Urachal cancer is a rare genitourinary malignant neoplasm that arises from the remnant of the embryological structure between the bladder and allantois. 1 It has been considered an extremely aggressive neoplasm, with a median overall survival (OS) ranging between 12 and 24 months among patients with locally advanced and metastatic disease. 2 Surgery is the preferred treatment for localized and regional disease, and chemotherapy and/or immunotherapy are recommended for metastatic disease. 3 We assessed the sociodemographic characteristics of patients with urachal cancer, treatments, and the association of patient characteristics with survival.Discussion | Despite being traditionally described as an aggressive neoplasm, most patients with urachal cancer did not present with metastatic disease at the time of diagnosis, and the median OS was 76 months. A study limitation is the retrospective nature of this epidemiological study.
22 Background: Androgen deprivation therapy (ADT) is considered standard of care in the treatment of metastatic prostate cancer (mPC). Over the past ten years, the approval of novel androgen receptor-axis-targeted therapies has changed the treatment landscape of mPC. All these novel therapies have only been approved for use in addition to ADT. Despite these new therapeutic advances, it remains unclear how often men with mPC receive standard of care treatment with ADT. Methods: Male adults aged 20 years and older with newly diagnosed metastatic (stage IV) prostate cancer between 2009 and 2018 were identified through the California Cancer Registry (n = 15,435). Patient characteristics including age, year of diagnosis, race/ethnicity, insurance status, socioeconomic status (SES), Charlson co-morbidity score, and death within 3 months of diagnosis were analyzed. Results: 23.1% (n = 3,568) of men with newly diagnosed mPC did not receive ADT. The highest rate of receiving ADT was in men between ages 75-84 (79.6%), and the lowest rate was in men aged over 85 (72.0%) as shown in the table. There was a trend toward more newly diagnosed men receiving ADT in 2018 (81.3%) compared to 2009 (68.8%). Asian men (n = 1077) had a larger proportion of receiving ADT (79.7%), followed by American Indian men (n = 152; 76.4%), Hispanic men (n = 2,368; 75.1%), non-Hispanic White (n = 6,790; 75.6%), and lastly non-Hispanic Black men (n = 1,312; 74.8%). Men from the highest SES had the highest rate of receiving ADT (77.3%), and lowest rate was in lowest SES (73.5%). There was no significant difference among men not receiving hormonal therapy based off Charlson comorbidity score: 0 (26.0%), 1-2 (25.3%), and 3+ (24.9%). Conclusions: Despite significant advancements in the treatment of mPC in recent years, nearly a quarter of patients in California did not receive ADT, which is the backbone for all new systemic therapies. Further statistical analysis of this data set is currently ongoing. This data set might be able to help addressing some of the prostate cancer care disparities in California. [Table: see text]
e16530 Background: The treatment of metastatic renal cell cancer (RCC) has changed since the approval of the first tyrosine kinase inhibitor (TKI) in 2005. Since then, combination therapy with immunotherapy and TKI is considered standard-of-care. Despite multiple drug approvals, it remains unclear whether patients should be initiated on treatment immediately (within 30 days) as opposed to delay treatment (after 30 days), and if time to initiating treatment correlates with survival. Methods: Adults aged 20 years and older with newly diagnosed metastatic RCC between 2010 and 2019 were identified through the California Cancer Registry (n = 5,193). Time to treatment was calculated as duration between date of diagnosis and date of treatment initiation, then categorized into: No treatment, treatment within 30 days, between 31-60 days, and > 60 days. Association between treatment timing and overall and cancer-specific survival were assessed using Cox proportional hazard model and Fine and Gray sub-distribution hazard model accounting for competing risk. Both models included patient and baseline clinical characteristics. Results: 47.6% (n = 2,470) of patients received treatment with 30 days of diagnosis, while 24.3% received treatment between days 31-60 from diagnosis and 14.1% started treatment at 61 days or after from the time of diagnosis. After adjusting for all covariates, patients who received treatment at 61 days or later were less likely to experience mortality from cancer (HR 0.76, 95% 0.69-0.84, p < 0.0001) compared to those who started treatment within 30 days. Patients who started treatment between days 31-60 from diagnosis were also less likely to experience mortality from cancer (HR 0.82, 95% CI 0.76-0.89, p < 0.001). There were no statistically significant associations between cancer-specific survival and variables such as sex, race/ethnicity, or neighborhood SES. Conclusions: Patients who started treatment within 30 days of diagnosis of metastatic kidney cancer experienced worse cancer-specific survival compared to those who started treatment between days 30-60 or after day 61 from time of diagnosis. The differences in survival may be a reflection of tumor biology and high- versus low-risk disease groups. Further research is warranted to identify which patients benefit from early versus delayed treatment initiation. [Table: see text]
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