Due to fewer adverse events, faster onset of action, and longer durable responses compared to chemotherapy, immunotherapy has been widely used to treat advanced solid tumors. Moreover, immunotherapy can improve the autoimmune status, thus allowing patients to benefit from the treatment in the long term. The immune microenvironment status is closely associated with the response to chemotherapies. Here, we analyzed the characteristics of the immune microenvironment in pheochromocytoma and paraganglioma (PPGL). Immunohistochemistry showed that PD-L1 is sparely expressed in PPGL with low positive rates and low expression levels, an expression pattern, that is, not correlated with tumor malignancy. Moreover, the level of intratumoral CD4⁺ and CD8⁺ lymphocyte infiltration in PPGL is low, suggesting that the immune microenvironment in PPGL may be in “immune desertification” or “immune rejection” states in which CD4⁺ and CD8⁺ lymphocyte infiltration is prevented, rendering immunotherapy less effective. In sum, our results indicate that PPGL is a microsatellite-stable tumor with low tumor mutational burden (TMB) levels, weak neoantigen production, and poor tumor antigenicity, hinting at a poor response of PPGL to chemotherapies.

The combined targeted and systematic biopsy (CTSBx) was the standard scheme for patients with visible suspicious lesions on MRI in recent years. 2024 European Association of Urology (EAU) guideline recommended targeted and perilesional biopsy (TPLBx) for the diagnosis of patients with MRI visible suspicious lesions. This RCT aims to comprehensively evaluate the efficacy and safety profiles of TPLBx and CTSBx schemes. A single-center non-inferiority RCT (NCT06482658) consecutively enrolled 380 biopsy-naïve patients (CTSBx: n=190, TPLBx: n=190) with a single unilateral suspicious lesion on prostate MRI from June 2024 to November 2024. The non-inferiority margin was -15%. All biopsies were undertaken transrectally through the cognitive fusion technique. The primary outcome was Grade Group (GG) ≥2 cancer (GG≥2-PCa) detection rate. The GG≥2-PCa [58% vs 58%, risk difference (RD): 0.53% (95%CI: -9.4%-11%)], and GG≥3-PCa [30% vs 30%, RD: 0.53% (95%CI: -8.7%-9.7%)] detection rates of TPLBx were non-inferior to that of CTSBx (p0.050). The complication rate of TPLBx was significantly lower than that of CTSBx group (Clavien-Dindo scale≥1: 62% vs 74%, p=0.023), especially for bleeding-related complications (rectal bleeding: 34% vs 48%, p=0.003; hematuria, 39% vs 56%, p<0.001) and rectal pain (25% vs 34%, p=0.018). TPLBx could significantly shorten the procedure time and saved the pathological cost (p<0.001). For patients with a single unilateral suspicious lesion on prostate MRI, TPLBx achieved the non-inferior diagnostic efficacy of csPCa and better safety than the CTSBx scheme.

Purpose The purpose of this study was to evaluate the nature of ultrasound characteristics during mpMRI/TRUS cognitive fusion targeted biopsy (cTB). Methods From 2023 to 2024, data from 502 lesions in 426 men who underwent targeted combined systematic biopsy were analyzed. All lesions had a Prostate Imaging Reporting and Data System (PI-RADS) score of ≥ 3. The primary endpoint was the detection rate of prostate cancer (PCa) according to the PI-RADS score/ultrasound characteristics, categorized as benign or invisible (Bi), hypoechoic only (Ho), and hypoechoic with microcalcification (Hm), assessed through cross-stratification. The secondary endpoints included the distribution of ultrasound characteristics across PI-RADS scores, prostate zones, and histological types. Finally, associations between ultrasound characteristics and clinically significant PCa (csPCa) were assessed using multivariate logistic regression analysis (MVA). Results Among lesions, 233 (46%) were Bi, 210 (42%) Ho, and 59 (12%) Hm. First, Bi lesions had a 64% (103/161) non-cancer rate in PI-RADS 3, while Ho + Hm lesions showed the highest csPCa rate in PI-RADS 5 at 82% (102/124). Additionally, Ho + Hm lesions were predominantly observed in PI-RADS 5 (92% [114/124]) and in the peripheral zone (64% [179/278]). Notably, Hm lesions had a significantly higher percentage of cribriform morphology than Ho lesions (32% vs. 14%, P = 0.001). Finally, MVA confirmed Ho ([Ref Bi] OR 4.95, P < 0.001) and Hm ([Ref Bi] OR 27.7, P < 0.001) as independent predictors of csPCa. Conclusion In cTB, the identification of Ho and Hm lesions on TRUS enhances the diagnostic yield of csPCa by facilitating more precise localization compared to Bi lesions. Clinical Trial Registration No. 2023-272-002, July 14, 2023.

This study aimed to comprehensively delineate the clinical characteristics, surgical interventions, and evolving trends over the past decade among patients undergoing surgery for renal cell carcinoma (RCC). A retrospective analysis was conducted on the clinical records of 9,110 patients diagnosed with RCC who underwent surgical treatment at Peking University First Hospital between January 2013 and December 2022. Statistical analyses were performed using SPSS 21.0 software. Categorical variables were analyzed using the Chi-square test or Fisher’s exact test, as appropriate. Numerical variables were assessed using the t-test or analysis of variance (ANOVA) for normally distributed data, while nonparametric tests were employed for non-normally distributed numerical variables or ordinal data. A p-value of less than 0.05 was considered statistically significant. The study cohort consisted of 6,416 males (70.4%) and 2,694 females (29.6%), with a median age of 55 years. Clear cell renal cell carcinoma (ccRCC) was the most prevalent histological subtype (87.6%), followed by chromophobe renal cell carcinoma (chRCC) (5.1%), papillary renal cell carcinoma (pRCC) (3.7%), and other subtypes (3.6%). Non-ccRCC patients exhibited a significantly higher proportion of advanced T3 + disease staging (19.4% vs. 15%, P < 0.001). Female patients demonstrated higher incidences of both non-ccRCC and special pathology types (P < 0.001), while non-ccRCC and advanced T-stage disease were more common in pediatric patients (P < 0.001) and were more likely to undergo radical nephrectomy (P < 0.001). Over the span of a decade, the demographic characteristics of RCC patients remained relatively stable; however, there was a notable decrease in tumor size over time (P < 0.001). Notably, partial nephrectomy rates surged between 2013 and 2016—reflecting growing acceptance of nephron-sparing techniques—but later balanced with radical nephrectomies as stricter selection criteria emerged, highlighting the dynamic evolution of RCC surgical management. Our study reveals dynamic shifts in RCC management over the past decade, marked by evolving surgical practices and a trend toward smaller tumor sizes at diagnosis, while distinct clinical features in pediatric patients underscore the need for continued refinement of early detection.