Emil Scosyrev

Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904.

BACKGROUND In the European Organization for Research and Treatment of Cancer (EORTC) randomized trial 30904, nephron-sparing surgery (NSS) was associated with reduced overall survival compared with radical nephrectomy (RN) over a median follow-up of 9.3 yr (hazard ratio: 1.50; 95% confidence interval [CI], 1.03-2.16). OBJECTIVE To examine the impact of NSS relative to RN on kidney function in EORTC 30904. DESIGN, SETTING, AND PARTICIPANTS This phase 3 international randomized trial was conducted in patients with a small (≤5 cm) renal mass and normal contralateral kidney who were enrolled from March 1992 to January 2003. INTERVENTION Patients were randomized to RN (n=273) or NSS (n=268). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Follow-up estimated glomerular filtration rates (eGFR; milliliters per minute per 1.73 m(2)) were recorded for 259 subjects in the RN arm and 255 subjects in the NSS arm. Percentages of subjects developing at least moderate renal dysfunction (eGFR <60), advanced kidney disease (eGFR <30), or kidney failure (eGFR <15) were calculated for each treatment arm based on the lowest recorded follow-up eGFR (intent-to-treat analysis). RESULTS AND LIMITATIONS With a median follow-up of 6.7 yr, eGFR <60 was reached by 85.7% with RN and 64.7% with NSS, with a difference of 21.0% (95% CI, 13.8-28.3); eGFR <30 was reached by 10.0% with RN and 6.3% with NSS, with a difference of 3.7% (95% CI, -1.0 to 8.5); and eGFR <15 was reached by 1.5% with RN and 1.6% with NSS, with a difference of -0.1% (95% CI, -2.2 to 2.1). Lack of longer follow-up for eGFR is a limitation of these analyses. CONCLUSIONS Compared with RN, NSS substantially reduced the incidence of at least moderate renal dysfunction (eGFR <60), although with available follow-up the incidence of advanced kidney disease (eGFR <30) was relatively similar in the two treatment arms, and the incidence of kidney failure (eGFR <15) was nearly identical. The beneficial impact of NSS on eGFR did not result in improved survival in this study population. REGISTRATION EORTC trial 30904; ClinicalTrials.gov identifier NCT00002473.

Sex and racial differences in bladder cancer presentation and mortality in the US

Sex, race, and age at diagnosis have a significant impact on mortality from bladder cancer (BC). Women, African Americans of both sexes, and the elderly, all experience higher mortality rates. Tumor grade, stage, and histologic type at presentation also affect outcome. To determine whether age and tumor characteristics alone explain the excess hazard of death from BC observed in some demographic groups, the authors queried the Surveillance, Epidemiology, and End Results (SEER) limited‐use database for the presentations of and outcomes from BC between 1990 and 2005.

Prostate cancer in the elderly: frequency of advanced disease at presentation and disease-specific mortality.

The objectives of this study were to determine the frequency of metastatic (M1) prostate cancer (PC) at presentation in different age groups, to examine the association of age with PC‐specific mortality, and to calculate the relative contribution of different age groups to the pool of M1 cases and PC deaths.

Prostate cancer in the elderly

The objectives of this study were to determine the frequency of metastatic (M1) prostate cancer (PC) at presentation in different age groups, to examine the association of age with PC‐specific mortality, and to calculate the relative contribution of different age groups to the pool of M1 cases and PC deaths.

Do mixed histological features affect survival benefit from neoadjuvant platinum-based combination chemotherapy in patients with locally advanced bladder cancer? A secondary analysis of Southwest Oncology Group-Directed Intergroup Study (S8710)

Study Type – Therapy (RCT)

DO MIXED HISTOLOGICAL FEATURES AFFECT SURVIVAL BENEFIT FROM NEOADJUVANT PLATINUM-BASED COMBINATION CHEMOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER?

We thank the reviewers for their thoughtful comments. We certainly agree with the reviewers concerning the limitations of our study in terms of absence of central histology review and that the proportion of non UC components unquestionably varied and was not usually reported. We also agree that in the future, molecular and genetic analyses will greatly assist management, but at the time of our writing this response to the reviewers, no pharmacogenomic analyses or other form of personalized therapy is available for routine clinical use, so we must rely on histologic analyses to decide who should be treated and with what agents. At the current time, therefore, based on our data, we believe that any patient with a mixed histology bladder cancer (UC + adeno or squamous) as described here, should be considered a candidate for neo-adjuvant chemotherapy with a cisplatin containing combination regimen before cystectomy.

Neoadjuvant gemcitabine and cisplatin chemotherapy for locally advanced urothelial cancer of the bladder

The purpose of this study was to investigate the effect of neoadjuvant chemotherapy with gemcitabine and cisplatin (GC) on pathologic down‐staging of patients with locally advanced urothelial cancer (UC) of the bladder.

Reply to prostate-specific antigen screening for prostate cancer and the risk of overt metastatic disease at presentation : analysis of trends over time.

The objective of this study was to estimate the total number of patients who would be expected to present with metastatic (M1) prostate cancer (PC) in the modern US population in a given year if the age‐specific and race‐specific annual incidence rates of M1 PC were the same as the rates in the era before prostate‐specific antigen (PSA) testing.

Urothelial Carcinoma Versus Squamous Cell Carcinoma of Bladder : Is Survival Different With Stage Adjustment?

OBJECTIVES To determine whether the survival of patients with squamous cell carcinoma (SCC) is different from that of patients with urothelial carcinoma, after adjusting for stage, grade, demographic factors, and the initial treatment. METHODS Information on bladder cancer cases diagnosed from 1988 to 2003 was obtained from the Surveillance, Epidemiology, and End Results database. The tumors were classified by histologic type, grade, and American Joint Committee on Cancer (AJCC) stage. Other covariates included age, sex, race, and information on the initial treatment (cystectomy and radiotherapy). The outcome variables examined were all-cause and bladder cancer-specific mortality within 2 years of diagnosis. Covariate-adjusted mortality differences were computed within each stage using the modified least squares model. RESULTS SCC histologic features were an independent predictor of all-cause and bladder cancer-specific mortality among patients with AJCC Stage I and II tumors who did not undergo cystectomy as a part of their initial treatment and among patients with AJCC Stage III and IV regardless of whether cystectomy was performed. SCC histologic features were not associated with increased mortality among patients with AJCC Stage I and II tumors treated with cystectomy. CONCLUSIONS SCC appears to be more aggressive than urothelial carcinoma after adjusting for stage and other prognostic factors, except for cases in which the tumor was confined to the bladder wall and the bladder was removed as a part of the initial treatment.

Surveillance Epidemiology and End Results (SEER) program and population-based research in urologic oncology: An overview

The Surveillance, Epidemiology, and End Results (SEER) program is a commonly used data source in cancer research. This article provides an introduction to the SEER database, describes important data items available from SEER on the most commonly diagnosed urologic malignancies (prostate, bladder, and kidney cancers), and reviews limitations of SEER data for urologic oncology research.