bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of patients (pts) with metastatic clear-cell renal cell carcinoma (mCCRCC) treated with second-line (2L) vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI) after first-line (1L) immune checkpoint inhibitors (ICI).
Authors: Shah Amishi Yogesh , Lemke Emily , Gao Jianjun , Chandramohan Anuradha , Campbell Matthew T. , Zurita Amado J. , Xiao Lianchun , Wang Jennifer , Corn Paul Gettys , Jonasch Eric , Sharma Padmanee , Tannir Nizar M. 
Published: February 2018

682 Background: Little data exists on objective response rates (ORR), progression-free survival (PFS), and safety of 2L VEGFR-TKI after 1L ICI therapy in pts with mCCRCC. Methods: This is a retrospective study of pts with mCCRCC who received 2L VEGFR-TKI after progressive disease (PD) with 1L ICI. Tumor response was assessed by a blinded radiologist using RECIST 1.1. Descriptive statistics, the Fisher’s test, and Kaplan-Meier method were used. Results: We report on 43 pts who were treated at MDACC from 2015 till present. Median age at mCCRCC diagnosis was 59 years (range: 43-72). 33 pts had lung mets, 20 had LN mets, 14 had bone mets, and 3 had liver mets. As 1L therapy, 20 pts received nivolumab + ipilimumab, 14 received nivolumab + bevacizumab, and 9 received nivolumab. Median time on ICI therapy was 29.4 weeks. All pts had resolution of Grade 3/4 AEs from ICI and PD before initiation of VEGFR-TKI. One patient (2%) had CR, 17 pts (40%) had PR, and 25 pts (58%) had SD, leading to 100% disease control rate (DCR) as best response to 2L VEGFR-TKI. Median PFS was 10.0 months (95% CI: 7.4, NA). Estimated 1-yr overall survival (OS) was 87.5% (95% CI: 74.6 - 100). Seven pts (16%) discontinued VEGFR-TKI therapy because of AEs: Gr 3 transaminitis (3 on pazopanib), Gr 3 hand-foot skin reaction (1 on axitinib), impaired wound healing (1 on axitinib), and Gr 3 pancreatitis (1 on pazopanib, 1 on axitinib). Conclusions: In this retrospective study, we observed a 42% ORR, a 10-month median PFS, and a 100% DCR in pts with mCCRCC who received VEGFR-TKI after PD with ICI. These results inform the design of trials with 2L VEGFR-TKI after failure of ICI therapy. [Table: see text]
Oncologic and functional outcomes of radical and partial nephrecotmy in PT3A patholigically upstaged renal cell carcinoma: A multi-instituitional analysis.
Authors: Reddy Madhumitha , Bindayi Ahmet , Hamilton Zachary , Ryan Stephen , Yim Kendrick , Nasseri Ryan , Joshi Shreyas , Peyronnet Benoit , Bensalah Karim , Pruthi Deepak Kumar , Montorsi Francesco , Capitanio Umberto , Lane Brian R. , Uzzo Robert , Derweesh Ithaar 
Published: February 2018

685 Background: Radical Nephrectomy (RN) has been the standard of care for complex and locally advanced renal cell carcinoma (RCC). Efficacy of PN in the setting of pT3a pathologic upstaged disease is controversial. We compared oncologic and functional outcomes of RN and PN in patients with upstaged pT3a RCC. Methods: Multicenter retrospective analysis of patients with cT1−2N0M0 RCC undergoing RN or PN upstaged to pT3a postoperatively. Primary outcome was Overall Survival (OS), with secondary outcomes being Recurrence Free Survival (RFS) and eGFR < 60 at last follow-up. Results: 8185 patients were analyzed (mean follow up 48 months). 945 (11.5%) were upstaged to pT3a [686 (72.6%) RN, 243 (25.7%) PN]. Logistic regression analysis showed that increasing age, decreasing BMI, increasing intraoperative EBL, and positive margin increased the OR of all-cause mortality (all p < 0.05, Table). Kaplan Meier analysis (KMA) revealed 5−year OS for PN cT1→pT3a, RN cT1→pT3a, PN cT2→pT3a, RN cT2→pT3a of 64%, 65.2%, 56.4% and 55.2% respectively (p = 0.059). KMA revealed 5−year RFS for PN cT1→pT3a, RN cT1→pT3a, PN cT2→pT3a, RN cT2→pT3a of 79%, 74%, 70% and 51% respectively (p < 0.001). PN was associated with a decreased risk of GFR < 60 at follow up (39.6% vs. 59.5% for RN, p = 0.008) Conclusions: PN did not adversely affect oncologic outcomes in select patients who are upstaged to pT3a RCC from cT1 or cT2 disease, and may provide renal functional benefit. Improvements with respect to RFS for PN are most likely driven by selection bias. [Table: see text]
Level of preoperative CRP as an independent predictor of survival in patients after nephrectomy for renal cell carcinoma: Long-term outcomes.
Authors: Saon Md , Patil Dattatraya H , Ding Tiffany , Kim Frances Y , Torlak Mersiha , Ogan Kenneth , Master Viraj A. 
Published: February 2018

687 Background: Preoperative C- Reactive Protein (CRP) has predictive value for metastasis development and mortality in renal cell carcinoma (RCC). However, the predictive potential of preoperative CRP at presentation on survival after nephrectomy remains unclear. This study investigates the prognostic value of preoperative CRP on overall long term survival in RCC patients post-nephrectomy. Methods: 683 post-nephrectomy patients for localized clear cell RCC were evaluated from 2005-2017 to investigate preoperative CRP’s prognostic value on overall survival. Cohort was divided into 3 groups based on preoperative CRP (≤ 10, 10-100, > 100 mg/L). Kaplan-Meier curve and Cox proportional hazards models evaluated the predictive value of preoperative CRP in addition to established covariates. Results: Mean age was 59±12 years. 81 (11.6%) patients were deceased at the end of follow-up. T-stage distribution of cohort as follows: T1 = 444 (65%), T2 = 38 (6%), T3 = 197 (29%), and T4 = 4 (1%). Log Rank test of the Kaplan–Meier estimates of survival probability in RCC patients stratified by preoperative CRP revealed significant difference (p-value < 0.001). Per Cox models, high preoperative CRP values were associated with higher mortality (P < 0.001), higher T Stage (P < 0.001), Fuhrman Grade (P < 0.001), fat invasion (P < 0.001), and necrosis (P < 0.001). Multivariable model identified high preoperative CRP ( > 100) as an independent predictor of survival compared to low-to-normal (HR: 2.1, 95%CI: 1.00-4.23, p-value-0.05). 5-year survival of patients with CRP > 100 was 43%. Conclusions: Preoperative CRP could potentially be used as an independent predictor of overall survival post nephrectomy in patients with RCC. Higher CRP values are associated with higher mortality in such patients.
Association of preoperative neutrophil-to-lymphocyte ratio with immune populations in the tumor microenvironment of patients with clear cell renal cell carcinoma.
Authors: Sanchez Alejandro , Liu Ming , Nixon Briana , Ghanaat Mazyar , DiNatale Renzo , Blum Kyle A , Russo Paul , Reuter Victor E. , Li Ming , Hakimi A. Ari 
Published: February 2018

688 Background: Currently, there are no blood biomarkers that reflect the composition of immune cells in the tumor microenvironment (TME) of patients with clear cell renal cell carcinoma (ccRCC). High pre-operative neutrophil-to-lymphocyte ratio (NLR) is associated with adverse oncologic outcomes in ccRCC. However, how NLR relates to the immune cell composition in the TME is not well understood. Methods: We performed flow cytometry on tumor and adjacent normal renal tissue from a prospective cohort of patients who underwent surgery from 6/2015-7/2017. Immune cell populations, as a percent of total CD45+, were compared to baseline age, sex, body mass index (BMI), SSIGN score, sarcomatoid differentiation, and AJCC stage (I-IV). NLR was calculated using pre-operative absolute neutrophil-to-lymphocyte counts and further categorized as inflamed if NLR was ≥ 3. Correlations between continuous variables were performed using Spearman’s rank correlation. Comparisons of means were made using the Wilcoxon signed-rank test. Results: Among 48 patients, 32 (71%) were male, median age was 59 (IQR 52-66), BMI of 38.5 (IQR 26-32.6), SSIGN score of 8 (IQR 5-12), 9 (20%) had sarcomatoid differentiation, and 20 (44%) had metastases at presentation. No correlations were found between age, BMI, and different immune cell populations or NLR. A higher ratio of tissue resident (CD8a+CD49a+CD103+) to circulating (CD8a+CD49a-CD103-) CD8+ T-cells in the TME was associated with increasing stage at presentation (p = 0.02). Inflamed patients had similar total CD45+, CD8+ T cell, CD4+ T cell, and macrophage immune infiltration. However, inflamed patients had a higher proportion of CD8+ Tres infiltration (p = 0.04) and a trend towards higher neutrophil infiltration (p = 0.15). Conclusions: A higher proportion of resident CD8+T-cells correlated with advanced disease at presentation. NLR may reflect a change in the type of CD8+T cell population found in the TME. This population of CD8+ T-cells, and NLR as a possible biomarker should be validated and further investigated in a larger cohort of patients. Funding: Ruth L. Kirschstein Research Service Award T32CA082088 (A.S., M.G.)
Evaluation of preoperative C-reactive protein: Albumin ratio in patients with clear cell renal cell carcinoma.
Authors: Patil Dattatraya H , Williams Sierra , Torlak Mersiha , Alemozaffar Mehrdad , Lay Aaron , Pattaras John , Kucuk Omer , Carthon Bradley Curtis , Bilen Mehmet Asim , Ogan Kenneth , Master Viraj A. 
Published: February 2018

690 Background: Multiple inflammatory markers have been evaluated in predicting preoperative risk in patient’s undergoing curative nephrectomy for Clear cell renal cell carcinoma. We propose that ratio of C-Reactive Protein to albumin (CA-ratio) would prove to be a good prognostic indicator for assessment of overall survival and comparable to established nomograms in clear call RCC. Methods: Patients that underwent nephrectomy for localized clear cell RCC between 2007 and 2016 were retrospectively identified. The optimal threshold for individual biomarkers among the panel was determined using grid search methodology, receiver operating characteristic (ROC) analysis, and sensitivity-specificity trade-off analysis. Prognostic value of CA-ratio was analyzed using the Kaplan-Meier method and Cox proportional regression models. ROC and chi-square analyses were performed to compare the predictive ability of CA-ratio to SSIGN, and UISS. Results: Among the 433 clear cell RCC patients treated with nephrectomy, mean age at surgery was 58.4±12, and mean BMI was 30.6±6.8. 158 (36.5%) had CA-ratio < 0.1, while 164 (37.9%) were between 0.1-0.2, and 111 (25.6%) were 0.2+. Pathological T-stage was distributed as follows: T1: 294 (67.9%), T2: 29 (6.7%), T3: 106 (24.5%), and T4: 4 (0.9%). Overall, 60 (13.9%) patients died before end of the follow-up. Area under the curve (AUC) for CA-ratio was 0.72, comparable to SSIGN (AUC 0.73, p = 0.12). On multivariate COX proportional hazards analysis, patients with ratio 0.2 or more were more likely to die compared to patients with ratio < 0.1 [HR:3.45 95%CI:1.68-7.10, p = < 0.001], while adjusting for T-stage, grade, necrosis, and age. Conclusions: CA-ratio is an cost-effective , independent and significant predictor of overall survival in clear cell RCC with accuracy at least as good as other established prognostic tools including SSIGN and UISS. [Table: see text]
National determinants of active surveillance among patients with clinical stage 1A kidney tumors.
Authors: Lu Amanda , Nguyen Kevin , Nolte Adam C , Alimi Oriyomo , Hsiang Walter , Ghabili Kamyar , Syed Jamil , Shuch Brian M. , Leapman Michael 
Published: February 2018

694 Background: Active surveillance (AS) has been increasingly recognized as a viable management strategy for patients with small renal masses (SRM). To better understand the contemporary management landscape of SRMs we examined practice patterns in a nationally representative cancer database. Methods: We identified patients with clinical T1a renal masses within the National Cancer Database (NCDB) between 2010 to 2014. Patients were classified according to initial management received including AS, surgery, ablation, or other treatment. We characterized time trends in the use of surveillance versus definitive therapy and examined clinical and socio-demographic determinants of AS among patients with small renal masses using multivariate logistic regression models. Results: We identified 59,189 patients who satisfied the inclusion criteria. Of the total cohort, 1,733 (2.9%) individuals received initial management with AS, while 57,456 (97.1%) received definitive treatment. There was a slight increase in initial management with surveillance however rates remained less than 5% in all years. On multivariate analysis, patient age (OR: 1.08, 95% CI 1.08-1.09), treatment at an academic center vs. community center (OR: 2.05, 95% CI: 1.83-2.29), and African American vs. Caucasian race (OR: 1.56, 95% CI:1.35-1.80) were independently associated with use of active surveillance. Moreover, regional-level differences were observed with the highest utilization of AS in the West North Central census division. Conclusions: Based on cancer registry data, national utilization of AS for SRMs remains very low, and we observed clinical and facility-level differences. Further investigation is warranted to better understand the factors underlying management for patients with SRMs.
Single center validation of neutrophil-to-lymphocyte ratio in localized and metastatic clear cell renal cell carcinoma.
Authors: Melnick Kevin Richard , Patil Dattatraya H , Khan Amir Ishaq , Kim Frances Y , Torlak Mersiha , Bilen Mehmet Asim , Kucuk Omer , Carthon Bradley Curtis , Filson Christopher Paul , Ogan Kenneth , Kissick Haydn T. , Master Viraj A. 
Published: February 2018

696 Background: The neutrophil-to-lymphocyte ratio (NLR) has been evaluated as a serum marker of inflammation and oncologic prognosis. In renal cell carcinoma (RCC), a higher preoperative NLR is associated with aggressive clinicopathologic features and is an independent predictor of poor survival. This study builds upon our institution’s prior work with the NLR in metastatic RCC and examines a larger validation cohort that includes localized disease. It also compares the predictive power of the NLR to established kidney cancer prognostic scores. Methods: Our kidney cancer database provided patients with clear cell RCC who underwent nephrectomy from January 2001 to June 2017 and had a documented preoperative NLR within 15 days prior to surgery. The optimal threshold of NLR was determined using receiver operating characteristic (ROC) curve and sensitivity-specificity trade-off analysis. Kaplan-Meier curves and logistic regression analysis were performed to assess the significance and independence of preoperative NLR in predicting OS. Finally, the prognostic ability of NLR was compared to current prognostic scores through chi-square analysis of their respective c-indices. Results: The 441 patient cohort was comprised of 361 patients with localized and/or regional disease and 80 patients with distant metastases. NLR values among all participants ranged from 0.4 to 74.0 (median 3.1). ROC analysis defined an optimal preoperative NLR threshold of 3.5. On multivariate analysis, after adjusting for clinicopathologic features and distant metastatic disease, a NLR ≥ 3.5 was found to be a significant and independent predictor of overall survival (HR = 1.41, 95% CI 1.05-1.91 & p value = 0.024). Our data also revealed no statistically significant difference between the c-indices of NLR and the UISS, SSIGN, or Leibovich scores in predicting survival. Conclusions: In our validation cohort of patients with both metastatic and non-metastatic clear cell RCC, our data show that a preoperative NLR ≥ 3.5 is a significant and independent predictor of overall survival in patients undergoing nephrectomy and is comparable to other established prognostic tools in RCC.
Validation of a novel preoperative inflammatory score in localized, clear cell RCC.
Authors: Melnick Kevin Richard , Patil Dattatraya H , Khan Amir Ishaq , Kim Frances Y , Bilen Mehmet Asim , Carthon Bradley Curtis , Kucuk Omer , Filson Christopher Paul , Ogan Kenneth , Kissick Haydn T. , Master Viraj A. 
Published: February 2018

697 Background: A previously created and analyzed composite renal cell carcinoma (RCC) inflammatory score composed of preoperative serum markers was found to be a significant and independent predictor of overall survival in RCC with accuracy at least as good as other established prognostic tools. The aim of our study was therefore to validate the prognostic significance of this novel score in a new, independent cohort of localized clear cell RCC patients. Methods: A new cohort was randomly selected out of our nephrectomy database from a group of patients with localized clear cell RCC, who underwent nephrectomy from March 2007 to June 2017. Biomarker composition, cutoffs, and calculations of the RCC inflammatory score were accurately recreated from the previous publication. The final score was the sum of points accrued for each biomarker, ranging from 0-10, followed by stratification into baseline (0), low (1-3), intermediate (4-6), and high-risk (7-10) groups. ROC and chi-square analysis were performed to compare the prognostic ability of this novel score to SSIGN, UISS, mGPS, and Leibovich Scores. Impact on overall survival was analyzed with multivariate logistic regression analysis. Results: 252 patients were included in the study. On multivariate analysis, after adjusting for confounding variables, a “high-risk” RCC inflammatory score proved to be an independent and significant predictor of increased mortality (HR = 9.65, 95%CI 1.06-87.79, p = 0.044). At median follow up time, only 45% of high-risk score patients were alive compared with 89-98% of all other patients. Chi-square analysis of c-indices for the RCC inflammatory score and current prognostic scores revealed no statistically significant difference in prognostication of overall survival. Conclusions: Concordant with our previous data, this study reveals that a high-risk RCC inflammatory score is an independent and significant predictor of overall survival in localized clear cell RCC with comparable accuracy to accepted prognostic tools. Distinct from the original study, the high-risk group displayed an even greater association than previously shown, but the intermediate-risk group was no longer significantly different from baseline risk.
Clinical features, treatment, prognosis, and outcome of 47 patients with pure squamous cell carcinoma of the prostate.
Authors: Brunnhoelzl Daniel , Wang Jue 
Published: February 2018

7 Background: Pure squamous cell carcinoma of the prostate is a rare entity. Data regarding clinical features, management, and treatment outcomes are limited. As such, management of this cancer has been variable throughout the reported literature, and with limited success. Methods: A systematic review of the literature and secondary data analysis was performed to characterize clinical features, management, and survival outcomes. Results: In total, 47 cases of histologically-confirmed pure squamous cell carcinoma of the prostate were included in analysis. Pure squamous cell carcinoma of the prostate is a disease of older males with mean age at diagnosis of 68.5 years (range 42-85). Urinary obstruction was reported as a presenting symptom in 60% of cases. PSA was usually normal with a mean value of 1.6 (n = 11). The disease was metastatic at diagnosis in 32% of patients among cases that stage was reported (n = 31). The most common sites ( > 30%) of distant metastases are bone and lymph nodes. Metastasis to lung, liver, and brain were 20%, 7%, and 7%, respectively. In terms of management, chemotherapy was given in 28% of cases, radiation in 30%, and prostatectomy in 25.5%. Hormone therapy was rarely attempted (4%). Metastatic disease was associated with a significant decrease in survival when compared to localized disease, p = 0.006. Surgical management was associated with significantly increased survival, p = 0.041. Overall 1-year survival was 32%, while 3-year survival was 9%. Conclusions: Squamous cell carcinoma of the prostate has an aggressive clinical course and is associated with poor prognosis. There is urgent need for early detection and the development of novel treatment options.[Table: see text]
Multivitamin use and risk of prostate cancer recurrence: Data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE).
Authors: Van Blarigan Erin , Kenfield Stacey A. , Cedars Benjamin E , Broering Jenny , Cowan Janet E. , Carroll Peter , Chan June M. 
Published: February 2018

70 Background: Multivitamin (MV) use is common among men with prostate cancer (PCa). Yet, data on MV use and risk of PCa recurrence are limited. Methods: We conducted a prospective study among 1,373 men with non-metastatic PCa to examine whether MV use after diagnosis was associated with risk of recurrence. Participants completed a comprehensive lifestyle survey a median of 2 y after diagnosis and were followed through 2016. We defined an event of recurrence as the first of the following: PCa death, bone metastasis from PCa, biochemical recurrence, or initiation of secondary treatment. Multivariate Cox Proportional Hazards regression models were used to calculate hazards ratios (HRs) and 95% confidence intervals (CI) for the association between MV use and PCa recurrence. We adjusted for time between diagnosis and the survey, age at diagnosis, Gleason grade, clinical T-stage, PSA at diagnosis, smoking, BMI, walking pace, and primary treatment. We also explored whether age at diagnosis, BMI, time since diagnosis, smoking, or clinical features (grade, stage, treatment) modified the association between MV use and recurrence. Results: We observed 142 events of PCa recurrence over a median follow-up of 10 y; 858 (62%) men were current MV users, 216 (16%) were past users, and 299 (22%) were never users. Overall, MV use was not associated with risk of PCa recurrence (current vs. never HR: 0.69; 95% CI: 0.45, 1.07; p-trend: 0.09). However, long-term MV users (≥10 y; n = 396) had a 56% lower risk of PCa recurrence compared to never users (HR: 0.44; 95% CI: 0.25, 0.78; p-trend: 0.006). Additionally, treatment modified the association between MV use and risk of PCa recurrence ( p-interaction: 0.02). Among the 845 men who had a radical prostatectomy (RP), current MV users had a 44% lower risk of PCa recurrence compared to past/never users (HR: 0.56; 95% CI: 0.34, 0.91; p-value: 0.02). MV use was not associated with risk of PCa recurrence among the 441 men who did not have a RP. Conclusions: Long-term MV use may be associated with lower risk of PCa recurrence.