BACKGROUND Renal cell carcinoma(RCC)is treated with surgical resection as the gold standard,as it is notoriously resistant to systemic therapy.Advancements with targeted therapies contribute to declining mortality,but...BACKGROUND Renal cell carcinoma(RCC)is treated with surgical resection as the gold standard,as it is notoriously resistant to systemic therapy.Advancements with targeted therapies contribute to declining mortality,but metastatic RCC(mRCC)survival remains poor.One possible factor is treatment at academic centers,which employ advanced providers and novel therapies.This study compared outcomes of mRCC in patients treated at academic/research facilities compared to those treated at non-academic centers.AIM To compare survival outcomes of mRCC and their various etiologies between academic and non-academic centers.METHODS The National Cancer Database was used to identify mRCC patients including all histology subtypes and stage IV disease.Descriptive statistics and Kaplan-Meier curves measured survival outcomes for user file facility types sorted into a binary academic/research and non-academic research variable.Multivariate logistic regression and Cox proportional hazard testing generated odds ratio and hazard ratio.Data was analyzed using Statistical Package for the Social Sciences version 29.0 using a significance level of P<0.05.RESULTS Overall,academic facility patients experienced greater 5-year and 10-year overall survival than non-academic facility patients.Treatment at non-academic facilities was associated with increased odds of death that persisted even after controlling for age,tumor size,sex,and distance traveled to treatment center.In comparison,nonacademic facility patients also experienced greater risk of hazard.CONCLUSION Patients with mRCC treated at academic/research facilities experienced increased survival compared to patients treated at non-academic facilities,were more likely to be younger,carry private insurance,and come from a large metropolitan area.They also were significantly more likely to receive surgery and adjuvant immunotherapy.展开更多
Objective:Guidelines for muscle-invasive bladder cancer(MIBC)recommend that patients receive neoadjuvant chemotherapy with radical cystectomy as treatment over radical cystectomy alone.Though trends and practice patte...Objective:Guidelines for muscle-invasive bladder cancer(MIBC)recommend that patients receive neoadjuvant chemotherapy with radical cystectomy as treatment over radical cystectomy alone.Though trends and practice patterns of MIBC have been defined using the National Cancer Database,data using the Surveillance,Epidemiology,and End Results(SEER)program have been poorly described.Methods:Using the SEER database,we collected data of MIBC according to the American Joint Commission on Cancer.We considered differences in patient demographics and tumor charac-teristics based on three treatment groups:chemotherapy(both adjuvant and neoadjuvant)with radical cystectomy,radical cystectomy,and chemoradiotherapy.Multinomial logistic regression was performed to compare likelihood ratios.Temporal trends were included for each treatment group.Kaplan-Meier curves were performed to compare cause-specific sur-vival.A Cox proportional-hazards model was utilized to describe predictors of survival.Results:Of 16728 patients,10468 patients received radical cystectomy alone,3236 received chemotherapy with radical cystectomy,and 3024 received chemoradiotherapy.Patients who received chemoradiotherapy over radical cystectomy were older and more likely to be African American;stage III patients tended to be divorced.Patients who received chemotherapy with radical cystectomy tended to be males;stage II patients were less likely to be Asian than Caucasian.Stage III patients were less likely to receive chemoradiotherapy as a treatment op-tion than stage II.Chemotherapy with radical cystectomy and chemoradiotherapy are both un-derutilized treatment options,though increasingly utilized.Kaplan-Meier survival curves showed significant differences between stage II and III tumors at each interval.A Cox proportional-hazards model showed differences in gender,tumor stage,treatment modality,age,andmarital status.Conclusion:Radical cystectomy alone is still the most commonly used treatment for muscle-invasive bladder cancer based on temporal trends.Significant disparities exist in those who receive radical cystectomy over chemoradiotherapy for treatment.展开更多
BACKGROUND Patients with a history of solid organ transplantation(SOT)or hematopoietic stem cell transplantation(HSCT)are at an increased risk of developing post-transplant lymphoproliferative disorder(PTLD).The gastr...BACKGROUND Patients with a history of solid organ transplantation(SOT)or hematopoietic stem cell transplantation(HSCT)are at an increased risk of developing post-transplant lymphoproliferative disorder(PTLD).The gastrointestinal(GI)tract is commonly affected as it has an abundance of B and T cells.AIM To determine typical GI-manifestations,risk factors for developing PTLD,and management.METHODS Major databases were searched until November 2021.RESULTS Non-case report studies that described GI manifestations of PTLD,risk factors for developing PTLD,and management of PTLD were included.Nine articles written within the last 20 years were included in the review.All articles found that patients with a history of SOT,regardless of transplanted organ,have a propensity to develop GI-PTLD.CONCLUSION GI tract manifestations may be nonspecific;therefore,consideration of risk factors is crucial for identifying GI-PTLD.Like other lymphoma variants,PTLD is very aggressive making early diagnosis key to prognosis.Initial treatment is reduction of immunosuppression which is effective in more than 50%of cases;however,additional therapy including rituximab,chemotherapy,and surgery may also be required.展开更多
文摘BACKGROUND Renal cell carcinoma(RCC)is treated with surgical resection as the gold standard,as it is notoriously resistant to systemic therapy.Advancements with targeted therapies contribute to declining mortality,but metastatic RCC(mRCC)survival remains poor.One possible factor is treatment at academic centers,which employ advanced providers and novel therapies.This study compared outcomes of mRCC in patients treated at academic/research facilities compared to those treated at non-academic centers.AIM To compare survival outcomes of mRCC and their various etiologies between academic and non-academic centers.METHODS The National Cancer Database was used to identify mRCC patients including all histology subtypes and stage IV disease.Descriptive statistics and Kaplan-Meier curves measured survival outcomes for user file facility types sorted into a binary academic/research and non-academic research variable.Multivariate logistic regression and Cox proportional hazard testing generated odds ratio and hazard ratio.Data was analyzed using Statistical Package for the Social Sciences version 29.0 using a significance level of P<0.05.RESULTS Overall,academic facility patients experienced greater 5-year and 10-year overall survival than non-academic facility patients.Treatment at non-academic facilities was associated with increased odds of death that persisted even after controlling for age,tumor size,sex,and distance traveled to treatment center.In comparison,nonacademic facility patients also experienced greater risk of hazard.CONCLUSION Patients with mRCC treated at academic/research facilities experienced increased survival compared to patients treated at non-academic facilities,were more likely to be younger,carry private insurance,and come from a large metropolitan area.They also were significantly more likely to receive surgery and adjuvant immunotherapy.
文摘Objective:Guidelines for muscle-invasive bladder cancer(MIBC)recommend that patients receive neoadjuvant chemotherapy with radical cystectomy as treatment over radical cystectomy alone.Though trends and practice patterns of MIBC have been defined using the National Cancer Database,data using the Surveillance,Epidemiology,and End Results(SEER)program have been poorly described.Methods:Using the SEER database,we collected data of MIBC according to the American Joint Commission on Cancer.We considered differences in patient demographics and tumor charac-teristics based on three treatment groups:chemotherapy(both adjuvant and neoadjuvant)with radical cystectomy,radical cystectomy,and chemoradiotherapy.Multinomial logistic regression was performed to compare likelihood ratios.Temporal trends were included for each treatment group.Kaplan-Meier curves were performed to compare cause-specific sur-vival.A Cox proportional-hazards model was utilized to describe predictors of survival.Results:Of 16728 patients,10468 patients received radical cystectomy alone,3236 received chemotherapy with radical cystectomy,and 3024 received chemoradiotherapy.Patients who received chemoradiotherapy over radical cystectomy were older and more likely to be African American;stage III patients tended to be divorced.Patients who received chemotherapy with radical cystectomy tended to be males;stage II patients were less likely to be Asian than Caucasian.Stage III patients were less likely to receive chemoradiotherapy as a treatment op-tion than stage II.Chemotherapy with radical cystectomy and chemoradiotherapy are both un-derutilized treatment options,though increasingly utilized.Kaplan-Meier survival curves showed significant differences between stage II and III tumors at each interval.A Cox proportional-hazards model showed differences in gender,tumor stage,treatment modality,age,andmarital status.Conclusion:Radical cystectomy alone is still the most commonly used treatment for muscle-invasive bladder cancer based on temporal trends.Significant disparities exist in those who receive radical cystectomy over chemoradiotherapy for treatment.
文摘BACKGROUND Patients with a history of solid organ transplantation(SOT)or hematopoietic stem cell transplantation(HSCT)are at an increased risk of developing post-transplant lymphoproliferative disorder(PTLD).The gastrointestinal(GI)tract is commonly affected as it has an abundance of B and T cells.AIM To determine typical GI-manifestations,risk factors for developing PTLD,and management.METHODS Major databases were searched until November 2021.RESULTS Non-case report studies that described GI manifestations of PTLD,risk factors for developing PTLD,and management of PTLD were included.Nine articles written within the last 20 years were included in the review.All articles found that patients with a history of SOT,regardless of transplanted organ,have a propensity to develop GI-PTLD.CONCLUSION GI tract manifestations may be nonspecific;therefore,consideration of risk factors is crucial for identifying GI-PTLD.Like other lymphoma variants,PTLD is very aggressive making early diagnosis key to prognosis.Initial treatment is reduction of immunosuppression which is effective in more than 50%of cases;however,additional therapy including rituximab,chemotherapy,and surgery may also be required.
