Paolo Dell'Oglio

Predicting survival of men with recurrent prostate cancer after radical prostatectomy

INTRODUCTION To develop and externally validate a novel nomogram aimed at predicting cancer-specific mortality (CSM) after biochemical recurrence (BCR) among prostate cancer (PCa) patients treated with radical prostatectomy (RP) with or without adjuvant external beam radiotherapy (aRT) and/or hormonal therapy (aHT). MATERIALS & METHODS The development cohort included 689 consecutive PCa patients treated with RP between 1987 and 2011 with subsequent BCR, defined as two subsequent prostate-specific antigen values >0.2 ng/ml. Multivariable competing-risks regression analyses tested the predictors of CSM after BCR for the purpose of 5-year CSM nomogram development. Validation (2000 bootstrap resamples) was internally tested. External validation was performed into a population of 6734 PCa patients with BCR after treatment with RP at the Mayo Clinic from 1987 to 2011. The predictive accuracy (PA) was quantified using the receiver operating characteristic-derived area under the curve and the calibration plot method. RESULTS The 5-year CSM-free survival rate was 83.6% (confidence interval [CI]: 79.6-87.2). In multivariable analyses, pathologic stage T3b or more (hazard ratio [HR]: 7.42; p = 0.008), pathologic Gleason score 8-10 (HR: 2.19; p = 0.003), lymph node invasion (HR: 3.57; p = 0.001), time to BCR (HR: 0.99; p = 0.03) and age at BCR (HR: 1.04; p = 0.04), were each significantly associated with the risk of CSM after BCR. The bootstrap-corrected PA was 87.4% (bootstrap 95% CI: 82.0-91.7%). External validation of our nomogram showed a good PA at 83.2%. CONCLUSIONS We developed and externally validated the first nomogram predicting 5-year CSM applicable to contemporary patients with BCR after RP with or without adjuvant treatment.

Population-Based External Validation of the Updated 2012 Partin Tables in Contemporary North American Prostate Cancer Patients.

To externally validate the updated 2012 Partin Tables in contemporary North American patients treated with radical prostatectomy (RP) for localized prostate cancer (PCa) at community institutions.

The New Prostate Cancer Grading System Does Not Improve Prediction of Clinical Recurrence After Radical Prostatectomy: Results of a Large, Two-Center Validation Study

A new prostate cancer (PCa) grading system (namely, Gleason score‐GS‐ ≤6 vs. 3 + 4 vs. 4 + 3 vs. 8 vs. ≥9) was recently proposed and assessed on biochemical recurrence (BCR) showing improved predictive abilities compared to the commonly used three‐tier system (GS ≤6 vs. 7 vs. ≥8). We assessed the predictive ability of the five‐tier grade group (GG) system on harder clinical endpoint, namely clinical recurrence (CR).

Comparison of Postoperative Complications and Mortality Between Laparoscopic and Percutaneous Local Tumor Ablation for T1a Renal Cell Carcinoma: A Population-based Study

OBJECTIVE To evaluate potential differences in local tumor ablation (LTA) perioperative outcomes between the percutaneous LTA (pLTA) and the laparoscopic LTA (lapLTA) approaches. METHODS Using the Surveillance, Epidemiology, and End Results-Medicare, we identified all patients diagnosed with T1a renal cell carcinoma (RCC) who underwent either pLTA or lapLTA between 2000 and 2009. Overall complications at 30 days and mortality at 90 days were examined for both groups. A multivariable logistic regression model was fitted to evaluate the effect of the approach on perioperative complications. A second model was fitted to test for associations between patient or tumor characteristics and type of LTA approach. RESULTS Overall, 516 patients diagnosed with T1a RCC were identified. Of those, 289 (56%) were treated with pLTA and 227 (44%) were treated with lapLTA. LapLTA-treated patients were younger (median 76 vs 78, P < .001) and healthier (median Charlson comorbidity index 2.1 vs 2.7, P = .03) than their counterpart. After pLTA and lapLTA, overall complication rates were 21% and 25%, respectively (P = .3). Similarly, 90-day mortality rates did not differ between the two groups (P = 1). After adjusting for patient and tumor characteristics, LTA approach was not associated with perioperative complications (odds ratio: 1.38, P = .1). However, older and sicker patients were less likely to be treated with lapLTA (both ≤ 0.04). CONCLUSION No differences in 30-day overall complications or 90-day mortality rates were detected between lapLTA and pLTA for T1a RCC. pLTA was more frequently used in older and sicker individuals. Further prospective studies comparing both procedures should be undertaken.

Sociodemographic Disparities in the Nonoperative Management of Small Renal Masses

BACKGROUND Local tumor ablation (LTA) and expectant management (EM) represent competing treatment modalities for patients with small renal masses (SRMs) who are unfit for surgery. We examined the potential social discrepancies in the access of LTA and EM. MATERIALS AND METHODS A total of 1860 patients with cT1a kidney cancer who had undergone either LTA (n = 553) or EM (n = 1307) from 2000 to 2009 were selected from the Surveillance, Epidemiology, and End Results-Medicare database. The baseline patient data (age, comorbidity status, defined as Charlson comorbidity index [CCI], and several sociodemographic variables) and tumor characteristics were examined. A multivariable analysis predicting access to LTA compared with EM was fitted. The subgroup analyses focused on patients aged ≥ 75 years with a CCI of ≥ 2. RESULTS Compared with LTA patients, the EM patients were significantly older (median age, 78 vs. 77 years; P < .001), more frequently unmarried (43% vs. 37%; P = .02), more frequently of African-American ethnicity (14% vs. 8%; P = .005), and more frequently of low socioeconomic status (SES; 55% vs. 46%; P = .001). No differences were seen according to gender, population density, CCI, or tumor size. In a multivariable analysis predicting access to LTA over EM, older age, African-American ethnicity, male gender, low SES, and unmarried status were associated with lower access to LTA (P ≤ .04 for all). In the subgroup of older and sicker patients, none of the previous sociodemographic characteristics represented barriers to LTA access (P ≥ .1 for all). CONCLUSION Sociodemographic characteristics might represent barriers to LTA access for patients with SRMs managed nonoperatively. However, these associations vanished when older and sicker patients were examined.

Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer: a competing risks analysis

To examine, using competing risks regression, differences in cancer‐specific mortality (CSM) that might distinguish between local tumour ablation (LTA) and observation (OBS) for patients with kidney cancer.

Treatment trends and Medicare reimbursements for localized prostate cancer in elderly patients

INTRODUCTION The absolute and proportional numbers of elderly patients diagnosed with localized prostate cancer (PCa) are on the rise. We examined treatment trends and reimbursement figures in localized PCa patients aged ≥80 years. METHODS Between 2000 and 2008, we identified 30 217 localized PCa patients aged ≥80 years in Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. Alternative treatment modalities consisted of conservative management (CM), radiation therapy (RT), radical prostatectomy (RP), and primary androgen-deprivation therapy (PADT). For all four modalities, utilization and reimbursements were examined. RESULTS PADT was the most frequently used treatment modality between 2000 and 2005. CM became the dominant treatment modality from 2006-2008. RP rates were marginal. RT ranked third, and its annual rate increased from 20.77% in 2000 to 29.13% in 2008. Median individual reimbursement of RT was highest and ranged from

Prediction of Competing Mortality for Decision-making Between Surgery or Observation in Elderly Patients With T1 Kidney Cancer

29 343 in 2000 to

Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: A 20-year single center experience

31 090 in 2008, followed by RP (from

Primary Gleason pattern upgrading in contemporary patients with D'Amico low-risk prostate cancer: implications for future biomarkers and imaging modalities.

20 560 in 2000 to