Clinical genitourinary cancer最新文献_第9页

Diagnostic Accuracy of Contrast-Enhanced Ultrasound in Differentiating RCC from AML in Small Hyperechoic Renal Masses (≤ 3 cm): A Retrospective Single-Center Study 对比增强超声鉴别肾小高回声肿块（≤3cm）与急性髓性白血病的诊断准确性：一项回顾性单中心研究

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-08-08 DOI: 10.1016/j.clgc.2025.102414

Fabrizio Urraro , Nicoletta Giordano , Vittorio Patanè , Marco Piscopo , Ferdinando De Vita , Davide Arcaniolo , Immacolata Cozzolino , Salvatore Cappabianca , Alfonso Reginelli

Background

Small (≤ 3 cm) hyperechoic renal masses are challenging to characterize due to overlapping features between angiomyolipomas (AMLs) and renal cell carcinomas (RCCs). Contrast-enhanced ultrasound (CEUS) offers a noninvasive alternative, particularly when CT or MRI are inconclusive or contraindicated. This study assessed CEUS diagnostic accuracy in differentiating RCC from AML and identified predictive enhancement patterns.

Methods

In this retrospective single-center study, 104 patients with incidentally detected small hyperechoic renal masses underwent CEUS between December 2021 and July 2024. Two blinded radiologists independently assessed wash-in and wash-out dynamics, peak intensity, homogeneity, and perilesional rim-like enhancement. Histopathology was obtained when available; lesions with ≥ 18 months of stable imaging follow-up were considered benign. Diagnostic metrics, interobserver agreement (ICC), and multivariate logistic regression (IBM SPSS Statistics 29.0) were used to identify independent predictors, reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Of 104 lesions, 80 were classified as AMLs and followed with ultrasound, while 28 were biopsied, confirming 26 RCCs (papillary 53%, chromophobe 32%, clear cell 15%) and 2 atypical AMLs. Rapid wash-out (sensitivity = 84%, specificity = 91%, AUC = 0.90) and perilesional rim-like enhancement (specificity = 95%, PPV = 90%) were the strongest CEUS predictors of RCC. Multivariate analysis identified rapid wash-out (OR = 5.0; 95% CI, 2.0-12.0) and perilesional enhancement (OR = 3.8; 95% CI, 1.5-10.0) as independent predictors. Combined CEUS features achieved an AUC = 0.93. Interobserver agreement was good (ICC 0.75–0.9).

Conclusion

CEUS accurately differentiates RCC from AML in small hyperechoic renal masses. Rapid wash-out and perilesional rim-like enhancement are independent predictors of malignancy and may guide biopsy versus surveillance decisions.

由于血管平滑肌脂肪瘤（AMLs）和肾细胞癌（rcc）之间的重叠特征，小的（≤3cm）高回声肾肿块的特征很难确定。对比增强超声（CEUS）提供了一种无创的替代方法，特别是当CT或MRI不确定或有禁忌时。本研究评估了超声造影在鉴别肾细胞癌和急性髓性白血病中的诊断准确性，并确定了预测性增强模式。方法在本回顾性单中心研究中，在2021年12月至2024年7月期间，104例偶然发现小高回声肾肿块的患者接受了超声造影。两名盲法放射科医师独立评估洗入和洗出动态、峰值强度、均匀性和病灶周围边缘样增强。可用时进行组织病理学检查；影像学稳定随访≥18个月的病变被认为是良性的。使用诊断指标、观察者间一致性（ICC）和多变量逻辑回归（IBM SPSS Statistics 29.0）来确定独立预测因子，报告为95%置信区间（ci）的比值比（ORs）。结果104例病变中，80例为aml并行超声检查，28例活检，证实rcc 26例（乳头状53%，厌色32%，透明细胞15%），2例为不典型aml。快速冲洗（敏感性= 84%，特异性= 91%,AUC = 0.90）和病灶周围边缘样增强（特异性= 95%,PPV = 90%）是超声造影预测RCC的最强指标。多变量分析确定快速洗脱（OR = 5.0; 95% CI, 2.0-12.0）和病灶周围增强（OR = 3.8; 95% CI, 1.5-10.0）为独立预测因子。综合超声造影特征AUC = 0.93。观察员间一致意见良好（ICC 0.75-0.9）。结论超声造影能准确鉴别肾小高回声肿块的肾小细胞癌和急性髓性白血病。快速冲洗和病灶周围边缘样增强是恶性肿瘤的独立预测因子，可以指导活检与监测的决定。

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引用次数: 0

Mesothelioma of the Tunica Vaginalis Testis 阴道睾丸膜间皮瘤

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-08-07 DOI: 10.1016/j.clgc.2025.102409

Alon Lazarovich , Gregory Raster , Samuel Tremblay , Aaron S. Dahmen , Jung Woo Kwon , Gladell P. Paner , Owen Mitchell , Hedy L. Kindler , Scott Eggener

•
Mesothelioma of the tunica vaginalis testis is a rare and aggressive malignancy with highly variable clinical presentation, most commonly appearing as hydrocele or testicular mass.
•
Radical surgery with negative margins is a cornerstone of treatment and may improve outcomes.
•
Systemic therapies, including chemotherapy and immunotherapy, are adapted from pleural mesothelioma treatment protocols. Their role in mesothelioma of the tunica vaginalis testis remains investigational and warrants further prospective study.

•睾丸阴道膜间皮瘤是一种罕见的侵袭性恶性肿瘤，临床表现多变，最常见的表现为鞘膜积液或睾丸肿块。•阴性切缘的根治性手术是治疗的基石，可以改善预后。•全身治疗，包括化疗和免疫治疗，改编自胸膜间皮瘤治疗方案。它们在阴道睾丸膜间皮瘤中的作用仍在调查中，值得进一步的前瞻性研究。

引用次数: 0

Active Surveillance in Intermediate-Risk Prostate Cancer: A Contemporary Synthesis of Evidence 主动监测中危前列腺癌：当代综合证据

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102407

Fausto Petrelli , Lorenzo Dottorini , Giada Parsani , Francesca Ceresoli , Domenico Taglialatela , Margherita Pampado , Alessandro Serino , Agostina De Stefani , Francesca Trevisan , Valentina Riboldi , Lorenza Bruschieri , Ivano Vavassori

Active surveillance (AS) is a widely accepted strategy for low-risk prostate cancer, but its application to intermediate-risk disease remains controversial. Given the potential to reduce overtreatment without compromising survival, this review evaluates the safety and clinical outcomes of AS in intermediate-risk prostate cancer (IR-PCa), with a focus on favorable intermediate-risk (FIR) subsets. The objective is to synthesize current evidence on AS utilization, selection criteria, oncologic outcomes, and predictors of disease progression.We conducted a narrative review of 85 studies published between 2009 and 2025 identified through PubMed, Embase, and Web of Science. Search terms included “AS,” “intermediate-risk prostate cancer,” “Gleason 3 + 4,” and “watchful waiting.” Eligible studies included prospective and retrospective cohorts, registry-based analyses, and comparative observational studies evaluating AS in IR-PCa. Data were extracted regarding inclusion criteria, follow-up protocols, progression rates, survival outcomes, and use of imaging and genomic tools for risk stratification. AS is increasingly used in FIR patients with low-volume Gleason 3 + 4 disease, low PSA density, and favorable imaging/genomic profiles. In these patients, 5-10 year metastasis-free survival exceeds 95%. However, AS in unfavorable IR disease is associated with higher risks of disease progression and prostate cancer–specific mortality. Limitations include heterogeneity in AS protocols, lack of randomized trials, and variable definitions of FIR. AS is a viable option for well-selected FIR-PCa patients. Incorporating PSA density, mpMRI, and genomic testing enhances risk stratification. Clinical guidelines should support tailored AS approaches with standardized follow-up and timely intervention triggers.

主动监测（AS）是一种被广泛接受的低危前列腺癌治疗策略，但其在中危前列腺癌中的应用仍存在争议。鉴于在不影响生存的情况下减少过度治疗的潜力，本综述评估了AS治疗中危前列腺癌（IR-PCa）的安全性和临床结果，重点关注有利的中危（FIR）亚群。目的是综合目前关于AS使用、选择标准、肿瘤预后和疾病进展预测因素的证据。我们通过PubMed、Embase和Web of Science对2009年至2025年间发表的85项研究进行了叙述性回顾。搜索词包括“AS”、“中等风险前列腺癌”、“Gleason 3 + 4”和“观察等待”。符合条件的研究包括前瞻性和回顾性队列，基于登记的分析，以及评估IR-PCa中AS的比较观察性研究。提取有关纳入标准、随访方案、进展率、生存结果以及使用成像和基因组工具进行风险分层的数据。AS越来越多地用于低体积Gleason 3 + 4疾病、低PSA密度和有利的影像学/基因组谱的FIR患者。在这些患者中，5-10年无转移生存率超过95%。然而，不利IR疾病的AS与疾病进展和前列腺癌特异性死亡率的高风险相关。局限性包括AS协议的异质性、缺乏随机试验和FIR的可变定义。对于精心挑选的FIR-PCa患者，AS是一种可行的选择。结合PSA密度，mpMRI和基因组检测增强了风险分层。临床指南应支持量身定制的AS方法，采用标准化的随访和及时的干预触发器。

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引用次数: 0

The Influence of Lymphovascular Invasion on T Stage Upstaging and Overall Survival in Renal Cell Carcinoma: A Population-Based Study 淋巴血管侵袭对肾细胞癌T期前期和总生存率的影响：一项基于人群的研究。

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102412

Giacomo Musso , Giuseppe Garofano , Mai Dabbas , Margaret F. Meagher , Kit L. Yuen , Natalie Birouty , Benjamin Baker , Cesare Saitta , Melis Guer , Francesco Montorsi , Alberto Briganti , Umberto Capitanio , Alessandro Larcher , Andrea Salonia , Ithaar H. Derweesh

Introduction

Lymphovascular invasion (LVI) is a recognized adverse pathological feature in renal cell carcinoma (RCC). However, its impact on staging and prognosis remains poorly defined, especially across T-stage subcategories.

Patients and Methods

We analyzed surgically treated RCC patients from the National Cancer Database (NCDB), including clear cell, papillary and chromophobe RCCs. Data on pathological T-stage and LVI status were retrieved, with overall survival (OS) as the primary outcome. Kaplan-Meier curves (KMA) and log-rank test evaluated survival differences between T-stages with and without LVI. Univariable and multivariable Cox Proportional Hazard Model (CoxPH) were fitted to test the association between LVI and All-cause Mortality (ACM) and the interaction term between LVI and T-stage. Forest plots and regression lines from the CoxPH interaction hazard ratios (HR) illustrated the impact of LVI across T-stages.

Results

Among 159,387 RCC patients, 11.3% showed LVI. LVI was associated with larger and higher‐grade tumors, and increased rates of nodal and metastatic disease (P < .001). KMA showed significantly lower 5‐year OS among LVI‐positive versus LVI‐negative patients (61% vs. 85%; P < .001). Across T stages, LVI conferred a “functional upstaging” with survival of T1a+LVI approximating T1b, T1b+LVI resembling T2, T2+LVI approximating T3, and T3a+LVI mirroring T3b outcomes. At univariable and multivariable CoxPH, LVI was an independent predictor of ACM (P < .001), with forest plots indicating its highest relative impact in earlier T-stages.

Conclusion

LVI is an aggressive pathological feature in RCC that impairs survival, especially in lower‐stage tumors. Incorporating LVI status into RCC staging may refine risk stratification and guide more intensive surveillance and adjuvant management, particularly for patients with early T-stage disease.

淋巴血管侵袭（LVI）是肾细胞癌（RCC）公认的不良病理特征。然而，其对分期和预后的影响仍不明确，特别是在t期亚类别中。患者和方法：我们分析了来自国家癌症数据库（NCDB）的手术治疗的RCC患者，包括透明细胞、乳头状和憎色细胞RCC。检索病理t期和LVI状态的数据，以总生存期（OS）为主要终点。Kaplan-Meier曲线（KMA）和log-rank检验评估了有无LVI的t期生存差异。采用单变量和多变量Cox比例风险模型（Cox Proportional Hazard Model, xph）检验LVI与全因死亡率（All-cause Mortality， ACM）的相关性，以及LVI与t期的相互作用项。CoxPH相互作用风险比（HR）的森林图和回归线说明了LVI在t期的影响。结果：159387例RCC患者中，11.3%出现LVI。LVI与更大和更高级别的肿瘤相关，并增加了淋巴结和转移性疾病的发生率（P < 0.001）。KMA显示lvi阳性患者的5年OS明显低于lvi阴性患者（61%比85%；P < 0.001）。在T分期中，LVI赋予了“功能性优势”，T1a+LVI的生存期接近T1b， T1b+LVI类似于T2， T2+LVI接近T3， T3a+LVI反映了T3b的结果。在单变量和多变量CoxPH中，LVI是ACM的独立预测因子（P < 0.001），森林样地表明其在t期早期的相对影响最大。结论：LVI是RCC的一种侵袭性病理特征，损害了生存，特别是在低分期肿瘤中。将LVI状态纳入RCC分期可以细化风险分层，指导更密集的监测和辅助管理，特别是对早期t期疾病患者。

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引用次数: 0

Reassessing the Evidence: Is Intensified Therapy Justified in Older Patients with Metastatic Hormone-Sensitive Prostate Cancer? 重新评估证据：老年转移性激素敏感前列腺癌患者强化治疗是否合理？

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102410

Lorenzo Dottorini , Italo Sarno , Alessandro Iaculli , Giandomenico Di Menna , Yasser Hussein , Ivano Vavassori , Mauro Rossitto , Andrea Luciani , Fausto Petrelli

To assess the comparative efficacy of intensified systemic treatments in older patients (≥ 65 years) with metastatic hormone-sensitive prostate cancer (mHSPC) through a network meta-analysis (NMA), and evaluate whether routine use of intensified regimens is justified in this population. A systematic literature search of MEDLINE, Embase, and Cochrane Library databases identified randomized controlled trials published between 2000 and 2024 evaluating first-line systemic therapies in mHSPC. Eligible studies combined androgen deprivation therapy (ADT) with docetaxel, abiraterone, enzalutamide, apalutamide, darolutamide, or antiandrogens. The primary endpoint was overall survival (OS). Bayesian NMA was conducted using a consistency model and Markov chain Monte Carlo simulations. SUCRA values were used to estimate treatment rankings. Subgroup data for older patients were extracted where available. Eleven were included in the analysis. Compared to ADT alone, none of the intensified regimens showed statistically significant superiority in OS in older subgroups. ADT + docetaxel + darolutamide had the highest probability of being the most effective treatment (SUCRA 87.8%), followed by ADT + abiraterone + enzalutamide (SUCRA 80.9%). In older patients with mHSPC, intensified systemic regimens demonstrate trends toward improved OS but fail to achieve clear statistical superiority over ADT alone. The substantial heterogeneity across studies and absence of older-specific subgroup data limit definitive conclusions. Treatment decisions in this population should be individualized using geriatric assessment, considering patient fitness, comorbidities, life expectancy, and treatment goals. Further dedicated trials in older and frail patients are warranted to guide optimal therapeutic strategies.

通过网络meta分析（NMA）评估老年（≥65岁）转移性激素敏感性前列腺癌（mHSPC）患者强化全身治疗的比较疗效，并评估在该人群中常规使用强化方案是否合理。对MEDLINE、Embase和Cochrane图书馆数据库进行了系统的文献检索，确定了2000年至2024年间发表的评估mHSPC一线系统治疗的随机对照试验。符合条件的研究将雄激素剥夺治疗（ADT）与多西他赛、阿比特龙、恩杂鲁胺、阿帕鲁胺、达罗卢胺或抗雄激素联合使用。主要终点是总生存期（OS）。贝叶斯NMA采用一致性模型和马尔可夫链蒙特卡罗模拟进行。SUCRA值用于估计治疗排名。如有可能，提取老年患者的亚组数据。其中11人被纳入分析。与单独ADT相比，在老年亚组中，强化方案在OS方面没有统计学上的显著优势。ADT +多西他赛+达罗他胺治疗效果最佳的概率最高（SUCRA为87.8%），其次为ADT +阿比特龙+恩杂鲁胺（SUCRA为80.9%）。在老年mHSPC患者中，强化的全身方案显示出改善OS的趋势，但与单独使用ADT相比，未能取得明显的统计学优势。研究间的巨大异质性和缺乏老年人特异性亚组数据限制了明确的结论。该人群的治疗决策应根据老年评估进行个体化，考虑患者健康、合并症、预期寿命和治疗目标。在老年人和体弱患者中进行进一步的专门试验是有必要的，以指导最佳的治疗策略。

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引用次数: 0

Is Active Surveillance a Suitable Approach for Bilateral Multifocal Renal Oncocytomas? The 20-Year National Cancer Institute Experience 主动监测是双侧多灶性肾嗜瘤细胞瘤的合适方法吗？20年的国家癌症研究所经验。

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102401

Aditi Chaurasia , Shiva Singh , Noah Pinson , Nikhil Gopal , Jessica Hsueh , Daniel Nethala , Rabindra Gautam , Christopher J. Ricketts , Cathy D. Vocke , Laura S. Schmidt , Maria J. Merino , Ashkan A. Malayeri , W. Marston Linehan , Mark W. Ball

Objectives

To investigate the clinical characteristics, tumor growth rate, oncologic and renal function outcomes in patients with bilateral, multifocal renal oncocytoma managed with active surveillance and/or surgery.

Materials and Methods

Bilateral, multifocal renal oncocytoma patients were evaluated using clinical, cross-sectional imaging and pathologic records. The cohort was divided into 3 groups: those under active surveillance only, those who underwent surgery in combination with active surveillance, and those who underwent multiple interventions. Growth rate, metastases and renal function outcomes were compared between the 3 groups.

Results

Sixty-two patients (median age 64 years (IQR 57.5-69), 49 men) were identified with 10 patients (16.1%) having a known family history of bilateral, multifocal oncocytoma. Overall, the combined median growth rate of primary tumors across all 3 groups was 0.25 cm/year (IQR 0.1-0.4). Comparing between all 3 groups identified a statistically significant difference in age of diagnosis (P = .01), whereas no difference was noted for age at death. No distant metastasis was observed. A statistically significant difference in median tumor size at the time of last follow-up (P = .02) was reported among the 3 groups. No statistically significant differences were seen in primary tumor growth rate (P = .50), initial eGFR (P = .35), final eGFR (P = .26) and change in eGFR levels over time (P = .10) among all 3 groups.

Conclusion

Disease-specific outcomes and renal function outcomes do not differ significantly among the patients managed with active surveillance and/or surgery.

目的：探讨主动监测和/或手术治疗双侧多灶肾嗜瘤细胞瘤患者的临床特征、肿瘤生长速度、肿瘤和肾功能结局。材料和方法：对双侧、多灶性肾嗜瘤患者进行临床、横断面成像和病理记录评估。该队列分为3组：仅接受主动监测组、接受手术联合主动监测组和接受多种干预组。比较三组患者的生长速度、转移情况及肾功能结局。结果：62例患者（中位年龄64岁（IQR 57.5-69）， 49例男性），其中10例（16.1%）有双侧多灶性嗜酸细胞瘤家族史。总体而言，三组原发性肿瘤的合并中位生长速率为0.25 cm/年（IQR 0.1-0.4）。三组患者的诊断年龄差异有统计学意义（P = 0.01），而死亡年龄差异无统计学意义。未见远处转移。三组患者末次随访时中位肿瘤大小差异有统计学意义（P = 0.02）。三组间肿瘤原发生长率（P = 0.50）、初始eGFR （P = 0.35）、最终eGFR （P = 0.26）及eGFR随时间变化（P = 0.10）差异均无统计学意义。结论：在接受主动监测和/或手术治疗的患者中，疾病特异性结局和肾功能结局没有显著差异。

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引用次数: 0

Impact of HRR Gene Subclass on Clinical Outcomes of PARP Inhibitors in Metastatic Castration-Resistant Prostate Cancer HRR基因亚类对PARP抑制剂治疗转移性去势抵抗性前列腺癌临床结果的影响

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102411

George Dimitrov , Elenko Popov

Objective

This retrospective study evaluates the clinical significance of mutations in effector genes (BRCA1, BRCA2, PALB2, RAD51, FANCD2) versus sensor genes (ATM, ATR, CHEK1, CHEK2, NBS1) in patients with metastatic castration-resistant prostate cancer (mCRPC) classified as homologous recombination deficiency (HRD)-positive. The study assesses their predictive value for response to poly(ADP-ribose) polymerase inhibitors (PARPi) combined with androgen receptor signaling inhibitors (ARSi).

Design

A multicenter, retrospective real-world study conducted across 6 oncology hospitals in Bulgaria. Patient data were obtained through a formal request to the Ministry of Health’s United Information Portal, an electronic health records repository. The analysis included mCRPC patients treated with olaparib plus abiraterone who underwent next-generation sequencing (NGS) between January 1, 2022, and January 1, 2025, conducted in a certified national reference laboratory, with a median follow-up of 16 months. The primary endpoints were overall survival (OS) and progression-free survival (PFS).

Results

Of the 210 mCRPC patients screened via NGS, 28% (n = 58) harbored mutations in at least one HRR gene, classified as sensor (n = 27) or effector (n = 31). Patients with effector mutations demonstrated a statistically significant improvement in PFS compared to those with sensor mutations (median PFS: 20 vs. 14 months, HR = 0.48, 95% CI: 0.252–0.914, P = .0294). Similarly, overall survival (OS) was significantly prolonged in the effector group. While the median OS for the sensor group was 19 months, the effector group had not yet reached median OS at the time of analysis (HR = 0.38, 95% CI, 0.154-0.945, P = .0373). Logistic regression analysis and PSM supported findings.

Conclusion

Patients with mCRPC harboring effector HRR mutations derive greater clinical benefit from PARPi plus ARSi than those with sensor mutations. These findings highlight the heterogeneous predictive value of HRR gene alterations and suggest that mutation sub-class should guide treatment decisions in HRD-positive mCRPC.

目的：本回顾性研究评价同源重组缺陷（HRD）阳性转移性去势抵抗性前列腺癌（mCRPC）患者中效应基因（BRCA1、BRCA2、PALB2、RAD51、FANCD2）与传感基因（ATM、ATR、CHEK1、CHEK2、NBS1）突变的临床意义。该研究评估了它们对聚（adp -核糖）聚合酶抑制剂（PARPi）联合雄激素受体信号抑制剂（ARSi）反应的预测价值。设计：保加利亚6家肿瘤医院开展的一项多中心、回顾性现实世界研究。患者数据是通过向卫生部联合信息门户（一个电子健康记录存储库）提出的正式请求获得的。该分析包括在2022年1月1日至2025年1月1日期间接受奥拉帕尼加阿比特龙治疗的mCRPC患者，这些患者在经过认证的国家参考实验室进行了下一代测序（NGS），中位随访时间为16个月。主要终点是总生存期（OS）和无进展生存期（PFS）。结果：在通过NGS筛选的210例mCRPC患者中，28% （n = 58）至少有一个HRR基因突变，分类为传感器（n = 27）或效应（n = 31）。与传感器突变患者相比，效应突变患者的PFS有统计学意义的改善（中位PFS: 20个月vs 14个月，HR = 0.48, 95% CI: 0.252-0.914, P = 0.0294）。同样，效应组的总生存期（OS）明显延长。传感器组的中位生存期为19个月，而效应组在分析时尚未达到中位生存期（HR = 0.38, 95% CI, 0.154-0.945, P = 0.073）。逻辑回归分析和PSM支持研究结果。结论：携带HRR效应突变的mCRPC患者从PARPi + ARSi中获得的临床获益大于携带传感器突变的患者。这些发现强调了HRR基因改变的异质性预测价值，并提示突变亚类应该指导HRR阳性mCRPC的治疗决策。

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引用次数: 0

Treatment Patterns and Outcomes in Lymph-Node-Positive (pN1) Prostate Cancer: A National Cancer Database Study 淋巴结阳性（pN1）前列腺癌的治疗模式和结果：一项国家癌症数据库研究。

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102413

Andrea Piccolini , Stephan M. Korn , Zhiyu Qian , Pietro Brin , Klara Pohl , Hanna Zurl , Boyuan Xiao , Giovanni Lughezzani , Nicolò M. Buffi , Paul L. Nguyen , Mutlay Sayan , Quoc-Dien Trinh , Alexander P. Cole

Introduction

Lymph node involvement after radical prostatectomy (pN1) is associated with worse oncologic outcomes, yet its optimal management remains controversial. We evaluated oncologic outcomes and treatment patterns in pN1 prostate cancer.

Patients and Methods

We analyzed data from the National Cancer Database (NCDB) on men undergoing radical pN1 between 2010 and 2020. Exclusion criteria included distant metastases and delayed androgen-deprivation therapy (ADT) or adjuvant radiotherapy (aRT) beyond 1 year from surgery. The primary outcome was overall survival (OS). Multinomial logistic regression identified demographic and clinical predictors of treatment selection. Inverse probability of treatment weighting (IPTW) was applied to adjust baseline characteristics and perform weighted survival analysis across treatment groups.

Results

Among 13,454 patients with pN1 disease, 51.2% were managed with observation, 17.8% received ADT alone, 26.9% ADT plus aRT, and 4.1% aRT alone. Median follow-up was 56.3 months (IQR:36-83). ISUP grade 4-5, pT3-4 disease, and increased nodal burden were associated with treatment intensification. Compared to Non-Hispanic Whites, Non-Hispanic Black patients had lower odds of receiving ADT plus aRT (aOR: 0.79, 95% CI, 0.69-0.91, P < .001). ADT alone or aRT alone did not improve OS; ADT combined with aRT was significantly associated with improved OS (HR: 0.78, 95% CI, 0.68-0.89, P < .001).

Conclusion

This national analysis revealed variability in postsurgical management for pN1 disease. Only less than a third of men received aRT, despite this treatment being associated with improved OS. Given the observed variability in treatment use and outcomes, our findings support the value of individualized management strategies and multidisciplinary decision-making.

导言：根治性前列腺切除术（pN1）后淋巴结累及与较差的肿瘤预后相关，但其最佳管理仍存在争议。我们评估了pN1前列腺癌的肿瘤预后和治疗模式。患者和方法：我们分析了国家癌症数据库（NCDB）中2010年至2020年间接受根治性pN1的男性的数据。排除标准包括远处转移和延迟雄激素剥夺治疗（ADT）或辅助放疗（aRT）手术后1年以上。主要终点是总生存期（OS）。多项逻辑回归确定了治疗选择的人口学和临床预测因素。应用治疗加权逆概率（IPTW）调整基线特征，并对各治疗组进行加权生存分析。结果：13454例pN1患者中，51.2%接受观察治疗，17.8%单独接受ADT治疗，26.9% ADT联合aRT治疗，4.1%单独接受aRT治疗。中位随访时间为56.3个月（IQR:36-83）。ISUP分级4-5级、pT3-4级疾病和淋巴结负担增加与强化治疗相关。与非西班牙裔白人相比，非西班牙裔黑人患者接受ADT + aRT的几率较低（aOR: 0.79, 95% CI: 0.69-0.91, P < 0.001）。单独ADT或单独aRT不能改善OS；ADT联合aRT与改善OS显著相关（HR: 0.78, 95% CI: 0.68-0.89, P < 0.001）。结论：这项全国性的分析揭示了pN1疾病的术后处理的可变性。只有不到三分之一的男性接受了aRT治疗，尽管这种治疗与改善OS有关。鉴于观察到的治疗使用和结果的可变性，我们的研究结果支持个性化管理策略和多学科决策的价值。

{"title":"Treatment Patterns and Outcomes in Lymph-Node-Positive (pN1) Prostate Cancer: A National Cancer Database Study","authors":"Andrea Piccolini , Stephan M. Korn , Zhiyu Qian , Pietro Brin , Klara Pohl , Hanna Zurl , Boyuan Xiao , Giovanni Lughezzani , Nicolò M. Buffi , Paul L. Nguyen , Mutlay Sayan , Quoc-Dien Trinh , Alexander P. Cole","doi":"10.1016/j.clgc.2025.102413","DOIUrl":"10.1016/j.clgc.2025.102413","url":null,"abstract":"<div><h3>Introduction</h3><div>Lymph node involvement after radical prostatectomy (pN1) is associated with worse oncologic outcomes, yet its optimal management remains controversial. We evaluated oncologic outcomes and treatment patterns in pN1 prostate cancer.</div></div><div><h3>Patients and Methods</h3><div>We analyzed data from the National Cancer Database (NCDB) on men undergoing radical pN1 between 2010 and 2020. Exclusion criteria included distant metastases and delayed androgen-deprivation therapy (ADT) or adjuvant radiotherapy (aRT) beyond 1 year from surgery. The primary outcome was overall survival (OS). Multinomial logistic regression identified demographic and clinical predictors of treatment selection. Inverse probability of treatment weighting (IPTW) was applied to adjust baseline characteristics and perform weighted survival analysis across treatment groups.</div></div><div><h3>Results</h3><div>Among 13,454 patients with pN1 disease, 51.2% were managed with observation, 17.8% received ADT alone, 26.9% ADT plus aRT, and 4.1% aRT alone. Median follow-up was 56.3 months (IQR:36-83). ISUP grade 4-5, pT3-4 disease, and increased nodal burden were associated with treatment intensification. Compared to Non-Hispanic Whites, Non-Hispanic Black patients had lower odds of receiving ADT plus aRT (aOR: 0.79, 95% CI, 0.69-0.91, <em>P</em> < .001). ADT alone or aRT alone did not improve OS; ADT combined with aRT was significantly associated with improved OS (HR: 0.78, 95% CI, 0.68-0.89, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>This national analysis revealed variability in postsurgical management for pN1 disease. Only less than a third of men received aRT, despite this treatment being associated with improved OS. Given the observed variability in treatment use and outcomes, our findings support the value of individualized management strategies and multidisciplinary decision-making.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102413"},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982359","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}

引用次数: 0

Neoadjuvant PD-1/PD-L1 Inhibitors for Muscle-Invasive Bladder Cancer: A Meta-Analysis 新辅助PD-1/PD-L1抑制剂治疗肌肉浸润性膀胱癌：荟萃分析

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-07-29 DOI: 10.1016/j.clgc.2025.102408

Lian Hu , Jia-Wei Hu , Chang-Quan Wang , Rui-Ying Li , Song Li

Neoadjuvant immune checkpoint inhibitors have emerged as a potential treatment option for muscle-invasive bladder cancer (MIBC), but their comparative efficacy and safety remain unclear. This meta-analysis evaluated pathological outcomes and adverse events of neoadjuvant PD-(L)1 inhibitors across different therapeutic approaches. A systematic search was conducted across multiple databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases), from their inception to December 21, 2024, for studies investigating neoadjuvant PD-(L)1 inhibitors in patients with MIBC. Primary outcomes included pathological complete response (pCR), pathological partial response (pPR), downstaging (DS), and grade ≥3 immune-related adverse events (irAEs). Random-effects models were used to calculate pooled estimates, with subgroup analyses performed based on treatment strategy and inhibitor type. Twenty-nine studies were finally included, involving 33 treatment arms. The overall pooled pCR rate was 32.7% (95% confidence interval [CI]: 27.7%-37.7%), with PD-(L)1 inhibitors plus chemotherapy showing the highest rate (39.2%, 95% CI: 32.1%-46.3%), followed by dual checkpoint inhibition (27.6%, 95% CI: 15.5%-39.6%), and monotherapy (24.6%, 95% CI: 16.9%-32.3%). The overall pooled pPR was 45.3% (95% CI: 38.4%-52.2%), and DS rate was 62.9% (95% CI: 53.1%-72.8%). Grade ≥3 irAEs varied significantly by approach: 9.4% (95% CI: 6.0%-12.7%) for monotherapy, 24.9% (95% CI: 9.6%-40.2%) for dual checkpoint inhibition, and 14.2% (95% CI: 6.9%-21.5%) for combination with chemotherapy. Sensitivity analyses confirmed the robustness of these findings. Neoadjuvant PD-(L)1 inhibitors demonstrate promising efficacy in MIBC with acceptable toxicity profiles. Combination with chemotherapy provides the highest pathological response rates with moderate toxicity, while monotherapy offers a favorable safety profile that may benefit cisplatin-ineligible patients. These findings support the continued investigation of these approaches in ongoing Phase III trials.

新辅助免疫检查点抑制剂已成为肌肉浸润性膀胱癌（MIBC）的潜在治疗选择，但其相对疗效和安全性尚不清楚。这项荟萃分析评估了新辅助PD-(L)1抑制剂在不同治疗方法中的病理结果和不良事件。系统检索多个数据库（PubMed, Embase， Cochrane图书馆，中国国家知识基础设施和万方数据库），从其成立到2024年12月21日，研究新辅助PD-(L)1抑制剂在MIBC患者中的应用。主要结局包括病理完全缓解（pCR）、病理部分缓解（pPR）、降低分期（DS）和≥3级免疫相关不良事件（irAEs）。随机效应模型用于计算汇总估计，并根据治疗策略和抑制剂类型进行亚组分析。最终纳入29项研究，涉及33个治疗组。总的聚合pCR率为32.7%(95%可信区间[CI]: 27.7%-37.7%)，其中PD-(L)1抑制剂加化疗的发生率最高（39.2%,95% CI: 32.1%-46.3%），其次是双检查点抑制（27.6%,95% CI: 15.5%-39.6%）和单药治疗（24.6%,95% CI: 16.9%-32.3%）。总合并pPR为45.3% (95% CI: 38.4% ~ 52.2%)， DS率为62.9% （95% CI: 53.1% ~ 72.8%）。≥3级irae在不同的治疗方法中差异显著：单药治疗为9.4% (95% CI: 6.0%-12.7%)，双检查点抑制为24.9% (95% CI: 9.6%-40.2%)，联合化疗为14.2% （95% CI: 6.9%-21.5%）。敏感性分析证实了这些发现的稳健性。新辅助PD-(L)1抑制剂在MIBC中显示出良好的疗效，并且具有可接受的毒性。联合化疗提供了最高的病理反应率和中等毒性，而单药治疗提供了有利的安全性，可能有利于顺铂不合格的患者。这些发现支持在正在进行的III期试验中继续研究这些方法。

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引用次数: 0

The Prognostic Role of 68GA-PSMA-PET/CT in Metastatic Hormone-Sensitive Prostate Cancer: A Preliminary Analysis 68GA-PSMA-PET/CT在转移性激素敏感前列腺癌预后中的作用初步分析

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer

Pub Date : 2025-07-29 DOI: 10.1016/j.clgc.2025.102406

Andrea Marchetti , Veronica Mollica , Andrea Farolfi , Gianfilippo Bianciardi , Matteo Rosellini , Elisa Tassinari , Linda Danielli , Lorenzo Bianchi , Riccardo Schiavina , Stefano Fanti , Francesco Massari

Background and objective

In metastatic hormone-sensitive prostate cancer (mHSPC), to evaluate therapy response is currently used conventional imaging and PSA levels. Positron emission tomography with ⁶⁸Gallium Prostate-specific membrane antigen (⁶⁸Ga-PSMA-PET/CT) could be useful, although it is not recommended by international guidelines. Its prognostic utility has been already investigated in several works in the castration-resistant setting, but no sufficient efforts have been made to better define it in mHSPC.

Methods

Retrospective monocentric study to preliminary explore the value of ⁶⁸Ga-PSMA-PET/CT in this setting. We enrolled metastatic patients at the baseline ⁶⁸Ga-PSMA-PET/CT, treated with androgen deprivation therapy plus docetaxel or androgen receptor signaling inhibitors (ARSI) or both as first-line.

Key findings and limitations

The survival analysis indicated that a Major SUVmax exceeding the cut-off (P = .037) and a SUVmean above the cut-off (P = .025) were linked to improved progression-free survival (PFS) as compared to values ≤ cut-off. While several parameters were associated with undetectable PSA levels at any point after the initiation of first-line therapy, only low-volume disease (HR 7.64, P .002), MTV ≤ cut-off 3-months PSA (HR 5.36, P = .012) and SUVmean ≤ cut-off 3-months PSA (HR 38.6, P < .001) were associated with a higher probability of reaching an undetectable value of PSA in the multivariate analysis. Limitations: retrospective nature, short follow-up time and lack of comparison with conventional imaging.

Conclusion and clinical implications

Lower values of ⁶⁸Ga-PSMA-PET/CT derived-parameters at baseline are negative prognostic factor, in view of the correlation with lower PFS. This study could help oncologists in the management of mHSPC patients, although further investigations are needed to better understand the prognostic and predictive ⁶⁸Ga-PSMA-PET/CT role in this setting.

背景和目的：在转移性激素敏感性前列腺癌（mHSPC）中，评估治疗反应目前使用常规影像学和PSA水平。正电子发射断层扫描68镓前列腺特异性膜抗原（68Ga-PSMA-PET/CT）可能是有用的，尽管国际指南不推荐。它的预后效用已经在一些阉割抵抗设置的工作中进行了调查，但没有做出足够的努力来更好地定义mHSPC。方法：回顾性单中心研究，初步探讨68Ga-PSMA-PET/CT在这种情况下的价值。我们招募了68Ga-PSMA-PET/CT基线转移性患者，接受雄激素剥夺治疗加多西紫杉醇或雄激素受体信号抑制剂（ARSI）或两者作为一线治疗。主要发现和局限性：生存分析表明，与≤临界值相比，超过临界值的主要SUVmax （P = 0.037）和高于临界值的SUVmean （P = 0.025）与改善的无进展生存（PFS）相关。虽然在一线治疗开始后的任何时间点，有几个参数与无法检测到的PSA水平相关，但只有小体积疾病(HR 7.64， P。002)、MTV≤截止3个月PSA （HR 5.36, P = 0.012）和SUVmean≤截止3个月PSA （HR 38.6, P < 0.001）与多因素分析中PSA达到不可检测值的概率较高相关。局限性：回顾性，随访时间短，缺乏与常规影像学的比较。结论及临床意义：68Ga-PSMA-PET/CT衍生参数基线值较低与PFS较低相关，是影响预后的不利因素。这项研究可以帮助肿瘤学家管理mHSPC患者，尽管需要进一步的研究来更好地了解68Ga-PSMA-PET/CT在这种情况下的预后和预测作用。

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引用次数: 0