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Non-surgical management vs active treatment in T1a renal cell carcinoma: a population-based study T1a肾细胞癌的非手术治疗与积极治疗:一项基于人群的研究
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-13 DOI: 10.1111/bju.70074
Bassam Mazin Hashim, Andreas Karlsson Rosenblad, Per-Olof Lundgren, Sven Lundstam, Börje Ljungberg

Objectives

To compare overall and cancer-specific survival for clinical (c)T1aN0M0 renal cell carcinoma (RCC) in patients treated with non-surgical management (NSM: surveillance and watchful waiting) or active treatment (surgery and ablative treatments).

Patients and methods

In this nationwide real-world population-based cohort study, data on clinical, demographic, and socioeconomic factors as well as tumour characteristics and cause of death were retrieved from the Renal Cell Carcinoma Database Sweden (RCCBaSe) for 3989 patients diagnosed with cT1aN0M0 RCC, 2011–2020 and treated with either NSM or active treatment. Differences in survival between NSM and active treated patients were analysed using standard and competing-risks Cox regression models.

Results

In total, 3727 (93.4%) patients underwent active treatments, while 262 patients (6.6%) were treated with NSM. Patients in the NSM group were significantly older and had a higher comorbidity burden. During a median follow-up time of 4.1 years, all-cause mortality was significantly higher among the NSM (38.9%) than the actively treated (10.9%) patients (P < 0.001), as was cancer-specific mortality (13.0% vs 3.4%, P < 0.001). Larger tumours, older age, male sex, increased comorbidity, being unmarried or widowed, having lower disposable income, and having clear cell or papillary RCC compared with chromophobe RCC were all independently associated with poorer overall and cancer-specific survival. One of the limitations is that treatment allocation was not randomised.

Conclusion

Non-surgical management of cT1aN0M0 RCC was associated with poorer survival compared with surgery/ablation and should be offered mainly for patients with limited life expectancy and indolent renal tumours.

目的比较临床(c)T1aN0M0型肾细胞癌(RCC)患者接受非手术治疗(NSM:监测和观察等待)或积极治疗(手术和消融治疗)的总体生存率和癌症特异性生存率。在这项全国范围内基于真实世界人口的队列研究中,从瑞典肾细胞癌数据库(RCCBaSe)检索了2011-2020年诊断为cT1aN0M0型RCC并接受NSM或积极治疗的3989例患者的临床、人口统计学、社会经济因素以及肿瘤特征和死亡原因的数据。使用标准和竞争风险Cox回归模型分析NSM和积极治疗患者的生存差异。结果3727例(93.4%)患者接受了积极治疗,262例(6.6%)患者接受了NSM治疗。NSM组的患者明显年龄较大,并有较高的合并症负担。在4.1年的中位随访期间,NSM患者的全因死亡率(38.9%)明显高于积极治疗患者(10.9%)(P < 0.001),癌症特异性死亡率(13.0% vs 3.4%, P < 0.001)。肿瘤较大、年龄较大、男性、合病增加、未婚或丧偶、可支配收入较低、透明细胞或乳头状RCC与憎色RCC相比,均与较差的总生存率和癌症特异性生存率独立相关。局限性之一是治疗分配不是随机的。结论:与手术/消融术相比,非手术治疗cT1aN0M0 RCC的生存率较低,应主要提供给预期寿命有限和惰性肾肿瘤患者。
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引用次数: 0
December's reviewers of the month 12月的月度评论家
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-12 DOI: 10.1111/bju.70077

Like most journals, BJUI relies on the hard work and dedication of its peer reviewers and we are grateful to them all. Each month the Editorial Team nominates peer reviewers whose reviews have stood out for their quality and timeliness and those selected as the best are highlighted on this page in recognition of their exceptional work.

Ben Ayres is a consultant urologist at St. George's University Hospitals NHS Foundation Trust and a Honorary Reader in Urology at City St George's. He is academic lead for Surgery and the Final Year at City St George's medical school. His subspecialist interests include penile cancer, bladder cancer, research and medical education.

Sorcha O′ Meara (FRCSurol) is a ST7 urology trainee in the Republic of Ireland, graduating from University College Dublin in 2015 and progressing onto the National Surgical Training Programme in 2017. She has just submitted her PhD thesis following three years of laboratory and clinical research focusing on the biomechanics of the human ureter and graft substitutes. She has received numerous awards and grants to support this research.

Sorcha is a proponent of collaborative research and is a committee member of the Irish Surgical Research Collaborative and the Human Factors in Surgery Network. In addition to her laboratory research, she has a keen interest in human factors and particularly the personal impact of adverse events and complications. Sorcha has a Masters in clinical education and is actively involved in medical student and surgical trainee teaching programmes.

像大多数期刊一样,《北京科技大学学报》依靠同行审稿人的辛勤工作和奉献精神,我们感谢他们所有人。每个月,编辑团队都会提名评审质量和及时性突出的同行审稿人,那些被评为最佳的审稿人将在本页突出显示,以表彰他们的杰出工作。本·艾尔斯是圣乔治大学医院NHS基金会信托的顾问泌尿科医生,也是圣乔治市泌尿科的荣誉读者。他是外科专业的学术带头人,也是圣乔治市医学院最后一年的学生。他的亚专科兴趣包括阴茎癌、膀胱癌、研究和医学教育。Sorcha O ' Meara (FRCSurol)是爱尔兰共和国ST7泌尿外科实习生,2015年毕业于都柏林大学学院,并于2017年进入国家外科培训计划。经过三年的实验室和临床研究,专注于人类输尿管和移植物替代品的生物力学,她刚刚提交了博士论文。为了支持这项研究,她获得了许多奖项和资助。Sorcha是合作研究的支持者,是爱尔兰外科研究合作组织和手术网络中的人为因素委员会成员。除了实验室研究外,她对人为因素,特别是不良事件和并发症对个人的影响有着浓厚的兴趣。Sorcha拥有临床教育硕士学位,并积极参与医学生和外科培训生教学计划。
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引用次数: 0
Taking guard for the next innings 为下一局站岗。
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-07 DOI: 10.1111/bju.70069
Marlon Perera, Matthew Roberts, Nathan Lawrentschuk

All good things must come to an end. After an extended tenure of 12 years of BJUI USANZ Supplement editor, Professor Nathan Lawrentschuk is taking off the gloves and passing editorial baton. In his place, Marlon Perera and Matthew Roberts and will be taking guard in this role.

What an incredible 12 years it has been. At its initial inception, the USANZ Supplement of BJUI was considered a novelty edition, a means to provide acknowledgement to the growing research enthusiasm of the antipodes. Gradually, but consistently, the USANZ Supplement has become a premier edition of the BJUI series – and frequently meets or exceeds key journal metrics compared to comparable high-quality journals. A deliberate theme has been carved into the respective editions, showcasing the best works from Australasia on a biannual basis. Many of these publications have been highly cited and represent key publications in contemporary urology [1-8]. Despite the sharp eye for key publications, it seemed that Nathan has a particular affinity or soft-spot in papers with a particularly catchy title [9, 10]. While significant credit is due to vision of Professor Lawrentschuk for the success of the BJUI USANZ Supplement, there is a deep gratitude to authors in the USANZ community and the respective reviewers.

With the changing of the guard, for the first time, there will be two co-editors of the USANZ Supplement of BJUI. Division of this role will facilitate more broader reviewer pools, timely editorial processes and ultimately improved article decision turn-around times. We look to prioritise novel, local, original works with an emphasis on clinical relevance rather than resource-intensive research. Equally, we aspire to promote representation across the various geographic, seniority and sub-speciality entities. We aim to continue to honour the works of Professor Lawrentschuk's vision and direction while continuing to innovate and adapt to the ever-changing demands of the research landscape.

As always, we welcome your ideas as your voices are critical in shaping the future of this supplement. USANZ is indebted to the ongoing support of BJUI and its commitment to Australasian research, thank you for ‘taking a punt’ on us. But for now, Nathan, raise your bat – what an innings it's been!

None declared.

天下没有不散的筵席。在BJUI USANZ增刊编辑延长了12年的任期后,Nathan Lawrentschuk教授摘下手套,传递编辑指挥棒。马龙·佩雷拉和马修·罗伯茨将接替他的位置。这是多么不可思议的12年啊。最初,BJUI的USANZ增刊被认为是一个新奇的版本,是对日益增长的对跖体研究热情的一种承认。逐渐地,但始终如一,USANZ增刊已成为BJUI系列的首要版本-与同类高质量期刊相比,它经常达到或超过关键期刊指标。一个深思熟虑的主题被雕刻成各自的版本,展示来自大洋洲的最佳作品,每两年一次。其中许多出版物被高度引用,是当代泌尿外科的重要出版物[1-8]。尽管对关键出版物有着敏锐的眼光,但Nathan似乎对标题特别吸引人的论文有着特殊的亲和力或软肋[9,10]。虽然很大程度上归功于Lawrentschuk教授对BJUI USANZ增刊的成功的远见卓见,但我们对USANZ社区的作者和各自的审稿人深表感谢。随着换届,BJUI的USANZ增刊将首次出现两位共同编辑。这个角色的划分将促进更广泛的审稿人池,及时的编辑过程,并最终改善文章的决策周转时间。我们希望优先考虑新颖的、本地的、原创的作品,强调临床相关性,而不是资源密集型的研究。同样,我们渴望促进不同地域、资历和分专业实体的代表性。我们的目标是继续尊重Lawrentschuk教授的愿景和方向,同时继续创新和适应研究领域不断变化的需求。一如既往,我们欢迎你的想法,因为你的声音对塑造这个增刊的未来至关重要。USANZ感谢BJUI的持续支持及其对澳大拉西亚研究的承诺,感谢您对我们的“下注”。但是现在,内森,举起你的球棒——这是多么艰难的一局啊!没有宣布。
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引用次数: 0
Complication rates and outcomes of suction devices in ureteroscopy and retrograde intrarenal surgery: a systematic review 输尿管镜和逆行肾内手术中使用吸引器的并发症发生率和结果:一项系统综述
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-07 DOI: 10.1111/bju.70061
Daniel Crisafi, Jordan Santucci, Anne Hong, Samuel Sii, Damien Bolton, Greg Jack
Objective To evaluate the safety profile and efficacy of novel suction devices compared to current practices in the management of renal and upper ureteric stones in the adult population, as negative pressure suction devices during retrograde intrarenal surgery (RIRS) are designed to overcome commonly encountered issues including poor visibility, residual fragments, and elevated intrarenal pressures (IRPs). Methods A systematic search of the literature was conducted on 21 December 2024 using Embase, Medline and Scopus. Only English papers involving adult populations with typical anatomy were accepted. Results A total of 35 articles were deemed suitable for the purposes of this review. Various methods of suction‐assisted RIRS have been described, including suction ureteric access sheaths, tip‐flexible suction ureteric access sheaths, direct in‐scope suction and aspiration catheters, as a means to improve the safety and efficacy of RIRS. Suction devices have shown significant advantages by vacuuming debris to improve visibility and maximise stone clearance, even for larger stones typically managed by percutaneous nephrolithotomy. Improved stone‐free rates, shorter operating times, less requirement for basketing and fewer auxiliary surgeries have subsequently been observed. Use of intelligent pressure monitoring has the added benefit of maintaining low IRP intraoperatively, which reduces infectious complications like fever and sepsis. These techniques may offer substantial health economic benefits by reducing operating time, intraoperative costs, and hospital stays. However, the lack of high‐level evidence limits the standardisation of this technology, currently. Conclusion Suction technology in RIRS optimises stone clearance and reduces complication rates by improving visibility, evacuating debris and also maintaining low IRP. With further research, it promises to be a useful adjunct to current practices.
目的评价新型吸引装置在成人肾结石和输尿管上段结石治疗中的安全性和有效性,因为负压吸引装置在逆行肾内手术(RIRS)中被设计用于克服常见的问题,包括能见度低、残留碎片和肾内压(IRPs)升高。方法于2024年12月21日采用Embase、Medline和Scopus进行系统检索。只有涉及具有典型解剖结构的成年人群的英文论文才被接受。结果共有35篇文章被认为适合本综述的目的。为了提高RIRS的安全性和有效性,已经描述了各种吸引辅助RIRS的方法,包括吸引输尿管通路鞘、尖端柔性吸引输尿管通路鞘、直接在镜内吸引和抽吸导管。吸入装置通过抽真空碎片来提高可见度和最大限度地清除结石,即使是通常经皮肾镜取石术处理的较大结石,也显示出显着的优势。随后观察到结石清除率提高,手术时间缩短,对篮筐的需求减少,辅助手术减少。使用智能压力监测具有在术中维持低IRP的额外好处,可减少发烧和败血症等感染并发症。这些技术可以通过减少手术时间、术中费用和住院时间,提供实质性的健康经济效益。然而,目前缺乏高水平的证据限制了这项技术的标准化。结论rrs吸痰技术通过提高能见度、清除碎片和保持较低的IRP,可优化结石清除,降低并发症发生率。随着进一步的研究,它有望成为当前实践的有用辅助。
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引用次数: 0
Expanding the global dialogue regarding gender equity in urology 扩大泌尿外科性别平等的全球对话
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-07 DOI: 10.1111/bju.70072
Hannah S. Thomas, Gallina Kazobinka, Tyler L. Overholt, Joanna Orzel, Ana Maria Ortiz-Zableh, Simone Thavaseelan
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引用次数: 0
Target trial emulation of early docetaxel and enzalutamide for metastatic hormone-sensitive prostate cancer 早期多西紫杉醇和恩杂鲁胺治疗转移性激素敏感前列腺癌的靶试验模拟。
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-05 DOI: 10.1111/bju.70065
Yu Yang Soon, Ian C. Marschner, I. Manjula Schou, Christopher J Sweeney, Ian D. Davis, Martin R. Stockler, Andrew J. Martin

Objective

To apply a trial emulation method using the ‘ENZAlutamide in first line androgen deprivation therapy for METastatic prostate cancer’ (ENZAMET) trial data to assess the effects of adding early docetaxel to enzalutamide on overall survival (OS) in metastatic hormone-sensitive prostate cancer (mHSPC), as the benefits of adding early docetaxel to novel androgen-receptor pathway inhibitors (ARPIs) are unclear.

Patients and Methods

The ENZAMET trial randomised 1125 patients with mHSPC to testosterone suppression plus enzalutamide or standard non-steroidal antiandrogen therapy. Investigators indicated at pre-randomisation if they planned to use early docetaxel. We emulated randomised comparisons of four treatments: (i) docetaxel plus enzalutamide, (ii) no docetaxel plus enzalutamide, (iii) docetaxel plus no enzalutamide, and (iv) no docetaxel plus no enzalutamide. Propensity score matching was applied to mitigate selection bias. OS was evaluated using Cox proportional hazards regression.

Results

Among 987 matched participants (87.7%), baseline characteristics were balanced. OS was similar with or without planned use of early docetaxel (hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.92–1.12; P = 0.72), with effect modification by enzalutamide use (interaction P = 0.02). Among those assigned enzalutamide, OS was similar according to the planned use of early docetaxel or not (HR 1.18, 95% CI 0.94–1.49), regardless of disease volume (interaction P = 0.37). Among those assigned no enzalutamide, OS was longer with the planned use of early docetaxel (HR 0.90, 95% CI 0.82–0.98), especially in high-volume disease (interaction P = 0.006).

Conclusion

Early docetaxel did not appear to improve survival when added to enzalutamide, regardless of disease volume, whereas it did appear to improve survival when enzalutamide was not used, particularly in high-volume disease. While residual confounding could not be excluded, these findings do not support the routine addition of early docetaxel to enzalutamide in mHSPC.

目的:在新型雄激素受体途径抑制剂(arpi)中加入早期多西他赛的益处尚不清楚的情况下,采用“ENZAMET在转移性前列腺癌一线雄激素剥夺治疗中ENZAlutamide”(ENZAMET)试验数据,应用试验模拟方法来评估早期多西他赛加入ENZAlutamide对转移性激素敏感前列腺癌(mHSPC)总生存期(OS)的影响。患者和方法:ENZAMET试验将1125例mHSPC患者随机分为睾酮抑制加恩杂鲁胺或标准非甾体抗雄激素治疗组。研究者在预随机化时表明他们是否计划使用早期多西他赛。我们模拟了四种治疗的随机比较:(i)多西他赛加恩杂鲁胺,(ii)无多西他赛加恩杂鲁胺,(iii)多西他赛加不恩杂鲁胺,(iv)无多西他赛加不恩杂鲁胺。采用倾向得分匹配来减轻选择偏差。采用Cox比例风险回归评价OS。结果987例(87.7%)匹配者基线特征平衡。无论是否计划使用早期多西他赛,OS相似(风险比[HR] 1.02, 95%可信区间[CI] 0.92-1.12; P = 0.72),使用恩杂鲁胺可改变疗效(相互作用P = 0.02)。在分配enzalutamide的患者中,无论疾病量如何,根据是否计划使用早期多西紫杉醇,OS相似(HR 1.18, 95% CI 0.94-1.49)(相互作用P = 0.37)。在未分配enzalutamide的患者中,计划使用早期多西紫杉醇的OS更长(HR 0.90, 95% CI 0.82-0.98),特别是在大容量疾病中(相互作用P = 0.006)。结论:早期多西他赛与恩杂鲁胺联合使用时,无论疾病体积大小,都不能改善生存,而不使用恩杂鲁胺时,特别是在大体积疾病中,确实可以改善生存。虽然不能排除残留的混杂因素,但这些发现不支持mHSPC患者在恩杂鲁胺中常规添加早期多西他赛。
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引用次数: 0
Prostate zonal impact of 5α-reductase inhibitors on multiparametric MRI characteristics and detection of prostate cancer 5α-还原酶抑制剂对前列腺癌多参数MRI特征和检测的前列腺分区影响
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-05 DOI: 10.1111/bju.70067
Arighno Das, Marcelo Bigarella, Krista Brackman, Glenn O. Allen, Soroush Rais-Bahrami, Kayla Bahr, Emily Schmitt, Andrew M. Fang, Hunter Boudreau, Christopher P. Filson, Melina Pectasides, Giuseppe V. Toia, David F. Jarrard

Objectives

To assess the impact of 5α-reductase inhibitors (5-ARIs) on multiparametric magnetic resonance imaging (mpMRI) features of Prostate Imaging-Reporting and Data System (PI-RADS) lesions and their influence on the detection of clinically significant prostate cancer (csPCa), with a focus on differences between prostate zones.

Patients and Methods

We retrospectively reviewed data from 1108 PI-RADS version 2 score 3–5 lesions in 718 patients across a multi-institutional cohort, all of whom underwent magnetic resonance imaging (MRI)-targeted biopsy. A subset of 66 lesions from patients receiving 5-ARI therapy was matched to lesions from untreated patients and independently reviewed by an experienced radiologist in a blinded fashion. Apparent diffusion coefficient (ADC) values were quantified for each lesion and for peripheral and transition zones.

Results

Among the 1108 lesions, 90 (8%) were in patients on 5-ARI therapy for ≥3 months prior to mpMRI. Multivariable analysis demonstrated that 5-ARI use was associated with significantly reduced odds of detecting csPCa on targeted biopsy (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.18–0.57). Stratified analysis revealed a pronounced reduction in csPCa detection in peripheral zone lesions (OR 0.20, 95% CI 0.05–0.68), but not in transition zone lesions (OR 0.38, 95% CI 0.11–1.18). Blinded radiological review showed higher mean ADC values in peripheral zone lesions among 5-ARI users (869 vs 765 mm2/s; P = 0.04) and lower lesion conspicuity (P = 0.027). There were no significant imaging differences in the transition zone.

Conclusions

Treatment with 5-ARIs is associated with decreased detection of csPCa on MRI-targeted biopsy, especially for peripheral zone lesions. These effects may be attributable to increased ADC values and reduced lesion conspicuity, suggesting a potential increase in false-positive mpMRI findings in patients receiving 5-ARIs.

目的探讨5α-还原酶抑制剂(5-ARIs)对前列腺影像报告与数据系统(PI-RADS)病变多参数磁共振成像(mpMRI)特征的影响及其对临床显著性前列腺癌(csPCa)检测的影响,并重点分析不同前列腺区之间的差异。患者和方法我们回顾性回顾了来自多机构队列中718例患者的1108例PI-RADS版本2的数据,这些患者均接受了磁共振成像(MRI)靶向活检。接受5-ARI治疗的患者的66个病灶子集与未治疗的患者的病灶相匹配,并由经验丰富的放射科医生以盲法独立审查。对每个病变、周围区和过渡区进行表观扩散系数(ADC)量化。结果在1108例病变中,90例(8%)患者在mpMRI前接受5-ARI治疗≥3个月。多变量分析表明,使用5-ARI与靶向活检中检测到csPCa的几率显著降低相关(优势比[OR] 0.32, 95%可信区间[CI] 0.18-0.57)。分层分析显示外周区病变的csPCa检测明显减少(OR 0.20, 95% CI 0.05-0.68),但在过渡区病变中没有(OR 0.38, 95% CI 0.11-1.18)。放射学盲检显示,5-ARI使用者外周区病变的平均ADC值较高(869 vs 765 mm2/s, P = 0.04),病变显著性较低(P = 0.027)。在过渡区没有明显的影像学差异。结论5-ARIs治疗与mri靶向活检中csPCa的检出率降低有关,尤其是外周区病变。这些影响可能归因于ADC值升高和病变显著性降低,这表明接受5-ARIs治疗的患者mpMRI假阳性结果可能增加。
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引用次数: 0
Cannabis use and risk of testicular germ cell tumour: a systematic review and meta-analysis 大麻使用和睾丸生殖细胞肿瘤的风险:系统回顾和荟萃分析。
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-04 DOI: 10.1111/bju.70062
Mehdi Kardoust Parizi, Ichiro Tsuboi, Akihiro Matsukawa, Alyssa Arbuiso, Joseph Cheaib, Shahrokh F. Shariat, Nirmish Singla

Objectives

To systematically review and analyse the association of cannabis use with the risk of testicular germ cell tumour (TGCT), as studies have implicated an association between cannabis exposure and an increased risk of developing TGCT.

Patients and Methods

The PubMed, Web of Science, and Cochrane Library databases were searched on November 2024 to identify eligible studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. Studies were selected that compared males (P: population) who had cannabis use (I: interventions) to non-users or infrequent users of cannabis (C: comparators) with development of TGCT as the endpoint (O: outcomes) using multivariable analyses that adjusted for the effects of covariates (S: study type). The primary study outcome was the risk of TGCT among cannabis users. Available multivariable odds ratios (ORs) and hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were included in quantitative analysis.

Results

A total of 86 articles were identified from our search, of which five were included for qualitative and quantitative analysis. Three studies were case–control and two were cohort in design. Current cannabis use was significantly associated with increased risk of TGCT (OR 1.62, 95% CI 1.13–2.31; P < 0.05 [two studies]), as was long-term (≥10 years) cannabis use (OR 1.68, 95% CI 1.19–2.36; P < 0.05 [three studies]). In subgroup analysis, ever cannabis use was significantly associated with increased risk of non-seminomatous germ cell tumour (NSGCT) (OR 1.71, 95% CI 1.12–2.60; P < 0.05 [two studies]).

Conclusion

Our findings highlight cannabis use as a significant modifiable risk factor for the development of TGCT, particularly NSGCT. Given the increasing legalisation and availability of cannabis, further research is necessary to explore the underlying biological mechanisms and to confirm these associations across diverse populations.

目的系统地回顾和分析大麻使用与睾丸生殖细胞瘤(TGCT)风险的关系,因为研究表明大麻暴露与发生TGCT的风险增加之间存在关联。患者和方法2024年11月检索PubMed、Web of Science和Cochrane Library数据库,根据系统评价和荟萃分析声明的首选报告项目和Cochrane干预措施系统评价手册,确定符合条件的研究。选择的研究将使用大麻的男性(P:人口)(I:干预措施)与不使用或不经常使用大麻的男性(C:比较者)进行比较,使用调整协变量(S:研究类型)影响的多变量分析,将TGCT的发展作为终点(O:结果)。主要研究结果是大麻使用者中TGCT的风险。定量分析采用可用的多变量优势比(ORs)和风险比(hr)以及相应的95%置信区间(ci)。结果共纳入86篇文献,其中5篇纳入定性和定量分析。3项研究为病例对照,2项为队列设计。当前大麻使用与TGCT风险增加显著相关(OR 1.62, 95% CI 1.13-2.31; P < 0.05[两项研究]),长期(≥10年)大麻使用与TGCT风险增加显著相关(OR 1.68, 95% CI 1.19-2.36; P < 0.05[三项研究])。在亚组分析中,曾经使用大麻与非半细胞瘤性生殖细胞肿瘤(NSGCT)风险增加显著相关(OR 1.71, 95% CI 1.12-2.60; P < 0.05[两项研究])。结论:我们的研究结果强调了大麻使用是TGCT,特别是NSGCT发展的一个重要的可改变的危险因素。鉴于大麻的日益合法化和可获得性,有必要进行进一步的研究,以探索潜在的生物学机制,并在不同的人群中确认这些关联。
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引用次数: 0
Response to Huang and Gu 黄和顾的回应
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-04 DOI: 10.1111/bju.70017
Chrystal Chang, David Barham, Martin S. Gross, Faysal Yafi, Jay Simhan
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引用次数: 0
Validation of the Testicular Health Outcomes Report (THOR): a testicular cancer health-related quality of life instrument 睾丸健康结果报告(THOR)的验证:睾丸癌与健康相关的生活质量工具。
IF 4.4 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-11-04 DOI: 10.1111/bju.70068
Samuel A. Gold, Amy L. Tin, Viranda H. Jayalath, Fady Baky, Nicole Liso, Brandon Williams, Rebecca Yu, Darren R. Feldman, Samuel A. Funt, Andrew J. Vickers, Joel Sheinfeld, Richard S. Matulewicz

Objective

To evaluate the psychometric properties of the Testicular Health Outcomes Report (THOR) tool by assessing associations of disease burden and treatment received with health-related quality of life (HRQoL) domains.

Materials and Methods

THOR, which comprises 26 questions across 14 HRQoL domains, was administered electronically to patients presenting for known or suspected testicular cancer prior to clinical visits and throughout their care longitudinally. We evaluated construct validity by determining whether related constructs showed better correlation with disease and treatment burden than unrelated constructs. Generalised estimating equations were used for each domain or predictor of interest.

Results

Between August 2022 and November 2024, 709 patients completed 906 surveys. More aggressive post-orchiectomy treatment – such as retroperitoneal lymph node dissection (RPLND), chemotherapy or post-chemotherapy RPLND – was associated with worse sexual function and problems with job/education. Patients undergoing nerve-sparing RPLND reported significantly better sexual function (22 points, 95% confidence interval 11, 33; P < 0.001) as compared to a non-nerve-sparing RPLND approach. Receipt of chemotherapy was associated with lower fertility confidence vs surveillance or primary RPLND (P = 0.005). Psychosocial domain scores and concern about disease relapse improved with time (P < 0.001). However, concern about relapse was not associated with initial clinical stage.

Conclusions

The THOR survey instrument is a valid measure of symptom burden and treatment received in men with testicular cancer.

目的通过评估疾病负担和接受的治疗与健康相关生活质量(HRQoL)域的关联,评估睾丸健康结局报告(THOR)工具的心理测量特性。材料和方法thor包括14个HRQoL域的26个问题,在临床就诊前和整个治疗过程中对已知或疑似睾丸癌的患者进行电子管理。我们通过确定相关构念是否比不相关构念与疾病和治疗负担有更好的相关性来评估构念效度。对每个感兴趣的域或预测因子使用广义估计方程。结果在2022年8月至2024年11月期间,709名患者完成了906项调查。更积极的睾丸切除术后治疗-如腹膜后淋巴结清扫(RPLND),化疗或化疗后RPLND -与性功能恶化和工作/教育问题有关。与不保留神经的RPLND入路相比,接受保留神经的RPLND患者的性功能显著改善(22分,95%可信区间11,33;P < 0.001)。与监测或原发性RPLND相比,接受化疗与较低的生育信心相关(P = 0.005)。心理社会领域评分和对疾病复发的关注随时间而提高(P < 0.001)。然而,对复发的担忧与初始临床阶段无关。结论THOR是衡量男性睾丸癌患者症状负担和治疗情况的有效方法。
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