Browsing by Author "Kamat, Ashish"
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Publication Comparative Analysis of Very Reduced vs Full Dose BCG Treatment for High-RiskNon-Muscle Invasive Bladder Cancer:A Contemporary Experience from Chile(2023) Grajales, Valentina; Contieri, Roberto; Tan, Wei Shen; Flores, Marta; Schultz, Marcela; Pinochet, Rodrigo; Bustamante, Alberto; Kamat, Ashish; Mario Fernandez; Fernández Arancibia, MarioBACKGROUND:Adjuvant bacillus Calmette-Gu ́erin (BCG) is recommended for high-risk (HR) non-muscle invasivebladder cancer (NMIBC), but BCG shortages have led to exploration of reduced-dose regimens and shortened maintenancedurations out of necessity, with limited data on treatment efficacy in Latin America.OBJECTIVE:Oncological outcomes of HR-NMIBC patients treated with reduced (RD,1/4th dose) vs full dose (FD) BCGinstillations ofDanish Strain1331 BCG.METHODS:We performed a retrospective study of HR-NMIBC patients treated with BCG between 2003 and 2022 at ourcenter in Santiago Chile. We stratified patients according to either RD (1/4th dose) or FD BCG. Univariate and multivariableCox regression models were used to predict recurrence. Kaplan-Meier method was used to calculate survival estimates.RESULTS:Of a total of 200 patients, 116 (58%) had RD and 84 (42%) FD BCG. Median follow-up was 57 months (IQR:29–100). Patients who received FD BCG had a lower risk of recurrence (HR: 0.41, 95% CI 0.22–0.74) and high-grade(HG)-recurrence (HR: 0.30, 95% CI 0.15–0.61;p= 0.001). More patients in the RD vs FD group progressed to MIBC (10/84vs 2/116;p= 0.18). Additionally, patients were less likely to stop BCG treatment in the RD group compared to the FD groupdue to toxicity (5% vs 11%,p= 0.14).CONCLUSIONS:A 1/4th dose ofDanish Strain1331 BCG treatment was associated with worse recurrence free rate andHG-recurrence rate in our cohort. Patients with RD had lower discontinuation treatment rates due to a reduced toxicity profile.These findings would suggest that RD BCG would compromise oncological outcomes in HR-NMIBC patients.Item What Is the Significance of Variant Histology in Urothelial Carcinoma?(European Association of Urology by Elsevier B.V, 2020-07) Lobo, Niyati; Shariat, Shahrokh; Guo, Charles; Fernández, Mario; Kassouf, Wassim; Choudhury, Ananya; Gao, Jianjun; Williams, Stephen; Galsky, Matthew; Taylor, John; Roupret, Morgan; Kamat, AshishContext: Urothelial carcinoma can exhibit a wide range of variant morphologies. Many variants present diagnostic challenges and carry clinical implications that inform prognosis and treatment decisions. Objective: To provide an overview of the diagnostic, therapeutic, and prognostic significance of histological variants of urothelial carcinoma. Evidence acquisition: A PubMed/MEDLINE-based literature search was conducted using the key terms "urothelial carcinoma", "variant histology", "nested", "micropapillary", "microcystic", "sarcomatoid", "squamous differentiation", "glandular differentiation", "clear cell", "plasmacytoid", "lymphoepithelioma-like carcinoma", "squamous cell carcinoma", "small cell carcinoma", "adenocarcinoma", "radiotherapy", "neoadjuvant chemotherapy", and "adjuvant chemotherapy". Evidence synthesis: The incidence of variant histology is increasing due to improved recognition. Nonetheless, diagnosis can pose challenges due to sampling limitations and interobserver variability. Although associated with advanced disease at presentation, survival outcomes for most variants do not differ significantly compared with pure urothelial carcinoma of the same stage. Controversy exists regarding optimal management due to the low quality of available evidence. For most cases, radical cystectomy with pelvic lymph node dissection (with neoadjuvant chemotherapy when appropriate) represents the standard of care. Small cell carcinoma and lymphoepithelioma-like carcinoma appear to be particularly chemosensitive. Conclusions: Accurate identification of variant histological subtypes is an important part of risk stratification, as these variants exhibit aggressive biological behaviour. Variant histology tumours are associated with advanced disease at presentation, which must be considered when counselling patients regarding survival outcomes. Optimal management remains to be defined but in most cases; neoadjuvant chemotherapy and radical cystectomy with pelvic lymph node dissection remains the mainstay of treatment.