Urologic Oncology-seminars and Original Investigations最新文献

{"title":"M2-LIKE POLARIZED TAMS SIGNATURE DEFINED BY SCRNA: IMPLICATIONS FOR POOR PROGNOSIS IN BLADDER CANCER AND CONSTRUCTION OF A PROGNOSTIC MODEL BASED ON M2-LIKE GENES","authors":"Eran Maina, Betty Wang, Christopher Weight, Nima Almassi, Samuel Haywood, Robert Abouassaly, Phillip Abbosh, Rebecca Campbell, Laura Bukavina","doi":"10.1016/j.urolonc.2024.12.044","DOIUrl":"10.1016/j.urolonc.2024.12.044","url":null,"abstract":"<div><h3>Introduction</h3><div>Bladder cancer (BCa) is among the most common malignancies worldwide and overall survival (OS) remains poor despite treatment advances. Tumor-associated macrophages (TAMs) are monocyte-derived cells that invade the BCa tumor microenvironment (TME) and display a range of functional pro-tumor and anti-tumor phenotypes dependent on distinct environmental factors and stimuli. Specifically, TAMs polarized toward M2-like states are associated with angiogenesis, immunosuppression, and metastasis. Despite this knowledge, the impact of M2-like subsets on BCa prognosis remains largely unexplored partly due to nonspecific transcriptomic signatures hindering identification. Single-cell (scRNA) sequencing technology has transformed our understanding of functional diversity at the single-cell level in multiple cancers. In this study, we harnessed scRNA data from bladder tumor patients and characterized a polarized M2-like gene signature to explore the association of M2-like TAMs with OS in BCa. We then constructed a prognostic risk model based on M2-like gene signatures to identify biomarkers predictive of poor prognosis.</div></div><div><h3>Methods</h3><div>The scRNA data of 15 BCa patients were collected and analyzed (Seurat R package, v5.0.1). Samples were from the NCBI Gene expression Omnibus and collaborators. Seurat objects were created, merged, and normalized as a single dataset (Seurat v5 integration pipeline). We identified the M2-like gene cluster based on canonical markers in the literature. Strict criteria were used to define the M2-like cluster and M2-like associate genes (|logFC|>3.0, <em>p</em><0.05). EnrichR database was used to functionally characterize the M2-like cluster. Infiltration levels of M2-like gene signatures in individual samples were estimated with single-sample Gene Set Enrichment Analysis. To construct a prognostic risk score based on M2-like TAMs, we used M2-like differentially expressed genes as candidate genes to explore those significantly associated with BCa prognosis. We integrated survival event and OS time with LASSO Cox regression model to find survival-related genes and form the prognostic model and risk score.</div></div><div><h3>Results</h3><div>The scRNA sequencing data of 15 BCa samples yielded 46,968 cells for further analysis after quality control and batch-effect correction. We identified 34 clusters and further annotated these 34 clusters into three major categories, keeping the M2-like cluster intact for simpler visualization (Figure 1). We selected 79 genes identified from the M2-like TAMs cluster from scRNA and used them as candidate genes to construct the prognostic risk model. LASSO Cox regression obtained nine key prognostic genes that had the highest impact on OS [<em>RGS2</em> (coef= 0.105918), <em>CCL3L3</em> (coef= -0.000413), <em>CXCL14</em> (coef= 0.006135), <em>AMICA1</em> (coef= -0.084312), <em>SPP1</em> (coef= 0.007112), <em>CPVL</em> (coef= 0.054197), <em>EMP","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 17"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510147","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}

{"title":"The role of intravesical chemotherapy following nephroureterectomy in upper tract urothelial carcinoma: A systematic review and meta-analysis","authors":"Stefano Moretto ,&nbsp;Andrea Piccolini ,&nbsp;Andrea Gallioli ,&nbsp;Roberto Contieri ,&nbsp;Nicolomaria Buffi ,&nbsp;Giovanni Lughezzani ,&nbsp;Alberto Breda ,&nbsp;Michael Baboudjian ,&nbsp;Bas WG van Rhijn ,&nbsp;Morgan Roupret ,&nbsp;Alessandro Uleri ,&nbsp;Benjamin Pradere","doi":"10.1016/j.urolonc.2024.10.035","DOIUrl":"10.1016/j.urolonc.2024.10.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy occurs in 22% to 47%. Intravesical chemotherapy is still underused due to concerns about its efficacy and safety. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of intravesical chemotherapy regimens in reducing the risk of intravesical recurrence following radical nephroureterectomy.</div></div><div><h3>Materials and methods</h3><div>A literature search was conducted using PubMed/Medline, Embase, and Web of Science databases to identify reports published until March 2024. The PRISMA guidelines were followed to identify eligible studies. The outcomes measured were intravesical recurrence rates and complications in patients treated with different intravesical instillation chemotherapy and timing after radical nephroureterectomy. Sub-analyses were performed on randomized controlled trials and studies involving patients with no history of bladder cancer.</div></div><div><h3>Results</h3><div>Eighteen studies met our inclusion criteria, and data from 2,483 patients were reviewed. Intravesical chemotherapy significantly reduced the risk of intravesical recurrence at 12 months (OR = 0.46; 95% CI: 0.33–0.65; <em>P</em> &lt; 0.001;) and at 24 months (OR = 0.41, 95% CI: 0.28–0.61; <em>P</em> &lt; 0.001). Notably, no association was found when confronting intra and postoperative instillations (OR = 0.66; 95% CI: 0.34–1.28; <em>P</em> = 0.2), nor single vs. multiple instillation (OR = 1.37; 95% CI: 0.75–2.50; <em>P</em> = 0.3). The pooled rate for minor and major complications was 9% and 0.9%, respectively.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that intravesical chemotherapy significantly reduces intravesical recurrence rates after radical nephroureterectomy at 12 and 24 months. Additionally, it underscores the favorable safety profile of intravesical chemotherapy, with a low incidence of major complications. The ideal instillation scheme and chemotherapy agent should be further defined.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 191.e1-191.e12"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732821","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 prostate-specific antigen (PSA) Testing rates and screening disparities in the all of us dataset","authors":"Jonathan T. Ryan B.S. ,&nbsp;William Jin M.D. ,&nbsp;Joao G. Porto M.D. ,&nbsp;Dinno Mendiola M.D. ,&nbsp;Tarek Ajami M.D. ,&nbsp;Hui Yu Ph.D. ,&nbsp;Brandon A. Mahal M.D. ,&nbsp;Sanoj Punnen M.D.","doi":"10.1016/j.urolonc.2024.11.011","DOIUrl":"10.1016/j.urolonc.2024.11.011","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine prostate cancer (PCa) screening disparities among ethnic groups in the U.S. using the All of Us database.</div></div><div><h3>Material and Methods</h3><div>White, Black, Hispanic, and Asian males ≥ 40 years old were included, excluding diagnosis's that conflict with PCa screening. We analyzed prostate-specific antigen (PSA) screening rates by age based on American Urological Association guidelines, using multivariable logistic regression (MLR) and a Cox time-to-event models that considered race, age, income, education, insurance, and home ownership as independent variables. Initial screening ages and biopsy rates were also compared.</div></div><div><h3>Results</h3><div>Of 56,473 individuals, 18,088 had PSA measurements: 74% White, 15% Black, 9% Hispanic, and 2% Asian. Hispanic (20%) and Black (21%) minorities were less likely to undergo PSA screening compared to White men (39%, <em>P</em> &lt; 0.001). However, minorities had their initial PSA earlier with their first test from 53–54 years old compared to White men at 58 years (<em>P</em> &lt; 0.001). MLR revealed race, age, income, education, insurance type, and home ownership as screening predictors (<em>P</em> &lt; 0.001). Screened Black men had higher odds of an elevated PSA (<em>P</em> &lt; 0.001), but the likelihood of receiving a biopsy postelevated PSA did not significantly differ from White men (<em>P</em> = 0.821). Additionally, those screened at age ≥ 70 were more likely to be White, have at least a college education, and be homeowners (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>White men, despite starting at a later age, are screened with PSAs more frequently than minorities, and often undergo screening at older ages outside the recommended guidelines. Black men did not have a higher rate of biopsy after having an elevated PSA compared to White men.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 194.e1-194.e8"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772644","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":"QUALITY OF LIFE OUTCOMES WITH NEUROMODULATION IN PROSTATE CANCER SURVIVORS","authors":"Bryn Launer,&nbsp;Melissa Kaufman","doi":"10.1016/j.urolonc.2024.12.100","DOIUrl":"10.1016/j.urolonc.2024.12.100","url":null,"abstract":"<div><h3>Introduction</h3><div>Prostate cancer (PCa) survivors experience significant impact on urinary function following treatment. While therapies to address stress urinary incontinence in PCa survivors have been well described, there is a dearth of information regarding urgency urinary incontinence and the role of sacral neuromodulation (SNM). This study aims to characterize outcomes for PCa survivors with medication refractory lower urinary tract symptoms who underwent SNM with Interstim.</div></div><div><h3>Methods</h3><div>A total of 50 male patients, all PCa survivors, from 12 institutions were included in a retrospective analysis. Patients were consented as part of the post-market Medtronic Product Surveillance Registry. Demographic information was collected, as well as outcomes data measured by the Patient Gobal Impression of Improvement (PGII) scale over multiple follow-up visits up to 96 months after SNM device placement.</div></div><div><h3>Results</h3><div>Patients were an average age of 73 at time of SNM device placement, with average BMI of 29. Ninety percent (45/50) were white, 8% (4/50) were Black or African American, and 2% (1/50) identified as Hispanic or Latino. Most patients (88%, 44/50) were enrolled following initial device placement, with 8% (4/50) undergoing replacement procedures. Forty-three percent (26/40) had previously undergone prostate surgery, and 51% (15/29) had previously undergone prostate radiation. The most common indication for device use was urinary urgency incontinence (54%, 27/50), followed by urinary urgency/frequency (24%, 12/50).</div><div>Mean follow up was 32 months, median follow up was 21 months, with a range from 0 months to 96 months. The majority reported improvement in symptoms as measured by the PGII at each follow up visit, with 73% (11/15) reporting improvement at 6 months, 83% (10/12) at 12 months, and 83% (5/6) at 72 months (Fig. 1).</div></div><div><h3>Conclusions</h3><div>Use of SNM in PCa survivors shows durable symptom improvement in this small cohort with mean follow up of almost 3 years. SNM should be considered as a treatment modality for patients with mixed LUTS after PCa treatment, aided by functional diagnosis with urodynamics. This study presents an opportunity for investigation into prospective studies to enhance our specificity for treatment to optimize outcomes in PCa survivors.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 40"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509806","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":"ANALYSIS OF THE INCREASED INCIDENCE OF AGGRESSIVE PROSTATE CANCER AFTER PRIOR TESTICULAR CANCER","authors":"Kevin Joseph Xu,&nbsp;Amir Khan,&nbsp;Minhaj Siddiqui","doi":"10.1016/j.urolonc.2024.12.101","DOIUrl":"10.1016/j.urolonc.2024.12.101","url":null,"abstract":"<div><h3>Introduction</h3><div>Some recent studies have suggested that testicular cancer survivors are at increased risk of developing aggressive prostate cancer compared to the general population while others have not found this link. The objective of this study is to determine if testicular cancer survivors are predisposed to higher incidence of aggressive prostate cancer later in life and greater risks of prostate cancer specific mortality.</div></div><div><h3>Methods</h3><div>This was a retrospective case-control study of patients who developed prostate cancer and who previously had either testicular cancer or a control group cancer greater than five years prior. We used the Surveillance, Epidemiology, and End Results (SEER) database to access national cancer patient data from 1975-2020 and identify if patients with a history of testicular cancer have an earlier development of more aggressive secondary prostate cancer with higher mortality compared to those in the control group. Due to the high 5-year relative survival of testicular cancer, the control group included breast, bladder, cranial nerves and nervous system (excluding the brain), eye/orbital, oral cavity, skin, renal, thyroid cancers. Patient morbidity and mortality was assessed using Gleason scores, PSA, tumor stage, and survival time and stratified into low, moderate, and high risk accordingly. Cox regression models were used to determine the risk of mortality.</div></div><div><h3>Results</h3><div>We identified that prostate cancer does occur globally more in patients with testicular cancer compared to controls. The mean age in years of prostate cancer diagnosis for the testicular cancer group was 61.62 +/- 7.88, while the control group was 66.66 +/- 8.8. By the age of 60, we found that 10.7% of patients in the testicular cancer group had developed prostate cancer, compared to 6.8% of the control group. Patients in the testicular cancer group saw a decreased survival time in months (105) compared to the control (136).</div></div><div><h3>Conclusions</h3><div>We determined that patients with a history of testicular cancer may be at an increased risk of developing prostate cancer earlier with a higher mortality rate compared to other cancer survivors. Confirmatory studies are warranted.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 40-41"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509812","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)00047-X","DOIUrl":"10.1016/S1078-1439(25)00047-X","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page IFC"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512273","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 TELEMEDICINE IN CANCER PATIENTS: CONTEMPORARY ANALYSIS OF THE NATIONAL HEALTH INTERVIEW SURVEY DURING AND POST COVID-19 ERA","authors":"Madhumita Parmar,&nbsp;Khalid Y. Alkhatib,&nbsp;Sydney Chambule,&nbsp;Yash Shah,&nbsp;Avanti Rangnekar,&nbsp;Roby Daniel,&nbsp;Morgan Leff,&nbsp;Katharine F. Michel,&nbsp;Thomas J. Guzzo,&nbsp;Phillip M. Pierorazio","doi":"10.1016/j.urolonc.2024.12.033","DOIUrl":"10.1016/j.urolonc.2024.12.033","url":null,"abstract":"<div><h3>Introduction</h3><div>During and after COVID-19 pandemic, the demand for telemedicine has skyrocketed. Evidence suggests that high-quality Uro-oncological care can be delivered by means of telemedicine, with some caveats. Against this backdrop, we sought to analyze the use of telemedicine among cancers, hypothesizing that its use may be higher for certain oncological conditions relative to others.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study on cancer patients using data starting from July 2020 using in the National Health Interview Survey (NHIS). We utilized an affirmative answer to <em>“Have you EVER been told by a doctor or other health professional that you had Cancer or a malignancy of any kind?”</em> to identify patients with cancer history. We used the question <em>“In the past 12 months, have you had an appointment with a doctor, nurse, or other health professional by video or by phone?”</em> to identify telemedicine recipients. Survey-weighted multivariable Poisson regression analysis adjusted for potential confounders was conducted to estimate risk ratios (RR) for receipt of telemedicine, and a two-way interaction between currently receiving treatment and cancer type was assessed for any effect modification.</div></div><div><h3>Results</h3><div>We identified 7,784 individuals with a cancer history, representing a weighted population of 40 million. The prevalence of telemedicine utilization was 47.8%. Relative to breast cancer, we found that PCa was a significant predictor of receipt of telemedicine (RR: 1.39, 95% CI: [1.06-1.81], P= 0.02), (see Table). A significant interaction was found between those currently receiving treatment for cancer and cancer type P_int&lt;0.01; marginal probability analysis showed patients currently receiving PCa treatment were more likely to receive telemedicine, with an adjusted risk difference of 0.18, (95% CI[0.01-0.35], P=0.04).</div></div><div><h3>Conclusions</h3><div>Our study suggests that telemedicine appointments were widely used among cancer survivors after July 2020, with PCa survivors more likely to use telemedicine compared to other malignancies. Such findings may point to wider adoption of telemedicine among urologists, as suggested by other studies, or that PCa care lends itself better to telemedicine, compared to other malignancies. Future studies should focus on understanding the dynamics of such patient- and provider-level factors.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 13"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509713","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":"ROBOTIC PARTIAL CYSTECTOMY FOLLOWING NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER CANCER: A SINGLE CENTER EXPERIENCE WITH A MULTIMODAL BLADDER-PRESERVING REGIMEN","authors":"Samuel Gold,&nbsp;Sidney Roberts,&nbsp;Vitaly Margulis","doi":"10.1016/j.urolonc.2024.12.037","DOIUrl":"10.1016/j.urolonc.2024.12.037","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Utilizing advances in multimodal treatment paradigms and minimally invasive surgical techniques, we investigated the role of robotic-assisted partial cystectomy (RAPC) as an alternative to radical cystectomy in a select cohort of patients with muscle-invasive bladder cancer (MIBC). Along with standard-of-care neoadjuvant platinum-based chemotherapy, we sought to assess whether RAPC provides similar oncologic efficacy as radical cystectomy with reduced rates of associated morbidity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective review was conducted of all patients with MIBC of primarily urothelial origin who underwent platinum-based neoadjuvant chemotherapy (NAC) and RAPC at our institution between 2018-2023. Patients with MIBC and unifocal tumors at the anterior, anterolateral bladder, or bladder dome were considered for RAPC. Biopsy and restaging was performed with transurethral resection of bladder tumor (TURBT). Immediately prior to RAPC, intravesical chemotherapy was administered. A robotic transperitoneal approach was used with concurrent cystoscopy to guide bladder resection. Bilateral pelvic lymph node dissection was performed. Pathology data was collected after each surgical episode. Primary endpoint was 30-day complications. Secondary endpoints included intravesical recurrences, disease progression to metastasis, systemic chemotherapy/immunotherapy, and/or death.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Seventeen patients met inclusion criteria. Median operative time was 289 minutes (IQR 229-312) and EBL was 100 mL (IQR 75-150). No patients experienced intraoperative complications, 11/17 (65%) were discharged on postoperative day 1. There was one 30-day complication: pelvic abscess requiring percutaneous drain placement and IV antibiotics.&lt;/div&gt;&lt;div&gt;Eight patients were ypT0 (47%) after RAPC. Of the seven patients who had no malignancy on post-NAC TURBT, 6/7 (86%) were ypT0 and one was ypTIS. Seven patients (41%) had MIBC on final pathology. No patients had positive margins.&lt;/div&gt;&lt;div&gt;Median follow-up was 6.8 months (IQR 3.7-20.3) with 7 patients having follow-up &gt;12 months. Three (19%) had intravesical recurrences: CIS (x2) and MIBC with CIS (x1). Time to recurrence ranged 7.2-12.5 months. No patients required salvage cystectomy. One patient developed metastatic progression; he was ypT0 after RAPC. Two patients died; neither had evidence of disease at times of death.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;While the gold standard treatment for MIBC remains platinum-based chemotherapy followed by radical cystectomy, there is significant morbidity associated with this surgical intervention. In a selected patient population, RAPC may serve as a less toxic surgical alternative. In this study population, RAPC is shown to be a safe procedure with minimal long-term morbidity. In the short term, response to NAC predicted pathologic complete response after RAPC. Durability of response is an ongoing focus of t","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 14-15"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509716","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":"UNDETECTABLE PRECYSTECTOMY TUMOR-INFORMED CTDNA AND CONVERSION DYNAMICS AFTER RADICAL CYSTECTOMY PREDICTS IMPROVED ONCOLOGICAL OUTCOMES","authors":"Reuben Ben-David,&nbsp;Sarah Lidagoster,&nbsp;Jack Gedulding,&nbsp;Kaushik P. Kolanukuduru,&nbsp;Yuval Elkun,&nbsp;Neeraja Tillu,&nbsp;Asher Mandel,&nbsp;Mohammed Almoflihi,&nbsp;Basil Kaufmann,&nbsp;Kyrollis Attalla,&nbsp;Reza Mehrazin,&nbsp;Peter Wiklund,&nbsp;John P. Sfakianos","doi":"10.1016/j.urolonc.2024.12.038","DOIUrl":"10.1016/j.urolonc.2024.12.038","url":null,"abstract":"<div><h3>Introduction</h3><div>umor-informed circulating tumor DNA (ctDNA) has emerged as a novel prognostic biomarker in bladder cancer. We seek to assess recurrence-free survival (RFS) outcomes in patients with undetectable precystectomy ctDNA and to evaluate if patients who converted from detectable to undetectable ctDNA status post radical cystectomy have similar RFS outcomes as those with persistently undetectable ctDNA status.</div></div><div><h3>Methods</h3><div>Patients who underwent radical cystectomy had prospectively and longitudinally collected tumor-informed ctDNA analyses during 2021-2023. The ctDNA status was informed from the pre-cystectomy specimen. The minimal residual disease (MRD) window was defined as the initial 90 days after radical cystectomy. RFS was evaluated using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>The cohort included 135 patients with 647 ctDNA analyses. The median age was 71 years (IQR 63-77). During a median follow-up time of 11 months (IQR 7-18), 41 patients (30%) had a recurrence. Precystectomy undetectable ctDNA status was found in 54 patients (40%). The RFS rates at 6, 12, and 21 months were 98%, 93%, and 82%, respectively. Seventy-seven patients had undetectable ctDNA status at the MRD window available for conversion dynamics analysis (Table 1); 43 had persistently undetectable ctDNA status (both at precystectomy and MRD window) and 31 converted from precystectomy detectable to MRD undetectable status (conversion group). The persistently undetectable group had significantly better RFS than the conversion group (log-rank, p=0.0002), with 12- month RFS rates of 97% vs. 51%, and 18-month RFS rates of 88% vs. 51%, respectively (Figure 1).</div></div><div><h3>Conclusions</h3><div>Patients with undetectable precystectomy ctDNA status have a favorable prognosis and may be candidates for treatment de-escalation. Those with persistently undetectable ctDNA had superior RFS compared to the conversion group. Precystectomy ctDNA status should be incorporated in trials examining the use of ctDNA in clinical decision-making.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 15"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509717","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}