Background and Objectives: To assess the potential prognostic role of the systemic immune-inflammation index (SII) in predicting oncological outcomes in a cohort of patients treated with radical cystectomy (RC). Materials and Methods: From 2016 to 2022, a retrospective monocentric study enrolled 193 patients who were divided into two groups based on their SII levels using the optimal cutoff determined by the Youden index. The SII was obtained from a preoperative blood test approximately one month before RC. Univariable and multivariable logistic regression analyses were conducted to investigate the capacity of SII to predict lymph node invasion (N), advanced pT stage (pT3/pT4), and locally advanced condition at the time of RC. Multivariable Cox regression models adjusted for preoperative and postoperative features were used to analyze the prognostic effect of SII on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Results: The optimal cutoff value of the SII was 640.27. An elevated SII was seen in 113 (58.5%) patients. Using the multivariable preoperative logistic regression models, an elevated SII was correlated with nodal invasion (N; p = 0.03), advanced pT stage (p = 0.04), and locally advanced disease (p = 0.005), with enhancement of AUCs for predicting locally advanced disease (p = 0.04). In multivariable Cox regression models that considered preoperative clinicopathologic factors, an elevated SII was linked to poorer RFS (p = 0.005) and OS (p = 0.01). Moreover, on multivariable Cox regression postoperative models, a high SII was linked to RFS (p = 0.004) and to OS (p = 0.01). Conclusions: In this monocentric retrospective study, higher preoperative SII values predicted worse oncological outcomes in patients with bladder cancer (BCa) who underwent RC.

Prostate cancer therapy for locally advanced and metastatic diseases includes androgen deprivation therapy (ADT). Second-generation antiandrogens have a role in castration-resistant prostate cancer. Nevertheless, some patients do not respond to this therapy, and eventually all the patients became resistant. This is due to modifications to intracellular signaling pathways, genomic alteration, cytokines production, metabolic switches, constitutional receptor activation, overexpression of some proteins, and regulation of gene expression. The aim of this review is to define the most important mechanisms that drive this resistance and the newest discoveries in this field, specifically for enzalutamide and abiraterone, with potential implications for future therapeutic targets. Furthermore, apalutamide and darolutamide share some resistance mechanisms with abiraterone and enzalutamide and could be useful in some resistance settings.

Renal cell carcinoma (RCC) is the most common form of kidney cancer with 403,262 diagnoses and 170,000 deaths worldwide in 2018. Although partial or radical nephrectomy can be considered a successful treatment in early-stage or localized RCC, in advanced-stage disease, there is a high risk of metastasis or recurrence with a significantly poorer prognosis. Metastatic RCC is generally resistant to both chemotherapy and radiotherapy, and, despite several novel therapeutic agents, disease progression and mortality rates remain high. It is necessary to identify new diagnostic and therapeutic strategies for the management of this cancer. Knowledge of microRNA (miRNA) has consistently increased in the last year. miRNAs play an important role in several biological processes, such as cell proliferation, differentiation, and cell death. Due to this, miRNAs have been identified as an important key in different diseases, especially in cancer, and several studies show miRNAs as attractive tools and targets for novel therapeutic approaches. Recently several miRNAs (including miR-22, miR-203, miR-301 and miR-193a-3p) have been linked to dysregulated molecular pathways involved with the proliferation of cancerous cells and resistance to therapeutic agents. In the present study, recent data from studies assessing the application of miRNAs as biomarkers, therapeutic targets, or modulators of response to treatment modalities in RCC patients are analyzed.

Article: Extraperitoneal robot-assisted radical prostatectomy by the da Vinci and Versius System: first comparative analysis - Minerva Urology and Nephrology 2024 Aug 02 - Minerva Medica - Journals

Background Minimally invasive surgical therapies have transformed the management of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction. Holmium laser enucleation of the prostate (HoLEP) is considered the gold standard for men with bothersome LUTS. HoLEP is performed with 26Ch instruments, which can cause urethral trauma, strictures, transient incontinence. Recent miniaturised 22Ch tools (MiLEP) aim to reduce morbidity without compromising efficacy. Methods This prospective multicenter study enrolled 65 men with BPH/BPO undergoing MiLEP. Preoperative assessment included IPSS, uroflowmetry, PSA, prostate volume and urinary continence. The MiLEP were performed en-bloc with early apical release. Follow-up assessed subjective and objective outcomes together with complications and patient satisfaction. Clinical success was defined as Trifecta. Logistic regression evaluated predictors of success. Results Mean age was 68,3 years and mean operative time was 82 minutes. Mean resected tissue weight was 42,6g. No major intraoperative complications occurred; median catheterisation and hospital stay were 2 and 2 days, respectively. Overall complication rate was 18,4%, mostly Clavien–Dindo grade I–II. Late complications were urethral stricture in 4,6% and persistent stress incontinence in 1,5%. At 12months, mean IPSS, IPSS QoL, Qmax, PSA significantly improved (all p < 0,001). Overall satisfaction was very high (97% “much or very much improved”). Trifecta was achieved in 61,5% of cases. Logistic regression identified lower pre operative Qmax as the only predictor of Trifecta achievement; prostate volume, age and resected tissue weight were not significant. Conclusions MiLEP is a safe and effective alternative to conventional HoLEP. Significant improvements in symptom scores, flow rate and PSA were sustained at 12 months with low morbidity and high continence preservation. These findings suggest that MiLEP may expand the benefits of enucleation to patients who might otherwise face higher complication risks. Larger trials and longer follow up are needed to confirm our data.