Clinical genitourinary cancer最新文献

{"title":"Age Does Not Impact Cancer Specific Mortality: From Sub-Distributional and Cause-Specific Hazard Analysis in RCC Patients Undergoing Radical Nephrectomy and Thrombectomy","authors":"Younjuong Kim ,&nbsp;Jun Gyo Gwon ,&nbsp;Hyun Young Lee ,&nbsp;Bumjin Lim ,&nbsp;Jung Kwon Kim ,&nbsp;Cheryn Song ,&nbsp;Dalsan You ,&nbsp;In Gab Jeong ,&nbsp;Jun Hyuk Hong ,&nbsp;Bumsik Hong ,&nbsp;Hanjong Ahn ,&nbsp;Jungyo Suh","doi":"10.1016/j.clgc.2024.102231","DOIUrl":"10.1016/j.clgc.2024.102231","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the impact of age on cancer-specific mortality (CSM) and other-cause mortality (OCM) in patients undergoing radical nephrectomy with thrombectomy (RNTx) for renal cell carcinoma (RCC) with venous thrombus.</div></div><div><h3>Patients and Methods</h3><div>We retrospectively analyzed 196 patients who underwent RNTx for RCC with venous thrombus between 1990 and 2018 at a single tertiary referral center. Patients were categorized into three age groups: &lt;60, 60-69, and ≥70 years. The cumulative incidence function (CIF) for CSM and OCM was calculated using the Aalen-Johansen estimator, and hazard ratios (HR) from sub-distributional hazard (SDH) and cause-specific hazard (CSH) models were employed to assess the impact of age on mortality.</div></div><div><h3>Results</h3><div>The median follow-up was 40.5 months. Of the 196 patients, 105 experienced disease progression, 125 had cancerrelated deaths, and 155 died from any cause. Perioperative outcomes, including ICU admission, 90-day readmission, and 90-day mortality, were similar across age groups. The CIF for 5-year CSM differed significantly among age groups (<em>p</em> = 0.032), though this difference was not observed at 10 years. OCM increased significantly with age, particularly in the ≥70 group at 10 years (<em>p</em> = 0.045). Multivariable SDH and CSH models showed no significant differences in CSM between age groups.</div></div><div><h3>Conclusion</h3><div>While age was associated with increased OCM, it did not significantly impact the hazard of CSM. Older age alone should not be considered a contraindication for surgical intervention in RCC with venous thrombus.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102231"},"PeriodicalIF":2.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549465","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":"The Association of Statin Use With Survival Outcomes in Patients With Metastatic Castration-Resistant Prostate Cancer (mCRPC) Treated With Androgen Receptor Targeted Therapies (ART)","authors":"Zakaria Chakrani ,&nbsp;Mann Patel ,&nbsp;George Mellgard ,&nbsp;Stephen McCroskery ,&nbsp;Nathaniel Saffran ,&nbsp;Nicole Taylor ,&nbsp;Bobby C. Liaw ,&nbsp;Matthew Galsky ,&nbsp;William Oh ,&nbsp;Che-Kai Tsao ,&nbsp;Teja Ganta ,&nbsp;Vaibhav Patel","doi":"10.1016/j.clgc.2024.102227","DOIUrl":"10.1016/j.clgc.2024.102227","url":null,"abstract":"<div><h3>Background</h3><div>Statins may provide a compounded effect on ART by decreasing cholesterol levels thus decreasing de novo androgen synthesis and tumor cell viability. We investigated the clinical efficacy of concurrent statin use on outcomes of patients with mCRPC taking ART.</div></div><div><h3>Methods</h3><div>A single-institution retrospective analysis of patients with mCRPC receiving ART from 2010 to 2021 was performed. Our primary outcome was PSA progression free survival (PFS), and our secondary outcomes were overall survival (OS). Patient characteristics were collected in addition to ART treatment course, statin treatment, and survival outcomes. Cox proportional hazards regression model was used to estimate hazard ratios (HR) for OS and PSA PFS and multivariable logistic regression to determine risk factors.</div></div><div><h3>Results</h3><div>153 patients with mCRPC treated with ART were included. A total of 67 patients (43.8%) received concurrent statins. Median PSA PFS was 20.4 months for patients that received statins versus 15.3 months for patients who did not receive statins. Median OS was 45.1 months for patients who received concurrent statins versus 29.7 months for patients who did not. On univariate and multivariate survival analyses, there was no statistically significant difference between groups for PSA PFS (HR 0.7; CI 0.44-1.1; <em>P</em> = .123) and OS (HR 0.67; CI 0.42-1.06; <em>P</em> = .089).</div></div><div><h3>Conclusions</h3><div>Our analysis suggests that statins do not significantly improve clinical outcomes in patients with mCRPC. Ultimately, current understanding remains limited, and prospective studies are needed, but here we provide a cost-effective, timely, and selective preliminary analysis.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102227"},"PeriodicalIF":2.3,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514712","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":"Distinct Gene Expression Patterns Identify Patients who Relapse After Neoadjuvant Pembrolizumab and Radical Cystectomy in the PURE-01 Study","authors":"Moritz J. Reike ,&nbsp;Daniele Raggi ,&nbsp;Chiara Mercinelli ,&nbsp;Antonio Cigliola ,&nbsp;Valentina Tateo ,&nbsp;Damiano Alfio Patanè ,&nbsp;Emanuele Crupi ,&nbsp;Tiago Costa de Padua ,&nbsp;Peter C. Black ,&nbsp;Ewan A. Gibb ,&nbsp;Andrea Necchi","doi":"10.1016/j.clgc.2024.102214","DOIUrl":"10.1016/j.clgc.2024.102214","url":null,"abstract":"<div><h3>Purpose</h3><div>The PURE-01 clinical trial reported the use of neoadjuvant treatment with pembrolizumab prior to radical cystectomy (RC) in patients with muscle-invasive bladder. Specific molecular subtypes and immune signatures were reported to be associated with a favorable survival. However, reports on the detailed tumor biology of patients relapsing after neoadjuvant pembrolizumab are lacking.</div></div><div><h3>Materials and Methods</h3><div>Microarray data from transurethral resection of the bladder tumor (TURBT; n = 102) and matched RC (N = 25) tissue from patients in PURE-01 who experience a disease relapse were analyzed, with gene expression signatures and molecular subtypes. The Kaplan–Meier method was used to estimate differences in patient outcomes. Immune-signatures were split by median for survival analysis. All significance testing used a two-sided t-test at a threshold of <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>The study cohort consisted of 102 patients, of whom N = 19 (19%) experienced relapse. Molecular subtyping revealed that neuroendocrine-like tumors had the worst outcomes, while tumors classified as Claudin-low did show only one recurrence event. Differential gene expression analysis identified genes associated with relapse, including KRT20, H19, and immune-associated genes such as CXCL9 and CXCL11.</div></div><div><h3>Conclusion</h3><div>This study provides a detailed characterization of patients who relapsed after neoadjuvant pembrolizumab and RC and identifies distinct gene expression patterns associated with relapse. These findings may have implications for predicting patient response and guiding treatment decisions in the neoadjuvant setting.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102214"},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514698","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":"Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma","authors":"Vincent E. Xu ,&nbsp;Oluwafolajimi Adesanya ,&nbsp;Sarah Azari ,&nbsp;Samita Islam ,&nbsp;Matthew Klein ,&nbsp;Arthur Drouaud ,&nbsp;Ryan M. Antar ,&nbsp;Phat Chang ,&nbsp;Armine Smith ,&nbsp;Michael J Whalen","doi":"10.1016/j.clgc.2024.102224","DOIUrl":"10.1016/j.clgc.2024.102224","url":null,"abstract":"<div><h3>Introduction</h3><div>Upper tract urothelial carcinoma (UTUC) is a rare malignancy with poor prognosis. Radical nephroureterectomy (RNU) remains the standard treatment for high-risk UTUC. Considering the decline in renal function with RNU and results from prospective trials, NAC has emerged as a favored perioperative treatment for chemo-eligible patients with UTUC. However, strong evidence of the efficacy of NAC and predictors for its use are scarce. We aimed to assess trends in NAC utilization and pathologic outcomes and survival with NAC use.</div></div><div><h3>Methods</h3><div>The National Cancer Database was queried for patients with high-grade cTanyNanyM0 UTUC treated with RNU from 2004 to 2019. Outcomes included overall survival (OS), pathologic response (pR) and pathologic complete response (pCR), defined as ≤pT1pN0/X and pT0pN0/X, respectively.</div></div><div><h3>Results</h3><div>Of 6,645 patients treated with RNU, 209 received RNU NAC. Greater distance from treatment facility decreased the likelihood of receiving NAC. Higher cT stages (OR 1.72, <em>P</em> = .028), cN+ status (OR 7.40, <em>P</em> &lt; .001) and treatment at an academic facility (OR 2.02, <em>P</em> &lt; .001) predicted NAC treatment. NAC was associated with 34.0% pR and 5.3% pCR. In multivariable analysis, patients with pR and pCR had improved OS (HR = 0.176, <em>P</em> &lt; .014).</div></div><div><h3>Conclusion</h3><div>We report significant response rates with NAC and improved OS in patients who experienced pR or pCR. Over a 15-year study period, NAC was underutilized, especially in nonacademic settings and among patients living farther from care facilities, underscoring the need for improved regionalization and multidisciplinary approaches in UTUC management.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102224"},"PeriodicalIF":2.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441172","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":"Efficacy and Safety of Pembrolizumab plus Axitinib combination for Metastatic Renal Cell Carcinoma in a Real-World Scenario: Data From the Prospective ProPAXI Study","authors":"Annalisa Guida ,&nbsp;Alessio Gili ,&nbsp;Claudia Mosillo ,&nbsp;Marco Maruzzo ,&nbsp;Eleonora Lai ,&nbsp;Francesco Pierantoni ,&nbsp;Davide Bimbatti ,&nbsp;Umberto Basso ,&nbsp;Giuseppe Fornarini ,&nbsp;Sara Elena Rebuzzi ,&nbsp;Fabio Calabrò ,&nbsp;Linda Cerbone ,&nbsp;Claudia Caserta ,&nbsp;Grazia Sirgiovanni ,&nbsp;Debora Serafin ,&nbsp;Orazio Caffo ,&nbsp;Sarah Scagliarini ,&nbsp;Sergio Bracarda","doi":"10.1016/j.clgc.2024.102225","DOIUrl":"10.1016/j.clgc.2024.102225","url":null,"abstract":"<div><h3>Background</h3><div>Pembrolizumab/Axitinib combination is approved as first-line therapy in mRCC. The aim of this study is to evaluate outcomes of PAXI combo in the real-world in Italy.</div></div><div><h3>Methods</h3><div>This is a prospective study including patients diagnosed with mRCC who received combination as first-line therapy in recruiting Italian Centers. Data about patient characteristics, safety and outcome were collected.</div></div><div><h3>Results</h3><div>170 pts have been treated from December 2020 to September 2023. The majority had clear-cell histology (83%). Sarcomatoid feature was present in 33%of available cases. About one half of patients (55%) had synchronous metastasis. In 58% of cases nephrectomy was performed, of which 27% were cytoreductive and 4% were deferred nephrectomies. Lung metastases were identified in 106 patients (62%), bone and liver involvement in 66 and 29 patients (38.8% and 17.1%) respectively. Stratifying by IMDC criteria, 32 patients (18.8%) were at favorable-risk, 106 (62.4%) at intermediate-risk, and 32 (18.8%) at poor-risk. At time of analysis, treatment was ongoing in 49% of patients. Progression occurred in 45% of patients. Median PFS was 19.2 months (95% CI: 15-NR). With a median follow-up of 19.3 months (range 1.3-34.5), at 24-months and 36-months landmark analysis 62% (95% CI, 53-70) and 58% (95% CI, 47-69) of treated patients are still alive respectively. Disease control rate was achieved in 84.6% of patients: 4.3% reached a complete response, 52% had a partial response and 28.8% a stable disease. Primary progression was observed in 15.3% of patients. In the multivariate analysis, the prognostic significance of age ≥ 65 years, non-clear cell histology, IMDC score, and adverse events and gender interaction as predictors of worse OS were confirmed.</div></div><div><h3>Conclusion</h3><div>This is the first available prospective study on first-line Pembrolizumab/Axitinib combination in real world scenario. Our findings support the effectiveness and safety of first-line this combination in mRCC and reveal that gender emerged as a prognostic factor in relation to the occurrence of adverse events.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102225"},"PeriodicalIF":2.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437945","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":"Evaluation of the Prognostic Role of TP53 Gene Mutations in Prostate Cancer Outcome: A Systematic Review and Meta-Analysis","authors":"Mohammad Moein Maddah,&nbsp;Akbar Hedayatizadeh-Omran,&nbsp;Mahmood Moosazadeh,&nbsp;Reza Alizadeh-Navaei","doi":"10.1016/j.clgc.2024.102226","DOIUrl":"10.1016/j.clgc.2024.102226","url":null,"abstract":"<div><h3>Introduction</h3><div>Prostate cancer, 1 of the most common cancers in men, is influenced by age, genetics, race, and lifestyle. The TP53 gene, encoding the p53 protein crucial for cell cycle regulation and DNA repair, is frequently mutated in metastatic prostate cancers. These mutations impact prognosis and resistance to treatments, underscoring the role of genetic factors in disease progression and therapeutic challenges.</div></div><div><h3>Methods</h3><div>Databases such as PubMed, Scopus, and ISI were searched using the keywords \"prostate cancer,\" \"P53,\" \"TP53,\" \"survival,\" and \"prognosis,\" along with manual searches in other sources. Initial screening and selection of articles were conducted independently and blinded by 2 reviewers, focusing on titles abstracts, and full texts when necessary. The Newcastle-Ottawa Scale (NOS) was used for full-text evaluation. Data were analyzed using STATA 11, with heterogeneity assessed using the I² index.</div></div><div><h3>Results</h3><div>Overall survival (OS) for prostate cancer patients with TP53 mutations was approximately 13% lower than for those without mutations at 1 year, 20% lower at 3 years, and 16% lower at 5 years. TP53 mutations were also associated with faster disease progression and a 15% reduction in progression-free survival (PFS) over 1 year. The hazard ratio (HR) for death in patients with TP53 mutations was 1.76, and for PFS, it was 1.62, indicating a 76% increased risk of death and a 62% increased risk of disease progression.</div></div><div><h3>Conclusion</h3><div>TP53 mutations are associated with shorter survival and faster disease progression in prostate cancer, underscoring the importance of precise evaluation and management of these mutations in treatment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102226"},"PeriodicalIF":2.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407385","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":"Impact of Baseline Renal Insufficiency on Piflufolastat F-18 Performance and Investigation of Changes in Renal Function Following Piflufolastat F-18 Administration: Results From the OSPREY Trial","authors":"Meera R. Chappidi ,&nbsp;Amir Iravani ,&nbsp;Nancy Stambler ,&nbsp;Saradha Baskaran ,&nbsp;Vincent A. DiPippo ,&nbsp;Bela S. Denes ,&nbsp;Daniel W. Lin","doi":"10.1016/j.clgc.2024.102223","DOIUrl":"10.1016/j.clgc.2024.102223","url":null,"abstract":"<div><h3>Introduction</h3><div>Piflufolastat F-18, a prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical, is predominantly eliminated via urinary excretion, and the kidneys have one of the highest absorbed doses. Therefore, this subgroup analysis aimed to investigate the impact of piflufolastat F-18 on renal function and its diagnostic performance in patients stratified by baseline renal function.</div></div><div><h3>Patients and Methods</h3><div>The OSPREY clinical trial enrolled 2 cohorts: A—high-risk patients undergoing radical prostatectomy with pelvic lymphadenectomy, and B—patients with suspected recurrent/metastatic prostate cancer on conventional imaging. Baseline estimated glomerular filtration rates were calculated, and patients were stratified by baseline chronic kidney disease (CKD) stage. Changes in serum creatinine within 28 days postdose and diagnostic performance of piflufolastat F-18 were assessed for each CKD stage group in both cohorts.</div></div><div><h3>Results</h3><div>385 patients (cohort A, n = 268; cohort B, n = 117) underwent piflufolastat F-18-PET/CT. Baseline and postpiflufolastat F-18 median creatinine levels (mg/dL) were similar for patients in cohort A (0.95 [n = 264] vs. 0.95 [n = 252], respectively) and cohort B (0.93 [n = 116] vs. 0.96 [n = 84], respectively). Among 332 men (cohort A, n = 249; cohort B, n = 83) with baseline and postpiflufolastat creatinine measurements, there were minimal changes in creatinine across all baseline CKD stage groups (median change ranged from -0.02 to 0.023 in groups with &gt;1 patient). The diagnostic performance of piflufolastat F-18 showed no meaningful differences when stratified by baseline CKD stage.</div></div><div><h3>Conclusion</h3><div>Piflufolastat F-18 appears to be safe and effective for imaging prostate cancer, including men with mild/moderate renal insufficiency.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102223"},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367878","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 Outcomes in Patients With Muscle-Invasive Bladder Cancer Receiving Neoadjuvant Chemotherapy Stratified by Number of Cycles","authors":"Anumita Chakraborty ,&nbsp;Jill Hasler ,&nbsp;Elizabeth Handorf ,&nbsp;Fern Anari ,&nbsp;Pooja Ghatalia ,&nbsp;Benjamin Miron ,&nbsp;Elizabeth R. Plimack ,&nbsp;Daniel M. Geynisman ,&nbsp;Matthew Zibelman","doi":"10.1016/j.clgc.2024.102218","DOIUrl":"10.1016/j.clgc.2024.102218","url":null,"abstract":"<div><h3>Introduction</h3><div>The ≥3 cycles of neoadjuvant cisplatin-based chemotherapy (NAC) are commonly administered to treat MIBC. However, some patients are unable to complete all planned cycles of NAC. Prognosis of patients receiving &lt;3 cycles of NAC has yet to be elucidated.</div></div><div><h3>Methods</h3><div>This retrospective single-center study quantifies pathologic complete response (pT0N0), recurrence-free survival (RFS), and 5-year overall survival (OS) in patients treated with &lt;3 cycles of NAC compared to ≥3 cycles. Patients with MIBC between 2004 and 2018 receiving at least 1 cycle of cisplatin-based NAC were included. Exclusion criteria were metastasis before initiation of NAC, progression/death during NAC. Patient characteristics were compared using chi-square tests, Fisher's exact tests, and Wilcoxon rank sum tests. Kaplan Meier curves, log-rank tests, and Cox proportional hazards models compared RFS adjusting for patient age, ECOG status, GFR, stage, node positivity, and NAC regimen. 5-year OS was analyzed via logistic regression with the aforementioned patient characteristics in the cohort of patients with 5 years of follow-up, unless deceased prior.</div></div><div><h3>Results</h3><div>In a cohort of 256 patients, the median RFS was 11.6 months (95% CI 7.79, 28.5) versus 79.5 months (95% CI 62.13, NA) in those receiving ≥3 cycles of NAC. Of 228 patients with documented pathologic stage, complete pathologic response (pT0) was observed in 9.4% of patients receiving &lt;3 cycles, and 27.0% of patients receiving ≥3 cycles of NAC (<em>P</em> = .008). In 195 patients with a minimum of 5 years of follow-up, patients with &lt;3 cycles the 5-year OS was 13.3% with &lt;3 cycles compared to 53.3% with ≥3 cycles of NAC.</div></div><div><h3>Conclusions</h3><div>In this retrospective, single-center investigation, early cessation of planned NAC was associated with worse pCR rate, RFS, and OS. While further prospective evaluation is required to confirm causality, clinicians should prioritize administering at least 3 cycles of NAC when feasible to optimize outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102218"},"PeriodicalIF":2.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402351","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":"Prognostic Impact of Bone Metastasis in Patients With Metastatic Urothelial Carcinoma Treated With Durvalumab With or Without Tremelimumab in the DANUBE Study","authors":"Carlos Stecca,&nbsp;Osama Abdeljalil,&nbsp;Srikala S. Sridhar","doi":"10.1016/j.clgc.2024.102215","DOIUrl":"10.1016/j.clgc.2024.102215","url":null,"abstract":"<div><h3>Introduction</h3><div>Bone metastases (BM) in metastatic urothelial carcinoma (mUC) may impact patient outcomes, but their independent effect with immune checkpoint inhibitors (ICIs) is uncertain. We aimed to assess the impact of BM and PD-L1 status on outcomes in mUC patients treated with ICIs.</div></div><div><h3>Patients and Methods</h3><div>This post hoc analysis of the DANUBE study included 1032 mUC patients treated with durvalumab (D), D + tremelimumab (T), or standard chemotherapy (SoC). Patients were categorized by BM status and assessed for median overall survival (mOS) and median progression-free survival (mPFS) stratified by PD-L1 expression and treatment arm. </div></div><div><h3>Results</h3><div>Among all patients enrolled in the study, those with BM had a lower mOS than those with no BM (8.7 vs. 15.8 months; <em>P</em> &lt; .0001). Patients with BM and high PD-L1 expression, treated with D or D + T, had numerically longer mOS than patients with BM and low PD-L1 expression. In contrast, in the chemotherapy arm, there was no difference in mOS for BM or no BM, based on PD-L1 expression. Patients with BM had shorter mPFS compared to no BM (2.6 vs. 5.4 months; <em>P</em> &lt; .0001). The study is limited by its post hoc nature.</div></div><div><h3>Conclusion</h3><div>Presence of BM was associated with worse outcomes across treatment arms. Patients with BM and high PD-L1 expression treated with D or D + T had longer mOS, suggesting potential benefits of ICIs in this subgroup. Consideration of BM and PD-L1 status in treatment decisions for mUC patients receiving ICIs may improve clinical outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102215"},"PeriodicalIF":2.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359549","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":"A Single Institution Experience in the Management of Localized Neuroendocrine Carcinoma of the Bladder","authors":"Casey Liveringhouse ,&nbsp;Austin J. Sim ,&nbsp;Jingsong Zhang ,&nbsp;Rohit K. Jain ,&nbsp;Shreyas U. Naidu ,&nbsp;Lauren Linkowski ,&nbsp;Logan W. Zemp ,&nbsp;Alice Yu ,&nbsp;Wade J. Sexton ,&nbsp;Philippe E. Spiess ,&nbsp;Scott M. Gilbert ,&nbsp;Michael A. Poch ,&nbsp;Julio Pow-Sang ,&nbsp;Roger Li ,&nbsp;Brandon J. Manley ,&nbsp;Aram Vosoughi ,&nbsp;Jasreman Dhillon ,&nbsp;Hongzhi Xu ,&nbsp;Javier F. Torres-Roca ,&nbsp;Peter A.S. Johnstone ,&nbsp;G. Daniel Grass","doi":"10.1016/j.clgc.2024.102222","DOIUrl":"10.1016/j.clgc.2024.102222","url":null,"abstract":"<div><h3>Background</h3><div>Neuroendocrine carcinoma of the bladder (NEC-bladder) is a rare disease with poor outcomes and variable treatment approaches.</div></div><div><h3>Materials and Methods</h3><div>Patients with localized NEC-bladder treated with surgery or radiation between 2001-2021 were retrospectively identified. Rates of pathologic complete response (pCR) and downstaging were evaluated following NAC in surgically-treated patients. Progression-free survival (PFS) and overall survival (OS) were analyzed with univariable (log-rank) and multivariable (MVA; Cox regression) methods.</div></div><div><h3>Results</h3><div>Sixty-five patients were identified having a median age of 73. The tumor histology distribution was small cell (64.6%) or urothelial with NE differentiation (35.4%). Most patients (69.2%) received NAC. Patients received local therapy by surgery (78.5%) or chemoradiation (21.5%). The majority (62.7%) of surgical patients had ≥ pT2 with 37.3% having nodal involvement (pN+). The pCR and downstaging rates were 21.6% and 35.1%, respectively. At a median follow-up of 60 months (m), the median PFS and OS were 16.4m and 25.9m, respectively. NAC improved PFS (p=0.04) and downstaging improved PFS (p=0.012) and OS (p&lt;0.001). Patients receiving NAC with ypN0 vs. ypN+ had median OS of 69.9m vs 15.3m, respectively (p&lt;0.001). MVA identified receipt of NAC and pN as predictors of PFS; pN was predictive of OS. No differences in PFS or OS were seen between histology of primary tumor. The brain metastasis rate was 10.8% with all patients having small cell histology.</div></div><div><h3>Conclusions</h3><div>Optimized therapy in NEC-bladder includes NAC followed by local consolidation. Ascertainment of ypN0 is associated with long term survival, while pN+ remains associated with poor outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102222"},"PeriodicalIF":2.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359548","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}