bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital related outcomes of acute kidney injury in patients with bladder cancer: A nationwide inpatient study.
Authors: Vinagolu-Baur Julia , Javaid Saad , Frasier Kelly , Li Vivian , Ortega Yaguachi Nataly , Rodriguez Evadne , Del Castillo Olivia , Batista Raquel , Jonas Kenlee , Palma Laura 
Published: June 2024

e16624 Background: Bladder cancer is the most common urinary tract cancer and is associated with a high risk of acute kidney injury(AKI). However, there is a lack of Nationwide data on bladder cancer concerning acute kidney injury. We studied the impact of AKI on bladder cancer and the predictors of these adverse outcomes. Methods: The National Inpatient Sample for the years 2017-2020 was employed to identify patients with a primary diagnosis of bladder cancer (local/regional and advanced metastatic), and they were stratified into two cohorts with and without acute kidney injury (AKI). We calculated mortality as the primary outcome and other factors such as hospital stay, cost, sepsis, and respiratory failure as secondary outcomes using multivariate regression analysis after adjusting for confounding factors. Results: A total of 102485 patients had Bladder cancer, among which 30345 had AKI. The mean age of patients with and without AKI was 74.02 vs 71.36 years, respectively (p<0.004). After adjusting for confounding variables, patients with AKI had higher odds of mortality (OR=2.7(2.06-3.54); p<0.001). Length of stay and total hospitalization cost was also significantly increased in patients with concurrent AKI (+2.5 days(2.25-2.76) and + $ 25924(21831-30017); p<0.001, respectively). Similarly, bladder cancer patients with AKI had an increased likelihood of Fluid and electrolyte disorders (OR=3.99(3.70-4.30); p<0.001), Acute respiratory failure (OR=3.65(3.09-4.32); p<0.001), Cardiac arrest (OR=4.32(2.62-7.10);p<0.001), Sepsis (OR=6.52(5.38-7.92);p <0.001), Intensive care unit admission (OR=3.19(2.73-3.73);p<0.001), Invasive mechanical ventilation (OR=3.35(2.76-4.07); p<0.001), Vasopressor use (OR=2.83(2.07-3.86);p<0.001), Pneumonia (OR=2.04(1.61-2.57); p<0.001) and constipation (OR=1.91(1.70-2.15), p<0.001). Conclusions: Our study concluded that AKI in bladder cancer patients was associated with more than twofold increased odds of mortality. The presence of AKI also leads to increased length of stay in the hospitals and increased healthcare resource utilization. Careful evaluation and prompt intervention in acute kidney injury patients can significantly improve outcomes and reduce mortality rates in individuals with bladder cancer. These proactive measures enhance patient survival and improve the quality of life with treatment. [Table: see text]
Avoiding unnecessary biopsy: Development of a predictive calculator to identify non-prostate cancer in patients with Prostate Imaging Reporting and Data System category ≥ 4 lesions.
Authors: Zeng Hong , Chen Yuntian , Xie Yandong , Dai Jindong , Wang Minghao , Wang Qian , Xu Nanwei , Chen Junru , Sun Guangxi , Zhao Jinge , Zeng Hao , Shen Pengfei 
Published: June 2024

e17094 Background: The application of the Prostate Imaging Reporting and Data System (PI-RADS) has accelerated the use and promotion of multi-parameter magnetic resonance imaging (mpMRI) in prostate cancer (PCa) detection. Despite the high PCa detection rate, a considerable proportion of PI-RADS category 4 and 5 lesions are benign. The primary goal of this study is to develop and validate a prediction model for non-prostate cancer (non-PCa) in biopsy-naive patients with PI-RADS category ≥ 4 lesions. Methods: We retrospectively collected patients with PI-RADS category 4 or 5 lesions who underwent transperineal biopsies at West China Hospital from January 2018 to December 2022. Cases with prostate-specific antigen (PSA) > 20 ng/ml, PCa away from the area of the index lesion, and > 3 months from mpMRI to prostate biopsy were excluded. The included patients were randomly divided into a training cohort (70%) and a validation cohort (30%) for building and validating the prediction model, respectively. Logistic regression was used to screen independent predictors of non-PCa, and a nomogram was drawn based on the regression coefficients of the prediction model. The discrimination and calibration were assessed by the C-index and the calibration plots, respectively, the latter being quantified by the Brier score. Decision curve analysis (DCA) and clinical impact curve (CIC) were applied to measure the clinical net benefit. Results: A total of 1580 patients were included and the prevalence of non-PCa was 40.1%. Five independent predictors of non-PCa were incorporated into the optimal model, including age, prostate volume (PV), prostate-specific antigen density (PSAD), apparent diffusion coefficient (ADC) values, and lesion zone. The C-index was 0.925 (95%CI, 0.910-0.939) and 0.931 (95%CI, 0.910-0.953) in the training cohort and validation cohort, respectively. Favorable agreement was exhibited from the calibration curve, with a Brier score of 0.104. The DCA demonstrated an increased net benefit of the nomogram over a wide range of threshold probabilities compared to biopsy-free-all or biopsy-free-none strategy. At biopsy-free thresholds of 60%, 70%, and 80%, the nomogram was able to avoid 74.0%, 65.8%, and 55.6% unnecessary biopsies against 9.0%, 5.0%, and 3.6% of missed PCa (or 35.9%, 30.2%, and 25.1% men forewent biopsies, respectively). Conclusions: We developed the first five-item predictive model based on quantitative ADC and PSAD in patients with PI-RADS category ≥ 4 lesions. In a risk-averse scenario, the strategy may safely identify non-PCa to support clinical decision-making and reduce unnecessary prostate biopsies. [Table: see text]
Management outcomes of localized low-risk prostate cancer: A population-based study.
Authors: Mao Shifeng S. , Yin Yue , Wegner Rodney E. , Sanguino Ramirez Angela M , Lyne John , Miller Ralph , Cohen Jeffrey , Samiei Arash 
Published: June 2024

e17096 Background: Optimal management of patients with low-risk prostate cancer (LRPC) remains a topic of debate. While active surveillance (AS) is an increasingly popular option, definitive local treatments, including radical prostatectomy (RP), external beam radiotherapy (EBRT), and prostate seed implantation (PSI), are also commonly used. This study assessed the treatment outcomes of patients with LRPC using a large patient population from the National Cancer Database (NCDB). Methods: We analyzed data from 195,452 patients diagnosed with LRPC between 2004 and 2015 using NCDB. Patients were classified based on their treatment modalities, including RP, EBRT, PSI, or no local therapy (NLT). Only patients with Charlson-Deyo comorbidity scores of 0 or 1 were included. Propensity score analysis was used to balance the treatment groups, and the accelerated failure time model was used to analyze the survival rates of the treatment groups. Results: After a median follow-up of 70.8 months, 24,545 deaths occurred, resulting in an all-cause mortality rate of 13%. Compared to NLT, RP significantly improved overall survival by 47% (1.47, p < .0001), 34% (1.34, p < .0001), 27% (1.27, p < .0001), and 10% (1.10, p = .0002) in the age groups < 60, 60-64, 65-69, and 70-74, respectively. However, the benefit of RP decreased with advancing age, leading to an 11% decrease in survival (0.89, p < .0001) in men aged ≥ 75 years. In contrast, EBRT did not improve overall survival in younger age groups; rather, it decreased survival by 11% (0.89, p = .0020) and 9% (0.91, p = .0111) in patients aged < 60 and 60-64, respectively. However, EBRT significantly improved overall survival in older patients by 6% (1.06, p = .0160) and 27% (1.27, p < .0001) for those aged 70-74 and over 75 years, respectively. Similarly, PSI did not improve overall survival in age groups younger than 64 years but exhibited significant overall survival benefits of 6% (1.06, p = .0242), 11% (1.11, p <.0001), and 34% (1.34, p < .0001) compared to NLT in age groups of 65-69, 70-74, and over 75, respectively. Conclusions: RP improves overall survival in patients with LRPC, especially in younger patients. EBRT and PSI primarily benefit older patients. NLT is a reasonable choice, particularly in younger patients when RP is not chosen. The study is hypothesis-generating and limited by the non-randomized, retrospective, and inherited nature of the NCDB data, which does not provide information regarding patients’ symptoms, sexual function, and disease-specific survival.
Radical prostatectomy versus XRT for early-stage prostate cancer: A retrospective, propensity-matched cohort study of 29,970 patients.
Authors: Salimath Varada , Mackey James David , Miles Brittany , Mehta Ankit 
Published: June 2024

e17099 Background: Both radical prostatectomy and external beam radiation therapy (XRT) are standard therapeutic options for definitive treatment of early-stage prostate cancer. While both modalities are generally viewed as comparable when matched for risk stratification, there is a paucity of literature directly comparing their outcomes. Slow-growing malignancies are generally regarded as less radiation-sensitive, but this has not been conclusively proven in prostate cancer. Aggressive variants of prostate cancer have, however, been shown to have higher rates of radiation-resistance. Here, we present a retrospective database analysis comparing rates of bone metastases and mortality among early-stage prostate cancer patients treated with radical prostatectomy versus XRT. Methods: The TriNetX research network was used for this study, with patient cohorts created by the use of International Classification of Disease 10 (ICD-10) codes and Current Procedural Terminology (CPT) codes. Both cohorts consisted of men over age 50 with a diagnosis of prostate cancer (C61) and PSA levels below 10 ng/mL. One cohort was treated with surgical prostatectomy (1014183 or 55866), while the other underwent Intensity Modulated Radiation Treatment (77385 or 77386). The cohorts were balanced for age, race, and ethnicity by propensity score matching and the greedy nearest neighbor algorithm, resulting in 14,985 patients in each arm. The cohorts were then evaluated for the development of bone metastases (C79.51) and mortality at five years. Results: Patients treated with prostatectomy were less likely to develop bone metastases within five years (3.4% vs 7.6%, RR 0.45, 95% CI (0.41,0.50), P value <0.0001). Prostatectomy was also associated with lower five-year mortality (4.2% vs 7.9%, RR 0.53, 95% CI (0.48,0.58), P value <0.0001). Conclusions: These results indicate that in early-stage prostate cancer, radical prostatectomy is associated with decreased rates of mortality and bone metastases within a 5-year period compared to XRT. Additional studies are needed to determine which prostate cancer variants are at increased risk of radiation treatment failure. Shared decision making regarding both outcomes and side effects is crucial when choosing a modality of definitive treatment in early-stage prostate cancer.
Rectal spacer in radiotherapy for prostate cancer: Correlation of spacer symmetry to rectal dosimetry.
Authors: Charas Tomer , Ben Dor Yossi , Bakouche Veronique , Billan Salem 
Published: June 2024

e17102 Background: Rectal spacers are used to temporarily position the anterior rectal wall away from the prostate during radiotherapy for prostate cancer, and to limit the exposure of the rectum to excessive radiation. These spacers use different insertion techniques and filling materials. Our study aims to compare and correlate the symmetry and rectal dosimetry in patients implanted with either the balloon spacer (BioProtect Balloon Implant System) or a gel spacer (SpaceOAR). Methods: A qualitative model utilizing measurements of prostate-rectal interspace from axial computed tomography scans was applied to assess 62 T1c-T4 prostate cancer patients (28 balloon, 34 gel spacer) undergoing SBRT (5/6 fractions, 36-40 Gy) or IMRT (20/28 fractions, 60-70 Gy). Spacer symmetry at midgland, 1 cm superior or inferior to midgland was scored as ‘S’. Asymmetrical placement (1 or 2cm lateral left or right) was scored as 1 or 2. Axial slices with no spacer was scored as 0. A total symmetry score (SYM) was evaluated by using a scoring of SYM-S indicating spacer symmetry in all 3 slices and scores ranging 1-to-4 representing increasing spacer asymmetry. SYM score was then evaluated relatively to rectal dosimetry at V60%-V100%. Results: For balloon and gel spacers, symmetrical distribution at midline, at 1 cm inferior and superior to midgland was observed in 16 (57.1%) and 18 (52.9%) patients, 16 (57.1%) and 15 (44.1%) patients, 10 (35.7%) and 12 (35.3%) patients, respectively. The balloon was not visible in 3 (10.7%) superior slices compared to 3 (8.8%) inferior and 6 (17.6%) superior gel spacer slices, receiving score 0. The mean rectal dose for the balloon spacer compared to the gel spacer was 9.8 and 12.9 for V60%, 5.6 and 7.9 for V70%, 3.1 and 4.5 for V80%, 1.5 and 2.0 for V90% and 0.12 and 0.17 for 100% respectively. The study results show that as the spacers became more asymmetric, the rectal dose-volume at V60%-V100% increased. Conclusions: The balloon provides a better symmetrical distribution and lower dose to the rectum compared to the gel. The potential advantages of the balloon should be further evaluated in a prospective setting.
In-hospital outcomes of patients with ovarian cancer and venous thromboembolism: A Nationwide Inpatient Sample analysis.
Authors: Gaddam Mrunanjali , Iqbal Rabia , Jayakumar Jayalekshmi , Ginjupalli Manasa , Sanghvi Ankushi , Nanavaty Dhairya , Sanka Sujana , Sekandlapuram Rohit , Thanneeru Priya , Hotwani Priya , Kumar Vikash , Koifman Michelle , Sinha Samridhi , Colon Ramos Ana , Clement Jincy 
Published: June 2024

e17576 Background: Ovarian Cancer is one of the most common gynecological cancers. It has 5-year relative survival of 50.8 %. Around 12700 people die from this cancer each year, and it ranks fifth in cancer death among women. Studies have shown a strong association of ovarian cancer with venous thromboembolism (VTE) which includes deep venous thrombosis (DVT) and Pulmonary Embolism (PE). However, data surrounding outcomes associated with VTE in this population is limited. We aim to estimate the effect of VTE on mortality and healthcare utilization in this population. Methods: We queried the National Inpatient Sample (NIS) 2018-2020 to collect data for all adult hospitalizations >18 years with a diagnosis of ovarian cancer using appropriate ICD 10 codes. These hospitalizations were further classified into hospitalizations with and without DVT and PE. Multivariate regression analysis was performed to study the impact of DVT/PE taking mortality as the primary outcome and total cost and length of hospital stay (LOS) as secondary outcomes in the subpopulation of ovarian cancer hospitalizations. Results: There were a total of 298085 adult hospitalizations with a diagnosis of ovarian cancer with a mean age of 63 years. Among hospitalizations with ovarian cancer, acute DVT was found in 2.75% and acute PE was present in 4.5 %. In these hospitalizations, in-patient mortality was 9.3% in those with either DVT or PE. Multivariate regression analysis revealed that among adults, hospitalizations with ovarian cancer had higher odds of Acute DVT [OR 3.5, P<0.01] and Acute PE [OR 3.76, P<0.01] than those without. The odds of all-cause mortality from VTE [OR 2.18, P<0.01] were significantly higher in patients with ovarian cancer than those without. The total cost of hospital stay was 26211 $ ($22183 - $30238, p<0.01) higher and LOS was 1.67 times higher (1.2 - 2.32; P<0.01) when patients with ovarian cancer developed VTE (Table). Conclusions: Our study concludes that ovarian cancer patients who develop VTE tend to have worse outcomes in terms of mortality. Length of hospital stay and total hospital charge are also increased in patients developing VTE, thereby increasing healthcare utilization. This highlights the importance of having larger-scale studies in the future to assess outcomes in ovarian cancer patients with VTE and the need to formulate risk assessment models for the role of primary thromboprophylaxis. Adjusted analysis showing odds ratio of mortality, total hospital charge and LOS in ovarian cancer hospitalizations. [Table: see text]
Outcomes in patients with anemia hospitalized for endometrial cancer resection: A nationwide analysis.
Authors: Frasier Kelly , Javaid Saad , Li Vivian , Vinagolu-Baur Julia , Ortega Yaguachi Nataly , Rodriguez Evadne , Del Castillo Olivia , Batista Raquel , Jonas Kenlee , Palma Laura 
Published: June 2024

e17585 Background: Endometrial cancer is the most common gynecological malignancy, and It is notably associated with the development of anemia. In light of this, we conducted a retrospective analysis to determine the impact of anemia on patients hospitalized for endometrial cancer resection and other complications during hospitalization. Methods: We conducted a study using the National Inpatient Sample (NIS) data from 2019 and 2020 to identify patients who were admitted with a primary diagnosis of endometrial cancer resection and had a concurrent secondary diagnosis of anemia. Primary outcomes included mortality, and secondary outcomes were the length of stay, total hospitalization charges, and other adverse hospital outcomes. Multivariate logistic regression analysis was used to adjust for confounding variables. Results: A total of 375,109 patients were hospitalized for resection of Endometrial cancer, among whom 55,345 had concurrent anemia. After adjusting for confounding factors, no difference in mortality between the two groups was observed(OR=1.37, 0.91-2.07; p=0.127). However, patients with anemia had a longer length of stay (4.11 days without and 6.05 days with anemia, p<0.001) and a higher total cost of hospitalization ($ 81,112 without and $ 108,436 with anemia, p<0.001). Patients with anemia were at a higher risk of developing sepsis (OR=3.15, 2.60-3.82, p<0.001), acute respiratory failure (OR= 2.64, 2.19-3.19; p<0.001), ICU admission (OR= 2.30, 1.95-2.72; p<0.001), acute coronary syndrome (OR= 2.17, 1.06-4.43; p=0.032), acute kidney injury (OR= 2.78, 2.50-3.09; p<0.001), constipation (OR =1.51, 1.33-1.71; p<0.001), diarrhea (OR= 2.11, 1.61-2.76; p<0.001), pneumonia (OR =2.20, 1.70-2.84; p<0.001), red blood cell transfusion (OR= 9.45, 8.39-10.64; p<0.001), platelet transfusions (OR= 4.43, 3.19-6.16; p<0.001), venous thromboembolism (OR= 2.50, 2.07-3.03; p<0.001), enteral feeding (OR= 6.96, 1.59-30.43; p=0.01), parenteral feeding (OR= 2.91, 2.19-3.85; p<0.001), urinary tract infection (OR =2.08, 1.77-2.43; p<0.001), and the involvement of palliative care (OR= 1.59, 1.18-2.13; p<0.001). There was no difference in having chemotherapy in both groups (OR 0.79, 95% CI 0.29-2.12, p=0.652). Conclusions: Anemia is associated with increased healthcare resource utilization and adverse in-hospital outcomes in patients undergoing resection of Endometrial cancer. Anemia might not be the only predictor of mortality, but identifying and treating it before any interventions can decrease the risk of adverse outcomes and improve quality of life. [Table: see text]
Clinical significance of the risk model based on exosome-derived miRNA and miR-486-5p for endometrial cancer.
Authors: Zheng Jianfeng , Lin Xuefen , Jiang Ruina , Sun Yang 
Published: June 2024

e17588 Background: Exosome-derived miRNAs are detectable in various body fluids and play a crucial role in the diagnosis and prognosis of endometrial cancer (EC). The objective of our study is to investigate the clinical significance of an exosome-derived miRNA-based risk model, specifically focusing on miR-486-5p for EC. Methods: The expression profile of plasma-derived exosomal miRNAs was obtained through high-throughput sequencing. The expression profile of mature miRNAs for patients with EC was also obtained from TCGA. The prognostic value of differentially expressed miRNAs was assessed using R packages. The accuracy and stability of exosomal miRNAs in diagnosing EC were assessed using machine learning algorithms. The risk model based on exosome-derived miRNA was established using LASSO Cox regression analysis. The clinical significance of the risk model, including prognosis and anti-tumor therapy, was identified and validated using R packages. The most significant exosomal miRNA, miR-486-5p, was selected for wet experiments, including quantitative real-time PCR, Western Blot, CCK8, colony formation, transwell migration, wound healing, flow cytometry, and dual-luciferase reporter assays. Six databases and comprehensive bioinformatics approaches were integrated to predict targets of miR-486-5p. Data of single cell RNA was used to screen out the recipient cell of exosomal miR-486-5p. Results: A total of 49 exosomal miRNAs exhibited differential expression between plasma samples obtained from women with EC and controls. A total of 33 exosomal miRNAs exhibiting prognostic significance were identified. The area under the receiver operating characteristic curve (AUC) of the diagnostic model calculated by machine learning algorithms exceeded 0.9 in all sets. The risk model based on exosome-derived miRNA could be used to stratify EC patients with different prognosis. The AUC value of the time-dependent ROC curve for the risk model exceeded 0.7. Additionally, our study revealed that patients with EC, stratified based on the risk model, exhibited varying responses to anti-tumor therapy such as Tamoxifen. The single-cell transcriptome sequencing data revealed a significantly elevated expression abundance of FOXO1, the miR-486-5p target gene, in macrophages within the immune microenvironment. The experimental results demonstrated that miR-486-5p exerted a promotive effect on cellular proliferation, migration, invasion, and metabolic dysfunction through the inhibition of FOXO1. Furthermore, we observed that the exclusion of miR-148a-3p via exosomes promoted macrophage M2 polarization by FOXO1-mediated metabolic dysfunction. Conclusions: Our data has provided insights into the clinical significance of the risk model based on exosome-derived miRNA, as well as revealing the mechanism involving miR-486-5p in metabolic dysfunction through FOXO1 for endometrial cancer.