Ryo Oka

External validation and comparison of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology in two patient populations: a retrospective cohort study

The aim of this study is to validate and compare the predictive accuracy of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology among representative patients with prostate cancer. We previously developed a nomogram, as did Chun et al. In this validation study, patients originated from two centers: Toho University Sakura Medical Center (n = 214) and Chibaken Saiseikai Narashino Hospital (n = 216). We assessed predictive accuracy using area under the curve values and constructed calibration plots to grasp the tendency for each institution. Both nomograms showed a high predictive accuracy in each institution, although the constructed calibration plots of the two nomograms underestimated the actual probability in Toho University Sakura Medical Center. Clinicians need to use calibration plots for each institution to correctly understand the tendency of each nomogram for their patients, even if each nomogram has a good predictive accuracy.

MP52-06 SERUM LIPID PROFILE CANNOT IMPROVE AFTER WITHDRAWAL OF ANDROGEN DEPRIVATION THERAPY IN PATIENTS WITH PROSTATE CANCER DESPITE THE RECOVERY OF SERUM TESTOSTERONE: IS THE CARDIOVASCULAR RISK STILL REMAINING?

METHODS: Patients with CRPC and bone metastases who completed 6 initial Ra-223 inj with no disease progression in bone and later progressed were eligible for Ra-223 re-tx (up to 6 additional Ra223 inj), provided that hematologic parameters were adequate. No concomitant cytotoxic agents were allowed; other concomitant agents (eg, abiraterone and enzalutamide) were allowed at investigator discretion. The primary objective was safety. Exploratory objectives included time to radiographic bone progression, radiographic progression-free survival (rPFS), time to total alkaline phosphatase (tALP) and prostate-specific antigen (PSA) progression, overall survival (OS), and time to first symptomatic skeletal event (SSE), all calculated from start of re-tx. The evaluation of safety and exploratory objectives included an active 2-year follow-up. Safety results from the active follow-up period and updated efficacy are reported. RESULTS: 44 patients were re-treated with Ra-223; 29 (66%) completed all 6 inj (median number inj 1⁄4 6). 34 (77%) of 44 patients entered active follow-up, during which no new safety concerns were noted. One new primary malignancy was reported (basal cell carcinoma; not considered related to study drug). There were no serious drug-related adverse events. 19 (43%) of 44 patients had an rPFS event (radiographic progression or death); median rPFS was 9.9 months. Only 5 (11%) of 44 patients had radiographic bone progression; median time to radiographic bone progression was not reached. Median time to tALP progression was not reached, median time to PSA progression was 2.2 months. Median OS was 24.4 months. Median time to first SSE was 16.7 months. CONCLUSIONS: Re-treating patients with Ra-223 was well tolerated in this select population, led to minimal hematologic toxicity, and provided continued disease control in bone at the 2-year follow-up.

External validation of two web-based postoperative nomograms predicting the probability of early biochemical recurrence after radical prostatectomy: a retrospective cohort study

The present study aimed to validate and compare the predictive accuracies of the Memorial Sloan Kettering Cancer Center (MSKCC) and Johns Hopkins University (JHU) web-based postoperative nomograms for predicting early biochemical recurrence (BCR) after radical prostatectomy (RP) and to analyze clinicopathological factors to predict early BCR after RP using our dataset. The c-index was 0.72 (95% confidence (CI): 0.61-0.83) for the MSKCC nomogram and 0.71 (95% CI: 0.61-0.81) for the and JHU nomogram, demonstrating fair performance in the Japanese population. Furthermore, we statistically analyzed our 174 patients to elucidate prognostic factors for early BCR within 2 years. Lymphovascular invasion (LVI) including lymphatic vessel invasion (ly) was a significant predictor of early BCR in addition to common variables (pT stage, extraprostatic extension, positive surgical margin and seminal vesicle invasion). LVI, particularly ly, may provide a good predictor of early BCR after RP and improve the accuracy of the nomograms.

Development and external validation of a nomogram to predict high-grade papillary bladder cancer before first-time transurethral resection of the bladder tumor

BackgroundThe aim of this study was to identify the clinical predictors related to the risk of high-grade papillary bladder cancer before first-time transurethral resection of a bladder tumor (TUR-Bt), and to develop and validate a nomogram predicting the risk of high-grade papillary bladder cancer.MethodsA retrospective clinical study of consecutive patients who underwent first-time TUR-Bt for papillary bladder cancer was performed. Medical records were reviewed uniformly, and the following data were collected: age, sex, episodes of urinary symptoms, tumor size, number of tumors, location of the largest tumor (lateral walls, base, posterior wall, dome, and anterior wall), tumor appearance (papillary or non-papillary, pedunculated or sessile), and urinary cytology. Data from 254 patients (Group A) were used for the development of a nomogram, while data from 170 patients (Group B) were used for its external validation.ResultsHigh-grade papillary bladder cancer was pathologically diagnosed in 51.6 and 74.6% of Group A and Group B patients, respectively. Based on univariable analyses in Group A, macrohematuria, tumor size, multiple tumors, appearance, and positive urinary cytology were selected as variables to incorporate into a nomogram. The AUC value was 0.81 for the internal validation (Group A), and 0.78 for the external validation (Group B). This novel nomogram can predict high-grade papillary bladder cancer accurately.ConclusionsThe present nomogram can help clinicians calculate the probability in patients with bladder cancer before TUR-Bt and decide on earlier intervention and priorities for the treatment of patients diagnosed with bladder cancer.

Worsening of the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in patients with prostate cancer after androgen deprivation therapy

Dear Editor, Prostate cancer (PCa) is the most frequently diagnosed male cancer in Western countries, and the number of PCa patients is also rapidly increasing in Japan.1,2 Simultaneously, androgen deprivation therapy (ADT) has also been increasingly used in PCa patients in recent years.3–5 However, the long-term use of ADT is associated with a variety of pivotal adverse events, including diabetes, anemia, osteoporosis, serum lipid profile changes, and cardiovascular disease (CVD).1,2 Higher low-density lipoprotein cholesterol (LDL-C) and/or lower high-density lipoprotein cholesterol (HDL-C) are well-established risk factors for CVD, and control of their levels has been an important goal in the treatment and prevention of CVD.6,7 Recently, another alternative parameter, the LDL-C to HDL-C (L/H) ratio, has been reported to be strongly associated with CVD and is thought to be a better predictor of future CVD than LDL-C alone. Closely monitoring serum lipid profile, including the L/H ratio changes affected by ADT, is a key to preventing CVD in PCa patients. Moreover, we previously suggested that a higher L/H ratio might have an impact on the development of arterial stiffness after ADT administration.7 Although some cutoff points of the L/H ratio have been reported in clinical use, it has been suggested that thrombosis can occur when the L/H ratio increases to around 2.5 or more in East Asian populations.6 The aim of the present study was to investigate the changes in serum lipid profile and to identify the clinical factors associated with an increased L/H ratio in PCa patients who received ADT. This was a retrospective study approved by the institutional review board of Toho University Sakura Medical Center (No. 2012-008). All patients enrolled in the study gave their written informed consent. One hundred patients with pathologically confirmed PCa scheduled to receive ADT for more than 6 months between March 2012 and August 2015 were analyzed. Patients and the statistical analysis methods are minutely described in the LETTER TO THE EDITOR

Bone markers predict survival in castration-resistant prostate cancer patients treated with docetaxel

Bone markers predict survival in castration-resistant prostate cancer patients treated with docetaxel