Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Multicenter study of active surveillance for small renal masses: Real world practice pattern.","authors":"Tarek Ajami, Eric Villalba Lázaro, Enrique Trilla Herrera, Cristina Ferreiro Pareja, Arnau Abella Serra, Albert Francés Comalat, Nicolas Valdes Figueroa, Carlos Adrián Aguayo Eldredge, Miguel Ángel Lopez-Costea, José Ignacio Pérez Reggeti, Carlos González Satué, Sergio Bernal Salguero, Gueisy Delgado Ortega, Lluís Cecchini Rosell, María José Ribal, Mireia Musquera, David Lorente García","doi":"10.1016/j.urolonc.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.01.009","url":null,"abstract":"<p><strong>Introduction: </strong>Active surveillance (AS) is a safe strategy for small renal masses (SRM) suspicious of renal cell carcinoma. In this study we analyze real world outcomes of active surveillance SRM from 5 tertiary Spanish centers, assessing clinical, radiological, and pathological characteristics, as well as therapeutic options.</p><p><strong>Methods: </strong>A multicenter retrospective review was conducted including patients on AS from January 2012 to September 2024. We analyzed the indication for AS, initial lesion size, growth rate (GR), and progression on active surveillance. Cox regression analysis was performed to identify predictor of deferred intervention (DI).</p><p><strong>Results: </strong>A total of 384 patients with renal tumors were included in AS, with an initial mean tumor size of 20.5mm. With a mean follow-up period of 43 months, the average GR across the cohort was 1.4 mm/y. About 15% of patients (n = 59) received active treatment (partial nephrectomy 56%, radical nephrectomy 16%, and radiofrequency 28%). Age, tumor size and tumor growth were factors correlated with delayed intervention, and only initial tumor size was correlated with GR. Pathological analysis after active treatment showed high grade clear cell carcinoma in 43.5% of cases with a GR of > 5 mm/y, as compared to 19.4% of oncocytomas in slow growing lesions. No disease progression nor cancer-specific deaths were observed in our series.</p><p><strong>Conclusions: </strong>In our multicenter cohort, AS is a valid option for SRMs without affecting oncological outcomes, with clinical factors such as age, tumor size, GR and initial biopsy influencing decisions on intervention.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075681","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":"Rethinking the definition of stage III disease in adrenocortical carcinoma: Assessing the impact of clinical lymph node positive disease.","authors":"Benjamin J Lichtbroun, Helen Gao, Kevin Chua, John Pfail, Rachel Passarelli, Hiren V Patel, Sammy Elsamra, Eric A Singer, Vignesh T Packiam, David Golombos, Thomas L Jang, Saum Ghodoussipour, Arnav Srivastava","doi":"10.1016/j.urolonc.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.01.004","url":null,"abstract":"<p><strong>Introduction: </strong>Stage III adrenocortical carcinoma encompasses both lymph node positive (TanyN1M0) and negative (T3-4N0M0) disease. Given the disease's rarity, the current staging paradigm's estimates of survival are supported by limited evidence. Consequently, we examined the impact of clinical lymph node positivity on survival outcomes in the context of the current staging of advanced adrenocortical carcinoma.</p><p><strong>Methods: </strong>We identified patients with clinical stage III and IV disease from the National Cancer Database. Kaplan-Meier methods and Cox proportional hazards models estimated overall survival for stage III lymph node negative, stage III lymph node positive, and stage IV disease.</p><p><strong>Results: </strong>We identified 917 patients with adrenocortical carcinoma - 322 (35.1%) stage III lymph node negative, 67 (7.3%) stage III lymph node positive, and 528 (57.6%) stage IV. 3-year overall survival for patients with stage III lymph node negative, stage III lymph node positive, and stage IV disease was 48.6%, 29.4%, and 15.6%, respectively. On univariable analysis, patients with stage III lymph node positive disease were associated with worse survival than those with stage III lymph node negative disease (HR 1.72, 95% CI 1.26-2.37, P < 0.001); however, this relationship did not maintain significance in multivariable analysis (HR 1.27, 95% CI 0.88-1.83, P = 0.21).</p><p><strong>Conclusion: </strong>Our study finds that patients with clinical stage III lymph node positive adrenocortical carcinoma may have worse survival outcomes than stage III patients without lymph node involvement. The results of this study suggest the need for an updated, more nuanced staging paradigm, which differentiates stage III disease by lymph node positivity.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075683","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":"Concordance of surgical treatment selection with the AUA guidelines for localized renal masses.","authors":"Bassel R Salka, Dennis Boynton, Chibuzor Nwachukwu, Bruce Lyu, Sabrina L Noyes, Conrad M Tobert, Brian R Lane","doi":"10.1016/j.urolonc.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.01.008","url":null,"abstract":"<p><strong>Objective: </strong>To examine and evaluate guideline concordance of surgical treatment selection at a community-based health system. The AUA guidelines provide specific guidance regarding appropriate utilization of radical nephrectomy (RN) and partial nephrectomy (PN). However, nearly 40% of patients did not fit a guideline-specified scenario in a prior report.</p><p><strong>Methods: </strong>Retrospective review of consecutive surgical patients (7/2019-9/2022) identified indications for RN/PN relative to 3 criteria: tumor complexity (RENAL ≥ 9), oncologic risk (size ≥ 7cm, cT3a, infiltrative features, and/or renal mass biopsy with high-risk features), and renal function (preoperative GFR ≥ 60 ml/min/1.73m²; predicted GFR following RN ≥ 45 ml/min/1.73m²).</p><p><strong>Results: </strong>Of 372 surgeries for cT1a-cT3aN0M0 renal masses, 138 were RN (37%) and 234 were PN (63%). Overall, 247 patients (66%) fit a guideline-specified scenario: 35 (9%) had a strong indication for RN of whom 34 underwent RN (97%) and 212 (57%) had a strong indication for PN of whom 191 underwent PN (90%). Of 125 patients (34% of total) that did not fit guidelines scenarios, 83 underwent RN (66%) and 42 underwent PN (34%). Oncologic risk was the most influential factor in both guideline-specified and non-specified cases with 96% of patients with high-oncologic risk undergoing RN whether renal function was adequate or impaired. Fellowship-trained urologic-oncologists were more likely to perform PN than general urologists for non-specified cases (47% vs. 28%, P < 0.001).</p><p><strong>Conclusion: </strong>We found strong AUA guideline compliance for RN and PN with some over-utilization of RN. Our results confirm that more than one third of cases are uncategorized. Subsequent iterations of guidelines could incorporate more cases by expanding indications for appropriate RN. Regardless, complex cases may benefit from tumor boards and multidisciplinary review.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068221","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":"Surgical options for advanced renal cell carcinoma.","authors":"Mohit Butaney, Wooju Jeong","doi":"10.1016/j.urolonc.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.01.010","url":null,"abstract":"<p><p>Detection of advanced renal cell carcinoma (RCC) is not uncommon, although there has been a stage migration due to frequent use of abdominal imaging allowing early detection of renal masses. Since open IVC thrombectomy was introduced in 1972, minimally invasive approaches such as laparoscopic approach, hand-assisted approach and robotic approach have been adopted. While robotic surgery has potential benefits to improve perioperative outcomes, and our experience with robotic surgery has grown significantly over the last decade, open surgery at an academic center remains the standard of care in this setting. In the setting of metastatic RCC, cytoreductive nephrectomies have been discussed for many years but their indications are unclearly defined, although cytoreductive nephrectomy can be considered in patients with disease largely limited to the kidney or on-going or impending symptomatic disease. Significant advances have been made in systematic therapy for RCC which will eventually lead to the evolution of neoadjuvant and adjuvant therapy in patients with advanced RCC. The surgical management of advanced RCC is a major and complex undertaking but has shown to be feasible and effective.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075436","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":"Recurrence after surgery for clear cell and papillary renal cell carcinoma: Head-to head comparison of validated risk scores.","authors":"Mattia Longoni, Giuseppe Rosiello, Pietro Scilipoti, Federico Belladelli, Francesco Trevisani, Chiara Re, Giacomo Musso, Francesco Cei, Lucia Salerno, Andrea Folcia, Zhe Tian, Pierre I Karakiewicz, Alexandre Mottrie, Isaline Rowe, Alberto Briganti, Andrea Salonia, Rayan Matloob, Roberto Bertini, Francesco Montorsi, Alessandro Larcher, Umberto Capitanio","doi":"10.1016/j.urolonc.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.01.003","url":null,"abstract":"<p><strong>Introduction: </strong>The American Urology Association (AUA) recently introduced in their guidelines a subtype-agnostic, 4-tiered risk classification score to assess oncologic outcomes after surgery in patients with localized renal cell carcinoma (RCC). We provide a head-to-head comparison of the AUA score with 3, internationally validated and EAU recommended, histological-specific models.</p><p><strong>Materials and methods: </strong>We retrieved from a prospectively-maintained database 2,560 surgically-treated patients with localized RCC in a single high-volume European center (1987-2023). Patients were classified into risk categories, according to 3 histology-specific prognostic models (i.e., Leibovich 2003, Leibovich 2018 and VENUSS). Kaplain-Meier (KM) analyses estimated 5-year progression-free (PFS) and cancer-specific (CSS) survival. Area under curves (AUCs) of each prognostic model to predict clinical progression or cancer-specific mortality (CSM) were calculated, according to histological subtypes.</p><p><strong>Results: </strong>Overall, 2,145 (84%) patients harbored clear-cell (ccRCC), whereas 415 (16%) harbored papillary (pRCC) RCC. Within ccRCC, proportions of low vs. intermediate vs. high/very-high risk patients ranged from 57 to 58% vs. 17 to 28% vs. 6.3 to 19%, respectively. In pRCC, proportions of low vs. intermediate vs. high/very-high risk patients ranged from 54 to 73% vs. 21 to 24% vs. 4.8 to 12%, respectively. Leibovich 2018 and VENUSS exhibited the highest AUCs for clinical progression (0.805 vs. 0.884) and CSM (0.847 vs. 0.862) prediction within ccRCC vs. pRCC, respectively. The AUA model demonstrated AUCs of 0.783 vs. 0.864 for clinical progression and 0.797 vs. 0.826 for CSM in ccRCC vs. pRCC, respectively.</p><p><strong>Conclusion: </strong>Within a European cohort of RCC patients, the AUA prognostic stratification exhibited reliable performance. Nevertheless, histology-specific models continue to demonstrate a substantial advantage in predicting RCC outcomes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068224","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":"Association between frailty and specific comorbidities on oncological outcomes in metastatic hormone-sensitive and castration resistant prostate cancer.","authors":"Mike Wenzel, Benedikt Hoeh, Carolin Siech, Clara Humke, Maria Welte, Marit Ahrens, Christoph Würnschimmel, Derya Tilki, Thomas Steuber, Markus Graefen, Luis Kluth, Felix K H Chun, Philipp Mandel","doi":"10.1016/j.urolonc.2025.01.001","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.01.001","url":null,"abstract":"<p><strong>Objective: </strong>Demographic changes will lead to higher proportions of metastatic hormone-sensitive (mHSPC) and castration resistant metastatic prostate cancer (mCRPC) patients with higher frailty index and multiple comorbidities.</p><p><strong>Materials and methods: </strong>We relied on an institutional tertiary-care database to explore the effect of frailty (Eastern Cooperative Oncology Group [ECOG]), as well as cardiovascular (CVD) and secondary malignancy (SecCa) comorbidities on overall survival (OS) and time to mCRPC in mHSPC and OS in mCRPC patients with Kaplan-Meyer estimates and Cox regression models.</p><p><strong>Results: </strong>Of 802 mHSPC patients, 61% were ECOG0 vs. 32% ECOG1 vs. 6.5% ECOG≥2. Significant differences in baseline patient and baseline mHSPC characteristics were observed for all three groups (all P ≤ 0.05). In time to mCRPC analyses and OS analyses of mHSPC and mCRPC patients, significant disadvantages were observed for ECOG 1/≥2 patients, relative to ECOG0, even after multivariable adjustment. Moreover, 31% of included patients had history/active CVD, which yielded significant median OS differences in mHSPC patients (95 vs. 63 months, multivariable hazard ratio: HR: 1.77, P < 0.01), but not in mCRPC patients (P = 0.085). After stratification according to SecCa, 14% had a SecCa which led to significant median OS differences in mCRPC patients (50 vs. 37 months, P < 0.01) but not in mHSPC patients (76 vs. 64 months, P = 0.089). Patients with higher frailty index and comorbidities showed significant differences in therapy lines.</p><p><strong>Conclusion: </strong>Frailty and specific comorbidities significantly influence cancer-control outcomes in mHSPC, as well as mCRPC patients, even after controlling for adverse tumor characteristics.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042399","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":"Metformin intake and risk of metabolic acidosis after radical cystectomy with urinary diversion: A comparative study using data from the TriNetX research network.","authors":"Maximilian Pallauf, Stephan Brönimann, Michael E Rezaee, Taylor P Kohn, Sean A Fletcher, Meghan McNamara, Dmitry Enikeev, Shahrokh F Shariat, Jean Hoffman-Censits, Armine K Smith, Nirmish Singla","doi":"10.1016/j.urolonc.2024.12.275","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.12.275","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association of diabetes mellitus and metformin use with metabolic acidosis risk after radical cystectomy (RC) and urinary diversion for bladder cancer.</p><p><strong>Materials and methods: </strong>This retrospective cohort study used TriNetX Research Network data. Patients undergoing RC with continent diversion or ileal conduit for bladder cancer were identified using International Classification of Diseases, 10th Revision (ICD-10) and ICD-10 Procedure Coding System (ICD-10-PCS) codes. The primary outcome was acidosis between 1 month and 3 years postsurgery. Risk ratios (RR) and odds ratios (OR) were calculated based on diabetes and metformin use, stratified by diversion type and chronic kidney disease stage. Propensity score matching balanced potential confounders.</p><p><strong>Results: </strong>We identified 1,986 patients who underwent continent diversion and 11,184 who underwent ileal conduit reconstruction. In matched analyses, diabetes patients had higher acidosis risk (continent diversion: RR 1.87, 95% confidence interval [CI] 1.39-2.51; ileal conduit: RR 1.94, 95% CI 1.66-2.27). The risk was highest for diabetes patients with metformin prescription (continent diversion: RR 2.06, 95% CI 1.63-2.61; ileal conduit: RR 2.13, 95% CI 1.84-2.47). However, among patients with diabetes, metformin use did not significantly affect acidosis rates in most analyses. Continent diversion patients had higher acidosis risk than ileal conduit patients (RR 1.89, 95% CI 1.58-2.26).</p><p><strong>Conclusion: </strong>Diabetes significantly increases metabolic acidosis risk after RC with urinary diversion, especially in continent diversion patients. While metformin may contribute to metabolic acidosis risk, its impact appears less significant than that of diabetes. Careful monitoring and appropriate metformin adjustments are crucial in this population.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029813","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":"Concordance between intraoperative macroscopic evaluation and permanent section analysis of tumor bed margin in partial nephrectomy: A prospective study.","authors":"Abbas Basiri, Navid Masoumi, Ali Amani-Beni, Sobhan Sabzi, Mahmoud Parvin, Atoosa Gharib, Nasser Shakhssalim, Alireza Lashay, Mohammad Hadi Radfar, Mohammadamin Omrani","doi":"10.1016/j.urolonc.2024.12.270","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.12.270","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the concordance between the intraoperative visual assessment of the tumor bed for completeness of resection following partial nephrectomy and the permanent section analysis of biopsies taken from the tumor bed.</p><p><strong>Methods: </strong>Patients undergoing partial nephrectomy at 2 university hospitals were prospectively enrolled. R.E.N.A.L. nephrometry score of tumors were calculated according to preoperative imaging. Masses were resected either by enucleation or with a safety margin. To ensure accurate excisional biopsy from the entire tumor bed, all resections were performed using the open technique. After tumor excision and confirmation of complete resection through gross inspection, 4 samples-1 from each quadrant of the tumor bed-were taken and sent for permanent section analysis. The concordance between the surgeons' visual inspection and final pathological analysis was then evaluated RESULTS: A total of 52 partial nephrectomies were included in this study. The mean tumor size was 49.5±22.6mm with a mean R.E.N.A.L nephrometry score of 7.13±1.93. Masses were removed by enucleation in 21 cases (40.4%) and with a safety margin in 31 cases (59.6%). Nine masses (17.3%) were benign, and 43 (82.7%) were renal cell carcinomas. None of the tumor bed biopsies were positive, indicating 100% concordance between the surgeons' visual inspection and the final pathological analysis.</p><p><strong>Conclusion: </strong>Our findings suggest that the surgeons' macroscopic evaluation of the tumor bed during partial nephrectomy is a reliable method for confirming complete resection. Performing biopsies from the tumor bed to confirm negative margins does not appear to provide additional diagnostic value.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012482","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":"Durability of response of UGN-101: Longitudinal follow up of multicenter study.","authors":"Solomon L Woldu, Daniel Igel, Brett Johnson, Katie S Murray, Hiroko Miyagi, Wade Sexton, Isamu Tachibana, Hristos Kaimakliotis, Joseph Jacob, Rian Dickstein, Jennifer Linehan, Alan Nieder, Marc A Bjurlin, Daniel Heidenberg, Mitchell Humphreys, Saum Ghodoussipour, Marcus L Quek, Michael O'Donnell, Brian H Eisner, Surena F Matin, Adam S Feldman, Yair Lotan","doi":"10.1016/j.urolonc.2024.12.279","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.12.279","url":null,"abstract":"<p><strong>Purpose: </strong>UGN-101, a reverse thermal mitomycin gel for upper tract instillation, recently became the first FDA approved treatment for upper tract urothelial carcinoma (UTUC). However, the durability of UGN-101 treatment has not been well described. Here we present long term outcomes from our multi-institutional cohort for patients who initially responded to treatment.</p><p><strong>Materials and methods: </strong>We identified patients from a multi-institutional database with UTUC who had a negative endoscopic evaluation following either adjuvant or chemoablative UGN-101 induction. Recurrence and progression data for those patients was reviewed. Kaplan-Meier survival analysis was performed, stratified by relevant clinical features.</p><p><strong>Results: </strong>We identified 56 renal units that met the inclusion criteria of which 93% had low-grade disease while 4 cases had high-grade UTUC. With a median follow-up of 23.5 months, 21.4% of renal units experienced a recurrence, with 65% of renal units recurrence-free at 36 months. Three patients experienced eventual progression of disease leading to mortality, however only 1 of these patients had presumed low-grade UTUC and did not undergo nephroureterectomy on recurrence due to solitary kidney.</p><p><strong>Conclusions: </strong>UGN-101 treatment has excellent durability in patients who initially respond to the treatment. Further study is needed to better understand the long term outcomes of this novel therapy and also the risks/benefits of maintenance therapy in this setting. Caution should be used in patients with high-grade disease who appear to be at higher risk of relapse and death despite initial response.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012488","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 pan-immune-inflammation value: A novel independent predictive factor for overall survival in ≥pT2a nonmetastatic renal cell carcinoma.","authors":"Serdar Baykal, Hasan Yilmaz, Naci Burak Cinar, Enes Malik Akdas, Enes Abdullah Baynal, Kerem Teke, Ozdal Dillioglugil","doi":"10.1016/j.urolonc.2024.12.261","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.12.261","url":null,"abstract":"<p><strong>Purpose: </strong>Aimed to evaluate the prognostic value of Pan-Immune-Inflammation Value (PIV) for overall survival (OS) in the localized RCC. We also tested the feasibility of incorporating the PIV into UCLA Integrated Staging System (UISS).</p><p><strong>Materials and methods: </strong>Retrospectively evaluated 197 consecutive ≥pT2a radical nephrectomy patients. PIV and other blood based inflammatory markers were calculated. The optimal cut-offs of inflammatory markers were determined. The C-index was calculated. Cox regression analyses were done.</p><p><strong>Results: </strong>Median age and follow-up time were 59 yrs. and 49 mo., respectively. Two, 5 and 10 years OS was 81.4%, 69.4% and 45.6%. Age, BMI, anemia, lymph node positivity, UISS and all inflammatory markers were found to be significant predictive factors. However, PIV had the highest hazard ratio [HR: 2.39 (1.38-4.14)] and also had highest C-index contribution (+0.24%) in multivariable analyses. Furthermore, both UISS and PIV remained independent predictive factors (P = 0.027 and P = 0.002, respectively). Additionally, pre- and postoperative low PIV provided about half reduction in the risk of death [HR: 0.44 (0.24-0.81), P = 0.008].</p><p><strong>Conclusions: </strong>PIV was found to be an independent predictive factor in localized RCC. When PIV was included to the model, both UISS and PIV remained significant predictors and also PIV increased the C-index of the model.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012494","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}