The genetic features of primary lymphoepithelioma‐like carcinoma (LELC) of the upper urinary tract have not been systematically explored. In this study, tumor mutation profiling was performed using whole‐genome sequencing in two patients with LELC of the renal pelvis. Novel candidate variants relevant to known disease genes were selected using rare‐variant burden analysis. Subsequently, a population‐based study was performed using the Surveillance, Epidemiology, and End Results (SEER), PubMed, MEDLINE, Embase, and Scopus databases to explore clinical features and prognostic risk factors. Immunohistochemical analysis revealed seven positive cytokeratin‐associated markers in tumor cells and five positive lymphocyte‐associated markers in and around the tumor area. Sub‐sequently, we identified KDM6A as the susceptibility gene and LEPR as the driver gene by Sanger sequencing in case 2 of LELC of the renal pelvis. Three mutation sites of the existing targeted drugs were screened: CA9, a therapeutic target for zonisamide; ARVCF, a therapeutic target for bupropion; and PLOD3, a therapeutic target for vitamin C. In a population‐based study, patients with primary LELC of the upper urinary tract had clinical outcomes similar to those of patients with primary upper urinary tract urothelial carcinoma (UUT‐UC) before and after propensity score matching at 1 : 5. Focal subtype was an independent prognostic factor for the overall survival of patients with LELC of the upper urinary tract. The carcinogenesis of primary LELC may be due to different genetic variations, including single‐nucleotide variants, insertion and deletions, structural variations, and repeat regions, which may provide the basis for clinical diagnosis and treatment. The prognosis of LELC in the upper urinary tract is similar to that of UUT‐UC. We suggest that the focal subtype can serve as a prognostic factor for LELC of the upper urinary tract; however, further studies are required to confirm this.

To get a better understanding of the genetic basis of primary signet ring cell carcinoma (SRCC) of the bladder, which is highly rare and not yet explored. First, by using immunohistochemistry to find histological pathological characteristics. Second, a massively parallel whole‐exome sequencing (WES) was performed on a 58‐year‐old male patient who had painless macroscopic hematuria and was pathologically diagnosed with primary SRCC of the bladder, followed by comparing with genes of ordinary urothelial cancer (UC) from TCGA. Furthermore, a population‐based analysis using the SEER database was performed to investigate the prognosis (SRCC vs. UC). We identified 63 copy number variations (CNVs) with gain counts and 181 CNVs with loss counts. Totally 4515 mutations were discovered in C > T with a success rate of greater than 89%. The most frequently mutated pathway was RTK‐RAS which has 85 genes involved in carcinogenic signaling. Final screening on predisposing genes is performed after filtering based on ACMG. Moreover, several driver genes, including NBN, KCTD18, SPATA13, ANKRD36, OR2L5, MALRD1, and LSMEM1, were detected. Sanger sequencing of germline DNA revealed the presence of a mutant base A/G of OR2L5 in the sequence, which was discovered for the first time in primary SRCC of the bladder. Furthermore, the immunohistochemical profile showed that primary SRCC of the bladder were positive for CK7, CK20, GATA‐3, and expression of CK(AE1/AE2), EMA, and Ki67. In the SEER‐based study, the patients with primary SRCC of the bladder got a worse prognosis compared to those with UC with median months overall survival (OS) 14 vs. 41, respectively, P = 0001, even after adjusting the variables in the Cox regression model, the SRCC of the bladder showed worse survival HR = 1.119, 95% CI = (1.081–1.328), P = 0.0001. These results imply that suppression of potential driver mutations may be a viable adjuvant treatment approach for primary SRCC in the bladder in place of standard chemotherapy, a possibility that warrants further clinical investigation.

Objective. Upper urinary tract urothelial carcinoma (UUT-UC) is a very aggressive disease, characterized by 2250 of patients suffering from subsequent bladder recurrence after radical nephroureterectomy (RNU). Although the therapy of intravesical instillation is reported to be effective in preventing bladder recurrence, no study had been reported in Northeast China. The findings relating to the clinical effectiveness of intravesical instillation after RNU are somewhat controversial, and the best efficacy and least adverse effects of instillation drugs have not been widely accepted. Here, we aimed at evaluating the efficacy of intravesical instillation for the prevention intravesical recurrence systematically. Methods. In this retrospective cohort study, from October 2006 to September 2017, 158 UUT-UC patients underwent RNU were divided into 4 groups: epirubicin (EPB) instillation group, hydroxycamptothecin (HCPT) instillation group, bacillus CalmetteGuerin (BCG) instillation group, and noninstillation group. Cox univariate and multivariate analyses were employed to identify the risk factors for intravesical recurrence-free survival (IVRFS). The nomogram model was also applied to predict patient outcomes. Subsequently, to evaluate the clinical significance of intravesical instillation comprehensively, several databases including PubMed, Ovid, and Embase were searched and data from published studies with our results were combined by direct meta-analysis. Moreover, a network meta-analysis comparing instillation therapies was conducted to evaluate the clinical efficacy of different instillation drugs. Results. In our retrospective cohort study, the KaplanMeier survival curve demonstrated noninstillation groups were associated with worsened IVRFS. Meanwhile, multivariate analysis indicated that intravesical instillation was independent protective factors for IVRFS (hazard ratio [HR]=0.731). Moreover, calibration plots, receiver operating characteristic (ROC) curves, area under the curve (AUC) values, and the C-index showed the priority of nomograms predictive accuracy. Next, direct meta-analysis including 19 studies showed that intravesical instillation could prevent the recurrence of bladder cancer with a pooled risk ratio (RR) estimate of 0.53. Subgroup analysis by study type, year of intravesical recurrence, first instillation time, and instillation times also confirmed the robustness of the results. Moreover, intraoperative instillation was associated with a decrease in the risk of bladder recurrence compared with postoperative instillation. Then, a network meta-analysis including 7 studies indicated that pirarubicin (THP) (surface under the cumulative ranking curve [SUCRA]=89.2) is the most effective therapy to reduce the risk of bladder recurrence, followed by BCG (SUCRA=83.5), mitomycin C (MMC) (SUCRA=53.6), EPB (SUCRA=52.6), and HCPT (SUCRA=5.1) after the analysis of the value ranking. Conclusions. A maintenance schedule of intravesical instillation prevents the recurrence of bladder cancer after RNU in UUT-UC patients effectively. Large, prospective trials are needed to further confirm its value. Compared with other chemotherapy regimens, THP may be a promising drug with favorable efficacy to prevent bladder recurrence. As included studies had moderate risk of bias, the results of network meta-analysis should be applied with caution.

Background: Although radical nephroureterectomy (RNU) with bladder cuff excision remains the gold standard treatment for upper tract urothelial carcinoma (UTUC), segmental ureterectomy (SU) may offer a nephron-sparing alternative. Studies comparing oncologic outcomes and renal functional outcomes between SU and RNU have yielded controversial, often conflicting results. Furthermore, investigations specifically involving ureteral UTUC patients in northern China are scarce. Methods: We retrospectively enrolled 546 ureteral urothelial carcinoma patients (282 SU and 264 RNU cases) from three hospitals between October 2003 and September 2024 to assess overall survival (OS) and intravesical recurrence-free survival (IV-RFS) as oncologic outcomes, and to evaluate renal functional outcomes (preoperative, postoperative [2-month] and delta change in estimated glomerular filtration rate [eGFR] and serum creatinine [Scr]). The prognostic impact of surgical approach and clinicopathological variables were evaluated using Kaplan–Meier analysis with log-rank tests and Cox regression models. Significant predictors were incorporated into a validated nomogram for personalized 3-, 4-, and 5-year OS and IV-RFS probability estimation. Furthermore, eight machine learning algorithms (Lasso Cox, random survival forest [RSF], CoxBoost, generalized boosted regression modeling [GBM], support vector machine [Survival-SVM], eXtreme Gradient Boosting [XGBoost], supervised principal components [SuperPC], and partial least squares regression for Cox [plsRcox]) were implemented for OS and IV-RFS prediction modeling. Finally, we quantitatively pooled our cohort data with literature evidence retrieved from major databases (PubMed, Cochrane, Embase, Web of Science) up to 21 May 2025, to compare survival and renal function outcomes between the two procedures using Stata 14.0. Subgroup assessments and leave-one-out sensitivity analyses were performed to address potential confounding factors related to heterogeneity. Results: Firstly, the multicenter retrospective cohort study revealed that SU was associated with reduced IV-RFS and was identified as a significant independent predictor of IV-RFS (HR = 1.48; P = 0.02). Meanwhile, there was no significant difference in OS between SU and RNU. Algorithm comparison confirmed optimal discriminative performance for IV-RFS (3-year AUC: 0.771, 4-year: 0.758, 5-year: 0.761) and OS (3-year AUC: 0.739, 4-year: 0.726, 5-year: 0.710). Decision curve analysis demonstrated the excellent clinical applicability of the nomograms for OS and IV-RFS, which enhanced model precision and clinical utility. Furthermore, in the meta-analysis, 21 studies including 31 293 patients were selected for inclusion, spanning publication years from 2010 to 2025. Regarding survival outcomes, although no statistically significant differences were observed in OS risk ( P = 0.696), CSS risk ( P = 0.765), or RFS ( P = 0.072) between patients receiving SU and those undergoing RNU, SU was associated with lower IV-RFS compared to RNU (HR = 1.21, P = 0.019). Subgroup analysis stratified by geographic region revealed significantly reduced OS with SU versus RNU in European cohorts (HR = 1.24, P = 0.001). Concerning renal functional outcomes, the SU group demonstrated significantly higher postoperative eGFR (WMD, 14.16 mL/min; P < 0.001) and greater delta change in eGFR (WMD, 11.78 mL/min; P < 0.001). Conclusion: SU achieves cancer-specific and overall survival comparable to RNU, even in high-grade ureteral UTUC, while significantly improving postoperative renal function. However, it necessitates multidisciplinary management of intravesical recurrence risk. Validation of molecular predictors and prospective trials in advanced disease are essential to further expand and validate the therapeutic landscape of SU.

Primary adrenal tuberculosis (TB) is a rare type of extrapulmonary tuberculosis (EPTB). A pathological biopsy is usually required to make a definite diagnosis due to nonspecific symptoms. Antituberculous chemotherapy is the main treatment regimen, and cortisol replacement therapy should be added when adrenal insufficiency is involved. Here, we present a 59-year-old man who had recurrence of oral and genital aphthosis for 3 years and was diagnosed with Behcet’s disease (BD), which was cured by thalidomide. After 10 days of admission, the patient had sudden abdominal pain in the right upper quadrant with high fever and was diagnosed with acute cholecystitis attack, which was treated by percutaneous transhepatic gallbladder drainage (PTGBD). Further contrast-enhanced CT showed a right adrenal mass with a diameter of 2.0 cm, and PET-CT indicated intense ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake in the right adrenal mass with a maximum standardized uptake value (SUV_max) of 15.2. As a metastatic adrenal mass was suspected, the patient underwent retroperitoneal laparoscopic adrenalectomy. Histopathological and immunohistochemical analysis revealed primary adrenal TB. After routine anti-tuberculosis treatment with isoniazid, rifampin, pyrazinamide and ethambutol for six months, the patient was cured and discharged. In summary, primary unilateral adrenal TB without adrenal insufficiency is difficult to diagnose only on the basis of clinical manifestations and examinations. Further studies are needed to develop an easier and more accurate diagnostic examination.

Aspirin, widely used to prevent cardiovascular disease, had been linked to the incidence of bladder cancer (BCa). Existing studies focusing on Chinese populations are relatively rare, especially for Northeast China. Meanwhile, relevant studies on the effects of aspirin on the occurrence or prognosis of BCa are inconsistent or even controversial. First, in the case control study, logistic regression analysis was used to investigate the association between aspirin intake and risk of BCa including 1121 patients with BCa and the 2242 controls. Subsequently, Kaplan-Meier curve and Cox regression analyses were applied to explore the association between aspirin intake and clinicopathological factors which may predict overall survival (OS) and recurrence-free survival (RFS) of BCa patients. Finally, we quantificationally combined the results with those from the published literature evaluating aspirin intake and its effects on the occurrence, outcome of surgery and prognosis of BCa by meta-analysis up to May 1, 2021.Our case-control study demonstrated that the regular use of aspirin was not associated with a reduced incidence of BCa (P=0.175). Stratified analyses of sex showed that aspirin intake did not lead to a lower risk of BCa in female patients (P=0.063). However, the male population who regularly took aspirin had a lower incidence of BCa (OR=0.748, 95% CI= 0.584-0.958, P=0.021). Subgroup analyses stratified by smoking found a significant reduction in the risk of BCa in current smokers with aspirin intake (OR=0.522, 95% CI=0.342-0.797, P=0.002). In terms of prognosis of BCa, patients with a history of aspirin intake did not had a markedly longer OS or RFS than those with no history of aspirin intake by Kaplan-Meier curves. Stratified analysis by sex showed no correlation between aspirin intake and the recurrence or survival of BCa for either male or female patients. However, in people younger than 68, aspirin intake seemed to have prolonged effects for overall survival (HR=3.876; 95% CI=1.326-11.325, P=0.019). Then, we performed a meta-analysis and the combined results from 19 articles and our study involving more than 39524 BCa cases indicated that aspirin intake was not associated with the occurrence of BCa (P=0.671). Subgroup analysis by whether regular use of aspirin, by the mean duration of use of aspirin, by sex, by smoking exposure, by research region and by study type also supported the above results. In terms of the impact of aspirin intake on the prognosis of patients with BCa, 11 articles and our study involving 8825 BCa cases were eligible. The combined results showed that patients with aspirin intake did not have significantly influence on survival, recurrence, progression and metastasis than those without aspirin intake. On the whole, both our retrospective study and literature meta-analysis suggested a lack of a strong relevant association between the use of aspirin and the incidence or prognosis of BCa. Thus, additional long-term follow-up prospective research is warranted to clarify the association of aspirin with BCa incidence and prognosis.