Aim: Recent studies have demonstrated the potential of PET/CT with 18F-labeled ligands targeting prostate-specific membrane antigen (PSMA), as a promising method for prostate cancer (PCa) management. The aim of this study is to assess the clinical value of [18F]AlF-Thretide ([18F]AlF-PSMA-BCH) PET/CT and early time-point PET acquisition for detecting and staging PCa. Materials and Methods: From November 2022 to May 2023, a total of 73 PCa patients were included in our study. Along with whole-body PET/CT conducted at a median time of 76 min (range: 59-139 min) post-injection, a single-bed pelvic early PET/CT scan was performed, starting at a median time of 187 s (range: 161-453 s) post-injection. Visual analysis of the images was performed first, followed by semiquantitative analysis of maximum standardized uptake value (SUVmax) of primary PCa lesions, metastases, bladder, and surrounding tissues on both early and routine time-point PET/CT scans. Results: Among 56 non-surgical patients (either treatment-naive or after androgen deprivation therapy only) who had previously undergone conventional imaging, N staging was revised in 4 cases, and M staging in 2 cases. In 54 patients with bone scans for comparison, 111 lesions on [18F]AlF-Thretide PET/CT and 41 lesions on bone scans were identified as indicative of bone metastases. The median tumor-to-bladder (T/BL) ratios for primary lesions increased from 0.33 (range: 0.03-6.22) on routine time-point PET/CT to 4.66 (range: 0.24-645.00) on early time-point PET/CT. In 94.6% (53/56) of patients, the T/BL ratios were higher on early PET/CT scans than on routine time-point PET/CT scans. However, the SUVmax of surrounding tissues was found to be higher on early PET/CT scans compared to routine PET/CT scans (external iliac vessels: 8.02 ± 1.64 vs. 2.66 ± 0.59; inferior vesical artery branches near the prostate: 4.70 ± 1.09 vs. 2.30 ± 0.49; gluteus maximus muscle: 1.19 ± 0.31 vs. 0.80 ± 0.25). Of the 17 patients who underwent surgery prior to PET/CT, early PET/CT scans improved the detection rate of local recurrences from 2/17 to 5/17. Conclusion: [18F]AlF-Thretide PET/CT was shown to be a valuable imaging modality in the management of patients with PCa. Early PET/CT scans can improve the detection rate of local recurrences and provide additional information for lesions that are challenging to distinguish from urinary uptake on routine PET/CT scans.

To evaluate the feasibility and diagnostic accuracy of indocyanine green (ICG)-guided pelvic lymph node dissection (PLND) during laparoscopic radical prostatectomy, and compare the lymph node detection rate and 3-year biochemical recurrence (BCR) rate between PLND and ICG-guided PLND. Sixty-eight patients were randomly divided into intervention and control groups (1:1). The intervention group underwent standard pelvic lymph node dissection (sPLND) and fluorescent visible sentinel lymph node dissection (SLND) after an ultrasound-guided injection of ICG (25 mg), while the control group received sPLND without ICG injection. Kaplan–Meier survival curves were used to compare the two groups of patients for BCR at a point three years post-surgery. In the intervention group, 284 lymph nodes were removed, and 58 lymph nodes were visualized by ICG, including 4 positive lymph nodes. In the control group, 205 lymph nodes were removed. There were three cases of ICG leakage and six cases of lymphocele in the intervention group and one case of lymphocele in the control group. The sensitivity and specificity of ICG-guided lymph node dissection was 80.00

Pluvicto® (Lutetium-177-PSMA-617) was the world’s first radiolabeled drug for the treatment of metastatic castration-resistant prostate cancer that was positive for prostate-specific membrane antigen with limited global use to date. Our study aimed to conduct a thorough analysis based on the Adverse Event (AE) reporting system FAERS of the Food and Drug Administration (FDA), providing insights for its future clinical application. The AEs reports suspected primarily of Pluvicto® from April 1, 2022, to December 31, 2024, were retrieved from the FAERS system to conduct a disproportionality test. The characteristics of these reports were analyzed including demographic features, time of AE occurrence, and features of AEs. AEs were classified by System Organ Classes (SOCs) and preferred terms (PTs) according to the Medical Dictionary for Regulatory Activities (MedDRA®). The disproportionality of results was analyzed by Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS). A total of 7654 patient reports primarily suspected of Pluvicto® were submitted to the database, demonstrating a monthly increasing trend in reporting frequency. Demographic analysis revealed 85 records with weights ≥ 90 kg (24.3

Background/Objectives: Bone metastasis is a frequent and life-threatening event in advanced cancers, affecting up to 70–85% of prostate cancer patients. Understanding the cellular and molecular mechanisms underlying bone metastasis is essential for developing targeted therapies. This study aimed to systematically characterize the heterogeneity and microenvironmental adaptation of prostate cancer bone metastases using single-cell transcriptomics. Methods: We integrated the largest single-cell transcriptome dataset to date, encompassing 124 samples from primary prostate tumors, various bone metastatic sites, and non-malignant tissues (e.g., benign prostatic hyperplasia, normal bone marrow). After quality control, 602,497 high-quality single-cell transcriptomes were analyzed. We employed unsupervised clustering, gene expression profiling, mutation analysis, and metabolic pathway reconstruction to characterize cancer cell subtypes and tumor microenvironmental remodeling. Results: Cancer epithelial cells dominated the tumor microenvironment but exhibited pronounced heterogeneity, posing challenges for conventional clustering methods. By integrating genetic and metabolic features, we revealed key evolutionary trajectories of epithelial cancer cells during metastasis. Notably, we identified a novel epithelial subpopulation, NEndoCs, characterized by unique differentiation patterns and distinct spatial distribution across metastatic niches. We also observed significant metabolic reprogramming and recurrent mutations linked to prostate-to-bone microenvironmental transitions. Conclusions: This study comprehensively elucidates the mutation patterns, metabolic reprogramming, and microenvironment adaptation mechanisms of bone metastasis in prostate cancer, providing key molecular targets and clinical strategies for the precise treatment of bone metastatic prostate cancer.

Objective Pluvicto® (Lutetium-177–PSMA-617) was the world's first radiolabeled drug for the treatment of metastatic castration-resistant prostate cancer that was positive for prostate-specific membrane antigen with limited global use to date. Our study aimed to conduct a thorough analysis based on the adverse event reporting system FAERS of the Food and Drug Administration (FDA), providing insights for its future clinical application. Methods The adverse event reports suspected primarily of Pluvicto® from April 1, 2022 to December 31, 2024 were retrieved from the FAERS system to conduct a disproportionality test. The characteristics of these reports were analyzed including demographic features, time of adverse event occurrence, and features of adverse events. Adverse events (AEs) were classified by System Organ Classes (SOCs) and preferred terms (PTs) according to the Medical Dictionary for Regulatory Activities (MedDRA®). The disproportionality of results was analyzed by Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS). Results A total of 7654 adverse event reports suspected primarily of Pluvicto® were submitted to the database, showing a monthly increasing trend in report numbers. 649 Preferred Terms (PTs) were identified, and after screening, from which 33 significant PT signals were identified by the 4 algorithms, involving 10 SOCs after classification. Additionally, our study revealed thrombotic microangiopathy (TMA) as an adverse event not previously documented in the label. Conclusions The study confirmed the majority of significant AE signals that have been listed in the prescribing information or reported in previous studies. It was recommended that intensified laboratory monitoring and screening of clinical parameters, baseline hepatic function and potential infestation risks during initial treatment phases.

OBJECTIVE:To describe our surgical technique for intracorporeal ureteroileal anastomosis and to assess its safety and short-term outcomes. PATIENTS AND METHODS:We performed a retrospective review of medical records for 90 consecutive patients who received an intracorporeal ileal conduit constructed using the Xing technique at our center from March 2018 to October 2022. In all cases, an intracorporeal ileal conduit was constructed using the Xing technique with a da Vinci Surgical System robot in a four-arm configuration or a Storz 3D laparoscopic system. Intraoperative variables, postoperative complications, and short-term follow-up data were assessed. A descriptive statistical analysis was performed. RESULTS:The median operative time was 244 min. No conversion to open surgery was needed. One patient needed a red blood cell transfusion (800 mL) for hemorrhage during surgery. Five patients (5.5%) experienced renal hydronephrosis after surgery because of a ureteroileal anastomosis stricture. The study is limited by its retrospective nature, lack of a control group, and short follow-up. CONCLUSION:Use of the Xing technique may simplify the ureteroileal anastomosis procedure for an intracorporeal ileal conduit and reduce the incidence of anastomosis stricture. The short-term results are satisfactory.

BACKGROUND:Circulating metabolites have been found to play an important role in the development of renal cancer, however, the specific pathways and mechanisms of their influence are still largely unknown. We aimed to investigate the role of metabolites in kidney cancer development and to explain the development of kidney cancer from a genetic perspective. METHOD:We explored the role of plasma metabolites and urinary metabolites in kidney cancer using two-sample mendelian randomization (MR) separately and validated it using multiple databases; in addition, we performed rigorous tests of pleiotropy and heterogeneity to ensure that the results were robust. Next, we explored the role of common modifiable risk factors in kidney cancer and identified the specific mechanisms by which risk factors affect kidney cancer by joint analysis of TCGA and GEO databases. RESULTS:Through MR analysis, we identified six plasma metabolites and one urinary metabolite that play a major role in kidney cancer, confirmed the effects of BMI and type 1 diabetes mellitus on kidney cancer, and constructed the BMI-plasma metabolite-kidney cancer causality networks through mediated MR. In addition, we found that SLPI could significantly affect the prognosis of kidney cancer through multiple databases' joint analyses, and through multiple methods explored the pathways of SLPI's influence on kidney cancer. CONCLUSIONS:In a word, this study shows that BMI can significantly increase the risk of kidney cancer, while the plasma metabolites 4-guanidinobutanoate may partially mitigate this risk, and that SLPI promotes tumorigenesis in obesity-related renal cancer by regulating protease activity.

Clear cell renal cell carcinoma, one of the most common types of renal cell carcinoma, has been increasing in incidence year by year. This study aims to investigate the impact of radiotherapy on the prognosis of patients with metastatic clear cell renal cell carcinoma (mccRCC) undergoing cytoreductive surgery. Clinical data of patients with mccRCC who underwent cytoreductive surgery were collected from the SEER database (2000-2021). This study employed propensity score matching (PSM) and R software to evaluate the overall survival (OS) of radiotherapy. Univariate and multivariate COX regression analyses were conducted to explore the impact of different variables on prognosis. Finally, a nomogram was developed to predict patient survival rates. A total of 2076 patients with mccRCC who underwent cytoreductive surgery were included in this study, with 538 (25.92%) in the radiotherapy group and 1539 (74.08%) in the non-radiotherapy group. After propensity score matching (PSM), there were 300 cases in each group. Kaplan-Meier values and the Cox proportional hazards model were used to plot the overall survival (OS) curves, which showed that the median survival time in the radiotherapy group was significantly lower than that in the non-radiotherapy group. Additionally, multivariate Cox regression analysis revealed that tumor grade, N stage, radiotherapy, lung metastasis, and liver metastasis were independent factors affecting the prognosis of patients with mccRCC undergoing cytoreductive surgery. Lastly, a nomogram was developed to estimate the survival rates of patients with mccRCC after cytoreductive surgery. Radiotherapy after cytoreductive surgery may have an adverse impact on the prognosis of patients with mccRCC.

Nephrometry scores play a critical role in the preoperative evaluation of partial nephrectomy. Although score comparisons have been performed for transperitoneal or open surgery, systematic comparisons for retroperitoneal operations are lacking. Authors have retrospectively evaluated the clinical records of patients who underwent partial nephrectomy at one center by one surgeon. Scores were generated according to the imaging results, and each score was categorized into low-, intermediate- and high-complexity groups. Then, the differences in perioperative outcomes were compared among the groups. We assessed whether the scores and sex, body mass index (BMI), age, or American Society of Anesthesiologists (ASA) Physical Status classification could predict whether the warm ischemia time (WIT) was likely be longer than 20 min and whether they could predict postoperative complications worse than Clavien–Dindo 1. The interobserver variability between two experienced surgeons for these scores was calculated with the intraclass correlation coefficient (ICC). Total of 107 patients were ultimately evaluated. The scores included in this study were significantly associated with the probability of having a WIT > 20 min and high-grade postoperative complications. Receiver Characteristic Operator (ROC) curves showed that there were no significant differences in their predictive power. NePhRo had the highest agreement (0.839), followed by DAP (0.827). RENAL was superior to SPARE and PADUA, which were 0.758, 0.724 and 0.667, respectively.

Objective: To investigate the impact of the kind and number of organs involved in metastatic tumors on postoperative survival of adrenal cortical carcinoma (ACC). Methods: Clinical data with ACC patients who underwent surgery were collected from the SEER databas (2000 – 2020). The overall survival (OS) of ACC patients with/without metastasis, single organ metastasis/multiple organ metastasis and liver/lung metastasis were compared, respectively. Propensity score matching (PSM) was used to balance the differences between baseline data. Results: This study included a total of 757 patients with ACC who underwent surgery. After PSM, the OS curve showed that patients without metastatic tumors had a higher survival rate than those with metastatic tumors (P< 0.001), patients with two or more tumor metastases had higher mortality than those with one metastasis (P = 0.041), and patients with lung metastasis had a higher survival rate than those with liver metastasis (P = 0.015). Conclusion: The kind and number of organs involved by metastatic tumors are associated with the postoperative survival time of patients with ACC. Compared to metastasis of a single organ, metastasis of two or more organs has a shorter life period. Liver metastasis has a worse prognosis than lung metastasis.

Immune checkpoint blockers (ICBs) therapy stands as the first-line treatment option for advanced renal cell carcinoma (RCC). However, its effectiveness is hindered by the immunosuppressive tumor microenvironment (TME). Sonodynamic therapy (SDT) generates tumor cell fragments that can prime the host's antitumor immunity. Nevertheless, the hypoxic microenvironment and upregulated autophagy following SDT often lead to cancer cell resistance. In response to these challenges, a hypoxia-responsive polymer (Poly(4,4'-azobisbenzenemethanol-PMDA)-mPEG5k, P-APm) encapsulating both a HIF-2α inhibitor (belzutifan) and the ultrasonic sensitize (Chlorin e6, Ce6) is designed, to create the nanoparticle APm/Ce6/HIF. APm/Ce6/HIF combined with ultrasound (US) significantly suppresses tumor growth and activates antitumor immunity in vivo. Moreover, this treatment effectively transforms the immunosuppressive microenvironment from "immune-cold" to "immune-hot", thereby enhancing the response to ICBs therapy. The findings indicate that APm/Ce6/HIF offers a synergistic approach combining targeted therapy with immunotherapy, providing new possibilities for treating RCC.

Overbiopsy is a serious health issue in prostate cancer (PCa) diagnostics. We have developed a urine tumor DNA multidimensional bioinformatic algorithm, utLIFE, to avoid unnecessary biopsy. The objective is to recognize all or clinically significant PCa. Of the 801 participants recruited in our study, 630 are selected for subsequent analysis. In the training cohort (n = 237), utLIFE-PC gets an area under the receiver operating characteristic curve (AUC) of 0.967 and a sensitivity of 85.57% at 95% specificity. In the independent prospective validation cohort (n = 343), utLIFE-PC has an AUC of 0.929, sensitivity of 84.24%, and specificity of 93.26%. Notably, in patients with ≥grade group (GG)2 and ≥GG3, the assay’s sensitivity is still excellent (85.33% and 87.10%, respectively). The model shows better performance than prostate-specific antigen (PSA) (p < 0.001) or the single-dimensional biomarkers (methylation, p < 0.001; copy-number variations [CNVs], p < 0.001; mutation, p < 0.001). The utLIFE-PC model can potentially optimize the PCa diagnostic process and avoid unnecessary biopsies. This study was registered at Chinese Clinical Trial Registry: ChiCTR2300071837.

Neutrophil extracellular traps (NETs) represent a novel form of inflammatory cell death within neutrophils. Emerging research indicates that NETs promote cancer progression and metastasis in various ways. This study aims to provide prognostic NETs characteristics and therapeutic targets for patients with renal cell carcinoma (RCC). NMF analysis was conducted on 89 NET-related genes in the training cohort. Subsequently, WGCNA networks were utilized to study the subtype feature genes. Six machine learning algorithms were assessed for model training, and the optimal model was selected based on 1-year, 3-year, and 5-year AUC values. A NETs signature was then constructed to predict overall survival in RCC patients. Furthermore, multi-omics validation was performed based on NETs signature. Finally, stable knockout key gene RCC cell lines were established to verify the biological function of KCNN4 both in vitro and in vivo. This study highlights the emerging hot topic of NETs in RCC. We provide a prognostic NETs signature and identify multiple roles of KCNN4 in RCC. This work contributes to risk stratification and the identification of new therapeutic targets for RCC patients.

Background:Controlling Nutritional Status (CONUT) score was used for screening the preoperative nutritional status. The correlation between the CONUT score and the prognosis of patients with prostate cancer (PCa) has yet to be elucidated. Herein, we analyzed the prognostic value of CONUT scores in patients with PCa who underwent laparoscopic radical prostatectomy.Materials and methods:Data of 244 patients were retrospectively evaluated. Perioperative variables and follow-up data were analyzed. The patients were categorized into 2 groups according to their preoperative CONUT scores. Postoperative complication and incontinence rates were also compared. The Kaplan-Meier method was used to estimate the median biochemical recurrence-free survival (BCRFS) between the 2 groups. Univariate and multivariate Cox regression analyses were performed to identify the potential prognostic factors for BCRFS.Results:Patients were categorized into the low-CONUT group (CONUT score <3, n = 207) and high-CONUT group (CONUT score ≥3, n = 37). The high-CONUT group had a higher overall complication rate (40.5% vs.19.3%, p = 0.004), a higher major complication rate (10.8% vs. 3.9%, p = 0.013), and longer postoperative length of stay (8 days vs. 7 days, p = 0.017). More fever, urinary infection, abdominal infection, scrotal edema, rash, and hemorrhagic events (all p values < 0.05) were observed in the high-CONUT group. A higher rate of urinary incontinence was observed in the high-CONUT group at 1 (34.4% vs. 13.2%, p = 0.030) and 3 months (24.1% vs. 8.2%, p = 0.023) postoperatively. The high-CONUT group had shorter medium BCRFS (23.8 months vs. 54.6 months, p = 0.029), and a CONUT score ≥3 was an independent risk factor for a shorter BCRFS (hazards ratio, 1.842; p = 0.026).Conclusions:The CONUT score is a useful predictive tool for higher postoperative complication rates and shorter BCRFS in patients with PCa who undergo laparoscopic radical prostatectomy.

BACKGROUND:At present, biopsy is essential for the diagnosis of prostate cancer (PCa) before radical prostatectomy (RP). However, with the development of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and multiparametric magnetic resonance imaging (mpMRI), it might be feasible to avoid biopsy before RP. Herein, we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI. METHODS:Between December 2017 and April 2022, 56 patients with maximum standardized uptake value (SUVmax) of ≥4 and Prostate Imaging Reporting and Data System (PI-RADS) ≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals. The consistency between clinical and pathological diagnoses was evaluated. Preoperative characteristics were compared among patients with different pathological types, T stages, International Society of Urological Pathology (ISUP) grades, and European Association of Urology (EAU) risk groups. RESULTS:Fifty-five (98%) patients were confirmed with PCa by pathology, including 49 (89%) with clinically significant prostate cancer (csPCa, defined as ISUP grade ≥2 malignancy). One patient was diagnosed with high-grade prostatic intraepithelial neoplasia (HGPIN). CsPCa patients, compared with clinically insignificant prostate cancer (cisPCa) and HGPIN patients, were associated with a higher level of prostate-specific antigen (22.9 ng/mL vs . 10.0 ng/mL, P = 0.032), a lower median prostate volume (32.2 mL vs . 65.0 mL, P = 0.001), and a higher median SUVmax (13.3 vs . 5.6, P <0.001). CONCLUSIONS:It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI. However, the diagnostic efficacy of csPCa with PI-RADS ≥4 and SUVmax of ≥4 is inadequate for performing a procedure such as RP. Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.

e16572 Background: The first-line regimens for locally advanced or metastatic urothelial carcinoma(la/mUC)remain an unmet need. RC48-ADC has been approved in China for platinum-refractory la/mUC with HER2 overexpression (IHC 2+ or 3+). Cadonilimab (AK104, PD-1/CTLA-4 bsAb) showed encouraging antitumor activity in gynecologic cancer, urological tumors, etc. The aim of this study is to evaluate the efficacy and safety characteristics of RC-48 ADC combined with cadonilimab in the treatment of la/mUC with HER2 expression. Methods: This is an open-label, multicenter, prospective, phase 2 trial to evaluate RC48-ADC combined with cadonilimab in mUC. The study set a safe introduction period, 6 patients were included and received the initial dose of RC48-ADC at 2 mg/kg combined with cadonilimab at 6 mg/kg every two weeks. If no DLT event occurred in the 6 patients, then continued to expand 30 patients, with an expected sample size of 36 cases; If DLT safety event occurred in 6 cases, the RC48-ADC dose reduced to 1.5 mg/kg and cadonilimab dose reduced to 4 mg/kg for Q2W; Treatment continued until disease progression, intolerable toxicity, death, etc. Primary endpoint was ORR and safety, Secondary endpoints included DOR, PFS, OS, and exploration of tumor biomarkers. Results: By the cutoff date of 4 February 2024, Thirteen la/mUC patients were enrolled who have not received systematic treatment or intolerant to cisplatin or refuse chemotherapy {8 males; median age 72 y [61-83]; 77%(10/13) of patients had distant metastasis. HER2 expression IHC 2+ or 3+ was in 85% patients (11/13), and PD-L1 low expression was 100% (6/6)}. Dose-limiting toxicity was observed (Bullous rash, ALT/AST elevated) among first 6 patients, therefore reduced cadonilimab from 6mg/kg to 4mg/kg Q2W, RC48-ADC remained. 8 patients have efficacy evaluation, ORR was 75.0% (6/8), including 12.5% CR (1/8). DCR was 100%. Median progression-free survival (PFS) and overall survival (OS) were not reached. 69.2% (9/13) Pts experienced treatment-related adverse events (TRAEs). The most common TRAEs were AST/ALT increase (30.8%), fever (23.1%), anemia (23.1%), rash (15.4%), and pruritus (15.4%), etc. TRAEs ≥G3 were occurred in 15.4%(2/13) patients, one patient died due to a cerebrovascular event. 30.8% had immune-related AEs(≥G3 irAE 15.4%), including immune-related skin reactions, hepatitis, and colitis. Conclusions: This was the first study to evaluate RC48-ADC in combination with cadonilimab (anti-PD-1/CTLA-4 bispecific antibody) in urothelial carcinoma. Preliminary results showed that the combination have promising efficacy in first-line treatment of la/mUC and a manageable safety profile, it may potentially provide a new option for la/mUC treatment, especially for those who cannot tolerate cisplatin-based chemotherapy. Clinical trial information: NCT06178601 .

ObjectiveTo quantitatively characterize the dosimetric effects of long on-couch time in prostate cancer patients treated with adaptive ultra-hypofractionated radiotherapy (UHF-RT) on 1.5-Tesla magnetic resonance (MR)-linac.Materials and methodsSeventeen patients consecutively treated with UHF-RT on a 1.5-T MR-linac were recruited. A 36.25 Gy dose in five fractions was delivered every other day with a boost of 40 Gy to the whole prostate. We collected data for the following stages: pre-MR, position verification-MR (PV-MR) in the Adapt-To-Shape (ATS) workflow, and 3D-MR during the beam-on phase (Bn-MR) and at the end of RT (post-MR). The target and organ-at-risk contours in the PV-MR, Bn-MR, and post-MR stages were projected from the pre-MR data by deformable image registration and manually adapted by the physician, followed by dose recalculation for the ATS plan.ResultsOverall, 290 MR scans were collected (85 pre-MR, 85 PV-MR, 49 Bn-MR and 71 post-MR scans). With a median on-couch time of 49 minutes, the mean planning target volume (PTV)-V95% of all scans was 97.83 ± 0.13%. The corresponding mean clinical target volume (CTV)-V100% was 99.93 ± 0.30%, 99.32 ± 1.20%, 98.59 ± 1.84%, and 98.69 ± 1.85%. With excellent prostate-V100% dose coverage, the main reason for lower CTV-V100% was slight underdosing of seminal vesicles (SVs). The median V29 Gy change in the rectal wall was -1% (-20%–17%). The V29 Gy of the rectal wall increased by >15% was observed in one scan. A slight increase in the high dose of bladder wall was noted due to gradual bladder growth during the workflow.ConclusionsThis 3D-MR–based dosimetry analysis demonstrated clinically acceptable estimated dose coverage of target volumes during the beam-on period with adaptive ATS workflow on 1.5-T MR-linac, albeit with a relatively long on-couch time. The 3-mm CTV-PTV margin was adequate for prostate irradiation but occasionally insufficient for SVs. More attention should be paid to restricting high-dose RT to the rectal wall when optimizing the ATS plan.

Objective:To evaluate the clinical value of Xing's ureteroileal anastomosis technique in radical cystectomy.Methods:The data of 38 patients who underwent radical cystectomy with Xing's ureteroileal anastomosis technique at Cancer Hospital, Chinese Academy of Medical Sciences and Beijing Chaoyang Hospital from July 2013 to June 2021 were retrospectively reviewed. There were 30 males and 8 females. The mean age was 61.6±15.1 years old. The mean body mass index (BMI) was 25.1±2.7 kg/m 2. The American Society of Anesthesiology (ASA) graded 25 cases as grade 1, 10 cases as grade 2 and 3 cases as grade 3. There were 35 cases with stage cT 2N 0M 0 and 3 cases with cT 3N 0M 0. All patients underwent radical cystectomy and ileal conduit, and the ureteroileal anastomosis was performed using the Xing's ureteroileal anastomosis technique. Afferent loop entry was divided equally into two lumens. After 1.5 cm-long lengthwise incisions, each ureter was directly and end-to-end anastomosed to the aforementioned lumens. Postoperative information was recorded, including ureteric stricture, ureteric reflux, hydronephrosis, anastomotic leakage, renal calculus, urinary tract infection, and pyelonephritis. Results:Ureteroileal anastomosis was performed successfully in 38 cases with 76 units. The median follow-up time was 35.6 (17.0, 46.3) months. Three patients developed unilateral anastomotic stenosis after operation. Five patients had unilateral ureteral reflux. Two patients had unilateral hydronephrosis. No anastomotic leakage, urinary tract infection, or pyelonephritis occurred after the operation. Renal calculus appeared in 3 cases, all on the left unit.Conclusions:Xing's ureteroileal anastomosis technique is a simple method with few postoperative and good functional outcomes.