Primary lymphomas of the genitourinary tract:A population-based study

Objective:We performed a population-based analysis focusing on primary extranodal lymphoma of either testis,kidney,bladder or prostate(PGUL).Methods:We identified all cases of localized testis,renal,bladder and prostate primary lymphomas(PL)versus primary testis,kidney,bladder and prostate cancers within the Surveillance,Epidemiology,and End Results database(1998e2015).Estimated annual proportion change methodology(EAPC),multivariable logistic regression models,cumulative incidence plots and multivariable competing risks regression models were used.Results:The rates of testis-PL,renal-PL,bladder-PL and prostate-PL were 3.04%,0.22%,0.18%and 0.01%,respectively.Patients with PGUL were older and more frequently Caucasian.Annual rates significantly decreased for renal-PL(EAPC:5.6%;pZ0.004)and prostate-PL(EAPC:3.6%;pZ0.03).In multivariable logistic regression models,older ager independently predicted testis-PL(odds ratio[OR]:16.4;p<0.001)and renal-PL(OR:3.5;p<0.001),while female gender independently predicted bladder-PL(OR:5.5;p<0.001).In surgically treated patients,cumulative incidence plots showed significantly higher 10-year cancer-specific mortality(CSM)rates for testis-PL,renal-PL and prostate-PL versus their primary genitourinary tumors.In multivariable competing risks regression models,only testis-PL(hazard ratio[HR]:16.7;p<0.001)and renal-PL(HR:2.52;p<0.001)independently predicted higher CSM rates.Conclusion:PGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder.Relative to primary genitourinary tumors,PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL,even after adjustment for other-cause mortality.

The association of type and number of high-risk criteria with cancer-specific mortality in prostate cancer patients treated with radical prostatectomy

Objectives:This study aimed to test the association between of type and number of D'Amico high-risk criteria(DHRCs)with cancer-specific mortality(CSM)in high-risk prostate cancer patients treated with radical prostatectomy.Materials and methods:In the Surveillance,Epidemiology,and End Results database(2004–2016),we identified 31,281 radical prostatectomy patients with at least 1 DHRC,namely,prostate-specific antigen(PSA)>20 ng/mL(hrPSA),biopsy Gleason Grade Group(hrGGG)score of 4 and 5,or clinical tumor stage≥T3(hrcT).Multivariable Cox regression models and competing risks regression models(adjusting for other cause mortality)tested the association between DHRCs and 5-year CSM.Results:Of 31,281 patients,14,394(67%)exclusively harbored hrGGG,3189(15%)harbored hrPSA,and 1781(8.2%)harbored hrcT.Only 2132 patients(6.8%)harbored a combination of the 2 DHRCs,and 138(0.6%)had all 3 DHRCs.Five-year CSMrates ranged from 0.9%to 3.0%when any individual DHRC was present(hrcT,hrPSA,and hrGGG,in that order),1.6%to 5.9%when 2 DHRCs were present(hrPSA-hrcT,hrcT-hrGGG,and hrPSA-hrGGG,in that order),and 8.1%when all 3 DHRCs were present.Cox regression models and competing risks regression confirmed the independent predictor status of DHRCs for 5-year CSM that was observed in univariable analyses,with hazard ratios from 1.00 to 2.83 for 1 DHRC,2.35 to 5.88 for combinations of 2 DHRCs,and 7.13 for all 3 DHRCs.Conclusions:Within individual DHRCs,hrcT and hrPSA exhibited weaker effects than hrGGG did.Moreover,a dose-response effect was identified according to the number of DHRCs.Accordingly,the type and number of DHRCs allow further risk stratification within the high-risk subgroup.

Differences in rates of pelvic lymph node dissection in National Comprehensive Cancer Network favorable,unfavorable intermediate-and high-risk prostate cancer across United States SEER registries

Background:The National Comprehensive Cancer Network(NCCN)guidelines recommend pelvic lymph node dissection(PLND)in NCCN high-and intermediate-risk prostate cancer patients.We tested for PLND nonadherence(no-PLND)rates within the Surveillance Epidemiology and End Results(2010-2015).Materials and methods:We identified all radical prostatectomy patients who fulfilled the NCCN PLND guideline criteria(n=23,495).Nonadherence rates to PLND were tabulated and further stratified according to NCCN risk subgroups,race/ethnicity,geographic distribution,and year of diagnosis.Results:Overall,the no-PLND rate was 26%;it was 41%,25%,and 11%in the NCCN intermediate favorable,intermediate unfavorable,and high-risk prostate cancer patients,respectively(p<0.001).Overtime,the no-PLND rates declined in the overall cohort and within each NCCN risk subgroup.Georgia exhibited the highest no-PLND rate(49%),whereas New Jersey exhibited the lowest(15%).Finally,no-PLND race/ethnicity differences were recorded only in the NCCN intermediate unfavorable subgroup,where Asians exhibited the lowest no-PLND rate(20%)versus African Americans(27%)versus Whites(26%)versus Hispanic-Latinos(25%).Conclusions:The lowest no-PLND rates were recorded in the NCCN high-risk patients followed by NCCN intermediate unfavorable and favorable risk in that order.Our findings suggest that unexpectedly elevated differences in no-PLND rates warrant further examination.In all the NCCN risk subgroups,the no-PLND rates decreased over time.