Urologic Oncology-seminars and Original Investigations最新文献

Background: Current guidelines recommend trimodal therapy (TMT) for muscle-invasive bladder cancer when complete visible transurethral resection is feasible, but no specific tumor size cutoff is defined. We evaluated the impact of tumor size on cancer-specific mortality (CSM) in T2N0M0 urothelial bladder cancer treated with TMT.

Methods: Using the Surveillance, Epidemiology, and End Results database (2004-2022), pT2N0M0 urothelial bladder cancer patients treated with TMT were identified. Sequential testing of tumor size cutoffs of 3, 4, 5, 6, and 7 cm were applied. Propensity score matching and multivariable competing risks regression (CRR) models were used.

Results: Among 3,014 included pT2N0M0 urothelial bladder cancer patients treated with TMT, tumor size ranged from 0.3 to 10.0 cm (median 4.0 cm). In multivariable CRR models, each tested cutoff independently predicted higher CSM, except for at 3 cm. Multivariable CRR-derived hazard ratios (HR) for cutoffs of 4, 5, 6, and 7 cm were respectively 1.23, 1.28, 1.72, and 2.22 (all P < 0.05). Applying established and recommended noninferiority margins in oncology trials of up to 30% suggests that tumor size cutoff of 6 cm (HR 1.72) could represent a clinically meaningful criterion used in patient selection for TMT. Limitations include retrospective design and lack of data on comorbidities and treatment specifics.

Conclusion: Tumor size is directly proportional to CSM rate in pT2N0M0 urothelial bladder cancer treated with TMT. A tumor size cutoff of 6 cm (HR 1.72) could represent a clinically meaningful criterion used in patient selection for TMT when the intent of avoiding excess CSM represents the endpoint of interest.

Renal cell carcinoma (RCC) is a heterogeneous malignancy marked by considerable variability in tumor biology and treatment response. Traditional 2-dimensional (2D) cell culture models have provided valuable insights into RCC, but their limitations in replicating the tumor microenvironment and complex cellular interactions necessitate more advanced platforms. Three-dimensional (3D) culture systems - particularly patient-derived organoids (PDOs) - have emerged as promising tools to model RCC with enhanced physiological relevance. This review provides a comprehensive overview of current methodologies for generating RCC PDOs, including Matrigel-based cultures, air-liquid interface (ALI) systems, and microfluidic organ-on-a-chip technologies. We explore the critical factors influencing successful organoid development, such as tissue sourcing, culture media composition, and the incorporation of tumor microenvironment components. The applications of RCC PDOs span drug screening, modeling tumorigenesis and metastasis, immunotherapy studies, and basic research into RCC biology. Notably, organoids have shown potential for predicting individual patient responses to therapy, advancing the vision of personalized medicine. Despite their promise, challenges remain in terms of long-term culture stability, standardization of protocols, and comprehensive microenvironment replication. Future directions include refining bioengineering techniques, integrating multi-omics analyses, and enhancing immunocompetency in organoid systems. In conclusion, RCC PDOs represent a transformative advance in preclinical modeling, with growing utility in translational and precision oncology.

Background: The role of redo minimally invasive partial nephrectomy (rMIPN) for single ipsilateral renal cancer recurrences (RCRs) after prior nephron-sparing surgery (NSS) remains debated. rMIPN offers the potential for renal preservation but carries substantial surgical complexity and perioperative risk. This dual-institutional study compared perioperative, functional, and oncologic outcomes of rMIPN versus redo minimally invasive radical nephrectomy (rMIRN) for solitary ipsilateral RCRs.

Methods: From January 2004 to October 2024, 2 prospectively maintained renal cancer databases were queried for patients with solitary, localized RCRs treated with rMIPN (n = 63) or rMIRN (n = 41). Baseline demographics, operative data, renal function, and pathologic findings were retrospectively extracted. Kaplan-Meier analysis tested overall survival (OS), cancer-specific survival (CSS), and progression to stage ≥ 3b chronic kidney disease (CKD), with log-rank test comparisons.

Results: Baseline demographics and tumor characteristics were similar between groups. rMIPN was associated with longer hospital stay (median 3 vs. 2 days), higher complication rates (22.2% vs. 4.9%), and greater transfusion requirements (7.9% vs. 0%; all P < 0.05). At a median follow-up of 47.5 months [IQR 22.2-75], OS, CSS, and CKD progression did not differ significantly between rMIPN and rMIRN (all P > 0.05).

Conclusions: rMIPN provides oncologic and functional outcomes comparable to rMIRN but at the cost of higher perioperative morbidity. Surgical selection should be individualized, weighing the potential benefits of nephron preservation against the higher surgical risks.

Introduction: To examine the association of presurgical physical activity with urinary and sexual function following radical prostatectomy for clinically localized prostate cancer.

Methods: Participants were recruited from 2011 to 2014 at 2 US institutions and provided self-reported urinary and sexual functions using the modified Expanded Prostate Cancer Index Composite (EPIC, scale from 0 to 100) at baseline (presurgery) and 5-week, 6-month, and 12-month after surgery. Moderate-to-vigorous intensity physical activity (MVPA) was assessed using the Community Healthy Activities Model Program for Seniors and classified into 3 categories. We evaluated changes in function pre- and postsurgery by linear generalized estimating equation (GEE) models and recovery in function after surgery by logistic GEE models.

Results: Among 401 eligible participants, 38.4%, 35.2% and 26.4% engaged in low, medium, and high MVPA before surgery. Urinary function did not vary by MVPA at baseline or during recovery. For sexual function, patients with high MVPA had better sexual function (p = 0.008) at baseline than those with low or medium levels of MVPA. During the recovery phase, this difference disappeared at 5-week postsurgery but returned by 6-month (p = 0.035) and persisted up to 12-month postsurgery (p = 0.004). A suggestive higher likelihood of sexual function recovery was observed by 12-month postsurgery among participants with high versus low MVPA (OR: 2.42; 95% CI: 0.96-6.08; p = 0.060).

Conclusion: Physically active prostate cancer patients had better sexual function before and after surgery, with a suggestive though statistically non-significant clinical recovery after surgery. These findings support the potential for exercise prehabilitation to improve side effects associated with radical prostatectomy.

Purpose: Currently, no standardized predictive model is widely adopted in clinical practice for assessing outcome and lymph node metastasis (LNM). This study aimed at predicting inguinal lymph node involvement and mortality in patients suffering penile squamous cell carcinoma (PSCC) by developing a simple and clinically applicable scoring system.

Methods: Clinical and histopathological data from 11 centers, collected between 2000 and 2021, were reclassified (the Eighth Edition of the AJCC Cancer Staging Manual). Data from 8 centers (517 patients) were randomized into training and internal validation cohorts (7:3), and data from the remaining 3 centers contributed 201 patients for external validation. A dual-outcome prediction model was established with univariate and multivariate logistic regression for LNM prediction, and Cox regression for outcome assessment. Kaplan-Meier curves were drawn to estimate the disease-specific survival (DSS), alongside the log-rank test conducted on the difference in survival. Model performance was evaluated through the AUC, calibration plots, Hosmer-Lemeshow goodness-of-fit test, along with decision curve analysis (DCA).

Results: The study enrolled 718 patients with penile cancer aged at 55 years (IQR: 46-65). Perineural invasion (PNI), lymphovascular invasion (LVI), tumor grade and T stage were independently associated with both LNM and survival (all P < 0.05). For LNM prediction, the scoring system achieved AUCs of 0.80 (95% CI: 0.75-0.84), 0.79 (95% CI: 0.72-0.86) and 0.76 (95% CI: 0.68-0.83) in the training, internal validation, and external validation cohorts, respectively. For 3-year DSS prediction, the time-dependent AUCs were 0.86 (95% CI: 0.81-0.91), 0.84 (95% CI: 0.75-0.92), and 0.87 (95% CI: 0.79-0.94) in respective cohorts. The scoring system was adopted to categorize patients into different risk groups for both LNM and 3-year DSS (Log-rank P < 0.05). Calibration plots revealed a strong consistency between predicted and actual probabilities for both LNM and 3-year DSS across all cohorts. DCA confirmed the favorable predictive accuracy of the scoring system for both inguinal lymph node involvement and mortality in PSCC.

Conclusion: This simple scoring system demonstrates robust predictive accuracy for inguinal LNM and DSS in PSCC, which practically benefits the risk stratification and personalized management decisions in penile cancer care.

Over the past 2 decades, risk stratification in non-muscle-invasive bladder cancer (NMIBC) has evolved considerably, progressing from simple clinico-pathologic scoring systems to sophisticated, molecular, and artificial intelligence (AI)-driven frameworks. This review summarizes evidence from peer-reviewed studies that evaluate prognostic models incorporating clinical, pathological, molecular, radiomic, or AI-derived variables to predict recurrence, progression, or response to BCG. Although traditional models, such as the EORTC and CUETO tables, are widely used, they demonstrate modest discrimination and limited calibration in contemporary cohorts. Molecular systems, including the 12-gene PCR score and the UROMOL21 classifier, offer deeper biological insight and improved prognostic accuracy. However, they require specialized platforms and lack prospective demonstration of clinical utility. More recent AI-based approaches, including machine learning applied to clinico-pathologic data, deep learning from whole-slide images, and MRI radiomics, have been shown to consistently outperform historical risk tables. These approaches offer improved patient stratification. However, challenges remain regarding reproducibility, interpretability, and integration into clinical pathways. Overall, no single prognostic tool currently fulfills all criteria for broad adoption. Future progress will depend on the development of rigorously validated, multimodal models that integrate clinical, molecular, imaging, and digital pathology data to enable more precise surveillance and treatment decisions for patients with NMIBC.

Prostate cancer is the fourth most frequently diagnosed malignancy worldwide. Since the inception of ileal pouch-anal anastomoses (IPAA) in 1978, the clinical situation of prostate cancer in the setting of an IPAA has arisen. We aimed to examine and synthesize the literature on oncologic, urologic and pouch outcomes after prostatectomy in patients with a pre-existing IPAA. We performed a systematic review according to PRISMA guidelines, searching MEDLINE, EMBASE, Scopus, PubMed, and Google Scholar for studies published from inception to June 2025. Studies not written in English or unable to be accessed were excluded. Descriptive statistics were performed on patient demographics, surgical details, characteristics of prostate cancer, and treatment outcomes. Eight retrospective studies were included, consisting of 93 male patients with a median follow-up of 9 months (range 1-174 months) postprostatectomy. Prostate cancer grade group 2 disease was most common. Prostatic adhesions and scarring were frequently encountered during surgery. Normal pouch function was preserved in 83.9% (78/93) of patients following prostatectomy and pouch failure occurred in 5.4% of cases postoperatively (5/93). Erectile function and urinary continence were preserved in 62.5% (10/16) and 88.2% (30/34) of patients respectively at the time of last follow-up. Most patients did not experience biochemical recurrence of prostate cancer (92.5%; 62/67). Prostatectomy can be considered when deciding to treat patients with a pre-existing IPAA who develop prostate cancer. There remains a need for prospective research to provide additional evidence on the effectiveness and safety of prostatectomies in this unique population.