VTE is an independent adverse prognostic factor in disseminated germ cell cancers, in particular for the intermediate prognostic group of the International Germ Cell Cancer Collaborative Group classification. The presence of VTE at diagnosis has also prognostic significance and should be further explored in future prognostic classifications.

Neuroendocrine differentiation of prostate cancer (NEDPC) includes de novo presentation and secondary to epigenetic changes, referred as therapy-induced neuroendocrine prostate cancer (t-NEPC). Molecular imaging with prostate-specific membrane antigen (PSMA) and somatostatin analogues positron emission tomography (PET/CT) in NEDPC have not been validated. 18F-FDG (fluorodeoxyglucose) PET/CT has numerous limitations in prostate cancer (PCa) and the utility in NEDPC has only been reported in a few series of cases. The objective of this study is to compare the lesions detection rate of the three radiotracers in metastatic t-NEPC patients. (1) Material and Methods: Retrospective evaluation of patients with prostate adenocarcinoma treated with androgen deprivation therapy, chemotherapy, a novel androgen receptor pathway inhibitor or a combination of them and a second tumour biopsy confirming t-NEPC was made. All patients underwent 18F PSMA-1007, 18F AlF-NOTA-Octreotide, and 18F-FDG PET/CT. Evaluation of positive lesions was determined and SUVmax of each radiotracer was estimated and correlated with computer tomography (CT) findings. (2) Results: A total of eight patients were included. The mean time from diagnosis of prostate adenocarcinoma to t-NEPC was 28.2 months, with a mean serum specific prostate antigen (PSA) of 16.6 ng/dl at the time of NEPC diagnosis. All patients were treated with antiandrogen therapy and 87.5% with chemotherapy. A total of 273 lesions were identified by CT from which 182 were detected by 18F-FDG PET/CT, 174 lesions by 18F PSMA-1007, and 59 by 18F AlF-NOTA-Octreotide. An interpatient analysis of the lesions was performed and dual tracer 18F-FDG PET/CT and 18F PSMA-1007 PET/CT detected a total of 270/273 lesions (98.9%). (3) Conclusions: NEDPC patients demonstrated wide inter and intrapatient molecular imaging heterogeneity within the three radiotracers. 18F-FDG detected most lesions in t-NEPC among all radiotracers, especially in visceral sites; 18F PSMA-1007 detected more bone lesions. 18F AlF-NOTA-Octreotide showed no significant utility.

with the registry data. The present study was undertaken to confirm the national database findings and better understand patients' decision process. Materials/Methods: Adult patients with stage II-IVa laryngeal squamous cell carcinoma diagnosed from 2006-2014 were identified from an institutional cancer database. Demographic and oncologic data were obtained from the database, then confirmed and augmented via comprehensive chart review. Patients who did not undergo curative treatment were excluded. Patients refusing laryngectomy in favor of chemoradiation were compared to those receiving surgery using paired t-tests and chi-squared tests for continuous and categorical variables, respectively. Patients refusing laryngectomy were then matched to those undergoing laryngectomy using propensity scoring with a 1:3 case:control ratio. Kaplan-Meier curves were developed for overall survival and compared by log-rank testing. Results: The study cohort consisted of 141 patients with median of 67 months follow-up. Six patients were identified as refusing surgery from registry data and an additional 3 from chart reviews, representing 12.6% refusal among 70 patients recommended surgery. Compared to patients undergoing laryngectomy, the 9 refusing patients were more often black (66.7% vs 18.0%, PZ.006), female (55.6% vs 26.2%, PZ.161) and current alcohol users (88.9% vs 44.3%, PZ.086). Age, subsite, and comorbidities were similar between groups. Overall survival curves were similar between patients refusing laryngectomy and matched controls (median 69 vs 51 months, PZ.470). Reasons for refusing laryngectomy included fear of surgery, uncertainty of recovery, and a stated desire to avoid a permanent stoma. Conclusion: Many patients who may benefit from laryngectomy are apprehensive about surgery, and a subset will refuse this treatment despite the recommendation of their treatment teams. After controlling for potential confounding factors, including those not available in prior registryderived studies, no survival difference was found associated with refusal.

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