Risk and prognosis of secondary bladder cancer after postoperative radiotherapy for gynecological cancer

The aim of this study was to investigate the impacts of radiation therapy (RT) on the occurrence risk of secondary bladder cancer (SBC) and on the patients’ survival outcome after being diagnosed with gynecological cancer (EC). The data was obtained from the SEER database between 1973 and 2015. Chi-squared test was used to compare the clinicopathological characteristics among the different groups. Fine and Gray’s competing risk model was used to assess the cumulative incidence and occurrence risk of SBC in GC survivors. Kaplan-Meier method was utilized for survival analysis. A total of 123,476 GC patients were included, among which 31,847 (25.8%) patients received RT while 91629 (74.2%) patients did not. The cumulative incidence of SBC was 1.59% or 0.73% among patients who had received prior GC specific RT or not, respectively. All EBRT (standardized incidence ratio (SIR) =2.49, 95% CI [2.17-2.86]), brachytherapy (SIR =1.96, 95% CI [1.60-2.38]), and combinational RT modality groups (SIR =2.73, 95% CI [2.24-3.28]) had dramatically higher SBC incidence as compared to the US general population. Receiving EBRT (HR = 2.83, 95% CI [2.34–3.43]), brachytherapy (HR = 2.17, 95% CI [1.67–2.82]), and combinational RT modality (HR = 2.97, 95% CI [2.34–3.77]) were independent risk factors for SBC development. Survival detriment was observed in SBC patients who received RT after GC diagnosis, as compared to those who did not receive RT. In conclusion, patients who underwent RT after GC had an increased risk of developing bladder as a secondary primary cancer. A long-term surveillance for SBC occurrence is necessary for GC patients who have received prior RT.

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Hemorrhagic and Cystic Brain Metastases Are Associated With an Increased Risk of Leptomeningeal Dissemination After Surgical Resection and Adjuvant Stereotactic Radiosurgery

Neurosurgery ◽

10.1093/neuros/nyy436 ◽

2018 ◽

Vol 85 (5) ◽

pp. 632-641 ◽

Cited By ~ 6

Author(s):

Robert H Press ◽

Chao Zhang ◽

Mudit Chowdhary ◽

Roshan S Prabhu ◽

Matthew J Ferris ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Cumulative Incidence ◽

Postoperative Radiotherapy ◽

Multivariable Analysis ◽

Treatment Strategies ◽

Competing Risk ◽

Leptomeningeal Dissemination ◽

Increased Risk

Abstract BACKGROUND Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.

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The increased risk for thromboembolism pre-cystectomy in patients undergoing neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer is mainly due to central venous access: a multicenter evaluation

International Urology and Nephrology ◽

10.1007/s11255-019-02338-4 ◽

2019 ◽

Vol 52 (4) ◽

pp. 661-669 ◽

Cited By ~ 1

Author(s):

Kristoffer Ottosson ◽

Sofia Pelander ◽

Markus Johansson ◽

Ylva Huge ◽

Firas Aljabery ◽

...

Keyword(s):

Bladder Cancer ◽

Neoadjuvant Chemotherapy ◽

Central Venous Access ◽

Urinary Bladder Cancer ◽

Venous Access ◽

Central Venous ◽

Chemotherapy Administration ◽

Increased Risk ◽

Chi Squared ◽

Muscle Invasive

Abstract Purpose To investigate if patients receiving neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) had an increased risk of thromboembolic events (TEE) and to evaluate when these events occur on a timeline starting from 6 months pre-cystectomy, during NAC-administration and 60 months post-cystectomy. Methods Two hundred and fifty five patients undergoing radical cystectomy during 2009–2014 at three Swedish cystectomy centers (Umeå, Linköping and Sundsvall) were in-detail reviewed retrospectively, using individual medical records. One hundred and twenty nine patients were ineligible for analysis. NAC patients (n = 67) were compared to NAC-naïve NAC-eligible patients (n = 59). The occurrence of TEE was divided into different periods pre-cystectomy and post-cystectomy. Statistical analyses included Chi-squared and logistical regression tests. Results Significant associations were found between receiving NAC and acquiring a TEE during NAC therapy pre-cystectomy. All but one pre-cystectomy event was venous and all but one of the patients received NAC. 31% (14/45) of TEEs occurred pre-cystectomy. The incidence of TEEs pre-cystectomy in NAC-naive NAC-eligible patients was only 10% (2/20), whereas the incidence of TEEs in NAC patients occurred pre-cystectomy in 48% (12/25) and 11/12 incidents were detected during NAC therapy—this including 7/11 (64%) incidents affecting veins in anatomical conjunction with the placement of central venous access for chemotherapy administration. Conclusions There is a significantly increased risk for TEE pre-cystectomy during chemotherapy administration in MIBC patients receiving NAC, compared to the risk in NAC-naïve NAC-eligible MIBC patients. In 64% of the pre-RC TEEs in NAC patients, there was a clinical connection to placement of central venous access.

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Development of a Ferroptosis-Related lncRNA Signature to Predict the Prognosis and Immune Landscape of Bladder Cancer

Disease Markers ◽

10.1155/2021/1031906 ◽

2021 ◽

Vol 2021 ◽

pp. 1-22

Author(s):

Ranran Zhou ◽

Jingjing Liang ◽

Hu Tian ◽

Qi Chen ◽

Cheng Yang ◽

...

Keyword(s):

Bladder Cancer ◽

Risk Model ◽

Assessment Model ◽

Chemotherapy Sensitivity ◽

Immune Infiltration ◽

Differential Coexpression ◽

Prognostic Assessment ◽

Kaplan Meier ◽

Cox Analysis ◽

Tight Correlation

The tight relationship between ferroptotic cell death and immune response demonstrated by recent studies enlightened us to detect the underlying roles of ferroptosis-related long noncoding RNAs (frlncRNAs) in the tumor microenvironment of bladder cancer (BCa). We collected 121 ferroptosis regulators from previous studies. Based on their expression values, 408 cases with BCa were clustered. The patients in different clusters showed diverse immune infiltration, immunotherapy response, and chemotherapy effectiveness, revalidating the tight correlation with ferroptosis and tumor immunity. Through differential, coexpression, Kaplan-Meier, Lasso, and Cox analysis, we developed a 22-lncRNA-pair signature to predict the prognosis of BCa based on gene-pair strategy, where there is no need for definite expression values. The areas under the curves are all over 0.8. The risk model also helped to predict immune infiltration, immunotherapeutic outcomes, and chemotherapy sensitivity. Totally, the prognostic assessment model indicated a promising predictive value, also providing clues for the interaction between ferroptosis and BCa immunity.

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Prognostic Significance of The Neutrophil-To-Lymphocyte Ratio in Patients With Non-Muscle Invasive Bladder Cancer Treated With Intravesical Bacillus Calmette–Guérin and The Relationship With The CUETO Scoring Model

10.21203/rs.3.rs-116331/v1 ◽

2020 ◽

Author(s):

Jin Woo Kim ◽

Jae-Wook Chung ◽

Eun Hye Lee ◽

So Young Chun ◽

Dong Jin Park ◽

...

Keyword(s):

Bladder Cancer ◽

Tumor Recurrence ◽

Risk Model ◽

Bacillus Calmette Guerin ◽

Muscle Invasive Bladder Cancer ◽

Free Survival ◽

Scoring Model ◽

Lymphocyte Ratio ◽

Kaplan Meier ◽

Muscle Invasive

Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) is a marker of the systemic inflammatory response, which is associated with tumor recurrence and progression. In this study, we evaluated the predictability of a modified Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and preoperative NLR in patients with non-muscle invasive bladder cancer (NMIBC). Methods: From August 2005 to May 2016, a total of 281 patients received intravesical bacillus Calmette–Guérin therapy after transurethral resection of a bladder tumor. The pathologic stage of all patients was Ta or T1. Multivariate Cox regression analysis and Kaplan–Meier curves were used to evaluate the prognosis predictability of the CUETO risk model and NLR. Of 281 patients, 84 (29.9%) experienced recurrence and 14 (5.0%) developed progression. The mean follow-up period was 46 months. The cut-off value for NLRs was 2.29. Results: Of the study patients, 108 (38.4%) displayed a high NLR (> 2.29). In Kaplan–Meier curve analysis, a high NLR was associated with lower recurrence-free survival (RFS) (P < 0.001) and progression-free survival (PFS) (P = 0.002). CUETO scores were associated with RFS (P < 0.001), but not with PFS (P = 0.423). A combination of NLRs and the CUETO risk model correlated with RFS (P < 0.001) and PFS (P = 0.002). In multivariate analysis, female gender, concomitant carcinoma in situ (CIS), tumor number >3, recurrent tumors, and a high NLR were independent factors predicting recurrence (all P < 0.05). Concomitant CIS, recurrent tumors, and a high NLR were independent factors for predicting progression (all P < 0.05). Conclusion: In patients with NMIBC, an NLR >2.29 was identified as a significant factor for predicting tumor recurrence and progression. Inclusion of preoperative NLR enhanced the accuracy of the CUETO model to predict disease progression. We therefore recommend that patients with a high NLR receive more aggressive management.

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Risk of secondary cancers after breast conserving therapy in Japan.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.256 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 256-256

Author(s):

Kenshiro Shiraishi ◽

Tomohiro Shinozaki

Keyword(s):

Cumulative Incidence ◽

Breast Conserving Therapy ◽

National Registry ◽

Cancer Type ◽

Secondary Malignancies ◽

Second Malignancies ◽

Secondary Cancers ◽

Kaplan Meier ◽

Increased Risk

256 Background: There is a growing body of evidence that vast majority of patients with early breast cancer who underwent breast conserving therapy (BCT) live their longer ‘cancer survivor’ lives through modern sophisticated treatment. Accordingly, second malignancies after BCT are on the rise, which are sticky dilemmas accompanied by additional anxiety and need for further medical care. Investigation of secondary malignancies should be made the first priority in Japan as the world's top country for longevity. Methods: In order to investigate the second malignancies after BCT, a cohort study was conducted based on our database from 1982 to mid-2015. Actuarial rates of second malignancies, overall (OS) and cause-specific survival (CSS), were calculated by using the Kaplan-Meier method. We calculated standardized incidence ratios (SIR) for each cancer type corresponding to the national registry. Results: 1,557 patients (49.5%) were followed-up for more than 10 years. At a median follow-up of 113 months, 180 patients had developed a second malignancy. The increases in risk were for leukemia (SIR: 3.89 (1.76–6.84)) and ovarian cancer (SIR: 3.65 (2.26–5.38)). Trends toward increased risk was seen in reno-ureteral cancer (SIR: 2.25 (0.96–4.08)) and endometrial cancer (SIR: 1.59 (0.92–2.43)) though it was not statistically significant. No increased risk was observed for other gastrointestinal and genitourinary cancer, malignant melanoma, lymphoma, thyroid or head and neck cancer. Overall 10-year cumulative incidence of OS was 93.3%, and overall 10-year cumulative incidence of CSS was 95.0%. Overall 10-year incidence of secondary cancer was 5.9%. A total number of secondary malignancies within 10 years was 157 and this number explained 84.4% of all cases observed during follow-up. Secondary cancers continued to occur afterward, and cumulative incidence at 15- and 20-years were 8.4% , and 9.6%, respectively. Conclusions: Secondary cancers after BCT continue to arise as long as patients survive. Given its nature of life-threatening to cancer survivors, attending care team must pay persistent attention to secondary malignancies especially in Japan with the longest life-span.

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Survival Impact of Postoperative Radiotherapy in Patients with Olfactory Neuroblastoma ： 513 Cases from the SEER Database

10.21203/rs.3.rs-353943/v1 ◽

2021 ◽

Author(s):

Guo-Shuai Duo ◽

Ji-Long Feng ◽

En-Yi Zhang ◽

Li-jun Wang

Keyword(s):

Risk Model ◽

Cox Regression ◽

Postoperative Radiotherapy ◽

Olfactory Neuroblastoma ◽

Seer Database ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Mortality Incidence ◽

The Impact ◽

Stage D

Abstract BackgroundTo evaluate the impact of postoperative radiotherapy (PORT) on survival in olfactory neuroblastoma (ONB) patients with different stages. MethodsPatients with ONB were selected in the Surveillance, Epidemiology, and End Results (SEER) database during 2004–2016. Survival analyses were performed using Kaplan Meier (K-M) method, Cox regression analysis, and competing risk model. ResultsA total of 513 patients were included in the study. Univariate and multivariate analysis results demonstrated that PORT was not an independent prognostic factor for overall survival (OS) of patients with modified Kadish stage A and B (p=0.699 and p=0.248, respectively). For C and D cases, patients who underwent PORT had significantly better OS than those who did not undergo PORT (p=0.03 and p< 0.0001, respectively). K-M curves illustrated that the 5- and 10-year OS rates according to radiotherapy (PORT vs. non-PORT) were 70.4% vs. 85.3% and 56.8% vs. 68.2% in stage C, respectively. For stage D patients, the 5-year OS rates were 42.6% and 70.7%, and 10-year OS rates were 29.5% and 53.4% in the PORT and non-PORT groups, respectively. The competitive risk model revealed that the 5-year cancer-specific cumulative mortality incidence decreased by 26.6% and the 10-year mortality incidence by 41.4% in patients with stage C who were treated using PORT; meanwhile, for patients with stage D who were treated with PORT, the 5- and 10-year mortality incidence reduced by 35.3% and 42.6%, respectively. Chemotherapy was not related to the prognosis of ONB (all p> 0.05).ConclusionsOur results indicate that PORT improved survival outcomes in ONB patients with modified Kadish stage C and D. However, for modified Kadish stage A and B cases, PORT may not affect survival. Chemotherapy was not recommended for ONB patients until more studies determine the role of chemotherapy.

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Squamous Differentiation in pT1 Low-Grade Bladder Urothelial Carcinoma is Associated with High Risk of Recurrence

10.21203/rs.3.rs-378427/v1 ◽

2021 ◽

Author(s):

Wanqing Wei ◽

Jianwei Zhang ◽

Keruo Wang ◽

Shunlin Xia ◽

Zhiqun Shang ◽

...

Keyword(s):

Bladder Cancer ◽

Independent Predictor ◽

Hazard Analysis ◽

Postoperative Recurrence ◽

Clinicopathological Characteristics ◽

Low Grade ◽

Squamous Differentiation ◽

Kaplan Meier ◽

Bladder Urothelial Carcinoma ◽

Multiple Recurrences

Abstract Background A large number of studies have confirmed that squamous differentiation is closely related to the prognosis of bladder cancer, and studies also showed that it is an independent predictor for the prognosis of such disease. However, the role of squamous differentiation in pT1 low-grade bladder cancer (LGBC) has not been reported yet. This study mainly intends to explore the clinical significance of squamous differentiation in pT1 LGBC.Methods The clinicopathological data of 582 patients with pT1 LGBC from April 2007 to December 2018 were retrospectively analyzed, including 51 cases pathologically diagnosed as pT1 LGBC with squamous differentiation, and 531 cases as pT1 LGBC without squamous differentiation. The clinicopathological characteristics and prognosis of patients in the two groups were compared.Results 51 cases (8.7%) were pathologically diagnosed as pT1 LGBC with squamous differentiation. As compared with non-squamous differentiation, squamous differentiation was closely related to the age of patients (P=0.009) and postoperative recurrence (P<0.001). Further studies on the pT1 LGBC recurrence group showed that the patients in the squamous differentiation group were more prone to multiple recurrences (P=0.033) and invasive recurrence (P<0.001) after surgery. The Kaplan-Meier analysis indicated that pT1 LGBC patients with squamous differentiation had shorter recurrence-free survival (RFS) time. The Cox proportional hazard analysis confirmed that squamous differentiation was an independent predictor of RFS time in patients with pT1 LGBC.Conclusions Squamous differentiation is closely related to postoperative recurrence of pT1 LGBC, especially multiple recurrences and invasive recurrence after surgery. Squamous differentiation is an independent predictor of the RFS time in patients with pT1 LGBC.

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Rac3 Expression and its Clinicopathological Significance in Patients With Bladder Cancer

Pathology & Oncology Research ◽

10.3389/pore.2021.598460 ◽

2021 ◽

Vol 27 ◽

Author(s):

Mei Chen ◽

Zhenyu Nie ◽

Hui Cao ◽

Yuanhui Gao ◽

Xiaohong Wen ◽

...

Keyword(s):

Bladder Cancer ◽

Western Blot ◽

Enrichment Analysis ◽

Clinicopathological Characteristics ◽

Gene Set Enrichment Analysis ◽

The Cancer Genome Atlas ◽

Qrt Pcr ◽

P53 Signaling ◽

Kaplan Meier ◽

Normal Bladder

Background: Ras-related C3 botulinum toxin substrate 3 (Rac3) is overexpressed in malignancies and promotes tumor progression. However, the correlations between Rac3 expression and the clinicopathological characteristics and prognoses of patients with bladder cancer (BC) remain unclear.Methods: Data from The Cancer Genome Atlas (TCGA) were used to analyze Rac3 expression in BC and normal bladder tissues and validated using the Oncomine database, quantitative real-time PCR (qRT-PCR) and western blot. The Kaplan-Meier method was used to analyze the relationship between Rac3 expression and the prognosis of patients with BC. Cox univariate and multivariate analyses of BC patients overall survival (OS) were performed. Signaling pathways that potentially mediate Rac3 activity in BC were then analyzed by gene set enrichment analysis (GSEA).Results: The Rac3 expression in BC tissues was significantly higher than that in normal bladder tissues. Rac3 expression was significantly correlated with grade and stage. Overexpression of Rac3 was associated with a poor prognosis. GSEA showed that the cell cycle, DNA replication, p53 signaling pathway and mismatch repair were differentially enriched in the high Rac3 expression phenotype. The qRT-PCR and western blot results confirmed that the Rac3 expression in BC tissues was higher than that in normal bladder tissues.Conclusion: Rac3 is highly expressed in BC, which is related to the advanced clinicopathological variables and adverse prognosis of patients with BC. These results provide a new therapeutic target for BC.

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The Relationship Between COVID-19-induced Death and Chronic Diseases

Journal of Client-centered Nursing Care ◽

10.32598/jccnc.7.3.334.3 ◽

2021 ◽

Vol 7 (3) ◽

pp. 167-174

Author(s):

Hasan Alinejad ◽

◽

Reza Vazirinejad ◽

Ahmadreza Sayadi ◽

Zeinab Hajaliakbari ◽

...

Keyword(s):

Chronic Diseases ◽

Multivariate Regression Analysis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Exact Test ◽

Risk Of Death ◽

Kaplan Meier ◽

Increased Risk ◽

Chi Squared ◽

The Relationship

Background: Morbidity and mortality due to Coronavirus Disease 2019 (COVID-19) are mainly related to age and comorbidity diseases (hypertension, diabetes, cardiovascular disease, malignancies, etc.). These conditions are associated with poorer clinical outcomes and sometimes lead to long-term hospitalization. The current study aimed to investigate the relationship between COVID-19-induced mortality and various chronic diseases in patients admitted to Ali Ibn Abitaleb Hospital in Rafsanjan City, Iran, in 2020. Methods: In this retrospective, descriptive, and cross-sectional study, patients with COVID-19 referring to Ali Ibn Abitaleb Hospital in Rafsanjan City, Iran, from March 2020 to September 2020 were assessed. The required data were collected using patients’ records and telephone calls by a researcher-made checklist and analyzed by Independent Samples t-test, Chi-squared test, Fisher’s Exact test, Kaplan-Meier plots, and multivariate regression analysis in SPSS v. 20. Results: This study assessed 238 hospitalized patients with COVID-19. The risk of death was significantly higher in patients aged over 75 years; they were 5.5 times more prone to expire, compared to the youngest age group (P<0.001). Chronic diseases, such as hypertension, heart disease, lung disease, and various cancers were more prevalent in patients who expired, compared to those who survived (P≤0.05). Of the patients who died, 73.8% were transferred to the Intensive U (ICU), while only 7.5% of surviving patients were transferred to the ICU (P<0.001). Longer hospitalization was associated with an increased risk of death among patients with underlying diseases and hypertension (P<0.05). Conclusion: This study identified the role of chronic diseases and other important indicators in the survival of patients with COVID-19 who were admitted to a hospital in Rafsanjan. It is recommended that nurses and healthcare staff consider these findings in the care of patients with COVID-19.

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Risk of Colorectal Cancer in Patients With Attention-Deficit Hyperactivity Disorder: A Nationwide, Population-Based Cohort Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.537137 ◽

2021 ◽

Vol 12 ◽

Author(s):

Je-Ming Hu ◽

Chia-Cheng Lee ◽

Tzu-Chiao Lin ◽

Chi-Hsiang Chung ◽

Chao-Yang Chen ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Health Insurance ◽

Attention Deficit ◽

Cumulative Incidence ◽

Rank Test ◽

Adhd Group ◽

Research Database ◽

Kaplan Meier ◽

Increased Risk

Background: The association between attention-deficit hypersensitivity disorder (ADHD) and the risk of developing colorectal cancer (CRC) is, as yet, to be investigated, and thus, we have conducted this nationwide, cohort study to examine the association in patients from Taiwan.Methods: In this study, 798 individuals with newly diagnosed ADHD and 2,394 (1:3) age-, gender-, and index year- matched controls without ADHD were enrolled, between 2000 and 2013, from the Longitudinal Health Insurance Database, a subset of the National Health Insurance Research Database in Taiwan. The cumulative incidence of CRC was assessed in each cohort by the Kaplan–Meier method. The multivariate Cox proportional hazards model was used to estimate the crude, and the adjusted hazards ratios (HRs) with 95% confidence intervals (CIs), was conducted to estimate the association between ADHD and CRC.Results: The Kaplan–Meier analysis revealed that the cumulative incidence of CRC was significantly higher in patients with ADHD than in those without it (log rank test, p < 0.001). After adjustments for age, gender, comorbidities, and other covariates, the ADHD group was associated with an increased risk of CRC in comparison to the non-ADHD group (adjusted HR = 3.458, 95% CI = 1.640–7.293, p < 0.001). In addition, the usage of methylphenidate was not associated with the risk of developing CRC in patients with ADHD.Conclusion: This retrospective cohort study depicts the evidence that ADHD was associated with the increased risk of CRC. Further studies are needed to confirm the association and the underlying mechanisms.

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