Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Prostate magnetic resonance imaging to predict grade concordance, extra prostatic extension, and biochemical recurrence after radical prostatectomy","authors":"Mitchell M. Huang M.D. ,&nbsp;Goran Rac M.D. ,&nbsp;Michael Felice M.D. ,&nbsp;Jeffrey L. Ellis M.D. ,&nbsp;Nicole Handa M.D. ,&nbsp;Eric V. Li M.D. ,&nbsp;Mallory McCormick D.O. ,&nbsp;Aya Bsatee D.O. ,&nbsp;Brandon Piyevsky M.D. ,&nbsp;Ashley E. Ross M.D., Ph.D. ,&nbsp;Paul M. Yonover M.D. ,&nbsp;Gopal N. Gupta M.D. ,&nbsp;Hiten D. Patel M.D., M.P.H.","doi":"10.1016/j.urolonc.2025.02.013","DOIUrl":"10.1016/j.urolonc.2025.02.013","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate whether preoperative prostate MRI findings predicted biopsy to radical prostate (RP) grade group concordance, presence of extraprostatic extension (EPE), and biochemical recurrence (BCR) after RP.</div></div><div><h3>Material and methods</h3><div>We conducted a multi-institutional study (tertiary academic center and community practice) including patients who underwent RP (2014-2021) with preoperative MRI. Grade concordance for systematic, targeted, and combined prostate biopsy was compared to RP. Concordances were also compared for a contemporaneous RP cohort without prebiopsy MRI (No MRI cohort). We assessed association of extracapsular extension on MRI (MRI-ECE) with EPE and BCR after RP.</div></div><div><h3>Results</h3><div>Among 768 men, concordance between biopsy and RP was 65.7% for combined, 58.3% for targeted, and 44.7% for systematic biopsy (<em>P</em> &lt; 0.001). There was no difference in upgrading, concordance, and downgrading compared to 1014 men in the No MRI cohort (<em>P</em> = 0.6). Combined biopsy decreased upgrading to Grade Group ≥3 by 9.2%. EPE after RP was present in 292/768 (38%). MRI-ECE had 56% sensitivity, 74% specificity, 57% positive predictive value, and 73% negative predictive value. MRI-ECE was associated with EPE (OR: 2.25, <em>P</em> &lt; 0.001) and BCR (HR: 1.77<em>, P</em> = 0.006). An MRI-based model improved EPE prediction in the development cohort (AUC 0.80) compared to a traditional nomogram but failed external validation (AUC 0.68).</div></div><div><h3>Conclusions</h3><div>Preoperative MRI findings predicted grade concordance, presence of EPE, and risk of BCR after RP. Variability in MRI-ECE interpretation limited generalizability of models to predict EPE indicating a need for more standardized reporting to increase clinical utility.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 445.e11-445.e19"},"PeriodicalIF":2.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626114","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":"Cover 3 - Information for Authors","authors":"","doi":"10.1016/S1078-1439(25)00103-6","DOIUrl":"10.1016/S1078-1439(25)00103-6","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 4","pages":"Page CO3"},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592570","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":"Cover 2 - Masthead","authors":"","doi":"10.1016/S1078-1439(25)00078-X","DOIUrl":"10.1016/S1078-1439(25)00078-X","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 4","pages":"Page IFC"},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592101","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":"Extracellular vesicles in renal cell carcinoma: A review of the current landscape and future directions","authors":"Nakanori Fujii ,&nbsp;Fumihiko Urabe ,&nbsp;Shinkuro Yamamoto ,&nbsp;Keiji Inoue ,&nbsp;Takahiro Kimura ,&nbsp;Koji Shiraishi","doi":"10.1016/j.urolonc.2025.02.022","DOIUrl":"10.1016/j.urolonc.2025.02.022","url":null,"abstract":"<div><div>Liquid biopsy, a minimally invasive biopsy method that uses patient body fluids (e.g., blood, urine, or saliva), is considered a useful biomarker for early diagnosis, monitoring of tumor progression, and evaluating treatment efficacy. Extracellular vesicles (EVs), a diverse group of particles classified according to their size and biosynthetic method, are liquid bilayer structures released from various cells. EVs contain specific information, such as DNA, RNA, and proteins derived from released cells. Consequently, they have attracted attention for use in liquid biopsy. EV-derived microRNAs (miRNAs) and long noncoding RNAs (lncRNAs) are useful biomarkers for cancer diagnosis, tumor progression, and drug treatment resistance. Renal cell carcinoma (RCC), one of the most common type of urological cancer, accounts for 90% of all renal tumors. In contrast to prostate cancer, for which a tumor marker has been established, clinically applicable and useful biomarkers remain to be established for RCC. EV-derived miRNAs and lncRNAs have been identified as useful biomarkers in several types of carcinoma for determining the diagnosis and predicting tumor progression, and drug treatment resistance in patients with RCC. The development and identification of biomarkers to diagnose and predict tumor progression in RCC will improve the management and prognosis of patients with RCC. This review focuses on EV-derived miRNAs and lncRNAs and discusses the currently available EV-based biomarkers in RCC and their future prospects.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 370-379"},"PeriodicalIF":2.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606507","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":"Cirrhosis and liver disease vs. adverse in-hospital outcomes after radical prostatectomy.","authors":"Fabian Falkenbach, Natali Rodriguez Peñaranda, Mattia Longoni, Andrea Marmiroli, Quynh Chi Le, Calogero Catanzaro, Michele Nicolazzini, Marie-Lyssa Lafontaine, Zhe Tian, Jordan A Goyal, Stefano Puliatti, Riccardo Schiavina, Carlotta Palumbo, Gennaro Musi, Felix K H Chun, Alberto Briganti, Fred Saad, Shahrokh F Shariat, Lars Budäus, Markus Graefen, Pierre I Karakiewicz","doi":"10.1016/j.urolonc.2025.02.012","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.02.012","url":null,"abstract":"<p><strong>Introduction: </strong>Radical prostatectomy (RP) may be a treatment option for prostate cancer patients with cirrhosis and liver disease (CLD). However, the effect of CLD on adverse in-hospital outcomes after RP has not been well described.</p><p><strong>Methods: </strong>Descriptive analyses, propensity score matching (PSM), and multivariable logistic and Poisson regression models were used to address National Inpatient Sample RP patients between 2005 and 2019. CLD severity was stratified as mild vs. moderate/severe.</p><p><strong>Results: </strong>Of 191,050 RP patients, 1,559 (0.8%) had CLD. Of those, 1,515 (97.2%) vs. 44 (2.8%) were classified as having mild and moderate/severe CLD, respectively. Any CLD rate increased from 0.6% to 1.5% (2005-2019, EAPC: +7.9%, P < 0.001). CLD patients exhibited higher rates of all 15 examined adverse in-hospital outcomes. The absolute differences were largest for overall complications (+13.9%), length of stay >2 days (+8.9%), and blood transfusions (+4.0%, all P < 0.001). After detailed multivariable adjustment, CLD independently predicted higher rates of all 15 adverse in-hospital outcomes (P < 0.01). The detrimental effect was most pronounced for in-hospital mortality (multivariable odds ratio (OR) 8.74), infectious complications (OR 4.59), and hepatic complications (OR 4.45). Finally, a convincing dose-response relationship, where the effect magnitude of moderate/severe CLD was at least 3 times higher than that of mild CLD, applied in 4 of 15 comparisons.</p><p><strong>Conclusions: </strong>CLD patients exhibited higher rates of adverse in-hospital outcomes after RP. However, mild CLD did not exert a prohibitive effect that would clearly preclude RP as a treatment option.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587205","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":"Molecular testing in urinary cytology specimens: Current status and future directions.","authors":"Fei Chen, Aylin Simsir, Liang Cheng","doi":"10.1016/j.urolonc.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.02.009","url":null,"abstract":"<p><p>Bladder cancer is a common type of urological cancer with high recurrence and mortality rates. Currently, it is diagnosed and monitored using minimal invasive cystoscopies and biopsies. Urinary cytology, the most widely accepted noninvasive and more economic urinary diagnosis method, aims to detect high grade urothelial carcinoma with a high specificity but low sensitivity, especially for detecting low-grade tumors. With advancements in molecular techniques, urine based liquid biopsy, artificial intelligence, and the growing interest in precision cytopathology, identification of urinary biomarkers for effective cancer screening, diagnosis, risk stratification, and therapeutic response monitoring has been a key focus of bladder cancer research and clinical practice guideline development. Urine allows noninvasive access to morphological, transcriptomic, epigenetic, and genomic materials from exfoliated cells in contact with tumor tissue. This review offers a comprehensive evaluation of the current utility of urinary biomarkers and technological innovations in cancer diagnosis and minimal residual disease detection. We also discuss the challenges and prospects for integrating molecular cytopathology into daily clinical practice.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587207","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":"Contemporary outcomes for robotic radical cystectomy and intracorporeal neobladder urinary diversion","authors":"Jordan M. Rich M.D. ,&nbsp;Neeraja Tillu M.D. ,&nbsp;Jack Geduldig M.D. ,&nbsp;Reuben Ben-David M.D. ,&nbsp;Etienne Lavallee M.D. ,&nbsp;YuonShuo Alice Wang M.D., Ph.D. ,&nbsp;Kyrollis Attalla M.D. ,&nbsp;Linda Dey M.D. ,&nbsp;Monish Aron M.D. ,&nbsp;Jorge Ballon M.D. ,&nbsp;Giovanni E. Cacciamani M.D. ,&nbsp;Mihir M. Desai M.D. ,&nbsp;Inderbir S. Gill M.D. ,&nbsp;Arad A. Hosseini M.D. ,&nbsp;Abolfazl Hosseini M.D. ,&nbsp;Gus Miranda B.S. ,&nbsp;Juhana Rautiola M.D. ,&nbsp;Viktor Skokic B.S. ,&nbsp;Gunnar Steineck M.D. ,&nbsp;Reza Mehrazin M.D. ,&nbsp;Peter N. Wiklund M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.02.006","DOIUrl":"10.1016/j.urolonc.2025.02.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Widespread adoption of robotic-assisted radical cystectomy (RARC) with totally intracorporeal neobladder urinary diversion (UD) has not been achieved, and there is a dearth of literature exploring its short-term and long-term safety. We aim to present perioperative, complications, and oncologic outcomes for this procedure.</div></div><div><h3>Materials and Methods</h3><div>Data from patients who underwent RARC with intracorporeal neobladder UD for bladder cancer between 2003 and 2022 from our multi-institutional cohort was prospectively collected. A retrospective review of this data was performed. The primary outcome was the number of days the patient was alive and outside of the hospital within 90 days postoperatively. Secondary outcomes were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) at 24-months estimated by Kaplan-Meier plots, and 30-day and 90-day overall and major (Clavien ≥III) complication rates.</div></div><div><h3>Results</h3><div>Of 410 patients (370 [90%] male), median (IQR) age was 64.2 (58.0, 69.4) and BMI was 26.8 (23.9, 29.1) kg/m². The cohort included 2 (0.5%) cT0, 46 (11%) cTa or cTis, 109 (7%) cT1, 202 (49%) cT2, 47 (11%) cT3, and 4 (1.0%) cT4 tumors preoperatively. Median (IQR) follow-up was 37.6 (11.1, 81.0) months. Surgical margins were positive in 8 (2.0%) patients. Median number of days alive and outside hospital within 90 days postoperatively was 82 (77,85). Clavien III-IV complications occurred in 63 (15%) and 88 (21%) patients within 30 and 90 days, respectively. Clavien V complications occurred in 1 (0.2%) and 2 (0.5%) patients within 30 and 90 days, respectively. Kaplan-Meier estimates for RFS, CSS, and OS at 24-months were 78%, 88%, and 86%, respectively.</div></div><div><h3>Discussion</h3><div>RARC with intracorporeal neobladder UD led to favorable recovery with increased days alive and out of the hospital within 90-days of surgery compared to open RC series, and major complication rates and oncologic outcomes were in line with prior open RC series.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 392.e13-392.e21"},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587206","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":"Mismatch repair deficiency testing for immune checkpoint inhibitor therapy in genitourinary malignancies.","authors":"Leonid M Yermakov, Regina Kwon, Eric Q Konnick","doi":"10.1016/j.urolonc.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.02.005","url":null,"abstract":"<p><p>DNA mismatch repair (MMR) proteins maintain genomic stability, and their deficiency (dMMR) results in hypermutability and microsatellite instability. The U.S. Food and Drug Administration (FDA) approved the immune checkpoint inhibitor pembrolizumab for use in any dMMR cancer but did not provide guidance regarding dMMR detection. This review examines laboratory methods (immunohistochemistry, polymerase chain reaction, and next-generation sequencing) for dMMR detection, emphasizing their sensitivity, specificity, and limitations. Using the current literature, we outline considerations for when to test and which method to use when assessing MMR status in genitourinary cancers.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568124","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":"Efficacy and safety of dose-dense gemcitabine and cisplatin as neoadjuvant chemotherapy for high-grade upper tract urothelial carcinoma (cT2-3N0M0)","authors":"Yuto Hattori,&nbsp;Akihiko Nagoshi,&nbsp;Tasuku Fujiwara,&nbsp;Takanari Kambe,&nbsp;Yuta Mine,&nbsp;Hidetoshi Kokubun,&nbsp;Yohei Abe,&nbsp;Masashi Kubota,&nbsp;Noboru Shibasaki,&nbsp;Mutsushi Kawakita,&nbsp;Toshinari Yamasaki","doi":"10.1016/j.urolonc.2025.02.010","DOIUrl":"10.1016/j.urolonc.2025.02.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Neoadjuvant chemotherapy for upper tract urothelial carcinoma has shown favorable results. However, few studies have been conducted on dose-dense regimens that have demonstrated superior efficacy in bladder cancer. We aimed to retrospectively evaluate the efficacy and safety of dose-dense gemcitabine and cisplatin as neoadjuvant chemotherapy for upper tract urothelial carcinoma.</div></div><div><h3>Materials and Methods</h3><div>Ninety-five patients who underwent radical nephroureterectomy for high-grade upper tract urothelial carcinoma (cT2-3N0M0) with dose-dense gemcitabine and cisplatin (<em>n</em> = 33) or without neoadjuvant chemotherapy (<em>n</em> = 62, Control) were included. Propensity score matching was performed based on the patient and tumor demographics. Efficacy was evaluated by the pathological response rate defined as pathological downstaging to ≤ pT1N0 and complete response (pT0N0). Progression-free survival, cancer-specific survival, and overall survival were estimated. All adverse events and postoperative complications were assessed.</div></div><div><h3>Results</h3><div>Thirty-one matched patients were included in each cohort after adjusting for baseline propensity score matching. The pathological downstaging to ≤ pT1N0 rate of the neoadjuvant chemotherapy group was significantly higher than the Control group. The complete response rate was 6.5% in the neoadjuvant chemotherapy group; pT0N0 was not observed in the Control group. The 2-year progression-free survival and cancer-specific survival rates were significantly better in the neoadjuvant chemotherapy group. Of the 33 patients who received neoadjuvant chemotherapy, 7 severe adverse events (grade 3 or higher) were observed in 6 patients.</div></div><div><h3>Conclusions</h3><div>Dose-dense gemcitabine and cisplatin showed a favorable pathological response and oncological outcome with good tolerability.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 392.e7-392.e12"},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of postprogression therapies on overall survival: Recommendations from the 2023 kidney cancer association think tank meeting","authors":"Stephanie A. Berg ,&nbsp;Salvatore La Rosa ,&nbsp;Tian Zhang ,&nbsp;Phillip M. Pierorazio ,&nbsp;Laurence Albiges ,&nbsp;Kathryn E. Beckermann ,&nbsp;Matthew T. Campbell ,&nbsp;Maria I. Carlo ,&nbsp;Katie Coleman ,&nbsp;Daniel J. George ,&nbsp;Daniel M. Geynisman ,&nbsp;Ritchie Johnson ,&nbsp;Eric Jonasch ,&nbsp;Jodi K. Maranchie ,&nbsp;Bradley A. McGregor ,&nbsp;Daniel D. Shapiro ,&nbsp;Eric A. Singer ,&nbsp;Brian M. Shuch ,&nbsp;Walter M. Stadler ,&nbsp;Nizar M. Tannir ,&nbsp;Pavlos Msaouel","doi":"10.1016/j.urolonc.2024.10.022","DOIUrl":"10.1016/j.urolonc.2024.10.022","url":null,"abstract":"<div><div>Modern advances in systemic and localized therapies for patients with renal cell carcinoma (RCC) have significantly improved patients’ outcomes. If disease progression occurs after initial treatment, clinicians often have multiple options for a first salvage therapy. Because salvage and initial treatments both may affect overall survival time, and they may interact in unanticipated ways, there is a growing need to determine sequences of initial therapy and first salvage therapy that maximize overall survival while maintaining quality of life. The complexity of this problem grows if a second salvage therapy must be chosen for patients with treatment-resistant disease or a second progression occurs following first salvage. On November 9, 2023, a think tank was convened during the International Kidney Cancer Symposium (IKCS) North America to discuss challenges in accounting for postprogression therapies when estimating overall survival (OS) time based on randomized controlled trial (RCT) data. The present manuscript summarizes the topics discussed, with the aim to encourage adoption of statistical methods that account for salvage therapy effects to obtain scientifically valid OS estimation. We highlight limitations of traditional methods for estimating OS that account for initial treatments while ignoring salvage therapy effects and discuss advantages of applying more sophisticated statistical methods for estimation and trial design. These include identifying multistage treatment strategies, correcting for confounding due to salvage therapy effects, and conducting Sequentially Multiple Assignment Randomized Trials (SMARTs) to obtain unbiased comparisons between multistage strategies. We emphasize the critical role of patient input in trial design, and the potential for information technology (IT) advances to support complex trial designs and real-time data analyses. By addressing these challenges, future RCTs can better inform clinical decision-making and improve patient outcomes in RCC.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 135-146"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}