bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of comorbidity burden on renal cell carcinoma prognosis: A Danish nationwide cohort study.
Authors: Horsbøll Trine Allerslev , Dalton Susanne Oksbjerg , Christensen Jane , Petersen Astrid , Azawi Nessn H. , Donskov Frede , Andersen Ole , Nørgaard Mette , Lund Lars 
Published: March 2021

360 Background: The incidence of renal cell carcinoma is increasing worldwide and have a 5-year relative survival rates of around 75%. Comorbidity has been found to be associated with complications and mortality after renal cancer surgery. No studies have focused on comorbidity as a prognostic factor in a nationwide cohort of patients with renal cell carcinoma with long-term follow-up. Purpose: The primary aim was to evaluate the prognostic impact of comorbidity on survival in older (≥70 years) and younger (<70 years) patients diagnosed with renal cell carcinoma. Methods: We established a nationwide register-based cohort of 7,894 patients aged 18 or more diagnosed with renal cell carcinoma in Denmark between 2006 and 2017, and followed their vital status for up to 13 years. We computed 1- and 5-year overall survival and hazard ratios (HRs) of death according to comorbidity status using Charlson Comorbidity Index (CCI) among patients aged < 70 years and ≥ 70 years. Results: In all, 36% of the patients had registered comorbidity at the time of diagnosis. Survival decreased with increasing CCI score. It did though increase for all groups of CCI scores (0, 1-2 and 3+) over time. For patients without comorbidity diagnosed in 2006-2008 and 2015-2017, 5-year survival rate increased from 57% to 69%. For patients with a CCI score of 1-2 vs 3, the 5-year survival rate increased from 46% to 62% vs 39% to 44%. In age- and gender-stratified analyses, patients with a CCI score of 1-2 and 3+ had increased mortality compared to patients without registered comorbidity (HR 1.15, 95 % CI 1.06-1.24) and (HR 1.56, 95 % CI 1.40-1.73). Patterns were similar for older (≥70 years) and younger (<70 years) patients. Particularly, diagnoses of congestive heart failure, peripheral vascular and cerebrovascular disease, dementia, chronic pulmonary disease, preexisting renal and liver disease, diabetes and lymphoma led to increased mortality. Conclusions: Comorbidity leads to inferior survival outcomes in patients with renal cell carcinoma, irrespective of age, despite an overall increasing survival. These data may guide patient counseling and prompt initiatives for controlling comorbidity.
A retrospective study of primitive neuroectodermal tumor (PNET) of the kidney in a tertiary cancer center in India.
Authors: Menon Nandini Sharrel , Kalra Devanshi , Prabhash Kumar , Noronha Vanita , Menon Santosh , Bakshi Ganesh , Prakash Gagan , Pal Mahendra , Laskar Siddhartha , Khanna Nehal Rishi , Agrawal Archi , Joshi Amit 
Published: March 2021

361 Background: Primitive neuroectodermal tumours (PNET) of the kidney are rare tumours with aggressive behaviour. This study was conducted to review the diagnosis and management of patients with renal PNET at our centre. Methods: This was a retrospective study conducted at a tertiary cancer care centre in Mumbai, India. The demographic and clinical data of 17 patients treated by the uro-oncology services were retrieved from electronic medical records. Descriptive analysis was performed for baseline characteristics.Overall & progression-free survival was determined using the Kaplan Meier method. Cox regression was used for multivariate analysis. Results: There were 12 male and 5 female patients in this cohort with a median age of 27 years. At diagnosis 2 patients had metastatic disease and 15 patients had non-metastatic disease. Median follow up in this cohort was 22 months (range 2-30 months). Presenting complaints were hematuria, abdominal pain, flank pain, fever, bone pain, and incidentally detected renal mass. All patients were Mic -2 positive and 13 were FLI-1 positive on immunohistochemistry. Fourteen patients underwent radical nephrectomy. One (5.9%) patient received both neoadjuvant and adjuvant chemotherapy, 8 (47.1%) received adjuvant and 2 (11.8%) received palliative chemotherapy upfront. Eight patients received adjuvant radiation to the renal bed.There was disease progression in12 patients,10 of 15 patients with non metastatic disease at diagnosis eventually developed metastasis.The median progression free survival (PFS) was 10.55 months.The pathological feature that was associated with a shorter PFS was tumor size ⩾10 cm(p = 0.044).The median overall survival was 20.04 months (95% CI 9.49 -not reached). The presence of metastasis and treatment received significantly impacted overall survival (OS). Median OS in patients with non-metastatic disease was not reached versus 14.1 months in those with metastatic disease (p = .019).The median OS in patients treated with multimodality approach was 20.11 months. Patients did not undergo surgery had a median OS of 5.45 months (p < .001) and those who did not receive any chemotherapy had a median OS of 4.57 months (p = .024).Thus, patients who received multimodality treatment had better outcomes. Conclusions: PNET kidney is an aggressive tumor which should be treated with a multimodality approach. Tumor size ⩾10 cm was an adverse prognostic factor.
Androgen deprivation therapy and risk of SARS-CoV-2 infection in men with prostate cancer: A University of California (UC) Health System registry study.
Authors: Kwon Daniel , Vashisht Rohit , Borno Hala , Aggarwal Rahul Raj , Small Eric Jay , Butte Atul , Huang Franklin W. 
Published: March 2021

37 Background: SARS-CoV-2 entry into host cells is facilitated by the transmembrane protease TMPRSS2. TMPRSS2 expression can be modulated by the androgen receptor. It is unclear whether androgen deprivation therapy (ADT) may partially protect from SARS-CoV-2 infection. Methods: A retrospective registry study of adult men with prostate cancer who underwent testing for SARS-CoV-2 in the UC Health System between February 1, 2020 and October 6, 2020 was performed. The University of California Health COVID Research Data Set (UC CORDS), which includes electronic health data of all patients who underwent testing for SARS-CoV-2 at 5 UC academic medical centers (UC Davis, UC Irvine, UC Los Angeles, UC San Diego, and UC San Francisco) and 12 affiliated hospitals across California, was used. Association of SARS-CoV-2 infection and receipt of ADT (GnRH agonist or antagonist) within 90 days of COVID testing was determined using the Chi-Squared test. Analyses (Chi-Squared or Fisher’s exact tests) were also performed in race/ethnicity subgroups. Results: Overall, 2,948 men with prostate cancer who underwent SARS-CoV-2 testing were identified, of whom 59 (2.0%) tested positive. Of the 2,948 men, 2,124 (72%) were White; 219 (7%) Black or African-American; 182 (6%) Asian or Native Hawaiian/Pacific-Islander; 176 (6%) Other race; and 247 (8%) Unknown race. There were 235 (8%) Hispanic or Latino men. Among the 444 men who received ADT in the entire cohort, 7 (1.6%) tested positive, and among the 2,504 men who did not receive ADT, 52 (2.1%) tested positive (OR 0.76, 95% CI 0.34-1.67, P = 0.49). No statistically significant association between ADT and SARS-CoV-2 positivity was found within race or ethnicity subgroups. Conclusions: No association between the use of ADT and the risk of testing positive for SARS-CoV-2 was identified in this study of a diverse patient population in the University of California Health System medical centers and hospitals. In this setting of an overall low prevalence of SARS-CoV-2 infection, thus far, there is no strong evidence of a protective benefit of ADT.
Paternity, relationship, sexual activity and fertility in testicular cancer (TC) survivors (TCS): Results from a single institution observational prospective study.
Authors: Bimbatti Davide , Pierantoni Francesco , Maruzzo Marco , Deppieri Filippo Maria , Msaki Aichi , Gatti Maura , Dionese Michele , Lai Eleonora , Marino Dario , Basso Umberto , Zagonel Vittorina 
Published: March 2021

380 Background: TC represents 1% of male neoplasms but it is the most common in young adults. Interdisciplinary management with chemotherapy, radiotherapy and surgery has led to a 10-year relative survival rate of up to 95%. These treatments (Tx) have short- and long-term side effects. While sexual dysfunction can reduce fertility, psychosocial distress can create relationship problems and finally affect the ability to procreate. Methods: From February 2020, we submitted a series of questionnaires to all the patients (pts) currently followed-up at the Istituto Oncologico Veneto free from TC recurrence for at least 2 years from the last Tx. International Index of Erectile Function (IIEF-15) and Premature Ejaculation Diagnostic Tool (PEDT) were used. We also set up a questionnaire to investigate paternity and family status. Data about disease and treatments were collected from medical records. Results: 84 TCS completed the questionnaires, clinical data are reported in the table below. 29,8% of pts fathered children before diagnosis with a strong correlation with older age at diagnosis (45,4 vs 30,8 years, p<0,001). After Tx, 14 pts had children: 9 of which naturally, 2 out 6 were successful via assisted reproductive technology (ART) (including one patient that received high-dose chemotherapy and stem cell transplantation), 3 via adoption. 89,3% of pts had stable relationships. Of pts who did not have children: 13,1% claimed to be due to lack of a partner, 39,3% claimed to be unready, while 14,3% had tried unsuccessfully to conceive. While 28,6% pts claim to currently have fertility issues, only 8,3% of pts reported to have these issues before diagnosis. 70,2% of pts performed a spermiogram after Tx, 10 pts had spermatogenic impairment. Higher rate of sexual dysfunction after Tx was detected by questionnaires while only 4 pts claimed to have had a pre-existing issue prior to TC diagnosis. PEDT shows that 38,1% had premature ejaculation and that in 22,6% this issue is highly probable. IIEF confirms a high rate of erectile dysfunction (14,3% severe and 10,7% mild or moderate). No correlations were identified between sexual dysfuntion and previous Tx. Conclusions: Most TCS had not planned fatherhood while 16,7% had children after Tx and 14.3% tried unsuccessfully to conceive. ART and adoption is possible but challenging and little used. PEDT and IIEF found high rates of sexual dysfunction but no association with previous Tx were found. [Table: see text]
Validation of testicular germ cell tumor (GCT) staging in nationwide cancer registries.
Authors: Badia Rohit R , Wong Daniel , Ghandour Rashed , Chertack Nathan , Meng Xiaosong , Hutchinson Ryan C. , Margulis Vitaly , Lotan Yair , Madrigales Alejandra , Woldu Solomon L. , Bagrodia Aditya 
Published: March 2021

383 Background: Nationwide cancer registries such as the National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results (SEER) rely on accurate data from institutional tumor registries to formulate hypotheses and report outcomes and treatment patterns for patients with cancer. We evaluated the accuracy of our institutional registry for testicular germ cell tumors (GCT) by comparing data abstracted by urologists with data abstracted by our tumor registry. Methods: We performed a retrospective review of patients receiving initial diagnosis and treatment for testicular cancer at our hospital system from 2005-2016. We reviewed registrar coding for American Joint Committee on Cancer clinical staging, overall composite stage grouping, and first-line treatment and compared it with urologist-reviewed staging at the time of diagnosis. Results: Paired staging from registry and urologist was available for 80 patients. T, N, M, and S-staging were accurate for 90%, 81%, 94%, and 54% of records, respectively. Composite staging and first-line treatment were concordant for 39% and 90% of patients, respectively. A separate review of 33 Stage IS patients per registry for composite staging revealed only 15% concordance. Conclusions: We identified significant inconsistencies with data abstracted by our institutional tumor registry for patients with testicular cancer, most notably with regards to S and composite stage. An educational intervention to improve abstraction by registry led to increased concordance. Assuming similar discrepancies may exist at other institutions and for other cancer types, caution should be used when interpreting NCDB and SEER cancer staging data. This sheds light on the need for improved clarification of staging guidelines, dynamic institutional internal auditing, and training reform within cancer registries.
Localized testicular germ cell tumor (TGCT) surveillance: A Delphi consensus study.
Authors: DA Silva Angélique , Flechon Aude , Culine Stephane , Coquan Elodie , Thiery Vuillemin Antoine , Planchamp François , Murez Thibaut , Mejean Arnaud , Pasquier David , Fizazi Karim , Joly Florence 
Published: March 2021

384 Background: Stage I testicular germ cell tumor (TGCT) has excellent cure rates and surveillance is fully included in patient’s management, particularly during the first years of follow-up. Surveillance guidelines differ between the academic societies, with different recommendations concerning clinical and imaging frequency de-escalation and long term follow-up. We evaluated surveillance practice and schedules followed by French specialists and set up a DELPHI method to obtain a consensual surveillance program with an optimal schedule for patients with localized TGCT. Methods: An online survey on surveillance practice of stage I TGCT based on clinical-cases was conducted among urologists, radiotherapists and oncologists. Results were compared to AFU, ESMO and EAU guidelines. Then a panel of experts assessed surveillance proposals following a formal consensus method (DELPHI method). Statements were drafted after analysis of the previous survey and systematic literature review, with 2 successive rounds to reach a consensus. Results: Survey and DELPHI were conducted between July 2018 and May 2019. Sixty-one (12.2%) participated to the survey (69% oncologists, 15% urologists, 16% radiotherapists). For the first 5 years of follow-up we observed 30 to 50% of adherence to AFU’s guidelines, 20 to 36% of adherence to ESMO’s guidelines and 6 to 45% of practices not corresponding to any of the guidelines depending on clinical situations. Only 25% of practitioners stopped surveillance after the 5th year, as recommended. No physician followed the ESMO guidelines of de-escalation chest imaging. For the Delphi study, a panel of 32 experts (78% oncologists, 16% urologists, 6% radiotherapists) was asked about 38 statements. Consensus was reached for 26 statements concerning clinico-biological surveillance modalities and end of surveillance after the 5th year of follow-up. For seminoma, abdominal ultrasound was proposed as an option to the abdominopelvic (AP) scan for the 4th year of follow-up. No consensus was reached regarding de-escalation of chest imaging. Conclusions: The survey proved that French TGCT specialists do not follow current guidelines. With DELPHI method, a consensus was obtained for frequency of clinico-biological surveillance, discontinuation of surveillance after the 5th year and stop of AP scan on the 4th year of follow-up for seminoma. Questions remains concerning type and frequency of chest imaging.
Comprehensive genomic profiling (CGP) in patients with relapsed/refractory germ cell tumors (GCT).
Authors: Akel Reem , Anouti Bilal , Kern Sean , Cary Clint , Masterson Timothy A. , Jacob Joseph M , Bratslavsky Gennady , Danziger Natalie , Pavlick Dean , Hanna Nasser H. , Einhorn Lawrence H. , Ross Jeffrey S. , Adra Nabil 
Published: March 2021

388 Background: Understanding the genetic alterations in patients with relapsed/refractory GCT (rrGCT) could delineate the pathogenesis of cisplatin resistance. Our study uses CGP to characterize genomic alterations (GA) in refractory GCT and correlate with clinical outcomes. Methods: 432 patients with rrGCT were seen at Indiana University between Jan 2016 to Sep 2019 of whom 52 patients underwent CGP using a hybrid-capture based commercial assay to evaluate all classes of GA. Tumor mutational burden (TMB) was determined on 1.1 Mbp of sequenced DNA and reported as mutations/Mb and microsatellite instability (MSI) was determined on 114 loci. PDL1 expression was determined by IHC (DAKO 22C3 antibody). Results: All patients relapsed after first-line cisplatin-based combination chemotherapy. Median age at diagnosis was 33 (range 15-68). Primary site of GCT was testicular in 85% and mediastinum in 8%. 6 patients had pure seminoma and 46 had non-seminoma. Platinum refractory disease, defined as serologic or radiographic progression within 4 weeks of first-line chemotherapy comprised 23% of patients. The primary tumor was used for sequencing in 6 cases (12%) and non-primary tumor metastatic site (lymph node, lung, liver, brain, omentum) in 46 cases (88%). The most common GA in the entire cohort were FGF6 (27%), FGF23 (27%), KDM5A (27%), CCND2 (27%), KRAS (18%), TP53 (14%), KIT (8%), APC (8%), ZNF217 (6%), MUTYH (6%), AURKA (6%), NRAS (6%), EGFR (6%), CTNNB1 (6%), GNAS (6%). Most common alterations for testicular primary tumors were FGF6, FGF23, KDM5A, CCND2, KRAS, TP53, KIT. For non-testicular primary GCT, most common GA were APC, TP53, EGFR. Most common GA for non-seminoma were FGF6, FGF23, KDM5A, CCND2, KRAS, TP53, APC. Most common GA for pure seminoma was KIT. Potentially targetable genomic alterations were found in 17 patients (33%). 10 of 17 patients (59%) tested had PDL1 score ≥1% and 3 patients had PDL1 ≥50%. Median TMB was 3.5 mutations/MB. There were 4 patients (8%) with TMB ≥ 10 mutations/Mb and 2 patients (4%) with TMB ≥ 20 mutations/Mb. 1 of 48 patients (2%) evaluated for MSI had MSI-High status. Isochromosome 12p was detected in the majority of samples where it was tested. Outcomes with GA-directed therapy will be presented at the conference. Conclusions: CGP can reveal potential therapeutic targets in patients with rrGCT including EGFR, ERBB3, KIT, and MET. Consistent with reported clinical trials in rrGCT, biomarkers predicting response to immune checkpoint blockade are uncommon with most patients having low TMB, absence of MSI-H status, and low expression of PDL1.
A multicenter, retrospective study on impact of immunotherapy in urothelial carcinoma with bone metastases (Meet-Uro01 Study).
Authors: Giannatempo Patrizia , Marandino Laura , Raggi Daniele , Pierantoni Francesco , Maruzzo Marco , Lipari Helga , Banna Giuseppe Luigi , De Giorgi Ugo , Naglieri Emanuele , Buti Sebastiano , Stellato Marco , Vignani Francesca , Roviello Giandomenico , Veccia Antonello , Losanno Tania , Mucciarini Claudia , Pignata Sandro , Necchi Andrea , Di Maio Massimo 
Published: March 2021

401 Background: Considerable numbers of patients (pts) with metastatic urothelial carcinoma (mUC) (approximately 25-47%) develop bone metastases (BoM). Their impact on the efficacy of immunotherapy (IO) is not yet sufficiently investigated. We developed a national collaboration on this issue, with the aim to assess the effect of BoM on survival outcomes of immunotherapy-treated pts in a large retrospective cohort. Methods: Data on pts diagnosed with mUC and treated between 07/14 and 08/20 with single-agent immunotherapy (IO) after failure of at least 1 previous line of chemotherapy (CT) for advanced disease, or (neo-)adjuvant CT within 12 months were retrospectively collected across 14 centers. PFS and OS were analyzed using the Kaplan-Meier method. Cox regression analysis was performed evaluating potential prognostic factors for OS and PFS. Each factor was evaluated in univariable (UV) and multivariable (MVA) analysis. Results: A total of 208 evaluable pts treated with single-agent immunotherapy (anti PD-1 n=42; anti PD-L1 n=166) were identified, including 122 without BoM (59% BoM-) and 86 (41%) BoM+. 13% of pts had progressed within 12 months after (neo-)adjuvant CT and 79% after a previous line of platinum-based CT for advanced disease (cisplatin 42.8%; carboplatin 36.5%). The presence of BoM negatively affected performance status (PS) of patients at baseline (ECOG PS 0/1/2 in 58% / 37% / 5% in BoM- vs 38% / 52% / 9% in BoM+; p=0.017). Other baseline characteristics were comparable. BoM+ showed shorter PFS (median 2.0 vs 2.6 months, HR 1.76 [95%CI, 1.31-2.37], p<0.001) and OS (median 3.9 vs 7.8 months, HR 1.59 [95%CI, 1.15-2.20], p=0.005) than BoM-. Probability of being alive was 62% vs 40% after 6 months, 38% vs 23% after 1 year and 24% vs 13% after 2 years, in BoM- and BoM+ respectively. Within each Bellmunt score, PFS and OS of BoM+ pts were shorter compared to BoM-. Both BoM and higher Bellmunt risk score were significantly associated with shorter PFS and OS in UV and MV analyses (Table). Conclusions: Patients with mUC treated with single-agent immunotherapy for BoM+ advanced disease have a dismal prognosis compared with BoM-. Further research is needed to understand the mechanism behind these clinical outcomes. [Table: see text]
Immune checkpoint inhibitors (ICI) in advanced upper tract and lower tract urothelial carcinoma (UC): A comparison of outcomes.
Authors: Esagian Stepan M. , Khaki Ali Raza , Carril-Ajuria Lucia , Park Joseph J. , Bilen Mehmet Asim , Stewart Tyler Francis , Santos Victor Sacristan , Jain Jayanshu , Morales-Barrera Rafael , Devitt Michael Edward , Hoimes Christopher J. , Shreck Evan , Tripathi Abhishek , Zakopoulou Roubini , Rodriguez-Vida Alejo , Drakaki Alexandra , Kumar Vivek , Msaouel Pavlos , Koshkin Vadim S , Grivas Petros 
Published: March 2021

406 Background: Despite anatomical and biological differences, upper and lower tract UC (UTUC; LTUC) are usually managed similarly. Modern era clinical trial data comparing their outcomes with ICI are conflicting. We hypothesized that response and outcomes would be similar in patients (pts) with advanced UTUC and LTUC. Methods: We performed a retrospective cohort study collecting demographic, clinicopathologic, treatment, and outcome data for pts with advanced UC receiving ICI (2013-2020) across 24 centers (US; Europe). We compared objective response rate (ORR), overall survival (OS), and progression-free survival (PFS) between pts with UTUC and LTUC. Uni- / multi- variable logistic and Cox regression were used to assess the effect of UTUC on ORR, OS, and PFS. Stratified subgroup analyses were performed according to histology (pure, mixed) and line of treatment (first-line, subsequent). Results: A total of 984 pts were identified, and 707, 717, and 738 were included in ORR, OS, and PFS analyses, respectively. After exclusions, the UTUC group comprised of 130 pts (vs. 616 in LTUC) with median age 71 (40-92) (vs. 70 [32-93]), 62% men (vs. 76%), 41% never smokers (vs. 29%), 62% with history of prior radical surgery for primary tumor (vs. 52%), and 29% with liver metastases (vs. 18%). Table shows results of ORR, OS, and PFS analyses. In the overall population, pts with UTUC and LTUC receiving ICI had comparable ORR, OS, and PFS. Pts with mixed-histology UTUC had significantly lower ORR (adjusted OR 0.20, 95%CI 0.05-0.91) and shorter PFS (adjusted HR 1.66, 95%CI: 1.06-2.59) vs. mixed-histology LTUC. Conclusions: Pts with advanced UTUC and LTUC receiving ICI have similar response and outcomes, except for pts with mixed-histology UTUC vs LTUC. Subset analysis of primary tumor location in ongoing clinical trials can validate our data, while biomarker work is ongoing. [Table: see text]