Citations 2
Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Multicenter, Multinational, Propensity Score-Matched Analysis
Grossmann, Nico C. , Juvet, Tristan , Potretzke, Aaron M. , Djaladat, Hooman , Ghoreifi, Alireza , Mari, Andrea , Fujita, Kazutoshi , Fontana, Matteo , Sfakianos, John P. , Pfail, John , Laukhtina, Ekaterina , Rajwa, Paweł , Pallauf, Maximillian, Poyet, Cédric , Cacciamani, Giovanni , Doeveren, Thomas van , Boormans, Joost L., Antonelli, Alessandro , Jamil, Marcus , Abdollah, Firas , Ploussard, Guillaume , Heidenreich, Axel , Storz, Enno , Boorjian, Stephen A. , Rink, Michael , Shariat, Shahrokh F. , Pradère, Benjamin , Ghoreifi, Alireza , Mari, Andrea , Fujita, Kazutoshi , Fontana, Matteo , Laukhtina, Ekaterina , Cacciamani, Giovanni E , Boormans, Joost L , Antonelli, Alessandro , Abdollah, Firas , Ploussard, Guillaume , Shariat, Shahrokh F , Pradere, Benjamin , Grossman, Nico C , Rajwa, Pawel , Soria, Francesco , Kikuchi, Eiji , Khene, Z. , Raman, Jay D. , Breda, Alberto , Daneshmand, Siamak , Rouprêt, Morgan
Cancers | February 23, 2023 | Volume: 15 | Issue: 5 | Pages: 1409
Objectives: To identify correlates of survival and perioperative outcomes of upper tract urothelial carcinoma (UTUC) patients undergoing open (ORNU), laparoscopic (LRNU), and robotic (RRNU) radical nephroureterectomy (RNU). Methods: We conducted a retrospective, multicenter study that included non-metastatic UTUC patients who underwent RNU between 1990–2020. Multiple imputation by chained equations was used to impute missing data. Patients were divided into three groups based on their surgical treatment and were adjusted by 1:1:1 propensity score matching (PSM). Survival outcomes per group were estimated for recurrence-free survival (RFS), bladder recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Perioperative outcomes: Intraoperative blood loss, hospital length of stay (LOS), and overall (OPC) and major postoperative complications (MPCs; defined as Clavien–Dindo > 3) were assessed between groups. Results: Of the 2434 patients included, 756 remained after PSM with 252 in each group. The three groups had similar baseline clinicopathological characteristics. The median follow-up was 32 months. Kaplan–Meier and log-rank tests demonstrated similar RFS, CSS, and OS between groups. BRFS was found to be superior with ORNU. Using multivariable regression analyses, LRNU and RRNU were independently associated with worse BRFS (HR 1.66, 95% CI 1.22–2.28, p = 0.001 and HR 1.73, 95%CI 1.22–2.47, p = 0.002, respectively). LRNU and RRNU were associated with a significantly shorter LOS (beta −1.1, 95% CI −2.2–0.02, p = 0.047 and beta −6.1, 95% CI −7.2–5.0, p < 0.001, respectively) and fewer MPCs (OR 0.5, 95% CI 0.31–0.79, p = 0.003 and OR 0.27, 95% CI 0.16–0.46, p < 0.001, respectively). Conclusions: In this large international cohort, we demonstrated similar RFS, CSS, and OS among ORNU, LRNU, and RRNU. However, LRNU and RRNU were associated with significantly worse BRFS, but a shorter LOS and fewer MPCs.
Globally accessible end-user-friendly prostate cancer risk prediction tools based on contemporary cohorts with heterogeneous missing risk factors
Neumair, Matthias, Freedland, Stephen J. , Haese, Alexander , Guerrios‐Rivera, Lourdes , Boorjian, Stephen A. , Poyet, Cédric , Herkommer, Kathleen , Meissner, Valentin H. , Kattan, Michael W. , Hoedt, Amanda M. De , Liss, Michael A. , Leach, Robin J. , Cooperberg, Matthew R , Saba, Karim , Vickers, Andrew J , Ankerst, Donna P.
No container title available | June 22, 2022 | Volume: No volume available | Issue: No issue available | Pages: No page available
Abstract Background: Missing risk factors, whether random or not measured at all, across different hospitals and patients provide challenges, both for the developers of online clinical risk tools and the patients trying to use such tools. This paper provides a development and end-user solution to the commonly encountered limitations of clinical risk tool based decision making due to missing information.Methods: Six state-of-the-art logistic regression approaches accommodating missing data were compared using prostate cancer data from ten North American and European cohorts from the Prostate Biopsy Collaborative Group (PBCG). An additional large European PBCG cohort was withheld for external validation, where calibration-in-the-large (CIL), calibration curves, and area-underneath-the-receiver-operating characteristic curve (AUC) were evaluated. Ten-fold leave-one-cohort-internal validation further validated the optimal missing data approach.Results: Among 12,703 biopsies from 10 training cohorts, 3,597 (28%) had clinically significant prostate cancer, compared to 1,757 of 5,540 (32%) in the external validation cohort. In external validation, the available cases method that pooled individual patient data containing all risk factors input by an end-user had best CIL, under-predicting risks as percentages by 2.9% on average, and obtained an AUC of 75.7%. Imputation had the worst CIL (-13.3%). The available cases method was further validated as optimal in internal cross-validation and thus used for development of an online risk tool. For end-users of the risk tool, two risk factors were mandatory: serum prostate-specific antigen (PSA) and age, and ten were optional: digital rectal exam, prostate volume, prior negative biopsy, 5-alpha-reductase-inhibitor use, prior PSA screen, African ancestry, Hispanic ethnicity, first-degree prostate-, breast-, and second-degree prostate-cancer family history.Conclusion: Developers of clinical risk prediction tools should optimize use of available data and sources even in the presence of high amounts of missing data and offer options for users with missing risk factors.