Background: We aimed to compare the oncologic outcomes of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following robot-assisted radical cystectomy (RARC) in patients diagnosed with bladder cancer. Materials and methods: Medical records of 730 patients who underwent RARC between April 2007 and May 2019 in 11 tertiary referral centers were retrospectively reviewed. We assessed recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in the two groups using the Kaplan–Meier method. Cox regression models were used to identify factors associated with RFS, CSS, and OS. Results: Among 591 patients neobladder diversion was performed more frequently in the ICUD group (70.8% vs 52.5%, P=0.001). The median follow-up duration was shorter in the ICUD group than in the ECUD group (16 vs 26 months, P<0.001). The rates of overall recurrence (36.5% vs 25.5%, P=0.013) and pelvic recurrence (12.1% vs 5.9%, P=0.031) were higher in the ECUD group. However, no differences in 5-year RFS (43.2% vs 58.4%, P=0.516), CSS (79.3% vs 89.7%, P=0.392), and OS (74.3% vs 81.4%, P=0.411) were noted between the two groups. Multivariable analysis revealed that when compared to ICUD, ECUD was not associated with RFS (hazard ratio [HR], 0.982; P=0.920), CSS (HR, 0.568; P=0.126), and OS (HR, 0.642; P=0.124). Conclusion: Although there was a difference in recurrence rate between the two groups, multivariable analysis indicated that the diversion technique after RARC did not affect the oncologic outcomes. Large prospective studies with long-term follow-up are warranted to verify the oncologic outcomes of ICUD and ECUD following RARC.

Recent investigations reported that some subtypes from the Lund or The Cancer Genome Atlas (TCGA) classifications were most responsive to PD-L1 inhibitor treatment. However, the association between previously reported subtypes and immune checkpoint inhibitor (ICI) therapy responsiveness has been insufficiently explored. Despite these contributions, the ability to predict the clinical applicability of immune checkpoint inhibitor therapy in patients remains a major challenge. Here, we aimed to re-classify distinct subtypes focusing on ICI responsiveness using gene expression profiling in the IMvigor 210 cohort (n = 298). Based on the hierarchical clustering analysis, we divided advanced urothelial cancer patients into three subgroups. To confirm a prognostic impact, we performed survival analysis and estimated the prognostic value in the IMvigor 210 and TCGA cohort. The activation of CD8⁺ T effector cells was common for patients of classes 2 and 3 in the TCGA and IMvigor 210 cohort. Survival analysis showed that patients of class 3 in the TCGA cohort had a poor prognosis, while patients of class 3 showed considerably prolonged survival in the IMvigor 210 cohort. One of the distinct characteristics of patients in class 3 is the inactivation of the TGFβ and YAP/TAZ pathways and activation of the cell cycle and DNA replication and DNA damage (DDR). Based on our identified transcriptional patterns and the clinical outcomes of advanced urothelial cancer patients, we constructed a schematic summary. When comparing clinical and transcriptome data, patients with downregulation of the TGFβ and YAP/TAZ pathways and upregulation of the cell cycle and DDR may be more responsive to ICI therapy.

Choi J, et al. Investig Clin Urol. 2024 May;65(3):248-255. https://doi.org/10.4111/icu.20230313

Nam JK, et al. World J Mens Health. 2023 Apr;41:e50. https://doi.org/10.5534/wjmh.220268

Kim JY, et al. Investig Clin Urol. 2022 Aug;63:e65. https://doi.org/10.4111/icu.20220190

Conditional survival is defined as the likelihood of subsequent survival given the precondition of having already survived a certain length of time. Most analyses of conditional survival in prostate cancer are not clinically applicable because they do not analyze outcomes conditioned on the durability of cure after treatment. We evaluated the conditional probability of biochemical recurrence (BCR)-free survival (C-BCRFS) after radical prostatectomy (RP) for prostate cancer according to the National Comprehensive Cancer Network risk classification and prognostic factors in patients who survived several years without BCR. Between January 2009 and December 2018, 877 patients with complete clinicopathologic and follow-up data were included. Using the Kaplan–Meier estimation, the probabilities of C-BCRFS after RP were estimated in patients who did not experience BCR at 0–4 years. C-BCRFS was analyzed according to the National Comprehensive Cancer Network risk classification and compared using the log-rank test. Prognostic factors at each year without BCR were evaluated using multivariable Cox regression analysis. The median follow-up duration and patient age were 48 months and 67 years, respectively. As the BCR-free interval increased (baseline, 1, 2, 3, and 4 years after RP), the 5-year C-BCRFS rates improved marginally (74.8%, 83.2%, 89.1%, 93.6%, and 98.5%, respectively). However, the 5-year C-BCRFS rates in the high/very high-risk group rose from 54.0% at baseline to 67.6%, 80.3%, 88.6, and 97.8% after 1–4 years free of BCR, respectively. In patients with a BCR-free duration more than 1 year, only seminal vesicle invasion and pathological Gleason score were significant predictive factors of BCR thereafter. In the high/very high-risk group, the C-BCRFS markedly improved as the interval without BCR increased. In patients who were BCR-free for several years, seminal vesicle invasion and pathological Gleason score were prognostic factors of continued BCRFS. This is useful not only for patient counseling but also to optimize postoperative follow-up strategies.