Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Prostate cancer screening in transgender women/transfeminine persons: Building on Canadian evidence.","authors":"David-Dan Nguyen, Ihtisham Ahmad, Emery Potter, Alexandra Millman, Yonah Krakowsky","doi":"10.1016/j.urolonc.2025.09.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.09.004","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207788","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":"Diagnostic accuracy of percutaneous renal mass biopsy in patients undergoing robot-assisted partial nephrectomy for localized renal cell carcinoma.","authors":"Jon Pedro Timane, Rasmus D Petersson, Rikke Karlin Jepsen, Frederik F Thomsen","doi":"10.1016/j.urolonc.2025.09.002","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.09.002","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to assess the diagnostic accuracy of renal mass biopsy in determining tumor subtype and grade, in patients with renal cell carcinoma who subsequently underwent partial nephrectomy.</p><p><strong>Material and methods: </strong>This retrospective, single-institution study included consecutive patients who underwent a renal mass biopsy revealing renal cell carcinoma, followed by robot-assisted partial nephrectomy between May 2016 and April 2023. The diagnostic accuracy of renal mass biopsy was evaluated using the final histopathology on the surgical specimens as the reference standard and presented as proportions.</p><p><strong>Results: </strong>We identified 275 patients diagnosed with renal cell carcinoma on biopsy, all of whom subsequently underwent surgery. The median age was 65 years, and 30% of the patients were female. The overall accuracy of tumor subtype identification in the biopsy was 89% (95% CI: 85%-93%). A Fuhrman grade was assigned in both biopsy and surgical specimen in 156 patients with clear cell renal cell carcinoma. The concordance between biopsy and surgical specimen for exact Fuhrman grade was 50% (95% CI: 42%-59%) but increased to 92% (95% CI: 86%-95%) when pooled into low grade (Fuhrman grades 1-2) and high grade (Fuhrman grade 3).</p><p><strong>Conclusion: </strong>The current study supports the use of renal mass biopsies in patients with small renal masses if it will influence the clinical decision as it offers valuable diagnostic information that assists clinicians in the diagnosis, risk assessment and management of small renal masses.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186789","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":"Small renal masses: Where do we stand? An updated analysis of trends and outcomes from the SEER database (2000-2021).","authors":"Ahmad Abdelaziz, Sarah Al Omari, Ahmet Urkmez, Caroline E Hayes, Mahzier Khazaali, Hazem Orabi, Geeta Joshi, Muhammed A M Hammad, Matthew D Ingham, Jairam R Eswara","doi":"10.1016/j.urolonc.2025.08.029","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.029","url":null,"abstract":"<p><strong>Objectives: </strong>To provide an updated analysis of trends and outcomes for these approaches using data from the SEER database (2000-2021).</p><p><strong>Methods: </strong>Patients diagnosed with localized T1a renal cell carcinoma (RCC) were identified from the SEER database. Management strategies were categorized as PN, RN, AT, or non-surgical management (NSM), including AS. Descriptive statistics assessed patient demographics and tumor characteristics. Logistic regression models identified predictors of NSM, adjusting for age, race, tumor grade, histology, and socioeconomic factors. Kaplan-Meier survival analysis and Cox proportional hazards regression evaluated associations between management type and 5-year overall survival.</p><p><strong>Results: </strong>RN usage declined sharply from ∼75% in 2000 to ∼14% in 2021, while PN steadily increased, surpassing RN around 2017 and reaching ∼50% by 2021. Notably, younger patients (<60 years) demonstrated a more rapid shift toward partial nephrectomy over time, whereas the oldest patients (>75 years) showed a slower uptake of partial nephrectomy and a higher ongoing utilization of non-surgical management. AT and NSM showed gradual adoption, peaking at ∼10% and ∼15% to 20%, respectively, by 2021. PN was associated with the best overall survival, followed by RN and AT, while NSM had the poorest outcomes. Predictors of NSM included advanced age (>75 years, OR = 3.54) and black race (OR = 1.63).</p><p><strong>Conclusion: </strong>PN has become the most widely used management for SRMs, aligned with AUA and EAU guidelines. AS remains a viable and guideline-recommended option for select patients with SRMs <2 cm. The variable use of AT and NSM, coupled with the poorer prognosis of NSM, underscores the importance of individualized patient selection and close follow-up to ensure optimal outcomes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186807","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":"Nivolumab plus gemcitabine-cisplatin for previously untreated unresectable or metastatic urothelial carcinoma: an Asian subgroup analysis from the global phase 3 CheckMate 901 trial.","authors":"Yoshihiko Tomita, Ding-Wei Ye, Akifumi Fujii, Naohiro Takeuchi","doi":"10.1016/j.urolonc.2025.08.022","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.022","url":null,"abstract":"<p><strong>Background: </strong>In the global phase 3 CheckMate 901 trial, nivolumab plus gemcitabine-cisplatin demonstrated significantly improved overall survival (OS) and progression-free survival (PFS) for unresectable or metastatic urothelial carcinoma (UC). However, clinical benefit for patients from Asian countries remains unclear. Here, we analyzed outcomes in the Asian population from CheckMate 901.</p><p><strong>Methods: </strong>Patients with unresectable or metastatic UC were randomized to receive nivolumab plus gemcitabine-cisplatin or gemcitabine-cisplatin alone. Efficacy including OS and PFS and safety were evaluated in the Asian population.</p><p><strong>Results: </strong>A total of 133 patients (72 received nivolumab plus gemcitabine-cisplatin, and 61 received gemcitabine-cisplatin alone) were enrolled from China, Japan, South Korea, Taiwan, and Singapore between January 2018 and September 2022. The median follow-up was 27.2 months. OS and PFS favored nivolumab plus gemcitabine-cisplatin over gemcitabine-cisplatin alone (median OS, 24.0 vs. 18.9 months; median PFS, 9.5 vs. 7.2 months) with hazard ratios of 0.69 for OS and 0.53 for PFS. Similar trends towards favorable OS and PFS was found in subgroups with tumor PD-L1 expression ≥1%, and regardless of tumor origin (bladder cancer or upper tract UC). The incidence of grade ≥3 treatment-related adverse events was 63.9% with nivolumab plus gemcitabine-cisplatin and 61.4% with gemcitabine-cisplatin alone.</p><p><strong>Conclusions: </strong>Nivolumab plus gemcitabine-cisplatin showed a trend towards improved OS and PFS outcomes in the Asian population, suggesting that the combination therapy may serve as a new treatment option for patients from Asian countries who have unresectable or metastatic UC.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT03036098.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182175","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":"Exploring the tumor-promoting function and prognostic value of ESPL1 in prostate adenocarcinoma.","authors":"Xuemei Zhang, Peng Pan, Shuaijie Wang, Shaohua Chen, Yiping Sun, Xuan Meng, Yuzhong Yang","doi":"10.1016/j.urolonc.2025.09.007","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.09.007","url":null,"abstract":"<p><strong>Background: </strong>Extra spindle pole bodies-like 1 (ESPL1), a gene encoding the Separase protein, has been implicated in cancer development across multiple tumor types. However, its precise role in prostate adenocarcinoma (PRAD) remains underexplored. This study investigates ESPL1's contribution to PRAD progression and evaluates its utility as a prognostic indicator and potential therapeutic target.</p><p><strong>Methods: </strong>We analyzed ESPL1 expression using datasets from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). The prognostic significance of ESPL1 was evaluated through survival analysis. Tissue expression of ESPL1 was examined via immunohistochemistry (IHC). Additionally, Gene Set Enrichment Analysis (GSEA) was performed to identify related biological pathways. Functional roles were tested in PRAD cell lines through proliferation assays (colony formation, CCK-8, EdU), apoptosis assays (TUNEL, flow cytometry), and cell cycle analysis.</p><p><strong>Results: </strong>ESPL1 expression was markedly elevated in PRAD tissues opposed to normal prostate samples and correlated with advanced disease features, such as higher T and N stages and residual tumor presence. Survival analysis linked high ESPL1 levels to reduced overall survival (OS) and progression-free interval (PFI). GSEA identified enrichment in pathways tied to cell division and DNA repair. Suppressing ESPL1 in vitro diminished cell growth and triggered apoptosis in PRAD cells.</p><p><strong>Conclusions: </strong>Our findings suggest that ESPL1 contributes to PRAD progression by regulating proliferation and apoptosis, potentially serving as both a prognostic biomarker and a candidate target for therapeutic development.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182164","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":"Utilization of intravesical chemotherapy following TURBT: A pre-implementation analysis of American College of Surgeon Commission on Cancer GU quality measures.","authors":"Omri Nativ, Sabika Sadiq, Adam Williams, Gareth Reid, Bruno Nahar, Sanoj Punnen, Mark Gonzalgo, Dipen J Parekh, Kristen Scarpato, Mohummad Minhaj Siddiqui, Chad R Ritch","doi":"10.1016/j.urolonc.2025.08.032","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.032","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate utilization trends of postoperative intravesical chemotherapy (IVC) following transurethral resection of bladder tumor (TURBT) in patients with low-grade Ta non-muscle invasive bladder cancer (NMIBC) prior to implementation of a new Commission on Cancer (CoC) quality measure, and to identify factors influencing adherence in order to refine strategies for improving compliance.</p><p><strong>Methods: </strong>Patients aged 18 years and older who underwent TURBT (2018-2020) were identified from the National Cancer Database (NCDB). Only those with low-grade Ta urothelial carcinoma were included. Patients with high-grade disease, advanced-stage NMIBC, or variant histology were excluded. The primary outcome was postoperative IVC utilization. Clinical and demographic variables analyzed included age, sex, race/ethnicity, insurance, tumor size, comorbidities, facility type, and geographic region. A multivariable logistic regression identified predictors of adherence.</p><p><strong>Results: </strong>Among 25,518 patients, 21.8% received IVC, increasing from 20.84% (2018) to 23.09% (2020) (P = 0.0024). Younger age, smaller tumors, non-Black/non-White race, treatment at integrated network cancer programs, urban residence, and lower income were associated with higher IVC use. Medicaid/Medicare coverage correlated with lower utilization.</p><p><strong>Conclusions: </strong>Significant disparities exist in IVC adherence. Addressing sociodemographic barriers, improving institutional compliance, and overcoming implementation challenges are essential to optimizing patient outcomes. The CoC quality measure may improve adherence and standardize care delivery.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177986","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":"Addition of androgen-receptor pathway inhibitors to standard of care in metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis.","authors":"Brigida Anna Maiorano, Chiara Mercinelli, Antonio Cigliola, Valentina Tateo, Giorgio Gandaglia, Alberto Briganti, Francesco Montorsi, Andrea Necchi","doi":"10.1016/j.urolonc.2025.08.017","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.017","url":null,"abstract":"<p><p>To evaluate activity, safety and nuances of androgen-receptor pathway inhibitors (ARPI) with standard-of-care therapy (SOC), i.e., androgen deprivation therapy (ADT) alone or with docetaxel, for metastatic hormone-sensitive prostate cancer (mHSPC). Several randomized clinical trials (RCTs) have evaluated different agents in this setting. We conducted a systematic review and meta-analysis to better define the benefits and risks of combining ARPI with SOC in mHSPC. A comprehensive literature search of MEDLINE/PubMed, Web of Science, Scopus, and meeting abstracts from the American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO) was performed in April 2025. The study adhered to PRISMA guidelines for systematic reviews and meta-analyses. Overall survival (OS) was the primary endpoint, with progression-free survival (PFS), time-to-progression of pain and PSA, and safety as secondary endpoints. Summary hazard ratios (HRs) were calculated for survival outcomes, and risk ratios (RRs) for safety. Random- or fixed-effects models were applied based on study heterogeneity. Eight RCTs fulfilled the prespecified inclusion criteria. The combination of ARPI and SOC significantly improved OS (HR = 0.74; P < 0.00001) and PFS (HR = 0.50 for clinical PFS, HR = 0.49 for radiological PFS; P < 0.0001) compared to the SOC. The benefit was confirmed excluding docetaxel. We did not show heterogeneity among treatment efficacy and disease burden, onset timing or treatment strategy. Adverse events (AEs) were not increased after adding ARPI to SOC, except from hypertension and any grade cardiac AEs. This meta-analysis supports the addition of ARPI to SOC in mHSPC, significantly improving survival outcomes. Uncertainties persist regarding the role of triple therapies including docetaxel. Identifying prognostic and predictive biomarkers is critical to tailoring therapy for patients most likely to benefit from different approaches.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179249","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 of interleukin-6 serum levels with local tumor stage and lymph node metastasis of urothelial carcinoma.","authors":"Benedikt Ebner, Judith Hirsch, Annkathrin Holz, Yannic Volz, Lennert Eismann, Julian Hermans, Nikolaos Pyrgidis, Marc Kidess, Marie Semmler, Sarah Takayama Fouladgar, Iason Papadopoulos, Michael Chaloupka, Maria Apfelbeck, Julian Marcon, Philipp Weinhold, Alice Ewert, Philipp Kazmierczak, Christian G Stief, Gerald B Schulz","doi":"10.1016/j.urolonc.2025.08.026","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.026","url":null,"abstract":"<p><strong>Introduction: </strong>Elevated preoperative interleukin-6 (IL-6) blood levels in urothelial carcinoma (UC) patients undergoing radical cystectomy (RC) have been linked to adverse pathological features. The aim of this prospective study of patients undergoing RC was to analyze whether preoperative IL-6 serum levels (i) correlate with local tumor stage, (ii) are associated with lymph node metastasis, and (iii) are elevated in patients with other oncologic or nononcologic indications for RC.</p><p><strong>Materials and methods: </strong>Patients undergoing RC for oncologic or nononcologic indications were prospectively included. IL-6 serum levels were measured preoperatively. Statistical analysis included Spearman correlation analysis and Receiver Operating Characteristics (ROC) analysis.</p><p><strong>Clinicaltrials: </strong>gov: NCT05153694.</p><p><strong>Results: </strong>Between December 2021 and November 2024, 214 patients underwent RC at our department. Preoperative IL-6 serum levels were measured in 169 patients who provided informed consent. In UC patients, IL-6 levels correlated with local tumor stage (r = 0.30, P = 0.001) and higher levels were associated with lymph node metastasis (P = 0.001). The AUC was 0.678 (95% CI 0.58-0.77) and 0.681 (95% CI 0.58-0.79) for non-organ confined tumor growth and lymph node metastasis, respectively. No significant difference in preoperative IL-6 serum levels was observed between UC patients and patients with other oncologic or nononcologic indications for RC.</p><p><strong>Conclusion: </strong>This prospective study found that elevated preoperative IL-6 serum levels correlated with local tumor stage and were associated with lymph node metastasis in UC patients undergoing RC. However, IL-6 levels were also elevated in patients with other oncologic or nononcologic indications for RC, underscoring the need for careful interpretation of this marker.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179170","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 randomized prospective trial comparing Bacillus Calmette-Guérin (BCG) RIVM and Russian strains in non-muscle invasive bladder cancer: Efficacy and side effects.","authors":"Khaled Obaid, Çağrı Akpınar, Murat Can Karaburun, Muhammed Arif İbiş, Çağatay Göğüş, Kadir Türkölmez, Sümer Baltacı, Evren Süer","doi":"10.1016/j.urolonc.2025.08.028","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.028","url":null,"abstract":"<p><strong>Background: </strong>Intravesical Bacillus Calmette-Guérin (BCG) therapy is widely used as an adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC). However, the optimal BCG substrain remains undetermined. This study compares the efficacy and safety of the BCG RIVM and Russian substrains in NMIBC treatment.</p><p><strong>Objective: </strong>To evaluate recurrence-free survival (RFS), progression-free survival (PFS), and adverse event profiles between the 2 substrains.</p><p><strong>Methods: </strong>In this randomized prospective trial, 149 patients with intermediate-, high-, and very high-risk NMIBC were randomized to receive either BCG RIVM or BCG Russian following transurethral resection of bladder tumor (TURBT). Patients with inadequate BCG therapy, short follow-up, or exposure to multiple strains were excluded from the per-protocol analysis (n = 125). Kaplan-Meier analysis was used to evaluate survival outcomes in both the per-protocol and intention-to-treat (ITT) populations. Adverse events were also assessed.</p><p><strong>Results: </strong>Of 125 patients, 61 received BCG RIVM and 64 received BCG Russian. Recurrence occurred in 17 (27.9%) and 19 (29.7%) patients in the RIVM and Russian groups, respectively (P = 0.822). The 48-month RFS rates were 72.1% (CI: 60.9-83.2) and 70.3% (CI: 59.2-81.4). Progression occurred in 4 patients (6.6%) vs. 8 patients (12.5%) in the RIVM and Russian groups, respectively (P = 0.365). The 48-month PFS rates were 93.4% (CI: 87.2-99.6) and 87.5% (CI: 79.4-96.9). Kaplan-Meier curves for RFS and PFS indicated no significant difference between the 2 groups (log-rank P = 0.875 for RFS and 0.267 for PFS). Similar findings were observed in the ITT analysis (log-rank P = 0.791 for RFS and 0.419 for PFS). Adverse events were reported in 76% of patients, with no significant differences between the groups in terms of toxicity (P = 0.545).</p><p><strong>Conclusions: </strong>BCG RIVM and Russian substrains demonstrated comparable efficacy and safety, supporting substrain selection based on availability and institutional preference.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179105","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 association between prior pelvic radiotherapy for cancer and surgical outcomes in patients undergoing radical cystectomy for bladder cancer: An analysis of national surgical quality improvement program targeted cystectomy database.","authors":"Renil S Titus, Vatsala Mundra, Eusebio Luna Velasquez, Jiaqiong Xu, Carlos Riveros, Sanjana Ranganathan, Aamuktha Porika, Rohit Reddy, Dharam Kaushik, Janet Kukreja, Roger Li, Christopher J D Wallis, Raj Satkunasivam","doi":"10.1016/j.urolonc.2025.08.016","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.016","url":null,"abstract":"<p><strong>Introduction: </strong>Patients undergoing radical cystectomy (RC) for bladder cancer (BCa) may have previously received pelvic radiotherapy (pRT), which is both a risk factor for BCa and is independently associated with an increased risk of intraoperative and postoperative complications. We sought to quantify this risk at the population level and to assess rates of granular, cystectomy-specific and general surgical outcomes of patients undergoing RC who received pRT for any pelvic malignancy any time prior using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Cystectomy database.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the ACS-NSQIP targeted cystectomy dataset of patients 18-90 years old who underwent RC for BCa from 2019 to 2022. The primary outcomes included rates of cystectomy-specific outcomes potentially related to pRT (e.g., rectal injury) and 30-day major postoperative outcomes: mortality, reoperation, cardiovascular events, and readmission rates. Secondary outcomes included general surgical complications such as rates of sepsis, surgical-site infections (SSIs), length of hospital stay (LOS) and surgery duration. We balanced for potential confounders by propensity score matching (PSM) with a 1:5 ratio between pRT and no-pRT groups with a caliper of 0.009.</p><p><strong>Results: </strong>We identified 5,058 patients of whom 403 (7.97%) had pRT prior to RC. After PSM, the analytical cohort consisted of 1,901 RC patients and 387 RC + pRT patients. Prior pRT was associated with significantly higher odds of rectal injury (OR 3.17, 95% CI: 1.59-6.33). Additionally, prior pRT was associated with infectious complications, including SSI (OR 1.48, 95% CI: 1.08-2.39), organ-site infection (OR 1.61, 95% CI: 1.08-2.39). Subgroup analyses suggested the association between prior pRT, and rectal injury was statistically significant among patients with age ≥ 65 years, BMI 25-29.9, open approach for RC and norreceipt of neoadjuvant chemotherapy.</p><p><strong>Conclusions: </strong>In a contemporary real-world, multicenter cohort, patients undergoing RC after pRT were associated with 3-fold higher odds of rectal injury, and higher odds of multiple infectious complications. These data provide a framework to assist in patient counseling and optimizing selection.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179254","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}