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Value of Whole-body Magnetic Resonance Imaging Using the MET-RADS-P Criteria for Assessing the Response to Intensified Androgen Deprivation Therapy in Metastatic Hormone-naïve and Castration-resistant Prostate Cancer. 使用 MET-RADS-P 标准评估转移性激素无效和阉割耐药前列腺癌患者对强化雄激素剥夺疗法反应的全身磁共振成像价值
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-05 DOI: 10.1016/j.euo.2024.10.009
Julien Van Damme, Bertrand Tombal, Nicolas Michoux, Sandy Van Nieuwenhove, Vassiliki Pasoglou, Perrine Triqueneaux, Anwar R Padhani, Frederic E Lecouvet

Background and objectives: We assessed the agreement between prostate-specific antigen (PSA) and imaging responses using whole-body magnetic resonance imaging (wbMRI). Our aim was to explore the potential prognostic value of PSA and wbMRI responses in metastatic hormone-naïve prostate cancer (mHNPC) and castration-resistant PC (mCRPC).

Methods: wbMRI was prospectively performed in 37 patients with mHNPC and 51 with mCRPC before and after 6-12 mo of androgen deprivation therapy and an androgen receptor pathway inhibitor (ARPI). Imaging responses were defined according to the Metastasis Reporting and Data System for PC (MET-RADS-P) criteria. A PSA response was defined as PSA ≤0.2 ng/ml in mHNPC and a ≥50% decrease from the pretreatment level in mCRPC. Agreement between PSA and wbMRI responses was assessed using Cohen's κ. The association between time to subsequent treatment and overall survival (OS) was analyzed using Cox regression analysis.

Key findings and limitations: Agreement between PSA and wbMRI responses was fair in mHNPC (κ = 0.30) but none to slight in mCRPC (κ = 0.15). In mHNPC, patients with a PSA or wbMRI response were less likely to receive subsequent treatments; wbMRI progression was associated with a significantly higher risk of death (hazard ratio 8.59; p = 0.002). In mCRPC, two-thirds of patients with a PSA response showed progression on wbMRI; neither PSA nor wbMRI progression changed the likelihood of starting a subsequent treatment or the risk of death.

Conclusions and clinical implications: In mHNPC, wbMRI progression was associated with a higher risk of needing subsequent treatment and shorter OS.

Patient summary: We evaluated the agreement between routine PSA (prostate-specific antigen) test results and whole-body MRI (magnetic resonance imaging) scans for assessing the response of metastatic prostate cancer to treatment. There was disagreement between the PSA and MRI results, mainly for patients with cancer that was resistant to hormone-based treatment. Combining PSA with whole-body MRI might provide a more accurate picture of the response of advanced prostate cancer to treatment.

背景和目的:我们评估了前列腺特异性抗原(PSA)与全身磁共振成像(wbMRI)成像反应之间的一致性。方法:在雄激素剥夺疗法和雄激素受体通路抑制剂(ARPI)治疗 6-12 个月之前和之后,对 37 名 mHNPC 患者和 51 名 mCRPC 患者进行了前瞻性的全身磁共振成像(wbMRI)检查。成像反应根据PC转移报告和数据系统(MET-RADS-P)标准进行定义。mHNPC的PSA≤0.2 ng/ml和mCRPC的PSA较治疗前水平下降≥50%即为PSA反应。PSA 和 wbMRI 反应之间的一致性采用 Cohen's κ 进行评估。采用Cox回归分析法分析了后续治疗时间与总生存期(OS)之间的关系:在mHNPC(κ = 0.30)中,PSA和wbMRI反应之间的一致性尚可,但在mCRPC(κ = 0.15)中,两者之间的一致性仅为微弱。在mHNPC中,PSA或wbMRI有反应的患者接受后续治疗的可能性较低;wbMRI进展与显著较高的死亡风险相关(危险比为8.59;p = 0.002)。在mCRPC中,三分之二的PSA反应患者在wbMRI上出现进展;PSA或wbMRI进展均未改变开始后续治疗的可能性或死亡风险:患者摘要:我们评估了常规PSA(前列腺特异性抗原)检测结果与全身MRI(磁共振成像)扫描结果在评估转移性前列腺癌治疗反应方面的一致性。前列腺特异性抗原检测结果与核磁共振成像结果之间存在分歧,主要是对激素治疗产生抗药性的癌症患者。将前列腺特异性抗原(PSA)与全身核磁共振成像(MRI)相结合,可能会更准确地反映晚期前列腺癌患者对治疗的反应。
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引用次数: 0
Management of Small Testicular Masses: A Delphi Consensus Study. 小睾丸肿块的处理:德尔菲共识研究
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-04 DOI: 10.1016/j.euo.2024.10.010
Karl H Pang, Giuseppe Fallara, João Lobo, Hussain M Alnajjar, Vijay Sangar, Conrad von Stempel, Dean Y Huang, Arie Parnham, Walter Cazzaniga, Francesco Giganti, Aiman Haider, Ashwin Sachdeva, Maarten Albersen, Costi Alifrangis, Marco Bandini, Fabio Castiglione, Hielke-Martijn De Vries, Christian Fankhauser, Daniel Heffernan Ho, David Nicol, Jonathan Shamash, Anita Thomas, Miles Walkden, Alex Freeman, Asif Muneer

Background and objective: The majority of small testicular masses (STMs) are benign and therefore radical orchidectomy (RO) may represent overtreatment. In appropriately selected patients, surveillance or testis-sparing surgery (TSS) is an alternative option to preserve testicular function. Since there are no clear guidelines, we aimed to develop consensus recommendations on the management of STMs.

Methods: A four-round Delphi study was conducted by 24 experts representing multiple subspecialties to reach consensus. Consensus was defined as ≥75% of the participants scoring within the same 3-point grouping (1-3, disagree; 4-6, uncertain; 7-9, agree.). The first two rounds were survey based, the third round was an online meeting to discuss uncertainties from the first two rounds, and the fourth round was a review of the final consensus statements from rounds 1-3.

Key findings and limitations: The initial survey consisted of 126 statements. Following the four rounds of assessment, a list of 96 statements were produced, which focused on clinical and biochemical assessment, colour Doppler ultrasound (CDUS) characteristics, and management options including surveillance, RO, and TSS. Management should be personalised according to risk factors for testicular cancer, fertility status, uni- or bilateral tumours, status of the contralateral testis, and CDUS characteristics, with solid lesions displaying vascularity and hypoechogenicity being more suspicious for malignancy. The consensus statements are prone to a bias, and some may not reflect robust, randomised evidence.

Conclusions and clinical implications: The expert panel has produced consensus recommendations on the management of STMs, and TSS should be considered in patients with an STM. The recommendations could aid in the dissemination of best practice.

Patient summary: There are no clear guidelines on the management of small testicular masses. Excising the whole testicle (radical orchidectomy) with a small or an indeterminate mass may affect fertility and hormonal function. A panel of experts was formed, and consensus recommendations were developed on how to deal with small and indeterminate testicular masses, which include surveillance or testis-sparing surgery.

背景和目的:大多数小睾丸肿块(STMs)是良性的,因此根治性睾丸切除术(RO)可能代表过度治疗。对于经过适当选择的患者,监视或保留睾丸手术(TSS)是保留睾丸功能的另一种选择。由于目前尚无明确的指导方针,我们旨在就STMs的治疗制定共识性建议:方法:代表多个亚专科的 24 位专家进行了四轮德尔菲研究,以达成共识。共识的定义是≥75%的参与者得分在相同的3点分组内(1-3,不同意;4-6,不确定;7-9,同意)。前两轮以调查为基础,第三轮为在线会议,讨论前两轮中的不确定因素,第四轮是对第一至三轮的最终共识声明进行审查:最初的调查包括 126 份声明。经过四轮评估后,形成了一份包含 96 项声明的清单,主要涉及临床和生化评估、彩色多普勒超声(CDUS)特征以及包括监测、RO 和 TSS 在内的管理方案。应根据睾丸癌的风险因素、生育状况、单侧或双侧肿瘤、对侧睾丸的状况以及 CDUS 特征进行个性化管理,其中显示血管和低栓塞的实性病变更可疑为恶性。共识声明容易出现偏差,有些可能并不反映可靠的随机证据:专家小组已就 STM 的管理提出了共识建议,STM 患者应考虑 TSS。这些建议有助于最佳实践的推广。患者总结:目前尚无关于小睾丸肿块治疗的明确指南。对于小肿块或不确定的肿块,切除整个睾丸(根治性睾丸切除术)可能会影响生育能力和激素功能。我们成立了一个专家小组,并就如何处理小的和不确定的睾丸肿块提出了共识性建议,其中包括监视或保睾手术。
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引用次数: 0
Reply to Alireza Ghoreifi and Hooman Djaladat's Letter to the Editor re: Yiling Chen, Chenyang Xu, Zezhong Mou, et al. Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2024.04.012. 回复 Alireza Ghoreifi 和 Hooman Djaladat 致编辑的信:Yiling Chen、Chenyang Xu、Zezhong Mou 等:《内镜下冷冻消融术与根治性肾切除术治疗上尿路上皮癌》。欧洲泌尿肿瘤杂志》。https://doi.org/10.1016/j.euo.2024.04.012.
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-25 DOI: 10.1016/j.euo.2024.10.007
Yiling Chen, Chenyang Xu, Zezhong Mou, Yun Hu, Chen Yang, Jinzhong Hu, Xinan Chen, Jianfeng Luo, Lujia Zou, Haowen Jiang
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引用次数: 0
Re: Yiling Chen, Chenyang Xu, Zezhong Mou, et al. Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2024.04.012. Re:Yiling Chen, Chenyang Xu, Zezhong Mou, et al. 内镜下冷冻消融术与根治性肾切除术治疗上尿路上皮癌。欧洲泌尿肿瘤杂志》。https://doi.org/10.1016/j.euo.2024.04.012.
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-24 DOI: 10.1016/j.euo.2024.09.020
Alireza Ghoreifi, Hooman Djaladat
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引用次数: 0
Regional Versus Systematic Biopsy in Addition to Targeted Biopsy: Results from a Systematic Review and Meta-analysis. 在靶向活检基础上进行区域活检与系统活检:系统综述和 Meta 分析的结果。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-24 DOI: 10.1016/j.euo.2024.10.006
Francesco Sanguedolce, Carol Nancy Gianna Lauwers, Alessandro Tedde, Giuseppe Basile, Daria Chernysheva, Alessandro Uleri, Michael Baboudjian, Gianluca Giannarini, Valeria Panebianco, Massimo Madonia, Lars Budeaus, Morgan Roupret, Joan Palou, Alberto Breda, Ivo Schoots, Anwar R Padhani

Background and objective: Intensification of targeted biopsy (TBx) around a magnetic resonance imaging (MRI)-visible lesion with regional biopsy (RBx) could obviate the need for systematic biopsy (SBx). We aimed to compare the detection yields of clinically significant prostate cancer (csPCa)-defined as International Society of Urological Pathology (ISUP) grade group ≥2-between TBx + RBx and the reference standard (TBx + SBx).

Methods: RBx was defined as perilesional or ipsilateral biopsy. A literature search was conducted up to September 2023 using PubMed, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Included studies were eligible when presenting data from SBx, TBx, and TBx + RBx cores and their detection yields. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria were used to assess the risk of bias of the included studies.

Key findings and limitations: Twenty-one studies were included for a meta-analysis. The overall detection yield of csPCa was not statistically different between TBx + SBX and TBx + RBx (46.1% vs 44.2%; odds ratio [OR] 1.07, 95% confidence interval [CI] 0.99-1.16, p = 0.07); similar findings were found also for ISUP grade group ≥3 prostate cancer (PCa; OR 1.06, 95% CI 0.92-1.22, p = 0.43) and in different subgroup analyses. TBx + SBx was associated with higher cancer detection of ISUP grade group 1 PCa (OR 1.16, 95% CI 1.04-1.30, p = 0.008). The main limitations include the retrospective nature of most of the selected studies, heterogeneity of RBx definition, and template.

Conclusions and clinical implications: Our study supports the use of the TBx + RBx template in the early detection pathway for the detection of csPCa. SBx can be omitted when targeting lesions visible on MRI.

Patient summary: A prostate biopsy strategy consisting of taking biopsy in and around an magnetic resonance imaging-visible lesion reduces the risk of detecting indolent prostate cancers without affecting the detection of aggressive tumours.

背景和目的:在磁共振成像(MRI)可见病灶周围加强靶向活检(TBx)并进行区域活检(RBx)可避免系统性活检(SBx)的需要。我们的目的是比较 TBx + RBx 和参考标准(TBx + SBx)对有临床意义的前列腺癌(csPCa)(定义为国际泌尿病理学会(ISUP)分级组≥2)的检出率:RBx定义为周围或同侧活检。使用PubMed、Embase和Web of Science数据库对截至2023年9月的文献进行了检索。研究遵循了系统综述和荟萃分析首选报告项目(PRISMA)指南。如果纳入的研究提供的数据来自 SBx、TBx 和 TBx + RBx 核心及其检测率,则符合条件。诊断准确性研究质量评估(QUADAS-2)标准用于评估纳入研究的偏倚风险:荟萃分析共纳入了 21 项研究。TBx+SBX和TBx+RBx对csPCa的总体检出率没有统计学差异(46.1% vs 44.2%;几率比[OR]1.07,95%置信区间[CI]0.99-1.16,p = 0.07);对于ISUP分级≥3级的前列腺癌(PCa;OR 1.06,95% CI 0.92-1.22,p = 0.43),在不同的亚组分析中也发现了类似的结果。TBx+SBx与更高的ISUP分级1组PCa癌症检出率相关(OR 1.16,95% CI 1.04-1.30,p = 0.008)。主要的局限性包括大多数所选研究的回顾性、RBx定义和模板的异质性:我们的研究支持在检测 csPCa 的早期检测路径中使用 TBx + RBx 模板。患者小结:前列腺活检策略包括在磁共振成像可见病灶及其周围进行活检,这种策略可降低检测出懒惰性前列腺癌的风险,同时不会影响侵袭性肿瘤的检测。
{"title":"Regional Versus Systematic Biopsy in Addition to Targeted Biopsy: Results from a Systematic Review and Meta-analysis.","authors":"Francesco Sanguedolce, Carol Nancy Gianna Lauwers, Alessandro Tedde, Giuseppe Basile, Daria Chernysheva, Alessandro Uleri, Michael Baboudjian, Gianluca Giannarini, Valeria Panebianco, Massimo Madonia, Lars Budeaus, Morgan Roupret, Joan Palou, Alberto Breda, Ivo Schoots, Anwar R Padhani","doi":"10.1016/j.euo.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.euo.2024.10.006","url":null,"abstract":"<p><strong>Background and objective: </strong>Intensification of targeted biopsy (TBx) around a magnetic resonance imaging (MRI)-visible lesion with regional biopsy (RBx) could obviate the need for systematic biopsy (SBx). We aimed to compare the detection yields of clinically significant prostate cancer (csPCa)-defined as International Society of Urological Pathology (ISUP) grade group ≥2-between TBx + RBx and the reference standard (TBx + SBx).</p><p><strong>Methods: </strong>RBx was defined as perilesional or ipsilateral biopsy. A literature search was conducted up to September 2023 using PubMed, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Included studies were eligible when presenting data from SBx, TBx, and TBx + RBx cores and their detection yields. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria were used to assess the risk of bias of the included studies.</p><p><strong>Key findings and limitations: </strong>Twenty-one studies were included for a meta-analysis. The overall detection yield of csPCa was not statistically different between TBx + SBX and TBx + RBx (46.1% vs 44.2%; odds ratio [OR] 1.07, 95% confidence interval [CI] 0.99-1.16, p = 0.07); similar findings were found also for ISUP grade group ≥3 prostate cancer (PCa; OR 1.06, 95% CI 0.92-1.22, p = 0.43) and in different subgroup analyses. TBx + SBx was associated with higher cancer detection of ISUP grade group 1 PCa (OR 1.16, 95% CI 1.04-1.30, p = 0.008). The main limitations include the retrospective nature of most of the selected studies, heterogeneity of RBx definition, and template.</p><p><strong>Conclusions and clinical implications: </strong>Our study supports the use of the TBx + RBx template in the early detection pathway for the detection of csPCa. SBx can be omitted when targeting lesions visible on MRI.</p><p><strong>Patient summary: </strong>A prostate biopsy strategy consisting of taking biopsy in and around an magnetic resonance imaging-visible lesion reduces the risk of detecting indolent prostate cancers without affecting the detection of aggressive tumours.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":null,"pages":null},"PeriodicalIF":8.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Oncological Outcomes of Active Surveillance versus Surgery or Ablation for Patients with Small Renal Masses: A Systematic Review and Quantitative Analysis. 对肾脏小肿块患者进行主动监测与手术或消融治疗的肿瘤学结果:系统回顾与定量分析
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-24 DOI: 10.1016/j.euo.2024.10.008
Ichiro Tsuboi, Pawel Rajwa, Riccardo Campi, Marcin Miszczyk, Tamás Fazekas, Akihiro Matsukawa, Mehdi Kardoust Parizi, Robert J Schulz, Stefano Mancon, Anna Cadenar, Ekaterina Laukhtina, Tatsushi Kawada, Satoshi Katayama, Takehiro Iwata, Kensuke Bekku, Koichiro Wada, Pierre I Karakiewicz, Mesut Remzi, Motoo Araki, Shahrokh F Shariat

Background and objective: While active surveillance (AS) is an alternative to surgical interventions in patients with small renal masses (SRMs), evidence regarding its oncological efficacy is still debated. We aimed to evaluate oncological outcomes for patients with SRMs who underwent AS in comparison to surgical interventions.

Methods: In April 2024, PubMed, Scopus, and Web of Science were queried for comparative studies evaluating AS in patients with SRMs (PROSPERO: CRD42024530299). The primary outcomes were overall (OS) and cancer-specific survival (CSS). A random-effects model was used for quantitative analysis.

Key findings and limitations: We identified eight eligible studies (three prospective, four retrospective, and one study based on Surveillance, Epidemiology and End Results [SEER] data) involving 4947 patients. Pooling of data with the SEER data set revealed significantly higher OS rates for patients receiving surgical interventions (hazard ratio [HR] 0.73; p = 0.007), especially partial nephrectomy (PN; HR 0.62; p < 0.001). However, in a sensitivity analysis excluding the SEER data set there was no significant difference in OS between AS and surgical interventions overall (HR 0.84; p = 0.3), but the PN subgroup had longer OS than the AS group (HR 0.6; p = 0.002). Only the study based on the SEER data set showed a significant difference in CSS. The main limitations include selection bias in retrospective studies, and classification of interventions in the SEER database study.

Conclusions and clinical implications: Patients treated with AS had similar OS to those who underwent surgery or ablation, although caution is needed in interpreting the data owing to the potential for selection bias and variability in AS protocols. Our review reinforces the need for personalized shared decision-making to identify patients with SRMs who are most likely to benefit from AS.

Patient summary: For well-selected patients with a small kidney mass suspicious for cancer, active surveillance seems to be a safe alternative to surgery, with similar overall survival. However, the evidence is still limited and more studies are needed to help in identifying the best candidates for active surveillance.

背景和目的:虽然主动监测(AS)是小肾肿块(SRMs)患者手术治疗的替代方案,但有关其肿瘤学疗效的证据仍存在争议。我们的目的是评估接受主动监测和手术治疗的 SRM 患者的肿瘤治疗效果:2024年4月,我们在PubMed、Scopus和Web of Science上查询了评估SRM患者接受AS的比较研究(PROSPERO:CRD42024530299)。主要结果为总生存期(OS)和癌症特异性生存期(CSS)。定量分析采用随机效应模型:我们确定了 8 项符合条件的研究(3 项前瞻性研究、4 项回顾性研究和 1 项基于监测、流行病学和最终结果 [SEER] 数据的研究),涉及 4947 名患者。与SEER数据集的数据汇总显示,接受手术干预的患者的OS率明显更高(危险比[HR] 0.73;P = 0.007),尤其是肾部分切除术(PN;HR 0.62;P 结论和临床意义:接受强直性脊柱炎治疗的患者与接受手术或消融治疗的患者的OS相似,但由于强直性脊柱炎治疗方案可能存在选择偏差和变异,因此在解释数据时需要谨慎。我们的综述强调了个性化共同决策的必要性,以确定最有可能从 AS 中获益的 SRM 患者:患者总结:对于经过精挑细选的肾脏小肿块疑似癌症患者,积极监测似乎是一种安全的手术替代方案,其总生存率与手术相似。然而,证据仍然有限,需要更多的研究来帮助确定接受主动监测的最佳人选。
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引用次数: 0
Real-world Study of Avelumab First-line Maintenance Treatment in Patients with Advanced Urothelial Carcinoma in France: Overall Results from the Noninterventional AVENANCE Study and Analysis of Outcomes by Second-line Treatment. 法国对晚期尿路上皮癌患者进行阿维单抗一线维持治疗的真实世界研究:非常规 AVENANCE 研究的总体结果和二线治疗的疗效分析。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-23 DOI: 10.1016/j.euo.2024.09.014
Philippe Barthélémy, Constance Thibault, Aude Fléchon, Marine Gross-Goupil, Eric Voog, Jean-Christophe Eymard, Christine Abraham, Matthieu Chasseray, Véronique Lorgis, Werner Hilgers, Aurélien Gobert, Sylvestre Le Moulec, Camille Simon, Emanuel Nicolas, Anne Escande, Damien Pouessel, Guillaume Mouillet, Constant Josse, Marie-Noelle Solbes, Prisca Lambert, Yohann Loriot
<p><strong>Background: </strong>Avelumab first-line maintenance treatment was approved for patients with advanced urothelial carcinoma (aUC) without progression following platinum-based chemotherapy (PBC), based on the results from the JAVELIN Bladder 100 phase 3 trial.</p><p><strong>Objective: </strong>To report the results from AVENANCE, a real-world study of avelumab first-line maintenance treatment.</p><p><strong>Design, setting, and participants: </strong>This is a retrospective and prospective, noninterventional study (NCT04822350). Eligible patients with aUC without progression on first-line PBC were enrolled at 82 centers in France between July 2021 and May 2022. The effectiveness population included 595 patients. The median follow-up was 26.3 mo.</p><p><strong>Intervention: </strong>Previous, ongoing, or planned avelumab first-line maintenance treatment.</p><p><strong>Outcome measurements and statistical analysis: </strong>Overall survival (OS) from avelumab initiation (primary endpoint) and safety were evaluated.</p><p><strong>Results and limitations: </strong>The median age was 73.0 yr, and performance status was 0/1 in 91% of patients and ≥2 in 9.3%. The most common prior first-line chemotherapy regimen was carboplatin plus gemcitabine (61%). At data cutoff (December 7, 2023), the median duration of avelumab treatment was 5.6 mo, 125 patients remained on avelumab, and 55% had received second-line treatment. The median OS from avelumab initiation was 21.3 mo (95% confidence interval [CI], 17.6-24.6), and the median progression-free survival was 5.7 mo (95% CI, 5.2-6.5). In exploratory analyses of this population without disease progression on PBC, the median OS from the start of first-line PBC was 26.5 mo overall, and in subgroups that received second-line enfortumab vedotin (n = 55) or PBC (n = 79), it was 41.5 and 24.5 mo, respectively.</p><p><strong>Conclusions: </strong>Real-world data from AVENANCE confirm the effectiveness and safety of avelumab first-line maintenance treatment in a heterogeneous population, supporting its recommendation for cisplatin-eligible and cisplatin-ineligible patients with aUC who are progression free after first-line PBC. In an exploratory analysis, a small subgroup that received a treatment sequence of first-line PBC without disease progression followed by avelumab first-line maintenance and second-line enfortumab vedotin had a median OS of >3 yr.</p><p><strong>Patient summary: </strong>A French real-world study, called AVENANCE, looked at avelumab maintenance treatment in people with advanced urothelial cancer whose tumor disappeared, shrank, or stopped growing with chemotherapy. Overall, results were consistent with those seen in a previous clinical trial, and on average, people treated with avelumab maintenance lived for 26.5 mo from the start of chemotherapy. Analyses of different groups of people found that survival varied, with people living for an average of 18-42 mo depending on what treatment
背景:根据JAVELIN膀胱100三期试验的结果,阿维列单抗一线维持治疗被批准用于铂类化疗(PBC)后无进展的晚期尿路上皮癌(aUC)患者:报告阿维列单抗一线维持治疗真实世界研究 AVENANCE 的结果:这是一项回顾性和前瞻性的非常规研究(NCT04822350)。2021年7月至2022年5月期间,法国82个中心招募了符合条件的一线PBC aUC无进展患者。有效人群包括 595 名患者。中位随访时间为26.3个月:曾接受、正在接受或计划接受阿维列单抗一线维持治疗的患者:结果测量和统计分析:评估阿维列单抗起始治疗后的总生存期(OS)(主要终点)和安全性:中位年龄为73.0岁,91%的患者表现为0/1,9.3%的患者表现为≥2。最常见的一线化疗方案是卡铂加吉西他滨(61%)。截至数据截止日(2023年12月7日),阿维列单抗治疗的中位持续时间为5.6个月,125名患者仍在使用阿维列单抗,55%的患者接受了二线治疗。从开始使用阿维列单抗起,中位OS为21.3个月(95%置信区间[CI],17.6-24.6),中位无进展生存期为5.7个月(95%置信区间,5.2-6.5)。在对PBC未出现疾病进展的人群进行的探索性分析中,从一线PBC开始的中位OS总体为26.5个月,而在接受二线恩福单抗维多汀(n = 55)或PBC(n = 79)的亚组中,中位OS分别为41.5个月和24.5个月:AVENANCE的真实世界数据证实了阿维单抗一线维持治疗在异质性人群中的有效性和安全性,支持将其推荐给符合顺铂条件和不符合顺铂条件、一线PBC治疗后无进展的aUC患者。在一项探索性分析中,一小部分亚组患者在接受一线PBC治疗后无疾病进展,随后接受阿维列单抗一线维持治疗和二线恩福单抗维多汀治疗,其中位OS>3年。总体而言,研究结果与之前一项临床试验的结果一致,接受阿维列单抗维持治疗的患者从化疗开始平均可存活26.5个月。对不同人群进行分析后发现,他们的存活时间各不相同,平均存活时间为18-42个月,这取决于他们在完成阿维鲁单抗治疗后所接受的治疗。
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引用次数: 0
Sex Disparity in Non-muscle-invasive Bladder Cancer: Pitfalls of Large Population-based Data Sets and Lessons from an Integrated Analysis. 非肌层浸润性膀胱癌的性别差异:基于人口的大型数据集的陷阱与综合分析的启示》。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-23 DOI: 10.1016/j.euo.2024.10.001
Niyati Lobo, Zhigang Duan, Akshay Sood, Hui Zhao, Sia V Lindskrog, Lars Dyrskjot, Sharon H Giordano, Stephen B Williams, Kelly K Bree, Ashish M Kamat

The impact of sex on non-muscle-invasive bladder cancer (NMIBC) remains uncertain and current evidence is conflicting. To address this uncertainty, we conducted an integrative analysis using Surveillance, Epidemiology and End Results (SEER)-Medicare and UROMOL data sets to explore sex disparities in NMIBC oncological outcomes. In the SEER-Medicare cohort, females had lower risks of recurrence and progression in comparison to males, but no significant difference in BC-specific mortality was observed. Analysis of the UROMOL cohort revealed no sex-specific differences in tumour biology across genomic, transcriptomic, and spatial proteomic domains. These findings highlight the limitations of relying on just SEER-Medicare data for NMIBC, for which identification of the true incidence of recurrence and progression is challenging, and emphasise the importance of combining population-based data and molecular biology results to gain a comprehensive understanding of NMIBC. PATIENT SUMMARY: The impact of sex on non-muscle-invasive bladder cancer (NMIBC) outcomes is unclear. Our analysis of a large population-based data set showed that the risks of recurrence and progression were lower for females. However, analysis of a separate molecular dataset showed no sex-specific differences. The results highlight the importance of combining population-based data and molecular biology results for a better understanding of NMIBC.

性别对非肌层浸润性膀胱癌(NMIBC)的影响仍不确定,目前的证据也相互矛盾。为了解决这一不确定性,我们利用监测、流行病学和最终结果(SEER)--医疗保险和UROMOL数据集进行了一项综合分析,以探讨非肌层浸润性膀胱癌肿瘤结局的性别差异。在SEER-Medicare队列中,女性的复发和进展风险低于男性,但在BC特异性死亡率方面未观察到显著差异。对UROMOL队列的分析表明,在基因组、转录组和空间蛋白质组领域,肿瘤生物学没有性别差异。这些发现凸显了仅依靠 SEER-Medicare 数据来确定 NMIBC 的局限性,因为确定复发和进展的真实发生率具有挑战性,这些发现还强调了结合基于人群的数据和分子生物学结果来全面了解 NMIBC 的重要性。患者摘要:性别对非肌层浸润性膀胱癌(NMIBC)预后的影响尚不清楚。我们对基于人群的大型数据集进行的分析表明,女性的复发和恶化风险较低。然而,对另一个分子数据集的分析表明,没有性别差异。这些结果凸显了将基于人群的数据与分子生物学结果相结合以更好地了解 NMIBC 的重要性。
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引用次数: 0
Digital Twins in Urological Oncology: Precise Treatment Planning via Complex Modeling. 泌尿肿瘤学中的数字双胞胎:通过复杂建模进行精确治疗规划。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-22 DOI: 10.1016/j.euo.2024.10.005
Enrico Checcucci, Christoph Oing, Daniele Amparore, Francesco Porpiglia, Pasquale Rescigno

Digital twins can revolutionize personalized medicine by providing virtual simulations for optimized treatment planning and patient care. Digital twins can enhance precision in oncology and surgery, although challenges regarding data and model complexity necessitate ongoing multidisciplinary collaboration for effective implementation.

数字孪生可以为优化治疗规划和病人护理提供虚拟仿真,从而彻底改变个性化医疗。数字孪生可以提高肿瘤学和外科手术的精确度,但由于数据和模型复杂性方面的挑战,需要持续的多学科合作才能有效实施。
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引用次数: 0
Diagnostic Effects of Omitting Systematic Biopsies in Prostate Cancer Screening. 前列腺癌筛查中省略系统活检的诊断效果。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-22 DOI: 10.1016/j.euo.2024.10.002
Jan Chandra Engel, Martin Eklund, Fredrik Jäderling, Thorgerdur Palsdottir, Ugo Falagario, Andrea Discacciati, Tobias Nordström

Background and objective: The optimal biopsy strategy in prostate cancer screening is unknown. This study aims to assess the diagnostic effects of omitting systematic biopsies in a screening cohort.

Methods: We used data from the STHLM3-MRI trial. A total of 7609 men aged 50-74 yr were randomised to undergo magnetic resonance imaging (MRI) if having an elevated risk of prostate cancer (prostate-specific antigen [PSA] ≥3 ng/ml or Stockholm3 ≥11%). Participants with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 underwent targeted and systematic biopsies. Cancer detection rates from combined and targeted-only biopsies were presented as a risk ratio (RR). Subgroup analyses were stratified by age, PSA density (PSAd), and PI-RADS. Differences in reclassification rates at radical prostatectomy were calculated.

Key findings and limitations: The median age of the participants was 66 yr (interquartile range: 61-71) and PSA 3.8 ng/ml (2.9-5.8). Out of 395 men undergoing combined biopsies, 52 (13.2%) had International Society of Urological Pathology (ISUP) grade group (GG) 1 and 230 (58%) had ISUP GG ≥2 prostate cancer. Omission of systematic biopsies reduced cancer detection rates (RR of ISUP GG 1: 0.83 [95% confidence interval 0.64-1.07]; ISUP GG ≥2: 0.85 [0.81-0.90]; and ISUP GG ≥3: 0.86 [0.79-0.95]). Each case of averted ISUP GG 1 cancer was associated with 3.8 cases of missed ISUP GG ≥2 and 1.1 case of ISUP GG ≥3 cancer. Detection of fewer ISUP GG ≥2 cases than the number of avoided ISUP 1 cancer cases was observed in all subgroups when systematic biopsies were omitted. Using PSAd ≥0.05 ng/ml2 as a cut-off for a biopsy resulted in the same numbers of ISUP GG 1 tumours saved, with higher detection rates of ISUP GG ≥2 tumours. In 146 men undergoing radical prostatectomy, 46 (31.5%) versus 28 (19.2%) were upgraded following targeted biopsies versus a combined biopsy strategy (p < 0.05).

Conclusions and clinical implications: Complete omission of systematic biopsies in prostate cancer screening is associated with decreased detection of significant cancer, while reducing overdetection of insignificant cancer to a smaller extent. This strategy also increased the risk of histopathological misclassification.

Patient summary: In a prostate cancer screening setting, we examined the diagnostic effects of systematic biopsies in addition to targeted biopsies in men with suspicious magnetic resonance imaging lesions. We found that exclusion of systematic biopsies led to reduced detection of clinically significant prostate cancer. Our findings emphasise the importance of incorporating systematic biopsies alongside targeted biopsies for improved diagnostic outcomes.

背景和目的:前列腺癌筛查的最佳活检策略尚不清楚。本研究旨在评估在筛查队列中省略系统活检的诊断效果:我们使用了 STHLM3-MRI 试验的数据。共有 7609 名年龄在 50-74 岁之间的男性被随机安排接受磁共振成像(MRI)检查,前提是前列腺癌风险升高(前列腺特异性抗原 [PSA] ≥3 纳克/毫升或斯德哥尔摩指数 3 ≥11%)。前列腺成像报告和数据系统(PI-RADS)≥3的参与者接受了靶向和系统活检。综合活检和靶向活检的癌症检出率以风险比(RR)表示。亚组分析按年龄、PSA密度(PSAd)和PI-RADS进行分层。计算了根治性前列腺切除术时重新分类率的差异:参与者的中位年龄为 66 岁(四分位间范围:61-71),PSA 为 3.8 纳克/毫升(2.9-5.8)。在接受联合活检的395名男性中,52人(13.2%)患有国际泌尿病理学会(ISUP)1级组(GG)前列腺癌,230人(58%)患有ISUP GG≥2级前列腺癌。省略系统活检降低了癌症检出率(ISUP GG 1 的 RR:0.83 [95% 置信区间 0.64-1.07];ISUP GG ≥2:0.85 [0.81-0.90];ISUP GG ≥3:0.86 [0.79-0.95])。每避免一例 ISUP GG 1 癌症与 3.8 例 ISUP GG ≥2 癌症和 1.1 例 ISUP GG ≥3 癌症相关。在省略系统活检的所有亚组中,发现的 ISUP GG ≥2 癌症病例数少于避免的 ISUP 1 癌症病例数。以 PSAd≥0.05 ng/ml2 作为活组织检查的临界值,结果是挽救的 ISUP GG 1 肿瘤数量相同,而 ISUP GG ≥2 肿瘤的检出率更高。在接受根治性前列腺切除术的146名男性中,46人(31.5%)与28人(19.2%)在接受靶向活检与联合活检策略后得到了提升(P 结论和临床意义:在前列腺癌筛查中完全不进行系统活检会降低重大癌症的检出率,同时在较小程度上减少不重大癌症的过度检出。患者总结:在前列腺癌筛查中,我们对磁共振成像病变可疑的男性进行了系统活检和靶向活检的诊断效果研究。我们发现,排除系统性活检会降低对有临床意义的前列腺癌的检出率。我们的研究结果强调了在进行靶向活检的同时进行系统活检以提高诊断效果的重要性。
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引用次数: 0
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European urology oncology
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