bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rho GDP dissociation inhibitor beta ARHGDIB in renal cell cancer.
Authors: von Klot Christoph A. J. , Dubrowinskaja Natalia , Hennenlotter Jörg , Kramer Mario W. , Merseburger Axel S. , Stenzl Arnulf , Peters Inga , Tezval Hossein , Kuczyk Markus A. , Serth Juergen 
Published: February 2017

474 Background: Rho GDP dissociation inhibitor 2 (ARHGDIB) is an important mediator of cellular signaling. The expression of ARHGDIB correlates with tumor growth and metastasis in a variety of non genitourinary cancers, however the role of ARHGDIB in renal cell cancer (RCC) has not yet been evaluated. Methods: Tissue samples from 106 patients undergoing surgery for RCC were obtained. The expression of ARHGDIB mRNA in normal kidney tissue and in corresponding cancer tissue was analyzed by means of quantitative real time PCR. Differences in mRNA expression levels were assessed using paired two-sample tests. Associations of relative mRNA expression levels and clinicopathological parameters were statistically analyzed using an univariate logistic regression model. Relative mRNA expression levels in healthy renal tissue compared to cancerous tissue from the same kidney was assessed using a paired t-test. Results: When comparing 74 tissues from kidney tumors with adjacent histologically normal appearing paired tissues, mRNA expression of ARHGDIB was significantly higher in the tumor tissue (p < 0.001). Paired analysis did not only show significantly higher mRNA expression levels for ARHGDIB over all RCC but also for the subgroup with clear cell RCC (ccRCC). The mRNA expression of ARHGDIB was also more pronounced in ccRCC when compared with papillary RCC (p < 0.001). When looking at clinicopathological parameters in univariate logistic regression analysis ccRCC was significantly associated with nodal involvement (p = 0.03) and also with tumor grade (p = 0.05). For all RCC there was no association with clinicopathological parameters. A bivariate Cox regression model, adjusted for metastatic status (p = 0.001), tumor diameter (p = 0.043), state of advanced disease (p = 0.030) and lymph node metastasis (p = 0.006) identified ARHGDIB mRNA expression as a candidate positive prognosticator for RFS. Conclusions: Increased ARHGDIB mRNA expression is significantly associated with RCC tissues. Higher relative expression observed within tumor tissues represents a candidate prognosticator for better RFS of patients.
The impact of rhabdoid differentiation on prognosis in patients with grade 4 renal cell carcinoma.
Authors: Zhang Ben Yiming , Cheville John C. , Thompson Robert Houston , Boorjian Stephen A. , Lohse Christine M. , Leibovich Bradley C. , Costello Brian Addis 
Published: February 2017

494 Background: Renal cell carcinoma (RCC) with rhabdoid differentiation is thought to portend a poor prognosis, similar to RCC with sarcomatoid differentiation. Both rhabdoid and sarcomatoid differentiation are classified as grade 4 RCC based on the most recent International Society of Urological Pathology (ISUP) grading system. We sought to determine the prognostic value of rhabdoid differentiation in comparison to RCC with sarcomatoid differentiation, grade 4 RCC without rhabdoid or sarcomatoid differentiation, and grade 3 RCC. Methods: Using the Mayo Clinic Nephrectomy Registry, we identified 406 patients with ISUP grade 4 RCC and 1,758 patients with grade 3 RCC. A urologic pathologist reviewed all specimens to determine the presence of both rhabdoid and sarcomatoid differentiation. Associations of clinical and pathologic features with death from RCC were evaluated using Cox models. Results: Among the 406 grade 4 RCC tumors, 111 (27%) had rhabdoid differentiation and 189 (47%) had sarcomatoid differentiation, although only 28 (7%) demonstrated both rhabdoid and sarcomatoid differentiation. In multivariable analysis of grade 4 RCC tumors, the presence of rhabdoid differentiation was not associated with death from RCC (HR 0.95, p=0.75); in contrast, sarcomatoid differentiation was significantly associated with death from RCC (HR 1.63, p<0.001). Patients with RCC with rhabdoid differentiation were significantly more likely to die of RCC than patients with grade 3 RCC (HR 2.45, p<0.001) and grade 3 RCC with necrosis (HR 1.62; p<0.001). Conclusions: This study confirms that RCC with rhabdoid differentiation is appropriately classified as grade 4. However, unlike sarcomatoid differentiation, the presence of rhabdoid differentiation in grade 4 RCC is not associated with an increased risk of death from RCC. Therefore, rhabdoid and sarcomatoid differentiation should not be grouped together when assessing risk in a patient with grade 4 RCC.
Outcomes of patients with late relapse metastatic renal cell carcinoma treated with targeted therapies: A single-institution experience.
Authors: Mandalapu Kamal Kishore , Matrana Marc Ryan , Poosarla Teja 
Published: February 2017

498 Background: Approximately 20-30% of patients (pts) with renal cell carcinoma (RCC) develop recurrence after treatment of localized disease. Of these pts, the great majority recur within the first few years following surgery. Rarely, late recurrences are seen after 5 years of disease free survival. The outcome of metastatic RCC has improved markedly with targeted therapies (TT). Little data are available about outcomes of pts with metastatic RCC from late recurrences who are treated with TT. Methods: We retrospectively reviewed records of consecutive pts with metastatic RCC who had late recurrence >5 years and were treated with TT between 11/1/2006 and 11/1/2013. All the pts had prior nephrectomies. Outcomes were tabulated using basic statistical techniques. Adverse events (AEs) were graded using CTCAE v4.0. Results: 24 pts (100% clear-cell, median age 69 years, 83% males, all with prior nephrectomies) met inclusion criteria with late recurrence >5 years. 79% had favorable risk and 21% intermediate risk by MSKCC criteria. 11 pts died. Estimated median overall survival time for all pts was 50.2 months (95% CI: 23.93–NR) .The 3-year overall survival rate was 71.78% (95% CI: 47.98-84.77). The median number of sequential TT received was 2 (range 1-4). Median time on first line TT was 20.7 months. 45% of pts received pazopanib in the frontline setting, 29% received sunitnib, and 25% received sorafenib. 68% received TT in the second-line and subsequent settings. Common adverse events of TT included fatigue (52%), diarrhea (36%), hypertension (36%), anorexia (28%), hair and skin changes (24%), increased liver function tests (20%), nausea/vomiting (16%), and 95% of adverse events were grade 1/2. Conclusions: In this retrospective study, pts diagnosed with metastatic RCC after disease free interval >5 years have prolonged survival when treated with TT. Overall survival and 3-year survival rates were better than historical controls. Adverse events were mild/moderate and manageable.
Predicting pulmonary metastases among patients with indeterminate pulmonary nodules with renal cell carcinoma.
Authors: Adibi Mehrad , Kenney Patrick , Thomas Arun Z. , Devine Catherine E , Karam Jose A. , Wood Christopher G. 
Published: February 2017

505 Background: Indeterminate pulmonary nodules (IPN) are of uncertain significance in renal cell carcinoma (RCC) patients. We sought to determine the natural history of IPN in patients undergoing radical nephrectomy and to identify clinical variables associated with the development of lung metastases. Methods: We reviewed all radical nephrectomy patients at a single institution from 2005 – 2009 who had ≥1 IPN on chest computed tomography (CT) within 6 months prior to surgery and no evidence of distant metastates. All chest CTs were re-reviewed by a radiologist who was blinded to outcomes to independently determine number, size, location of nodules and whether the IPN appeared concerning for metastases based on nodule size, tissue density, and morphology. Univariate and multivariate Cox regression was used to assess associated predictive factors. Results: Of 258 patients with IPN, 73 (28%) developed pulmonary metastases. Median follow−up was similar in the groups at 36 months. Patients who developed pulmonary metastases had significantly poorer survival compared to those who did not (3-year DSS 54.5 versus 86.5 months, p<0.001), and 39 (53%) developed pulmonary metastases at the same location as the largest IPN. On univariate analysis, larger renal tumor diameter (HR 1.12, p<0.001), number of pulmonary nodules CT (HR 1.12, p 0.001), presence of hilar lymphadenopathy on chest CT were associated with both lung metastasis development and cancer-specific mortality. After adjusting for age, performance status, comorbidities, histology, and smoking status, higher tumor grade (HR 5.11, p 0.007), presence of tumor thrombus above the diaphragm (HR 4.38, p 0.013), perinephric (HR 4.29, p 0.002) or renal sinus (HR 2.16, p 0.045) fat invasion, and a chest CT concerning for metastasis by the radiologist (HR 2.91, p<0.001) were associated with development of pulmonary metastases. Conclusions: RCC patients with IPN who develop pulmonary metastases have a significantly poorer outcome. Independent predictors of developing lung metastases include tumor grade, presence of tumor thrombus above the diaphragm, perinephric or renal sinus fat invasion, and a chest CT concerning for metastasis.
Long-term survivorship in patients (pts) with metastatic renal cell cancer (mRCC): A retrospective study from the MD Anderson Cancer Center (MDACC).
Authors: Campbell Matthew T. , Shah Amishi Yogesh , Hashemi Neda , Nautiyal Kirtan Das , Corn Paul Gettys , Pagliaro Lance C. , Jonasch Eric , Tannir Nizar M. 
Published: February 2017

510 Background: The overall survival (OS) of pts with mRCC has improved since the introduction of targeted therapies (TT). We sought to characterize the baseline characteristics, management, and outcomes of pts who survived > 4 yrs from date of diagnosis of metastatic disease (Met Dx). Methods: We retrospectively reviewed medical records of consecutive pts who were diagnosed with mRCC and evaluated at MDACC from 1/1/2001 to 12/31/2008. Descriptive statistics and Kaplan-Meier methods were used to estimate OS times. Results: For 729 mRCC pts identified, median OS was 2.3 years (95% CI: 2.1, 2.5); 219 (30.0%) pts have survived >4 yrs, and 167 (22.9%) pts have survived >5 yrs. For pts diagnosed in the cytokine era (2000 to 2004) median OS was 2.3 yrs (95%CI: 2-2.6) compared to median OS 2.4 yrs (95%CI: 2.0-3.0) for pts diagnosed in the targeted era (2005-2008). Of the 219 pts, 205 pts had adequate baseline information. Conclusions: Since 2000, approximately 30% of mRCC pts have survived >4 yrs and 23% have survived >5 yrs. Patients spent more time on treatment in the targeted compared to the cytokine era. Understanding the health problems and costs long-term survivors face is essential to devise therapeutic and coping strategies. [Table: see text] [Table: see text] [Table: see text]
Societal costs after renal cancer surgery.
Authors: Chang Peter , Renehan Peter , Taylor Kimberly , Dovirak Ostap , McAnally Kyle , Carneiro Arie , Crociani Catrina , Percy Andrew , Wagner Andrew A 
Published: February 2017

512 Background: The hospital costs of radical or partial nephrectomy for treatment of confirmed or suspected renal cell carcinoma have been well described. We sought to estimate a previously unreported societal cost of renal cancer surgery by assessing surgery-related time off work (TOW) taken by patients and their caretakers. Methods: To a cohort of 315 subjects enrolled in an IRB-approved prospective renal quality-of-life study who underwent radical or partial nephrectomy at our institution, we administered an occupational survey asking subjects to recall employment status, physical demands at work (sedentary, moderate activity, heavy lifting), income by tax bracket, surgery-related TOW (in days), and caretaker assistance. We excluded subjects who underwent cytoreductive nephrectomy. We estimated potential wages lost using individual income and TOW, and used logistic regression to assess for factors predictive of TOW > 30 days. Results: Of the 108 subjects who responded to the survey, 69 were employed at time of surgery. 4 subjects did not return to work after surgery, all of whom were older than 65. 12 subjects were excluded per the above-described criteria, leaving 53 subjects with complete occupational information. Mean (SD) age was 54. The majority (54%) of subjects had sedentary jobs. Subjects’ time off work ranged from 14 to 88 days; mean (SD) and median (IQR) TOW was 38 (17) and 34 (26-45) days, respectively. Mean potential wages lost for TOW was $10,371 (SD=$7,966). 23 (43%) subjects had at least one caretaker take TOW (mean/median caretaker TOW: 10/5 days, respectively) to assist in post-operative recovery. On univariate and multivariable analysis, age, work physicality, type of surgery (radical vs partial nephrectomy), surgical approach (minimally invasive vs open), income bracket, post-operative complications, or caretaker assistance were not significantly associated with taking > 30 days off from work. Conclusions: Despite advances in minimally invasive surgery, most patients take over one month off from work after renal cancer surgery. Incorporating these societal costs may allow for more comprehensive cost-effectiveness analyses in renal cancer care. Future directions include assessing TOW prospectively in a larger, more diverse cohort.
Does the extent of pelvic lymph node dissection affect long-term survival in men undergoing radical prostatectomy after radiation for adenocarcinoma of the prostate?
Authors: Huynh Danny Long , Henderson Alex , Pokala Naveen 
Published: February 2017

67 Background: Salvage prostatectomy (SP) in radiation resistant prostate cancer is feasible in select patients that do not have metastatic disease. The correlation between the extent of pelvic lymph node dissection (PLND) and long-term survival in SP has not been clearly established. This study evaluates the role of PLND on long-term survival outcome in men that underwent radical prostatectomy (RP) following radiation. Methods: SEER 18 registry was searched for patients that underwent RP following radiation for adenocarcinoma of the prostate between 1988 and 2010. The patients were analyzed for demographics, grade and stage, pelvic lymph node status, nodal yield and survival. Patients with metastatic disease, more than one primary cancer and unknown stage were excluded. Results: 364 men were identified. Mean age was 63.6 years and 86.3% were white. Grade differentiation was well (n=12), moderate (n=198), poor (n=150) and unknown (n=4). The T stage was pT2 (n=178), pT3 (n=90) and pT4 (n=96). PLND was performed in 78.6% (n=286) of the patients. The nodal yield was 0-5 (n=75), 6-10 (n=45) and >10 (78). For the 40 patients with positive nodes (PN), 25 (62.5%) had 1 PN, 8 (20%) had 2 PN and 7 (17.5%) had >2 PN. The 10 and 20-year overall survival (OS) was 77.5% and 37.3% and cancer specific survival (CSS) was 88.6% and 72.7%, respectively. The CSS at 20 years was >70% for all grades and stages. On comparison, there was no significant improvement in survival for PLND vs. no PLND (p=0.14) but there was a trend toward improved CSS for patients undergoing PLND. There was no significant improvement (p=0.89) in survival for increasing total nodal yield. CSS at 20 years for N0 and N1 patients was 75% and 65%, respectively. Patients with 0 or 1 PN had similar 20 year CSS of ~75%. Patients with 2 PN had the worst survival with CSS of 30% at 15 years. Conclusions: Good long-term survival can be achieved with RP following radiation therapy. Patients who have node positive disease have similar long-term outcomes to patients that are node negative. However, patients with 2 PN have the worst survival. PLND status and extent of nodal dissection does not significantly confer a survival advantage.
End-of-radiation PSA as a novel prognostic factor in patients undergoing definitive radiation for prostate cancer.
Authors: Tran Phuoc T. , Narang Amol , Ram Ashwin , Robertson Scott P. , He Pei , Griffith Emiliy , Singh Harleen , DeWeese Tate , Honig Stephanie , McNutt Todd R. , Song Danny , DeWeese Theodore L. 
Published: February 2017

68 Background: In patients with localized prostate cancer undergoing radiation therapy (RT) +/- androgen deprivation therapy (ADT), an end of radiation (EOR) PSA obtained during the last week of RT may serve as an early post-treatment predictor of poor outcomes and identify patients in whom to pursue treatment intensification or novel therapies. Methods: We reviewed an IRB-monitored, prospectively acquired database of patients with prostate cancer treated with definitive RT at our institution from 1993-2007 (n=890). Patients with an available EOR PSA were divided into two cohorts and analyzed separately based on inclusion of ADT into the treatment regimen. EOR PSA thresholds of 0.5 ng/mL and 1.0 ng/mL were explored. Multivariate analysis was performed to determine prognostic factors for biochemical failure-free survival (BFFS, Phoenix criteria) and overall survival (OS). Kaplan-Meier survival curves were constructed, with stratification by EOR PSA thresholds. Results: Median age was 69 years, with an even distribution of NCCN low risk (33.5%), intermediate risk (34.0%), and high risk (32.5%) patients. Median RT dose was 7020 cGy, and 54.5% were treated with ADT. Median follow-up of the entire cohort was 11.7 yrs. EOR PSA level was available for the majority of patients (77.5%). On multivariate analysis, EOR PSA >0.5 ng/mL was significantly associated with worse BFFS (p<0.0001) and OS (p<0.0001). In the subset of patients undergoing RT with ADT for NCCN intermediate/high risk disease, 5 yr BFFS was more disparate based an EOR PSA threshold of 0.5 ng/mL (5 yr BFFS: 87.3% vs. 41.1%, p<0.001), than initial NCCN risk level (5 yr BFFS: 88.7% vs. 76.9%, p=0.038). In NCCN low risk patients undergoing definitive RT alone, an EOR PSA threshold of 1.0 ng/mL was significantly prognostic of outcome (5 yr BFFS: 100.0% vs. 88.6%, p=0.024). Conclusions: For NCCN intermediate/high risk patients undergoing RT with ADT, EOR PSA >0.5 ng/mL may represent a better surrogate for poor outcomes than initial risk group. In addition, NCCN low risk patients undergoing RT alone who obtained an EOR PSA ≤1.0 ng/mL experienced excellent BFFS. Prospective evaluation of the utility of EOR PSA should be explored.
Simplified prostate lesion grading for magnetic resonance imaging and improved cancer detection at fusion-targeted prostate biopsy.
Authors: Kardos Steven V. , Nawaf Cayce , Fan Richard , Cornfeld Daniel , Weinreb Jeffrey , Schulam Peter , Sprenkle Preston 
Published: February 2017

69 Background: Prostate cancer (PCa) is the most common solid organ malignancy in men and the second leading cause of cancer related death; however, it is the only tumor that is diagnosed by a non-targeted sampling method. Fusion targeted prostate biopsy is emerging as a more accurate way to detect PCa. The use of a multiparametric MRI (MP-MRI) with an endorectal coil (ERC) has traditionally been used, though the benefit for detection with ERC is controversial. In addition, there is significant heterogeneity in classification of MRI-identified lesions. We provide an initial report with fusion biopsy without an ERC and utilizing a simplified 3-point Likert scale for grading prostatic lesions. Methods: Patients underwent MRI-USG fusion biopsy for elevated PSA, abnormal DRE, or prior negative biopsy. Lesions visible on MRI were outlined in 3D and assigned increasing cancer suspicion levels using a simplified 3-point Likert scale by dedicated pelvic radiologists. The Artemis biopsy tracking system was used to fuse the MRI with real-time ultrasound. Using the 3D model, a 12-core systematic biopsy, as well as a targeted biopsy of suspicious areas, was performed by a urologist (PS). Results: 190 patients underwent MRI and fusion biopsy between 12/2012 and 8/2014. The overall cancer detection rate (CDR) for systematic biopsy was 52.3% and the CDR for fusion biopsy was 55.0%. However, the CDR for clinically significant PCa with systematic biopsy was 28.7% and for targeted biopsy was 43.8% (p=0.02). Evaluation of cancer suspicion level for each ROI revealed that patients with high suspicion scores had a higher overall CDR (p<0.0001) and higher risk of detecting clinically significant cancer under the Cochran Armitage Trend test (p=0.0001). Conclusions: MRI-USG fusion prostate biopsy using MP-MRI without an ERC and a read using a simplified 3-point Likert scale demonstrate improved detection of clinically significant PCa compared to a systematic 12 core TRUS biopsy, and further demonstrate that lesion suspicion correlates with CDR. CDR and lesion stratification are comparable to the published literature when using methodologies that may be more practical in a larger number of medical centers.
Feminization of the workforce in urologic oncology: Socioeconomic, workforce, and quality-of-life issues.
Authors: Pruthi Nicholas , Spencer E. Sophie , Lyons Matthew , Greene Peter , Nielsen Matthew Edward , Pruthi Raj , Raynor Mathew , Wallen Eric , Woods Michael , Smith Angela 
Published: February 2017

72 Background: In recent years, the proportion of women in urology has been increasing, from <0.5% in 1981 to approximately 10% today. Nearly 25% of students matching in urology are now female. Our objective was to characterize the female workforce in urologic oncology and compare income, workload, and job satisfaction to the male counterpart and a non-oncology career. Methods: We queried the American Urological Association (AUA) domestic membership of practicing urologists regarding socioeconomic, workforce, and quality of life issues. A total of 6,511 valid survey invitations were sent via e-mail, and 848 responses were collected for a total response rate of 13%. Results: The percentage of females in the urology workforce is 11%, and only 4% of urologists with an oncology focus are female. Of those with a primary focus that is non-oncology, 13% are female. Demographics, income, and practice characteristics between these groups are shown in the Table below. Conclusions: Females appear to be relatively under-represented in urologic oncology, with lower income among women both in oncology and non-oncology fields. [Table: see text]