Background:The National Comprehensive Cancer Network(NCCN)guidelines recommend pelvic lymph node dissection(PLND)in NCCN high-and intermediate-risk prostate cancer patients.We tested for PLND nonadherence(no-PLND)rate...Background:The National Comprehensive Cancer Network(NCCN)guidelines recommend pelvic lymph node dissection(PLND)in NCCN high-and intermediate-risk prostate cancer patients.We tested for PLND nonadherence(no-PLND)rates within the Surveillance Epidemiology and End Results(2010-2015).Materials and methods:We identified all radical prostatectomy patients who fulfilled the NCCN PLND guideline criteria(n=23,495).Nonadherence rates to PLND were tabulated and further stratified according to NCCN risk subgroups,race/ethnicity,geographic distribution,and year of diagnosis.Results:Overall,the no-PLND rate was 26%;it was 41%,25%,and 11%in the NCCN intermediate favorable,intermediate unfavorable,and high-risk prostate cancer patients,respectively(p<0.001).Overtime,the no-PLND rates declined in the overall cohort and within each NCCN risk subgroup.Georgia exhibited the highest no-PLND rate(49%),whereas New Jersey exhibited the lowest(15%).Finally,no-PLND race/ethnicity differences were recorded only in the NCCN intermediate unfavorable subgroup,where Asians exhibited the lowest no-PLND rate(20%)versus African Americans(27%)versus Whites(26%)versus Hispanic-Latinos(25%).Conclusions:The lowest no-PLND rates were recorded in the NCCN high-risk patients followed by NCCN intermediate unfavorable and favorable risk in that order.Our findings suggest that unexpectedly elevated differences in no-PLND rates warrant further examination.In all the NCCN risk subgroups,the no-PLND rates decreased over time.展开更多
Objective:Robot-assisted radical prostatectomy(RARP)is the most commonly performed surgical treatment for prostate cancer.However,decision regret(DR)represents a concern for both patients undergoing the procedure and ...Objective:Robot-assisted radical prostatectomy(RARP)is the most commonly performed surgical treatment for prostate cancer.However,decision regret(DR)represents a concern for both patients undergoing the procedure and clinicians involved in therapeutic management.To address this need,we performed a systematic review exploring DR severity and its associations after RARP.Methods:A comprehensive search in scientific literature databases(PubMed,Embase,Scopus,and Web of Science)identified studies on DR in RARP-treated patients.All studies objectively evaluating DR were included.Within studies using the validated 5-item DR scale(range 0-100),the pooled estimate was calculated using fixedand random-effects models accounting for different follow-ups.A qualitative synthesis analyzed the impact of multiple baseline,perioperative,and postoperative factors on DR.Results:We retrieved 493 articles using our search strategy,with 15 meeting inclusion criteria.A total of 3480 prostate cancer patients with objective DR assessment after RARP were identified.The median follow-up ranged from 4.8 months to 6.3 years while response rates varied between 45% and 100%.Among the included studies,10 used the Decision Regret Scale,with a pooled mean estimate of 15.22(95%confidence interval 11.52-18.93)under the random-effects model.In the remaining five studies,DR was generally low(65%-75%)and even absent in some(12%-49%).Functional outcomes,such as continence and potency,were the most frequently reported factors significantly associated with DR.However,variability in assessing DR and other outcomes limits the ability to draw definitive conclusions.Conclusion:Most patients report low DR after RARP.Functional outcomes correlate with DR,but the heterogeneity in assessments and reporting methods warrants the need for more standardized evaluation.展开更多
Objective:We performed a population-based analysis focusing on primary extranodal lymphoma of either testis,kidney,bladder or prostate(PGUL).Methods:We identified all cases of localized testis,renal,bladder and prosta...Objective:We performed a population-based analysis focusing on primary extranodal lymphoma of either testis,kidney,bladder or prostate(PGUL).Methods:We identified all cases of localized testis,renal,bladder and prostate primary lymphomas(PL)versus primary testis,kidney,bladder and prostate cancers within the Surveillance,Epidemiology,and End Results database(1998e2015).Estimated annual proportion change methodology(EAPC),multivariable logistic regression models,cumulative incidence plots and multivariable competing risks regression models were used.Results:The rates of testis-PL,renal-PL,bladder-PL and prostate-PL were 3.04%,0.22%,0.18%and 0.01%,respectively.Patients with PGUL were older and more frequently Caucasian.Annual rates significantly decreased for renal-PL(EAPC:5.6%;pZ0.004)and prostate-PL(EAPC:3.6%;pZ0.03).In multivariable logistic regression models,older ager independently predicted testis-PL(odds ratio[OR]:16.4;p<0.001)and renal-PL(OR:3.5;p<0.001),while female gender independently predicted bladder-PL(OR:5.5;p<0.001).In surgically treated patients,cumulative incidence plots showed significantly higher 10-year cancer-specific mortality(CSM)rates for testis-PL,renal-PL and prostate-PL versus their primary genitourinary tumors.In multivariable competing risks regression models,only testis-PL(hazard ratio[HR]:16.7;p<0.001)and renal-PL(HR:2.52;p<0.001)independently predicted higher CSM rates.Conclusion:PGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder.Relative to primary genitourinary tumors,PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL,even after adjustment for other-cause mortality.展开更多
Objectives:This study aimed to test the association between of type and number of D'Amico high-risk criteria(DHRCs)with cancer-specific mortality(CSM)in high-risk prostate cancer patients treated with radical pros...Objectives:This study aimed to test the association between of type and number of D'Amico high-risk criteria(DHRCs)with cancer-specific mortality(CSM)in high-risk prostate cancer patients treated with radical prostatectomy.Materials and methods:In the Surveillance,Epidemiology,and End Results database(2004–2016),we identified 31,281 radical prostatectomy patients with at least 1 DHRC,namely,prostate-specific antigen(PSA)>20 ng/mL(hrPSA),biopsy Gleason Grade Group(hrGGG)score of 4 and 5,or clinical tumor stage≥T3(hrcT).Multivariable Cox regression models and competing risks regression models(adjusting for other cause mortality)tested the association between DHRCs and 5-year CSM.Results:Of 31,281 patients,14,394(67%)exclusively harbored hrGGG,3189(15%)harbored hrPSA,and 1781(8.2%)harbored hrcT.Only 2132 patients(6.8%)harbored a combination of the 2 DHRCs,and 138(0.6%)had all 3 DHRCs.Five-year CSMrates ranged from 0.9%to 3.0%when any individual DHRC was present(hrcT,hrPSA,and hrGGG,in that order),1.6%to 5.9%when 2 DHRCs were present(hrPSA-hrcT,hrcT-hrGGG,and hrPSA-hrGGG,in that order),and 8.1%when all 3 DHRCs were present.Cox regression models and competing risks regression confirmed the independent predictor status of DHRCs for 5-year CSM that was observed in univariable analyses,with hazard ratios from 1.00 to 2.83 for 1 DHRC,2.35 to 5.88 for combinations of 2 DHRCs,and 7.13 for all 3 DHRCs.Conclusions:Within individual DHRCs,hrcT and hrPSA exhibited weaker effects than hrGGG did.Moreover,a dose-response effect was identified according to the number of DHRCs.Accordingly,the type and number of DHRCs allow further risk stratification within the high-risk subgroup.展开更多
Objectives:To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(U...Objectives:To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(UTUC).Materials and methods:We retrospectively identified patients treated for UTUC from 2010 to 2020 from our institutional database.Patients undergoing laparoscopic or open RNU with no suspicion of metastasis(cM0)were for the current study population.Patients with suspected metastases at diagnosis(cM1)or those undergoing other surgical treatments were excluded.Tabulation was performed according to the laparoscopic versus open surgical approach.Kaplan-Meier plots were used to test for differences in overall and recurrence-free survival with regard to the surgical approach.Furthermore,separate Kaplan-Meier plots were used to test the effect of preoperative ureterorenoscopy on overall and recurrence-free survival within the overall study cohort.Results:Of the 59 patients who underwent nephroureterectomy,29%(n=17)underwent laparoscopic nephroureterectomy,whereas 71%(n=42)underwent open nephroureterectomy.Patient and tumor characteristics were comparable between groups(p≥0.2).The median overall survival was 93 and 73 months in the laparoscopic nephroureterectomy group compared to the open nephroureterectomy group(p=0.5),respectively.The median recurrence-free survival did not differ between open and laparoscopic nephroureterectomies(73 months for both groups;p=0.9).Furthermore,the median overall and recurrence-free survival rates did not differ between patients treated with and without preoperative ureterorenoscopy.Conclusions:The results of this retrospective,single-center institution showed that overall and recurrence-free survival rates did not differ between patients with UTUC treated with laparoscopic and open RNU.Furthermore,preoperative ureterorenoscopy before RNU was not associated with higher overall or recurrence-free survival rates.展开更多
文摘Background:The National Comprehensive Cancer Network(NCCN)guidelines recommend pelvic lymph node dissection(PLND)in NCCN high-and intermediate-risk prostate cancer patients.We tested for PLND nonadherence(no-PLND)rates within the Surveillance Epidemiology and End Results(2010-2015).Materials and methods:We identified all radical prostatectomy patients who fulfilled the NCCN PLND guideline criteria(n=23,495).Nonadherence rates to PLND were tabulated and further stratified according to NCCN risk subgroups,race/ethnicity,geographic distribution,and year of diagnosis.Results:Overall,the no-PLND rate was 26%;it was 41%,25%,and 11%in the NCCN intermediate favorable,intermediate unfavorable,and high-risk prostate cancer patients,respectively(p<0.001).Overtime,the no-PLND rates declined in the overall cohort and within each NCCN risk subgroup.Georgia exhibited the highest no-PLND rate(49%),whereas New Jersey exhibited the lowest(15%).Finally,no-PLND race/ethnicity differences were recorded only in the NCCN intermediate unfavorable subgroup,where Asians exhibited the lowest no-PLND rate(20%)versus African Americans(27%)versus Whites(26%)versus Hispanic-Latinos(25%).Conclusions:The lowest no-PLND rates were recorded in the NCCN high-risk patients followed by NCCN intermediate unfavorable and favorable risk in that order.Our findings suggest that unexpectedly elevated differences in no-PLND rates warrant further examination.In all the NCCN risk subgroups,the no-PLND rates decreased over time.
文摘Objective:Robot-assisted radical prostatectomy(RARP)is the most commonly performed surgical treatment for prostate cancer.However,decision regret(DR)represents a concern for both patients undergoing the procedure and clinicians involved in therapeutic management.To address this need,we performed a systematic review exploring DR severity and its associations after RARP.Methods:A comprehensive search in scientific literature databases(PubMed,Embase,Scopus,and Web of Science)identified studies on DR in RARP-treated patients.All studies objectively evaluating DR were included.Within studies using the validated 5-item DR scale(range 0-100),the pooled estimate was calculated using fixedand random-effects models accounting for different follow-ups.A qualitative synthesis analyzed the impact of multiple baseline,perioperative,and postoperative factors on DR.Results:We retrieved 493 articles using our search strategy,with 15 meeting inclusion criteria.A total of 3480 prostate cancer patients with objective DR assessment after RARP were identified.The median follow-up ranged from 4.8 months to 6.3 years while response rates varied between 45% and 100%.Among the included studies,10 used the Decision Regret Scale,with a pooled mean estimate of 15.22(95%confidence interval 11.52-18.93)under the random-effects model.In the remaining five studies,DR was generally low(65%-75%)and even absent in some(12%-49%).Functional outcomes,such as continence and potency,were the most frequently reported factors significantly associated with DR.However,variability in assessing DR and other outcomes limits the ability to draw definitive conclusions.Conclusion:Most patients report low DR after RARP.Functional outcomes correlate with DR,but the heterogeneity in assessments and reporting methods warrants the need for more standardized evaluation.
文摘Objective:We performed a population-based analysis focusing on primary extranodal lymphoma of either testis,kidney,bladder or prostate(PGUL).Methods:We identified all cases of localized testis,renal,bladder and prostate primary lymphomas(PL)versus primary testis,kidney,bladder and prostate cancers within the Surveillance,Epidemiology,and End Results database(1998e2015).Estimated annual proportion change methodology(EAPC),multivariable logistic regression models,cumulative incidence plots and multivariable competing risks regression models were used.Results:The rates of testis-PL,renal-PL,bladder-PL and prostate-PL were 3.04%,0.22%,0.18%and 0.01%,respectively.Patients with PGUL were older and more frequently Caucasian.Annual rates significantly decreased for renal-PL(EAPC:5.6%;pZ0.004)and prostate-PL(EAPC:3.6%;pZ0.03).In multivariable logistic regression models,older ager independently predicted testis-PL(odds ratio[OR]:16.4;p<0.001)and renal-PL(OR:3.5;p<0.001),while female gender independently predicted bladder-PL(OR:5.5;p<0.001).In surgically treated patients,cumulative incidence plots showed significantly higher 10-year cancer-specific mortality(CSM)rates for testis-PL,renal-PL and prostate-PL versus their primary genitourinary tumors.In multivariable competing risks regression models,only testis-PL(hazard ratio[HR]:16.7;p<0.001)and renal-PL(HR:2.52;p<0.001)independently predicted higher CSM rates.Conclusion:PGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder.Relative to primary genitourinary tumors,PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL,even after adjustment for other-cause mortality.
文摘Objectives:This study aimed to test the association between of type and number of D'Amico high-risk criteria(DHRCs)with cancer-specific mortality(CSM)in high-risk prostate cancer patients treated with radical prostatectomy.Materials and methods:In the Surveillance,Epidemiology,and End Results database(2004–2016),we identified 31,281 radical prostatectomy patients with at least 1 DHRC,namely,prostate-specific antigen(PSA)>20 ng/mL(hrPSA),biopsy Gleason Grade Group(hrGGG)score of 4 and 5,or clinical tumor stage≥T3(hrcT).Multivariable Cox regression models and competing risks regression models(adjusting for other cause mortality)tested the association between DHRCs and 5-year CSM.Results:Of 31,281 patients,14,394(67%)exclusively harbored hrGGG,3189(15%)harbored hrPSA,and 1781(8.2%)harbored hrcT.Only 2132 patients(6.8%)harbored a combination of the 2 DHRCs,and 138(0.6%)had all 3 DHRCs.Five-year CSMrates ranged from 0.9%to 3.0%when any individual DHRC was present(hrcT,hrPSA,and hrGGG,in that order),1.6%to 5.9%when 2 DHRCs were present(hrPSA-hrcT,hrcT-hrGGG,and hrPSA-hrGGG,in that order),and 8.1%when all 3 DHRCs were present.Cox regression models and competing risks regression confirmed the independent predictor status of DHRCs for 5-year CSM that was observed in univariable analyses,with hazard ratios from 1.00 to 2.83 for 1 DHRC,2.35 to 5.88 for combinations of 2 DHRCs,and 7.13 for all 3 DHRCs.Conclusions:Within individual DHRCs,hrcT and hrPSA exhibited weaker effects than hrGGG did.Moreover,a dose-response effect was identified according to the number of DHRCs.Accordingly,the type and number of DHRCs allow further risk stratification within the high-risk subgroup.
文摘Objectives:To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(UTUC).Materials and methods:We retrospectively identified patients treated for UTUC from 2010 to 2020 from our institutional database.Patients undergoing laparoscopic or open RNU with no suspicion of metastasis(cM0)were for the current study population.Patients with suspected metastases at diagnosis(cM1)or those undergoing other surgical treatments were excluded.Tabulation was performed according to the laparoscopic versus open surgical approach.Kaplan-Meier plots were used to test for differences in overall and recurrence-free survival with regard to the surgical approach.Furthermore,separate Kaplan-Meier plots were used to test the effect of preoperative ureterorenoscopy on overall and recurrence-free survival within the overall study cohort.Results:Of the 59 patients who underwent nephroureterectomy,29%(n=17)underwent laparoscopic nephroureterectomy,whereas 71%(n=42)underwent open nephroureterectomy.Patient and tumor characteristics were comparable between groups(p≥0.2).The median overall survival was 93 and 73 months in the laparoscopic nephroureterectomy group compared to the open nephroureterectomy group(p=0.5),respectively.The median recurrence-free survival did not differ between open and laparoscopic nephroureterectomies(73 months for both groups;p=0.9).Furthermore,the median overall and recurrence-free survival rates did not differ between patients treated with and without preoperative ureterorenoscopy.Conclusions:The results of this retrospective,single-center institution showed that overall and recurrence-free survival rates did not differ between patients with UTUC treated with laparoscopic and open RNU.Furthermore,preoperative ureterorenoscopy before RNU was not associated with higher overall or recurrence-free survival rates.
