Urologic Oncology-seminars and Original Investigations最新文献_第9页

Lymph node density as a prognostic marker of relapse in patients who underwent primary retroperitoneal lymph node dissection 淋巴结密度是接受腹膜后淋巴结清扫术的患者复发的预后指标。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-26 DOI: 10.1016/j.urolonc.2024.07.012

Julian Chavarriaga M.D. , Ahmad Mousa M.D., F.R.C.S.C. , Eshetu G. Atenafu M.Sc. , Lynn Anson-Cartwright , Carley Langleben , Michael Jewett M.D., F.R.C.S.C. , Robert J. Hamilton MD., M.P.H., F.R.C.S.C.

Introduction

Primary retroperitoneal lymph node dissection (pRPLND) is a treatment option for clinical stage (CS) II testicular germ cell tumors (TGCTs) and CS I with retroperitoneal relapse. Increasing raw lymph node yield during pRPLND has been associated a decreased relapse risk. However, this metric has limitations due to variations in surgical templates and specimen processing methods. We aimed to evaluate the lymph node density (LND), which is the ratio of positive lymph nodes to the total number of nodes removed, as a prognostic marker for relapse after pRPLND.

Methods

We reviewed all patients who underwent pRPLND at the Princess Margaret Cancer Centre between 1990 and 2022. The primary endpoint was relapse-free survival (RFS). RFS was calculated using the Kaplan-Meier product-limit method. The log-rank test was used to assess the impact of LND, and recursive binary partitioning was used to determine the threshold LND that provides optimum separation in RFS.

Results

In this study, 178 patients were treated with pRPLND. A total of 137 (77%) patients had pathological evidence of nodal metastasis, 96 were treated with open RPLND, and 41 with robotic RPLND. The median number of lymph nodes harvested was 32 (IQR 23–43) and median total positive nodes was 2 (IQR 1–36). This translated into a median LND of 3.1% (IQR 1.7–57.1). There was no significant difference in the LND between robotic and open approaches (P = 0.6664). After a median follow-up of 38.6 months, 11 patients (8.02%) had relapsed. LND was not significantly associated with relapse (HR 1.018, 95% CI, 0.977–1.061). The optimal threshold to dichotomize LND that provides optimum separation in RFS was ≥ 26.75%, however, it did not reach statistical significance (P = 0.0651).

Conclusion

In conclusion, the LND was not associated with RFS after pRPLND in patients with TGCTs. The unique characteristics of TGCTs and the presence of other established risk factors limit the utility of the LND alone in predicting relapse.

简介：原发性腹膜后淋巴结清扫术（primary retroperitoneal lymph node dissection，ppRPLND）是临床 II 期睾丸生殖细胞瘤（testicular germ cell tumors，TGCTs）和腹膜后复发的 I 期睾丸生殖细胞瘤的一种治疗方法。在 pRPLND 期间提高原始淋巴结产量与降低复发风险有关。然而，由于手术模板和标本处理方法的不同，这一指标存在局限性。我们的目的是评估淋巴结密度（LND），即阳性淋巴结与切除的结节总数之比，作为 pRPLND 后复发的预后指标：我们回顾了1990年至2022年间在玛格丽特公主癌症中心接受pRPLND的所有患者。主要终点是无复发生存期（RFS）。RFS采用Kaplan-Meier乘积限值法计算。对数秩检验用于评估LND的影响，递归二元分区法用于确定可提供最佳RFS分离的LND阈值：在这项研究中，178名患者接受了pRPLND治疗。共有 137 例（77%）患者有结节转移的病理证据，其中 96 例采用开放式 RPLND 治疗，41 例采用机器人 RPLND 治疗。切除淋巴结的中位数为 32 个（IQR 23-43），阳性淋巴结总数的中位数为 2 个（IQR 1-36）。这意味着中位 LND 为 3.1%（IQR 1.7-57.1）。机器人和开放式方法的 LND 无明显差异（P = 0.6664）。中位随访 38.6 个月后，11 名患者（8.02%）复发。LND与复发无明显相关性（HR 1.018，95% CI，0.977-1.061）。对LND进行二分法的最佳阈值是≥26.75%，该阈值可使RFS达到最佳分离效果，但未达到统计学意义（P = 0.0651）：总之，LND与TGCTs患者pRPLND后的RFS无关。TGCT的独特性和其他既定风险因素的存在限制了LND单独预测复发的效用。

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引用次数: 0

Barriers and facilitators of the application of precision medicine to the genitourinary cancer care pathway: Perspective from a low- and middle- income country in sub-Saharan Africa 在泌尿生殖系统癌症治疗过程中应用精准医疗的障碍和促进因素：来自撒哈拉以南非洲中低收入国家的视角。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-24 DOI: 10.1016/j.urolonc.2024.07.014

Musliu Adetola Tolani F.W.A.C.S. , Ismail Hadi Zubairu F.W.A.C.S. , Kabir Balarabe F.M.C.S. , Mudi Awaisu F.W.A.C.S. , Mubarak Abdullahi F.W.A.C.S. , Adeoluwa Akeem Adeniji F.W.A.C.S. , Shehu Salihu Umar F.W.A.C.S. , Ahmad Bello F.W.A.C.S. , Scott T. Tagawa M.D.

The benefit of the delivery of the right form of cancer care, tailored to the right patient, at the right time is increasingly being recognized in the global oncology community. Information on the role and feasible potential of precision oncology during the management of genitourinary cancer in Nigeria, the most populous country in Africa, is limited. This article, therefore, describes the present application of personalized medicine in Nigeria and its barriers and facilitators. It provided granular details on manpower distribution and epidemiological disparities. It also explored the use of clinical and biological markers for screening and early diagnosis, the application of team science to support genomic profiling, cost-effective approaches for image-based phenotypic precision oncology, the emerging role of molecular imaging, access to clinical trials; and their potential to support data driven diagnosis, treatment decision and care availability in order to address gaps in genitourinary cancer management in the country.

全球肿瘤学界日益认识到，在正确的时间为正确的患者提供正确的癌症治疗方式的益处。尼日利亚是非洲人口最多的国家，但有关精准肿瘤学在泌尿生殖系统癌症治疗中的作用和可行潜力的信息却很有限。因此，本文介绍了个性化医疗在尼日利亚的应用现状及其障碍和促进因素。文章详细介绍了人力分布和流行病学差异。文章还探讨了临床和生物标记物在筛查和早期诊断中的应用、团队科学在支持基因组剖析中的应用、基于图像表型的精准肿瘤学的成本效益方法、分子成像的新兴作用、获得临床试验的机会；以及它们在支持数据驱动的诊断、治疗决策和护理可用性方面的潜力，以弥补该国在泌尿生殖系统癌症管理方面的差距。

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引用次数: 0

The learning curve for transperineal MRI/TRUS fusion prostate biopsy: A prospective evaluation of a stepwise approach. 经会阴 MRI/TRUS 融合前列腺活检的学习曲线：对渐进方法的前瞻性评估。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-22 DOI: 10.1016/j.urolonc.2024.08.002

Lorenzo Storino Ramacciotti, Masatomo Kaneko, David Strauss, Jacob S Hershenhouse, Severin Rodler, Jie Cai, Gangning Liang, Manju Aron, Vinay Duddalwar, Giovanni E Cacciamani, Inderbir Gill, Andre Luis Abreu

Objective: To evaluate the learning curve of a transperineal (TP) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion prostate biopsy (PBx).

Materials and methods: Consecutive patients undergoing MRI followed by TP PBx from May/2017 to January/2023, were prospectively enrolled (IRB# HS-13-00663). All participants underwent MRI followed by 12 to 14 core systematic PBx (SB), with at least 2 additional targeted biopsy (TB) cores per PIRADS ≥3. The biopsies were performed transperineally using an organ tracking image-fusion system. The cohort was divided into chronological quintiles. An inflection point analysis was performed to determine proficiency. Operative time was defined from insertion to removal of the TRUS probe from the patient's rectum. Grade Group ≥2 defined clinically significant prostate cancer (CSPCa). Statistically significant if P < 0.05.

Results: A total of 370 patients were included and divided into quintiles of 74 patients. MRI findings and PIRADS distribution were similar between quintiles (P = 0.08). The CSPCa detection with SB+TB was consistent across quintiles: PIRADS 1 and 2 (range, 0%-18%; P = 0.25); PIRADS 3 to 5 (range, 46%-70%; P = 0.12). The CSPCa detection on PIRADS 3 to 5 TB alone, for quintiles 1 to 5, was respectively 44%, 58%, 66%, 41%, and 53% (P = 0.08). The median operative time significantly decreased for PIRADS 1 and 2 (33 min to 13 min; P < 0.01) and PIRADS 3 to 5 (48 min to 19 min; P < 0.01), reaching a plateau after 156 cases. Complications were not significantly different across quintiles (range, 0-5.4%; P = 0.3).

Conclusions: The CSPCa detection remained consistently satisfactory throughout the learning curve of the Transperineal MRI/TRUS fusion prostate biopsy. However, the operative time significantly decreased with proficiency achieved after 156 cases.

目的评估经会阴（TP）磁共振成像（MRI）和经直肠超声（TRUS）融合前列腺活检（PBx）的学习曲线：从2017年5月至2023年1月，连续接受MRI和TP PBx检查的患者均被纳入前瞻性研究（IRB# HS-13-00663）。所有参与者都接受了 MRI 检查，随后进行了 12 到 14 个核芯的系统性 PBx（SB）检查，根据 PIRADS ≥3，至少增加了 2 个靶向活检（TB）核芯。活检使用器官跟踪图像融合系统经会阴部进行。组群按时间顺序分为五等分。进行拐点分析以确定熟练程度。手术时间是指从插入 TRUS 探针到从患者直肠中取出探针的时间。等级≥2组定义为有临床意义的前列腺癌（CSPCa）。如果 P < 0.05，则具有统计学意义：共纳入 370 名患者，将 74 名患者分为五等分。五分位数之间的 MRI 结果和 PIRADS 分布相似（P = 0.08）。SB+TB的CSPCa检测结果在各五分位组之间是一致的：PIRADS 1 和 2（范围：0%-18%；P = 0.25）；PIRADS 3 至 5（范围：46%-70%；P = 0.12）。在五分位数 1 至 5 中，仅 PIRADS 3 至 5 TB 的 CSPCa 检出率分别为 44%、58%、66%、41% 和 53% (P = 0.08)。PIRADS 1 和 2（33 分钟至 13 分钟；P＜0.01）以及 PIRADS 3 至 5（48 分钟至 19 分钟；P＜0.01）的中位手术时间明显缩短，在 156 例病例之后达到高峰。并发症在五分位数之间无明显差异（0-5.4%；P = 0.3）：结论：在经会阴MRI/TRUS融合前列腺活检术的学习曲线中，CSPCa的检测结果始终令人满意。结论：在经会阴MRI/TRUS融合前列腺活检术的学习曲线中，CSPCa检测结果始终令人满意。

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引用次数: 0

Clinical performance of Bladder EpiCheck™ versus voided urine cytology for detecting recurrence of nonmuscle invasive bladder cancer: Systematic review and meta-analysis Bladder EpiCheck™ 与排空尿液细胞学在检测非肌层浸润性膀胱癌复发方面的临床表现：系统回顾与荟萃分析。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-21 DOI: 10.1016/j.urolonc.2024.07.009

Cho-Han Chiang MD, MMSc , Yu-Cheng Chang MD , Chun-Yu Peng MD , Shih-Syuan Wang MD , Aunchalee Jaroenlapnopparat MD , Jeff Chun Hao Wang MD , Chen Liang Jou MD , Pui-Un Tang MD , Yuan Ping Hsia MD , Cho-Hsien Chiang MD , Cho-Hung Chiang MD

Background

Nonmuscle invasive bladder cancer (NMIBC) has a favorable prognosis but has high propensity for recurrence. Recent development in one of the urinary biomarker tests, Bladder EpiCheck™, offers a noninvasive and accurate method to detect NMIBC recurrence. In this study, we aimed to compare the diagnostic performance of Bladder EpiCheck™ with urine cytology to detect NMIBC recurrence.

Methods

We performed a systematic review search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to July 2023. Diagnostic accuracy was defined by sensitivity, negative predictive value (NPV), specificity, and positive predictive value (PPV).

Results

A total of 6 studies involving 1588 patients were included. Bladder EpiCheck™ has a sensitivity and specificity of 0.81 (95% CI: 0.63–0.91; I²: 43%) and 0.87 (95% CI: 0.83–0.91; I²: 20%), respectively. On the other hand, urine cytology has a sensitivity and specificity of 0.63 (95% CI: 0.29–0.87; I²: 61%) and 0.97 (95% CI: 0.78–1.00; I²: 79%), respectively. EpiCheck™ has a higher NPV (0.94 (95% CI: 0.87–0.97) vs. 0.84 (95% CI: 0.80–0.87) though a lower PPV (0.62 (95% CI: 0.45–0.76) vs. 0.87 (95% CI: 0.56–0.97) than urine cytology. In our subgroup analysis, the sensitivity of Bladder EpiCheck™ for detecting high-grade tumors improved to 0.90 (95% CI: 0.83–0.94) while that for urine cytology improved to 0.72 (95% CI: 0.50–0.87).

Conclusion

Bladder EpiCheck™ has a high sensitivity and NPV for detecting recurrence among patients with NMIBC.

背景：非肌层浸润性膀胱癌（NMIBC）预后良好，但复发率高。最近开发的一种尿液生物标志物检测方法 Bladder EpiCheck™ 为检测 NMIBC 复发提供了一种无创、准确的方法。本研究旨在比较 Bladder EpiCheck™ 和尿液细胞学检测 NMIBC 复发的诊断性能：我们在 PubMed、Embase、Cochrane Central Register of Controlled Trials、Web of Science 和 Scopus 上进行了系统性综述检索，检索时间从开始到 2023 年 7 月。诊断准确性由灵敏度、阴性预测值（NPV）、特异性和阳性预测值（PPV）定义：结果：共纳入 6 项研究，涉及 1588 名患者。Bladder EpiCheck™ 的敏感性和特异性分别为 0.81（95% CI：0.63-0.91；I2：43%）和 0.87（95% CI：0.83-0.91；I2：20%）。另一方面，尿液细胞学检查的敏感性和特异性分别为 0.63（95% CI：0.29-0.87；I2：61%）和 0.97（95% CI：0.78-1.00；I2：79%）。EpiCheck™ 的 NPV（0.94（95% CI：0.87-0.97）对 0.84（95% CI：0.80-0.87））高于尿液细胞学检查，但 PPV（0.62（95% CI：0.45-0.76）对 0.87（95% CI：0.56-0.97）低于尿液细胞学检查。在我们的亚组分析中，膀胱EpiCheck™检测高级别肿瘤的灵敏度提高到0.90 (95% CI: 0.83-0.94)，而尿液细胞学检测的灵敏度提高到0.72 (95% CI: 0.50-0.87)：结论：膀胱 EpiCheck™ 对检测 NMIBC 患者的复发具有较高的灵敏度和 NPV。

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引用次数: 0

Radical cystectomy with stentless urinary diversion: A systematic review and meta-analysis of comparative studies. 根治性膀胱切除术与无支架尿流改道：比较研究的系统回顾和荟萃分析。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-19 DOI: 10.1016/j.urolonc.2024.06.025

Alessandro Veccia, Davide Brusa, Lorenzo Treccani, Sarah Malandra, Emanuele Serafin, Sonia Costantino, Francesco Cianflone, Francesco Ditonno, Francesca Montanaro, Francesca Fumanelli, Matteo Ferro, Giorgio Mazzon, Riccardo Autorino, Riccardo Bertolo, Alessandro Antonelli

Purpose: To systematically compare the evidence about surgical outcomes, postoperative complications, and sequelae of Radical cystectomy with urinary diversion with or without stent placement.

Material and methods: A literature search was performed through PubMed, Scopus®, and Web of Science up to December 2023 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The study protocol was registered in PROSPERO (CRD 42023492384), and the research question was formulated according to the PICOs model. Three comparative studies were identified, 2 randomized and 1 prospective coming from a randomized cohort.

Results: The stent group showed higher odds of postoperative major complications (OR 3.00 - 95%CI 1.06; 8.52; P = 0.04) than the stentless group. There was no statistically significant difference between the 2 groups regarding 30-day readmission (P = 0.06), postoperative uretero-ileal anastomotis stricture (UIAS) (P = 0.09), postoperative uretero-ileal anastomotis leak (UIAL) (P = 0.20), postoperative urinary tract infections (UTIs) (P = 0.08), and postoperative ureteral obstruction (P = 0.35). No statistically significant difference between the 2 groups was found regarding UIAS management in terms of ureteral reimplantation (P = 0.28) or dilatation (P = 0.36).

Conclusions: Our pooled data analysis shows no statistically significant difference between stentless and stented urinary diversion after radical cystectomy. Stentless could be a reasonable choice when performing diversion during radical cystectomy.

目的：系统比较有支架或无支架根治性膀胱切除术的手术效果、术后并发症和后遗症的相关证据：根据《系统综述与元分析首选报告项目》（Preferred Reporting Items for Systematic Review and Meta-analysis，PRISMA）声明，通过 PubMed、Scopus® 和 Web of Science 对截至 2023 年 12 月的文献进行了检索。研究方案已在 PROSPERO（CRD 42023492384）上注册，研究问题根据 PICOs 模型制定。共确定了三项比较研究，其中两项是随机研究，一项是来自随机队列的前瞻性研究：支架组术后出现主要并发症的几率（OR 3.00 - 95%CI 1.06; 8.52; P = 0.04）高于无支架组。两组在 30 天再入院（P = 0.06）、术后输尿管-回肠吻合口狭窄（UIAS）（P = 0.09）、术后输尿管-回肠吻合口漏（UIAL）（P = 0.20）、术后尿路感染（UTI）（P = 0.08）和术后输尿管梗阻（P = 0.35）方面没有统计学差异。在输尿管再植（P = 0.28）或扩张（P = 0.36）方面，两组患者在UIAS处理方面没有统计学差异：我们的汇总数据分析显示，根治性膀胱切除术后，无支架和有支架尿流改道之间没有统计学意义上的显著差异。在根治性膀胱切除术后进行尿流改道时，无支架可能是一个合理的选择。

{"title":"Radical cystectomy with stentless urinary diversion: A systematic review and meta-analysis of comparative studies.","authors":"Alessandro Veccia, Davide Brusa, Lorenzo Treccani, Sarah Malandra, Emanuele Serafin, Sonia Costantino, Francesco Cianflone, Francesco Ditonno, Francesca Montanaro, Francesca Fumanelli, Matteo Ferro, Giorgio Mazzon, Riccardo Autorino, Riccardo Bertolo, Alessandro Antonelli","doi":"10.1016/j.urolonc.2024.06.025","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.06.025","url":null,"abstract":"<p><strong>Purpose: </strong>To systematically compare the evidence about surgical outcomes, postoperative complications, and sequelae of Radical cystectomy with urinary diversion with or without stent placement.</p><p><strong>Material and methods: </strong>A literature search was performed through PubMed, Scopus®, and Web of Science up to December 2023 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The study protocol was registered in PROSPERO (CRD 42023492384), and the research question was formulated according to the PICOs model. Three comparative studies were identified, 2 randomized and 1 prospective coming from a randomized cohort.</p><p><strong>Results: </strong>The stent group showed higher odds of postoperative major complications (OR 3.00 - 95%CI 1.06; 8.52; P = 0.04) than the stentless group. There was no statistically significant difference between the 2 groups regarding 30-day readmission (P = 0.06), postoperative uretero-ileal anastomotis stricture (UIAS) (P = 0.09), postoperative uretero-ileal anastomotis leak (UIAL) (P = 0.20), postoperative urinary tract infections (UTIs) (P = 0.08), and postoperative ureteral obstruction (P = 0.35). No statistically significant difference between the 2 groups was found regarding UIAS management in terms of ureteral reimplantation (P = 0.28) or dilatation (P = 0.36).</p><p><strong>Conclusions: </strong>Our pooled data analysis shows no statistically significant difference between stentless and stented urinary diversion after radical cystectomy. Stentless could be a reasonable choice when performing diversion during radical cystectomy.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009565","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}

引用次数: 0

Radical cystectomy in the female patient: The pelvic floor, sexual function, and patient/provider education. 女性患者的根治性膀胱切除术：盆底、性功能和患者/医护人员教育。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-18 DOI: 10.1016/j.urolonc.2024.07.007

David E Rapp, Jacqueline Zillioux

Radical cystectomy in women results in numerous deleterious anatomic impacts to the pelvic floor that can result in sexual dysfunction, pelvic organ prolapse, and other disorders of pelvic floor function. A comprehensive understanding of this relationship and the quality-of-life impacts of radical cystectomy in women is important. This narrative review provides an overview of female pelvic floor disorders in the setting of radical cystectomy, with focus on present understanding of related anatomy, incidence, and prevention strategies, as well as the importance of both provider and patient education.

女性根治性膀胱切除术会对盆底造成许多有害的解剖影响，从而导致性功能障碍、盆腔器官脱垂和其他盆底功能紊乱。全面了解这种关系以及根治性膀胱切除术对女性生活质量的影响非常重要。这篇叙述性综述概述了根治性膀胱切除术中女性盆底功能紊乱的情况，重点是目前对相关解剖结构、发病率和预防策略的了解，以及对提供者和患者进行教育的重要性。

引用次数: 0

Factors influencing readmission patterns following radical cystectomy: An analysis of social determinants and discharge outcomes "影响根治性膀胱切除术后再入院模式的因素：对社会决定因素和出院结果的分析"。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-16 DOI: 10.1016/j.urolonc.2024.06.011

Valentina Grajales M.D., M.S. , Jonathan Y. Lin M.S. , Danielle Sharbaugh M.P.H. , Maria Pere M.D. , Adam Sharbaugh M.D. , David T. Miller M.D. , Dan Pelzman M.D. , ZhaoJun Sun Ph.D., M.S. , Kirsten Y. Eom M.P.H. , Benjamin J. Davies M.D. , Jonathan G. Yabes Ph.D. , Lindsay M. Sabik Ph.D. , Bruce L. Jacobs M.D., M.P.H.

Introduction and objectives

Radical cystectomy readmission rates remain high, with around 25% of patients readmitted to index and nonindex hospitals in 30 days. Nonindex readmissions have been associated with poorer outcomes, including longer lengths of stay and higher mortality rates. This study aimed to examine the associations of social factors (e.g., sex, race, socioeconomic status, insurance type, and resident location) on readmission to index versus nonindex hospitals and discharge disposition.

Methods

We conducted a population-based retrospective study using the Pennsylvania Cancer Registry (PCR) to identify patients diagnosed with nonmetastatic muscle-invasive bladder cancer who underwent radical cystectomy in Pennsylvania between 2010 and 2018. Readmitted patients were identified using the Pennsylvania Health Care Cost Containment Council data (PHC4). The primary outcome was readmission location (i.e., index or nonindex hospital) following radical cystectomy. We used chi-square tests for categorical variables, Wilcoxon rank sum test for continuous variables, multivariable logistic regression model to assess predictors of being readmitted to an index hospital and calculating the predicted probability of being admitted to an index hospital depending on discharge disposition.

Results

A total of 517 patients were readmitted within 30-days after radical cystectomy. The majority of readmissions were index readmissions (83%). Median readmission hospital stay was 4 days (interquartile range [IQR] 4) for index and 5 days (IQR 7) for nonindex hospitals, P = 0.01. Patients readmitted to index hospitals had fewer comorbidities (median weighted Elixhauser Comorbidity Index 2 (IQR 2)) and lived in urban areas (89%). Discharge with home care was associated with a higher odds of index readmission (odds ratio, [OR] 2.40; 95% confidence interval, [CI] 1.25–4.52).

Conclusions

Patients residing in urban areas and with fewer comorbidities were more likely to be readmitted to index hospitals than nonindex hospitals. Socioeconomic status and insurance type did not correlate with the type of readmission. Finally, being discharged with home health care was found to be a predictor of readmission to an index hospital.

导言和目标：根治性膀胱切除术的再入院率仍然很高，约有 25% 的患者在 30 天内再次入院到指标医院和非指标医院。非指标再入院与较差的治疗效果有关，包括较长的住院时间和较高的死亡率。本研究旨在探讨社会因素（如性别、种族、社会经济地位、保险类型和居住地）与再入指标医院和非指标医院以及出院处置之间的关联：我们利用宾夕法尼亚州癌症登记处（PCR）开展了一项基于人群的回顾性研究，以确定2010年至2018年间在宾夕法尼亚州接受根治性膀胱切除术的非转移性肌浸润性膀胱癌患者。再入院患者通过宾夕法尼亚州医疗成本控制委员会数据（PHC4）确定。主要结果是根治性膀胱切除术后的再入院地点（即指数医院或非指数医院）。我们对分类变量采用卡方检验，对连续变量采用Wilcoxon秩和检验，使用多变量逻辑回归模型评估再次入院的预测因素，并根据出院处置计算再次入院的预测概率：共有517名患者在根治性膀胱切除术后30天内再次入院。大多数再入院患者都是指数再入院（83%）。指标医院再入院住院时间中位数为 4 天（四分位数间距 [IQR] 4），非指标医院为 5 天（IQR 7），P = 0.01。再次入住指标医院的患者合并症较少（中位数加权Elixhauser合并症指数为2（IQR为2）），且居住在城市地区（89%）。出院时接受家庭护理的患者再次入院的几率更高（几率比[OR]2.40；95%置信区间[CI]1.25-4.52）：结论：与非指标医院相比，居住在城市地区且合并症较少的患者更有可能再次入住指标医院。社会经济地位和保险类型与再入院类型无关。最后，出院时接受家庭医疗服务也是再次入住指数医院的一个预测因素。

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引用次数: 0

Comprehensive behavioural assessment of TERT in bladder cancer 膀胱癌 TERT 综合行为评估。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-14 DOI: 10.1016/j.urolonc.2024.06.024

Meryem El Azzouzi , Hajar El Ahanidi , Ilias Hassan , Mohammed Tetou , Ahmed Ameur , Mounia Bensaid , Abderrahmane Al Bouzidi , Mohamed Oukabli , Chaimae Hafidi Alaoui , Boutaina Addoum , Imane Chaoui , Laila Benbacer , Mohammed El Mzibri , Mohammed Attaleb

Background

Telomerase activity plays a crucial role in cancer development and progression. Thus, telomerase activation through the interplay of mutations and epigenetic alterations in the telomerase reverse transcriptase (TERT) promoter may provide further insight into bladder cancer induction and progression.

Methods

In this study 100 bladder tumour tissues were selected, and four molecular signatures were analysed: THOR methylation status, TERT promotor mutation, telomere length, and TERT expression.

Results

In our study, 88% of bladder cancer patients had an hypermethylation of the THOR region and 60% had mutations in the TERT promoter region. TERT promoter methylation was observed in all stages and grades of bladder cancer. While, TERT promoter mutations were detected in advanced stages and grades. In our cohort, high levels of TERT expression and long telomeres have been found in noninvasive cases of bladder cancer, with a significant association between TERT expression and Telomere length. Interestingly, patients with low TERT expression and cases with long telomeres had significantly longer Disease-free survival and overall survival.

Conclusion

The methylation and mutations occurring in the TERT promoter are implicated in bladder carcinogenesis, offering added prognostic and supplying novel insight into telomere biology in cancer.

背景：端粒酶活性在癌症的发生和发展中起着至关重要的作用。因此，通过端粒酶逆转录酶（TERT）启动子的突变和表观遗传学改变的相互作用来激活端粒酶，可以进一步揭示膀胱癌的诱发和进展：本研究选取了100例膀胱肿瘤组织，分析了四个分子特征：THOR甲基化状态、TERT启动子突变、端粒长度和TERT表达：在我们的研究中，88%的膀胱癌患者存在THOR区域的高甲基化，60%的患者存在TERT启动子区域的突变。在所有阶段和等级的膀胱癌中都能观察到 TERT 启动子甲基化。而TERT启动子突变则在晚期和分级中被检测到。在我们的队列中，非侵袭性膀胱癌病例中发现了高水平的TERT表达和长端粒，TERT表达与端粒长度之间存在显著关联。有趣的是，TERT表达量低的患者和端粒长的病例的无病生存期和总生存期明显更长：结论：TERT启动子中发生的甲基化和突变与膀胱癌的发生有关，可增加预后效果，并为端粒生物学在癌症中的应用提供新的见解。

{"title":"Comprehensive behavioural assessment of TERT in bladder cancer","authors":"Meryem El Azzouzi , Hajar El Ahanidi , Ilias Hassan , Mohammed Tetou , Ahmed Ameur , Mounia Bensaid , Abderrahmane Al Bouzidi , Mohamed Oukabli , Chaimae Hafidi Alaoui , Boutaina Addoum , Imane Chaoui , Laila Benbacer , Mohammed El Mzibri , Mohammed Attaleb","doi":"10.1016/j.urolonc.2024.06.024","DOIUrl":"10.1016/j.urolonc.2024.06.024","url":null,"abstract":"<div><h3>Background</h3><div>Telomerase activity plays a crucial role in cancer development and progression. Thus, telomerase activation through the interplay of mutations and epigenetic alterations in the telomerase reverse transcriptase (TERT) promoter may provide further insight into bladder cancer induction and progression.</div></div><div><h3>Methods</h3><div>In this study 100 bladder tumour tissues were selected, and four molecular signatures were analysed: THOR methylation status, TERT promotor mutation, telomere length, and TERT expression.</div></div><div><h3>Results</h3><div>In our study, 88% of bladder cancer patients had an hypermethylation of the THOR region and 60% had mutations in the TERT promoter region. TERT promoter methylation was observed in all stages and grades of bladder cancer. While, TERT promoter mutations were detected in advanced stages and grades. In our cohort, high levels of TERT expression and long telomeres have been found in noninvasive cases of bladder cancer, with a significant association between TERT expression and Telomere length. Interestingly, patients with low TERT expression and cases with long telomeres had significantly longer Disease-free survival and overall survival.</div></div><div><h3>Conclusion</h3><div>The methylation and mutations occurring in the TERT promoter are implicated in bladder carcinogenesis, offering added prognostic and supplying novel insight into telomere biology in cancer.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"42 12","pages":"Pages 451.e19-451.e29"},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988916","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}

引用次数: 0

A global view of the challenges and limitations of precision medicine for genitourinary cancers 全球泌尿生殖系统癌症精准医疗面临的挑战和局限性。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-14 DOI: 10.1016/j.urolonc.2024.07.001

Mariane S. Fontes M.D.

Prostate and bladder cancers are the most common genitourinary cancers. In the past 2 decades, there has been increasing drug approval for these cancers, but there are patients who inherently do not respond or progress on such therapies highlighting the need for a better understanding of disease biology and mechanisms of resistance. Precision medicine has attempted to better select patients for specific therapies, although many advances have taken place in this field, access to targeted therapies and technology is distinct in different parts of the world. In this special Seminars issue, precision medicine and derived therapies were explored, as well as the impact on the management of prostate and bladder cancer, specially focusing on the challenges and limitations encountered by the international community when attempting to incorporate and implement the best clinical practice as recommended by worldwide accepted guidelines.

前列腺癌和膀胱癌是最常见的泌尿生殖系统癌症。在过去的二十年里，越来越多的药物获准用于治疗这些癌症，但有些患者对这些疗法本身没有反应或没有进展，这突出表明需要更好地了解疾病生物学和耐药机制。精准医学试图为特定疗法更好地选择患者，尽管该领域已取得了许多进展，但世界各地获得靶向疗法和技术的途径各不相同。本期研讨会特刊探讨了精准医学和衍生疗法，以及对前列腺癌和膀胱癌治疗的影响，特别关注国际社会在尝试纳入和实施全球公认指南推荐的最佳临床实践时遇到的挑战和限制。

引用次数: 0

Telehealth visit type and patient-reported outcomes among patients with cancer 癌症患者的远程医疗就诊类型和患者报告的结果。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations

Pub Date : 2024-08-13 DOI: 10.1016/j.urolonc.2024.07.015

Daniel S. Carson M.D., M.S. , Sam Simpson B.S. , Adam J. Gadzinski M.D., M.S. , Sarah K. Holt Ph.D. , Blair Stewart M.S. , Erika M. Wolff Ph.D. , Chad Ellimoottil M.D., M.S. , John L. Gore M.D., M.S., F.A.C.S.

Background

Relaxed licensing restrictions on telehealth use during the COVID-19 pandemic allowed broad use irrespective of visit type. As these telehealth waivers expire, optimal uses of telehealth must be assessed to inform policy and clinical care. We evaluated patient experience associated with telehealth and in-person new or established visits.

Methods

Patients seen in-person and via telehealth for urologic cancer care from August 2019 to June 2022 received a survey on satisfaction with care, perceptions of communication during their visit, travel time, travel costs, and days of work missed. We assessed survey responses with descriptive statistics.

Results

Surveys were completed for 1,031 patient visits (N = 494 new visits, N = 537 established visits). Satisfaction rates were high for all visit modalities among new and established patients (mean score range 59.9–60.7 [maximum 63], P > 0.05). Patient-rated quality of the encounter did not differ by visit type and modality (P > 0.05, for nearly all comparisons). New in-person patient visits were associated with significantly higher travel costs (mean $496.10, SD $1021) compared with new telehealth visits (mean $26.60, SD $141; P < 0.001); 27% of new in-person patients required plane travel and 41% required a hotel stay (P < 0.001 vs. 0.8% and 3.2% of new telehealth patients, respectively).

Conclusions

Satisfaction outcomes among patients with urologic cancer receiving new patient telehealth care equaled those of new patients cared for in-person while costs were significantly lower. Offering telehealth exemption beyond COVID-19 licensing waivers to include new patient visits would allow for ongoing delivery of high-quality urologic cancer care irrespective of geographic location.

背景：在 COVID-19 大流行期间，放宽了对远程保健使用的许可限制，允许不分就诊类型广泛使用远程保健。随着这些远程医疗豁免的到期，必须对远程医疗的最佳使用进行评估，以便为政策和临床护理提供依据。我们评估了与远程医疗和面对面新就诊或已就诊相关的患者体验：从 2019 年 8 月到 2022 年 6 月，亲自就诊和通过远程医疗接受泌尿系统癌症护理的患者接受了一项调查，内容包括对护理的满意度、对就诊期间沟通的看法、旅行时间、旅行费用和误工天数。我们通过描述性统计对调查回复进行了评估：共完成了 1,031 次患者就诊的调查（N = 494 次新就诊，N = 537 次已就诊）。新患者和老患者对所有就诊方式的满意度都很高（平均得分范围为 59.9-60.7 [最高 63]，P > 0.05）。患者对就诊质量的评分在就诊类型和就诊方式上没有差异（几乎所有比较中，P > 0.05）。与新的远程医疗就诊（平均 26.60 美元，标准差 141 美元；P < 0.001）相比，新的面对面就诊患者的差旅费用明显更高（平均 496.10 美元，标准差 1021 美元）；27% 的新面对面就诊患者需要乘坐飞机，41% 的新面对面就诊患者需要入住酒店（P < 0.001，而新的远程医疗就诊患者的差旅费用分别为 0.8% 和 3.2%）：结论：接受远程医疗服务的泌尿系统癌症新患者的满意度与接受面对面服务的新患者相当，而费用却明显较低。在 COVID-19 许可豁免范围之外提供远程医疗豁免，将新患者就诊纳入其中，将使高质量的泌尿系统癌症护理得以持续提供，而不受地理位置的限制。

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引用次数: 0