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The impact of progression-directed therapy on survival in metastatic castration-refractory prostate cancer: MEDCARE phase 3 trial. 进展导向疗法对转移性难治性前列腺癌患者生存期的影响:MEDCARE 3期试验。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-06 DOI: 10.1111/bju.16574
Kato Rans, Karolien Goffin, Steven Joniau, Gedske Daugaard, Julie den Hartog, Lodewijk Van Wynsberge, Gert De Meerleer

Background: Metastatic castration-refractory prostate cancer (mCRPC) presents a therapeutic challenge despite advancements in treatment. Once mCRPC is attained, patients face limited survival prospects. Next-line systemic treatment (NEST) is the standard of care for progressive mCRPC, encompassing various therapeutic options with associated toxicity and costs. In patients with oligoprogressive mCRPC, data suggest that progression-directed therapy (PDT), such as metastasectomy or stereotactic body radiotherapy, delays the initiation of NEST.

Methods and design: The MEDCARE phase III trial aims to assess the impact of PDT on overall survival (OS) in oligoprogressive mCRPC. In this multicentric, randomised, prospective trial, we aim to randomise 246 patients in 1:1 allocation ratio between the standard-of-care therapy (surveillance or NEST) or PDT while continuing the current systemic treatment. Patients will be stratified based on number of progressive lesions (one vs ≥one), location of progressive lesions (local recurrence, N or M1a vs M1b or M1c) and previous systemic therapy (palliative androgen-deprivation therapy [pADT] vs pADT + androgen receptor-targeted agent or patients who received docetaxel in the past). The primary endpoint is OS, and the secondary endpoints include quality of life, radiographic progression-free survival (PFS), modified PFS, prostate cancer-specific survival and PDT-induced toxicity.

Discussion: This is the first randomised phase 3 trial in the setting of PDT in patients with oligoprogressive mCRPC with OS as the primary endpoint.

背景:尽管治疗手段不断进步,但转移性难治性前列腺癌(mCRPC)仍是一项治疗难题。一旦患上mCRPC,患者的生存前景十分有限。下线系统治疗(NEST)是进展期mCRPC的标准治疗方法,包括各种治疗方案,但都有相关的毒性和费用。对于少进展期mCRPC患者,有数据表明,转移灶切除术或立体定向体放疗等进展导向疗法(PDT)可延迟NEST的启动:MEDCAREⅢ期试验旨在评估PDT对少进展mCRPC患者总生存期(OS)的影响。在这项多中心、随机、前瞻性试验中,我们旨在以 1:1 的分配比例随机分配 246 名患者,让他们接受标准治疗(监测或 NEST)或 PDT,同时继续接受当前的系统治疗。患者将根据进展病灶的数量(一个 vs ≥一个)、进展病灶的位置(局部复发、N或M1a vs M1b或M1c)和既往接受过的系统治疗(姑息性雄激素剥夺疗法 [pADT] vs pADT + 雄激素受体靶向药物或既往接受过多西他赛治疗的患者)进行分层。主要终点为OS,次要终点包括生活质量、放射学无进展生存期(PFS)、改良PFS、前列腺癌特异性生存期和PDT诱导的毒性:这是首个以OS为主要终点的PDT治疗少进展mCRPC患者的随机3期试验。
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引用次数: 0
Response to Takahashi. 回应高桥。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-06 DOI: 10.1111/bju.16581
Zen Yang Ang, Yuke-Lin Kong, Zarith Nameyrra Md Nesran, Shaun Wen Huey Lee
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引用次数: 0
A luminal non-coding RNA-based genomic classifier confirms favourable outcomes in patients with clinically organ-confined bladder cancer treated with radical cystectomy. 基于腔内非编码 RNA 的基因组分类器证实,采用根治性膀胱切除术治疗的临床器官局限性膀胱癌患者疗效良好。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1111/bju.16572
Joep J de Jong, James A Proudfoot, Siamak Daneshmand, Robert S Svatek, Vikram Naryan, Ewan A Gibb, Elai Davicioni, Shreyas Joshi, Aaron Dahmen, Roger Li, Brant A Inman, Paras Shah, Iftach Chaplin, Jonathan Wright, Yair Lotan

Objective: To further evaluate a genomic classifier (GC) in a cohort of patients undergoing radical cystectomy (RC), as long non-coding RNA (lncRNA)-based genomic profiling has suggested utility in identifying a distinct tumour subgroup corresponding to a favourable prognosis in patients with bladder cancer.

Patients and methods: Transcriptome-wide expression profiling using Decipher Bladder was performed on transurethral resection of bladder tumour samples from a cohort of patients with high-grade, clinically organ-confined (cTa-T2N0M0) urothelial carcinoma (UC) who subsequently underwent RC without any neoadjuvant therapy (n = 226). The lncRNA-based luminal favourable status was determined using a previously developed GC. The primary endpoint was overall survival (OS) after RC. Secondary endpoints included cancer-specific mortality and upstaging at RC.

Results: In the study, 134 patients were clinical non-muscle-invasive bladder cancer (cTa/Tis/T1) and 92 patients were cT2. We identified 60 patients with luminal favourable subtype, all of which showed robust gene expression patterns associated with less aggressive bladder cancer biology. On multivariate analysis, patients with the luminal favourable subtype (vs without) were significantly associated with lower odds of upstaging to pathological (p)T3+ disease (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.12-0.82; P = 0.02), any upstaging (OR 0.41, 95% CI 0.20-0.83; P = 0.01), and any upstaging and/or pN+ (OR 0.50, 95% CI 0.25-1.00; P = 0.05). Luminal favourable bladder cancer was significantly associated with better OS (hazard ratio 0.33, 95% CI 0.15-0.74; P = 0.007).

Conclusions: This study validates the performance of the GC for identifying UCs with a luminal favourable subtype, harbouring less aggressive tumour biology.

目的基于长非编码RNA(lncRNA)的基因组图谱分析表明,基因组分类器(GC)在接受根治性膀胱切除术(RC)的患者队列中可用于识别与膀胱癌患者良好预后相对应的独特肿瘤亚组:使用Decipher Bladder对经尿道切除的膀胱肿瘤样本进行了全转录组表达谱分析,样本来自一组高级别、临床器官局限性(cTa-T2N0M0)尿路上皮癌(UC)患者,这些患者随后接受了RC治疗,但未接受任何新辅助治疗(n = 226)。基于lncRNA的管腔有利状态是通过之前开发的GC来确定的。主要终点是RC后的总生存期(OS)。次要终点包括癌症特异性死亡率和 RC 分期:研究中,134 名患者为临床非肌层浸润性膀胱癌(cTa/Tis/T1),92 名患者为 cT2。我们发现了 60 例腔内有利亚型患者,所有这些患者都显示出与侵袭性较低的膀胱癌生物学相关的强大基因表达模式。在多变量分析中,管腔良好亚型患者(与无管腔良好亚型患者相比)的病理(p)T3+上行分期几率(几率比 [OR] 0.32,95% 置信区间 [CI] 0.12-0.82;P = 0.02)、任何上行分期(OR 0.41,95% CI 0.20-0.83;P = 0.01)以及任何上行分期和/或 pN+(OR 0.50,95% CI 0.25-1.00;P = 0.05)均显著降低。腔隙良好的膀胱癌与较好的OS显著相关(危险比0.33,95% CI 0.15-0.74;P = 0.007):这项研究验证了GC在鉴别腔隙性有利亚型膀胱癌方面的性能,腔隙性有利亚型膀胱癌的肿瘤生物学侵袭性较低。
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引用次数: 0
Unravelling the evolution of medical scientific publishing to hold the promise of science for better patient care. 揭开医学科学出版的演变之谜,让科学为更好的病人护理带来希望。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 DOI: 10.1111/bju.16573
Riccardo Bertolo, Riccardo Campi, Nicholas G Zaorsky, Alessandro Antonelli, Sergio Serni, Alessandro Crestani, Gianluca Giannarini
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引用次数: 0
Mortality rates in radical cystectomy patients with bladder cancer after radiation therapy for prostate cancer. 前列腺癌放射治疗后膀胱癌根治性切除术患者的死亡率。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-27 DOI: 10.1111/bju.16571
Mario de Angelis, Carolin Siech, Francesco Di Bello, Natali Rodriguez Peñaranda, Jordan A Goyal, Zhe Tian, Nicola Longo, Felix K H Chun, Stefano Puliatti, Fred Saad, Shahrokh F Shariat, Giorgio Gandaglia, Marco Moschini, Mattia Longoni, Francesco Montorsi, Alberto Briganti, Pierre I Karakiewicz

Objective: To conduct a population-based study examining cancer-specific mortality (CSM) and other-cause mortality (OCM) differences in patients with radiation-induced secondary bladder cancer (RT-BCa) vs those with primary bladder cancer (pBCa) undergoing radical cystectomy (RC).

Methods: Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients with T2-4N0-3M0 bladder cancer treated with RC, who had previously been treated with external beam radiation therapy (EBRT) or brachytherapy for prostate cancer, as well as patients with T2-4N0-3M0 pBCa treated with RC. Cumulative incidence plots and multivariable competing risks regression (CRR) models were used to assess CSM after additional adjustment for OCM. The same methodology was then repeated based on organ-confined (OC: T2N0M0) and non-organ-confined (NOC: T3-4 and/or N1-3) disease.

Results: Of 9957 RC patients, RT-BCa was identified in 347 (3%) compared with 9610 (97%) who had pBCa. In multivariable CRR models, no CSM differences were recorded in the overall comparison (P = 0.8), nor in sub-groups based on OC and NOC disease (P = 0.8 and 0.7, respectively). Conversely, multivariable CRR models identified RT-BCa as an independent predictor of 1.3-fold higher OCM in the overall cohort and of 1.5-fold higher OCM in those with NOC disease. In a sensitivity analysis of patients with NOC disease, EBRT was associated with higher OCM rates (hazard ratio 1.5). By contrast, OCM rates were not different in those with OC disease (P = 0.8).

Conclusion: Our study showed that RC for RT-BCa was associated with similar CSM rates as RC for pBCa, regardless of disease stage. However, patients who had undergone EBRT exhibited significantly higher OCM in the NOC sub-group.

目的开展一项基于人群的研究,探讨接受根治性膀胱切除术(RC)的辐射诱发继发性膀胱癌(RT-BCa)患者与原发性膀胱癌(pBCa)患者的癌症特异性死亡率(CSM)和其他原因死亡率(OCM)差异:在监测、流行病学和最终结果数据库(2004-2020 年)中,我们确定了接受根治性膀胱切除术治疗的 T2-4N0-3M0 膀胱癌患者,这些患者之前曾接受过前列腺癌体外放射治疗 (EBRT) 或近距离放射治疗,以及接受根治性膀胱切除术治疗的 T2-4N0-3M0 原发性膀胱癌患者。在对 OCM 进行额外调整后,使用累积发病率图和多变量竞争风险回归 (CRR) 模型评估 CSM。然后根据器官封闭(OC:T2N0M0)和非器官封闭(NOC:T3-4和/或N1-3)疾病重复相同的方法:结果:在9957例RC患者中,347例(3%)与9610例(97%)pBCa患者相比,发现了RT-BCa。在多变量 CRR 模型中,总体比较(P = 0.8)以及基于 OC 和 NOC 疾病的亚组(P = 0.8 和 0.7)均未发现 CSM 差异。相反,多变量 CRR 模型发现,RT-BCa 是一个独立的预测因素,可使总体队列中的 OCM 高出 1.3 倍,并使 NOC 疾病患者的 OCM 高出 1.5 倍。在对 NOC 疾病患者进行的敏感性分析中,EBRT 与较高的 OCM 率相关(危险比为 1.5)。相比之下,OC 疾病患者的 OCM 率没有差异(P = 0.8):我们的研究表明,无论疾病分期如何,RT-BCa 的 RC 与 pBCa 的 RC 的 CSM 率相似。然而,在 NOC 亚组中,接受过 EBRT 的患者的 OCM 明显更高。
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引用次数: 0
An international multicentre randomised controlled trial of en bloc resection of bladder tumour vs conventional transurethral resection of bladder tumour: first results of the en bloc resection of urothelium carcinoma of the bladder (EBRUC) II trial 膀胱肿瘤整体切除术与传统经尿道膀胱肿瘤切除术的国际多中心随机对照试验:膀胱尿路上皮癌整体切除术(EBRUC)II 试验的初步结果
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-27 DOI: 10.1111/bju.16543
Julian Peter Struck, Nadim Moharam, Armin Leitenberger, Jörg Weber, Lukas Lusuardi, David Oswald, Jens J. Rassweiler, Marcel Fiedler, Jakub Horňák, Marek Babjuk, Salvatore Micali, Carlo Zaraca, Thomas Spreu, Frank Friedersdorff, Hendrik Borgmann, Axel S. Merseburger, Mario W. Kramer
ObjectivesTo determine the safety and oncological advantages of en bloc resection of bladder tumour (ERBT) vs conventional transurethral resection of bladder tumour (cTURBT) in terms of resection quality, staging quality, and safety.Patients and MethodsWe conducted a single‐blinded randomised controlled trial at seven European hospitals with the following inclusion criteria: first diagnosis of non‐muscle‐invasive bladder cancer, no singular carcinoma in situ, and tumour size >4.3 mm. Patients were randomised intraoperatively in a 1:1 ratio to either the ERBT or cTURBT group. Outcome analysis was performed using the chi‐square test, t‐test, and multivariate regression analysis.ResultsA total of 97 patients were randomised into the study (cTURBT = 40, ERBT = 57). A switch to cTURBT was necessary in two patients (3.5%) and 11.5% of the screened patients were preoperatively excluded for ERBT. There was no difference in the specimen presence of detrusor muscle with 73.7% in cTURBT and 67.3% in ERBT specimens (P = 0.69). There were no significant differences in mean operative time (ERBT 27.6 vs cTURBT 25.4 min, P = 0.450) or mean resection time (ERBT 16.3 vs cTURBT 15.5 min, P = 0.732). Overall the complication rate did not differ significantly (ERBT 18.2% vs cTURBT 7.5%, P = 0.142). Bladder perforations occurred significantly more often in the ERBT group (ERBT seven vs cTURBT none, P = 0.020). R0 status was reported more often after ERBT, whilst a second resection was significantly less frequent after ERBT (P = 0.018). Recurrence rates were comparable for both techniques after 6 months of follow‐up.ConclusionThe feasibility of ERBT is higher than previously reported. Whereas other perioperative and safety parameters are comparable to cTURBT, bladder perforations occurred significantly more often in the ERBT group and raised safety concerns. This is why this trial was terminated.
目的确定膀胱肿瘤全切术(ERBT)与传统经尿道膀胱肿瘤切除术(cTURBT)在切除质量、分期质量和安全性方面的安全性和肿瘤学优势。患者和方法我们在七家欧洲医院开展了一项单盲随机对照试验,纳入标准如下:首次诊断为非肌层浸润性膀胱癌,无单发原位癌,肿瘤大小为 4.3 mm。患者在术中按 1:1 的比例随机分配到 ERBT 或 cTURBT 组。结果共有97名患者被随机纳入研究(cTURBT=40人,ERT=57人)。有两名患者(3.5%)必须转为 cTURBT,11.5% 的筛选患者在术前排除了 ERBT。cTURBT和ERBT标本中存在逼尿肌的比例没有差异,前者为73.7%,后者为67.3%(P = 0.69)。平均手术时间(ERBT 27.6 分钟 vs cTURBT 25.4 分钟,P = 0.450)和平均切除时间(ERBT 16.3 分钟 vs cTURBT 15.5 分钟,P = 0.732)无明显差异。总体而言,并发症发生率没有明显差异(ERBT 18.2% vs cTURBT 7.5%,P = 0.142)。ERBT组的膀胱穿孔发生率明显更高(ERBT 7例 vs cTURBT 0例,P = 0.020)。ERBT术后R0状态的报告更多,而ERBT术后第二次切除的频率明显降低(P = 0.018)。结论 ERBT 的可行性高于之前的报道。尽管其他围手术期和安全性参数与 cTURBT 相当,但 ERBT 组的膀胱穿孔发生率明显更高,这引起了人们对安全性的担忧。这也是该试验终止的原因。
{"title":"An international multicentre randomised controlled trial of en bloc resection of bladder tumour vs conventional transurethral resection of bladder tumour: first results of the en bloc resection of urothelium carcinoma of the bladder (EBRUC) II trial","authors":"Julian Peter Struck, Nadim Moharam, Armin Leitenberger, Jörg Weber, Lukas Lusuardi, David Oswald, Jens J. Rassweiler, Marcel Fiedler, Jakub Horňák, Marek Babjuk, Salvatore Micali, Carlo Zaraca, Thomas Spreu, Frank Friedersdorff, Hendrik Borgmann, Axel S. Merseburger, Mario W. Kramer","doi":"10.1111/bju.16543","DOIUrl":"https://doi.org/10.1111/bju.16543","url":null,"abstract":"ObjectivesTo determine the safety and oncological advantages of <jats:italic>en bloc</jats:italic> resection of bladder tumour (ERBT) vs conventional transurethral resection of bladder tumour (cTURBT) in terms of resection quality, staging quality, and safety.Patients and MethodsWe conducted a single‐blinded randomised controlled trial at seven European hospitals with the following inclusion criteria: first diagnosis of non‐muscle‐invasive bladder cancer, no singular carcinoma <jats:italic>in situ</jats:italic>, and tumour size &gt;4.3 mm. Patients were randomised intraoperatively in a 1:1 ratio to either the ERBT or cTURBT group. Outcome analysis was performed using the chi‐square test, <jats:italic>t</jats:italic>‐test, and multivariate regression analysis.ResultsA total of 97 patients were randomised into the study (cTURBT = 40, ERBT = 57). A switch to cTURBT was necessary in two patients (3.5%) and 11.5% of the screened patients were preoperatively excluded for ERBT. There was no difference in the specimen presence of detrusor muscle with 73.7% in cTURBT and 67.3% in ERBT specimens (<jats:italic>P</jats:italic> = 0.69). There were no significant differences in mean operative time (ERBT 27.6 vs cTURBT 25.4 min, <jats:italic>P</jats:italic> = 0.450) or mean resection time (ERBT 16.3 vs cTURBT 15.5 min, <jats:italic>P</jats:italic> = 0.732). Overall the complication rate did not differ significantly (ERBT 18.2% vs cTURBT 7.5%, <jats:italic>P</jats:italic> = 0.142). Bladder perforations occurred significantly more often in the ERBT group (ERBT seven vs cTURBT none, <jats:italic>P</jats:italic> = 0.020). R0 status was reported more often after ERBT, whilst a second resection was significantly less frequent after ERBT (<jats:italic>P</jats:italic> = 0.018). Recurrence rates were comparable for both techniques after 6 months of follow‐up.ConclusionThe feasibility of ERBT is higher than previously reported. Whereas other perioperative and safety parameters are comparable to cTURBT, bladder perforations occurred significantly more often in the ERBT group and raised safety concerns. This is why this trial was terminated.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"61 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490764","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}
引用次数: 0
Clinical determination of the natural distensibility of the human ureter: initial study 人体输尿管自然伸缩性的临床测定:初步研究
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-26 DOI: 10.1111/bju.16564
Sohrab N. Ali, Amanda McCormac, Andrei D. Cumpanas, Jaime Altamirano-Villarroel, Paul Piedras, Minh-Chau Vu, Andrew S. Afyouni, Zachary E. Tano, Kathryn Osann, Michael Klopfer, Pengbo Jiang, Roshan M. Patel, Jaime Landman, Ralph V. Clayman
To define the natural distensibility of the human ureter and evaluate the impact of other possibly favourable factors on ureteric distensibility.
确定人体输尿管的自然伸缩性,并评估其他可能的有利因素对输尿管伸缩性的影响。
{"title":"Clinical determination of the natural distensibility of the human ureter: initial study","authors":"Sohrab N. Ali, Amanda McCormac, Andrei D. Cumpanas, Jaime Altamirano-Villarroel, Paul Piedras, Minh-Chau Vu, Andrew S. Afyouni, Zachary E. Tano, Kathryn Osann, Michael Klopfer, Pengbo Jiang, Roshan M. Patel, Jaime Landman, Ralph V. Clayman","doi":"10.1111/bju.16564","DOIUrl":"https://doi.org/10.1111/bju.16564","url":null,"abstract":"To define the natural distensibility of the human ureter and evaluate the impact of other possibly favourable factors on ureteric distensibility.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"15 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490673","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}
引用次数: 0
Cumulative re‐operation rates during follow‐up after hypospadias repair 尿道下裂修补术后随访期间的累积再手术率
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-26 DOI: 10.1111/bju.16562
Ali Atan, Kaan Sonmez, Ramazan Karabulut, Zafer Turkyilmaz
{"title":"Cumulative re‐operation rates during follow‐up after hypospadias repair","authors":"Ali Atan, Kaan Sonmez, Ramazan Karabulut, Zafer Turkyilmaz","doi":"10.1111/bju.16562","DOIUrl":"https://doi.org/10.1111/bju.16562","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"25 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490291","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}
引用次数: 0
Reply to the letter by Atan, Sonmez, Karabulut and Turkyilmaz 对 Atan、Sonmez、Karabulut 和 Turkyilmaz 来信的答复
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-26 DOI: 10.1111/bju.16563
Niklas Pakkasjärvi, Annaleena Anttila, Seppo Taskinen
{"title":"Reply to the letter by Atan, Sonmez, Karabulut and Turkyilmaz","authors":"Niklas Pakkasjärvi, Annaleena Anttila, Seppo Taskinen","doi":"10.1111/bju.16563","DOIUrl":"https://doi.org/10.1111/bju.16563","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"8 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490434","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}
引用次数: 0
Primary retroperitoneal lymph node dissection in stage II testicular seminoma: a systematic review II期睾丸精原细胞瘤的原发性腹膜后淋巴结清扫:系统性综述
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-25 DOI: 10.1111/bju.16536
Jianliang Liu, Mrunal Hiwase, Dixon T.S. Woon, Benjamin Thomas, Ben Tran, Nathan Lawrentschuk
ObjectiveTo conduct a systematic review of the current literature to determine the current role of primary retroperitoneal lymph node dissection (RPLND) in stage II testicular seminoma and its associated oncological, functional and peri‐operative outcomes.Materials and MethodsA comprehensive literature search was conducted in Medline, Embase, and Scopus for publications from inception until November 2023. The systematic review was registered on PROSPERO (ID CRD42023449781), was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and utilised the Methodological Index for Non‐Randomised Studies (MINORS) tool.ResultsSix studies involving 385 patients were analysed, with 48.5% clinical stage IIA and 51.5% stage IIB seminomas. The patients’ mean (range) age was 37 (20–64) years. The median operation time was 187 min, median estimated blood loss was 150 mL and median length of hospital stay was 4 days. In all, 6.1% of patients developed complications that were greater or equal to Clavien–Dindo grade 3. Only four studies reported on anejaculation rate (median: 4.9%). Only one study had long‐term data, demonstrating a 92% 5‐year overall survival for stage IIA/B disease treated with RPLND. The remaining five studies had a median follow‐up of between 18.5 and 37 months and reported a mean recurrence rate of 15.6%. Most recurrences (78%) were not within the field of RPLND. Recurrence was associated with higher clinical and pathological lymph node stage, and metachronous or delayed development of retroperitoneal lymphadenopathy (initially stage I disease, as opposed to de novo stage IIA/B disease).DiscussionPrimary RPLND, performed by experienced surgeons, has good peri‐operative outcomes. Recurrence is more common than with standard treatment, but long‐term survival and functional data are limited, although promising.
目的对目前的文献进行系统综述,以确定目前腹膜后淋巴结清扫术(RPLND)在 II 期睾丸精原细胞瘤中的作用及其相关的肿瘤学、功能和围手术期结果。材料与方法在 Medline、Embase 和 Scopus 中对从开始到 2023 年 11 月的出版物进行了全面的文献检索。该系统性综述在 PROSPERO(ID CRD42023449781)上进行了注册,按照系统性综述和荟萃分析首选报告项目(PRISMA)指南进行,并使用了非随机研究方法索引(MINORS)工具。患者的平均年龄为 37(20-64)岁。手术时间中位数为 187 分钟,估计失血量中位数为 150 毫升,住院时间中位数为 4 天。总共有 6.1% 的患者出现了大于或等于 Clavien-Dindo 3 级的并发症。只有四项研究报告了无射精率(中位数:4.9%)。只有一项研究提供了长期数据,显示接受 RPLND 治疗的 IIA/B 期患者的 5 年总生存率为 92%。其余五项研究的中位随访时间在 18.5 至 37 个月之间,报告的平均复发率为 15.6%。大多数复发(78%)不在 RPLND 治疗范围内。复发与较高的临床和病理淋巴结分期、腹膜后淋巴结病的后期或延迟发展(最初是I期疾病,而不是新发的IIA/B期疾病)有关。与标准治疗相比,复发更为常见,但长期生存和功能数据有限,尽管前景看好。
{"title":"Primary retroperitoneal lymph node dissection in stage II testicular seminoma: a systematic review","authors":"Jianliang Liu, Mrunal Hiwase, Dixon T.S. Woon, Benjamin Thomas, Ben Tran, Nathan Lawrentschuk","doi":"10.1111/bju.16536","DOIUrl":"https://doi.org/10.1111/bju.16536","url":null,"abstract":"ObjectiveTo conduct a systematic review of the current literature to determine the current role of primary retroperitoneal lymph node dissection (RPLND) in stage II testicular seminoma and its associated oncological, functional and peri‐operative outcomes.Materials and MethodsA comprehensive literature search was conducted in Medline, Embase, and Scopus for publications from inception until November 2023. The systematic review was registered on PROSPERO (ID CRD42023449781), was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and utilised the Methodological Index for Non‐Randomised Studies (MINORS) tool.ResultsSix studies involving 385 patients were analysed, with 48.5% clinical stage IIA and 51.5% stage IIB seminomas. The patients’ mean (range) age was 37 (20–64) years. The median operation time was 187 min, median estimated blood loss was 150 mL and median length of hospital stay was 4 days. In all, 6.1% of patients developed complications that were greater or equal to Clavien–Dindo grade 3. Only four studies reported on anejaculation rate (median: 4.9%). Only one study had long‐term data, demonstrating a 92% 5‐year overall survival for stage IIA/B disease treated with RPLND. The remaining five studies had a median follow‐up of between 18.5 and 37 months and reported a mean recurrence rate of 15.6%. Most recurrences (78%) were not within the field of RPLND. Recurrence was associated with higher clinical and pathological lymph node stage, and metachronous or delayed development of retroperitoneal lymphadenopathy (initially stage I disease, as opposed to <jats:italic>de novo</jats:italic> stage IIA/B disease).DiscussionPrimary RPLND, performed by experienced surgeons, has good peri‐operative outcomes. Recurrence is more common than with standard treatment, but long‐term survival and functional data are limited, although promising.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"59 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489599","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}
引用次数: 0
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