Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Urethral cancer management in contemporary practice: A review.","authors":"Herney Andrés García-Perdomo, Angélica María Dávila-Raigoza, Philippe E Spiess","doi":"10.1016/j.urolonc.2026.04.006","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.04.006","url":null,"abstract":"<p><p>Primary urethral carcinoma (PUC) is a very rare and aggressive genitourinary cancer. Its low incidence has limited the availability of clinical trials and robust information, with most evidence derived from retrospective series, population-based registries, and expert consensus. This review synthesizes contemporary knowledge on epidemiology, diagnosis, histopathology, molecular biology, treatment, and future perspectives in PUC. Sex-specific and anatomical differences strongly influence presentation and histology: squamous cell carcinoma predominates in men with distal disease, urothelial carcinoma is more frequent in the prostatic urethra, and adenocarcinoma arises mainly from female periurethral diverticula. Chronic inflammation, strictures, long-term catheterization, and human papillomavirus infection are established etiologic factors. Diagnostic delays are common, particularly in women, underscoring the need for heightened suspicion, early biopsy, and advanced imaging for accurate staging. Surgical resection remains the cornerstone for localized disease, with penile- or urethra-preserving approaches favored in distal tumors to optimize functional outcomes. Radical surgery, including penectomy or anterior exenteration, is often required in proximal or advanced cases but carries significant morbidity. Radiotherapy, historically applied in women and unfit surgical candidates, retains a role in organ preservation when combined with other therapies. Systemic treatment, centered on cisplatin-based regimens, has demonstrated improved survival in advanced disease, with neoadjuvant strategies enhancing resectability. Emerging evidence supports integrating immunotherapy and targeted agents guided by molecular alterations. Multimodal therapy has become the standard in advanced stages, improving survival while enabling functional preservation in selected patients. Prognosis is dictated by stage, nodal status, histology, and surgical margins. Future priorities include international collaborations, harmonized registries, biomarker-driven personalization, and integration of patient-reported outcomes to align oncologic control with quality of life. PUC management today is defined by risk-adapted, multidisciplinary strategies delivered in specialized centers, reflecting both historical lessons and modern advances.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856982","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":"Early oncologic and functional outcomes of partial gland high-intensity focused ultrasound (HIFU) for prostate cancer: First 110 cases at a large U.S. tertiary referral center.","authors":"Eric M Lo, Michael Luu, Sanjay Das, Hyung L Kim, Timothy J Daskivich","doi":"10.1016/j.urolonc.2026.04.007","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.04.007","url":null,"abstract":"<p><strong>Introduction: </strong>High-intensity focused ultrasound (HIFU) is increasingly being used in the United States for primary treatment of localized prostate cancer, but there is limited evidence documenting outcomes during the initial adoption of this technology in the United States. We sought to evaluate cancer control, side effects, and complication rates in the first 110 men who underwent HIFU for localized prostate cancer at our academic tertiary referral center.</p><p><strong>Methods: </strong>We retrospectively evaluated the records of men who underwent HIFU as primary treatment for clinically localized prostate cancer at our center from July 2018 to August 2023. Kaplan-Meier analysis was used to calculate failure-free survival (FFS)-defined as freedom from radical treatment, metastases, or death from disease-freedom from repeat HIFU, and in-field clinically significant (Gleason ≥ 3 + 4) recurrence-free survival. Surveillance included prostate-specific antigen (PSA) checks at 3, 6, and 12 months, then every 6 months thereafter, and a multiparametric prostate MRI followed by a biopsy between 6 and 12 months. Urinary incontinence (requirement for pads) and deviation from baseline erectile function were evaluated at 1 year after treatment. The frequency of complications according to the Clavien-Dindo classification system was reported.</p><p><strong>Results: </strong>A total of 110 patients comprised our final analytic sample, of whom 3%, 56%, 26%, and 15% had low-, favorable intermediate-, unfavorable intermediate-, and high-risk disease, respectively. Most patients underwent focal/hemigland (67%) or subtotal (29%) HIFU. Median follow-up was 17.5 months. FFS (95% CI) was 99% (96%-100%), 97% (93%-100%), and 92% (84%-100%) at 12, 18, and 24 months, respectively. Freedom from repeat HIFU (95% CI) was 90% (84%-97%), 86% (78%-95%), and 84% (74%-94%) at 12, 18, and 24 months, respectively. In-field clinically significant recurrence-free survival (95% CI) was 88% (81%-95%), 81% (73%-91%), and 79% (69%-90%) at 12, 18, and 24 months, respectively. A total of 14 patients developed a urethral stricture following HIFU. Urethral stricture rates were lower in the focal and hemigland ablation groups (5.8%) compared to the subtotal (18.9%) and whole gland (75%). Of the 69 men with 1-year follow-up, 66 (95.7%) were continent with zero pad requirement, and 61 (88.4%) maintained baseline pre-operative erectile function.</p><p><strong>Conclusions: </strong>Our initial experience with partial gland HIFU for patients with select localized prostate cancers shows low rates of treatment escalation, modest rates of in-field recurrence and retreatment, and low morbidity.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843360","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":"Sex-based prognostic differences in upper tract urothelial carcinoma: A multicenter cohort study from Taiwan.","authors":"Hao-Han Chang, Yao-Chou Tsai, Chih-Chin Yu, Wun-Rong Lin, Marcelo Chen, Chi-Ping Huang, Wei-Ming Li, Tsz-Yi Tang, Hsiang Ying Lee","doi":"10.1016/j.urolonc.2026.04.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.04.004","url":null,"abstract":"<p><strong>Objective: </strong>To investigate sex-based differences in oncologic outcomes and prognostic factors in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU) in a large multicenter cohort from Taiwan.</p><p><strong>Methods: </strong>We retrospectively analyzed 1,337 patients with UTUC (565 men and 772 women) who underwent RNU with bladder cuff excision across 21 hospitals in Taiwan. Survival outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), were evaluated using Kaplan-Meier analysis and Cox proportional hazards models. Overlap weighting based on propensity scores was applied to balance baseline characteristics between sexes. Sex-stratified multivariable analyses were further performed to identify prognostic factors in men and women separately.</p><p><strong>Results: </strong>There were no significant sex-based differences in OS, CSS, or DFS. In contrast, female patients had significantly better BRFS than male patients on Kaplan-Meier analysis (P < 0.001), and this association remained significant after overlap weighting adjustment. In multivariable analysis, female sex was independently associated with a lower risk of bladder recurrence after RNU (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.46-0.71; P < 0.001). Established adverse prognostic factors for survival outcomes included poor Eastern Cooperative Oncology Group performance status, advanced pathological stage, lymphovascular invasion, and positive surgical margins. Sex-stratified analyses further showed differences in prognostic profiles between men and women across survival endpoints.</p><p><strong>Conclusions: </strong>In this large multicenter Taiwanese cohort, sex was not associated with OS, CSS, or DFS after RNU for UTUC. However, female patients had a significantly lower risk of intravesical recurrence, independent of clinicopathological factors. These findings suggest that sex-specific biological or clinical factors may influence bladder recurrence after RNU and support consideration of sex-informed postoperative surveillance strategies.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843409","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":"Interpreting clear cell renal neoplasm pathology reports: Practical guidance for urologists.","authors":"Ameer Hamza","doi":"10.1016/j.urolonc.2026.04.012","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.04.012","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of clinicopathologic factors associated with adverse oncologic outcomes in bladder cancer patients undergoing radical cystectomy: Evidence from multivariable survival prediction models.","authors":"Alberto Artiles Medina, José Daniel Subiela, Alfonso Muriel García, Ana Domínguez Gutiérrez, Victoria Gómez Dos Santos, Noelia Álvarez Díaz, Ana Tagalos Muñoz, David López Curtis, César Mínguez Ojeda, Irene de la Parra Sánchez, Luis Crespo, Almudena Coloma Del Peso, Francisco Javier Burgos Revilla","doi":"10.1016/j.urolonc.2026.03.003","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.03.003","url":null,"abstract":"<p><p>This systematic review aimed to identify robust clinicopathologic predictors of overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS) following radical cystectomy (RC) from published prediction models. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) recommendations were followed, and the study was registered in PROSPERO (CRD42024509410). MEDLINE (Ovid) and Embase (Elsevier) were searched from inception to January 2024 for studies developing or validating multivariable prediction models in patients undergoing RC for non-metastatic bladder cancer. Data were extracted following the CHARMS checklist, and risk of bias was assessed using the PROBAST (Prediction model Risk Of Bias Assessment) tool. Pooled hazard ratios (HRs) were estimated with DerSimonian-Laird random-effects models. Seventy-seven studies involving survival models met the inclusion criteria: 36 for OS, 44 for CSS, and 26 for RFS. For OS, adverse predictors included advanced age (HR 1.03, 95% confidence interval [CI] 1.02-1.04), gender (female) (HR 1.08, 95% CI 1.01-1.14), higher pathologic T stage, lymph node involvement (HR 1.91, 95% CI 1.70-2.14), lymphovascular invasion (LVI) (HR 1.49, 95% CI 1.40-1.58), positive surgical margins (HR 1.74, 95% CI 1.46-2.06), and concomitant carcinoma in situ (HR 1.09, 95% CI 1.03-1.16). Neoadjuvant (HR 0.66, 95% CI 0.47-0.93) and adjuvant chemotherapy (HR 0.74, 95% CI 0.71-0.76) and compliance with pentafecta criteria (HR 0.49, 95% CI 0.30-0.79) were associated with improved OS. CSS displayed similar prognostic patterns, with additional associations for lymph node density, hydronephrosis, sarcopenia, and elevated neutrophil-lymphocyte ratio. This meta-analysis identified consistent clinicopathologic predictors of adverse oncological outcomes after RC for bladder cancer. Systematic assessment of these variables allows more accurate postoperative prognostic stratification and supports clinical decision-making regarding adjuvant treatment selection, surveillance intensification, and patient counseling.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843258","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":"Predictive value of the HAS-BLED score in the course of radical cystectomy: A pilot study.","authors":"Enis Mert Yorulmaz, Yigit Akin, Kursad Donmez, Sacit Nuri Gorgel, Serkan Ozcan, Osman Kose, Ahmet Gorgel, Berkant Sag","doi":"10.1016/j.urolonc.2026.03.010","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.03.010","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the predictive value of the preoperative HAS-BLED score in estimating clinically significant blood loss in the course of radical cystectomy.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 176 patients who underwent radical cystectomy. Major hemorrhage was defined as a change in hemoglobin level (delta hemoglobin = preoperative hemoglobin level - postoperative hemoglobin level) of ≥4 g/dl, the need for blood transfusion to manage bleeding, or the necessity of early reintervention due to postoperative hemorrhage or related complications within 14 days. HAS-BLED scores were calculated preoperatively. Univariable and multivariable logistic regression analyses were performed to identify independent predictors. Receiver operating characteristic analysis was used to assess the discriminative ability of the HAS-BLED score.</p><p><strong>Results: </strong>Major postoperative bleeding occurred in 22 patients (12.5%). Bleeding patients had significantly higher HAS-BLED scores compared to those without bleeding (P < 0.001). Each 1-point increase in the HAS-BLED score tripled the odds of bleeding (odds ratio: 3.01, 95% confidence interval: 1.83-4.93). Multivariable analysis identified hypertension, renal or hepatic dysfunction, and a history of stroke as independent risk factors. Receiver operating characteristic analysis showed an area under the curve of 0.796, and the Youden-optimal cutoff was 2.5, corresponding to a clinical threshold of ≥3. In a subgroup of patients on anticoagulants (n = 35), 40% experienced bleeding, and HAS-BLED remained predictive (odds ratio: 2.02, P = 0.045).</p><p><strong>Conclusion: </strong>The HAS-BLED score effectively predicts clinically meaningful bleeding after radical cystectomy and may aid in preoperative risk stratification. A threshold of ≥3 appears suitable for identifying high-risk patients, particularly in those on anticoagulant therapy.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821218","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":"Specialty differences in treatment recommendations for low-risk prostate cancer.","authors":"Jinping Xu, Justin Woo, James Janisse, Michael Goodman, Steven Miller, Kevin B Ginsburg, Rami Yacoub, Cathryn H Bock","doi":"10.1016/j.urolonc.2026.04.002","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.04.002","url":null,"abstract":"<p><strong>Purpose: </strong>To identify physician characteristics and beliefs associated with active surveillance (AS) recommendation by urologists and radiation oncologists for men with low-risk prostate cancer (LRPC).</p><p><strong>Methods: </strong>Cross-sectional survey of prostate cancer specialists in Michigan and Georgia, U.S.</p><p><strong>Results: </strong>Overall, 225 practicing urologists and 95 radiation oncologists participated, with a 36% response rate. While both urologists and radiation oncologists reported that AS is effective, that they discussed AS with all eligible LRPC patients, and provided AS themselves, responses were higher among urologists compared with radiation oncologists (96% vs. 89%, P = 0.02; 97% vs. 90%, P = 0.01; 99% vs. 95%, P = 0.026, respectively). A higher proportion of urologists compared with radiation oncologists endorsed that Black men were more likely to have aggressive LRPC (79% vs. 63%, P = 0.004) and perceived a survival benefit for definitive therapies among men with LRPC. While urologists were more likely to recommend AS than radiation oncologists, especially when patients reported a lower fear of cancer progression (OR = 2.27, P = 0.003), both specialists were less likely to recommend AS to younger men (OR = 0.53, P < 0.001) and Black men (OR = 0.88, P < 0.001). Physicians in Georgia were less likely to recommend AS compared with physicians in Detroit (OR = 0.64, P = 0.024). AS recommendation likelihood decreased with years in practice (OR = 0.97 per year, P = 0.001).</p><p><strong>Conclusions: </strong>AS recommendations varied by physician specialty, practice location, years in practice, and patients' characteristics. These findings highlight clinician-related factors as underrecognized but actionable contributors to variability in AS uptake. Addressing clinician-level barriers may improve consistency in AS recommendations and support more equitable, guideline-concordant care.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782160","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":"Presentation, management, and outcomes of testicular germ cell tumors by age.","authors":"Joseph G Cheaib, Carlos A Rivera López, Alyssa Arbuiso, Craig Cronin, Taibo Li, Philipp Korn, Soum D Lokeshwar, Nirmish Singla","doi":"10.1016/j.urolonc.2026.03.001","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.03.001","url":null,"abstract":"<p><strong>Objective: </strong>Although testicular germ cell tumors (TGCTs) most commonly affect younger men, there has been an increase in their incidence among men older than 45 years in the past 2 decades. We sought to characterize differences in clinicopathologic features, management patterns, and survival outcomes for TGCTs by age at diagnosis.</p><p><strong>Materials and methods: </strong>The Surveillance, Epidemiology, and End Results database was used to identify all patients aged 15 to 70 years who were diagnosed with TGCTs by orchiectomy between 2004 and 2021. Comparative statistics assessed differences in clinicopathologic characteristics and management patterns between younger (15-44) and older (45-70) patients. The Kaplan-Meier method and log-rank test were used to evaluate cancer-specific survival (CSS) by age group.</p><p><strong>Results: </strong>A total of 34,738 patients were included in the analysis, of whom 5719 (16.5%) were in the older age group. Older patients were more likely to present with seminoma (78.7% vs. 49.9%, P < 0.001) and clinical stage I disease (72.9% vs. 70.0%, P < 0.001) compared to younger patients. Among stage I patients, there were no significant differences in histology-specific management patterns by age. Overall, 1,052 (3.0%) deaths were attributable to testicular cancer over a median follow-up of 7.4 years. Five-year CSS surpassed 96% for patients with clinical stage I and stage II disease, irrespective of histology or age group; however, for patients with stage III disease, older age was associated with statistically significant worse CSS compared to younger age, both for seminoma (86.0% vs. 92.2%, P < 0.001) and non-seminoma (65.7% vs. 81.6%, P < 0.001).</p><p><strong>Conclusions: </strong>Older men with TGCTs present with higher rates of seminoma and stage I disease compared to younger men. Among patients with stage III disease, CSS is worse in those who are older at diagnosis. Understanding how age influences TGCT phenotype and outcomes can help inform age-specific management strategies.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782174","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 evolving global burden of kidney cancer: A comparative analysis of trends in China and worldwide with projections to 2041.","authors":"Qing Yu, Yifan Zhang, Lin Qiao, Xiaotian Jiang, Jiaqi Li, Chao Ju, Wei Chen, Jiageng Zhu, Luwei Xu","doi":"10.1016/j.urolonc.2026.03.005","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.03.005","url":null,"abstract":"<p><strong>Background: </strong>Kidney cancer (KC) is a significant global health concern. This study comprehensively assesses its burden in China versus global trends to inform strategic responses.</p><p><strong>Methods: </strong>Using Global Burden of Disease (GBD) 2021 data (1990-2021), we examined KC incidence, prevalence, mortality, and disability-adjusted life years (DALYs) globally and in China. We calculated age-standardized rates (ASIR, ASMR, ASPR, and DALY rate), estimated annual percentage changes (AAPC), and male-to-female ratios, stratified by age, sex, region, and sociodemographic index (SDI). Bayesian Age-Period-Cohort modeling projected trends to 2041.</p><p><strong>Results: </strong>From 1990 to 2021, Chinese male ASIR rose from 2.3 to 4.8 per 100,000 (AAPC 2.83%), while female ASIR increased more modestly. Chinese male ASPR more than doubled. Globally, ASIR increased modestly with persistent gender disparity. Mortality declined globally but increased among Chinese males. DALY rates decreased globally but rose in Chinese males. In 2021, the global burden reached 387,829 new cases and 161,195 deaths. Projections to 2041 indicate a continued ASIR rise in Chinese males alongside a global ASMR decline.</p><p><strong>Conclusions: </strong>The rapid growth of China's kidney cancer burden, coupled with nondeclining mortality, underscores an urgent need for tailored strategies. Health policies should prioritize equitable access to timely diagnosis and guideline-concordant treatment, expand standardized multidisciplinary care, and strengthen prevention targeting modifiable risk factors to ensure that earlier detection translates into improved survival.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782261","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":"Venous thromboembolism in patients with urothelial carcinoma receiving systemic therapy.","authors":"Irene Huebner-Resch, Nicolai A Huebner, Regina Girgis, Renate Pichler, Eva Zebedin-Brandl, Johanna Krauter, Manuela Schmidinger, David D'Andrea, Shahrokh F Shariat, Melanie R Hassler","doi":"10.1016/j.urolonc.2026.03.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.03.004","url":null,"abstract":"<p><strong>Background: </strong>Patients with urothelial carcinoma (UC) undergoing systemic therapy face an increased risk of venous thromboembolism (VTE). While the Khorana Risk Score (KRS) is widely applied in oncology to predict VTE, its performance in UC remains uncertain. This study evaluated VTE incidence and clinical predictors in a real-world UC cohort.</p><p><strong>Methods: </strong>A retrospective cohort study of 140 patients with bladder or upper-tract UC treated with systemic therapy (2008-2020) was conducted. Clinical and laboratory data, including KRS variables, treatment details, and venous catheter (VC) status, were analyzed. Logistic regression, ROC, and decision curve analyses (DCA) assessed predictive factors and model performance.</p><p><strong>Results: </strong>VTE occurred in 24 patients (17.1%) during a median follow-up of 22.4 months. Among KRS components, only erythropoietin (EPO) use showed a statistically significant association with VTE (OR 4.70; 95% CI: 0.96-22.82, p = 0.049). Independent predictors were regional lymph node (LN) metastases (OR 4.35; 95% CI: 1.63-11.94, p = 0.003) and long-term VC presence (OR 4.78; 95% CI: 1.41-22.64, p = 0.023). No other KRS components or traditional factors were significant. None of the patients on therapeutic anticoagulation developed VTE. A multivariable model including EPO, LN metastases, and VC achieved numerically higher predictive accuracy compared with KRS (AUC 0.73 vs. 0.65) and showed greater net clinical benefit on DCA at 5%-40% thresholds.</p><p><strong>Conclusions: </strong>UC patients on systemic therapy face a high VTE risk not well captured by the KRS. Incorporating EPO use, LN status, and VC presence may improve prediction and support the need for UC-specific risk models to guide thromboprophylaxis.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782344","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}