Arnav Srivastava | Johns Hopkins University School of Medicine (original) (raw)
Papers by Arnav Srivastava
Journal of the American College of Surgeons
Journal of Kidney Cancer and VHL
Renal angiomyolipomas (AMLs) are a subset of perivascular epithelioid cell neoplasms (PEComas) th... more Renal angiomyolipomas (AMLs) are a subset of perivascular epithelioid cell neoplasms (PEComas) that are associated with tuberous sclerosis complex (TSC). Epithelioid angiomyolipomas (EAMLs) are a rare variant of AML with more aggressive propensities. EAMLs with malignant potential can be difficult to distinguish from relatively benign AMLs and other renal tumors. Although there are no established criteria for predicting EAML malignancy, there are proposed histologic parameters that are associated with higher tumor risk. EAML can be treated with surgical resection as well as mTOR inhibitors. Here, we present a unique case of a patient with a 36-cm renal EAML metastatic to the lungs that was treated with complete surgical resection of the primary lesion and mTOR inhibition.
Cancers
The role of CN in the treatment of metastatic renal cell carcinoma (mRCC) has been studied over t... more The role of CN in the treatment of metastatic renal cell carcinoma (mRCC) has been studied over the course of the past few decades. With the advent of immuno-oncologic (IO) agents, there has been a paradigm shift in the treatment of RCC. Within this new era of cancer care, the role of CN is unclear. There are several studies currently underway that aim to assess the role of CN in combination with these therapies. We reviewed articles examining CN, both historically and in the modern immunotherapy era. While immune-oncologic agents are relatively new and large clinical trials have yet to be completed, data thus far is promising that CN may provide clinical benefit. Multiple ongoing trials may clarify the role of CN in this new era of cancer care.
Prostate International, 2022
Journal of the American College of Surgeons, 2021
Purpose: The American Urological Association (AUA) Annual Meeting serves as the premier platform ... more Purpose: The American Urological Association (AUA) Annual Meeting serves as the premier platform for presenting unpublished research in urology. Among selected abstracts, podium presentations represent the most impactful submissions. While podium presentations receive a large audience through conference attendance and social media posts, it is unclear how often they manifest as publications in peer-reviewed journals. Materials and Methods: Podium presentations from the 2017 AUA Annual Meeting were reviewed. Abstracts were assessed for publication between January 1, 2015 and May 31, 2020 allowing for a 3-year window of publication and accounting for publications prior to the submission deadline. Abstract authors were individually searched with key terms being added sequentially until <30 results were generated in PubMed®. Abstracts were deemed published if at least 1 author and 1 conclusion matched a manuscript. Publication rate, time to publication, and 2019 journal impact factor were collected. Statistical analysis was performed by linear and logistic regression. Results: Of 872 podium presentations, 453 (51.9%) were published within 3 years. Median time from submission to publication was 12.5 months (IQR: 7.5–20.5). The number of articles published at 1, 2 and 3 years from submission was 203, 368 and 430, respectively. The median journal impact factor of publications was 3.2 (IQR: 2.0–5.8). Oncology studies (OR=1.21 [95% CI: 0.91–1.60], p=0.186) had similar rates of publication compared to non-oncology studies. Conclusions: While AUA podium presentations disseminate valuable data, approximately half were not published in peer-reviewed journals within 3 years. Therefore, care must be taken when promoting findings or adopting new practices based on these presentations alone.
Current Urology Reports, 2021
Purpose of Review Pheochromocytoma and paraganglioma (PPGLs) are neuroendocrine tumors with diver... more Purpose of Review Pheochromocytoma and paraganglioma (PPGLs) are neuroendocrine tumors with diverse clinical presentations. PPGLs can be sporadic but often are associated with various syndromes, which can have variable clinical presentations. A thorough workup is therefore critical for staging, treatment, and follow-up. Imaging is an essential part of the workup and diagnosis of PPGLs. Recent Findings Improvements in cross-sectional imaging with radionuclides have increased specificity and sensitivity for identifying and treating PPGLs. Furthermore, a variety of targets on PPGLs has allowed for optimal imaging with radionuclides that can be used for staging and treatment. Currently, radionuclides are being evaluated for staging and treatment of PPGLs. Summary Developing novel radionuclides that can identify disease sites and target them simultaneously provides a potential for improving survival and outcomes in patients with PPGLs. Given the clinical diversity among PPGLs, expanding the therapeutic arsenal against locally advanced or metastatic PPGLs can allow clinicians to evaluate and treat PPGLs thoroughly.
Urologic Oncology: Seminars and Original Investigations, 2021
During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, ... more During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, many elective surgeries for renal cell carcinoma (RCC) were deferred, with an unknown impact on outcomes. Since surveillance is commonplace for small renal masses, we focused on larger, organ-confined RCCs. Our primary endpoint was pT3a upstaging and our secondary endpoint was overall survival. Materials and methods: We retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database, stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within 1 month, 1−3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed overall survival. Results: A total of 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR = 0.90; 95% CI: 0.77−1.05, P = 0.170), cT2a (OR = 0.90; 95% CI: 0.69−1.19, P = 0.454), or cT2b (OR = 0.96; 95% CI: 0.62−1.51, P = 0.873). In all clinical stage strata, nonclear cell RCCs were significantly less likely to be upstaged (P <0.001). A sensitivity analysis, performed for delays of <1, 1−3, 3−6, and >6 months, also showed no increase in upstaging risk. Conclusion: Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered.
Journal of Clinical Oncology, 2021
297 Background: Palliative care (PC) offers various benefits for patient with cancer that include... more 297 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC. Results: We identified 20,122 and 42,014 patients with stage III and IV RCC, respectively. Among this cohort, 329 and 9,317 patients rec...
Urology, 2021
OBJECTIVES To determine the feasibility and perceived usefulness of a pre-residency urology boot ... more OBJECTIVES To determine the feasibility and perceived usefulness of a pre-residency urology boot camp for first and second year urology residents. METHODS First and second year urology residents attended a multi-institutional boot camp in July 2019, which consisted of lectures, a hands-on practical, patient simulation session, and networking social event. Attendees completed a pre-course survey where they rated their comfort level in managing interpersonal, post-operative, and urology-specific scenarios on a Likert scale of 0-5. Participants completed follow-up surveys immediately and 6 months after the course regarding confidence in managing the same scenarios and the impact of boot camp on their training. RESULTS 6 urology PGY1s (55%) and 5 PGY2s (45%) from 4 institutions attended the boot camp. On the pre-course survey, PGY2s had higher average comfort scores compared to PGY1 for all post-operative scenarios besides hypotension but just two urology-specific scenarios, difficult Foley troubleshooting (4 vs. 3, p<0.01) and obstructing urolithiasis with urosepsis (3.6 vs. 2.2, p= 0.05). Immediately after the course, 10/11 (91%) residents reported feeling better prepared to handle all scenarios. All participants reported they would recommend this training to other urology residents. 6 months later, the majority of respondents reported using knowledge learned in boot camp on a daily basis. All agreed that it was a useful networking experience, and 63% had since contacted other residents they met at the course. CONCLUSIONS A pre-residency boot camp is both feasible and valuable for first and second year urology residents for gaining practical medical knowledge and professional networking.
Diagnostics, 2020
Although the gold standard treatment for localized renal cell carcinoma (RCC) is radical nephrect... more Although the gold standard treatment for localized renal cell carcinoma (RCC) is radical nephrectomy (RN) or partial nephrectomy (PN), recurrence rates remain high at 7%, 26%, and 39% for T1, T2, and T3 staged disease, respectively [...]
Journal of Clinical Oncology, 2020
e17052 Background: RPLND for clinical stage (CS) I & IIA/B NSGCT has both staging and therapeutic... more e17052 Background: RPLND for clinical stage (CS) I & IIA/B NSGCT has both staging and therapeutic implications. Single center studies have reported on the impact of lymph node count on outcome after 1° RPLND for men with NSGCT. However, this has yet to be corroborated in a nationally representative dataset. Methods: Using the National Cancer Database, patients who received a 1° RPLND from 2004-2014 for CS I & IIA/B NSGCT were identified. The analytic cohort was stratified according to LN count (≤20, 21-40, and > 40 LNs). Sociodemographic characteristics were compared among groups. The Kaplan-Meier method was calculated and pairwise comparisons performed. Based on sensitivity analyses to determine LN cutoff that impacts survival, subsequent analysis compared patients with ≤20 and > 20 LNs resected. Multivariate analysis using stepwise regression was used to determine factors associated with receipt of an RPLND with > 20 LNs resected. Results: Of 1,376 men who received 1° RPL...
Canadian Urological Association Journal, 2020
The COVID-19 pandemic has impeded health care delivery and may permanently transform the patient-... more The COVID-19 pandemic has impeded health care delivery and may permanently transform the patient-urologist relationship. Here we examine the long-term implications of COVID-19 pandemic on this relationship and explore the impact it has on urologic care in the post-COVID-19 era.
Journal of Clinical Oncology, 2020
670 Background: Clinical trials are critical for the development of new treatment paradigms for r... more 670 Background: Clinical trials are critical for the development of new treatment paradigms for renal cell carcinoma (RCC). The primary objective of this study was to characterize the factors associated with clinical trial participation for patients with RCC. The secondary objective was to examine survival outcomes in the clinical trial and control cohorts. Methods: The National Cancer Database (NCDB) was queried for patients with RCC who were coded as having enrolled in a clinical trial. Trial patients were matched in a 1:5 ratio to controls from the same institution based on clinical stage. Sociodemographic variables were compared between the two groups and univariate and multivariate logistic regression models evaluated factors associated with clinical trial participation. Kaplan-Meier product limit estimate was used to compare overall survival (OS) between the groups. Results: From 2004-2015, 681 patients enrolled in clinical trials were included for analysis. The mean age of tr...
Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improv... more Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improve oncologic outcomes in patients with high-risk prostate cancer (PCa) in a recent clinical trial, controversy remains regarding its benefit. We aimed to illustrate national trends of post-RP radiotherapy and compare outcomes and toxicities in patients receiving eRT vs. observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥ pT3N0 and/or positive surgical margins). Our study cohort was consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (IRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both IRT and observation. Trends of post-RP radiotherapy were compared using the Cochran-Armitage trend test. Cox regression models...
BMC Urology, 2019
Background: In this era of precision medicine, the DNA damage response (DDR) pathway has been sho... more Background: In this era of precision medicine, the DNA damage response (DDR) pathway has been shown to be a viable target of intervention in metastatic castration-resistant prostate cancer (CRPC) as approximately one-third of CRPC patients harbor DDR pathway mutations. To determine whether DDR pathway is a potential therapeutic target in localized disease, we analyzed The Cancer Genome Atlas (TCGA) in the present study. Methods: TCGA is a publically available cancer genome database that is sponsored by the United States National Cancer Institute. Total of 455 cases were available in the database at the time of this analysis. Results: DDR pathway gene mutations or copy number alterations were present in 136 (29.9%) of the 455 cases. On a univariate analysis, DDR pathway status did not correlate with serum prostate specific antigen, tumor stage or grade. However, among patients with high-risk features post-operatively (pathologic stage ≥ T3, Gleason score ≥ 8, or PSA > 20 ng/ml), DDR pathway alteration was associated with a lower overall survival (p = 0.0291). Conclusions: Collectively these results suggest that DDR pathway alterations may also be significant in localized prostate cancer and agents such as PARP inhibitors should be considered in patients with a high-risk disease.
Journal of Urology, 2019
QoL (WHOQOL-BREF), perception of disease (B-IPQ), symptoms of the disease (QLQ-PR25) and percepti... more QoL (WHOQOL-BREF), perception of disease (B-IPQ), symptoms of the disease (QLQ-PR25) and perception of cohesion within the patient-partner relationship (dyadic adjustment, DAS-16). The results are presented as mean AE standard deviation. The final analysis included 492 patients (74.2 years AE 8.1), including 470 with a partner evaluation (70.5 AE 9.0 years). RESULTS: Patient QoL remained mostly stable (0 AE21.2), while patients' satisfaction with their health improved significantly (6.3 AE 24.8, p <0.001). The scores of physical (-1.4 AE 14.5), psychological (-2.3 AE 13.3) and social (-3.2 AE 15.9) health were significantly degraded during the study. QoL was significantly deteriorated in patients who had good cohesion in the couple (-4.1AE19.8) versus medium (2.8AE19.8) or poor (1.6AE22.5). A good cohesion in the couple seemed overall an unfavorable factor for the evolution of the scores of QoL, of health and of perception of environment. Associated factors in multivariate analysis with improvement in QoL were: initial presence of symptoms (OR [95% CI]: 3.0 [1.46, 6.17]) and initial low level (2.04 [1.12, 3.72]) or absence of sexual activity (2.23 [1.11, 4.50]). CONCLUSIONS: The men who benefited the most from hormone therapy in terms of QoL were those who suffered from symptoms and those who had no sexual activity at baseline. The influence of the cohesion within the couple on the evolution of the QoL is not confirmed in multivariate analysis.
Annals of Translational Medicine, 2019
The Journal of Urology, 2018
patients reported high anxiety (7-10), which decreased to 16% at the end of the encounter. Most p... more patients reported high anxiety (7-10), which decreased to 16% at the end of the encounter. Most patients (88%) answered yes when asked if knowledge of cancer diagnosis would help make them make treatment decision and 94% of patients answered yes when asked whether they would consider renal mass biopsy. Following counseling, 43% of surveyed patients received renal mass biopsy. The most common reason given for not obtaining a biopsy was that physician did not believe it would change treatment recommendation. Prior to counseling, patients reported that they would consider treatment options including: 71% active surveillance (AS), 76% thermal ablation (TA), 78% partial nephrectomy (PN), and 39% radical nephrectomy (RN). When patients ranked (1-4) most important factors to consider before treatment, the most common reasons were: risk of cancer spreading or coming back after treatment (75%) and risk of damage to the kidney (25%). Diagnosis (biopsy or surgery) of SRM was RCC in 53, oncocytoma/AML 12, metastatic esophageal cancer and not biopsied in 34. Active surveillance/no treatment was primary management for 48 patients. CONCLUSIONS: A large majority of SRM patients are in favor of pre-treatment biopsy to improve decision making, although less than half of patients received biopsy after counseling. High anxiety is reported by half of SRM patients but decreases following physician visit.
Journal of the American College of Surgeons
Journal of Kidney Cancer and VHL
Renal angiomyolipomas (AMLs) are a subset of perivascular epithelioid cell neoplasms (PEComas) th... more Renal angiomyolipomas (AMLs) are a subset of perivascular epithelioid cell neoplasms (PEComas) that are associated with tuberous sclerosis complex (TSC). Epithelioid angiomyolipomas (EAMLs) are a rare variant of AML with more aggressive propensities. EAMLs with malignant potential can be difficult to distinguish from relatively benign AMLs and other renal tumors. Although there are no established criteria for predicting EAML malignancy, there are proposed histologic parameters that are associated with higher tumor risk. EAML can be treated with surgical resection as well as mTOR inhibitors. Here, we present a unique case of a patient with a 36-cm renal EAML metastatic to the lungs that was treated with complete surgical resection of the primary lesion and mTOR inhibition.
Cancers
The role of CN in the treatment of metastatic renal cell carcinoma (mRCC) has been studied over t... more The role of CN in the treatment of metastatic renal cell carcinoma (mRCC) has been studied over the course of the past few decades. With the advent of immuno-oncologic (IO) agents, there has been a paradigm shift in the treatment of RCC. Within this new era of cancer care, the role of CN is unclear. There are several studies currently underway that aim to assess the role of CN in combination with these therapies. We reviewed articles examining CN, both historically and in the modern immunotherapy era. While immune-oncologic agents are relatively new and large clinical trials have yet to be completed, data thus far is promising that CN may provide clinical benefit. Multiple ongoing trials may clarify the role of CN in this new era of cancer care.
Prostate International, 2022
Journal of the American College of Surgeons, 2021
Purpose: The American Urological Association (AUA) Annual Meeting serves as the premier platform ... more Purpose: The American Urological Association (AUA) Annual Meeting serves as the premier platform for presenting unpublished research in urology. Among selected abstracts, podium presentations represent the most impactful submissions. While podium presentations receive a large audience through conference attendance and social media posts, it is unclear how often they manifest as publications in peer-reviewed journals. Materials and Methods: Podium presentations from the 2017 AUA Annual Meeting were reviewed. Abstracts were assessed for publication between January 1, 2015 and May 31, 2020 allowing for a 3-year window of publication and accounting for publications prior to the submission deadline. Abstract authors were individually searched with key terms being added sequentially until <30 results were generated in PubMed®. Abstracts were deemed published if at least 1 author and 1 conclusion matched a manuscript. Publication rate, time to publication, and 2019 journal impact factor were collected. Statistical analysis was performed by linear and logistic regression. Results: Of 872 podium presentations, 453 (51.9%) were published within 3 years. Median time from submission to publication was 12.5 months (IQR: 7.5–20.5). The number of articles published at 1, 2 and 3 years from submission was 203, 368 and 430, respectively. The median journal impact factor of publications was 3.2 (IQR: 2.0–5.8). Oncology studies (OR=1.21 [95% CI: 0.91–1.60], p=0.186) had similar rates of publication compared to non-oncology studies. Conclusions: While AUA podium presentations disseminate valuable data, approximately half were not published in peer-reviewed journals within 3 years. Therefore, care must be taken when promoting findings or adopting new practices based on these presentations alone.
Current Urology Reports, 2021
Purpose of Review Pheochromocytoma and paraganglioma (PPGLs) are neuroendocrine tumors with diver... more Purpose of Review Pheochromocytoma and paraganglioma (PPGLs) are neuroendocrine tumors with diverse clinical presentations. PPGLs can be sporadic but often are associated with various syndromes, which can have variable clinical presentations. A thorough workup is therefore critical for staging, treatment, and follow-up. Imaging is an essential part of the workup and diagnosis of PPGLs. Recent Findings Improvements in cross-sectional imaging with radionuclides have increased specificity and sensitivity for identifying and treating PPGLs. Furthermore, a variety of targets on PPGLs has allowed for optimal imaging with radionuclides that can be used for staging and treatment. Currently, radionuclides are being evaluated for staging and treatment of PPGLs. Summary Developing novel radionuclides that can identify disease sites and target them simultaneously provides a potential for improving survival and outcomes in patients with PPGLs. Given the clinical diversity among PPGLs, expanding the therapeutic arsenal against locally advanced or metastatic PPGLs can allow clinicians to evaluate and treat PPGLs thoroughly.
Urologic Oncology: Seminars and Original Investigations, 2021
During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, ... more During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, many elective surgeries for renal cell carcinoma (RCC) were deferred, with an unknown impact on outcomes. Since surveillance is commonplace for small renal masses, we focused on larger, organ-confined RCCs. Our primary endpoint was pT3a upstaging and our secondary endpoint was overall survival. Materials and methods: We retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database, stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within 1 month, 1−3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed overall survival. Results: A total of 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR = 0.90; 95% CI: 0.77−1.05, P = 0.170), cT2a (OR = 0.90; 95% CI: 0.69−1.19, P = 0.454), or cT2b (OR = 0.96; 95% CI: 0.62−1.51, P = 0.873). In all clinical stage strata, nonclear cell RCCs were significantly less likely to be upstaged (P <0.001). A sensitivity analysis, performed for delays of <1, 1−3, 3−6, and >6 months, also showed no increase in upstaging risk. Conclusion: Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered.
Journal of Clinical Oncology, 2021
297 Background: Palliative care (PC) offers various benefits for patient with cancer that include... more 297 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC. Results: We identified 20,122 and 42,014 patients with stage III and IV RCC, respectively. Among this cohort, 329 and 9,317 patients rec...
Urology, 2021
OBJECTIVES To determine the feasibility and perceived usefulness of a pre-residency urology boot ... more OBJECTIVES To determine the feasibility and perceived usefulness of a pre-residency urology boot camp for first and second year urology residents. METHODS First and second year urology residents attended a multi-institutional boot camp in July 2019, which consisted of lectures, a hands-on practical, patient simulation session, and networking social event. Attendees completed a pre-course survey where they rated their comfort level in managing interpersonal, post-operative, and urology-specific scenarios on a Likert scale of 0-5. Participants completed follow-up surveys immediately and 6 months after the course regarding confidence in managing the same scenarios and the impact of boot camp on their training. RESULTS 6 urology PGY1s (55%) and 5 PGY2s (45%) from 4 institutions attended the boot camp. On the pre-course survey, PGY2s had higher average comfort scores compared to PGY1 for all post-operative scenarios besides hypotension but just two urology-specific scenarios, difficult Foley troubleshooting (4 vs. 3, p<0.01) and obstructing urolithiasis with urosepsis (3.6 vs. 2.2, p= 0.05). Immediately after the course, 10/11 (91%) residents reported feeling better prepared to handle all scenarios. All participants reported they would recommend this training to other urology residents. 6 months later, the majority of respondents reported using knowledge learned in boot camp on a daily basis. All agreed that it was a useful networking experience, and 63% had since contacted other residents they met at the course. CONCLUSIONS A pre-residency boot camp is both feasible and valuable for first and second year urology residents for gaining practical medical knowledge and professional networking.
Diagnostics, 2020
Although the gold standard treatment for localized renal cell carcinoma (RCC) is radical nephrect... more Although the gold standard treatment for localized renal cell carcinoma (RCC) is radical nephrectomy (RN) or partial nephrectomy (PN), recurrence rates remain high at 7%, 26%, and 39% for T1, T2, and T3 staged disease, respectively [...]
Journal of Clinical Oncology, 2020
e17052 Background: RPLND for clinical stage (CS) I & IIA/B NSGCT has both staging and therapeutic... more e17052 Background: RPLND for clinical stage (CS) I & IIA/B NSGCT has both staging and therapeutic implications. Single center studies have reported on the impact of lymph node count on outcome after 1° RPLND for men with NSGCT. However, this has yet to be corroborated in a nationally representative dataset. Methods: Using the National Cancer Database, patients who received a 1° RPLND from 2004-2014 for CS I & IIA/B NSGCT were identified. The analytic cohort was stratified according to LN count (≤20, 21-40, and > 40 LNs). Sociodemographic characteristics were compared among groups. The Kaplan-Meier method was calculated and pairwise comparisons performed. Based on sensitivity analyses to determine LN cutoff that impacts survival, subsequent analysis compared patients with ≤20 and > 20 LNs resected. Multivariate analysis using stepwise regression was used to determine factors associated with receipt of an RPLND with > 20 LNs resected. Results: Of 1,376 men who received 1° RPL...
Canadian Urological Association Journal, 2020
The COVID-19 pandemic has impeded health care delivery and may permanently transform the patient-... more The COVID-19 pandemic has impeded health care delivery and may permanently transform the patient-urologist relationship. Here we examine the long-term implications of COVID-19 pandemic on this relationship and explore the impact it has on urologic care in the post-COVID-19 era.
Journal of Clinical Oncology, 2020
670 Background: Clinical trials are critical for the development of new treatment paradigms for r... more 670 Background: Clinical trials are critical for the development of new treatment paradigms for renal cell carcinoma (RCC). The primary objective of this study was to characterize the factors associated with clinical trial participation for patients with RCC. The secondary objective was to examine survival outcomes in the clinical trial and control cohorts. Methods: The National Cancer Database (NCDB) was queried for patients with RCC who were coded as having enrolled in a clinical trial. Trial patients were matched in a 1:5 ratio to controls from the same institution based on clinical stage. Sociodemographic variables were compared between the two groups and univariate and multivariate logistic regression models evaluated factors associated with clinical trial participation. Kaplan-Meier product limit estimate was used to compare overall survival (OS) between the groups. Results: From 2004-2015, 681 patients enrolled in clinical trials were included for analysis. The mean age of tr...
Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improv... more Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improve oncologic outcomes in patients with high-risk prostate cancer (PCa) in a recent clinical trial, controversy remains regarding its benefit. We aimed to illustrate national trends of post-RP radiotherapy and compare outcomes and toxicities in patients receiving eRT vs. observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥ pT3N0 and/or positive surgical margins). Our study cohort was consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (IRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both IRT and observation. Trends of post-RP radiotherapy were compared using the Cochran-Armitage trend test. Cox regression models...
BMC Urology, 2019
Background: In this era of precision medicine, the DNA damage response (DDR) pathway has been sho... more Background: In this era of precision medicine, the DNA damage response (DDR) pathway has been shown to be a viable target of intervention in metastatic castration-resistant prostate cancer (CRPC) as approximately one-third of CRPC patients harbor DDR pathway mutations. To determine whether DDR pathway is a potential therapeutic target in localized disease, we analyzed The Cancer Genome Atlas (TCGA) in the present study. Methods: TCGA is a publically available cancer genome database that is sponsored by the United States National Cancer Institute. Total of 455 cases were available in the database at the time of this analysis. Results: DDR pathway gene mutations or copy number alterations were present in 136 (29.9%) of the 455 cases. On a univariate analysis, DDR pathway status did not correlate with serum prostate specific antigen, tumor stage or grade. However, among patients with high-risk features post-operatively (pathologic stage ≥ T3, Gleason score ≥ 8, or PSA > 20 ng/ml), DDR pathway alteration was associated with a lower overall survival (p = 0.0291). Conclusions: Collectively these results suggest that DDR pathway alterations may also be significant in localized prostate cancer and agents such as PARP inhibitors should be considered in patients with a high-risk disease.
Journal of Urology, 2019
QoL (WHOQOL-BREF), perception of disease (B-IPQ), symptoms of the disease (QLQ-PR25) and percepti... more QoL (WHOQOL-BREF), perception of disease (B-IPQ), symptoms of the disease (QLQ-PR25) and perception of cohesion within the patient-partner relationship (dyadic adjustment, DAS-16). The results are presented as mean AE standard deviation. The final analysis included 492 patients (74.2 years AE 8.1), including 470 with a partner evaluation (70.5 AE 9.0 years). RESULTS: Patient QoL remained mostly stable (0 AE21.2), while patients' satisfaction with their health improved significantly (6.3 AE 24.8, p <0.001). The scores of physical (-1.4 AE 14.5), psychological (-2.3 AE 13.3) and social (-3.2 AE 15.9) health were significantly degraded during the study. QoL was significantly deteriorated in patients who had good cohesion in the couple (-4.1AE19.8) versus medium (2.8AE19.8) or poor (1.6AE22.5). A good cohesion in the couple seemed overall an unfavorable factor for the evolution of the scores of QoL, of health and of perception of environment. Associated factors in multivariate analysis with improvement in QoL were: initial presence of symptoms (OR [95% CI]: 3.0 [1.46, 6.17]) and initial low level (2.04 [1.12, 3.72]) or absence of sexual activity (2.23 [1.11, 4.50]). CONCLUSIONS: The men who benefited the most from hormone therapy in terms of QoL were those who suffered from symptoms and those who had no sexual activity at baseline. The influence of the cohesion within the couple on the evolution of the QoL is not confirmed in multivariate analysis.
Annals of Translational Medicine, 2019
The Journal of Urology, 2018
patients reported high anxiety (7-10), which decreased to 16% at the end of the encounter. Most p... more patients reported high anxiety (7-10), which decreased to 16% at the end of the encounter. Most patients (88%) answered yes when asked if knowledge of cancer diagnosis would help make them make treatment decision and 94% of patients answered yes when asked whether they would consider renal mass biopsy. Following counseling, 43% of surveyed patients received renal mass biopsy. The most common reason given for not obtaining a biopsy was that physician did not believe it would change treatment recommendation. Prior to counseling, patients reported that they would consider treatment options including: 71% active surveillance (AS), 76% thermal ablation (TA), 78% partial nephrectomy (PN), and 39% radical nephrectomy (RN). When patients ranked (1-4) most important factors to consider before treatment, the most common reasons were: risk of cancer spreading or coming back after treatment (75%) and risk of damage to the kidney (25%). Diagnosis (biopsy or surgery) of SRM was RCC in 53, oncocytoma/AML 12, metastatic esophageal cancer and not biopsied in 34. Active surveillance/no treatment was primary management for 48 patients. CONCLUSIONS: A large majority of SRM patients are in favor of pre-treatment biopsy to improve decision making, although less than half of patients received biopsy after counseling. High anxiety is reported by half of SRM patients but decreases following physician visit.