Pub Date : 2025-11-23DOI: 10.1016/j.clgc.2025.102477
Monica S. Nair , Jessica Scarborough , Chandana A. Reddy , Anirudh R. Bommireddy , Erin Brooks , Nima Almassi , Christopher J. Weight , Steven Campbell , Moshe C. Ornstein , Amanda Nizam , Timothy Gilligan , Christopher Wee , Shilpa Gupta , Jacob G. Scott , Anthony Mastroianni , Rahul Tendulkar , Omar Y. Mian
Purpose
We sought to define patient and disease characteristics associated with outcomes after trimodality therapy (TMT) for high-risk nonmuscle invasive and muscle invasive bladder cancer (MIBC). A retrospective analysis of a large single institution cohort treated with bladder preservation therapy was performed to identify factors associated with survival.
Methods and Materials
Patients with high-risk non-MIBC or MIBC who underwent definitive bladder sparing treatment between 2006 and 2022 were included. Variables for analysis included age, sex, Charlson Comorbidity Index (CCI), surgical candidacy, neoadjuvant/induction chemotherapy (NAC), tumor size, presence of hydronephrosis, carcinoma in-situ, and histologic subtype. Kaplan–Meier analysis was done to calculate rates of overall survival (OS) and disease-free survival (DFS), while cumulative incidence analysis was done to calculate rates of cancer specific mortality (CSM) and local recurrence. Cox proportional hazards regression was done to identify factors associated with OS and DFS. Competing risk regression was done to identify factors associated with CSM and local recurrence.
Results
226 patients were included in the cohort with a median follow up of 18.9 months (range 0.9-172.3). The median age was 79 years (range 49-98) and 79.2% were male. On univariate Cox proportional hazards regression, younger age, NAC, and cystectomy candidacy were associated with improved OS (P < .0001, HR = 1.05, 95% CI, 1.03-1.08; P = .04, HR = 0.62, 95% CI, 0.39-0.99; P < .0001, HR = 0.42, 95% CI, 0.27-0.65; respectively). On multivariable analysis, only younger age and cystectomy eligibility were associated with improved OS (P = .002, HR = 1.04, 95% CI, 1.02-1.07; P = .006, HR = 0.52, 95% CI, 0.33-0.83; respectively).
Conclusion
This study finds cystectomy eligibility to be associated with improved survival and underscores the importance of multi-disciplinary assessment in determining candidacy for organ preserving therapy in MIBC patients.
{"title":"Trimodality Therapy for Bladder Cancer: A Single Institution Retrospective Analysis of Factors Associated With Outcomes for High-Risk Patients Undergoing Organ-Sparing Therapy","authors":"Monica S. Nair , Jessica Scarborough , Chandana A. Reddy , Anirudh R. Bommireddy , Erin Brooks , Nima Almassi , Christopher J. Weight , Steven Campbell , Moshe C. Ornstein , Amanda Nizam , Timothy Gilligan , Christopher Wee , Shilpa Gupta , Jacob G. Scott , Anthony Mastroianni , Rahul Tendulkar , Omar Y. Mian","doi":"10.1016/j.clgc.2025.102477","DOIUrl":"10.1016/j.clgc.2025.102477","url":null,"abstract":"<div><h3>Purpose</h3><div>We sought to define patient and disease characteristics associated with outcomes after trimodality therapy (TMT) for high-risk nonmuscle invasive and muscle invasive bladder cancer (MIBC). A retrospective analysis of a large single institution cohort treated with bladder preservation therapy was performed to identify factors associated with survival.</div></div><div><h3>Methods and Materials</h3><div>Patients with high-risk non-MIBC or MIBC who underwent definitive bladder sparing treatment between 2006 and 2022 were included. Variables for analysis included age, sex, Charlson Comorbidity Index (CCI), surgical candidacy, neoadjuvant/induction chemotherapy (NAC), tumor size, presence of hydronephrosis, carcinoma in-situ, and histologic subtype. Kaplan–Meier analysis was done to calculate rates of overall survival (OS) and disease-free survival (DFS), while cumulative incidence analysis was done to calculate rates of cancer specific mortality (CSM) and local recurrence. Cox proportional hazards regression was done to identify factors associated with OS and DFS. Competing risk regression was done to identify factors associated with CSM and local recurrence.</div></div><div><h3>Results</h3><div>226 patients were included in the cohort with a median follow up of 18.9 months (range 0.9-172.3). The median age was 79 years (range 49-98) and 79.2% were male. On univariate Cox proportional hazards regression, younger age, NAC, and cystectomy candidacy were associated with improved OS (<em>P</em> < .0001, HR = 1.05, 95% CI, 1.03-1.08; <em>P</em> = .04, HR = 0.62, 95% CI, 0.39-0.99; <em>P</em> < .0001, HR = 0.42, 95% CI, 0.27-0.65; respectively). On multivariable analysis, only younger age and cystectomy eligibility were associated with improved OS (<em>P</em> = .002, HR = 1.04, 95% CI, 1.02-1.07; <em>P</em> = .006, HR = 0.52, 95% CI, 0.33-0.83; respectively).</div></div><div><h3>Conclusion</h3><div>This study finds cystectomy eligibility to be associated with improved survival and underscores the importance of multi-disciplinary assessment in determining candidacy for organ preserving therapy in MIBC patients.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102477"},"PeriodicalIF":2.7,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835589","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}
Enfortumab vedotin (EV) in combination with pembrolizumab (P) is the first-line treatment for advanced urothelial carcinoma, but real-world toxicity profiles and associations with survival remain an area of active investigation.
Patients and Methods
Here, we first perform a single-center (University of Pennsylvania) retrospective study of EV ± P patients to characterize frequency and clinical importance of 5 relevant toxicities (skin reaction, neuropathy, ocular disorder, hyperglycemia, and pneumonitis). We associate these toxicities with survival and then evaluate these findings in a larger national cohort (Flatiron Health Research Database [FHRD]).
Results
We find that toxicities were common in the single-center cohort, with skin reaction (60%) and neuropathy (47%) most frequent, but toxicity-related discontinuation or hospitalization were less frequent (13%). Without a landmark analysis, multiple toxicities were linked to survival, but landmark analysis to address immortal time bias preserved only the skin reaction-survival association (Penn: HR = 0.28, 95% CI, 0.14-0.58; FHRD: HR = 0.69, 95% CI, 0.53-0.90).
Conclusions
These findings highlight the clinical relevance of EV ± P related toxicities, demonstrate the importance of accounting for immortal time bias in associations of these toxicities with survival, and add to a growing evidence base showing a survival association with skin toxicity in EV ± P treated patients. Future prospective studies are needed to evaluate skin toxicity as a favorable marker for survival.
{"title":"Real-World Enfortumab Vedotin ± Pembrolizumab Treatment-Based Toxicities and Associations With Survival in Advanced Urothelial Carcinoma","authors":"Martin Kurian , Ronac Mamtani , Omar Elghawy , Vivek Nimgaonkar","doi":"10.1016/j.clgc.2025.102474","DOIUrl":"10.1016/j.clgc.2025.102474","url":null,"abstract":"<div><h3>Introduction</h3><div>Enfortumab vedotin (EV) in combination with pembrolizumab (P) is the first-line treatment for advanced urothelial carcinoma, but real-world toxicity profiles and associations with survival remain an area of active investigation.</div></div><div><h3>Patients and Methods</h3><div>Here, we first perform a single-center (University of Pennsylvania) retrospective study of EV ± P patients to characterize frequency and clinical importance of 5 relevant toxicities (skin reaction, neuropathy, ocular disorder, hyperglycemia, and pneumonitis). We associate these toxicities with survival and then evaluate these findings in a larger national cohort (Flatiron Health Research Database [FHRD]).</div></div><div><h3>Results</h3><div>We find that toxicities were common in the single-center cohort, with skin reaction (60%) and neuropathy (47%) most frequent, but toxicity-related discontinuation or hospitalization were less frequent (13%). Without a landmark analysis, multiple toxicities were linked to survival, but landmark analysis to address immortal time bias preserved only the skin reaction-survival association (Penn: HR = 0.28, 95% CI, 0.14-0.58; FHRD: HR = 0.69, 95% CI, 0.53-0.90).</div></div><div><h3>Conclusions</h3><div>These findings highlight the clinical relevance of EV ± P related toxicities, demonstrate the importance of accounting for immortal time bias in associations of these toxicities with survival, and add to a growing evidence base showing a survival association with skin toxicity in EV ± P treated patients. Future prospective studies are needed to evaluate skin toxicity as a favorable marker for survival.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102474"},"PeriodicalIF":2.7,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770269","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}
Pub Date : 2025-11-21DOI: 10.1016/j.clgc.2025.102475
Patricia Capdevila, Jorge Aparicio
Purpose
To quantify long-term, competing-risk–adjusted absolute risks of non–germ-cell second malignant neoplasms and contralateral germ-cell tumor in stage I testicular germ-cell tumor survivors treated in the contemporary era, and to contextualize these estimates against prior population-based cohorts.
Methods
Retrospective single-center cohort of consecutive stage I TGCT (1994-2023); time zero was orchiectomy. Primary endpoints were time to first non–germ-cell SMN and to contralateral TGCT (cGCT). Death was modeled as a competing event. Absolute risks were estimated with the Aalen–Johansen cumulative incidence function (CIF) with 95% CIs; follow-up by reverse Kaplan–Meier. CIFs were compared by initial strategy (surveillance vs. adjuvant therapy) using Gray’s test.
Results
Among 169 survivors, SMN occurred in 9 (5.3%; median latency 9.4 y) and cGCT in 8 (4.7%; median 7.7 y). The 10-year CIFs were 3.7% (95% CI, 0.7-7.2) for SMN and 4.6% (1.4-8.8) for cGCT; by 25 years, 11.1% (3.6-20.9) and 8.4% (2.9-16.8), respectively. There were no TGCT-related deaths; overall mortality was 5.3% (3 SMN-related; 6 non-cancer). No clear difference emerged between surveillance and adjuvant therapy (SMN, Gray’s P = .9; cGCT curves overlapped).
Conclusions
In a contemporary, stage I cohort with long-term follow-up, late events were driven by competing risks. Absolute risks of late events were modest but clinically relevant (SMN ≈ 11% and cGCT ≈ 8% by 25 years), lower than historical series treated with high-dose radiotherapy.
Implications for Cancer Survivors
Our findings support survivorship plans that prioritize targeted second-cancer screening, cardiometabolic prevention with early postcisplatin vigilance, and proactive mental-health support, while maintaining a minimum-effective-dose approach to initial and follow-up treatments.
{"title":"Second Malignancies and Non-Cancer Mortality in Long-Term Survivors of Stage I Testicular Cancer: A 30-Year Institutional Experience and Literature Review","authors":"Patricia Capdevila, Jorge Aparicio","doi":"10.1016/j.clgc.2025.102475","DOIUrl":"10.1016/j.clgc.2025.102475","url":null,"abstract":"<div><h3>Purpose</h3><div>To quantify long-term, competing-risk–adjusted absolute risks of non–germ-cell second malignant neoplasms and contralateral germ-cell tumor in stage I testicular germ-cell tumor survivors treated in the contemporary era, and to contextualize these estimates against prior population-based cohorts.</div></div><div><h3>Methods</h3><div>Retrospective single-center cohort of consecutive stage I TGCT (1994-2023); time zero was orchiectomy. Primary endpoints were time to first non–germ-cell SMN and to contralateral TGCT (cGCT). Death was modeled as a competing event. Absolute risks were estimated with the Aalen–Johansen cumulative incidence function (CIF) with 95% CIs; follow-up by reverse Kaplan–Meier. CIFs were compared by initial strategy (surveillance vs. adjuvant therapy) using Gray’s test.</div></div><div><h3>Results</h3><div>Among 169 survivors, SMN occurred in 9 (5.3%; median latency 9.4 y) and cGCT in 8 (4.7%; median 7.7 y). The 10-year CIFs were 3.7% (95% CI, 0.7-7.2) for SMN and 4.6% (1.4-8.8) for cGCT; by 25 years, 11.1% (3.6-20.9) and 8.4% (2.9-16.8), respectively. There were no TGCT-related deaths; overall mortality was 5.3% (3 SMN-related; 6 non-cancer). No clear difference emerged between surveillance and adjuvant therapy (SMN, Gray’s <em>P</em> = .9; cGCT curves overlapped).</div></div><div><h3>Conclusions</h3><div>In a contemporary, stage I cohort with long-term follow-up, late events were driven by competing risks. Absolute risks of late events were modest but clinically relevant (SMN ≈ 11% and cGCT ≈ 8% by 25 years), lower than historical series treated with high-dose radiotherapy.</div></div><div><h3>Implications for Cancer Survivors</h3><div>Our findings support survivorship plans that prioritize targeted second-cancer screening, cardiometabolic prevention with early postcisplatin vigilance, and proactive mental-health support, while maintaining a minimum-effective-dose approach to initial and follow-up treatments.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102475"},"PeriodicalIF":2.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733548","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}
Pub Date : 2025-11-19DOI: 10.1016/j.clgc.2025.102473
Ha Un Kim , Jaeha Lee , Yoon Young Jo , Sumin Lee , Yeon Joo Kim
Introduction
We compared toxicity profiles of moderate hypofractionated radiotherapy (HFRT) and conventional radiotherapy (CFRT) in salvage radiotherapy (SRT) for prostate cancer patients who underwent radical prostatectomy.
Patients and Methods
We retrospectively reviewed prostate cancer patients who underwent SRT between 2022 and 2023. Two groups were analyzed: CFRT (66 Gy in 30 fractions) and HFRT (55 Gy in 20 fractions). Propensity score matching was performed using variables associated with toxicity outcomes including androgen deprivation therapy usage, anticoagulant usage, diabetes mellitus, baseline genitourinary symptoms, SRT field, and boost irradiation. Follow-up evaluations were conducted every 3 months for the first year and every 6 months thereafter, for up to 2 years. The primary endpoint was acute and late genitourinary (GU) and gastrointestinal (GI) toxicity.
Results
A total of 70 CFRT and 66 HFRT patients were included. After matching, 112 patients (56 per group) were analyzed with median follow-up of 27.8 and 24.8 months, respectively. There was no significant difference in baseline toxicities before SRT between the 2 groups. GU toxicities at 3 months were comparable except for grade 1 urgency, which was more frequent in CFRT (30.4% vs. 14.3%, P = .041) but resolved by 1 year. Late GU toxicities at 1 or 2 years were not significantly different between the 2 groups. No grade ≥ 3 late GU toxicities were observed. For GI toxicities, grade 3 rectal bleeding occurred in 3.6% of CFRT and 1.8% of HFRT patients within 1 year (P = 1.000). Aside from more grade 2 diarrhea at 3 months in CFRT (26.8% vs. 8.9%, P = .014), no significant differences in GI toxicity were found.
Conclusion
Four-week HFRT for SRT showed favorable long-term toxicity outcomes, sustained for up to 2 years and comparable to those of 6-week CFRT.
简介：我们比较了中度低分割放疗（HFRT）和常规放疗（CFRT）在根治性前列腺切除术后前列腺癌患者补救性放疗（SRT）中的毒性。患者和方法：我们回顾性分析了2022年至2023年间接受SRT的前列腺癌患者。两组进行分析：CFRT（30组66 Gy）和HFRT（20组55 Gy）。使用与毒性结果相关的变量进行倾向评分匹配，包括雄激素剥夺治疗的使用、抗凝血剂的使用、糖尿病、基线泌尿生殖系统症状、SRT领域和增强照射。第一年每3个月进行一次随访评估，此后每6个月进行一次随访评估，直至2年。主要终点是急性和晚期泌尿生殖系统（GU）和胃肠道（GI）毒性。结果：共纳入70例CFRT和66例HFRT患者。配对后，分析112例患者（每组56例），中位随访时间分别为27.8个月和24.8个月。两组在SRT前的基线毒性无显著差异。3个月时的GU毒性具有可比性，除了1级急症，1级急症在CFRT中更常见（30.4%比14.3%,P = 0.041），但在1年后消退。两组患者1年和2年晚期GU毒性差异无统计学意义。未观察到≥3级晚期GU毒性。对于胃肠道毒性，1年内发生3级直肠出血的CFRT患者占3.6%，HFRT患者占1.8% （P = 1.000）。除了CFRT患者在3个月时出现更多的2级腹泻（26.8% vs. 8.9%, P = 0.014），胃肠道毒性方面没有发现显著差异。结论：4周HFRT替代SRT显示出良好的长期毒性结果，持续时间长达2年，与6周CFRT相当。
{"title":"Toxicity Comparison between a Four-Week Moderate Hypofractionation and a Six-Week Conventional Fractionation in the Post-Prostatectomy Salvage Radiotherapy for Prostate Cancer","authors":"Ha Un Kim , Jaeha Lee , Yoon Young Jo , Sumin Lee , Yeon Joo Kim","doi":"10.1016/j.clgc.2025.102473","DOIUrl":"10.1016/j.clgc.2025.102473","url":null,"abstract":"<div><h3>Introduction</h3><div>We compared toxicity profiles of moderate hypofractionated radiotherapy (HFRT) and conventional radiotherapy (CFRT) in salvage radiotherapy (SRT) for prostate cancer patients who underwent radical prostatectomy.</div></div><div><h3>Patients and Methods</h3><div>We retrospectively reviewed prostate cancer patients who underwent SRT between 2022 and 2023. Two groups were analyzed: CFRT (66 Gy in 30 fractions) and HFRT (55 Gy in 20 fractions). Propensity score matching was performed using variables associated with toxicity outcomes including androgen deprivation therapy usage, anticoagulant usage, diabetes mellitus, baseline genitourinary symptoms, SRT field, and boost irradiation. Follow-up evaluations were conducted every 3 months for the first year and every 6 months thereafter, for up to 2 years. The primary endpoint was acute and late genitourinary (GU) and gastrointestinal (GI) toxicity.</div></div><div><h3>Results</h3><div>A total of 70 CFRT and 66 HFRT patients were included. After matching, 112 patients (56 per group) were analyzed with median follow-up of 27.8 and 24.8 months, respectively. There was no significant difference in baseline toxicities before SRT between the 2 groups. GU toxicities at 3 months were comparable except for grade 1 urgency, which was more frequent in CFRT (30.4% vs. 14.3%, <em>P</em> = .041) but resolved by 1 year. Late GU toxicities at 1 or 2 years were not significantly different between the 2 groups. No grade ≥ 3 late GU toxicities were observed. For GI toxicities, grade 3 rectal bleeding occurred in 3.6% of CFRT and 1.8% of HFRT patients within 1 year (<em>P</em> = 1.000). Aside from more grade 2 diarrhea at 3 months in CFRT (26.8% vs. 8.9%, <em>P</em> = .014), no significant differences in GI toxicity were found.</div></div><div><h3>Conclusion</h3><div>Four-week HFRT for SRT showed favorable long-term toxicity outcomes, sustained for up to 2 years and comparable to those of 6-week CFRT.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102473"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745989","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}
Pub Date : 2025-11-17DOI: 10.1016/j.clgc.2025.102469
Kara Ingram , Robert Wilson , Jason M. Doherty , Daniel B. Eaton Jr , Sumrah Khan , Martin W. Schoen
Introduction
Treatment of metastatic hormone sensitive prostate cancer (mHSPC) has traditionally included combination therapy of androgen deprivation therapy (ADT) with docetaxel or an androgen receptor pathway inhibitor (ARPI). There are no comparative studies to compare the real-world hospitalization rates and adverse events (AEs).
Material and Methods
A nationwide retrospective study of 1549 US veterans was conducted to compare treatment with ADT+docetaxel (n = 500) versus ADT+ARPI (n = 1049) between 2013 and 2021. Hospitalizations were determined 1 year before and after treatment. Baseline cohort characteristics and incidence rate differences of adverse events were then compared in the year prior to treatment with the year after.
Results
In patients who received ADT+docetaxel, hospitalizations increased by 245%, and ADT+ARPI hospitalizations increased by 125% (P < .001). The docetaxel cohort was younger and had fewer comorbidities (median age 66.8 vs. 73.4 years; CCI 1 vs. 2). Docetaxel had higher rates of hospitalizations due to digestive (+ 600%, P < .001) and respiratory complications (+ 157%, P = .04). The ARPI cohort had increased hospitalizations due to respiratory (+ 243%, P < .001), endocrine/metabolic (+ 80%, P = .002), and circulatory complications (+ 64%, P = .009). The ARPI cohort had a decrease in acute renal failure admissions (−24%, P = .401).
Discussion and Conclusions
Overall, in the real-world setting, the 2 therapy regimens have distinct hospitalization risks and AEs. Patients with respiratory and gastrointestinal comorbidities may be at higher risk when receiving treatment with docetaxel. Alternatively, older and frailer patients who are susceptible to infections and metabolic complications may be at increased risk with ARPIs. These findings may aid physicians in determining the optimal, individualized therapy to mitigate adverse outcomes in patients with mHSPC.
{"title":"Real World Hospitalizations in US Veterans Treated for Metastatic Prostate Cancer with Combination Therapy","authors":"Kara Ingram , Robert Wilson , Jason M. Doherty , Daniel B. Eaton Jr , Sumrah Khan , Martin W. Schoen","doi":"10.1016/j.clgc.2025.102469","DOIUrl":"10.1016/j.clgc.2025.102469","url":null,"abstract":"<div><h3>Introduction</h3><div>Treatment of metastatic hormone sensitive prostate cancer (mHSPC) has traditionally included combination therapy of androgen deprivation therapy (ADT) with docetaxel or an androgen receptor pathway inhibitor (ARPI). There are no comparative studies to compare the real-world hospitalization rates and adverse events (AEs).</div></div><div><h3>Material and Methods</h3><div>A nationwide retrospective study of 1549 US veterans was conducted to compare treatment with ADT+docetaxel (<em>n</em> = 500) versus ADT+ARPI (<em>n</em> = 1049) between 2013 and 2021. Hospitalizations were determined 1 year before and after treatment. Baseline cohort characteristics and incidence rate differences of adverse events were then compared in the year prior to treatment with the year after.</div></div><div><h3>Results</h3><div>In patients who received ADT+docetaxel, hospitalizations increased by 245%, and ADT+ARPI hospitalizations increased by 125% (<em>P</em> < .001). The docetaxel cohort was younger and had fewer comorbidities (median age 66.8 vs. 73.4 years; CCI 1 vs. 2). Docetaxel had higher rates of hospitalizations due to digestive (+ 600%, <em>P</em> < .001) and respiratory complications (+ 157%, <em>P</em> = .04). The ARPI cohort had increased hospitalizations due to respiratory (+ 243%, <em>P</em> < .001), endocrine/metabolic (+ 80%, <em>P</em> = .002), and circulatory complications (+ 64%, <em>P</em> = .009). The ARPI cohort had a decrease in acute renal failure admissions (−24%, <em>P</em> = .401).</div></div><div><h3>Discussion and Conclusions</h3><div>Overall, in the real-world setting, the 2 therapy regimens have distinct hospitalization risks and AEs. Patients with respiratory and gastrointestinal comorbidities may be at higher risk when receiving treatment with docetaxel. Alternatively, older and frailer patients who are susceptible to infections and metabolic complications may be at increased risk with ARPIs. These findings may aid physicians in determining the optimal, individualized therapy to mitigate adverse outcomes in patients with mHSPC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102469"},"PeriodicalIF":2.7,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727684","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}
Pub Date : 2025-11-15DOI: 10.1016/j.clgc.2025.102467
Caio Vinicius Suartz , Lucas Amorim Santos , Caio Felipe Araujo Matalani , Vinícius DallAqua , Leonam Bringhenti Schumacher , Henrique Laurent Lepine , José Bessa Júnior , Walid Shahrour , Walid Shabana , Leonardo Oliveira Reis , Bárbara Vieira Lima Aguiar , Maurício Dener Cordeiro , William Carlos Nahas , Leopoldo Alves Ribeiro-Filho
To compare the safety and diagnostic performance of transperineal (TP) versus transrectal (TR) ultrasound-guided prostate biopsies using only data from randomized controlled trials (RCTs). A systematic search was performed in multiple databases up to May 2025. We included only RCTs comparing TP and TR approaches in men undergoing MRI-targeted prostate biopsies. Meta-analysis was conducted using odds ratios (OR) and 95% confidence intervals (CI) for categorical outcomes. The primary endpoints were cancer detection rate and postbiopsy infection rate. Secondary outcomes included urinary retention, bleeding, pain, and complications stratified by the Clavien–Dindo system. Study quality and certainty of evidence were assessed using the Cochrane ROB2 and GRADE tools. Four RCTs encompassing 2682 patients (TP: 1323; TR: 1359) were included. No significant differences were observed in overall prostate cancer detection rates (OR 1.03, 95% CI, 0.79-1.36) or detection of anterior lesions (OR 1.01, 95% CI, 0.41-2.45). Similarly, no differences were found in bleeding (OR 1.14, 95% CI, 0.66-1.95), urinary retention (OR 1.01, 95% CI, 0.50-2.04), total infections (OR 1.02, 95% CI, 0.77-1.35), or severe infections (OR 2.17, 95% CI, 0.97-4.88). Mild pain was more frequent in the TP group (OR 1.56, 95% CI, 1.20-2.03), while moderate to severe pain did not differ significantly (OR 0.65, 95% CI, 0.39-1.07). Transperineal and transrectal MRI–fusion–guided biopsy approaches demonstrated equivalent diagnostic accuracy and safety profiles. While the transperineal route was associated with slightly greater mild discomfort, cancer detection and complication rates were comparable. The selection of approach should be guided by principles of antimicrobial stewardship, patient preference, and institutional expertise.
{"title":"Transperineal versus Transrectal Prostate Biopsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Caio Vinicius Suartz , Lucas Amorim Santos , Caio Felipe Araujo Matalani , Vinícius DallAqua , Leonam Bringhenti Schumacher , Henrique Laurent Lepine , José Bessa Júnior , Walid Shahrour , Walid Shabana , Leonardo Oliveira Reis , Bárbara Vieira Lima Aguiar , Maurício Dener Cordeiro , William Carlos Nahas , Leopoldo Alves Ribeiro-Filho","doi":"10.1016/j.clgc.2025.102467","DOIUrl":"10.1016/j.clgc.2025.102467","url":null,"abstract":"<div><div>To compare the safety and diagnostic performance of transperineal (TP) versus transrectal (TR) ultrasound-guided prostate biopsies using only data from randomized controlled trials (RCTs). A systematic search was performed in multiple databases up to May 2025. We included only RCTs comparing TP and TR approaches in men undergoing MRI-targeted prostate biopsies. Meta-analysis was conducted using odds ratios (OR) and 95% confidence intervals (CI) for categorical outcomes. The primary endpoints were cancer detection rate and postbiopsy infection rate. Secondary outcomes included urinary retention, bleeding, pain, and complications stratified by the Clavien–Dindo system. Study quality and certainty of evidence were assessed using the Cochrane ROB2 and GRADE tools. Four RCTs encompassing 2682 patients (TP: 1323; TR: 1359) were included. No significant differences were observed in overall prostate cancer detection rates (OR 1.03, 95% CI, 0.79-1.36) or detection of anterior lesions (OR 1.01, 95% CI, 0.41-2.45). Similarly, no differences were found in bleeding (OR 1.14, 95% CI, 0.66-1.95), urinary retention (OR 1.01, 95% CI, 0.50-2.04), total infections (OR 1.02, 95% CI, 0.77-1.35), or severe infections (OR 2.17, 95% CI, 0.97-4.88). Mild pain was more frequent in the TP group (OR 1.56, 95% CI, 1.20-2.03), while moderate to severe pain did not differ significantly (OR 0.65, 95% CI, 0.39-1.07). Transperineal and transrectal MRI–fusion–guided biopsy approaches demonstrated equivalent diagnostic accuracy and safety profiles. While the transperineal route was associated with slightly greater mild discomfort, cancer detection and complication rates were comparable. The selection of approach should be guided by principles of antimicrobial stewardship, patient preference, and institutional expertise.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102467"},"PeriodicalIF":2.7,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733454","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}
Pub Date : 2025-11-15DOI: 10.1016/j.clgc.2025.102470
Tobias Peres, James Larkin
Background and Objective
To evaluate the efficacy and toxicity of ipilimumab and nivolumab in advanced clear cell renal cell carcinoma (ccRCC) and rare variant RCC, and assess the impact of immune-related adverse events (irAEs) and steroid use on survival.
Methods
This retrospective study included patients with advanced ccRCC and rare variant RCC treated with first-line ipilimumab and nivolumab at the Royal Marsden Hospital between 2016 and 2025. Survival, toxicity, and the impact of irAEs and steroid use were analyzed using landmark and time-dependent methods.
Key Findings and Limitations
Among 154 patients, 35 had rare variant RCC and 18 had brain metastases (BM). Median follow-up was 20.3 months (ccRCC) and 24.2 months (rare variants). Median overall survival (OS) was 31.9 months (95% CI, 23.5-59.1) for ccRCC and 25.9 months (95% CI, 21.9-not estimable (NE)) for rare variants. Median progression-free survival (PFS) was 9.0 months (95% CI, 7.1-12.8) and 7.2 months (95% CI, 4.6-NE), respectively. Objective response rates (ORR) were 41.0% (ccRCC) and 38.2% (rare variants). In BM patients, median OS was 14.5 months (95% CI, 8.3-NE), PFS 6.2 months (95% CI, 3.3-NE), and ORR 27.8%. Grade 3–4 irAEs occurred in 28.4% and were associated with longer OS at 6-week landmark (NR vs. 23.1 months, P = .033). Prednisone ≥ 40 mg was associated with improved OS (61.2 vs. 22.3 months, P = .021), confirmed on multivariable analysis. Limitations include small sample size and retrospective design.
Conclusions and Clinical Implications
Ipilimumab and nivolumab demonstrated real-world efficacy in both ccRCC and rare variant RCC. Grade 3–4 irAEs and the use of high-dose steroids for their management were associated with improved OS.
{"title":"Ipilimumab and Nivolumab in Renal Cell Carcinoma: Real-World Experience in Rare Variant Renal Cell Carcinoma, Brain Metastases and Impact of Immune-Related Adverse Events and Steroid Use","authors":"Tobias Peres, James Larkin","doi":"10.1016/j.clgc.2025.102470","DOIUrl":"10.1016/j.clgc.2025.102470","url":null,"abstract":"<div><h3>Background and Objective</h3><div>To evaluate the efficacy and toxicity of ipilimumab and nivolumab in advanced clear cell renal cell carcinoma (ccRCC) and rare variant RCC, and assess the impact of immune-related adverse events (irAEs) and steroid use on survival.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with advanced ccRCC and rare variant RCC treated with first-line ipilimumab and nivolumab at the Royal Marsden Hospital between 2016 and 2025. Survival, toxicity, and the impact of irAEs and steroid use were analyzed using landmark and time-dependent methods.</div></div><div><h3>Key Findings and Limitations</h3><div>Among 154 patients, 35 had rare variant RCC and 18 had brain metastases (BM). Median follow-up was 20.3 months (ccRCC) and 24.2 months (rare variants). Median overall survival (OS) was 31.9 months (95% CI, 23.5-59.1) for ccRCC and 25.9 months (95% CI, 21.9-not estimable (NE)) for rare variants. Median progression-free survival (PFS) was 9.0 months (95% CI, 7.1-12.8) and 7.2 months (95% CI, 4.6-NE), respectively. Objective response rates (ORR) were 41.0% (ccRCC) and 38.2% (rare variants). In BM patients, median OS was 14.5 months (95% CI, 8.3-NE), PFS 6.2 months (95% CI, 3.3-NE), and ORR 27.8%. Grade 3–4 irAEs occurred in 28.4% and were associated with longer OS at 6-week landmark (NR vs. 23.1 months, <em>P</em> = .033). Prednisone ≥ 40 mg was associated with improved OS (61.2 vs. 22.3 months, <em>P</em> = .021), confirmed on multivariable analysis. Limitations include small sample size and retrospective design.</div></div><div><h3>Conclusions and Clinical Implications</h3><div>Ipilimumab and nivolumab demonstrated real-world efficacy in both ccRCC and rare variant RCC. Grade 3–4 irAEs and the use of high-dose steroids for their management were associated with improved OS.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102470"},"PeriodicalIF":2.7,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688792","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}
Pub Date : 2025-11-12DOI: 10.1016/j.clgc.2025.102468
Kenrick Ng , Garima Priyadarshini , Aaron Prendergast , Charlotte Ackerman , Susanna Alexander , Sarah Rudman , Han Hsi Wong , Constantine Alifrangis , Daniel Lawrence , Daniel M. Berney , Ewa Nowosinska , Jonathan Shamash
Background
Many patients with relapsed germ cell tumors (GCTs) can still be cured with salvage chemotherapy. Oxaliplatin-based therapies may offer reduced toxicity and noncross resistance to cisplatin-based therapies. PET scan response early during therapy may predict long term outcome.
Methods
Eligible patients with GCTs who progressed following cisplatin-based chemotherapy were recruited into this single-arm, phase II clinical trial. Participants received four 21-day cycles of actinomycin D, methotrexate, paclitaxel, and oxaliplatin. The primary endpoint was objective response rate. Secondary endpoints were progression-free survival (PFS), overall survival and toxicity. A survival analysis was performed based on International Prognostic Factors Study Group (IPFSG) classes. The early predictive value of response on PET CT after 1 cycle of treatment was also assessed.
Results
Forty four patients received at least 1 dose of the study medication between 2012 and 2020. The median age was 38, and 70% had intermediate, high or very high-risk disease by IPFSG criteria. The objective response rate of the evaluable population was 59.0%. The median combined radiological or tumor marker PFS was 9.7 months (95% CI, 3.0-22.0 months). At a median follow-up of 26.9 months, the median overall survival was not reached (95% CI, 17.8-NR). Analyses of outcomes based on IPFSG showed relatively favorable outcomes in patients with high and very high-risk disease, with a 2-year combined PFS rates of 33%. PET CT response after 1 cycle of treatment did not predict PFS benefit.
Conclusions
The GAMMA regimen demonstrates encouraging antitumor activity in relapsed GCT, despite recruiting a cohort of patients with predominantly poor risk disease.
{"title":"GAMMA: Results from a Phase II Study for Relapsed Germ Cell Tumors using an Oxaliplatin-Based Treatment Regimen","authors":"Kenrick Ng , Garima Priyadarshini , Aaron Prendergast , Charlotte Ackerman , Susanna Alexander , Sarah Rudman , Han Hsi Wong , Constantine Alifrangis , Daniel Lawrence , Daniel M. Berney , Ewa Nowosinska , Jonathan Shamash","doi":"10.1016/j.clgc.2025.102468","DOIUrl":"10.1016/j.clgc.2025.102468","url":null,"abstract":"<div><h3>Background</h3><div>Many patients with relapsed germ cell tumors (GCTs) can still be cured with salvage chemotherapy. Oxaliplatin-based therapies may offer reduced toxicity and noncross resistance to cisplatin-based therapies. PET scan response early during therapy may predict long term outcome.</div></div><div><h3>Methods</h3><div>Eligible patients with GCTs who progressed following cisplatin-based chemotherapy were recruited into this single-arm, phase II clinical trial. Participants received four 21-day cycles of actinomycin D, methotrexate, paclitaxel, and oxaliplatin. The primary endpoint was objective response rate. Secondary endpoints were progression-free survival (PFS), overall survival and toxicity. A survival analysis was performed based on International Prognostic Factors Study Group (IPFSG) classes. The early predictive value of response on PET CT after 1 cycle of treatment was also assessed.</div></div><div><h3>Results</h3><div>Forty four patients received at least 1 dose of the study medication between 2012 and 2020. The median age was 38, and 70% had intermediate, high or very high-risk disease by IPFSG criteria. The objective response rate of the evaluable population was 59.0%. The median combined radiological or tumor marker PFS was 9.7 months (95% CI, 3.0-22.0 months). At a median follow-up of 26.9 months, the median overall survival was not reached (95% CI, 17.8-NR). Analyses of outcomes based on IPFSG showed relatively favorable outcomes in patients with high and very high-risk disease, with a 2-year combined PFS rates of 33%. PET CT response after 1 cycle of treatment did not predict PFS benefit.</div></div><div><h3>Conclusions</h3><div>The GAMMA regimen demonstrates encouraging antitumor activity in relapsed GCT, despite recruiting a cohort of patients with predominantly poor risk disease.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102468"},"PeriodicalIF":2.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673174","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}
FGFR3 alterations are observed in 10% to 15% of patients with advanced urothelial carcinoma (UC). We aimed to clarify the prognostic and predictive value of FGFR3 alterations in patients receiving first-line platinum-based chemotherapy (PBC) for advanced urothelial carcinoma.
Patients and Methods
We conducted a multicenter retrospective cohort study including patients with histologically confirmed UC treated in first line with PBC, with or without immune-checkpoint inhibitors (ICIs) administered as maintenance or second line. Only patients with known FGFR3 status on baseline tumor tissue, locally assessed were included. Progression-free survival (PFS) was the primary endpoint. Secondary endpoints included overall survival (OS), objective response rates (ORR), and PFS with ICIs, stratified by FGFR3 status.
Results
Between 2016 and 2022, 191 pts were included, of whom 58 (30.4%) had FGFR3-altered tumors (FGFR3^alt). Baseline characteristics were well balanced. ICIs were administered to 34% of patients. After a median follow-up of 32 months, median PFS under PBC was 6.6 months in FGFR3^alt and 7.5 in FGFR3 wild type subgroups (HR = 1.27; P = .15) respectively. Median OS was 22.1 versus 20.8 months (HR = 0.91; P = .658), and ORR in 133 pts were similar across subgroups (70.7% vs. 69.2% respectively). In multivariate analysis, FGFR3 status was not associated with survival.
Conclusions
FGFR3 status did not significantly impact response to PBC in first-line treatment or ICIs. These findings underscore that the presence of an FGFR3 alteration does not guide the choice of platinum-based treatment, and the need for prospective biomarker-driven trials to identify best treatment sequences in advanced UC.
导读：在10% - 15%的晚期尿路上皮癌（UC）患者中观察到FGFR3改变。我们旨在阐明FGFR3改变在接受一线铂基化疗（PBC）晚期尿路上皮癌患者中的预后和预测价值。患者和方法：我们进行了一项多中心回顾性队列研究，包括组织学证实的UC患者，接受一线PBC治疗，使用或不使用免疫检查点抑制剂（ICIs）作为维持或二线治疗。仅纳入局部评估的FGFR3基线肿瘤组织状态已知的患者。无进展生存期（PFS）是主要终点。次要终点包括总生存期（OS）、客观缓解率（ORR）和ICIs患者的PFS，按FGFR3状态分层。结果：在2016年至2022年期间，纳入191例患者，其中58例（30.4%）患有FGFR3改变的肿瘤（FGFR3^alt）。基线特征平衡良好。34%的患者使用了ICIs。中位随访32个月后，FGFR3^alt和FGFR3野生型亚组PBC下的中位PFS分别为6.6个月和7.5个月（HR = 1.27; P = 0.15）。中位OS分别为22.1个月和20.8个月（HR = 0.91; P = 0.658）， 133名患者的ORR在亚组间相似（分别为70.7%和69.2%）。在多变量分析中，FGFR3状态与生存无关。结论：FGFR3状态对一线治疗或ici患者对PBC的应答没有显著影响。这些发现强调，FGFR3改变的存在并不能指导选择基于铂的治疗，需要前瞻性生物标志物驱动的试验来确定晚期UC的最佳治疗序列。
{"title":"Impact of FGFR3 Alterations on First-Line Platinum Based Chemotherapy in Patients With Metastatic or Locally Advanced Urothelial Carcinoma: The Retrospective IFUCA Study","authors":"Thibaut Reverdy , Floriane Izarn , Benoit Allignet , Guilhem Roubaud , Nyere Gibson , Diego Teyssonneau , Constance Thibault , Hugo Berthou , Nadine Houede , Aude Fléchon , Sophie Tartas , Fabien Moinard-Butot , Philippe Barthelemy , Denis Maillet","doi":"10.1016/j.clgc.2025.102465","DOIUrl":"10.1016/j.clgc.2025.102465","url":null,"abstract":"<div><h3>Introduction</h3><div><em>FGFR3</em> alterations are observed in 10% to 15% of patients with advanced urothelial carcinoma (UC). We aimed to clarify the prognostic and predictive value of <em>FGFR3</em> alterations in patients receiving first-line platinum-based chemotherapy (PBC) for advanced urothelial carcinoma.</div></div><div><h3>Patients and Methods</h3><div>We conducted a multicenter retrospective cohort study including patients with histologically confirmed UC treated in first line with PBC, with or without immune-checkpoint inhibitors (ICIs) administered as maintenance or second line. Only patients with known <em>FGFR3</em> status on baseline tumor tissue, locally assessed were included. Progression-free survival (PFS) was the primary endpoint. Secondary endpoints included overall survival (OS), objective response rates (ORR), and PFS with ICIs, stratified by <em>FGFR3</em> status.</div></div><div><h3>Results</h3><div>Between 2016 and 2022, 191 pts were included, of whom 58 (30.4%) had <em>FGFR3</em>-altered tumors (<em>FGFR3</em>^alt). Baseline characteristics were well balanced. ICIs were administered to 34% of patients. After a median follow-up of 32 months, median PFS under PBC was 6.6 months in <em>FGFR3</em>^alt and 7.5 in <em>FGFR3</em> wild type subgroups (HR = 1.27; <em>P</em> = .15) respectively. Median OS was 22.1 versus 20.8 months (HR = 0.91; <em>P</em> = .658), and ORR in 133 pts were similar across subgroups (70.7% vs. 69.2% respectively). In multivariate analysis, <em>FGFR3</em> status was not associated with survival.</div></div><div><h3>Conclusions</h3><div><em>FGFR3</em> status did not significantly impact response to PBC in first-line treatment or ICIs. These findings underscore that the presence of an <em>FGFR3</em> alteration does not guide the choice of platinum-based treatment, and the need for prospective biomarker-driven trials to identify best treatment sequences in advanced UC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102465"},"PeriodicalIF":2.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688818","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}
Pub Date : 2025-11-09DOI: 10.1016/j.clgc.2025.102466
Patrick Squires , Erin E. Cook , Yan Song , Ching-Yu Wang , Adina Zhang , Shravanthi M. Seshasayee , Aljosja Rogiers , Haojie Li , Ronac Mamtani
Introduction
The treatment landscape for muscle-invasive bladder cancer (MIBC) is evolving, and the real-world clinical burden in patients undergoing radical cystectomy (RC) remains poorly characterized. This study evaluated treatment patterns, recurrence, and overall survival (OS) in patients aged ≥ 65 years who underwent RC for MIBC.
Patients and methods
Using the SEER-Medicare database (2007-2020), we identified patients with MIBC post-RC. Trends in treatment modality (RC alone [no neoadjuvant or adjuvant therapy], neoadjuvant therapy + RC only, RC + adjuvant therapy only, or both neoadjuvant and adjuvant therapy + RC) were summarized. Recurrence and OS were analyzed using Kaplan-Meier estimates overall and by disease stage (T2N0M0, T3-T4N0M0, T1-T4N1M0) and treatment modality. OS among patients with vs. without recurrence was compared using an adjusted Cox proportional hazards model.
Results
Among 1149 patients with MIBC (60.2% T2N0M0; 31.7% T3-T4N0M0; 8.1% T1-T4N1M0), 53.6% received RC alone; others received neoadjuvant therapy + RC (33.9%), RC + adjuvant therapy (10.2%), or both (2.3%). From 2007-2009 to 2019-2020, the proportion of patients treated with RC alone fell from 77.7% to 33.9% whereas neoadjuvant therapy + RC rose from 9.2% to 61.0%. The overall 5-year recurrence rate was 53.1%, varying by disease stage (T2N0M0: 46.0%, T3-T4N0M0: 61.1%, T1-T4N1M0: 77.7%) and treatment modality (RC alone: 51.4%, neoadjuvant therapy + RC: 47.6%, RC + adjuvant therapy: 69.3%, both: not estimable). The overall 5-year OS rate was 53.0%, varying by disease stage (T2N0M0: 61.3%; T3-T4N0M0: 42.6%; T1-T4N1M0: 33.6%) and treatment modality (RC alone: 48.2%; neoadjuvant therapy +RC: 66.9%, RC + adjuvant therapy: 42.0%, both: 38.0%). Patients with vs. without recurrence had significantly shorter OS (hazard ratio = 1.88, P < .001).
Conclusion
Patients with MIBC post-RC experience high recurrence rates and poor survival outcomes across stages and treatment modalities. Effective strategies to prevent or delay recurrence are urgently needed to improve long-term survival in this population.
{"title":"Treatment Patterns, Disease Recurrence, and Overall Survival in Patients With Muscle-Invasive Bladder Cancer After Radical Cystectomy: A Population-Level Claims-Based Analysis","authors":"Patrick Squires , Erin E. Cook , Yan Song , Ching-Yu Wang , Adina Zhang , Shravanthi M. Seshasayee , Aljosja Rogiers , Haojie Li , Ronac Mamtani","doi":"10.1016/j.clgc.2025.102466","DOIUrl":"10.1016/j.clgc.2025.102466","url":null,"abstract":"<div><h3>Introduction</h3><div>The treatment landscape for muscle-invasive bladder cancer (MIBC) is evolving, and the real-world clinical burden in patients undergoing radical cystectomy (RC) remains poorly characterized. This study evaluated treatment patterns, recurrence, and overall survival (OS) in patients aged ≥ 65 years who underwent RC for MIBC.</div></div><div><h3>Patients and methods</h3><div>Using the SEER-Medicare database (2007-2020), we identified patients with MIBC post-RC. Trends in treatment modality (RC alone [no neoadjuvant or adjuvant therapy], neoadjuvant therapy + RC only, RC + adjuvant therapy only, or both neoadjuvant and adjuvant therapy + RC) were summarized. Recurrence and OS were analyzed using Kaplan-Meier estimates overall and by disease stage (T2N0M0, T3-T4N0M0, T1-T4N1M0) and treatment modality. OS among patients with vs. without recurrence was compared using an adjusted Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Among 1149 patients with MIBC (60.2% T2N0M0; 31.7% T3-T4N0M0; 8.1% T1-T4N1M0), 53.6% received RC alone; others received neoadjuvant therapy + RC (33.9%), RC + adjuvant therapy (10.2%), or both (2.3%). From 2007-2009 to 2019-2020, the proportion of patients treated with RC alone fell from 77.7% to 33.9% whereas neoadjuvant therapy + RC rose from 9.2% to 61.0%. The overall 5-year recurrence rate was 53.1%, varying by disease stage (T2N0M0: 46.0%, T3-T4N0M0: 61.1%, T1-T4N1M0: 77.7%) and treatment modality (RC alone: 51.4%, neoadjuvant therapy + RC: 47.6%, RC + adjuvant therapy: 69.3%, both: not estimable). The overall 5-year OS rate was 53.0%, varying by disease stage (T2N0M0: 61.3%; T3-T4N0M0: 42.6%; T1-T4N1M0: 33.6%) and treatment modality (RC alone: 48.2%; neoadjuvant therapy +RC: 66.9%, RC + adjuvant therapy: 42.0%, both: 38.0%). Patients with vs. without recurrence had significantly shorter OS (hazard ratio = 1.88, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>Patients with MIBC post-RC experience high recurrence rates and poor survival outcomes across stages and treatment modalities. Effective strategies to prevent or delay recurrence are urgently needed to improve long-term survival in this population.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102466"},"PeriodicalIF":2.7,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733453","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}
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