European urology oncology最新文献

{"title":"Impact of Histological Subtypes/Divergent Differentiation on Clinicopathological and Oncological Outcomes for Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Comprehensive Updated Systematic Review and Meta-analysis.","authors":"Wojciech Krajewski, Łukasz Nowak, Jan Łaszkiewicz, Joanna Chorbińska, Wojciech Tomczak, Adam Gurwin, Marco Moschini, Benjamin Pradere, Andrea Gallioli, José D Subiela, Ekaterina Laukhtina, Francesco Del Giudice, Gautier Marcq, Luca Afferi, Magdalena Krajewska, Muhammad S Khan, Rajesh Nair, Bartosz Małkiewicz, Tomasz Szydełko","doi":"10.1016/j.euo.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.003","url":null,"abstract":"<p><strong>Background and objective: </strong>Upper tract urothelial carcinoma (UTUC) is associated with poor survival. Recent studies have evaluated whether the presence of histological subtypes or divergent differentiation (HS/DD) is associated with worse UTUC prognosis. Our aim was to assess the relationship between HS/DD and clinicopathological features and oncological outcomes for patients with UTUC undergoing radical nephroureterectomy (RNU) without investigating causal pathways.</p><p><strong>Methods: </strong>A literature search was conducted in September 2024. Patients with UTUC who underwent RNU were included. The main outcomes were differences in clinicopathological features and oncological outcomes between HS/DD and pure urothelial carcinoma (PUC) groups.</p><p><strong>Key findings and limitations: </strong>We included 22 studies involving 14 407 patients in our review. HS/DD was present in 14% of tumours. In comparison to PUC, the HS/DD group had significantly higher rates of ≥pT3 stage, high-grade tumours, lymph node invasion (LNI), lymphovascular invasion (LVI), and receipt of adjuvant chemotherapy. Pooled results revealed that the HS/DD group had significantly worse cancer-specific survival (CSS) (hazard ratio [HR] 1.65, 95% confidence interval CI] 1.39-1.96), overall survival (OS; HR 1.84, 95% CI 1.52-2.22) ,and recurrence-free survival (RFS; HR 1.64, 95% CI 1.43-1.87). Intravesical RFS (IVRFS) and urothelial RFS (URFS) were comparable between the groups.</p><p><strong>Conclusions and clinical implications: </strong>Our findings suggest that UTUC with HS/DD is associated with more advanced/aggressive features, such as higher pathological stage and grade, LNI, and LVI. HS/DD is associated with significantly worse CSS, OS, and RFS, but does not predict worse IVRFS or URFS. Therefore, HS/DD detection should prompt extensive treatment and closer follow-up. To improve the quality of recommendations and patient care, well-designed studies with central pathological review are needed.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nationwide Real-world Evaluation of Upfront Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Renal Cell Carcinoma in the Immunotherapy Era.","authors":"Hilin Yildirim, Katja K H Aben, Maarten J Bijlsma, Arnoud W Postema, Maureen J B Aarts, Martijn G H van Oijen, Axel Bex, Adriaan D Bins, Patricia J Zondervan","doi":"10.1016/j.euo.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.euo.2025.02.011","url":null,"abstract":"<p><strong>Background and objective: </strong>Since the advent of targeted therapy, deferred cytoreductive nephrectomy (dCN) has been offered to patients with metastatic renal cell carcinoma (mRCC) who respond to systemic therapy. Transition to the immunotherapy (IO) era necessitates a re-evaluation of the role of upfront CN (uCN) in mRCC management. Our aim was to determine whether uCN improves overall survival (OS) in patients with mRCC receiving IO in comparison to tyrosine kinase inhibitor (TKI) therapy.</p><p><strong>Methods: </strong>This nationwide historical cohort study included patients with synchronous mRCC diagnosed in the Netherlands between 2018 and 2020 who were treated with IO or TKI agents. We used propensity score-based inverse probability of treatment weighting (IPTW) to adjust for prognostic differences in Kaplan-Meier and Cox regression analyses. OS was compared for patients with versus without uCN. Analyses were stratified for IO and TKI therapy.</p><p><strong>Key findings and limitations: </strong>Of 872 patients, 433 received IO (63 uCN + IO, 370 IO ± dCN) and 439 received TKI (67 uCN + TKI, 372 TKI ± dCN) therapy. The uCN treatment arms had more favourable prognostic factors than those starting with systemic therapy. In the IO cohort, the IPTW-adjusted median OS was 33 mo for uCN + IO versus 24 mo for IO ± dCN (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.40-0.97). There was no significant difference in median OS in the TKI cohort (19 mo for uCN + TKI versus 17 mo for TKI ± dCN; HR 0.76, 95% CI 0.52-1.12). Limitations include the observational nature of the study and the risk of residual confounding.</p><p><strong>Conclusions and clinical implications: </strong>In the absence of randomised controlled trials (RCTs), our results indicate a preference for uCN in patients with mRCC with favourable prognostic factors in the IO era. Owing to the risk of residual confounding, strong evidence from RCTs is needed.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventative Function-sparing Radical Prostatectomy: Experience in a Tertiary Referral Centre.","authors":"Alexander Haese, Markus Graefen, Aliaksandra Pott, Felix Preisser","doi":"10.1016/j.euo.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.euo.2025.02.005","url":null,"abstract":"<p><strong>Background and objective: </strong>The oncological and functional outcomes after preventative radical prostatectomy (pRP) are unknown. Our aim was to assess functional and oncological outcomes and the patient perspective, motivation, and postprocedural experiences of a highly selected pRP cohort.</p><p><strong>Methods: </strong>We identified patients who underwent pRP between 2012 and 2021 in a single high-volume centre without a prostate cancer (PCa) diagnosis before surgery. Functional and oncological outcomes were assessed via validated questionnaires. In-depth semistructured interviews were conducted with the patients about their pRP experience.</p><p><strong>Key findings and limitations: </strong>Seven patients who ranged in age from 37 to 57 yr underwent pRP. Final pathology revealed PCa in 71% of cases, which was International Society of Urological Pathology grade group 1 in two patients, and grade group 2 in three. The mean distress score was 7.7 points before pRP versus 1.3 points after surgery. At ≥12 mo after pRP, all the patients had erections firm enough for intercourse and were fully continent. A significant improvement in quality of life was reported because of mental relief and maintenance of physical functioning. The interviewees emphasised the importance of patient-centred medicine. Limitations include the small sample size, lack of a control cohort, and the single-centre setting.</p><p><strong>Conclusions and clinical implications: </strong>No patient regretted his decision after pRP and all patients were free of recurrence. For men with a serious fear of PCa that causes them distress and affects their quality of life, pRP could be a good option outside of guideline recommendations if performed by experts for well-informed patients. Improvements in the legal foundation for this approach are needed.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Volume as a Determinant of Outcomes After Partial Nephrectomy: A Systematic Review by the European Association of Urology Renal Cell Carcinoma Guidelines Panel.","authors":"Lorenzo Marconi, Teele Kuusk, Milan Hora, Tobias Klatte, Saaed Dabestani, Umberto Capitanio, Yasmin Abu-Ghanem, Riccardo Campi, Sergio Fernández-Pello, Laurence Albiges, Jens Bedke, Thomas Powles, Alessandro Volpe, Börje Ljungberg, Axel Bex","doi":"10.1016/j.euo.2025.01.013","DOIUrl":"https://doi.org/10.1016/j.euo.2025.01.013","url":null,"abstract":"<p><p>The influence of surgical volume on partial nephrectomy (PN) outcomes is a subject of debate. The European Association of Urology (EAU) renal cell carcinoma (RCC) guideline panel performed a protocol-driven systematic review of the association between hospital volume (HV) and oncological, functional, and complication outcomes following PN for RCC. The intervention was PN performed in a higher-volume hospital (defined according to the number of procedures per unit time) and the comparator was PN performed in a lower-volume hospital. Ten studies involving a total of 106 569 patients were included in the review. Higher HV was associated with lower complication rates, shorter length of stay, lower positive surgical margin rates, and lower transfusion rates. For six studies, multivariable analyses showed that low HV was an independent risk factor for inpatient complications, PSM presence, longer LOS, and failure to achieve a trifecta of no complications, warm ischemia time <25 min, and negative surgical margins. Most studies were judged to have high risk of bias. The available evidence suggests a potential association between higher HV and better PN outcomes in RCC. The EAU RCC guidelines panel encourages the development and rigorous evaluation of indicators of surgery quality in RCC to better inform the designation of high-quality centers within models of centralized care.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological Outcomes in Bacillus Calmette-Guérin-naïve High-risk Non-muscle-invasive Bladder Cancer Patients: A Systematic Review on Current Treatment Strategies and Future Perspectives.","authors":"Mattia Longoni, Pietro Scilipoti, Francesco Soria, Benjamin Pradere, Wojciech Krajewski, David D'Andrea, Andrea Mari, Francesco Del Giudice, Renate Pichler, José Daniel Subiela, Luca Afferi, Simone Albisinni, Andrea Gallioli, Laura S Mertens, Ekaterina Laukhtina, Keiichiro Mori, Piotr Radziszewski, Aleksander Ślusarczyk, Shahrokh F Shariat, Andrea Necchi, Evanguelos Xylinas, Paolo Gontero, Morgan Rouprêt, Francesco Montorsi, Alberto Briganti, Marco Moschini","doi":"10.1016/j.euo.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Bacillus Calmette-Guérin (BCG) is the standard treatment in patients harboring high-risk (HR) non-muscle-invasive bladder cancer (NMIBC). However, BCG therapy faces frequent adverse events (AEs), limited efficacy, and ongoing shortages, leading to a low completion rate, access challenges, and high recurrence. In consequence, there is a growing interest in exploring alternative treatments, including immune checkpoint inhibitors, chemotherapy combinations, and novel intravesical therapies. This systematic review summarizes current prospective evidence on BCG and alternative treatment options for BCG-naïve HR-NMIBC patients (PROSPERO: CRD42024564900).</p><p><strong>Methods: </strong>A systematic search in MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library retrieved 1042 studies, of which 17 met the inclusion criteria (following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines).</p><p><strong>Key findings and limitations: </strong>In 12 studies on BCG-treated patients (n = 1418), recurrence-free survival (RFS) rates were 66-96% at 1-yr, 63-96% at 2-yr, and 39-66% at 5-yr follow-up. Progression-free survival (PFS) rates were 81-98% at 1-yr, 70-96% at 2-yr, and 70-84% at 5-yr follow-up. In nine studies focusing on patients treated with alternative strategies (n = 657), RFS rates were 51-99% at 1-yr, 48-88% at 2-yr, and 47-55% at 5-yr follow-up. PFS was 90-100% at 1-yr, 88-96% at 2-yr, and 84-93% at 5-yr follow-up. AE rates varied widely across studies, for both BCG and alternative treatments. Unfortunately, studies heterogeneity and a small sample sizes limit statistically meaningful conclusions. Twelve clinical trials are currently investigating new strategies for BCG-naïve HR NMIBC patients.</p><p><strong>Conclusions and clinical implications: </strong>Alternative therapies for BCG-naïve HR NMIBC patients are emerging but need further validation. As challenges such as toxicity, cost, and long-term efficacy persist, ongoing trial results will be crucial in determining their role in future clinical practice.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suffering in Silence: Loneliness Among Men with Prostate Cancer and the Potential for Exercise as Connection.","authors":"Kerri Winters-Stone, Sydnee Stoyles, Nathan F Dieckmann, Mary Crisafio, Alexandra O Sokolova, Julie N Graff, Arthur Hung, Karen S Lyons","doi":"10.1016/j.euo.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.013","url":null,"abstract":"<p><p>Prostate cancer can make men feel socially isolated, even from friends and family, leading to feelings of loneliness that negatively impact their health and quality of life. Group-based exercise shows promise in addressing the social, emotional, and physical needs of men with prostate cancer.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Trial Protocol for ACCURATE: A CCafU-UroCCR Randomized Trial: Three-dimensional Image-guided Robot-assisted Partial Nephrectomy for Renal Complex Tumor (UroCCR 99).","authors":"Gaëlle Margue, Jean-Christophe Bernhard, Joris Giai, Assilah Bouzit, Solène Ricard, Manon Jaffredo, Bénédicte Guillaume, Eva Jambon, Gaëlle Fiard, Pierre Bigot, Thibaut Waeckel, Louis Surlemont, Stéphane De Vergie, Nicolas Branger, Nicolas Doumerc, Romain Boissier, Hervé Lang, François Audenet, Jean-Baptiste Beauval, Karim Bensalah, Aurelien Descazeaud, Sandra David-Tchouda, Laura Richert, Jean-Alexandre Long, Jean-Luc Descotes","doi":"10.1016/j.euo.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Renal cancer often requires nephron-sparing surgery for optimal patient outcomes. Despite advances in imaging and robot-assisted surgery, there is a need to enhance surgical precision and renal preservation. This trial evaluates the effectiveness of three-dimensional image-guided robot-assisted partial nephrectomy versus standard methods in improving surgical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical trial design and timeframe: &lt;/strong&gt;This trial is a prospective, 1:1 randomized, single-blind phase 3 superiority study conducted across 14 centers within the French Network for Research on Kidney Cancer, aiming to enroll 694 patients over 36 mo.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Endpoints: &lt;/strong&gt;The primary endpoint is a composite trifecta score, including negative surgical margins, no complications, and renal function preservation (estimated glomerular filtration rate &gt;90% at 1 mo). The secondary endpoints include oncological outcomes, conversion rates, perioperative parameters, and economic evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources and statistical analysis plan: &lt;/strong&gt;Data are collected via the UroCCR database. Logistic regression will analyze the primary endpoint, and various regression methods will address the secondary outcomes. Economic evaluations involve incremental cost-utility and cost-effectiveness ratios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;Strengths include the multicenter design and robust randomization. Limitations involve variability in surgeons' experience with the new three-dimensional technology and logistical challenges in technology adoption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient summary: &lt;/strong&gt;This clinical trial is designed to evaluate a new surgical technique for treating kidney tumors called three-dimensional (3D) image-guided robot-assisted partial nephrectomy. This study aims to determine whether this new method is more effective and safer than the current standard robot-assisted surgery by improving surgical precision and preserving kidney function. Kidney tumors require precise surgical removal to ensure the best outcomes for patients both during and after surgery. While robotic assistance has improved many surgeries, use of advanced 3D imaging during these procedures might enhance the surgeon's ability to operate with greater accuracy, potentially leading to better patient outcomes and fewer complications. Participants in the trial will undergo surgery using either the conventional robotic-assisted method or the new 3D image-guided technique. The method used for each participant will remain undisclosed to maintain the study's integrity. All participants will receive the highest standard of care, and their progress will be monitored closely throughout the trial. This study hopes to demonstrate that the 3D image-guided method can improve surgical precision and outcomes for patients undergoing kidney tumor removal. If successful, this technique could set a new standard for kidney surgery and improve t","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Large-scale Digital Survey of Patients with Localized and Advanced Prostate Cancer in Germany, the UK, and the USA.","authors":"Joe M O'Sullivan, Brian D Gonzalez, Lisa M Gudenkauf, Axel Heidenreich, Stephen Allen, Carl Ernst-Gunther, Howard Wolinsky, Reiner Lehmann, Andreas Poschenrieder, Osvaldo Mirante, Alicia K Morgans","doi":"10.1016/j.euo.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.006","url":null,"abstract":"<p><strong>Background and objective: </strong>We conducted a prostate cancer (PC) survey to provide a better understanding of the patient journey, expectations, and attitudes related to treatment.</p><p><strong>Methods: </strong>This large-scale digital survey of patients with localized or advanced PC from Germany, the UK, and the USA assessed their demographics, diagnosis, treatment history, perception of therapy, medical care team involvement, and health-related quality of life (HRQoL). The survey was designed and interpreted by a large multistakeholder group. Descriptive statistics were primarily used. Univariate and multivariate analyses of the impact on HRQoL by demographic and clinical factors, including disease and treatment history, were examined using simple and multiple linear regression analyses, respectively.</p><p><strong>Key findings and limitations: </strong>Overall, 15 824 participants completed the survey and 14 812 reported their disease status (79.6% had localized and 20.4% had advanced PC). Across the three countries, there were similarities and differences in diagnosis, treatment patterns, and medical specialists involved. Diagnosis by routine screening was more common in Germany and the USA than in the UK. For localized disease, the most common treatment was prostatectomy in Germany and the USA, and radiotherapy in the UK. Hormone therapy was the most common treatment for advanced disease across countries. Overall, treatment satisfaction was high but decreased over time. Patients not on active treatment generally had negative perceptions of treatment types and their impact on HRQoL. Advanced disease and multiple comorbidities were identified as the predictors of worse HRQoL.</p><p><strong>Conclusions and clinical implications: </strong>This study highlights differences in the PC patient journey in Germany, the UK, and the USA. HRQoL did not differ between countries but was affected by advanced disease status and comorbidity burden. A common approach to PC diagnosis, treatment practices, and guidelines could improve outcomes.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Patients at Risk of Early Lethal Prostate Cancer by Integrating Family History, Polygenic Risk Score, Rare Variants in DNA Repair Genes, and Lifestyle Factors.","authors":"Zhizhu Zhang, Yiwen Zhang, Konrad H Stopsack, Adam S Kibel, Edward L Giovannucci, Kathryn L Penney, Anqi Wang, Joseph Vijai, Philip W Kantoff, Mark M Pomerantz, Kenneth Offit, Lorelei A Mucci, Anna Plym","doi":"10.1016/j.euo.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.008","url":null,"abstract":"<p><strong>Background and objective: </strong>In men with prostate cancer, one-third of deaths occur before the age of 75 yr. There remains a need to characterize heritable and environmental risk factors for these early deaths. This study aims to improve risk stratification for early lethal outcomes among prostate cancer patients with genetic factors beyond family history and with modifiable factors.</p><p><strong>Methods: </strong>This study included 966 prostate cancer patients, enriched for high-risk localized disease and with germline genetic data, in two prospective cohorts. Three genetic factors (family history of prostate cancer, polygenic risk score [PRS] in the top 20%, and rare variants in DNA repair genes) and a lifestyle score were examined for their association with early lethal (metastases/prostate cancer death before the age of 75 yr) compared with nonlethal cases using logistic regression and by calculating 10-yr lethal disease risks.</p><p><strong>Key findings and limitations: </strong>In total, 289 lethal, including 77 early lethal, cases were observed (median age at the end follow-up: 84.3 yr). Early lethal cases had higher percentages of men with a family history (23% vs 15%), a high PRS (47% vs 36%), and rare variants (14% vs 7.8%). Having two or more genetic factors was strongly associated with increased odds of early lethal disease (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.8-7.0) and linked to higher 10-yr lethal disease risks in high-risk localized patients diagnosed before the age of 75 yr. Healthy men with none of the genetic factors had the lowest odds of early lethal disease (OR, 0.3: 95% CI, 0.1-0.7), compared with unhealthy men with any genetic factor. The pattterns were similar for early fatal disease. The study had limited data for more detailed analyses.</p><p><strong>Conclusions and clinical implications: </strong>The combination of family history with rare variants, a PRS, and lifestyle factors may improve the identification of prostate cancer patients at risk of early lethal and fatal disease.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors for Oligometastatic Renal Cell Carcinoma Treated with Stereotactic Radiation: A Retrospective Study.","authors":"Allen Yen, Shanshan Tang, Alana Christie, Joseph Kwon, Mihailo Miljanic, Tidie Song, Aurelie Garant, Chul Ahn, Ang Gao, Robert Timmerman, James Brugarolas, Jing Wang, Raquibul Hannan","doi":"10.1016/j.euo.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.009","url":null,"abstract":"<p><strong>Background and objective: </strong>Stereotactic ablative radiotherapy (SAbR) has shown promise in controlling oligometastatic renal cell carcinoma (omRCC). Careful patient selection is critical, and yet the selection criteria remain unknown for patients who will not be harmed by delayed systemic therapy using SAbR. Here, we analyzed long-term follow-up of omRCC patients treated with SAbR to derive the predictors of survival benefit.</p><p><strong>Methods: </strong>We retrospectively reviewed patients with up to five omRCC sites treated with sequential SAbR from November 2007 to July 2022. Overall survival (OS), progression-free survival (PFS), local control (LC), and toxicity were analyzed. The predictors of PFS were analyzed using a univariate analysis and a Cox proportional hazard (CPH) model-based machine learning approach.</p><p><strong>Key findings and limitations: </strong>We analyzed 153 patients who underwent SAbR to 337 metastases with a median follow-up of 27 mo. The median OS and PFS were 61.3 and 32 mo, respectively. The rate of grade ≥3 toxicity was 1.3%, and the 3-yr rate of LC was 98%. Patients with bone and brain metastases had lower PFS on the univariate analysis. When compared with historical controls, the delayed-onset PFS with first-line systemic therapy in this cohort was not compromised. The CPH model found bone, brain, and number of metastases at diagnosis to be the predictors of PFS, with a C-index of 0.66 and 1-yr area under the curve of 0.68.</p><p><strong>Conclusions and clinical implications: </strong>For selected patients, SAbR is effective in controlling omRCC for >2 yr and can delay systemic therapy without compromising patient outcome. Bone and brain metastases, as well as an increasing number of metastases are poor predictive factors for omRCC patients treated with sequential SAbR who may benefit from upfront systemic therapy. Prospective studies are required to verify these findings.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}