European urology oncology最新文献

{"title":"Reducing Interval Censoring in Time-to-event Analyses of Functional Recovery After Radical Prostatectomy Using Patient-estimated Moment of Recovery.","authors":"Matei M Buzoianu, Amy L Tin, Simone Scuderi, John P Mulhall, Andrew J Vickers","doi":"10.1016/j.euo.2026.07.016","DOIUrl":"https://doi.org/10.1016/j.euo.2026.07.016","url":null,"abstract":"<p><strong>Background and objective: </strong>Functional recovery after radical prostatectomy happens continually but is only measured at set times when questionnaires are given. This leads to what is known as interval censoring. In the urologic literature, patients are typically considered to have recovered function at the moment they complete a follow-up survey, although recovery may have occurred earlier, leading to systematic overestimation of recovery time. At our institution, patients completing function assessments are additionally asked to estimate when recovery occurred, and this estimate is incorporated into the analysis. We aimed to compare our approach with the standard method, which assigns recovery to the survey completion date.</p><p><strong>Methods: </strong>We retrospectively identified 11 161 men who underwent radical prostatectomy between 2009 and 2025. Patients completed urinary and erectile function questionnaires at regular intervals after surgery; at the first response meeting recovery criteria (eg, pads no longer used), patients estimated the timing of recovery using predefined intervals. We used Kaplan-Meier analyses to estimate cumulative recovery over time, using both the survey completion date and the patient-reported estimate.</p><p><strong>Key findings and limitations: </strong>We identified 7896 patients who recovered continence and 6521 who recovered erectile function. Patient-estimated recovery time was considerably earlier than recovery time based on the survey completion date. Median time to continence recovery was 5 mo using our approach versus 8 mo using the survey completion date approach, whereas median time to erectile function recovery was 18 mo versus 23 mo. At 6 mo, recovery rates were higher when based on patient-estimated dates compared with survey completion dates for both continence (57% vs 40%) and erectile function (35% vs 28%).</p><p><strong>Conclusions and clinical implications: </strong>Functional questionnaires should include an additional item asking patients to report when recovery occurred. The reported time of recovery should be used in the analysis rather than the survey completion date.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760663","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":"Saline-assisted Fascial Exposure Microultrasound-guided Nerve Preservation During Robotic Prostatectomy: Interim Analysis of a Randomized Controlled Trial.","authors":"Adriana M Pedraza, Monali Fatterpekar, Himanshu Joshi, Manish Choudhary, Coskun Kacagan, Asher Mandel, Chahat Arora, Neeraja Tillu, Murilo De Almeida Luz, Cristina Pasat-Karasik, Ashutosh Maheshwari, Raghav Gupta, Mani Menon, Ashutosh K Tewari","doi":"10.1016/j.euo.2026.07.015","DOIUrl":"https://doi.org/10.1016/j.euo.2026.07.015","url":null,"abstract":"<p><strong>Background: </strong>Erectile dysfunction remains a major morbidity after radical prostatectomy. The SAFE technique uses real-time, micro-ultrasound-guided low-pressure hydrodissection to enable atraumatic nerve sparing.</p><p><strong>Objective: </strong>We compared functional and oncologic outcomes of SAFE versus standard robotic-assisted radical prostatectomy (RARP).</p><p><strong>Design, setting, and participants: </strong>In this randomized trial, patients were assigned 1:1 to micro-ultrasound-guided SAFE-RARP or standard RARP. Surgeons were unblinded; patients and outcome assessors were blinded.</p><p><strong>Outcome measurements and statistical analysis: </strong>The primary endpoint was erectile function recovery at 6 mo (SHIM ≥17), with secondary functional and oncologic outcomes. The primary endpoint was assessed at the prespecified interim analysis using a one-sided pooled z-test within a group-sequential O'Brien-Fleming α-spending framework (interim efficacy boundary, one-sided p < 0.002).</p><p><strong>Results and limitations: </strong>A total of 107 patients were analyzed (SAFE, n = 54; control, n = 53). At 6 mo, erectile function recovery was higher with SAFE than with standard RARP (52% vs 43%; absolute difference 8.5%, 95% CI -10% to 27%; one-sided p = 0.22), without crossing the prespecified interim efficacy boundary. At 6 weeks, early recovery rates were higher with SAFE (37% vs 21%; one-sided p = 0.032), with a smaller difference at 3 mo. Linear mixed-effects modeling showed earlier improvement in SHIM with SAFE, with convergence by 6 mo. Continence, oncologic outcomes, and complication rates were similar between groups. Limitations include the prespecified interim nature of the analysis, the relatively small sample size, and the need for longer follow-up to determine the durability and clinical significance of functional differences.</p><p><strong>Conclusions: </strong>In this prespecified interim analysis, the primary endpoint of 6-mo recovery was not met. Exploratory analyses suggested earlier postoperative recovery with SAFE, without evidence of compromised safety or oncologic outcomes; these findings are hypothesis-generating.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697229","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":"NeoBLAST: A Pilot Randomized Controlled Trial of Active Surveillance Versus Definitive Bladder Treatment Following Clinical Complete Response to Neoadjuvant Therapy in Muscle-invasive Bladder Cancer - Study Protocol.","authors":"Marie-Pier St-Laurent, Bernhard J Eigl, Scott Tyldesley, Ren Yuan, Silvia Chang, Gillian Vandekerkhove, Peter C Black","doi":"10.1016/j.euo.2026.07.008","DOIUrl":"https://doi.org/10.1016/j.euo.2026.07.008","url":null,"abstract":"<p><p>Although many patients with muscle-invasive bladder cancer (MIBC) achieve a pathologic complete response (CR) following neoadjuvant therapy (NAT), subsequent definitive bladder treatment (DBT) - radical cystectomy (RC) or trimodal therapy (TMT) remain standard treatments. Preliminary evidence suggests that a subset of patients may avoid DBT, but a definitive randomized comparison has not been conducted. NeoBLAST aims to evaluate the feasibility of randomizing patients with MIBC who achieve a clinical CR (cCR) following NAT to active surveillance (AS) versus DBT and to ultimately demonstrate the non-inferiority of AS. This study is an open-label phase 2/3 randomized controlled trial. Patients with resectable MIBC cT2-T4aN0M0 who achieve a cCR after receiving NAT are randomized 1:1 to AS or DBT. cCR determined by conventional imaging, circulating tumor DNA, bladder MRI, and template bladder biopsy. NeoBLAST phase 2 opened in August 2025 with the plan to enrol for 2 years and expand to a multicenter phase 3 trial in 2027. The phase 2 primary endpoint is feasibility to randomize, defined as ≥25% (≥18 of 72) acceptance of randomization in patients with cCR. The phase 3 primary endpoint is metastasis-free survival at 2 years. To determine a non-inferiority margin of 10%, the trial will need to randomize 172 patients with cCR. This study has the potential to be practice-changing by establishing the non-inferiority of AS in a randomized setting, but carries a risk of poor feasibility and unintended cross over after randomization. FUNDING: Canadian Institutes of Health Research and the Vancouver Prostate Centre. ETHICS AND TRIAL REGISTRATION: University of British Columbia H23-02447, NCT06537154.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688788","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":"Detection and Localization of Unfavorable-histology Prostate Cancer Using MRI and Whole-mount Histopathology.","authors":"Mariluz Rojo Domingo, Anna Dornisch, Christopher C Conlin, Aditya Bagrodia, Tristan Barrett, Matthew Cooperberg, Juan Javier Desloges, Deondre D Do, Son Do, Michael E Hahn, Mukesh Harisinghani, Gary Hollenberg, Karoline Kallis, Christopher J Kane, Joshua Kim, Kang-Lung Lee, Jonathan Levine, Michael A Liss, Jasmine Liu, Nabih Nakrour, Thomas Osinski, Christopher Pare, Rebecca Rakow-Penner, Rhea Rupareliya, Amirali Salmasi, Jeffry Simko, Yuze Song, Nikita Sushentev, Eric Weinberg, Sean Woolen, Anders M Dale, Ahmed S Shabaik, Tyler M Seibert","doi":"10.1016/j.euo.2026.07.011","DOIUrl":"https://doi.org/10.1016/j.euo.2026.07.011","url":null,"abstract":"<p><strong>Background and objective: </strong>Detecting localized prostate cancer (PC) with metastatic potential-defined as unfavorable-histology PC (uhPC), comprising Grade Group (GG) ≥3 disease or GG 2 disease with cribriform/intraductal features-is critical for guiding appropriate intervention. We evaluated the utility of the Prostate Imaging Reporting and Data System (PI-RADS) and the automated Restriction Spectrum Imaging restriction score (RSIrs; a biophysics-based quantitative MRI biomarker) for uhPC detection and localization.</p><p><strong>Methods: </strong>We evaluated patient-level detection of uhPC in a multicenter cohort with biopsy as the reference standard and lesion-level localization in a separate cohort with whole-mount histopathology (WMHP) from radical prostatectomy. The area under the receiver operating characteristic curve (AUC) was calculated to compare patient-level detection of uhPC using PI-RADS and RSIrs. PI-RADS and RSIrs were used to evaluate sensitivity for the most aggressive tumor within the prostate (index tumor) and for all uhPC tumors on WMHP.</p><p><strong>Key findings and limitations: </strong>The AUC for patient-level detection of uhPC did not differ significantly between PI-RADS and RSIrs in 1022 patients from five centers (p = 0.13). At the lesion level (n = 103 patients), sensitivity for the index tumor was 87% (95% confidence intervals [CI], 79-94) for PI-RADS, 85% (95% CI, 78-93) for RSIrs, and 93% (95% CI, 86-98) for the two combined. For all uhPC tumors, sensitivity was 81% (95% CI, 73-90) for PI-RADS, 86% (95% CI, 78-93) for RSIrs, and 90% (95% CI, 82-97) for the two combined. A limitation of the lesion-level analyses was that only patients who opted for surgery could be included.</p><p><strong>Conclusions and clinical implications: </strong>MRI showed high sensitivity for detecting uhPC, reinforcing its value for identifying biologically aggressive disease. Both PI-RADS and automated RSIrs may be useful for targeted biopsy and tumor-focused treatment, such as focal radiation dose escalation to aggressive intraprostatic lesions.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688773","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":"Reducing MRI Use in Organized Prostate Cancer Testing Using Blood-based Biomarkers: The OPT Stockholm3 Study.","authors":"Ugo Giovanni Falagario, Shuang Hao, Olof Akre, Stefan Carlsson, Ahmad Abbadi, Markus Arvendell, Lottie Phillips, Fredrik Sundquist, Thomas Jiborn, Rebecka Arnsrud Godtman, Ola Bratt, Anna Lantz","doi":"10.1016/j.euo.2026.07.013","DOIUrl":"https://doi.org/10.1016/j.euo.2026.07.013","url":null,"abstract":"<p><strong>Background and objective: </strong>We assessed the feasibility of implementation, reduction in magnetic resonance imaging (MRI) use, and cost implications of integrating Stockholm3 as a reflex blood test in organized prostate cancer testing (OPT).</p><p><strong>Methods: </strong>This pragmatic, population-based implementation study included men aged 50-52 yr invited to OPT in 2023 (n = 17 801) and 2024 (n = 30 556) in Health Region Stockholm-Gotland. The experimental group (2024) had a Stockholm3 test if prostate-specific antigen (PSA) ≥2 ng/ml and an MRI if Stockholm3 ≥15%. The control group (2023) followed standard OPT (MRI if PSA ≥3 ng/ml). Outcomes were MRI use (primary), biopsies performed, detection of Grade Group (GG) 1 and GG ≥2 cancer, and Stockholm3 cost thresholds. Relative proportions (RPs) and decision-tree cost modeling were used.</p><p><strong>Key findings and limitations: </strong>MRI use decreased by 64%, from 2.7% (181/6663) in 2023 to 1.0% (70/7070) in 2024 (RP 0.36; 95% confidence intervals [CI], 0.28-0.48); biopsy rates decreased from 0.6% to 0.4% (RP 0.67; 95% CI, 0.41-1.07). Detection of GG 1 cancer decreased from 0.17% (11/6663) to 0.08% (6/7070) (RP 0.51; 95% CI, 0.19-1.39), and detection of GG ≥2 cancer decreased from 0.20% (13/6663) to 0.14% (10/7070) (RP 0.72; 95% CI, 0.32-1.65). A cost of €92 per Stockholm3 test would achieve cost neutrality. Limiting Stockholm3 testing to men with PSA ≥3 ng/ml would reduce MRI use and costs. Study limitations include the nonrandomized design, few cancer events, restricted age range, and short follow-up.</p><p><strong>Conclusions and clinical implications: </strong>Integrating Stockholm3 as a reflex test in the first round of an OPT program is feasible. Reflex testing at PSA ≥2 ng/ml and PSA ≥3 ng/ml was associated with reductions in the numbers of MRI scans and biopsies performed. No cancers were detected at PSA 2.0-2.9 ng/ml; however, the study was underpowered to assess cancer detection, and this finding should be considered hypothesis-generating.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688791","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":"PSMA PET in Prostate Cancer: Clinical Value, Access Challenges, and Priorities for Implementation.","authors":"Arthur Peyrottes, Léa Turpin, Laura Fernández Hernández, Juan Gómez Rivas, Morgan Rouprêt","doi":"10.1016/j.euo.2026.07.007","DOIUrl":"https://doi.org/10.1016/j.euo.2026.07.007","url":null,"abstract":"<p><p>Prostate-specific membrane antigen positron emission tomography (PSMA PET) has become an integral component of contemporary prostate cancer (PCa) management, improving disease characterization in clinically relevant settings such as initial staging of higher-risk disease and biochemical recurrence. Beyond its superior diagnostic performance compared with conventional imaging, PSMA PET increasingly influences treatment planning, patient stratification, and multidisciplinary decision-making. However, despite growing incorporation into international clinical guidelines, access to PSMA PET remains heterogeneous across health care systems. Variability in reimbursement policies, regulatory frameworks, tracer availability, imaging capacity, referral pathways, and local expertise may limit timely access for eligible patients. These disparities have important clinical implications, potentially affecting staging accuracy, localization of recurrent disease, treatment selection, and equity of care. In this expert perspective, we discuss the evolving role of PSMA PET in PCa management, highlight the clinical consequences of unequal access, and identify key priorities to facilitate implementation across Europe. Improving access to high-quality PSMA PET should be regarded not only as a logistical objective but also as a clinical priority to ensure that advances in molecular imaging translate into more precise, timely, and equitable PCa care.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701119","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":"Think Twice Before You Continue Long-term FU in Localised nccRCC after Surgery","authors":"Patricia J. Zondervan,&nbsp;Luuk T. de Haan,&nbsp;Axel Bex","doi":"10.1016/j.euo.2026.05.002","DOIUrl":"10.1016/j.euo.2026.05.002","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"9 4","pages":"Pages 750-751"},"PeriodicalIF":8.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053528","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":"EZH2 Inhibition Remodels Cell States and Enhances EGFRi Sensitization in Bladder Cancer","authors":"Hongda Zhao,&nbsp;Jinyue Liao,&nbsp;Ho Vincy Wing Sze,&nbsp;Kang Liu,&nbsp;Xuan Chen,&nbsp;Hongwei Wu,&nbsp;Qiaoxiu Wang,&nbsp;Jiahui Hu,&nbsp;Peter Ho Yin Luk,&nbsp;Peter Ka-Fung Chiu,&nbsp;Chi Fai Ng,&nbsp;Dinglan Wu,&nbsp;Jeremy Yuen-Chun Teoh","doi":"10.1016/j.euo.2026.05.009","DOIUrl":"10.1016/j.euo.2026.05.009","url":null,"abstract":"<div><h3>Background</h3><div>Bladder cancer (BCa) displays interpatient heterogeneity and epigenetic plasticity that may limit treatment efficacy.</div></div><div><h3>Objective</h3><div>To investigate whether inhibition of Enhancer of zeste homolog 2 (EZH2) remodels tumor cell states and creates therapeutic vulnerabilities in BCa.</div></div><div><h3>Design, setting, and participants</h3><div>We integrated single-nucleus ribonucleic acid sequencing (snRNA-seq) of formalin-fixed paraffin-embedded (FFPE) primary tumors with single-cell ribonucleic acid sequencing (scRNA-seq) of matched patient-derived organoids (PDOs) from four BCas spanning stages Ta–T3.</div></div><div><h3>Intervention</h3><div>PDOs were treated with the EZH2 inhibitor tazemetostat. Sequential tazemetostat pretreatment followed by afatinib treatment was used to evaluate whether EZH2 inhibition enhanced sensitivity to epidermal growth factor receptor (EGFR)-targeted therapy.</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>Transcriptional responses to EZH2 inhibition were profiled by scRNA-seq. Trimethylation of histone H3 lysine 27 (H3K27me3) chromatin immunoprecipitation sequencing (ChIP-seq) was performed in PDOs and EZH2 ChIP-seq in HT1376 cells to assess epigenomic changes associated with treatment. Gene set enrichment analysis was used to evaluate treatment-associated pathway alterations, including EGFR tyrosine kinase inhibitor resistance-related signatures. Functional relevance was assessed using afatinib sensitivity assays after sequential tazemetostat pretreatment.</div></div><div><h3>Results and limitations</h3><div>Native tumors showed heterogeneity in epithelial, stromal, and immune composition, whereas matched PDOs selectively retained and expanded tumor-intrinsic stress- and plasticity-associated epithelial states. EZH2 inhibition induced model-specific reprogramming, including inflammatory, proliferative, hypoxic/glycolytic, and neural/neuroendocrine (NE)-like programs. EZH2-bound regions were preferentially associated with treatment-related H3K27me3 loss, and loci with both EZH2 occupancy and reduced H3K27me3 were enriched for neural and NE developmental processes. Despite these heterogeneous responses, gene set enrichment analysis showed downregulation of EGFR tyrosine kinase inhibitor resistance-related signatures across all PDOs, and sequential tazemetostat pretreatment increased afatinib sensitivity in all four models. Limitations include the small cohort, ex vivo design, and use of a cell line for EZH2 ChIP-seq.</div></div><div><h3>Conclusions</h3><div>EZH2 is a context-dependent regulator of cell-state plasticity in BCa. Although EZH2 inhibition alone induced heterogeneous adaptive responses, it also suppressed EGFR inhibitor resistance-related programs and enhanced subsequent afatinib sensitivity, supporting further evaluation of sequential epigenetic priming before EGFR-targeted therapy in BCa.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"9 4","pages":"Pages 895-910"},"PeriodicalIF":8.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Outcomes of Robot-assisted versus Open Radical Nephrectomy with IVC Thrombectomy in France: Insights from the Robocav Study (UroCCR 188)","authors":"Jean Tournant,&nbsp;Gaëlle Margue,&nbsp;Franck Bruyere,&nbsp;Nicolas Doumerc,&nbsp;Bastien Parier,&nbsp;Pablo Lemercier,&nbsp;Hervé Lang,&nbsp;Jonathan Olivier,&nbsp;Clément Sarrazin,&nbsp;Morgan Rouprêt,&nbsp;Jean-Christophe Bernhard","doi":"10.1016/j.euo.2026.03.017","DOIUrl":"10.1016/j.euo.2026.03.017","url":null,"abstract":"<div><h3>Background</h3><div>While robotic-assisted radical nephrectomy with IVC thrombectomy (R-CT) has emerged as a minimally invasive alternative to the open approach (O-CT), the latter remains the standard, with limited comparative studies.</div></div><div><h3>Objective</h3><div>This study aimed to compare perioperative outcomes and oncological efficacy of R-CT versus O-CT based on the French multicenter experience.</div></div><div><h3>Design, setting, and participants</h3><div>We conducted a retrospective, multicenter, propensity score-matched study using prospectively collected data from the UroCCR kidney cancer research network. Patients with Mayo level 1-2 thrombus who underwent O-CT or R-CT between December 2015 and July 2024 in eight tertiary centers were included.</div></div><div><h3>Intervention</h3><div>Open or robotic-assisted radical nephrectomy with IVC thrombectomy.</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>Propensity scores were estimated through a logistic model including demographic, clinical, and tumor-related variables. Matching was performed using optimal full matching and a 0.2 SD caliper. Treatment effects were estimated using linear, logistic, or Cox regression models and pooled across imputations according to Rubin’s rules. The primary outcome was surgical morbidity, while secondary outcomes included surgical, oncological and functional outcomes.</div></div><div><h3>Results and limitations</h3><div>After matching, 92 of the 94 included patients remained, including 57 open and 35 robotic cases. Lower estimated blood loss (median, 400 mL vs. 1300 mL; <em>p</em>=0.013) and global length of stay (median, 5 days vs. 8 days; <em>p</em>=0.008) were observed in the robotic group. There were no statistically significant differences in complications, oncological and functional outcomes.</div></div><div><h3>Conclusions</h3><div>In selected patients and expert centers, R-CT was associated with reduced blood loss and faster recovery compared to O-CT.</div></div><div><h3>Patient summary</h3><div>We compared two surgical techniques to remove kidney tumors that extend into the IVC. The robotic approach was associated with less blood loss and shorter hospital stays. Cancer control and kidney function were similar between both techniques.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"9 4","pages":"Pages 851-859"},"PeriodicalIF":8.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155981","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":"Adjusted Comparison of First-line Enfortumab Vedotin Plus Pembrolizumab Versus Platinum-based Chemotherapy ± Avelumab Maintenance for the Treatment of Locally Advanced/Metastatic Urothelial Carcinoma","authors":"Ryan Dillon,&nbsp;Robert Jones,&nbsp;Aude Fléchon,&nbsp;Keith Chan,&nbsp;Alicia N. Pepper,&nbsp;Dylan McLoone,&nbsp;Sam Keeping,&nbsp;Jeroen P. Jansen,&nbsp;Allison Thompson,&nbsp;Florence R. Wilson","doi":"10.1016/j.euo.2026.06.004","DOIUrl":"10.1016/j.euo.2026.06.004","url":null,"abstract":"<div><h3>Background and objective</h3><div>First-line (1L) treatment options for locally advanced or metastatic urothelial carcinoma (la/mUC) include enfortumab vedotin plus pembrolizumab (EV+P), based on EV-302, or platinum-based chemotherapy (PBC) with avelumab maintenance for patients without progression, based on JAVELIN-Bladder 100 (JB-100). Clinicians must choose between EV+P and PBC without knowing whether patients will respond to PBC and qualify for avelumab. In EV-302, avelumab maintenance was approved after trial initiation and therefore, was potentially underutilized among patients without progression. This modeling study facilitated a true 1L comparison of EV+P versus PBC ± avelumab.</div></div><div><h3>Methods</h3><div>Progression-free survival and overall survival were compared using EV-302 patient-level data and JB-100 study-level data. The JB-100 hazard ratio (HR) for avelumab versus best supportive care was applied to a comparable EV-302 PBC subgroup of patients without progression after a 22-week 1L period. This replaced EV-302 data for patients without progression to reflect outcomes assuming all EV-302 patients without progression received avelumab as observed in JB-100. Using a weighted hazard approach, patients without progression were combined with EV-302 patients with progression to obtain a hybrid PBC ± avelumab arm, which was compared with observed EV+P outcomes. Weighted average HRs with 95% confidence intervals (CIs) were calculated.</div></div><div><h3>Key findings and limitations</h3><div>EV+P improved progression-free survival (HR 0.51, 95% CI 0.44–0.59) and overall survival (HR 0.64, 95% CI 0.49–0.86) versus PBC ± avelumab. Results were consistent across sensitivity analyses. Limitations include assuming all patients without progression received avelumab, which may not reflect real-world patterns.</div></div><div><h3>Conclusions and clinical implications</h3><div>EV+P provides progression-free survival and overall survival benefits over PBC ± avelumab, reinforcing its position as the 1L standard of care in patients with la/mUC.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"9 4","pages":"Pages 938-945"},"PeriodicalIF":8.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}