European urology focus最新文献

Background and objective: Radiomics and artificial intelligence (AI)-based imaging models offer a noninvasive approach to preoperative risk stratification in localized renal cell carcinoma (RCC), where existing prognostic tools remain limited. We conducted a systematic review and meta-analysis to evaluate their predictive performance and methodological quality for recurrence and survival outcomes.

Methods: A systematic review was conducted in PubMed and Scopus from inception through April 2025. Radiomics and AI models were assessed for prognostic accuracy regarding 5-yr fixed-time recurrence-free survival (RFS) and overall survival after surgery for localized RCC. The extracted data included model type, radiomic features, validation methods, and area under the curve (AUC). Methodological quality was assessed using the APPRAISE-AI framework. Pooled 5-yr AUCs were synthesized using a prespecified random-effect model; heterogeneity was quantified (Q and τ²) and explored using a prespecified analysis restricted to external validation-only cohorts and sensitivity analyses.

Key findings and limitations: Thirty studies (n = 17 639) were included, predominantly retrospective and computed tomography (CT) based. The most predictive and frequently retained radiomic features were from the gray-level co-occurrence matrix and shape families. A meta-analysis of 20 radiomic model cohorts showed a pooled AUC of 0.87 (95% confidence interval [CI]: 0.84-0.90) for 5-yr RFS (Q = 271.08; p < 0.001; τ² = 0.0037). External validation cohorts showed a pooled AUC of 0.86 (95% CI: 0.83-0.88; Q = 12.81; p = 0.172; τ² = 0.0004). APPRAISE-AI revealed overall moderate methodological quality (median score: 54/100), with limited adherence to TRIPOD-AI and underuse of explainability tools.

Conclusions and clinical implications: Radiomic models for localized RCC built on standardized CT protocols and robust segmentation, and incorporating shape and texture features combined with clinical variables demonstrated high prognostic accuracy. Our meta-analysis confirms that such models predict recurrence and survival outcomes accurately.

Background and objective: Treatment options for metastatic or recurrent penile squamous cell carcinoma (PSCC) progressing after first-line platinum-based chemotherapy are limited, and no standard subsequent-line systemic therapy exists. We systematically reviewed the efficacy, safety, and survival outcomes of second- and later-line systemic treatments in this setting.

Methods: A systematic review, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, was performed across PubMed, Scopus, Embase, Medline, Web of Science, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), and International Clinical Trials Registry Platform (from inception to June 2025). Eligible studies enrolled adult males receiving systemic chemotherapy, immunotherapy, or targeted therapy after progression on first-line treatment. The primary outcomes were overall (OS) and progression-free (PFS) survival; the secondary outcomes included objective response rate, disease control rate, duration of response, adverse events (AEs), and quality of life (QoL).

Key findings and limitations: Seventeen studies (seven nonrandomized trials and ten case series; 367 patients) were included. Evidence quality was low due to small cohorts, heterogeneity, and potential bias. The reported median OS ranged from 4.3 to 9.5 mo and PFS ranged from 1.3 to 4.8 mo. Targeted therapies showed the most favorable OS (6.7-9.5 months) and lowest grade 3-4 AE rates (0-30%), followed by immunotherapy and chemotherapy. Biomarker-driven benefit was observed in patients with human papillomavirus positivity, programmed death-ligand 1 expression, or actionable genomic alterations (eg, PIK3CA, RAD51, and NOTCH1). QoL data were reported in only two studies, underscoring a major evidence gap. Interpretation is limited by the absence of randomized studies, inconsistent reporting, and the inability to distinguish second-line from later-line therapies in most studies.

Conclusions and clinical implications: No standard systemic therapy exists beyond first-line treatment for metastatic or recurrent PSCC. Targeted agents and immune checkpoint inhibitors show encouraging activity in biomarker-selected subgroups. Prospective biomarker-guided trials and international collaborations are needed, while multidisciplinary management and clinical trial enrollment remain essential for optimizing outcomes for this rare malignancy.