No abstract

This external validation of the Gandaglia nomogram shows relevant accuracy with one out of ten patients in this intermediate risk PCa group with pathologically proven organ-confined disease. This validated risk calculator can help physician to distinguish favorable intermediate risk PCa that can be treated by conservative approach or safer nerve-sparing surgery.

No abstract

ObjectiveTo evaluate the prognostic value of programmed death ligand‐1 (PD‐L1) and programmed death‐1 (PD‐1) expression in patients with upper tract urothelial carcinoma (UTUC).Patients and methodsA retrospective multicentre study was conducted in 283 patients with UTUC treated with radical nephroureterectomy (RNU) between 2000 and 2015 at 10 French hospitals. Immunohistochemistry analyses were performed using 2 mm‐core tissue microarrays with NAT105® and 28.8® antibodies at a 5% cut‐off for positivity on tumour cells and tumour‐infiltrating lymphocytes to evaluate PD‐L1 and PD‐1 expression, respectively. Multivariable Cox regression models were used to determine the independent predictors of recurrence‐free (RFS), cancer‐specific (CSS) and overall survival (OS).ResultsOverall, 63 (22.3%) and 220 (77.7%) patients with UTUC had PD‐L1‐positive and ‐negative disease, respectively, while 91 (32.2%) and 192 (67.8%) had PD‐1‐positive and ‐negative disease, respectively. Patients who expressed PD‐L1 or PD‐1 were more likely to have pathological tumour stage ≥pT2 (68.3% vs 49.5%, P = 0.009; and 69.2% vs 46.4%, P < 0.001, respectively) and high‐grade (90.5% vs 70.0%, P = 0.001; and 91.2% vs 66.7%, P < 0.001, respectively) disease with lymphovascular invasion (52.4% vs 17.3%, P < 0.001; and 39.6% vs 18.2%, P < 0.001, respectively) as compared to those who did not. In multivariable Cox regression analysis adjusting for each other, PD‐L1 and PD‐1 expression were significantly associated with decreased RFS (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.09–3.08, P = 0.023; and HR 1.59, 95% CI 1.01–2.54, P = 0.049; respectively), CSS (HR 2.73, 95% CI 1.48–5.04, P = 0.001; and HR 1.96, 95% CI 1.12–3.45, P = 0.019; respectively) and OS (HR 2.08, 95% CI 1.23–3.53, P = 0.006; and HR 1.71, 95% CI 1.05–2.78, P = 0.031; respectively). In addition, multivariable Cox regression analyses evaluating the four‐tier combination of PD‐L1 and PD‐1 expression showed that only PD‐L1/PD‐1‐positive patients (n = 38 [13.4%]) had significantly decreased RFS (HR 3.07, 95% CI 1.70–5.52; P < 0.001), CSS (HR 5.23, 95% CI 2.62–10.43; P < 0.001) and OS (HR 3.82, 95% CI 2.13–6.85; P < 0.001) as compared to those with PD‐L1/PD‐1‐negative disease (n = 167 [59.0%]).ConclusionsWe observed that PD‐L1 and PD‐1 expression were both associated with adverse pathological features that translated into an independent and cumulative adverse prognostic value in UTUC patients treated with RNU.

Background: Complications can occur following radical nephroureterectomy (RNU) in 20-40% of patients. The Comprehensive Complication Index (CCI) is an alternative grading system to the Clavien-Dindo (CD) grading system that aggregates all complications experienced by a patient on a continuous (as opposed to categorical) scale. We investigate whether the cumulative nature of CCI renders it superior to CD in predicting perioperative course after RNU. Methods:The records of 596 patents who underwent RNU at 7 academic medical centers from 2005 to 2015 were reviewed. Complications occurring within 30 days of RNU were annotated using both the CD and CCI classification systems. Logistic regression was used to determine associations between CD and CCI with perioperative covariates as well as measures of convalescence [hospital length of stay (LOS) and readmission].Results: A total of 377 men and 219 women with a median age of 71, BMI of 27, and Charlson comorbidity score of 4 were included. Over half underwent a minimally invasive RNU. Median LOS following RNU was 6.0 days (range, 1-37 days) and readmission within 30-days occurred in 45 (8%) patients. Overall, 136 patients (23%) experienced a post-operative complication with 91 having a single complication and 45 with multiple (range, 2-6); 44 (7%) patients had Clavien III or greater complications, and the median CCI for those patients experiencing a complication was 20.9 (range, 8.7-100). Both the upper quartile of CCI (≥75th %) and major CD complications were associated with higher baseline Charlson score, ECOG ≥2, and CKD stage ≥ III (all P<0.05). However, only the upper quartile of CCI was associated with LOS (8.9 vs. 5.4 days, P<0.01) and hospital readmission (OR 3.2, 95% CI: 1.9-5.6, P=0.02) after RNU. Conclusions:The CD and CCI classification systems both are associated with similar baseline and perioperative characteristics for RNU patients. However, the cumulative nature of the CCI allows for superior prediction of postoperative course after RNU including LOS and readmission.