bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel risk stratification to predict local-regional failures in urothelial carcinoma of the bladder after radical cystectomy.
Authors: Baumann Brian Christopher , Guzzo Thomas J. , He Jiwei , Keefe Stephen Michael , Tucker Kai , Bekelman Justin E. , Hwang Wei-Ting , Vaughn David J. , Malkowicz S. Bruce , Christodouleas John Paul 
Published: February 2017

262 Background: Invasive urothelial bladder carcinoma is typically treated with radical cystectomy (RC) plus pelvic lymph node dissection (PLND) +/− chemotherapy. Local-regional failures (LF) following cystectomy are a significant problem. Adjuvant radiation therapy (RT) could potentially reduce LF but currently has no defined role because of previously reported morbidity. Modern RT techniques with improved normal tissue sparing have rekindled interest in adjuvant RT. Stratifying patients by differing LF risk could facilitate selection for adjuvant RT. Methods: From 1990–2008, 442 patients with urothelial bladder carcinoma were prospectively followed at the University of Pennsylvania after RC+PLND +/− chemotherapy with routine pelvic CT or MRI. Univariate and multivariate competing risk analyses identified subgroups with differing LF risk. Results: On univariate analysis, stage pT3-4, total nodes removed (<10 vs. ≥10), positive margins, positive nodes, hydronephrosis, lymphovascular invasion, and mixed histology were significant predictors of LF, while use of chemotherapy, number of positive nodes, surgical diversion type, age, gender, race, smoking history and BMI were not. Node density was a marginal predictor of LF. On multivariate analysis, only stage ≥pT3-4 and nodes removed (<10) were significant independent predictors of LF with hazard ratios of 3.17 and 2.37 respectively (p<0.01). Analysis identified 3 patient subgroups with significantly different LF risk: low-risk (pT0-2), intermediate-risk (pT3-4, ≥10 nodes), and high-risk (pT3-4, <10 nodes) with 5-year LF rates of 8%, 23%, and 42% (p <0.01). Conclusions: This study of local-regional recurrence risk factors after RC is based on the largest reported, prospectively maintained patient database with routine follow-up pelvic CT surveillance. LF after RC varies significantly among different subgroups. This risk stratification model could facilitate selection for future adjuvant radiotherapy trials.
Risk-adapted screening in bladder cancer using the open-access Internet-based questionnaire RiskCheck bladder cancer: First evaluation by the health services research foundation IQUO, Germany.
Authors: Luedecke Gerson , Geiges Goetz ,   Interessenverband zur Qualitätssicherung der Arbeit niedergelassener Uro-Onkologen in Deutschland e.V. \(IQUO\)
Published: February 2017

263 Background: Till this day urologists are waiting on symptomatic persons to initiate any diagnostic work-up to identify bladder cancer (BC) patients. In result we diagnose a quarter to a third of our patients as muscle-invasive cancers. The open-access questionnaire RiskCheck bladder cancer (RCBC) was proven in a pilot-study in daily routine from German urologists organized in the health services research foundation IQUO on asymptomatic patients. Methods: The open-access RCBC questionnaire was used in urological offices to check asymptomatic patients for their BC risk exposure (personal, smoking, occupation and medical induced). The tool delivers the classical risk stratification in low- intermediate- and high risk. All people with intermediate and high risk were checked for tumor presence by urine diagnostics and in case of suspect results controlled by cystoscopy. Statistical analysis was made by IBM-SPSS 19 for incidence distribution and correlation between risk stratification and tumor detection was proven by classification tree analysis, significance p < 0.05. Results: Out of 196 checked asymptomatic persons 185 (93.4%) were negative for tumor and 11 had a detectable tumor. In the group of NED 125 (68.1%) persons were classified as low risk, 26 (15.7%) as intermediate and 30 (16.2%) as high risk. Out of the 11 detected tumors 9 were at intermediate or high risk (81.8%). This resulted in an over all detection rate of 5.6% and focused on the risk population of 13.2%. The association of tumor presence and increased risk was significant (p < 0.01). Compared to the western incidence rates this is an increase in effectiveness of 377. Conclusions: Risk-adapted screening in bladder cancer delivers a reasonable approach to diagnose bladder cancer before emerging symptoms. The questionnaire RCBC integrates evidence based bladder cancer inductors, is easy in use and as a open-access tool available in 10 languages via the Internet ( www.riskcheck-bladder-cancer.info) .
Phase Ib/II study of eribulin mesylate administered in combination with gemcitabine/cisplatin as first-line therapy for locally advanced or metastatic bladder cancer: Phase Ib results.
Authors: Vogelzang Nicholas J. , Conkling Paul , Duran Ignacio , Maroto José Pablo , Modiano Manuel , De Leonardis Piero , Hodge Jeff Paul , Lieberman Ronald 
Published: February 2017

273 Background: Eribulin mesylate (E) is a synthetic analog of the natural, marine-sponge product halichondrin B. A phase (Ph) II study of E monotherapy in urothelial carcinoma with no prior cytotoxic therapy for advanced disease reported an overall response rate of 38% (95% CI: 23%, 54%; Quinn et al ASCO 2010, abstract 4539). Therefore, we combined E with gemcitabine (G) and cisplatin (C) to assess the feasibility, safety, and preliminary activity of the combination, in patients (pts) with advanced bladder cancer. This is an open-label, multicenter study consisting of a Ph Ib and Ph II portion. Methods: In the Ph Ib portion, three ascending doses of E were to be administered IV on days 1 and 8 q21d to determine the MTD with standard doses of G (1000 mg/m2, days 1 and 8 q21d) and C (70 mg/m2, day 1). In Ph II, pts are randomized 1:1 to E plus G/C, or G/C alone. Results: Nine pts (median age: 59 years; 7 male/2 female) entered Ph Ib. Pts received E 0.7 mg/m2 (n=3) or 1.0 mg/m2 (n=6), with standard dose G/C. Thirty-four cycles were given (2 pts are ongoing). One dose-limiting toxicity (DLT) was observed at 1.0 mg/m2 (Gr 4 thrombocytopenia). The 1.4 mg/m2 dose of E was not explored due to an investigator consensus that, with that dose, the probability of DLTs (severe hematologic toxicity) developing was high. Thus, the MTD was not achieved or defined. The recommended Ph II dose (RP2D) of E in combination with G/C was established as 1.0 mg/m2. Most common adverse events at the RP2D were nausea (83%), neutropenia (83%), fatigue (83%), thrombocytopenia (83%), anemia (83%), and anorexia (50%). Best responses at 1.0 mg/m2 were 1 complete response (CR) (unconfirmed) and 4 partial responses (PR) (all confirmed). Overall response for both cohorts was 89% – 2 CRs (1 confirmed, 1 unconfirmed) and 6 PRs (4 confirmed, 2 unconfirmed). Six pts have been randomized into the Ph II portion of the study to date. Conclusions: E combined with standard G/C chemotherapy is feasible and has encouraging clinical activity. Hematologic toxicity is the main limiting factor.
Association of tumor hypoxia with lower survival after radiotherapy for muscle-invasive bladder cancer.
Authors: Tolan Shaun P. , Thoms John , Dal Pra Alan , Ahmed Omer , Chung Peter W. M. , Warde Fiona , Zlotta Alexandre , Evans Andrew , Bristow Robert Glen , Milosevic Michael 
Published: February 2017

292 Background: Hypoxia may influence clinical outcomes in many human tumors, including muscle invasive urothelial carcinoma (UC) of the bladder. Hypoxia inducible factor-1 (HIF1), glucose transporter protein-1 (GLUT1) and carbonic anhydrase IX (CAIX) are all upregulated by hypoxia. This study examined the relationship between biomarkers of hypoxia or proliferation (Ki67) and clinical outcome in UC patients treated with radiotherapy (RT). Methods: 70 patients were treated with curative intent using RT alone or RT plus neoadjuvant or concurrent chemotherapy (RTCT) between 1997 and 2006. Archived, paraffin-embedded, transurethral biopsy material was available for 44 patients (35 men and 9 women). Tumor was clinically confined to the bladder wall (cT2) in 28 patients and involved perivesical tissues or adjacent organs (cT3/T4) in 16. Tissue micro-arrays were constructed and immunohistochemical analyses performed to assess biomarker expression, which was scored independently by 3 observers in a semi-quantitative manner. The biomarker scores were correlated with clinico-pathologic data extracted from the medical record and with patient outcome. Median follow-up was 4.2 years. Results: HIF1, GLUT1 and CAIX expression was seen in 43%, 96% and 65% of tumors respectively. The median Ki67 expression was 60%. There were no correlations between biomarkers expression and clinico-pathologic prognostic factors. The cystoscopic complete response rate was 71% at 2-3 months post-RT. The 4-year actuarial local control (LC) and overall survival (OS) rates were 48% and 55% respectively. High Ki67 expression was strongly predictive of better LC by univariate and multivariate analyses (70% vs 20% at 4 years, HR 0.95, p= 0.002), whereas no hypoxic marker predicted LC. High CAIX expression was predictive of inferior OS by multivariate analysis (HR 1.6, p=0.04). Conclusions: Tumor hypoxia influences the outcome of patients with bladder cancer treated with RT or RTCT and is a potential therapeutic target. High Ki67 has been reported previously to be a marker of sustained LC in the bladder following RTCT but the biologic mechanism underlying this association is unknown and requires further investigation.
Incidence of peritoneal carcinomatosis in recurrent plasmacytoid urothelial carcinomas (PUC) of the bladder: A retrospective analysis of patient outcomes at M. D. Anderson Cancer Center (MDACC).
Authors: Dayyani Farshid , Munsell Mark F. , Siefker-Radtke Arlene O. 
Published: February 2017

297 Background: PUC are a rare subset of urothelial cancers with a paucity of available literature regarding their clinical behavior. Methods: Retrospective analysis of outcomes among all patients (pts) with predominant PUC (pPUC) seen at MDACC from 1999-2010. Results: 31 pts with pPUC histology were identified (median age:63.5yrs; 83.3% male; TNM stage:cT1N0,n=4;cT2N0,n=8;cT3b-4aN0,n=6; cT4b, N+ or M+ n = 13). Median survival for all pts was 17.7mo (Stage I-III vs IV: 38.1 vs 13.3mo). Of 18 pts with potentially surgically resectable PUC (<=pT4aN0M0) 7 received neoadjuvant chemotherapy,10 had initial surgery, and one was treated with TURBT alone. Despite pathologic downstaging in 67% of pts treated with neoadjuvant chemotherapy relapses were common and there was no difference in survival between pts treated with neoadjuvant chemotherapy compared to initial surgery, even though adjuvant chemotherapy was given in 7 patients. Only 1 pt in pCR remains in remission >18 mo after surgery. The most common site of recurrence was in the peritoneum (13/18pts), with relapses occurring even in those with pCR at surgery. At least 4 pts developed CNS involvement with lepto-meningeal disease. In pts presenting with metastatic disease who were treated with chemotherapy, the median survival was 12.6 months. Conclusions: Plasmacytoid bladder tumors are a very aggressive subset with overall poor outcomes. Though chemotherapy sensitive with downstaging seen with neoadjuvant chemotherapy, there are few long-term survivors. There is a strong predilection for recurrences along the peritoneal lining, and peritoneal carcinomatosis should remain high on a clinician’s differential when patients develop obstructive bowel symptoms.
Trends in metastatic bladder cancer incidence and prognosis by histologic subtypes.
Authors: Koll Thuy , Fang Xiang , Subbiah Shanmuga 
Published: February 2017

322 Background: Approximately 5% of patients present with metastatic bladder cancer (MBC) at diagnosis.We aim to assess the trends of MBC at presentation over the last two decades using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Retrospective analysis of MBC patients at presentation was done using data from SEER for 1988-2003. Age, Sex, Histology, Race, use of palliative surgery and survival data was extracted. Results: 9357 patients with MBC were identified. Incidence of MBC remained same in the last 2 decades (6.05% vs 6.34%). The most common histology was (TCC) transitional cell with least common being Signet cell. Squamous cell carcinoma (SCC) was common in African Americans and in females. Common grade at presentation was poorly differentiated. Palliative surgery was done in 18.15% patients with radical cystectomy being the common type of surgery. Median survival was better in TCC with the worst outcomes in patients with SCC (Table). Conclusions: Incidence of MBC at presentation hasn’t changed over the last two decades with TCC being the most common type. Clinical trials integrating targeted therpy with chemotherapy is needed to improve outcomes of MBC patients. [Table: see text]
Relapses in metastatic germ-cell tumors and relationship to international guidelines compliance: A study from the Institut Gustave Roussy.
Authors: Thibault Constance , Loriot Yohann , Barrios Gonzales Daniel , Massard Christophe , Di Palma Mario , Bossi Alberto , Blanchard Pierre , Escudier Bernard J. , Patard Jean Jacques , Baumert Herve , Fizazi Karim 
Published: February 2017

323 Background: Germ-cell tumors (GCT) are rare but highly curable cancers even in patients with metastatic spread. We aimed at assessing whether relapse after upfront treatment could be explained by low compliance with international guidelines. Methods: All patients (pts) who were referred to Institut Gustave Roussy from 2000 to 2010 with progression or relapse after treatment for metastatic GCT were included. International guidelines available at the time of diagnosis were used as reference. A list of noncompliant criteria defined as disagreement with the recommendations with a potential impact on outcome was set up. Results: 78 pts were included. According to the IGCCCG classification, 18 pts (23.1%) had good, 25 pts (32%) had intermediary and 34 pts (43.6%) had poor prognosis. The first-line chemotherapy administered consisted of PEB regimen (70.5%) , PE regimen (15.4%) or other regimen (12.8%). Most patients were treated in cancer centers (52.5%, n=41), whereas 26.9% and 17.9% pts were treated in private or public general hospitals, respectively. Only 50% pts received treatment according to guidelines recommendations. This percentage was significantly higher in cancer centres than in public hospitals (75.6% versus 28.6%, p< 0.001) or also when compared with private hospitals (75.6% versus 14,3%, p<0.001). The most frequent noncompliance criteria were: time to surgery for residual mass (over 6 weeks after the latest chemotherapy cycle)(20.3%) and respected chemotherapy schedule (20.3%). Other noncompliance findings were: inadequate chemotherapy dose (15.6%), number of cycles (12.5%), decision regarding residual disease (12.5%), chemotherapy regimen (6.3%), follow up (4.6%), type of surgery (3.1%), staging(1.6%), IGCCCG classification (1.6%), or decision regarding chemotherapy after residual mass surgery (1.6%). Conclusions: This study suggests that the majority of relapse for metastatic GCT may be explained by a poor conformity to international guidelines and not only by aggressive tumor biology. These data represent a strong argument for treatment centralization in reference centers in patients with GCT.
Advanced urethral carcinomas: A retrospective analysis of survival outcomes and the role of cisplatin-based chemotherapy—The M. D. Anderson experience.
Authors: Dayyani Farshid , Pettaway Curtis A. , Kamat Ashish M. , Munsell Mark F. , Pagliaro Lance C. 
Published: February 2017

330 Background: Primary carcinomas of the urethra (PCU) are rare and often advanced when diagnosed. Given the low incidence of this disease, there is a paucity of data regarding treatment standards. The purpose of this report was to study the treatment response and survival in a relatively large cohort of patients with PCU, with emphasis on modern platinum-containing chemotherapy regimens, in combination with surgery for (locally) advanced PCU. Methods: We performed a retrospective chart review of consecutive patients with PCU seen at the MD Anderson Cancer Center over a recent 5-year period (2005-2010). Clinical outcome was measured as best response to chemotherapy (either neo-adjuvant or for metastatic disease). Kaplan-Meier estimates were generated for survival and Cox proportional hazard was used for prognostic factors for survival. Results: We identified 44 consecutive pts with PCU. The majority (64%) were female, and the median age at diagnosis was 66.5 yrs. Squamous cell carcinoma and adenocarcinoma were the most common histologic subtypes of PCU in our cohort. 43% and 16% presented with lymph node–positive (LN+) and distant metastases, respectively. For all evaluable pts, the overall survival (OS) was 31.7 mo. Platinum-containing neoadjuvant chemotherapy achieved a response rate of 72%. 21/44 pts had locally advanced or LN+ PCU and were treated with chemotherapy followed by surgery. In this cohort, the median OS from chemotherapy initiation was 25.6 months. Among pts with LN+ PCU at diagnosis, 4/9 (44%) were alive as of July 2011, with a minimum follow-up of >3 years. Conclusions: We report the clinical outcomes in the to the best of our knowledge largest cohort of consecutive pts with PCU. Our data suggests that modern platinum-containing regimens are effective in a subset of advanced PCU. Neoadjuvant treatment leads to prolonged disease-free survival in a substantial proportion of lymph node positive cases.
Pilot study on the correlation of multiphoton microscopy of human testicular tumors with histology.
Authors: Najari Bobby B. , Ramasamy Ranjith , Sterling Joshua , Aggarwal Amit , Sheth Seema , Jain Manu , Robinson Brian D. , Shevchuk Maria M. , Shariat Shahrokh F. , Mukherjee Sushmita , Scherr Douglas 
Published: February 2017

338 Background: Partial orchiectomy is becoming more accepted for indications such as a solitary testis, and small nonpalpable testicular masses found incidentally on scrotal ultrasonography. Unfortunately, intraoperative frozen-section pathological analysis is often unable to accurately predict the presence of malignancy. Multiphoton microscopy (MPM) enables in vivo imaging of tissue without the use of labeling techniques and could potentially diagnose testicular tumor pathology. We performed a non-randomized, non-controlled study to evaluate the feasibility of MPM to image testicular biopsies. Methods: Two men with testicular masses underwent radical orchiectomy for primary testicular tumor from June to August 2011. A total of six specimens from testicular tumor and uninvolved testes were imaged with MPM. In order to assess the diagnostic accuracy of MPM, we performed a blinded assessment by three uropathologists. The diagnosis rendered based on these images was then correlated with the findings seen on hematoxylin and eosin (H&E) staining. Results: Our diagnosis based on MPM correlated with H&E in five of six (83%) specimens. Images of seminoma acquired with the MPM are easily distinguished from those of teratoma and normal testicular parenchyma. Images of seminoma show abnormal architectural and cellular changes compared to cystic structures often seen with teratoma. Conclusions: Multiphoton microscopy can be used to reliably differentiate between teratoma, seminoma and normal testis tissue in our pilot group. MPM imaging could be potentially applied in intra-operative diagnosis of testicular tumors especially in testis-sparing surgery. Additional imaging of non-seminomatous germ cell tumors and non-germ cell tumors need to performed to verify the ultimate role of this technology.
The University of Southern California penile cancer experience: Clinicopathologic characteristics of patients from 1991 to 2011.
Authors: Jayaratna Isuru Sampath , Schwartz Rachel L. , Mitra Anirban Pradip , Cai Jie , Ma Yanling , Quinn David I. , Dorff Tanya B. , Schuckman Anne 
Published: February 2017

342 Background: Penile squamous cell carcinoma (PSCC) is a disfiguring and deadly disease. USCS data has shown an increased incidence in specific US minority communities. Methods: After IRB approval, a retrospective review of patients treated for PSCC at LAC-USC Medical Center, USC University Hospital, and Norris Comprehensive Cancer Center from 1991 to 2011 was completed. Patient characteristics were evaluated with descriptive statistics and contingency analyses. Results: Of 69 patients identified with PSCC, 64 had surgical staging information available. Median follow up was 18 months (range 0 – 161). Median age at diagnosis was 50 (range 23–86), with 50.7% of patients ≥50 and 49.3% <50 at diagnosis. Hispanic patients represented 71% (n=44) of our cohort. 44 patients underwent partial penectomy, 10 total penectomy and 8 had [1]a diagnostic biopsy. T stage distribution was Tis: 7.8% (n=5), T1: 39.1% (n=25), T2: 29.7% (n=19), T3: 18.8% (n=12), T4: 1.6% (n=1) and unknown: 3.1% (n=2). 38 groins were surgically evaluated, and 14 pelvic lymph node dissections were performed. Of the 24 patients who underwent a surgical lymph node evaluation. The N stage distribution was N1: 41.7% (n=10), N2: 12.5% (n=3) and N3: 45.8% (n=11). Median lymph node yield in groin dissections was 11, with a lymph node positivity rate of 49%. 30.8% (n=20), 41.5% (n=27), 12.3% (n=8) and 15.4% (n=10) of patients had well, moderately, poorly differentiated PSCC or unknown grade, respectively. There was no association of age (p=0.16) or race (p=0.24) with clinical stage. Stage was significantly associated with grade (p=0.049), with 75% of poorly differentiated tumors being Stage 4, compared with 21.4% of well-moderately differentiated tumors. Conclusions: In our cohort, we found a primarily Hispanic ethnic prevalence, which is reflective of our patient population, as well as a younger age at diagnosis in contrast to previously published reports. We observed a higher average stage in both T and N stages in our population compared with national averages. It is noted that the small sample size limits our power to draw conclusions, however this initial description of our population suggests variation in the disease process that may be related to demographic factors.