Baseline Edmonton Symptom Assessment System and Survival in Metastatic Renal Cell Carcinoma

Background: Baseline symptom burden as measured using the Edmonton Symptom Assessment System (ESAS), a patient-reported, validated, and reliable tool measuring symptom severity in 9 separate domains, might yield prognostic information in patients receiving treatment for metastatic renal cell carcinoma (MRCC) and might add to the existing prognostic models. Methods: In this retrospective single-centre cohort study, we included patients receiving first-line sunitinib therapy for MRCC between 2008 and 2012. Baseline variables included information relevant to the pre-existing prognostic models and pre-treatment ESAS summation scores (added together across all 9 domains), with higher scores representing greater symptom burden. We used Kaplan–Meier curves and Cox regression modelling to determine if symptom burden can provide prognostic information with respect to overall survival. Results: We identified 68 patients receiving first-line therapy for MRCC. Most had intermediate- or poor-risk disease based on both the Memorial Sloan Kettering Cancer Center (MSKCC) and the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) models. The median baseline ESAS summation score was 16 (range: 6–57). In univariable analysis, the hazard ratio for overall survival was 1.270 (p = 0.0047) per 10-unit increase in summation ESAS. In multivariable analysis, the hazard ratio was 1.208 (p = 0.0362) when controlling for MSKCC risk group and 1.240 (p = 0.019) when controlling for IMDC risk group. Conclusions: Baseline symptom burden as measured by ESAS score appears to provide prognostic information for survival in patients with mrcc. Those results should encourage the investigation of patient-reported symptom scales as potential prognostic indicators for patients with advanced cancer

Thoracic Sarcoidosis Mimicking Metastatic Testicular Cancer: Three Case Reports

Recurrence of testicular tumors in young males generally prompts rapid investigation and treatment. We report 3 patients with past histories of treated testicular cancer referred with radiographic evidence suggestive of intrathoracic metastases. In each case chest imaging demonstrated mediastinal/hilar lymphadenopathy. In one case pulmonary nodules were also identified. In all three patients further work-up revealed non-caseating granulomas consistent with sarcoidosis. All patients have since been followed and remain free of testicular cancer. No patient has required therapy for sarcoidosis. Although rare, new intra-thoracic lymphadenopathy in previously treated testicular cancer patients can represent sarcoidosis. Tissue diagnosis is essential when the clinical picture remains unclear