Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Is primary retroperitoneal lymph node dissection the way forward for patients with testicular seminoma and limited retroperitoneal metastases?","authors":"Mithun Kailavasan F.R.C.S,&nbsp;Nicholas Power M.D.,&nbsp;Benjamin B Beech M.D.","doi":"10.1016/j.urolonc.2025.01.016","DOIUrl":"10.1016/j.urolonc.2025.01.016","url":null,"abstract":"<div><div>Testicular cancer represents 1% of adult neoplasms and is the most common solid malignancy in young men. Of men presenting with seminoma, approximately 20% will have clinical stage (CS) II disease, characterized by enlarged retroperitoneal lymph nodes without further metastasis. A further group of men will present with CS I disease but later experience relapse in the retroperitoneal lymph nodes. The standard treatment for many decades in these patients is either radiotherapy (30–36Gy) or chemotherapy (BEPx3, EPx4). Despite high cure rates with these modalities, concerns persist regarding short and long-term treatment-related toxicities. Survivors of testicular cancer treated with chemotherapy or radiotherapy face increased risks of cardiovascular disease (1.5–6-fold) and secondary malignancies (twice as likely for solid cancers and 5 times for leukemia). An alternative approach explored is primary Retroperitoneal Lymph Node Dissection (RPLND). Several institutional series along with 4 single-arm phase II trials have investigated primary RPLND in men with low-volume retroperitoneal metastases. Herein, we review the evidence, strengths and limitations of the current studies and future for primary RPLND for seminoma.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 318-323"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469287","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 fragility index of randomized controlled trials in advanced/metastatic renal cell cancer","authors":"Yingwei Bi ,&nbsp;Haotian Wei ,&nbsp;Qifeng Ma ,&nbsp;Rui Wang ,&nbsp;Jiacheng Jin ,&nbsp;Kexin Qu ,&nbsp;Yuxin Liu ,&nbsp;Ziwei Zhai ,&nbsp;Liang Zhu ,&nbsp;Jianbo Wang","doi":"10.1016/j.urolonc.2025.03.003","DOIUrl":"10.1016/j.urolonc.2025.03.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The fragility index (FI) has been applied as a supplement to the noncomprehensive <em>P</em>-values to assess the robustness of randomized controlled trials (RCTs). The objective of this study is to evaluate the statistical robustness of RCTs of advanced/metastatic renal cell cancer (a/mRCC) using the FI.</div></div><div><h3>Materials and methods</h3><div>RCTs related to a/mRCC published in the 4 highest-impact general medical journals and the 25 highest-impact urological journals between January 1, 2000, and December 31, 2023, were identified from PubMed database. The FI was calculated by using Fisher's exact test. Spearman's correlation analysis was conducted to assess potential correlates regarding FI.</div></div><div><h3>Results</h3><div>16 eligible RCTs were screened with a median total sample size of 654.5 (IQR, 461–847) and a median patients lost to follow-up of 14 (IQR, 3–23). The median FI was 12.5 (IQR, 8.5–27), suggesting that a switch in outcomes in only 13 patients would have reversed the significance of the trials. The number of patients lost to follow-up exceeded or equaled to the FI in 7 (44%) RCTs. <em>P</em>-values were negatively associated with the FI, while the number of patients lost to follow-up and patients enrolled were not statistically significant.</div></div><div><h3>Conclusion</h3><div>Not all RCTs associated with a/mRCC are as statistically robust as previously considered and should therefore be construed carefully. We suggest that additional reporting of FI in urological RCTs as a supplement to the <em>P</em>-value to assist readers in concluding reliably by considering the fragility of the outcomes.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 333.e9-333.e15"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744093","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":"Bempegaldesleukin plus nivolumab in first-line advanced/metastatic urothelial carcinoma: Results from a phase II single-arm study (PIVOT-10)","authors":"Arlene O. Siefker-Radtke MD ,&nbsp;Robert A. Huddart PhD ,&nbsp;Mehmet A. Bilen MD ,&nbsp;Arjun Balar MD ,&nbsp;Daniel Castellano MD ,&nbsp;Srikala S Sridhar MD ,&nbsp;Ugo De Giorgi MD ,&nbsp;Konstantin Penkov PhD ,&nbsp;Aleksandr Vasiliev MD ,&nbsp;Avivit Peer MD ,&nbsp;Riikka Järvinen MD ,&nbsp;Hakan Harputluoğlu PhD ,&nbsp;Vadim S. Koshkin MD ,&nbsp;Shermeen Poushnejad MBA ,&nbsp;Tianhua Wang PhD ,&nbsp;Anila Qureshi MD ,&nbsp;Mary A. Tagliaferri MD ,&nbsp;Jonathan Zalevsky PhD ,&nbsp;Yohann Loriot PhD","doi":"10.1016/j.urolonc.2024.09.030","DOIUrl":"10.1016/j.urolonc.2024.09.030","url":null,"abstract":"<div><h3>Background</h3><div>In PIVOT-02, bempegaldesleukin (BEMPEG), a pegylated interleukin-2 cytokine prodrug, in combination with nivolumab (NIVO), a Programmed cell death protein 1 inhibitor, demonstrated the potential to provide additional benefits over immune checkpoint inhibitor monotherapy in patients with urothelial carcinoma, warranting further investigation. We evaluated BEMPEG plus NIVO in cisplatin-ineligible patients with previously untreated locally advanced or metastatic urothelial carcinoma.</div></div><div><h3>Methods</h3><div>This open-label, multicenter, single-arm, phase II study enrolled patients with locally advanced/surgically unresectable or metastatic urothelial carcinoma and who were ineligible for cisplatin-based treatment. Patients received BEMPEG plus NIVO were administered intravenously every 3 weeks for ≤2 years or until progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) by blinded independent central review (BICR) in patients with low programmed death ligand-1 (PD-L1) expression. Secondary endpoints included ORR and duration of response in the overall population. Progression-free survival (PFS) and overall survival (OS) were exploratory endpoints.</div></div><div><h3>Results</h3><div>One hundred and eighty-eight patients were enrolled; 123 patients were PD-L1 low (combined positive score [CPS] &lt;10; 65.4%), 59 were PD-L1 high (31.4%; CPS ≥10), and 6 had PD-L1 status unknown (3.2%). ORR per blinded independent central review in patients with PD-L1-low tumors was 17.9% (95% confidence interval [CI] 11.6–25.8) while in all treated patients was 19.7% (95% CI 14.3–26.1). Median PFS and OS in the overall population were 3.0 months and 12.6 months, respectively. BEMPEG plus NIVO combination was well tolerated, with a safety profile similar to previously reported trials; no new or unexpected safety signals were reported.</div></div><div><h3>Conclusions</h3><div>BEMPEG plus NIVO did not meet the efficacy threshold for ORR in patients with previously untreated locally advanced or metastatic urothelial carcinoma and low PD-L1 expression.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 330.e1-330.e9"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547748","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":"Reducing infectious complications and healthcare costs in transrectal ultrasound-guided prostate biopsy with single-dose cefmetazole and levofloxacin","authors":"Katsuhiro Onishi ,&nbsp;Hiroshi Morioka MD, PhD ,&nbsp;Kazuki Nishida MD, PhD ,&nbsp;Masashi Yamamoto ,&nbsp;Daisuke Tsuchimoto ,&nbsp;Yoshie Moriya MD ,&nbsp;Osamu Kamihira MD, PhD","doi":"10.1016/j.urolonc.2025.01.017","DOIUrl":"10.1016/j.urolonc.2025.01.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Fluoroquinolones (FQ) are currently the first choice as prophylactics for transrectal ultrasound-guided prostate biopsy (TRUS-PBx). However, infections caused by FQ-resistant or extended-spectrum β-lactamase producing <em>Escherichia coli</em> remain a significant concern. Although cefmetazole (CMZ) is effective against these resistant <em>E. coli</em> strains, there are only a few reports on its use in TRUS-PBx. We investigated the efficacy of antimicrobial prophylaxis (AP) for TRUS-PBx using intravenous CMZ and oral levofloxacin (LVFX).</div></div><div><h3>Methods</h3><div>This single-center retrospective observational before-and-after study was conducted between January 2014 and December 2023 at Komaki City Hospital, Japan. The incidence of febrile urinary tract infection (UTI), urosepsis, bacteremia, readmission, abscess, and healthcare-related costs after TRUS-PBx were compared between individuals who received a single dose of intravenous cefazolin (CEZ) and oral LVFX and those who received single doses of intravenous CMZ and oral LVFX. The risk factors for post-TRUS-PBx febrile UTI were analyzed using multivariable logistic analysis.</div></div><div><h3>Results</h3><div>The incidence of febrile UTI after TRUS-PBx was 0.77% (9/1,168) in the CEZ+LVFX group and 0.20% (2/1,008) in the CMZ+LVFX group. Complications such as urosepsis (5 cases), bacteremia (3 cases), abscess (2 cases), and readmission (3 cases) were observed only in the CEZ+LVFX group. Multivariable analysis indicated that the use of CMZ+LVFX significantly decreased febrile UTI after TRUS-PBx (odds ratio: 0.20, 95% confidence interval: 0.04–0.98, <em>P</em> = 0.047). CMZ+LVFX use reduced healthcare-related costs by JPY 975.5 (USD 6.8) per TRUS-PBx compared to CEZ+LVFX.</div></div><div><h3>Conclusions</h3><div>Empirical AP with CMZ+LVFX before TRUS-PBx reduced the incidence of infectious complications and healthcare-related costs.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 335.e1-335.e8"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400067","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 retrospective analysis of tissue, liquid, and germline testing in Hispanic and non-Hispanic men with advanced hormone-sensitive prostate cancer","authors":"Aaron J. Bertolo M.D. ,&nbsp;Ricardo J. Estrada-Mendizabal M.D. ,&nbsp;Megan K. Taylor M.D. ,&nbsp;Kenneth Barker M.D. ,&nbsp;Jose Guillen-Rodriguez M.Sc ,&nbsp;Ronald L. Heimark Ph.D. ,&nbsp;Ken Batai Ph.D. ,&nbsp;Juan Chipollini M.D. ,&nbsp;Alejandro Recio-Boiles M.D.","doi":"10.1016/j.urolonc.2025.02.011","DOIUrl":"10.1016/j.urolonc.2025.02.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Prostate cancer (PCa) is a major cause of cancer mortality among American men, with significant racial and ethnic disparities. Hispanic Americans (HAs) are underrepresented in PCa genomic studies despite comprising a large portion of cancer diagnoses. By comparing the frequency of common PCa mutations between HA and non-Hispanics (NHs), we aim to continue understanding the drivers of disparities in this underrepresented population.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 111 metastatic prostate adenocarcinoma patients with 313 tissue, liquid, and germline genomic sample results from patient blood at the University of Arizona Cancer Center (2015-2023). Patients were categorized by ethnicity into HAs and NHs. We assessed de-identified demographic, pathological, clinical, and genomic data. Continuous and categorical variables determined statistical significance were evaluated using t-tests or Kruskal-Wallis Rank sum tests and Chi-square or Fisher's exact tests, respectively (<em>P</em> &lt; 0.05). Time-to-event data was analyzed using Kaplan-Meier Methods.</div></div><div><h3>Results</h3><div>Of the 111 patients included HAs represented 41%. HAs had higher median PSA levels at the time of diagnosis (148.5 ng/ml vs. 52.6 ng/ml, <em>P</em> = 0.024), more advanced pathological disease stages, including T4 (36% vs. 15%), and M1c (37.8% vs. 13.6%), less time to first-line treatment (1 vs 2 months, <em>P</em> ≤ 0.01), and higher median survival time from first-line to second-line treatment (23 vs 13 months, <em>P</em> &lt; 0.01). TMPRSS2-ERG fusion and TMB-High (&gt;10) mutations were more common in HAs (36% vs. 6%, <em>P</em> = 0.0009; 20% vs. 3%, <em>P</em> = 0.003).</div></div><div><h3>Conclusion</h3><div>Our study shows a more advanced clinical presentation of HAs PCa compared to NHs. Furthermore, significant genomic differences in PCa between HAs and NHWs, particularly in TMPRSS2-ERG fusion and TMB-High mutations, highlight the need for early detection and personalized treatment options. Addressing treatment disparities and expanding genomic research in HAs are crucial for developing effective interventions in this underrepresented population.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 337.e1-337.e8"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537745","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 clinical relevance of cut-off percentage for high-grade urothelial carcinoma within low-grade urothelial carcinoma: A determining factor?","authors":"Gozde Kir M.D. ,&nbsp;Gozde Ecem Cecikoglu M.D. ,&nbsp;Abdullah Aydin M.D. ,&nbsp;Asif Yildirim M.D.","doi":"10.1016/j.urolonc.2024.10.016","DOIUrl":"10.1016/j.urolonc.2024.10.016","url":null,"abstract":"<div><h3>Aims</h3><div>The aim of the study was to analyze the cut-off value for the percentage of the high-grade (HG) component that has clinical significance in urothelial carcinoma (UC).</div></div><div><h3>Material and Methods</h3><div>The study included a total of 362 patients, mixed-grade UC (MGUC) patients were classified as Combine Group (CG) 1 based on the presence of less than 5% HG areas. High-grade papillary UC (HGPUC) patients were grouped based on HG component proportions: CG2 (≥5%–&lt;50% HG), CG3 (≥50%–&lt;100% HG), and pure HGPUC (PHGPUC) for 100% HG components.</div></div><div><h3>Results</h3><div>There was a statistically significant difference between low-grade papillary UC (LGPUC) and CG1, CG2, or CG3, as well as LGPUC and PHGPUC, in terms of cancer-specific survival (CSS) (<strong>hazard ratio (HR) = 19.85, 95% confidence interval (CI) = 2.30–171.10 <em>P</em> = 0.007, HR = 28.38, 95% CI = 3.50–229.97 <em>P</em> = 0.002, HR = 18.64, 95% CI = 2.26–153.64 <em>P</em> = 0.007, and HR = 35.41, 95% CI = 4.61–271.72 <em>P</em> &lt; 0.001, respectively</strong>). There was no statistically significant difference between PHGPUC and CG1, CG2, or CG3 in terms of CSS.</div></div><div><h3>Conclusions</h3><div>These findings suggest that even the presence of less than 5% HGPUC within LGPUC significantly impacts CSS. Furthermore, the increase in the percentage of HGPUC beyond 5% does not substantially influence the CSS. Based on these findings, disclosing the percentage of the high-grade component may be crucial for future patient management and treatment.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 329.e9-329.e21"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591301","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":"Patient preferences for life expectancy cutoffs for aggressive treatment in clinically localized prostate cancer","authors":"John R. Heard M.D. ,&nbsp;John M. Masterson M.D. ,&nbsp;Michael Luu M.P.H. ,&nbsp;Rebecca Gale M.P.H. ,&nbsp;Brennan Spiegel M.D., M.S.H.S. ,&nbsp;Stephen J. Freedland M.D. ,&nbsp;Timothy J. Daskivich M.D., M.S.H.P.M.","doi":"10.1016/j.urolonc.2024.11.020","DOIUrl":"10.1016/j.urolonc.2024.11.020","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines for prostate cancer treatment in men with limited life expectancy are based on expert opinion. Patient preferences for when to defer treatment based on longevity are unknown. We sought to define life expectancy thresholds at which men are more likely to choose conservative management in the context of varying risks of cancer death and treatment-related side effects.</div></div><div><h3>Materials and methods</h3><div>We crowdsourced a conjoint analysis exercise to 2,046 men sociodemographically matched to a US prostate cancer population. Subjects were given a longevity estimate based on their age and comorbidity. They then chose between treatment and conservative management across scenarios with varying risks of cancer death at 5, 10, and 15 years, erectile dysfunction, urinary incontinence, and irritative urinary symptoms. Multivariable multinomial logistic regression identified the life expectancy threshold when men were more likely to choose conservative management over treatment.</div></div><div><h3>Results</h3><div>Across all men, there was a significant interaction between longevity and treatment choice (P &lt; 0.001), with probability of treatment decreasing 15% for every 5-year decrease in life expectancy (OR0.85, 95% CI0.82–0.89). Across all tumor risk subtypes, men were significantly more likely to choose conservative management at life expectancy&lt;10 years(OR&lt;1, P &lt; 0.05). For low-, favorable-intermediate-, unfavorable-intermediate-, and high-risk cancers, men were more likely to choose conservative management at life expectancy thresholds of ≤15, ≤10, ≤9, and ≤7 years, respectively (P &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Preferences for when to consider conservative management of prostate cancer based on longevity align with current guidelines recommendations, except for low-risk disease, for which men are likely to consider conservative management at even higher life expectancy thresholds.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 335.e17-335.e24"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824512","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":"Increase in workload among genitourinary oncologists drives burnout: Insights from the BUCARE survey","authors":"Alisher Kahharov M.D., Ph.D. ,&nbsp;Ilya Tsimafeyeu M.D., Ph.D. ,&nbsp;Dilyara Kaidarova M.D., Ph.D. ,&nbsp;Djamilya Polatova M.D., Ph.D. ,&nbsp;Fuad Guliyev M.D., Ph.D. ,&nbsp;Bakytzhan Ongarbayev M.D., Ph.D. ,&nbsp;Ramil Abdrakhmanov M.D., Ph.D. ,&nbsp;Timur Mitin M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.03.019","DOIUrl":"10.1016/j.urolonc.2025.03.019","url":null,"abstract":"<div><h3>Background</h3><div>Burnout is a significant issue among GU oncologists, driven by increasing workloads and the emotional demands of patient care. This study aims to identify the prevalence, risk factors, and potential interventions to address burnout in this population.</div></div><div><h3>Methods</h3><div>A comprehensive survey, including a visual mood assessment, was conducted among 674 GU oncologists. The survey assessed work conditions, mood, and burnout indicators, alongside demographic and professional characteristics.</div></div><div><h3>Results</h3><div>Among the respondents, 72% (482 out of 674) displaying symptoms of burnout, characterized by high emotional exhaustion and/or depersonalization. Key risk factors included long working hours (more than 8 hours per day for 54% of respondents), high patient volumes (48% managing over 15 patients daily), and night shifts (16%). Despite signs of burnout in 72% of participants, a visual mood assessment showed that 72% reported being in a good or excellent mood. Additionally, 92% of respondents expressed passion for their work, and 84% showed a strong desire for professional development.</div></div><div><h3>Conclusions</h3><div>Burnout is prevalent among GU oncologists, despite their dedication to their profession. Strategic interventions, such as expanding the workforce and reducing daily patient volumes, are essential to mitigate burnout and improve well-being.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 324-327"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789196","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)00144-9","DOIUrl":"10.1016/S1078-1439(25)00144-9","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Page IFC"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928795","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 efficacy of adjuvant mitotane therapy and radiotherapy following adrenalectomy in patients with adrenocortical carcinoma: A systematic review and meta-analysis","authors":"Ichiro Tsuboi ,&nbsp;Mehdi Kardoust Parizi ,&nbsp;Akihiro Matsukawa ,&nbsp;Stefano Mancon ,&nbsp;Marcin Miszczyk ,&nbsp;Robert J. Schulz ,&nbsp;Tamás Fazekas ,&nbsp;Anna Cadenar ,&nbsp;Ekaterina Laukhtina ,&nbsp;Tatsushi Kawada ,&nbsp;Satoshi Katayama ,&nbsp;Takehiro Iwata ,&nbsp;Kensuke Bekku ,&nbsp;Koichiro Wada ,&nbsp;Mesut Remzi ,&nbsp;Pierre I. Karakiewicz ,&nbsp;Motoo Araki ,&nbsp;Shahrokh F. Shariat","doi":"10.1016/j.urolonc.2024.09.014","DOIUrl":"10.1016/j.urolonc.2024.09.014","url":null,"abstract":"<div><div>Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with a high recurrence rate after surgical therapy with curative intent. Adjuvant radiotherapy (RT) and mitotane therapy have been proposed as options following the adrenalectomy. However, the efficacy of adjuvant RT or mitotane therapy remains controversial. We aimed to evaluate the efficacy of adjuvant therapy in patients who underwent adrenalectomy for localised ACC. The PubMed, Scopus, and Web of Science databases were queried on March 2024 for studies evaluating adjuvant therapies in patients treated with surgery for localized ACC (PROSPERO: CRD42024512849). The endpoints of interest were overall survival (OS) and recurrence-free survival (RFS). Hazard ratios (HR) with 95% confidence intervals (95%CI) were pooled in a random-effects model meta-analysis. One randomized controlled trial (<em>n</em> = 91) and eleven retrospective studies (<em>n</em> = 4,515) were included. Adjuvant mitotane therapy was associated with improved RFS (HR: 0.63, 95%CI: 0.44-0.92, <em>p</em> = 0.016), while adjuvant RT did not reach conventional levels of statistical significance (HR:0.79, 95%CI:0.58-1.06, <em>p</em> = 0.11). Conversely, Adjuvant RT was associated with improved OS (HR:0.69, 95%CI:0.58-0.83, p&lt;0.001), whereas adjuvant mitotane did not (HR: 0.76, 95%CI: 0.57-1.02, <em>p</em> = 0.07). In the subgroup analyses, adjuvant mitotane was associated with better OS (HR:0.46, 95%CI: 0.30-0.69, <em>p</em> &lt; 0.001) and RFS (HR:0.56, 95%CI: 0.32-0.98, <em>p</em> = 0.04) in patients with negative surgical margin. Both adjuvant RT and mitotane were found to be associated with improved oncologic outcomes in patients treated with adrenalectomy for localised ACC. While adjuvant RT significantly improved OS in general population, mitotane appears as an especially promising treatment option in patients with negative surgical margin. These data can support the shared decision-making process, better understanding of the risks, benefits, and effectiveness of these therapies is still needed to guide tailored management of each individual patient.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 297-306"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393713","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}