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Background: Bladder cancer with divergent differentiation (BCDD) comprises a heterogenous group of tumors with a poor prognosis, and differential expression of nectin‐4 and programmed death ligand‐1 (PD‐L1) has been reported in BCDD. Importantly, nectin‐4 expression in bladder cancer is associated with response to enfortumab vedotin, and PD‐L1 expression is associated with responses to immune checkpoint inhibitors (ICIs). Methods: The authors conducted a retrospective review identifying 117 patients with advanced or metastatic BCDD who were treated at Winship Cancer Institute from 2011 to 2021. They performed immunohistochemistry staining for nectin‐4 and PD‐L1 expression by histologic subtype as well as genomic analysis of these patients, including RNA sequencing, whole‐exome sequencing, and fusion detection analysis as well as a subgroup genomic analysis of patients with BCDD who received ICIs. Results: The results indicated that nectin‐4 expression was highest in the groups who had the squamous and plasmacytoid subtypes, whereas the group that had the sarcomatoid subtype (70.8%) had the highest proportion of PD‐L1–positive patients. Genomic analysis yielded several key findings, including a 50% RB1 mutation rate in patients who had small cell BCDD, targetable PIK3CA mutations across multiple subtypes of BCDD, and significantly higher expression of TEC in responders to ICIs. Conclusions: In this study, the authors identified clinically relevant data on nectin‐4 and PD‐L1 expression in patients with rare bladder tumors. They also identified several novel findings in the genomic analysis that highlight the role of precision medicine in this population of patients. Larger, prospective studies are needed to validate these hypothesis‐generating data. In this study, the authors performed a retrospective analysis focused on the histologic and genomic characterization of bladder cancer with divergent differentiation. The results indicated that nectin‐4 expression was highest in patients with squamous and plasmacytoid differentiation, whereas patients who had sarcomatoid differentiation (70.8%) had the highest proportion of programmed death ligand‐1–positive disease, and several novel findings were identified in the genomic analysis that have potential clinical implications for these patients with rare tumors. [ABSTRACT FROM AUTHOR]

Background: Poor comprehension of prostate cancer (PCa) medical terms can create barriers to PCa treatment discussions. The authors measured comprehension of PCa terms and its relationship to health literacy in a group of Black men who were newly diagnosed with PCa. They examined whether tailoring communication with alternative colloquial words would be helpful and acceptable. Methods: Patients were recruited from urology clinics (N = 152). After they met with their providers to discuss PCa treatment options, they participated in an educational supplement delivered as a structured interview. The supplement tailored PCa treatment information by allowing men to choose between colloquial and medical terms for genitourinary (GU) function. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine, and comprehension of common PCa terms was assessed using published methods. Pearson correlation was used to estimate the association between health literacy and comprehension of PCa terms. Spearman rank correlation (r) was used to assess the relation between the total number of medical terms preferred (range, 0–10) and Rapid Estimate of Adult Literacy in Medicine scores (range, 0–66). Results: Most patients (62%) had low health literacy, which was strongly correlated with their understanding of PCa terms (r = 0.526; p <.001). Poor comprehension of many PCa terms established the need to use alternative language for GU function (only 20% knew the word incontinence). There was a statistically significant positive association between the number of medical terms preferred and health literacy (r = 0.358; p <.001). A majority of patients (91%) preferred a mixture of medical and colloquial terms. Conclusions: Tailoring communications with colloquial terms for GU function was preferred by most patients regardless of health literacy. Poor comprehension of common prostate cancer terms for genitourinary function creates health literacy barriers to treatment discussions. Tailoring medical terms with alternative colloquial words preferred by patients was helpful regardless of health literacy. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effects of immunotherapy compared to chemotherapy as first‐ and second‐line treatment of advanced or metastatic urothelial carcinoma. Methods: Based on a published protocol, we performed a systematic search of multiple databases. Two review authors independently performed the literature selection, identified relevant studies, assessed the eligibility of studies for inclusion, and extracted data. We performed statistical analyses using a random‐effects model and assessed the quality of the evidence on a per‐outcome basis according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: We included five randomised controlled trials and also identified seven single‐arm studies. When used as first‐line therapy, immunotherapy probably has little to no effect on the risk of death from any cause compared to chemotherapy (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.87–1.07; moderate‐certainty evidence). immunotherapy probably has little to no effect on health‐related quality of life (mean difference [MD] 4.10, 95% CI 3.83–4.37; moderate). Immunotherapy probably reduces grade 3–5 adverse events (risk ratio [RR] 0.47, 95% CI 0.29–0.75; moderate). In the second‐line setting immunotherapy may reduce the risk of death from any cause (HR 0.72, 95% CI 0.63–0.81; low). Immunotherapy may have little to no effect on health‐related quality of life when compared to chemotherapy (MD 4.82, 95% CI −3.11 to 12.75; low). Immunotherapy may reduce grade 3–5 adverse events (RR 0.89, 95% CI 0.81–0.97; low). Conclusions: Compared to chemotherapy, immunotherapy has little to no effect on the risk of death from any cause in a first‐line setting. Nevertheless, it may reduce the risk of death from any cause when used as second‐line therapy. The health‐related quality of life of participants receiving first‐ and second‐line therapy does not appear to be affected by immunotherapy. Immunotherapy probably reduces or may reduce grade 3–5 adverse events when used as first‐ and second‐line therapy, respectively. [ABSTRACT FROM AUTHOR]

Background: The 2018 Leibovich prognostic model for nonmetastatic renal cell carcinoma (RCC) combines clinical, surgical, and pathologic factors to predict progression‐free survival (PFS) and cancer‐specific survival (CSS) for patients with clear cell (ccRCC), papillary (pRCC), and chromophobe (chRCC) histology. Despite high accuracy, <1% of the original cohort was Black. Here, the authors examined this model in a large population with greater Black patient representation. Methods: By using a prospectively maintained RCC institutional database, patients were assigned Leibovich model risk scores. Survival outcomes included 5‐year and 10‐year PFS and CSS. Prognostic accuracy was determined using area under the curve (AUC) analysis and calibration plots. Black patient subanalyses were conducted. Results: In total, 657 (29%) of 2295 patients analyzed identified as Black. Declines in PFS and CSS were observed as scores increased. Discrimination for ccRCC was strong for PFS (AUC: 5‐year PFS, 0.81; 10‐year PFS, 0.78) and for CSS (AUC: 5‐year CSS, 0.82; 10‐year CSS, 0.74). The pRCC AUC for PFS was 0.74 at 5 years and 0.71 at 10 years; and the AUC for CSS was 0.74 at 5 years and 0.70 at 10 years. In chRCC, better performance was observed for CSS (AUC at 5 years, 0.75) than for PFS (AUC: 0.66 at 5 years; 0.55 at 10 years). Black patient subanalysis revealed similar‐to‐improved performance for ccRCC at 5 years (AUC: PFS, 0.79; CSS, 0.87). For pRCC, performance was lower for PFS (AUC at 5 years, 0.63) and was similar for CSS (AUC at 5 years, 0.77). Sample size limited Black patient 10‐year and chRCC analyses. Conclusions: The authors externally validated the 2018 Leibovich RCC prognostic model and found optimal performance for ccRCC, followed by pRCC, and then chRCC. Importantly, the results were consistent in this large representation of Black patients. Plain Language Summary: In 2018, a model to predict survival in patients with renal cell carcinoma (kidney cancer) was introduced by Leibovich et al.This model has performed well; however, Black patients have been under‐represented in examination of its performance.In this study, 657 Black patients (29%) were included, and the results were consistent.This work is important for making sure the model can be applied to all patient populations. The authors examined and externally validated the 2018 Leibovich prognostic model for nonmetastatic renal cell carcinoma in a large population with greater Black patient representation. The results indicated optimal performance of the model across all histologies and were consistent among Black patients. [ABSTRACT FROM AUTHOR]

PURPOSE: Treatment of non–muscle-invasive bladder cancer (NMIBC) is guided by risk stratification using clinical and pathologic criteria. This study aimed to develop a natural language processing (NLP) model for identifying patients with high-risk NMIBC retrospectively from unstructured electronic medical records (EMRs) and to apply the model to describe patient and tumor characteristics. METHODS: We used three independent EMR-derived data sets including adult patients with a bladder cancer diagnosis in 2011-2020 for NLP model development and training (n = 140), validation (n = 697), and application for the retrospective cohort analysis (n = 4,402). Deep learning methods were used to train NLP recognition of medical chart terminology to identify seven high-risk NMIBC criteria; model performance was assessed using the F1 score, weighted across features. An algorithm was then used to classify each patient as high-risk NMIBC (yes/no). Manually reviewed records served as the gold standard. RESULTS: The F1 scores after model training were >0.7 for all but one uncommon feature (prostatic urethral involvement). The highest area under the receiver operating curves (AUC) was observed for Ta (0.897) and T1 (0.897); the lowest AUC was for carcinoma in situ (CIS; 0.617). For high-risk NMIBC classification, positive predictive value was 79.4%, negative predictive value was 93.2%, and false-positive rate was 8.9%. Sensitivity and specificity were 83.7% and 91.1%, respectively. Of 748 patients manually confirmed as having high-risk NMIBC, 196 (26%) had CIS (of whom 19% also had T1 and 23% also had Ta disease); 552 tumors (74%) had no associated CIS. CONCLUSION: The NLP model, combined with a rule-based algorithm, identified high-risk NMIBC with good performance and will enable future work to study real-world treatment patterns and clinical outcomes for high-risk NMIBC. [ABSTRACT FROM AUTHOR]