Clinical genitourinary cancer最新文献

{"title":"Real-World Outcomes of Nivolumab Plus Ipilimumab Versus Pembrolizumab Plus Axitinib for First-Line Treatment of Advanced Renal Cell Carcinoma","authors":"Daniel M. Geynisman ,&nbsp;William S. John ,&nbsp;Taavy A. Miller ,&nbsp;Parisa Asgarisabet ,&nbsp;Angelica Falkenstein ,&nbsp;Kristin M. Zimmerman Savill ,&nbsp;Xin Yin ,&nbsp;Viviana del Tejo ,&nbsp;Sarah B. Guttenplan ,&nbsp;Lisa Rosenblatt","doi":"10.1016/j.clgc.2025.102443","DOIUrl":"10.1016/j.clgc.2025.102443","url":null,"abstract":"<div><h3>Background</h3><div>In the absence of head-to-head trials, real-world (RW) outcomes of patients with advanced renal cell carcinoma (aRCC) treated with immuno-oncology combinations are important for clinicians and patients. Here, we describe treatment patterns, adverse events (AEs), and outcomes of patients with aRCC treated with first-line (1L) nivolumab plus ipilimumab (NIVO+IPI) or pembrolizumab plus axitinib (PEM+AXI).</div></div><div><h3>Methods</h3><div>This retrospective medical chart review included patients with aRCC who initiated 1L NIVO+IPI between May-2018 and May-2021 or PEM+AXI between May-2019 and May-2021. Inverse probability of treatment weighting was performed, providing balanced baseline characteristics. Physician-reported response (RW objective response rate [rwORR], duration of response [rwDOR]) and immune-related AEs are described. RW progression-free survival (rwPFS) and overall survival (rwOS) were estimated using Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>225 patients were treated with 1L NIVO+IPI and 130 with 1L PEM+AXI. The median duration of 1L therapy was 15.0 months for NIVO+IPI and 14.5 months for PEM+AXI. After weighting, each cohort was ∼60% male, ∼65 years old, and ∼90% had intermediate/poor risk scores at initiation. The median follow-up post-1L initiation was 22.4 months for NIVO+IPI and 19.0 months for PEM+AXI (<em>P</em> = .006). The rwORR was comparable between cohorts (NIVO+IPI, 71.5%; PEM+AXI, 77.3%; <em>P</em> = .24), whereas the median rwDOR was significantly longer in the NIVO+IPI versus the PEM+AXI cohort (11.0 vs. 8.0 months; <em>P</em> &lt; .0001). While median rwPFS and rwOS did not differ by treatment (<em>P</em> = .20 and 0.37, respectively), estimates for rwPFS and rwOS probability at 24 months post-1L initiation for treatment were nonsignificantly higher for NIVO+IPI versus PEM+AXI (rwPFS: 0.29 vs. 0.18, respectively; rwOS: 0.63 vs. 0.57, respectively). The overall rate of immune-related AEs was similar between cohorts (NIVO+IPI, 29.1%; PEM+AXI, 25.3%; significance not tested).</div></div><div><h3>Conclusions</h3><div>Overall results from this RW study were similar for patients with aRCC who received 1L NIVO+IPI or PEM+AXI, although nonsignificant results suggest rwPFS and rwOS at later timepoints may be improved for patients who receive 1L NIVO+IPI versus PEM+AXI. Additional research with larger samples and extended follow-up is necessary to understand potential long-term differences in clinical outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102443"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411087","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":"Sarcopenia in mCSPC: Beyond Radiological Metrics—The Need for Functional and Supportive Assessments","authors":"Cevat İlteriş Kıkılı ,&nbsp;Maide Müreva ,&nbsp;Caner Kapar ,&nbsp;Bahadır Köylü ,&nbsp;Fatih Kemik ,&nbsp;Feyyaz Hazar Yağmur ,&nbsp;Fatih Selçukbiricik ,&nbsp;Ercan İnci ,&nbsp;Deniz Tural","doi":"10.1016/j.clgc.2025.102440","DOIUrl":"10.1016/j.clgc.2025.102440","url":null,"abstract":"","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102440"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321093","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":"Sarcopenia in mCSPC: Beyond Radiological Metrics—The Need for Functional and Supportive Assessments","authors":"Parth Aphale,&nbsp;Himanshu Shekhar,&nbsp;Shashank Dokania","doi":"10.1016/j.clgc.2025.102439","DOIUrl":"10.1016/j.clgc.2025.102439","url":null,"abstract":"","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102439"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304952","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":"Prognostic Impact of Biopsy Gleason 4 + 5, 5 + 4, and 5 + 5 in Grade Group 5 after Radical Prostatectomy","authors":"Yu Ozawa ,&nbsp;Rohan Sharma ,&nbsp;Marcio Covas Moschovas ,&nbsp;Marco Sandri ,&nbsp;Shady Saikali ,&nbsp;Ari Diamond ,&nbsp;Travis Rogers ,&nbsp;Vipul Patel","doi":"10.1016/j.clgc.2025.102441","DOIUrl":"10.1016/j.clgc.2025.102441","url":null,"abstract":"<div><h3>Background</h3><div>Grade Group 5 (GG5) subtypes exhibit prognostic heterogeneity, but evidence remains limited, and mainly derived from population-based studies. We evaluated their impact on oncologic outcomes following radical prostatectomy (RP).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 892 patients with biopsy-confirmed GG5 prostate cancer who underwent robot-assisted RP by a single surgeon between 2015 and 2024. Oncologic outcomes were compared among GG5 subtypes: Gleason score (GS) 4 + 5 (n = 688), 5 + 4 (n = 149), and 5 + 5 (n = 55). Primary endpoints were PSA persistence and biochemical recurrence (BCR). PSA persistence was assessed using multivariable logistic regression adjusting for potential confounders including age, race, PSA at diagnosis, clinical T stage, positive core rate, neoadjuvant hormonal therapy, and year of surgery. BCR was evaluated using Kaplan–Meier and log-rank analyses, followed by multivariable Cox regression with the same covariates.</div></div><div><h3>Results</h3><div>Despite neoadjuvant hormonal therapy in 614 patients with comparable distribution across subtypes, organ-confined disease was observed in only 24% (211/892) following RP. PSA persistence occurred in 117 patients. During a median follow-up period of 36 months (Interquartile range: 18-60), BCR occurred in 242 patients, while 326 were followed up without PSA persistence or BCR for at least 60 months. Significant differences in BCR were observed among 3 subtypes (<em>P</em> = .028). Both GS 5 + 4 and 5 + 5 were independent predictors of PSA persistence (adjusted ORs: 1.80 [95% CI 1.08–3.01] and 2.33 [95% CI 1.08–5.02], respectively). GS 5 + 5 was significantly associated with BCR (adjusted HR 2.15 [95% CI 1.29–3.58]), whereas GS 5 + 4 was not (adjusted HR 1.30 [95% CI 0.94–1.81]). The main limitation was the relatively short follow-up.</div></div><div><h3>Conclusions</h3><div>Our study highlights the clinical relevance of GG5 subtyping within a cohort treated with a consistent surgical technique. Among these subtypes, GS 5 + 5 confers the highest risk of PSA persistence and BCR following RP. These findings support biopsy interpretation and preoperative counseling, particularly regarding multimodal treatment strategies for the highest-grade prostate cancer.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102441"},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357223","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 Bisphosphonates in Hormone-sensitive Metastatic Prostate Cancer A Systematic Review and Meta-Analysis","authors":"Gabriel Berlingieri Polho ,&nbsp;Adler Araujo Ribeiro Melo ,&nbsp;Laerte Canedo Ornelas-Filho ,&nbsp;Paulo Siqueira Amaral ,&nbsp;Felippe Lazar Neto ,&nbsp;Gabriella Fernandes Soares ,&nbsp;Andre Silva Franco ,&nbsp;Diogo Assed Bastos","doi":"10.1016/j.clgc.2025.102438","DOIUrl":"10.1016/j.clgc.2025.102438","url":null,"abstract":"<div><h3>Introduction</h3><div>Bone modifying agents (BMA) are part of the management of metastatic hormone-refractory prostate cancer, however its use in hormone-sensitive scenario is controversial. The objective of this meta-analysis is to determine whether the addition of BMA on standard of care (SoC) in metastatic hormone sensitive prostate cancer (mHSPC) improves OS or time to first skeletal related event (SRE).</div></div><div><h3>Patients and Methods</h3><div>A literature search of Web of Science, Pubmed and references lists of relevant articles was conducted. Eligible studies were prospective randomized trials comparing SoC to SoC plus BMA in mHSPC. We extracted data on: SoC option; type, dosing and duration of BMA; adverse events; hazard ratio and confidence interval for time to SRE and OS. Hazard radios were pooled using random-effects model. The main outcomes were OS and time to SRE. Secondary outcomes were the relative risk of grade 3-5 adverse events, osteonecrosis and renal dysfunction.</div></div><div><h3>Results</h3><div>Among 4949 studies identified, we selected 7 for the meta-analysis. Pooled results showed favorable OS (HR 0.87 [95% CI, 0.79-0.96], <em>P</em> = .007) and time to SRE (HR 0.74 [95% CI, 0.57-0.98], <em>P</em> = .003) for patients treated with bisphosphonates (BP). However, only 1 trial used androgen receptor pathway inhibitors (ARPI) and no trial included anti-RANK-L inhibitors. There was a significant increase in the risk of jaw osteonecrosis (RR 9.6 [95% CI, 1.98-46.82]).</div></div><div><h3>Conclusion</h3><div>BP may be beneficial in mHSPC, although there is scarcity of data on anti-RANKL agents and association with ARPI.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102438"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276966","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 Impact of Computed Tomography-Defined Sarcopenia on Surgical Outcomes in Patients with Sarcomatoid Renal Cell Carcinoma: A Comprehensive Assessment of Abdominal, Psoas, and Paraspinal Musculature","authors":"Tongpeng Liu ,&nbsp;Zhijian Zhou ,&nbsp;Yu Yao ,&nbsp;Yang Hu ,&nbsp;Lijiang Sun ,&nbsp;Guiming Zhang","doi":"10.1016/j.clgc.2025.102434","DOIUrl":"10.1016/j.clgc.2025.102434","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the prognostic impact of computed tomography (CT)-defined sarcopenia, assessed via different muscle groups (total abdominal muscle [TAM], psoas muscle [PM], and paraspinal muscle [PS]), on outcomes in patients with sarcomatoid renal cell carcinoma (SRCC) undergoing surgical treatment.</div></div><div><h3>Patients and Methods</h3><div>A retrospective cohort of 125 pathologically confirmed SRCC patients (2009-2024) was analyzed. Sarcopenia was defined using sex-specific cut-offs for height-adjusted TAM and PM indices, and absolute PS area at the third lumbar vertebra on preoperative CT. The primary endpoint was overall survival (OS). Statistical analyses included Kaplan-Meier curves, Cox regression, LASSO selection, and bootstrap-validated nomogram construction.</div></div><div><h3>Results</h3><div>Multivariable analysis identified PS-defined sarcopenia as an independent predictor of worse OS (HR = 2.74, 95% CI, 1.001-7.481, <em>P</em> &lt; .05), while TAM- and PM-defined sarcopenia lacked independent prognostic value. Subgroup analysis revealed significant prognostic association of PS-sarcopenia only in male patients. A nomogram incorporating tumor size, N stage, M stage, platelet-neutrophil ratio, platelet-albumin ratio, and PS-sarcopenia demonstrated good predictive accuracy for 1-, 2-, and 3-year OS (AUCs: 0.807, 0.760, 0.781), with a bootstrap-corrected C-index of 0.750.</div></div><div><h3>Conclusion</h3><div>CT-quantified paraspinal muscle mass is an independent prognostic factor for OS in SRCC patients after surgery, particularly in males, and may serve as a valuable biomarker for risk stratification. A nomogram incorporating PS-sarcopenia shows promising predictive performance for individualized prognosis.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102434"},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245922","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":"Comprehensive Evaluation of Androgen Receptor Pathway Inhibitors in Metastatic Castration-Sensitive Prostate Cancer: A Multicenter Inverse Probability of Treatment Weighting-Based Study","authors":"Keita Kobayashi ,&nbsp;Takanori Tokunaga ,&nbsp;Kazuhiro Nagao ,&nbsp;Koki Fujikawa ,&nbsp;Kazuo Oba ,&nbsp;Kimio Takai ,&nbsp;Hiroaki Matsumoto ,&nbsp;Shigeru Sakano ,&nbsp;Satoshi Shirataki ,&nbsp;Yasuhide Tei ,&nbsp;Masanori Tabara ,&nbsp;Satoru Yoshihiro ,&nbsp;Seiji Yano ,&nbsp;Hideaki Ito ,&nbsp;Seiji Kitahara ,&nbsp;Chietaka Ohmi ,&nbsp;Jumpei Akao ,&nbsp;Koji Shiraishi","doi":"10.1016/j.clgc.2025.102437","DOIUrl":"10.1016/j.clgc.2025.102437","url":null,"abstract":"<div><h3>Introduction</h3><div>Androgen receptor pathway inhibitor (ARPI) plus androgen deprivation therapy (ADT) is a guideline-endorsed standard for metastatic castration-sensitive prostate cancer (mCSPC). Robust comparative data on individual ARPIs and their subsequent management after castration resistance remain limited.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study included consecutive patients who received first-line ARPI for mCSPC between January 2018 and December 2023. Inverse probability of treatment weighting (IPTW) balanced the baseline clinicopathological variables across the abiraterone (<em>n</em> = 136), enzalutamide (<em>n</em> = 80), and apalutamide (<em>n</em> = 58) cohorts. PSA response subgroups were defined as early response (PSA &lt;0.2 ng/mL by 3 months and sustained for 12 months), delayed response (first attainment ≥6 months, sustained for 12 months), early relapse (attainment but rebound ≥0.2 ng/mL within 12 months), and nonresponse (no attainment).</div></div><div><h3>Results</h3><div>Among 274 evaluable male patients, apalutamide yielded more grade ≥2 toxicities and dose modifications, although grade ≥3 events were comparable across arms. After IPTW, time to castration-resistant prostate cancer (CRPC) and overall survival (OS) did not differ among the ARPIs (<em>P</em> = .657, <em>P</em> = .286), and PSA ≤0.2 ng/mL conversion rates at 1, 3, 6, and 12 months were similar. Patients with early and delayed responses showed equivalent times to CRPC, whereas patients with early relapse and nonresponse experienced a significantly shorter time to CRPC and OS (<em>P</em> &lt; 0.001). Eighty-one patients developed CRPC; first-line docetaxel (<em>n</em> = 35) and ARPI (<em>n</em> = 26) achieved comparable OS (<em>P</em> = .849).</div></div><div><h3>Conclusion</h3><div>The efficacies of abiraterone, enzalutamide, and apalutamide were equivalent if the baseline imbalances were mitigated. Sustained PSA suppression &lt;0.2 ng/mL for 12 months predicts favorable outcomes, regardless of the speed of decline, whereas failure to achieve or maintain this threshold is associated with poorer prognosis. The choice between docetaxel and alternative ARPI for first-line treatment of metastatic CRPC showed no survival differences.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102437"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276909","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":"Study Endpoint Fulfillment and FDA Approval Success in Phase III Clinical Trials of Genitourinary Malignancies","authors":"Matthew Steidle ,&nbsp;Kamil Malshy ,&nbsp;Trevor C. Hunt ,&nbsp;Zijing Cheng ,&nbsp;Ashley Li ,&nbsp;Karen Doersch ,&nbsp;Jathin Bandari","doi":"10.1016/j.clgc.2025.102436","DOIUrl":"10.1016/j.clgc.2025.102436","url":null,"abstract":"<div><h3>Introduction</h3><div>This study investigates the impact of Phase-III genitourinary oncology trial endpoint fulfillment (EF+) on FDA approval probability over the past 15 years.</div></div><div><h3>Methods</h3><div>We identified urothelial/bladder cancer (UCa), renal cancer (RCa), and prostate cancer (PCa) trials from ClinicalTrials.gov. The primary analysis compared the time from primary completion to FDA approval between trials with overall survival EF+ (OS+) and those without (OS−). Secondary analyses assessed the impact of OS+ versus non-OS primary EF (PE+) studies on FDA approval, considering disease site, disease status, and treatment line.</div></div><div><h3>Results</h3><div>Of 183 trials screened, 78 (42.6%) met inclusion criteria: 41 (52.6%) PCa, 23 (29.5%) RCa, and 14 (17.9%) UCa. FDA approval was granted in 40/78 trials. OS+ (<em>n</em> = 31 [39.7%]) significantly increased approval likelihood (HR 8.38, 95% CI, 4.1-17.1, <em>P</em> &lt; 0.001) compared to OS− trials. The median time to approval was 348 days (95% CI, 294-380) in the OS+ group and was not reached in the OS− group. One- and two-year approval rates were 63.3% and 8.5%, and 86.6% and 19.2%, respectively. Among trials with PE+, 39/50 received approval. Trials with both OS and non-OS PE+ had higher approval rates (HR 2.3, 95% CI, 1.04-5.3, <em>P</em> = 0.041), particularly in PCa studies (Log HR 0.51, 95% CI, 0.29-1.06, <em>P</em> &lt; 0.001) and metastatic disease (HR 0.74, 95% CI, 0.30-1.17, <em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>OS EF+ remains a strong predictor of FDA approval. Non-OS PE+ benefit trials gain better success when accompanied by OS+. These findings can guide future trial designs to optimize regulatory success in GU oncology.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102436"},"PeriodicalIF":2.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145263070","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":"Data Sources for Clinical T1 Renal Masses and the Potential for Bias","authors":"Avani P. Desai ,&nbsp;Gianpaolo Carpinito ,&nbsp;Amir Feinberg ,&nbsp;Marvin A. Meza Jarquín ,&nbsp;Isaiah Zipple ,&nbsp;Deborah Usinger ,&nbsp;Shannon Myers ,&nbsp;Ram Sankar Basak ,&nbsp;Eric Wallen ,&nbsp;Marc A. Bjurlin ,&nbsp;Mathew Raynor ,&nbsp;Matthew E. Nielsen ,&nbsp;Hung-Jui Tan","doi":"10.1016/j.clgc.2025.102435","DOIUrl":"10.1016/j.clgc.2025.102435","url":null,"abstract":"<div><h3>Introduction</h3><div>The rising incidence of early-stage kidney cancer has driven comparative effectiveness research using cancer registry and administrative data. These sources may be biased for small renal masses (SRM), where histologic confirmation prior to treatment is not standard. To better understand these limitations, we compared characteristics of patient populations across three SRM data sources.</div></div><div><h3>Patients and Methods</h3><div>We identified patients diagnosed with clinical T1 renal masses from 2019 to 2020 at our institution. Data were obtained from the institutional cancer registry, a prospective clinical trial, and electronic health record (EHR) extraction. Demographic and clinical characteristics were compared across cohorts using chi-squared, Fisher’s exact testing, and multivariable regression analysis. Radiologic reports were reviewed for terminology concordance with registry inclusion criteria.</div></div><div><h3>Results</h3><div>Among 555 cases, 169 (30.5%) were in the clinical trial, 273 (49.2%) in the cancer registry only, and 113 (20.4%) from EHR extraction only. Active surveillance was more common in the EHR extraction cohort (85%) than in the registry (48%) or trial (33%) (<em>P</em> &lt; .001). The registry and trial cohorts had higher Charlson Comorbidity Index scores (<em>P</em> &lt; .001), and the clinical trial cohort included fewer Hispanic/Latino patients (<em>P</em> = .04) and non-English speakers (<em>P</em> &lt; .01). Registry capture was limited by terminology in radiologic reports, with qualifying terms present in only 15% of EHR cases and 49% of delayed registry entries.</div></div><div><h3>Conclusions</h3><div>Cohort composition differed by data source, particularly for patients undergoing active surveillance. Clinicians must recognize potential bias when interpreting findings. Standardized radiologic reporting and revised registry criteria may ensure more complete data for early-stage kidney cancer.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102435"},"PeriodicalIF":2.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145263069","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":"Optimizing Unilateral Pelvic Lymph Node Dissection in the PSMA Era: Balancing Oncological Safety, Contralateral Involvement Risk, and Overtreatment in Prostate Cancer: A Multicenter Study of the Turkish Urooncology Association","authors":"Cagri Akpinar ,&nbsp;Evren Suer ,&nbsp;Nejdet Karsıyakalı ,&nbsp;Nihat Karakoyunlu ,&nbsp;Serhat Cetin ,&nbsp;Güven Aslan ,&nbsp;Deniz Bolat ,&nbsp;Volkan Izol ,&nbsp;Cenk Y. Bilen ,&nbsp;Sinan Sozen ,&nbsp;Levent Turkeri ,&nbsp;Sumer Baltaci","doi":"10.1016/j.clgc.2025.102432","DOIUrl":"10.1016/j.clgc.2025.102432","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the risk of contralateral lymph node involvement (LNI) and the feasibility of safely performing unilateral pelvic lymph node dissection (PLND) in unfavorable-intermediate and high-risk prostate cancer (PCa) patients with cN0 status on preoperative ⁶⁸Ga-PSMA PET/CT, tumor involvement in single lobe, or dominant lobe involvement with worse tumor characteristics on biopsy.</div></div><div><h3>Material and Methods</h3><div>In this retrospective multicenter study were analyzed 768 patients who underwent RP and bilateral extended-PLND. Patients with cN0 status on PSMA PET/CT and PI-RADS ≥ 3 lesions on multiparametric magnetic resonance imaging(mpMRI) were included. Tumor lobe (single/dominant-prostatic lobe) involvement and LNI status were recorded for all patients. The dominant lobe was determined based on higher ISUP grade group(GG), number and percentage of more positive cores, and more advanced features on MRI, respectively. LNI status was analyzed by tumor side and location. Statistical analysis included univariate and multivariate models to evaluate predictors of contralateral LNI.</div></div><div><h3>Results</h3><div>LNI was observed in 96(12.5%) of 768 patients, with 61(7.9%) having ipsilateral LNI and 35(4.6%) contralateral LNI with or without ipsilateral LNI. Patients with contralateral LNI had higher preoperative PSA, more frequent EAU high-risk classification, larger-index lesion diameter, higher ISUP GG on both the dominant and nondominant side, and a higher rate of positive percentages in the nondominant side (all <em>P</em> values &lt; .05). Multivariate analysis identified preoperative PSA (HR 1.028, 95% Cl 1.001-1.057, <em>P</em> = .044), ISUP GG 2 (HR 4.325,95% Cl-1.620-14.374,<em>P</em> = .007<em>)</em> and ≥ ISUP-GG 3 (HR 14.004, 95% Cl 3.025-54.773, <em>P</em> &lt; .001) on the nondominant side as independent predictors for contralateral LNI. The ROC-derived AUC for predicting contralateral LNI was 0.873, indicating good predictive accuracy.</div></div><div><h3>Conclusion</h3><div>In cases where preoperative ⁶⁸Ga-PSMA PET/CT indicates a negative LN status, contralateral PLND may not be necessary in intermediate-risk patients with negative biopsy or ISUP GG 1 tumor on the nondominant side.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102432"},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276903","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}