Clinical genitourinary cancer最新文献

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Titrating Cabozantinib in Metastatic Renal Cell Carcinoma Patients Using Goldilocks Principle: A Real-World Evidence Study 用金凤花原则在转移性肾细胞癌患者中滴定卡博赞替尼:一项真实世界的证据研究
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-31 DOI: 10.1016/j.clgc.2025.102419
Malou Aarønæs Thybo , Johanne Ahrenfeldt , Iben Lyskjær , Niels Fristrup
{"title":"Titrating Cabozantinib in Metastatic Renal Cell Carcinoma Patients Using Goldilocks Principle: A Real-World Evidence Study","authors":"Malou Aarønæs Thybo ,&nbsp;Johanne Ahrenfeldt ,&nbsp;Iben Lyskjær ,&nbsp;Niels Fristrup","doi":"10.1016/j.clgc.2025.102419","DOIUrl":"10.1016/j.clgc.2025.102419","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of renal cell carcinoma (RCC) continues to rise worldwide, and this malignancy has demonstrated substantial sensitivity to both immunotherapies and targeted agents, particularly tyrosine kinase inhibitors (TKIs). Cabozantinib, a commonly utilized TKI, has shown promising efficacy across multiple clinical trials. This study aims to evaluate the real-world effectiveness of individualized cabozantinib dosing as a later-line treatment in patients with metastatic RCC (mRCC).</div></div><div><h3>Patients and methods</h3><div>Patients with mRCC treated at the Department of Oncology, Aarhus University Hospital, Denmark, were identified to estimate the median progression free survival (mPFS) and median overall survival (mOS) from treatment initiation. Best radiological response was evaluated using RECIST 1.1. Multivariable cox regression analyses were performed, including covariates such as brain metastasis, first-line treatment, line of treatment, ECOG Performance Status, IMDC risk group, nephrectomy status, and toxicity.</div></div><div><h3>Results</h3><div>A total of 179 patients were included, of which 139 patients received second-line (2L) treatment, and 40 patients received third+-line (3+L) treatment. We found a mPFS of 11.2 months for 2L treatment and 11.6 months for 3+L treatment. The mOS was 15.6 months for the 2L group and 17.1 months for the 3+L group. The mPFS and mOS in the IMDC favourable risk group were 28.5 and 52.1 months, respectively. No significant differences in mPFS or mOS were observed based on prior 1L treatment or the presence of brain metastases. The mOS and mPFS found in this study are comparable to, and in some cases exceed, those reported in other real-world cohorts. Interestingly, we found treatment-related toxicity to correlate significantly with an increased survival (mOS 66.8 vs. 32.8 months, <em>P</em> = .016) (mPFS 14,7 vs. 8,5 months, P = .013).</div></div><div><h3>Conclusion</h3><div>This study reinforces the existing data on effectiveness of cabozantinib as a later-line treatment for mRCC in real-world settings. We report 40 mg as the preferred landing zone. Furthermore we identify patients needing dose reductions due to toxicity as a subgroup carrying a significantly better prognosis. The results emphasize the importance of individual dosage for optimizing treatment outcomes and points out treatment-related toxicity as a surrogate marker for sufficient serum concentration of the active substance.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102419"},"PeriodicalIF":2.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stage Migration in Surgically Treated Renal Cell Carcinoma in México: A 44-Year Analysis of Survival Outcomes and Stage-Specific Prognostic Factors 手术治疗的肾细胞癌的分期转移:44年的生存结果和分期特异性预后因素分析
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-20 DOI: 10.1016/j.clgc.2025.102416
Jorge Augusto Alcacio-Mendoza, Horst Emanuel Lagos-Beitz, Petra Betsabé Carreño-Hinojosa, Yoztinn Bernal-Benitez, Guillermo H Martínez-Delgado, Ricardo A Castillejos-Molina, Francisco Rodriguez-Covarrubias
{"title":"Stage Migration in Surgically Treated Renal Cell Carcinoma in México: A 44-Year Analysis of Survival Outcomes and Stage-Specific Prognostic Factors","authors":"Jorge Augusto Alcacio-Mendoza,&nbsp;Horst Emanuel Lagos-Beitz,&nbsp;Petra Betsabé Carreño-Hinojosa,&nbsp;Yoztinn Bernal-Benitez,&nbsp;Guillermo H Martínez-Delgado,&nbsp;Ricardo A Castillejos-Molina,&nbsp;Francisco Rodriguez-Covarrubias","doi":"10.1016/j.clgc.2025.102416","DOIUrl":"10.1016/j.clgc.2025.102416","url":null,"abstract":"<div><h3>Background and objective</h3><div>Renal cancer (RC) diagnosis has shifted toward earlier stages globally. However, this phenomenon and its impact on outcomes have not been characterized in Mexico. We aimed to analyze temporal trends in RC stage at diagnosis and assess their impact on survival rates.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 807 patients surgically treated (1980-2024), categorized by diagnosis decade. Median follow-up was 29.0 months (range: 0.0-298.4) calculated using reverse Kaplan-Meier method. We developed the Stage Migration Index (SMI) using weighted averages of stage proportions to quantify migration magnitude. Survival was analyzed using Kaplan-Meier curves and multilevel analysis evaluated hierarchical effects of decade and stage on outcomes.</div></div><div><h3>Results</h3><div>Stage I cases increased from 29.9% to 52.9%, while Stage III decreased from 31.9% to 13.4% (<em>P</em> &lt; .001) and Stage IV from 10.6% to 6.7% (<em>P</em> = .317, nonsignificant). The SMI increased from 2.766 to 3.261, reflecting significant shift toward earlier stages (<em>P</em> &lt; .001). Incidental detection increased from 44.7% (95% CI, 31.4%-58.8%) to 58.2% (95% CI, 49.7%-66.2%) (<em>P</em> &lt; .001). Five-year survival improved from 85.7% (1980-1989) to 96.3% (2020-2024) (<em>P</em> &lt; .001), though the 2020 to 2024 cohort had limited follow-up (median 1.4 months). Multilevel analysis revealed decade effects varied by stage, with greatest improvement for Stage IV patients (β = −0.542, <em>P</em> = .013). Among deceased patients, survival time increased from 5.2 to 50.2 months between 1980-1989 and 2010-2019 (<em>P</em> &lt; .001). Limitations include retrospective single-center design, surgical cohort selection bias, and 12.5% missing survival data.</div></div><div><h3>Conclusions</h3><div>RC has undergone significant stage migration in Mexico over 4 decades. While this shift contributes to improved outcomes, our analysis demonstrates substantial survival gains across all stages, particularly in advanced disease, suggesting improvements in comprehensive RC management beyond earlier detection alone.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102416"},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Socioeconomic Disparities in Prostate Cancer Presentation: The Impact of ADI on Prostate Cancer Stage at Diagnosis 前列腺癌表现的社会经济差异:诊断时ADI对前列腺癌分期的影响。
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-19 DOI: 10.1016/j.clgc.2025.102418
Alessandro Bertini , Anna Tylecki , Alex Stephens , Alessio Finocchiaro , Silvia Viganò , Nicholas Cusmano , Arjun Dinesh , Elnaz Guivatchian , Giovanni Lughezzani , Nicolò Buffi , Ettore Di Trapani , Vincenzo Ficarra , Alberto Briganti , Andrea Salonia , Francesco Montorsi , Akshay Sood , Craig Rogers , Firas Abdollah
{"title":"Socioeconomic Disparities in Prostate Cancer Presentation: The Impact of ADI on Prostate Cancer Stage at Diagnosis","authors":"Alessandro Bertini ,&nbsp;Anna Tylecki ,&nbsp;Alex Stephens ,&nbsp;Alessio Finocchiaro ,&nbsp;Silvia Viganò ,&nbsp;Nicholas Cusmano ,&nbsp;Arjun Dinesh ,&nbsp;Elnaz Guivatchian ,&nbsp;Giovanni Lughezzani ,&nbsp;Nicolò Buffi ,&nbsp;Ettore Di Trapani ,&nbsp;Vincenzo Ficarra ,&nbsp;Alberto Briganti ,&nbsp;Andrea Salonia ,&nbsp;Francesco Montorsi ,&nbsp;Akshay Sood ,&nbsp;Craig Rogers ,&nbsp;Firas Abdollah","doi":"10.1016/j.clgc.2025.102418","DOIUrl":"10.1016/j.clgc.2025.102418","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the impact of socioeconomic deprivation, as measured by Area Deprivation Index (ADI), on PCa stage at diagnosis in a North-American statewide cohort.</div></div><div><h3>Methods</h3><div>The Michigan Department of Health and Human Services (MDHHS) was queried to identify men aged ≥30 with a confirmed diagnosis of PCa at prostate biopsy between 2004 and 2022. An ADI score was assigned to each patient based on their residential census block group. Individuals were further categorized into quartiles, where the fourth 1 (ADI 75-100) represented those living in the most deprived areas. Logistic regression analysis tested the impact of ADI on diagnosis with NCCN high-risk PCa (T3-T4 or PSA &gt;20 ng/ml or ISUP GG ≥4) or metastatic PCa (N1 or M1) at presentation.</div></div><div><h3>Results</h3><div>We included 78018 patients, 17% of whom were Non-Hispanic Black (NHB). Median (IQR) age was 66 (59-72) years. Patients in the most disadvantage quartile (Q4) were more likely to be NHB (40.1% vs. 5.4%), had higher proportion with PSA&gt;20 ng/ml (10.6 % vs. 5.1%), GG≥4 (55.4% vs. 53.1%), clinical <em>T</em> ≥ 3 (4% vs. 3%) and metastasis (3.3% vs. 1.8%) at diagnostic presentation, compared to those in the least disadvantaged quartile (Q1) (all <em>P</em> &lt; .0001). At MVA, for each 10-unit increase in ADI percentile, the relative odds of being diagnosed with NCCN high-risk and metastatic PCa increases by 2% (95% CI, 1.01-1.02) and 4% (95% CI, 1.02-1.05), respectively. Moreover, when compared to NHW men, NHB men had a 1.16 (95% CI, 1.12-1.22) and a 1.52-fold (95% CI, 1.38-1.68) higher relative odds of being diagnosed with NCCN high-risk PCa and metastatic PCa, respectively (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Living in more deprived areas was associated with higher relative odds of newly diagnosed PCa with unfavorable features. Our study underscores the silent barrier that socioeconomic deprivation poses to cancer early diagnosis and echo the call for tailored interventions to bridge this gap.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102418"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic Accuracy of Contrast-Enhanced Ultrasound in Differentiating RCC from AML in Small Hyperechoic Renal Masses (≤ 3 cm): A Retrospective Single-Center Study 对比增强超声鉴别肾小高回声肿块(≤3cm)与急性髓性白血病的诊断准确性:一项回顾性单中心研究
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-08 DOI: 10.1016/j.clgc.2025.102414
Fabrizio Urraro , Nicoletta Giordano , Vittorio Patanè , Marco Piscopo , Ferdinando De Vita , Davide Arcaniolo , Immacolata Cozzolino , Salvatore Cappabianca , Alfonso Reginelli
{"title":"Diagnostic Accuracy of Contrast-Enhanced Ultrasound in Differentiating RCC from AML in Small Hyperechoic Renal Masses (≤ 3 cm): A Retrospective Single-Center Study","authors":"Fabrizio Urraro ,&nbsp;Nicoletta Giordano ,&nbsp;Vittorio Patanè ,&nbsp;Marco Piscopo ,&nbsp;Ferdinando De Vita ,&nbsp;Davide Arcaniolo ,&nbsp;Immacolata Cozzolino ,&nbsp;Salvatore Cappabianca ,&nbsp;Alfonso Reginelli","doi":"10.1016/j.clgc.2025.102414","DOIUrl":"10.1016/j.clgc.2025.102414","url":null,"abstract":"<div><h3>Background</h3><div>Small (≤ 3 cm) hyperechoic renal masses are challenging to characterize due to overlapping features between angiomyolipomas (AMLs) and renal cell carcinomas (RCCs). Contrast-enhanced ultrasound (CEUS) offers a noninvasive alternative, particularly when CT or MRI are inconclusive or contraindicated. This study assessed CEUS diagnostic accuracy in differentiating RCC from AML and identified predictive enhancement patterns.</div></div><div><h3>Methods</h3><div>In this retrospective single-center study, 104 patients with incidentally detected small hyperechoic renal masses underwent CEUS between December 2021 and July 2024. Two blinded radiologists independently assessed wash-in and wash-out dynamics, peak intensity, homogeneity, and perilesional rim-like enhancement. Histopathology was obtained when available; lesions with ≥ 18 months of stable imaging follow-up were considered benign. Diagnostic metrics, interobserver agreement (ICC), and multivariate logistic regression (IBM SPSS Statistics 29.0) were used to identify independent predictors, reported as odds ratios (ORs) with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Of 104 lesions, 80 were classified as AMLs and followed with ultrasound, while 28 were biopsied, confirming 26 RCCs (papillary 53%, chromophobe 32%, clear cell 15%) and 2 atypical AMLs. Rapid wash-out (sensitivity = 84%, specificity = 91%, AUC = 0.90) and perilesional rim-like enhancement (specificity = 95%, PPV = 90%) were the strongest CEUS predictors of RCC. Multivariate analysis identified rapid wash-out (OR = 5.0; 95% CI, 2.0-12.0) and perilesional enhancement (OR = 3.8; 95% CI, 1.5-10.0) as independent predictors. Combined CEUS features achieved an AUC = 0.93. Interobserver agreement was good (ICC 0.75–0.9).</div></div><div><h3>Conclusion</h3><div>CEUS accurately differentiates RCC from AML in small hyperechoic renal masses. Rapid wash-out and perilesional rim-like enhancement are independent predictors of malignancy and may guide biopsy versus surveillance decisions.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102414"},"PeriodicalIF":2.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144919687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mesothelioma of the Tunica Vaginalis Testis 阴道睾丸膜间皮瘤
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-07 DOI: 10.1016/j.clgc.2025.102409
Alon Lazarovich , Gregory Raster , Samuel Tremblay , Aaron S. Dahmen , Jung Woo Kwon , Gladell P. Paner , Owen Mitchell , Hedy L. Kindler , Scott Eggener
{"title":"Mesothelioma of the Tunica Vaginalis Testis","authors":"Alon Lazarovich ,&nbsp;Gregory Raster ,&nbsp;Samuel Tremblay ,&nbsp;Aaron S. Dahmen ,&nbsp;Jung Woo Kwon ,&nbsp;Gladell P. Paner ,&nbsp;Owen Mitchell ,&nbsp;Hedy L. Kindler ,&nbsp;Scott Eggener","doi":"10.1016/j.clgc.2025.102409","DOIUrl":"10.1016/j.clgc.2025.102409","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>Mesothelioma of the tunica vaginalis testis is a rare and aggressive malignancy with highly variable clinical presentation, most commonly appearing as hydrocele or testicular mass.</div></span></li><li><span>•</span><span><div>Radical surgery with negative margins is a cornerstone of treatment and may improve outcomes.</div></span></li><li><span>•</span><span><div>Systemic therapies, including chemotherapy and immunotherapy, are adapted from pleural mesothelioma treatment protocols. Their role in mesothelioma of the tunica vaginalis testis remains investigational and warrants further prospective study.</div></span></li></ul></div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 6","pages":"Article 102409"},"PeriodicalIF":2.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Active Surveillance in Intermediate-Risk Prostate Cancer: A Contemporary Synthesis of Evidence 主动监测中危前列腺癌:当代综合证据
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102407
Fausto Petrelli , Lorenzo Dottorini , Giada Parsani , Francesca Ceresoli , Domenico Taglialatela , Margherita Pampado , Alessandro Serino , Agostina De Stefani , Francesca Trevisan , Valentina Riboldi , Lorenza Bruschieri , Ivano Vavassori
{"title":"Active Surveillance in Intermediate-Risk Prostate Cancer: A Contemporary Synthesis of Evidence","authors":"Fausto Petrelli ,&nbsp;Lorenzo Dottorini ,&nbsp;Giada Parsani ,&nbsp;Francesca Ceresoli ,&nbsp;Domenico Taglialatela ,&nbsp;Margherita Pampado ,&nbsp;Alessandro Serino ,&nbsp;Agostina De Stefani ,&nbsp;Francesca Trevisan ,&nbsp;Valentina Riboldi ,&nbsp;Lorenza Bruschieri ,&nbsp;Ivano Vavassori","doi":"10.1016/j.clgc.2025.102407","DOIUrl":"10.1016/j.clgc.2025.102407","url":null,"abstract":"<div><div>Active surveillance (AS) is a widely accepted strategy for low-risk prostate cancer, but its application to intermediate-risk disease remains controversial. Given the potential to reduce overtreatment without compromising survival, this review evaluates the safety and clinical outcomes of AS in intermediate-risk prostate cancer (IR-PCa), with a focus on favorable intermediate-risk (FIR) subsets. The objective is to synthesize current evidence on AS utilization, selection criteria, oncologic outcomes, and predictors of disease progression.We conducted a narrative review of 85 studies published between 2009 and 2025 identified through PubMed, Embase, and Web of Science. Search terms included “AS,” “intermediate-risk prostate cancer,” “Gleason 3 + 4,” and “watchful waiting.” Eligible studies included prospective and retrospective cohorts, registry-based analyses, and comparative observational studies evaluating AS in IR-PCa. Data were extracted regarding inclusion criteria, follow-up protocols, progression rates, survival outcomes, and use of imaging and genomic tools for risk stratification. AS is increasingly used in FIR patients with low-volume Gleason 3 + 4 disease, low PSA density, and favorable imaging/genomic profiles. In these patients, 5-10 year metastasis-free survival exceeds 95%. However, AS in unfavorable IR disease is associated with higher risks of disease progression and prostate cancer–specific mortality. Limitations include heterogeneity in AS protocols, lack of randomized trials, and variable definitions of FIR. AS is a viable option for well-selected FIR-PCa patients. Incorporating PSA density, mpMRI, and genomic testing enhances risk stratification. Clinical guidelines should support tailored AS approaches with standardized follow-up and timely intervention triggers.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102407"},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Influence of Lymphovascular Invasion on T Stage Upstaging and Overall Survival in Renal Cell Carcinoma: A Population-Based Study 淋巴血管侵袭对肾细胞癌T期前期和总生存率的影响:一项基于人群的研究。
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102412
Giacomo Musso , Giuseppe Garofano , Mai Dabbas , Margaret F. Meagher , Kit L. Yuen , Natalie Birouty , Benjamin Baker , Cesare Saitta , Melis Guer , Francesco Montorsi , Alberto Briganti , Umberto Capitanio , Alessandro Larcher , Andrea Salonia , Ithaar H. Derweesh
{"title":"The Influence of Lymphovascular Invasion on T Stage Upstaging and Overall Survival in Renal Cell Carcinoma: A Population-Based Study","authors":"Giacomo Musso ,&nbsp;Giuseppe Garofano ,&nbsp;Mai Dabbas ,&nbsp;Margaret F. Meagher ,&nbsp;Kit L. Yuen ,&nbsp;Natalie Birouty ,&nbsp;Benjamin Baker ,&nbsp;Cesare Saitta ,&nbsp;Melis Guer ,&nbsp;Francesco Montorsi ,&nbsp;Alberto Briganti ,&nbsp;Umberto Capitanio ,&nbsp;Alessandro Larcher ,&nbsp;Andrea Salonia ,&nbsp;Ithaar H. Derweesh","doi":"10.1016/j.clgc.2025.102412","DOIUrl":"10.1016/j.clgc.2025.102412","url":null,"abstract":"<div><h3>Introduction</h3><div>Lymphovascular invasion (LVI) is a recognized adverse pathological feature in renal cell carcinoma (RCC). However, its impact on staging and prognosis remains poorly defined, especially across T-stage subcategories.</div></div><div><h3>Patients and Methods</h3><div>We analyzed surgically treated RCC patients from the National Cancer Database (NCDB), including clear cell, papillary and chromophobe RCCs. Data on pathological T-stage and LVI status were retrieved, with overall survival (OS) as the primary outcome. Kaplan-Meier curves (KMA) and log-rank test evaluated survival differences between T-stages with and without LVI. Univariable and multivariable Cox Proportional Hazard Model (CoxPH) were fitted to test the association between LVI and All-cause Mortality (ACM) and the interaction term between LVI and T-stage. Forest plots and regression lines from the CoxPH interaction hazard ratios (HR) illustrated the impact of LVI across T-stages.</div></div><div><h3>Results</h3><div>Among 159,387 RCC patients, 11.3% showed LVI. LVI was associated with larger and higher‐grade tumors, and increased rates of nodal and metastatic disease (<em>P</em> &lt; .001). KMA showed significantly lower 5‐year OS among LVI‐positive versus LVI‐negative patients (61% vs. 85%; <em>P</em> &lt; .001). Across T stages, LVI conferred a “functional upstaging” with survival of T1a+LVI approximating T1b, T1b+LVI resembling T2, T2+LVI approximating T3, and T3a+LVI mirroring T3b outcomes. At univariable and multivariable CoxPH, LVI was an independent predictor of ACM (<em>P</em> &lt; .001), with forest plots indicating its highest relative impact in earlier T-stages.</div></div><div><h3>Conclusion</h3><div>LVI is an aggressive pathological feature in RCC that impairs survival, especially in lower‐stage tumors. Incorporating LVI status into RCC staging may refine risk stratification and guide more intensive surveillance and adjuvant management, particularly for patients with early T-stage disease.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102412"},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reassessing the Evidence: Is Intensified Therapy Justified in Older Patients with Metastatic Hormone-Sensitive Prostate Cancer? 重新评估证据:老年转移性激素敏感前列腺癌患者强化治疗是否合理?
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102410
Lorenzo Dottorini , Italo Sarno , Alessandro Iaculli , Giandomenico Di Menna , Yasser Hussein , Ivano Vavassori , Mauro Rossitto , Andrea Luciani , Fausto Petrelli
{"title":"Reassessing the Evidence: Is Intensified Therapy Justified in Older Patients with Metastatic Hormone-Sensitive Prostate Cancer?","authors":"Lorenzo Dottorini ,&nbsp;Italo Sarno ,&nbsp;Alessandro Iaculli ,&nbsp;Giandomenico Di Menna ,&nbsp;Yasser Hussein ,&nbsp;Ivano Vavassori ,&nbsp;Mauro Rossitto ,&nbsp;Andrea Luciani ,&nbsp;Fausto Petrelli","doi":"10.1016/j.clgc.2025.102410","DOIUrl":"10.1016/j.clgc.2025.102410","url":null,"abstract":"<div><div>To assess the comparative efficacy of intensified systemic treatments in older patients (≥ 65 years) with metastatic hormone-sensitive prostate cancer (mHSPC) through a network meta-analysis (NMA), and evaluate whether routine use of intensified regimens is justified in this population. A systematic literature search of MEDLINE, Embase, and Cochrane Library databases identified randomized controlled trials published between 2000 and 2024 evaluating first-line systemic therapies in mHSPC. Eligible studies combined androgen deprivation therapy (ADT) with docetaxel, abiraterone, enzalutamide, apalutamide, darolutamide, or antiandrogens. The primary endpoint was overall survival (OS). Bayesian NMA was conducted using a consistency model and Markov chain Monte Carlo simulations. SUCRA values were used to estimate treatment rankings. Subgroup data for older patients were extracted where available. Eleven were included in the analysis. Compared to ADT alone, none of the intensified regimens showed statistically significant superiority in OS in older subgroups. ADT + docetaxel + darolutamide had the highest probability of being the most effective treatment (SUCRA 87.8%), followed by ADT + abiraterone + enzalutamide (SUCRA 80.9%). In older patients with mHSPC, intensified systemic regimens demonstrate trends toward improved OS but fail to achieve clear statistical superiority over ADT alone. The substantial heterogeneity across studies and absence of older-specific subgroup data limit definitive conclusions. Treatment decisions in this population should be individualized using geriatric assessment, considering patient fitness, comorbidities, life expectancy, and treatment goals. Further dedicated trials in older and frail patients are warranted to guide optimal therapeutic strategies.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102410"},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is Active Surveillance a Suitable Approach for Bilateral Multifocal Renal Oncocytomas? The 20-Year National Cancer Institute Experience 主动监测是双侧多灶性肾嗜瘤细胞瘤的合适方法吗?20年的国家癌症研究所经验。
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102401
Aditi Chaurasia , Shiva Singh , Noah Pinson , Nikhil Gopal , Jessica Hsueh , Daniel Nethala , Rabindra Gautam , Christopher J. Ricketts , Cathy D. Vocke , Laura S. Schmidt , Maria J. Merino , Ashkan A. Malayeri , W. Marston Linehan , Mark W. Ball
{"title":"Is Active Surveillance a Suitable Approach for Bilateral Multifocal Renal Oncocytomas? The 20-Year National Cancer Institute Experience","authors":"Aditi Chaurasia ,&nbsp;Shiva Singh ,&nbsp;Noah Pinson ,&nbsp;Nikhil Gopal ,&nbsp;Jessica Hsueh ,&nbsp;Daniel Nethala ,&nbsp;Rabindra Gautam ,&nbsp;Christopher J. Ricketts ,&nbsp;Cathy D. Vocke ,&nbsp;Laura S. Schmidt ,&nbsp;Maria J. Merino ,&nbsp;Ashkan A. Malayeri ,&nbsp;W. Marston Linehan ,&nbsp;Mark W. Ball","doi":"10.1016/j.clgc.2025.102401","DOIUrl":"10.1016/j.clgc.2025.102401","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the clinical characteristics, tumor growth rate, oncologic and renal function outcomes in patients with bilateral, multifocal renal oncocytoma managed with active surveillance and/or surgery.</div></div><div><h3>Materials and Methods</h3><div>Bilateral, multifocal renal oncocytoma patients were evaluated using clinical, cross-sectional imaging and pathologic records. The cohort was divided into 3 groups: those under active surveillance only, those who underwent surgery in combination with active surveillance, and those who underwent multiple interventions. Growth rate, metastases and renal function outcomes were compared between the 3 groups.</div></div><div><h3>Results</h3><div>Sixty-two patients (median age 64 years (IQR 57.5-69), 49 men) were identified with 10 patients (16.1%) having a known family history of bilateral, multifocal oncocytoma. Overall, the combined median growth rate of primary tumors across all 3 groups was 0.25 cm/year (IQR 0.1-0.4). Comparing between all 3 groups identified a statistically significant difference in age of diagnosis (<em>P</em> = .01), whereas no difference was noted for age at death. No distant metastasis was observed. A statistically significant difference in median tumor size at the time of last follow-up (<em>P</em> = .02) was reported among the 3 groups. No statistically significant differences were seen in primary tumor growth rate (<em>P</em> = .50), initial eGFR (<em>P</em> = .35), final eGFR (<em>P</em> = .26) and change in eGFR levels over time (<em>P</em> = .10) among all 3 groups.</div></div><div><h3>Conclusion</h3><div>Disease-specific outcomes and renal function outcomes do not differ significantly among the patients managed with active surveillance and/or surgery.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102401"},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of HRR Gene Subclass on Clinical Outcomes of PARP Inhibitors in Metastatic Castration-Resistant Prostate Cancer HRR基因亚类对PARP抑制剂治疗转移性去势抵抗性前列腺癌临床结果的影响
IF 2.7 3区 医学
Clinical genitourinary cancer Pub Date : 2025-08-05 DOI: 10.1016/j.clgc.2025.102411
George Dimitrov , Elenko Popov
{"title":"Impact of HRR Gene Subclass on Clinical Outcomes of PARP Inhibitors in Metastatic Castration-Resistant Prostate Cancer","authors":"George Dimitrov ,&nbsp;Elenko Popov","doi":"10.1016/j.clgc.2025.102411","DOIUrl":"10.1016/j.clgc.2025.102411","url":null,"abstract":"<div><h3>Objective</h3><div>This retrospective study evaluates the clinical significance of mutations in effector genes (<em>BRCA1, BRCA2, PALB2, RAD51, FANCD2</em>) versus sensor genes (<em>ATM, ATR, CHEK1, CHEK2, NBS1</em>) in patients with metastatic castration-resistant prostate cancer (mCRPC) classified as homologous recombination deficiency (HRD)-positive. The study assesses their predictive value for response to poly(ADP-ribose) polymerase inhibitors (PARPi) combined with androgen receptor signaling inhibitors (ARSi).</div></div><div><h3>Design</h3><div>A multicenter, retrospective real-world study conducted across 6 oncology hospitals in Bulgaria. Patient data were obtained through a formal request to the Ministry of Health’s United Information Portal, an electronic health records repository. The analysis included mCRPC patients treated with olaparib plus abiraterone who underwent next-generation sequencing (NGS) between January 1, 2022, and January 1, 2025, conducted in a certified national reference laboratory, with a median follow-up of 16 months. The primary endpoints were overall survival (OS) and progression-free survival (PFS).</div></div><div><h3>Results</h3><div>Of the 210 mCRPC patients screened via NGS, 28% (<em>n</em> = 58) harbored mutations in at least one HRR gene, classified as sensor (<em>n</em> = 27) or effector (<em>n</em> = 31). Patients with effector mutations demonstrated a statistically significant improvement in PFS compared to those with sensor mutations (median PFS: 20 vs. 14 months, HR = 0.48, 95% CI: 0.252–0.914, <em>P</em> = .0294). Similarly, overall survival (OS) was significantly prolonged in the effector group. While the median OS for the sensor group was 19 months, the effector group had not yet reached median OS at the time of analysis (HR = 0.38, 95% CI, 0.154-0.945, <em>P</em> = .0373). Logistic regression analysis and PSM supported findings.</div></div><div><h3>Conclusion</h3><div>Patients with mCRPC harboring effector HRR mutations derive greater clinical benefit from PARPi plus ARSi than those with sensor mutations. These findings highlight the heterogeneous predictive value of HRR gene alterations and suggest that mutation sub-class should guide treatment decisions in HRD-positive mCRPC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 5","pages":"Article 102411"},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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