European urology focus最新文献

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The Role of Salvage Cystectomy After Prior Trimodality Therapy: A Multinational Match-paired Analysis 在先前的三位一体治疗后保留膀胱切除术的作用：一项多国配对分析。

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.04.028

Nikolaos Pyrgidis , Gerald Bastian Schulz , Pietro Scilipoti , Francesco Pellegrino , Jozefina Casuscelli , Lazaros Tzelves , Stamatios Katsimperis , Davide Ciavarella , Maria Carmen Mir , Ioannis Sokolakis , Tobias Klatte , Alberto Ramos Belinchon , Jorge Caño Velasco , Yasuhisa Fujii , Hajime Tanaka , Soichiro Yoshida , Shunya Matsumoto , Paolo Umari , Jeremy Yuen-Chun Teoh , Chris Wong Ho Ming , Marco Moschini

Background and objective

Trimodality therapy (TMT) with transurethral resection followed by radiation of the urinary bladder and chemotherapy is associated with similar long-term survival rates to radical cystectomy (RC) for well-selected patients. Nevertheless, salvage RC may become necessary in 10% of patients receiving TMT. We aimed to assess the perioperative and long-term outcomes of salvage RC after prior TMT through a large multinational cohort study.

Methods

We included patients with pure urothelial cancer of the urinary bladder. Patients undergoing salvage RC after prior TMT due to recurrence in the urinary bladder from 13 high-volume centers were matched with a propensity score analysis in a 1:1 ratio with patients without prior TMT undergoing primary RC. The two groups were adjusted for institution, age, histological status, American Society of Anesthesiologists score, and surgical technique (open or minimally invasive RC).

Key findings and limitations

We included 118 patients (59 per group) with a median age of 73 yr (interquartile range [IQR]: 66–79). Seven patients (11%) developed severe, grade 4 or 5 perioperative complications during RC after prior TMT. The 30- and 90-d survival rates of salvage RC after prior TMT were 93% and 91%, respectively. RC in patients with prior TMT was associated with higher blood loss by 297 ml (95% confidence interval [CI]: 73–520, p = 0.010) and higher odds of admission to the intensive care unit (odds ratio: 2.8, 95% CI: 1.2–6.7, p = 0.017) than primary RC in matched patients. At a median follow-up of 10 mo (IQR: 5–34), 29 deaths occurred in patients requiring RC after prior TMT. Prior TMT was associated with worse overall survival than primary RC (hazard ratio: 1.9, 95% CI: 1.2–4.1, p = 0.032).

Conclusions and clinical implications

Salvage RC after TMT and primary RC have comparable perioperative outcomes. Patients undergoing salvage RC after TMT may have worse overall survival in the long term, likely reflecting tumor biology.

背景和目的：三联疗法（TMT）经尿道切除术后膀胱放疗和化疗与根治性膀胱切除术（RC）的长期生存率相似。然而，10%接受TMT的患者可能需要补救性RC。我们旨在通过一项大型跨国队列研究来评估先前TMT后抢救性RC的围手术期和长期结果。方法：我们纳入单纯的膀胱尿路上皮癌患者。在13个大容量中心，由于膀胱复发而进行TMT后补救性RC的患者与没有TMT的患者进行原发性RC的倾向评分分析，比例为1:1。根据机构、年龄、组织学状况、美国麻醉医师学会评分和手术技术（开放或微创RC）对两组进行调整。主要发现和局限性：我们纳入了118例患者（每组59例），中位年龄为73岁（四分位数间距[IQR]: 66-79）。7名患者（11%）在术前TMT后的RC期间出现严重的4级或5级围手术期并发症。术后30天和90天的存活率分别为93%和91%。既往TMT患者的RC与297 ml出血量增加相关（95%可信区间[CI]: 73-520， p = 0.010），并且与匹配患者的原发性RC相比，其进入重症监护病房的几率更高（优势比：2.8,95% CI: 1.2-6.7, p = 0.017）。在中位随访10个月（IQR: 5-34）， 29例患者在既往TMT后需要RC。既往TMT患者的总生存期较原发性RC患者差（风险比：1.9,95% CI: 1.2-4.1, p = 0.032）。结论和临床意义：TMT后补救性RC和原发性RC的围手术期预后相当。TMT后接受补救性RC的患者可能有较差的长期总生存率，可能反映了肿瘤生物学。

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引用次数: 0

Re: Cristina Negrean, Ammar Alam, Duane Hickling, et al. Preoperative Magnetic Resonance Imaging Membranous Urethral Length as a Predictor of Urinary Continence After Radical Prostatectomy: A Systematic Review and Meta-analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.02.002 回复：Cristina Negrean， Ammar Alam， Duane Hickling等。术前磁共振成像膜性尿道长度作为根治性前列腺切除术后尿失禁的预测因素：一项系统回顾和荟萃分析。Eur url Focus。在出版社。https://doi.org/10.1016/j.euf.2025.02.002。

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.03.022

Yalong Zhang, Rui Yan, Li Yang

引用次数: 0

Neoadjuvant Chemotherapy for Upper Tract Urothelial Cancer 临床咨询指南：上尿路上皮癌的新辅助化疗。

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.07.014

Sean A. Fletcher , Nirmish Singla , Jean Hoffman-Censits

引用次数: 0

Clinical Trial in Progress: SWOG S2210, a Phase 2 Study of Neoadjuvant Carboplatin for Localized High-risk Prostate Cancer with Germline BRCA1/2 Mutations 临床试验正在进行：SWOG S2210，新辅助卡铂治疗局部高危前列腺癌生殖系BRCA1/2突变的2期研究。

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.11.011

Heather H. Cheng , Sam Callis , Evan Y. Yu , Scott E. Delacroix , Alexandra O. Sokolova , Catherine M. Tangen , Seth P. Lerner , Tanya Barauskas Dorff , Daniel W. Lin

引用次数: 0

Urothelial Cancer: What Is the Role of Expression-based Subtypes to Guide Neoadjuvant Therapy in Muscle-invasive Bladder Cancer? 尿路上皮癌：基于表达的亚型在指导肌肉浸润性膀胱癌新辅助治疗中的作用是什么？

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.11.014

Joshua J. Meeks

引用次数: 0

Prostate Cancer: Current Status of Novel Molecular Imaging and Future Prospects 前列腺癌：新型分子成像的现状和未来展望。

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.11.013

Donald C. Wunsch 3rd, Baris Turkbey

Molecular imaging has become an essential component of diagnosis, treatment planning, and monitoring in prostate cancer. Prostate-specific membrane antigen–targeted positron emission tomography is now the most widely used molecular imaging approach in prostate cancer. This mini review provides an overview of the status and prospects of novel molecular imaging in prostate cancer management.

Patient summary

Recent years have seen improvements in scans for prostate cancer. Our mini review focuses on PSMA PET (prostate-specific membrane antigen positron emission tomography) for diagnosis of prostate cancer, especially metastatic disease, and treatment planning and monitoring. The results show that in the right setting, PSMA PET has benefits in improving outcomes for patients with prostate cancer.

分子成像已成为前列腺癌诊断、治疗计划和监测的重要组成部分。前列腺特异性膜抗原靶向正电子发射断层扫描是目前在前列腺癌中应用最广泛的分子成像方法。本文综述了新型分子成像技术在前列腺癌治疗中的现状和前景。患者总结：近年来，前列腺癌的扫描技术有所改善。我们的小综述集中在PSMA PET（前列腺特异性膜抗原正电子发射断层扫描）诊断前列腺癌，特别是转移性疾病，治疗计划和监测。结果表明，在适当的环境下，PSMA PET对改善前列腺癌患者的预后有好处。

引用次数: 0

Current Standard for High-risk Upper Tract Urothelial Cancer: Platinum-based Chemotherapy—Proven, Not Postulated 高危上尿路癌的现行标准：经证实的铂类化疗，而非假设。

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.11.012

Alison J. Birtle

引用次数: 0

Long-term Oncological Outcomes for Patients with Non–muscle-invasive Bladder Cancer Treated with Bacillus Calmette-Guérin (BCG): A Comparative Analysis of Adequate Versus Inadequate BCG Treatment 卡介苗治疗非肌肉侵袭性膀胱癌患者的长期肿瘤预后：卡介苗治疗充分与不充分的比较分析

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.04.033

Pietro Scilipoti , Mattia Longoni , Mario de Angelis , Paolo Zaurito , Aleksander Ślusarczyk , Francesco Soria , Benjamin Pradere , Wojciech Krajewski , David D’Andrea , Andrea Mari , Francesco Del Giudice , Renate Pichler , José Daniel Subiela , Gautier Marcq , Andrea Gallioli , Luca Afferi , Riccardo Mastroianni , Giuseppe Simone , Simone Albisinni , Laura S. Mertens , Marco Moschini

Background and objective

Intravesical bacillus Calmette-Guérin (BCG) instillation is recommended for intermediate-risk (IR) and high-risk (HiR) non–muscle-invasive bladder cancer (NMIBC). There are limited comparisons of long-term outcomes between adequate and inadequate BCG.

Methods

We analyzed data from a multicenter European database (2010–2024) for 1558 patients diagnosed with IR- or HiR-NMIBC who underwent BCG treatment and received at least five BCG instillations. Adequate BCG was defined as at least five of six induction instillations and two of three maintenance doses, or two of six doses of a reinduction course. A 3-mo landmark analysis was conducted. Recurrence-free survival (RFS), high-grade RFS (HG-RFS), progression-free survival (PFS), and overall survival (OS) were estimated using inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and IPTW-adjusted multivariable Cox regression models. Cancer-specific mortality (CSM) was assessed via cumulative incidence curves and Fine-Gray competing-risks regression analysis.

Key findings and limitations

The cohort included 606 IR-NMIBC (39%), 840 HiR-NMIBC (54%), and 112 very HiR (VHR)-NMIBC (7.1%) cases. Adequate BCG was administered to 1226 patients (78%). Among 1239 patients (80%) with documented treatment termination reasons, 503 (41%) completed guideline-recommended treatment and 150 (12%) discontinued because of BCG intolerance. Over median follow-up of 37 mo, adequate BCG was associated with higher IPTW-adjusted 5-yr RFS (72% vs 52%; hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.31–0.85; p < 0.001), HG-RFS (83% vs 68%; HR 0.43, 95% CI 0.32–0.58; p < 0.001), PFS (92% vs 85%; HR 0.47, 95% CI 0.30–0.74; p = 0.001), and OS (88% vs 71%; HR 0.52, 95% CI 0.37–0.74; p = 0.001). CSM rates were comparable between the groups (3% vs 4.9%; p = 0.3).

Conclusions and clinical implications

Adequate BCG, as defined by the International Bladder Cancer Group (IBCG), was associated with significantly better RFS, PFS, and OS. These findings support use of the IBCG definition as a standardized benchmark for BCG exposure. However, further prospective validation to confirm causality is needed.

背景与目的：膀胱内卡介苗（BCG）被推荐用于治疗中危（IR）和高危（HiR）非肌肉浸润性膀胱癌（NMIBC）。卡介苗充足和不充足之间的长期结果比较有限。方法：我们分析了来自欧洲多中心数据库（2010-2024）的1558例诊断为IR或IR- nmibc的患者的数据，这些患者接受了卡介苗治疗并接受了至少5次卡介苗注射。适当的卡介苗被定义为6次诱导注射中至少5次，3次维持剂量中至少2次，或6次再诱导过程中至少2次。进行3个月的里程碑分析。使用治疗加权逆概率（IPTW）调整的Kaplan-Meier曲线和IPTW调整的多变量Cox回归模型估计无复发生存期（RFS）、高级别生存期（HG-RFS）、无进展生存期（PFS）和总生存期（OS）。通过累积发病率曲线和Fine-Gray竞争风险回归分析评估癌症特异性死亡率（CSM）。主要发现和局限性：该队列包括606例IR-NMIBC(39%)， 840例IR-NMIBC（54%）和112例very HiR (VHR)-NMIBC（7.1%）。1226例患者（78%）接受足量卡介苗治疗。在1239例（80%）有治疗终止原因的患者中，503例（41%）完成了指南推荐的治疗，150例（12%）因卡介苗不耐受而停止治疗。在37个月的中位随访中，适当的BCG与更高的iptw调整后的5年RFS相关(72% vs 52%；风险比[HR] 0.40, 95%可信区间[CI] 0.31-0.85；结论和临床意义：根据国际膀胱癌组织（IBCG）的定义，适当的卡介苗与更好的RFS、PFS和OS相关。这些发现支持使用IBCG定义作为BCG暴露的标准化基准。然而，需要进一步的前瞻性验证来确认因果关系。

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引用次数: 0

Exciting Times in Urological Oncology: Rapid Advances and Greater Complexity Are Changing Practice and Improving Outcomes 泌尿肿瘤学的激动人心的时代：快速发展和更大的复杂性正在改变实践和改善结果。

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.11.017

Shilpa Gupta , James W.F. Catto

引用次数: 0

Bladder Preservation After Neoadjuvant Therapy for Muscle-invasive Bladder Cancer in the Current Era: Myth and Reality 当代肌肉浸润性膀胱癌新辅助治疗后膀胱保存：神话与现实。

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2026-01-01 DOI: 10.1016/j.euf.2025.11.002

Emanuele Crupi , Andrea Necchi , Ashish M. Kamat

引用次数: 0

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