Marital status impacts survival in patients with upper tract urothelial carcinoma: a population-based, propensity-matched study.

BACKGROUND: Marital status has been considered as an independent prognostic factor for various types of cancer survival. The objectives of our study were to investigate the function of marital status on the survival of upper tract urothelial carcinoma (UTUC) patients. METHODS: The patients diagnosed with UTUC between 1988 and 2015 were captured within the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified into married, divorced/separated, widowed and single cohorts. Kaplan-Meier and Cox regression analysis was conducted to assess the effects of marital status on overall survival (OS) and cancer-specific survival (CSS). A 1:1 matched-pair analysis was performed to optimize the final statistical results by propensity score matching (PSM). RESULTS: Among the 10,852 eligible patients, the percentage of married, divorced/separated, widowed and single patients accounted for 58.2% (6,321), 9.0% (980), 23.3% (2,526) and 9.4% (1,025) respectively. The widowed patients had the worst OS and CSS. Marital status was a predictive factor for OS and CSS of UTUC patients. The results of multivariate Cox regression showed that the worst OS [hazard ratio (HR): 1.41; 95% confidence interval (CI): 1.33-1.49, P<0.001] and the poorer CSS (HR: 1.32; 95% CI: 1.22-1.43, P<0.001) were existed in the widowed patients, compared with married patients. The results of the stratified analysis by primary site also indicated the same conclusion. Furthermore, the results were confirmed in the 1:1 matched group. CONCLUSIONS: Marital status acted as an independent prognostic and protective factor for survival in UTUC patients. Additionally, being widowed was related with a high risk of death in UTUC compared with married, divorced, or single patients.

Prostate cancer in Asia: A collaborative report.

The incidence of prostate cancer (PCa) within Asian population used to be much lower than in the Western population; however, in recent years the incidence and mortality rate of PCa in some Asian countries have grown rapidly. This collaborative report summarized the latest epidemiology information, risk factors, and racial differences in PCa diagnosis, current status and new trends in surgery management and novel agents for castration-resistant prostate cancer. We believe such information would be helpful in clinical decision making for urologists and oncologists, health-care ministries and medical researchers.

Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy: a single-center 10-year report.

BACKGROUND: Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients. METHODS: From 2000 to 2009, 149 patients with prostate cancer received radical prostatectomy and were followed up. Among these patients, 111 received retropubic radical prostatectomies, 38 received laparoscopic radical prostatectomies. All patients were followed-up on in the 3rd month, 6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint, serum prostate-specific antigen (PSA), full biochemical test and uroflowmetry was acquired. RESULTS: The average age was (69.0 ± 6.1) years, preoperative average serum PSA was (10.1 ± 12.1) ng/ml and average Gleason score was 6.4 ± 1.3. The incidence of total complications was about 47.7%, the incidence of the most common complication, bladder outlet obstruction, was about 26.8%, and that of the second most common complication, urinary stress incontinence, was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4 ± 17.6) ng/ml), average Gleason score (7.1 ± 1.3) and pathological T stage score (7.0 ± 1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0 ± 5.8) ng/ml, 6.0 ± 1.2 and 5.4 ± 1.4, respectively) (P = 0.004, P = 0.001 and P = 0.001, respectively). A univariate analysis showed that positive surgical margin had a positive statistical association with serum PSA (P = 0.007), Gleason score (P < 0.001), pathological T stage score (P < 0.001) and biochemical recurrence (BCR) (P = 0.035). The most common location of a positive surgical margin was in the apex of the prostate, which was about 63% (36/57). Sixty-four percent (23/36) of patients with positive surgical margin in apex were also involved in prostate lobe; other locations were prostate lobe (23%, 13/57), seminal vesicle (9%, 5/57). The multivariate analysis showed that positive surgical margin had a positive statistical association with Gleason score (P = 0.03) and pathological T stage score (P = 0.02). Neither univariate analysis or multivariate analysis showed any statistical relationship between BCR and any other risk factors covered in this study. CONCLUSIONS: Positive surgical margin is associated with pre-operative PSA, Gleason score, pathological T stage and biochemical recurrence. Earlier diagnosis and improved techniques of dissection of prostate apex could decrease the incidence of positive surgical margins.

Comparisons of the incidence and pathological characteristics of prostate cancer between Chinese and Portuguese in Macau.

BACKGROUND: Aging of population in Macau has become a serious problem and we are diagnosing more and more patients with prostate cancer. To investigate the effect of ethnicity and environment on incidence of prostate carcinoma, we compared the difference of biopsy and postoperative pathology of prostate between indigenous Chinese (Chinese) and Chinese of Portuguese descent (Portuguese) with elevated serologic prostate specific antigen (PSA) and incidence of prostate carcinoma in Macau. METHODS: Between 1999 and 2006, prostate biopsy was performed in a random sample of 462 patients with elevated serologic PSA who, on followup, were diagnosed in this hospital with benign prostate hyperplasia. Of these, 416 were indigenous Chinese, 46 Portuguese. Based on demographic statistics by Macau government for 2005, we compared differences in incidences of prostate carcinoma, positive rate of random prostate biopsy in patients with elevated serologic PSA, factors related to serological PSA and pathological grade and stage between both ethnic groups. RESULTS: Prostate carcinoma was diagnosed on biopsy in 178 cases. Positive biopsies of prostate carcinoma were present in 160 Chinese with positive rate of 38.5% and in 18 Portuguese with 39.1%. For patients diagnosed with prostate carcinoma, there was no significant difference in age, incidence, grade of cancerous cells, stage of the disease, incidence of inflammation of prostatic tissues or prostatic intraepithelial neoplasia (PIN) related to elevated PSA between the groups (All P>0.05). CONCLUSIONS: There was no significant difference in incidence or characteristics of prostate carcinoma between people of Portuguese and Chinese descent in Macau based on our limited data. Long term residence in the same environment may be associated with the incidence and progression of prostate carcinoma in Portuguese living in Macau, but further rigorous epidemiological investigation and analysis of risk factors about prostate carcinoma are needed to corroborate this conclusion.