Rodolphe Thuret

Age-Adjusted Incidence, Mortality, and Survival Rates of Stage-Specific Renal Cell Carcinoma in North America: A Trend Analysis

BACKGROUNDnThe rising incidence of renal cell carcinoma (RCC) has been largely attributed to the increasing use of imaging procedures.nnnOBJECTIVEnOur aim was to examine stage-specific incidence, mortality, and survival trends of RCC in North America.nnnDESIGN, SETTING, AND PARTICIPANTSnWe computed age-adjusted incidence, survival, and mortality rates using the Surveillance Epidemiology and End Results database. Between 1988 and 2006, 43,807 patients with histologically confirmed RCC were included.nnnMEASUREMENTSnWe calculated incidence, mortality, and 5-yr survival rates by year. Reported findings were stratified according to disease stage.nnnRESULTS AND LIMITATIONSnAge-adjusted incidence rate of RCC rose from 7.6 per 100,000 person-years in 1988 to 11.7 in 2006 (estimated annual percentage change [EAPC]: +2.39%; p<0.001). Stage-specific age-adjusted incidence rates increased for localized stage: 3.8 in 1988 to 8.2 in 2006 (EAPC: +4.29%; p<0.001) and decreased during the same period for distant stage: 2.1 to 1.6 (EAPC: -0.57%; p=0.01). Stage-specific survival rates improved over time for localized stage but remained stable for regional and distant stages. Mortality rates varied significantly over the study period among localized stage, 1.3 in 1988 to 2.4 in 2006 (EAPC: +3.16%; p<0.001), and distant stage, 1.8 in 1988 to 1.6 in 2006 (EAPC: -0.53%; p=0.045). Better detailed staging information represents a main limitation of the study.nnnCONCLUSIONSnThe incidence rates of localized RCC increased rapidly, whereas those of distant RCC declined. Mortality rates significantly increased for localized stage and decreased for distant stage. Innovation in diagnosis and management of RCC remains necessary.

A Competing-Risks Analysis of Survival After Alternative Treatment Modalities for Prostate Cancer Patients: 1988–2006

BACKGROUNDnThe efficacy of prostate cancer (PCa) treatment modalities is a subject of continuous debate.nnnOBJECTIVEnWe tested the hypothesis that significant differences in survival rates may exist among PCa patients treated with radical prostatectomy (RP), radiation therapy (RT), and observation.nnnDESIGN, SETTING, AND PARTICIPANTSnWe focused on 404,604 patients with clinically localized PCa within 17 Surveillance, Epidemiology and End Results registries.nnnMEASUREMENTSnCompeting-risks survival analyses were used to estimate cancer-specific mortality (CSM) and other-cause mortality (OCM) rates. Patients were stratified according to treatment type, age group, and PCa risk group (high risk: T2c and/or Gleason score 8-10; low to intermediate risk: all others).nnnRESULTS AND LIMITATIONSnThe 10-yr CSM and OCM rates were 6.1% and 29.2%, respectively. In RP, RT, and observation patients, CSM rates were 3.6%, 6.5%, and 10.8% (p<0.001), respectively; OCM rates were 17.1%, 32.4%, and 48.9% (p<0.001), respectively. In low- to intermediate-risk patients, the lowest CSM (1.3-3.7%) and OCM (6.9-31.6%) rates within all age categories except octogenarians (8.9% and 62.8%, respectively) were recorded in RP. In high-risk patients, the lowest CSM (5.8-7.2%) and OCM (8.7-16.1%) rates in patients aged ≤69 yr were also recorded in RP. RT was equally favorable to RP in the 70-79 age category and appeared ideal in all octogenarian patients.nnnCONCLUSIONSnOur results showed that RP provides the most favorable survival rates in most patients. The exception is octogenarian men, in whom RT provides the best results. Finally, the least-favorable outcomes were recorded after observation. However, these findings must be interpreted within the context of the limitations of observational data.

Decreasing Rate and Extent of Lymph Node Staging in Patients Undergoing Radical Prostatectomy May Undermine the Rate of Diagnosis of Lymph Node Metastases in Prostate Cancer

BACKGROUNDnAt radical prostatectomy (RP), pelvic lymph node dissection (PLND) represents the most accurate staging procedure for the presence of lymph node (LN) metastases.nnnOBJECTIVEnWe evaluated the rate of PLND use and its lymph node count (LNC) over the last two decades. We also tested the relationship between LNC and the rate of pN1 stage.nnnDESIGN, SETTING, AND PARTICIPANTSnBetween 1988 and 2006, 130,080 RPs were recorded in 17 Surveillance Epidemiology and End Results registries.nnnMEASUREMENTSnThe statistical significance of temporal trends was evaluated with the chi-square trend test. Separate univariable and multivariable regression analyses tested the relationship between predictors and two end points: (1) lack of LN staging (pNx) and (2) presence of LN metastases (pN1).nnnRESULTS AND LIMITATIONSnStage pNx was recorded in 25.9% of patients, and pNx rate was higher in more contemporary years (30.1% in 2000-2006 vs 20.8% in 1988-1993; multivariable p < 0.001). When PLND was performed, an average of 7.4 LNs (median: 6) were removed. The average LNC decreased from 12.0 nodes (median: 12) in 1988 to 6.0 nodes (median: 4) in 2006. Overall pN1 rate was 3.4% and decreased from 10.7% to 3.1% between 1988 and 2006 (p < 0.001). LNC was an independent predictor of pN1 stage (multivariable p < 0.001).nnnCONCLUSIONSnAn increasingly larger proportion of prostate cancer patients remain without LN staging at RP. Fewer LNs were removed at PLND over time, resulting in fewer patients diagnosed with pN1 stage at RP. The impact of this phenomenon on cancer control outcomes is still to be verified.

Incidence, survival and mortality rates of stage-specific bladder cancer in United States: A trend analysis

PURPOSEnTo examine the overall and stage-specific age-adjusted incidence, 5-year survival and mortality rates of bladder cancer (BCa) in the United States, between 1973 and 2009.nnnMATERIALS AND METHODSnA total of 148,315 BCa patients were identified in the Surveillance, Epidemiology and End Results database, between years 1973 and 2009. Incidence, mortality, and 5-year cancer-specific survival rates were calculated. Temporal trends were quantified using the estimated annual percentage change (EAPC) and linear regression models. All analyses were stratified according to disease stage, and further examined according to sex, race, and age groups.nnnRESULTSnIncidence rate of BCa increased from 21.0 to 25.5/100,000 person-years between 1973 and 2009. Stage-specific analyses revealed an increase incidence for localized stage: 15.4-20.2 (EAPC: +0.5%, p < 0.001) and distant stage: 0.5-0.8 (EAPC: +0.7%, p = 0.001). Stage-specific 5-year survival rates increased for all stages, except for distant disease. No significant changes in mortality were recorded among localized (EAPC: -0.2%, p = 0.1) and regional stage (EAPC: -0.1%, p = 0.5). An increase in mortality rates was observed among distant stage (EAPC: +1.0%, p = 0.005). Significant variations in incidence and mortality were recorded when estimates were stratified according to sex, race, and age groups.nnnDISCUSSIONnAlbeit statistically significant, virtually all changes in incidence and mortality were minor, and hardly of any clinical importance. Little or no change in BCa cancer control outcomes has been achieved during the study period.

A population-based competing-risks analysis of the survival of patients treated with radical cystectomy for bladder cancer

Patients treated with radical cystectomy represent a very heterogeneous group with respect to cancer‐specific and other‐cause mortality. Comorbidities and comorbidity‐associated events represent very important causes of mortality in those individuals. The authors examined the rates of cancer‐specific and other‐cause mortality in a population‐based radical cystectomy cohort.

Racial disparities and socioeconomic status in men diagnosed with testicular germ cell tumors: a survival analysis.

Previous reports indicated that African‐American men with testicular germ cell tumors (TGCTs) have more aggressive tumor characteristics and less favorable outcomes than other men. The authors of this report evaluated the effects of race and socioeconomic status (SES) on stage distribution, overall mortality (OM), and cancer‐specific mortality (CSM) in men with TGCTs.

Mortality and Morbidity After Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma: A Population-Based Study

PurposeTo test whether the rates of in-hospital mortality, complications, and transfusions are higher in patients treated with cytoreductive nephrectomy (CNT) for metastatic renal cell carcinoma (mRCC) relative to patients treated with nephrectomy (NT) for non-mRCC.MethodsWe assessed 17,688 patients treated with a NT between years 1999 and 2008, within the Florida Inpatient Database. Chi-square and Student t-tests were used to compare the statistical significance of differences in proportions and means, respectively. Univariable and multivariable logistic regression analyses tested the relationship between surgery type (CNT vs. NT) and three end points: in-hospital mortality, complications, and transfusions.ResultsOverall, 6.0% of patients underwent CNT. The rates of in-hospital mortality, complications, and transfusions were 2.4, 26.5, and 24.3% in CNT patients versus 0.9, 18.9, and 11.1% in NT patients. At multivariable analyses, CNT patients demonstrated a 2.0-, 1.3-, and 2.4-fold higher risk of in-hospital mortality, complications, and transfusions (all Pxa0<xa00.001). Similarly, more advanced age, comorbidity, and the cumulative number of secondary surgical procedures were independent predictors of a higher risk of in-hospital mortality, complications, and transfusions (all Pxa0<xa00.001).ConclusionsThe rate of in-hospital mortality, complications, and transfusions is higher in patients treated with CNT relative to NT. Older age, higher comorbidity, and the necessity of secondary surgical procedures further increases the risk of all aforementioned end points. Physicians should consider these observations during the planning of a CNT, and patients should be informed accordingly.

Lymph node count threshold for optimal pelvic lymph node staging in prostate cancer.

Objectives:u2003 To test the relationship between the extent of pelvic lymph node dissection at radical prostatectomy and the rate of lymph node metastases, and to identify the ideal number of lymph nodes that should be removed to achieve an optimal staging.

Survival Benefit of Radical Prostatectomy in Patients with Localized Prostate Cancer: Estimations of the Number Needed to Treat According to Tumor and Patient Characteristics

PURPOSEnThe benefit of active treatment for prostate cancer is a subject of continuous debate. We assessed the relationship between treatment type (radical prostatectomy vs observation) and cancer specific mortality in a large, population based cohort.nnnMATERIALS AND METHODSnWe examined the records of 44,694 patients treated with radical prostatectomy or observation between 1992 and 2005 in the SEER (Surveillance, Epidemiology and End Results)-Medicare linked database. Patients were matched by propensity score. Competing risks analysis was done to test the effect of treatment type on cancer specific mortality after accounting for other cause mortality. The number needed to treat was calculated. All analysis was stratified by prostate cancer risk group, baseline Charlson comorbidity index and patient age.nnnRESULTSnFor patients treated with radical prostatectomy vs observation the 10-year cancer specific mortality rate was 5.2% vs 12.8% for high risk prostate cancer, 1.4% vs 3.8% for low-intermediate risk prostate cancer, 2.4% vs 5.8% for a Charlson comorbidity index of 0, 2.3% vs 6.4% for a comorbidity index of 1, 2.5% vs 5.4% for a comorbidity index of 2 or greater, 2.0% vs 4.6% at ages 65 to 69, 2.6% vs 5.6% at ages 70 to 74 and 2.7% vs 8.1% at ages 75 to 80 years (each p <0.001). The corresponding number need to treat was 13, 42, 29, 24, 34, 38, 33 and 19, respectively. On multivariable analysis radical prostatectomy was an independent predictor of more favorable cancer specific mortality in all categories (each p <0.001).nnnCONCLUSIONSnPatients with high risk prostate cancer benefit the most from radical prostatectomy. The lowest benefit was observed in patients with low-intermediate risk prostate cancer. An intermediate benefit was observed when patients were classified by Charlson comorbidity index and age category.

Competing-Risks Mortality After Radiotherapy vs. Observation for Localized Prostate Cancer: A Population-based Study

PURPOSEnContemporary patients with localized prostate cancer (PCa) are more frequently treated with radiotherapy. However, there are limited data on the effect of this treatment on cancer-specific mortality (CSM). Our objective was to test the relationship between radiotherapy and survival in men with localized PCa and compare it with those treated with observation.nnnMETHODSnA population-based cohort identified 68,797 men with cT1-T2 PCa treated with radiotherapy or observation between the years 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type (radiotherapy vs. observation) on CSM, after accounting to other-cause mortality. All analyses were carried out within PCa risk, baseline comorbidity status, and age groups.nnnRESULTSnRadiotherapy was associated with more favorable 10-year CSM rates than observation in patients with high-risk PCa (8.8 vs. 14.4%, hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.50-0.68). Conversely, the beneficial effect of radiotherapy on CSM was not evident in patients with low-intermediate risk PCa (3.7 vs. 4.1%, HR: 0.91, 95% CI: 0.80-1.04). Radiotherapy was beneficial in elderly patients (5.6 vs. 7.3%, HR: 0.70, 95% CI: 0.59-0.80). Moreover, it was associated with improved CSM rates among patients with no comorbidities (5.7 vs. 6.5%, HR: 0.81, 95% CI: 0.67-0.98), one comorbidity (4.6 vs. 6.0%, HR: 0.87, 95% CI: 0.75-0.99), and more than two comorbidities (4.2 vs. 5.0%, HR: 0.79, 95% CI: 0.65-0.96).nnnCONCLUSIONSnRadiotherapy substantially improves CSM in patients with high-risk PCa, with little or no benefit in patients with low-/intermediate-risk PCa relative to observation. These findings must be interpreted within the context of the limitations of observational data.