bluuebunny/crossref_metadata_2025_split huggingface dataset:
C-reactive protein prior to cystectomy: An external validation of the TNR-C score.
Authors: Kramer Mario W. , Heinisch Annika , Wegener Gerd , Abbas Mahmoud , Peters Inga , von Klot Christoph A. J. , Tezval Hossein , Herrmann Thomas R. W. , Kuczyk Markus A. , Merseburger Axel S. 
Published: February 2017

344 Background: Systemic inflammation has been described as a common reaction to cancer progression. Besides other malignancies, elevated serum CRP levels have been sparsely reported in bladder cancer patients prior to treatment. The aim of this study was to analyze whether our patient cohort showed association of CRP levels and survival after radical cystectomy as well as for external validation of the recently described TNR-C score. Methods: We retrospectively reviewed charts of patients undergoing radical cystectomy and bilateral pelvic lymphadenectomy between 1996 and 2005 identifying 279 patients of which 194 had preoperative CRP levels and no concomitant infection. CRP levels were defined as elevated if they were >5 mg/l. Cancer-specific outcome was predicted based on the aforementioned CRP-based scoring model (T=T-stage; N=N-stage; R=residual tumor; C=CRP). The mean follow-up was 29 months (0-131). Results: Elevated serum CRP levels were found in 89 (45.9%) patients preoperatively. These patients were more likely to have advanced tumor stages (pT3-4; p<0.01), positive resection margins (p<0.01) and positive lymph nodes (p<0.05). Cancer specific survival was decreased by approx. 17% after 12, 36, and 60 months. In multivariate analysis, CRP was identified as an independent prognostic indicator for poor cancer-specific survival. The 3-year CSS in patients with a TNR-score in the ranges 0-2, 3-6, and 7-10 was 74.0%, 33.3%, and 4.0%, respectively (p<0.001) with a concordance index of 0,833 (p<0.001). Conclusions: Elevated preoperative CRP levels might be used in nomograms to predict poor survival after radical cystectomy. The prognostic impact of the TNR-C score could be validated. However, more evidence, especially from prospective studies is needed.
Association of care transitions with treatment delay for patients with muscle-invasive bladder cancer.
Authors: Tomaszewski Jeffrey J. , Handorf Elizabeth , Corcoran Anthony , Mehrazin Reza , Canter Daniel , Bekelman Justin E. , Kutikov Alexander , Chen David Y. T. , Uzzo Robert G. , Smaldone Marc C. 
Published: February 2017

346 Background: Population-based data suggest an association between timely treatment (<3 months) and improved survival in patients undergoing radical cystectomy (RC). Hypothesizing that care transitions at the time of hospital referral may delay timely treatment in patients with muscle invasive bladder cancer (MIBC), our objective was to identify the association between care transitions and treatment delay ≥3 months using a large national tumor registry. Methods: Using the National Cancer Database, all patients with stage ≥II urothelial carcinoma treated with RC from 2003-2010 were identified. A care transition was defined as a change in hospital from diagnosis to first course of treatment. A logistic regression model was used to test the association between care transition and treatment delay (from diagnosis to RC or initiation of neoadjuvant chemotherapy), adjusting for year, demographic, clinicopathologic, and hospital characteristics. Results: Of 22,251 patients identified, 14.2% of patients experienced a treatment delay of ≥3 months. Further, this proportion increased over the study period (13.5% [2003-2006] versus 14.8% [2007-2010], p=0.01). 19.4% of patients undergoing a care transition experienced a delay to definitive treatment compared to 10.7% of patients diagnosed and treated at the same hospital (p<0.001). The proportion of patients experiencing a care transition increased over the study period (37.4% [2003-2006] versus 42.3% [2007-2010], p<0.001). Following adjustment, patients were more likely to experience a treatment delay when undergoing a care transition (OR 2.0 [CI 1.8-2.2]). Additional covariates associated with treatment delay included African American race (OR 1.5 [CI 1.3-1.7]), Hispanic ethnicity (OR 1.6 [CI 1.3-1.9]), insurance status (Medicaid OR 1.4 [CI 1.1-1.7], Medicare OR 1.2 [CI 1.08-1.34], no insurance OR 1.3 [CI 1.07-1.54]), and Charlson comorbidity count ≥2 (OR 1.3 [CI 1.08-1.45]). Conclusions: Patients with MIBC who experienced a care transition between diagnosis and treatment hospitals were more likely to experience a treatment delay of ≥3 months. Strategies to expedite care transitions at the time of hospital referral may be a means to improve quality of care.
The significance of protocol biopsy after intravesical BCG treatment in patients with non-muscle–invasive bladder cancer.
Authors: Maruyama Satoru , Shinohara Nobuo , Murahashi Norihiro , Suzuki Hidetaka , Matsumoto Ryuji , Akino Tomoshige , Miyajima Naoto , Tsuchiya Kunihiko , Abe Takashige , Nonomura Katsuya 
Published: February 2017

356 Background: Currently, there are few well-validated data of the optimal schedule of follow-up after BCG intravesical instillation. The objective of the study were to elucidate the ability of conventional exams (cystoscopy, urine cytology) to diagnose presence of carcinoma and the significance of protocol biopsy after BCG intravesical treatment in patients with high-risk non-muscle-invasive bladder cancer (NMIBC). Methods: The study included patients treated with BCG intravesical treatment. From January 2002 to October 2012, we retrospectively reviewed a total of 72 patients (61 men and 11 women). The median age was 72 years (range 47-84). The pathological stages were Tis in 4 patients (6%), Ta in 29 (40%) and T1 in 39 (54%) (T1 with CIS in 30 [42%]). Tumors were multifocal in 56 (78%) and second TUR had been performed in 53 (74%) patients. We investigated the prognosis and accuracy of tumor existence by conventional exams referring with the protocol biopsy. A protocol biopsy was performed within 5 to 9 months after the final TUR. CTCAE v4.0 was used to grade adverse events. Results: Of 72 patients, we performed protocol biopsy in 62 patients and 9 (15%) had cancer. The conventional methods had a sensitivity of 78%, specificity of 81%, positive predictive value of 41% and negative predictive value of 96% in diagnosing cancer. Although three (5%) had grade2 adverse events, there were no grade 3 or greater adverse events. Of 53 patients with no cancer in protocol biopsy, 8 (8%) patients experienced a recurrence but 51patients (96%) were alive with no evidence of disease. Of 9 patients pointed out cancer in protocol biopsy, 7patients (78%) had no evidence of disease recurrence at last follow-up. The 5-year recurrence-free survival rate and overall survival rate were 77% and 95%, respectively. Conclusions: To the best of our knowledge, this is the first report of the ability of conventional exams for follow-up after BCG treatment. Our findings revealed that conventional exams were limited for meticulous follow-up, so that the protocol biopsy will be recommended to obtain the better survival in high-risk NMIBC patients.
Outcomes of radical cystectomy in potential candidates for bladder-preservation therapy.
Authors: Pietzak Eugene J. , Smith Zachary L. , Malkowicz S. Bruce , Guzzo Thomas J. 
Published: February 2017

357 Background: Outcomes for Bladder Preservation Therapy (BPT) in urothelial-type bladder cancer (UBC) are often compared to those achieved by Radical Cystectomy (RC). However, BPT patients are usually “carefully selected” which may limit comparisons. Our objective was to analyze the outcomes of RC within a “carefully selected” patient cohort. Methods: We identified 471 consecutive patients with UBC who underwent RC with curative intent from 1987 to 2008 at a single academic center. Patients were considered eligible for BPT if tumors were clinical T2 without carcinoma in-situ (CIS), hydronephrosis, multiple invasive tumors, or mixed histology. Patients with ≥1 contraindications were considered ineligible. Renal function was not factored into eligibility. Clinicopathologic characteristics and survival outcomes for BPT eligible patients were compared to ineligible patients. Results: 275 patients had cT2 tumors, of which 157 (57.1%) were ineligible for BPT (CIS=54; hydro=77; multiple tumors=29; mixed histology=55; ≥2 contraindications=51). BPT eligible and ineligible patients did not statistically differ with regards to age, gender, race, BMI, smoking, ASA score, or neoadjuvant chemotherapy. At time of RC, BPT eligible patients were less likely to have positive lymph nodes (p=0.01), pathologic LVI (p=0.02), & upstaging to pT3/pT4 (p=0.002). 2 and 5 year overall survival (OS) for all cT2 patients was 65.2% and 40.3%. 2 and 5 year OS was 76.7% and 44.2% for BPT eligible patients, but only 57.1% and 37.4% for ineligible (p=0.07). No statistical difference was seen in distant Recurrence Free Survival (RFS) (p=0.9), but BPT eligible patients had better local-RFS (p=0.05). 2-year Cancer Specific Survival (CSS) for all cT2, BPT eligible, and BPT ineligible patients was 71.8, 85.4%, and 62.3% respectively. Fine-Gray competing risk analysis revealed significantly better CSS for BPT eligible patients compared to those ineligible (Sub-HR=0.46 [CI=0.29-0.72] p=0.001). Conclusions: RC provides excellent CSS for patients potentially eligible for BPT. This should be included in an informed discussion of treatment options. In the absence of randomized trials, comparisons between RC and BPT must factor in selection bias.
Trends of multimodal therapy in high-stage penile cancer.
Authors: Ferry Elizabeth Kate , Zhu Hui 
Published: February 2017

370 Background: Penile cancer (PC) is associated with high mortality and treatment failure in higher stage disease. While no prospective data exists, small anecdotal reports advocate the use of perioperative chemotherapy and/or radiotherapy for advanced disease. The 2013 National Comprehensive Cancer Network (NCCN) guidelines advocate the use of multimodal therapy for advanced disease. This study aimed to examine the trend in the use of perioperative chemotherapy or radiotherapy for advanced stage PC in the U.S. from 2000 – 2011. Methods: The National Cancer Database (NCDB) Datalinks Portal was queried. Diagnosis by year, first course treatment by stage, in all hospitals from 2000 – 2011 was obtained. Percentages of men treated with surgery alone, surgery with radiation, and surgery with chemotherapy in stages III and IV by year were determined to assess trends. Results: From 2000 – 2011, there were 1,028 and 440 men diagnosed with stage III and IV PC, respectively, who were recorded as having either surgery alone, surgery with radiation (+XRT), or surgery with chemotherapy (+Chemo). Addition of radiation therapy was variable, but low. Addition of chemotherapy has gradually increased, most dramatically in stage III PC. Conclusions: Consistent with the 2013 NCCN guidelines on penile cancer, the use of multimodal therapy for higher stage PC has increased, though modestly. Surgery with chemotherapy is the most common multimodal therapy. Further studies are needed to determine if this corresponds to a change in PC mortality. [Table: see text]
Enhancing risk stratification in primary mediastinal nonseminomatous germ cell tumors (PMNSGCT): A 27-year experience at a tertiary cancer center.
Authors: Necchi Andrea , Lo Vullo Salvatore , Giannatempo Patrizia , Farè Elena , Raggi Daniele , Nicolai Nicola , Piva Luigi , Biasoni Davide , Torelli Tullio , Catanzaro Mario , Stagni Silvia , Maffezzini Massimo , Scanagatta Paolo , Gianni Alessandro M. , Mariani Luigi , Salvioni Roberto , Pastorino Ugo 
Published: February 2017

373 Background: Mediastinal GCTs and PMNSGCTs poorly benefit from CT and half of patients (pts) still die for disease. Enhancing the risk stratification may result in tailoring a personalized treatment strategy since diagnosis. Methods: Between 1985 and 2012, 87 pts with PM-GCT were treated at our center. Of them, pure seminomatous histology was excluded. Cox proportional hazards regression analysis was conducted to examine the prognostic impact of these candidate factors on overall survival (OS): type of 1st-line CT (high [HDCT] vs conventional dose [CDCT]), post-CT surgery, type of baseline elevated serum tumor marker (STM), presence of lung or liver-bone-brain metastases (LBB), STM response (still elevated vs normal or normalized), and histology (viable cancer [VC] vs necrosis/teratoma [NT]). OS curves were compared by Kaplan Meier method with the log-rank test. Results: The study included 68 cases with PMNSGCT. Median age was 28.5 yrs (IQR: 23-35). 12 pts (17.7%) presented with mediastinal syndrome, 23 (33.8%) had lung and 7 (10.3%) LBB metastases. 12 pts received upfront HDCT and 45 pts (66.2%) underwent post-CT surgery. The final model of poor prognostic factors included no surgery (HR: 8.74, 95%CI, 1.77-43.01), surgery + VC (HR: 6.97, 95%CI, 1.46-33.30), and lung metastases (HR: 2.92, 95%CI, 0.99-8.64). The model demonstrated moderate discriminatory ability for OS (c-statistic=0.68). A risk stratification model based on the combination of these factors and accounting for a 50% five-year survival cutoff identified 2 groups (poor prognosis, N=28 vs good prognosis, N=26) with distinct overall survival curves (p<0.001). Pre-operative STM and final histology were not associated (p=0.574 at Chi squared test). 5-yr OS after receiving 2nd line CT (n=25) was 18.7% (95%CI, 7.9-44.5). Results are limited by small numbers. Conclusions: Pts with PMNSGCT classified as having a good prognosis in this model had a fairly high survival estimate, while a strategy of consolidation CT for pts with poorest risk features warrants investigation, once the model is confirmed. The effect of surgery on survival was independent of post-CT STM, which also poorly predicted final histology.
Surgical management trends of penile cancer in the United States between 2000 and 2010.
Authors: Ferry Elizabeth Kate , Zhu Hui 
Published: February 2017

379 Background: Penile cancer may cause significant morbidities to those who are treated with aggressive surgery. Conversely, there has been no improvement in penile cancer survival rates since 1990. While the causes for this stagnation may be multifactorial, one potential cause is undertreatment of high-risk disease. This study aimed to examine both the trend in the stage-dependent surgical treatment for penile cancer from 2000 to 2010 and the patterns of possible over and/or undertreatment during this period. Methods: The National Cancer Database (NCDB) Datalinks Portal was queried. Diagnosis by year, first course surgery by stage, in all hospitals from 2000-2010 was first obtained. Data was grouped into no surgery, penile sparing, and radical surgery. Data was also obtained for first course surgery by stage in community hospitals (C), comprehensive centers (CC), and teaching research hospitals (TR), individually. Groups were similar as above, with the exclusion of the no surgery group. Results: There were 1,405 patients with recorded first course surgical treatments in community hospitals, 3,930 in comprehensive hospitals, and 3,667 in teaching research hospitals from 2000 to 2010. Graphically, there has been no change in the trend in the pattern of surgical management of penile cancer from 2000 to 2010 in high or low stage penile cancers. Consistent overtreatment of stage I penile cancer with radical surgery was observed in all hospitals during this period. A variable, but high, percentage of penile-sparing surgery was observed for advanced stages among all hospital types. Conclusions: Corresponding to the stagnation in the survival rates of penile cancer, the surgical management trends ded not change between 2000 and 2010. Contrary to the 2013 National Comprehensive Cancer Network (NCCN) Guidelines, penile-sparing surgery continues to be performed in all types of treating hospitals for higher stage penile cancers, which may represent an undertreatment of potentially fatal penile cancers. Conversely, there was a persistent pattern of overtreatment of stage I penile cancer. [Table: see text]
Stage I testicular tumor: How frequently to scan?
Authors: Ramamurthy Sindhu , Mahtab Najibah , Showler Helen , Frew John A. , Pedley Ian D. , Azzabi Ashraf , Brown Jolene , McMenemin Rhona Margaret 
Published: February 2017

380 Background: Testicular malignancy is the most common cancer affecting men aged between 15 and 44 years. In our centre, almost all low-risk seminoma (LRS) stage-I and non-seminomatous germ cell tumours (NSGCT) stage I (high and low-risk) tumours are followed-up on a surveillance program (SP) for a minimum of 5 years. LRS patients are scanned at 4, 6, and 12 monthly intervals during years 1, 2, and 3 to 5 years respectively. NSGCT undergo computer tomography (CT) scan at 3 monthly intervals in years 1 and 2, 4 monthly in year 3 and 6 monthly thereafter. Clinical examination, Chest X-ray (CXR) and tumour markers (TM) are performed at each visit. This retrospective audit examined if relapses were first detected by raised TM or radiologically, and if there was any difference in detection rate between these investigations to recommend reducing the frequency of CT scans, especially in lower risk groups, and therefore cumulative radiation exposure. Methods: The patient population was obtained from hospital electronic database. Metastatic patients, clinical trials patients and those who received adjuvant treatment upfront were excluded. Results: 396 patients were enrolled from 1999 to September 2013. 153 patients were followed-up in SP. 33 relapses (mean age 37 years, range 17-56) detected in SP. The mean relapse free survival period was 55.3 months (range 9.6-43.3) from date of diagnosis. No relapses were first detected on CXR. 4 patients had only TM elevated and 6 had CT abnormality found post TM elevation. 11 had simultaneous CT and TM abnormalities. For 12 patients, CT abnormality was detected with no TM raise. Of these, 8 were high risk (7 NSGCT and 1 pure seminoma) and 4 were low risk NSGCT. Patients were treated with standard BEP/EP chemotherapy regimen on relapse. All patients are alive to date and continue to be followed-up regularly. Conclusions: 12 patients in our study had relapses detected radiologically with no TM rise. 25% of these patients had low risk NSGCT. Without the CT scan, these patients would have faced potential delay in diagnosis and treatment. Results of prospective randomised trials are awaited to produce evidence to place confidence in less number of CT-scans for these patients during follow- up. Until then we recommend the current standard protocol be followed.
Impact of extrascrotal symptoms on treatment outcome in patients with nonseminomatous germ cell tumor with intermediate or poor prognosis.
Authors: Yamada Shigeyuki , Saito Hideo , Mitsuzuka Koji , Ito Akihiro , Arai Yoichi 
Published: February 2017

384 Background: The International Germ Cell Consensus (IGCC) classification is based on primary tumor localization, presence of non-pulmonary visceral metastases, and serum tumor marker levels, not the general condition of patients. The present study aimed to identify novel prognostic factors for nonseminomatous germ cell tumors (NSGCTs) with IGCC intermediate or poor prognosis. Methods: We retrospectively analyzed 399 patients with germ cell tumors (GCT) treated at Tohoku University Hospital between 1979 and 2011. Of these, 52 and 61 patients with NSGCTs were classified as having intermediate and poor prognosis, respectively. Several clinical parameters were reviewed, including age, IGCC prognosis group, kind of induction chemotherapy, and extra-scrotal symptoms at presentation. Extra-scrotal symptoms were defined as symptoms other than scrotal swelling, such as abdominal pain, lumbago, and dyspnea. Survival was estimated using the Kaplan-Meier method. A Cox proportional hazards model was used to assess potential predictors of outcome. Results: The median age of the 113 patients was 30. Median length of follow-up was 57 months. At presentation, 12 (23%) patients with intermediate prognosis and 32 (52%) patients with poor prognosis had extra-scrotal symptoms. In the intermediate prognosis group, the five year overall survival (OS) of patients with extra-scrotal symptoms was significantly worse than that of patients without symptoms (95% vs. 63%, p= 0.0008), but there was no significant difference in five year OS between patients with and without extra-scrotal symptoms in the poor prognosis group (60% vs. 66%, p= 0.265). On multivariate analysis, the presence of extra-scrotal symptoms (hazard ratio [HR] = 2.48, p= 0.0184) and induction chemotherapy not including etoposide (HR = 12.0, p< 0.0001) were independent predictors of inferior OS. Conclusions: The presence of extra-scrotal symptoms was associated with inferior OS, particularly in patients with intermediate prognosis. Intermediate-prognosis patients with extra-scrotal symptoms should be recognized as having poor prognosis.
Nonseminomatous germ cell tumor of the testis: Prognostic factors for a lethal phenotype.
Authors: Tu Shi-Ming , Bilen Mehmet Asim , Tu Zachary H. , General Raphael , Ward John Francis , Pisters Louis L. , General Rosale , Chen Adrienne H. , Nieto Yago , Pagliaro Lance C. , Yeung S. J. , Logothetis Christopher , Lin Sue-Hwa , Gorlov Ivan 
Published: February 2017

390 Background: Cancer is a heterogeneous disease. Studying cancer heterogeneity may enable us to elucidate the various subtypes of a particular cancer, and improve the diagnosis, prognostication, and therapy of cancer. Nonseminomatous germ cell tumor (NSGCT) is a prime example of a heterogeneous disease. We determined potential lethality of NSGCT by characterizing the histological makeup of primary testicular tumors, the tumor burden, psychosocial issues, and surgical factors. Methods: From November 1997 to October 2012, 142 consecutive patients diagnosed with a NSGCT of the testis were evaluated for this study. The log-rank test was used to identify prognostic factors in univariate Kaplan-Meier analysis. A multivariate Cox regression model was used to evaluate predictive factors for overall survival. Results: Patient and tumor characteristics: median (range) age 25 (12 to 53); pathology – embryonal carcinoma 15%, teratoma 6%, and mixed NSGCT 79%; stage – I 46%, II 32%, and III 21%. Ten (7%) patients died from their NSGCT. Seven (5%) patients had incurable NSGCT. Multivariate analysis showed that presence of seminoma (p=0.007), presence of yolk sac tumor (p=0.019), clinical stage (p=0.027), and psychosocial issues (p=0.04), have unfavorable prognostic significance. Conclusions: Certain subtypes of NSGCT containing yolk sac tumor and seminoma are inherently chemotherapy resistant and potentially lethal. Psychosocial factors can delay the diagnosis and treatment of patients with such tumors and adversely affect their clinical outcome. Results of this study need to be validated in another data base or a prospective clinical trial.