Direct to CT screening pilot for patients with COPD in a deprived area: longitudinal analysis of the pulmonary nodule cohort outcomes

Introduction: Lung cancer is third most common cancer and highest cause of cancer death in the UK. COPD and smoking are known cancer risk factors so early intervention is essential. Incidence is higher in areas of deprivation where early presentation is less likely and outcomes poorer. Middlesbrough has some of the highest areas of deprivation. Aim(s): To evaluate diagnostic value of CT screening pilot in detecting lung cancer and follow-up outcomes for patients with incidental finding of pulmonary nodules. Method(s): Between March 2019 - December 2022 17 GP practices in Middlesbrough were invited to offer non-contrast CT thorax to asymptomatic COPD patients eligible for review, aged 50-75 with 20 pack year history and QCancer risk >5%. Pulmonary nodules followed up as per BTS guidelines. This pilot was conducted in partnership and with support from the Northern Cancer Alliance. Result(s): 407 patients referred for CT, 312 met the criteria and enrolled. 5 (1.6% conversion rate) lung cancers, also 1 renal cancer diagnosed. 51 (17%) had features of pulmonary nodules or groundglass opacities and selected for follow up. 2 died from COVID infection before follow-up CT. 32 (62.8%) discharged after followup CT revealed stable appearances or resolution, follow-up CT still outstanding for 2. 4 (7.8%) selected for further follow-up of sub-solid, new or increasing nodules. 2 (3.9%) received radiological diagnosis of lung cancer and referred for radiotherapy, 1 underwent surgical resection revealing lung tumourlets and 1 referred for surgical resection of enlarging nodule. Conclusion(s): Pulmonary nodules consisted significant part of the CT screening pilot findings in COPD patients with significant further conversion rate to lung cancer diagnosis after follow-up. Therefore, CT screening of high-risk population in deprived areas has a role in detecting lung cancer and identifying pulmonary nodules, with a proportion of those later diagnosed as early lung cancer. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Viruses and the risk of lung cancer: prevention and treatment

Lung cancer is the most common cancer in males and the second most common among females both in Europe and worldwide. Moreover, lung cancer is the leading cause of death due to cancer in males. The European region accounts for 23% of total cancer cases and 20% of cancer-related deaths. Relationships have been described between a number of infectious agents and cancers, but our knowledge of the role of viruses, both respiratory and systemic, in the pathogenesis of lung cancer is still rudimentary and has been poorly disseminated. In this chapter, we review the available evidence on the involvement of HPV, Epstein-Barr virus, HIV, cytomegalovirus and measles virus in the epidemiology and pathogenesis of lung cancer.Copyright © ERS 2021.

Ablation for hepatocellular carcinoma (HCC)

Ablation includes ethanol injection, radiofrequency ablation (RFA), microwave ablation (MWA), etc. Ablation can be potentially curative, minimally invasive and easily repeatable for recurrence. RFA has been the most widely used ablation technique for liver tumors. The new-generation MWA system incorporating antenna cooling and high-power generation has attracted attention. It can create a more predictable ablation zone and a larger ablation volume in a shorter procedure time. Many high-volume centers have introduced new-generation MWA in Japan. However, many studies failed to show that new-generation MWA is superior to RFA in terms of local control and overall survival. In MWA, clinical data have been insufficient compared with those of RFA. There has been keen competition between surgical resection and ablation for almost 40 years since the era of ethanol injection. In 2021, SURF trial revealed that overall survival and recurrence-free survival were not significantly different between surgical resection and RFA. SURF trial was a multicenter randomized controlled trial in which 49 major centers in Japan enrolled patients with good hepatic function (Child-Pugh scores <= 7) and primary HCC of largest diameter <= 3 cm, and <= 3 nodules during the 6-year period of 2009-2015. The registered patients were followed for at least 5 years. As the result of SURF trial and other comparative studies, the revised Japanese clinical practice guidelines in 2021 treats hepatic resection and ablation equally for patients with <= 3 lesions, <= 3 cm in diameter. Recently, the combination of systemic and locoregional therapies has been attracting much attention. Systemic therapy using molecular targeted agents or immune checkpoint inhibitors is used for advanced HCC which cannot be treated by surgery or ablation. On the other hand, some locoregional therapies, such as hepatectomy and ablation, are potentially curative, but they cannot be indicated for advanced HCC. Combination of both therapies is an approach to improve the prognosis of advanced HCC, which is not indicated for curative treatment. Systemic therapy is used to shrink the tumor, and then locoregional therapies are performed to eradicate it. The combination may build a new strategy for advanced HCC. Ablation is highly operator-dependent. The skills and outcomes are very different from operator to operator. Before the pandemic of COVID-19, we held domestic and international training programs for intermediate and advanced doctors and hands-on seminars for young doctors. These were activities to exchange knowledge and experience and standardize the procedure. During the pandemic, we cannot get together. Since August 2020, we have conducted Japan Ablation Webinar 8 times with a total of 1,566 participants. We have also conducted International Ablation Webinar 4 times with a total of 1,272 participated doctors. Education is important to acquire skills and knowledge for successful ablation. We have established Japan Academy of Tumor Ablation (JATA) this year. There are two triggers. One is that SURF trial revealed that there is no difference between hepatectomy and ablation. The other is that ablation for lung, bone and soft tissue and kidney cancers has become reimbursed with health insurance since this September.

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers-In Search for the Ideal Tumour.

Over the recent years, the progress in imaging techniques has led to an increased detection of kidney tumours, including small renal masses. While surgery is still the standard of care, there is a growing interest in minimally invasive methods. Ultrasound (US)-guided percutaneous ablation is particularly attractive because it is a safe and relatively simple procedure. In this study, we investigated the success of percutaneous radiofrequency ablation (RFA) in relation to kidney tumour diameter and location. Between August 2016 and September 2021, 253 patients with 259 renal tumours underwent US-guided RFA as a primary treatment in our institution. A total of 67 patients were excluded from this study. Abdominal computed tomography (CT) and tumour biopsy were performed before the procedure. Patients were followed with contrast-enhanced CT, the average follow-up time was 28 months. The studied group was composed of 186 patients with 191 renal tumours-only biopsy-confirmed renal cancers were included. During the follow-up, 46 cases of residual disease and 4 cases of local progression were found. There was a significant correlation between tumour size and the ablation success rate. The success rate was 73.5% and 87.6% for lesions ≤25 mm, 94.6% for lesions ≤25 mm and exophytic, 79.1% for lesions 26-30 mm and 84.4% for lesions 26-30 mm and exophytic, respectively. Four Clavien-Dindo grade ≥2 complications were observed. US-guided percutaneous RFA of T1a renal cancers is safe and well-tolerated. Its effectiveness depends on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours can be successfully re-treated with US-guided percutaneous RFA.

Signatures of Co-Deregulated Genes and Their Transcriptional Regulators in Kidney Cancers.

There are several studies on the deregulated gene expression profiles in kidney cancer, with varying results depending on the tumor histology and other parameters. None of these, however, have identified the networks that the co-deregulated genes (co-DEGs), across different studies, create. Here, we reanalyzed 10 Gene Expression Omnibus (GEO) studies to detect and annotate co-deregulated signatures across different subtypes of kidney cancer or in single-gene perturbation experiments in kidney cancer cells and/or tissue. Using a systems biology approach, we aimed to decipher the networks they form along with their upstream regulators. Differential expression and upstream regulators, including transcription factors [MYC proto-oncogene (MYC), CCAAT enhancer binding protein delta (CEBPD), RELA proto-oncogene, NF-kB subunit (RELA), zinc finger MIZ-type containing 1 (ZMIZ1), negative elongation factor complex member E (NELFE) and Kruppel-like factor 4 (KLF4)] and protein kinases [Casein kinase 2 alpha 1 (CSNK2A1), mitogen-activated protein kinases 1 (MAPK1) and 14 (MAPK14), Sirtuin 1 (SIRT1), Cyclin dependent kinases 1 (CDK1) and 4 (CDK4), Homeodomain interacting protein kinase 2 (HIPK2) and Extracellular signal-regulated kinases 1 and 2 (ERK1/2)], were computed using the Characteristic Direction, as well as GEO2Enrichr and X2K, respectively, and further subjected to GO and KEGG pathways enrichment analyses. Furthermore, using CMap, DrugMatrix and the LINCS L1000 chemical perturbation databases, we highlight putative repurposing drugs, including Etoposide, Haloperidol, BW-B70C, Triamterene, Chlorphenesin, BRD-K79459005 and ß-Estradiol 3-benzoate, among others, that may reverse the expression of the identified co-DEGs in kidney cancers. Of these, the cytotoxic effects of Etoposide, Catecholamine, Cyclosporin A, BW-B70C and Lasalocid sodium were validated in vitro. Overall, we identified critical co-DEGs across different subtypes in kidney cancer, and our results provide an innovative framework for their potential use in the future.

Standardization of Surgical Outcome Across the Tumor Complexity Spectrum in Robotic Partial Nephrectomy.

Introduction: Standardization of surgical steps or techniques can decrease error rates, increase efficiency, and ensure reproducible outcomes. In this study, we aimed to analyze the benefit of a standardized approach to robotic partial nephrectomy (RPN) on the reproducibility of outcomes across different tumor complexities. Methods: A single-center study of patients who have undergone a transperitoneal robotic-assisted partial nephrectomy for kidney cancer using the first assistant sparing technique between May 2014 and March 2022 was performed. Overall, 496 patients were included in the analysis. We compared clinical data and perioperative and postoperative outcomes for low, moderate, and high complexity score renal tumors. Tumor complexity was stratified using the Radius, Exophytic/Endophytic, Nearness to the collecting system or sinus, Anterior/Posterior, Location relative to the polar line nephrometry score. Data were compared using Kruskal-Wallis test, Chi-square test of Independence, and Fisher's exact test. Results: Of the patients in the study, 54.64% were low tumor complexities (n = 271), 40.32% were moderate tumor complexities (n = 200), and 5.04% were high tumor complexities (n = 25). High tumor complexity patients had significantly longer operative time (149 minutes versus 137 minutes moderate complexity versus 125 minutes low complexity, P = .001), longer ischemia time (12 minutes versus 11 minutes intermediate versus 10 minutes low complexity, P = .0001), and significant reduction in estimated glomerular filtration rate (-12.58 mL/min/1.73 m2 versus -5.51 mL/min/1.73 m2 intermediate versus -3.08 mL/min/1.73 m2 low complexity, P = .005). There was no significant difference in estimated blood loss (P = .074), blood transfusion rate (P = .454), postoperative complication rate (P = .527), surgical complication rate (P = .210), major complication rate (P = .098), length of hospital stay (P = .583), positive surgical margins (P = .872), and trifecta achievement (P = .740). Conclusion: Irrespective of tumor complexity, approaching RPN using a standardized approach will offer patients favorable perioperative outcomes. This approach has standardized our preoperative counseling, patient expectation, and postoperative surgical pathway across the tumor complexity spectrum.

COVID-19 vaccination behavior and outcomes in patients with genitourinary cancer in comparison with other cancer types

Background: Cancer(ca) and old age are risk factors for developing severe COVID-19 (C19+) disease, related morbidity and mortality. These patients (pts) were excluded from clinical trials evaluating the safety and efficacy of 3 FDA approved C19 vaccines (vax). Genitourinary (GU) ca-prostate, bladder and kidney ca contribute to the majority of non-skin ca and median age of these pts range from 65-75 yrs. We aimed to study these highly vulnerable pts behavior and outcomes regarding C19 vax in comparison to non-GU ca pts (18-89 years). Method(s): A prospective and observational single center study. Adult ca pts seen in clinics from Nov 2021-Sept 2022 were randomly interviewed using telephone surveys after a verbal consent. Type of ca and therapy data were collected from pts' medical records. The survey included C19 disease status, vax status positive (+) or negative (-), reason for vax status, side effects (s.e), impact on ca Rx or ca progression. Data was entered on REDCap. The primary end point was rate of vaccination in adult ca pts. Secondary end points were to quantify C19 vax acceptance vs. hesitance, identify s.e of C19 vax and effect of C19 vax on outcomes in GU and non-GU Ca pts. Result(s): N=172;GU ca 21 (12.2%) and non-GUca 151 (87.8%). Among GU ca pts- 9 had prostate ca, 7 had bladder ca and 5 had renal ca. C19+ in 4 (19%) GU and 45 (30.2%) non-GU pts. GU pts: 90.5% received C19 vax (Pfizer 47.6%;Moderna 42.9%, J & J 0%);9.5% were not vaxed. Non-GU pts: 85.2% received C19 vax (Pfizer 39.1%;Moderna 43%, J & J 2.6%);14.8% were not vaxed. The top 3 risk factors for serious C19+ were age >65yr (76.2%), heart disease (61.9%) and BMI.30 (42.9%) in GU ca pts and age >65yr (46.4%), BMI.30 (35.1%) and smoking (19.9%) in non-GU ca pts. The top 3 reasons for C19 vax (+) in GU ca pts: protection against C19+ for self (81%), for others (47.6%) and provider recommendation (38.1%). The main reasons for vax hesitancy in C19 vax (-) GU ca pts: concern for allergy to the vax (4.8%) and prior C19 infection (4.8%). The common s.e of C19 vax reported in GU ca pts were injection site inflammation (19%), headache (4.8%), muscle/body aches (4.8%) but no lymphadenopathy. None of GU ca pts reported delay in Rx or progression of the disease due to C-19 vax. Conclusion(s): C19 vax were overall well tolerated and did not impact ca outcomes in pts with GU malignancies. Oncologists should discuss the importance of C19 vax in the context of ca.

IMPACT OF THE COVID-19 PANDEMIC ON CANCER INCIDENCE IN PATIENTS UNDERGOING CANCER SCREENING DURING ANNUAL HEALTH CHECKUP (POPULATION-BASED STUDY).

Background. During the COVID-19 pandemic, annual adult check-ups have been postponed, resulting in cancer screening disruption. The aim of the study was to evaluate changes in the incidence and stage distribution of malignancies included in the screening program during the COVID-19 pandemic using the Arkhangelsk Regional Cancer Registry (ARRC). Material and Methods. We assessed the changes of the incidence rates and stage distribution for the colon, rectum, lung, breast, cervix, uterine body, ovary, prostate and kidney cancers over the periods 2018-19 and 2020-21. Results. A total of 12354 cases with 9 cancers were selected: 6680 for the period 2018-19 and 5674 (-15.1 %) for the period 2020-21. The most significant decrease in crude and age-standardized incidence rates was registered in patients with lung (-18.0-18.1 %), rectum (-25.1-25.9 %) and cervix (-33.6-36.9 %) cancers, p<0.001. The decrease was not significant in patients with breast, uterine body, and kidney cancers. The proportion of patients with stage I decreased in lung cancer (-20.0 %, from 14.8 % to 11.8 %), rectum (-20.2 %, from 20.9 % to 16.7 %), and uterine cervix (-37.1 %, from 53.2 % to 33.5 %). In prostate and kidney cancers, the proportion of patients with stage I increased by 30 % (from 19.5 % to 25.4 %) and 17.6 % (from 45.9 % to 54.0 %), respectively. A significant reduction in the proportion of early stages during the COVID-19 pandemic was observed in lung and cervical cancer. Conclusion Postponed health checkups due to COVID-19 pandemic disruptions have led to substantial reductions in new cancers being diagnosed, mainly for cervical, lung, colon and rectal cancers. No significant changes were observed for other cancers. Further analysis of mortality and survival of cancer patients is required.Copyright © 2022, Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved.

The Impact of COVID-19 on New Kidney Cancer Diagnosis: Stage and Treatment in Northern Italy.

This study aims to evaluate the impact of COVID-19 on new renal carcinoma (RC) diagnoses using data from the Reggio Emilia Cancer Registry in 2018-2020. A total of 293 RCs were registered, with roughly 100 cases yearly. The distribution by age shows a significant decrease in the 30-59 age group (33.7% in 2018, 24.8% in 2019, and 19.8% in 2020). The incidence of Stage I was 59.4%, 46.5%, and 58.2% in 2018, 2019, and 2020, respectively, whereas the Stage II rate had values of 6.9%, 7.9%, and 2.2% in the years 2018, 2019, and 2020, respectively. Slight non-significant variations were observed in Stages III and IV. Surgery was performed in 83.2% of cases in 2018, 78.2% in 2019, and 82.4% in 2020; the surgery distribution by stage showed no significant differences. Chemotherapy showed an increase in 2020, which was statistically significant only for Stage IV. The gender incidence trends over the last 25 years showed an increase in the male sex in the first period; then, a decline was documented, likely due to a decrease in cigarette consumption. In females, the trend was constant. The RC mortality trend significantly dropped in both genders over the entire study period.

IMPACT OF THE COVID-19 PANDEMIC ON CANCER INCIDENCE IN PATIENTS UNDERGOING CANCER SCREENING DURING ANNUAL HEALTH CHECKUP (POPULATION-BASED STUDY)

Background. During the COVID-19 pandemic, annual adult check-ups have been postponed, resulting in cancer screening disruption. The aim of the study was to evaluate changes in the incidence and stage distribution of malignancies included in the screening program during the COVID-19 pandemic using the Arkhangelsk Regional Cancer Registry (ARRC). Material and Methods. We assessed the changes of the incidence rates and stage distribution for the colon, rectum, lung, breast, cervix, uterine body, ovary, prostate and kidney cancers over the periods 2018–19 and 2020–21. Results. A total of 12354 cases with 9 cancers were selected: 6680 for the period 2018–19 and 5674 (-15.1 %) for the period 2020-21. The most significant decrease in crude and age-standardized incidence rates was registered in patients with lung (-18.0–18.1 %), rectum (-25.1–25.9 %) and cervix (-33.6–36.9 %) cancers, p<0.001. The decrease was not significant in patients with breast, uterine body, and kidney cancers. The proportion of patients with stage I decreased in lung cancer (-20.0 %, from 14.8 % to 11.8 %), rectum (-20.2 %, from 20.9 % to 16.7 %), and uterine cervix (-37.1 %, from 53.2 % to 33.5 %). In prostate and kidney cancers, the proportion of patients with stage I increased by 30 % (from 19.5 % to 25.4 %) and 17.6 % (from 45.9 % to 54.0 %), respectively. A significant reduction in the proportion of early stages during the COVID-19 pandemic was observed in lung and cervical cancer. Conclusion Postponed health checkups due to COVID-19 pandemic disruptions have led to substantial reductions in new cancers being diagnosed, mainly for cervical, lung, colon and rectal cancers. No significant changes were observed for other cancers. Further analysis of mortality and survival of cancer patients is required.

A retrospective study to evaluate the efficacy and safety of SARS-CoV-2 vaccine in patients with advanced genitourinary cancers.

Background: COVID-19 vaccination is one of the pivotal key tools against the ongoing pandemic, but its acceptance relies on efficacy and safety data among various populations, including patients with cancers. However, there is limited data on seroconversion rates, efficacy, and safety of the COVID-19 vaccine in patients with cancer. Breakthrough infections after vaccination have also been reported, which could further strengthen the refusal behavior of specific populations to be immunized. Our objective was to investigate the efficacy and safety of COVID-19 vaccination in real-world patients with advanced genitourinary cancers. Methods and results: A retrospective study of the 738 patients with advanced metastatic genitourinary malignancy was conducted at our genitourinary oncology clinic from October 2020 to September 2021, out of which 462 patients (62.6%) were vaccinated. During the study period, two vaccinated, and six unvaccinated patients tested positive for SARS-CoV-2 (breakthrough infection rate: 0.4% vs. 2.2%, p = 0.027). Vaccine protection against infection was 81.8% (95% CI: 0.04-0.98). One vaccinated and 4 unvaccinated patients were hospitalized due to COVID-19 (0.2% vs. 1.4%, p = 0.048). Vaccine effectiveness in preventing hospitalization was 85.7% (95% CI: 0.02-1.33). Within one month of vaccination, 1.5% of patients (n = 7) had emergency visits, 0.8% (n = 4) were hospitalized for any reason, and of these, 3 (0.6%) experienced a delay in the receipt of their cancer therapy. Conclusion: In our hypothesis-generating data among patients with advanced genitourinary cancers, COVID-19 vaccination was efficacious and safe and was rarely associated with treatment disruptions. These data should help improve the acceptance of the COVID-19 vaccine in the general population and patients with cancer. The vaccine effectiveness in our patients is comparable with existing published data without cancer.

In vitro assessment of genotoxic and cytotoxic effects of Artemisia annua L. tincture

The genus Artemisia (fam. Asteraceae) is one of the largest and widely distributed with around 500 species, majority used as aromatic and medicinal plants. Artemisia annua L. is widely used as a dietary spice, herbal tea, as a supplement, and in a non-pharmaceutical form for treatment of malaria and fever. It is orally consumed as capsules, extracts and tinctures and topically applied as an essential oil diluted in lotions and ointments. Artemisinin is the main constituent of Artemisia annua L. extracts. Since the discovery that the artemisinin is efficient in malaria treatment, there is also a growth in consumption of A. annua extracts for antitumour and even recently for antiviral treatments against SARS-CoV-2 infections. This study aimed to investigate genotoxic effect in peripheral blood culture and cytotoxic effects in cancer and normal cell lines, of commercially available A. annua L. tincture in series of dilutions. Both comet and neutral red uptake assays revealed dose-dependent genotoxicity and cytotoxicity of A. annua tincture dilutions. Comet assay revealed significantly increased DNA damage in peripheral blood cells while neutral-red assays showed increase in cytotoxicity (p<0.001) in both normal and cancer cell cultures treated with the lowest extract dilution compared to the highest one applied. Obtained results indicate caution needed in A. annua L. tincture use, especially when poorly diluted.

A Comparison of Urological Cancer Stage and Diagnosis Rates Before and During the COVID-19 Pandemic in a District General Hospital

Introduction: COVID-19 has caused disruption to medical services, which may have led to delayed cancer diagnoses. This study aims to compare the number and stage of new cancer diagnoses before and during the COVID-19 pandemic. Methods: A hospital-based cancer registry of patients who were diagnosed with Urological (ie, Kidney, Uppertract, Bladder, Prostate, Testis and Penis) between January 2019 and February 2020 Pre-COVID) and March 2020 and September 2021 (During COVID). Monthly numbers of patients with newly diagnosed cancer were compared in Pre-COVID and During-COVID groups. Results: 849 patients (753 men [89%];96 women [11%]) (n = 385 Pre-COVID [45%];n = 464 during-COVID [55%] were included. During-COVID there was a significant 11.2% reduction in monthly new cancer diagnoses (Monthly new diagnoses: Pre-COVID of 27.5 [SD 5.54];During-COVID 24.4 [SD 6.97];p < 0.001). The number of cases & T-staging at diagnosis in the pre- COVID-19 period and the During-COVID period were compared (Figure 1) There is a significant increase in the TNM stage at diagnosis of bladder cancer (Pre-COVID 0.85 [SD 1.0] vs During COVID 1.2 [SD 1.0]) and Upper Tract (Pre-COVID 2.5 [SD 1.1] vs During-COVID 3.5 [SD 0.7] in patients diagnoses during the COVID-19 pandemic compared to beforehand. No difference was found for Prostate, Kidney, Testicular or Penile cancers. Conclusions and Relevance There has been a significant 11% reduction in the total number of monthly urological cancers diagnoses during COVID. Patients with Upper tract and Bladder cancer were diagnosed at a significantly higher stage during the COVID-19 pandemic than beforehand.

Leaders in Healthcare Conference 2020

The proceedings contain 198 papers. The topics discussed include: can a magazine mentor? how a student-led publication is shaping prospective current medical, veterinary and dental student leaders;the four watches: a small island approach to COVID-19 in the emergency department;care navigation in primary care: a student-led clinical audit quality improvement project;wicked problem? trainees creating a novel foundation interim year 1 (FiY1) program at South Tees NHS foundation trust;quality improvement project on community induction for foundation year 2 doctors;centralizing the renal cancer multi-disciplinary team for equitable access to specialist services;improving wellbeing through peer to peer support;skills for collaborative change;and leadership during the COVID-19 crisis: how did we do and how can we do better?.

UROLOGICAL CANCERS DURING COVID-19: ANALYSES OF SHORT-TERM OUTCOMES FROM THE COVIDSURG-CANCER STUDY

INTRODUCTION AND OBJECTIVE: COVID-19 has caused significant disruption to the management of urological cancer, this study aims to assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic. METHODS: COVIDSurg study is the largest international, multicentre study of COVID-19 in surgical patients performed to date. COVIDSurg-Cancer explored the safety of performing elective cancer surgery during the pandemic. All bladder, kidney, UTUC and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 were included. Univariable and multivariable regression was performed to assess association of patient factors with mortality, respiratory complications and operative complications. RESULTS: A total of 1,902 patients from 36 countries were included. 658 (34.6%) patients had bladder cancer, 590 (31.0%) kidney cancer or UTUC, and 654 (34.4%) prostate cancer. These patients underwent elective curative surgery for their cancers (prostatectomies, nephrectomies, cystectomies, nephroureterectomy, TURBTs). 62% of sites were not designated “hot” COVID-19 sites (i.e. did not actively admit patients with COVID-19).A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed;of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4- 81.42, p<0.001), aged over 80, ASA grade 3+ and ECOG grade 1+. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.41-144.45, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1+. There were 84 major complications (Clavien-Dindo score ≥3). Patients with a concurrent COVID-19 infection (OR 7.45, 95% CI 2.73-20.3, p<0.001) or aged 80 or above were more likely to experience major complications. CONCLUSIONS: Elective urological cancer surgeries are safe to perform during the COVID-19 pandemic. This study highlights important risk-factors associated with worse outcomes. Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.

Real world data analysis of patients with genitourinary cancers receiving systemic anticancer treatment during the COVID-19 pandemic at Guy's Cancer Centre: A single centre retrospective study in the UK

Background: To understand the impact of the COVID-19 pandemic on National Health Services (NHS) cancer service delivery, care and patients, we examined the impact of changes in cancer service delivery, treatment intensity and delay by evaluating oncological outcomes of genitourinary (GU) cancer patients receiving systemic anticancer treatment (SACT) during 1st March and 8th July 2020. Methods: We used data from patients with GU cancers (i.e. prostate, urothelial, kidney and testicular) treated with SACT at Guy's Cancer Centre during the first wave of the COVID-19 pandemic in the UK: demographics (sex, age, ethnicity, ECOG performance status (PS), comorbidities, smoking history, socio-economic status (SES)) and disease characteristics (stage, treatment type and setting, lines of treatment), as well as results from SARS-CoV-2 PCR testing. Classification of COVID-19 severity was based on the World Health Organisation (WHO) guidelines. Results: A total of 457 GU cancer patients received SACT during the study period: 68% prostate cancer, 23% renal cancer, 7% urothelial cancer, 2% testicular cancer. Mean age was 69 years (SD: 11.2). 91% were males, 82% were classified as low SES and out of the 291 patients we had ethnicity data on 199 (68%) were White British. The majority of patients had a PS of 1 and 95% of all patients had stage IV disease and hence received palliative SACT, with 58% being in the second line setting. Half of the patients received hormone therapy, 17% received chemotherapy, 20% received targeted therapy, 13% received immunotherapy (IO) and 1% received combination IO and targeted treatment. Only 5 (1%) patients tested SARS-CoV-2 positive: 2 had prostate cancer, 2 renal and 1 bladder cancer. Mean age was 66 years (SD: 5.6). They were all male, 2 White British, 1 Black African and 2 of unknown ethnicity and were all classified as low SES. Average PS was 2. Of these 5 patients 3 had at least two comorbidities (i.ehypertension, diabetes mellitus, renal impairment, frailty) and were receiving multiple medications. All had stage IV disease and received palliative SACT. 3 were on hormone therapy alone and 2 on chemotherapy. 2 of the patients presented symptoms within less than 7 days from PCR diagnosis, 1 within 7 to 14 days and 1 after 14 days. All 5 COVID-19 positive patients required hospitalization, 4 suffered severe pneumonia, 1 died from COVID-19 and 2 died from cancer related causes. In comparison, the mortality rate for the COVID-19 negative patients was 3.3%. Conclusion: Despite the impact of COVID-19 in health provision, a large number of our GU patients at Guy's Cancer Centre safely received SACT. Our results suggest that the continuation of SACT during the COVID-19 pandemic did not increase the risk of COVID-19 in our patient cohort (SARS-CoV-2 infection rate: 1%). Of note, the infection rate was lower than observed in a similar study in our centre for gastrointestinal cancer patients (SARS-CoV-2 infection rate: 3.4%). In light of the above, decisions against SACT or SACT intensity should carefully be evaluated.

Waning efficacy of COVID-19 vaccination at six months in patients (pts) with genitourinary malignancies

Background: Short-term effectiveness of COVID-19 vaccination is widely demonstrated, but the emerging real-world data suggest that immunity may wane over-time (Levin et al. NEJM 2021). Herein we aimed to explore the long-term efficacy of the COVID-19 vaccination among pts with genitourinary cancer. Methods: In this study, pts with genitourinary malignancies (prostate, kidney, and bladder cancers) who had not received COVID-19 vaccination were included. Blood samples were collected prior to and after one dose of either an adenovirus- or mRNA-based COVID-19 vaccine at the 2- and 6-month timepoints. Additional blood samples from pts receiving systemic treatment were collected at 3 consecutive therapy cycles following vaccination. Antibody titers were assessed using the SCoV-2 Detect IgG ELISA assay and results were reported as immune status ratios (ISR). T-cell receptor (TCR) repertoire sequencing was performed using the MiXCR software (MiLabs) and custom strips were used to assess TCR abundance and homology clustering. Results: A total of 183 pts were enrolled, and 136 pts provided baseline blood samples. Among these, 59 (8:51 F:M) provided samples for both the 2-and 6-month timepoints by the 10/6/2021 data cut-off. In this subset of pts, median age was 66 (range 48-85) and 33 (55.9%), 25 (42.4%), and 1 (1.7%) pts had prostate, kidney, and bladder cancer, respectively. A majority of the pts (93.2%) were on systemic treatment with 23.7% on immune checkpoint inhibitors, 18.6% on targeted agents, and 1.7% on chemotherapy. The most commonly administered vaccines were BNT162b2 (61.0%) followed by mRNA-1273 (37.3%) and Ad26.COV2.S (1.7%). The mean (±standard deviation) ISR values at baseline and 2 months were 0.68±1.59 and 6.62±1.75, respectively. At the 6-month timepoint, mean ISR was 5.46±1.61;this was significantly lower than the 2-month antibody titers (p < 0.0001), and reflects a reduction of 17.6%. Further data on TCR sequencing will be presented at the meeting. Conclusions: To our knowledge, this is the first data assessing the long-term serologic outcomes of COVID-19 vaccination in pts with cancer. Our data suggest waning immunity over time in cancer pts. Strategies to prolong host immunity against SARS COV-2 (e.g., booster vaccination) are likely warranted.

Short term outcomes of urological cancers during COVID-19, an analysis of the covidsurg-cancer study

Aim: We assessed the short-term outcomes and characteristics of urological cancer patients operated on during the COVID-19 pandemic. This is the first time these outcomes are assessed in urological patients on a large scale. Method: All bladder, kidney, and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 in the international COVIDSurg-Cancer collaborative database were included in the study. The primary outcome was 30-day mortality. Secondary outcomes were respiratory complications within 30-days and the factors associated with COVID-19 infection. Results: A total of 1,902 patients were included in the study. A total of 21 (0.1%) mortalities and 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30-days of operation. Mortality was more likely in patients aged 80 or above, ASA grade 3 or 4, ECOG grade 1 or above, undergoing major surgery, and amongst patients who had concurrent COVID-19 infection (OR 31.9, 95%CI 12.4-81.42, p<0.001;univariable logistic regression). Respiratory complications were more likely in patients aged over 70, from an area with high community risk, with a revised cardiac risk index of 1 or higher or with a concurrent COVID-19 infection (OR 40.6, 95% CI 11.41-144.45, p<0.001;multivariate). A total of 42 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay;designated COVID-19 sites were not associated with increased COVID-19 infections. Conclusions: Major urological cancer surgeries are safe to perform during the COVID-19 pandemic on well-selected patients with appropriate risk-stratification. Concurrent COVID-19 infection is associated with a higher risk of mortality and respiratory complications.

Characteristics and 30-day outcomes for urological cancer patients operated on during the COVID-19 pandemic

Introduction & Objectives: Coronavirus disease (COVID-19) has caused significant disruption to the management of urological cancers and significant cancellation or delay to elective cancer surgeries. Guidelines have been rapidly developed to facilitate optimal triaging, however, they are largely based on expert opinion and observational studies of small retrospective cohorts. This international, multicentre, prospective observational study aimed to evaluate the impact of the COVID-19 pandemic on the 30-day outcomes of patients with kidney, bladder and prostate cancer who underwent elective cancer surgery. Materials & Methods: The COVIDSurg-Cancer Study is a global collaborative observational study that includes urological (prostate, bladder and renal) cancer patients managed between March 2020 and June 2020 who were planned for elective surgery during the COVID-19 pandemic. The primary outcome was mortality within 30 days. The secondary outcomes were COVID-19 infections, respiratory complications and post-operative complications within 30 days. Results: Between 11th March and 19th April 2020, prospective data on 436 consecutive patients were collected from centres (Figure 1). Patients with SARS-CoV-2 were significantly more likely to die and experience post-operative respiratory complications including adult respiratory distress syndrome (3/14, 21.4%) (p<0.01), pneumonia (4/14, 28.6%) (p<0.01), oxygen therapy (10/14, 71.4%) (p<0.01) and pulmonary embolism (1/13, 7.1%) (p<0.01) within 30 days. 2/412 (0.5%) COVID-negative patients died within 30 days of operation, compared to 3/14 (21.4%) COVID positive patients, (p<0.01). The rates of 30-day post-operative Clavien-Dindo Grade III+ complications for nephrectomy, cystectomy and prostatectomy were 1.7% (2/119), 7.6% (4/53) and 3.3% (2/61,) respectively. (Figure Presented) Conclusions: This prospective multicentre study demonstrates that patients with COVID-19 undergoing elective cancer surgery were more likely to experience respiratory complications and die than patients who did not develop COVID-19. To continue elective cancer surgery throughout future waves of the pandemic, it would be sensible to take precautions to minimise the risk of patients developing COVID-19 peri-operatively.

COVID-19 vaccination effective for patients with renal cell carcinoma

"Recently published studies exploring the immune response following COVID-19 vaccination [among patients with cancer] have shown that patients with solid tumor malignancies have higher rates of seroconversion than those with hematologic malignancies," researcher Jasnoor Malhotra, BS, clinical research assistant at City of Hope, told HemOnc Today. [...]those studies included a limited number of patients with renal cell carcinoma and more information is needed about vaccine efficacy and responses in this population, according to study background. Malhotra and colleagues identified 38 patients (median age, 63 years;range, 57-70;68.4% men;81.6% white) with renal cell carcinoma who had not received any COVID-19 vaccine.