Christopher Kniep, Tobias Maurer, Ben Frederik Hartwieg, Philipp Mandel, Mike Wenzel, Fabian Falkenbach, Kristian Krpina, Lars Budäus, Alexander Haese, Georg Salomon, Thomas Steuber, Markus Graefen, Derya Tilki, Felix Preisser
Objective To evaluate the diagnostic performance of different staging modalities and oncological outcomes in patients with intermediate‐risk (IR) prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND). Patients and Methods Patients with IR PCa who underwent RP and PLND between 2015 and 2021 were retrospectively analysed. Patients who had received neoadjuvant hormone therapy were excluded. The effectiveness of computed tomography (CT), magnetic resonance imaging (MRI), and prostate‐specific membrane antigen‐positron emission tomography (PSMA‐PET) in detecting lymph node invasion (LNI) was assessed. Kaplan–Meier analysis was used to evaluate biochemical recurrence‐free and metastasis‐free survival. Results Among 8043 patients with IR PCa undergoing RP with PLND, 624 (7.8%) had LNI. PSMA‐PET was performed in 400 patients: six true positives, 40 false negatives, 14 false positives, and 340 true negatives. CT was used in 2079 patients: two true positives, 228 false negatives, seven false positives, and 1842 true negatives. MRI was performed in 148 patients: one true positive, 11 false negatives, and 136 true negatives, with no false positives. Sensitivity was highest for PSMA‐PET (13%), followed by MRI (8.3%) and CT (0.9%). Negative predictive values were 92.5% for MRI, 89.5% for PSMA‐PET, and 89% for CT. Patients with negative PSMA‐PET findings had significantly better biochemical recurrence‐free and metastasis‐free survival than those with suspicious findings on PSMA‐PET. Conclusions All evaluated staging modalities demonstrated limited sensitivity in detecting LNI in patients with IR PCa, including PSMA‐PET. Given the poor diagnostic performance of conventional imaging, such methods may be omitted in this setting. PSMA‐PET may still be considered selectively, as it provides modest sensitivity and prognostic value, although its role remains limited.
{"title":"Diagnostic accuracy and outcomes of lymph node staging in intermediate‐risk prostate cancer","authors":"Christopher Kniep, Tobias Maurer, Ben Frederik Hartwieg, Philipp Mandel, Mike Wenzel, Fabian Falkenbach, Kristian Krpina, Lars Budäus, Alexander Haese, Georg Salomon, Thomas Steuber, Markus Graefen, Derya Tilki, Felix Preisser","doi":"10.1111/bju.70155","DOIUrl":"https://doi.org/10.1111/bju.70155","url":null,"abstract":"Objective To evaluate the diagnostic performance of different staging modalities and oncological outcomes in patients with intermediate‐risk (IR) prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND). Patients and Methods Patients with IR PCa who underwent RP and PLND between 2015 and 2021 were retrospectively analysed. Patients who had received neoadjuvant hormone therapy were excluded. The effectiveness of computed tomography (CT), magnetic resonance imaging (MRI), and prostate‐specific membrane antigen‐positron emission tomography (PSMA‐PET) in detecting lymph node invasion (LNI) was assessed. Kaplan–Meier analysis was used to evaluate biochemical recurrence‐free and metastasis‐free survival. Results Among 8043 patients with IR PCa undergoing RP with PLND, 624 (7.8%) had LNI. PSMA‐PET was performed in 400 patients: six true positives, 40 false negatives, 14 false positives, and 340 true negatives. CT was used in 2079 patients: two true positives, 228 false negatives, seven false positives, and 1842 true negatives. MRI was performed in 148 patients: one true positive, 11 false negatives, and 136 true negatives, with no false positives. Sensitivity was highest for PSMA‐PET (13%), followed by MRI (8.3%) and CT (0.9%). Negative predictive values were 92.5% for MRI, 89.5% for PSMA‐PET, and 89% for CT. Patients with negative PSMA‐PET findings had significantly better biochemical recurrence‐free and metastasis‐free survival than those with suspicious findings on PSMA‐PET. Conclusions All evaluated staging modalities demonstrated limited sensitivity in detecting LNI in patients with IR PCa, including PSMA‐PET. Given the poor diagnostic performance of conventional imaging, such methods may be omitted in this setting. PSMA‐PET may still be considered selectively, as it provides modest sensitivity and prognostic value, although its role remains limited.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"101 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joost van Drumpt,Tim Govers,Ricardo Almeida-Magana,Diederik Baas,Aiman Haider,Michiel Sedelaar,Greg Shaw,Diederik Somford
OBJECTIVETo determine whether current intraoperative margin assessment (IOMA) techniques (such as Neurovascular Structure Adjacent Frozen-section Examination [NeuroSAFE] or confocal laser microscopy [CLM]) used during radical prostatectomy (RP) to enhance nerve-sparing surgery (NSS) while reducing positive surgical margins (PSMs) justify their extra costs, this study assessed their cost-effectiveness.METHODSA decision analytical model assessed health outcomes and costs associated with NeuroSAFE and CLM (using the Histolog® Scanner) compared to bilateral, unilateral, and non-NSS. Outcomes were calculated in quality-adjusted life years (QALYs), with a cost-effectiveness threshold of €50 000 per QALY. NSS reduced erectile dysfunction and incontinence probabilities. However, when extraprostatic extension was present but not identified pre- or intraoperatively, NSS resulted in a PSM, increasing the risk of biochemical recurrence (BCR) and development of metastases.RESULTSThe NeuroSAFE and CLM were cost-effective strategies compared to non-IOMA strategies. NeuroSAFE was most cost-effective if NeuroSAFE and CLM were used in an equal number of patients. However, if NeuroSAFE was used in >8% fewer patients compared to CLM, CLM was most cost-effective. Sensitivity analyses highlighted the impact of PSMs on cost-effectiveness. In hospitals with higher RP volumes (>160 per year), CLM had lower costs per procedure than NeuroSAFE.CONCLUSIONSIntraoperative margin assessment during RP is a cost-effective intervention. The choice to implement NeuroSAFE or CLM should be guided by both surgical volume and available capacity, as the more labour-intensive nature of NeuroSAFE may limit its use and reduces its cost-effectiveness compared with CLM.
{"title":"The cost-effectiveness of intraoperative margin assessment strategies during radical prostatectomy.","authors":"Joost van Drumpt,Tim Govers,Ricardo Almeida-Magana,Diederik Baas,Aiman Haider,Michiel Sedelaar,Greg Shaw,Diederik Somford","doi":"10.1111/bju.70121","DOIUrl":"https://doi.org/10.1111/bju.70121","url":null,"abstract":"OBJECTIVETo determine whether current intraoperative margin assessment (IOMA) techniques (such as Neurovascular Structure Adjacent Frozen-section Examination [NeuroSAFE] or confocal laser microscopy [CLM]) used during radical prostatectomy (RP) to enhance nerve-sparing surgery (NSS) while reducing positive surgical margins (PSMs) justify their extra costs, this study assessed their cost-effectiveness.METHODSA decision analytical model assessed health outcomes and costs associated with NeuroSAFE and CLM (using the Histolog® Scanner) compared to bilateral, unilateral, and non-NSS. Outcomes were calculated in quality-adjusted life years (QALYs), with a cost-effectiveness threshold of €50 000 per QALY. NSS reduced erectile dysfunction and incontinence probabilities. However, when extraprostatic extension was present but not identified pre- or intraoperatively, NSS resulted in a PSM, increasing the risk of biochemical recurrence (BCR) and development of metastases.RESULTSThe NeuroSAFE and CLM were cost-effective strategies compared to non-IOMA strategies. NeuroSAFE was most cost-effective if NeuroSAFE and CLM were used in an equal number of patients. However, if NeuroSAFE was used in >8% fewer patients compared to CLM, CLM was most cost-effective. Sensitivity analyses highlighted the impact of PSMs on cost-effectiveness. In hospitals with higher RP volumes (>160 per year), CLM had lower costs per procedure than NeuroSAFE.CONCLUSIONSIntraoperative margin assessment during RP is a cost-effective intervention. The choice to implement NeuroSAFE or CLM should be guided by both surgical volume and available capacity, as the more labour-intensive nature of NeuroSAFE may limit its use and reduces its cost-effectiveness compared with CLM.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"64 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlo Silvani, Alfonso Santangelo, Jack Considine, Anna Tylecki, Alex Stephens, Adam Mssika, Benjamin Robinson, Sebastiano Nazzani, Alberto Briganti, Andrea Salonia, Francesco Montorsi, Akshay Sood, Nicola Nicolai, Emanuele Montanari, Craig Rogers, Firas Abdollah
Objectives: To evaluate whether neighbourhood socioeconomic deprivation, measured by the Area Deprivation Index (ADI), is associated with cancer-specific mortality (CSM) in patients with non-muscle-invasive bladder cancer (NMIBC).
Patients and methods: We retrospectively reviewed patients with NMIBC (T stage <2, node-negative, non-metastatic) from Michigan Cancer Surveillance Program (2004-2019). ADI national percentiles were assigned based on residential census block groups and stratified into quartiles, with the fourth quartile (ADI 75-100) being the most deprived. Cumulative incidence functions compared CSM between quartiles, and competing-risk regression analysis assessed the association between ADI and CSM after adjusting for covariates.
Results: Among 19 722 patients (92.2% non-Hispanic White; median [interquartile range] age 72 [64-80] years; 76.7% male), most resided in metropolitan areas (81%) and 61% were married. Overall, 8.5%, 26.4%, 34.9%, and 30.2% of patients were in the first, second, third, and fourth ADI quartile, respectively. At 10 years, the cumulative incidence of CSM was 7.3%, 7.9%, 8.7%, and 9.7% across the first-fourth quartiles, respectively (P = 0.002). At the competing risk analysis, each 25-point increase in ADI was associated with a 6% higher hazard of CSM (95% confidence interval 1.01-1.12; P = 0.032). Older age, higher T stage, unmarried status, and Medicaid insurance were independently associated with greater CSM.
Conclusions: Higher ADI was associated with increased CSM in our cohort. Evaluating socioeconomic context in NMIBC care may inform follow-up and therapy and, potentially, influence progression and mortality.
{"title":"Area deprivation and cancer-specific mortality in non-muscle-invasive bladder cancer: a statewide analysis.","authors":"Carlo Silvani, Alfonso Santangelo, Jack Considine, Anna Tylecki, Alex Stephens, Adam Mssika, Benjamin Robinson, Sebastiano Nazzani, Alberto Briganti, Andrea Salonia, Francesco Montorsi, Akshay Sood, Nicola Nicolai, Emanuele Montanari, Craig Rogers, Firas Abdollah","doi":"10.1111/bju.70151","DOIUrl":"https://doi.org/10.1111/bju.70151","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether neighbourhood socioeconomic deprivation, measured by the Area Deprivation Index (ADI), is associated with cancer-specific mortality (CSM) in patients with non-muscle-invasive bladder cancer (NMIBC).</p><p><strong>Patients and methods: </strong>We retrospectively reviewed patients with NMIBC (T stage <2, node-negative, non-metastatic) from Michigan Cancer Surveillance Program (2004-2019). ADI national percentiles were assigned based on residential census block groups and stratified into quartiles, with the fourth quartile (ADI 75-100) being the most deprived. Cumulative incidence functions compared CSM between quartiles, and competing-risk regression analysis assessed the association between ADI and CSM after adjusting for covariates.</p><p><strong>Results: </strong>Among 19 722 patients (92.2% non-Hispanic White; median [interquartile range] age 72 [64-80] years; 76.7% male), most resided in metropolitan areas (81%) and 61% were married. Overall, 8.5%, 26.4%, 34.9%, and 30.2% of patients were in the first, second, third, and fourth ADI quartile, respectively. At 10 years, the cumulative incidence of CSM was 7.3%, 7.9%, 8.7%, and 9.7% across the first-fourth quartiles, respectively (P = 0.002). At the competing risk analysis, each 25-point increase in ADI was associated with a 6% higher hazard of CSM (95% confidence interval 1.01-1.12; P = 0.032). Older age, higher T stage, unmarried status, and Medicaid insurance were independently associated with greater CSM.</p><p><strong>Conclusions: </strong>Higher ADI was associated with increased CSM in our cohort. Evaluating socioeconomic context in NMIBC care may inform follow-up and therapy and, potentially, influence progression and mortality.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamad Abou Chakra,Ian M McElree,Sarah L Mott,Michael A O'Donnell
OBJECTIVESTo compare oncological outcomes between intravesical bacillus Calmette-Guérin (BCG) and gemcitabine/docetaxel (Gem/Doce) in patients with primary high-grade (HG) Ta non-muscle-invasive bladder cancer (NMIBC) and assess the prognostic utility of the American Urological Association (AUA) risk stratification system, which classifies these tumours as intermediate risk (IR) or high risk (HR).PATIENTS AND METHODSRetrospective cohort of 128 treatment-naïve patients with HG Ta NMIBC treated from January 2011 to December 2024 was analysed. After resection, patients received intravesical therapy with either BCG (n = 65) or Gem/Doce (n = 63), with Gem/Doce on a 24-month maintenance schedule and BCG at 3, 9, and 15 months. Cox regression models evaluated the impact of patient, disease, and treatment characteristics on oncological outcomes.RESULTSThe follow-up was longer in the BCG group (median [interquartile range, IQR] 81 [44-113] months) than in the Gem/Doce group (median [IQR] 37 [26-55] months). Recurrence-free survival (RFS) at 12 and 24 months was 80% and 76% for Gem/Doce, and 76% and 70% for BCG, respectively. HG-RFS at 12 and 24 months was 82% and 78% for Gem/Doce, and 79% and 75% for BCG, respectively. The 24-month progression-free survival was 100% for Gem/Doce and 91% for BCG. There were no significant associations between AUA risk classification (IR vs HR; hazard ratio 1.05, P = 0.89 for RFS; hazard ratio 1.12, P = 0.75 for HG-RFS) or treatment type (BCG vs Gem/Doce; hazard ratio 1.19, P = 0.60 for RFS; hazard ratio 1.02, P = 0.96 for HG-RFS) and recurrence outcomes. Adverse events were less frequent with Gem/Doce than BCG (40% vs 46%), with no Grade III events in the Gem/Doce group.CONCLUSIONTreatment with Gem/Doce is a well-tolerated, effective alternative to BCG for HG Ta NMIBC. In this subset, AUA risk stratification (IR vs HR) was not significantly associated with recurrence outcomes, warranting prospective validation.
目的比较膀胱内卡介子-古萨林（BCG）和吉西他滨/多西他赛（Gem/Doce）治疗原发性高级别（HG） Ta非肌肉浸润性膀胱癌（NMIBC）患者的肿瘤预后，并评估美国泌尿学会（AUA）风险分层系统的预后价值，该系统将这些肿瘤分为中度风险（IR）和高风险（HR）。患者与方法回顾性分析2011年1月至2024年12月接受治疗的128例treatment-naïve HG Ta NMIBC患者。切除后，患者接受BCG （n = 65）或Gem/Doce （n = 63）的膀胱内治疗，Gem/Doce维持24个月，BCG维持3、9和15个月。Cox回归模型评估了患者、疾病和治疗特征对肿瘤预后的影响。结果BCG组随访时间较Gem/Doce组长（中位[四分位间距，IQR] 81[44-113]个月），中位[IQR] 37[26-55]个月。Gem/Doce组12个月和24个月的无复发生存率（RFS）分别为80%和76%，BCG组为76%和70%。Gem/Doce组12个月和24个月的HG-RFS分别为82%和78%，BCG组为79%和75%。Gem/Doce的24个月无进展生存率为100%，BCG为91%。AUA风险分类（IR vs HR；风险比1.05，RFS为P = 0.89；风险比1.12，HG-RFS为P = 0.75）或治疗类型（BCG vs Gem/Doce；风险比1.19，RFS为P = 0.60；风险比1.02，HG-RFS为P = 0.96）与复发结果无显著相关性。Gem/Doce组的不良事件发生率低于BCG组（40% vs 46%）， Gem/Doce组无III级不良事件。结论Gem/Doce治疗HG Ta NMIBC是一种耐受性良好、有效的替代BCG治疗方法。在这个子集中，AUA风险分层（IR vs HR）与复发结果没有显著相关，需要前瞻性验证。
{"title":"Impact of American Urological Association risk category on outcomes of intravesical BCG vs gemcitabine/docetaxel in high-grade Ta non-muscle-invasive bladder cancer.","authors":"Mohamad Abou Chakra,Ian M McElree,Sarah L Mott,Michael A O'Donnell","doi":"10.1111/bju.70149","DOIUrl":"https://doi.org/10.1111/bju.70149","url":null,"abstract":"OBJECTIVESTo compare oncological outcomes between intravesical bacillus Calmette-Guérin (BCG) and gemcitabine/docetaxel (Gem/Doce) in patients with primary high-grade (HG) Ta non-muscle-invasive bladder cancer (NMIBC) and assess the prognostic utility of the American Urological Association (AUA) risk stratification system, which classifies these tumours as intermediate risk (IR) or high risk (HR).PATIENTS AND METHODSRetrospective cohort of 128 treatment-naïve patients with HG Ta NMIBC treated from January 2011 to December 2024 was analysed. After resection, patients received intravesical therapy with either BCG (n = 65) or Gem/Doce (n = 63), with Gem/Doce on a 24-month maintenance schedule and BCG at 3, 9, and 15 months. Cox regression models evaluated the impact of patient, disease, and treatment characteristics on oncological outcomes.RESULTSThe follow-up was longer in the BCG group (median [interquartile range, IQR] 81 [44-113] months) than in the Gem/Doce group (median [IQR] 37 [26-55] months). Recurrence-free survival (RFS) at 12 and 24 months was 80% and 76% for Gem/Doce, and 76% and 70% for BCG, respectively. HG-RFS at 12 and 24 months was 82% and 78% for Gem/Doce, and 79% and 75% for BCG, respectively. The 24-month progression-free survival was 100% for Gem/Doce and 91% for BCG. There were no significant associations between AUA risk classification (IR vs HR; hazard ratio 1.05, P = 0.89 for RFS; hazard ratio 1.12, P = 0.75 for HG-RFS) or treatment type (BCG vs Gem/Doce; hazard ratio 1.19, P = 0.60 for RFS; hazard ratio 1.02, P = 0.96 for HG-RFS) and recurrence outcomes. Adverse events were less frequent with Gem/Doce than BCG (40% vs 46%), with no Grade III events in the Gem/Doce group.CONCLUSIONTreatment with Gem/Doce is a well-tolerated, effective alternative to BCG for HG Ta NMIBC. In this subset, AUA risk stratification (IR vs HR) was not significantly associated with recurrence outcomes, warranting prospective validation.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"9 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Logan G Briggs,Sara C Parke,Vikram S Gill,Matthew J Van Ligten,Kelsey L Beck,Debarshi Sinha,Khalid Y Alkhatib,Mouneeb M Choudry,Paul A Bain,Jaxon Quillen,Christopher A Dodoo,Phillip Pierorazio,Haidar Abdul-Muhsin,Paul E Andrews,Quoc-Dien Trinh,Sarah P Psutka
OBJECTIVESTo comprehensively review the available literature on prehabilitation and rehabilitation exercise, nutrition, and psychological support interventions for patients with kidney cancer (KC), to summarise the clinically relevant efficacy and cost-effectiveness of interventions, to expose key knowledge gaps, and to inform future investigations and initiatives.METHODSThis review was performed according to the per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews Guidelines. We included randomised controlled trials (RCTs) assessing programmes of prehabilitation or rehabilitation, exercise, psychological support, or nutrition components in patients with KC or KC caregivers from January 2004 to March 2022. Statistically significant positive (SS+) and negative (SS-) results were summarised.RESULTSThe systematic search yielded 10 968 records including 18 RCTs, involving 2774 unique subjects, 706 of whom were KC patients/survivors. None included caregivers or assessed cost-effectiveness. Two interventions were implemented before surgery, one was implemented prior to initiation of systemic therapy, eight were implemented during systemic or radiation therapy, three were implemented after treatment, while implementation time was not specified for four interventions.CONCLUSIONMost (14/18) RCTs involving exercise, nutrition, psychological support, or prehabilitative or rehabilitative programmes for KC performed to date demonstrated SS+ results. The evidence was most robust regarding previously evaluated psychological support, especially mindfulness-based interventions (9/10 studies demonstrating SS+ improvement in primary outcomes), followed by therapeutically valid exercise with/without psychological support (5/8 RCTs demonstrated efficacy), then nutrition or pharmacological interventions (2/5 demonstrated efficacy). Level 1 evidence supports counselling patients and referral to mindfulness-based psychological therapy along with physical therapy or physical medicine and rehabilitation, as well as consideration of preoperative carbohydrate drinks. No studies have examined impact on caregivers, or cost-effectiveness, which are both critical areas for future study.
{"title":"Exercise, nutrition, and psychological support for kidney cancer: a scoping review.","authors":"Logan G Briggs,Sara C Parke,Vikram S Gill,Matthew J Van Ligten,Kelsey L Beck,Debarshi Sinha,Khalid Y Alkhatib,Mouneeb M Choudry,Paul A Bain,Jaxon Quillen,Christopher A Dodoo,Phillip Pierorazio,Haidar Abdul-Muhsin,Paul E Andrews,Quoc-Dien Trinh,Sarah P Psutka","doi":"10.1111/bju.70134","DOIUrl":"https://doi.org/10.1111/bju.70134","url":null,"abstract":"OBJECTIVESTo comprehensively review the available literature on prehabilitation and rehabilitation exercise, nutrition, and psychological support interventions for patients with kidney cancer (KC), to summarise the clinically relevant efficacy and cost-effectiveness of interventions, to expose key knowledge gaps, and to inform future investigations and initiatives.METHODSThis review was performed according to the per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews Guidelines. We included randomised controlled trials (RCTs) assessing programmes of prehabilitation or rehabilitation, exercise, psychological support, or nutrition components in patients with KC or KC caregivers from January 2004 to March 2022. Statistically significant positive (SS+) and negative (SS-) results were summarised.RESULTSThe systematic search yielded 10 968 records including 18 RCTs, involving 2774 unique subjects, 706 of whom were KC patients/survivors. None included caregivers or assessed cost-effectiveness. Two interventions were implemented before surgery, one was implemented prior to initiation of systemic therapy, eight were implemented during systemic or radiation therapy, three were implemented after treatment, while implementation time was not specified for four interventions.CONCLUSIONMost (14/18) RCTs involving exercise, nutrition, psychological support, or prehabilitative or rehabilitative programmes for KC performed to date demonstrated SS+ results. The evidence was most robust regarding previously evaluated psychological support, especially mindfulness-based interventions (9/10 studies demonstrating SS+ improvement in primary outcomes), followed by therapeutically valid exercise with/without psychological support (5/8 RCTs demonstrated efficacy), then nutrition or pharmacological interventions (2/5 demonstrated efficacy). Level 1 evidence supports counselling patients and referral to mindfulness-based psychological therapy along with physical therapy or physical medicine and rehabilitation, as well as consideration of preoperative carbohydrate drinks. No studies have examined impact on caregivers, or cost-effectiveness, which are both critical areas for future study.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paulo Gustavo Bergerot, Cristiane Decat Bergerot, Kathryn H. Schmitz, Sumanta Pal
{"title":"Enhancing quality of life in patients with prostate cancer through a remote exercise programme","authors":"Paulo Gustavo Bergerot, Cristiane Decat Bergerot, Kathryn H. Schmitz, Sumanta Pal","doi":"10.1111/bju.70152","DOIUrl":"https://doi.org/10.1111/bju.70152","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"30 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paolo Zaurito, Hans Garmo, Rolf Gedeborg, Mats Alhberg, Stefan Carlsson, Camilla Thellenberg, David Robinson, Pär Stattin, Marcus Westerberg
To estimate risk of prostate-specific antigen (PSA) relapse after radical radiotherapy (RT) for prostate cancer (PCa), and risk of PCa death after relapse according to Gleason score and time to relapse.
{"title":"Incidence and prognostic implications of PSA relapse after radical radiotherapy for prostate cancer: a population-based study","authors":"Paolo Zaurito, Hans Garmo, Rolf Gedeborg, Mats Alhberg, Stefan Carlsson, Camilla Thellenberg, David Robinson, Pär Stattin, Marcus Westerberg","doi":"10.1111/bju.70148","DOIUrl":"https://doi.org/10.1111/bju.70148","url":null,"abstract":"To estimate risk of prostate-specific antigen (PSA) relapse after radical radiotherapy (RT) for prostate cancer (PCa), and risk of PCa death after relapse according to Gleason score and time to relapse.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"261 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pietro Piazza, Attilio Barretta, Carlo Andrea Bravi, Angelo Mottaran, Luca Sarchi, Marco Paciotti, Sophie Knipper, Stefano Puliatti, Marco Amato, Rui Farinha, Edoardo Beatrici, Maria Peraire Lores, Giovanni Enrico Cacciamani, Edward Lambert, Ruben De Groote, Geert De Naeyer, Frederiek D'Hondt, Riccardo Schiavina, Alexandre Mottrie
Objectives To evaluate whether cumulative smoking exposure and time since cessation are associated with perioperative morbidity after robot‐assisted radical cystectomy (RARC). Patients and Methods We retrospectively analysed 475 patients who underwent RARC with urinary diversion at a high‐volume tertiary centre between 2004 and 2024. Outcomes of interest were postoperative early complications, postoperative readmission, overall risk of postoperative morbidity according to smoking status, cumulative smoking exposure, and time since smoking cessation. Multivariable logistic regressions were performed to explore the effect of smoking status, cumulative smoking exposure, and time since smoking cessation on perioperative morbidity after RARC. The locally estimated scatterplot smoothing (LOESS) function was used to graphically explore this relationship. Results Early complications occurred in 60% of current smokers, 50% of former smokers, and 37% of never smokers. Compared with never smokers, former (odds ratio [OR] 3.83, 95% confidence interval [CI] 1.73–9.38) and current smokers (OR 6.75, 95% CI 2.85–12.40) had significantly higher odds of perioperative morbidity. Each 10 additional pack‐years increased complication risk (OR 1.20, 95% CI 1.05–1.40), whereas each year since cessation reduced risk (OR 0.84, 95% CI 0.76–0.91). The LOESS curves showed a steadily increasing risk with cumulative exposure and a gradual decline following cessation. Conclusion Both lifetime smoking burden and time since cessation are strong and independent predictors of perioperative morbidity after RARC. Evaluating smoking exposure as a continuous variable improves risk stratification and provides more accurate information for preoperative counselling in patients undergoing RC.
目的评估机器人辅助根治性膀胱切除术（RARC）后，累计吸烟暴露和戒烟时间是否与围手术期发病率相关。患者和方法我们回顾性分析了2004年至2024年间在大容量三级中心接受RARC伴尿分流的475例患者。研究的结果包括术后早期并发症、术后再入院、根据吸烟状况、累计吸烟暴露和戒烟时间确定的术后总发病率。采用多变量logistic回归探讨吸烟状况、累计吸烟暴露和戒烟时间对RARC术后围手术期发病率的影响。使用局部估计的散点图平滑（黄土）函数来图形化地探索这种关系。结果60%的吸烟者、50%的戒烟者和37%的从不吸烟者出现早期并发症。与从不吸烟者相比，既往吸烟者（优势比[OR] 3.83, 95%可信区间[CI] 1.73-9.38）和当前吸烟者（优势比[OR] 6.75, 95%可信区间[CI] 2.85-12.40）围手术期发病率显著高于既往吸烟者。每增加10包年并发症风险增加（OR 1.20, 95% CI 1.05-1.40），而戒烟后每增加一年并发症风险降低（OR 0.84, 95% CI 0.76-0.91）。黄土曲线显示，随着暴露的累积，风险稳步增加，戒烟后风险逐渐下降。结论终生吸烟负担和戒烟时间是RARC术后围手术期发病率的独立预测因素。将吸烟暴露作为一个连续变量进行评估可以改善风险分层，并为接受RC的患者提供更准确的术前咨询信息。
{"title":"Impact of cumulative smoking exposure on morbidity after robot‐assisted radical cystectomy","authors":"Pietro Piazza, Attilio Barretta, Carlo Andrea Bravi, Angelo Mottaran, Luca Sarchi, Marco Paciotti, Sophie Knipper, Stefano Puliatti, Marco Amato, Rui Farinha, Edoardo Beatrici, Maria Peraire Lores, Giovanni Enrico Cacciamani, Edward Lambert, Ruben De Groote, Geert De Naeyer, Frederiek D'Hondt, Riccardo Schiavina, Alexandre Mottrie","doi":"10.1111/bju.70147","DOIUrl":"https://doi.org/10.1111/bju.70147","url":null,"abstract":"Objectives To evaluate whether cumulative smoking exposure and time since cessation are associated with perioperative morbidity after robot‐assisted radical cystectomy (RARC). Patients and Methods We retrospectively analysed 475 patients who underwent RARC with urinary diversion at a high‐volume tertiary centre between 2004 and 2024. Outcomes of interest were postoperative early complications, postoperative readmission, overall risk of postoperative morbidity according to smoking status, cumulative smoking exposure, and time since smoking cessation. Multivariable logistic regressions were performed to explore the effect of smoking status, cumulative smoking exposure, and time since smoking cessation on perioperative morbidity after RARC. The locally estimated scatterplot smoothing (LOESS) function was used to graphically explore this relationship. Results Early complications occurred in 60% of current smokers, 50% of former smokers, and 37% of never smokers. Compared with never smokers, former (odds ratio [OR] 3.83, 95% confidence interval [CI] 1.73–9.38) and current smokers (OR 6.75, 95% CI 2.85–12.40) had significantly higher odds of perioperative morbidity. Each 10 additional pack‐years increased complication risk (OR 1.20, 95% CI 1.05–1.40), whereas each year since cessation reduced risk (OR 0.84, 95% CI 0.76–0.91). The LOESS curves showed a steadily increasing risk with cumulative exposure and a gradual decline following cessation. Conclusion Both lifetime smoking burden and time since cessation are strong and independent predictors of perioperative morbidity after RARC. Evaluating smoking exposure as a continuous variable improves risk stratification and provides more accurate information for preoperative counselling in patients undergoing RC.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"46 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145955135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Cei,Daniele Cignoli,Irene Franco,Koon Ho Rha,Christian Wagner,Alexander Kutikov,James Porter,Ben Chalacombe,Ketan Badani,Eduard Roussel,Riccardo Bertolo,Alessandro Antonelli,Riccardo Schiavina,Attilio Barretta,Karim Bensalah,Xu Zhang,Ithaar Derweesh,Ruben De Groote,Geert De Naeyer,Alexandre Mottrie,Alberto Breda,Andrea Minervini,Riccardo Campi,Andrea Salonia,Alberto Briganti,Francesco Montorsi,Umberto Capitanio,Alessandro Larcher
OBJECTIVESTo explore the effects of ischaemia time (IT) in a multicentre cohort of patients with solitary kidney (SK), treated with partial nephrectomy (PN) for a renal mass, on short- and long-term kidney function, haemorrhagic risk and pathological outcomes.METHODSThis is an observational study of 426 patients with SK treated with on- and off-clamp PN for a single cT1-3 N0M0 renal mass from 2000 to 2023 at 19 global institutions. The primary outcomes were postoperative and 1-year renal function. The secondary outcomes of the study were haemorrhagic risk, defined as estimated blood loss (EBL) and peri-operative transfusions, and presence of positive surgical margins. The effect of IT and arterial clamping strategy was estimated using linear and logistic regressions for continuous and categorical outcomes, respectively.RESULTSOn-clamp PN was performed in 56% of patients (n = 237). The median (interquartile range [IQR]) age, body mass index, preoperative estimated glomerular filtration rate (eGFR), clinical size and PADUA score were 65 (58-71) years, 27 (24-29) kg/m2, 58 (45-46) mL/min, 3 (2-4.2) cm and 8 (7-10), respectively. The median (IQR) duration of IT was 19 (13-25) min. In multivariable linear and logistic regression analyses (MVA), IT was not associated with decreased postoperative eGFR (estimate -0.08 mL/min; P = 0.3) or 1-year eGFR (estimate -0.1 mL/min; P = 0.2). No association between on-clamp strategy and eGFR decline was recorded either postoperatively (estimate -3.11 mL/min; P = 0.1) or at 1 year (estimate -3.12 mL/min; P = 0.1). The median (IQR) EBL was lower in the on-clamp group at 200 (100-400) mL vs 300 (145-500) mL in the off-clamp group. In MVA predicting haemorrhagic risk, arterial clamping was associated with lower risk of transfusions (odds ratio 0.45; P = 0.01).CONCLUSIONSIn patients with SK, on-clamp PN did not affect long-term renal function and was associated with a modestly lower need for peri-operative transfusion. The routine use of the off-clamp technique is therefore not supported by these findings, although its selective application may remain appropriate in cases with a high risk of renal function decline.
目的：探讨局部肾切除术（PN）治疗肾肿块的孤立肾（SK）患者的缺血时间（IT）对短期和长期肾功能、出血风险和病理结果的影响。方法：这是一项观察性研究，来自19家全球机构，从2000年到2023年，426例SK患者接受了cT1-3 N0M0肾肿块的钳上和钳下PN治疗。主要结局是术后和1年的肾功能。该研究的次要结果是出血风险，定义为估计失血量（EBL）和围手术期输血，以及手术切缘阳性。分别使用线性和逻辑回归对连续和分类结果进行估计IT和动脉夹持策略的影响。结果56%的患者（n = 237）接受了钳上PN术。年龄、体重指数、术前估计肾小球滤过率（eGFR）、临床尺寸和PADUA评分的中位数（四分位间距[IQR]）分别为65（58-71）岁、27 (24-29)kg/m2、58 (45-46)mL/min、3 (2-4.2)cm和8（7-10）。IT的中位（IQR）持续时间为19（13-25）分钟。在多变量线性和逻辑回归分析（MVA）中，IT与术后eGFR（估计-0.08 mL/min; P = 0.3）或1年eGFR（估计-0.1 mL/min; P = 0.2）降低无关。术后（估计-3.11 mL/min; P = 0.1）或1年后（估计-3.12 mL/min; P = 0.1）均未记录钳上策略与eGFR下降之间的关联。钳上组的中位（IQR） EBL为200 (100-400)mL，低于钳下组的300 (145-500)mL。在MVA预测出血风险时，动脉夹持与输血风险较低相关（优势比0.45;P = 0.01）。结论：在SK患者中，钳上PN不影响长期肾功能，且与围手术期输血需求的适度降低相关。因此，这些发现不支持常规使用脱钳技术，尽管在肾功能下降风险高的病例中选择性应用可能仍然是合适的。
{"title":"Impact of ischaemia duration and clamping strategy in patients with solitary kidney undergoing partial nephrectomy.","authors":"Francesco Cei,Daniele Cignoli,Irene Franco,Koon Ho Rha,Christian Wagner,Alexander Kutikov,James Porter,Ben Chalacombe,Ketan Badani,Eduard Roussel,Riccardo Bertolo,Alessandro Antonelli,Riccardo Schiavina,Attilio Barretta,Karim Bensalah,Xu Zhang,Ithaar Derweesh,Ruben De Groote,Geert De Naeyer,Alexandre Mottrie,Alberto Breda,Andrea Minervini,Riccardo Campi,Andrea Salonia,Alberto Briganti,Francesco Montorsi,Umberto Capitanio,Alessandro Larcher","doi":"10.1111/bju.70146","DOIUrl":"https://doi.org/10.1111/bju.70146","url":null,"abstract":"OBJECTIVESTo explore the effects of ischaemia time (IT) in a multicentre cohort of patients with solitary kidney (SK), treated with partial nephrectomy (PN) for a renal mass, on short- and long-term kidney function, haemorrhagic risk and pathological outcomes.METHODSThis is an observational study of 426 patients with SK treated with on- and off-clamp PN for a single cT1-3 N0M0 renal mass from 2000 to 2023 at 19 global institutions. The primary outcomes were postoperative and 1-year renal function. The secondary outcomes of the study were haemorrhagic risk, defined as estimated blood loss (EBL) and peri-operative transfusions, and presence of positive surgical margins. The effect of IT and arterial clamping strategy was estimated using linear and logistic regressions for continuous and categorical outcomes, respectively.RESULTSOn-clamp PN was performed in 56% of patients (n = 237). The median (interquartile range [IQR]) age, body mass index, preoperative estimated glomerular filtration rate (eGFR), clinical size and PADUA score were 65 (58-71) years, 27 (24-29) kg/m2, 58 (45-46) mL/min, 3 (2-4.2) cm and 8 (7-10), respectively. The median (IQR) duration of IT was 19 (13-25) min. In multivariable linear and logistic regression analyses (MVA), IT was not associated with decreased postoperative eGFR (estimate -0.08 mL/min; P = 0.3) or 1-year eGFR (estimate -0.1 mL/min; P = 0.2). No association between on-clamp strategy and eGFR decline was recorded either postoperatively (estimate -3.11 mL/min; P = 0.1) or at 1 year (estimate -3.12 mL/min; P = 0.1). The median (IQR) EBL was lower in the on-clamp group at 200 (100-400) mL vs 300 (145-500) mL in the off-clamp group. In MVA predicting haemorrhagic risk, arterial clamping was associated with lower risk of transfusions (odds ratio 0.45; P = 0.01).CONCLUSIONSIn patients with SK, on-clamp PN did not affect long-term renal function and was associated with a modestly lower need for peri-operative transfusion. The routine use of the off-clamp technique is therefore not supported by these findings, although its selective application may remain appropriate in cases with a high risk of renal function decline.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"385 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joost van Drumpt,Diederik Baas,Katja Aben,Arno van Leenders,Lambertus Kiemeney,Michiel Sedelaar,Peter Mulders,Jean-Paul van Basten,Inge van Oort,Berdine Heesterman,Diederik Somford
OBJECTIVESTo evaluate the impact of the presence, extent and location of positive surgical margins (PSMs) on the risk of biochemical recurrence (BCR) and metastases in a nationwide cohort of patients who underwent radical prostatectomy (RP) and had 5 years of follow-up.METHODSAll patients diagnosed with prostate cancer in the Netherlands between October 2015 and April 2016 who underwent RP were included in a prospective cohort. Data on these patients from the Netherlands Cancer Registry and the PALGA pathology registry were analysed. BCR was defined as a prostate-specific antigen (PSA) level ≥0.1 ng/mL >28 days after RP. Exclusion criteria were (neo)adjuvant treatment, pN1 disease, and salvage therapy initiated at PSA <0.1 μg/L. Multivariable Cox regression analyses were performed to evaluate the impact of PSM presence, extent and location on the risk of BCR and metastases.RESULTSOf 998 patients, 311 (31%) had PSMs (median length 5.0 mm). Over 5 years of follow-up, 36% of patients experienced BCR and 11% developed metastases. PSMs ≥3 mm were associated with a significantly increased risk of BCR (hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.58-2.64; P < 0.001) and metastases (HR 2.12, 95% CI 1.21-3.74; P = 0.009) compared to negative surgical margins. By contrast, PSMs <3 mm and PSM location did not significantly increase the risk of BCR or metastases.CONCLUSIONOur study showed that PSMs ≥3 mm appear to be independently associated with an increased risk of BCR and metastases after RP. Therefore, avoiding or limiting the extent of PSMs during RP remains essential.
目的评估在全国范围内接受根治性前列腺切除术（RP）并随访5年的患者中，阳性手术切缘（psm）的存在、范围和位置对生化复发（BCR）和转移风险的影响。方法：2015年10月至2016年4月期间在荷兰诊断为前列腺癌并接受RP的所有患者纳入前瞻性队列。对来自荷兰癌症登记处和PALGA病理登记处的这些患者的数据进行分析。BCR定义为RP后28天前列腺特异性抗原（PSA）水平≥0.1 ng/mL。排除标准为（neo）辅助治疗、pN1疾病和PSA <0.1 μg/L时开始的补救性治疗。采用多变量Cox回归分析评估PSM的存在、程度和位置对BCR和转移风险的影响。结果998例患者中，311例（31%）有psm（中位长度5.0 mm）。在5年的随访中，36%的患者发生BCR， 11%的患者发生转移。与手术切缘阴性患者相比，psm≥3 mm与BCR（风险比[HR] 2.04, 95%可信区间[CI] 1.58-2.64; P < 0.001）和转移（风险比[HR] 2.12, 95% CI 1.21-3.74; P = 0.009）的风险显著增加相关。相比之下，PSM < 3mm和PSM位置并没有显著增加BCR或转移的风险。结论：我们的研究表明，psm≥3mm似乎与RP后BCR和转移风险增加独立相关。因此，在RP期间避免或限制psm的程度仍然是必不可少的。
{"title":"Impact of positive surgical margins on biochemical recurrence and metastases after radical prostatectomy.","authors":"Joost van Drumpt,Diederik Baas,Katja Aben,Arno van Leenders,Lambertus Kiemeney,Michiel Sedelaar,Peter Mulders,Jean-Paul van Basten,Inge van Oort,Berdine Heesterman,Diederik Somford","doi":"10.1111/bju.70136","DOIUrl":"https://doi.org/10.1111/bju.70136","url":null,"abstract":"OBJECTIVESTo evaluate the impact of the presence, extent and location of positive surgical margins (PSMs) on the risk of biochemical recurrence (BCR) and metastases in a nationwide cohort of patients who underwent radical prostatectomy (RP) and had 5 years of follow-up.METHODSAll patients diagnosed with prostate cancer in the Netherlands between October 2015 and April 2016 who underwent RP were included in a prospective cohort. Data on these patients from the Netherlands Cancer Registry and the PALGA pathology registry were analysed. BCR was defined as a prostate-specific antigen (PSA) level ≥0.1 ng/mL >28 days after RP. Exclusion criteria were (neo)adjuvant treatment, pN1 disease, and salvage therapy initiated at PSA <0.1 μg/L. Multivariable Cox regression analyses were performed to evaluate the impact of PSM presence, extent and location on the risk of BCR and metastases.RESULTSOf 998 patients, 311 (31%) had PSMs (median length 5.0 mm). Over 5 years of follow-up, 36% of patients experienced BCR and 11% developed metastases. PSMs ≥3 mm were associated with a significantly increased risk of BCR (hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.58-2.64; P < 0.001) and metastases (HR 2.12, 95% CI 1.21-3.74; P = 0.009) compared to negative surgical margins. By contrast, PSMs <3 mm and PSM location did not significantly increase the risk of BCR or metastases.CONCLUSIONOur study showed that PSMs ≥3 mm appear to be independently associated with an increased risk of BCR and metastases after RP. Therefore, avoiding or limiting the extent of PSMs during RP remains essential.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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