Background:Over the past decade, the treatment landscape for metastatic urothelial carcinoma (mUC) has improved significantly with the introduction of immunotherapy, targeted agents, and antibody-drug conjugates. The median overall survival (mOS) reached 36.7 months in cisplatin-eligible and 25.6 months in cisplatin-ineligible patients in the first-line setting and over 10 months post-platinum failure. However, liver metastases remain a known poor prognostic factor. Methods:We conducted a retrospective analysis of mUC patients treated at 79 global institutions. Two cohorts were defined: cohort 1 included patients who progressed after platinum-based therapy and received pembrolizumab, and cohort 2 included patients who received avelumab as maintenance therapy. Treatments were administered between 1 January 2016 and 31 October 2024. Results:Cohort 1 (n = 1,341) had an mOS of 17.5 months. Patients without liver metastases had significantly longer OS than those with liver involvement (20.1 vs. 9.4 months, p <0.001). Among patients with liver metastases, OS was 11.8 months in males vs. 5.8 months in females (p = 0.066). OS was longer in those with BMI ≥25 kg/m² (14.1 vs. 8.1 months, p = 0.028) and better ECOG-PS (ECOG 0: 17.0 months; ECOG 1: 9.8; ECOG ≥2: 3.1; p <0.001). Cohort 2 (n = 291) had an mOS of 25.8 months. Again, OS was longer in patients without liver metastases (27.0 vs. 16.4 months, p <0.001). Among those with liver involvement, OS was 14.7 months in males and 20.0 months in females (p = 0.310). Patients with BMI ≥25 had non-reached OS versus 17.1 months in those with lower BMI (p <0.001). ECOG-PS remained a strong prognostic factor (NR for ECOG 0; 14.7 months for ECOG 1; 4.6 months for ECOG ≥2, p <0.001). Conclusion:Liver metastases are associated with significantly reduced survival in patients with mUC receiving immunotherapy. However, both pembrolizumab and avelumab demonstrated improved outcomes compared with historical chemotherapy data. These findings underscore the need for personalized treatment strategies in high-risk subgroups.
Neoadjuvant therapy (NAT) is a cornerstone of breast cancer management (1). However, real-world criteria for patient selection remain poorly defined outside the context of clinical trials. A previous Italian study, which included southern regions, highlighted substantial variability in NAT utilization (2,3). According to EUSOMA, the use of NAT represents a key quality indicator within breast unit care pathways (4). This study aimed to investigate which centers in the Apulia region offer NAT, the criteria employed for patient selection, perceived barriers to its use, and the level of adherence to EUSOMA guidelines. Twelve regional Breast Units (BUs) and five of the seven spoke centers in Apulia participated in the survey (one BU did not respond). The survey was conducted between October and November 13, 2024, and analyzed data from the preceding six months. It consisted of three thematic sections: • C1: Organizational structure, multidisciplinary team (MDT) case volume, proportion of NAT-eligible cases, and the interval between the end of NAT and surgery. • C2: Proportion of NAT-eligible cases by tumor subtype (HER2+, ER/PgR+/HER2-, triple-negative). • C3: Subtype-specific barriers to NAT, with relative relevance ratings. The results are described in table 1 Barriers to Neoadjuvant Therapy (NAT) Identified by Clinicians: Breast Units reports • HER2+ cases: 41% considered tumor size ≤2 cm and node-negative status (T≤2/N0) as a barrier to NAT. • ER/PgR+ cases: 100% identified T1-T2 and node-negative status (T1-T2/N0) as a limiting factor. • Triple-negative breast cancer (TNBC): 83% considered tumor size ≤1 cm as a barrier. Spokes reports: • 80% cited T≤1 cm and node-negative status (T≤1 cm/N0) as a barrier in HER2+ cases. • 100% cited T1-T2 with N0-N1 status (T1-T2/N0-1) as a limitation in ER/PgR+/HER2- cases. • 100% identified T≤1 cm/N0 as a barrier in TNBC cases. Although limited to a six-month period, the findings reflect the heterogeneity previously reported in broader studies. NAT rates and surgery timing were consistent with guideline recommendations, despite an unselected patient population. Tumor and nodal size—particularly in small, high-risk subtypes—emerged as key limiting factors. Spoke centers expressed greater concern about the risk of over-treatment in low-volume, high-risk scenarios. Further analyses will investigate treatment decision-making and access to clinical trials. M. Ciccarese, L. Orlando, F. Giotta, M. Di Millo, M. Morritti, L. Ciuffreda, S. Bambace, F. Giuliani, O. Custodero, S. Bruno, S. Stucci, M. Moschetta, S. Pisconti, G. Palmiotti, E. De Matteis, G. Cairo, S. Cinieri. Neoadjuvant breast cancer in a real life experience in Southern of Italy [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-08-21.
PURPOSE:To compare the capacity of isolated medial or lateral meniscus allograft transplantation (MAT) and isolated anterior cruciate ligament (ACL) reconstruction (ACLR) to reduce pre-operative knee laxity in vivo. Isolated MAT was hypothesized to restore knee stability comparably to isolated ACLR. METHODS:All surgical procedures performed with intraoperative navigation were retrospectively analyzed. Patients with post-meniscectomy syndrome and intact ACL undergoing medial or lateral MAT (MAT-M and MAT-L groups) were matched 1:1 by age and sex to patients with intact menisci undergoing ACLR (ACLR-M and ACLR-L groups, respectively). Intraoperative anteroposterior (AP), internal/external rotation, varus/valgus and pivot-shift (PS) laxity were quantified using the navigation system before and after surgery. Repeated-measures ANOVA was used to compare laxity between groups across pre- and post-operative states. Statistical significance was set at p < 0.05. RESULTS:From a total of 232 patients, 36 were selected: 8 in the MAT-M group, 8 in the ACLR-M group, 10 in the MAT-L group and 10 in the ACLR-L group. MAT-M reduced pre-operative AP laxity with no statistically significant difference compared to ACLR, across all measured parameters, including AP translation at 30° and 90° of flexion, internal/external rotation and varus-valgus. Conversely, ACLR was a significantly more effective stabilizer compared to MAT-L, demonstrating a greater reduction in AP laxity at 30° (43.2% vs. 37.2%, p = 0.045) and 90° of flexion (62.6% vs. 36.3%, p = 0.007), and PS area (62.5% vs. 32.5%, p = 0.002). CONCLUSIONS:In patients with chronic post-meniscectomy syndrome, isolated MAT-M restored AP knee stability comparably to isolated ACLR, suggesting that the medial meniscus acts as a primary stabilizer in this population. In contrast, isolated MAT-L was significantly less effective than ACLR in controlling AP and PS laxity, despite significantly reducing it. These findings highlight the critical, compartment-specific biomechanical role of the menisci. LEVEL OF EVIDENCE:Level III.
Percutaneous liver biopsy is widely performed and generally safe; however, rare vascular complications may occur. We report a 43-year-old man with a history of allogeneic haematopoietic stem cell transplantation undergoing ultrasound evaluation for multiple hepatic and splenic lesions detected during investigation of persistent fever. After a non-diagnostic biopsy, follow-up ultrasound three weeks later demonstrated vascular features within a left-lobe lesion selected for repeat sampling. Contrast-enhanced ultrasound (CEUS) showed rapid and persistent arterial enhancement. Colour Doppler revealed turbulent bidirectional flow with a “yin–yang” pattern, and pulsed-wave Doppler demonstrated a characteristic “to-and-fro” waveform consistent with pseudoaneurysm. CT angiography confirmed a pseudoaneurysm arising from a peripheral intrahepatic branch of the left hepatic artery. The patient remained asymptomatic, haemodynamically stable and without laboratory evidence of bleeding. Selective endovascular embolisation was performed. This case highlights how combined CEUS and Doppler may detect delayed, clinically silent vascular complications after liver biopsy.
