Publications by authors named "Luis Kluth"
Purpose: Temporal trends in and predictors of inpatient palliative care use in patients with metastatic renal cell carcinoma (mRCC) undergoing critical care therapy are unknown.
Methods: Relying on the National Inpatient Sample (2008-2019), we identified mRCC patients undergoing critical care therapy, namely invasive mechanical ventilation, percutaneous endoscopic gastrostomy tube insertion, dialysis for acute kidney failure, total parenteral nutrition, or tracheostomy. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models addressed inpatient palliative care use.
Objective: To evaluate the impact of a standardized antibiotic stewardship protocol on three subsequent endpoints in patients undergoing urethroplasty.
Methods: Men undergoing bulbar substitution urethroplasty between January 2009 and December 2016 were stratified by urine culture (UCx) at the time of surgery (sterile non-sterile) and were subjected to a standardized algorithm for urinalysis and antimicrobial therapy. We performed quantitative and qualitative exploration of UCx results and the microbial spectrum.
Article Synopsis
- The study investigated the relationship between lymphovascular invasion (LVI) and perineural invasion (PNI) in prostate cancer patients who underwent radical prostatectomy and their rates of biochemical recurrence (BCR).
- Results from 822 patients showed that those with LVI had a five-year BCR-free survival rate of 62%, while those with PNI had a rate of 64%, both lower than their counterparts without these invasions.
- After adjusting for factors like age, PSA levels, and tumor stage, the association between LVI and PNI with BCR became insignificant, indicating that tumor stage and Gleason Grade were more critical predictors of recurrence.
Article Synopsis
- The study focuses on understanding how different metastatic sites (lymph nodes, bones, and visceral organs) affect outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC), specifically regarding progression-free survival (PFS) and overall survival (OS).
- Using data from the Frankfurt Metastatic Cancer Database, researchers classified 363 patients based on their metastatic sites and analyzed PFS and OS using Cox regression models.
- Results showed that M1c mCRPC patients have significantly worse outcomes, with higher risks for both progression and death compared to M1a patients, while M1a patients experienced the best outcomes overall.
: Progression to metastatic castration-resistant prostate cancer (mCRPC) is defined either biochemically, radiographically or both. Moreover, staging for mCRPC can be performed either conventionally or with molecular imaging such as prostate-specific membrane antigen computer tomography (PSMA-PET/CT). : We relied on the Frankfurt Metastatic Cancer Database of the Prostate (FRAMCAP) database to compare progression-free (PFS) and overall survival (OS) outcomes regarding the cause of castration resistance and the staging modality used.
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- This study analyzed the clinicopathologic characteristics and treatment patterns of adult prostate sarcoma patients using data from the Surveillance, Epidemiology, and End Results database between 2004 and 2020.
- Among 125 patients, the most common subtype was leiomyosarcoma (36%), with rhabdomyosarcoma (14%) being more likely to present at a metastatic stage compared to other types.
- The overall median survival was 27 months, with treatment approaches differing significantly based on the subtype; metastatic disease was linked to higher mortality rates, while stromal sarcoma had a lower overall mortality risk.
Article Synopsis
- The study focuses on improving follow-up care for patients with testicular cancer to detect relapses early by analyzing different imaging methods used for relapse detection in a large cohort of patients (1175 enrolled) from the Swiss Austrian German Testicular Cancer Cohort Study.
- Key findings included that 76% of analyzed patients had stage I disease, with a high 5-year relapse-free survival rate of 90.1%. Cross-sectional imaging of the abdomen was found to be the most effective method for detecting relapses, especially abdominal CT scans.
- The researchers proposed updated follow-up schedules emphasizing abdominal imaging while reducing reliance on chest X-rays, aiming to guide clinicians in future patient management strategies.
Background And Objective: Currently available post hoc phase 3 trial-derived data suggest better cancer-control outcomes in apalutamide-treated metastatic hormone-sensitive prostate cancer (mHSPC) patients achieving an (ultra)low prostate-specific antigen (PSA) nadir. This study aims to validate ultralow PSA nadir cutoffs.
Methods: Relying on an institutional prostate cancer database, 107 eligible patients were yielded.
Article Synopsis
- Simulation-based training in urology is becoming increasingly important, and a study assessed its impact on the surgical confidence of residents after a workshop focused on ureteroscopy (URS) and transurethral resection of the bladder (TURB).
- The workshop involved 40 participants, and results showed that while men generally reported higher surgical confidence before and after the session, both genders experienced an increase in confidence after the training.
- Despite achieving similar surgical performance outcomes, women were less confident in performing URS tasks compared to men, indicating a gap that could be addressed through targeted support and training.
Purpose: We investigated regional differences in patients with stage III nonseminoma germ cell tumor (NSGCT). Specifically, we investigated differences in baseline patient, tumor characteristics and treatment characteristics, as well as cancer-specific mortality (CSM) across different regions of the United States.
Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), patient (age, race/ethnicity), tumor (International Germ Cell Cancer Collaborative Group [IGCCCG] prognostic groups) and treatment (systemic therapy and retroperitoneal lymph dissection [RPLND] status) characteristics were tabulated for stage III NSGCT patients, according to 12 SEER registries representing different geographic regions.
Objective: Systemic therapy is guideline-recommended for metastatic urothelial carcinoma of the urinary bladder (UCUB). Unmarried status represents an important barrier to treatment access in many primaries. The importance of married status is unknown in the context of systemic therapy in metastatic UCUB and was addressed in the current study.
View Article and Find Full Text PDFObjective: To test for differences in recovery of lower urinary tract symptoms (LUTS) between patients with storage-positive vs -negative symptoms after laser enucleation of the prostate (LEP).
Patients And Methods: Consecutive storage-positive (severe storage symptoms, International Prostate Symptom Score [IPSS] storage subscore >8) vs storage-negative patients treated with LEP (November 2017-September 2022) within our tertiary-care database were identified. Mixed linear models tested for changes in IPSS and quality of life (QoL) at 1, 3 and 12 months after LEP.
Article Synopsis
- Metachronous metastatic prostate cancer (mmPCa) patients exhibit different characteristics and outcomes compared to DeNovo metastatic patients, influenced by primary cancer features like Gleason score (GS) and stage.
- A study of 341 mmPCa patients found that higher Gleason scores and more advanced stages were linked to earlier onset of metastatic disease and significantly affected overall survival (OS) rates.
- The research concluded that longer intervals between initial prostate cancer diagnosis and the onset of mmPCa are associated with better overall survival, highlighting the importance of grading and staging in treatment outcomes.
Article Synopsis
- The study investigates the differences in overall survival (OS) between patients with metastatic hormone-sensitive prostate cancer (mHSPC) based on whether their condition was "De Novo" (newly diagnosed) or "secondary" (progressed from previous conditions), and their disease volume (high vs. low).
- The research used a database of 504 mHSPC patients, finding that those with De Novo high volume mHSPC had shorter time to develop metastatic castration resistant prostate cancer (mCRPC) and worse OS compared to secondary and low volume cases.
- The results highlight that patients with De Novo high volume mHSPC have a more challenging prognosis even when treated with intensified combination therapies, and this trend
Lymphoepithelioma-like carcinoma of the bladder (LELC-B) is a rare histologic subtype characterized by strong immune cell (IC) infiltrates. A better prognosis and favorable response rates to immune checkpoint inhibitors have been described. We aimed to characterize the molecular profiles and IC infiltration of LELC-B for a better understanding of its therapeutic implications.
View Article and Find Full Text PDFBackground: To test for differences in organ-confined pathological tumor stage (pT) and intermediate International Society of Urological Pathologists (ISUP) grade vs. nonorgan confined pT stage and high ISUP grade and biochemical recurrence (BCR) after radical prostatectomy (RP).
Methods: Relying on a tertiary-care database, prostate cancer patients undergoing RP between January 2014 and December 2021 were stratified according to their combination of pT stage and ISUP grade in RP specimens (pT2 ISUP4/5 vs.
: Biochemical recurrence (BCR) represents the rise of prostate-specific antigen (PSA) levels after treatment with curative radical prostatectomy (RP) or radiation for prostate cancer. The objective of the current study was to test for the association between patient characteristics, namely age, body mass index (BMI), as well as prostate volume at surgery, and BCR after RP. : Within a tertiary care database, patients with prostate cancer treated with RP between January 2014 and June 2023 were included.
View Article and Find Full Text PDFBackground And Objective: With approval of novel systemic therapies within the past decade for metastatic hormone-sensitive (mHSPC) and castration-resistant (mCRPC) prostate cancer, patients may receive several therapy lines. However, the use of these treatments is under an ongoing change. We investigated contemporary treatment trends and progression-free (PFS) and overall (OS) survival of different therapy lines.
View Article and Find Full Text PDFBackground: To assess cancer-specific mortality (CSM) and other-cause mortality (OCM) rates in patients with rare histological prostate cancer subtypes.
Methods: Using the Surveillance, Epidemiology, and End Results database (2004-2020), we applied smoothed cumulative incidence plots and competing risks regression (CRR) models.
Results: Of 827,549 patients, 1510 (0.
Background: The landscape of systemic therapies for metastatic hormone-sensitive (mHSPC) and castration resistant prostate cancer (mCRPC) extensively improved within the last decades resulting in a significantly prolonged overall survival. However, subgroup analyses of phase III trials suggest potentially different overall survival outcomes for older adults.
Methods: We relied on our institutional metastatic prostate cancer database to identify mHSPC and subsequently mCRPC patients.
Background: In metastatic urethral cancer, temporal trends, and patterns of inpatient palliative care (IPC) use are unknown.
Methods: Relying on the National Inpatient Sample (2006-2019), metastatic urethral cancer patients were stratified according to IPC use. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models (LRM) for the prediction of IPC use were fitted.
Purpose: To assess in-hospital mortality and complication rates after radical cystectomy (RC) in patients with history of heart-valve replacement.
Materials And Methods: Using the National Inpatient Sample (2000-2019), non-metastatic bladder cancer patients undergoing RC were stratified according to history of heart-valve replacement. Regression models (RM) predicted hospital outcomes.
Background: In-hospital mortality and complication rates after partial and radical nephrectomy in patients with history of heart-valve replacement are unknown.
Patients And Methods: Relying on the National Inpatient Sample (2000-2019), kidney cancer patients undergoing partial or radical nephrectomy were stratified according to presence or absence of heart-valve replacement. Multivariable logistic and Poisson regression models addressed adverse hospital outcomes.