Urologic Oncology-seminars and Original Investigations最新文献

Objective: To compare outcomes of cutaneous ureterostomy (CU) and ileal conduit (IC) after radical cystectomy (RC), evaluating whether CU may expand surgical eligibility for frail patients with bladder cancer.

Methods: This longitudinal study, incorporating both prospective and retrospective data, included patients with urothelial carcinoma of the bladder who underwent radical cystectomy (RC) between January 2013 and June 2020. The clinical characteristics, surgical outcomes, complication rates, and mortality at 90 days and 365 days were analyzed and compared according to the type of urinary diversion.

Results: A total of 127 patients were included: 70 (55%) underwent IC and 57 (45%) CU, all with a single stoma. CU patients were significantly older (P < 0.01), had higher ASA scores (P = 0.008), and showed a trend toward more advanced tumor staging (P = 0.051). Despite their poorer clinical status, CU patients demonstrated complication and mortality rates at 90 and 365 days, which were comparable to those of the IC group (P = 0.12, 0.28, and 0.62, respectively). CU was also associated with a shorter length of hospital stay (P < 0.01), earlier diet resumption (P < 0.01), and more days out of hospital within the first 90 days (P = 0.04).

Conclusions: A standardized CU technique represents a viable option for frail patients undergoing cystectomy, offering morbidity and mortality outcomes comparable to those of IC and potentially expanding surgical eligibility in high-risk populations.

Background: To identify the effect of denosumab treatment on survival outcomes and skeletal related events (SREs) in Asian patients with castration-resistant prostate cancer (mCRPC).

Materials and methods: The data of 268 patients with mCRPC were collected retrospectively between January 2019 and December 2023. Patient characteristics, SREs, treatment patterns, and AEs were analyzed. Descriptive statistics showed baseline characteristics, SRE rates, and denosumab use. Comparisons between groups were performed using independent t-tests and chi-squared analyses. PSA progression-free survival (PSA-PFS), SRE-free survival (SRE-FS), time to opiate use survival, and overall survival (OS) were calculated using the log-rank test and Kaplan-Meier method. A Cox proportional hazards regression model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for multivariate and univariate analyses to identify the factors associated with SRE-FS, time to opioid use survival, PSA-PFS, and OS.

Results: A total of 156 men underwent denosumab treatment. Denosumab significantly reduced SRE incidence (P = 0.0008). In unadjusted analyses, denosumab treatment was associated with prolonged SRE-FS (P < 0.001), delayed time to opioid use (P = 0.047), and improved OS (P = 0.047); however, PSA-PFS showed a borderline trend without statistical significance (P = 0.069). Notably, after adjusting for confounders, multivariate analysis demonstrated that denosumab treatment was an independent prognostic factor for superior SRE-FS, time to opioid use, OS, and PSA-PFS (P = 0.006).

Conclusion: In men with mCRPC, denosumab treatment was associated with a lower risk of SREs, longer time to opioid use, and longer time to first SRE occurrence. Furthermore, denosumab was associated with improved overall survival in this Asian cohort.

Penile carcinoma (PC) is a rare malignancy with substantial geographic and etiological heterogeneity. Histologically, it is stratified into HPV-associated and HPV-independent subtypes, each with distinct clinical behaviors and molecular features. Prognostic markers such as histologic tumor stage, grade, nodal involvement, and lymphovascular invasion guide therapeutic decision-making, while emerging predictive biomarkers-HPV status, PD-L1 expression, and tumor mutational burden-show potential to personalize systemic treatment. Advances in tumor microenvironment (TME) profiling have revealed immune and stromal signatures that have the potential to influence treatment response. While immune checkpoint inhibitors (ICIs) and antibody-drug conjugates (ADCs) show early clinical benefits, biomarker-driven patient selection remains essential to optimize efficacy. This review summarizes current evidence on the TME in PC and novel therapeutic strategies, aiming to guide future personalized treatment strategies.

Purpose: To investigate the incidence and determine the risk factors associated with acute kidney injury (AKI) following radical nephrectomy with inferior vena cava (IVC) thrombectomy.

Methods: We retrospectively reviewed the records of patients who underwent radical nephrectomy and IVC thrombectomy for renal cell carcinoma between 2000 and 2023. Patients on pre-existing renal replacement therapy were excluded. Postoperative AKI was diagnosed and classified into 3 stages according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression analysis was performed to evaluate the association between perioperative factors and the risk of developing moderate/severe AKI (KDIGO stage 2 or 3) following surgery. Renal function status at 90 days postoperatively was also evaluated in these patients.

Results: A total of 155 patients were included in the analysis. Median (IQR) age of the cohort was 65 (59-71) years, and 105 of the patients (68%) were male. Following surgery, 104 patients (67%) developed AKI, including 74 (48%) stage 1, 19 (12%) stage 2, and 11 (7%) stage 3. On multivariable logistic regression analysis, adjusting for age, coronary artery disease, and body mass index (BMI), obesity (BMI ≥ 30 kg/m²) was associated with a significantly higher rate of moderate or severe AKI following surgery (odds ratio 3.02, P = 0.02). Within the 90-day follow-up of patients with moderate/severe AKI, only 1 required dialysis.

Conclusions: AKI is common after radical nephrectomy and IVC thrombectomy; however, most cases are mild and do not require dialysis. Obesity is associated with an increased risk of moderate to severe AKI following surgery.

Objective: To determine the utility of hemoglobin, albumin, lymphocyte, platelet (HALP) score in stratifying muscle-invasive bladder cancer (MIBC) patients according to their response to neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC).

Material and methods: Using an IRB-approved database, patients with MIBC who received NAC were retrospectively evaluated between February 2018 and November 2023. X-tile was used to generate a HALP cutoff score based on overall survival, and NAC response was compared between the prechemotherapy clinical stage and the pathological stage at RC. Logistic regressions were performed to identify demographic or clinical factors associated with NAC response.

Results: We stratified 70 MIBC patients using a pre-NAC HALP score of 25.0 into Low HALP (N = 18) and High HALP (N = 52) groups. There was a positive association between high pre-NAC HALP score and complete response to NAC vs. no response (OR = 3.14, P = 0.113, 95% CI: 0.76-12.91). Patients from the Low HALP group had a higher rate of no response to NAC at 66.7% vs. 44.2%, and patients from the High HALP group had a higher rate of complete response to NAC at 34.6% vs. 16.7%.

Conclusion: Patients in the Low HALP group had a very high rate of nonresponse while patients in the High HALP group had a 2.1 times greater likelihood of having a complete response to NAC compared to those in the Low HALP group. This work is hypothesis-generating suggesting that pre-treatment HALP has the potential to help identify patients who may not benefit from NAC.

Background and objective: In metastatic hormone-sensitive prostate cancer (mHSPC), first-line treatment with either docetaxel + androgen deprivation therapy (ADT) or androgen receptor pathway inhibitors (ARPI) + ADT represented the standard of care. Triplet therapy (docetaxel + ARPI + ADT) has shown superiority over docetaxel + ADT, leading to regulatory approval. However, real-world data directly comparing ARPI + ADT and triplet therapy are lacking. This study evaluates real-world outcomes across 3 treatment regimens using inverse probability of treatment weighting (IPTW).

Methods: We retrospectively analyzed data from 13 centers of men with mHSPC treated with docetaxel + ADT, ARPI (apalutamide or enzalutamide) + ADT, or darolutamide + docetaxel + ADT. The primary endpoint was progression-free survival (PFS); secondary endpoints included adverse events. To address baseline imbalances, IPTW was employed. Time-to-event data were analyzed using weighted Cox proportional hazards regression with robust variance estimation.

Results: After excluding incomplete cases, 346 men were analyzed: 58 (16.8%) received docetaxel + ADT, 203 (58.7%) ARPI + ADT, and 85 (24.6%) triplet therapy. Before weighting, triplet patients demonstrated more adverse baseline features. After achieving covariate balance through IPTW adjustment, no significant differences in PFS were observed, with hazard ratios of 1.60 (95% CI: 0.78-3.28, P = 0.20) for docetaxel + ADT and 0.70 (95% CI: 0.36-1.35, P = 0.29) for ARPI + ADT compared to triplet therapy. Grade ≥3 adverse events occurred in 36.2%, 10.9%, and 31.8% of patients, respectively (P < 0.001).

Conclusions: In this IPTW-adjusted real world cohort, triplet therapy was not significantly associated with improved PFS compared to ARPI + ADT or docetaxel + ADT. These findings should be interpreted in the context of limited sample size and follow-up, and further prospective studies are warranted.

Background: Enfortumab vedotin (EV) + pembrolizumab (P) is now first-line standard-of-care for locally advanced or metastatic urothelial carcinoma (la/mUC) after the phase 3 EV-302 trial doubled overall survival (OS) vs. platinum chemotherapy. Whether definitive local therapy-radiation, transurethral resection of bladder tumor (TURBT) or radical cystectomy adds benefit after EV remains unclear.

Methods: We performed a multi-institutional, retrospective cohort study using the TriNetX analytics network. Adults with ICD-10-CM C67.0-C67.9 or equivalent SNOMED CT codes for bladder cancer who received ≥1 dose of EV (identified by HCPCS J9177) between January 2019 and 2 February 2025 were included. Primary endpoints were (1) utilization of any bladder-directed therapy after EV, (2) time from EV initiation to local therapy, and (3) OS, all stratified by treatment modality. Kaplan-Meier estimates and log-rank tests were used.

Results: Among 459 EV-treated patients (mean age 73.1 ± 10 years; 68.9% male), median follow-up was 251 days (IQR 356). Only 108 (23.5%) underwent local therapy: external-beam radiotherapy (EBRT) 71.3%, cystectomy 14.8%, TURBT 13.9%. Local interventions clustered early with median 119 days for TURBT, 134 days for cystectomy, 164 days for EBRT and occurred almost exclusively in line-of-therapy (LOT) 1 (>90% of EBRT, 100% of cystectomies). Median OS for the cohort was 217 days. Survival varied by modality: cystectomy, median not reached (>600 days in several patients); TURBT 316 days; EBRT 217 days; no local therapy 204 days. Cystectomy retained a favorable survival signal in adjusted analysis.

Conclusions: In real-world practice, three-quarters of la/mUC patients treated with EV receive no subsequent bladder-directed therapy. When employed early, radical cystectomy was associated with the longest survival, supporting multidisciplinary evaluation of surgical consolidation in select EV responders. Prospective trials are warranted to define patient selection, timing, and comparative efficacy of surgery vs. radiotherapy in the EV era.

Radiopharmaceuticals therapy (RPT) has been a major breakthrough in the treatment of prostate cancer. This therapy utilizes radioactive isotopes targeted specifically to prostate cancer, combining the advantages of systemic therapy with targeted radiation. The 2 currently FDA approved agents are ²²³Ra and ¹⁷⁷Lu-PSMA-617 which have both demonstrated an overall survival advantage. In this review we will discuss the approved agents, their similarities and differences, treatment sequencing, combinations with other therapies, as well as future directions of this promising field.

While disitamab vedotin (DV) shows promising efficacy in HER2-positive locally advanced/metastatic urothelial carcinoma (la/mUC), its clinical efficacy in HER2-negative and HER2-low (immunohistochemistry [IHC] 0 and 1+) populations is unclear. This meta-analysis aims to evaluate DV-based therapy in these underserved subgroups. PubMed, Scopus, Embase, and Cochrane were main databases when searching articles published from January 2000 to December 2025 (PROSPERO: CRD420251130969). Primary endpoints were objective response rate (ORR) and median progression-free survival (mPFS). Secondary endpoints included disease control rate (DCR) and median overall survival (mOS). Random-effects models assessed pooled effects, with subgroup analyses by HER2 expression. Nonrandomized studies of interventions version I tool (ROBINS-I) was used to evaluate the risk of bias. 16 studies with 279 HER2-negative and HER2-low la/mUC cases were included. DV-based therapy achieved an ORR of 51% (95% confidence interval [CI], 44%-57%), DCR of 75% (95% CI, 63%-84%), and mPFS of 5.48 (95% CI, 4.99-5.97) months, with better outcomes in HER2-low (ORR, 55%; 95% CI, 48%-63%) versus HER2-negative (ORR, 34%; 95% CI, 22%-49%) subgroups. Insufficient available data precluding formal meta-analytic synthesis of mOS. Limitations include small sample size and the inability to perform in-depth subgroup analyses. This study establishes the first comprehensive evidence for the clinical efficacy of DV-based therapy in HER2-negative and HER2-low la/mUC, providing a foundation for expanding DV applications in biomarker-selected la/mUC patients. Future high-quality studies are warranted to further elucidate the clinical efficacy of DV-based therapy in this patient population.