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  • 1
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    Online Resource
    Renal mass biopsy: A strategy to reduce associated costs and morbidity when managing localized renal masses
    Elsevier BV ; 2021
    In:  Urologic Oncology: Seminars and Original Investigations Vol. 39, No. 11 ( 2021-11), p. 790.e9-790.e15
    Details
    In: Urologic Oncology: Seminars and Original Investigations, Elsevier BV, Vol. 39, No. 11 ( 2021-11), p. 790.e9-790.e15
    Type of Medium: Online Resource
    ISSN: 1078-1439
    URL: Article
    DOI: 10.1016/j.urolonc.2021.06.015
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2011021-2
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  • 2
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    Temporal trends and factors associated with receipt of systemic therapy among patients undergoing cytoreductive nephrectomy.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 4_suppl ( 2014-02-01), p. 503-503
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 4_suppl ( 2014-02-01), p. 503-503
    Abstract: 503 Background: We evaluated temporal patterns in the utilization of systemic therapy among patients undergoing cytoreductive nephrectomy (CN) for metastatic Renal Cell Carcinoma (mRCC) from a large national cancer registry and assessed patient characteristics associated with receipt of systemic treatment. Methods: We reviewed the National Cancer Database to identify patients with stage IV RCC who underwent CN between 1998-2010. Systemic therapy was defined as any treatment with immunotherapy and/or chemotherapy (including targeted agents). We evaluated the association between clinicopathologic features and receipt of systemic therapy using multivariable logistic regression with generalized estimating equations, and assessed the interaction of treatment with time, stratified as immunotherapy (1998-2004) versus targeted-therapy (2005-2010) eras. Results: Of 22,409 patients with mRCC undergoing CN, 8,830 (39%) received systemic therapy. Receipt of systemic therapy increased from 32% in 1998 to 49% in 2010 (p 〈 0.001), largely due to increased utilization of chemotherapy (13.9% vs. 46.7%; p 〈 0.001). Following adjustment, increasing patient age (51-60 years: OR 0.82 [CI 0.73-0.92]; 61-70 years: OR 0.67 [CI 0.59-0.76] ; ≥71 years: OR 0.36 [CI 0.31-0.43]), as well as coverage with Medicaid (OR 0.61 [CI 0.5-0.74] ), Medicare (OR 0.70 [CI 0.62-0.79]), or no insurance (OR 0.75 [CI 0.63-0.91] ) were associated with decreased utilization of systemic therapy. Although use of systemic therapy in the elderly (≥71 years) and in patients with Medicare/Medicaid remained lower throughout the study period, each of these cohorts was significantly more likely to receive systemic treatment in the targeted versus immunotherapy era (all p values 〈 0.05). Conclusions: Utilization of systemic therapy among patients undergoing CN has increased over time, coinciding with the introduction of targeted therapies. Nevertheless, still less than half of such patients receive systemic treatment. While the etiology for lack of treatment is likely multifactorial, the potential health policy implications of continued disparities in care warrant further investigation.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.4_suppl.503
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
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  • 3
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    Clinical Performance of Technetium-99m–Sestamibi SPECT/CT Imaging in Differentiating Oncocytic Tumors From Renal Cell Carcinoma in Routine Clinical Practice
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Urology Vol. 210, No. 3 ( 2023-09), p. 438-445
    Details
    In: Journal of Urology, Ovid Technologies (Wolters Kluwer Health), Vol. 210, No. 3 ( 2023-09), p. 438-445
    Type of Medium: Online Resource
    ISSN: 0022-5347 , 1527-3792
    URL: Article
    DOI: 10.1097/JU.0000000000003557
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 4
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    Contemporary utilization trends and survival outcomes in patients undergoing radical cystectomy and bladder preservation therapy for muscle invasive bladder cancer.
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Clinical Oncology Vol. 34, No. 2_suppl ( 2016-01-10), p. 387-387
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 2_suppl ( 2016-01-10), p. 387-387
    Abstract: 387 Background: To compare overall survival (OS) in patients undergoing radical cystectomy (RC) and bladder preservation therapy (BPT) for muscle invasive urothelial carcinoma of the bladder. Methods: We conducted a retrospective, observational cohort study in which we reviewed the National Cancer Database (NCDB) to identify patients with analytic stage II-III (N0M0) urothelial carcinoma of the bladder from 2003-2011. BPT patients were stratified as any external beam radiotherapy (EBRT), definitive radiotherapy (RT) [50-80Gy], and definitive RT + chemotherapy. Treatment trends were evaluated using Pearson Chi-square tests. OS was compared between RC and BPT using unadjusted Kaplan Meier curves and Cox regression models adjusted for year of treatment, hospital volume, and patient/tumor characteristics using increasingly stringent selection criteria to identify those undergoing BPT. Results: Of the 603,298 patients with bladder cancer captured in the NCDB from 2003-2011, 9% (n = 54,518) had analytic stage II-III with urothelial histology. 51.1% (n = 27,843) of these patients were treated with RC (70.9%, n = 19,745) or BPT (29.1%, n = 8,098). Of the patients undergoing BPT, stratified by selection criteria, 26.9% (n = 2,176) and 15.0% (n = 1,215) were treated with definitive RT and definitive RT + chemotherapy, respectively. Following adjustment, improved survival in patients undergoing RC was noted regardless of BPT definition employed in multivariate analysis. However, we noted attenuated differences in OS using increasingly stringent definitions for BPT (EBRT: HR 2.2 [CI 2.15-2.29] ; definitive RT: HR 1.94 [CI 1.74-2.14]; definitive RT + chemotherapy: HR 1.56 [CI 1.45-1.68] ). Conclusions: In the NCDB, receipt of BPT was associated with decreased OS compared to RC in all patients with stage II-III urothelial carcinoma, in part due to selection biases. However, the use of increasingly stringent definitions of BPT attenuated the observed survival differences. Further randomized prospective controlled trials are needed to compare trimodal BPT to RC to identify optimal candidates for bladder preservation.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2016.34.2_suppl.387
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 5
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    Association of hospital readmission following cystectomy with omission of postoperative chemotherapy in patients with urothelial carcinoma of the bladder.
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 6_suppl ( 2013-02-20), p. 254-254
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 6_suppl ( 2013-02-20), p. 254-254
    Abstract: 254 Background: Hypothesizing that complications after radical cystectomy requiring hospital re-admission may preclude subsequent systemic treatment, our objective was to test the association between readmission within 30 days of surgery and receipt of post-operative chemotherapy in Medicare beneficiaries. Methods: Using 1995-2007 linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, all patients undergoing cystectomy for pathologic stage III-IV urothelial carcinoma were identified. Univariate and multivariate logistic regression analyses were used to test the association between hospital readmission within 30 days and receipt of post-operative chemotherapy (defined ≤9 months from surgery) adjusting for demographic, clinical, hospital, and procedural characteristics. Results: We identified 4,034 patients undergoing radical cystectomy for urothelial carcinoma, of which 1,498 met final inclusion criteria (mean age 75.9±6.3 years, 62.7% male). 563 patients (37.6%) were readmitted within 30 days of surgery (7.5% with ≥2 readmissions). Postoperative chemotherapy was administered in 26.1% of candidates who were readmitted, compared to 35.4% who were not readmitted following surgery (p 〈 0.001). Following adjustment, the odds of receiving chemotherapy were 30% less in patients readmitted to the hospital (OR 0.70 [CI 0.53-0.92]) when compared to patients who were not readmitted. Stratified by number of readmissions, the odds of receiving chemotherapy in patients with 1 and ≥2 readmissions were 26% (OR 0.74 [CI 0.56-0.99] ) and 54% (OR 0.46 [CI 0.27-0.79]) less when compared to patients not readmitted. Use of a more restrictive 6 month post operative chemotherapy definition did not significantly impact our findings (OR 0.66 [CI 0.47-0.93] ). Conclusions: In a cohort of Medicare beneficiaries undergoing cystectomy, hospital readmission within 30 days is associated with omission of post-operative chemotherapy in patients with Stage III-IV urothelial carcinoma. These data inform treatment planning decisions and strengthen the argument supporting chemotherapy utilization in the neoadjuvant setting.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.6_suppl.254
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
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  • 6
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    Receipt of inguinal lymph node dissection in patients with T2 penile cancer: Results from the National Cancer Database.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 7_suppl ( 2015-03-01), p. 383-383
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 7_suppl ( 2015-03-01), p. 383-383
    Abstract: 383 Background: Per the NCCN guidelines, inguinal lymph node dissection (ILND) is recommended for patients with intermediate (T1b) or high (Any T2 or Grade 3) risk disease even in the absence of palpable inguinal nodes. Our objective was to assess temporal trends in utilization of ILND and to determine factors associated with the receipt of ILND using National Cancer Database (NCDB). Methods: The NCDB was queried for all patients diagnosed with T2 penile cancer from 1998-2011. Temporal trends for receipt of ILND were assessed. Adjusting for patient, demographic, and clinicopathologic characteristics, multivariable logistic regression models were used to examine the association between available covariates and receipt of ILND. Results: Of 2019 patients identified over the study period, 693 (34.3%) underwent ILND. Rates of ILND did not significantly improve from 1998 to 2011 (34.2 to 40.0%; p = 0.09). Significant differences were observed in patients undergoing ILND with respect to age (p 〈 0.001), Hispanic ethnicity (p=0.04), insurance status (p 〈 0.001), and facility type (p 〈 0.001), while no changes were seen with respect to race, income, education, urban/rural location, tumor grade, or Charlson co-morbidity score. Following adjustment, patients with high grade disease (OR 1.35 [CI 1.1-1.7]) and those treated at academic centers (OR 3.2 [CI 2.2-4.7] ) were more likely to receive ILND, while patients 〉 70 years of age (OR 0.41 [CI 0.28-0.60]) were less likely to receive ILND. Conclusions: In the NCDB, less then 35% of patients with T2 penile cancer receive ILND and the rates have not significantly changed over the last decade. Referral of patients with this uncommon, highly morbid lethal disease to experienced centers may increase adherence to guideline recommended care.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.7_suppl.383
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 7
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    The use of radiation for stage I seminoma: Analysis of the National Cancer Database.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 7_suppl ( 2015-03-01), p. 385-385
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 7_suppl ( 2015-03-01), p. 385-385
    Abstract: 385 Background: Primary radiotherapy has historically been the preferred treatment for stage I seminoma. However, there is emerging consensus that observation or primary chemotherapy may be preferred in order to reduce overtreatment and risk of secondary malignancy. Hypothesizing that the use of radiotherapy has decreased in the modern era, our objective was to assess temporal practice patterns in stage I seminoma using a large national cancer registry. Methods: The National Cancer Database (NCDB) was queried for all patients diagnosed with stage I seminoma from 1998 to 2011. Temporal trends for receipt of systemic chemotherapy, radiation, and observation (defined as no treatment) were assessed. Following adjustment for patient, demographic, and clinicopathologic characteristics, generalized estimating equations were used to assess for associations between covariates and receipt of primary radiotherapy. Results: Of the 34,251 patients identified with stage I seminoma in the NCDB, 20,627 were treated with radiation (60.2%), 2,278 were treated with chemotherapy (6.7%), and 11,346 were managed with observation (33.1%). Radiation use significantly declined from 73.5% in 1998 to 29.6% in 2011 (p 〈 0.0001), while utilization of chemotherapy (1.9% to 16.5%, p 〈 0.0001) and observation (24.6% to 53.9%, p 〈 0.0001) increased. Following adjustment, age categories 30−39 years (OR 1.06 [CI 1.01−1.13]) and 40−49 years (OR 1.10 [CI 1.03−1.17] ), and stage T2 (OR 1.25 [CI 1.17−1.32]) and T3 (OR 1.21 [CI 1.04−1.41] ) were associated with increased utilization of radiotherapy. Uninsured patients (OR 0.78 [CI 0.71−0.86]) and those with Medicaid (OR 0.82 [CI 0.73−0.92] ) or Medicare (OR 0.62 [CI 0.55−0.69]) were less likely to undergo primary radiotherapy, while those with non-Medicare/Medicaid government insurance were more likely to receive radiation (OR 1.40 [CI 1.13-1.75] ). Conclusions: In the largest known cohort of patients with Stage I seminoma reported to date, these data demonstrate that utilization of radiation therapy for stage I seminoma is on the decline. Coinciding with shifts in evidence−based guidelines, observation is now the most commonly employed management strategy for patients with Stage I seminoma.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.7_suppl.385
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 8
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    Variation in performance of candidate surgical quality measures for muscle‐invasive bladder cancer by hospital type
    Wiley ; 2015
    In:  BJU International Vol. 115, No. 2 ( 2015-02), p. 230-237
    Details
    In: BJU International, Wiley, Vol. 115, No. 2 ( 2015-02), p. 230-237
    Abstract: To test the association between hospital type and performance of candidate quality measures for treatment of muscle‐invasive bladder cancer ( MIBC ) using a large national tumour registry. Proposed quality measures include receipt of neoadjuvant chemotherapy, timely treatment, adequate lymph node dissection, and continent urinary diversion. Patients and Methods Using the N ational C ancer D atabase, patients with stage ≥ II urothelial carcinoma treated with radical cystectomy ( RC ) from 2003 to 2010 were identified. Hospitals were grouped by type and annual RC volume: community, comprehensive low volume ( CLV ), comprehensive high volume ( CHV ), academic low volume ( ALV ), and academic high volume ( AHV ) groups. Logistic regression models were used to test the association between hospital group and performance of quality measures, adjusting for year, demographic, and clinical/pathological characteristics; generalised estimating equations were fitted to the models to adjust for clustering at the hospital level. Results In all, 23 279 patients underwent RC at community (12.4%), comprehensive ( CLV 38%, CHV 5%), and academic ( ALV 17%, AHV 28%) hospitals. While only 0.8% (175) of patients met all four quality criteria, 61% of patients treated at AHV hospitals met two or more quality metric indicators compared with ALV (45%), CHV (44%), CLV (38%), and community (37%) hospitals ( P 〈 0.001). After adjustment, patients were more likely to receive two or more quality measures when treated at AHV (odds ratio [ OR ] 2.4, confidence interval [ CI ] 2.0–2.9), ALV ( OR 1.3, CI 1.1–1.6), and CHV ( OR 1.3, CI 1.03–1.7) hospitals compared with community hospitals. Conclusions Patients undergoing RC at AHV hospitals were more likely to meet quality criteria. However, performance remains low across hospital types, highlighting the opportunity to improve quality of care for MIBC .
    Type of Medium: Online Resource
    ISSN: 1464-4096 , 1464-410X
    URL: Issue
    URL: Article
    DOI: 10.1111/bju.2015.115.issue-2
    DOI: 10.1111/bju.12638
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2019983-1
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  • 9
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    Hypoalbuminaemia is associated with mortality in patients undergoing cytoreductive nephrectomy
    Wiley ; 2015
    In:  BJU International Vol. 116, No. 3 ( 2015-09), p. 351-357
    Details
    In: BJU International, Wiley, Vol. 116, No. 3 ( 2015-09), p. 351-357
    Abstract: To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy ( CN ) for metastatic renal cell carcinoma ( mRCC ). Patients and Methods A multi‐institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993 to 2012. Nutritional markers evaluated were: body mass index 〈 18.5 kg/m 2 , serum albumin 〈 3.5 g/dL, or preoperative weight loss of ≥5% of body weight. Primary outcomes were overall ( OS ) and disease‐specific survival ( DSS ). Secondary outcome was ‘early mortality’ defined as death at ≤6 months of surgery. Survival curves were estimated using the Kaplan–Meier product‐limit method and multivariate analysis using logistic regression was used to test associations between nutritional markers and survival outcomes. Results In all, 119 patients (median follow‐up 17 months) were categorised as having any abnormal nutrition parameter (48%). Hypoalbuminaemia was the only independent predictor of OS and DSS ( OS : median 8 vs 23 months, P 〈 0.001; DSS : 11 vs 33 months, P 〈 0.001). On multivariate analysis, hypoalbuminaemia remained a significant predictor of death for both overall [hazard ratio ( HR ) 2, 95% confidence interval ( CI ) 1.4–2.8; P 〈 0.001) and disease‐specific mortality ( HR 2.2, 95% CI 1.4–3.3; P 〈 0.001). Hypoalbuminaemia was also associated with early mortality (overall: P 〈 0.001 and disease specific: P = 0.002). Conclusion Patients with mRCC and hypoalbuminaemia undergoing CN have decreased OS and CSS , and increased risk of all‐cause and disease‐specific early mortality. As such, serum albumin may help risk stratify patients selected as candidates for CN . Furthermore, future work should evaluate whether nutritional depletion is a modifiable risk factor.
    Type of Medium: Online Resource
    ISSN: 1464-4096 , 1464-410X
    URL: Issue
    URL: Article
    DOI: 10.1111/bju.2015.116.issue-3
    DOI: 10.1111/bju.12897
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2019983-1
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  • 10
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    Safety of neoadjuvant chemotherapy in patients with muscle‐invasive bladder cancer and malignant ureteric obstruction
    Wiley ; 2022
    In:  BJU International Vol. 129, No. 3 ( 2022-03), p. 364-372
    Details
    In: BJU International, Wiley, Vol. 129, No. 3 ( 2022-03), p. 364-372
    Abstract: To determine whether patients with carcinoma invading bladder muscle (MIBC) and ureteric obstruction can safely receive cisplatin‐based neoadjuvant chemotherapy (C‐NAC), and to determine whether such patients require relief of obstruction with a ureteric stent or percutaneous nephrostomy prior to beginning C‐NAC. Patients and Methods We performed a single‐institution retrospective analysis of MIBC patients receiving C‐NAC and falling into three groups: no ureteric obstruction (NO); relieved ureteric obstruction (RO); and unrelieved ureteric obstruction (URO). To address whether patients with obstruction can safely receive C‐NAC, we compared patients with NO to those with RO, with the primary outcome of premature chemotherapy discontinuation. To investigate whether patients with obstruction should have the obstruction relieved prior to NAC, we compared RO to URO patients using a primary composite outcome of grade ≥ 3 adverse events, premature chemotherapy discontinuation, dose reduction, or dose interruption. The primary outcomes were compared using multivariable logistic regression. Sensitivity analyses were performed for the RO vs URO comparison, in which patients with only mild degrees of obstruction were excluded from the URO group. Results A total of 193 patients with NO, 49 with RO, and 35 with URO were analysed. There were no statistically significant differences between those with NO and those with RO in chemotherapy discontinuation (15% vs 22%; P = 0.3) or any secondary outcome. There was no statistically significant difference between those with RO and URO in the primary composite outcome (51% vs 53%; P = 1) or any secondary outcome. Conclusion Patients with ureteric obstruction can safely receive C‐NAC. Relief of obstruction was not associated with increased safety of C‐NAC delivery.
    Type of Medium: Online Resource
    ISSN: 1464-4096 , 1464-410X
    URL: Issue
    URL: Article
    DOI: 10.1111/bju.v129.3
    DOI: 10.1111/bju.15410
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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