Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Impact of glucocorticoid treatment and clinical prognostic factors for outcome in patients with advanced urothelial cancer treated with pembrolizumab.","authors":"Gustav Hjorthén, Fernanda Costa Svedman, Karin Holmsten, Anders Ullén","doi":"10.1016/j.urolonc.2025.02.017","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.02.017","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors have become a cornerstone in treatment of metastatic urothelial cancer (mUC), but reliable prognostic and treatment predictive factors remain to be defined. Glucocorticoids (GC) are used to manage immune-related adverse events (irAE), and the potential impact on treatment outcome is still unclear.</p><p><strong>Objectives: </strong>The aim of this study was to explore the impact of GC treatment alongside clinical parameters on outcome in pembrolizumab-treated mUC patients.</p><p><strong>Materials and method: </strong>A single-center retrospective real-world study was performed including all consecutive mUC patients in first- or second-line treated with pembrolizumab. Multivariate analyses were used to explore the impact of baseline characteristics on response-rate and overall survival (OS). Landmark analysis was applied to adjust for immortal time bias in survival analyzes.</p><p><strong>Results: </strong>107 patients were included. Patients developing irAE requiring GC treatment had superior OS compared to those who did not (17.6 months vs. 8.8 months, P = 0.003). Ongoing treatment with GC prior to the initiation of pembrolizumab, ECOG PS >1 and liver metastases were independently associated with worse OS. We constructed a risk-score model where the number of zero, 1, 2 or 3 risk factors correlated to an OS of 11.7 months, 3.8 months, and 3.0 months respectively (P < 0.001).</p><p><strong>Conclusion: </strong>The development of irAE requiring GC treatment was associated with favorable survial outcomes. Ongoing GC treatment before the commencement of pembrolizumab, ECOG PS >1, and presence of liver metastases were associated with worse OS. We propose a risk-score model to assist clinicians in selecting patients for treatment with pembrolizumab.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721345","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":"Neoadjuvant chemotherapy prior to radical nephroureterectomy: Survival outcomes and recurrence patterns by pathologic node status","authors":"Farshad Sheybaee Moghaddam ,&nbsp;Rashid K. Sayyid ,&nbsp;Alireza Ghoreifi ,&nbsp;Antonio Franco ,&nbsp;Zhenjie Wu ,&nbsp;Linhui Wang ,&nbsp;Alessandro Antonelli ,&nbsp;Francesco Ditonno ,&nbsp;Firas Abdollah ,&nbsp;Marco Finati ,&nbsp;Giuseppe Simone ,&nbsp;Gabriele Tuderti ,&nbsp;Emma Helstrom ,&nbsp;Andres F. Correa ,&nbsp;Ottavio De Cobelli ,&nbsp;Matteo Ferro ,&nbsp;Francesco Porpiglia ,&nbsp;Daniele Amparore ,&nbsp;Antonio Tufano ,&nbsp;Sisto Perdonà ,&nbsp;Hooman Djaladat","doi":"10.1016/j.urolonc.2025.03.001","DOIUrl":"10.1016/j.urolonc.2025.03.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate survival outcomes and recurrence patterns by pathologic nodal status in upper tract urothelial carcinoma (UTUC) patients receiving neoadjuvant chemotherapy (NAC) prior to radical nephroureterectomy (RNU) and lymph node dissection (LND).</div></div><div><h3>Materials and Methods</h3><div>Using the international ROBUUST 2.0 database, a retrospective analysis of UTUC patients who underwent robotic/laparoscopic RNU+LND±NAC was performed. Patients were stratified by NAC and pathologic nodal status into pN0, ypN0, pN+, and ypN+ subgroups. Overall (OS), metastasis-free (MFS), and urothelial recurrence-free survivals (RFS) were compared using Kaplan-Meier curves and multivariable Cox regression modeling.</div></div><div><h3>Results</h3><div>The cohort included 883 patients (15% received NAC). 212 (24%) patients had (y)pN+ disease. Median follow-up was 19 months. Compared to pN+ patients, ypN+ patients had significantly worse 1- (64% vs. 72%), 3- (40% vs. 54%), and 5-year (20% vs. 31%) OS rates. Node-negative patients had similar OS, irrespective of NAC treatment (1-year: 94%; 3-year: 77%–82%). At 1 year, all ypN+ patients had metastases, while 13% of pN+ patients remained metastasis-free. Among ypN+ patients, 89% experienced nodal/regional or distant metastases as the site of initial recurrence, compared to 39% of pN+ patients. Initial nodal/regional or distant metastases occurred in 42% and 18% of ypN0 and pN0 patients, respectively.</div></div><div><h3>Conclusion</h3><div>ypN+ patients have worse survival compared to pN+ patients. Recurrence patterns differ by nodal and NAC status, with ypN+ patients having a significantly higher incidence of nodal/regional or distant metastases as the initial site of recurrence. These survival outcomes and recurrence patterns differences may have important surveillance and treatment implications.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 441.e19-441.e27"},"PeriodicalIF":2.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711026","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":"Application of RNA sequencing in urologic malignancies: Advances and challenges.","authors":"Khaleel I Al-Obaidy, Liang Cheng","doi":"10.1016/j.urolonc.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.007","url":null,"abstract":"<p><p>RNA sequencing became a key tool in identifying the differences between cells and their functions, aiding in the recognition of the functional elements disrupted during the disease process. In urologic malignancies, many studies aiming to provide comprehensive molecular classifications through the assessment of RNA expression or fusion analysis have been published. The distinctive presence of these molecular alterations related to cancer development, growth, and survival and the discoveries of these breakthrough studies provide insight into the development of personalized management and aid in the identification of new therapeutic targets.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693025","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 performance of high-resolution micro-ultrasound and conventional ultrasound in fusion biopsy for clinically significant prostate cancer detection","authors":"Ghazal Khajir ,&nbsp;Lindsey T. Webb ,&nbsp;Soum D. Lokeshwar ,&nbsp;Gabriela M. Diaz ,&nbsp;Taira Anderson ,&nbsp;Ankur U. Choksi ,&nbsp;Julian Zhao ,&nbsp;Michael S. Leapman ,&nbsp;Preston C. Sprenkle ,&nbsp;Joseph F. Renzulli","doi":"10.1016/j.urolonc.2025.03.006","DOIUrl":"10.1016/j.urolonc.2025.03.006","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to evaluate the diagnostic outcomes of MRI-ultrasound fusion targeted biopsy in detecting clinically significant prostate cancer (csPCa) using either microUS technology or conventional ultrasound.</div></div><div><h3>Methods</h3><div>We identified a matched sample of 899 patients who underwent biopsy at a single institution between January 2017 and January 2023. A paired group of 470 patients was included. The proportion of cancers detected (any cancer and grade group (GG) ≥ 2) was compared between MRI-microUS and MRI-conventional US fusion biopsy groups.</div></div><div><h3>Results</h3><div>The overall incidence of GG ≥ 2 cancer was similar between MRI-microUS and MRI-conventional US fusion biopsy groups (53.6% vs. 55.3%, <em>P</em> &gt; 0.05). In patients undergoing MRI-microUS fusion biopsy, detection of any cancer in SB was greater than TB (69.2% vs. 57.1%, <em>P</em> &lt; 0.001), while GG ≥ 2 detection was similar between SB and TB (44.9% vs. 40.5%, <em>P</em> = 0.06). Moreover, detection of any cancer and GG ≥ 2 using TB were lower in the MRI-microUS fusion biopsy group. On multivariable analysis, age, race, biopsy status, PSA density, and PI-RADS score were significantly associated with detection of GG ≥ 2.</div></div><div><h3>Conclusion</h3><div>MicroUS-guided biopsy and conventional US-guided biopsy had similar rates of overall csPCa detection. Targeted biopsy using MRI-microUS fusion yielded lower overall and csPCa detection compared with MRI-conventional US fusion biopsy. MicroUS fusion biopsy is a reasonable alternative to conventional biopsy to detect csPCa.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 399.e1-399.e8"},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693031","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 perioperative activity levels and discharge outcomes after radical cystectomy.","authors":"Ryan S Lee, Mazyar Zahir, Antoin Douglawi, Seyedeh Sanam Ladi-Seyedian, Chirag Doshi, Alireza Ghoreifi, Madeleine Burg, Azadeh Nazemi, Siamak Daneshmand","doi":"10.1016/j.urolonc.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.005","url":null,"abstract":"<p><strong>Introduction: </strong>Early postoperative ambulation shortens the recovery of radical cystectomy (RC). This study aims to evaluate the potential associations between perioperative activity levels, measured by wearable fitness trackers (WFTs), and discharge outcomes after RC.</p><p><strong>Methods: </strong>In this prospective study, patients undergoing RC between 2017 and 2019 wore WFTs from a maximum of 2 weeks preoperatively, throughout their hospitalization, and up to 2 weeks after discharge. Activity levels were recorded as daily steps and calorie expenditure. Primary outcomes of interest were discharge disposition to a nursing facility and prolonged length of stay (LOS ≥ 5 days).</p><p><strong>Results: </strong>A total of 55 patients (80.0% male), with a median (IQR) age of 74 (65.0-79.5) years participated in the study, wearing the WFTs for a median of 18 (14.5-23) days. Twenty-seven (49%) patients had neobladders, and 11 (20.0%) were discharged to a nursing facility. The median LOS at the hospital was 4 (3.5-6) days. Patients with ileal conduit and those discharged to a nursing facility had significantly lower preoperative daily step counts compared to those who had neobladder and were discharged to home, respectively (both P < 0.05). Patients with prolonged LOS had lower daily calorie expenditure preoperatively (1,970 vs. 2,490, P < 0.001), and during hospitalization (1,850 vs. 2,070, P = 0.009).</p><p><strong>Conclusion: </strong>Lower preoperative calorie expenditure and step counts are associated with prolonged LOS and higher rates of discharge to nursing facilities. Larger studies are required to determine whether lower baseline activity can affect clinical outcomes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693313","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":"Convalescence after radical orchiectomy: Detailing surgical recovery with a novel electronic patient reported outcome (ePRO) platform","authors":"Samuel A. Gold M.D. ,&nbsp;Viranda H. Jayalath M.D. ,&nbsp;Rebecca Yu M.S. ,&nbsp;Fady Baky M.D. ,&nbsp;Nicole Liso B.A. ,&nbsp;Brandon Williams ,&nbsp;Amy L. Tin M.A. ,&nbsp;Sigrid Carlsson M.D. ,&nbsp;Jennifer Cracchiolo M.D. ,&nbsp;Andrew J. Vickers Ph.D. ,&nbsp;Joel Sheinfeld M.D. ,&nbsp;Richard S. Matulewicz M.D.","doi":"10.1016/j.urolonc.2025.02.018","DOIUrl":"10.1016/j.urolonc.2025.02.018","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess implementation of an electronic patient reported outcomes platform, Recovery Tracker, which characterizes short term recovery following radical orchiectomy in patients with testicular cancer.</div></div><div><h3>Methods</h3><div>Recovery Tracker was assigned based on procedure codes to patients undergoing radical orchiectomy at our institution. Patients were surveyed daily for the 10-day postoperative period in multiple symptom domains. To assess implementation outcomes, responders of at ≥1 survey were compared to nonresponders based on demographic and disease characteristics. Responses were described to ascertain recovery across domains. Clinically significant symptoms were identified based on reporting “moderate” or greater severity, or “occasional” or higher frequency answers.</div></div><div><h3>Results</h3><div>From 06/2021 to 10/2023, 244 patients underwent orchiectomy. 236 (97%) were assigned a survey and 206 (87%) completed ≥1 survey. American Society of Anesthesiologists score of 3-4 (a measure of health comorbidities for which higher scores indicate worse overall health) was associated with worse response rates (<em>P</em> = 0.014). There were no other differences in survey response rates among demographic or disease factors, including clinical stage. There were no Clavien-Dindo Grade ≥2 30-day postoperative complications and 2 (0.8%) Grade 1 complications. Regarding symptomatology, only “pain” and “limited activities due to pain” were reported to be moderate/severe among most patients early in the postoperative period. After postoperative day 5, very few patients reported moderate or severe symptoms.</div></div><div><h3>Conclusions</h3><div>Recovery Tracker was successfully assigned to and completed by nearly all patients undergoing radical orchiectomy. Convalescence data establishes clear recovery benchmarks to provide preoperative guidance on expected symptoms and identify potential abnormal postoperative courses for rapid intervention.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 399.e15-399.e21"},"PeriodicalIF":2.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674495","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 cuff excision at radical nephroureterectomy improved survival in upper tract urothelial carcinoma","authors":"Francesco Di Bello ,&nbsp;Carolin Siech ,&nbsp;Mario de Angelis ,&nbsp;Natali Rodriguez Peñaranda ,&nbsp;Letizia Maria Ippolita Jannello ,&nbsp;Zhe Tian ,&nbsp;Jordan A. Goyal ,&nbsp;Claudia Collà Ruvolo ,&nbsp;Gianluigi Califano ,&nbsp;Francesco Mangiapia ,&nbsp;Fred Saad ,&nbsp;Shahrokh F. Shariat ,&nbsp;Ottavio de Cobelli ,&nbsp;Alberto Briganti ,&nbsp;Felix K.H. Chun ,&nbsp;Salvatore Micali ,&nbsp;Nicola Longo ,&nbsp;Pierre I. Karakiewicz","doi":"10.1016/j.urolonc.2025.02.014","DOIUrl":"10.1016/j.urolonc.2025.02.014","url":null,"abstract":"<div><h3>Objective</h3><div>To test for survival differences after radical nephroureterectomy (RNU) in pT1-T3N0 upper tract urothelial carcinoma (UTUC) patients according to bladder cuff excision (BCE) status.</div></div><div><h3>Methods</h3><div>Within the Surveillance, Epidemiology, and End Results database (2004–2020), we identified RNU patients and documented BCE status. Prior and after propensity score matching (ratio 1:1), cumulative incidence plots and competing risk regression (CRR) models addressed cancer specific mortality (CSM) and other-cause mortality (OCM).</div></div><div><h3>Results</h3><div>Of 4,426 RNU-treated patients, 3,186 (72%) patients underwent BCE and 1,240 (28%) did not. BCE rates significantly increased over time from 65.2 to 77.0% (EAPC: +1.0%, 95% CI +0.4 to +1.6%, <em>P</em> = 0.004) between 2004 and 2020. After 1:1 propensity score matching for T stage, 1,240 of 1,240 (100%) RNU patients without BCE and 1,240 of 3,186 (39%) RNU patients with BCE were included in subsequent analyses. Five-year CSM rates were 30% in RNU with BCE vs. 36% in RNU without BCE patients (Δ = 6%). In multivariable CRR, RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70–0.93; <em>P</em> &lt; 0.001). Conversely, BCE status did not affect OCM (<em>P</em> = 0.4).</div></div><div><h3>Conclusion</h3><div>The rate of guideline recommended BCE at RNU increased over time. Additionally, RNU with BCE is associated with significantly lower CSM than RNU without BCE in pT1-T3N0 UTUC patients. In consequence, BCE should represent an integral part of a comprehensive RNU.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 442.e1-442.e7"},"PeriodicalIF":2.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674487","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 tobacco use on postoperative complications following partial nephrectomy","authors":"José Ignacio Nolazco M.D., M.M.Sc. ,&nbsp;Kevin R. Melnick M.D. ,&nbsp;Jeffrey Che-Wei Chang M.D., M.P.H. ,&nbsp;Madhur Nayan M.D., Ph.D. ,&nbsp;Yuzhe Tang M.D., Ph.D., M.M.Sc. ,&nbsp;Dejan K. Filipas M.D. ,&nbsp;Krzysztof Przewoźniak Ph.D. ,&nbsp;Stênio de Cássio Zequi M.D., M.Sc., Ph.D. ,&nbsp;Leonardo O. Reis M.D., M.Sc., Ph.D., M.B.A. ,&nbsp;Khalid Y. Alkhatib M.D., M.M.Sc. ,&nbsp;Michael S. Leapman M.D., M.H.S. ,&nbsp;David E. Hinojosa-Gonzalez M.D. ,&nbsp;Marc A. Bjurlin D.O., M.Sc. ,&nbsp;Matthew Mossanen M.D., M.P.H. ,&nbsp;Benjamin I. Chung M.D., M.S. ,&nbsp;Steven Lee Chang M.D., M.S.","doi":"10.1016/j.urolonc.2025.02.020","DOIUrl":"10.1016/j.urolonc.2025.02.020","url":null,"abstract":"<div><h3>Purpose</h3><div>While tobacco use has been associated with postoperative surgical complications, its specific impact on postoperative outcomes following partial nephrectomy remains incompletely understood. Therefore, we aim to investigate the association between tobacco use and the incidence and severity of 90-day postoperative complications in patients who underwent partial nephrectomy.</div></div><div><h3>Materials and Methods</h3><div>A cross-sectional study was conducted using the Premier Healthcare Database (2010–2019). Our primary outcome was the occurrence of 90-day postoperative complications, classified according to the Dindo-Clavien system. Multinomial logistic regression, adjusted for confounders, estimated the association between tobacco use and the risk of postoperative complications, including 90-day mortality. Predicted probabilities of postoperative complications were calculated from the regression analysis.</div></div><div><h3>Results</h3><div>The study included 44,392 patients (median age 56.3; 66.1% males) who underwent elective partial nephrectomy. Among them, 16,048 (36.15%) were tobacco users. Tobacco users were generally younger, less frequently married, predominantly of white ethnicity, and had elevated Charlson Comorbidity Index scores as compared to nonusers. Multinomial logistic regression revealed that tobacco use was significantly associated with increased odds of 90-day postoperative minor complications (OR 1.19, 95% CI 1.14–1.24), major complications (OR 1.41, 95% CI 1.31–1.52), and mortality (OR 1.5, 95% CI 1.01–2.24).</div></div><div><h3>Conclusions</h3><div>In our cohort, tobacco use significantly increased the risk of minor and major postoperative complications, as well as mortality, in patients undergoing partial nephrectomy. These findings emphasize the importance of tailored preoperative smoking cessation programs to mitigate these risks.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 395.e13-395.e21"},"PeriodicalIF":2.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670828","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":"Predicting pathological tumor volume in prostate cancer lesions: A head-to-head comparison of micro-ultrasound vs. MRI","authors":"Adrien Richemond ,&nbsp;Max Peters ,&nbsp;Sandy Schaer ,&nbsp;Julien Dagher ,&nbsp;Stefano La Rosa ,&nbsp;Jade Matthey ,&nbsp;Naik Vietti-Violi ,&nbsp;Beat Roth ,&nbsp;Ilaria Lucca ,&nbsp;Massimo Valerio ,&nbsp;Arnas Rakauskas","doi":"10.1016/j.urolonc.2025.02.015","DOIUrl":"10.1016/j.urolonc.2025.02.015","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Our objective was to evaluate the agreement between micro-ultrasound, MRI and pathological tumor and prostate volume.</div></div><div><h3>Methods</h3><div>Retrospective analysis of consecutive prostate cancer patients with MRI and micro-ultrasound diagnostic assessment who subsequently underwent radical prostatectomy. Tumor and prostate volume on micro-ultrasound and MRI imaging calculated by a dedicated software were compared to those of the prostatectomy specimen. Clinical, radiological, and pathological predictors of pathological tumor size were assessed.</div></div><div><h3>Results</h3><div>65 men with a total of 104 lesions in the final pathology were included. Median micro-ultrasound tumor size was 1.05 ml (IQR 0.35–2.65). On MRI T2WI, DWI and ADC sequences median tumor volume was 0.73 ml (IQR 0.34–1.94), 0.94 ml (IQR 0.38–2.09) and 0.86 ml (IQR 0.42–1.58), respectively. The pathological median tumor size was 1.2 ml (IQR 0.2–3.9). On average, micro-ultrasound underestimated pathological tumor volume by 0.15 ml (<em>P</em> &lt; 0.01) while DWI, the most precise MRI sequence underestimated tumor size by 0.26 ml (<em>P</em> &lt; 0.01). The MRI and micro-ultrasound underestimated the pathological prostate volume by 6 ml (<em>P</em> &lt; 0.01) and 3 ml (<em>P</em> = 0.47), respectively.</div></div><div><h3>Conclusions</h3><div>Both micro-ultrasound and MRI tend to slightly underestimate pathological tumor and prostate volume. Our study shows that both micro-ultrasound and MRI can be useful in the surgical planning although the underestimation of actual tumor size should be considered.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 398.e15-398.e21"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630843","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":"Transcriptomic and proteo-metabolic determinants of the grading system in clear cell renal cell carcinoma.","authors":"Giuseppe Lucarelli, Francesco Lasorsa, Martina Milella, Antonio d'Amati, Giuseppe Ingravallo, Mariella Silecchia, Mariella Errede, Cristina Bianchi, Marco Spilotros, Michele Battaglia, Pasquale Ditonno, Monica Rutigliano","doi":"10.1016/j.urolonc.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.02.016","url":null,"abstract":"<p><strong>Background: </strong>Pathological grade is a morphological parameter of clear cell-renal cell carcinoma (ccRCC) and an independent predictor of cancer-specific survival. The aim of this study was to identify grade-dependent metabolic signatures and corresponding gene and protein expression changes that connect variations in cancer metabolism with nuclear grade, especially in high-grade tumors.</p><p><strong>Methods: </strong>Forty ccRCC samples were collected and stratified according to nuclear grade: 23 low-grade (LG = G1-G2) and 17 high-grade (HG = G3-G4) samples. In addition, 122 patients with sarcomatoid ccRCC (sRCC) were classified according to the abundance of sarcomatoid features as low sarcomatoid (LS; sarcomatoid component<20%; n = 67) or high sarcomatoid (HS; sarcomatoid component≥20%; n = 55). Untargeted metabolomic analysis was performed. To study the relative changes in gene and protein expression in HG vs. LG ccRCC, data from 4 different datasets were downloaded and stratified according to nuclear grade. Immunohistochemistry and immunofluorescence were used to evaluate protein expression. Cancer-specific survival (CSS) and progression-free survival (PFS) were calculated using Kaplan-Meier analysis. Multivariate analysis was performed using a Cox regression model.</p><p><strong>Results: </strong>The Warburg effect, in association with changes in Krebs cycle intermediates and related metabolites, was more prominent in HG ccRCC than in LG ccRCC. Additional alterations included metabolic reprogramming in the urea cycle and modulation of glutathione metabolism with the accumulation of reduced glutathione and carnitine derivatives in HG tumors, while the concentrations of long- and medium-chain fatty acids were greater in LG ccRCC. CSS and PFS were significantly decreased in patients with HS tumors. According to the multivariate analysis, the abundance of the sarcomatoid component was an adverse prognostic factor.</p><p><strong>Conclusions: </strong>ccRCC is characterized by a particular grade-dependent metabolic reprogramming. Metabolic pathways and associated molecular alterations are grade-specific and could represent potential therapeutic targets, especially in HG tumors. sRCC subclassification based on the abundance of sarcomatoid components into HS vs. LS tumors have prognostic value.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626118","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}