Chang Wook Jeong, Jang Hee Han, Dong Deuk Kwon, Jae Young Joung, Choung-Soo Kim, Hanjong Ahn, Jun Hyuk Hong, Tae-Hwan Kim, Byung Ha Chung, Seong Soo Jeon, Minyong Kang, Sung Kyu Hong, Tae Young Jung, Sung Woo Park, Seok Joong Yun, Ji Yeol Lee, Seung Hwan Lee, Seok Ho Kang, Cheol Kwak
Cancer Res Treat. 2024;56(2):634-641. Published online December 5, 2023
Purpose In men with metastatic castration-resistant prostate cancer (mCRPC), new bone lesions are sometimes not properly categorized through a confirmatory bone scan, and clinical significance of the test itself remains unclear. This study aimed to demonstrate the performance rate of confirmatory bone scans in a real-world setting and their prognostic impact in enzalutamide-treated mCRPC.
Materials and Methods Patients who received oral enzalutamide for mCRPC during 2014-2017 at 14 tertiary centers in Korea were included. Patients lacking imaging assessment data or insufficient drug exposure were excluded. The primary outcome was overall survival (OS). Secondary outcomes included performance rate of confirmatory bone scans in a real-world setting. Kaplan-Meier analysis and multivariate Cox regression analysis were performed.
Results Overall, 520 patients with mCRPC were enrolled (240 [26.2%] chemotherapy-naïve and 280 [53.2%] after chemotherapy). Among 352 responders, 92 patients (26.1%) showed new bone lesions in their early bone scan. Confirmatory bone scan was performed in 41 patients (44.6%), and it was associated with prolonged OS in the entire population (median, 30.9 vs. 19.7 months; p < 0.001), as well as in the chemotherapy-naïve (median, 47.2 vs. 20.5 months; p=0.011) and post-chemotherapy sub-groups (median, 25.5 vs. 18.0 months; p=0.006). Multivariate Cox regression showed that confirmatory bone scan performance was an independent prognostic factor for OS (hazard ratio 0.35, 95% confidence interval, 0.18 to 0.69; p=0.002).
Conclusion Confirmatory bone scan performance was associated with prolonged OS. Thus, the premature discontinuation of enzalutamide without confirmatory bone scans should be discouraged.
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Chang Wook Jeong, Sung Kyu Hong, Seok Soo Byun, Seong Soo Jeon, Seong Il Seo, Hyun Moo Lee, Hanjong Ahn, Dong Deuk Kwon, Hong Koo Ha, Tae Gyun Kwon, Jae Seung Chung, Cheol Kwak, Hyung Jin Kim
Cancer Res Treat. 2018;50(1):265-274. Published online April 14, 2017
Purpose
Korean patients with prostate cancer (PC) typically present with a more aggressive disease than patients in Western populations. Consequently, it is unclear if the current criteria for active surveillance (AS) can safely be applied to Korean patients. Therefore, this study was conducted to define appropriate selection criteria for AS for patients with PC in Korea.
Materials and Methods
We conducted a multicenter retrospective study of 2,126 patients with low risk PC who actually underwent radical prostatectomy. The primary outcome was an unfavorable disease, which was defined by non-organ confined disease or an upgrading of the Gleason score to ≥ 7 (4+3). Predictive variables of an unfavorable outcome were identified by multivariate analysis using randomly selected training samples (n=1,623, 76.3%). We compared our selected criteria to various Western criteria for the primary outcome and validated our criteria using the remaining validation sample (n=503, 23.7%).
Results
A non-organ confined disease rate of 14.9% was identified, with an increase in Gleason score ≥ 7 (4+3) of 8.7% and a final unfavorable disease status of 20.8%. The following criteria were selected: Gleason score ≤ 6, clinical stage T1-T2a, prostate-specific antigen (PSA) ≤ 10 ng/mL, PSA density < 0.15 ng/mL/mL, number of positive cores ≤ 2, and maximum cancer involvement in any one core ≤ 20%. These criteria provided the lowest unfavorable disease rate (11.7%) when compared to Western criteria (13.3%-20.7%), and their validity was confirmed using the validation sample (5.9%).
Conclusion
We developed AS criteria which are appropriate for Korean patients with PC. Prospective studies using these criteria are now warranted.
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Purpose The purpose of this study is to evaluate the effect of diabetes mellitus (DM) and preoperative glycemic control on prognosis in Korean patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). Materials and Methods A total of 566 patients who underwent RNU at six institutions between 2004 and 2014 were reviewed retrospectively. Kaplan-Meier and Cox regression analyses were performed to assess the association between DM, preoperative glycemic control, and recurrence-free, cancer-specific, and overall survival.
Results The median follow-up period was 33.8 months (interquartile range, 41.4 months). A total of 135 patients (23.8%) had DM and 67 patients (11.8%) had poor preoperative glycemic control. Patients with poor preoperative glycemic control had significantly shorter median recurrence-free, cancer-specific, and overall survival than patients with good preoperative glycemic control and non-diabetics (all, p=0.001). In multivariable Cox regression analysis, DM with poor preoperative glycemic control showed association with worse recurrence-free survival (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.31 to 3.90; p=0.003), cancer-specific survival (HR, 2.96; 95% CI, 1.80 to 4.87; p=0.001), and overall survival (HR, 2.13; 95% CI, 1.40 to 3.22; p=0.001). Conclusion Diabetic UTUC patients with poor preoperative glycemic control had significantly worse oncologic outcomes than diabetic UTUC patients with good preoperative glycemic control and non-diabetics. Further investigation is needed to elucidate the exact mechanism underlying the impact of glycemic control on UTUC treatment outcome.
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PURPOSE E-cadherin, a cell adhesive molecule that plays a diverse role in cell-cell and cell-matrix interaction, is essential for maintaining epithelial intercellular adhesion and acts particularly as a suppressor of invasive ability of cancer. To detennine the potential pro- gnostic values of membranous E-cadherin, we evaluated the correlation between the clin- ical outcome and its expression in patients with transitional cell carcinoma of the bladder. MATERIALS AND METHODS Membranous E-cadherin immunoreactivity was evaluated in 75 cases of transitional bladder cancer and 15 controls (5 cases of cystitis and 10 normal controls). The expression of membranous E-cadherin were compared with histological grade, T category of TNM stage, and survival. RESULTS Abnonnal immunohistochemical expression of membranous E-cadherin was observed in 53 (70.7%) patients with bladder cancer and undetected in controis. Abnormal immunohistochemical expression of membranous E-cadherin was significantly correlated with grade (p<0.01) and T category of TNM stage (p<0.01) of transitional cell carcinoma of the bladder. Progression to invasive cancer occurred in 6 patients with 45 superficial bladder cancer and 5 of them showed abnormal expression of E-cadherin, which had statistical significance (p<0.05) but not with recurrence.
There was statistically significant correlation between the abnormal expression of E-cadherin and poor prognosis (p < 0.01). CONCLUSIONS We conclude that abnormal expression of membranous E-cadherin is a useful prognostic marker in patients with transitional bladder cancer.
PURPOSE The detection of bladder cancers by noninvasive techniques remains an unsolved problem. We evaluate the availability of an immunoassay for urinary nuclear matrix protein, NMP 22, as an indicator for transitional cell carcinoma of the bladder. MATERIALS AND METHODS Three groups of subjects participated in this trial of NMP 22: 22 patients with transitional cell carcinoma (group 1), 12 patients with urinary tract infection (group 2) and 31 healthy volunteers (group 3). NMP 22 was determined by ELISA using a commercial test kit (NMP 22 Test Kit, Matritech Inc., USA), We compared urinary NMP 22 levels to the grade, stage, cytology and DNA flowcytometry of transitional cell carcinoma of bladder. RESULTS NMP 22 values in these 3 groups were significantly different (group 1, median 24.81 U/mL; group 2, median 8.41 U/mL; and group 3, median 5.12 U/mL; Mann-Whitney U test for differences between 3 medians, p < 0.05). The patients with transitional cell carcinoma had significantly greater urinary NMP 22 levels than those with no evidence of tumor (Mann-Whitney U test for differences between 2 medians, p<0.01). There was no zelationship between the urinary NMP 22 levels and tumor grade, stage, cytology or DNA flowcytometry. CONCLUSIONS It is possible that urinary NMP 22 could improve the detection of bladder transitional cell carcinoma.