Impact of Salvage Cytotoxic Chemotherapy on Prognosis in Patients with Recurrence After Radical Cystectomy: A Multi-Institutional Retrospective Study

Abstract Background In patients experiencing disease recurrence after radical cystectomy (RC) for bladder cancer, data about the impact of clinicopathologic factors, including salvage treatment using cytotoxic chemotherapy, on the survival are scarce. We investigated the prognostic value of clinicopathologic factors and the treatment effect of salvage cytotoxic chemotherapy (SC) in such patients. Methods In this retrospective study, we evaluated the clinical data for 86 patients who experienced recurrence after RC. Administration of SC or of best supportive care (BSC) was determined in consultation with the urologist in charge and in accordance with each patient’s performance status, wishes for treatment, and renal function. Statistical analyses explored for prognostic factors and evaluated the treatment effect of SC compared with BSC in terms of cancer-specific survival (CSS). Results Multivariate analyses showed that liver metastasis after RC (hazard ratio [HR]: 2.13; 95% confidence interval [CI]: 1.17 to 3.85; P = 0.01) and locally advanced disease at RC (HR: 1.92; 95% CI: 1.06 to 3.46; P = 0.03) are independent risk factors for worse CSS in patients experiencing recurrence after RC. In a risk stratification model, patients were assigned to one of two groups based on liver metastasis and locally advanced stage. In the high-risk group, which included 68 patients with 1–2 risk factors, CSS was significantly better for patients receiving SC than for those receiving BSC (median survival duration: 9.4 months vs. 2.4 months, P = 0.005). The therapeutic effect of SC was not related to a history of adjuvant chemotherapy. Conclusions The present study indicated the potential value of 1st-line SC in patients experiencing recurrence after RC even with advanced features, such as liver metastasis after RC and locally advanced disease at RC.

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Combination of AST to ALT and neutrophils to lymphocytes ratios as predictors of locally advanced disease in patients with bladder cancer subjected to radical cystectomy: Results from a single-institutional series

Urologia Journal ◽

10.1177/03915603211035191 ◽

2021 ◽

pp. 039156032110351

Author(s):

Alessandro Uleri ◽

Rodolfo Hurle ◽

Roberto Contieri ◽

Pietro Diana ◽

Nicolòmaria Buffi ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Advanced Disease ◽

Independent Predictor ◽

Small Sample Size ◽

Statistical Significance ◽

Locally Advanced ◽

Small Sample ◽

Locally Advanced Disease ◽

Increased Risk

Background: Bladder cancer (BC) staging is challenging. There is an important need for available and affordable predictors to assess, in combination with imaging, the presence of locally-advanced disease. Objective: To determine the role of the De Ritis ratio (DRR) and neutrophils to lymphocytes ratio (NLR) in the prediction of locally-advanced disease defined as the presence of extravescical extension (pT ⩾ 3) and/or lymph node metastases (LNM) in patients with BC treated with radical cystectomy (RC). Methods: We retrospectively analyzed clinical and pathological data of 139 consecutive patients who underwent RC at our institution. Logistic regression models (LRMs) were fitted to test the above-mentioned outcomes. Results: A total of 139 consecutive patients underwent RC at our institution. Eighty-six (61.9%) patients had a locally-advanced disease. NLR (2.53 and 3.07; p = 0.005) and DRR (1 and 1.17; p = 0.01) were significantly higher in patients with locally-advanced disease as compared to organ-confined disease. In multivariable LRMs, an increasing DRR was an independent predictor of locally-advanced disease (OR = 3.91; 95% CI: 1.282–11.916; p = 0.017). Similarly, an increasing NLR was independently related to presence of locally-advanced disease (OR = 1.28; 95% CI: 1.027–1.591; p = 0.028). In univariate LRMs, patients with DRR > 1.21 had a higher risk of locally advanced disease (OR = 2.83; 95% CI: 1.312–6.128; p = 0.008). Similarly, in patients with NLR > 3.47 there was an increased risk of locally advanced disease (OR = 3.02; 95% CI: 1.374–6.651; p = 0.006). In multivariable LRMs, a DRR > 1.21 was an independent predictor of locally advanced disease (OR = 2.66; 95% CI: 1.12–6.35; p = 0.027). Similarly, an NLR > 3.47 was independently related to presence of locally advanced disease (OR = 2.24; 95% CI: 0.95–5.25; p = 0.065). No other covariates such as gender, BMI, neoadjuvant chemotherapy or diabetes reached statistical significance. The AUC of the multivariate LRM to assess the risk of locally advanced disease was 0.707 (95% CI: 0.623–0.795). Limitations include the retrospective nature of the study and the relatively small sample size.

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Risk Factors and Diagnosis of Advanced Cutaneous Squamous Cell Carcinoma

Dermatology Practical & Conceptual ◽

10.5826/dpc.11s2a166s ◽

2021 ◽

Vol 11 (S2) ◽

pp. e2021166S

Author(s):

Gabriella Brancaccio ◽

Maria Concetta Fargnoli ◽

Giulia Briatico ◽

Cristina Pellegrini ◽

Tea Rocco ◽

...

Keyword(s):

Risk Factors ◽

Squamous Cell Carcinoma ◽

Prognostic Factors ◽

Cell Carcinoma ◽

Squamous Cell ◽

Advanced Disease ◽

Locally Advanced ◽

Cutaneous Squamous Cell Carcinoma ◽

Tumor Diameter ◽

Locally Advanced Disease

Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer affecting humans. The combination of the increasing incidence and high mortality in advanced stages of the disease, defines cSCC as an emerging public health problem. Advanced disease includes metastatic and locally advanced cSCC. Metastatic disease refers to the presence of locoregional metastasis (in transit or to regional lymph nodes) or distant metastasis. Locally advanced disease has been defined as non-metastatic cSCC that is unlikely to be cured with surgery, radiotherapy, or combination treatment. While metastatic cSCC is easily diagnosed, locally advanced disease lacks consensus definition and diagnosis is made after multidisciplinary board consultation. Identifying patients with aggressive cSCC at highest risk for relapse may prevent the occurrence of advanced disease. Prognostic factors suggested by most guidelines include tumor diameter (>2 cm), localization on temple/ear/lip/area, thickness (>6 mm), or invasion beyond subcutaneous fat, poor grade of differentiation, desmoplasia, perineural invasion, bone erosion, immunosuppression, undefined borders, recurrence, growth rate, site of prior radiotherapy, and lymphatic or vascular involvement. Although risk factors associated with worse outcomes are well known, there is still a gap of knowledge on the precise risk of each factor taken individually. The aim of this review is to summarize cSCC prognostic factors and encompass the various staging systems to guide management and follow-up in cSCC patients at higher risk for local recurrence and metastasis. Finally, we describe the hallmarks of the advanced disease. Advanced cSCC diagnosis should be made by a multidisciplinary board considering patients’ performance status and disease characteristics

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Neutrophil-to-lymphocyte ratio as biomarker for predicting locally advanced disease and survival in patients treated with radical cystectomy

European Urology Open Science ◽

10.1016/s2666-1683(20)36264-9 ◽

2020 ◽

Vol 21 ◽

pp. S230

Author(s):

A.M. Pinheiro ◽

S. Duarte ◽

A. Barcelos ◽

S. Ramos ◽

A. Furtado ◽

...

Keyword(s):

Radical Cystectomy ◽

Advanced Disease ◽

Locally Advanced ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Locally Advanced Disease

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Locally advanced disease: Treatment choice based on risk factors in head and neck cancer

Annals of Oncology ◽

10.1093/annonc/mds452 ◽

2012 ◽

Vol 23 ◽

pp. x171

Keyword(s):

Risk Factors ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Advanced Disease ◽

Locally Advanced ◽

Treatment Choice ◽

Disease Treatment ◽

Locally Advanced Disease

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Can 3T multiparametric magnetic resonance imaging accurately detect prostate cancer extracapsular extension?

Canadian Urological Association Journal ◽

10.5489/cuaj.245 ◽

2013 ◽

Vol 7 (11-12) ◽

pp. 699 ◽

Cited By ~ 25

Author(s):

Yannick Cerantola ◽

Massimo Valerio ◽

Aida Kawkabani Marchini ◽

Jean-Yves Meuwly ◽

Patrice Jichlinski

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Advanced Disease ◽

Locally Advanced ◽

Resonance Imaging ◽

Extracapsular Extension ◽

Predictive Values ◽

Locally Advanced Disease ◽

Multiparametric Magnetic Resonance Imaging

Background: Accurate staging is essential to determine the correct management of patients diagnosed with prostate cancer. We assess the accuracy of 3T multiparametric magnetic resonance imaging (MRI) with endorectal coil (3TemMRI) in detecting prostate cancer local extension.Methods: We retrospectively reviewed charts from January 2008 to July 2012 from all patients undergoing radical prostatectomy. Patients were only included if 3TemMRI and radical prostatectomywere performed at our institution. Based on the presence of extracapsular extension (ECE) at 3TemMRI, prostate cancer was dichotomized into locally advanced or organ-confined disease. The accuracy of 3TemMRI local staging was then evaluated using definitive pathology as a reference.Results: Overall, 177 radical prostatectomies were performed within the timeframe. After applying exclusion criteria, 60 patients were included in the final analysis. The mean patient age was 67 ± 7 (standard deviation) years. Mean prostate-specific antigen value was 12.7 ± 12.7 ng/L. Based on preoperative characteristics, we considered 38 of the 60 patients (63%) patients high risk. 3TemMRI identified an organ-confined tumour in 46 patients and locally advanced disease in 14 patients. When correlated to final pathology, 3TemMRI specificity, sensitivity, negative and positive predictive values, and accuracy in detecting locally advanced prostate cancer were 90%, 35%, 57%, 79% and 62%, respectively.Interpretation: This study shows that the use of preoperative 3TemMRI can be used to identify organ-confined prostate cancer when locally advanced disease is suspected.

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Effect of Positive Hepatitis B Surface Antigen on The Risk of Synchronous Liver Metastasis: A Retrospective Study of 868 Consecutive Patients of Newly Diagnosed Gastric Cancer

10.21203/rs.3.rs-113459/v1 ◽

2020 ◽

Author(s):

Tingya Wang ◽

Haijun Zhang

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Logistic Regression ◽

Regression Analysis ◽

Retrospective Study ◽

Liver Metastasis ◽

Hepatitis B ◽

Surface Antigen ◽

Hepatitis B Surface Antigen ◽

Newly Diagnosed

Abstract Background. The study aimed to explore the influence of hepatitis B virus (HBV) infection on the risk of synchronous gastric cancer liver metastasis (synGCLM).Methods. This was a retrospective study which enrolled 868 patients with newly diagnosed gastric cancer (GC). The study compared the prevalence of synGCLM between hepatitis B surface antigen (HBsAg)-positive (HBsAg+) and -negative (HBsAg-) patients. Logistic regression analysis was utilized to analyze the risk factors for synGCLM. Among patients with and without synGCLM, aspartate aminotransferase to platelet ratio index (APRI), liver fibrosis-4 index (FIB-4) and hepatitis B e antigen (HBeAg) status were further analyzed. Results. The prevalence of synGCLM in the HBsAg+ patients was higher than that in the HBsAg- patients, which was statistically significant (P = 0.025). Multivariate logistic regression analysis demonstrated that HBsAg, the elevated level of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), γ-glutamyltransferase (GGT) and alkaline phosphatase (ALP) were risk factors for synGCLM. Among the HBsAg+ patients, both ARPI and FIB-4 were significantly higher in the patients with synGCLM (synGCLM+) than those without synGCLM (synGCLM-) (ARPI: P = 0.045; FIB-4: P = 0.047); HBeAg positivity was detected in 20.0% of synGCLM+ patients compared to 6.0% of synGCLM- patients, but the difference was of no significance (P = 0.190). Conclusions. HBV infection significantly increases the risk of synGCLM, and elevated ARPI and FIB-4 may be pro-metastatic especially among the HBsAg+ GC patients.

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