Clinical destiny of indeterminate pulmonary nodules in patients undergoing radical cystectomy for urothelial carcinoma of the bladder.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 297-297
Author(s):  
David B. Cahn ◽  
Brian McGreen ◽  
Albert Lee ◽  
Elizabeth R. Plimack ◽  
Daniel M. Geynisman ◽  
...  
Keyword(s):  
Natural History ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Preoperative Staging ◽  
Pulmonary Nodules ◽  
Open Approach ◽  
Metastatic Urothelial Cancer ◽  
History Of ◽  
Carcinoma Of The Bladder

297 Background: Perioperative risks and significant quality of life concerns following radical cystectomy (RC) render accurate pre-operative staging paramount, since metastatic patients are unlikely to benefit from extirpation. Yet, incidental indeterminate pulmonary nodules (IPNs) are a common pre-operative finding in clinical practice, thus representing a significant management challenge. As such, we sought to evaluate the natural history of IPNs in a large institutional cohort that underwent RC. Methods: We reviewed our institutional database for patients who underwent RC from 2000 through 2014 for urothelial carcinoma (UCC) of the bladder and had at least 1 identifiable pulmonary lesion on preoperative staging imaging measuring <2cm in any axis. Patients who were M1 at surgery, had gynecologic, colorectal, or missing pathology, or non-urothelial histology were excluded. We sought to determine the natural history of these pulmonary lesions and evaluated predictors of metastatic etiology. Results: During the study period, 681 RC were performed at our institution. We identified 73 patients with an identifiable preoperative IPN who met inclusion criteria and underwent RC. In this subset, 23.3% were female, 21.9% were active smokers, and 54.8% former smokers. The median age at surgery was 70±8.6 years. Nearly half (49.3%) received neoadjuvant chemotherapy. 61.6% of RC were performed using the traditional open approach, while 38.4% were performed robotically. Final pathologic staging included 16.4% pT0N0Mx, 19.2% pTa/Tis/T1N0Mx, 42.5% pT2-4N0Mx, and 21.9% pTanyN+Mx. Median IPN size was 0.7±0.3cm. At median follow up of 23.5±21.9 months, 93% (68/73) of IPNs in our cohort were clinically benign, with metastatic urothelial cancer confirmed in only 4 patients, and a primary lung malignancy diagnosed in 1 patient. Conclusions: The majority of IPNs in patients who proceeded to RC for UCC of the bladder were stable upon follow-up and rarely represented malignancy. As such, in appropriately screened UCC patients, IPNs should not be a barrier to proceeding with extirpative surgical therapy.

Impact of Routine Laboratory Parameters in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: A Long-Term Follow-Up

2020 ◽  
Vol 104 (7-8) ◽  
pp. 551-558
Author(s):  
Alexander Tamalunas ◽  
Alexander Buchner ◽  
Alexander Kretschmer ◽  
Friedrich Jokisch ◽  
Gerald Schulz ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Routine Laboratory ◽  
Laboratory Parameters ◽  
Long Term Follow Up ◽  
Carcinoma Of The Bladder

The Natural History of Clinically Complete Responders to Neoadjuvant Chemotherapy for Urothelial Carcinoma of the Bladder

2014 ◽  
Vol 192 (3) ◽  
pp. 696-701 ◽  
Author(s):  
Alexa Meyer ◽  
Rashed Ghandour ◽  
Ari Bergman ◽  
Crystal Castaneda ◽  
Matthew Wosnitzer ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Natural History ◽  
Urothelial Carcinoma ◽  
History Of ◽  
Carcinoma Of The Bladder

Natural History of Disseminated Coccidioidomycosis: Examination of the Veterans Affairs–Armed Forces Database

2020 ◽  
Author(s):  
Derek J Bays ◽  
George R Thompson ◽  
Susan Reef ◽  
Linda Snyder ◽  
Alana J Freifeld ◽  
...  
Keyword(s):  
Natural History ◽  
Pulmonary Nodules ◽  
Armed Forces ◽  
Veterans Affairs ◽  
Initial Infection ◽  
All Cause Mortality ◽  
History Of ◽  
Insight Into

Abstract Background The natural history of non–central nervous system (non-CNS) disseminated coccidioidomycosis (DCM) has not been previously characterized. The historical Veterans Affairs (VA)–Armed Forces coccidioidomycosis patient group provides a unique cohort of patients not treated with standard antifungal therapy, allowing for characterization of the natural history of coccidioidomycosis. Methods We conducted a retrospective study of 531 VA–Armed Forces coccidioidomycosis patients diagnosed between 1955–1958 and followed to 1966. Groups were identified as non-DCM (462 patients), DCM (44 patients), and CNS (25 patients). The duration of the initial infection, fate of the primary infection, all-cause mortality, and mortality secondary to coccidioidomycosis were assessed and compared between groups. Results Mortality due to coccidioidomycosis at the last known follow-up was significantly different across the groups: 0.65% in the non-DCM group, 25% in the DCM group, and 88% in the CNS group (P &lt; .001). The primary fate of pulmonary infection demonstrated key differences, with pulmonary nodules observed in 39.61% of the non-DCM group, 13.64% of the DCM group, and 20% of the CNS group (P &lt; .001). There were differences in cavity formation, with 34.20% in the non-DCM group, 9.09% in the DCM group, and 8% in the CNS group (P &lt; .001). Dissemination was the presenting manifestation or was concurrent with the initial infection in 41% and 56% of patients in the non-CNS DCM and CNS groups, respectively. Conclusions This large, retrospective cohort study helps characterize the natural history of DCM, provides insight into the host immunologic response, and has direct clinical implications for the management and follow-up of patients.

The natural history of preoperative indeterminate pulmonary nodules in patients with resectable pancreatic adenocarcinoma.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 161-161
Author(s):  
Dennis C. Nguyen ◽  
Stephanie Chang ◽  
Zhou Gongfu ◽  
Andrea Wang-Gillam ◽  
David Linehan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Natural History ◽  
Pancreatic Adenocarcinoma ◽  
Preoperative Evaluation ◽  
Pulmonary Nodules ◽  
Metastatic Adenocarcinoma ◽  
History Of ◽  
Head Of The Pancreas ◽  
Ground Glass Nodules

161 Background: Preoperative abdominal imaging often detects indeterminate pulmonary nodules (IPN) in patients with resectable pancreatic adenocarcinoma. The natural history of IPN in this setting is not well characterized. Methods: Patients with adenocarcinoma of the head of the pancreas who underwent pancreaticoduodenectomy (PD) were queried from a prospectively maintained database. Pre- and postoperative imaging was reviewed and IPN characterized and analyzed for associations with nodule progression and overall survival (OS). Results: 463 patients underwent PD for adenocarcinoma of the head of the pancreas from 2000-2010. Of these, 329 (71%) had reviewable pre-operative imaging. 48 patients (15%) had pre-operative IPN (non-calcified) identified with follow-up imaging available for review. The only pre-operative factor associated with the presence of IPN was increasing age (68 v. 64 years; p=0.003). 8 patients (12%) had new or enlarging nodules, of whom 5 (7%) had confirmed pulmonary metastatic adenocarcinoma. There was no difference in OS between patients with or without pre-operative IPN (2-year OS 41% v. 38%, respectively; p=0.37). Further, no radiographic criteria of IPN (including # of, size of, bilateral, calcified, solid, spiculated, smooth, lobular, or ground-glass nodules) was associated with OS. On follow-up, new or enlarging nodules were not associated with OS. Conclusions: IPN are often found in patients undergoing PD for pancreatic adenocarcinoma. The majority of IPN remain stable on post-operative imaging. Neither the presence of IPN nor nodule characteristics was associated with OS. These data do not support the routine additional workup of pre-operative IPN in patients with resectable adenocarcinoma of the head of the pancreas; however, larger studies are needed to further characterize the significance of IPN in the preoperative evaluation of patients with pancreatic adenocarcinoma.

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