Clinical genitourinary cancer最新文献

{"title":"Prognostic Value of NLR, PLR, SII, and dNLR in Urothelial Bladder Cancer Following Radical Cystectomy","authors":"","doi":"10.1016/j.clgc.2024.102144","DOIUrl":"10.1016/j.clgc.2024.102144","url":null,"abstract":"<div><h3>Background</h3><p>Inflammation plays a crucial role in tumor development and progression, with inflammatory markers showing promise in predicting cancer prognosis. However, their significance in muscle-invasive bladder cancer (MIBC), especially in the context of neoadjuvant chemotherapy (NAC), remains poorly understood. This study aims to evaluate the prognostic utility of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and derived neutrophil-to-lymphocyte ratio (dNLR) for overall survival (OS) in bladder cancer (BC) patients undergoing radical cystectomy (RC) in the NAC era.</p></div><div><h3>Patients and Methods</h3><p>A retrospective review analyzed prospectively-collected data from our institutional BC registry, covering patients with MIBC undergoing RC with curative intent from March 1st, 2016, to December 31st, 2022. Blood samples were collected preoperatively to calculate NLR, PLR, SII, and dNLR. OS was defined from surgery to last follow-up or death. Statistical analyses included ROC curves, Kaplan-Meier Curves, and Cox proportional hazards regression models.</p></div><div><h3>Results</h3><p>A total of 187 patients with median duration follow-up of 14.7 month were included in this study and 50.8% experienced death. NAC was administered in 50.3% of cases. The ideal cut-off for dichotomizing NLR, PLR, SII, and dNLR was 1.76, 104.30, 410.66, and 1.30, respectively. In multivariable analysis each of these biomarkers emerged as an independent prognostic factor for predicting OS. The results showed a correlation between higher NLR, PLR, SII, and dNLR levels and a deterioration in OS.</p></div><div><h3>Conclusion</h3><p>Elevated values of these inflammatory markers indicate poorer survival, highlighting their potential as indicators of disease aggressiveness. Identifying patients with elevated markers can help healthcare providers personalize treatment strategies, improving patient outcomes and survival rates.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141570089","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}

{"title":"Clinical Outcomes and Risk Stratification in Patients With Metastatic Hormone-Sensitive Prostate Cancer Treated With New-Generation Androgen Receptor Signaling Inhibitors","authors":"","doi":"10.1016/j.clgc.2024.102140","DOIUrl":"10.1016/j.clgc.2024.102140","url":null,"abstract":"<div><h3>Background</h3><p>Optimal drug selection for metastatic hormone-sensitive prostate cancer (mHSPC) remains unclear. We therefore assessed the clinical outcomes of mHSPC treated with new-generation androgen receptor pathway inhibitors (ARSIs) and identified risk factors associated with the prognosis of mHSPC.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 324 patients with mHSPC who were treated with ARSIs, including abiraterone acetate, enzalutamide, and apalutamide, between January 2018 and December 2022. In addition to assessing the prostate-specific antigen (PSA) response and overall survival (OS) during ARSI treatment, we investigated several potential risk factors for a poor OS in patients with mHSPC.</p></div><div><h3>Results</h3><p>Patients with a ≥ 90% PSA reduction (hazard ratio [HR]: 0.24, 95% confidence interval [CI], 0.10-0.58; <em>P</em> = .002) and those whose PSA declined to ≤ 0.2 ng/mL (HR: 0.22, 95% CI, 0.08-0.63; <em>P</em> = .005) showed significantly better OS than other patients. Gleason grade group 5 (GG5), presence of liver metastasis, and an LDH ≥ 250 U/L were identified as prognostic factors significantly associated with a poor OS, with HRs of 2.31 (95% CI, 1.02-5.20; <em>P</em> = .044), 7.87 (95% CI, 2.61-23.8; <em>P</em> &lt; .001) and 3.21 (95% CI, 1.43-7.23; <em>P</em> = .005).</p></div><div><h3>Conclusion</h3><p>We identified GG5, the presence of liver metastasis, and elevated LDH at the diagnosis as significant factors predicting the OS of mHSPC, but the choice of ARSIs did not affect the prognosis. The potential prognostic impact of these markers requires further investigation.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141397277","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}

{"title":"Survival of Metastatic Urothelial Carcinoma of Urinary Bladder According to Number and Location of Visceral Metastases","authors":"Francesco Di Bello ,&nbsp;Mario de Angelis ,&nbsp;Carolin Siech ,&nbsp;Letizia Maria Ippolita Jannello ,&nbsp;Natali Rodriguez Peñaranda ,&nbsp;Zhe Tian ,&nbsp;Jordan A. Goyal ,&nbsp;Claudia Ruvolo ,&nbsp;Gianluigi Califano ,&nbsp;Roberto La Rocca ,&nbsp;Fred Saad ,&nbsp;Shahrokh F. Shariat ,&nbsp;Ottavio de Cobelli ,&nbsp;Alberto Briganti ,&nbsp;Felix K.H. Chun ,&nbsp;Stefano Puliatti ,&nbsp;Nicola Longo ,&nbsp;Pierre I. Karakiewicz","doi":"10.1016/j.clgc.2024.102139","DOIUrl":"10.1016/j.clgc.2024.102139","url":null,"abstract":"<div><h3>Objective</h3><p>To test the association between number as well as locations of organ-specific metastatic sites and overall survival (OS) in systhemic-therapy exposed metastatic urothelial carcinoma of urinary bladder (mUCUB) patients.</p></div><div><h3>Methods</h3><p>Within Surveillance, Epidemiology and End Results database (2010-2020), all systhemic therapy-exposed mUCUB patients were identified. Kaplan-Meier and multivariable Cox regression (CRM) models first addressed OS in patients according to number of metastatic organ-locations: solitary versus 2 versus 3 or more. Subsequently, separate analyses stratified according to location type were completed in patients with solitary metastatic organ-location as well as in patients with 2 metastatic organ-locations.</p></div><div><h3>Results</h3><p>Of 1,310 mUCUB, 1,069 (82%) harbored solitary metastatic organ-location versus 193 (15%) harbored 2 separate metastatic organ-locations versus 48 (3%) harbored 3 or more metastatic organ-locations. Median OS decreased with increasing number of metastatic organ-locations (solitary vs. 2 vs. 3 or more, <em>P</em> &lt; .0001). In multivariable CRM, relative to solitary metastatic organ-location, 2 (HR: 1.57, 95 Confidence interval [CI], 1.33-1.85) as well as 3 or more (HR: 1.69, 95% CI, 1.23-2.31) metastatic organ-locations independently predicted higher overall mortality (OM) (<em>P</em> = .001). In patients with solitary metastatic organ-location, brain metastases independently predicted higher OM (HR 1.67; 95% CI, 1.05-2.67; <em>P</em> = .03) than other locations. In patients with 2 metastatic organ-locations, no differences in OM were recorded according to organ type location.</p></div><div><h3>Conclusion</h3><p>In systemic therapy exposed mUCUB, number of metastatic organ-locations (solitary vs. 2 vs. 3 or more), independently predicted increasingly worse prognosis. In patients with solitary metastatic organ-location, brain purported worse prognosis than others.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141403736","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}

{"title":"Hormonal Agents in Localized and Advanced Prostate Cancer: Current Use and Future Perspectives","authors":"Fabio Turco ,&nbsp;Consuelo Buttigliero ,&nbsp;Marco Donatello Delcuratolo ,&nbsp;Silke Gillessen ,&nbsp;Ursula Maria Vogl ,&nbsp;Thomas Zilli ,&nbsp;Nicola Fossati ,&nbsp;Andrea Gallina ,&nbsp;Giovanni Farinea ,&nbsp;Rosario Francesco Di Stefano ,&nbsp;Mariangela Calabrese ,&nbsp;Isabella Saporita ,&nbsp;Veronica Crespi ,&nbsp;Stefano Poletto ,&nbsp;Erica Palesandro ,&nbsp;Massimo Di Maio ,&nbsp;Giorgio Vittorio Scagliotti ,&nbsp;Marcello Tucci","doi":"10.1016/j.clgc.2024.102138","DOIUrl":"10.1016/j.clgc.2024.102138","url":null,"abstract":"<div><p>Prostate cancer (PC) is generally a hormone-dependent tumor. Androgen deprivation therapy ( has been the standard of care in metastatic disease for more than 80 years. Subsequent studies have highlighted the efficacy of ADT even in earlier disease settings such as in localized disease or in the case of biochemical recurrence (BCR). Improved knowledge of PC biology and ADT resistance mechanisms have led to the development of novel generation androgen receptor pathway inhibitors (ARPI). Initially used only in patients who became resistant to ADT, ARPI have subsequently shown to be effective when used in patients with metastatic hormone-naive disease and in recent years their effectiveness has also been evaluated in localized disease and in case of BCR. The objective of this review is to describe the current role of agents interfering with the androgen receptor in different stages of PC and to point out future perspectives.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141411333","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}

{"title":"Predicting Treatment Effects from Surrogate Endpoints in Historical Trials in First-Line Metastatic Castration-Resistant Prostate Cancer","authors":"Imtiaz A. Samjoo ,&nbsp;Tim Disher ,&nbsp;Elena Castro ,&nbsp;Jenna Ellis ,&nbsp;Stefanie Paganelli ,&nbsp;Jonathan Nazari ,&nbsp;Alexander Niyazov","doi":"10.1016/j.clgc.2024.102137","DOIUrl":"10.1016/j.clgc.2024.102137","url":null,"abstract":"<div><p>Surrogate endpoints are becoming increasingly important in health technology assessment, where decisions are based on complex cost-effectiveness models (CEMs) that require numerous input parameters. Daniels and Hughes Surrogate Model was used to predict missing effect estimates in randomized controlled trials (RCTs) evaluating first-line treatments in metastatic castration-resistant prostate cancer (mCRPC) patients. Network meta-analyses (NMAs) were conducted to assess the comparative efficacy of these treatments. Databases were searched (inception to October 2022) using Ovid®. Several grey literature searches were also conducted (PROSPERO: CRD42021283512). Available trial data for radiographic progression-free survival (rPFS) and overall survival (OS) were used to predict the unreported effect of rPFS or OS for relevant comparator treatments. Bayesian NMAs were conducted using observed and predicted treatment effects. Effect estimates and 95% credible intervals were calculated for each comparison. Mean ranks and the probability of being best (p-best) were obtained. Twenty-five RCTs met the eligibility criteria and of these, 8 reported jointly rPFS and OS; while rPFS was predicted for 12 RCTs and 10 comparators, and OS was predicted for 5 RCTs and 6 comparators. A nonstandard dose of docetaxel (docetaxel 50 mg/m² every 2 weeks) had the highest probability of being the most effective for rPFS (p-best: 59%) and OS (p-best: 48%), followed by talazoparib plus enzalutamide (13% and 19%, respectively). Advanced surrogate modelling techniques allowed obtaining relevant parameter and indirect estimates of previously unavailable data and may be used to populate future CEMs requiring rPFS and OS in first-line mCRPC.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1558767324001083/pdfft?md5=e1e96543b6c9dc187715f8866b5bf383&pid=1-s2.0-S1558767324001083-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141402170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Treatment of Residual Disease After Immunotherapy-Based Combinations on Complete Response Rate of Patients With Metastatic Renal Cell Carcinomas","authors":"F. Moinard-Butot ,&nbsp;M. Oriel ,&nbsp;T. Tricard ,&nbsp;RL. Cazzato ,&nbsp;L. Pierard ,&nbsp;V. Gaillard ,&nbsp;P. Werle ,&nbsp;V. Lindner ,&nbsp;S. Martin ,&nbsp;C. Schuster ,&nbsp;C. Roy ,&nbsp;M. Burgy ,&nbsp;A. Anthony ,&nbsp;C. Bigot ,&nbsp;P. Boudier ,&nbsp;A. Fritsch ,&nbsp;A. Olland ,&nbsp;G. Malouf ,&nbsp;H. Lang ,&nbsp;P. Barthélémy","doi":"10.1016/j.clgc.2024.102134","DOIUrl":"10.1016/j.clgc.2024.102134","url":null,"abstract":"<div><h3>Introduction</h3><p>Immune checkpoint inhibitor (ICI)-based combinations have revolutionized the management of first-line metastatic renal cell carcinoma (mRCC) by improving patient survival. Large phase 3 randomized trials assessing ICI-based combinations have reported complete response (CR) rates of 10% to 18% in the first-line setting. However, there is a scarcity of data about the effect of treatment of residual disease regarding CR rates improvement.</p></div><div><h3>Materials and Methods</h3><p>We included retrospectively all consecutive mRCC patients treated in first-line setting at the Institut de Cancérologie Strasbourg Europe with an ICI-based combination involving ICI or TKI, either alone or with added local treatment of residual disease. Patients were characterized according to IMDC risk. Radiologic response was defined according to RECIST v1.1.</p></div><div><h3>Results</h3><p>We enrolled 80 mRCC patients treated with ICI-based combinations between May 2015 and May 2022. The median age was 63 years. Regarding IMDC risk, there were 12 favourable (15%), 50 intermediate (63%), and 18 poor-risk (22%) patients. Forty-seven patients (59%) received ICI + ICI, 24 (30%) received ICI + TKI, and 9 (11%) received another ICI-based therapy. In total, 8 achieved CR (10%), 36 patients (45%) achieved partial response, 23 (29%) achieved stable disease and 12 achieved progressive disease (15%) as the best response with systemic therapy alone. By adding local treatment of residual disease, 11 additional patients (14%) <em>achieved radiological NED.</em> Residual disease resected sites included kidney (n = 6), lymph nodes (n = 5), lung metastases (n = 2) and liver metastases (n = 1).</p></div><div><h3>Conclusions</h3><p>The resection of residual disease after first-line ICI-based therapy is associated with improved CR rate <em>(CR + NED)</em> in patients with mRCC. These results need to be validated in prospective trial.</p></div><div><h3>Patient Summary</h3><p>In recent years, the advent of immunotherapy has radically changed the management of patients with metastatic kidney cancer. Approximately 10% to 18% of these patients using immune checkpoint inhibitor (ICI)-based combinations no longer have detectable disease on CT scans (complete response). There are currently few data on the use of treatment of residual disease to increase the number of patients in complete response. In this retrospective study, the complete response rate with ICI-based treatment was 10%. When local treatment was added, the number of patients with a complete response increased to 24%. This strategy could increase the number of patients with a prolonged complete response in the future.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1558767324001058/pdfft?md5=4dc178a26fb815b014f86daf58a64f25&pid=1-s2.0-S1558767324001058-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bi-Parameter MRI Could Quantitatively Assess the Zonal Heterogeneity of Prostate Cancer","authors":"Ye Han ,&nbsp;Lei Yuan ,&nbsp;Jingliang Zhang ,&nbsp;Zunjian Xiao ,&nbsp;Jianhua Jiao ,&nbsp;Fan Shen ,&nbsp;Weijun Qin ,&nbsp;Yi Huan ,&nbsp;Jing Ren","doi":"10.1016/j.clgc.2024.102135","DOIUrl":"10.1016/j.clgc.2024.102135","url":null,"abstract":"<div><h3>Introduction</h3><p>Prostate cancer (PCa) located in the peripheral zone (PZ) and transitional zone (TZ) showed a different clinical and pathological characteristic. This passage aims to preliminarily evaluate the relationship between the zonal heterogeneity of PCa quantitatively assessed by bpMRI and pathological risk stratification of the primary lesion.</p></div><div><h3>Methods</h3><p>This prospective study was conducted from January 2019 to February 2023. A total of 113 PCa patients whose bpMRI data indicated that the lesions located in only 1 single zone of the prostate were selected. A transrectal ultrasound and MRI-targeted biopsy were performed to verify the bpMRI results, and then radical prostatectomy (RP) was performed in 3 weeks after the biopsy. The high-risk (HR) group was defined as ISUP grades ≥ 3. Binary regression was performed to evaluate if the zonal heterogeneity could be an independent predictor of the HR group. The receiver operator characteristic (ROC) curve was performed to analyze the added value of zonal location in predicting the HR group.</p></div><div><h3>Results</h3><p>PSA, T staging, and ISUP grades, incidence of positive surgical margins were significantly lower in the TZ PCa, and the ADCmin, and ADCmean values in the TZ PCa were significantly higher (all <em>P</em> &lt; .01). The zonal heterogeneity could independently predict the HR group patients (OR: 5.170 [1.663-16.067], <em>P</em> = .005) and improve the predicting efficiency of HR patients (AUC 0.824, 95% CI, 0.741-0.889).</p></div><div><h3>Conclusions</h3><p>BpMRI could quantitively assess the zonal heterogeneity of PCa precisely and increase the predicting efficacy of HR patients<strong>,</strong> which can provide better help for clinical individualized treatment.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408707","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}

{"title":"Preoperative Plasma Insulin-Like Growth Factor-I and Its Binding Proteins-Based Risk Stratification of Patients Treated With Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma","authors":"","doi":"10.1016/j.clgc.2024.102133","DOIUrl":"10.1016/j.clgc.2024.102133","url":null,"abstract":"<div><h3>Introduction</h3><p>We evaluate the predictive and prognostic value of insulin-like growth factor-I (IGF-1), IGF binding protein-2 (IGFBP-2) and -3 (IGFBP-3) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).</p></div><div><h3>Methods</h3><p>This is a retrospective analysis of a multi-institutional database comprising 753 patients who underwent RNU for UTUC and had a preoperative plasma available. Logistic and Cox regression analyses were performed. The discriminative ability and clinical utility of the models was calculated using the lasso regression test, area under receiver operating characteristics curves, C-index, and decision curve analysis (DCA).</p></div><div><h3>Results</h3><p>Lower preoperative plasma levels of IGFBP-2 and -3 independently correlated with increased risks of lymph node metastasis, pT3/4 disease, nonorgan confined disease, and worse recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) (all <em>P</em> ≤ .004). The addition of both IGFBP-2 and -3 to a postoperative multivariable model, that included standard clinicopathologic characteristics, improved the model's concordance index by 10%, 9%, and 8% for RFS, CSS, and OS, respectively. On DCA, addition of both IGFBP-2 and -3 to base models improved their performance for RFS, CSS, and OS by a statistically and clinically significant margin. Plasma IGF-1 was not associated with any of outcomes.</p></div><div><h3>Conclusions</h3><p>We confirmed that a lower plasma levels of IGFBP-2 and -3 both are independent and clinically significant predictors of adverse pathological features and survival outcomes in UTUC patients treated with RNU. These findings might help guide the clinical decision-making regarding perioperative systemic therapy and follow-up scheduling.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1558767324001046/pdfft?md5=90fd732d4d9b2a44e78fdad37fd82230&pid=1-s2.0-S1558767324001046-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Preoperative Plasma Potassium Levels on Oncological Outcomes, Major Complications, and 30-Day Mortality in Bladder Cancer Patients Undergoing Radical Cystectomy","authors":"Jakob Klemm ,&nbsp;Shahrokh F. Shariat ,&nbsp;Ekaterina Laukhtina ,&nbsp;Pawel Rajwa ,&nbsp;Malte W. Vetterlein ,&nbsp;Victor M. Schuettfort ,&nbsp;Markus von Deimling ,&nbsp;Roland Dahlem ,&nbsp;Margit Fisch ,&nbsp;Michael Rink","doi":"10.1016/j.clgc.2024.102079","DOIUrl":"10.1016/j.clgc.2024.102079","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>We examined the impact of preoperative plasma potassium levels (PPLs) on outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB), hypothesizing that potassium imbalances might influence outcomes.</p></div><div><h3>Patients and Methods</h3><p>In this retrospective study, 501 UCB patients undergoing RC from 2009 to 2017 at a tertiary center were analyzed. Blood samples collected a week prior to surgery defined normal and abnormal PPL based on institutional standards. We assessed overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), postoperative complications, 30-day mortality, and non-organ confined disease. Kaplan-Meier estimates, Cox proportional hazards, logistic regression, and decision curve analyses (DCA) were employed.</p></div><div><h3>Results</h3><p>63 (13%) patients had abnormal preoperative PPLs, with 50 (10%) elevated and 13 (2.5%) decreased. In a 59 months median follow-up, 152 (31%) had disease recurrence, 197 (39%) died from any cause, and 119 (24%) from UCB. Multivariable cox regression analyses adjusting for perioperative parameters demonstrated abnormal PPL was associated with worse OS (HR=1.9, <em>P</em>=0.009), CSS (HR=2.8, <em>P</em>&lt;0.001) and RFS (HR=2.1; <em>P</em>=0.007). Elevated preoperative PPLs also demonstrated significant associations with adverse outcomes in OS, CSS, and RFS (all <em>P</em>&lt;0.05). In multivariable logistic regression analyses, abnormal and elevated PPLs were not associated with 30-day mortality, major 30-day postoperative complications, positive nodal disease, pT3/4 stage, and non-organ confined disease (all <em>P</em>&gt;0.05).</p></div><div><h3>Conclusion</h3><p>Abnormal and elevated preoperative PPLs correlate with adverse oncologic outcomes in UCB patients treated with RC. Pending external validation, preoperative PPLs might be a cost-effective, easily obtainable supplemental biomarker for enriching accuracy of outcome prediction in this highly variable maladie.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1558767324000508/pdfft?md5=e308907a56f50d112897d2f8abb9a483&pid=1-s2.0-S1558767324000508-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140270775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation Therapy for the Management of Renal Medullary Carcinoma: A Multi-Case Study","authors":"Robert H. Mbilinyi ,&nbsp;Pavlos Msaouel ,&nbsp;Priya Rao ,&nbsp;Jose A. Karam ,&nbsp;Nizar M. Tannir ,&nbsp;Chad Tang","doi":"10.1016/j.clgc.2024.102065","DOIUrl":"10.1016/j.clgc.2024.102065","url":null,"abstract":"<div><p></p><ul><li><span>•</span><span><p>This study addresses the clinical management of renal medullary carcinoma (RMC), a rare and aggressive cancer primarily affecting young individuals of African descent with sickle cell trait. Unlike renal cell carcinoma (RCC), RMC is known for its poor prognosis, with a survival rate of less than 5% beyond three years and limited response to standard systemic treatments effective in other renal cancers.</p></span></li><li><span>•</span><span><p>The key findings of this study are significant. It shows that combining definitive radiation and systemic therapies, especially in patients with oligometastatic or oligoprogressive RMC, can greatly improve outcomes. In some cases, this approach resulted in over 12 months of disease-free survival, a substantial improvement over current treatment outcome. Notably, patients receiving this combined treatment exhibited complete radiographic responses lasting more than 12 months, highlighting the substantial benefits of this strategy.</p></span></li><li><span>•</span><span><p>Clinically, these findings could reshape RMC treatment by endorsing an aggressive, personalized, and multimodal approach. we recommend early integration of radiation with systemic therapy. Additionally, we recommend an aggressive combinational regimen especially post-relapse, contrasting with conventional treatments. Insights, like minimizing therapy interruptions and careful systemic therapy selection, may enhance outcomes in this historically challenging disease.</p></span></li><li><span>•</span><span><p>The significance of this study lies in its potential to influence clinical practice by offering a promising treatment approach for RMC, a condition in need of more effective therapeutic regimen. Further research is necessary to validate these findings and refine the integration of radiation therapy in RMC treatment.</p></span></li></ul></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140072079","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}