European urology oncology最新文献_第3页

Bladder EpiCheck triggered Photodynamic Diagnosis biopsies Detect High-grade Bladder Cancer Recurrences Missed by White Light Cystoscopy 膀胱上皮检查触发光动力诊断活检发现白光膀胱镜检查未发现的高级别膀胱癌复发。

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.11.007

Paramananthan Mariappan , Jasmin Hart-Brooke , Rebecca Sparks , Tanya Lord-McKenzie

Background and objective

White light cystoscopy (WLC) misses ∼70% of carcinoma in situ bladder recurrences that could be identified via photodynamic diagnosis (PDD). The Bladder EpiCheck (BE) test has high sensitivity and specificity, with a recognised anticipatory positive signal. Our aim was to determine the diagnostic accuracy of BE and WLC against PDD-guided biopsy as the diagnostic benchmark during surveillance for high-grade (HG) non–muscle-invasive bladder cancer (NMIBC).

Methods

As part of a National Health Service (NHS) quality improvement project, all consecutive patients with HG-NMIBC who were fit for general anaesthesia and on surveillance in a tertiary centre underwent both WLC and BE from July 2023 to August 2024. Data were prospectively collected. Voided urine was collected before WLC for BE testing. Positive WLC and/or BE results triggered PDD-guided biopsy/resection under general anaesthesia. Performance metrics for WLC and BE were calculated on the basis of biopsies performed within 6 mo of a surveillance visit.

Key findings and limitations

Valid BE results were available for 315 HG-NMIBC surveillance visits. Of the 37 pathologically confirmed recurrences, 23 (62%, 95% confidence interval [CI] 46–76%) were detected by WLC and 34 (92%, 95% CI 79–97%) by BE (p = 0.0074). Of the 30 HG recurrences, 19 (63%, 95% CI 46–78%) were detected by WLC and 27 (90%, 95% CI 74–97%) by BE (p = 0.0386). Most of the HG cancers missed by WLC and detected by BE (73%) were Tis. Performing PDD-guided biopsies for patients with negative WLC and positive BE results increased the BE specificity from 87% (95% CI 82–90%) to 93% (95% CI 89-96%), and the positive predictive value from 35% (95% CI 24–48%) to 57% (95% CI 44–68%) at 6 mo, and to 70% (95% CI 58–80%) at longer-term follow-up. The main limitations are the nonrandomised setting and the lack of a control group.

Conclusions and clinical implications

BE addition to WLC, with PDD-guided biopsy performed for BE-positive cases, reveals the true performance of BE and WLC and significantly improves the detection of HG disease, allowing earlier intervention with potentially bladder-sparing options.

背景和目的：白光膀胱镜检查（WLC）漏诊了70%的可通过光动力学诊断（PDD）识别的膀胱原位癌复发。膀胱上皮检查（BE）具有高灵敏度和特异性，具有公认的预期阳性信号。我们的目的是确定BE和WLC对pdd引导活检的诊断准确性，作为监测高级别（HG）非肌肉浸润性膀胱癌（NMIBC）的诊断基准。方法：作为国家卫生服务（NHS）质量改进项目的一部分，从2023年7月至2024年8月，所有适合全身麻醉并在三级中心接受监测的连续HG-NMIBC患者均接受了WLC和BE。前瞻性地收集数据。在WLC前收集空尿进行BE检测。全身麻醉下WLC和/或BE阳性触发pdd引导活检/切除。WLC和BE的绩效指标是根据监测访问后6个月内进行的活检计算的。主要发现和局限性：315次HG-NMIBC监测访问可获得有效的BE结果。在病理证实的37例复发中，WLC检测到23例（62%，95%可信区间[CI] 46 ~ 76%）， BE检测到34例（92%,95% CI 79 ~ 97%）（p = 0.0074）。在30例HG复发中，WLC检测到19例（63%,95% CI 46-78%）， BE检测到27例（90%,95% CI 74-97%）（p = 0.0386）。WLC漏诊和BE检出的HG癌（73%）多为Tis。对WLC阴性和BE阳性的患者进行pdd引导活检，BE特异性从87% （95% CI 82-90%）增加到93% (95% CI 89-96%)， 6个月时阳性预测值从35% （95% CI 24-48%）增加到57% (95% CI 44-68%)，长期随访时阳性预测值从70% （95% CI 58-80%）。主要的限制是非随机设置和缺乏对照组。结论和临床意义：BE + WLC，在pdd引导下对BE阳性病例进行活检，揭示了BE和WLC的真实表现，并显着提高了HG疾病的检测，允许早期干预，可能的膀胱保留选择。

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引用次数: 0

Green Perspectives in Radiation Oncology 放射肿瘤学的绿色展望。

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.05.020

Jennifer Le Guevelou , David Ali , Stéphane Supiot

The health care sector contributes 4.4% of global greenhouse gas emissions. Many countries are aiming for a carbon net-zero health care system by 2040–2050. Climate-smart practices in radiation oncology units include a progressive shift towards stereotactic body radiotherapy, the use of telemedicine, and strategies to streamline treatment workflows. Integration of geographic appropriateness in health care policies can also significantly mitigate the carbon footprint of clinical practice. Our rapid review assesses the environmental impact of climate-smart practices in radiation oncology departments, with a focus on management of prostate cancer.

Patient summary

Health care accounts for a significant proportion of greenhouse gas emissions. A number of actions are already possible in radiotherapy departments to limit their environmental impact, such as reducing the number of radiotherapy sessions, simplifying treatment planning, and using telemedicine. These strategies should be combined with government measures to ensure that all cancer patients have access to local care centers.

卫生保健部门占全球温室气体排放量的4.4%。许多国家的目标是到2040-2050年实现零碳净卫生保健系统。放射肿瘤学单位的气候智能型实践包括逐步转向立体定向全身放疗、远程医疗的使用以及简化治疗工作流程的战略。将地理适宜性纳入卫生保健政策也可显著减轻临床实践的碳足迹。我们的快速回顾评估了气候智能实践在放射肿瘤学部门的环境影响，重点是前列腺癌的管理。患者总结：卫生保健占温室气体排放的很大比例。放射治疗部门已经可以采取一些行动来限制其对环境的影响，例如减少放射治疗次数、简化治疗计划和使用远程医疗。这些策略应与政府措施相结合，以确保所有癌症患者都能获得当地护理中心的服务。

引用次数: 0

Revisiting Neoadjuvant Chemotherapy in Cisplatin-eligible Muscle-invasive Bladder Cancer 适于顺铂治疗的肌肉浸润性膀胱癌的新辅助化疗

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.09.006

Javier Molina-Cerrillo , James Catto , Ashish M. Kamat , Andrea Necchi , Morgan Roupre^t , Enrique Grande

Background and objective

Management of muscle-invasive bladder cancer (MIBC) is evolving rapidly due to advances in systemic therapies and molecular understanding. Neoadjuvant cisplatin-based chemotherapy remains the cornerstone of cisplatin-eligible patients, supported by strong evidence of improved overall survival and pathological complete response. Phase 3 trials such as VESPER and NIAGARA have refined the standard of care by demonstrating the benefits of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin combination and chemoimmunotherapy, respectively. This review aims to summarize current and emerging neoadjuvant strategies and outline future directions toward a more individualized approach.

Methods

We reviewed the recent literature and pivotal clinical trial data evaluating neoadjuvant therapies for MIBC, with a focus on systemic chemotherapy, immunotherapy, combination regimens, novel agents, and biomarker-driven approaches. Emerging bladder-preserving strategies were also examined.

Key findings and limitations

Neoadjuvant cisplatin-based chemotherapy remains the established benchmark; however, the NIAGARA trial has provided the first phase 3 evidence supporting neoadj chemo and perioperative IO as a new therapeutic option. The addition of durvalumab to cisplatin-based chemotherapy resulted in a significant improvement in survival and response endpoints. Antibody-drug conjugates and biomarkers such as circulating tumor DNA and DNA damage response mutations are shaping a more personalized treatment paradigm. However, optimal regimen selection, sequencing of therapies, and robust methods for response assessment remain unresolved.

Conclusions and clinical implications

Recent therapeutic advances, particularly the integration of immunotherapy, novel agents, and biomarker-driven strategies, are redefining the neoadjuvant landscape in MIBC. Neoadjuvant treatment for MIBC is moving toward a biomarker-informed risk-adapted approach, integrating novel agents and multidisciplinary decision-making. Refinement of patient selection and treatment sequencing will be critical to improving outcomes and advancing personalized, precision-based care.

背景与目的：肌肉浸润性膀胱癌（MIBC）的治疗正在迅速发展，这是由于全身治疗和分子认识的进步。基于顺铂的新辅助化疗仍然是符合顺铂条件的患者的基石，有强有力的证据支持总生存期和病理完全缓解的改善。VESPER和NIAGARA等3期试验分别证明了剂量密集甲氨蝶呤、长春花碱、阿霉素和顺铂联合化疗和化学免疫治疗的益处，从而完善了护理标准。本综述旨在总结当前和新兴的新辅助治疗策略，并概述未来的发展方向，以实现更个性化的治疗方法。方法：我们回顾了最近评价新辅助治疗MIBC的文献和关键临床试验数据，重点是全身化疗、免疫治疗、联合方案、新型药物和生物标志物驱动的方法。新兴的膀胱保留策略也进行了研究。主要发现和局限性：以顺铂为基础的新辅助化疗仍然是既定基准；然而，NIAGARA试验提供了第一个3期证据，支持新辅助化学免疫治疗作为一种新的治疗选择。在以顺铂为基础的化疗中加入durvalumab可显著改善患者的生存期和缓解终点。抗体-药物偶联物和生物标记物，如循环肿瘤DNA和DNA损伤反应突变，正在形成一种更加个性化的治疗模式。然而，最佳方案的选择、治疗的排序和有效的反应评估方法仍然没有解决。结论和临床意义：最近的治疗进展，特别是免疫治疗、新型药物和生物标志物驱动策略的整合，正在重新定义MIBC的新辅助治疗前景。MIBC的新辅助治疗正朝着生物标志物知情的风险适应方法发展，整合了新型药物和多学科决策。优化患者选择和治疗顺序对于改善结果和推进个性化、精准护理至关重要。

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引用次数: 0

Targeted Prostate Health Checks, a Novel Screening System to Identify Men at Risk of Prostate Cancer: Real-world Evidence from More than 18 000 Prostate-specific Antigen Tests 靶向前列腺健康检查，一种识别前列腺癌风险男性的新型筛查系统：来自18000多个前列腺特异性抗原测试的真实证据

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.10.007

Stephen Langley , Santiago Uribe-Lewis , Jennifer Uribe , Hendrik Van Poppel , Jeremy Goad , Stephanie Bell , Lee Foster , Michele Pietrasik , Alison Rooke , Nicola Pereira , Kishore Raja , Catherine Hodges , Marc Laniado , Matthew Knight , Edward Bosonnet , Simon Bott

Background and objective

The Targeted Prostate Health Check (TPHC) programme was set up to identify men with prostate cancer (PC) in the Surrey and Sussex region of England that was undetected during the COVID-19 era. We report outcomes for more than 18 000 prostate-specific antigen (PSA) checks using modern diagnostic techniques.

Methods

Men aged 50–70 yr, or 45–70 yr if Black or with a family history of PC, were identified via primary care (general practitioner [GP]) records. Text messages invited men to visit www.talkprostate.co.uk for information on PC and consent to PSA checks coordinated by Medefer, a virtual health care provider. Elevated age-related PSA (40–49 yr: >2.5 ng/ml; 50–59 yr: >3.5 ng/ml, 60–70 yr: >4.5 ng/ml) or a level ≥3 ng/ml triggered referral for multiparametric magnetic resonance imaging (mpMRI) and, if indicated, local anaesthetic transperineal (LATP) biopsy. GPs were informed of the results.

Key findings and limitations

From 137 993 text messages inviting 66 911 individuals, 21 905 (33%) completed online surveys and consented to a PSA check. Of 18 317 men with a PSA result, 865 had elevated PSA (4.7%). After 817 mpMRI examinations, 344 patients underwent biopsy, 263 were diagnosed with PC, and 221 had International Society of Urological Pathology grade group 2–5 PC (84% of those diagnosed, 1.2% of those with a PSA test). The detection rate for grade group 2–5 PC was 26% with the age-related PSA cutoffs, and 25% with the ≥3 ng/ml cutoff. The average PC knowledge score increased by 1.87 points after the survey.

Conclusions and clinical implications

The TPHC programme screened men for PC untested during the COVID-19 pandemic without burdening primary care. Men were targeted from at-risk groups and their awareness was raised. Real-world data demonstrate the detection of significant PC via a modern pathway using MRI and LATP biopsies.

背景和目的：目标前列腺健康检查（TPHC）计划的建立是为了识别在COVID-19时代未被发现的英格兰萨里和苏塞克斯地区患有前列腺癌（PC）的男性。我们报告的结果超过18000前列腺特异性抗原（PSA）检查使用现代诊断技术。方法：通过初级保健（全科医生[GP]）记录确定年龄为50-70岁的男性，或45-70岁的黑人或有PC家族史的男性。短信邀请男性访问www.talkprostate.co.uk获取个人电脑信息，并同意接受由虚拟医疗服务提供商Medefer协调的PSA检查。年龄相关性PSA升高（40-49岁：>2.5 ng/ml； 50-59岁：>3.5 ng/ml， 60-70岁：>4.5 ng/ml）或水平≥3ng /ml触发转诊多参数磁共振成像（mpMRI），如果有指示，局部麻醉经会阴（LATP）活检。全科医生被告知了结果。主要发现和局限性：从邀请66 911人的137993条短信中，21 905人（33%）完成了在线调查并同意进行PSA检查。在有PSA结果的18317名男性中，865名PSA升高（4.7%）。817例mpMRI检查后，344例患者接受了活检，263例诊断为PC， 221例为国际泌尿病理学学会分级2-5组PC（84%的确诊患者，1.2%的PSA检测患者）。2-5级组PC的检出率为26%，年龄相关PSA的检出率为26%，≥3 ng/ml的检出率为25%。调查结束后，平均个人电脑知识得分上升了1.87分。结论和临床意义：TPHC项目在COVID-19大流行期间筛查了未检测的男性PC，而没有增加初级保健的负担。男性是高危人群的目标，他们的意识得到了提高。真实世界的数据表明，通过MRI和LATP活检的现代途径可以检测到显著的PC。

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引用次数: 0

Hall of Fame 名人堂

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/S2588-9311(26)00033-7

引用次数: 0

Penile Cancer Survivorship: Research Gaps in Psychosocial Health and Sexual Quality of Life 阴茎癌幸存者：社会心理健康和性生活质量的研究差距。

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.11.008

Cameron J. Britton , Omar Almidani , Avi S. Baskin , Chad Ritch , Omer Raheem , Curtis A. Pettaway , Kelvin A. Moses

引用次数: 0

Re: M. Roupret, A. Bertaut, G. Pignot, et al. ALBAN (GETUG-AFU 37): A Phase 3, Randomized, Open-label, International Trial of Intravenous Atezolizumab and Intravesical Bacillus Calmette–Guérin (BCG) Versus BCG Alone in BCG-naive High-risk, Non-muscle-invasive bladder cancer (NMIBC). Ann Oncol. In press. https://doi.org/10.1016/j.annonc.2025.09.017 Re: M. Roupret， A. Bertaut， G. Pignot等。ALBAN (GETUG-AFU 37)：一项静脉注射Atezolizumab和膀胱内卡介苗（BCG）与单独卡介苗治疗原发性高危非肌肉侵袭性膀胱癌（NMIBC）的3期、随机、开放标签的国际试验。安杂志。在出版社。https://doi.org/10.1016/j.annonc.2025.09.017。

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.12.003

David D’Andrea , Shahrokh F. Shariat

引用次数: 0

Predictive Value of Prior Non–muscle-invasive Bladder Cancer for the Effectiveness of Neoadjuvant Chemotherapy in Localized Muscle-invasive Bladder Cancer: A Real-world Analysis of the BLADRAC Cohort 既往非肌肉浸润性膀胱癌对局部肌肉浸润性膀胱癌新辅助化疗有效性的预测价值：对BLADRAC队列的现实世界分析

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.11.006

Elisabeth Grobet-Jeandin , Elliott Diamant , Pierre-Etienne Gabriel , Alexandre De Olivera , Théo Harber , Marc Colombel , Paul Hanquiez , Vera Chatain , Dimitri Vordos , Igor Duquesne , Mihnea Bogdan Borz , Gregory Verhoest , Anne Mauger De Varennes , Louis Surlemont , Marion Ghenassia , Alexandra Masson-Lecomte , Arthur Peyrottes , Cédric Lebacle , Peter Beniac , Priscilla Léon , Thomas Seisen

Background and objective

It remains currently unknown whether the effectiveness of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is the same in patients with or without prior non–muscle invasive bladder cancer (NMIBC). This study aims to perform a real-world analysis of the predictive value of prior NMIBC for the effectiveness of NAC in patients undergoing RC for MIBC.

Methods

We included 2378 patients from the BLADRAC cohort who received RC with (n = 870; 37%) or without (n = 1508; 63%) NAC for primary (n = 1825; 77%) or secondary (n = 553; 23%) MIBC at 15 French centers from 2001 to 2023. Multivariable logistic regression models were fitted to identify the predictors of NAC delivery as well as those of pathological complete (pCR = [y]pT0N0) and pathological objective (pOR ≤[y]pT1N0) responses, while we assessed the predictors of recurrence-free (RFS), cancer-specific (CSS), and overall (OS) survival using multivariable Cox regression models. The heterogeneity of treatment effect of NAC according to the occurrence of prior NMIBC was determined further by testing the interaction terms between the occurrence of prior NMIBC and the effect of NAC within the models evaluating pathological and survival outcomes.

Key findings and limitations

Patients with secondary MIBC were significantly less likely to receive NAC (odds ratio [OR] = 0.63; 95% confidence interval [CI] = [0.5–0.79]; p < 0.001) than those with primary MIBC. The use of NAC was an independent predictor of better pCR (OR = 6.02; 95% CI = [4.63–7.83]; p < 0.001), pOR (OR = 5.08; 95% CI = [4.09–6.3]; p < 0.001), RFS (HR = 0.61; 95% CI = [0.53–0.71]; p < 0.001), CSS (HR = 0.57; 95% CI = [0.47–0.69]; p < 0.001), and OS (HR = 0.61; 95% CI = [0.51–0.72]; p < 0.001), while the occurrence of prior NMIBC was not significantly associated with any of these endpoints (all p > 0.05). There was no significant interaction between the occurrence of prior NMIBC and the impact of NAC on pCR, pOR, RFS, CSS, and OS (all p_interaction > 0.05). The study is limited by its retrospective design.

Conclusions and clinical implications

Our real-world data suggest that the occurrence of prior NMIBC could limit the access to NAC, while not predicting its effectiveness in patients treated with RC for localized MIBC.

背景与目的：目前尚不清楚在患有或未患有非肌肉浸润性膀胱癌（NMIBC）的患者中，根治性膀胱切除术（RC）前新辅助化疗（NAC）的有效性是否相同。本研究旨在对既往NMIBC对接受RC治疗的MIBC患者NAC有效性的预测价值进行现实分析。方法：我们纳入了2001年至2023年在法国15个中心的2378例来自BLADRAC队列的患者，他们接受了RC治疗，原发性（n = 1825; 77%）或继发性（n = 553; 23%） MIBC的NAC （n = 870; 37%）或无NAC （n = 1508; 63%）。拟合多变量logistic回归模型以确定NAC输送、病理完全（pCR = [y]pT0N0）和病理客观（pOR≤[y]pT1N0）反应的预测因子，同时我们使用多变量Cox回归模型评估无复发（RFS）、癌症特异性（CSS）和总（OS）生存的预测因子。在评估病理和生存结果的模型中，通过检验既往NMIBC发生与NAC效果之间的相互作用项，进一步确定NAC治疗效果根据既往NMIBC发生的异质性。主要发现和局限性：继发性MIBC患者接受NAC的可能性显著降低（优势比[OR] = 0.63； 95%可信区间[CI] = [0.5-0.79]; p 0.05）。既往NMIBC的发生与NAC对pCR、pOR、RFS、CSS和OS的影响无显著交互作用（均为0.05）。本研究受限于其回顾性设计。结论和临床意义：我们的真实世界数据表明，既往NMIBC的发生可能限制NAC的使用，但不能预测其在RC治疗局限性MIBC患者中的有效性。

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引用次数: 0

Cambridge kidney One-Stop Mass Investigation Clinic (CkOSMIC): A Nonrandomised Feasibility Study 剑桥肾脏一站式肿块调查诊所（CkOSMIC）：一项非随机可行性研究。

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.09.007

Chiara Re , James P. Blackmur , Teele Kuusk , Thomas J. Mitchell , James N. Armitage , Antony C.P. Riddick , Lorraine Starling , Hannah Fox , Vineetha Thankappan Nair , Sue Norman , Claire Gilby , James O. Jones , Brent O’Carrigan , Tristan Barrett , Robert Bakewell , Teikchoon See , Nicholas Hilliard , Simon Hilliard , Akash Prashar , Nadeem Shaida , Grant D. Stewart

Background and objective

Our aim was to evaluate the feasibility and outcomes of a one-stop renal mass biopsy (RMB) clinic at which same-day biopsy results were facilitated by the use of confocal microscopy.

Methods

The Cambridge kidney One-Stop Mass Investigation Clinic (CkOSMIC) was established in January 2024. Patients underwent an ultrasound (US)-guided biopsy, and the sample was assessed via a confocal laser microscopy scan, which provided results within minutes. Traditional histopathology processing was also conducted. A historical cohort of patients who underwent RMB according to the standard pathology pathway was used as the comparator. We assessed the feasibility, safety, and diagnostic accuracy, as well as the acceptability among patients and clinicians.

Key findings and limitations

Overall, CkOSMIC US-guided biopsy was conducted in 50 patients over a period of 12 mo, of whom 48 received a provisional diagnosis immediately. The sensitivity and specificity for identification of malignancy were 94% (29/31; 95% confidence interval [CI] 79–98%) and 100% (17/17; 95% CI 82–100%), respectively. There was complete agreement between confocal and final pathology for 91.7% (n = 44) of the patients, and partial concordance (cancer identified but equivocal histological subtype) for 8.3% (n = 4). Time from first consultation to a treatment decision, and time from biopsy to a treatment decision were significantly shorter in the CkOSMIC pathway (25 d, interquartile range [IQR] 15–42) than in the standard pathway (55 d, IQR 41–77; p < 0.001). Time from biopsy to a treatment decision was also significantly shorter in the CkOSMIC pathway (0 d) than in the standard pathway (24 d, IQR 17–34; p < 0.001). All participants were “satisfied” or “very satisfied” with the pathway.

Conclusions and clinical implications

CkOSMIC was feasible and showed high sensitivity and specificity in diagnosing cancer, while being safe and acceptable. It allows cancer targets to be met, reduces hospital visits and potentially reduces anxiety of delays in forming a treatment plan.

背景和目的：我们的目的是评估一站式肾肿块活检（RMB）诊所的可行性和结果，在该诊所，使用共聚焦显微镜可以方便地进行当日活检。方法：剑桥肾脏一站式肿块检查诊所（ccosmic）于2024年1月成立。患者接受超声（US）引导活检，并通过共聚焦激光显微镜扫描评估样本，该扫描在几分钟内提供结果。同时进行传统的组织病理学处理。根据标准病理途径进行RMB的历史队列患者作为比较。我们评估了可行性、安全性和诊断准确性，以及患者和临床医生的可接受性。主要发现和局限性：总体而言，在12个月的时间内，对50例患者进行了CkOSMIC us引导活检，其中48例立即接受了临时诊断。鉴别恶性肿瘤的敏感性和特异性分别为94%（29/31；95%可信区间[CI] 79-98%）和100% （17/17;95% CI 82-100%）。91.7% （n = 44）的患者共焦和最终病理完全一致，8.3% （n = 4）的患者部分一致（癌症确诊但组织学亚型不明确）。CkOSMIC途径从首次会诊到做出治疗决定的时间，以及从活检到做出治疗决定的时间（25 d，四分位间距[IQR] 15-42）明显短于标准途径（55 d, IQR 41-77）； p结论及临床意义：CkOSMIC是可行的，在诊断癌症方面具有较高的敏感性和特异性，同时是安全可接受的。它可以达到癌症目标，减少医院就诊，并可能减少对制定治疗计划延误的焦虑。

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引用次数: 0

Comparative Performance of Machine Learning Models in Reducing Unnecessary Targeted Prostate Biopsies 机器学习模型在减少不必要的前列腺活检中的比较性能。

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.euo.2025.01.005

Fuyao Chen , Roxana Esmaili , Ghazal Khajir , Tal Zeevi , Moritz Gross , Michael Leapman , Preston Sprenkle , Amy C. Justice , Sandeep Arora , Jeffrey C. Weinreb , Michael Spektor , Steffan Huber , Peter A. Humphrey , Angelique Levi , Lawrence H. Staib , Rajesh Venkataraman , Darryl T. Martin , John A. Onofrey

Background and objective

Conventional core needle biopsy for prostate cancer diagnosis can lead to diagnostic uncertainty and complications, prompting exploration of alternative risk assessment approaches that use clinical and imaging features. Our aim was to evaluate the effectiveness of machine learning (ML) models in reducing unnecessary biopsies.

Methods

We conducted a retrospective analysis of data for 1884 patients across two academic centers who underwent prostate magnetic resonance imaging and biopsy between 2016 and 2020 or 2004 and 2011. Twelve ML models were assessed for prediction of clinically significant prostate cancer (csPCa; Gleason grade group ≥2) using combinations of clinical features, including patient age, prostate-specific antigen level and density, Prostate Imaging-Reporting and Data System/Likert score, lesion volume, and gland volume. The models were trained and validated using a tenfold split for intrasite, intersite, and combined-site data sets. Model effectiveness was evaluated using the area under the receiver operating characteristic curve and decision curve analysis.

Key findings and limitations

The best-performing ML model would reduce the number of biopsies by 13.07% at a false-negative rate of 1.91%. Performance was consistent across sites, although the study is limited by the small number of centers and the absence of specific clinical data.

Conclusions and clinical implications

ML-enhanced clinical models provide an effective and generalizable approach for prediction of csPCa using standard clinical data. These models allow personalized risk assessment and follow-up, support clinical decision-making, and improve workflow efficiency.

Patient summary

Models that are enhanced by machine learning can predict the severity of prostate cancer and help doctors in tailoring treatments for individual patients. This approach can simplify health care decisions and improve clinical efficiency.

背景和目的：前列腺癌诊断的常规穿刺活检可能导致诊断不确定性和并发症，促使人们探索利用临床和影像学特征的替代风险评估方法。我们的目的是评估机器学习（ML）模型在减少不必要的活检方面的有效性。方法：我们对2016年至2020年或2004年至2011年期间接受前列腺磁共振成像和活检的两个学术中心的1884名患者的数据进行了回顾性分析。对12个ML模型进行评估，以预测临床显著性前列腺癌(csPCa；Gleason分级组≥2)，结合临床特征，包括患者年龄、前列腺特异性抗原水平和密度、前列腺成像报告和数据系统/Likert评分、病变体积和腺体体积。使用10倍的站点内、站点间和组合站点数据集对模型进行训练和验证。采用受试者工作特征曲线下面积和决策曲线分析评价模型的有效性。主要发现和局限性：表现最好的ML模型将减少13.07%的活检次数，假阴性率为1.91%。尽管研究受到中心数量少和缺乏具体临床数据的限制，但在不同地点的表现是一致的。结论和临床意义：ml增强的临床模型为使用标准临床数据预测csPCa提供了有效和可推广的方法。这些模型允许个性化风险评估和随访，支持临床决策，提高工作流程效率。患者总结：通过机器学习增强的模型可以预测前列腺癌的严重程度，并帮助医生为个别患者量身定制治疗方案。这种方法可以简化医疗保健决策，提高临床效率。

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引用次数: 0