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Purpose: This study aims to assess outcomes and characteristics associated with resection of metastatic renal cell carcinoma (mRCC) to the pancreas. Materials and Methods: From April 1989 to July 2012, a total of 42 patients underwent resection of pancreatic mRCC at our institution. We retrospectively reviewed records from a prospectively managed database and analyzed patient demographics, comorbidities, perioperative outcomes, and overall survival. Cox proportional hazards models were used to evaluate the association between patient-specific factors and overall survival. Results: The mean time from resection of the primary tumor to reoperation for pancreatic mRCC was 11.2 years (range, 0-28.0 years). In total, 17 patients underwent pancreaticoduodenectomy, 16 underwent distal pancreatectomy, and 9 underwent total pancreatectomy. Perioperative complications occurred in 18 (42.9 %) patients; there were two (4.8 %) perioperative mortalities. After pancreatic resection, the median follow-up was 7.0 years (0.1-23.2 years), and median survival was 5.5 years (range, 0.4-21.9). The overall 5-year survival was 51.8 %. On univariate analysis, vascular invasion (hazard ratio, 5.15; p = 0.005) was significantly associated with increased risk of death. Conclusions: Pancreatic resection of mRCC can be safely achieved in the majority of cases and is associated with long-term survival. Specific pathological factors may predict which patients will benefit most from resection. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Occult non-localized disease (N1 or M1) at the time of definitive treatment of high-risk prostate cancer (HR-PCa) underlies most treatment failures. We recently developed a nomogram tuned to the identification of non-localized disease on prostate specific membrane antigen PET/CT (PSMA PET/CT) in patients with cN0M0 HR-PCa by conventional imaging, which incorporates iPSA, percent positive core on biopsy, Gleason Grade and cT stage. We systematically compared the prognostic performance of the PSMA nomogram against other validated risk stratification tools for HR-PCa.Materials/methods: We identified 5275 men from a multi-institutional database treated with radical prostatectomy (55%), external beam radiation therapy (EBRT, 31%), or EBRT and brachytherapy (14%). The prognostic performance of the PSMA nomogram was compared against the STAR-CAP score, the Cancer of the Prostate Risk Assessment (CAPRA) score, Cambridge Prognostic Groups (CPG) risk group, and Memorial Sloan Kettering Cancer Center (MSKCC) nomogram of 5-year recurrence probability. Accuracy was determined for 5- and 10-year distant metastasis (DM) and prostate cancer specific mortality (PCSM) using the concordance index (C-index).Results: Median follow-up was 50.3 months (interquartile range 28.1-84.5 months). Overall, 16.1% developed DM, and 4.6% died from PCa. C-indices for the PSMA nomogram were 0.67 and 0.67 for 5- and 10-year DM, and 0.69 and 0.73 for 5- and 10-year PCSM, respectively. The PSMA nomogram outperformed CAPRA, CPG, and MSKCC for all endpoints, outperformed STAR-CAP for 10-year DM, and performed similarly to STAR-CAP for all other endpoints (see Table). The comparative performance between the tools was generally maintained at different follow-up times and in subgroup analyses stratified by primary treatment modalities.Conclusion: A nomogram tuned to the detection of non-localized disease on PSMA/PET in HR-PCa patients is significantly prognostic of important clinical endpoints, with performance comparable to STAR-CAP and superior to other tools. These data strongly suggest that upstaging based on PSMA PET/CT provides clinically relevant information and warrant prospective validation. [ABSTRACT FROM AUTHOR]