Our findings support inclusion of Gleason pattern 4 quantification in pathology reports and risk prediction models for patients with GrdGrp 2/GS 3+4=7 prostate cancer. Total length of GP4 across all cores provides the strongest benefit for prediction of adverse pathology.
To evaluate trends in oncologic characteristics and outcomes, as well as perioperative management, among patients undergoing radical cystectomy at Memorial Sloan Kettering from 1995 to 2015.
Materials and Methods:We retrospectively reviewed our institutional database to analyze changes in disease recurrence probability, cancer-specific and all-cause mortality, incidence of muscle-invasive bladder cancer, use of perioperative chemotherapy, rate of positive soft-tissue surgical margins, and lymph node yield.
Results:In 2,740 patients with non-metastatic urothelial carcinoma undergoing radical cystectomy from 1995 to 2015, the 5-year probability of disease recurrence decreased from a peak of 42% in 1997 to 34% in 2013 (p=0.045), while 5-year probability of cancer-specific mortality likewise declined from 36% in 1997 to 24% in 2013 (p=0.009). Incidence of non-muscle-invasive disease before radical cystectomy did not change, comprising 30%-35% of patients across the study period. Use of neoadjuvant chemotherapy rose significantly: 57% of patients with muscleinvasive bladder cancer from 2010 to 2015 received it. We observed a corresponding rise in complete pathologic response (pT0) at radical cystectomy, as well as decreasing positive softtissue surgical margins (10% to 2.5%) and rising lymph node yield (7 to 24) from 1995 to 2015.Conclusions: Over a 21-year period, outcomes after radical cystectomy at our institution improved significantly, as probability of recurrence and cancer-specific mortality decreased. Increasing utilization of neoadjuvant chemotherapy, rising pT0 rates, decreased positive soft-tissue surgical margins, and increasing lymph node yields likely contributed, suggesting that optimized surgical and perioperative care led to improved cancer outcomes in patients undergoing radical cystectomy.
Purpose:Percutaneous ablation therapy (AT) and partial nephrectomy (PN) are successful management strategies for T1a renal cancer. Our objective was to compare AT to PN with respect to recurrence-free survival (RFS) and overall survival (OS).Materials and Methods:Patients post PN or AT for cT1aN0M0 renal cancer from 2011 – 2021 were identified from the national Canadian Kidney Cancer Information System (CKCis). Inverse probability of treatment weighting (IPTW) using propensity scores (PS) was used. The primary outcomes, RFS and OS, were compared using Kaplan-Meier log rank test analyses and Cox proportional hazard regression models.Results:275 patients underwent AT and 2,001 underwent PN, with a median follow-up of 2.0 years (IQR 0.6-4.1 years). Covariates were well balanced between the AT and PN cohorts following PS matching. Two-year RFS following IPTW PS analysis for patients undergoing AT and PN was 88.1% and 97.4% (p<0.0001) respectively, while two-year OS was 97.4% and 99.0% (p=0.7), respectively. Five-year RFS following IPTW PS analysis for patients undergoing AT and PN was 86.0% and 95.1% respectively (p=0.003), while five-year OS was 94.2% and 95.1%, respectively (p=0.9). Following IPTW PS analysis, treatment modality (PN versus AT) was a predictor for disease recurrence (HR 0.36; p=0.003) but not for overall survival (HR 0.96; p=0.9).Conclusions:With short follow-up, PN offers better RFS than AT, although no significant difference in overall survival was detected following propensity score adjustments. Both modalities can be offered to appropriately selected patients while we await a prospective randomized data.
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