Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Ex-vivo digital pathological imaging with the Vivascope confocal microscopy for intraoperative diagnostics during ureterorenoscopy for upper tract urothelial cancer","authors":"Luca Afferi M.D., M.P.H. ,&nbsp;Angelo Territo M.D., Ph.D. ,&nbsp;Andrea Gallioli M.D. ,&nbsp;Paolo Verri M.D. ,&nbsp;Giuseppe Basile M.D. ,&nbsp;Alessandro Uleri M.D. ,&nbsp;Donato Cannoletta M.D. ,&nbsp;Marta Casadevall M.D. ,&nbsp;Pietro Diana M.D. ,&nbsp;Pavel Gavrilov M.D. ,&nbsp;Yolanda Arce M.D. ,&nbsp;Josep Maria Gaya M.D. ,&nbsp;Joan Palou Prof. ,&nbsp;Ferran Algaba Arrea M.D. ,&nbsp;Alberto Breda M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.11.009","DOIUrl":"10.1016/j.urolonc.2025.11.009","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of intraoperative diagnostic during ureterorenoscopy (URS) for upper tract urothelial cancer (UTUC) may assist in deciding between kidney-sparing or radical surgical approaches. We assessed the diagnostic performance of confocal microscopy (CM) using the Vivascope CM system compared to conventional histopathology.</div></div><div><h3>Methods</h3><div>This prospective feasibility cohort study included patients undergoing URS for suspected UTUC or during UTUC follow-up between May and August 2022. Each biopsy was analyzed first with the Vivascope CM, followed by conventional histopathology. The primary outcome was the UTUC detection rate with the VivaScope CM and conventional histopathological analysis, considering conventional analysis as the gold standard. Concordance between Vivascope CM and conventional histopathology in terms of high-grade UTUC was reported in terms of raw numbers and proportions. Analyses were conducted <em>per biopsy sample</em> and <em>per patient.</em></div></div><div><h3>Results</h3><div>Ten patients underwent URS, with a total of fourteen biopsy samples. Suspicion of UTUC emerged in four (28.6%) cases because of hematuria and in four (28.6%) cases by CT-scan, while the remaining 6 cases (42.9%) underwent URS during the follow-up for UTUC. Per-biopsy analysis showed a cancer detection rate of 70% using Vivascope CM and a high-grade concordance of 50%. Among 5 CM high-grade cases, 2 were downgraded; 1 low-grade case was upgraded by conventional histopathology. Per-patient analysis showed a cancer detection rate of 77.8% using Vivascope CM and a high-grade concordance of 66.7%. Among 5 high-grade patients classified by CM, one was downgraded by conventional analysis, while one low-grade case was upgraded by conventional analysis. Vivascope CM produced artifacts that prevented histological analysis in 2 cases. The main limitation of current study is the low sample size.</div></div><div><h3>Conclusions</h3><div>VivaScope CM shows promise as an intraoperative tool for UTUC detection during URS. However, its performance in terms of tumor grading was limited in this preliminary experience. Larger, blinded studies, preferably including multiple biopsies per UTUC lesion, are needed to confirm the diagnostic accuracy of VivaScope CM and better define its potential role in clinical decision-making during URS.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 120.e13-120.e19"},"PeriodicalIF":2.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic prognostication of non-muscle invasive bladder cancer using conditional recurrence- and progression-free survival: A SEER-Medicare analysis","authors":"Jenny Chia-Chen Chang ,&nbsp;Agustin Perez-Londoño ,&nbsp;Sumedh Kaul ,&nbsp;Jamil Almohtasib ,&nbsp;Aaron Fleishman ,&nbsp;Ruslan Korets ,&nbsp;Peter Chang ,&nbsp;Andrew Wagner ,&nbsp;Joaquim Bellmunt ,&nbsp;Aria F. Olumi ,&nbsp;Boris Gershman","doi":"10.1016/j.urolonc.2025.11.005","DOIUrl":"10.1016/j.urolonc.2025.11.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Accurate prediction of recurrence and progression risk in non-muscle invasive bladder cancer (NMIBC) is essential for patient counseling and risk-adapted management. However, conventional models fail to account for the decrease in baseline risk over time. We therefore examined the conditional survival free of recurrence and progression in older adults with NMIBC to develop a dynamic risk prediction model.</div></div><div><h3>Methods</h3><div>We identified patients 66 to 89 years with Ta/Tis/T1 cN0 cM0 urothelial bladder cancer treated with transurethral resection of bladder tumor (TURBT) between 2000 and 2017 in SEER-Medicare. Conditional recurrence-free (RFS) and progression-free (PFS) survival were estimated using the Kaplan–Meier method. The associations of baseline characteristics with RFS and PFS at prespecified landmark times were evaluated using Cox-proportional hazards models.</div></div><div><h3>Key findings and limitations</h3><div>A total of 39,862 patients were included. Of these, 26,339 (66%) had Ta, 11,758 (29%) had T1, and 1,765 (4%) had Tis-disease. Median follow-up was 65 months. The 60-month RFS and PFS increased from 0.39 and 0.85 at baseline to 0.73 and 0.89 at 24-months event-free survival. Conditional RFS rapidly improved within the first 24 months before plateauing. Patients with T1-disease demonstrated the greatest improvement in conditional RFS. On multivariable analyses, T stage and tumor grade were less predictive of RFS with longer landmark times. Limitations include measurement error and risk heterogeneity within grade and stage subgroups.</div></div><div><h3>Conclusions and clinical implications</h3><div>Among patients with NMIBC, recurrence and progression risks decrease with longer event-free intervals, particularly among patients at highest risk of each event as reflected by tumor stage and grade. A dynamic risk prediction model can improve patient counseling and support risk-adapted management during follow-up.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 119.e7-119.e16"},"PeriodicalIF":2.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of kynurenine and tryptophan metabolism in bladder cancer: Diagnostic and prognostic implications of IDO1 polymorphism","authors":"Kemal Kayar M.D., FEBU ,&nbsp;Rıdvan Kayar M.D., FEBU ,&nbsp;Dilara Sönmez ,&nbsp;Mehmet Tolgahan Hakan Ph.D. ,&nbsp;Cem Horozoğlu Ph.D. ,&nbsp;Ömer Ergin Yücebaş M.D. ,&nbsp;İlhan Yaylım ,&nbsp;Levent Verim","doi":"10.1016/j.urolonc.2025.11.011","DOIUrl":"10.1016/j.urolonc.2025.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>The tryptophan–kynurenine (TRP–KYN) pathway, regulated by indoleamine 2,3-dioxygenase 1 (IDO1), plays a pivotal role in tumor immune escape. Altered TRP catabolism and IDO1 gene polymorphisms may influence bladder cancer (BC) behavior through immune metabolic mechanisms. To evaluate the diagnostic and prognostic value of plasma and urinary KYN/TRP ratios and the IDO1 rs10089084 (<em>G</em> &gt; <em>C</em>) polymorphism in patients with BC.</div></div><div><h3>Methods</h3><div>In this case-control study, plasma and urine samples were obtained from 58 patients with BC and 70 healthy controls before diagnostic cystoscopy. TRP and KYN levels were quantified by high-performance liquid chromatography. IDO1 rs10089084 genotypes were determined via PCR-RFLP. Diagnostic accuracy was assessed by ROC analysis, and recurrence risk was analyzed using Cox regression.</div></div><div><h3>Results</h3><div>Plasma KYN/TRP ratios were significantly higher in BC patients than in controls (<em>P</em> = 0.011; AUC = 0.617). Among BC cases, the urinary KYN/TRP ratio discriminated patients with a visible bladder mass (AUC = 0.879; 95% CI 0.774–0.984; cut-off = 0.0895; sensitivity = 100%; specificity = 70.8%). In recurrence analysis, the IDO1 rs10089084 C allele independently predicted recurrence risk (HR = 7.51; 95% CI 1.70–33.10; <em>P</em> = 0.008). No association was found with progression.</div></div><div><h3>Conclusions</h3><div>Combined metabolic and genetic profiling implicates the IDO1-TRP-KYN axis in BC pathophysiology. Urinary KYN/TRP ratio offers a noninvasive, biologically grounded marker for intravesical tumor activity, while the IDO1 rs10089084 variant provides complementary prognostic information. These findings support the integration of immunometabolic biomarkers into risk-adapted surveillance strategies.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 119.e17-119.e25"},"PeriodicalIF":2.3,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somatic alterations of genitourinary malignancy of Chinese population based on tumor NGS data","authors":"Xin Lu M.D. ,&nbsp;Xiang Zhang M.Med. ,&nbsp;Shaochen Cheng Ph.D. ,&nbsp;Weiqiang Ning B.S. ,&nbsp;Shuhua Zhao B.S. ,&nbsp;Yuan Shao M.D. ,&nbsp;Wei Chen M.D. ,&nbsp;Jun Zhang M.D.","doi":"10.1016/j.urolonc.2025.11.007","DOIUrl":"10.1016/j.urolonc.2025.11.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Genitourinary malignancies represent a major global health burden, with rising incidence and mortality rates, particularly in China. Comprehensive genomic profiling in Chinese patients remains limited. This study aimed to characterize the mutational landscape of genitourinary cancers to identify potential biomarkers for improved diagnosis and treatment.</div></div><div><h3>Patients and Methods</h3><div>Tumor tissues from 244 Chinese patients, encompassing 321 samples of bladder, renal, and prostate cancers, were analyzed using next-generation sequencing (NGS) with a 680-gene cancer-specific panel. Somatic mutation profiles were compared across cancer types and with Western (MSK-IMPACT) cohorts.</div></div><div><h3>Results</h3><div>PD-L1 positivity was observed in 13.89 % of bladder, 10.00 % of renal, and 4.55 % of prostate cancers. Median tumor mutational burden (TMB) was 3.29 mut/Mb for bladder, 2.13 mut/Mb for renal, and 0.66 mut/Mb for prostate cancer. Frequently mutated genes included VHL (20.45 %), TP53 (20.07 %), KMT2D (13.01 %), KMT2C (10.04 %), and TERT (9.67 %). Across tumor types, gene–PD-L1 correlations were modest to moderate. In bladder cancer, TP53 (<em>r</em> = 0.551, FDR = 0.0086) and CCNE1 (<em>r</em> = 0.469, FDR = 0.0338) showed significant positive associations with PD-L1 expression, while AXL and AKT2 were borderline significant. In renal and prostate cancers, AXL, RARA, and LARP4 exhibited weaker yet significant correlations. Comparative analysis with Western cohorts revealed moderate gene overlap (Jaccard ≈ 0.20–0.24) but weak frequency concordance (<em>r</em> &lt; 0.25), indicating population-specific genomic heterogeneity.</div></div><div><h3>Conclusion</h3><div>This study delineates the genomic landscape of bladder, renal, and prostate cancers in Chinese patients and identifies distinct mutational profiles compared with Western populations, supporting region-tailored precision oncology in genitourinary malignancies.</div></div><div><h3>Microabstract</h3><div>This study analyzed 321 tumor samples from 244 Chinese patients with genitourinary cancers using targeted NGS. Distinct mutational landscapes and PD-L1–associated genes were identified across bladder, renal, and prostate cancers. Comparative analysis with Western cohorts revealed population-specific genomic heterogeneity, supporting region-tailored precision oncology.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 126.e11-126.e21"},"PeriodicalIF":2.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal epithelioid angiomyolipoma: A multi-institutional, international cohort study with emphasis on clinicopathologic prognostic indicators","authors":"Angela Pecoraro ,&nbsp;Daniele Amparore ,&nbsp;Riccardo Bertolo ,&nbsp;Nicolas Branger ,&nbsp;Anna Caliò ,&nbsp;Umberto Carbonara ,&nbsp;Pietro Diana ,&nbsp;Alfredo Distante ,&nbsp;Selcuk Erdem ,&nbsp;Michele Marchioni ,&nbsp;Gaelle Margue ,&nbsp;Guido Martignoni ,&nbsp;Constantijn H.J. Muselaers ,&nbsp;Nicola Pavan ,&nbsp;Hannah Warren ,&nbsp;Zhenjie Wu ,&nbsp;Maarten Albersen ,&nbsp;Maria Rosaria Raspollini ,&nbsp;Riccardo Campi ,&nbsp;Eduard Roussel","doi":"10.1016/j.urolonc.2025.10.018","DOIUrl":"10.1016/j.urolonc.2025.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Renal angiomyolipoma (AML) is a benign perivascular epithelioid cell neoplasm that is often associated with tuberous sclerosis complex (TSC). Epithelioid AML (eAML), a very rare and potentially malignant variant, can be challenging to radiologically differentiate from benign AML and other renal tumors. Adverse histological features have previously been associated to poorer oncological outcomes. This study aimed to characterize this rare disease entity and validate previously reported adverse prognostic factors.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective cohort study analyzed 76 patients diagnosed with eAML between 2001 and 2024 across 15 participating centers. Inclusion criteria were histological diagnosis of eAML with negative cytokeratin markers and positive melanocytic markers. Patients were stratified according to previously described adverse pathological features.</div></div><div><h3>Results</h3><div>A total of 76 patients were studied. Most were female (70%), with a median age of 48 years and, 19 patients had TSC. Median tumor size was 45 mm, with a rate of atypical epithelioid cells &gt;70% in 26 (34.2%) patients. According to the Nese’s and Brimo’s classifications, 4% and 14% of patients were at high risk, respectively. During a median follow- up of 30-months, 5 (6.7 %) patients developed metastases, and 4 (5.3 %) died. At univariable analysis, the number of adverse pathological risk factors, according to both classifications, was significantly associated with worse metastasis free survival (MFS) and cancer specific survival (CSS). Due to the low number of events, a multivariable analysis was not carried out.</div></div><div><h3>Conclusions</h3><div>eAML is extremely rare, and primarily affects middle-aged women. This cohort validated previously described pathological risk factors for worse prognosis, suggesting that patients with multiple adverse features may require more intensive follow-up.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 122.e11-122.e17"},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The American college of surgeons, commission on cancer genitourinary quality measures: Ensuring high quality care in the management of urological malignancies","authors":"Chad R. Ritch M.D., M.B.A. ,&nbsp;Kristen R. Scarpato M.D., M.P.H. ,&nbsp;M. Minhaj Siddiqui M.D.","doi":"10.1016/j.urolonc.2025.11.006","DOIUrl":"10.1016/j.urolonc.2025.11.006","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 110-113"},"PeriodicalIF":2.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing risk stratification in Bacillus Calmette–Guérin–treated high-grade Ta nonmuscle-invasive bladder cancer patients","authors":"Alessio Finocchiaro M.D. ,&nbsp;Roberto Contieri M.D. ,&nbsp;Andrea Piccolini M.D. ,&nbsp;Pietro Brin M.D. ,&nbsp;Stefano Moretto M.D. ,&nbsp;Filippo Dagnino M.D. ,&nbsp;Muhannad Aljoulani M.D. ,&nbsp;Alessandro Uleri M.D. ,&nbsp;Pierpaolo Avolio M.D. ,&nbsp;Edoardo Beatrici M.D. ,&nbsp;Stefano Mancon M.D. ,&nbsp;Marco Paciotti M.D. ,&nbsp;Vittorio Fasulo M.D. ,&nbsp;Alberto Saita M.D. ,&nbsp;Paolo Casale M.D. ,&nbsp;Giovanni Lughezzani M.D. ,&nbsp;Nicolò Buffi M.D. ,&nbsp;Massimo Lazzeri PhD ,&nbsp;Rodolfo Hurle M.D.","doi":"10.1016/j.urolonc.2025.11.003","DOIUrl":"10.1016/j.urolonc.2025.11.003","url":null,"abstract":"<div><h3>Purpose</h3><div>According to European Association of Urology (EAU) guidelines, nonmuscle-invasive bladder cancer (NMIBC) is stratified by pathological stage and three clinical risk factors (age &gt;70, size &gt;3 cm, multiple lesions). High-grade (HG) Ta can be categorized as intermediate-risk (IR) or high-risk (HR). However, the 2021 EAU stratification is based on non-BCG-treated patients. This study investigated the predictive value of EAU risk groups and factors in TaHG treated with BCG.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed NMIBC patients treated with BCG from 2005 to 2022. Patients were stratified by EAU 2021 risk groups. The primary endpoint was HG recurrence-free survival (RFS).</div></div><div><h3>Results</h3><div>Among 163 TaHG patients, 84 (54%) had one risk factor, 40 (23%) two, and 8 (4%) three. According to EAU 2021, 71% (115) were IR and 29% (48) HR. Median follow-up was 37 months (IQR 19–64). Three patients progressed to MIBC or M+. Three-year HG RFS was 84% (95% CI: 69–96), 80% (95% CI: 68–87), 83% (95% CI: 66–92), and 87% (95% CI: 38–98) for patients with 0, 1, 2, and 3 risk factors, respectively (<em>P</em> = 0.85). For IR and HR groups, 3-year HG RFS was 81% (95% CI: 76–90) and 84% (95% CI: 68–92) (<em>P</em> = 0.97). At Cox regression analysis, neither the number of risk factors nor HR classification was a predictor of HG recurrence (<em>P</em> = 0.9).</div></div><div><h3>Conclusions</h3><div>Progression to MIBC was rare in our real-world cohort of BCG-treated TaHG NMIBC, while HG recurrence rates mirrored those of T1HG cases. Neither the EAU 2021 risk groups nor individual clinical RFs predicted HG recurrence effectively. Development of recurrence-based risk models for TaHG NMIBC is therefore warranted.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 119.e1-119.e6"},"PeriodicalIF":2.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative use of venous thromboembolism prophylaxis following major urologic oncology surgeries: A survey of the Society of Urologic Oncology","authors":"Michelle Slinger M.D. ,&nbsp;Katharine F. Michel M.D. ,&nbsp;Leilei Xia M.D. ,&nbsp;Shirley Wang M.D. ,&nbsp;Thomas J. Guzzo M.D. ,&nbsp;Daniel J. Lee M.D., M.S. ,&nbsp;Stanley Bruce Malkowicz M.D. ,&nbsp;Trinity J. Bivalacqua M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.10.020","DOIUrl":"10.1016/j.urolonc.2025.10.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Venous thromboembolism (VTE) is a significant concern following radical cystectomy (RC) and other major urologic oncologic surgeries. In a 2019 survey of the Society of Urologic Oncology (SUO), 80% of respondents reported using extended VTE prophylaxis (EP), usually enoxaparin, though many cited financial concerns, poor compliance, and administration difficulty as barriers. We hypothesize that practice patterns may have changed since the adoption of apixaban for EP, and aim to describe current practices for RC and other oncologic surgeries, as well as compare barriers to both forms of EP.</div></div><div><h3>Methods</h3><div>A survey of SUO members was conducted between August and September 2023. Participants reported their EP practices following RC, retroperitoneal lymph node dissection (RPLND), robotic-assisted laparoscopic prostatectomy (RALP), and nephrectomies. Demographic and practice data were analyzed alongside trends in EP usage, preferred agents, and barriers to adoption.</div></div><div><h3>Results</h3><div>Sixty-two SUO members (6% response rate) completed the survey. EP use after RC increased from 80% in 2019 to 98% (<em>P</em> &lt; 0.001), with 70% now prescribing apixaban compared to 0% previously. Other urologic procedures, such as RPLND and RALP, saw EP usage in only ∼30% of cases. Enoxaparin was reported as less favored due to patient compliance issues, while apixaban faced challenges with cost and insurance coverage. Cost aids, such as manufacturer coupons, were noted as helpful in reducing apixaban’s financial barriers.</div></div><div><h3>Conclusions</h3><div>EP after RC has increased substantially, with apixaban emerging as the preferred agent. However, usage remains limited for other urologic procedures, reflecting variability in perceived VTE risk. Barriers such as cost and accessibility persist but may be alleviated by the introduction of generic apixaban. Efforts to address these barriers are crucial for optimizing VTE prevention across urologic oncology.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 102-108"},"PeriodicalIF":2.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative and oncological outcomes of incomplete thermal ablations with or without immediate retreatment for patients with small renal masses","authors":"Letizia Maria Ippolita Jannello M.D. ,&nbsp;Stefano Luzzago M.D. ,&nbsp;Mattia Luca Piccinelli M.D. ,&nbsp;Francesco A. Mistretta M.D. ,&nbsp;Chiara Vaccaro M.D. ,&nbsp;Marco Tozzi M.D. ,&nbsp;Elena Lievore M.D. ,&nbsp;Daniele Maiettini M.D. ,&nbsp;Giovanni Cordima M.D. ,&nbsp;Maria Giovanna Pitoni M.D. ,&nbsp;Giulia Corrao M.D. ,&nbsp;Paolo Della Vigna M.D. ,&nbsp;Giulia Marvaso M.D. ,&nbsp;Guido Bonomo M.D. ,&nbsp;Barbara Alicja Jereczek-Fossa M.D., Ph.D. ,&nbsp;Gennaro Musi M.D. ,&nbsp;Franco Orsi M.D.","doi":"10.1016/j.urolonc.2025.11.002","DOIUrl":"10.1016/j.urolonc.2025.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>Thermal ablation (TA) offers an alternative to partial nephrectomy in treating small renal masses (SRMs). However, little is known about the perioperative outcomes of incomplete TA or the effects of re-ablation for residual masses.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively analyzed 551 SRMs (cT1a-b) treated with TA at a single center (2008–2022). Apparent incomplete ablation was defined as contrast enhancement on a 24-hour computed tomography, while true incomplete ablation was confirmed by persistent enhancement at a 6-week follow-up. Multivariable logistic regression models assessed predictors of apparent incomplete ablation. Kaplan–Meier (KM) plots evaluated local recurrence rates (LRR), systemic recurrence (SR), cancer-specific survival (CSS), and overall survival (OS) in patients with complete vs. true incomplete ablation. Scatter plots analyzed renal function in single or multiple TA sessions. Finally, a sensitivity analysis was conducted for biopsy-proven renal cell carcinoma.</div></div><div><h3>Results</h3><div>Of 551 patients, 49 (8.9%) and 29 (5.2%) experienced apparent and true incomplete ablation, respectively. Predictors of apparent incomplete ablation included higher RENAL complexity (moderate odds ratio [OR]: 3.96, <em>P</em> &lt; 0.001; high OR: 3.47, <em>P</em> = 0.026), larger tumors (OR: 1.69, <em>P</em> &lt; 0.001), and greater comorbidity burden (age-adjusted Charlson Comorbidity Index OR: 1.27, <em>P</em> = 0.004). KM plots showed no differences in LRR (<em>P</em> = 0.79), SR (<em>P</em> = 0.19), CSS (<em>P</em> = 0.56), or OS (<em>P</em> = 0.14) between complete and true incomplete ablation groups. Of 29 patients with true incomplete ablation, 27 underwent re-ablation, with scatter plots showing no adverse effects of multiple TAs on kidney function. The sensitivity analysis restricted to biopsy-proven RCC (<em>n</em> = 438) confirmed the robustness of our findings.</div></div><div><h3>Conclusion</h3><div>Apparent incomplete ablation occurred in 8.9% of cases, but only 5.2% had true incomplete ablation requiring re-ablation. Multiple TA sessions were effective, renal function was preserved, and tumor-related outcomes were unaffected.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 124.e1-124.e8"},"PeriodicalIF":2.3,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant pembrolizumab and tyrosine kinase inhibitor to facilitate imperative partial nephrectomy for renal cell carcinoma","authors":"Ashley N. Gonzalez M.D. ,&nbsp;Wadih Issa M.D. ,&nbsp;Tian Zhang M.D. ,&nbsp;Hans Hammers M.D., Ph.D. ,&nbsp;Vitaly Margulis M.D. ,&nbsp;Jeffrey A. Cadeddu M.D.","doi":"10.1016/j.urolonc.2025.11.001","DOIUrl":"10.1016/j.urolonc.2025.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>To describe clinical outcomes of patients who received neoadjuvant therapy for tumor downsizing to facilitate imperative partial nephrectomy (PN), including patients with a solitary kidney, bilateral complex renal masses, or chronic kidney disease.</div></div><div><h3>Patients and Methods</h3><div>All patients who received neoadjuvant immunotherapy (IO) prior to planned surgery were reviewed and data extracted from chart review, including neoadjuvant regimen, patient characteristics, tumor characteristics, medication adverse events, and peri‑operative outcomes. Choice of neoadjuvant IO regimen was selected at the discretion of the medical oncologist—all were IO-tyrosine kinase inhibitor regimens.</div></div><div><h3>Results</h3><div>A case series of nine patients and 11 tumors was identified, with median pretherapy tumor size of 7.6 cm and RENAL score 10. Of nine patients (11 tumors) who completed at least 1 month of therapy, 90% responded with measurable tumor size decrease, and all were able to undergo surgery, without stage progression on therapy. Median tumor diameter was decreased by 2.1 cm following neoadjuvant therapy, and RENAL nephrometry score was reduced by a median 1 point. Pathologic complete response rate was 27%.</div></div><div><h3>Conclusions</h3><div>Neoadjuvant IO-based combinations result in a significant decrease in primary renal tumor size that may facilitate nephron-sparing surgery for those patients with an imperative indication and otherwise infeasible PN prior to treatment.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 123.e11-123.e15"},"PeriodicalIF":2.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}