Accumulating evidence indicates that hypoxia is highly associated with bladder cancer genesis, progression, and immune microenvironment. Nevertheless, few studies have identified the role of hypoxia-related genes as a prognostic signature in bladder cancer. This study aimed to establish a hypoxia-related signature with high accuracy for prognosis and immune microenvironment prediction in bladder cancer. We obtained expression profiles and clinical information from Gene Expression Omnibus and The Cancer Genome Atlas. Then the univariate Cox regression, random survival forest algorithm, and multivariate Cox regression analysis were conducted to identify the core genes and four hypoxia-related genes (ANXA2, GALK1, COL5A1, and HS3ST1) were selected to construct the signature. Kaplan-Meier survival analysis demonstrated that patients with a low-risk score had a higher disease-specific survival rate (p < 0.0001). The areas under the curve of the signature were 0.829 at 1 year, 0.869 at 3 years, and 0.848 at 5 years, respectively. Additionally, we found this hypoxia-related signature was highly correlated with tumor immune microenvironment and had the potential to predict the efficacy of immunotherapy. In summary, our study developed a hypoxia-related signature, which had high accuracy for prognosis prediction and the potential to guide the immunotherapy for bladder cancer patients.

Background: Disitamab vedotin (DV, RC48-ADC) has shown promising efficacy and manageable safety as monotherapy or combined with immune checkpoint inhibitors (ICIs) in metastatic urothelial carcinoma (mUC) patients progressing after systemic chemotherapy. This study evaluates the efficacy and safety of RC48-ADC plus ICIs in metastatic upper tract urothelial carcinoma (mUTUC) in a real-world setting. Methods: This retrospective, multicenter study included 198 mUTUC patients treated with RC48-ADC plus ICI at 23 clinical centers between June 2021 and December 2023. Data were analyzed from July to September 2024. Primary endpoint: objective response rate (ORR). Secondary endpoints: progression-free survival (PFS), overall survival (OS), duration of response (DoR), time to objective response, and treatment-related adverse events (TRAEs). Result: Among the patients, 122 (61.6%) received combination therapy as first-line treatment, while 76 (38.4%) as second-line or beyond. ORR was 58.6% (95% CI: 51.4–65.5), with a median PFS of 13.0 months; median OS was not reached. Subgroup analyses showed consistent ORR across all subgroups. Adverse events (AEs) occurred in 79.8% of patients, with grade 3–4 AEs in 19.7%. Common AEs included neuropathy (40.4%), fatigue (26.8%), alopecia (25.3%), and rash (21.7%). The main limitations of this study include its retrospective design and the population of the study only include patients from China, leading to potential selection bias. Conclusions: RC48-ADC combined with ICIs demonstrated robust antitumor activity and a favorable safety profile in real-world mUTUC, particularly in selected patient groups. Further studies are needed to explore its potential in this high-risk population.

The present study compared the safety and efficacy of combined laparoscopic ureterolithotomy (LU) and flexible ureteroscopy with percutaneous nephrolithotomy (PCNL) for removing large impacted upper ureteral stones with concurrent renal stones. This study included 52 patients who underwent combined LU and retrograde flexible ureteroscopy for removing renal stones (group A) or PCNL (group B) for removing large upper impacted ureteral stones and concurrent renal stones at our department from January 2014 to December 2016. Patient demographics, stone characteristics, and procedure-related parameters including stone-free rate, operation time, hospital stay after surgery, mean decrease in hemoglobin levels, visual analog scale (VAS) score, auxiliary procedure rate, and complication rate were compared between groups A and B. Results of this study showed that both procedures were effective for removing large impacted upper ureteral stones with concurrent renal stones. The stone-free rate after a single procedure was 95.7% in group A and 89.7% in group B (p = 0.62). The operation time was longer in group A than in group B (112.2 ± 23.3 min versus 96.2 ± 16.4 min, p = 0.006). However, no significant difference was observed between the two groups with respect to the length of hospital stay after the surgery (5 days versus 6 days, p = 0.06). The decrease in hemoglobin levels was significantly higher in group B than in group A (−0.64 ± 0.36 g/dL versus −1.44 ± 0.65 g/dL, p < 0.0001). The mean VAS scores obtained at 24 hours (2.91 ± 1.08 versus 5.10 ± 1.01, p < 0.0001) and 48 hours after the surgery (1.09 ± 0.73 versus 2.28 ± 0.96, p < 0.0001) were significantly higher for group B than for group A. Moreover, the auxiliary procedure rate was higher in group B than in group A (6.9% versus 0%). These results indicate that both combined LU and flexible ureteroscopy and PCNL are suitable for removing large impacted upper ureteral stones with concurrent renal stones and are associated with a high rate of patients being stone free afterwards. Despite the longer operation time, the combined laparoscopic and endourological procedure may be associated with less postoperative pain and fewer major complications. However, the choice of treatment depends on the preferences of surgeons and patients.

(1) Background: To present the initial experience in retroperitoneal robot-assisted single-port laparoscopic partial nephrectomy for renal cell carcinoma and evaluate its efficiency and safety.(2) Methods: Retrospectively analyzed four patients underwent retroperitoneal robot-assisted single-port laparoscopic partial nephrectomy in our hospital during September 2020 to December 2020. Patients who with renal cell carcinoma (T1b or T1c) were selected into our study. A multichannel port was inserted retroperitoneally through a 4-5cm incision. Preoperative, intraoperative and postoperative outcomes were finally recorded and analyzed.(3) Results: The median patient age was 62.0(range 49-68) year, the median body mass index was 23.0(range 21.3-24.2) kg/m². No one had abdominal surgery history. All surgeries were successfully completed and none of them was changed to open surgery or added additional auxiliary channels. The median docking time was 16.5(range 15-25) minutes, the median operation time was 177.5(range 145-230) minutes, the median warm ischemia time was 19.0(range 15-25) minutes, the median estimated blood loss was 50.0(range 40-60) mL. No patient needed blood transfusion. The median postoperative fasting time was 3.5(range 1-5) days, the median catheter removal time was 5.5(range 5-7) days, and the median hospital stay was 7.0(6-8) days. None of the patients had intraoperative or postoperative complications. After 3 months of follow-up, there was no tumor recurrence in all four patients. (4) Conclusions: Retroperitoneal robot-assisted single-port laparoscopic partial nephrectomy is a feasible surgical method, but additional investigations are still needed to evaluate its safety and oncologic adequacy.