Urologic Oncology-seminars and Original Investigations最新文献

Background: Age ≥ 40 predisposes to higher testis cancer-specific mortality (CSM) in non-seminoma. However, it is unknown, whether an incremental dose-response effect applies to subgroups of testis cancer patients (tertiles aged ≥ 40). We tested this hypothesis in contemporary non-seminoma patients.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database (2004-2018) was used. Kaplan-Meier plots and multivariable Cox regression models tested the effect of age on CSM after stratification for stage (I vs. II vs. III).

Results: Of 13,679 non-seminoma patients, 11,034 (81%) were aged < 40 vs. 2,645 (19%) were aged ≥ 40. Of patients aged ≥ 40, 943 were aged 40 to 44 (young age tertile) vs. 855 were aged 45 to 52 (intermediate age tertile) vs. 847 were aged ≥ 53 (old age tertile). In overall multivariable analyses relative to patients aged < 40, young age tertile (Hazard ratio [HR] 1.4, P < 0.01), intermediate age tertile (HR 1.9, P < 0.001) and old age tertile (HR 3.6, P < 0.001) were associated with higher CSM. In stage-specific multivariable analyses relative to patients aged < 40, old age tertile predicted higher CSM in stage I (HR 4.7, P < 0.001), stage II (HR 9.9, P < 0.001) and stage III (HR 3.0, P < 0.001). In stage III, intermediate age tertile (HR 1.9, P < 0.001) and young age tertile (HR 1.5, P = 0.007) also predicted higher CSM.

Conclusions: We identified a dose-response effect of increasing age in non-seminoma patients aged ≥ 40, in the overall analysis as well as in stage-specific analyses.

Purpose: Host-associated microbiota can influence host immunity and tumor responses. Emerging evidence suggests the bladder microbiome contributes to urothelial cell carcinoma (UCC), though most data come from urine samples. Urinary microbiomes are different in UCC compared to inflamed bladder, though their impact on host immune responses is understudied. Similarly, the effect of Bacillus Calmette-Guérin (BCG) treatment on bladder microbiome remains unexplored.

Materials and methods: Formalin-fixed paraffin-embedded (FFPE) transurethral resection of bladder tumor (TURBT) specimens from UCC tumor stages (T1 = 42), (T2 = 5), and 16 benign pathologies were examined. Six patients who underwent BCG vaccine with post-treatment TURBT specimens were examined. Microbial communities were characterized using RNA extraction, reverse transcription, and 16S rRNA amplicon sequencing.

Results: UCC patients exhibited greater microbial diversity and distinct bladder microbiome compositions compared to those with benign pathology. Several genera in the bladder including Streptococcus, Staphylococcus, Actinomyces, and Cutibacterium were more abundant in the benign group. Conversely, T1-UCC patients showed higher relative abundances of putative proinflammatory genera including Escherichia-Shigella and unclassified Yersiniaceae, plus commonly reported skin-associated dysbiotic genera Enhydrobacter and Micrococcus. Five of 6 BCG-treated patients showed marked reduction in microbial diversity along with significant alteration in their microbiome composition, including decreased relative abundance of bacteria from genera Streptococcus and Rothia.

Conclusions: This proof-of-concept study suggests that: (1) microbiome sequencing from FFPE TURBT specimens can be used for microbiota assessment and can effectively distinguish UCC from benign pathology. (2) bladder microbiomes are heavily depleted following BCG treatment, indicating therapy-induced microbiome alterations.

Background: With the expanding therapeutic options for localized prostate cancer (PCa), little is known regarding patient values and perspectives that influence the selection process for focal therapy (FT) vs. conventional treatments. This study explores the socioeconomic and demographic factors that influence patients' decisions for FT.

Methods: This was a single-center cross-sectional study using a patient-centered survey of men with concerns about or a diagnosis of localized prostate cancer who were potential candidates for focal therapy. Information on patient demographics and clinical status was collected along with hypothetical scenarios to study the preferences of patients. Descriptives and univariate tests of associations were utilized for analysis.

Results: In total, 158 patients were enrolled; only 41.1% of patients had prior knowledge of FT. Among those with a diagnosis of PCa and endorsing prior FT knowledge, 44.3% did not understand its efficacy, while 27.9% did not know if FT has any potential side effects. Education and income significantly influenced FT knowledge. Specifically, 52.4% of patients with advanced education were familiar with FT compared to 20% of those with only a high school education (P < 0.01). Patients with income of >$75,000 were more likely to be aware of FT (60.7%, P = 0.010). Interestingly, neither disease stability nor treatment status influenced therapy preferences. Sexually active patients were more likely to be aware of FT as an option.

Conclusions: A considerable proportion of PCa patients, specifically those in lower socioeconomic groups, remain unaware of FT's existence and its potential role in well-selected PCa management. Educated and higher-income patients had comparatively better knowledge about FT and also leaned towards functional outcomes. As FT demand continues to expand, addressing knowledge gaps is crucial to ensure informed and equitable healthcare delivery.

Introduction: Shared decision-making involves understanding a person's goals and healthcare preferences, especially for older adults with cancer. When making treatment decisions, older adults with non-muscle-invasive bladder cancer (NMIBC) face tradeoffs due to aging and multimorbidity. Our objective was to obtain initial feedback from older adults with NMIBC and their urologists to begin adapting an existing written goal-elicitation tool, Patient Priorities Care (PPC), for shared decision-making in NMIBC.

Methods: We recruited 5 dyads of older adults with NMIBC (age ≥65) paired with their urologists to use PPC and collected demographics. Patients also completed a frailty assessment. Qualitative interviews with participants were conducted to assess modifications needed (n = 10). We calculated descriptive statistics of quantitative data and used Braun and Clarke's six-phase framework and Interpretative Phenomenological Analysis to analyze interview transcripts.

Results: Mean patient age was 76.4 years, and all were males and frail. Urologists had been in practice for an average of 14.8 years. Four themes emerged from the interviews: 1) PPC should be administered periprocedurally and at multiple time points, 2) PPC was appropriate but modifications were needed to the format and to make it specific to NMIBC, 3) PPC helped urologists learn about their patients, and 4) age, multimorbidity, and urinary symptoms contributed to NMIBC treatment decisions.

Conclusions: In this pilot qualitative study, participants found PPC easy to use with appropriate content, but it required modifications for format and specificity for NMIBC. Next steps include focus groups to further adapt PPC followed by feasibility testing in the clinic.

Objectives: To assess the impact of statin use on survival outcomes in the phase III SPARTAN trial of apalutamide for nonmetastatic castration-resistant prostate cancer.

Subjects and methods: We analyzed data from all 1,207 SPARTAN participants, identifying baseline statin users and matching them 1:1 to nonusers using propensity scores. The primary endpoint was metastasis-free survival (MFS), compared between groups using Kaplan-Meier analysis. A multivariable Cox proportional hazards model, adjusted for key covariates, was applied to the matched cohort to assess associations between statin use and survival outcomes.

Results: Of the 1,207 SPARTAN participants, 463 (38%) were baseline statin users; 456 users were propensity matched to 456 nonusers with balanced characteristics. Statin and nonstatin users were similarly distributed across treatment arms. While statin use was not associated with differences in metastasis-free survival (MFS) overall (P = 0.64), we observed a significant interaction by treatment arm (P = 0.018), with statin use linked to worse MFS in the placebo group (Hazard Ratio [HR] 1.40, 95% Confidence Interval [95% CI] 1.04-1.88). Statin use was also not associated with secondary endpoints overall, but again showed interaction for anticancer therapy-free survival, with harm in the placebo group (HR 1.32) and benefit in the apalutamide group (HR 0.79).

Conclusion: In this secondary analysis of the SPARTAN trial, statin use was not associated with improved survival outcomes overall. However, a significant interaction was observed, with statin use linked to worse metastasis-free survival in the placebo arm. These findings suggest a hypothesized interplay between statins and androgen receptor inhibition that warrants further prospective investigation.

Objectives: To characterize clinical, radiological and histopathological features of upper tract urothelial carcinoma (UTUC) with venous tumor thrombus (VTT) and assess associated oncological outcomes in patients who underwent radical nephroureterectomy (RNU).

Material and methods: We retrospectively identified consecutive patients with UTUC with VTT who underwent radical nephroureterectomy (RNU) at our institution. Cross-sectional imaging was reviewed by a dedicated genitourinary radiologist, and pathology was reviewed by a dedicated genitourinary pathologist. Clinical characteristics, radiographic features, pathologic features, and oncologic outcomes were analyzed.

Results: Eight patients (median age: 74 years, range: 56-91) with UTUC and macroscopic VTT were identified. Imaging consistently revealed collecting system filling defects, irregular mural thickening, and an infiltrative, noncircumscribed growth pattern. Venous involvement was confined to the renal vein in 63% and extended into the inferior vena cava in 37%. Seventy-five percent of patients had pT4 disease, and 63% had pathologic nodal involvement (pN+). Sarcomatoid differentiation was present in 88% of tumors and was disproportionately enriched within the thrombus component, while absent in nodal metastases. One patient experienced a major complication (Clavien-Dindo ≥ III) from surgery. Over a median follow-up of 13.3 months (IQR: 7.7-41.4), 71% of patients developed metastatic disease, and overall mortality was 62.5%. Two patients received adjuvant chemotherapy following surgery. Notably, one achieved a complete response to pembrolizumab, confirmed radiologically and by circulating tumor DNA (ctDNA) clearance.

Conclusions: UTUC with VTT represents a rare but distinctly aggressive phenotype characterized by advanced local stage, frequent nodal involvement, and a striking prevalence of sarcomatoid differentiation. The consistent enrichment of sarcomatoid elements within thrombi suggests a unique biologic behavior potentially driven by epithelial-mesenchymal transition that may underlie vascular invasion and influence treatment response. Recognizing key imaging features may facilitate accurate diagnosis, avoid misclassification as RCC, and prompt timely multimodal treatment.