scholarly journals Survival Outcomes in Stage IV Bladder Cancer Patients Treated with Cisplatin/Gemcitabine Versus Carboplatin/Gemcitabine: A Retrospective Analysis in Veteran Patients

2020 ◽  
pp. 1-4
Author(s):  
Anuradha Kunthur ◽  
Anuradha Kunthur ◽  
Eric Siegel ◽  
Rangaswamy Govindarajan
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Cox Regression ◽  
Performance Status ◽  
Stage Iv ◽  
Rank Test ◽  
Poor Performance Status ◽  
Health Administration ◽  
Standard Regimen ◽  
Urothelial Bladder

Purpose: Gemcitabine/cisplatin (GCi) is the standard regimen used to treat stage IV urothelial bladder cancers. However, most of the bladder cancer patients are older, with poor performance status and renal dysfunction, and are not eligible for cisplatin-containing regimens. There are no randomized studies comparing gemcitabine/carboplatin (GC) and gemcitabine/cisplatin (GCi). Methods: We identified stage IV bladder cancer patients treated within the Veterans Health Administration (VHA), healthcare system between January 2000 and December 2010 from Veterans Affairs Central Cancer Registry (VACCR). Overall survival (OS) was visualized using Kaplan-Meier curves and tested for the significance of the treatment-arm difference using the log-rank test. Results: There were 196 patients with stage IV bladder cancer, out of which 78 patients were treated with GC and 118 patients treated with GCi. The median OS for all patients was 12.5 months a 95% confidence interval (CI) of 10.0-14.6 months. The median OS for patients treated with GC was 13.4 months (95% CI 9.8-17.5 months), and that of the patients treated with GCi was 11.7 months (95% CI 9.3-14.9 months). Cox regression revealed equal group mortality rates, with GC having a (hazard ratio (HR) of 0.96 (CI 0.72-1.27; P= 0.81)) compared to GCi. Conclusion: Our study is the largest comparing GC and GCi in stage IV urothelial bladder cancer patients. It showed that there is no difference in OS in patients treated with GC and GCi.

Incidence, characteristics, and implications of thrombo-embolic events in patients with urothelial carcinoma of the bladder undergoing neoadjuvant chemotherapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 393-393 ◽  
Author(s):  
Wilhelmina CM Duivenvoorden ◽  
Siamak Daneshmand ◽  
Daniel J. Canter ◽  
Yair Lotan ◽  
Peter C. Black ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Retrospective Study ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Significant Risk ◽  
Pelvic Surgery ◽  
Rank Test ◽  
Vein Thrombosis ◽  
Urothelial Bladder Carcinoma ◽  
Urothelial Bladder

393 Background: Neoadjuvant chemotherapy (NAC), in combination with radical cystectomy (RC), is associated with a significant survival advantage for patients with muscle-invasive bladder cancer. Chemotherapy as well as pelvic surgery are significant risk factors for thrombo-embolic events (TEE). The objectives of this study were to investigate the incidence and characteristics of TEE during and after NAC and subsequent RC for urothelial bladder cancer patients. Methods: A retrospective study was carried out on 827 consecutive patients who underwent NAC and cystectomy for urothelial bladder carcinoma from 2002 to 2014 at ten different tertiary centers across North America and Europe. The median time of follow-up from bladder cancer diagnosis was 13 months (range 1-119 months). The incidence (venous, arterial, port-site or deep vein thrombosis, thrombosis, clinical or incidentally detected pulmonary embolism) and timing of TEE (before or after ( < or > 30 days) RC) and Khorana score (based on baseline hemoglobin, platelet and leukocyte counts, BMI and tumor site, which was established for cancer patients treated with chemotherapy) was determined for all patients. Multivariate analysis was performed on 827 patients. Kaplan Meier survival curves and log rank test were used to compare survival between patients who developed TEE and those who did not. Results: The Khorana criteria indicated intermediate TEE risk in most patients. Khorana risk score was 1 or 2 in 88% of patients. Nevertheless, the incidence of TEE in patients undergoing NAC was 15%. 59 TEE were detected pre-operatively (7.1%), 21 early within 30 days of RC (2.5%) and 36 late post-operatively (4.3%). 32% of the TEE events were detected incidentally by imaging, 68% were detected clinically. Median overall survival of patients who developed TEE was 28 months compared to 71 months for those who did not develop TEE (p = 0.012). Conclusions: This multi-centre retrospective study suggests that TEE are very common in bladder cancer patients undergoing NAC followed by RC and is associated with poorer survival. Further investigation with a prospective prevention trial is warranted.

Neoadjuvant FOLFIRINOX versus adjuvant gemcitabine in pancreatic cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4123-4123 ◽  
Author(s):  
Adam R Wolfe ◽  
Eric David Miller ◽  
Laith I. Abushahin ◽  
Jordan Cloyd ◽  
Adrei Manilchuck ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Cox Regression ◽  
Performance Status ◽  
Disease Free Survival ◽  
Hazard Ratio ◽  
Tumor Board ◽  
Rank Test ◽  
Borderline Resectable

4123 Background: In the metastatic or adjuvant setting for pancreatic cancer, the combination chemotherapy of fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) resulted in longer overall survival (OS) compared to gemcitabine therapy. We conducted an institutional study to compare the efficacy of neoadjuvant modified FOLFIRINOX (neo-mFOLFIRINOX) to adjuvant gemcitabine (adj-gem) for pancreatic cancer patients who completed resection. Methods: The study retrospectively enrolled patients from 2006 to 2017 from Ohio State University. While patients who received adjuvant gemcitabine were considered to be resectable upfront, patients who received neo-mFOLFIRINOX were either staged as borderline resectable (BR) or un-resectable (UR) by the institutional tumor board group. 111 patients received adj-gem (average cycles, 5.5) and 52 patients received neo-mFOLFIRINOX (average cycles, 3.5). The survival rates were determined by the Kaplan-Meier method and analyzed using Cox regression and log-rank test. Results: At a median follow up of 21.3 months, the median OS was 35.4 months in the neo-mFOLFIRINOX group and 21.8 months in the adj-gem group (hazard ratio, 0.56, 95% confidence interval (CI), 0.37-0.84 p = 0.005). The OS rate at 3 years was 46% in the neo-mFOLFIRINOX group and 22% in the adjuvant gemcitabine group (p = 0.001). The median disease free survival (DFS) was 18.6 months in the neo-mFOLFIRINOX group and 12.0 months in the adj-gem group (hazard ratio, 0.63, 95% CI, 0.43-0.93 p = 0.022). The DFS rate at 3 years was 17% in the neo-mFOLFIRINOX group and 11% in the adj-gem group (p = 0.02). On surgical pathological specimen review, the neo-mFOLFIRINOX group had statistically (p < 0.05) lower tumor grade, lower rates of perineural invasion and lymphovascular invasion, lower pathological T stage, lower pathological N stage, and lower number of nodes positive compared to the adj-gem group. Frequencies of obtaining R0 resections were higher in the neo-mFOLFIRINOX versus adj-gem groups but not statistically different (51.9% vs 40.4, p = 0.2). The average age and performance status were similar between the two groups. Conclusions: At our institution, BR and UR pancreatic cancer patients who received neo-mFOLFIRINOX and completed resection had longer OS, DFS, and more favorable pathological indicators compared to those patients who had upfront surgery and adjuvant gemcitabine. Randomized clinical trials comparing neoadjuvant versus adjuvant FOLFIRINOX are needed to validate these findings.

Cisplatin and gemcitabine versus carboplatin and gemcitabine in metastatic bladder cancer: Survival analysis of veterans' health care data.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16023-e16023
Author(s):  
Anuradha Kunthur ◽  
Eric R Siegel ◽  
Rangaswamy Govindarajan
Keyword(s):  
Bladder Cancer ◽  
Cancer Survival ◽  
Cox Regression ◽  
Stage Iv ◽  
Veterans Health ◽  
Standard Regimen ◽  
Poor Renal Function ◽  
Medical Centers ◽  
Metastatic Bladder Cancer ◽  
Kaplan Meier

e16023 Background: Background: Cisplatin and gemcitabine combination chemotherapy is the standard regimen used for the treatment of metastatic bladder cancer. Most Veterans Administration (VA) patients with metastatic bladder cancer are elderly or with poor renal function, and are considered not good candidates for cisplatin administration. It is a common practice to substitute carboplatin for cisplatin in this population. Methods: Methods: We identified stage IV bladder cancer patients treated initially with cisplatin plus gemcitabine (Ci+G) or carboplatin plus gemcitabine (Ca+G) at VA medical centers from 2000 to 2010. The data was obtained via the VA central cancer registry from all VA medical centers across the country. Overall survival (OS) was summarized as Kaplan-Meier medians and compared for difference between platinum groups via Cox regression. Results: Results: 196 subjects () with stage IV bladder cancer were identified. There were 194 males , 78 received Ca+G, 118 received Ci+G. 149 deaths occurred during 197.49 person-years of follow up, for a median OS of 10.35 months. Median OS was 11.14 months with Ca+G versus 10.35 months with Ci+G. Cox regression revealed nearly equal group mortality rates, with Ca+G having a hazard ratio (90% confidence limits) of 1.02 (0.77–1.34) compared to Ci+G ( P= 0.93). Conclusions: Conclusion: Patients treated with Ca+G and Ci+G regimens had similar median OS, supporting the substitution of carboplatin for cisplatin with gemcitabine in this patient population.

Perioperative blood transfusion and postoperative outcomes in patients undergoing radical cystectomy for bladder cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17012-e17012
Author(s):  
Leonidas Nikolaos Diamantopoulos ◽  
Rishi Robert Sekar ◽  
Ali Raza Khaki ◽  
Natalie Miller ◽  
Adam John Gadzinski ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Blood Transfusion ◽  
Radical Cystectomy ◽  
Cox Regression ◽  
Performance Status ◽  
Length Of Hospital Stay ◽  
Postoperative Outcomes ◽  
Red Blood Cell Transfusion ◽  
Rank Test ◽  
Perioperative Blood Transfusion

e17012 Background: Perioperative blood transfusion (PBT) has been associated with worse outcomes in surgical oncology across tumor types. We report our institutional experience of postoperative outcomes related to PBT utilization, in patients (pts) with bladder cancer (BC) treated with radical cystectomy (RC). We hypothesized that PBT is associated with worse clinical outcomes. Methods: Pts with BC treated with RC were retrospectively identified. Clinicopathologic and peri/post-operative data were extracted. PBT was defined as red blood cell transfusion during RC or postoperative hospitalization. Overall survival (OS, diagnosis to death) and recurrence free survival (RFS, RC to recurrence/death) were estimated with the KM method. T-test, χ2 and log-rank test were used for group comparison analysis. Univariate/multivariate logistic (LR) and Cox regression (CR) were used to identify variables associated with dependent dichotomous outcomes and OS/RFS, respectively. Results: 784 consecutive pts (78% men; median age 67) were identified. At least one post-operative complication (POC) occurred in 407 (52%) pts; most common were pyelonephritis and sepsis (11% each). PBT was administered to 238 pts (30%). Those with PBT had a higher proportion of POCs (35% vs 28%, p = .02). Median follow-up, OS and RFS were 66 (95% CI: 60 - 72), 94 (95% CI: 79 - 109) and 66 months (95% CI: 50 – 82), respectively. Pts who received PBT had shorter OS (51 vs 130 months, p < .001) and RFS (27 vs 86 months, p < .001). In multivariate LR and CR, PBT was independently associated with higher odds of POCs (OR 1.5, 95% CI: 1.03 – 2.2, p = .03), length of hospital stay (LOS) > 10 days (OR 2.0, 95% CI 1.1 – 3.5, p = .02), shorter OS (HR 1.6, 95% CI 1.2-2.0, p = .001), and RFS (HR 1.5, 95% CI 1.2 - 1.9, p = .001), after adjustment for other relevant clinicopathologic variables (age, gender, performance status, neoadjuvant chemotherapy, baseline hemoglobin, open/robotic approach, pT/N stage, surgical margins, lymphovascular invasion at RC, variant histologies). Conclusions: Pts who received PBT had higher odds of POC, longer LOS and poor outcomes after RC. This is hypothesis-generating due to inherent study limitations. Further studies are needed to validate this finding, explain underlying mechanisms and explore putative interventions to improve outcomes.

Predictive Factors for the Development of Dyspnea Within 7 Days After Admission Among Terminally Ill Cancer Patients

2021 ◽  
pp. 104990912110288
Author(s):  
Ryo Matsunuma ◽  
Takashi Yamaguchi ◽  
Masanori Mori ◽  
Tomoo Ikari ◽  
Kozue Suzuki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Predictive Factors ◽  
Performance Status ◽  
Univariate Analysis ◽  
Terminally Ill ◽  
Primary Lung Cancer ◽  
Poor Performance Status ◽  
Terminally Ill Cancer Patients ◽  
Development Group

Background: Predictive factors for the development of dyspnea have not been reported among terminally ill cancer patients. Objective: This current study aimed to identify the predictive factors attributed to the development of dyspnea within 7 days after admission among patients with cancer. Methods: This was a secondary analysis of a multicenter prospective observational study on the dying process among patients admitted in inpatient hospices/palliative care units. Patients were divided into 2 groups: those who developed dyspnea (development group) and those who did not (non-development group). To determine independent predictive factors, univariate and multivariate analyses using the logistic regression model were performed. Results: From January 2017 to December 2017, 1159 patients were included in this analysis. Univariate analysis showed that male participants, those with primary lung cancer, ascites, and Karnofsky Performance Status score (KPS) of ≤40, smokers, and benzodiazepine users were significantly higher in the development group. Multivariate analysis revealed that primary lung cancer (odds ratio [OR]: 2.80, 95% confidence interval [95% CI]: 1.47-5.31; p = 0.002), KPS score (≤40) (OR: 1.84, 95% CI: 1.02-3.31; p = 0.044), and presence of ascites (OR: 2.34, 95% CI: 1.36-4.02; p = 0.002) were independent predictive factors for the development of dyspnea. Conclusions: Lung cancer, poor performance status, and ascites may be predictive factors for the development of dyspnea among terminally ill cancer patients. However, further studies should be performed to validate these findings.

scholarly journals Myosteatosis as a novel prognostic biomarker after radical cystectomy for bladder cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shimpei Yamashita ◽  
Yuya Iwahashi ◽  
Haruka Miyai ◽  
Takashi Iguchi ◽  
Hiroyuki Koike ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Cox Regression ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Psoas Muscle ◽  
Hounsfield Units ◽  
Computed Tomography Images ◽  
Psoas Muscles

AbstractThis study aims to evaluate the influence of myosteatosis on survival of patients after radical cystectomy (RC) for bladder cancer. We retrospectively identified 230 patients who underwent RC for bladder cancer at our three institutions between 2009 and 2018. Digitized free-hand outlines of the left and right psoas muscles were made on axial non-contrast computed tomography images at level L3. To assess myosteatosis, average total psoas density (ATPD) in Hounsfield Units (HU) was also calculated as an average of bilateral psoas muscle density. We compared cancer-specific survival (CSS) between high ATPD and low ATPD groups and performed cox regression hazard analyses to identify the predictors of CSS. Median ATPD was 44 HU (quartile: 39–47 Hounsfield Units). Two-year CSS rate in overall patients was 76.6%. Patients with low ATPD (< 44 HU) had significantly lower CSS rate (P = 0.01) than patients with high ATPD (≥ 44 HU). According to multivariate analysis, significant independent predictors of poor CSS were: Eastern Cooperative Oncology Group performance status ≥ 1 (P = 0.03), decreasing ATPD (P = 0.03), non-urothelial carcinoma (P = 0.01), pT ≥ 3 (P < 0.01), and pN positive (P < 0.01). In conclusion, myosteatosis (low ATPD) could be a novel predictor of prognosis after RC for bladder cancer.

scholarly journals Development and Validation of A Seven-microRNA Signature as a Novel Prognostic Biomarker for Bladder Cancer

2020 ◽  
Author(s):  
Jin-Xing Lv ◽  
Fei Lin ◽  
Zhi-Bin Ke ◽  
Yun-Zhi Lin ◽  
Peng-Fei Zhuang ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Mirna Expression ◽  
Prognostic Model ◽  
Cox Regression ◽  
Expression Profiles ◽  
Univariate Analysis ◽  
Test Group ◽  
Differential Analysis ◽  
Mirna Signature

Abstract Background The differential expression of miRNAs has played a significant role in bladder tumors. The aim of our study was to screen new biomarkers . Methods Through differential analysis of bladder cancer mRNA and miRNA expression data in the TCGA, differential genes and miRNAs were screened. Furthermore, Cox univariate analysis and multifactor analysis were used to establish a prognostic prediction model . The predictive ability of the prognostic model was then verified on the patient. The action mechanism of these miRNAs was analyzed.Results By the differential analysis and standardization of miRNA expression profiles. Differentially expressed miRNAs were screened, then all the patients were then randomly divided into train group and the test group. 23 miRNAs were revealed , then a Seven-miRNA signature prognostic biomarkers was constituting.Univariate cox regression and multivariate cox regression considering other clinical factors displayed that the seven-miRNA signature could serve as an independent prognostic factor.Target genes of these seven miRNAs were analyzed by KEGG signaling pathway and GO enrichment analysis. . Conclusion The prognostic model constructed by seven miRNAs has possessed certain degree of sensitivity and specificity for the prediction of the survival of bladder cancer patients, which can be used as a potential new clinical marker for bladder cancer patients.

Sign in / Sign up

Export Citation Format

Share Document