scholarly journals Effects on annual income changes after radical radiotherapy versus after prostatectomy in patients with localized prostate cancer with a specific employment status: A web-based pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0258116
Author(s):  
Masanari Minamitani ◽  
Tomoya Mukai ◽  
Hideomi Yamashita ◽  
Atsuto Katano ◽  
Keiichi Nakagawa
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Employment Status ◽  
Significant Risk ◽  
Post Treatment ◽  
Localized Prostate Cancer ◽  
Annual Income ◽  
Radical Radiotherapy ◽  
Web Based ◽  
Multivariable Logistic Regression

Men with localized prostate cancers are insured for undergoing radical radiotherapy or prostatectomy. However, limited information is available on the influence of cancer treatments on patients’ employment status in Japan. Therefore, in this web-based survey, we aimed to compare the effects of post-treatment changes on the annual income of patients with prostate cancer after undergoing radical radiotherapy and prostatectomy and to identify the risk factors associated with the decrease in annual income. We investigated the clinical characteristics and demographics including pre-treatment working status, self-employment, non-regular employment, working for wage or salary, and joblessness of patients with localized prostate cancer. Multivariable logistic regression was performed to analyze the effects of various factors on the change in the annual income of self-employed and non-regularly employed workers. Seventy-eight eligible patients with localized prostate cancer had undergone radiotherapy, and 128 patients had undergone prostatectomy. Among self-employed and non-regularly employed workers, post-treatment income decline rates in those who underwent radiotherapy were smaller but not significant (12% vs. 42%, P = 0.074). Multivariable logistic regression analysis revealed that initial treatment for prostate cancer was the only significant risk factor for the post-treatment income decline among self-employed and non-regularly employed workers. Radiotherapy was associated with a smaller decrease in income (odds ratio, 0.22; 95% confidence interval, 0.052–0.95; P = 0.042). Our novel results implied the effectiveness of radiotherapy in preventing post-treatment income decline among patients with prostate cancer based on specific employment status: self-employed or non-regularly employed.

scholarly journals The influence of comorbid depression and overweight status on peripheral inflammation and cortisol levels

2021 ◽  
pp. 1-8
Author(s):  
Anna P. McLaughlin ◽  
Naghmeh Nikkheslat ◽  
Caitlin Hastings ◽  
Maria A. Nettis ◽  
Melisa Kose ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Significant Risk ◽  
Normal Weight ◽  
Cortisol Awakening Response ◽  
Peripheral Inflammation ◽  
Comorbid Depression ◽  
Diurnal Cortisol ◽  
Overweight Status ◽  
Multivariable Logistic Regression ◽  
Cortisol Levels

Abstract Background Depression and overweight are each associated with abnormal immune system activation. We sought to disentangle the extent to which depressive symptoms and overweight status contributed to increased inflammation and abnormal cortisol levels. Methods Participants were recruited through the Wellcome Trust NIMA Consortium. The sample of 216 participants consisted of 69 overweight patients with depression; 35 overweight controls; 55 normal-weight patients with depression and 57 normal-weight controls. Peripheral inflammation was measured as high-sensitivity C-Reactive Protein (hsCRP) in serum. Salivary cortisol was collected at multiple points throughout the day to measure cortisol awakening response and diurnal cortisol levels. Results Overweight patients with depression had significantly higher hsCRP compared with overweight controls (p = 0.042), normal-weight depressed patients (p < 0.001) and normal-weight controls (p < 0.001), after controlling for age and gender. Multivariable logistic regression showed that comorbid depression and overweight significantly increased the risk of clinically elevated hsCRP levels ⩾3 mg/L (OR 2.44, 1.28–3.94). In a separate multivariable logistic regression model, overweight status contributed most to the risk of having hsCRP levels ⩾3 mg/L (OR 1.52, 0.7–2.41), while depression also contributed a significant risk (OR 1.09, 0.27–2). There were no significant differences between groups in cortisol awakening response and diurnal cortisol levels. Conclusion Comorbid depression and overweight status are associated with increased hsCRP, and the coexistence of these conditions amplified the risk of clinically elevated hsCRP levels. Overweight status contributed most to the risk of clinically elevated hsCRP levels, but depression also contributed to a significant risk. We observed no differences in cortisol levels between groups.

Temporal trends and predictors in diagnosing pathologic node-positive prostate cancer in clinically node-negative patients.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 128-128
Author(s):  
Ryan Hutten ◽  
Matthew Parsons ◽  
Christopher Weil ◽  
Jonathan David Tward ◽  
Nataniel Hernan Lester-Coll ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Temporal Trends ◽  
Demographic Factors ◽  
Grade Group ◽  
Node Negative ◽  
Node Positive ◽  
Multivariable Logistic Regression ◽  
Treatment Facilities ◽  
Over Time

128 Background: The management of men with pathologically node positive (pN+) prostate cancer (PCa) is controversial. Here, we describe the temporal patterns and predictors of incidental pN+ PCa men with clinically node negative (cN0) PCa. Methods: We performed a retrospective analysis of men with nonmetastatic, cN0, PCa from the National Cancer Database from 2010 to 2017. Clinical factors included in analysis were pretreatment PSA, pre-surgical International Society of Urological Pathology (ISUP) grade group (GG), clinical T-stage, margin status, and number of nodes sampled. Patient demographic factors included in analysis were age, comorbidity index, race, insurance status, and treatment facility type. We performed univariable and multivariable logistic regression to evaluate temporal trends in the rates of cN0,pN+ prostate cancer diagnosed over time. Two-level hierarchical logistic regression was used to identify covariates associated with pN+ disease. Patients were clustered within treatment facilities to account for individual facility practice patterns. Results: We identified 304,234 men with cN0 PCa who underwent radical prostatectomy (RP) between 2010 and 2017. Within this group 10,919 (3.59%) were found to have pN+ disease. During this period, the annual rate of pN+ PCa increased from 2.02% (n=822) in 2010 to 5.12% (n=2,072) in 2017 (p<0.001). On multivariable logistic regression, ISUP GG was most strongly associated with detection of pN+ PCa. Compared to ISUP GG1, GG2 (OR 3.5, p <0.001), GG3 (OR 8.8, p <0.001), GG4 (OR 12.6, p <0.001) and GG 5 (OR 26.5, p <0.001 ) were all significantly associated with pN+ PCa. Over the study period, the rates of pN+ identification increased from 5.5% to 9.4% in men with GG4, and from 13.4% to 19.5% in men with GG5 (p <0.001). Between 2010 and 2017, the rates of RP in GG4 and GG5 similarly increased by 12% and 16%, respectively (p <0.001). Other significant covariates are depicted in Table. 22% of the total variance was explained by inter-facility variation. Conclusions: The proportion of men with cN0 found to have pN+ PCa is increasing over time, with pN+ incidentally found in nearly 1 in 10 men with GG4 and 1 in 5 men with GG5 PCa. GG4 and GG5 are the strongest independent predictors of pN+ disease, while controlling for clinical and demographic factors. As incidental pN+ results in upstaging, often requiring adjuvant treatment with radiation and systemic therapies, these data are useful for informing discussions prior to RP. [Table: see text]

Proton radiotherapy for prostate cancer in the Medicare population: Patterns of care and comparison of early toxicity with IMRT.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4651-4651
Author(s):  
James B. Yu ◽  
Pamela R. Soulos ◽  
Laura D. Cramer ◽  
Kenneth B Roberts ◽  
Jeph Herrin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Cancer Patients ◽  
Post Treatment ◽  
Complication Rates ◽  
Proton Radiotherapy ◽  
Short Term ◽  
Significant Difference ◽  
Patient Reported ◽  
One Year

4651 Background: Proton radiotherapy (PRT) is a costly treatment used for prostate cancer despite little evidence supporting its use. We examined patterns of PRT use in the Medicare program and assessed the short-term toxicity of PRT vs. intensity modulated radiation therapy (IMRT). Methods: Using national Medicare claims from 2008-2009, we identified a sample of prostate cancer patients ages 66-94 who had received PRT or IMRT. We used multivariable logistic regression to identify patient and regional factors associated with receipt of PRT. We searched claims for procedure and diagnosis codes indicative of treatment-related complications and grouped the complications into genitourinary (GU), gastrointestinal (GI), and other complications. To compare the effect of PRT and IMRT on short-term toxicity, we used a Mahalanobis distance approach to match each PRT patient to two IMRT patients, achieving balanced distribution of clinical and sociodemographic characteristics. We compared six-month and one-year outcomes between the two treatment groups using conditional logistic regression. Results: We identified 27,647 men; 421 (2%) received PRT and 27,226 (98%) received IMRT. Patients who received PRT were widely geographically distributed, with some patients traveling >500 miles for treatment. PRT patients were younger, healthier, and of higher socioeconomic status. Although PRT was associated with a significant reduction in GU complications at six-months compared with IMRT (6.1% vs. 12.0%, OR 0.60 [95% CI 0.38-0.96], p=0.03), at one-year post-treatment there was no longer any difference in cumulative complication rates (18.9% vs. 21.9%, OR 0.96 [95% CI 0.61-1.53], p=0.88). There was no significant difference in GI or other complications at six-months or one-year post-treatment. Conclusions: Although PRT remains a scarcely used treatment, some prostate cancer patients traveled great distances for treatment. While PRT was associated with a reduction in six-month GU toxicity, there were no differences in toxicity at one-year. Further study on longer-term effects and other clinical and patient-reported outcomes is needed to inform the widespread application of PRT.

Frequency of post-treatment surveillance and survival in localized prostate cancer: AFT-30 a national study.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 6503-6503
Author(s):  
Ronald C. Chen ◽  
Zahed Mohammed ◽  
Jessica R. Schumacher ◽  
Amanda B. Francescatti ◽  
Amanda Cuddy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Post Treatment ◽  
Localized Prostate Cancer ◽  
National Study

Increasing utilization of multi-parametric magnetic resonance imaging in prostate cancer active surveillance.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 125-125
Author(s):  
Avinash Maganty ◽  
Michelle Yu ◽  
Liam C Macleod ◽  
Jonathan G Yabes ◽  
Mina M Fam ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Logistic Regression ◽  
Magnetic Resonance ◽  
Active Surveillance ◽  
Urban Areas ◽  
Resonance Imaging ◽  
Entire Study ◽  
Multivariable Logistic Regression ◽  
Comorbidity Burden

125 Background: Multi-parametric resonance imaging (mpMRI) has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. Therefore, we sought to characterize the use of multiparametric magnetic resonance imaging (mpMRI) in Medicare beneficiaries electing active surveillance for prostate cancer. Methods: SEER-Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008-2013 and managed with active surveillance. We classified men into two treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. Results: We identified 9,467 men on active surveillance. Of these, 8,178 (86%) did not receive mpMRI and 1,289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (p = 0.004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all p < 0.05). Conclusions: From 2008-2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.

scholarly journals EP-1700: Prognostic value of FCH PET/CT in response to radical radiotherapy for localized prostate cancer

2017 ◽  
Vol 123 ◽  
pp. S930
Author(s):  
M. Sepulcri ◽  
L. Evangelista ◽  
M. Fusella ◽  
S. Galuppo ◽  
L. Corti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Value ◽  
Localized Prostate Cancer ◽  
Radical Radiotherapy ◽  
Pet Ct

scholarly journals An Externally Validated Dynamic Nomogram for Predicting Unfavorable Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

2021 ◽  
Vol 12 ◽  
Author(s):  
Ping Hu ◽  
Yang Xu ◽  
Yangfan Liu ◽  
Yuntao Li ◽  
Liguo Ye ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prognostic Factors ◽  
Subarachnoid Hemorrhage ◽  
Validation Cohort ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
External Validation ◽  
Brier Score ◽  
Web Based ◽  
Training Cohort ◽  
Multivariable Logistic Regression

Background: Aneurysmal subarachnoid hemorrhage (aSAH) leads to severe disability and functional dependence. However, no reliable method exists to predict the clinical prognosis after aSAH. Thus, this study aimed to develop a web-based dynamic nomogram to precisely evaluate the risk of poor outcomes in patients with aSAH.Methods: Clinical patient data were retrospectively analyzed at two medical centers. One center with 126 patients was used to develop the model. Least absolute shrinkage and selection operator (LASSO) analysis was used to select the optimal variables. Multivariable logistic regression was applied to identify independent prognostic factors and construct a nomogram based on the selected variables. The C-index and Hosmer–Lemeshow p-value and Brier score was used to reflect the discrimination and calibration capacities of the model. Receiver operating characteristic curve and calibration curve (1,000 bootstrap resamples) were generated for internal validation, while another center with 84 patients was used to validate the model externally. Decision curve analysis (DCA) and clinical impact curves (CICs) were used to evaluate the clinical usefulness of the nomogram.Results: Unfavorable prognosis was observed in 46 (37%) patients in the training cohort and 24 (29%) patients in the external validation cohort. The independent prognostic factors of the nomogram, including neutrophil-to-lymphocyte ratio (NLR) (p = 0.005), World Federation of Neurosurgical Societies (WFNS) grade (p = 0.002), and delayed cerebral ischemia (DCI) (p = 0.0003), were identified using LASSO and multivariable logistic regression. A dynamic nomogram (https://hu-ping.shinyapps.io/DynNomapp/) was developed. The nomogram model demonstrated excellent discrimination, with a bias-corrected C-index of 0.85, and calibration capacities (Hosmer–Lemeshow p-value, 0.412; Brier score, 0.12) in the training cohort. Application of the model to the external validation cohort yielded a C-index of 0.84 and a Brier score of 0.13. Both DCA and CIC showed a superior overall net benefit over the entire range of threshold probabilities.Conclusion: This study identified that NLR on admission, WFNS grade, and DCI independently predicted unfavorable prognosis in patients with aSAH. These factors were used to develop a web-based dynamic nomogram application to calculate the precise probability of a poor patient outcome. This tool will benefit personalized treatment and patient management and help neurosurgeons make better clinical decisions.

scholarly journals Metastasis-Free Survival Is a Strong Surrogate of Overall Survival in Localized Prostate Cancer

2017 ◽  
Vol 35 (27) ◽  
pp. 3097-3104 ◽  
Author(s):  
Wanling Xie ◽  
Meredith M. Regan ◽  
Marc Buyse ◽  
Susan Halabi ◽  
Philip W. Kantoff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Treatment Effects ◽  
Significant Risk ◽  
Localized Prostate Cancer ◽  
Free Survival ◽  
Risk Of Death ◽  
End Point ◽  
Kendall’S Τ

Purpose Adjuvant therapy for intermediate-risk and high-risk localized prostate cancer decreases the number of deaths from this disease. Surrogates for overall survival (OS) could expedite the evaluation of new adjuvant therapies. Methods By June 2013, 102 completed or ongoing randomized trials were identified and individual patient data were collected from 28 trials with 28,905 patients. Disease-free survival (DFS) and metastasis-free survival (MFS) were determined for 21,140 patients from 24 trials and 12,712 patients from 19 trials, respectively. We evaluated the surrogacy of DFS and MFS for OS by using a two-stage meta-analytic validation model by determining the correlation of an intermediate clinical end point with OS and the correlation of treatment effects on both the intermediate clinical end point and OS. Results Trials enrolled patients from 1987 to 2011. After a median follow-up of 10 years, 45% of 21,140 men and 45% of 12,712 men experienced a DFS and MFS event, respectively. For DFS and MFS, 61% and 90% of the patients, respectively, were from radiation trials, and 63% and 66%, respectively, had high-risk disease. At the patient level, Kendall’s τ correlation with OS was 0.85 and 0.91 for DFS and MFS, respectively. At the trial level, R2 was 0.86 (95% CI, 0.78 to 0.90) and 0.83 (95% CI, 0.71 to 0.88) from weighted linear regression of 8-year OS rates versus 5-year DFS and MFS rates, respectively. Treatment effects—measured by log hazard ratios—for the surrogates and OS were well correlated ( R2, 0.73 [95% CI, 0.53 to 0.82] for DFS and 0.92 [95% CI, 0.81 to 0.95] for MFS). Conclusion MFS is a strong surrogate for OS for localized prostate cancer that is associated with a significant risk of death from prostate cancer.

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