Caroline Tai

Severe lack of comprehension of common prostate health terms among low-income inner-city men.

Patients diagnosed with prostate cancer are often counseled about treatment options with the use of terms that are part of the “core vocabulary” of prostate cancer. It is hypothesized that predominantly lower literacy patients would demonstrate a severe lack of comprehension of prostate cancer terms, thus validating the findings of a previous single‐institution study.

Video‐based educational tool improves patient comprehension of common prostate health terminology

Health care providers often counsel prostate cancer patients about treatment options with medical terminology. However, studies have demonstrated a severe lack of comprehension of these terms, particularly in underserved populations. It was hypothesized that a video‐based educational tool would significantly improve the understanding of key terms related to prostate health in a predominantly lower literacy population.

External validation of the modified Glasgow prognostic score for renal cancer.

Purpose: The modified Glasgow prognostic Score (mGPS) incorporates C-reactive protein and albumin as a clinically useful marker of tumor behavior. The ability of the mGPS to predict metastasis in localized renal cell carcinoma (RCC) remains unknown in an external validation cohort. Patients and Methods: Patients with clinically localized clear cell RCC were followed for 1 year post-operatively. Metastases were identified radiologically. Patients were categorized by mGPS score as low-risk (mGPS = 0 points), intermediate-risk (mGPS = 1 point) and high-risk (mGPS = 2 points). Univariate, Kaplan-Meier and multivariate Cox regression analyses examined Recurrence -free survival (RFS) across patient and disease characteristics. Results: Of the 129 patients in this study, 23.3% developed metastases. Of low, intermediate and high risk patients, 10.1%, 38.9% and 89.9% recurred during the study. After accounting for various patient and tumor characteristics in multivariate analysis including stage and grade, only mGPS was significantly associated with RFS. Compared with low-risk patients, intermediate- and high-risk patients experienced a 4-fold (hazard ratios [HR]: 4.035, 95% confidence interval [CI]: 1.312-12.415, P = 0.015) and 7-fold (HR: 7.012, 95% CI: 2.126-23.123 P < 0.001) risk of metastasis, respectively. Conclusions: mGPS is a robust predictor of metastasis following potentially curative nephrectomy for localized RCC. Clinicians may consider mGPS as an adjunct to identify high-risk patients for possible enrollment into clinical trials or for patient counseling

Preoperative C-reactive protein combined with SSIGN score as an independent predictor of cancer-specific survival in patients with clear cell renal cell carcinoma.

451 Background: Renal cell carcinoma (RCC) demonstrates heterogeneous behavior. Approximately 30% to 40% of patients with clinically localized RCC will later metastasize. Current tools are imperfect for predicting who will have distant spread of disease. C-reactive protein (CRP) levels and the Mayo Clinic SSIGN scores are widely use to predict outcomes of clear cell RCC. We investigated the predictive value of the combined use of pre-operative CRP and SSIGN score for cancer specific survival. METHODS Patients undergoing nephrectomy for clinically localized RCC from 2005 to 2010 were studied. Inclusion criteria required clear cell histology, no nodal or metastatic disease at the time of surgery, two years follow-up time, and a recorded preoperative CRP level. SSIGN score was based on postoperative data and was categorized into scores 0-2, 3-5, and ≥ 6. A cut-point of 20 mg/l was used to classify elevated preoperative CRP. Univariate analysis identified variables associated with cancer specific survival (CSS). Variables significant in univariate analysis at p < 0.05 were entered into a multivariate Cox regression model using forward stepwise regression to identify significant predictors of CSS. RESULTS Study criteria identified 284 patients. Of these patients, 62% were men and 13% had preoperative CRP values ≥ 20 mg/L. No patients had T4 disease, while 22% had T3, 7% had T2, and 70% had T1 disease. SSIGN scores of 0-2, 3-5, and ≥ 6 were assigned to 57%, 30%, and 13% of patients, respectively. On univariate analysis CRP ≥ 20 mg/L was a statistically significant predictor of CSS (p < 0.0004, HR 7.07, CI 95% 2.42, 20.68). Multivariate Cox Regression found preoperative CRP (p = 0.033, HR 3.65, CI 95% 1.11, 11.97) to be an independent predictor of CSS despite controlling for age at surgery (p < 0.05) and SSIGN score (p < 0.05), which were also independent predictors of CSS. CONCLUSIONS In patients with clear cell RCC, pre-operative CRP levels in combination with SSIGN score provides additional information for predicting CSS.

Postoperative modified Glasgow prognostic score as an independent predictor of overall survival in clinically localized clear cell renal cell carcinoma.

456 Background: Renal cell carcinoma (RCC) demonstrates heterogeneous behavior. Approximately 30% to 40% of patients with clinically localized RCC will later metastasize. Current tools are imperfect for predicting who will have distant spread of disease. The utility of the modified Glasgow Prognostic Score (mGPS) calculated from C-reactive protein (CRP) and albumin levels, has been well-studied as a pre-operative predictive tool in patients with various solid organ malignancies, including clear cell renal cell carcinoma. This score has not been used in the post-operative setting, and we hypothesized that mGPS can be a powerful tool to predicting overall survival. METHODS Patients undergoing nephrectomy for clinically localized RCC from 2005 to 2010 were studied. Inclusion criteria required clear cell histology and no nodal or metastatic disease at the time of surgery. Additionally, only patients with post-operative C-reactive protein and albumin recorded were included in the analyses. Demographic and clinico-pathological variables were analyzed as categorical variables with the exception of age and tumor size, which were analyzed as continuous variables. Patients were assigned an mGPS score of 0, 1, or 2 based on post-operative data (0 = CRP ≤ 10 mg/l, 1 = CRP>10 mg/l and 2 = CRP>10 mg/l and albumin<3.5 g/dL). Survival analyses utilized Kaplan-Meier and multivariate Cox regression models. RESULTS Study criteria were met in 142 patients. Mean age was 59 years and 61% were men. No patients had T4 disease while 25% had T3, 9% had T2, and 66% had T1 disease. A post-operative mGPS of 0, 1, and 2 was assigned to 69%, 13% and 18% of the study population, respectively. Multivariate analysis identified post-operative high mGPS (mGPS = 2) as an independent predictor of overall survival (HR 5.591; CI 95% 1.508, 20.734; p = 0.010). CONCLUSIONS In patients with clinically localized clear cell renal cell carcinoma, post-operative mGPS score is an independent predictor of overall survival. Accordingly, mGPS may be a useful tool to monitor disease progression in this patient population.