A substantial number of patients with superficial bladder cancer do not have follow-up examinations at the recommended intervals, according to a study in the April 16 issue of the Journal of the National Cancer Institute .
Patients with superficial bladder cancer who have not had their bladder removed are at high risk of recurrence of the disease. Therefore, several organizations recommend that such patients have a cystoscopy, or examination of the bladder with an endoscope, every 3 to 6 months for the first 3 years after diagnosis and at least annually after thereafter. To determine whether these recommendations were being followed and to determine what characteristics might be associated with low adherence to these guidelines, Deborah Schrag, M.D., M.P.H., and colleagues from Memorial Sloan-Kettering Cancer Center, New York, examined the medical records of 6717 bladder cancer patients aged 65 years and older who underwent any bladder surveillance.
They found that only 40% of the entire cohort had an examination during all five possible 6-month intervals and that about 18% of patients had an examination in fewer than two of the five possible follow-up intervals. Patient characteristics that were independently associated with low-intensity surveillance were being age 75 years or older, nonwhite, having favorable tumor histology, high comorbidity, and residence in an urban area or in a census tract with low median income.
"Our results should not be construed to mean that efforts to increase adherence to surveillance are necessarily warranted," the authors note in their discussion. "Rather, our findings are a challenge to the urologic oncology community to support studies to determine the reasons underlying existing patterns of care."
Contact: Media Relations, Memorial Sloan-Kettering Cancer Center, 212-639-3573, publicaffairs@mskcc.org
Gene Expression Ratio Test Predicts Outcome of Mesothelioma Treatment
A test that measures the expression levels of four genes in samples of pleural mesothelioma accurately predicted treatment-related patient outcomes. Such a test could ultimately be used to help clinicians determine the best way to treat the disease, according to a study in the April 16 issue of the Journal of the National Cancer Institute .
Treatments for pleural mesothelioma include surgery and aggressive chemoradiation. There are no predictive factors, other than histologic subtype, to identify which patients will best respond to treatment for pleural mesothelioma. Gavin J. Gordon, Ph.D., and Raphael Bueno, M.D., of Brigham and Women's Hospital, Boston, and colleagues examined whether simple ratios of the expression levels of selected genes in tumor samples, a technique that can be used to distinguish among types of thoracic malignancies, could predict treatment-related outcome for patients with mesothelioma.
They used gene expression profiling data from 17 mesothelioma patients with different overall survival times to define two outcome-related groups of patients, to train an expression ratio-based outcome predictor model, and to develop a four-gene expression ratio test that could accurately predict treatment-related patient outcome in an independent group of 29 mesothelioma patients independent of the histologic subtypes of the tumors.
"The prognostic tool described herein could dramatically influence the current clinical treatment of mesothelioma by allowing the identification of those patients who are unlikely to respond to conventional treatment modalities, thus sparing them from radical surgery," the authors conclude.
Contact: Media Relations, Brigham and Women's Hospital, 617-534-1600
Bestatin Improves Survival in Patients with Stage I Squamous-Cell Lung Cancer
Compared with a placebo, the drug bestatin increases overall survival and cancer-free survival in patients with stage I squamous-cell lung cancer that has been completely removed, according to the results of a study in the April 16 issue of the Journal of the National Cancer Institute .
Bestatin is an aminopeptidase inhibitor with immunostimulatory and antitumor activity. Yukito Ichinose, M.D., of the National Kyushu Cancer Center, Japan, and colleagues conducted a prospective randomized double-blind placebo-controlled trial to determine whether postoperative adjuvant treatment with bestatin could prolong the survival of patients with completely resected stage I squamous-cell lung carcinoma.
After a median follow-up of 76 months, the 5-year overall survival was 81% in the bestatin group and 74% in the placebo group. The 5-year cancer-free survival was 71% in the bestatin group and 62% in the placebo group. The authors note that this result requires confirmation in other phase III trials.
Also in the April 16 JNCI:
Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage.
JNCI Journal of the National Cancer Institute