Abstract Objectives There are numerous reports describing the use of radiofrequency ablation (RFA) to treat renal cell carcinoma. Many series, however, describe heterogeneous populations, lack ...histologic descriptions, use various RFA systems, and indicate tumor destruction by different ablation end points. This study examined the outcomes of computed tomography–guided, impedance-based RFA of biopsy-proven renal cell carcinoma clinically staged as T1a with a minimum of 1 year of postablation follow-up. Methods and materials This retrospective study identified all consecutive patients who had undergone renal RFA since May 2005 at our institution. Patients without biopsy-proven renal cell carcinoma (RCCa) were excluded. Of the patients who met these criteria, evaluation was limited to patients with a minimum of 12 months of follow-up. Data collected from the patients׳ electronic medical and radiologic records included demographic data, tumor-related data, procedural details, and clinical follow-up visits. Results A total of 39 patients (46 lesions) met the inclusion criteria. The mean tumor diameter was 2.6 cm (range: 1.2–4.0 cm). The most common histologies were clear cell ( n = 27) and papillary ( n = 16) renal cancer. The lesion location was equally divided between upper pole ( n = 16), middle pole ( n = 16), and lower pole ( n = 14). Overall, 83% of the tumors were exophytic. No residual or recurrent enhancing mass was identified in the ablation bed on post-RFA imaging during the mean follow-up period of 35.3 months (range: 12–83). All patients were treated in a single encounter and no lesion required a second ablation; technical success (absence of residual tumor) on the initial post-RFA imaging study was 46 of 46 (100%). Clinical success was achieved in 45 of 46 lesions (98%); residual, viable tumor was found in a pretransplant nephrectomy specimen on postprocedure day 127. The mean cancer-free survival was 36.2 months. Comparison of preablation and postablation renal function found no statistically significant change. Conclusions The consistent outcomes in our post-RFA imaging and clinical surveillance allow us to offer image-guided ablation to patients with T1a RCCa as a valid treatment option offering long-term cancer-free survival. Impedance-based RFA in a carefully selected patient population with T1a RCCa is a reliable treatment option, with disease-free survival rates that are comparable to partial nephrectomy.
Cancer care guidelines recommend aligning surveillance frequency with underlying cancer risk, ie, more frequent surveillance for patients at high vs low risk of cancer recurrence.
To assess the ...extent to which such risk-aligned surveillance is practiced within US Department of Veterans Affairs facilities by classifying surveillance patterns for low- vs high-risk patients with early-stage bladder cancer.
US national retrospective cohort study of a population-based sample of patients diagnosed with low-risk or high-risk early-stage bladder between January 1, 2005, and December 31, 2011, with follow-up through December 31, 2014. Analyses were performed March 2017 to April 2018. The study included all Veterans Affairs facilities (n = 85) where both low-and high-risk patients were treated.
Low-risk vs high-risk cancer status, based on definitions from the European Association of Urology risk stratification guidelines and on data extracted from diagnostic pathology reports via validated natural language processing algorithms.
Adjusted cystoscopy frequency for low-risk and high-risk patients for each facility, estimated using multilevel modeling.
The study included 1278 low-risk and 2115 high-risk patients (median interquartile range age, 77 71-82 years; 99% 3368 of 3393 male). Across facilities, the adjusted frequency of surveillance cystoscopy ranged from 3.7 to 6.2 (mean, 4.8) procedures over 2 years per patient for low-risk patients and from 4.6 to 6.0 (mean, 5.4) procedures over 2 years per patient for high-risk patients. In 70 of 85 facilities, surveillance was performed at a comparable frequency for low- and high-risk patients, differing by less than 1 cystoscopy over 2 years. Surveillance frequency among high-risk patients statistically significantly exceeded surveillance among low-risk patients at only 4 facilities. Across all facilities, surveillance frequencies for low- vs high-risk patients were moderately strongly correlated (
= 0.52;
< .001).
Patients with early-stage bladder cancer undergo cystoscopic surveillance at comparable frequencies regardless of risk. This finding highlights the need to understand barriers to risk-aligned surveillance with the goal of making it easier for clinicians to deliver it in routine practice.
The presence and depth of urothelial cancer involvement in the prostatic urethra can significantly affect the management of a patient with non-muscle invasive bladder cancer. This article presents an ...overview of the incidence, diagnosis, management, and follow-up of urothelial cancer.
Improving the consistency and reproducibility of bladder cancer prognoses necessitates the development of accurate, predictive prognostic models. Current methods of determining the prognosis of ...bladder cancer patients rely on manual decision-making, including factors with high intra- and inter-observer variability, such as tumor grade. To advance the long-term prediction of bladder cancer prognoses, we developed and tested a computational model to predict the 10-year overall survival outcome using population-based bladder cancer data, without considering tumor grade classification. The resulted predictive model demonstrated promising performance using a combination of clinical and molecular features, and was also strongly related to patient overall survival in Cox models. Our study suggests that machine learning methods can provide reliable long-term prognoses for bladder cancer patients, without relying on the less consistent tumor grade. If validated in clinical trials, this automated approach could guide and improve personalized management and treatment for bladder cancer patients.
Abstract Introduction Dysregulation of the hedgehog signaling pathway has been linked to the development and progression of a variety of different human tumors including cancers of the skin, brain, ...colon, prostate, blood, and pancreas. We assessed the clinicopathological factors that are potentially related to expression of Gli1, the transcription factor that is thought to be the most reliable marker of hedgehog pathway activation in bladder cancer. Methods Bladder cancer cases were identified from the New Hampshire State Cancer Registry as histologically confirmed primary bladder cancer diagnosed between January 1, 2002, and July 31, 2004. Immunohistochemical analysis was performed on a tissue microarray to detect Gli1and p53 expression in these bladder tumors. We computed odds ratios (ORs) and their 95% CIs for Gli1 positivity for pathological category using T category (from TNM), invasiveness, and grade with both the World Health Organization 1973 and World Health Organization International Society of Urological Pathology criteria. We calculated hazard ratios and their 95% CI for Gli1 positivity and recurrence for both Ta-category and invasive bladder tumors (T1+). Results A total of 194 men and 67 women, whose tumors were assessable for Gli1 staining, were included in the study. No appreciable differences in Gli1 staining were noted by sex, age, smoking status, or high-risk occupation. Ta-category tumors were more likely to stain for Gli1 as compared with T1-category tumors (adjusted OR = 0.38, CI: 0.17–0.87). Similarly, low-grade (grades 1–2) tumors were more likely to stain for Gli1 as compared with high-grade tumors (grade 3) (adjusted OR = 0.44, CI: 0.21–0.93). In a Cox proportional hazards regression analysis, non–muscle-invasive bladder tumors expressing Gli1 were less likely to recur (adjusted hazard ratio = 0.48; CI: 0.28–0.82; P <0.05) than those in which Gli1 was absent. Conclusion Our findings indicate that Gli1 expression may be a marker of low-stage, low-grade bladder tumors and an indicator of a reduced risk of recurrence in this group.
Metastatic embyronal carcinoma to the subcutaneous tissues is rare. Prior cases have occurred in the setting of undiagnosed widely metastatic disease. Here we present the first case of metastatic ...embyronal cancer to the contralateral subcutaneous inguinal region in the absence of any other sites of metastatic disease.
Benefits of early diagnosis and treatment remain debatable for men with low-risk prostate cancer. Active surveillance (AS) is an alternative to treatment. The goal of AS is to identify patients whose ...cancer is progressing rapidly while avoiding treatment in the majority of patients. The purpose of this study was to explore cognitive and affective representations of AS within a clinical environment that promotes AS a viable option for men with low-risk prostate cancer. Participants included patients for whom AS and active treatment were equally viable options, as well as practitioners who were involved in consultations for prostate cancer. Data were generated from semistructured interviews and audits of consultation notes and were analyzed using thematic analysis. Nineteen patients and 16 practitioners completed a semistructured interview. Patients generally viewed AS as a temporary strategy that was largely equated with inaction. There was variation in the degree to which inaction was viewed as warranted or favorable. Patient perceptions of AS were generally malleable and able to be influenced by information from trusted sources. Encouraging slow deliberation and multiple consultations may facilitate greater understanding and acceptance of AS as a viable treatment option for low-risk prostate cancer.
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