bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcomes of intermediate risk metastatic germ cell tumors (IRGCT): Results from a single-institution series.
Authors: Raggi Daniele , Lo Vullo Salvatore , Giannatempo Patrizia , Giardiello Daniele , Nicolai Nicola , Piva Luigi , Biasoni Davide , Catanzaro Mario , Torelli Tullio , Stagni Silvia , Maffezzini Massimo , Mariani Luigi , Salvioni Roberto , Necchi Andrea 
Published: February 2017

380 Background: IRGCT comprises a consistent category of metastatic patients (pts), and information on the recommended management of these pts should be updated. Usually they enter clinical trials for poor prognosis GCT. We aimed to address the heterogeneity of this category and to identify clinical prognostic factors for sub-stratification of pts. Methods: Data on consecutive pts with IRGCT and who received treatment at Fondazione INT Milano in the time-frame 02/1980-03/2014 were collected. Cox regression analyses were done evaluating potential prognostic factors for overall survival (OS, primary endpoint) to first-line therapy. Each factor was evaluated in a multivariable model. An exploratory OS comparison between outlier groups was undertaken with Kaplan Meier curves and logrank test. Results: Data on 181 pts were collected. Median age was 27 yrs (IQR 22-32), 10 pts had a retroperitoneal (RP) primary, 6 had pure seminoma. 72 (39.8%) had lung metastases and 54 (32.3%) bulky (i.e. ≥10cm) RP lymph-nodes (LN). Pts received cisplatin, bleomycin and etoposide (PEB, n=156) or vinblastine (PVB, n=23), 2 other treatments. Median follow up was 173 months (IQR: 87-237). Globally, 5-y PFS and OS were 66.8% (95%CI: 60.1-74.2) and 83.3% (77.8-89.2). However, 5-y OS for pts with AFP 5,000-10,000 IU/ml (N=19) was 61.8% (95%CI: 43.0-88.7) while it was 89.1% (95%CI: 81.2-97.7) for nonseminomas with elevated LDH only (N=57) and similar for elevated HCG only (N=22); overall p<0.001. Multivariable analysis for OS is shown in the table (c-index= 0.63). Distribution of variables over time: bulky RP LN and elevated LDH were more frequent in earlier series (p=0.003 and 0.011). Conclusions: The prognostic heterogeneity of IRGCT category is a matter of fact and should be addressed by clinical trials. Pts with highly elevated AFP have an OS similar to poor prognostic category, while those categorized by elevated HCG or LDH only are close to good risk ones. [Table: see text]
Association of age 40 and older with adverse outcome in metastatic testicular cancer (TC).
Authors: Miller Rowan , Markt Sarah C , O'Donnell Elizabeth , Bernard Brandon David , Albiges Laurence , Lago-Hernandez Carlos , Curreri Stephanie A. , Beard Clair , Wright Alexi A. , Sweeney Christopher 
Published: February 2017

386 Background: We sought to determine factors associated with poorer outcome in older patients (≥ 40) with TC in a large institutional dataset. Methods: A retrospective review of a 1095 patient, IRB approved database, of men treated for TC between 1997 and 2012 at the Dana-Farber Cancer Institute was performed. Information regarding histology, stage, treatment and patient characteristics was obtained from electronic medical records. Using logistic regression analysis and Cox proportional hazard regression we investigated the association between age and outcome for (a) men with clinical stage 1 (CS1) TC and (b) men with metastatic TC, either at diagnosis or following CS1 relapse. Results: 26% of the TC patients were ≥ 40 at diagnosis. Amongst the 616 men with CS1 disease 150 (24%) were age ≥ 40, there was an association with increased likelihood of seminoma (OR 2.46, 95%CI 1.68-3.60) and larger tumour size (> 4cm, OR 1.81, 95%CI 1.23-2.66). Age ≥ 40 was not associated with an increased risk of relapse (HR 0.931, 95%CI 0.575-1.505, p=0.77). 605 men (159, 26% ≥ 40) with metastatic disease were identified. Men ≥ 40 were more likely to have seminoma (OR 3.07 95%CI 2.07-4.54). Distribution of IGCCC prognostic stage was similar in men < 40 and ≥ 40. After adjusting for stage and histology, men ≥ 40 were more likely to receive chemotherapy other than BEP as their primary treatment (OR 1.87 95%CI 1.17-3.00, p=0.009) and men ≥ 40 were also more likely to receive non-optimal chemotherapy than men < 40 (OR 2.91 95%CI 1.12-7.60, p=0.03). When adjusted for confounding variables, age ≥ 40 was associated with a non-significant increased risk of relapse (HR 1.467 95%CI 0.94-2.29, p=0.09) post primary treatment and a significant increased risk of death from TC (HR 2.41 95%CI 1.41-4.11, p=0.0013), which was greater for those with non-seminoma (HR 2.54 95%CI 1.45-4.44, p=0.0011) than seminoma (HR 1.53, 95%CI 0.33-7.2, p=0.56). Conclusions: Men ≥ 40 years diagnosed with metastatic TC were less likely to be cured with therapy for metastatic disease compared to men < 40.
Is the International Germ Cell Consensus Classification (IGCCC) sufficiently predictive in 2015?
Authors: Nichols Craig R. , Jeldres Claudio , Kollmannsberger Christian K. 
Published: February 2017

387 Background: The IGCCC has been an invaluable tool to guide clinical trial development in disseminated germ cell tumors. This classification was developed in the early 1990s. The data were abstracted from records of pts treated between 1975 and 1990 and > 100 institutions submitted data. This analysis resulted in the development and validation of a simple system based on clinically derived parameters. Three risk groups were identified for disseminated nonseminoma.; “good risk” group with a predicted 5 year overall survival (OS) > 90%, ‘intermediate risk” with a 5 yr OS of 75% and “poor risk” with a predicted 48% 5 yr OS. Recently, a number of clinical trials and large institutions have reported outcomes in intermediate and poor risk disseminated germ cell tumors. Outcomes reported exceed IGCCC predictions. We hypothesize that the IGCCC substantially underestimates outcomes in the modern era. Further we speculate that a re-analysis of existing clinical trial data would be fruitful in predicting outcomes for disseminated germ cell tumors in the 21st century. Methods: Reports from large randomized clinical trials reporting outcomes in intermediate and poor risk disseminated germ cell tumors were reviewed and estimates of Progression Free and Overall survival made. Results: See Table. Conclusions: Compared to the IGCCC predictions based on data from 25-40 years ago, there appears to be improved overall survival in disseminated germ cell tumors in the modern era. Intermediate risk and poor risk disease appears to have OS exceeding 80-85% and 75% respectively. A more accurate prediction of outcomes with standard treatments should inform clinical trial design going forward. [Table: see text]
A meta-analysis of health-related quality of life after primary treatment for prostate cancer as measured by the Expanded Prostate Cancer Index Composite.
Authors: Cnossen Nicholas RIchard , Orman Amber Gail , Kwon Deukwoo , Ritch Chad , Gonzalgo Mark , Ishkanian Adrian , Reis Isildinha , Pollack Alan , Abramowitz Matthew 
Published: February 2017

39 Background: Health-related quality of life (HRQoL) outcomes are important in treatment selection for prostate cancer. The Expanded Prostate Cancer Index Composite (EPIC) is a validated and widely-utilized HRQoL survey which accounts for newer radiotherapeutic, surgical, and hormonal treatment methods. We present a meta-analysis of patient reported HRQoL outcomes collected with EPIC and compare HRQoL trends with radiation therapy, surgery, or active surveillance as primary treatment. Methods: The PubMed database was systematically searched for all studies which presented data directly derived from the use of EPIC on patients with prostate cancer prior to 07/09/2014. All eligible studies were selected for either inclusion and analysis or exclusion based on pre-determined criteria. The data from included studies was compiled and a simulation-based estimation method using Approximate Bayesian Computation was performed to obtain missing standard deviation estimate. A longitudinal meta-analysis was conducted to estimate EPIC-profiles for each component using Bayesian p-spline method. Results: Over 4,000 studies were searched, 152 were deemed eligible, and 39 were included. The calculated mean summary score estimates are shown in the attached table. Conclusions: In the urinary domain, radical prostatectomy (RP) has lower acute scores than active surveillance (AS) or radiation therapy (RT) without long-term difference. In the bowel domain, RT has lower scores than AS or RP acutely and long-term. In the sexual domain, RT and RP have lower acute scores than AS. RP has lower scores than RT without long-term difference. In the hormonal domain, little difference was noted between modalities. [Table: see text]
A review of clinical stage 1 testicular cancer mortality in a high-volume center.
Authors: Kamran Sophia C. , Markt Sarah C. , Miller Rowan , O'Donnell Elizabeth , Bernard Brandon David , Curreri Stephanie A. , Albiges Laurence K. , Sweeney Christopher , Beard Clair 
Published: February 2017

390 Background: Clinical stage 1 (CS1) testicular germ-cell tumors (GCT) have an overall survival of nearly 99% regardless of histology. We seek to describe the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) features of the clinical stage 1 testicular cancer patients who died of testis cancer. Methods: Analyses included 1,095 males treated at DF/BWCC between 1997-2012 with data entered into an IRB-approved database developed from electronic medical record abstraction. Patient, tumor, and treatment characteristics were summarized. Analyses focused on testicular-cancer death among the CS1 participants. Results: 616 CS1 testicular patients (291 seminoma-SEM and 324 non-seminoma- NS) were identified and 4 died from their disease (cause-specific survival of 99.3%). Average age at diagnosis amongst the latter patients was 26.7 years. All 4 patients had NS and 2 were embryonal predominant. Average tumor size was 6.3 cm, 2 patients did not have lymphovascular invasion, and 2 were unknown. Following treatment with orchiectomy, 2 patients received 2 cycles of adjuvant bleomycin, etoposide, cisplatin (BEP) chemotherapy. See table 1 for details. Conclusions: Four of 616 (0.6%) patients died after initial presentation with CS1 NSGCT, having relapsed at 1.25, 5.4, 6.25, and 20.7 years after orchiectomy. All patients had non-seminoma histology, 3 of these patients were late relapses (> 2 years), and 2 cases relapsed despite adjuvant BEP. [Table: see text]
Invasive penile carcinoma: Are p16, p53 and HPV ISH prognostically significant?
Authors: Dhillon Jasreman , Berglund Anders E. , Pow-Sang Julio , Spiess Philippe E. , Magliocco Anthony M. 
Published: February 2017

394 Background: Penile carcinoma accounts for 0.4% to 0.6% of all malignancies in men. Due to its low incidence the prognostic role of clinicopathological characteristics, p16, p53 and HPV infection remains unclear. We report our experience with p16, p53 and HPV ISH (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 66) in determining the aggressive nature of this carcinoma. Methods: A tissue microarray (TMA) of 57 cases of invasive penile squamous cell carcinomas was immunohistochemically stained with immunohistochemical stains p16 and p53. HPV ISH was performed as well. The TMA slides were scored semi quantitatively by a specialized genitourinary surgical pathologist. The H score was calculated for p53 using a combination of staining intensity and extent according to the following formula: H score = 1 x % of tumor cells with weak staining + 2 x % of tumor cells with moderate staining + 3 x % of tumor cells with strong staining, resulting in a total score of 0 – 300. Calculations for p53 were done considering values above 0 as positive. For p16 and HPV ISH, the results were recorded as negative or positive. The overall survival curves for up to 60 months were estimated by Kaplan-Meier (KM) method. Results: HPV ISH was positive in 23 cases and p16 was positive in 23 cases as well. However, there were 9 discordant cases between the two (p16+/HPV ISH- = 5; p16-/HPV ISH+ = 4). p53 was positive in 39 cases. Tumors positive for HPV ISH had a better survival as compared to HPV ISH negative tumors (p = 0.0040; Hazard ratio 4.991). Whereas p16 (p = 0.206; Hazard ratio 1.838) and p53 (p = 0.1582; Hazard ratio 0.5198) were not significantly associated with survival at 60 months. Conclusions: Overall HPV positive penile carcinomas appear to have a distinct biology with better prognosis. There is no significant difference in survival for tumors with different p16 and p53 expression.
Need to travel for urologic care: The impact of insurance.
Authors: Mossanen Matthew , Dhartha Kenn , Holt Sarah , Wright Jonathan L. , Harper Jonathan D. , Gore John L. 
Published: February 2017

396 Background: We sought to examine the impact of the Affordable Care Act on access to subspecialty services, such as urologic care, through evaluating the need to travel by insurance status for index urologic procedures. Methods: We accessed the Comprehensive Hospital Abstract Reporting System from 2011-2012. Patients were identified using billing claims and ICD-9 codes. Procedures analyzed were: radical cystectomy (RC), radical prostatectomy (RP), transurethral prostate resection, shockwave lithotripsy, nephrectomy, percutaneous nephrolithotomy (PCNL), retroperitoneal lymph node dissection (RPLND), and pyeloplasty. Patients were categorized as Medicaid, Medicare, private/Health Maintenance Organization, or other (i.e. charity care). Hospital service areas (HSAs, where the majority of local patients were hospitalized), and hospital referral regions (HRR, where most patients received tertiary care) were identified. Chi squared analysis and multivariate logistic regression were performed. Results: We identified 600 patients with Medicaid, 3,806 patients with Medicare, 4,998 patients with private insurance, and 554 with other. 13.3% of Medicaid patients undergoing RC left their HRR versus 29.9% for Medicare and 39.8% for private insurance (Chi squared p < 0.05). We found similar trends for RP (10.8% of Medicaid traveled outside of their HRR vs. 19.5% for Medicare and 24.6% for private, p < 0.05) and PCNL (21.9% of patients with private insurance traveled outside of HRR vs. 12% with Medicare and 17.2% with Medicaid, p < 0.05). On multivariate analysis, (adjusting for race, age, and comorbidity) private insurance had higher odds of leaving their HRR (OR = 1.4, CI 1.1 – 1.8, p< 0.002). Non-white patients (OR = 0.66, 0.54 – 0.81, p <0.001), those with increased comorbidities (OR = 0.95, CI 0.91 - .99, p<0.04), and older patients (p < 0.001) are less likely to travel outside of their HRR. Conclusions: Patients undergoing complex urologic procedures like RC, RP, and PCNL are more likely to travel outside of their HRR if they have private insurance, potentially reflecting increased capacity to access healthcare resources based on income. Patients of older age and with greater comorbidities may be less likely to travel outside of their HRR to obtain urologic care.
Treatment outcome of patients with intermediate- and poor-prognosis metastatic testicular cancer in the 2000s: A multicenter experience in Japan.
Authors: Kojima Takahiro , Kawai Koji , Tsuchiya Kunihiko , Abe Takashige , Shinohara Nobuo , Tanaka Toshiaki , Masumori Naoya , Yamada Shigeyuki , Arai Yoichi , Narita Shintaro , Tsuchiya Norihiko , Habuchi Tomonori , Nishiyama Hiroyuki 
Published: February 2017

397 Background: As a risk classification system of metastatic germ cell tumors, the International Germ Cell Consensus (IGCC) classification was proposed in 1997 and has received broad approval. We aimed to clarify the significance of the IGCC classification in the 2000s especially in intermediate and poor-prognosis patients in Japan. Methods: We analyzed 118 patients with intermediate- and poor-prognosis metastatic non-seminomatous germ cell testicular cancer treated at five university hospitals in Japan between 2000 and 2010. Data were collected on age, levels of serum AFP, HCG and LDH, lung metastases, spread to non-pulmonary visceral metastases (NPVM) and on treatment details (first, second and third-line chemotherapy and post-chemotherapy surgery) and survival data. Results: The median age at diagnosis was 31 years (range, 2-54 years). The median follow-up period of all patients was 57 months. Sixty-eight patients were classified as poor prognosis, having LDH elevation in 14 (21%), AFP in 13 (19%), HCG in 27 (40%), presence of NPVM in 44 (65%). As first line chemotherapy, 93 (79%) were treated by BEP (bleomycin, etoposide and cisplatin)-containing regimen. Of 118 patients, 75 (64%) received second-line chemotherapy, in which the most frequently used regimen was taxane-containing regimen, including TIP (paclitaxel, ifosfamide and cisplatin), TIN (paxlitaxel, ifosfamide and nedaplatin) and DIN (docetaxel, ifosfamide and nedaplatin). Third-line chemotherapy was carried out in 33 patients (28%). Eighty-nine patients (75%) underwent post-chemotherapy surgery. The 5-year overall survivals for intermediate (n=50) and poor (n=68) prognosis was 89% and 83% (P=0.23), respectively. In poor prognosis patients, patients with more than 2 poor-prognostic factors had significantly worse survival than those with only one prognostic factor (72% vs 91%, P=0.01). Conclusions: There was a trend of increase in survival for any risk groups and, in particular, large increase in survival for patients with a poor prognosis. Further classification of poor-prognosis patients into two subgroups has a potential to identify a patient group with very poor-prognosis.
Outcomes following immediate versus delayed radical prostatectomy among men on active surveillance for prostate cancer.
Authors: Welty Christopher James , Fillipou Pauline , Cowan Janet E. , Carroll Peter 
Published: February 2017

40 Background: Little is known about the risk of delaying radical prostatectomy (RP) until biopsy progression following active surveillance (AS) for prostate cancer. This study examines the pathological outcomes associated with surgery following AS compared to immediate treatment of prostate cancer with similar grades. Methods: Men who underwent RP between 1997-2013 at University of California San Francisco were included. The first comparison consisted of men who met strict AS inclusion criteria (Gleason Score ≤ 6, PSA ≤ 10, clinical stage <T3, ≤ 33% biopsy cores positive, and <= 50% of any single core positive) at diagnosis and underwent AS prior to RP (AS+RP) compared to men who met strict AS criteria and underwent RP within 6 monts (immediate RP). The second comparison consisted of men who met strict AS criteria and were upgraded on follow-up biopsy compared to a cohort of men matched on the basis pre-treatment biopsy pathology. Logistic regression was used to determine associations of RP group with adverse pathology (stage ≥pT3/N1, positive margins, and/or upgrade to Gleason >=4+3), adjusting for clinical and demographic factors. Results: We identified 241 men who underwent RP after a period of AS, 157 of whom initially met strict AS criteria. The median time to RP was 20 months (IQR 14-36). Men who met strict criteria and underwent immediate RP were less likely to have unfavorable pathology than those who underwent AS+RP (OR 0.39, 95% CI 0.24-0.62). Fifty-four of the men who underwent AS+RP did so have upgrading to Gleason 3+4 disease. These patients were matched with 154 men based on their pre-treatment biopsy features. After appropriate matching, the timing of RP was not associated with adverse pathology (OR 1.27, 9% CI 0.65-2.49). Conclusions: Men who undergo surgery following AS are a selected subset of men with low risk prostate cancer. The surgical pathology features of these patients are more similar to men undergo surgery after diagnosis with intermediate risk prostate cancer than those diagnosed with very low risk disease. Additional follow-up of this and other cohorts is needed to assess long term clinical outcomes following delayed RP.
BMI at diagnosis and adverse outcomes among men with malignant testicular germ cell tumors.
Authors: Markt Sarah C , Miller Rowan , O'Donnell Elizabeth , Albiges Laurence , Bernard Brandon David , Lago-Hernandez Carlos , Curreri Stephanie A. , Wright Alexi A. , Beard Clair , Sweeney Christopher 
Published: February 2017

400 Background: Previous studies evaluating the relationship between measures of anthropometry, such as body mass index (BMI), and risk of testicular cancer have been conflicting, with most finding null or inverse associations. Methods: We conducted a retrospective review of 960 germ cell tumors among patients treated at the Dana-Farber Cancer Institute (DFCI) between 1997 and 2012 with information on BMI. BMI at diagnosis, tumor characteristics, IGCCC classification, treatment, relapse and cause of death was ascertained from electronic medical record review. We divided the men and conducted the analyses separately for two groups: 1) men who presented as clinical stage 1 (CS1), and 2) men who presented with metastases or were CS1 at diagnosis and developed metastases (lifemets). We conducted logistic regression to evaluate the association between BMI and characteristics at diagnosis, and Cox proportional hazards regression to investigate the risk of relapse and testicular cancer death. Results: 65% of men (n=628) were overweight or obese at diagnosis. We did not find an association between BMI and tumor characteristics at baseline, such as histology, lymphovascular invasion, or tumor size for either group. Among CS1 patients, men who were overweight or obese had a non-statistically significant reduced risk of relapse compared to men who were normal weight (HR: 0.83, 95% CI: 0.53-1.30). Among the lifemets group, 16% of men relapsed (n=83) and 8% died of testicular cancer (n=43). Although not statistically significant, men who were overweight or obese were less likely to present with intermediate (OR = 0.77, 95 CI: 0.39-1.52) and poor (OR = 0.66, 95% CI: 0.36-1.20) rather than good risk disease when compared to men with normal BMI. After adjusted for confounding variables, BMI was not associated with risk of relapse (HR: 0.94, 95% CI: 0.59-1.51) or risk of testicular cancer death (HR: 1.00, 95% CI: 0.54-1.84) among the lifemets group. Conclusions: We did not find an association between BMI at diagnosis and tumor characteristics at baseline, or risk of relapse or testicular cancer death among men with testicular cancer.