Search

This study was designed to evaluate the impact of upper tract urothelial carcinoma (UTUC) history on prognosis in patients with non-muscle-invasive bladder cancer (NMIBC) receiving intravesical chemotherapy. We conducted a single center, retrospective, cohort study of 444 NMIBC patients who received intravesical chemotherapy after transurethral resection of the bladder cancer (TURBT) at Peking University People's Hospital from 2000 to 2015. Patients were divided into UTUC-NMIBC group (with UTUC history) and primary NMIBC group (without UTUC history) by presence of previous UTUC. Demographic, clinical and pathologic factors were analyzed. Kaplan–Meier curves and the log-rank test were used to depict and compare recurrence-free survival (RFS) and progression-free survival (PFS) between the two groups. Multivariable Cox regression models were constructed to determine the variables associated with RFS and PFS. Compared to the primary NMIBC group (n = 410), the UTUC-NMIBC group (n = 34) had an older median age [72.0 (65.0–81.0) vs. 66.0 (58–75) years; P = 0.007], a higher incidence of multiple tumors (52.9% vs. 33.9%; P = 0.026) and a higher recurrence rate (52.9% vs. 30.7%; P = 0.008) and worse RFS (P < 0.001). In multivariate analysis, UTUC history was an independent risk factor for recurrence (hazard ratio = 2.242; P = 0.001), but not for progression. Interestingly, subgroup analysis indicated patients with recent UTUC history (≤ 24 months between UTUC and NMIBC diagnoses) were associated with increased recurrence rates (73.7% vs. 26.7%; P = 0.014). Presence of UTUC history was an independent risk factor for recurrence in patients with NMIBC who received intravesical chemotherapy, especially in those with a shorter interval between UTUC and NMIBC diagnoses. [ABSTRACT FROM AUTHOR]

Background: The treatment paradigm of metastatic bladder cancer has remained largely unchanged for decades and the prognosis is extremely poor. This study aimed to evaluate the role of cystectomy in patients with single-site oligometastatic bladder cancer., Methods: Patients with single-site distant metastasis at the time of bladder cancer diagnosis from 2010-2017 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Cohorts were defined by target organ [bone, brain, lung, liver, distant lymph nodes (DLNs)] and then stratified by local treatment received [no surgery, transurethral resection of bladder tumor (TURBT) and cystectomy]. Patients not receiving chemotherapy were excluded. Two-year cancer specific survival (CSS) was assessed using Kaplan-Meier (K-M) analysis and multivariable Cox proportional hazards analysis, adjusting for demographic, clinical and pathologic factors., Results: A total of 1,381 patients met study criteria. K-M analysis indicated that cystectomy was associated with improved survival when compared to no surgery in patients with bone and DLNs metastasis. In multivariable analysis, patients with bone [hazard ratio (HR) =0.58; P=0.03] or DLNs (HR =0.51; P=0.005) metastasis who underwent cystectomy had a significant survival advantage over those receiving systemic therapy only. And patients with liver (HR =0.40; P=0.07) and lung (HR =0.84; P=0.58) who underwent cystectomy failed to exhibit superior survival than those receiving chemotherapy only. Patients with brain metastasis were omitted in subgroup analysis due to the limit of small sample size (n=20). In addition, the advent of immune checkpoint inhibitors improved the survival of patients, with HR of 0.78, indicating the reduction of death risk by 22%., Conclusions: Cystectomy in the setting of multimodality protocols may prolong survival in bladder cancer patients with single-site metastasis of the bone and DLNs. It should be considered in a multidisciplinary setting., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-586/coif). The authors have no conflicts of interest to declare., (Copyright © 2025 AME Publishing Company. All rights reserved.)

Background: Bladder cancer (BCa) is one of the most common tumors of the urinary system, imposing a significant societal burden. BCa is categorized into muscle-invasive BCa (MIBC) and non-MIBC (NMIBC) types. Radical cystoprostatectomy (RCP) is the standard treatment for MIBC and refractory NMIBC, but it can lead to serious side effects. Incidental prostate cancer (IPCa) is frequently found in RCP specimens, with varying incidence rates across ethnic groups, ranging from 7.3% to 60%. The clinical significance is unclear, and disparities in incidence and tumor characteristics exist within the Chinese population. The impact of IPCa on survival is debated, highlighting the need for research on its incidence and pathology for tailored interventions. This study aimed to compare the clinicopathological characteristics and prognostic significance of IPCa in RCP specimens taken from Chinese and Western BCa populations., Methods: Data from patients who underwent RCP in our hospital between 2008 and 2022 were collated and compared to data from the Surveillance, Epidemiology, and End Results (SEER) database between 2008 and 2019. Chi-squared and non-parametric testing were conducted with survival analysis to investigate differences between IPCa traits and their impact on prognosis., Results: Twenty-four IPCa cases were detected in 300 patients undergoing RCP, with a median age of 73 [interquartile range (IQR), 67-77] years. The median prostate-specific antigen (PSA) value was 2.81 (IQR, 1.19-4.81) ng/mL. 66.6% (n=16) had Gleason score (GS) ≤6 and all patients were stage T2. There were 315 IPCa patients in the 'Western' sample, with a median age of 68 (IQR, 63-74) years. The median PSA value was 1.9 (IQR, 0.9-4.1) ng/mL. 64.8% (n=204) had GS ≤6 and 93.0% (n=293) were stage T2. Comparative analysis showed that the clinicopathological features of IPCa were similar. Cox's regression analysis showed that T stage [hazard ratio (HR), 1.846; 95% confidence interval (CI): 1.394-2.444; P<0.001] and N stage (HR, 1.416; 95% CI: 1.011-1.984; P=0.04) of BCa were independent risk factors for cancer-specific survival (CSS). Advanced age (HR, 1.043; 95% CI: 1.018-1.069; P=0.001), T stage (HR, 1.569; 95% CI: 1.281-1.922; P<0.001), and N stage (HR, 1.317; 95% CI: 1.012-1.716; P=0.04) were independent risk factors for overall survival (OS). In the subgroup of patients with NMIBC, patients with clinically significant IPCa (csIPCa) had worse OS., Conclusions: There were significant differences in IPCa detection rates between Chinese and Western populations. The main factors affecting survival were patient age and stage of BCa. However, in the NMIBC population, OS for patients with csIPCa appears poorer and further research is required., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-441/coif). S.L. reports that this work was supported by the Peking University Medicine Sailing Program for Young Scholars’ Scientific & Technological Innovation (Grant No. BMU2023YFJHPY009, EBS No. 2127000305) and the Project Supported by Peking University People’s Hospital Research and Development Funds (No. RDJP2022-69). The other authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Objective: To assess health related quality of life (HRQOL) in patients with kidney stones and to predict risk factors for reduced HRQOL in the patients by the Chinese version of Wisconsin stone quality of life questionnaire (C-WISQOL)., Methods: The patients with renal stones admitted to Peking University People ' s Hospital from July 2020 to June 2021 were prospectively enrolled. The inclusion criteria included the patients with renal stones aged 18-80 years and sufficient Chinese language foundation, and the exclusion criteria included the patients with internal ureteral stents, malignant tumors, sepsis, etc . Demographic data and clinical data related to kidney stones were collected, and the C-WISQOL and the short form 36 health survey (SF-36) questionnaire completed by the patients was recorded. C-WISQOL included four domains (D): emotional impact (D1), social impact (D2), stone-related impact (D3) and vitality impact (D4). Cronbach ' s α coefficient was used to verify the internal consistency of C-WISQOL, Spearman ' s rho coefficient was used to verify the criterion validity between C-WISQOL and SF-36 questionnaire, confirmatory factor analysis was used to verify the structural validity, convergent validity and discrimination validity of C-WISQOL, and univariate and multivariate analyses were used to explore the risk factors leading to the decline of HRQOL in the patients with kidney stones., Results: The study included 307 patients with kidney stones, of whom 212 (69.1%) were male, with a mean age of (51.9±13.5) years, and a mean body mass index (BMI) of (25.4±3.6) kg/m 2 . 160 (52.1%) patients were complicated with metabolic syndrome (MS), 202 (65.8%) had history of calculi, 217 (70.7%) had calculi related symptoms, 53 (17.3%) had bilateral renal calculi, 82 (26.7%) had ureteral calculi, 199 (64.8%) had hydronephrosis, 78 (25.4%) had renal insufficiency, and urinary tract infection (UTI) was found in 168 patients (54.7%) with an average diameter of (15.6±5.9) mm. The mean total score of C-WISQOL questionnaire for all the patients was (94.9±13.7) points, D1 was (27.2±4.2) points, D2 was (23.8±3.7) points, D3 was (27.0±3.6) points, and D4 was (10.1±1.9) points. The Cronbach ' s α coefficient of the total score of C-WISQOL questionnaire was 0.968 and the four dimensions ranged from 0.860 to 0.898. The Spearman' s rho co- efficient between C-WISQOL and SF-36 total score was 0.564, and the Spearman' s rho coefficient between dimensions was 0.684-0.901, indicating that C-WISQOL had good internal consistency and criterion validity. Confirmatory factor analysis showed that C-WISQOL had good structural validity, convergent validity and discrimination validity. Univariate analysis showed that the patients with MS ( OR =1.607, P < 0.001), calculi related symptoms ( OR =1.268, P < 0.001), bilateral kidney stones ( OR =1.900, P < 0.001), combined with ureteral calculi ( OR =1.018, P < 0.001), accompanied by hydronephrosis ( OR =1.685, P < 0.001), and UTI ( OR =1.275, P < 0.001) were risk factors for decreased HRQOL in the patients with kidney stones, and multivariate analysis showed that the patients with MS ( OR =1.475, P < 0.001), calculi related symptoms ( OR =1.546, P =0.043) and UTI ( OR =1.646, P =0.005) were independent risk factors for HRQOL decline in the patients with renal calculi. The t -test results showed that C-WISQOL scores were significantly higher in the patients without MS, stone-related symptoms and UTI than those in the patients with associated risk factors ( P < 0.001)., Conclusion: C-WISQOL the questionnaire can be used to evaluate the HRQOL of patients with kidney stones with good reliability. The combination of MS, stone-related symptoms and UTI were independent risk factors for HRQOL reduction in the patients with renal stones.

Background: Radical cystectomy (RC) patients are at significant risk for venous thromboembolism (VTE). Current predictive models, such as the Caprini risk assessment (CRA) model, have limitations. This research aimed to create a novel predictive model for forecasting the risk of VTE after RC., Methods: This single-center study involved RC patients treated between January 1, 2010 and December 31, 2019. The individuals were divided into training and testing groups in a random manner. Multivariate and stepwise logistic regression were utilized to create two novel models. The models' performance was compared to the commonly used CRA model, employing metrics including net reclassification improvement (NRI), integrated discrimination improvement (IDI), and receiver operating characteristic (ROC) curve analyses., Results: A total of 272 patients were enrolled, among whom 36 were diagnosed with VTE after RC. Model A and Model B were then conducted. The area under ROC of Model A and Model B is 0.806 [95% confidence interval (CI): 0.748-0.856] and 0.833 (95% CI: 0.777-0.880), respectively, which were also determined in the testing cohorts. The two new Models were superior both in classification ability and prediction ability (NRI >0, IDI >0, P<0.01). Model A and Model B had a concordance index (C-index) of 0.806 and 0.833, respectively. In decision curve analysis (DCA), the two new models provided a net benefit between 0.02 and 0.84, suggesting promising clinical utility., Conclusions: Regarding predictive accuracy, both models surpass the existing CRA model, with Model A being advantageous due to its fewer variables. This easy-to-use model enables swift risk assessment and timely intervention for high-risk groups, yielding favorable patient outcomes., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-194/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Background: Cisplatin-based combination chemotherapy alone is currently considered the standard of care for patients with metastatic upper tract urothelial carcinoma (mUTUC). However, less research has been done on the efficacy of other combinations. In this study, we explored the role of cytoreductive surgery in patients with mUTUC receiving different types of systemic therapy., Methods: Data from 9,436 anonymized records were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2008-2018. Of these, 508 individuals received systemic therapy subsequent to being diagnosed with mUTUC. These patients had all been treated with systemic therapies such as chemotherapy and/or radiotherapy. Patients were stratified into either a non-surgical or surgical group based on cytoreductive surgery status before systemic therapeutics commenced. Kaplan-Meier curves were used to compare overall survival (OS) and cancer-specific survival (CSS). Cox's proportional hazard models were then used to analyze prognostic factors related to OS and CSS., Results: Of the 508 cases, 36.8% (n=187) had received cytoreductive surgery with systemic treatments. The remaining 63.2% (n=321) received either chemotherapy and/or radiotherapy alone. Kaplan-Meier curves showed that 11.6% had 3-year OS [95% confidential interval (CI): 7.1-17.3] for cytoreductive surgery with systemic treatment and 4.9% (95% CI: 2.7-8.0) for systemic treatment alone (P=0.001). The 3-year CSS was 14.9% for cytoreductive surgery plus systemic treatment (95% CI: 9.4-21.7%) and 6.0% (95% CI: 3.4-9.8%) for systemic treatments alone (P=0.003). Under multivariate regression analysis, primary ureter site OS had a hazard ratio (HR) of 0.74 (95% CI: 0.58-0.95, P=0.02) and a CSS HR of 0.72 (95% CI: 0.56-0.94, P=0.01). The cytoreductive surgery OS HR was 0.79 (95% CI: 0.65-0.95, P=0.02) and the CSS HR was 0.75 (95% CI: 0.61-0.92, P=0.006). Additionally, chemotherapy had an OS HR of 0.46 (95% CI: 0.33-0.0.65, P<0.001) and a CSS HR of 0.44 (95% CI: 0.31-0.63, P<0.001). Bones and liver metastases were also indicative of poorer prognosis. Validation was conducted through subgroup analysis which suggested cytoreductive surgery was effective only for patients who received chemotherapy or combined chemo-radiotherapy but not for radiotherapy alone., Conclusions: Cytoreductive surgery provided significantly increased OS and CSS for mUTUC patients who received chemotherapy or combined chemo-radiotherapy in this study. In addition, the primary tumor and metastatic sites were shown to be related to improved patient survival although this was a small and relatively homogeneous cohort of study, sample therefore, further research is required., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-23-619/coif). The authors have no conflicts of interest to declare., (2024 Translational Andrology and Urology. All rights reserved.)

Objective: To assess prognostic differences between primary and progressive muscle-invasive bladder cancer (MIBC) following radical cystectomy., Material and Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to abstract MIBC data following radical cystectomy from 2000 to 2019. Patients were classified as either 'Primary' MIBC (defined as the presentation of muscle-invasive disease at initial diagnosis) or 'Progressive' MIBC (defined as a non-muscle invasive disease that later progressed to MIBC). Baseline characteristics for the two groups were balanced using a propensity score overlap weight (PSOW) technique. Survival differences between the two groups were analyzed using Kaplan-Meier's plots and log-rank tests. Cox's proportional hazard regression was used to assess risk factors associated with overall survival (OS) and cancer-specific survival (CSS)., Results: Six thousand six hundred thirty-two MIBC patients were identified in the SEER database. Among them, 83.3% ( n =5658) were considered primary MIBC patients, and 16.7% ( n =974) were categorized as progressive MIBC patients. Distribution of baseline covariates, including age, sex, race, T stage, N stage, tumour grade, marital status, and chemotherapy, were well-balanced after PSOWs were applied. After stable PSOW adjustments, Kaplan-Meier survival analysis showed that the CSS for progressive MIBC [hazard ratio (HR)=1.25, 95% confidence interval (CI): 1.12-1.38, P <0.001) was poorer than the primary MIBC group. However, the difference in OS (HR=1.08, 95% CI: 0.99-1.18) was not significant ( P =0.073). Multivariate analysis also suggested that patients with progressive MIBC have significantly poorer CSS (HR=1.24, 95% CI: 1.19-1.38, P <0.001) but not OS (HR=1.08, 95% CI: 0.99-1.18, P =0.089)., Conclusion: CSS for progressive MIBC patients appears worse than for those with primary MIBC. This highlights the need to direct more resources for this patient population and particularly for high-risk cases of non-MIBC, where timely radical surgery will improve patients prognoses., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)