Clinical genitourinary cancer最新文献

{"title":"Clinical and Pathological Predictors for Occult Lymph Node Involvement in Patients With Clinical Node-Negative Bladder Cancer Undergoing Radical Cystectomy","authors":"Salvador Jaime-Casas ,&nbsp;Miguel Zugman ,&nbsp;Regina Barragan-Carrillo ,&nbsp;Hedyeh Ebrahimi ,&nbsp;Koral Shah ,&nbsp;Wesley Yip ,&nbsp;Cory M. Hugen ,&nbsp;Kevin G. Chan ,&nbsp;Clayton S. Lau ,&nbsp;Bertram E. Yuh ,&nbsp;Benjamin Mercier ,&nbsp;Nicholas J. Salgia ,&nbsp;Daniela V. Castro ,&nbsp;Xiaochen Li ,&nbsp;JoAnn Hsu ,&nbsp;Charles B. Nguyen ,&nbsp;Alexander Chehrazi-Raffle ,&nbsp;Sumanta K Pal ,&nbsp;Abhishek Tripathi","doi":"10.1016/j.clgc.2025.102405","DOIUrl":"10.1016/j.clgc.2025.102405","url":null,"abstract":"<div><h3>Background</h3><div>Occult pathological lymph node involvement in patients with clinical node-negative (cN0) bladder cancer (BC) remains a diagnostic challenge. We evaluate predictors of lymph node positivity (pN+) in patients with cT1-4N0M0 BC undergoing radical cystectomy and pelvic lymph node dissection (RC-PLND).</div></div><div><h3>Methods</h3><div>We included patients with cT1-4N0M0 BC undergoing RC-PLND from February 2004 through October 2020. Patients were classified as pN+ vs. pN0. Baseline characteristics were summarized using descriptive statistics. Logistic regression models and multivariable analysis estimated odds ratios (OR) for pN+ status. Kaplan Meier analysis and multivariable Cox proportional hazards models analyzed recurrence-free survival (RFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>440 patients were evaluated, of which 81% (<em>n</em> = 359) had pN0 and 17% (<em>n</em> = 74) had pN+ disease. Most were male (80%), white (88%), and had a median age of 71 years. Most had clinical T2 (55%) and T1 (25%) disease. Lymphovascular invasion (LVI) on TURBT (OR 2.62, <em>P</em> = .04), positive surgical margins (OR 16.77, <em>P</em> &lt; .001), and ≥ cT2 disease (OR 1.89, <em>P</em> = .04) had higher odds of pN+ status. pN+ patients were more likely to suffer recurrence (HR 7.67, <em>P</em> &lt; .001) or death (HR 3.26, <em>P</em> &lt; .001) compared to pN0 patients. Preoperative hydronephrosis predicted worse RFS (HR 1.76, <em>P</em> = .011) and OS (HR 1.55, <em>P</em> = .007). Positive surgical margins (HR 2.34, <em>P</em> = .008) and preoperative renal function (HR 1.50, <em>P</em> = .004) predicted worse OS.</div></div><div><h3>Conclusion</h3><div>Positive surgical margins, LVI, and ≥ cT2 disease strongly predict pN+ findings in patients with cT1-4N0M0 BC. Preoperative variables can inform treatment for patients with a higher risk for positive lymph node findings at surgery.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102405"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Cabozantinib Treatment in Patients with Advanced Renal Cell Carcinoma in Spanish and Portuguese Real-world Practice: The SOGUG-SPRWEC Study","authors":"Cristina Suárez ,&nbsp;Òscar Reig Torras ,&nbsp;Rafael Morales Barrera ,&nbsp;Ángel Rodríguez Sánchez ,&nbsp;Georgia Anguera Palacios ,&nbsp;André Miguel Branco Manshino ,&nbsp;Natalia Fernández Núñez ,&nbsp;María José Méndez Vidal ,&nbsp;Icíar García Carbonero ,&nbsp;Ovidio Fernández Calvo ,&nbsp;Regina Gironés Sarrió ,&nbsp;Guillermo Crespo Herrero ,&nbsp;Javier Afonso Afonso ,&nbsp;María José Juan Fita ,&nbsp;Josep Gumà Padró ,&nbsp;Martín Lázaro Quintela ,&nbsp;Alejo Rodriguez-Vida ,&nbsp;Carolina Hernández Pérez ,&nbsp;Ana Medina Colmenero ,&nbsp;Ricardo Collado Martín ,&nbsp;Enrique Gallardo","doi":"10.1016/j.clgc.2025.102402","DOIUrl":"10.1016/j.clgc.2025.102402","url":null,"abstract":"<div><h3>Background</h3><div>The SPRWEC study investigated cabozantinib effectiveness and safety in patients with advanced renal cell carcinoma (RCC) in real-world Spanish and Portuguese settings.</div></div><div><h3>Patients and methods</h3><div>Observational, ambispective, multicenter study including adult patients with advanced RCC receiving cabozantinib between October 2016 and May 2020 as second or subsequent treatment line. Primary endpoint was progression-free survival (PFS).</div></div><div><h3>Results</h3><div>About 258 patients (mean [SD] age 62.5 [11.0] years, 75.6% male) were included, 55.8% with prior immunotherapy. Median follow-up was 34.3 months. Median PFS was 7.63 months (95% CI, 6.64-8.72). Median overall survival (OS) was 15.36 months (95% CI, 11.58-19.11); objective response rate (ORR), 29.5% (95% CI, 24.0-35.4); median time to first response, 3.27 months (95% CI, 3.03-3.68); median duration of response, 9.77 months (95% CI, 7.24-12.63); median time to discontinuation, 6.97 months (95% CI, 5.79-8.42). Prior immunotherapy increased ORR (OR 2.132) and decreased OS (HR 1.529). ECOG 0-1 and dose reductions were associated with increased PFS (HR 0.470 and 0.558); poor and intermediate MSKCC (HR 3.861 and 1.681) and IMDC risks (HR 2.558 and 1.537) with decreased PFS. Most common AEs were diarrhea (41.9%), asthenia (34.9%), and anorexia (18.2%).</div></div><div><h3>Conclusion</h3><div>Cabozantinib’s effectiveness and safety as second or subsequent treatment line for advanced RCC in real-world settings are similar to those observed in clinical trials. This treatment after prior immunotherapy, the front-line standard of care, resulted in increased ORR and decreased OS, without changes in PFS.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102402"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of the Introduction of PSMA-PET/CT in Danish Men Diagnosed with Prostate Cancer","authors":"Hein V. Stroomberg ,&nbsp;Klaus Brasso ,&nbsp;Andreas Røder","doi":"10.1016/j.clgc.2025.102404","DOIUrl":"10.1016/j.clgc.2025.102404","url":null,"abstract":"<div><h3>Background</h3><div>Conventional imaging in patients with newly diagnosed prostate cancer is gradually being replaced with PSMA-PET/CT. However, the possible impact of newer imaging modalities on stage migration is poorly understood. We have studied the effects of introducing PSMA-PET/CT on the incidence of newly diagnosed hormone-sensitive prostate cancer.</div></div><div><h3>Patients and methods</h3><div>This population-based nationwide study included all Danish men born between 1920 and 1970 and diagnosed with prostate cancer between 2010 and 2022 (<em>N</em> = 58,635). Information on prostate cancer diagnosis and diagnostic workup was retrieved from prospectively maintained nationwide registries. Cause of death was retrieved until the last date of follow-up (August 11, 2024). Multivariable linear regression, logistic regression, and Cause-specific Cox proportional hazards were utilized to obtain estimates.</div></div><div><h3>Results</h3><div>Each PSMA-PET/CT performed increased the number of metastatic diagnoses by 0.29 (95% confidence interval [CI]: 0.21-0.38, <em>P</em> &lt; .001), primarily driven by regions with a higher use of PSMA-PET/CT. Having PSMA-PET/CT performed increased the likelihood of having the therapies radiation to the prostate in an oligometastatic setting (Odds ratio: 4.1, 95% CI: 3.5-4.9) or chemotherapy (Odds ratio: 1.27, 95% CI: 1.04-1.56). Five-year prostate cancer-specific mortality in all men diagnosed with prostate cancer decreased only in areas with high PSMA-PET/CT usage, from 15% (95% CI: 14-16) when diagnosed in 2010 to 2014 to 13% (95% CI: 12-14) when diagnosed in 2019 to 2022.</div></div><div><h3>Conclusion</h3><div>Our data shows that the implementation of PSMA-PET/CT on a nationwide level led to prostate cancer stage migration, coinciding with a slight decrease in prostate cancer-specific mortality in regions with the highest usage of PSMA-PET/CT.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102404"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression and Prognostic Significance of Different Antibody-Drug Conjugate Target Proteins in Urachal Carcinoma","authors":"Tian Han ,&nbsp;Honglei Cui ,&nbsp;Gan Du ,&nbsp;Youyan Guan ,&nbsp;Xingang Bi ,&nbsp;Lei Guo ,&nbsp;Hongzhe Shi ,&nbsp;Jianzhong Shou","doi":"10.1016/j.clgc.2025.102403","DOIUrl":"10.1016/j.clgc.2025.102403","url":null,"abstract":"<div><h3>Background</h3><div>Urachal carcinoma (UrC), a rare malignancy originating from urachal remnants, currently lacks standardized therapeutic options for advanced stages. While antibody-drug conjugate (ADC) therapy has emerged as a transformative approach in oncology, its clinical application in UrC remains investigational due to the paucity of data regarding target antigen expression profiles. This study systematically characterized the immunohistochemical landscape of UrC through the lens of established ADC targets and evaluated their prognostic implications, thereby informing future therapeutic development.</div></div><div><h3>Patients and Methods</h3><div>We retrospectively analyzed 41 histologically confirmed UrC specimens with complete clinical information. Immunohistochemical evaluation was performed for 6 therapeutic targets: HER2, Nectin-4, Claudin18.2, Trop2, Mesothelin, and PD-L1. Standardized scoring system was used to quantify the level of target expression and to determine the rate of high expression for each target. Survival outcomes were assessed through Kaplan–Meier method and Cox proportional hazards modeling.</div></div><div><h3>Results</h3><div>With a median follow-up of 99 months, the cohort exhibited a 5-year overall survival (OS) rate of 62.4% (95% CI, 48.5%-80.3%). Analysis of ADC target protein expression showed that Trop2 had the highest rate of high expression (58.5%), followed by Mesothelin (43.9%), Claudin18.2 (34.1%), Nectin-4 (24.4%), HER2 (9.8%), and PD-L1 (4.9%). Survival analysis demonstrated significantly reduced 5-year overall survival (OS) in the Trop2-high group (47.1% vs. 87.5%, <em>P</em> = 0.01). Multivariate Cox regression analysis identified both Trop2 and Sheldon stage as independent prognostic determinants.</div></div><div><h3>Conclusion</h3><div>Our findings confirm that UrC has the potential to be treated by ADC. Trop2 has the highest high expression rate in UrC and is associated with a worse prognosis, which may be a potential target for ADC therapy for UrC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102403"},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Stratification for the Prognosis of Patients With pT3aN0M0 Clear Cell Renal Cell Carcinoma","authors":"Shigeki Koterazawa ,&nbsp;Takayuki Sumiyoshi ,&nbsp;Katsuhiro Ito ,&nbsp;Kimihiko Masui ,&nbsp;Atsushi Igarashi ,&nbsp;Koji Inoue ,&nbsp;Noriyuki Ito ,&nbsp;Noboru Shibasaki ,&nbsp;Takaaki Takuma ,&nbsp;Masakatsu Ueda ,&nbsp;Takehiro Yamane ,&nbsp;Ken Maekawa ,&nbsp;Sojun Kanamaru ,&nbsp;Akihiro Hoshiyama ,&nbsp;Toru Kanno ,&nbsp;Yoshio Sugino ,&nbsp;Kazuma Hiramatsu ,&nbsp;Toru Yoshida ,&nbsp;Shuhei Koike ,&nbsp;Kazutoshi Okubo ,&nbsp;Takashi Kobayashi","doi":"10.1016/j.clgc.2025.102400","DOIUrl":"10.1016/j.clgc.2025.102400","url":null,"abstract":"<div><h3>Background</h3><div>Predicting postoperative recurrence in patients with pathological T3aN0M0 clear cell renal cell carcinoma (pT3a ccRCC) is important to identify patients suitable for adjuvant immunotherapy. This study aimed to develop a novel predictive model for postoperative recurrence of pT3a ccRCC.</div></div><div><h3>Materials and Methods</h3><div>Patients diagnosed with pT3a ccRCC between 2010 and 2022 were retrospectively enrolled from 19 institutions. Multivariable Cox proportional hazards regression was used to identify clinical factors associated with poor disease-free survival (DFS). A risk model was established based on the hazard ratios of the identified factors. DFS and overall survival were calculated using the Kaplan-Meier method according to the risk group. The association between the risk model categories and the International Metastatic RCC Database Consortium (IMDC) score at recurrence was also evaluated using the chi-square test.</div></div><div><h3>Results</h3><div>This study included 541 patients with pT3a ccRCC. With a median follow-up of 46 months, postoperative recurrence occurred in 165 (30.5%) patients and death occurred in 81 (15.0%) patients. Multivariate analysis identified 6 variables associated with shorter DFS: male sex, ≥3 extrarenal tumor extension patterns, tumor size &gt;70 mm, nuclear grade 3 or 4, sarcomatoid differentiation, and C-reactive protein ≥1.0 mg/L. The predictive model classified patients into low-, intermediate-, and high-risk categories, with 5-year DFS rates of 88%, 67%, and 39%, respectively. The area under the curve for the 5-year DFS was 0.752. At recurrence, half of the patients in the low-risk group were classified in the IMDC-favorable group, compared to 23.1% in the high-risk group.</div></div><div><h3>Conclusions</h3><div>This risk model can predict postoperative recurrence risk in patients with pT3a ccRCC. This model may help in selecting candidates for adjuvant therapy for pT3aN0M0 ccRCC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102400"},"PeriodicalIF":2.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Surgical Outcomes of Bladder Paraganglioma: A 20-Year Nationwide Center Experience","authors":"Wencong Han ,&nbsp;Xiaoteng Yu ,&nbsp;Shiwei Chen ,&nbsp;Zejin Ou ,&nbsp;Tai Kang ,&nbsp;Zheng Zhang","doi":"10.1016/j.clgc.2025.102397","DOIUrl":"10.1016/j.clgc.2025.102397","url":null,"abstract":"<div><h3>Objective</h3><div><strong>:</strong> Bladder paraganglioma (BPGL) is a rare neuroendocrine tumor. This study evaluates the clinical characteristics, perioperative course, and long-term outcomes of BPGL treated at a nationwide center over the past 2 decades.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 45 patients who underwent surgery for BPGL between January 2004 and September 2024. Demographic data, clinical features, tumor characteristics, surgical approach, intraoperative hemodynamic instability (HDI), and follow-up outcomes were assessed.</div></div><div><h3>Results</h3><div>The median age of patients was 54.0 years (IQR, 36.5, 65.0), with 66.4% being female. A preoperative diagnosis was made in 53.3% of cases. Younger patients (age ≤40 years) exhibited more catecholamine-related symptoms (75.0% vs. 24.2%, <em>P</em> = .006), larger tumor sizes (4.3 cm vs. 1.8 cm, <em>P</em> = .010), higher plasma normetanephrine levels (14.0 nmol/L vs. 1.9 nmol/L, <em>P</em> = .014), were more likely to be diagnosed preoperatively (83.3% vs. 42.4%, <em>P</em> = .015), and had a higher rate of metastasis (41.7% vs. 3.0%, <em>P</em> = .004) compared to older patients. Intraoperative HDI occurred in 51.1% of patients. Prolonged anesthesia (189.0 min vs. 97.5 min, <em>P</em> = .013) and surgery time (134.0 min vs. 25.5 min, <em>P</em> = .005) were significantly associated with HDI. The median follow-up time was 5.1 years (IQR, 1.4-8.3 years), during which 1 patient (2.4%) experienced recurrence, and 1 patient (2.4%) died from the disease. No other patients experienced recurrence or metastasis.</div></div><div><h3>Conclusion</h3><div>Younger age predicts more aggressive BPGL behavior. Transurethral resection (TUR) is a safe and effective option for tumors ≤3 cm. Early recognition, meticulous perioperative management and lifelong surveillance are essential to optimize outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102397"},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Lutetium-177 PSMA Therapy for Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Zineddine Belabaci ,&nbsp;Mouhammed Sleiay ,&nbsp;Abdelrahman Abdelshafi ,&nbsp;Zina Otmani ,&nbsp;Elsayed S. Moubarak ,&nbsp;Faten Amer","doi":"10.1016/j.clgc.2025.102398","DOIUrl":"10.1016/j.clgc.2025.102398","url":null,"abstract":"<div><h3>Background and aim</h3><div>Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy using lutetium-177 has emerged as a promising treatment for metastatic castration-resistant prostate cancer (mCRPC). In this systematic review and meta-analysis, the safety and efficacy of PSMA-targeted radioligand therapy (PRLT) using lutetium-177 ([¹⁷⁷Lu]Lu-PSMA) were assessed.</div></div><div><h3>Methods</h3><div>This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A detailed searches were conducted across PubMed, EMBASE, Cochrane Library and Scopus for randomized controlled trials (RCTs) on [177Lu]Lu-PSMA radioligand therapy in mCRPC. Prostate-specific antigen (PSA) responses, toxicity profiles, and outcomes including radiographic progression-free survival (rPFS) and overall survival were assessed. Quantitative analyses with Review Manager 5.4 software, using Risk estimates (hazard ratios, RR and OR) and 95% confidence intervals for outcomes in random effects were performed.</div></div><div><h3>Results</h3><div>Six RCTs involving 2113 patients with mCRPC were included in the meta-analysis. Patients treated with [¹⁷⁷Lu]Lu-PSMA had a significantly higher response to therapy compared to controls based on ≥50% PSA decrease (OR = 4.27; 95% confidence interval [CI]: 2.59-7.06; <em>P</em> &lt; .00001) and objective response rate (ORR) (RR=2.93; 95% CI, 1.62-5.30; <em>P</em> = .0004). [¹⁷⁷Lu]Lu-PSMA reduced the risk of rPFS (HR=0.57; 95% CI, 0.46-0.70; <em>P</em> &lt; .00001). However, no significant impact on overall survival was observed (HR = 0.81; 95% CI, 0.62-1.06; <em>P</em> = .13). No significant difference in grade ≥3 adverse events was reported (RR = 0.85; 95% CI, 0.63-1.15; <em>P</em> = .32).</div></div><div><h3>Conclusion</h3><div>These findings support the use of [¹⁷⁷Lu]Lu-PSMA for metastatic castration-resistant prostate cancer, demonstrating both safety profile and efficacy. The potential of this therapeutic approach warrants further investigative efforts to optimize treatment methodologies and improve the quality of patient care and the criteria for patient selection.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102398"},"PeriodicalIF":2.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of gastrectomy on cabozantinib exposure: Clinical case of a patient with clear renal cell carcinoma","authors":"Sanae Kdadri ,&nbsp;Fabien Moinard-Butot ,&nbsp;Antonin Schmitt ,&nbsp;Bernard Royer ,&nbsp;Philippe Barthélémy","doi":"10.1016/j.clgc.2025.102396","DOIUrl":"10.1016/j.clgc.2025.102396","url":null,"abstract":"<div><div>This case report describes the pharmacokinetic (PK) alterations of cabozantinib in a gastrectomised patient with metastatic renal cell carcinoma (mRCC). The patient, who had previously been treated with cabozantinib, underwent a gastrectomy due to complications from a diaphragmatic hernia. After disease progression, cabozantinib was reintroduced at a reduced dose of 40 mg daily. PK analysis revealed early absorption and rapid elimination of the drug compared to typical profiles, suggesting that gastric resection impacts cabozantinib’s absorption and clearance. These findings indicate that standard dosing regimens may not be appropriate for gastrectomised patients, emphasizing the need for personalized dose adjustments. This case highlights the importance of pharmacokinetic (PK) monitoring to optimize treatment outcomes in this patient population and suggests further research on the broader impact of gastrectomy on tyrosine kinase inhibitors (TKI).</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102396"},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder","authors":"Aleksander Ślusarczyk ,&nbsp;Pietro Scilipoti ,&nbsp;Roberto Contieri ,&nbsp;Mattia Longoni ,&nbsp;Mario de Angelis ,&nbsp;Marcin Miszczyk ,&nbsp;Wojciech Krajewski ,&nbsp;Ekaterina Laukthina ,&nbsp;Francesco Del Giudice ,&nbsp;Andrea Gallioli ,&nbsp;Paweł Rajwa ,&nbsp;Benjamin Pradere ,&nbsp;Paras Shah ,&nbsp;Stephen A. Boorjian ,&nbsp;Marco Moschini ,&nbsp;Piotr Radziszewski","doi":"10.1016/j.clgc.2025.102399","DOIUrl":"10.1016/j.clgc.2025.102399","url":null,"abstract":"<div><h3>Context</h3><div>Patients with bladder cancer and clinically positive pelvic lymph nodes (cN+) have poor prognosis, and the optimal definitive treatment method remains controversial.</div></div><div><h3>Objective</h3><div>To compare survival outcomes between chemotherapy followed by radical cystectomy (RC) and chemoradiation (CRT) in patients with cN+ bladder cancer.</div></div><div><h3>Methods</h3><div>We queried the Surveillance, Epidemiology, and End Results (2000-2021) database to identify patients with cN+ bladder cancer treated with CRT or chemotherapy and RC. Cumulative incidence functions, Fine–Gray model, and Cox proportional hazards were used for the survival analysis. Inverse probability treatment weighting (IPTW) was used to adjust for confounders. The primary endpoints were cancer-specific mortality (CSM) and all-cause mortality (ACM).</div></div><div><h3>Results</h3><div>Among 552 patients identified, 175 (32%) received CRT and 377 (68%) underwent chemotherapy plus RC, and 5-year ACM was 75% (95% confidence interval [CI]: 71%-78%). RC and CRT were associated with 5-year CSM of 62% (95% CI: 57%-67%) and 72% (95% CI: 65%-78%), and 5-year ACM of 70% (95% CI: 65%-75%) and 85% (95% CI: 75%-90%), respectively. After IPTW, on multivariable Cox proportional hazard analysis adjusted for nodal and tumor staging, age, gender, tumor size and race, RC was associated with a significantly lower risk of CSM (hazard ratio [HR]: 0.47, 95% CI: 0.37-0.60, <em>P</em> &lt; .001) and ACM (HR: 0.53, 95% CI: 0.46-0.60, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Patients with cN+ bladder cancer who received CRT had a worse prognosis compared to those who underwent chemotherapy followed by RC. The incorporation of more effective systemic therapies is required to improve outcomes, as in our analysis, only one in four cN+ patients survived beyond 5 years.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102399"},"PeriodicalIF":2.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Disparities by Sex, Race, and Age in the Era of Contemporary Advanced Urothelial Carcinoma Therapy: A Real-World Analysis","authors":"Adam A. Barsouk ,&nbsp;Austin Yang ,&nbsp;Jonathan H. Sussman ,&nbsp;Omar Elghawy ,&nbsp;Jessica Xu ,&nbsp;Jason Xu ,&nbsp;Lingbin Meng ,&nbsp;Shunsuke Koga ,&nbsp;Wei Du ,&nbsp;Ronac Mamtani ,&nbsp;Lin Mei","doi":"10.1016/j.clgc.2025.102395","DOIUrl":"10.1016/j.clgc.2025.102395","url":null,"abstract":"<div><h3>Introduction</h3><div>Retrospective data suggest poorer survival for female, racial minority, and older advanced urothelial carcinoma (aUC) patients. However, data on survival disparities in the modern era remain limited.</div></div><div><h3>Methods</h3><div>This cohort study used Flatiron Health’s nationwide de-identified electronic health record (EHR)-derived database. Patients who initiated systemic therapy for aUC between January, 2017 and May, 2024 were included. Baseline characteristics, treatment history, and clinical outcomes were abstracted. PFS and OS were compared by sex (male vs. female), race (White, Black, vs. Asian/Pacific Islander [API]), and age at diagnosis (&gt; 65 years [y] vs. ≤ 65 y), using Kaplan-Meier log-rank analysis and Cox proportional hazards models. Independent sample t-tests and chi-square analyses were used for univariate comparisons. <em>P</em>-values &lt; <em>.</em>05 were considered statistically significant.</div></div><div><h3>Results</h3><div>A total of 5142 patients with aUC were identified. 1419 were (28%) female and 575 (11%) were &gt; 65 y. Of those with recorded race (<em>n</em> = 3492), 1% were API, 5% Black, 14% categorized as “other,” and 80% White. There was no difference in PFS (8.7 vs. 9.0 months [m], HR1.03; <em>P</em> = <em>.</em>82) or OS (13.2 vs. 13.5 m; HR1.05, <em>P</em> = <em>.</em>31) between women and men. Women had shorter PFS to men on immune checkpoint inhibitors (ICI) (<em>P</em> = <em>.</em>002) but not with other first-line (1L) therapy. API patients had comparable PFS (9.6 vs. 8.9 m; HR0.91; <em>P</em> = <em>.</em>45) but longer OS (28.5 vs. 14.1 m; HR0.56; <em>P</em> = <em>.</em>008) compared to White patients. Black patients had comparable PFS (7.9 vs. 8.5; HR1.06; <em>P</em> = <em>.</em>81) and OS (11.5 vs. 14.1 m; HR1.32; <em>P</em> = <em>.</em>73) vs White patients. Patients &gt; 65 y had shorter PFS to ≤ 65 y (7.6 vs. 9.0 m; HR1.14, <em>P</em> = <em>.</em>019); however, OS was longer in older patients (16.5 vs. 12.8 m; HR0.80, <em>P</em> &lt; <em>.</em>001). Only on 1L ICI, OS was longer in those &gt; 65 y compared to those ≤ 65 y (HR0.71; <em>P</em> = <em>.</em>021)</div></div><div><h3>Conclusion</h3><div>In this large real-world database, female aUC patients had comparable PFS and OS to males. API patients showed superior OS to White patients. Patients &gt; 65 y had inferior PFS but superior OS to patients ≤ 65 y.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102395"},"PeriodicalIF":2.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}