Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Mini-subcostal incision technique for open radical nephrectomy: A practical alternative for complex renal masses.","authors":"Kyle A Blum, Chun Huang, A Ari Hakimi, Paul Russo","doi":"10.1016/j.urolonc.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.002","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the open radical nephrectomy mini-subcostal incision technique (msRN) and evaluate renal function, perioperative, and oncological outcomes as an alternative to traditional or minimally invasive nephrectomy for complex renal masses. This study aims to document the msRN approach, highlighting its value in preserving open nephrectomy skills for selected cases.</p><p><strong>Methods: </strong>Patients undergoing msRN from 2013 to 2016 were retrospectively analyzed. An 8 to 12 cm incision between the costal margin and 11th rib was used, with all patients managed using a rapid recovery pathway. Clinicopathologic, perioperative, and renal function metrics were analyzed. Statistical analyses included univariable and multivariable logistic regression for predictors of length of stay (LOS) >2 days and 30-day complications. Kaplan-Meier analysis was used to evaluate overall survival, and significance was set at P < 0.05.</p><p><strong>Results: </strong>In 193 patients (median age 59.5, IQR 58.4-68.8), median tumor size was 7.2 cm (IQR 5.0-9.6), and 67.9% were ≥pT3. Notably, 56% of patients had a high R.E.N.A.L. Nephrometry score, and 41.5% had a moderate score, highlighting the complexity of the cases. Median incision was 10 cm, operating time 123 minutes (IQR 102-151), and EBL 300 mL (IQR 100-550). Twenty-three (11.9%) received blood transfusions, and median LOS was 2 days. Predictors of LOS >2 days included age (OR 1.27, P = 0.003) and operating time (OR 1.12, P = 0.015). The 30-day complication rate was 18.1%, with predictors including tumor size (OR 1.14, P = 0.032) and transfusion (OR 3.04, P = 0.031). Median eGFR decreased 34.1%, with no dialysis requirements.</p><p><strong>Conclusions: </strong>msRN provides favorable outcomes, serving as a practical alternative to traditional and MIS approaches. Its documented utility supports the continued relevance of open surgical techniques for complex renal cases.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161131","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":"Inflammatory status of periprostatic adipose tissue from men with prostate cancer: Ethno-geographic variations and association with lipid composition.","authors":"Michel Samson, Michèle Pinault, Franck Bruyère, Pascal Blanchet, Souhil Lebdai, Georges Fournier, Jerome Rigaud, Romain Mathieu, Gaëlle Fromont","doi":"10.1016/j.urolonc.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.001","url":null,"abstract":"<p><strong>Background: </strong>Since prostate cancer (PCa) risk is associated with ethnicity, it is crucial to investigate ethno-geographic variations in PCa studies. Periprostatic adipose tissue (PPAT) has been involved in cancer aggressiveness through the release of lipids and inflammatory mediators, and we previously reported a different lipid composition of PPAT according to the ethno-geographic origin. We aimed to analyze the expression of a panel of adipokines in PPAT from African-Caribbean and Caucasian patients, in correlation with features of PCa aggressiveness and lipid composition.</p><p><strong>Methods: </strong>Adipokines expression was analyzed by RTqPCR in PPAT from 110 Caucasians and 50 African-Caribbeans patients, in parallel with the characterization of fatty acids and cholesterol content.</p><p><strong>Results: </strong>The most expressed cytokines were IL10, leptin and IL8. The expression of most adipokines was higher in PPAT from Caucasians compared to African-Caribbean patients. IL6 was associated with features of PCa aggressiveness in Caucasians, with a difference close to significance. Most cytokines were associated with the lipid composition of PPAT, mainly with arachidonic acid and free cholesterol content.</p><p><strong>Conclusions: </strong>The differential cytokines expression in PPAT from African-Caribbean patients compared to Caucasians probably reflects a different inflammatory status. The close relationship between adipokines expression and lipid composition highlights the importance of diet and lipid metabolism in adipose tissue inflammation.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143608","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":"Comparative efficacy of adjuvant chemotherapy and immunotherapy after radical surgery for upper tract urothelial carcinoma: A systematic review and meta-analysis.","authors":"Yang Liu, Yuxuan Song, Jincong Li, Chen Rui, Caipeng Qin, Tao Xu","doi":"10.1016/j.urolonc.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.023","url":null,"abstract":"<p><p>To evaluate the effects of adjuvant chemotherapy (AC) and adjuvant immunotherapy (AI) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). A systematic review and meta-analysis was conducted using studies identified from PubMed, Cochrane Library, Embase, CENTRAL, and ClinicalTrials.gov up to September 2024. We performed pair-wise and network meta-analyses to evaluate survival outcomes, focusing on overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), recurrence-free survival, and metastasis-free survival. A total of 43 studies involving 13,132 patients were included. Pair-wise meta-analysis showed that AC significantly improved OS (HR 0.74, 95% CI 0.63-0.86, P = 0.0001), CSS (HR 0.74, 95% CI 0.60-0.90, P < 0.00001), and DFS (HR 0.61, 95% CI 0.51-0.75, P < 0.00001). A pooled analysis of three RCTs with 384 UTUC patients showed that AI did not significantly improve DFS (HR 1.19, 95% CI 0.87-1.64, P = 0.28) or OS (HR 1.28, 95% CI 0.81-2.03). Network meta-analysis suggested that combining AC with AI could offer better DFS than AC alone, with AC outperforming AI. Ranking analysis indicated that MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) was the most effective for OS and CSS improvement, followed by GC (gemcitabine and cisplatin). AC improves the prognosis of UTUC patients, whereas the results with AI are less promising. AC shows better outcomes than AI after RNU. Preliminary evidence suggests that combining AC with AI may enhance DFS, but further research is needed to confirm its effectiveness.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143571","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":"Re-analysis of intravesical gemcitabine in the era of Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer.","authors":"Manuel R De Jesus Escano, Emily A Vertosick, Neeta D'Souza, Nicole Benfante, Andrew T Lenis, Peter A Reisz, Christopher Gaffney, Alvin Goh, Timothy F Donahue, Eugene Cha, S Machele Donat, Harry W Herr, Guido Dalbagni, Dean Bajorin, Judy Sarungbam, Hikmat Al-Ahmadie, Bernard H Bochner, Daniel D Sjoberg, Eugene J Pietzak","doi":"10.1016/j.urolonc.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.006","url":null,"abstract":"<p><strong>Purpose: </strong>Uncertainty exits over the best treatments for patients whom Bacillus Calmette-Guérin (BCG) has failed. We aim to contextualize novel therapies approved based on single-arm, nonrandomized trials and those supported only by retrospective data by re-analyzing oncologic outcomes achieved with intravesical gemcitabine.</p><p><strong>Materials and methods: </strong>Patients with non-muscle-invasive bladder cancer (NMIBC) who were treated for BCG failure with single agent intravesical gemcitabine at our institution were analyzed to compare clinical outcomes (high-grade recurrence/progression) across different BCG failure definitions. Associations between clinicopathologic variables with outcomes after gemcitabine were estimated using Cox models.</p><p><strong>Results: </strong>Of the 127 patients, 57% met the historical definition of BCG-refractory NMIBC and 33% met BCG-unresponsive criteria using a 12-month cut-off. Twelve-month recurrence-free survival was similar between BCG-refractory (47%; 95% CI: 36%, 60%) and BCG-unresponsive (52%; 95% CI: 38%, 71%) definitions. BCG-unresponsive patients who received gemcitabine in a clinical trial had significantly worse recurrence-free survival compared to those receiving the same treatment outside a trial (12-month recurrence-free survival difference: 41%; P = 0.02). A positive pretreatment urine cytology was associated with increased risk of recurrence (P = 0.005) and progression (P = 0.002) and may better indicate minimal residual disease than carcinoma in-situ on pretreatment biopsies.</p><p><strong>Conclusions: </strong>Our data raise concern over US Food and Drug Administration approval based on single-arm, nonrandomized trials using expert-based BCG-unresponsive criteria and for the use of combination gemcitabine-docetaxel as a de facto standard treatment based on retrospective data alone. Improved assessments of minimal residual disease, such as pretreatment urinary cytology, are needed to improve risk stratification in NMIBC.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143019","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":"Bladder-sparing management for high grade noninvasive urothelial carcinoma of the prostate.","authors":"Alexander C Martin, Ian M McElree, Sarah L Mott, Helen Y Hougen, Ryan L Steinberg, Michael A O'Donnell, Vignesh T Packiam","doi":"10.1016/j.urolonc.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.007","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize the oncologic outcomes in patients with high-grade noninvasive urothelial carcinoma of the prostate (NMIUC-P) treated with intravesical therapy and assess for clinicopathologic features associated with response.</p><p><strong>Subjects and methods: </strong>Patients with high-grade NMIUC-P treated with intravesical Bacillus Calmette-Guerin (BCG) or chemotherapy between 2005 and 2021 were retrospectively analyzed. Survival probabilities were estimated using the Kaplan-Meier method. Cox regression was used to evaluate the effect of clinicopathologic and treatment characteristics on high-grade recurrence-free survival (HG-RFS) and progression-free survival (PFS).</p><p><strong>Results: </strong>A total of 62 patients with median follow-up of 38 months (IQR 19-74) were included. NMIUC-P pathology was carcinoma in situ containing in 52 (84%), high-grade Ta in 9 (14%), and high-grade T1 in 1 (2%). Fifty (80%) patients had concomitant bladder UC. Induction regimens were BCG (44%), gemcitabine/docetaxel (42%), and other chemotherapies (14%). HG-RFS was 45%, 43%, and 38% at 1, 2, and 3 years, respectively. Seventeen patients (27%) underwent cystectomy at a median of 12 months, of whom 5 (29%) had ≥T2 and 3 (18%) had N+ disease. Among all patients, PFS was 87%, 69%, and 69% at 1, 2, and 3 years, respectively. Cystectomy-free, cancer-specific, and overall survival were 65%, 92%, and 83% at 3 years, respectively. No clinicopathologic or treatment characteristics were significantly associated with HG-RFS.</p><p><strong>Conclusion: </strong>In a high-risk cohort of patients with NMIUC-P, a select number of patients were able to avoid cystectomy and remain recurrence-free at 3-years after pursuing bladder-sparing intravesical treatment. However, given the high incidence of disease progression, careful patient selection is critical. Further prospective studies are needed to identify markers of response.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143570","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":"Nomogram for predicting long-term survival in renal cell carcinoma patients undergoing thermal ablation.","authors":"Giuseppe Garofano, Cesare Saitta, Giacomo Musso, Margaret F Meagher, Umberto Capitanio, Dhruv Puri, Mai Dabbas, Natalie Birouty, Kit L Yuen, Alessandro Larcher, Benjamin Baker, Riccardo Autorino, Savio D Pandolfo, Francesco Montorsi, Giovanni Lughezzani, Paolo Casale, Nicolò M Buffi, Ithaar H Derweesh","doi":"10.1016/j.urolonc.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.012","url":null,"abstract":"<p><strong>Objective: </strong>Thermal Ablation (TA) represents a valid option for management of renal cortical neoplasms. Recognizing paucity of tools to predict overall survival (OS) for patients undergoing TA, we developed a nomogram to offer personalized OS predictions utilizing the National Cancer Database.</p><p><strong>Methods: </strong>We included patients diagnosed with primary renal tumors who underwent TA between 2004 and 2020. Cox proportional hazards (CPH) model included age, Charlson-Deyo Comorbidity Index (CCI), tumor size, insurance status, ethnicity, histology, and tumor grade. A nomogram was developed to predict OS at 1, 5, and 10 years using a multivariable CPH model. Model robustness was confirmed through bootstrap validation with 1,000 iterations. Model performance was evaluated using Harrell's C-index, calibration plots at 1, 5, and 10 years, and time-dependent area under the curve (AUC) from ROC curves for 1-, 5-, and 10-year OS predictions RESULTS: We identified 10,121 patients (median age: 69 years; median follow-up: 55 months). Significant predictors of worse OS included advanced age (Hazard Ratio [HR] = 1.04, P < 0.001), higher CCI (HR = 2.20, P < 0.001), larger tumor size (HR = 1.03, P < 0.001), non-private insurance (HR = 2.16, P < 0.001), high-grade (HR = 1.31, P < 0.001), and clear cell (HR = 1.14, P = 0.015). Bootstrap validation confirmed the stability of the model, which achieved a C-index of 0.68. Calibration plots showed agreement between predicted and observed survival probabilities at 1, 5, and 10 years, with AUC values of 0.70, 0.71, and 0.74, respectively.</p><p><strong>Conclusion: </strong>We constructed a nomogram incorporating clinical, pathological, and socioeconomic factors to offer personalized OS prediction for TA. Future research should focus on external validation and clinical implementation.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143609","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":"Incidence and prevention strategies for postprostate biopsy infections in the United States from 2012 to 2021.","authors":"Adithya Balasubramanian, Gal Wald, Stephen Rhodes, Aaron Gurayah, Camilo Arenas-Gallo, Jack Millot, Leo Dreyfuss, Jonathan Shoag, Patrick Lewicki","doi":"10.1016/j.urolonc.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.05.005","url":null,"abstract":"<p><strong>Purpose: </strong>Infectious complications following prostate biopsy are costly and potentially deadly. Multiple strategies have been devised to avoid infections, including augmented prophylaxis and transperineal biopsy (TPBx). Their uptake and success in reducing population-level infectious outcomes following biopsy are largely unknown. Here, we evaluate contemporary postbiopsy infections and hospital admissions in a large insurance claims dataset.</p><p><strong>Methods and materials: </strong>The Merative MarketScan Database was queried for prostate biopsies from 2012 to 2021. MarketScan contains inpatient and outpatient data on >40 million individuals annually. Our primary endpoint was overall and sepsis-related hospitalizations within 14-days of prostate biopsy, and postbiopsy infections not requiring admission. Multvariable analysis evaluated temporal trends in endpoints.</p><p><strong>Results: </strong>We identified 301,733 patients undergoing prostate biopsy between 2012 and 2021 among whom 2,587 developed sepsis. The proportion of patients with sepsis decreased from 1.1% in 2017 to 0.7% in 2021, following an increase from 0.6% in 2012 to 1.1% in 2016. This paralleled trends in hospitalizations within 14-days. Postbiopsy infections not requiring hospitalization remained stable across the study period. These temporal trends persisted even after adjustment for patient age, comorbidities, biopsy history, insurance status, and geographic region. Single-agent fluoroquinolone use decreased alongside an increase in multiagent prophylaxis over the study period.</p><p><strong>Conclusions: </strong>We identified a decrease in postbiopsy all-cause and sepsis-related hospitalization, synchronous with augmented prophylaxis. Our findings suggest population-level improvement in major postbiopsy complications, reversing a trend from historical series.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143607","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":"Prognostic role of pathological substaging in high-grade pT1 bladder cancer undergoing BCG therapy: Insights on recurrence and progression.","authors":"Kemal Kayar, Ridvan Kayar, Emre Karabay, Bugrahan Buhur Ozdemir, Cagatay Tosun, Gulistan Gumrukcu, Metin Ishak Ozturk, Omer Ergin Yucebas","doi":"10.1016/j.urolonc.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.05.004","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Bladder cancer is a common malignancy, with pT1 tumors carrying a higher risk of recurrence and progression compared to other non-muscle-invasive bladder cancers (NMIBC). Substaging of pT1 tumors into superficial (pT1a) and deeper (pT1b) invasion into the lamina propria has shown potential prognostic value. This study investigates the impact of pT1 substaging on predicting progression and recurrence in patients with high-grade pT1 bladder cancer treated with Bacillus Calmette-Guérin (BCG) therapy.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 99 patients with primary high-grade pT1 bladder cancer who underwent transurethral resection of the bladder tumor (TURBT) followed by BCG therapy. Patients were stratified into pT1a and pT1b subgroups based on pathological findings. Predictors of disease progression and recurrence were assessed using logistic regression, adjusting for age, tumor size, carcinoma in situ (CIS), and multiplicity.</p><p><strong>Results: </strong>Of the 99 patients, 71.7% were classified as pT1a, and 28.3% as pT1b. Disease progression was significantly more frequent in pT1b cases (P < 0.001), particularly in the presence of concurrent CIS (P = 0.002). Logistic regression identified pT1b substaging (odds ratio [OR]: 28.9, 95% confidence interval [CI]: 12.4-58.7) and CIS (OR: 8.65, 95% CI: 3.21-18.8) as independent predictors of progression.</p><p><strong>Discussion: </strong>Pathological substaging of pT1 bladder cancer provides critical prognostic insights. Patients with pT1b tumors, especially those with concurrent CIS, are at higher risk for disease progression and may benefit from intensified management strategies. Incorporating pT1 substaging into routine pathological evaluations can improve risk stratification and inform individualized treatment planning.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142537","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":"Prognostic significance of pathologic response to neoadjuvant chemotherapy in muscle-invasive urothelial carcinoma of the bladder with histologic subtype.","authors":"Seth L Teplitsky, Will Cranford, Joon Kyung Kim, Spencer Bell, Sydney Strup, Derek Allison, Amanda Buchanan, Zin Myint, Stephen E Strup, Frances Martin, Akshay Sood, Ashish M Kamat, Christopher J McLouth, Patrick J Hensley","doi":"10.1016/j.urolonc.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.010","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with histologic subtypes (HS) of urothelial cancers are often excluded from neoadjuvant chemotherapy (NAC) trials for muscle-invasive bladder cancer (MIBC). Additionally, there exist conflicting data regarding the inherent chemotherapeutic sensitivity of individual HS. Herein, we assess the prognostic significance of pathologic response to NAC, a common surrogate endpoint of success in NAC trials, in patients with HS versus pure urothelial carcinoma (PUC).</p><p><strong>Methods: </strong>The National Cancer Database (NCDB) was queried for patients with cT2-4N0M0 MIBC who received NAC and radical cystectomy (RC) between 2004 and 2020. Pathologic response to NAC was defined as complete (ypT0N0), partial (<ypT2N0), and no response (≥ypT2 or ypN+). Kaplan-Meier analysis and log-rank tests were performed for overall survival (OS) and Cox proportional hazard regressions were performed to test relationships between NAC response and the presence of a HS in predicting OS.</p><p><strong>Results: </strong>5,372 patients were included, with 345 (6.4%) having HS. Nonresponse rates to NAC in HS patients were significantly higher than those with PUC (65.2% vs. 55.8%, P = 0.003). Patients with squamous and glandular differentiation exhibited the highest rates of nonresponse (79% and 72.2%, respectively). In unstratified analysis, patients with HS exhibited shorter OS (P < 0.0001). Patients with HS had uniformly worse OS even after controlling for pathologic response (P = 0.013), with the most notable discrepancy in partial responders (HR = 4.88, 95% CI 2.29-10.38, P < 0.001; 3-year OS 91% vs. 66% for partial response in PUC vs. HS, respectively).</p><p><strong>Conclusions: </strong>Patients with HS MIBC exhibit poor survival when treated with NAC followed by RC compared with PUC, even when controlling for pathologic response. These data suggest that pathologic response is a less accurate surrogate endpoint in patients with HS relative to PUC, and may suggest a role for therapeutic intensification in the adjuvant setting for patients with HS.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142549","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":"Genomic profiling of urological malignancies using tissue-based next generation sequencing.","authors":"Zainab I Alruwaii, Gamze Gokturk Ozcan, Oudai Hassan, Liang Cheng, Khaleel I Al-Obaidy","doi":"10.1016/j.urolonc.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.011","url":null,"abstract":"<p><p>Advances in understanding genomic drivers of human malignancies have evolved from morphologic evaluations to in-depth DNA and RNA analyses and gene expression profiling. In urologic malignancies, these molecular diagnostics are integral to patient management, aiding pathological diagnosis, providing prognostic and predictive relevance, and identifying therapeutic options for advanced diseases. For instance, renal cell carcinoma frequently harbors alterations in VHL, PBRM1, and BAP1, influencing therapeutic responses, while urothelial carcinoma is characterized by FGFR3 mutations and TERT promoter alterations, which have implications for targeted therapy. Prostate cancer commonly involves TMPRSS2-ERG fusions and BRCA2 mutations, affecting treatment strategies, and penile squamous cell carcinoma follows distinct HPV-dependent and HPV-independent pathways, with mutations in TP53 and CDKN2A genes. These advances in molecular pathology have deepened our understanding of these complex diseases and facilitated the introduction of novel targeted therapies. While these advances promise improved diagnosis, prognosis, and treatment options, many questions remain regarding the variable patient responses within the same histologic types. Addressing these will enable optimal management strategies and the development of personalized treatments targeting specific molecular alterations to improve patient outcomes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133254","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}