Trends over time in survival in patients with urothelial carcinoma in the real-world: A multicenter analysis.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 412-412
Author(s):  
Sunil Samnani ◽  
Zachary William Neil Veitch ◽  
Jeenan Kaiser ◽  
Carlos Stecca ◽  
Husam Alqaisi ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Real World ◽  
Surgical Techniques ◽  
Disease Free Survival ◽  
Novel Therapies ◽  
Free Survival ◽  
The Real ◽  
Time Period ◽  
Platinum Based Chemotherapy ◽  
Over Time

412 Background: Patients with muscle-invasive bladder cancer (MIBC) historically have poor long-term outcomes, with nearly 50% developing metastatic disease. Similarly, patients with metastatic urothelial carcinoma (mUC) have had median overall survivals of less than 2 years. Novel therapies have been implemented over time in attempts to improve outcomes. This study evaluates trends in survival over time in patients with MIBC and mUC treated in the real-world setting. Methods: Retrospective data was collected from two major cancer centres in Alberta and the Princess Margaret Cancer Centre in Ontario, Canada. Consecutive patients treated with platinum-based chemotherapy between 01/2005 and 01/2018 who had confirmed MIBC or mUC were evaluated. Patients were excluded if they had been treated as part of a clinical trial in the first-line setting. Patients were categorized based on year of diagnosis at presentation: time period 1 (T1) diagnosed between 01/2005 and 12/2011, and time period 2 (T2) diagnosed between 01/2012 and 12/2018. The co-primary endpoints were disease-free survival (DFS) for MIBC, progression-free survival (PFS) for mUC, and overall survival (OS) for both. Results: 572 patients were included, 196 (78% male; median age 63.8 years) had MIBC and 376 (76% male; median age 68.4 years) were treated for mUC. Amongst patients with MIBC, 33% (65) were treated in T1 and 67% (131) in T2. Median DFS and OS were significantly improved in T2 compared to T1 for patients with MIBC (Table). On multivariate analysis, earlier year of diagnosis and ECOG status ≥2 was independently associated with poor outcomes (p=0.016 and p=0.008, respectively). Amongst patients with mUC, 205 (55%) were treated in T1 and 171 (45%) in T2. Median PFS and OS did not significantly improve over time in patients with mUC from T1 to T2 (Table). Conclusions: In this real-world analysis, outcomes for patients with MIBC have significantly improved over time. This is likely attributed to standardization of perioperative chemotherapy protocols and improvements in surgical techniques. Similar improvements have not yet been demonstrated for patients with mUC during the two time periods. However, novel therapies (eg. immunotherapy) were only approved in 2017. Future analysis may explore the reasons for improvement in patients with MIBC and will evaluate outcomes in mUC patients treated from 2017 onwards. CI= confidence interval, HR= hazard ratio. [Table: see text]

scholarly journals LGALS4 as a Prognostic Factor in Urothelial Carcinoma of Bladder Affects Cell Functions

2019 ◽  
Vol 18 ◽  
pp. 153303381987660 ◽  
Author(s):  
Yu Ding ◽  
Qifeng Cao ◽  
Chen Wang ◽  
Huangqi Duan ◽  
Haibo Shen
Keyword(s):  
Urothelial Carcinoma ◽  
Survival Curve ◽  
Disease Free Survival ◽  
Hub Genes ◽  
Free Survival ◽  
Polymerase Chain ◽  
Carcinoma Of The Bladder ◽  
Bladder Cells ◽  
And Migration ◽  
Disease Free

Background: To identify the hub genes related to urothelial carcinoma of the bladder prognosis and to understand their underlying mechanism. Methods: The expression profiles of 18 pairs of urothelial carcinoma of the bladder patient tissue and paired adjacent tissue obtained from the Cancer Genome Atlas were performed. Weighted gene coexpression network analysis was employed to screen gene modules and hub genes with significant differential expressions in urothelial carcinoma of the bladder. The hub genes expression in urothelial carcinoma of the bladder tissues was validated by reverse transcription-quantitative polymerase chain reaction. The overall survival curve and disease-free survival curve of prognostic factor ( LGALS4) were plotted using the Kaplan-Meier method. Furthermore, LGALS4 messenger RNA and protein expression were also assessed in 2 urothelial carcinoma of the bladder cell lines (T24 and 5637) by quantitative reverse transcription–polymerase chain reaction and Western blot. The functions of urothelial carcinoma of the bladder cells with transfected pcDNA3.1- LGALS4 were identified through MTT assay, plate clone formation assay, flow cytometry, and cell migration experiments. Results: LGALS4 was the hub gene of pink module and it was related to prognosis. Higher LGALS4 expression predicted higher probabilities of overall survival and disease-free survival. Overexpression of LGALS4 in urothelial carcinoma of the bladder cells suppressed cell viability and migration but induced apoptosis. Conclusion: LGALS4 played a critical role in the progression of urothelial carcinoma of the bladder and held a promise to be the biomarker for diagnosis and treatment of urothelial carcinoma of the bladder. It predicted good prognosis of urothelial carcinoma of the bladder and restrained the growth and migration of urothelial carcinoma of the bladder cells.

Disease-free survival as a surrogate for overall survival in upper tract urothelial carcinoma

2012 ◽  
Vol 31 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Harun Fajkovic ◽  
Eugene K. Cha ◽  
Evanguelos Xylinas ◽  
Michael Rink ◽  
Armin Pycha ◽  
...  
Keyword(s):  
Overall Survival ◽  
Urothelial Carcinoma ◽  
Disease Free Survival ◽  
Upper Tract Urothelial Carcinoma ◽  
Free Survival ◽  
Upper Tract ◽  
Disease Free

scholarly journals 630 Oncologists' perspectives on evolution of first-line immune checkpoint inhibitor maintenance therapy in management of advanced urothelial carcinoma in the US

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A660-A660
Author(s):  
Petros Grivas ◽  
Phani Veeranki ◽  
Kevin Chiu ◽  
Vivek Pawar ◽  
Jane Chang ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Disease Control ◽  
Urothelial Carcinoma ◽  
Real World ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Treatment Patterns ◽  
First Line ◽  
Platinum Based Chemotherapy

BackgroundAvelumab, a PD-L1 immune checkpoint inhibitor (ICI), was recently approved as first-line (1L) maintenance therapy for locally advanced/unresectable or metastatic urothelial carcinoma (aUC) after disease control with platinum-based chemotherapy.1 Given the evolving treatment landscape, the study aim was to gain real-world insights into clinical decision-making among oncologists for patients with aUC.MethodsIn March 2021, a cross-sectional web-based survey was administered to a sample of US oncologists treating patients with aUC. Oncologists' demographics, practice characteristics, and treatment patterns were obtained; descriptive statistics were used.ResultsThe study included 151 medical oncologists, who reported that 54% and 31% of their patients, on average, would be classified as cisplatin or carboplatin eligible for their 1L treatment, respectively. Approximately 78% of oncologists (n=118) considered using ICI maintenance in ≥40% of their patients following disease control with platinum chemotherapy and were categorized as the “high-consideration” group, for further exploratory analysis; the rest (22%) were in the low-consideration group (See table 1). Approximately, 31% and 27% of oncologists in the high- and low-consideration groups reported administering ICI maintenance with a 2–3-week gap after chemotherapy, while 45% and 46% reported administering it with a 4–6-week gap after chemotherapy, respectively.ConclusionsSurveyed oncologists reported that 85% of patients with aUC in US may be eligible for platinum-based chemotherapy. Further, 78% of the surveyed oncologists would consider 1L ICI maintenance therapy after disease control with platinum-based chemotherapy for over 40% of their patients. Future studies are warranted to evaluate real-world treatment patterns, barriers, and utilization of ICI maintenance therapy as the new 1L standard of care.AcknowledgementsThe authors would like to acknowledge all physicians at who participated and completed the survey for the study.ReferencePowles T, et al. N Engl J Med 2020;383(13):1218–1230.Ethics ApprovalThe study was reviewed and determined to be exempt by Advarra IRB.ConsentAll survey participated signed a consent form.Abstract 630 Table 1Oncologists characteristics and considerations for 1L ICI maintenance therapy

scholarly journals Induction Chemotherapy Followed by Pleurectomy Decortication and Hyperthermic Intraoperative Chemotherapy (HITHOC) for Early-Stage Epitheliod Malignant Pleural Mesothelioma—A Prospective Report

2021 ◽  
Vol 10 (23) ◽  
pp. 5542
Author(s):  
Stefano Bongiolatti ◽  
Francesca Mazzoni ◽  
Ottavia Salimbene ◽  
Enrico Caliman ◽  
Carlo Ammatuna ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Malignant Pleural Mesothelioma ◽  
Early Stage ◽  
Disease Free Survival ◽  
Stage I ◽  
Long Term Results ◽  
Pleural Mesothelioma ◽  
Free Survival ◽  
Therapy Regimen ◽  
Platinum Based Chemotherapy

Malignant pleural mesothelioma (MPM) is an aggressive disease with poor prognosis and the current treatment for early-stage MPM is based on a multimodality therapy regimen involving platinum-based chemotherapy preceding or following surgery. To enhance the cytoreductive role of surgery, some peri- or intra-operative intracavitary treatments have been developed, such as hyperthermic chemotherapy, but long-term results are weak. The aim of this study was to report the post-operative results and mid-term outcomes of our multimodal intention-to-treat pathway, including induction chemotherapy, followed by surgery and Hyperthermic Intraoperative THOracic Chemotherapy (HITHOC) in the treatment of early-stage epithelioid MPM. Since 2017, stage I or II epithelioid MPM patients have been inserted in a surgery-based multimodal approach comprising platinum-based induction chemotherapy, followed by pleurectomy and decortication (P/D) and HITHOC with cisplatin. The Kaplan–Meier method was used to estimate overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS). During the study period, n = 65 patients affected by MPM were evaluated by our institutional Multidisciplinary Tumour Board; n = 12 patients with stage I-II who had no progression after induction chemotherapy underwent P/D and HITHOC. Post-operative mortality was 0, and complications developed in n = 7 (58.3%) patients. The median estimated OS was 31 months with a 1-year and 3-year OS of 100% and 55%, respectively. The median PFS was 26 months with 92% of a 1-year PFS, whereas DFS was 19 months with a 1-year DFS rate of 83%. The multimodal treatment of early-stage epithelioid MPM, including induction chemotherapy followed by P/D and HITHOC, was well tolerated and feasible with promising mid-term oncological results.

Ontology Versioning Driven by Instance Evolution in the τOWL Framework

2021 ◽  
Author(s):  
Zouhaier Brahmia ◽  
Fabio Grandi ◽  
Abir Zekri ◽  
Rafik Bouaziz
Keyword(s):  
Semantic Web ◽  
Real World ◽  
Ontology Construction ◽  
Web Based ◽  
The Real ◽  
Initial Design ◽  
Design Time ◽  
Schema Versioning ◽  
History Of ◽  
Over Time

Like other components of Semantic Web-based applications, ontologies are evolving over time to reflect changes in the real world. Several of these applications require keeping a full-fledged history of ontology changes so that both ontology instance versions and their corresponding ontology schema versions are maintained. Updates to an ontology instance could be non-conservative that is leading to a new ontology instance version no longer conforming to the current ontology schema version. If, for some reasons, a non-conservative update has to be executed, in spite of its consequence, it requires the production of a new ontology schema version to which the new ontology instance version is conformant so that the new ontology version produced by the update is globally consistent. In this paper, we first propose an approach that supports ontology schema changes which are triggered by non-conservative updates to ontology instances and, thus, gives rise to an ontology schema versioning driven by instance updates. Note that in an engineering perspective, such an approach can be used as an incremental ontology construction method driven by the modification of instance data, whose exact structure may not be completely known at the initial design time. After that, we apply our proposal to the already established [Formula: see text]OWL (Temporal OWL 2) framework, which allows defining and evolving temporal OWL 2 ontologies in an environment that supports temporal versioning of both ontology instances and ontology schemas, by extending it to also support the management of non-conservative updates to ontology instance versions. Last, we show the feasibility of our approach by dealing with its implementation within a new release of the [Formula: see text] OWL-Manager tool.

Grey Paints: Using Earnings Quality Concepts to Clarify the Earnings Measurement Process

2002 ◽  
Vol 17 (4) ◽  
pp. 431-445
Author(s):  
Jerry G. Kreuze ◽  
Jack M. Ruhl
Keyword(s):  
Earnings Management ◽  
Real World ◽  
Correct Answer ◽  
Earnings Quality ◽  
Measurement Process ◽  
Accounting Students ◽  
The Real ◽  
Time Period ◽  
Inherent Ambiguity

This case uses the concepts of earnings quality and earnings management to illustrate the inherent ambiguity in the earnings measurement process. Accounting students are often uncomfortable with ambiguity. Students want faculty to provide them with a single correct answer, such as the precise earnings for a given time period. Accounting textbooks rarely address this perception; we have yet to find a textbook that illustrates a range of acceptable amounts. This case demonstrates that earnings can be, and often are, ambiguous in the real world.

Comparison of 5-FU vs capecitabine in combination with mitomycin or cisplatin in the treatment of anal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3576-3576
Author(s):  
Irene Yu ◽  
Winson Y. Cheung
Keyword(s):  
Anal Cancer ◽  
Real World ◽  
Cancer Survival ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Operative Management ◽  
Population Based ◽  
Alternative Form ◽  
The Real ◽  
Treatment Groups

3576 Background: The patterns of capecitabine use as an alternative form of fluoropyrimidine to infusional 5-FU in the non-operative management of anal cancer in the real world are poorly described. Our objectives were to determine the frequency of capecitabine use, compare the observed outcomes between oral and intravenous fluoropyrimidines, and examine for variations in treatment-related adverse events between the two agents. Methods: All anal cancer patients who received either capecitabine or infusional 5-FU as part of their chemoradiation treatment from 2004 to 2013 at any 1 of 6 cancer centers in British Columbia were included. Chi-square and Wilcoxon-Mann tests were used to assess for associations between treatment groups and clinical characteristics and outcomes. Results: A total of 486 patients were identified: median age was 59 (IQR 53-67) years, 175 (36%) were men, 418 (86%) had ECOG 0/1, and 30 (6%) were HIV positive. Median total radiation dose was 54 cGy (IQR 50-54) and 47 (10%) underwent a colostomy prior to chemoradiation. Baseline characteristics were balanced between the two groups with respect to age, gender, ECOG, and HIV status (all p > 0.05). Prior to 2010, only 5-FU was utilized. From 2010 to 2013, 155 and 82 patients (65% vs 35%) received capecitabine vs 5-FU, respectively. Overall (68% vs 67%, p = 0.831) and disease-free survival rates (59% vs 59%, p = 0.926) at 3 years were similar in the capecitabine vs 5-FU groups. Rates of subsequent abdomino-perineal resection were also similar (10% vs 14%, p = 0.164). Patients who received 5-FU were more likely to report adverse effects (76% vs 57%, p < 0.01). The capecitabine group had a lower incidence of stomatitis (7% vs 43%, p < 0.01) whereas the 5-FU cohort reported less frequent hand-foot syndrome (1% vs 7%, p < 0.01). The rates of myelosuppression, nausea/vomiting, diarrhea, and rash were similar between the two groups (all p > 0.05). Conclusions: This represents one of the largest population-based studies to demonstrate a preference for capecitabine in place of 5-FU in the management of anal cancer. Survival outcomes were similar between the two treatment groups, but capecitabine may be better tolerated in the real world.

Real-world implementation of serious illness care program (SICP) in cancer care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24112-e24112
Author(s):  
Safiya Karim ◽  
Sasha M. Lupichuk ◽  
Amy Tan ◽  
Aynharan Sinnarajah ◽  
Jessica Simon
Keyword(s):  
Real World ◽  
Care Program ◽  
Patient Reported Outcome ◽  
Comfort Level ◽  
Healthcare Team ◽  
Serious Illness ◽  
The Real ◽  
Patient Reported ◽  
Seriously Ill Patients ◽  
Over Time

e24112 Background: The Serious Illness Care Program (SICP) is a system-based intervention, including a conversation guide, which facilitates improved advance care planning (ACP) conversations between clinicians and seriously ill patients. A recent randomized control trial found the program reduced symptoms of depression and anxiety amongst oncology out-patients and improved process outcomes. We implemented the SICP in our center to determine if the effects of this program could be translated into the real world. Methods: Two outpatient oncology clinics implemented the SICP, each over a 16-week period. Patients were identified based on an answer of “no” to the question “would I be surprised if this patient died within the next year?”, or any patient with a diagnosis of metastatic pancreatic cancer, or symptom scores of > 7 on more than three categories of the patient reported outcome dashboard. Physicians were trained on how to conduct the SICP conversation. One patient per week was identified and prepared to have the SICP conversation with the goal of at least 12 conversations in each 16-week period. Rates of SICP conversation documentation on our system’s “ACP and goals of care designation (GCD) Tracking Record” and GCD orders were recorded. Patient satisfaction after each conversation and physician comfort level over time were assessed. Results: 16 patients were identified (8 patients in each 16-week period). One patient was lost to follow-up. Of the remaining 15 patients who had the SICP conversation, 14 (93%) had documentation on the Tracking Record and 8 (53%) had a GCD order. This was a major improvement over baseline rates of documentation (e.g. < 1 % Tracking Record use and 16% GCD for patients with GI cancers). 14 patients completed satisfaction surveys, of which 12 (86%) felt “completely” or “quite a bit” more heard or understood. Physician comfort level increased from 3.6 to 4.8 and from 4.8 to 5 out of 5, respectively over each 16-week period. Conclusions: SICP implementation resulted in high rates of documentation of goals and preferences. Patients felt heard and understood by their healthcare team, and comfort in these conversations improved over time for physicians. The goal number of conversations was not met, but otherwise the SICP was feasible to implement in the real world. Further study is required to identify the appropriate triggers and barriers to routine SICP conversations.

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