David B. Cahn

Contemporary use trends and survival outcomes in patients undergoing radical cystectomy or bladder‐preservation therapy for muscle‐invasive bladder cancer

The current study was performed to examine temporal trends and compare overall survival (OS) in patients undergoing radical cystectomy (RC) or bladder‐preservation therapy (BPT) for muscle‐invasive urothelial carcinoma of the bladder.

The role of radical prostatectomy in high-risk localized, node-positive and metastatic prostate cancer

A lack of quality evidence comparing management strategies confounds complex treatment decisions for patients with high-risk prostate cancers. No randomized trial comparing surgery to radiation has been successfully completed. Despite inherent selection biases, however, observational and registry data suggest improved outcomes for patients initially managed with prostatectomy. As consensus shifts away from aggressive treatment for low-risk disease and toward multimodal treatment of locally advanced and metastatic disease, there is renewed interest in surgery for local control in patients presenting with high-risk localized, node-positive and minimally metastatic disease. The objective of this review is to examine the evidence evaluating clinical outcomes of patients with high-risk clinically localized, node-positive and metastatic prostate cancer treated with radical prostatectomy.

Safety and early effectiveness of robot-assisted partial nephrectomy for large angiomyolipomas.

To evaluate a multicentre series of robot‐assisted partial nephrectomy (RAPN) performed for the treatment of large angiomyolipomas (AMLs).

Bladder Preservation Therapy: A Review of the Literature and Future Directions

Trimodal bladder preservation therapy (ie, transurethral resection followed by chemoradiotherapy) may be an acceptable treatment alternative to radical cystectomy with urinary diversion in the carefully selected patient with muscle invasive bladder cancer. Although no head-to-head randomized controlled trials have been performed, large retrospective cohort reviews and observational data analyses suggest comparable oncologic outcomes in select patients with the additional benefit of maximizing quality of life and maintaining the patients native bladder. In this review, we discuss the evolution and clinical outcomes of bladder preservation therapy, highlighting its role in the contemporary management of muscle invasive bladder cancer.

Contemporary practice patterns and survival outcomes for locally advanced urethral malignancies: A National Cancer Database Analysis

PURPOSE Primary urethral carcinoma (PUC) has an aggressive natural history; however, controversy exists regarding the role of multimodal therapy for its treatment. Our objective was to examine practice patterns and survival outcomes for locally advanced urethral cancers. METHODS The National Cancer Database was queried for patients with T2-4 or N1-2M0 PUC with urothelial, squamous, or adenocarcinoma histology from 2004 to 2013. Temporal trends for receipt of local or definitive surgery, radiotherapy (XRT), and systemic therapy were assessed. Adjusting for clinicopathologic characteristics, we evaluated the effect of tumor stage and histology on receipt of definitive multimodal therapy (cystectomy + chemotherapy ± XRT) and effects of treatment on overall survival. RESULTS A total of 1,749 patients met inclusion criteria (22.2% adenocarcinoma, 29.3% squamous, and 48.5% urothelial). Only 29.6% underwent cystectomy ± XRT, and 15.6% underwent definitive multimodal therapy. Following adjustment, older patients (age 50-75: odds ratio [OR] = 0.42 [95% CI: 0.28-0.63]; age 75+: OR = 0.06 [95% CI: 0.03-0.13]) and those with squamous histology (OR = 0.46 [95% CI: 0.3-0.7]) were less likely to receive definitive multimodal therapy. More advanced stage (T3: OR = 1.66 [95% CI: 1.15-2.41]; T4: OR = 3.57 [95% CI: 2.47-5.16]); and N2 status (OR = 1.88 [95% CI: 1.27-2.78]) were more likely to receive definitive multimodal therapy. On adjusted analysis, an overall survival benefit was only observed with definitive multimodal therapy for PUC of urothelial origin (hazard ratio = 0.61 [95% CI: 0.45-0.83]). CONCLUSIONS Despite a survival benefit, most patients with locally advanced PUC do not undergo definitive multimodal therapy. We advocate for a multidisciplinary-based treatment approach for these patients. Future prospective trials of multimodal therapy are crucial.

Use of administrative data for comparative effectiveness research in the treatment of non-prostate genitourinary malignancies

Comparative effectiveness research (CER) is imperative for objective and balanced assessment of treatment outcomes. CER that uses administrative databases (AD-CER) affords unique opportunities for large scale data analyses that potentially transcend limitations of small institutional datasets. Prostate cancer has received much attention from the AD-CER research community, whereas non-prostate genitourinary malignancies are less well-studied. The objective of this article is to review the currently available AD-CER that has been published in the non-prostate genitourinary malignancies space.

A Review of Translocation T(6;11) Renal Cell Carcinoma Tumors in the Adult Patient

Historically, T(6;11) renal cell carcinoma (RCC) has been associated with the pediatric and adolescent populations and documentation of this tumor in adults has been rare. However, the frequency of translocation renal cell carcinoma (TRCC) may be widely underestimated in the adult population due to an inadequate immunohistochemical workup or misdiagnosis from similar gross and histological findings to other RCC. A subset of MiT family translocation carcinomas, t(6:11) (p21;q12) translocation tumors cause an alpha-TFEB gene fusion. Morphologically, this neoplasm tends to mimic the various types of RCCs, including clear cell, papillary, and even epitheloid angiomyolipomas. Adult cases of TRCC have shown to behave more aggressively than their indolent pediatric counterpart, but due to the limited number of reported cases the true nature of these tumors has yet to be determined. The aim of this review is to bring an awareness of translocation RCC to better understand its diagnoses, treatment and prognosis, and, in turn, to allow for new cases to further highlight the behavior of this rare variant.

Partial Nephrectomy Is Not Associated With an Overall Survival Advantage Over Radical Nephrectomy in Elderly Patients With Stage I and II Renal Masses: An Analysis of the National Cancer Database: Survival Differences in PN Versus RN

Partial nephrectomy (PN) is recommended for localized T1a (≤4 cm) renal masses and is preferred over radical nephrectomy (RN) for amenable T1b/T2 (>4 cm) tumors. The objective of the current study was to assess overall survival (OS) differences between PN and RN in patients with T1 and T2 renal cell carcinoma (RCC).

MP49-15 SAFETY AND EARLY EFFECTIVENESS OF ROBOTIC PARTIAL NEPHRECTOMY FOR LARGE ANGIOMYOLIPOMAS

transperitoneal vs. retroperitoneal group, respectively (p1⁄40.049). However, after adjustment for multiple confounders, no statistically significant difference between the two approaches was observed (OR: 1.14; 95%CI: 0.712-1.826; p1⁄40.585). Conversely, both increasing PADUA score and male gender were associated with worse surgical outcomes (p<0.001). CONCLUSIONS: In expert hands, both the transperitoneal and the retroperitoneal approach can be safely adopted to perform a RAPN, with the latter being associated with lower EBL and length of stay.

MP58-12 CLINICAL DESTINY OF INDETERMINATE PULMONARY NODULES IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA OF THE BLADDER

groups: very low risk (1⁄4pT3a disease, pure transitional histology and negative STSM), low risk (1⁄4pT3a disease, non-pure transitional histology and negative STSM), intermediate risk (pT4 disease, negative STSM and any histology), and high risk (all patients with positive STSM). CONCLUSIONS: LF is a common event in RC patients. We developed a new risk model based on BCa characteristics. Our findings should be considered by threating physicians when deciding the necessity of adjuvant radiotherapy.