Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Neoadjuvant chemotherapy before radical cystectomy in patients with organ-confined and non-organ-confined urothelial carcinoma","authors":"Mario de Angelis M.D. ,&nbsp;Letizia Maria Ippolita Jannello M.D. ,&nbsp;Carolin Siech M.D. ,&nbsp;Andrea Baudo M.D. ,&nbsp;Francesco Di Bello M.D. ,&nbsp;Jordan A. Goyal ,&nbsp;Zhe Tian M.Sc ,&nbsp;Nicola Longo M.D. ,&nbsp;Ottavio de Cobelli M.D. ,&nbsp;Felix K.H. Chun M.D. ,&nbsp;Fred Saad M.D., Ph.D. ,&nbsp;Shahrokh F. Shariat M.D., Ph.D. ,&nbsp;Luca Carmignani M.D. ,&nbsp;Giorgio Gandaglia M.D. ,&nbsp;Marco Moschini M.D., Ph.D. ,&nbsp;Francesco Montorsi M.D. ,&nbsp;Alberto Briganti M.D., Ph.D. ,&nbsp;Pierre I. Karakiewicz M.D.","doi":"10.1016/j.urolonc.2024.09.015","DOIUrl":"10.1016/j.urolonc.2024.09.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is guideline-recommended in patients with cT2-T4N0M0 urothelial carcinoma of urinary bladder (UCUB). However, no population-based study validated the survival benefit of NAC recorded in clinical trials in a stage-specific fashion. We addressed this knowledge gap.</div></div><div><h3>Methods</h3><div>Within the Surveillance, Epidemiology, and End Results database (2007–2020), we identified patients with cT2-T4N0M0 UCUB treated with NAC before RC versus RC alone. Cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. Survival analyses were performed according to organ confined (OC: cT2N0M0) versus nonorgan confined stages (NOC: cT3-T4N0M0).</div></div><div><h3>Results</h3><div>Of 3,743 assessable patients, 1,020 (27%) underwent NAC versus 2,723 (73%) RC alone. NAC rates increased over time in OC stage (EAPC = 11.9%, <em>P</em> &lt; 0.001) and NOC stage (EAPC = 8.6%, <em>P</em> &lt; 0.001). In OC stage, cumulative incidence plots derived 5-year CSM was 15.6% in NAC and 19.9% in RC alone patients (<em>P</em> = 0.008). In multivariable CRR models, NAC independently predicted lower CSM (hazard ratio (HR): 0.74, <em>P</em> = 0.01). Similarly, in NOC stage, cumulative incidence plots derived 5-year CSM was 36.1% in NAC and 46.0% in RC alone patients (<em>P</em> = 0.01). In multivariable CRR models, NAC independently predicted lower CSM (HR: 0.66, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>NAC is associated with improved CSM compared to RC alone, both in OC and NOC stages. Specifically, the magnitude of the protective NAC effect was greater in NOC than OC patients. Thus, NAC should always be administered in all eligible patients before RC.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 1","pages":"Pages 62.e1-62.e6"},"PeriodicalIF":2.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475861","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 nephrectomy: Indications, patient selection, and setup for success.","authors":"Patrick Etta, Michael Chien, Yuzhi Wang, Amit Patel","doi":"10.1016/j.urolonc.2024.08.021","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.08.021","url":null,"abstract":"<p><p>Robot-assisted partial nephrectomy (RAPN) has readily become the benchmark treatment of small renal masses (SRMs). The management of SRMs is focused on preserving renal function and limiting the morbidity of a traditional open operation, thus greatly impacting overall prognosis and long-term survival. Indications and techniques have evolved over the last 2 decades. In this article, we discuss the application of this nephron-sparing technique regarding its indications, surgical considerations, and functional outcomes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475878","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":"Real-world treatment patterns and outcomes of patients with unresectable or metastatic urothelial carcinoma receiving systemic therapy in Japan.","authors":"Shotaro Yasuoka, Toshihiko Minegishi, Shingo Kojima, Kotoba Okuyama, Toshiki Fukasawa, Mizuho Akahane, Hidetoshi Uenaka, Yuichiro Ito, Makito Miyake","doi":"10.1016/j.urolonc.2024.09.020","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.09.020","url":null,"abstract":"<p><strong>Background: </strong>Cisplatin-based chemotherapy has traditionally been the standard treatment for unresectable or metastatic urothelial carcinoma (mUC). Recently, the longstanding paradigm has changed with the emergence of immune checkpoint inhibitors and antibody-drug conjugates, such as pembrolizumab and enfortumab vedotin (EV). This longitudinal descriptive study aimed to identify real-world treatment patterns and assess the outcomes of patients with mUC between 2010 and 2023.</p><p><strong>Methods: </strong>Patients with mUC who received first-line systemic therapy were identified from a Japanese electronic medical records database. A Sankey diagram was used to present the proportion of patients who transitioned to second- and third-line therapies. Kaplan-Meier survival analysis was used to estimate the time to next treatment (TTNT) and overall survival (OS).</p><p><strong>Results: </strong>A total of 794 patients were included in this study. The median age of the patients was 73.0 years, and 72.9% were male. The most common primary tumor site was the bladder (59.7%). First-line therapy comprised cisplatin-based regimens in 52.0% of the patients (11.8% at standard doses, 32.4% at reduced doses, and 7.8% at unknown doses), carboplatin-based regimens in 32.1%, and other regimens in 15.9%. Among the patients enrolled after 2017, following the approval of pembrolizumab for mUC progressing after chemotherapy in Japan, 58.2% received pembrolizumab as second-line therapy, and 19.1% received EV monotherapy as third-line therapy. The median OS for the total population was 24.1 months, with patients enrolled between 2010 and 2016 having a shorter OS (21.1 months) than those enrolled between 2017 and 2022 (24.9 months). For patients with eGFRs of ≥60 and <60 mL/min/1.73 m², the median OS was 24.1 and 23.8 months, respectively.</p><p><strong>Conclusion: </strong>Platinum-based regimens, including reduced-dose cisplatin and carboplatin, remain the predominant first-line systemic therapies. Since 2017, pembrolizumab and EV have become widespread choices for second-line and subsequent treatments, gradually surpassing the previously prevalent platinum-based regimens. The introduction of these novel therapies might have prolonged the OS of patients with mUC. A plain language summary is available in this article.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475877","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":"Unveiling LGR5: Prostate cancer's hidden stem cell and treatment target","authors":"Yashvi Patel,&nbsp;Akhilesh Prajapati","doi":"10.1016/j.urolonc.2024.10.001","DOIUrl":"10.1016/j.urolonc.2024.10.001","url":null,"abstract":"<div><div>Prostate cancer poses a significant risk to the well-being and way of life of countless men, with an increased likelihood of relapse recorded following modern treatment. This highlights the need for innovative approaches, specifically targeting LGR5. This systematic review aims to establish a connection between LGR5 and the various signaling pathways involved in the progression of prostate cancer. LGR5, a gene targeted by Wnt signaling, encodes a receptor protein that serves as a prognostic biomarker for stem cells and indicates the presence of cancer stem cells in colorectal and gastrointestinal cancers. The functions of LGR5 include processes such as cell proliferation, differentiation, and signaling pathways. Any modifications to the LGR5 gene, whether caused by mutations or mechanical stimuli, can lead to the development of treatment-resistant stem cell cancers. This review examines the molecular mechanisms associated with LGR5 and emphasizes methodologies aimed at targeting LGR5 to enhance understanding and promote the development of LGR5-specific therapies.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"42 12","pages":"Pages 438-446"},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475880","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":"Comparing direct medical care costs of patients with bladder cancer who received an ileal conduit vs. neobladder in the year following cystectomy.","authors":"Matthew P Banegas, Maureen O'Keeffe Rosetti, Scott M Gilbert, Marilyn L Kwan, Michael C Leo, Kim N Danforth, Joanna Bulkley, Sheila Weinmann, David K Yi, Valerie S Lee, Carmit McMullen","doi":"10.1016/j.urolonc.2024.09.031","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.09.031","url":null,"abstract":"<p><strong>Purpose: </strong>Bladder cancer is 1 of the most costly cancers, however there is limited research on medical care costs by type of urinary diversion. The objective of our study was to compare medical care costs of the 2 most common urinary diversions in the year following radical cystectomy.</p><p><strong>Methods: </strong>The Bladder Cancer Quality of Life Study included patients diagnosed with bladder cancer who underwent radical cystectomy and received an ileal conduit (IC, n = 821) or neobladder (NB, n = 181) in 3 integrated health systems. Medical care costs per patient per quarter were estimated for the year following cystectomy. Multivariable generalized linear models with a gamma distribution and log link were used to estimate mean monthly medical care costs (2022 USD$), adjusted for patient demographic and clinical characteristics.</p><p><strong>Results: </strong>In multivariable analysis, mean monthly costs per quarter were not significantly different between IC and NB patients in the 12 months following cystectomy. Overall, mean monthly costs in IC and NB patients were highest during the first quarter and decreased thereafter. Factors associated with higher mean costs across all quarters included presence of any complications and advanced tumor stage at cystectomy (all P < 0.001).</p><p><strong>Conclusion: </strong>Our study addresses an important knowledge gap by quantifying the medical costs of bladder cancer patients by urinary diversion type and comparing costs of different treatment approaches. Studies that assess patient-reported outcomes and out-of-pocket costs, by urinary diversion type, are warranted to inform treatment decision-making and cost conversations.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475858","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":"Investigating the pattern of prostate specific antigen screening among E-cigarette smokers within the behavioral risk factor surveillance system.","authors":"Filippo Dagnino, Zhiyu Qian, Muhieddine Labban, Daniel Stelzl, Hanna Zurl, Stephan Korn, Edoardo Beatrici, Giovanni Lughezzani, Nicolò M Buffi, Stuart R Lipsitz, Adam S Kibel, Nora Osman, Quoc-Dien Trinh, Alexander P Cole","doi":"10.1016/j.urolonc.2024.09.036","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.09.036","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>E-cigarettes use has recently increased, even among older individuals quitting smoking. Though past studies suggest tobacco smokers may avoid cancer screening, the relationship between e-cigarette uses and preventive health behaviors like prostate specific antigen screening is uncertain. We assessed the relationship between self-reported e-cigarette smoking and prostate specific antigen screening utilization among US adults with a history of e-cigarette use.</p><p><strong>Materials and methods: </strong>We included men aged 50-69 years, who provided responses regarding PSA screening receipt and smoking status, from Behavioral Risk Factor Surveillance System 2020 and 2022 surveys. Primary outcome was PSA screening receipt. Multivariable regression model was performed to investigate the association between smoking status (never-smokers, current or former e-cigarette smokers, current or former tobacco smokers) and PSA screening.</p><p><strong>Results: </strong>We included a weighted population of 8.1 million men aged 50-69. 2.3 million (28.3%) received PSA screening. 3.9 million (48.2%) were never-smokers. 1.3 million (16.6%) were from e-cigarettes smokers group, and 2.9 million (35.2%) were from tobacco smokers group. E-cigarettes smokers were less likely to receive PSA screening within last 2 years (0.76 [0.66-0.88]) than never-smokers. No significant difference in PSA screening was detected between never-smokers and tobacco smokers (0.91 [0.82-1.02]). E-cigarette smokers were less likely to receive PSA screening within the selected time frame (0.84 [0.72-0.97]) than tobacco smokers. When examining potential mediation by primary care visits, e-cigarette smokers were less likely to have had a check-up visit in past 2 years than tobacco smokers (0.77 [0.65-0.92]).</p><p><strong>Conclusions: </strong>E-cigarette smokers were less likely to undergo PSA screening than never-smokers and tobacco smokers, possibly due to reduced use of primary care services.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475860","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":"Critical care therapy and in-hospital mortality after radical nephroureterectomy for nonmetastatic upper urinary tract carcinoma.","authors":"Francesco Di Bello, Carolin Siech, Mario de Angelis, Natali Rodriguez Peñaranda, Zhe Tian, Jordan A Goyal, Claudia Collà Ruvolo, Gianluigi Califano, Massimiliano Creta, Fred Saad, Shahrokh F Shariat, Alberto Briganti, Felix K H Chun, Stefano Puliatti, Nicola Longo, Pierre I Karakiewicz","doi":"10.1016/j.urolonc.2024.09.035","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.09.035","url":null,"abstract":"<p><strong>Background: </strong>Use of critical care therapies (CCT), that include invasive mechanical ventilation (IMV), total parenteral nutrition (TPN) and other modalities are unknown after radical nephroureterectomy (RNU) for upper urinary tract carcinoma (UUTC). Their relationship with in-hospital mortality is also unknown.</p><p><strong>Methods: </strong>Within the National Inpatient Sample (2008-2019), we identified non-metastatic UUTC patients treated with RNU. Multivariable logistic regression models were used.</p><p><strong>Results: </strong>Of 8,995 patients, 375 (4.2%) received CCT and 82 (0.9%) experienced in-hospital mortality. Of CCT modalities, 215 (2.4%) received IMV and 139 (1.5%) TPN. Temporal CCT, IMV, and TPN trends very closely followed in-hospital mortality trends. Relative to historical UUTC patients (2008-2013), contemporary (2014-2019) patients exhibited lower CCT (Δ = 2.2%, P value < 0.0001), lower IMV (Δ = 1.4%, P < 0.0001), lower TPN (Δ = 2.2%, P < 0.0001), and lower in-hospital mortality (Δ = 0.4%, P = 0.03) rates. Of in-hospital mortalities, 52 out of 82 received CCT but 30 of 82 did not. Median age (> 72 years; odds ratio [OR] 1.4; P = 0.002) and Charlson comorbidity index ≥ 3 (OR 4.1; P < 0.001) and ≥ 1-2 (OR 1.7; P = 0.001) independently predicted overall higher CCT, IMV, TPN, and in-hospital mortality.</p><p><strong>Conclusion: </strong>After RNU, CCT rates parallels in-hospital mortality rates. CCT represents a 5 to 6-fold multiple of in-hospital mortality rate. In RNU patients, CCT rates are higher in older and sicker individuals. Lower CCT rates that are paralleled by lower in-hospital mortality may be interpreted as an indicator of improved quality of care. Ideally all in-hospital mortalities should be predated by CCT exposure.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475859","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":"Tumor location at trans-urethral resection is predictive of ipsilateral pelvic lymph-nodal metastases in patients undergoing radical cystectomy for bladder cancer.","authors":"Francesco Cianflone, Giovanni Mazzucato, Emanuele Rubilotta, Rossella Orlando, Nicola De Maria, Michele Boldini, Francesca Fumanelli, Francesca Montanaro, Greta Pettenuzzo, Luca Roggero, Alessandra Gozzo, Alberto Bianchi, Alessandro Veccia, Riccardo Giuseppe Bertolo, Maria Angela Cerruto, Alessandro Antonelli","doi":"10.1016/j.urolonc.2024.09.037","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.09.037","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether tumor location at diagnostic TURBT is predictive of ipsilateral nodal involvement in patients who underwent radical cystectomy (RC) with lymph-nodes dissection for bladder cancer (BCa).</p><p><strong>Materials and methods: </strong>All patients who underwent RC for BCa at a single institution between 2014-2023 were assessed. Tumor location at TURBT was defined as right-sided, median-line, left-sided, and diffused. Distribution in the percentage of ipsilateral positive lymph-nodes and number of ipsilateral positive lymph-nodes between tumor locations were assessed with Kruskal-Wallis tests. Linear regressions were fitted to assess whether left or right location, compared to the remaining locations grouped, was associated to the percentage and number of positive ipsilateral lymph-nodes.</p><p><strong>Results: </strong>239 patients were included. The number of ipsilateral positive lymph nodes was superior in right-sided tumors when compared to the rest of the bladder (0, I.Q.R. 0-1 vs. 0, I.Q.R. 0-0, P = 0.047), as well as the percentage of ipsilateral positive lymph-nodes (0, I.Q.R. 0-14.3 vs. 0, I.Q.R. 0-3.7, P = 0.042). The number of ipsilateral positive lymph-nodes in left-sided tumors was superior when compared to the rest of the bladder (0, I.Q.R. 0-1 vs. 0, I.Q.R. 0-0, P = 0.02), as well as the percentage (0, I.Q.R. 0-13.7 vs. 0, I.Q.R. 0-0, P = 0.036). At linear regression analyses, right- and left-sided tumors were associated with an increased percentage of ipsilateral positive lymph-nodes (P = 0,019 and P = 0,003) out of the total ipsilateral lymph-nodes excised.</p><p><strong>Conclusions: </strong>Lateral wall tumor location at diagnostic TURBT (either right or left side) predicts a higher percentage of ipsilateral positive lymph-nodes s/p RC.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475879","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":"Oncologic outcomes of pelvic organ-preserving radical cystectomy vs. Standard radical cystectomy: A systematic review and meta-analysis.","authors":"David E Hinojosa-Gonzalez, Gal Saffati, Eric Wahlstedt, Madeline Chaput, Sagar R Patel, Gustavo Salgado-Garza, Shane Kronstedt, Michal R Segall, Juan C Angulo-Lozano, Jeffrey A Jones, Jennifer M Taylor, Jeremy R Slawin","doi":"10.1016/j.urolonc.2024.09.024","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.09.024","url":null,"abstract":"<p><strong>Background and objective: </strong>Radical Cystectomy is indicated in muscle-invasive bladder cancer and select cases of nonmuscle invasive bladder cancer. Women often undergo additional reproductive organ removal, greatly impacting sexual function and quality of life. Pelvic organ-preserving radical cystectomy aims to mitigate these effects, but its oncologic outcomes are not well-defined. This presents a meta-analysis of available literature on oncological outcomes of pelvic organ-preserving radical cystectomy in women with muscle invasive disease.</p><p><strong>Methods: </strong>A systematic search across PubMed, Web of Science, Scopus, and Google Scholar was performed to identify studies comparing oncological outcomes between pelvic organ-preserving radical cystectomy and standard radical cystectomy in women with muscle-invasive bladder cancer or high-risk or recurrent nonmuscle invasive cancer. The search included English or Spanish studies, statistically comparing overall survival, cancer-specific survival, and recurrence-free survival. Statistical analysis used Review Manager, employing fixed or random-effects models based on heterogeneity.</p><p><strong>Key findings and limitations: </strong>Six retrospective studies met inclusion criteria, totaling 597 patients of which 303 received pelvic organ-preserving radical cystectomy and 294 received standard radical cystectomy. Overall Survival was not different between the 2 groups (HR 1.05 [0.77, 1.43]; P = 0.77). Cancer-Specific Survival also was found to be not different between the 2 groups (HR 1.27 [0.86, 1.87]; P = 0.22). Additionally, recurrence-free survival was not different between the 2 groups (HR 0.85 [0.41, 1.75]; P = 0.65. Four of the included studies exhibited a moderate risk of bias, with 1 study demonstrating low risk and the remaining study manifesting a serious risk of bias.</p><p><strong>Conclusion: </strong>The comparison showed no significant differences in overall survival, cancer-specific survival, or recurrence-free survival rates.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475862","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":"Prevalence of unnecessary kidney function exclusion criteria in urologic oncology clinical trials","authors":"Merrick Bank BA ,&nbsp;Madison Krischak MD ,&nbsp;Ted Skolarus MD, MPH ,&nbsp;Patrick Lewicki MD, MS ,&nbsp;Rishi Sekar MD, MS ,&nbsp;Lindsey Herrel MD, MSc ,&nbsp;Geoffrey D. Barnes MD, MSc ,&nbsp;Khurshid Ghani MBChB ,&nbsp;Gretchen Piatt MPH, PhD ,&nbsp;Randy Vince MD ,&nbsp;Kristian Stensland MD, MPH, MS","doi":"10.1016/j.urolonc.2024.08.017","DOIUrl":"10.1016/j.urolonc.2024.08.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical trials play a pivotal role in advancing treatments for people with cancer, but often struggle with low enrollment. Unnecessarily including kidney function eligibility criteria when a trial's interventions do not have any potential kidney effects may contribute to this problem by needlessly limiting the pool of eligible patients, adding complexity to the patient screening process, and raising issues of inequitable access to trials. For these reasons, we applied custom natural language processing to assess renal function eligibility criteria, and the appropriateness of these exclusions, within phase 3 urologic oncology trials.</div></div><div><h3>Methods</h3><div>We accessed all phase 3 urologic oncology trials registered on ClinicalTrials.gov from 2007 to 2021. We used a custom natural language processing script to extract kidney function requirements (e.g., creatinine, GFR) from trial free-text records. For each trial, we manually coded whether any trial intervention affected renal function or was renally excreted. Additionally, we recorded the formula used to calculate GFR in each trial.</div></div><div><h3>Results</h3><div>Of 850 trials, 299 (35%) listed kidney function eligibility restrictions, and 432 (51%) tested an intervention with possible renal effects. Of the 299 trials with kidney function exclusions, 124 (41%) tested interventions with no kidney effects.</div></div><div><h3>Conclusion</h3><div>There is a major disconnect in urologic oncology clinical trials between renal function exclusions and potential harm to the kidneys from the tested interventions. Standardizing eligibility criteria and restricting enrollment based on renal function only when necessary has the potential to increase the success, access, and applicability of clinical trials.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"42 12","pages":"Pages 452.e15-452.e19"},"PeriodicalIF":2.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406951","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}