Background
Nephron-sparing surgery (NSS) is the treatment of choice for T1 renal tumors. This study compared the implementation of NSS in the United States and Germany.
Methods
Data were derived from ...the National Inpatient Sample and from the Nationwide German Hospital Billing Database. All cases of NSS and radical nephrectomy from 2006 to 2014 were analyzed. To assess tumor stage distribution, data from the Surveillance, Epidemiology, and End Results database (United States) and from German cancer registries were used.
Results
The study identified 74,663 cases in the United States and 130,051 cases in Germany. The proportion of NSS for T1 tumors increased from 30.6 to 57% in the United States compared with 38.5 to 72.9% (estimation) in Germany (
p
< 0.001). The proportion of robotic NSS increased from 0 to 54.5% in the United States (
p
< 0.001) and from 0.2 to 8.6% in Germany (
p
< 0.001). In a multivariate model, hospitals with higher annual caseloads and a surgical robot favored NSS.
Conclusion
Patients with renal tumors might receive inhomogeneous care based on the resources of the treating institution. The robotic approach is a key driver for better implementation of NSS in the United States, and relevant potential still may exist for more organ preservation.
Background
The analysis aimed to compare the radiotracers
68
Ga-Ga-PSMA-11 and
18
F-F-PSMA-1007 intraindividually in terms of malignant lesions, mi(molecular-imaging)TNM staging and presumable ...unspecific lesions retrospectively as used in routine clinical practice.
Methods
A retrospective analysis of 46 prostate cancer patients (median age: 71 years) who underwent consecutive
68
Ga-Ga-PSMA-11- and
18
F-F-PSMA-1007-PET/CT or PET/MRI within a mean of 12 ± 8.0 days was performed. MiTNM staging was performed in both studies by two nuclear medicine physicians who were blinded to the results of the other tracer. After intradisciplinary and interdisciplinary consensus with two radiologists was reached, differences in both malignant and presumable nonspecific tracer accumulation were analyzed.
Results
Differences in terms of miTNM stages in both studies occurred in nine of the 46 patients (19.6%). The miT stages differed in five patients (10.9%), the miN stages differed in three patients (6.5%), and different miM stages occurred only in one patient who was upstaged in
18
F-F-PSMA-1007 PET. Concordant miTNM stages were obtained in 37 patients (80.4%). There was no significant difference between
18
F-F-PSMA-1007 and
68
Ga-Ga-PSMA-11 in the SUV
max
locally (31.5 vs. 32.7;
p
= 0.658), in lymph node metastases (28.9 vs. 24.9;
p
= 0.30) or in bone metastases (22.9 vs. 27.6;
p
= 0.286). In
18
F-F-PSMA-1007 PET, more patients featured presumable unspecific uptake in the lymph nodes (52.2% vs. 28.3%;
p
: < 0.001), bones (71.7% vs. 23.9%;
p
< 0.001) and ganglia (71.7% vs. 43.5%;
p
< 0.001). Probable unspecific, exclusively
18
F-F-PSMA-1007-positive lesions mainly occurred in the ribs (58.7%), axillary lymph nodes (39.1%) and cervical ganglia (28.3%).
Conclusion
In terms of miTNM staging, both tracers appeared widely exchangeable, as no tracer relevantly outperformed the other. The differences between the two tracers were far more common in presumable unspecific lesions than in malignant spots. A routinely performed two-tracer study could not be shown to be superior. Since it seems at least challenging for most nuclear medicine departments to provide both
18
F-F-PSMA-1007 and
68
Ga-Ga-PSMA-11, it appears reasonable to choose the PSMA radiotracer depending on local availability with attention to the greater occurrence of nonspecific bone findings with
18
F-F-PSMA-1007.
Background
Penile cancer is a rare disease and surgical treatment often entails a significant impact on quality of life. The aim of this study was to analyze trends in surgical treatment patterns in ...Germany.
Methods
We analyzed data from the nationwide German hospital billing database and the German cancer registry from 2006 to 2016. All penile cancer cases with penile surgery or lymph node dissection (LND) were included. We also analyzed the distribution of cases, extent of surgery, and length of hospital stay, stratified for annual caseload. The geographical distribution of centers for 2016 was presented.
Results
During the investigated timespan, tumor incidences increased from 748 to 971 (
p
= 0.001). We identified 11,353 penile surgery cases, increasing from 886 to 1196 (
p
< 0.001), and 5173 cases of LND, increasing from 332 to 590 (
p
< 0.001). Cases of partial amputation increased from 45.8 to 53.8% (
p
< 0.001), while total amputation remained stable at 11.2%. Caseload in high-volume hospitals increased from 9.0 to 18.8% for penile surgery (
p
< 0.001) and from 0 to 13.1% for LND (
p
< 0.001). The increase in LND caseload was caused by an increase in inguinal LND, from 297 to 505 (
p
< 0.001), with increasing sentinel LND, from 14.2 to 21.9% (
p
= 0.098). The assessment of geographical distribution of cases in Germany revealed extensive areas without sufficient coverage by experienced centers.
Conclusions
We saw consistent increases in penile surgery and LND, with a growing number of cases in high-volume hospitals, and, accordingly, an increase in tumor incidence. The increasing use of inguinal LND and organ-preserving surgery reflect the adaptation of current guidelines; however, geographical distribution of experienced centers could be improved.
Objectives
To compare targeted, transperineal magnetic resonance imaging (MRI)/ultrasound (US)‐fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate ...biopsy and to evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/US‐fusion biopsies.
Patients and Methods
In all, 263 consecutive patients with suspicion of prostate cancer were investigated. All patients were evaluated by 3‐T multiparametric MRI (mpMRI) applying the European Society of Urogenital Radiology criteria. All patients underwent MRI/US‐fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores).
Results
In all, 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. The median age was 66 years, median PSA level was 8.3 ng/mL and median prostate volume was 50 mL. Overall, the prostate cancer detection rate was 52% (137/263). MRI/US‐fusion biopsy detected significantly more cancer than systematic prostate biopsy (44% 116/263 vs 35% 91/263; P = 0.002). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (P = 0.002). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (P = 0.527). In all, 80% (110/137) of biopsy confirmed prostate cancers were clinically significant. For the upgrading of Gleason score, 44% (32/72) more clinically significant prostate cancer was detected by using additional targeted biopsy than by systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy.
Conclusions
MRI/US‐fusion biopsy was associated with a higher detection rate of clinically significant prostate cancer while taking fewer cores, especially in patients with prior negative biopsy. Due to a high portion of additional tumours with Gleason score ≥7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.
Objective
Our aim was to assess and compare trends of urinary diversion (UD) for patients receiving radical cystectomy for the treatment of bladder cancer in the US and Germany, and to investigate ...decisive predictors for the choice of UD.
Methods
We analyzed the nationwide German hospital billing database and the Nationwide Inpatient Sample (NIS) from 2006 to 2014. Cases with a bladder cancer diagnosis combined with RC were included, and trends in the choice of UD, transfusion rates, length of stay, and mortality were assessed.
Results
From 2006 to 2014, the total number of RCs recorded within the NIS were 17,711, with a varying annual caseload of 1666–2009, while RC numbers increased from 5627 to 7390 in Germany (
p
< 0.001 for trends), with a total of 60,447 cases. The share of incontinent UD in the US remained stable at 93%, while increasing from 63.2 to 70.8% in Germany. Multivariate models indicated age and sex were the most important factors associated with the choice of UD in both countries, while hospital caseload and teaching status were less relevant factors in the US. In-hospital mortality was lower in the US compared with Germany (1.9% vs. 4.6%;
p
< 0.001), with significantly shorter hospital stays (10.7 days in the US vs. 25.1 days in Germany;
p
< 0.001).
Conclusions
The increasing age of patients with presumably higher comorbidity in recent years led to increased use of incontinent UD in Germany, while continent UD appears to be underused in the US. Mortality and transfusion rates were significantly lower in the US within a shorter hospital stay.
Introduction
Retroperitoneal lymph node dissection (RPLND) is a standard treatment in the management of metastatic testicular cancer. Due to modified treatment algorithms, it is becoming less ...frequent.
Materials and methods
We analyzed data from the nationwide German hospital billing database covering 2006–2015. Cases with a testicular cancer diagnosis combined with RPLND were included. We assessed the length of hospital stay (LOS), blood transfusion, and in-hospital mortality stratified for surgical approach, hospital characteristics, and annual caseload. Annual hospital caseload categories were defined as low (< 4), medium (4–10), and high (> 10). We supplemented tumor incidence and staging data from the German cancer registry (60% of population).
Results
4926 cases were included with decreasing annual caseload numbers from 623 in 2006 to 382 in 2015. The incidence of testicular cancer and higher tumor stages remained stable. High-volume hospitals performed 19.4%, medium-volume hospitals 43.7%, and low-volume hospitals 36.8% RPLNDs. Low- abd medium-volume hospitals declined, while high-volume hospitals (
n
= 5) maintained their annual caseload. Overall in-hospital mortality was 0.47%. Blood transfusion rates were higher in high-volume centers assumedly due to selection of more complex cases. However, high-volume hospitals showed a shorter LOS with 10.5 vs. 11.2 (medium volume), and 12.7 days (low volume).
Conclusion
Total numbers of RPLND have declined from 2006 to 2015, while tumor incidences and stages remained fairly stable. Constant reduction of indication in guidelines contributes to this finding. High-volume hospitals achieve shorter hospital stays in spite of assumedly more complex and extensive cases. There is a modest trend towards unregulated centralization.
Purpose
To explore associations of nutritional, infectious, and lifestyle factors with esophageal cancer (EC) occurrence in a high-risk area of Malawi.
Methods
This case–control study was performed ...with 227 patients undergoing endoscopy for dysphagia or other upper gastrointestinal complaints. Data on clinicopathological characteristics and risk factors were collected using a questionnaire developed for this study specifically. Ninety-eight blood samples were collected and the prevalence of antibodies against human immunodeficiency virus, herpes simplex virus, cytomegalovirus, Epstein–Barr virus, varicella-zoster virus, and
Helicobacter pylori
were determined serologically.
Results
The tumor and control groups comprised 157 (69.2%) and 70 (31.8%) patients, respectively. Patients with tumors were significantly older than controls (55.5 vs. 43.5 years,
p
< 0.001). The male/female ratio did not differ between groups (59% and 54% male, respectively;
p
= 0.469). EC was associated with smoking (
p
< 0.001), and alcohol consumption (
p
= 0.020), but 43% of patients with tumors did not smoke or drink. EC was associated with the consumption of hot food and tea (
p
= 0.003) and smoked fish (
p
= 0.011). EC was not associated with any serologically investigated infectious agents. In an age adjusted binary logistic regression analysis of all nutritive factors, only locally made alcohol was significant odds ratio (OR), 9.252; 95% confidence interval (CI), 1.455—58.822;
p
= 0.018.
Conclusions
Apart from alcohol consumption and smoking, the consumption of hot food or tea and smoked fish are associated with EC. Locally distilled alcohol consumption increases the EC risk in Malawi.
Purpose
To compare long-term functional outcomes after robotic vs. retropubic RP for patients with localized prostate cancer in routine care.
Methods
“HAROW” was a large German noninterventional ...health services research study that prospectively evaluated the treatment of patients with localized prostate cancer (≤ T2c). We sent validated questionnaires to 1260 patients who underwent RP to evaluate long-term outcomes.
Results
After a median follow-up of 6.3 interquartile range (IQR) 4.8–7.6 years, 42 (3%) patients had died. The return rate of the questionnaire was 76.8% (936/1218). The approach was robotic in 404 and retropubic in 532 patients. In the multivariate analysis, lack of postoperative radiotherapy odds ratio (OR) 3.1, younger patient age (< 60 years: OR 2.8; 60–69 years: OR 2.1), preoperative urinary continence (OR 2.4), and higher annual hospital caseload (≥ 200 cases: OR 1.6) were independent predictors of urinary continence. The potency rate after nerve-sparing RP in preoperatively potent men was 40.5% (111/274). In the multivariate analysis, younger patient age (< 60 years: OR 17.9; 60–69 years: OR 8.0), lower oncologic risk (OR 2.8), and lack of postoperative radiotherapy (OR 2.2) were independent predictors of potency.
Conclusion
Younger age and lack of postoperative radiotherapy were associated with better urinary continence and erectile function. Additionally, a high annual caseload (≥ 200 RP/year) was associated with better urinary continence. Younger age, low or intermediated oncological risk and lack of postoperative radiotherapy were independent predictors for a trifecta outcome. The surgical approach did not affect long-term functional outcomes.
For decades, mono androgen deprivation therapy (ADT) has been the gold standard for metastatic hormone-sensitive prostate cancer (mHSPC) treatment. Several studies have been published within the last ...seven years demonstrating a significant survival advantage by combination treatment with standard ADT plus docetaxel or androgen receptor-axis-targeted therapy (ARAT) compared to ADT monotherapy. As a result, overall survival can be prolonged by at least 18 months. Recently published congress data of the PEACE-1 study suggests that in the future, triple therapy might be the new gold standard. In addition to this study, which has shown that triple treatment with standard ADT plus docetaxel plus abiraterone is superior to standard ADT plus docetaxel, several other phase III triple therapy studies are currently ongoing. The different modes of action that are investigated reach from AR-targeting over mitotic inhibition and immunotherapy to PARP and AKT inhibition. In this review we will explore if triple therapy has the potential to be the new standard for mHSPC treatment in the near future.
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