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[German Society of Urology fellowships: career booster and opportunity]. [德国泌尿外科学会研究金:职业生涯的助推器和机遇]。
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1007/s00120-024-02476-3
Christoph Becker, Christian Thomas
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引用次数: 0
[Adjuvant therapy for renal cell carcinoma : Relevant patient and tumor factors]. [肾细胞癌辅助治疗:相关患者和肿瘤因素]。
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-11-15 DOI: 10.1007/s00120-024-02474-5
Jens Bedke, Viktor Grünwald

The gold standard in the treatment of localized and locally advanced renal cell carcinoma is surgery. Nevertheless, there is still a risk of tumor relapse. Reducing the risk of recurrence and extending overall survival is the goal of subsequent adjuvant treatment. The aim of this work is to discuss the current and future landscape of adjuvant therapy, taking into account the risk-benefit balance in the individual patient selected for adjuvant treatment. The immune checkpoint inhibitor (CPI) pembrolizumab demonstrated a significant increase in disease-free and overall survival after surgery for the first time. However, other CPI studies demonstrated no improvement. Patient selection for adjuvant treatment is currently based on the parameters of the TNM system. Prospective biomarkers are currently not available. Here, kidney injury molecule‑1 (KIM-1) represents an initial promising biomarker in the prediction of adjuvant immunotherapy.

手术是治疗局部和局部晚期肾细胞癌的金标准。然而,肿瘤仍有复发的风险。降低复发风险和延长总生存期是后续辅助治疗的目标。本文旨在讨论辅助治疗的现状和未来,同时考虑到选择辅助治疗的个体患者的风险-效益平衡。免疫检查点抑制剂(CPI)pembrolizumab 首次证明了术后无病生存率和总生存率的显著提高。然而,其他 CPI 研究结果显示无改善。目前,辅助治疗的患者选择是基于 TNM 系统的参数。目前还没有前瞻性的生物标志物。在此,肾损伤分子-1(KIM-1)是预测辅助免疫疗法的一个初步可行的生物标志物。
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引用次数: 0
[Update from d-uo: what can healthcare research contribute to renal cell carcinoma?] [来自 d-uo 的最新消息:医疗保健研究可为肾细胞癌做出哪些贡献?]
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-11-12 DOI: 10.1007/s00120-024-02465-6
Manfred Johannsen, Rolf Eichenauer, Jörg Klier, Frank König, Robert Schönfelder, Jörg Schröder, Elke Hempel, Christian Doehn

Background: Renal cell carcinoma (RCC) accounts for about 13.5% of all urological tumors. Healthcare research analyzes whether treatment recommendations from controlled studies or guidelines are being implemented in routine care. A prerequisite for the assessment and scientific study of the quality of care in the treatment of urological tumors is standardized documentation.

Objectives: This article illustrates healthcare research in RCC by presenting current data from the prospective of the VERSUS study (VERSorgUngsStudie) by d‑uo (Deutsche Uro-Onkologen).

Materials and methods: The VERSUS study is a noninterventional, prospective, multicentric study for the documentation and descriptive statistical analysis of the diagnosis, treatment, and aftercare of uro-oncological patients.

Results: Of 25,065 patients currently included in the VERSUS study, 1976 have a diagnosis of RCC. Data regarding stage distribution, reason leading to initial diagnosis, distribution of symptomatic vs. asymptomatic patients as well as surgical margins from surgical treatment of RCC are presented.

Conclusions: Despite providing interesting results, the VERSUS study remains limited with regard to the depth of the data, since it relies on the same dataset as the German cancer registry. In order to provide more comprehensive healthcare research, organ-related cancer registries like the Urothelial Cancer National Registry (UroNAT) and the Prostate Cancer National Registry (ProNAT) by d‑uo are necessary. These national cancer registries by d‑uo are unique in that they comprise all tumor stages. The Renal Cancer National Registry (ReNAT) by d‑uo is in preparation and will be a valuable contribution to quality assurance of oncological care in Germany.

背景:肾细胞癌(RCC)约占所有泌尿系统肿瘤的 13.5%。医疗保健研究分析了对照研究或指南中提出的治疗建议是否在常规护理中得到实施。对泌尿系统肿瘤治疗质量进行评估和科学研究的先决条件是标准化文件:本文通过介绍 d-uo(Deutsche Uro-Onkologen)的 VERSUS 研究(VERSorgUngsStudie)的前瞻性数据来说明 RCC 的医疗保健研究:VERSUS研究是一项非介入性、前瞻性、多中心研究,旨在对泌尿肿瘤患者的诊断、治疗和术后护理进行记录和描述性统计分析:在目前纳入 VERSUS 研究的 25065 名患者中,1976 人被诊断为 RCC。结果:在目前纳入 VERSUS 研究的 25,065 名患者中,1976 人被确诊为 RCC。研究提供了分期分布、导致初步诊断的原因、有症状与无症状患者的分布以及 RCC 手术治疗的手术切缘等方面的数据:尽管 VERSUS 研究提供了令人感兴趣的结果,但由于它依赖于与德国癌症登记处相同的数据集,因此在数据深度方面仍然存在局限性。为了提供更全面的医疗保健研究,有必要通过 d-uo 进行器官相关癌症登记,如全国泌尿系统癌症登记(UroNAT)和全国前列腺癌登记(ProNAT)。这些 d-uo 国家癌症登记处的独特之处在于它们涵盖了所有肿瘤分期。d-uo 的全国肾癌登记处(ReNAT)正在筹备中,它将为德国肿瘤治疗的质量保证做出重要贡献。
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引用次数: 0
[Living an error culture]. [错误文化生活]
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-08 DOI: 10.1007/s00120-024-02374-8
Ute Brockhaus
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引用次数: 0
Berufspolitik BvDU. Berufspolitik BvDU .
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 DOI: 10.1007/s00120-024-02482-5
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引用次数: 0
[Contemporary treatment standards and trends of systemic therapy in metastatic hormone-sensitive prostate cancer-implementing study data in clinical practice]. [转移性激素敏感前列腺癌系统治疗的当代治疗标准和趋势--将研究数据应用于临床实践]。
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-14 DOI: 10.1007/s00120-024-02410-7
Mike Wenzel, Séverine Banek, Felix K H Chun, Philipp Mandel

Background: The treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC) has undergone fundamental changes in recent decades, moving away from the sole use of androgen deprivation therapy (ADT) and towards intensified combination therapies.

Purpose: To what extent have the data from prospective phase III studies influenced clinical practice in the management of mHSPC over the past 5 or 10 years?

Results: A total of 1098 mHSPC patients with a median age at metastasis of 70 years and a median prostate-specific antigen (PSA) level of 43 ng/ml were included in the present study. Significant differences were observed in terms of PSA nadirs in mHSPC after stratification by year of metastatic onset. Significant differences were also observed regarding systemic therapies applied in mHSPC and metastatic castration-resistant prostate cancer (mCRPC; p < 0.001). Regarding the annual estimated percentage change (EAPC) over the past 10 years, a significant decrease in ADT monotherapy from 85% (2013) to 29% (2023; EAPC: -12%, p < 0.001) was observed. Conversely, there was a significant increase in androgen receptor signaling inhibitor (ARSI) use from 6% in 2013 to 55% in 2023 (EAPC: +21.7%, p < 0.001). Regarding docetaxel chemotherapy, a bell-shaped pattern was apparent over the past 10 years, with rates increasing from 8% in 2013 to 25% in 2019 and decreasing to 0% in 2023. The proportion of triplet therapies was 16% in 2023.

Conclusion: Over the past 10 years there has been an adaptation of intensified combination therapies for mHSPC in clinical reality, with the most frequent use of ARSI and triplet therapies.

背景:近几十年来,转移性激素敏感性前列腺癌(mHSPC)的治疗格局发生了根本性变化,从单一使用雄激素剥夺疗法(ADT)转向强化综合疗法。目的:在过去5年或10年中,前瞻性III期研究的数据在多大程度上影响了mHSPC治疗的临床实践?本研究共纳入了1098例mHSPC患者,其中位转移年龄为70岁,中位前列腺特异性抗原(PSA)水平为43纳克/毫升。按转移发病年份分层后,mHSPC 患者的 PSA 中位数存在显著差异。mHSPC 和转移性去势抵抗性前列腺癌(mCRPC)在采用系统疗法方面也存在显著差异:在过去的 10 年中,临床上对 mHSPC 的强化综合疗法进行了调整,其中最常用的是 ARSI 和三联疗法。
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引用次数: 0
[Non-clear cell renal cell carcinoma]. [非透明细胞肾细胞癌]。
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-11-26 DOI: 10.1007/s00120-024-02473-6
Marit Ahrens, Lothar Bergmann

Non-clear cell renal cell carcinomas (nccRCC) account for approximately 20-25% of renal cell carcinomas. Approximately 20 different histologically and/or molecularly defined entities are subsumed under nccRCC. Many entities only have a share of 1% or less. Due to the rarity of the subpopulations, there are currently no larger randomized studies and there is a some uncertainty regarding the optimal treatment recommendations. The previous treatment recommendations for localized and advanced nccRCC are presented. Data from the various systemic therapies are presented. For nccRCC, there are no different entity-related therapy guidelines due to a lack of data and especially randomized studies. The tumors should be treated in the same way as clear cell renal cell carcinomas. Monotherapies with a tyrosine kinase inhibitor (TKI; in chromophobe RCC also with an mTOR inhibitor) or with combination therapy ICI/ICI or TKI/ICI (ICI: immune checkpoint inhibitor) can be used, depending on the risk factors and individual decision. Randomized trials are urgently needed.

非透明细胞肾细胞癌(nccRCC)约占肾细胞癌的 20-25%。约有 20 种不同的组织学和/或分子学定义的实体被归入 nccRCC。许多实体的比例仅为1%或更低。由于亚群的罕见性,目前还没有更大规模的随机研究,因此最佳治疗建议还存在一定的不确定性。本文介绍了以往针对局部和晚期 nccRCC 的治疗建议。此外,还介绍了各种系统疗法的数据。对于 nccRCC,由于缺乏数据,尤其是随机研究,因此没有不同的实体相关治疗指南。这些肿瘤的治疗方法与透明细胞肾细胞癌相同。可使用酪氨酸激酶抑制剂(TKI;在嗜色素 RCC 中也可使用 mTOR 抑制剂)或 ICI/ICI 或 TKI/ICI (ICI:免疫检查点抑制剂)联合疗法进行单药治疗,具体取决于风险因素和个人决定。目前急需进行随机试验。
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引用次数: 0
Sind Sie bereit ? 你准备好了吗?
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 DOI: 10.1007/s00120-024-02480-7
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引用次数: 0
[Small renal mass: which criteria are decisive for a tumor board?] [肾脏小肿块:哪些标准对肿瘤委员会具有决定性意义?]
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-11-06 DOI: 10.1007/s00120-024-02471-8
Désirée Louise Dräger, Cesar Rojas Cruz, Jascha Held, Ferry Niepel, Annette Zimpfer, Oliver W Hakenberg

Small renal masses (SRM) are a heterogeneous group of tumors with varying metastatic potential. The increasing use and improvement in the quality of abdominal imaging have led to an increasingly earlier diagnosis of incidental SRM, which are asymptomatic and confined to the organ. Despite these advances in imaging and the growing use of renal tumor biopsies, preoperative diagnosis of malignancy remains difficult. The treatment of SRM has shifted away from radical nephrectomy and now primarily includes organ-sparing surgery or active surveillance. The optimal strategy for treating SRM is continuously evolving as studies from prospective data registries can identify factors that influence both short- and long-term patient outcomes. Recent research on biomarkers, imaging techniques, and machine learning offer promising approaches to a deeper understanding of tumor biology and treatment options for this patient population.

肾小肿块(SRM)是一类具有不同转移潜力的异质性肿瘤。随着腹部成像技术的普及和质量的提高,越来越多无症状且局限于器官内的偶然性肾小肿块得以早期诊断。尽管成像技术取得了这些进步,肾肿瘤活检的应用也越来越广泛,但术前诊断恶性肿瘤仍然很困难。SRM的治疗方法已从根治性肾切除术转变而来,目前主要包括保全器官手术或积极监测。随着前瞻性数据登记研究能够确定影响患者短期和长期预后的因素,SRM 的最佳治疗策略也在不断发展。最近对生物标志物、成像技术和机器学习的研究为深入了解肿瘤生物学和这一患者群体的治疗方案提供了有希望的方法。
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引用次数: 0
[Androgen deprivation as initial and backbone therapy for prostate carcinoma cancer : A retrospective data analysis from urological practices in Germany]. [雄激素剥夺作为前列腺癌的初始和骨干疗法:德国泌尿外科临床的回顾性数据分析]。
IF 0.5 4区 医学 Q4 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-29 DOI: 10.1007/s00120-024-02434-z
Peter J Goebell, Felix Cornelius, Annika Fernandez Milano, Sybill Hessler, Matthias Schulze

Background: The aim of this study was to determine the proportion of patients with prostate cancer (PCa) who remained on primary androgen deprivation therapy (ADT) after starting treatment for castration-resistant prostate cancer (CRPC) and to describe their treatment patterns.

Materials and methods: The study comprises a retrospective analysis of 609,308 patients in urological practices in Germany from 2011 to 2020 based on anonymized secondary data from the UROscience webserver. PCa patients were eligible for inclusion if they received ADT after a 6-month prescription-free pre-index period.

Results: A total of 3,112 patients (mean age 75.5 [±8.0] years) were included. Most patients received gonadotropin-releasing hormone (GnRH) agonists (72.3%), followed by antiandrogens (24.9%). The median duration of ADT treatment was 25.9 months. The estimated probabilities of continuing ADT 3, 6, and 8 years after starting treatment were 40.7%, 20.1%, and 12.7%, respectively. Interruption across all ADTs occurred in 42.7% of patients, switching of primary ADT in 52.2% and discontinuation in 82.2% of patients. After starting ADT, 14.6% of patients received treatment for CRPC, of whom 76.4% continued primary ADT. The median duration of CRPC treatment was 11.0 months. The estimated probabilities of developing CRPC 3, 6, and 8 years after starting ADT were 11.1%, 20.1%, and 25.9%, respectively.

Conclusion: This study has shown that a relevant proportion of patients discontinued primary ADT after starting treatment for CRPC, although guidelines recommend continuing ADT if the disease progresses.

研究背景本研究的目的是确定前列腺癌(PCa)患者在开始接受对去势抵抗性前列腺癌(CRPC)的治疗后仍在接受初级雄激素剥夺疗法(ADT)的比例,并描述他们的治疗模式:该研究基于UROscience网站服务器上的匿名二级数据,对2011年至2020年间德国泌尿外科的609,308名患者进行了回顾性分析。如果 PCa 患者在索引前 6 个月的无处方期后接受了 ADT 治疗,则符合纳入条件:结果:共纳入 3,112 例患者(平均年龄为 75.5 [±8.0] 岁)。大多数患者接受了促性腺激素释放激素(GnRH)激动剂治疗(72.3%),其次是抗雄激素治疗(24.9%)。ADT 治疗的中位持续时间为 25.9 个月。开始治疗 3 年、6 年和 8 年后继续 ADT 治疗的估计概率分别为 40.7%、20.1% 和 12.7%。42.7%的患者中断了所有 ADT,52.2%的患者更换了主要 ADT,82.2%的患者中断了 ADT。开始 ADT 治疗后,14.6% 的患者接受了 CRPC 治疗,其中 76.4% 的患者继续接受主要 ADT 治疗。CRPC治疗的中位持续时间为11.0个月。开始 ADT 治疗 3 年、6 年和 8 年后发展为 CRPC 的估计概率分别为 11.1%、20.1% 和 25.9%:这项研究表明,尽管指南建议在疾病进展时继续使用 ADT,但仍有相当一部分患者在开始治疗 CRPC 后中断了 ADT。
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引用次数: 0
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Urologie
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