Clinical genitourinary cancer最新文献

{"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":"2025-12-01","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}

{"title":"Pathological and Clinical Implications of Tumor Microenvironment Evaluated With Multiplex Immunohistochemistry in Testicular Embryonal Carcinoma","authors":"Valentina Tateo ,&nbsp;Costantino Ricci ,&nbsp;Sofia Melotti ,&nbsp;Elisa Tassinari ,&nbsp;Matteo Rosellini ,&nbsp;Andrea Marchetti ,&nbsp;Linda Danielli ,&nbsp;Antonio Maestri ,&nbsp;Andrea Necchi ,&nbsp;Veronica Mollica ,&nbsp;Michelangelo Fiorentino ,&nbsp;Francesco Massari","doi":"10.1016/j.clgc.2025.102444","DOIUrl":"10.1016/j.clgc.2025.102444","url":null,"abstract":"<div><h3>Introduction</h3><div>Testicular germ cell tumors (TGCTs) are the most common cancer in young men. Their development is closely linked to embryogenesis, yet much about their pathogenesis remains unknown. TGCTs exhibit exceptional sensitivity to cisplatin-based chemotherapy, achieving high cure rates even in metastatic disease. Further research is needed to deepen our understanding of TGCTs and refine risk stratification. In this pilot study, we focused on embryonal carcinoma (EC), a subtype with increased risk of relapse and considered a key step in TGCT reprogramming.</div></div><div><h3>Patients and Methods</h3><div>We analyzed the tumor microenvironment (TME) in 49 EC samples using bright-field multiplex immunohistochemistry (BF-mIHC), which enables the simultaneous evaluation of multiple biomarkers, making it particularly useful for TME characterization. We evaluated B-cells (CD20), T-cells (CD3), and tumor-associated macrophages (TAMs, CD68) and established cutoffs that correlated with reprogramming phase, clinical stage, and relapse.</div></div><div><h3>Results</h3><div>High TAM levels (CD68 + &gt; 83/mm²) were strongly associated with phase I of reprogramming (pure EC or EC mixed only with seminoma), while low TAM characterized phase II (<em>P</em> <em>&lt;</em> <em>.</em>001), suggesting a role in stemness maintenance through epigenetic regulation. High CD68 (&gt; 46/mm²) and CD3 (&gt; 125.5/mm²) correlated with metastatic disease (<em>P</em> <em>&lt;</em> <em>.</em>001 and <em>P</em> <em>=</em> <em>.</em>026, respectively), whereas high CD20 (&gt; 38.5/mm²) and CD3 (&gt; 83/mm²) were linked to lower relapse risk (<em>P</em> <em>=</em> <em>.</em>014 and <em>P</em> <em>=</em> <em>.</em>017, respectively). Important limits are small sample size and few relapse events.</div></div><div><h3>Conclusions</h3><div>These findings highlight the relevance of TME in TGCT biology and prognosis. The observed associations suggest TME may influence tumor plasticity, metastatization and relapse risk, warranting validation in larger studies.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102444"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373387","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":"Pathogenic Germline Variant Prevalence and Genetic Testing Outcomes in Patients With Urothelial Carcinoma","authors":"Eugene Oh ,&nbsp;Ye Chua ,&nbsp;Piroz Bahar ,&nbsp;Marie-Louise Accardo ,&nbsp;Xiaochen Li ,&nbsp;Erika Koeppe ,&nbsp;Steven Monda ,&nbsp;Phillip L. Palmbos ,&nbsp;Irene Tsung ,&nbsp;Zachery R. Reichert ,&nbsp;Ulka N Vaishampayan ,&nbsp;Udit Singhal ,&nbsp;Tobias Else ,&nbsp;Charles B. Nguyen","doi":"10.1016/j.clgc.2025.102451","DOIUrl":"10.1016/j.clgc.2025.102451","url":null,"abstract":"<div><h3>Introduction</h3><div>Urothelial carcinoma (UC) is rarely attributed to hereditary causes, but recent studies suggest inherited factors may play a larger role. Current guidelines recommend genetic evaluation in patients with UC diagnosed at &lt; 50 years old or features associated with Lynch syndrome. However, the full pathogenic germline variant landscape and optimal genetic evaluation criteria in UC remain poorly understood.</div></div><div><h3>Patients and Methods</h3><div>A retrospective analysis of all patients with UC referred for genetic evaluation between 2002 and 2024 was performed. Genetic testing outcomes, variant prevalence and characterization, and associated clinicopathologic features were recorded. Fisher’s Exact test was used to compare factors between patients with pathogenic or likely pathogenic (P/LP) variant versus those with negative testing.</div></div><div><h3>Results</h3><div>Overall, 128 patients underwent genetic evaluation. Median age at diagnosis was 59 (IQR: 48-68). Most (58.6%) had non-muscle invasive disease at initial diagnosis; 8.6% had metastatic disease. Pure urothelial histology was most frequent (71%). Upper tract disease was present at 14.8%. Among the cohort, 34 (26.6%) had a confirmed P/LP variant. The most common P/LP variants were Lynch syndrome-associated genes (9.4%) and DNA damage repair genes (9.4%). Having a history of ≥ 2 additional cancers was associated with a positive genetic test (<em>P</em> = .010). Otherwise, there were no statistically significant differences in testing outcomes based on age at diagnosis, primary tumor location, or initial stage at diagnosis.</div></div><div><h3>Conclusion</h3><div>Among patients with UC referred for genetic evaluation, 26.6% had a confirmed P/LP variant, although this cohort was a selected population. Age and traditional clinicopathologic features were not associated with testing results, though history of ≥ 2 additional cancers was associated. These findings may suggest a broader use of genetic evaluation in UC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102451"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440336","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":"A Multi-Center Comparative Analysis of the G8-Score and Charlson Comorbidity Index as General Health Assessment Tools in Older Patients With Prostate Cancer","authors":"Brecht Chys ,&nbsp;Philip R. Debruyne ,&nbsp;Lore Decoster ,&nbsp;Cindy Kenis ,&nbsp;Hans Wildiers ,&nbsp;Diederik Ponette ,&nbsp;Steven Joniau","doi":"10.1016/j.clgc.2025.102454","DOIUrl":"10.1016/j.clgc.2025.102454","url":null,"abstract":"<div><h3>Introduction</h3><div>Frail and older patients who develop prostate cancer (PCa), are at risk of overtreatment. Multiple general health assessment (GHA) tools have been validated in oncology. we aim to validate and compare the performance of the G8 screening tool, age and Charlson Comorbidity Index (CCI) as a predictor of overall survival (OS) in men older than 70 years with a newly diagnosed prostate cancer. Is it possible to identify a CCI cut-off indicative for frailty?</div></div><div><h3>Patients and methods</h3><div>Between 2009 and 2015, a national multicenter initiative on geriatric screening and GHA’s took place in Belgium. Baseline characteristics were collected on the date of inclusion on which a specialist nurse completed multiple GHA questionnaires for each patient. We performed a sub analysis on the prostate cancer (<em>n</em> = 182) cohort, ≥ 70 years old. GHA’s were compared through multivariate-, Kaplan-Meier- and sensitivity analysis. If indicated, Case-control matching was applied to reduce variate heterogeneity. Ten-year OS is the primary endpoint.</div></div><div><h3>Results</h3><div>Men with a G8-score of ≤14 points had a significantly worse OS both in the unmatched: 86.8 months (95% CI: 70.5-103.1) vs. 137.9 months (95% CI: 129.4-146.4) (<em>P</em> &lt; .001) and matched population: 99.3 months (95% CI 81.9-116.73) vs. 136.0 months (95% CI: 121.8-150.2) (<em>P</em> &lt; .05). Defining frailty as the presence of comorbidities (CCI ≥ 1 point) shows inferior (HR:1.3, 95% CI: 0.8-2.1—AUC: 0.583) accuracy compared to the G8-score (HR 2.9, 95% CI 1.8-4.5—AUC: 0.715). If the frailty threshold of the CCI is raised to ≥ 2 points, accuracy is matched (HR 4.9, 95% CI 2.8-8.4—AUC 0.735).</div></div><div><h3>Conclusion</h3><div>This multicenter analysis validates the predictive value of the G8-score and CCI on OS in newly diagnosed PCa in the older patient. Both GHA’s appear more accurate than age. A CCI ≥ 2 points approximates the sensitivity of G8 defined frailty. External validation of these findings is needed.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102454"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454263","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":"Rising Trends of Aggressive Renal Cell Carcinoma Among Younger Adults: Insights From the National Cancer Database","authors":"Giuseppe Garofano ,&nbsp;Cesare Saitta ,&nbsp;Giacomo Musso ,&nbsp;Margaret F. Meagher ,&nbsp;Umberto Capitanio ,&nbsp;Dhruv Puri ,&nbsp;Mai Dabbas ,&nbsp;Natalie Birouty ,&nbsp;Sanjana Karamcheti ,&nbsp;Breanna Kim ,&nbsp;Kit L. Yuen ,&nbsp;Alessandro Larcher ,&nbsp;Benjamin Baker ,&nbsp;Riccardo Autorino ,&nbsp;Savio D. Pandolfo ,&nbsp;Francesco Montorsi ,&nbsp;Alberto Saita ,&nbsp;Massimo Lazzeri ,&nbsp;Giovanni Lughezzani ,&nbsp;Paolo Casale ,&nbsp;Ithaar H. Derweesh","doi":"10.1016/j.clgc.2025.102425","DOIUrl":"10.1016/j.clgc.2025.102425","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate trends, and characteristics of renal cell carcinoma (RCC) in younger adults, as its rise has been primarily attributed to increasing incidental discovery of small renal masses in older adults.</div></div><div><h3>Methods</h3><div>We utilized the National Cancer Database to examine RCC patients aged 20-39 years between 2004 and 2021. Annual Average Percent Change (AAPC) was estimated via negative binomial regression. Aggressive RCC was defined as pT3+, high-grade (G3/G4), pN1, or metastatic disease. Logistic regression identified risk factors for aggressive RCC. Kaplan-Meier and Cox models assessed survival impact.</div></div><div><h3>Results</h3><div>Among 30,849 RCC cases, 8,465 (27.45%) were classified as aggressive RCC. The number of diagnosed cases increased over time (AAPC: 3.53%, <em>P</em> &lt; .001), with aggressive RCC increasing at a similar rate (AAPC: 3.58%, <em>P</em> &lt; .001). Compared to clear cell RCC, papillary (OR = 1.49, <em>P</em> &lt; .001), chromophobe (OR = 1.14, <em>P</em> = .006), collecting duct (OR = 35.68, <em>P</em> &lt; .001), and RCC NOS (OR = 1.51, <em>P</em> &lt; .001) had higher odds of aggressive RCC. Black (OR = 1.53, <em>P</em> &lt; .001) and Asian/Pacific Islander patients (OR = 1.51, <em>P</em> &lt; .001) were more likely to present with aggressive RCC compared to White patients. Uninsured (OR = 1.18, <em>P</em> = .001) and unknown insurance status patients (OR = 1.49, <em>P</em> &lt; .001) had significantly higher odds of aggressive RCC compared to privately insured patients. At 120 months, survival was significantly lower for aggressive vs nonaggressive RCC (65.0% vs. 91.7%, <em>P</em> &lt; .001). The negative impact of aggressive RCC on survival was attenuated in patients aged ≥ 35 years (HR = 0.78, <em>P</em> = .001)</div></div><div><h3>Conclusion</h3><div>Rising RCC cases in younger adults are accompanied by an increase in aggressive disease, not attributable to stage migration. The drivers for this rise are unclear and demand more investigation.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102425"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139791","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":"Sarcomatoid Differentiation as a Predictor of Recurrence in Intermediate- and High-Risk RCC: Implications for Adjuvant Immunotherapy Selection","authors":"Francisco Tomás Rodriguez-Covarrubias,&nbsp;Horst Emanuel Lagos-Beitz,&nbsp;Jorge Augusto Alcacio-Mendoza,&nbsp;Betsabé Petra Carreño-Hinojosa,&nbsp;Yoztinn Bernal-Benitez,&nbsp;Guillermo Martínez-Delgado,&nbsp;Guillermo Trujillo-Martínez","doi":"10.1016/j.clgc.2025.102430","DOIUrl":"10.1016/j.clgc.2025.102430","url":null,"abstract":"<div><h3>Background</h3><div>Adjuvant pembrolizumab improves survival in clear cell renal cell carcinoma (ccRCC) at elevated recurrence risk. However, broad application may lead to overtreatment. Sarcomatoid differentiation, a histologic feature associated with poor prognosis, is not currently used to guide adjuvant decisions.</div></div><div><h3>Objective</h3><div>To evaluate whether sarcomatoid differentiation can refine patient selection for adjuvant immunotherapy in intermediate- and high-risk ccRCC.</div></div><div><h3>Methods</h3><div>Retrospective analysis of 136 patients with localized/locally advanced ccRCC who underwent nephrectomy (2000-2023) meeting modified KEYNOTE-564 criteria. Recurrence-free survival (RFS) and predictive factors were analyzed using Kaplan-Meier estimates, logistic regression, and Cox models. Clinical utility was assessed via the number needed to treat (NNT) and cost-effectiveness modeling.</div></div><div><h3>Results</h3><div>At median follow-up of 55 months, recurrence occurred in 26 patients (19.1%). Sarcomatoid differentiation was significantly associated with recurrence (HR = 2.31; 95% CI, 1.03-5.18; <em>P</em> = .042). Among intermediate-risk patients, those with sarcomatoid features had 50.0% recurrence versus 16.7% without (<em>P</em> = .007). number needed to treat (NNT) improved from 5 (treating all) to 2 (treating sarcomatoid-positive only). Combining sarcomatoid status and ECOG 0 allowed 39.1% of patients to avoid therapy with 7.0% recurrence rate. This strategy could theoretically save $11.4 million USD.</div></div><div><h3>Conclusions</h3><div>Sarcomatoid differentiation was independently associated with recurrence and may help inform adjuvant therapy decisions. Selective immunotherapy based on histologic features may optimize outcomes while avoiding overtreatment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102430"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208859","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 Systemic Therapy for Renal Cell Carcinoma With a Tumor Thrombus: Results From the Intercontinental Collaboration on Renal Cell Carcinoma Database","authors":"Maxwell Sandberg ,&nbsp;Gregory Russell ,&nbsp;Dana Feldman ,&nbsp;Mitchell Hayes ,&nbsp;Reuben Ben David ,&nbsp;Justin Miller ,&nbsp;Kartik Patel ,&nbsp;Brejjette Aljabi ,&nbsp;Seok-Soon Byun ,&nbsp;Oscar Rodriguez Faba ,&nbsp;Donato Cannoletta ,&nbsp;Tatiana Letowski ,&nbsp;Gustavo Villoldo ,&nbsp;Patricio Garcia Marchinena ,&nbsp;Thiago Mourao ,&nbsp;Gaetano Ciancio ,&nbsp;Charles C. Peyton ,&nbsp;Rafael Zanotti ,&nbsp;Steven Chang ,&nbsp;Philippe E. Spiess ,&nbsp;Alejandro Rodriguez","doi":"10.1016/j.clgc.2025.102442","DOIUrl":"10.1016/j.clgc.2025.102442","url":null,"abstract":"<div><h3>Purpose</h3><div>The primary objective of this study was to assess the utility of using systemic therapy for patients with renal cell carcinoma with tumor thrombus (RCC-TT) in the setting of both metastatic (mRCC-TT) and non-mRCC-TT disease.</div></div><div><h3>Methods</h3><div>This was a multi-institutional retrospective analysis from 1999-present, and every patient underwent radical nephrectomy with tumor thrombectomy (RN-TT) plus/minus systemic therapy. Systemic therapy was defined as chemotherapy, immunotherapy, targeted therapy, or any combination administered ≤12 months from RN-TT. Overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) were studied. We examined the effect of preoperative systemic therapy before RN-TT for non-mRCC-TT, preoperative systemic therapy before RN-TT for mRCC-TT, and postoperative systemic therapy after RN-TT.</div></div><div><h3>Results</h3><div>A total of 206 patients were nonmetastatic before RN-TT, and 146 (70.9%) did not receive systemic therapy and 60 (29.1%) did. There was no difference in OS and CSS (<em>p</em> &gt; .05), but MFS was significantly better in the no systemic therapy group (Median not reached; 80 months 50.6% of the cohort did not experience metastatic event vs. 13 months; <em>p</em> &lt; .0001). 117 patients had mRCC-TT before RN-TT, and of these, 84 (71.2%) received preoperative systemic therapy and 33 (28.2%) did not receive systemic therapy before surgery. Median OS was 24 months in the systemic therapy group and 5.7 months in the non-systemic therapy group (<em>p</em> = .0007). Median CSS was 27.6 months in the systemic therapy grouping and 6 months in the non-systemic therapy grouping (<em>p</em> = .0007). 315 patients were in the last analysis, and of these, 119 (37.8%) received systemic therapy after RN-TT and 196 (62.2%) did not. OS, CSS, and MFS did not differ (<em>p</em> &gt; .05).</div></div><div><h3>Conclusion</h3><div>There appears to be an OS and CSS benefit to preoperative systemic therapy for mRCC-TT. Further analysis is required to elucidate the best therapy regimens and ideal timing.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102442"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350479","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":"Nationwide Real-World Outcomes of Trial Eligible and Trial Ineligible Patients With Metastatic Renal Cell Carcinoma Treated With Nivolumab Plus Ipilimumab","authors":"Mette Syberg Jespersen ,&nbsp;Jesper Andreas Evers Palshof ,&nbsp;Niels Fristrup ,&nbsp;Niels Viggo Jensen ,&nbsp;Jon Røikjær Henriksen ,&nbsp;Ane Bundsbæk Bøndergaard Iversen ,&nbsp;Sarah Grønbech Steen ,&nbsp;Morten Andersen ,&nbsp;Kasper Madsen ,&nbsp;Inge Marie Svane ,&nbsp;Anne Kirstine Møller Darras","doi":"10.1016/j.clgc.2025.102450","DOIUrl":"10.1016/j.clgc.2025.102450","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical trials have demonstrated efficacy and safety of immune checkpoint inhibitor-based combination therapy in metastatic renal cell carcinoma (mRCC). However, patients who do not meet trial eligibility criteria constitute a large proportion of the real-world population, and their outcomes remain poorly described.</div></div><div><h3>Patients and Methods</h3><div>This nationwide, retrospective cohort study included all Danish patients with mRCC who initiated nivolumab plus ipilimumab (NIVO/IPI) by May 5, 2022. Clinical data were obtained from electronic patient records. Outcomes included median progression-free survival (mPFS), median overall survival (mOS), and objective response rate (ORR), assessed by treating physicians. Patients were classified as trial-eligible or ineligible according to CheckMate 214 (CM214) key criteria. Survival was estimated using Kaplan–Meier methods, and subgroups were explored.</div></div><div><h3>Results</h3><div>A total of 464 patients were included, with a median follow-up of 33 months. In the total cohort, mPFS was 9 months, mOS 41 months, and ORR 43%, including 13% complete responses. Among 282 trial-eligible patients, outcomes were comparable to CM214 with mPFS 12 months and mOS 49 month, while 182 ineligible patients had inferior outcomes, with mPFS 6 months and mOS 26 months (both <em>P</em> &lt; .001). The presence of brain metastases did not adversely affect OS, while patients with autoimmune disease demonstrated unexpectedly favorable outcomes. Severe treatment-related toxicity (≥ grade 3) occurred in 44% in the total cohort, comparable to CM214.</div></div><div><h3>Conclusion</h3><div>This is the first nationwide real-world study evaluating NIVO/IPI outcomes in unselected mRCC. Trial-eligible patients achieved survival outcomes comparable to clinical trial results. Although ineligible patients derived less benefit, they still experienced meaningful clinical outcomes. These findings provide benchmark data for treatment of real-world mRCC populations in routine clinical practice.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102450"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427213","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":"2025-12-01","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":"Impact of Impaired Renal Function on the Efficacy and Safety of Enfortumab Vedotin Monotherapy in a Multicenter Real-World Cohort of Patients With Metastatic Urothelial Cancer: YUSHIMA Study","authors":"Hiroshi Fukushima ,&nbsp;Yuki Nakamura ,&nbsp;Hajime Tanaka ,&nbsp;Noboru Numao ,&nbsp;Atsushi Yoshinaga ,&nbsp;Naoko Kawamura ,&nbsp;Kenji Tanabe ,&nbsp;Keita Izumi ,&nbsp;Takanobu Yamamoto ,&nbsp;Sho Uehara ,&nbsp;Yuya Maezawa ,&nbsp;Takahiko Soma ,&nbsp;Ryoji Takazawa ,&nbsp;Saori Araki ,&nbsp;Soichiro Yoshida ,&nbsp;Yasuhisa Fujii","doi":"10.1016/j.clgc.2025.102426","DOIUrl":"10.1016/j.clgc.2025.102426","url":null,"abstract":"<div><h3>Introduction</h3><div>Enfortumab vedotin (EV) has become a standard of care for patients with metastatic urothelial cancer (mUC). However, the impact of impaired renal function on its efficacy and safety remains unclear, especially in patients with severe renal impairment who are considered unfit for platinum-based chemotherapy.</div></div><div><h3>Patients and Methods</h3><div>This multicenter retrospective study included 115 patients with mUC who were treated with EV monotherapy after progression on platinum-based chemotherapy and immune checkpoint inhibitors. Patients were stratified into 3 groups based on pretreatment estimated glomerular filtration rate (eGFR, mL/min/1.73 m²): Preserved (eGFR ≥ 45, <em>n</em> = 65), Moderately Impaired (30 ≤ eGFR &lt; 45, <em>n</em> = 36), and Severely Impaired (eGFR &lt; 30, <em>n</em> = 14). Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were compared among the 3 groups.</div></div><div><h3>Results</h3><div>The median follow-up time following after the initiation of EV treatment was 7.2 months. Although relative dose intensity (RDI) was lower in the Severely Impaired group, ORR (<em>P</em> = .62), PFS (<em>P</em> = .33), and OS (<em>P</em> = .81) were not significantly different among the 3 groups. There was no significant difference in the incidence of any grade TRAEs among the 3 groups (<em>P</em> = .22). For grade ≥ 3 TRAEs, its incidence was significantly different overall (<em>P</em> = .040), but no pairwise differences were found after Bonferroni correction. Among patients with RDI ≥ 80%, impaired renal function was not significantly associated with the incidence of TRAEs.</div></div><div><h3>Conclusions</h3><div>EV monotherapy demonstrated comparable efficacy and safety regardless of renal function in patients with mUC. Our findings suggest that impaired renal function alone may not warrant avoiding EV monotherapy or routinely reducing its dose. Moreover, EV monotherapy can be effective and well-tolerated even in patients with eGFR &lt; 30 who are considered unfit for platinum-based chemotherapy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102426"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115467","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}