines for Prostate Cancer include recommendations regarding diagnosis, risk stratification and workup, treatment options for localized disease, and management of recurrent and advanced disease for clinicians who treat patients with prostate cancer. The portions of the guidelines included herein focus on the roles of germline and somatic genetic testing, risk stratification with nomograms and tumor multigene molecular testing, androgen deprivation therapy, secondary hormonal therapy, chemotherapy, and immunotherapy in patients with prostate cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Joseph E Ippolito
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Jesse McKenney
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - George Netto
- University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | - Sylvia Richey
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Edward Schaeffer
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ahmad Shabsigh
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Eric J Small
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Jonathan Tward
- Huntsman Cancer Institute at the University of Utah; and
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13
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D’Andrea D, Foerster B, Matin SF, Ku JH, Muilwijk T, Monteiro LL, Liao R, Petros FG, Spiess PE, Bivalacqua TJ, Hendricksen K, van Rhijn BW, Shabsigh A, Briganti A, Joniau S, Kassouf W, Pierorazio PM, Margulis V, Necchi A, Shariat SF. Impact of Sex on Response to Neoadjuvant Chemotherapy in Patients with Upper-tract Urothelial Cancer. EUR UROL SUPPL 2020; 19:16-19. [PMID: 34337449 PMCID: PMC8317786 DOI: 10.1016/j.euros.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- David D’Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Surena F. Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ja H. Ku
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Leonardo L. Monteiro
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Ross Liao
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Firas G. Petros
- Department of Urology and Kidney Transplant, The University of Toledo Medical Center and Eleanor N. Dana Cancer Center, Toledo, OH, USA
| | - Philippe E. Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Trinity J. Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas W.G. van Rhijn
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ahmad Shabsigh
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Wassim Kassouf
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Phillip M. Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, University of Jordan, Amman, Jordan
- Corresponding author. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Tel.: +43 1 404002615; Fax: +43 1 404002332.
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14
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Kleinmann N, Matin SF, Pierorazio PM, Gore JL, Shabsigh A, Hu B, Chamie K, Godoy G, Hubosky S, Rivera M, O'Donnell M, Quek M, Raman JD, Knoedler JJ, Scherr D, Stern J, Weight C, Weizer A, Woods M, Kaimakliotis H, Smith AB, Linehan J, Coleman J, Humphreys MR, Pak R, Lifshitz D, Verni M, Adibi M, Amin MB, Seltzer E, Klein I, Konorty M, Strauss-Ayali D, Hakim G, Schoenberg M, Lerner SP. Primary chemoablation of low-grade upper tract urothelial carcinoma using UGN-101, a mitomycin-containing reverse thermal gel (OLYMPUS): an open-label, single-arm, phase 3 trial. Lancet Oncol 2020; 21:776-785. [PMID: 32631491 DOI: 10.1016/s1470-2045(20)30147-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Most patients with low-grade upper tract urothelial cancer are treated by radical nephroureterectomy. We aimed to assess the safety and activity of a non-surgical treatment using instillation of UGN-101, a mitomycin-containing reverse thermal gel. METHODS In this open-label, single-arm, phase 3 trial, participants were recruited from 24 academic sites in the USA and Israel. Patients (aged ≥18 years) with primary or recurrent biopsy-proven, low-grade upper tract urothelial cancer (measuring 5-15 mm in maximum diameter) and an Eastern Cooperative Oncology Group performance status score of less than 3 (Karnofsky Performance Status score >40) were registered to receive six instillations of once-weekly UGN-101 (mitomycin 4 mg per mL; dosed according to volume of patient's renal pelvis and calyces, maximum 60 mg per instillation) via retrograde catheter to the renal pelvis and calyces. All patients had a planned primary disease evaluation 4-6 weeks after the completion of initial therapy, in which the primary outcome of complete response was assessed, defined as negative 3-month ureteroscopic evaluation, negative cytology, and negative for-cause biopsy. Activity (complete response, expected to occur in >15% of patients) and safety were assessed by the investigator in all patients who received at least one dose of UGN-101. Data presented are from the data cutoff on May 22, 2019. This study is registered with ClinicalTrials.gov, NCT02793128. FINDINGS Between April 6, 2017, and Nov 26, 2018, 71 (96%) of 74 enrolled patients received at least one dose of UGN-101. 42 (59%, 95% CI 47-71; p<0·0001) patients had a complete response at the primary disease evaluation visit. The median follow-up for patients with a complete response was 11·0 months (IQR 5·1-12·4). The most frequently reported all-cause adverse events were ureteric stenosis in 31 (44%) of 71 patients, urinary tract infection in 23 (32%), haematuria in 22 (31%), flank pain in 21 (30%), and nausea in 17 (24%). 19 (27%) of 71 patients had study drug-related or procedure-related serious adverse events. No deaths were regarded as related to treatment. INTERPRETATION Primary chemoablation of low-grade upper tract urothelial cancer with intracavitary UGN-101 results in clinically significant disease eradication and might offer a kidney-sparing treatment alternative for these patients. FUNDING UroGen Pharma.
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Affiliation(s)
- Nir Kleinmann
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John L Gore
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA
| | - Ahmad Shabsigh
- Department of Urology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Brian Hu
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Guilherme Godoy
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Scott Hubosky
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Marcelino Rivera
- Department of Urology, Mayo Clinic Health System, Rochester, MN, USA
| | | | - Marcus Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Jay D Raman
- Division of Urology, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - John J Knoedler
- Division of Urology, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Douglas Scherr
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA
| | - Joshua Stern
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christopher Weight
- Department of Urology, University of Minnesota Health, Minneapolis, MN, USA
| | - Alon Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Michael Woods
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Hristos Kaimakliotis
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Angela B Smith
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jennifer Linehan
- Department of Urology, John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Jonathan Coleman
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Raymond Pak
- Department of Urology, Mayo Clinic Jacksonville, Jacksonville, FL, USA
| | - David Lifshitz
- Department of Urology, Rabin Medical Center, Tel Aviv, Israel
| | | | - Mehrad Adibi
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mahul B Amin
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | | | | | | | - Mark Schoenberg
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA; UroGen Pharma, New York, NY, USA
| | - Seth P Lerner
- Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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15
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Shabsigh A, Lee CT. Closing the Loop on the Role of Multiparametric Magnetic Resonance Imaging-Targeted Prostate Biopsy. JAMA Surg 2019; 154:818. [PMID: 31188409 DOI: 10.1001/jamasurg.2019.1735] [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: 11/14/2022]
Affiliation(s)
- Ahmad Shabsigh
- Department of Urology, Ohio State University Wexner Medical Center, Columbus
| | - Cheryl T Lee
- Department of Urology, Ohio State University Wexner Medical Center, Columbus
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16
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Wolfe AR, Grecula JC, Blakaj D, Wald P, Carlson M, Woods K, Dziedzic E, Vidrick A, Martin D, Shabsigh A. Robotic-assisted Intraoperative High-dose Rate Remote Brachytherapy Following Laparoscopic Robotic-assisted Resection of Pelvic Recurrence of Urethral Carcinoma. Adv Radiat Oncol 2019; 4:443-446. [PMID: 31360797 PMCID: PMC6639745 DOI: 10.1016/j.adro.2019.03.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 02/26/2019] [Accepted: 03/19/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Adam R Wolfe
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - John C Grecula
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - Dukagjin Blakaj
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - Patrick Wald
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - Michael Carlson
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - Kyle Woods
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - Erin Dziedzic
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - Ann Vidrick
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - Douglas Martin
- Department of Radiation Oncology, James Cancer Hospital, Columbus, Ohio
| | - Ahmad Shabsigh
- Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
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17
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Feuerstein MA, Goldstein L, Reaves B, Sun A, Goltzman M, Morganstern BA, Shabsigh A, Bajorin DF, Rosenberg JE, Donat SM, Herr HW, Laudone VP, Atkinson TM, Li Y, Dalbagni G, Rapkin B, Bochner BH. Propensity-matched analysis of patient-reported outcomes for neoadjuvant chemotherapy prior to radical cystectomy. World J Urol 2019; 37:2401-2407. [PMID: 30798382 DOI: 10.1007/s00345-019-02692-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/18/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate patient-reported outcomes (PROs) for bladder cancer patients undergoing neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) using longitudinal data and propensity-matched scoring analyses. METHODS 155 patients with muscle-invasive bladder cancer scheduled for RC completed the European Organization for Research and Treatment of Cancer questionnaires, EORTC QLQ-C30, EORTC QLQ-BLM30, Fear of Recurrence Scale, Mental Health Inventory and Satisfaction with Life Scale within 4 weeks of surgery. A propensity-matched analysis was performed comparing pre-surgery PROs among 101 patients who completed NAC versus 54 patients who did not receive NAC. We also compared PROs pre- and post-chemotherapy for 16 patients who had data available for both time points. RESULTS In propensity-matched analysis, NAC-treated patients reported better emotional and sexual function, mental health, urinary function and fewer financial concerns compared to those that did not receive NAC. Longitudinal analysis showed increases in fatigue, nausea and appetite loss following chemotherapy. CONCLUSION Propensity-matched analysis did not demonstrate a negative effect of NAC on PRO. Several positive associations of NAC were found in the propensity-matched analysis, possibly due to other confounding differences between the two groups or actual clinical benefit. Longitudinal analysis of a small number of patients found small to modest detrimental effects from NAC similar to toxicities previously reported. Our preliminary findings, along with known survival and toxicity data, should be considered in decision-making for NAC.
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Affiliation(s)
- Michael A Feuerstein
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA.
| | - Leah Goldstein
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Brieyona Reaves
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Arony Sun
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Michael Goltzman
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Bradley A Morganstern
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Ahmad Shabsigh
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Dean F Bajorin
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Jonathan E Rosenberg
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - S Machele Donat
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Harry W Herr
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Vincent P Laudone
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guido Dalbagni
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
| | - Bruce Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bernard H Bochner
- Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, 170 E. 77th St, New York, NY, 10075, USA
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18
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Shabsigh A. To Treat or Not to Treat. J Men's Health 2019. [DOI: 10.22374/jomh.v15i1.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The question may still remain when and how to treat localized prostate cancer
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19
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Shabsigh A, Lee CT. Editorial Commentary. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.08.011] [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: 11/29/2022]
Affiliation(s)
- Ahmad Shabsigh
- Department of Urology, The Ohio State University, Columbus, Ohio
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20
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Parekh DJ, Reis IM, Castle EP, Gonzalgo ML, Woods ME, Svatek RS, Weizer AZ, Konety BR, Tollefson M, Krupski TL, Smith ND, Shabsigh A, Barocas DA, Quek ML, Dash A, Kibel AS, Shemanski L, Pruthi RS, Montgomery JS, Weight CJ, Sharp DS, Chang SS, Cookson MS, Gupta GN, Gorbonos A, Uchio EM, Skinner E, Venkatramani V, Soodana-Prakash N, Kendrick K, Smith JA, Thompson IM. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet 2018; 391:2525-2536. [PMID: 29976469 DOI: 10.1016/s0140-6736(18)30996-6] [Citation(s) in RCA: 448] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radical cystectomy is the surgical standard for invasive bladder cancer. Robot-assisted cystectomy has been proposed to provide similar oncological outcomes with lower morbidity. We aimed to compare progression-free survival in patients with bladder cancer treated with open cystectomy and robot-assisted cystectomy. METHODS The RAZOR study is a randomised, open-label, non-inferiority, phase 3 trial done in 15 medical centres in the USA. Eligible participants (aged ≥18 years) had biopsy-proven clinical stage T1-T4, N0-N1, M0 bladder cancer or refractory carcinoma in situ. Individuals who had previously had open abdominal or pelvic surgery, or who had any pre-existing health conditions that would preclude safe initiation or maintenance of pneumoperitoneum were excluded. Patients were centrally assigned (1:1) via a web-based system, with block randomisation by institution, stratified by type of urinary diversion, clinical T stage, and Eastern Cooperative Oncology Group performance status, to receive robot-assisted radical cystectomy or open radical cystectomy with extracorporeal urinary diversion. Treatment allocation was only masked from pathologists. The primary endpoint was 2-year progression-free survival, with non-inferiority established if the lower bound of the one-sided 97·5% CI for the treatment difference (robotic cystectomy minus open cystectomy) was greater than -15 percentage points. The primary analysis was done in the per-protocol population. Safety was assessed in the same population. This trial is registered with ClinicalTrials.gov, number NCT01157676. FINDINGS Between July 1, 2011, and Nov 18, 2014, 350 participants were randomly assigned to treatment. The intended treatment was robotic cystectomy in 176 patients and open cystectomy in 174 patients. 17 (10%) of 176 patients in the robotic cystectomy group did not have surgery and nine (5%) patients had a different surgery to that they were assigned. 21 (12%) of 174 patients in the open cystectomy group did not have surgery and one (1%) patient had robotic cystectomy instead of open cystectomy. Thus, 302 patients (150 in the robotic cystectomy group and 152 in the open cystectomy group) were included in the per-protocol analysis set. 2-year progression-free survival was 72·3% (95% CI 64·3 to 78·8) in the robotic cystectomy group and 71·6% (95% CI 63·6 to 78·2) in the open cystectomy group (difference 0·7%, 95% CI -9·6% to 10·9%; pnon-inferiority=0·001), indicating non-inferiority of robotic cystectomy. Adverse events occurred in 101 (67%) of 150 patients in the robotic cystectomy group and 105 (69%) of 152 patients in the open cystectomy group. The most common adverse events were urinary tract infection (53 [35%] in the robotic cystectomy group vs 39 [26%] in the open cystectomy group) and postoperative ileus (33 [22%] in the robotic cystectomy group vs 31 [20%] in the open cystectomy group). INTERPRETATION In patients with bladder cancer, robotic cystectomy was non-inferior to open cystectomy for 2-year progression-free survival. Increased adoption of robotic surgery in clinical practice should lead to future randomised trials to assess the true value of this surgical approach in patients with other cancer types. FUNDING National Institutes of Health National Cancer Institute.
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Affiliation(s)
- Dipen J Parekh
- Department of Urology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Isildinha M Reis
- Division of Biostatistics, Department of Public Health Sciences, Sylvester Biostatistics and Bioinformatics Shared Resource, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Erik P Castle
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
| | - Mark L Gonzalgo
- Department of Urology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Michael E Woods
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert S Svatek
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Tracey L Krupski
- Department of Urology, University of Virginia Health Science Center, Charlottesville, VA, USA
| | - Norm D Smith
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Ahmad Shabsigh
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Atreya Dash
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Adam S Kibel
- Harvard Medical School, Boston, MA, USA; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Raj S Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - David S Sharp
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael S Cookson
- Department of Urology, Oklahoma University of Oklahoma, Norman, OK, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Alex Gorbonos
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Edward M Uchio
- Department of Urology, University of California at Irvine, Irvine, CA, USA
| | - Eila Skinner
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Vivek Venkatramani
- Department of Urology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nachiketh Soodana-Prakash
- Department of Urology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Kerri Kendrick
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Joseph A Smith
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian M Thompson
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; CHRISTUS Santa Rosa Medical Center Hospital, San Antonio, TX, USA
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Hatahet S, Saleh K, Turnquist A, Hendawi M, Shabsigh A. MP80-03 CAUSES OF 30-DAYS REOPERATION AND READMISSIONS POST ENDOUROLOGIC SURGERY: A NATIONAL DATABASE ANALYSES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Shabsigh A. V12-12 ROBOTIC CYSTOPROSTATECTOMY WITH PUBECTOMY AND ILEAL CONDUIT FOR PATIENTS WITH OSTEOMYELITIS PUBIS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hatahet S, Hendawi M, Shabsigh A. MP54-05 VALIDATION OF NATIONAL SURGERY QUALITY IMPROVEMENT PROGRAM (NSQIP) RISK CALCULATOR OF POST-OP COMPLICATIONS AND READMISSION AFTER RADICAL CYSTECTOMY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1677] [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: 12/01/2022]
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Abaza R, Eun DD, Gallucci M, Gill IS, Menon M, Mottrie A, Shabsigh A. Robotic Surgery for Renal Cell Carcinoma with Vena Caval Tumor Thrombus. Eur Urol Focus 2016; 2:601-607. [DOI: 10.1016/j.euf.2017.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/18/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022]
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Petros F, Zynger D, Shabsigh A, Sharp D, Box G. MP75-14 ROLE OF NEPHRON-SPARING SURGERY FOR RENAL CELL CARCINOMA IN THE SETTING OF VENOUS TUMOR THROMBUS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shabsigh A. PD43-06 THE IMPACT OF SURGICAL TECHNIQUE ON UNPLANNED REOPERATION FOLLOWING OPEN AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY: ANALYSIS OF THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1784] [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: 10/22/2022]
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Abaza R, Shabsigh A, Castle E, Allaf M, Hu JC, Rogers C, Menon M, Aron M, Sundaram CP, Eun D. Multi-Institutional Experience with Robotic Nephrectomy with Inferior Vena Cava Tumor Thrombectomy. J Urol 2015; 195:865-71. [PMID: 26602891 DOI: 10.1016/j.juro.2015.09.094] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Since the first report of robotic management of renal tumors with inferior vena cava tumor thrombi, few additional cases have been reported in the literature. We report our combined experience with this procedure, to our knowledge the first multi-institutional and largest series reported to date. MATERIALS AND METHODS A retrospective, multi-institutional review of robotic nephrectomy with inferior vena cava tumor thrombectomy was performed with institutional review board approval. RESULTS A total of 32 cases were performed among 9 surgeons at 9 institutions since the first known procedure in 2008. Of these cases 30 were level II and 2 were level III thrombi with no level I thrombi (renal vein only) included in the analysis. Each surgeon performed between 1 and 10 procedures. Mean patient age was 63 years (range 43 to 81) with a mean body mass index of 30 kg/m(2) (range 17 to 43) and mean maximal tumor diameter of 9.6 cm (range 5.4 to 20). The length of inferior vena cava tumor thrombi ranged from 1 to 11 cm (median 4.2) on preoperative imaging. The inferior vena cava required cross-clamping in 24 cases. One patient had 2 renal veins with 2 caval thrombi and 1 patient required synthetic patch cavoplasty. Mean operative time was 292 minutes (range 180 to 411) with a mean blood loss of 399 cc (range 25 to 2,000). There were no conversions to open surgery or aborted procedures and there were 3 transfusions of 1 to 3 units. All but 2 patients ambulated by postoperative day 1 and mean hospital stay was 3.2 days (range 1 to 7). Lymphadenectomy in 24 patients yielded a mean of 11 nodes and 8 patients had node positive disease. There were 7 patients who experienced distant recurrence at a mean followup of 15.4 months, including 4 who had node positive disease on postoperative pathological examination. CONCLUSIONS Robotic nephrectomy in the setting of inferior vena cava tumor thrombus is feasible and was performed safely in selected patients. Despite the complex and critical nature of these procedures, our series demonstrates favorable outcomes and reproducibility with adequate robotic experience.
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Affiliation(s)
- Ronney Abaza
- OhioHealth Dublin Methodist Hospital, Dublin, Ohio.
| | - Ahmad Shabsigh
- Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Jim C Hu
- Weill Cornell Medical College, New York, New York
| | | | - Mani Menon
- Henry Ford Health System, Detroit, Michigan
| | - Monish Aron
- University of Southern California Medical Center, Los Angeles, California
| | | | - Daniel Eun
- Temple University Medical Center, Philadelphia, Pennsylvania
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Khemees TA, Lam ET, Joehlin-Price AS, Mortazavi A, Phillips GS, Shabsigh A, Sharp DS, Zynger DL. Does the Renal Parenchyma Adjacent to the Tumor Contribute to Kidney Function? A Critical Analysis of Glomerular Viability in Partial Nephrectomy Specimens. Urology 2015; 87:114-9. [PMID: 26505834 DOI: 10.1016/j.urology.2015.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/08/2015] [Accepted: 10/15/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the viability of glomeruli in the peritumor parenchyma of partial nephrectomy specimens removed for renal cell carcinoma (RCC) and relate it to kidney function, to better understand the contribution of peritumor parenchyma to renal function. MATERIALS AND METHODS A retrospective analysis of 53 partial nephrectomies containing RCC was performed. Glomeruli within 0.25-cm increments from the tumor were quantified and histologically assessed for viability. Tumor size, minimum and maximum margin size, and pre- and postoperative estimated glomerular filtration rate (eGFR) were obtained. RESULTS Glomerular viability positively correlated with distance from tumor with mean viable glomeruli in successive 0.25-cm increments of 0-0.25 cm, 58%; 0.25-0.5 cm, 80%; 0.5-0.75 cm, 90%; and 0.75-1.0 cm, 92%. Glomerular viability near the tumor did not correlate with preoperative eGFR, whereas decreased viability further from the tumor did correlate with worse preoperative eGFR. Tumor size showed a nonstatistically significant positive trend with minimum (median 0.15 cm) and maximum margin (median 0.7 cm) sizes. Percent change of glomerular filtration rate did not correlate with margin size (P = .190). CONCLUSION Renal parenchyma immediately adjacent to RCC contains fewer viable glomeruli compared with the parenchyma further from the tumor. Based on this information, attempts to preserve all non-neoplastic renal parenchyma via a surgical margin approaching zero may not necessarily result in clinically relevant differences in the amount of viable glomeruli remaining or the renal function preserved.
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Affiliation(s)
- Tariq A Khemees
- Department of Urology, The Ohio State University, Columbus, OH.
| | - Elaine T Lam
- Deparment of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH; Department of Internal Medicine, Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO
| | | | - Amir Mortazavi
- Deparment of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - Gary S Phillips
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Ahmad Shabsigh
- Department of Urology, The Ohio State University, Columbus, OH
| | - David S Sharp
- Department of Urology, The Ohio State University, Columbus, OH
| | - Debra L Zynger
- Department of Pathology, The Ohio State University, Columbus, OH
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Feng MA, Ebel JJ, Shabsigh A, Zynger DL. Concordance of lymphovascular invasion diagnosed in penile carcinoma with and without the immunohistochemical markers ERG and CD31. Histol Histopathol 2015; 31:293-8. [PMID: 26452171 DOI: 10.14670/hh-11-675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lymphovascular invasion (LVI) is an independent predictor of metastatic lymph node disease in penile carcinoma and is one factor used to guide clinical management. The presence of LVI with and without the use of the endothelial immunohistochemical (IHC) markers, ERG and CD31, was retrospectively assessed in 46 penectomy cases containing invasive penile carcinoma (43 squamous cell carcinoma and 3 non-squamous cell carcinoma). Concordance for the detection of LVI between the original report, upon pathology review, and with the use of IHC was determined and histologic pitfalls were identified. For penile squamous cell carcinoma, LVI was diagnosed in 27.9% of tumors in the original reports, 16.3% upon pathology review, and in 16.3% with use of ERG and CD31. Concordance of LVI identification in the original report compared to IHC was 74.4% while concordance of review compared to IHC was 95.3%. Using IHC data as the reference, false positive LVI diagnoses were more common in the original report than false negatives. Histologic mimickers of LVI including involvement of the penile corpora cavernosum or spongiosum vasculature, seromucinous colonization, and a nested pattern of tumor invasion were identified. We demonstrated that it was not uncommon for LVI in penile carcinoma to be overdiagnosed or underdiagnosed. The use of endothelial IHC markers, such as ERG or CD31, or additional pathology consultation is recommended for penectomy cases in which LVI is difficult to histologically discern.
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Affiliation(s)
- Megan A Feng
- Department of Pathology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Joshua J Ebel
- Department of Urology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Ahmad Shabsigh
- Department of Urology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Debra L Zynger
- Department of Pathology, The Ohio State University Medical Center, Columbus, Ohio, USA.
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Sarhan A, Sharp D, Shabsigh A. MP62-07 PREDICTORS OF READMISSION FOLLOWING OPEN AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2381] [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: 11/27/2022]
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Serhan A, Shabsigh A. MP63-19 PREDICTORS OF READMISSION FOLLOWING OPEN AND MINIMALLY INVASIVE PARTIAL NEPHRECTOMY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sarhan A, Shabsigh A, Shah K. MP29-20 PERIOPERATIVE OUTCOMES FOLLOWING OPEN AND MINIMALLY INVASIVE SACRAL COLPOPEXY. ANALYSIS OF THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.623] [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: 10/23/2022]
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Smith ND, Castle EP, Gonzalgo ML, Svatek RS, Weizer AZ, Montgomery JS, Pruthi RS, Woods ME, Tollefson MK, Konety BR, Shabsigh A, Krupski T, Barocas DA, Dash A, Quek ML, Kibel AS, Parekh DJ. The RAZOR (randomized open vs robotic cystectomy) trial: study design and trial update. BJU Int 2015; 115:198-205. [PMID: 25626182 DOI: 10.1111/bju.12699] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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: 11/30/2022]
Abstract
The purpose of the RAZOR (randomized open vs robotic cystectomy) study is to compare open radical cystectomy (ORC) vs robot-assisted RC (RARC), pelvic lymph node dissection (PLND) and urinary diversion for oncological outcomes, complications and health-related quality of life (HRQL) measures with a primary endpoint of 2-year progression-free survival (PFS). RAZOR is a multi-institutional, randomized, non-inferior, phase III trial that will enrol at least 320 patients with T1-T4, N0-N1, M0 bladder cancer with ≈160 patients in both the RARC and ORC arms at 15 participating institutions. Data will be collected prospectively at each institution for cancer outcomes, complications of surgery and HRQL measures, and then submitted to trial data management services Cancer Research and Biostatistics (CRAB) for final analyses. To date, 306 patients have been randomized and accrual to the RAZOR trial is expected to conclude in 2014. In this study, we report the RAZOR trial experimental design, objectives, data safety, and monitoring, and accrual update. The RAZOR trial is a landmark study in urological oncology, randomizing T1-T4, N0-N1, M0 patients with bladder cancer to ORC vs RARC, PLND and urinary diversion. RAZOR is a multi-institutional, non-inferiority trial evaluating cancer outcomes, surgical complications and HRQL measures of ORC vs RARC with a primary endpoint of 2-year PFS. Full data from the RAZOR trial are not expected until 2016-2017.
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Feuerstein M, Goltzman M, Morganstern B, Roberts N, Blass S, Shabsigh A, Li Y, Coleman J, Donat SM, Herr H, Dalbagni G, Laudone V, Rapkin B, Bochner B. MP60-16 THREE-MONTH PATIENT-REPORTED OUTCOMES AFTER OPEN VERSUS ROBOTIC RADICAL CYSTECTOMY: A RANDOMIZED CLINICAL TRIAL. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1770] [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: 10/25/2022]
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Allen J, Sarhan A, Shabsigh A. MP60-10 PREDICTORS OF EARLY POST-OPERATIVE READMISSION AFTER OPEN AND ROBOTIC RADICAL CYSTECTOMY FOR PATIENTS WITH BLADDER CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1764] [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: 10/25/2022]
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Ebel JJ, Shabsigh A, Sharp DS, Zynger DL. Whole-mount evaluation of penectomies for penile cancer: feasibility, cost and comparison to routine sectioning. Histopathology 2013; 63:64-73. [PMID: 23738630 DOI: 10.1111/his.12149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/25/2013] [Indexed: 11/28/2022]
Abstract
AIMS Pathological staging in penectomies may be difficult due to the anatomical complexity of penile anatomy, and may be additionally challenging due to the low volume at most institutions. Our study aimed to assess the feasibility of whole-mount processing for penectomy specimens. METHODS AND RESULTS A 7-year retrospective search for partial or radical penectomies identified 55 specimens, which were processed routinely (n = 31) from 2006 to 2009 and whole-mounted (n = 24) from 2010 to 2012. Routine cases used more slides per case compared to whole mounts (mean 10.4 versus 7.2). Recuts occurred more often in routine cases (12.9% versus 0%). More routine cases had additional blocks grossed (19.4% versus 4.2%). Upon review, five discrepancies that impacted pT staging were identified in the routine group, with none in the whole-mount group. The average estimated additional cost for each whole-mount case compared to routine processing was $40.74, with an increased turnaround time of 1 day. CONCLUSIONS Whole-mounting is a feasible technique for penectomy that can be utilized with minimal increased cost and turnaround time, and may improve staging. Institutions in which whole-mounting is already established for other organs, such as prostate, may wish to consider utilizing this format for penectomy specimens.
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Affiliation(s)
- Joshua J Ebel
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH 43210, USA
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Abstract
CONTEXT Ureteroscopic biopsy is the gold standard for the histopathologic diagnosis of urothelial carcinoma of the upper urinary tract. OBJECTIVE To assess the accuracy of endoscopically obtained biopsy samples in diagnosing, grading, and staging urothelial carcinoma and correlate diagnostic findings to biopsy sample size. DESIGN We retrospectively reviewed endoscopic biopsies of the ureter, renal pelvis, and ureteropelvic junction from 2008 to 2011. Biopsy diagnoses that were discordant with follow-up pathology and/or ureteroscopic impression were re-reviewed and samples were immunohistochemically analyzed. RESULTS Endoscopic biopsies (n = 118) yielded a sensitivity of 85.4% for the ureter (n = 79), 77.8% for the renal pelvis (n = 37), and 100% for the ureteropelvic junction (n = 2). A specificity of 100% for all locations and a diagnostic accuracy of 98.3% were identified. The median sample size was 0.3 cm for true positives, 0.3 cm for true negatives, and 0.2 cm for false negatives with no statistical significance. We found that 87.1% of tumors diagnosed on biopsy had concordant grade and 60.0% had concordant pT stage with follow-up surgical resections (n = 43) and biopsies (n = 24). Biopsy samples with concordant tumor grades (mean = 0.6 cm) compared with follow-up resection were larger than biopsy samples with discordant grades (mean = 0.3 cm) (P = .04). CONCLUSIONS Though highly specific, endoscopic biopsy does provide a significant false-negative rate owing to both sampling and diagnostic errors when assessing the upper urinary tract for urothelial carcinoma. Tumor grading is accurate, particularly with larger tissue samples, but tumor staging is unreliable.
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Affiliation(s)
- Vishal Vashistha
- Department of Pathology, Ohio State University Medical Center, Columbus, OH 43210, USA
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Khemees TA, Petros F, Shabsigh A, Sharp DS, Box GN. 1808 THE IMPACT OF PERI-RENAL FAT ON SURGICAL OUTCOMES FOLLOWING PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khemees TA, Shabsigh A. Regaining candidacy for heart transplantation after robotic assisted laparoscopic radical prostatectomy in left ventricular assist device patient. Case Rep Transplant 2012; 2012:716201. [PMID: 23259138 PMCID: PMC3505944 DOI: 10.1155/2012/716201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/14/2012] [Indexed: 01/11/2023] Open
Abstract
Several factors may highlight the relevance of prostate cancer to the pre-heart-transplant population. First, the expansion in candidate selection criteria led to increased number of men over the age of fifty to be considered for heart transplantation. With the introduction of left ventricular assist device (LVAD) therapy, waiting-list mortality has dramatically declined over the past decade. Additionally, transplant candidates are diligently screened for preexisting neoplasm while on the waiting list. Taken together, screening-detected prostate cancer may increasingly be diagnosed in patients on the waiting list. If discovered, it will pose unique challenge to clinicians as to date there has been no universally accepted management guideline. We report a case of LVAD-treated heart transplant candidate diagnosed with prostate cancer while on the waiting list. Patient screening demonstrated PSA elevation which prompted prostate biopsy. Low-risk clinically localized prostate cancer was confirmed and led to removal of patient from transplant list. When counseled regarding management of his cancer, the patient elected to undergo radical prostatectomy in a hope to regain candidacy for heart transplantation. Despite being of high surgical risk, multidisciplinary team approach led to successful management of prostate cancer and the patient eventually received heart transplant one year following prostatectomy.
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Affiliation(s)
- Tariq A. Khemees
- Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43212, USA
| | - Ahmad Shabsigh
- Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43212, USA
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Khemees TA, Prall DN, Bahnson RR, Shabsigh A. Early Postoperative Complications After Robotic Vs Open Radical Cystectomy. J Am Coll Surg 2012. [DOI: 10.1016/j.jamcollsurg.2012.06.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khemees TA, Lam ET, Mortazavi A, Phillip G, Shabsigh A, Sharp DS, Zynger DL. 1106 VIABILITY OF GLOMERULI ADJACENT TO TUMOR IN PARTIAL NEPHRECTOMY SPECIMENS FOR RENAL CELL CARCINOMA. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1214] [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: 10/28/2022]
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Mitra N, Monk JP, Pohar KS, Shabsigh A, Sharp DS, Abaza R, Box GN, Zynger DL, Vandlik SL, Bhinder AS, Olencki T, Bahnson RR, Clinton SK, Mortazavi A. Early outcomes with neoadjuvant high-dose intensity methotrexate, vinblastine, doxorubicin, and cisplatin (HD-MVAC) or gemcitabine and cisplatin (GC) in muscle-invasive urothelial carcinoma of the bladder: A single-institution experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mitra N, Monk JP, Pohar KS, Shabsigh A, Sharp DS, Abaza R, Box GN, Zynger DL, Clinton SK, Mortazavi A. Early outcomes with neoadjuvant high-dose intensity methotrexate, vinblastine, doxorubicin, and cisplatin (HD-MVAC) or gemcitabine and cisplatin (GC) in muscle-invasive urothelial carcinoma of the bladder: A single-institution experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
280 Background: Compared to MVAC, HD-MVAC achieves significantly higher complete response rates in patients (pts) with metastatic bladder cancer. Based on current literature, 7%-38% of pts with muscle-invasive bladder cancer achieve pathological down-staging (pT0) with neoadjuvant chemotherapy (NC), which correlates with improved disease-free and overall survival. The role of HD-MVAC has not been evaluated in the neoadjuvant setting. In this retrospective study, we present our data in pts who received NC with HD-MVAC or GC followed by radical cystectomy (RC). Methods: From July 2008 to August 2010, 38 (pts) received 4 cycles of NC with either HD-MVAC or GC for at least T2 bladder cancer followed by RC. The endpoints of interest of this study were the complete pathologic response (pT0) or down-staging to < pT2 (pT0, pTis, and pT1) at RC; and median interval to RC from the time of diagnosis of muscle-invasive bladder cancer and start of NC. Results: Median age at the time of diagnosis was 66 years (35-80 years). Fifteen pts received neoadjuvant HD-MVAC, and 23 received neoadjuvant GC. Clinical T stage at the time of diagnosis was T2 in 29 (76%), T3 in 3 (8%), and T4 in 6 (16%) pts. Down-staging to < pT2 was achieved in 8 (53%) of HD-MVAC pts and 10 (43%) of GC pts. pT0 was achieved in 5 (33%) of HD-MVAC pts and 9 (39%) of GC pts. The median interval from time of diagnosis to RC was 129 days (range 84-154) for the HD-MVAC pts, and 145 days (range 108-252) for the GC pts. The median interval from initiation of NC to RC was 85 days (range 53-122) for the HD-MVAC pts and 107 days (range 60-126) for the GC pts. Overall, NC was well tolerated with 80% of HD-MVAC pts and 78% of GC pts completing the planned chemotherapy. To this date, none of the pT0 pts had recurrence. Conclusions: Both neoadjuvant HD-MVAC and GC appear to be well tolerated, with very promising rate of pathological down-staging. Longer follow-up is needed for the survival outcomes of these patients. A shorter interval from diagnosis and initiation of NC to RC might be responsible for our better outcomes comparing to some historical data. No significant financial relationships to disclose.
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Affiliation(s)
- N. Mitra
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - J. P. Monk
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - K. S. Pohar
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - A. Shabsigh
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - D. S. Sharp
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - R. Abaza
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - G. N. Box
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - D. L. Zynger
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - S. K. Clinton
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - A. Mortazavi
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
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Morganstern BA, Bochner B, Dalbagni G, Shabsigh A, Rapkin B. The psychological context of quality of life: a psychometric analysis of a novel idiographic measure of bladder cancer patients' personal goals and concerns prior to surgery. Health Qual Life Outcomes 2011; 9:10. [PMID: 21324146 PMCID: PMC3045868 DOI: 10.1186/1477-7525-9-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 02/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past two decades, there has been an increasing focus on quality of life outcomes in urological diseases. Patient-reported outcomes research has relied on structured assessments that constrain interpretation of the impact of disease and treatments. In this study, we present content analysis and psychometric evaluation of the Quality of Life Appraisal Profile. Our evaluation of this measure is a prelude to a prospective comparison of quality of life outcomes of reconstructive procedures after cystectomy. METHODS Fifty patients with bladder cancer were interviewed prior to surgery using the Quality of Life Appraisal Profile. Patients also completed the EORTC QLQ-C30 and demographics. Analysis included content coding of personal goal statements generated by the Appraisal Profile, examination of the relationship of goal attainment to content, and association of goal-based measures with QLQ-C30 scales. RESULTS Patients reported an average of 10 personal goals, reflecting motivational themes of achievement, problem solving, avoidance of problems, maintaining desired circumstances, letting go of roles and responsibilities, acceptance of undesirable situations, and attaining milestones. 503 goal statements were coded using 40 different content categories. Progress toward goal attainment was positively correlated with relationships and activities goals, but negatively correlated with health concerns. Associations among goal measures provided evidence for construct validity. Goal content also differed according to age, gender, employment, and marital status, lending further support for construct validity. QLQ-C30 functioning and symptom scales were correlated with goal content, but not with progress toward goal attainment, suggesting that patients may calibrate progress ratings relative to their specific goals. Alternately, progress may reflect a unique aspect of quality of life untapped by more standard scales. CONCLUSIONS The Brief Quality of Life Appraisal Profile was associated with measures of motivation, goal content and progress, as well as relationships with demographic and standard quality of life measures. This measure identifies novel concerns and issues in treating patients with bladder cancer, necessary for a more comprehensive evaluations of their health-related quality of life.
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Affiliation(s)
- Bradley Andrew Morganstern
- Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Bronx, New York 10461, USA.
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DeCastro GJ, Shabsigh A, Poon SA, Laor L, Glassberg KI. Adolescent Varicocelectomy—Is the Potential for Catch-Up Growth Related to Age and/or Tanner Stage? J Urol 2009; 181:322-7; discussion 327. [DOI: 10.1016/j.juro.2008.09.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Indexed: 10/21/2022]
Affiliation(s)
- G. Joel DeCastro
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York–Presbyterian and Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ahmad Shabsigh
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York–Presbyterian and Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Stephen A. Poon
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York–Presbyterian and Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Laurent Laor
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York–Presbyterian and Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Kenneth I. Glassberg
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York–Presbyterian and Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
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Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, Raj G, Bochner BH, Dalbagni G, Herr HW, Donat SM. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2008; 55:164-74. [PMID: 18675501 DOI: 10.1016/j.eururo.2008.07.031] [Citation(s) in RCA: 966] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 07/02/2008] [Indexed: 12/28/2022]
Abstract
BACKGROUND Reporting methodology is highly variable and nonstandardized, yet surgical outcomes are utilized in clinical trial design and evaluation of healthcare provider performance. OBJECTIVE We sought to define the type, incidence, and severity of early postoperative morbidities following radical cystectomy (RC) using a standardized reporting methodology. DESIGN, SETTING, AND PARTICIPANTS Between 1995 and 2005, 1142 consecutive RCs were entered into a prospective complication database and retrospectively reviewed for accuracy. All patients underwent RC/urinary diversion by high-volume fellowship-trained urologic oncologists. MEASUREMENTS All complications within 90 d of surgery were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center complication grading system. Complications were defined and stratified into 11 specific categories. Univariate and multivariate regression models were used to define predictors of complications. RESULTS AND LIMITATIONS Sixty-four percent (735/1142) of patients experienced a complication within 90 d of surgery. Among patients experiencing a complication, 67% experienced a complication during the operative hospital admission and 58% following discharge. Overall, the highest grade of complication was grade 0 in 36% (n=407), grade 1-2 in 51% (n=582), and grade 3-5 in 13% (n=153). Gastrointestinal complications were most common (29%), followed by infectious complications (25%) and wound-related complications (15%). The 30-d mortality rate was 1.5%. CONCLUSIONS Surgical morbidity following RC is significant and, when strict reporting guidelines are incorporated, higher than previously published. Accurate reporting of postoperative complications after RC is essential for counseling patients, combined modality treatment planning, clinical trial design, and assessment of surgical success.
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Affiliation(s)
- Ahmad Shabsigh
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, United States
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Donat SM, Shabsigh A, Savage C, Cronin AM, Bochner BH, Dalbagni G, Herr HW, Milowsky MI. Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: a high-volume tertiary cancer center experience. Eur Urol 2008; 55:177-85. [PMID: 18640770 DOI: 10.1016/j.eururo.2008.07.018] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 07/02/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Perioperative cisplatin combination chemotherapy is associated with a survival benefit in patients with invasive bladder cancer (BCa). However, in a recent report from the National Cancer Database (NCDB), only 11.6% of stage III BCa patients received perioperative chemotherapy, the majority in the adjuvant setting. OBJECTIVE We explore the impact of postoperative complications on the timing of adjuvant chemotherapy. DESIGN, SETTING, AND PARTICIPANTS An independent review board approved the review of 1142 consecutive radical cystectomies (RC), and data from these cases were entered into a prospective complication database (1995-2005) which was utilized and retrospectively reviewed for accuracy at a single, academic, tertiary cancer center. INTERVENTIONS All patients underwent RC/urinary diversion by high-volume, fellowship-trained, urologic oncologists. MEASUREMENTS All complications within 90 d of surgery were defined and graded using a five-grade modification of the original Clavien system utilized at Memorial Sloan-Kettering Cancer Center and stratified into 11 categories. Grade 2-5 complications typically prohibit starting adjuvant chemotherapy. Univariate and multivariable logistic regression were used to evaluate variables associated with complications. RESULTS AND LIMITATIONS Overall, 64% (735 of 1142 patients) experienced one or more complications, of which 83% (611 of 735) were grade 2-5. Furthermore, 57% of grade 2-5 complications (347 of 611) occurred between discharge and 90 d, 38% (233 of 611) within 6 wk, and 19% (114 of 611) between 6 wk and 12 wk, the general time frame for adjuvant chemotherapy. Overall, 26% (298 of 1142 patients) required readmission. Surgical morbidity at a high-volume tertiary cancer center may not reflect the case mix or surgical experience seen in the community setting. CONCLUSION This series demonstrates that 30% of patients (347 of 1142) undergoing RC may not have been able to receive adjuvant chemotherapy due to postoperative complications. This information should be taken into consideration when planning multimodal therapy and further supports the use of perioperative chemotherapy in the neoadjuvant setting.
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Affiliation(s)
- S Machele Donat
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, United States.
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Donat SM, Shabsigh A, Savage CJ, Cronin AM, Bernard BH, Dalbagni G, Herr HW, Milowsky MI. THE IMPACT OF POSTOPERATIVE COMPLICATIONS ON THE TIMING OF ADJUVANT CHEMOTHERAPY IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR INVASIVE OR NODE POSITIVE BLADDER CANCER (BCa). J Urol 2008. [DOI: 10.1016/s0022-5347(08)60856-3] [Citation(s) in RCA: 7] [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] [Indexed: 11/26/2022]
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Lambert EH, Pierorazio PM, Shabsigh A, Olsson CA, Benson MC, McKiernan JM. Prognostic Risk Stratification and Clinical Outcomes in Patients Undergoing Surgical Treatment for Renal Cell Carcinoma with Vascular Tumor Thrombus. Urology 2007; 69:1054-8. [PMID: 17572185 DOI: 10.1016/j.urology.2007.02.052] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [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: 09/27/2006] [Revised: 01/19/2007] [Accepted: 02/26/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Approximately 4% to 10% of patients with renal cell carcinoma (RCC) present with vascular tumor thrombus. Often, these patients also present with metastatic disease. This study examined the clinical outcome and morbidity of patients with RCC and vascular tumor thrombus treated with aggressive surgical therapy. METHODS From 1989 to 2006, 118 patients were identified with Stage pT3b or pT3c RCC who had undergone radical nephrectomy and thrombectomy. Disease-specific survival (DSS) and overall survival were measured by Kaplan-Meier statistics with the log-rank test to assess differences in survival stratified by the clinical and pathologic variables. Cox regression techniques were used to identify significant predictors of DSS. RESULTS The median follow-up was 18 months (range 1 month to 13.55 years). Tumor thrombus was at the level of the renal vein in 67 patients (56.8%), the infradiaphragmatic inferior vena cava in 39 (33%), and the supradiaphragmatic inferior vena cava in 12 patients (10%). Of the 118 patients, 42 (35.6%) presented with metastasis. The median tumor size was 8.2 cm. The 5-year overall survival rate was 40.7%. The 5-year DSS rate was 60.3% in those without metastasis and 10% in those with metastasis (P <0.001). The level of tumor thrombus did not significantly affect survival (P = 0.85). When the patients without metastasis were analyzed separately, nodal positivity (P = 0.03) and a tumor diameter greater than 7 cm (P = 0.05) were significant predictors of DSS. CONCLUSIONS Our results support the role of radical nephrectomy and thrombectomy in patients with RCC and vascular tumor thrombus. The absence of significant morbidity makes aggressive radical surgery feasible in the patients with tumor thrombus and metastatic disease. The current TNM staging system may need to be revised, given the evidence that the level of tumor thrombus invasion does not affect the survival outcomes.
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Affiliation(s)
- Erica H Lambert
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Dash A, Otero JR, Bianco FJ, Shabsigh A, Serio AM, Vickers AJ, Eastham JA, Sandhu JS. 17: The Concordance between a Systematically Administered Physician Reported Assessment of Function and a Health-Related Quality of Life Instrument. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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