European urology oncology最新文献

Background and objective: Current European Association of Urology guidelines universally recommend a second transurethral resection (ReTUR) for all T1 non-muscle-invasive bladder cancer (NMIBC) cases. However, ReTUR is an invasive and costly procedure that is often negative for residual disease, and may represent overtreatment in appropriately selected patients who have undergone complete initial TUR. Our aim was to report 2-yr oncological outcomes and confirm the safety of a novel, response-guided strategy with selective ReTUR for patients with T1 NMIBC.

Methods: The prospective, observational, multicenter HuNIRe trial enrolled patients with T1 NMIBC from 2020 to 2024. Patients with complete TUR underwent urine cytology at 3-4 wk and cystoscopy at 4-6 wk. ReTUR was performed only if cytology was positive (Paris system 3-6) or disease was detected on cystoscopy; otherwise, patients proceeded directly to bacillus Calmette-Guérin (BCG) induction therapy. The primary endpoints were 2-yr recurrence-free survival (RFS) and progression-free survival (PFS). Secondary endpoints included comparison of outcomes between the groups with and without ReTUR, and between the overall HuNIRe cohort and a retrospective cohort of patients with T1 NMIBC who underwent routine ReTUR. Kaplan-Meier estimates and the log-rank test were used for survival analysis.

Key findings and limitations: A total of 90 patients were prospectively enrolled. The protocol successfully avoided ReTUR in 71% (n = 64) of patients, who proceeded directly to BCG therapy. Only 29% (n = 26) of the patients required ReTUR according to early evaluation; importantly, no patient was upstaged to MIBC at ReTUR. After median follow-up of 26 mo, 2-yr survival rates for the entire cohort were 69% for RFS and 91% for PFS. There were no significant differences between the groups with and without ReTUR in RFS (p = 0.9) or PFS (p = 0.6). Oncological outcomes were also comparable between the HuNIRe cohort and a retrospective cohort that underwent routine ReTUR (2-yr RFS: 74% vs 74%; 2-yr PFS: 91% vs 92%).

Conclusions and clinical implications: Results from the HuNIRe trial confirm that a risk-adapted approach to ReTUR in selected patients with T1 NMIBC after complete initial TUR is feasible, although oncological outcomes should be interpreted with caution owing to the short follow-up. This strategy spared 71% of patients from ReTUR, and could support a tailored, response-guided approach rather than the blanket guideline recommendation for ReTUR.

Background and objective: Inferior vena cava (IVC) tumor thrombus can impact the surgical management of locally advanced renal cell carcinoma (RCC). While open surgery remains the standard for complex thrombi, minimally invasive surgery (MIS) is increasingly adopted. The aim of this review was to compare perioperative outcomes across the different surgical approaches for IVC thrombectomy in nonmetastatic RCC.

Methods: We systematically searched the PubMed, Embase, Scopus, and Web of Science databases from inception to January 10, 2025 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol was registered on PROSPERO (CRD42022330114). Retrospective and prospective studies reporting operative time (OT), estimated blood loss (EBL), complication rates, or length of stay (LOS) after IVC thrombectomy were included. A meta-analysis of proportions and a network meta-analysis (NMA) of comparative studies were performed using random-effects models.

Key findings and limitations: Sixty-six studies (3241 patients) were included. Conventional meta-analysis revealed that mean OT was similar across approaches (p = 0.07), while mean EBL was significantly lower with MIS (robotic: 918.2 ml; laparoscopic: 253.7 ml) than with open surgery (1488.4 ml; p < 0.001). Overall complication rates were 28.5% with robotic, 12.6% with laparoscopic, and 28.9% with open surgery (p = 0.05), with corresponding major complication rates of 5.1%, 2.8%, and 12.9% (p = 0.02). NMA revealed shorter mean OT for robotic (-58.7 min; p < 0.001) and laparoscopic (-43.3 min; p = 0.01) approaches versus open surgery, and lower odds ratios for overall complications (robotic 0.37, p = 0.01; laparoscopic 0.24, p < 0.001) with MIS. Mean LOS was also shorter with MIS (robotic: -3.8 d; laparoscopic: -4.8 d; p < 0.05). Differences in major complication rates were not significant on NMA. Limitations include the retrospective design of the studies included, selection bias favoring open surgery for advanced thrombi, and under-reporting of oncological outcomes.

Conclusions and clinical implications: High-quality comparative evidence on MIS for IVC thrombectomy is limited and affected by substantial selection bias, which restricts robust comparisons to open surgery. Our findings suggest that MIS is associated with favorable perioperative outcomes in carefully selected patients, mainly with Mayo I-II thrombi in experienced centers, but no definitive conclusions on their comparative effectiveness versus open surgery can be drawn.

Background and objective: ENZAMET randomised 1125 participants with metastatic hormone-sensitive prostate cancer to receive enzalutamide or a standard nonsteroidal antiandrogen (NSAA) combined with testosterone suppression with or without docetaxel. Enzalutamide demonstrated superior progression-free and overall survival (OS). Radiographic progression without prior/concurrent prostate-specific antigen progression (discordant progression; DP) portends poor outcomes. Our aim was to determine the frequency of DP in ENZAMET and the impact of enzalutamide on disease-state transitions.

Methods: A multistate Cox proportional-hazards regression model was used to partition participants into four states: (1) event-free; (2) discordant progression (DP); (3) other types of progression (other progression; OP); and (4) death.

Key findings and limitations: Enzalutamide prolonged OS in the entire cohort of 1125 participants (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.58-0.84; p < 0.0001). Radiographic progression occurred in 388/1125 (34%) participants, and DP in 114/1125 (10%), with similar proportions in the enzalutamide arm (55/114, 48%) and NSAA arm (59/114, 52%). Participant characteristics in the DP group were similar between the treatment arms. Enzalutamide delayed DP (HR 0.66, 95% CI 0.46-0.96; p = 0.03) and OP (HR 0.37, 95% CI 0.31-0.44; p < 0.001). The 5-yr OS rate was lower in the DP group (24%) than in the OP group (42%). Among participants whose cancer had not progressed (495/1125), 51/495 (10%) died of non-prostate cancer causes (median follow-up 68 mo). This exploratory analysis is limited by its post hoc nature.

Conclusions and clinical implications: DP occurred in 10% of participants and accounted for 30% of progression events observed in ENZAMET. DP was associated with worse OS regardless of treatment. Enzalutamide delayed DP and reduced the risk of DP and OP. Regularly scheduled imaging may be preferable to for-cause imaging in metastatic hormone-sensitive prostate cancer.