Urologic Oncology-seminars and Original Investigations最新文献_第10页

Measuring what matters to patients: Systematic literature review of patient-reported outcomes assessment and reporting in locally advanced or metastatic urothelial cancer real-world and clinical studies 衡量对患者重要的：对局部晚期或转移性尿路上皮癌患者报告的结果评估和报告的系统文献综述，现实世界和临床研究。

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-27 DOI: 10.1016/j.urolonc.2025.09.016

Mairead Kearney MB, BCh, MPH, MBA, MSc , Thomas Macmillan MSc , Julia Poritz PhD , Sherrie Schreiber-Gosche MSc , Mihaela Georgiana Musat PhD

Introduction

A systematic literature review (SLR) was conducted to evaluate patient-reported outcome (PRO) instruments used in clinical trials and real-world evidence (RWE) studies of locally advanced/metastatic urothelial cancer (la/mUC) therapies.

Methods

Five databases were used to identify publications up to May 29, 2024 and recent conference abstracts of phase 2/3 clinical trials and RWE studies. We reviewed reported adverse events and qualitative research to evaluate PRO instrument reporting quality using the CONSORT-PRO and ESMO-MCBS checklists.

Results

The SLR identified 37 trials and 12 RWE studies. High heterogeneity in PRO instrument choice was observed (11/18 different instruments were used in 1 study each). The most common instrument was the EORTC QLQ-C30 (36 studies). Minimal clinically important difference thresholds were not consistently used (9/36 studies reporting EORTC QLQ-C30 used a 10-point threshold). Based on qualitative research findings, assessed PRO instruments did not comprehensively capture patient concerns, with symptom coverage ranging from 27% to 82%. Unexpectedly, baseline EORTC QLQ-C30 and Short Form-36 scores indicated that patients with la/mUC have a similar quality of life to the general population. In 18/37 clinical trials, PRO timepoints preceded the median clinical follow-up, with differences ranging from 0.96 to 59.4 months.

Conclusions

PROs can assist in the tailoring of treatment strategies to improve outcomes and can aid in enhancing communication between patients and healthcare professionals about treatment choice. Our evaluation of PRO reporting quality identified room for improvement in most studies, indicating a need for robust, consistent reporting of PRO data to adequately capture the experiences of patients with la/mUC.

本研究对局部晚期/转移性尿路上皮癌（la/mUC）治疗的临床试验和真实世界证据（RWE）研究中使用的患者报告结果（PRO）仪器进行了系统的文献综述（SLR）。方法：使用5个数据库来识别截至2024年5月29日的出版物和最近的2/3期临床试验和RWE研究的会议摘要。我们回顾了报告的不良事件和定性研究，使用conber -PRO和ESMO-MCBS核对表评估PRO仪器报告的质量。结果：SLR纳入了37项试验和12项RWE研究。观察到PRO仪器选择的高度异质性（每项研究使用11/18种不同的仪器）。最常见的仪器是EORTC QLQ-C30（36项研究）。最小临床重要差异阈值并未一致使用（9/36报告EORTC QLQ-C30的研究使用10分阈值）。根据定性研究结果，评估的PRO仪器没有全面捕获患者的担忧，症状覆盖率从27%到82%不等。出乎意料的是，基线EORTC QLQ-C30和Short - form36评分表明la/mUC患者的生活质量与一般人群相似。在18/37的临床试验中，PRO时间点先于中位临床随访，差异范围为0.96 ~ 59.4个月。结论：pro可以帮助制定治疗策略以改善结果，并有助于加强患者与医疗保健专业人员之间关于治疗选择的沟通。我们对PRO报告质量的评估确定了大多数研究的改进空间，表明需要健全、一致的PRO数据报告，以充分捕捉la/mUC患者的经历。

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引用次数: 0

HPV and urological cancers: Investigating renal and prostate cancer associations 人乳头瘤病毒和泌尿系统癌症：调查肾癌和前列腺癌的关系

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-25 DOI: 10.1016/j.urolonc.2025.09.014

Maham Ayman M.S. , Ayesha Irfan M.S. , Khalid Farouk F.C.P.S. , Nuzhat Sultana F.C.P.S. and Ph.D , Muhammad Usman M.S. , Sabahat Zulfiqar M.S. , Sobia Asghar Ph.D , Aneela Javed Ph.D , Saira Justin Ph.D

Background

Human papillomavirus (HPV)-attributable cancers are more pronounced in low- and middle-income countries (LMICs), where limited access to healthcare screening and management programs poses a significant challenge. The etiological association of HPV infections with urological cancers is under-researched in Pakistan. Therefore, this study aims to investigate the link between HPV and renal and prostate cancers.

Methods

After obtaining informed consent, 50 biopsy samples from each cancer type, confirmed by H&E and IHC staining, were collected along with histopathological and clinical data. DNA was extracted and processed for HPV detection using GP5+/6+ consensus primers followed by HPV genotyping using E6-E7 specific primers for HPV16 and HPV18 via conventional PCR and Sanger sequencing. For comparative structural analysis of HPV-L1 protein, HPV-positive samples were amplified with MY09/11 primers and sequenced using the Sanger method. Protein sequences were translated using MEGA 11 software, followed by homology modeling via trROSETTA and 3D structure alignment via MOE.

Results

For renal cancer, 30% (15) of the cases tested positive for HPV, of which 93% of the cases exhibited HPV16&18 co-infection. Contrarily, all the prostate cancer samples tested negative for HPV. Additionally, no significant structural variations were seen in HPV-L1 proteins of HPV-positive samples.

Conclusion

This study established a low-frequency association of HPV with renal cancer but no association with prostate cancer. To gain deeper insights, more comprehensive research is needed. Considering the HPV burden in LMICs, it is essential to actively engage in managing HPV to reduce cancer rates and mitigate the associated socioeconomic impacts.

人类乳头瘤病毒（HPV）导致的癌症在低收入和中等收入国家（LMICs）更为明显，在这些国家，获得医疗筛查和管理计划的机会有限，这构成了重大挑战。在巴基斯坦，HPV感染与泌尿系统癌症的病因学关联研究不足。因此，本研究旨在探讨HPV与肾癌和前列腺癌之间的联系。方法在获得知情同意后，收集经H&；E和免疫组化染色证实的每种癌型活检标本50份，并收集组织病理学和临床资料。提取DNA，使用GP5+/6+共识引物进行HPV检测，然后使用E6-E7特异性引物对HPV16和HPV18进行常规PCR和Sanger测序进行HPV基因分型。为了比较HPV-L1蛋白的结构分析，用MY09/11引物扩增hpv阳性样本，并使用Sanger法测序。用MEGA 11软件翻译蛋白序列，然后用trROSETTA进行同源性建模，用MOE进行三维结构比对。结果在肾癌中，30%（15例）的病例HPV检测呈阳性，其中93%的病例出现hpv16和hpv18合并感染。相反，所有前列腺癌样本的HPV检测结果均为阴性。此外，hpv阳性样本中HPV-L1蛋白未见明显的结构变化。结论HPV与肾癌呈低频率相关，与前列腺癌无相关性。为了获得更深入的认识，需要进行更全面的研究。考虑到中低收入国家的HPV负担，积极参与HPV管理以降低癌症发病率并减轻相关的社会经济影响至关重要。

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引用次数: 0

The changing landscape of urinary diversion post cystectomy: A 15-year analysis of the NSQIP database 膀胱切除术后尿分流的变化：NSQIP数据库的15年分析

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-25 DOI: 10.1016/j.urolonc.2025.09.013

Marwan Zein M.D., Towfik Sebai M.D., Baraa AlJardali M.D., Yara Ghandour M.D., Bilal Alameddine M.D., Albert El Hajj M.D.

Background

Radical cystectomy (RC) with urinary diversion is the standard of care for high-risk non–muscle-invasive and muscle-invasive bladder cancer. While continent urinary diversions offer potential quality-of-life benefits, their adoption over time remains poorly defined.

Objective

To evaluate national trends in the use of continent versus incontinent urinary diversion following RC and identify demographic and clinical factors associated with diversion type.

Methods

We analyzed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2008 to 2022. Patients undergoing RC with urinary diversion were identified using CPT codes. Diversion type, temporal trends, and associated demographic and clinical variables were assessed using descriptive statistics and multivariable Firth logistic regression models.

Results

Among 26,587 patients, 85.1% received incontinent diversion and 14.9% received continent diversion. The use of continent diversion declined significantly over time, particularly among males, patients under 75 years old, and White patients. No significant trends were observed among female, Black or Asian patients.

Conclusion

Continent urinary diversions have declined over the past decade despite surgical advancements, with notable variation by age, sex, and race. These findings highlight the influence of clinical and sociodemographic factors on diversion selection. The extent to which these findings reflect practice patterns beyond NSQIP remains uncertain.

背景：根治性膀胱切除术（RC）加尿改道是治疗高危非肌侵及肌侵性膀胱癌的标准治疗方法。虽然大陆尿改道提供了潜在的生活质量效益，但随着时间的推移，它们的采用仍然模糊不清。目的评价RC术后尿潴留与尿失禁转移的国家趋势，并确定与转移类型相关的人口统计学和临床因素。方法分析2008 - 2022年美国外科医师学会国家手术质量改进计划（ACS NSQIP）的数据。使用CPT代码识别接受RC伴尿分流的患者。使用描述性统计和多变量Firth逻辑回归模型评估转移类型、时间趋势以及相关的人口统计学和临床变量。结果26587例患者中，85.1%的患者接受了尿失禁分流，14.9%的患者接受了尿失禁分流。随着时间的推移，大陆转移的使用显著下降，尤其是在男性、75岁以下的患者和白人患者中。在女性、黑人或亚洲患者中没有观察到明显的趋势。结论：尽管外科手术有所进步，但在过去的十年中，尿潴留有所下降，且在年龄、性别和种族方面存在显著差异。这些发现强调了临床和社会人口因素对转移选择的影响。这些发现在多大程度上反映了NSQIP之外的实践模式仍不确定。

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引用次数: 0

Palliative and hospice care in prostate cancer: A scoping review 前列腺癌的姑息治疗和临终关怀：范围综述

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-25 DOI: 10.1016/j.urolonc.2025.09.018

Andrew Glaza MD , Aidan Kennedy MD , Minhaj Jabeer MD , Siddharth Ramanathan MD , Agyeiwaa Obeng BSN, RN , Bernadette Zwaans Phd , Jason Hafron MD

Advanced prostate cancer presents therapeutic and prognostic challenges at the end of life. Palliative and hospice care improve quality of life, reduce hospitalizations, and enhance patient-centered decision-making. This scoping review emphasizes therapy and prognosis by evaluating the utilization, timing, and clinical impact of palliative and hospice care in prostate cancer. We systematically searched MEDLINE (PubMed), CINAHL, Embase, APA PsycInfo, Scopus, and Web of Science for English-language studies published between January 2014 and March 2024. Eligible studies included adults with prostate cancer that assessed exposure to palliative or hospice care and reported patient-reported or clinical outcomes. The population included men with localized or metastatic prostate cancer; the intervention was palliative and/or hospice care; no comparator was required. Outcomes of interest included quality of life, hospitalization patterns, cost savings, and end-of-life treatment after palliative care involvement. Quantitative, qualitative, and mixed-methods studies were included. Four reviewers independently screened records and extracted data using standardized criteria. Of 3,152 articles screened, 24 met inclusion criteria. On average, 40.4% of patients received palliative care, 14.74% hospice, and 1.3% received both. Early integration was associated with better quality of life, fewer hospital admissions, reduced aggressive interventions, and increased cost savings. Most referrals occurred late in the disease trajectory. Limitations included study heterogeneity, inconsistent outcome reporting, lack of formal quality appraisal, and exclusion of non-English literature. Palliative care in prostate cancer is highly beneficial and often delayed. Future research should focus on barriers to timely referral and evaluate their effects on clinical and economic outcomes in prostate cancer.

晚期前列腺癌在生命末期提出了治疗和预后方面的挑战。缓和疗护和安宁疗护改善生活品质，减少住院，并加强以病人为中心的决策。本综述通过评估前列腺癌姑息治疗和临终关怀的使用、时间和临床影响来强调治疗和预后。我们系统地检索了MEDLINE （PubMed）、CINAHL、Embase、APA PsycInfo、Scopus和Web of Science，检索了2014年1月至2024年3月间发表的英语研究。符合条件的研究包括评估接受姑息治疗或临终关怀的成年前列腺癌患者，并报告患者报告或临床结果。研究人群包括患有局限性或转移性前列腺癌的男性；干预是姑息治疗和/或临终关怀；不需要比较国。结果包括生活质量、住院模式、成本节约和临终治疗后的姑息治疗。包括定量、定性和混合方法研究。四名审稿人独立筛选记录并使用标准化标准提取数据。在筛选的3152篇文章中，24篇符合纳入标准。平均而言，40.4%的患者接受了姑息治疗，14.74%接受了临终关怀，1.3%同时接受了这两种治疗。早期整合与更好的生活质量、更少的住院率、更少的积极干预和更多的成本节约有关。大多数转诊发生在疾病发展的晚期。局限性包括研究异质性、不一致的结果报告、缺乏正式的质量评估和排除非英语文献。前列腺癌的姑息治疗是非常有益的，但往往延迟。未来的研究应集中于及时转诊的障碍，并评估其对前列腺癌临床和经济结果的影响。

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引用次数: 0

Featured SUO Fellow: Alon Y. Lazarovich, MD, MBA 特约研究员：Alon Y. Lazarovich，医学博士，MBA

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-24 DOI: 10.1016/j.urolonc.2025.09.026

Alon Lazarovich MD, MBA

引用次数: 0

Sex-based differences in bladder cancer: Functional, oncologic, and biological considerations 膀胱癌的性别差异：功能、肿瘤学和生物学方面的考虑。

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-23 DOI: 10.1016/j.urolonc.2025.10.006

Adrien N. Bernstein M.D., M.S.

引用次数: 0

Should MRI-invisible low-risk prostate cancer be managed differently? A retrospective study of upgrading risk and future intervention mri不可见的低风险前列腺癌是否应该采用不同的治疗方法？升级风险及未来干预的回顾性研究。

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-22 DOI: 10.1016/j.urolonc.2025.09.020

Jae Woong Jang , Nicole Handa , Ridwan Alam, Marina Schnauss, Clayton Neill, Sai Kumar, Mitchell Huang, Adam B. Murphy, Ashley E. Ross, Hiten D. Patel

Purpose

Active surveillance is the standard of care for men with low-risk prostate cancer (CaP). However, ideal, risk-adapted frequencies of protocol-driven biopsies is undetermined. Magnetic resonance imaging (MRI) visible CaP with high MRI Prostate Imaging Reporting and Data System (PI-RADS) score is prognostic for progression during surveillance. Here we explore the implications of MRI invisibility on outcomes of low-risk CaP.

Methods

We retrospectively identified men undergoing prostate MRI since 2018 who were diagnosed with unilateral Gleason Grade Group 1 disease on initial biopsy. Inclusion was limited to patients receiving a subsequent repeat/confirmatory biopsy. MRI visibility was defined as PI-RADS ≥3 lesion(s) ipsilateral to Grade Group 1 disease. We analyzed differences in baseline and outcome variables between MRI-visible and MRI-invisible groups. Predictors of ipsilateral upgrading and future CaP intervention were identified via Cox regression, and Kaplan-Meier curves were plotted for upgrading and treatment-free survival.

Results

We identified 233 patients where 150 had MRI-visible and 83 had MRI-invisible unilateral GG1 disease. Groups were similar except for maximum PI-RADS score on MRI. The 2-year ipsilateral upgrading-free survival was 77% and 36% for MRI-invisible and MRI-visible groups, respectively. On multivariable analysis, MRI visibility (hazard ratio = 2.89, 95% confidence interval: 1.54–5.42, P < 0.001), PSA density, and presence of inflammation were independently predictive of ipsilateral upgrading. Predictors of future intervention were similar, with MRI visibility remaining significant (hazard ratio = 2.07, 95% confidence interval: 1.20–3.56; P = 0.008) on multivariable models.

Conclusions

MRI visibility on initial imaging predicts pathologic upgrading and future intervention among men with low-risk CaP. MRI findings may help refine risk stratification in men considered for active surveillance.

目的：主动监测是低危前列腺癌（CaP）患者的标准护理。然而，理想的、适合风险的方案驱动活检频率尚不确定。磁共振成像（MRI）可见CaP与高MRI前列腺成像报告和数据系统（PI-RADS）评分是监测期间进展的预后。在这里，我们探讨了MRI不可见性对低风险cap预后的影响。方法：我们回顾性地确定了自2018年以来接受前列腺MRI检查的男性，这些男性在初次活检时被诊断为单侧Gleason级1组疾病。纳入仅限于接受后续重复/确认性活检的患者。MRI可见性定义为PI-RADS≥3个病变与1级组疾病同侧。我们分析了mri可见组和mri不可见组之间基线和结果变量的差异。通过Cox回归确定同侧升级和未来CaP干预的预测因素，并绘制Kaplan-Meier曲线用于升级和无治疗生存。结果：我们确定了233例患者，其中150例mri可见，83例mri不可见单侧GG1疾病。除了MRI上PI-RADS评分最高外，各组相似。mri不可见组和mri可见组的2年同侧无升级生存率分别为77%和36%。在多变量分析中，MRI可见性（风险比= 2.89,95%可信区间：1.54-5.42,P < 0.001）、PSA密度和炎症的存在是同侧升级的独立预测指标。未来干预的预测因子相似，在多变量模型中，MRI可见性仍然显著（风险比= 2.07,95%可信区间：1.20-3.56;P = 0.008）。结论：MRI在初始成像上的可见性可以预测低风险CaP男性的病理升级和未来的干预。MRI的发现可能有助于细化考虑进行主动监测的男性的风险分层。

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引用次数: 0

Population-based utilization and survival of competing treatments for small renal masses: The growing role of thermal ablation 基于人群的小肾肿块治疗的使用和生存：热消融的作用越来越大。

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-22 DOI: 10.1016/j.urolonc.2025.09.010

B. Malik Wahba , Claudia Ramirez Marcano , Evan Suzman , Kyle A. Blum , Timothy D. McClure , Jim C. Hu

Background

Thermal ablation has emerged as a minimally-invasive alternative to surgery for select patients with clinical T1a Renal Cell Carcinoma (RCC).

Methods

Using the Survival, Epidemiology and End Results (SEER) database (2004–2022), we identified patients with T1a RCC who underwent thermal ablation, partial nephrectomy, radical nephrectomy, or observation. Baseline characteristics were compared using chi-squared and t-tests or Wilcoxon rank-sum tests. Multivariable logistic regression identified factors associated with thermal ablation use. Kaplan-Meier and Cox regression analyses evaluated cancer-specific survival and overall survival.

Results

Among 73,143 patients, thermal ablation utilization increased from 3.2% to 13% while RN decreased from 56% to 19%. Older age, smaller tumors, and later year of diagnosis were associated with thermal ablation use. African-American race, female sex, and chromophobe histology were associated with lower use of thermal ablation. At 10 years, cancer-specific survival was higher for surgery and thermal ablation than for observation (97%, 96%, 82%, respectively, P < 0.0001).

Conclusion

Thermal ablation use for clinical stage T1a RCC has increased substantially, particularly among older patients with smaller tumors. Cancer-specific survival is similar between thermal ablation and surgery despite selection of higher-risk patients for thermal ablation, indicated by significantly worse overall survival. Findings support thermal ablation as an option for select patients, while highlighting disparities and the need for further study of long-term outcomes across thermal ablation modalities.

背景：对于临床T1a型肾细胞癌（RCC）患者，热消融已成为手术的一种微创替代方法。方法：使用生存、流行病学和最终结果（SEER）数据库（2004-2022），我们确定了接受热消融、部分肾切除术、根治性肾切除术或观察的T1a RCC患者。基线特征比较采用卡方检验和t检验或Wilcoxon秩和检验。多变量逻辑回归确定了与热消融使用相关的因素。Kaplan-Meier和Cox回归分析评估了癌症特异性生存和总生存。结果：在73143例患者中，热消融利用率从3.2%上升到13%，而RN从56%下降到19%。年龄越大、肿瘤越小、诊断年份越晚与热消融的使用有关。非裔美国人种族、女性和憎色组织学与较少使用热消融相关。10年时，手术和热消融组的癌症特异性生存率高于观察组（分别为97%、96%和82%，P < 0.0001）。结论：临床T1a期RCC的热消融应用已显著增加，特别是在肿瘤较小的老年患者中。肿瘤特异性生存率在热消融和手术之间相似，尽管选择高危患者进行热消融，表明总生存率明显较差。研究结果支持热消融作为选择性患者的一种选择，同时强调了不同热消融方式的差异和进一步研究长期结果的必要性。

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引用次数: 0

Comparison of oncologic outcomes following robot-assisted radical prostatectomy in high- and very high-risk prostate cancer based on the 2025 National Comprehensive Cancer Network risk stratification 基于2025年国家综合癌症网络风险分层的机器人辅助根治性前列腺切除术治疗高、高危前列腺癌的肿瘤预后比较

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-19 DOI: 10.1016/j.urolonc.2025.09.015

Yu Ozawa M.D. , Shady Saikali M.D. , Marcio Covas Moschovas Ph.D. , Marco Sandri M.Sc. , Rohan Sharma M.D. , Ahmed Gamal M.D. , Travis Rogers M.D. , Vipul Patel M.D.

Introduction

National Comprehensive Cancer Network (NCCN) risk stratification was updated in 2025. We compared oncologic outcomes between high-risk (HR) and very high-risk (VHR) prostate cancer following robot-assisted radical prostatectomy (RARP).

Methods

Among 14,878 men who underwent RARP from 2008 to 2023, 2,871 and 100 met the 2025 NCCN HR and VHR criteria. Cumulative incidences of biochemical recurrence (BCR), cancer-specific mortality, and all-cause mortality were compared between two groups using Kaplan–Meier curves and log-rank tests. Prostate-specific antigen (PSA) persistence was also compared. Multivariable logistic and Cox regression models were used to adjust for potential confounders: age, race, ethnicity, comorbidity, neoadjuvant hormonal therapy, and surgery year. Further, we conducted multivariable analyses to identify VHR features (cT3–4, grade group 4–5, and PSA > 40 ng/ml) associated with PSA persistence and BCR.

Results

VHR patients were 4.25 and 3.37 times more likely to have pT4 and pN1 disease, respectively; 35% exhibited PSA persistence. After adjustment, VHR patients continued to exhibit higher risks of PSA persistence (odds ratio: 3.67, 95% CI: 2.38–5.58) and BCR (hazard ratio: 2.36, 95% CI: 1.65–3.38). Cancer-specific and all-cause mortality were comparable; however, the short follow-up (median 48 months, interquartile range: 24–72) limited mortality analyses. All VHR features were independent predictors of PSA persistence and BCR.

Conclusions

The 2025 NCCN VHR stratification is associated with adverse pathology, PSA persistence, and BCR. Preoperative counseling—including discussion of the potential need for neoadjuvant, adjuvant, and salvage therapy—and meticulous patient selection are essential when considering RARP as an initial treatment for patients with HR, particularly VHR disease, within a multidisciplinary framework.

国家综合癌症网络（NCCN）风险分层于2025年更新。我们比较了机器人辅助根治性前列腺切除术（RARP）后高危（HR）和高危（VHR）前列腺癌的肿瘤预后。方法：在2008年至2023年接受RARP的14878名男性中，2871名和100名符合2025年NCCN HR和VHR标准。采用Kaplan-Meier曲线和log-rank检验比较两组间生化复发率（BCR）、肿瘤特异性死亡率和全因死亡率的累积发生率。前列腺特异性抗原（PSA）的持久性也进行了比较。多变量logistic和Cox回归模型用于校正潜在的混杂因素：年龄、种族、民族、合并症、新辅助激素治疗和手术年份。此外，我们进行了多变量分析，以确定与PSA持久性和BCR相关的VHR特征（cT3-4、分级组4-5和PSA > 40 ng/ml）。结果：VHR患者发生pT4和pN1疾病的可能性分别为4.25和3.37倍；35%表现出PSA持续性。调整后，VHR患者继续表现出更高的PSA持续性风险（优势比：3.67,95% CI: 2.38-5.58）和BCR（风险比：2.36,95% CI: 1.65-3.38）。癌症特异性死亡率和全因死亡率具有可比性；然而，短随访（中位48个月，四分位数范围：24-72）限制了死亡率分析。所有VHR特征都是PSA持续性和BCR的独立预测因子。结论：2025 NCCN VHR分层与不良病理、PSA持续性和BCR相关。在多学科框架内考虑RARP作为HR（尤其是VHR）患者的初始治疗时，术前咨询（包括讨论新辅助、辅助和挽救性治疗的潜在需求）和细致的患者选择是必不可少的。

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引用次数: 0

Mucinous tubular and spindle cell carcinoma and its prognostic paradox: A population-based study 粘液管状和梭形细胞癌及其预后悖论：一项基于人群的研究。

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2025-10-18 DOI: 10.1016/j.urolonc.2025.09.022

Omar Tluli , Humam Emad Rajha , Dina Tluli , Ahmad Hamdan , Giridhara Rathnaiah Babu MD, PhD , Ivan Damjanov MD, PhD , Semir Vranic MD, PhD

Objectives

To compare the clinicopathologic features, treatment patterns, and survival outcomes of mucinous tubular and spindle cell carcinoma (MTSCC) with those of clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (PRCC).

Subjects and Methods

This retrospective cohort study used SEER data from 1983 to 2022, including 461 MTSCC, 133,229 ccRCC, and 29,442 PRCC cases. Demographic, clinical, and treatment variables were analyzed using chi-square, ANOVA/Kruskal-Wallis tests, and Kaplan-Meier methods. Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) for overall (OS) and disease-specific survival (DSS), adjusting for age, sex, race, stage, grade, treatment, and metastasis status.

Results

MTSCC patients were more often female (54.9%), Black (20.6%), and aged ≥70 years (50.5%) compared to ccRCC and PRCC (P < 0.001). MTSCC had a lower incidence of distant metastasis than ccRCC (8.7% vs. 9.5%), but higher than PRCC (4.2%). Although most MTSCC patients presented with early-stage disease and underwent surgery (87.9%), they had the shortest mean survival (47.9 months) and the highest proportion of deaths within 100 months (83.5%). Kaplan–Meier analysis showed higher early mortality for MTSCC, with survival curves converging after 75 to 100 months. In adjusted models, MTSCC was associated with a nonsignificant increase in mortality compared to ccRCC (OS HR: 1.36, P = 0.422; DSS HR: 1.13, P = 0.832), while PRCC had a significantly higher DSS risk (HR: 1.24, P = 0.001). Poor survival in MTSCC was associated with older age, high-grade tumors, distant metastases, and absence of surgery.

Conclusion

MTSCC shows distinct demographic and clinical features and a paradoxically shorter survival despite early-stage presentation. Early mortality may contribute to its poorer outcomes, indicating that MTSCC is not uniformly indolent. Closer surveillance and individualized risk assessment are warranted in selected patients.

目的：比较粘液管状和梭形细胞癌（MTSCC）与透明细胞肾细胞癌（ccRCC）和乳头状肾细胞癌（PRCC）的临床病理特征、治疗方式和生存结果。对象和方法：本回顾性队列研究使用1983年至2022年的SEER数据，包括461例MTSCC， 133,229例ccRCC和29,442例PRCC。采用卡方、方差分析/Kruskal-Wallis检验和Kaplan-Meier方法分析人口统计学、临床和治疗变量。Cox比例风险回归模型用于估计总体（OS）和疾病特异性生存（DSS）的风险比（hr），调整年龄、性别、种族、分期、分级、治疗和转移状态。结果：与ccRCC和PRCC相比，MTSCC患者多为女性（54.9%），黑人（20.6%），年龄≥70岁（50.5%）（P < 0.001）。MTSCC远端转移发生率低于ccRCC (8.7% vs. 9.5%)，但高于PRCC（4.2%）。尽管大多数MTSCC患者表现为早期疾病并接受了手术（87.9%），但他们的平均生存期最短（47.9个月），100个月内死亡比例最高（83.5%）。Kaplan-Meier分析显示，MTSCC的早期死亡率较高，生存曲线在75至100个月后趋同。在调整后的模型中，与ccRCC相比，MTSCC与死亡率的增加不显著相关（OS HR: 1.36, P = 0.422; DSS HR: 1.13, P = 0.832），而PRCC的DSS风险明显更高（HR: 1.24, P = 0.001）。MTSCC的低生存率与年龄较大、肿瘤级别高、远处转移和未手术相关。结论：MTSCC表现出明显的人口学和临床特征，尽管早期出现，但其生存期却相对较短。早期死亡可能导致其预后较差，这表明MTSCC并非都是惰性的。有必要对选定的患者进行更密切的监测和个体化风险评估。

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