Clinical genitourinary cancer最新文献

{"title":"Incidence of Bladder Cancer, Healthcare Pathways, and Economic Burden: A Real-World Observational Study From the French National Healthcare System Database","authors":"Aldéric Masoandro Fraslin ,&nbsp;Simone Benhamou ,&nbsp;Thierry Lebret ,&nbsp;François Radvanyi ,&nbsp;Yves Allory ,&nbsp;Maryam Karimi ,&nbsp;Julia Bonastre","doi":"10.1016/j.clgc.2025.102344","DOIUrl":"10.1016/j.clgc.2025.102344","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the incidence (all lesions) of bladder cancer (BC) in France, describe patient characteristics and healthcare pathways during the first year after diagnosis, and estimate medical costs.</div></div><div><h3>Methods</h3><div>All adult patients with an initial BC diagnosis (ICD-10 codes: C67, D09.0, D41.4) in 2017 were selected from the French National Healthcare System Database. Patients were classified according to the most invasive surgical procedure they underwent. Treatments included cystectomy, transurethral resection of bladder tumor (TURBT), intravesical therapy, chemotherapy, and radiotherapy. Healthcare pathways were analyzed as sequences and grouped using hierarchical clustering. Medical costs during the first year of the disease were estimated for each cluster.</div></div><div><h3>Results</h3><div>Out of 24,737 incident BC patients selected, the median age at diagnosis was 72 years, and 80.2% were men. Nearly 20% had received treatment for a cancer other than BC in the previous year. The majority (<em>n</em> = 9501, 38.4%) underwent TURBT only with a mean medical cost of €4435 [95% CI: 4322; 4548]. A total of 3037 patients (12.3%) underwent cystectomy as their initial treatment. The estimated costs for the group receiving intravesical instillations following a single TURBT (€6129 [5994; 6264]) were lower than those for the group with repeated TURBT (€9357 [9086; 9628]). Costs for patients who received systemic treatment after cystectomy were the highest at €25,636 [24,519; 26,752].</div></div><div><h3>Conclusion</h3><div>Our study estimates the incidence of BC in France, describes healthcare pathways at the national level, and analyses the associated economic burden.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102344"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870811","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":"Significance of Body Surface Area Correction for Cisplatin Eligibility Based on Renal Function of Patients With Muscle-Invasive Bladder Cancer","authors":"Yushi Naito ,&nbsp;Satoshi Inoue ,&nbsp;Kosuke Tochigi ,&nbsp;Noritoshi Shamoto ,&nbsp;Hiroki Abe ,&nbsp;Kaichi Sugihara ,&nbsp;Yohei Kondo ,&nbsp;Yoshie Kanada ,&nbsp;Hirotaka Matsui ,&nbsp;Jun Nagayama ,&nbsp;Yoshihisa Matsukawa ,&nbsp;Shusuke Akamatsu","doi":"10.1016/j.clgc.2025.102339","DOIUrl":"10.1016/j.clgc.2025.102339","url":null,"abstract":"<div><h3>Introduction</h3><div>Creatinine clearance (CCr) ≥60 mL/min without body surface area (BSA) correction is commonly applied to determine the cisplatin (CDDP) eligibility of patients with bladder cancer. However, since CDDP dosages are calculated according to BSA, there is concern that applying renal function without BSA correction may underestimate CDDP eligibility, especially of patients with low BSA. The purpose of this study was to determine whether BSA correction for renal function affects the decision of CDDP eligibility and oncological outcomes.</div></div><div><h3>Patients and Methods</h3><div>The data of 294 patients who received platinum-based neoadjuvant chemotherapy (NAC) and underwent radical cystectomy for muscle-invasive bladder cancer were retrospectively analyzed. Patients with BSA below and above the median BSA value (1.70 m²) were divided into low-BSA and high-BSA groups. Patients who received ≥20% dose reduction of CDDP or replacement by carboplatin at the first NAC cycle were categorized as “inadequate-CDDP” recipients. “CDDP-eligibility underestimation” was defined as CCr with BSA correction &gt;60 mL/min/1.73 m2 while CCr without BSA correction &lt;60 mL/min. The association of BSA with inadequate-CDDP was evaluated using multivariate analysis. Additionally, differences in clinical outcomes, namely cancer-specific survival (CSS) and objective response rate (ORR) to NAC, between the low- and high-BSA groups were evaluated.</div></div><div><h3>Results</h3><div>CDDP-eligibility underestimation was more frequent in the low-BSA group than in the high-BSA group (17% vs. 0%; <em>P</em> &lt; .001). Multivariate analysis revealed that low-BSA was independently associated with the risk of inadequate CDDP (odds ratio, 2.07; <em>P</em> = .012). CSS from initiation of NAC was significantly shorter in the low-BSA group than in the high-BSA group (hazard ratio, 2.24; <em>P</em> = .002). The ORR for NAC was also significantly lower in the low-BSA group (40.8% vs. 57.1%; <em>P</em> = .007).</div></div><div><h3>Conclusions</h3><div>When determining CDDP eligibility for renal function in patients with low BSA, renal function values corrected by standard BSA should be applied to prevent inappropriate dosing reductions.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102339"},"PeriodicalIF":2.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942576","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":"Modifiable Cardiovascular Risk Factors Amongst Men With and Without Prostate Cancer in a Large, Prospective Registry","authors":"James Janopaul-Naylor ,&nbsp;Adithya K. Yadalam ,&nbsp;Jeffrey Shi Kai Chan ,&nbsp;Edward Christopher Dee ,&nbsp;Yan V. Sun ,&nbsp;Stephanie M. Cantu ,&nbsp;Anant Mandawat ,&nbsp;Sagar A. Patel","doi":"10.1016/j.clgc.2025.102340","DOIUrl":"10.1016/j.clgc.2025.102340","url":null,"abstract":"<div><h3>Introduction</h3><div>Noncancer mortality, namely cardiovascular, is the leading cause of death in men with prostate cancer. We examined modifiable risk factors for cardiovascular disease in men with and without prostate cancer.</div></div><div><h3>Patients and Methods</h3><div>We used data from the UK Biobank, a large, prospective registry, to identify 186 830 men recruited between 2006 and 2010 without missing clinical covariate data. We performed age-matched comparisons (1:5) between men with (<em>N</em> = 2 720) and without (<em>N</em> = 13 600) prostate cancer to assess for differences in modifiable cardiovascular risk factors (smoking status, lipid profile, hypertension, etc.). This analysis was repeated after stratifying for men with (<em>N</em> = 4 302) and without dyslipidemia (<em>N</em> = 12 018).</div></div><div><h3>Results</h3><div>In the overall cohort, men with prostate cancer were significantly less likely to be smokers or have diabetes than age-matched men without prostate cancer but were more likely to have higher total (<em>P</em> = .006) and low-density lipoprotein (LDL)-cholesterol (<em>P</em> = .006) levels. Cholesterol-lowering medication use did not differ between groups (<em>P</em> = .479). In the subgroup with dyslipidemia, men with prostate cancer had significantly higher total cholesterol levels (<em>P</em> = .004) without differences in cholesterol medication use (<em>P</em> = .722). In the cohort without dyslipidemia, men with prostate cancer trended toward lower active smoking (<em>P</em> = .052) and higher blood pressure medication use (<em>P</em> = .052) but had no difference in total cholesterol levels (<em>P</em> = .266).</div></div><div><h3>Conclusion</h3><div>In this analysis, we show that men with prostate cancer may have a higher total and LDL-cholesterol levels. However, cholesterol-lowering medication use may be underutilized in this population. As cardiovascular mortality is a leading cause of death in this population, integrated oncologic, cardiovascular, and primary care is paramount. Further work refining personalized, longitudinal risk factor modification is important for optimizing life expectancy in this population.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102340"},"PeriodicalIF":2.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848116","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":"Expert Opinion on Current Treatment Alternatives for Patients With Prostate Cancer Progressing From the Metastatic Hormone-Sensitive Stage to the Castration-Resistant Stage After Receiving Early Treatment Intensification","authors":"Sergio Vázquez-Estévez ,&nbsp;Enrique Gallardo ,&nbsp;Ovidio Fernández-Calvo ,&nbsp;María José Juan-Fita ,&nbsp;Álvaro Montesa-Pino ,&nbsp;Martín Lázaro-Quintela ,&nbsp;Urbano Anido-Herranz ,&nbsp;Aránzazu González-del-Alba","doi":"10.1016/j.clgc.2025.102338","DOIUrl":"10.1016/j.clgc.2025.102338","url":null,"abstract":"<div><div>For patients with castration-sensitive prostate cancer (mCSPC), treatment intensification with androgen deprivation therapy (ADT) plus new androgen receptor pathway inhibitors (ARPIs) has opened a scenario where no guidance exists to indicate the best treatment after progression to metastatic castration-resistant prostate cancer (mCRPC). Clinical decision-making has become even more complex, with the proven benefit for selected patients of triplet therapy with abiraterone or darolutamide added to the double combination therapy of ADT plus docetaxel. The profile of patients for whom triple therapy would be more beneficial is being defined beyond metastatic disease presentation and volume (eg, poor prognosis features). In October 2023 and October 2024, a panel of eight Spanish medical oncologists with expertise in the management of prostate cancer met to discuss the challenges in treating mCRPC. The scientific evidence was reviewed during this meeting, knowledge and experience were shared, and controversies were discussed until a consensus was reached. This information was collected and turned into a manuscript aimed at helping clinicians determine the optimal treatment sequence after disease progression based on scientific evidence and experts’ opinions and consensus. To this end, the profile of mCSPC patients who may have received double or triplet therapy is analyzed, current treatment options are reviewed, and treatment algorithms are proposed. New and expected advancements in this field are also presented.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102338"},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844228","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":"Paratesticular Sarcoma: Analysis of Oncological Outcomes and Prognostic Factors","authors":"Theo Reback ,&nbsp;Karl H. Pang ,&nbsp;Aiman Haider ,&nbsp;Alex Freeman ,&nbsp;Arj Shankar ,&nbsp;Hussain M. Alnajjar ,&nbsp;Asif Muneer","doi":"10.1016/j.clgc.2025.102331","DOIUrl":"10.1016/j.clgc.2025.102331","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Paratesticular sarcomas are a rare subtype of genitourinary sarcoma. Incomplete excision results in high recurrence rates. The aim of this study was to report oncological outcomes following surgery and characterize risk factors associated with poor survival.</div></div><div><h3>Materials and Methods</h3><div>Paratesticular sarcomas managed at a tertiary sarcoma referral center were identified. Kaplan-Meier survival curves were calculated for local recurrence-free survival (LRFS), metastasis-free survival (MFS) and disease-specific survival (DSS). Univariate analysis was used to identify predictive factors for these outcomes.</div></div><div><h3>Results</h3><div>A total of 56 cases were identified between 2002 and 2023. The median age at tumor resection was 63 years. Dedifferentiated liposarcoma (DDLPS) was the most common histological subtype with n = 23 (42%) patients. Of the 51 patients with localized disease at presentation, 9 (18%) developed local recurrence, 10 (20%) developed metastatic disease and 10 (20%) have died from the disease at a median follow up of 48 months (IQR 16-93). The 5-year LRFS, MFS and DSS rate was 54.4%, 60.8% and 90.8% respectively. Positive surgical margin was significantly associated with reduced LRFS (HR 3.92, <em>P</em> = .005). T3 stage was associated with reduced LRFS (HR 5.78, <em>P</em> = .022). Tumor Grade 3 was significantly associated with reduced DSS (HR 12.0, <em>P</em> = .038). Patients who underwent wide re-resection (WRR) due to suboptimal primary resection had equivalent LRFS (<em>P</em> = .5) and DSS (<em>P</em> = .75) compared to patients who did not require WRR.</div></div><div><h3>Conclusion</h3><div>Positive surgical margin status is the single most important parameter for locoregional treatment failure. In these cases, wide re-resection including hemiscrotectomy is required to achieve negative surgical margins. With better awareness, prompt referral to a specialist center which provides a multidisciplinary approach will ensure individualized treatment, risk stratification and optimal oncological outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102331"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942572","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":"Causal Associations Between the Presence of Prostate Cancer or Testosterone Levels and Bladder Cancer Risk: A Mendelian Randomization Study","authors":"Wenbiao Ren ,&nbsp;Yewen Zhu","doi":"10.1016/j.clgc.2025.102334","DOIUrl":"10.1016/j.clgc.2025.102334","url":null,"abstract":"<div><h3>Background</h3><div>Previous observational studies and meta-analyses have indicated that prostate cancer and testosterone levels could be potential risk factors for bladder cancer. However, these studies are vulnerable to confounding variables and reverse causality. Thus, we conducted a 2-sample Mendelian Randomization (MR) study to elucidate the causal link between the presence of prostate cancer or testosterone levels and bladder cancer.</div></div><div><h3>Methods</h3><div>We acquired summary statistics for the presence of prostate cancer or testosterone levels and bladder cancer from genome-wide association studies (GWAS). MR analysis was employed to investigate the potential causal relationship between the presence of prostate cancer or testosterone levels and bladder cancer. The primary method employed was the inverse variance weighted (IVW) method, with results rigorously assessed through sensitivity analysis.</div></div><div><h3>Results</h3><div>IVW Mendelian randomization results demonstrated that prostate cancer was causally associated with an elevated risk of bladder cancer in FinnGen (OR 1.22, 95% CI, 1.13-1.31, <em>P</em> &lt; .001), UK Biobank (OR 17.9, 95% CI, 3.28-97.62, <em>P</em> &lt; .001), and the PRACTICAL database (OR 1.13, 95% CI, 1.05-1.22, <em>P</em> &lt; .001). There was no evidence of heterogeneity in the effects of genetic factors on bladder cancer risk, as indicated by Cochran's Q statistical test (FinnGen Q = 68.86, <em>P</em> = .13; UK Biobank Q = 29.05, <em>P</em> = .61; PRACTICAL Q = 108.88, <em>P</em> = .48). Sensitivity analyses confirmed the stability and robustness of the genetically determined risk effect of prostate cancer on bladder cancer. However, there was no causal link between testosterone levels and bladder cancer (<em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>This study identified that genetically predicted prostate cancer was causally linked to an increased risk of bladder cancer. Appropriate measures should be taken to prevent the subsequent development of bladder cancer in patients with prostate cancer.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102334"},"PeriodicalIF":2.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820918","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 TP53 Alterations on Clinical Outcomes in Penile Squamous Cell Carcinoma","authors":"Yajian Li ,&nbsp;Ziru Tian ,&nbsp;Zhannan Si,&nbsp;Yifan Wang,&nbsp;Gang Song","doi":"10.1016/j.clgc.2025.102323","DOIUrl":"10.1016/j.clgc.2025.102323","url":null,"abstract":"<div><h3>Background</h3><div>Penile squamous cell carcinoma (PSCC) is a rare, aggressive malignancy with a high risk of mortality due to metastasis. A comprehensive understanding of its mutational landscape is critical for improving early detection and therapeutic strategies.</div></div><div><h3>Methods</h3><div>We analyzed tissue samples from 28 patients with PSCC treated at the Cancer Hospital of the Chinese Academy of Medical Sciences between January 2019 and March 2023. DNA from primary tumors and/or matched inguinal lymph nodes underwent targeted sequencing. Somatic mutations were profiled to compare primary and metastatic lesions. Statistical analyses assessed associations between mutational features, clinical outcomes, and treatment responses.</div></div><div><h3>Results</h3><div>A total of 980 mutations were identified across 354 genes. Frequently mutated genes included TP53 (67.5%), TERT (45%), CDKN2A (40%), FAT1 (37.5%), and NOTCH1 (30%). Copy number variations (CNVs) revealed amplifications in EGFR, SOX2, and MSH6 and deletions in CDKN2B and CDKN2A. A strong correlation was observed between mutational profiles of primary and metastatic lesions (r = 0.61, <em>P</em> &lt; .001). Metastatic tumors exhibited higher tumor mutational burden (TMB) than primary tumors (38.9% vs. 9.5%, <em>P</em> = .030) and displayed a greater prevalence of mismatch repair deficiency-associated mutational signatures. Patients with higher TP53 mutation frequencies responded more favorably to immune checkpoint inhibitors (<em>P</em> = .024), with treatment efficacy strongly correlated (AUC = 0.938).</div></div><div><h3>Conclusion</h3><div>Key mutational alterations in PSCC, including high TMB and TP53 mutations, have significant implications for early diagnosis and personalized therapies. These findings support the potential use of specific genetic markers to guide targeted therapeutic approaches.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102323"},"PeriodicalIF":2.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942571","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":"Osteoporosis Amongst Testicular Cancer Survivors: Long Term Follow-Up of the Veterans Affairs Health System","authors":"Nuphat Yodkhunnatham ,&nbsp;Paul Riviere ,&nbsp;Kshitij Pandit ,&nbsp;Kylie Morgan ,&nbsp;Margaret Meagher ,&nbsp;Mai Dabbas ,&nbsp;Tyler Nelson ,&nbsp;Dhruv Puri ,&nbsp;Kit Yuen ,&nbsp;Jacob Taylor ,&nbsp;Daniel Herchenhorn ,&nbsp;Heather Hofflich ,&nbsp;Tyler Stewart ,&nbsp;Juan Javier-Desloges ,&nbsp;Amirali Salmasi ,&nbsp;Rana R. McKay ,&nbsp;Sean Q. Kern ,&nbsp;Frederick Millard ,&nbsp;Brent Rose ,&nbsp;Aditya Bagrodia","doi":"10.1016/j.clgc.2025.102332","DOIUrl":"10.1016/j.clgc.2025.102332","url":null,"abstract":"<div><h3>Introduction</h3><div>Testicular cancer (TC) is the most common malignancy among young males and is associated with cure rates over 95%. However, the long-term health implications of treatments, such as the risk of osteoporosis, remain inadequately understood. This study aims to explore the incidence of osteoporosis in TC survivors and associated risk factors.</div></div><div><h3>Methods</h3><div>This retrospective study utilized data from the Veterans Affairs (VA) national electronic health record system, identifying 1686 TC patients and 7412 matched noncancer controls. The incidence of osteoporosis was determined through diagnosis codes and osteoporosis medication prescriptions. Statistical analyses, including chi-squared tests, t-tests, and Cox proportional hazards models, were employed to evaluate risk factors.</div></div><div><h3>Results</h3><div>TC survivors exhibited a significantly elevated hazard of developing osteoporosis (HR =2.18; 95% CI, 1.52-3.14; <em>P</em> &lt; .001), which persisted after adjusting for covariates (HR = 1.58; 95% CI, 0.99-2.51; <em>P</em> = .013). There was no significant TC treatment-specific effect: neither radiation nor chemotherapy were associated with an increased hazard of osteoporosis in multivariable analysis.</div></div><div><h3>Conclusion</h3><div>TC survivors face a higher hazard of osteoporosis, with age at diagnosis being a significant factor. These findings highlight the need for regular bone health monitoring in TC survivors. Future prospective studies are necessary to validate these results and better understand the mechanisms linking TC, hypogonadism, and osteoporosis risk.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102332"},"PeriodicalIF":2.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799231","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":"mRNA-Based Urine Test Performance in High and Very-High Risk Non–Muscle-Invasive Bladder Cancer Patients Undergoing Contextual Endoscopic Follow-up (VERNAL: Vesical Tumor Early Monitoring: mRNA-Based Follow-up)","authors":"Alberto Macchi ,&nbsp;Martina Bruniera ,&nbsp;Sebastiano Nazzani ,&nbsp;Tommaso Ceccato ,&nbsp;Claudia Colbacchini ,&nbsp;Alessandra Taverna ,&nbsp;Giuseppe Aiello ,&nbsp;Valentina Bernasconi ,&nbsp;Mario Catanzaro ,&nbsp;Tullio Torelli ,&nbsp;Davide Biasoni ,&nbsp;Silvia Stagni ,&nbsp;Antonio Tesone ,&nbsp;Carlo Silvani ,&nbsp;Melanie Claps ,&nbsp;Patrizia Giannatempo ,&nbsp;Matteo Zimatore ,&nbsp;Chiara Bonini ,&nbsp;Daniele Morelli ,&nbsp;Nicola Nicolai","doi":"10.1016/j.clgc.2025.102333","DOIUrl":"10.1016/j.clgc.2025.102333","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Non–muscle-invasive bladder cancer (NMIBC) patients need a strict follow-up with cystoscopy (UCS) and voided urinary cytology (vUC) due to high rate of recurrence and progression. To reduce invasiveness and costs, a new diagnostic biomarker, namely Xpert Monitor BC^Ⓡ—detecting 5 mRNAs in voided urine—, has been proposed. We test Xpert Monitor BC^Ⓡ ability to detect tumor recurrence at an early point during follow-up of high risk (HR) or very high risk (VHR) NMIBC patients, aiming at evaluating reliability of this test as a single procedure.</div></div><div><h3>Materials and Methods</h3><div>Between September 2022 and July 2023 included, 80 HR or VHR NMIBC patients were prospectively enrolled. Both naïve and previously treated patients (including Bacillus Calmette-Guérin—BCG—and/or systemic immunotherapy) were admitted. Patients with known upper urinary tract urothelial carcinoma (UTUC) were excluded. Xpert Monitor BC^Ⓡ test was carried out on precystoscopy voided urine samples. In case of suspicious urethra-cystoscopy (UCS), a transurethral resection (TURB) or a biopsy was indicated. vUC was usually prescribed to be performed prior to UCS. Negative predictive value (NVP), positive predictive value (PPV), sensitivity (SE) and specificity (SP) of Xpert Monitor BC^Ⓡ and vUC, were assessed and compared with UCS and secondarily with histology at TURB/bladder biopsy.</div><div>Patients who proceeded with follow-up underwent a second evaluation with Xpert Monitor BC^Ⓡ test.</div></div><div><h3>Results</h3><div>Seventy-six patients were evaluable. Median age was 70 years (interquartile range [IQR] 65-78) and 62 (81.6%) patients were male. VHR patients were 14 (18.4%), 47 (61.8%) had a history of carcinoma in situ (CIS) and 37 (49.3%) had multifocal disease while 51 patients (67.1%) had recurrent bladder cancer (BC).</div><div>BC recurred in 15 patients (19.7%): in 3 of them as a muscle-invasive bladder cancer (MIBC). Xpert Monitor BC^Ⓡ showed a NPV, PPV, SE, SP of 95.3% (41/43), 57.6% (19/33), 90.5% (19/21) and 74.5% (41/55) respectively. When available, vUC displayed a NPV of 78.9% (30/38), a PPV of 75% (3/4), a SE of 27.3% (3/11) and a SP of 96.7% (30/31). Twenty patients underwent a subsequent Xpert Monitor BC^Ⓡ test and UCS during their follow-up, and 3 had a bladder cancer recurrence. Of note Xpert Monitor BC^Ⓡ was positive in all those 3 patients who previously tested positive despite a negative UC.</div></div><div><h3>Conclusions</h3><div>High NPV and SE of Xpert Monitor BC^Ⓡ are confirmed in our HR and VHR NMIBC series. Apparent false positive tests may be regarded as suspicious for persistent/recurrent disease. Implementation of Xpert Monitor BC^Ⓡ aiming at improving cancer detection is supported by these findings, and a single test based follow-up may be explored.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102333"},"PeriodicalIF":2.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791569","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 Extended Versus Limited Lymph Node Dissection on Surgical Outcome, Recurrence Patterns and Survival After Radical Cystectomy","authors":"Mulham Al-Nader ,&nbsp;Ulrich Krafft ,&nbsp;Christopher Darr ,&nbsp;Jochen Heß ,&nbsp;Claudia Kesch ,&nbsp;Lukas Püllen ,&nbsp;Tibor Szarvas ,&nbsp;Henning Reis ,&nbsp;Stephan Tschirdewahn ,&nbsp;Boris A. Hadaschik ,&nbsp;Osama Mahmoud","doi":"10.1016/j.clgc.2025.102337","DOIUrl":"10.1016/j.clgc.2025.102337","url":null,"abstract":"<div><h3>Background</h3><div>The aim of our study is to evaluate the impact of extended versus limited lymph node dissection (LND) in patients undergoing radical cystectomy (RC) on survival, perioperative outcomes and pattern of recurrence.</div></div><div><h3>Patients and methods</h3><div>We reviewed our charts to identify patients who underwent RC and LND with curative intent between January 2003 and November 2022. Standard open RC with limited or extended LND was routinely performed, depending on surgeon's preference. The upper limit of extended LND is usually the ureteral crossing with the common iliac artery, unless further extension to the aortic bifurcation or inferior mesenteric artery is clinically indicated. Whereas limited LND includes removal of external and internal iliac and obturator Lymph nodes (LNs). The primary outcome was to compare the 2 patient groups in terms of cancer-specific survival (CSS) and overall survival (OS). The secondary outcome was to assess the impact of the extent of LND on the pattern of recurrence (local and distant metastasis free-survival) and perioperative complications.</div></div><div><h3>Results</h3><div>Of 642 patients, 439 and 203 underwent limited and extended LND, respectively. In the extended LND group, the median number of LNs removed was 23 compared to 8 in the limited LND group (<em>P</em> &lt; .001), which was associated with higher median positive LNs in the extended group (3 vs. 2, <em>P</em> = .05). Extended LND was associated with longer operative time (300 vs. 250 min., <em>P</em> &lt; .001), but not with blood loss, postoperative hemoglobin drop, hospital stay, 90-days major complications and hospital readmission rates. Lymphocele requiring surgical intervention was higher in extended group (7.4% vs. 1.8%, <em>P</em> = .001). The median follow-up time of survivors was 41 months in the limited group and 52 months in the extended group, (<em>P</em> = .1). Overall, 127 (29%) and 52 (26%) patients in the limited and extended groups experienced clinical recurrence (<em>P</em> = .39). At multivariable Cox regression analysis, LND template was not associated with either local and distant metastasis-free survival or CSS, while resection of ≥16 LNs was an independent predictor of local recurrence-free survival (HR 0.54; <em>P</em> = .01) and CSS (HR 0.6; <em>P</em> = .002), regardless of the dissected template. Both extended LND (HR 0.63; <em>P</em> = .004) and resection of ≥16 LNs (HR 0.66; <em>P</em> = .003) were associated with improved OS.</div></div><div><h3>Conclusion</h3><div>The number of LNs removed appears to be more important than the LN template in patients undergoing RC. Resection of at least 16 LNs is associated with better cancer control and oncologic outcome.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 3","pages":"Article 102337"},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943137","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}