Daniel Zainfeld

Enhanced recovery after urologic surgery—Current applications and future directions

Coordinated multidisciplinary perioperative care through enhanced recovery protocols has improved outcomes within urologic surgery. Continued development and refinement of enhanced recovery after surgery (ERAS) pathways will further augment the care of patients undergoing all urologic procedures. Among the challenges, moving forward is identification of barriers to ERAS adoption by providers, maximizing adherence among patients, standardization of ERAS pathways through establishment of evidence‐based principles, and application in additional complex urologic procedures beyond radical cystectomy.

Circulating Tumor Cells in Genitourinary Malignancies: An Evolving Path to Precision Medicine

Precision medicine with molecularly directed therapeutics is rapidly expanding in all subspecialties of oncology. Molecular analysis and treatment monitoring require tumor tissue, but resections or biopsies are not always feasible due to tumor location, patient safety, and cost. Circulating tumor cells (CTCs) offer a safe, low-cost, and repeatable tissue source as an alternative to invasive biopsies. “Liquid biopsies” can be collected from a peripheral blood draw and analyzed to isolate, enumerate, and molecularly characterize CTCs. While there is deserved excitement surrounding new CTC technologies, studies are ongoing to determine whether these cells can provide reliable and accurate information about molecular drivers of cancer progression and inform treatment decisions. This review focuses on the current status of CTCs in genitourinary (GU) cancer. We will review currently used methodologies to isolate and detect CTCs, their use as predictive biomarkers, and highlight emerging research and applications of CTC analysis in GU malignancies.

PD36-02 IMPACT OF NON-MODIFIABLE PATIENT FACTORS ON PERIOPERATIVE OUTCOME FOLLOWING RADICAL CYSTECTOMY WITH ENHANCED RECOVERY PROTOCOL

INTRODUCTION AND OBJECTIVES: Radical cystectomy for bladder cancer is performed in an aged, highly comorbid population, and associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population. METHODS: Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California between years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery (Figure). Descriptive statistics were performed, and multivariable logistic regression models were fit in a nonparsimonious fashion, including all patient demographic and clinical variables, in order to isolate the effect of the LACE score on outcomes (90-day readmission and mortality). RESULTS: Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated ’high-risk’ LACE score 10, patients experienced an increased risk of 90-day readmission (22.8% vs 17.7%, p1⁄40.002) and mortality (9.1% vs 3.5%, p<0.001). On adjusted multivariable analysis, 0high risk0 patients by LACE score had increased 90-day odds of readmission (aOR1⁄41.24, 95% CI: 0.99-1.54, p1⁄40.050) and mortality (aOR1⁄42.09, 95% CI: 1.47-2.99, p<0.001). Separate multivariate models demonstrated a one point increase in LACE score had a 7.3% increased adjusted odds of readmission, and a 33.2% increased odds of mortality. CONCLUSIONS: The LACE score reasonably predicts patients at risk for 90-day readmission and mortality following radical cystectomy. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention. Source of Funding: None

Liquid Biopsy in Prostate Cancer: Circulating Tumor Cells and Beyond

Prostate cancer is a common malignancy impacting countless men without curative options in the advanced state. Numerous therapies have been introduced in recent years improving survival and symptom control, yet optimal methods for predicting or monitoring response have not been developed. In the era of precision medicine, characterization of individual cancers is necessary to inform treatment decisions. Liquid biopsies, through evaluation of various blood-based analytes, provide a method of patient evaluation with potential applications in virtually all disease states. In this review, we will describe current approaches with a particular focus on demonstrated clinical utility in the evaluation and management of prostate cancer.