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Background: The American Joint Committee on Cancer (AJCC) has increasingly recognized the need for individual risk prediction model. The AJCC has emphasized the attractiveness of ...disease-specific mortality (DSM), which can properly control for competing events. as an endpoint of risk model, as well as overall survival (OS) and disease-specific survival (DSS). For the era of tailored therapy, we aimed to develop a new pretreatment gastric cancer nomogram for prediction of DSM. Methods: The nomogram was developed using data of 5,231 patients with primary gastric cancer treated at Shizuoka Cancer Center (Shizuoka, Japan), and it was created with a Fine and Gray competing-risks proportional hazards regression model. Fifteen clinical variables, which were obtained at pretreatment, were collected and registered, to develop the nomogram. Data of independent cohort of patients from the University of Verona (Italy; 389 patients) formed the external validation cohort. The model was validated internally and externally using measures of discrimination (Harrell’s C-index), calibration and decision curve analysis. Results: In the development procedure, multivariable analysis for DSM selected 14 variables for constructing the nomogram. The developed nomogram showed good discrimination, with a C-index of 0.887 (95%CI; 0.881-0.894); that of the American Joint Committee on Cancer (AJCC) clinical stage was 0.794 (0.784-0.804). In the external validation procedure, the C-index was 0.713 (0.680-0.746) (AJCC, 0.582, 0.539-0.622) in the University of Verona cohort. The nomogram performed well in the calibration and decision curve analyses when applied to both the internal and external validation cohorts. Conclusions: This new pretreatment risk model accurately predicts DSM in gastric cancer and can be used for patient counseling in clinical practice and stratification in clinical trials.
We review the effectiveness of androgen‐deprivation therapy (ADT) in the management of prostate cancer, and the effect that this treatment has on a patient’s quality of life (QoL), based on ...discussions held at a European symposium on the management of prostate cancer. The overall QoL is reduced in asymptomatic men, and there are known decreases in cognitive function, self‐esteem, libido and sexual function. Hot flashes are also a frequent problem. Prolonged ADT can lead to osteoporosis and subsequently fractures. Various effective methods exist to manage and minimize these side‐effects; some are specific to the side‐effect, whereas other more general methods include lifestyle changes, specific drugs and added hormonal manipulations. Intermittent ADT for patients taking luteinizing hormone‐releasing hormone agonists offers a promising method to reduce adverse effects, and possibly increases the time to androgen independence. Initial studies indicate that prostate‐specific antigen‐based progression with intermittent ADT is similar to that seen with continuous ADT, but there is a reduction in side‐effects, leading to an improvement in QoL.
A proportion of UC patients with restorative proctocolectomy and IPAA develop pouch failure. Accurate risk assessment is critical for making proper evaluation and treatment. Information on factors ...that may reliably predict pouch failure for the patients requiring referral to a specialized care unit is minimal.
We sought to develop and internally validate a nomogram for the prediction of late-onset pouch failure.
The study cohort included all eligible UC patients with restorative proctocolectomy and IPAA at the subspecialty Pouchitis Clinic from 2002 to 2009. Inclusion criteria were patients having: 1) inflammatory bowel disease; 2) ileal pouches; and 3) regular follow-up at the Pouchitis Clinic. Demographic and clinical variables were prospectively collected. Multivariable accelerated failure time regression model was developed to predict pouch failure defined as pouch excision or permanent diversion. Discrimination and calibration of the model were assessed following bootstrapping methods for correcting optimism, and the model was presented as a nomogram.
A total of 921 patients were included for the model. The mean age for this cohort was 45.5years old. The mean follow-up at the Pouchitis Clinic was 5.8years. Kaplan–Meier analysis showed that the probabilities for pouch retention are 0.939, 0.916 and 0.907 at 3, 5 and 7years, respectively. The predictor variables which were included in the nomogram were smoking, duration of the pouch, baseline pouch diagnosis, and pre- and post-op use of biologics. The concordance index was 0.824. The nomogram seemed well calibrated based on the calibration curve.
The nomogram model appeared to predict late-onset pouch failure reasonably well with satisfactory concordance index and calibration curve. The nomogram is readily applicable for clinical practice in pouch patients.
Making predictions is an essential part of any medical decision. It is particularly crucial when considering treatment of clinically localized prostate cancer. Nomograms and prediction model software ...typically provide the most accurate predictions. Many nomograms have been developed, for all prostate cancer clinical states. Some of these are discussed in this review, as is their utility in facilitating decision making and informed consent.
Treatment decisions on prostate cancer diagnosed by trans-urethral resection (TURP) of the prostate are difficult. The current TNM staging system for pT1 prostate cancer has not been re-evaluated for ...25 years. Our objective was to optimise the predictive power of tumor extent measurements in TURP of the prostate specimens. A total of 914 patients diagnosed by TURP of the prostate between 1990 and 1996, managed conservatively were identified. The clinical end point was death from prostate cancer. Diagnostic serum prostate-specific antigen (PSA) and contemporary Gleason grading was available. Cancer extent was measured by the percentage of chips infiltrated by cancer. Death rates were compared by univariate and multivariate proportional hazards models, including baseline PSA and Gleason score. The percentage of positive chips was highly predictive of prostate cancer death when assessed as a continuous variable or as a grouped variable on the basis of and including the quintiles, quartiles, tertiles and median groups. In the univariate model, the most informative variable was a four group-split (≤10%, >10-25%, >25-75% and >75%); (HR=2.08, 95% CI=1.8-2.4, P<0.0001). The same was true in a multivariate model (ΔX(2) (1 d.f.)=15.0, P=0.0001). The current cutoff used by TNM (<=5%) was sub-optimal (ΔX(2) (1 d.f.)=4.8, P=0.023). The current TNM staging results in substantial loss of information. Staging by a four-group subdivision would substantially improve prognostication in patients with early stage disease and also may help to refine management decisions in patients who would do well with conservative treatments.
Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Treatment regret can have an adverse impact on a patient's overall outlook and has ...been associated with a poorer global quality of life. Understanding predictors of regret can help clinicians better counsel patients about their treatments so that later regret can be avoided. In previous studies, regret has been associated with lesser educational attainment, non‐White race, greater post‐treatment declines in sexual function and systemic symptoms.
The present study found that, among men with recurrent prostate cancer, those with cardiovascular comorbidity were >50% more likely to regret their treatment choice than men without cardiovascular comorbidity. This study highlights the growing importance of considering comorbidity when counselling patients about prostate cancer treatment options, and provides a rationale for men with cardiovascular comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer.
OBJECTIVE
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To determine whether cardiovascular comorbidity is associated with increased treatment regret among men with recurrent prostate cancer.
METHODS
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The study cohort comprised 795 men in the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry who experienced biochemical recurrence at a median (interquartile range) of 5.5 (2.8–9.1) years after prostatectomy (n= 410), external beam radiation therapy (n= 237), brachytherapy (n= 124) or primary androgen deprivation therapy (n= 24).
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Multivariable logistic regression analysis was used to determine whether cardiovascular comorbidity was associated with treatment regret.
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Cardiovascular comorbidity, which included myocardial infarction, congestive heart failure, angina, diabetes, stroke or circulation problems, was defined using a validated two‐question screening process after adjusting for sociodemographic and treatment factors and post‐treatment bladder and bowel toxicity.
RESULTS
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Of 795 men, 14.8% reported regret.
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Men with cardiovascular comorbidity were more likely to experience post‐therapy bowel toxicity (P= 0.022).
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In the adjusted multivariable model, the factors associated with increased treatment regret were: cardiovascular comorbidity (adjusted odds ratio AOR= 1.52 95% CI:1.00–2.31, P= 0.048); younger age (AOR: 0.97 95% CI 0.94–0.99 per year increase in age, P= 0.019); and bowel toxicity after treatment (AOR 1.58 95% CI 1.03–2.43, P= 0.038).
CONCLUSIONS
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Among men with recurrent prostate cancer, those with cardiovascular comorbidity were >50% more likely to experience treatment regret than men without cardiovascular comorbidity.
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These data provide a rationale for men with cardiovascular comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer.
We determined the frequency of tumor multifocality in patients with renal cortical tumors, characterized clinical and pathological features associated with multifocality and evaluated its effect on ...patient survival.
Between July 1989 and July 2002, 1,071 radical nephrectomies were performed at our institution. Specimens were examined grossly and microscopically for multifocal tumors. Preoperative imaging was reviewed to determine whether multifocality was suspected prior to operation. Multivariate analysis was performed to identify clinical and pathological factors associated with multifocality.
Of 1,071 radical nephrectomy specimens 57 (5.3%) had pathological evidence of tumor multifocality. Bilateral synchronous renal cortical tumors were present in 6 of the 57 multifocal cases (11%). A total of 19 cases (33%) had evidence of multifocality on preoperative imaging and, therefore, occult multifocality undetected on preoperative imaging was present in 3.5% of radical nephrectomies (38 of 1,071). Primary tumors in the multifocal group were most commonly conventional clear cell carcinoma, followed by papillary carcinoma. Of multifocal cases 74% had the same histological subtype in all tumors. Multivariate analysis demonstrated that bilaterality, papillary subtype, advanced tumor stage and lymph node metastasis were associated with multifocality. At a median follow up of 40.5 months overall survival, disease-free survival, and disease-free probability were not significantly different between the multifocal and unifocal groups.
We report a 5.3% frequency of multifocal renal cortical tumors and a 3.5% frequency of clinically unsuspected multifocal tumors. Multifocality had no apparent effect on recurrence or survival in patients who underwent radical nephrectomy.
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