Pub Date : 2025-12-31DOI: 10.1016/j.euo.2025.12.013
Amit Sud, Alan McNeill, Andrew J Vickers
Polygenic risk scores (PRSs) have generated considerable interest as a means of personalizing prostate cancer (PC) screening by stratifying individuals according to their genetic risk. The single-arm BARCODE1 study recently showed that PRS-based screening detected more PCs than prostate-specific antigen (PSA) testing or magnetic resonance imaging (MRI). The absence of a comparator arm limits the interpretability of this finding. We compared outcomes from BARCODE1 with those from two contemporaneous, large-scale screening trials-Göteborg-2 and ProScreen-that used MRI with or without a PC blood marker to risk-stratify men for biopsy. When standardized to 10 000 men tested, BARCODE1 biopsied more men (704 vs 386 and 338), diagnosed more low-grade PCs (126 vs 103 and 41), and detected fewer high-grade PCs (155 vs 178 and 165) versus Göteborg-2 and ProScreen. Combining PRS with PSA or MRI in BARCODE1 reduced the detection of high-grade PCs by 50-75% in comparison to Göteborg-2 and ProScreen. These findings reflect the limited risk discrimination of PRSs and their inability, unlike MRI and blood-based markers, to preferentially detect aggressive disease. PRS-based PC screening underperforms relative to current best practice and, on the basis of BARCODE1 data, should not be adopted in clinical practice.
多基因风险评分（prs）作为一种根据遗传风险对个体进行分层的个性化前列腺癌（PC）筛查手段，已经引起了相当大的兴趣。单臂BARCODE1研究最近表明，基于prs的筛查比前列腺特异性抗原（PSA）检测或磁共振成像（MRI）检测到更多的pc。没有比较组限制了这一发现的可解释性。我们将BARCODE1的结果与同期的两项大规模筛查（trials-Göteborg-2和proscreen）的结果进行了比较，这两项筛查使用带有或不带有PC血液标志物的MRI对男性进行活检的风险分层。当标准化到10,000名男性测试时，BARCODE1活检了更多的男性（704 vs 386和338），诊断出更多的低级pc (126 vs 103和41)，检测到更少的高级pc （155 vs 178和165）与Göteborg-2和ProScreen相比。与Göteborg-2和ProScreen相比，在BARCODE1中将PRS与PSA或MRI结合可减少50-75%的高级pc的检测。这些发现反映了PRSs的风险区分有限，并且与MRI和基于血液的标记物不同，它们无法优先检测侵袭性疾病。基于prs的PC筛查相对于目前的最佳实践表现不佳，根据BARCODE1数据，不应在临床实践中采用。
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Pub Date : 2025-12-31DOI: 10.1016/j.euo.2025.12.002
Francesco Soria, Frederik Liedberg, Elin Stahl, José L Dominguez-Escrig, Marco Moschini, Benjamin Pradere, David D'Andrea, Jeremy Y-C Teoh, Otakar Capoun, Viktor Soukup, Bhavan P Rai, Alison Birtle, Eva M Compérat, Param Mariappan, Bas W G van Rhijn, Joyce Baard, Thomas Seisen, Evanguelos N Xylinas, Shahrokh F Shariat, Paolo Gontero, Alexandra Masson-Lecomte
Background and objective: Distal ureterectomy (DU) is a kidney-sparing option for low-risk upper tract urothelial carcinoma (UTUC) and may be considered for selected high-risk cases. Long-term outcomes and recurrence predictors remain poorly defined. Our aim was to evaluate oncological outcomes of DU and identify preoperative predictors of disease recurrence, with a particular focus on ipsilateral upper tract recurrence (iUTR).
Methods: This retrospective multicentre study included 450 patients with nonmetastatic UTUC in the distal ureter treated with DU and bladder cuff excision between 2010 and 2023. The primary endpoint was iUTR-free survival (iUTRFS). Secondary endpoints were intravesical recurrence-free survival (IVRFS), recurrence-free survival (RFS), cancer-specific survival (CSS), overall survival (OS), and perioperative outcomes. Survival outcomes were visualised using Kaplan-Meier curves, and multivariable Cox regression analyses were performed.
Key findings and limitations: The 5-yr survival estimates were 82% for iUTRFS, 49% for IVRFS, 81% for RFS, 89% for CSS, and 72% for OS. IVRFS, iUTRFS, CSS, and OS did not significantly differ between the low-risk and high-risk groups. iUTR occurred in 16% of patients, with one in four of these cases arising after 5 yr. Salvage radical nephroureterectomy was performed in 10% of patients. Preoperative double-J stenting (hazard ratio [HR] 2.85, 95% confidence interval [CI] 1.11-7.30), tumour size (HR 1.04, 95% CI 1.01-1.07) and endoscopic bladder cuff management (HR 9.73, 95% CI 1.66-56.89) were independent predictors of iUTR. Perioperative complications were rare, with only 7% graded as high grade within 90 d. Limitations include the retrospective design, lack of centralised pathology review, and variability in surgical technique.
Conclusions and clinical implications: DU provides favourable perioperative and long-term oncological outcomes and may also be appropriate for selected high-risk cases. iUTR is not uncommon, and prolonged upper tract follow-up is essential. Avoidance of preoperative stenting and endoscopic bladder cuff management may reduce the risk of iUTR.
背景和目的：远端输尿管切除术（DU）是低风险上尿路上皮癌（UTUC）的一种保留肾脏的选择，可用于选定的高风险病例。长期预后和复发预测因素仍不明确。我们的目的是评估DU的肿瘤预后，并确定疾病复发的术前预测因素，特别关注同侧上尿路复发（iUTR）。方法：本回顾性多中心研究纳入了2010年至2023年间450例输尿管远端非转移性UTUC患者，采用DU和膀胱袖切除术治疗。主要终点为无iutr生存期（iUTRFS）。次要终点是膀胱内无复发生存期（IVRFS）、无复发生存期（RFS）、癌症特异性生存期（CSS）、总生存期（OS）和围手术期结果。生存结果采用Kaplan-Meier曲线可视化，并进行多变量Cox回归分析。主要发现和局限性：iUTRFS的5年生存率估计为82%，IVRFS为49%，RFS为81%，CSS为89%，OS为72%。IVRFS、iUTRFS、CSS和OS在低危组和高危组之间无显著差异。16%的患者发生了iUTR，其中四分之一的病例发生在5年后。10%的患者进行了补救性根治性肾输尿管切除术。术前双j支架置入术（风险比[HR] 2.85, 95%可信区间[CI] 1.11-7.30）、肿瘤大小（HR 1.04, 95% CI 1.01-1.07）和内镜下膀胱袖带处理（HR 9.73, 95% CI 1.66-56.89）是iUTR的独立预测因素。围手术期并发症很少见，只有7%的患者在90天内被评为高级别。局限性包括回顾性设计、缺乏集中的病理检查和手术技术的可变性。结论和临床意义：DU提供了良好的围手术期和长期肿瘤预后，也可能适用于选定的高危病例。iUTR并不罕见，延长上尿路随访是必要的。避免术前支架置入术和内窥镜膀胱袖处理可降低iUTR的风险。
{"title":"Perioperative and Oncological Outcomes of Distal Ureterectomy for Upper Tract Urothelial Carcinoma (UTUC): A Multicentre Study from the European Association of Urology Non-muscle-invasive Bladder Cancer/UTUC Guidelines Panels with a Focus on Survival Free from Ipsilateral UTUC Recurrence.","authors":"Francesco Soria, Frederik Liedberg, Elin Stahl, José L Dominguez-Escrig, Marco Moschini, Benjamin Pradere, David D'Andrea, Jeremy Y-C Teoh, Otakar Capoun, Viktor Soukup, Bhavan P Rai, Alison Birtle, Eva M Compérat, Param Mariappan, Bas W G van Rhijn, Joyce Baard, Thomas Seisen, Evanguelos N Xylinas, Shahrokh F Shariat, Paolo Gontero, Alexandra Masson-Lecomte","doi":"10.1016/j.euo.2025.12.002","DOIUrl":"https://doi.org/10.1016/j.euo.2025.12.002","url":null,"abstract":"<p><strong>Background and objective: </strong>Distal ureterectomy (DU) is a kidney-sparing option for low-risk upper tract urothelial carcinoma (UTUC) and may be considered for selected high-risk cases. Long-term outcomes and recurrence predictors remain poorly defined. Our aim was to evaluate oncological outcomes of DU and identify preoperative predictors of disease recurrence, with a particular focus on ipsilateral upper tract recurrence (iUTR).</p><p><strong>Methods: </strong>This retrospective multicentre study included 450 patients with nonmetastatic UTUC in the distal ureter treated with DU and bladder cuff excision between 2010 and 2023. The primary endpoint was iUTR-free survival (iUTRFS). Secondary endpoints were intravesical recurrence-free survival (IVRFS), recurrence-free survival (RFS), cancer-specific survival (CSS), overall survival (OS), and perioperative outcomes. Survival outcomes were visualised using Kaplan-Meier curves, and multivariable Cox regression analyses were performed.</p><p><strong>Key findings and limitations: </strong>The 5-yr survival estimates were 82% for iUTRFS, 49% for IVRFS, 81% for RFS, 89% for CSS, and 72% for OS. IVRFS, iUTRFS, CSS, and OS did not significantly differ between the low-risk and high-risk groups. iUTR occurred in 16% of patients, with one in four of these cases arising after 5 yr. Salvage radical nephroureterectomy was performed in 10% of patients. Preoperative double-J stenting (hazard ratio [HR] 2.85, 95% confidence interval [CI] 1.11-7.30), tumour size (HR 1.04, 95% CI 1.01-1.07) and endoscopic bladder cuff management (HR 9.73, 95% CI 1.66-56.89) were independent predictors of iUTR. Perioperative complications were rare, with only 7% graded as high grade within 90 d. Limitations include the retrospective design, lack of centralised pathology review, and variability in surgical technique.</p><p><strong>Conclusions and clinical implications: </strong>DU provides favourable perioperative and long-term oncological outcomes and may also be appropriate for selected high-risk cases. iUTR is not uncommon, and prolonged upper tract follow-up is essential. Avoidance of preoperative stenting and endoscopic bladder cuff management may reduce the risk of iUTR.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":9.3,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888570","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}
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