OBJECTIVE:To explore the risk factors for acute kidney injury (AKI) in patients with stage 3 chronic kidney disease (CKD) after partial nephrectomy. METHODS:The clinical data of 126 stage 3 CKD patients who underwent partial nephrectomy at Peking University Third Hospital from January 2013 to December 2025 were retrospectively analyzed. Demographic characteristics, comorbidities, surgical-related indicators, and laboratory data of the patients were collected. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Univariate and multivariate regression analyses were used to identify the independent risk factors for postoperative AKI, and the predictive cutoff value of the receiver operating characteristic (ROC) curve was determined. RESULTS:A total of 126 stage 3 CKD patients were included. The incidence of AKI after surgery was 31.0% (39/126). Univariate analysis showed that the proportion of robotic surgery was lower in the AKI group (12.8% vs. 33.3%, P=0.018), the duration of renal artery occlusion was longer (25 min vs. 18 min, P < 0.001), and the intraoperative blood loss was greater (20 mL vs. 50 mL, P=0.028). Multivariate Logistic regression analysis confirmed that the duration of renal artery occlusion (OR=1.105, 95%CI: 1.041-1.173, P=0.001) and intraoperative blood loss (OR=1.004, 95%CI: 1.000-1.007, P=0.046) were independent risk factors for postoperative AKI. ROC curve analysis showed that the area under the curve for predicting AKI by renal artery occlusion time was 0.737, and the optimal cutoff value was 18 min. The incidence of AKI was significantly higher in the patients with renal artery occlusion time ≥ 18 min than those with < 18 min (43.2% vs. 8.8%, P < 0.001). CONCLUSION:The incidence of AKI after partial nephrectomy in stage 3 CKD patients is relatively high. The duration of renal artery occlusion and intra-operative blood loss are independent risk factors for postoperative AKI. Controlling the renal artery occlusion time within 18 min and minimizing intraoperative blood loss can help reduce the risk of AKI in this high-risk population after surgery.

Retroperitoneal vascular leiomyosarcoma (RVLMS), which originates from vascular wall smooth muscle cells, typically requires inferior vena cava (IVC) reconstruction during radical surgery. A retrospective cohort study was conducted on 24 patients who underwent primary resection of RVLMS from June 2015 to November 2023 in one institution. The patient details, operative management, and follow-up data were assessed. Regarding the imaging classification of RVLMS, 6 patients were intraluminal type, 9 patients were intermediate type, 4 patients were extraluminal type, and 5 patients were peripheral type. The median tumor size was 80 mm (interquartile range, IQR 63–105 mm). The median operative time was 294 min. The median blood loss was 650 ml. There were significant differences in operation time, blood loss, blood transfusion, and Intensive Care Unit admission rate among the four types of RVLMS. The procedures of vascular reconstruction included primary repair (n = 15), patch angioplasty (n = 2), and IVC ligation (n = 4). 3 patients suffered an R1/R2 margin. With a median follow-up time of 12.5 months, 5 patients developed local recurrence while 7 patients developed distant metastasis. 1 patient had both local recurrence and distant metastasis. The median disease-free survival was 19.0 months (IQR 7.0–59.0 months). A reasonable surgical strategy of vascular resection and reconstruction in the context of RVLMS surgery was of value in achieving good postoperative outcomes and long-term survival. The imaging classification of RVLMS might help to evaluate the surgical complexity and the prognosis.

OBJECTIVE:To investigate the prognostic factors for all-cause mortality in patients with muscle-invasive bladder cancer (MIBC) with intermediate-to-high-risk primary prostate cancer. METHODS:From January 2012 to October 2023, the clinical data of the patients with MIBC with intermediate-to-high-risk primary prostate cancer in Peking University Third Hospital were retrospectively analyzed. All the patients were monitored and the occurrence of all-cause death was documented as the outcome event in the prognostic study. Univariate and multivariate Cox proportional risk regression analysis models were implemented to search for independent influences on the prognosis of patients. For significant influencing factors (pathological T stage, M stage and perineural invasion of bladder cancer), survival curves were plotted before and after multifactorial Cox regression adjusting for confounding factors. RESULTS:A total of 32 patients were included in this study. The mean age was (72.5±6.6) years; the median preoperative total prostate specific antigen (tPSA) was 6.68 (2.47, 6.84) μg/L; the mean preoperative creatinine was (95±36) μmol/L, and the median survival time was 65 months. The majority of the patients (87.5%) had high-grade bladder cancer, 53.1% had lymphatic invasion, and 31.3% had perineural invasion. Prostate involvement was observed in 25.0% of the cases, and the positive rate of soft-tissue surgical margin was 37.5%. Multivariate Cox analysis revealed that preoperative creatinine level (HR=1.02, 95%CI: 1.01-1.04), pathological stage of bladder cancer T3 (HR=11.58, 95%CI: 1.38-97.36) and T4 (HR=19.53, 95%CI: 4.26-89.52) metastasis of bladder cancer (HR=9.44, 95%CI: 1.26-70.49) and perineural invasion of bladder cancer (HR=6.26, 95%CI: 1.39-28.27) were independent prognostic factors (P < 0.05). Survival curves with Log-rank test after adjusting for confounding factors demonstrated that bladder cancer pathology T3, T4, M1, and perineural invasion were unfavorable factors affecting the patients' survival prognosis (P < 0.05). CONCLUSION:Patients with MIBC with intermediate-to-high risk primary prostate cancer generally portends a poor prognosis. High preoperative serum creatinine, T3 or T4 pathological stage of bladder cancer, metastasis of bladder cancer and bladder cancer perineural invasion are poor prognostic factors for patients with MIBC with intermediate-to-high risk primary prostate cancer.

Introduction and importance:Bronchogenic cyst is a rare congenital malformation of the tracheobronchial bud originating from the primitive foregut, especially in the retroperitoneal region. Retroperitoneal bronchogenic cysts in adults are difficult to make an accurate diagnosis preoperatively. Case presentation:We present three cases of retroperitoneal bronchogenic cysts resembling adrenal tumors in adults. Three cases were asymptomatic, and all were located on the left side. There was no significant enhancement of the cyst walls on contrast-enhanced computed tomography. Two cases presented with typical multilocular sacs and scattered calcification on radiology, whereas the other one showed unilocular sacs, without calcification, and elevation of serum carbohydrate antigen (CA) 19-9 and CA 24-2. Three cases underwent retroperitoneal laparoscopic surgeries. Histopathologic examination confirmed the diagnosis of retroperitoneal bronchogenic cysts. There was no recurrence of the three cases during follow-up. Clinical Discussion:A retroperitoneal bronchogenic cyst is mostly asymptomatic. It can be found in adults with variable findings in computed tomography. It can be likely ignored and misdiagnosed as an adrenal tumor. Conclusion:The tests of CA 19-9 and CA 24-2 could help diagnose retroperitoneal bronchogenic cysts. Retroperitoneal laparoscopic surgery is recommended for the treatment of retroperitoneal bronchogenic cysts with a favorable prognosis.

Background: Extramedullary epidural metastatic tumors of small cell lung cancer (SCLC) are rare, and their clinical symptoms and imaging features lack specificity. This study was aimed at improving understanding of epidural metastatic SCLC tumors. Case report: We present the case of a 75-year-old patient with an extramedullary epidural metastatic SCLC tumor that was misinterpreted as a primary intraspinal tumor according to preoperative CT and MRI resonance imaging. Laboratory test results for CA-153 (28.30 U/mL) were substantially abnormal. A solid, well-defined, soft tissue mass approximately 0.3 cm × 1.5 cm in diameter at the seventh and eighth thoracic canals was observed on CT and MRI images. A dural tail sign was observed on contrast-enhanced magnetic MRI. Because the tumor compressed the spinal cord, the intraspinal mass was resected, and the vertebral canal was decompressed. Pathological examination confirmed the diagnosis of an extramedullary epidural metastatic SCLC tumor. Conclusions: Extramedullary epidural metastatic SCLC tumors lack clinical specificity. Imaging is helpful for early diagnosis, treatment, prediction of the disease course, and evaluation of curative effects. Ultimately, pathological examination and biopsy are required to confirm the diagnosis.

OBJECTIVE:To investigate the treatment outcome of laparoscopic partial nephrectomy in the patients with renal tumors of moderate to high complexity (R.E.N.A.L. score 7-10).METHODS:In the study, 186 patients with a renal score of 7-10 renal tumors who underwent laparoscopic partial nephrectomy in Peking University Third Hospital from February 2016 to April 2021 were selected. Laparoscopic partial nephrectomy was performed after examination. The patients were followed-up, and their postoperative hemoglobin, creatinine, complications, and length of hospital stay recorded. The data were represented by mean±standard deviation or median (range).RESULTS:There were 128 males and 58 females in this group, aged (54.6±12.8) years, with body mass index of (25.4 ± 3.4) kg/m2; The tumors were located in 95 cases on the left and 91 cases on the right, with maximum diameter of (3.1±1.2) cm. The patient's preoperative hemoglobin was (142.9±15.8) g/L, and blood creatinine was 78 μmol/L (47-149 μmol/L). According to preoperative CT images, the R.E.N.A.L. score was 7 points for 43 cases, 8 points for 67 cases, 9 points for 53 cases, and 10 points for 23 cases. All the ope-rations were successfully completed, with 12 cases converted to open surgery. The operation time was 150 minutes (69-403 minutes), the warm ischemic time was 25 minutes (3-60 minutes), and the blood loss was 30 mL (5-1 500 mL). There were 9 cases of blood transfusions, with a transfusion volume of 800 mL (200-1 200 mL). Postoperative hemoglobin was (126.2±17.0) g/L. The preoperative crea-tinine was 78 μmol/L (47-149 μmol/L), the postoperative creatinine was 83.5 μmol/L (35-236 μmol/L), the hospital stay was 6 days (3-26 days), and surgical results achieved "the trifecta" in 87 cases (46.8%). In the study, 167 cases were followed up for 12 months (1-62 months), including 1 case with recurrence and metastasis, 4 cases with metastasis, and 2 cases with other tumors (1 case died).CONCLUSION:Laparoscopic partial nephrectomy is safe and effective in the treatment of renal tumors with R.E.N.A.L. score of 7-10. Based on the complexity of the tumor, with the increase of difficulty, the warm ischemia time and operation time tend to increase gradually, while "the trifecta" rate gradually decreases. The complications of this operation are less, and the purpose of preserving renal function to the greatest extent is achieved.

Background The Gleason Score is well correlated with biological behavior and prognosis in prostate adenocarcinoma (PRAD). This study was derived to determine the clinical significance and function of Gleason-Score-related genes in PRAD. Methods RNA-sequencing profiles and clinical data were extracted from the The Cancer Genome Atlas PRAD database. The Gleason-Score-related genes were screened out by the Jonckheere-Terpstra rank-based test. The “limma” R package was performed for differentially expressed genes. Next, a Kaplan–Meier survival analysis was performed. Correlation MT1L expression levels with tumor stage, non-tumor tissue stage, radiation therapy, and residual tumor were analyzed. Further, MT1L expression was detected in PRAD cell lines by reverse transcription-quantitative polymerase chain reaction assay. Overexpression of MT1L was constructed and used for cell count kit-8, flow cytometric assay, transwell assay, and wound-healing assay. Results Survival analysis showed 15 Gleason-Score-related genes as prognostic biomarkers in PRAD. The high-frequency deletion of MT1L was verified in PRAD. Furthermore, MT1L expression was decreased in PRAD cell lines than RWPE-1 cells, and overexpression of MT1L repressed cell proliferation and migration, and induced apoptosis in PC-3 cells. Conclusion Gleason-Score-related MT1L may serve as a biomarker of poor prognostic biomarker in PRAD. In addition, MT1L plays a tumor suppressor in PRAD progression, which is beneficial for PRAD diagnosis and treatment research.

Hypoxia-inducible factor–proline hydroxylase inhibitors (HIF-PHIs) are an emerging approach in the treatment of erythropoietin (EPO) deficiency among chronic kidney disease (CKD) patients with anaemia. In recent years, fibroblast growth factor 23 (FGF23) has been shown to interact with renal anaemia [1].However, evidence on the direct effect that HIF-PHIs exert on the change in FGF23 levels in the context of anaemic patients with CKD is limited. Based on our previous trial of roxadustat treat-ment in CKD patients with anaemia [2], we examined the effect ofroxadustatonthechangeinlevelsofFGF23andtheassociated mineral parameters in patients

Context: The role of tumor size in predicting prognosis in upper tract urothelial carcinoma (UTUC) patients remains poorly defined. Objective: To assess the prognostic value of tumor size in patients with UTUC through a systematic review and meta-analysis. Evidence acquisition: A comprehensive literature search of the PubMed and Embase databases were performed to identify all relevant articles published up to December 2021 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Available hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were analyzed to evaluate the association between tumor size and survival outcomes. Evidence synthesis: A total of 35 articles representing 32 292 patients met the eligibility criteria and were finally included for the meta-analysis. Tumor size was significantly associated with poor outcomes in terms of overall survival (HR = 1.42, 95% CI = 1.28–1.58), cancer-specific survival (HR = 1.66, 95% CI = 1.47–1.88), recurrence-free survival (HR = 1.25, 95% CI = 1.13–1.38), and intravesical recurrence (HR = 1.12, 95% CI = 1.04–1.20). There was between-study heterogeneity in the effect of tumor size on all these meta-analyses, with p < 0.10 and I2 generally >50%. Subgroup analyses illustrated that the association of tumor size with adverse prognosis in UTUC patients is not affected by treatment modalities. Segmental resection of ureter, whether receiving lymph node dissection, cutoff of tumor size, and region of population were potential sources of heterogeneity. The funnel plot test indicated no significant publication bias in the meta-analysis of survival outcomes. Conclusions: This study shows that larger tumor size is associated with an increased risk of overall and cancer-specific mortality, and disease recurrence in UTUC. Integration of tumor size with other prognostic indicators may help in risk stratification and individualized treatment of UTUC. Patient summary: Through a systematic review and meta-analysis, this study found that larger tumor size is associated with an increased risk of overall and cancer-specific mortality, and disease recurrence in patients with upper tract urothelial carcinoma.

You have accessJournal of UrologyCME1 May 2022MP57-05 ONE NOVEL NOMOGRAM TO PREDICT BIOCHEMICAL RECURRENCE MORE ACCURATE IN RADICAL PROSTATECTOMY Jian Lu, Ji De He, Ye Yan, Xue Hua Zhu, Ze Nan Liu, Hai Zhui Xia, Hai Bi, Bin Yang, Run Zhuo Ma, Wei He, Zhi Ying Zhang, Yu Ting Zhang, Lu Lin Ma, and Xiao Fei Hou Jian LuJian Lu More articles by this author , Ji De HeJi De He More articles by this author , Ye YanYe Yan More articles by this author , Xue Hua ZhuXue Hua Zhu More articles by this author , Ze Nan LiuZe Nan Liu More articles by this author , Hai Zhui XiaHai Zhui Xia More articles by this author , Hai BiHai Bi More articles by this author , Bin YangBin Yang More articles by this author , Run Zhuo MaRun Zhuo Ma More articles by this author , Wei HeWei He More articles by this author , Zhi Ying ZhangZhi Ying Zhang More articles by this author , Yu Ting ZhangYu Ting Zhang More articles by this author , Lu Lin MaLu Lin Ma More articles by this author , and Xiao Fei HouXiao Fei Hou More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Various prediction tools have been developed to predict biochemical recurrence (BCR) after radical prostatectomy (RP), however, few of the previous prediction tools used serum prostate specific antigen (PSA) nadir after RP and maximum tumor diameter (MTD) at the same time. In this study, a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival. METHODS: 337 patients who underwent RP were retrospectively enrolled in this study. The maximum diameter of the index lesion was measured on magnetic resonance imaging (MRI). Cox regression analysis was performed to evaluate independent predictors of BCR. A nomogram was subsequently developed for the prediction of BCR-free survival at 3 and 5 years after RP. Time-dependent receiver operating characteristic (ROC) curve and decision curve analysis were performed to identify the advantage of the new nomogram in comparison with the CAPRA-S score. RESULTS: A novel nomogram was developed to predict BCR by including PSA nadir, MTD, Gleason score, surgical margin (SM), and seminal vesicle invasion (SVI), since these variables were significantly associated with BCR in both univariate and multivariate analysis (p <0.05). In addition, a basic model including Gleason score, SM, and SVI was developed and used as a control to assess the incremental predictive power of the new model. The concordance index of our model was slightly higher than CAPRA-S model (0.76 vs. 0.70, p=0.02) and it was significantly higher than that of the basic model (0.76 vs. 0.66, p=0.001). Time-dependent ROC curves and decision curve analyses also demonstrated the advantages of the new nomogram. CONCLUSIONS: PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR. By incorporating PSA nadir and MTD into the conventional predictive model, our newly developed nomogram significantly improved the accuracy in predicting BCR-free survival after RP. Source of Funding: This work was supported by grants from the National Natural Science Foundation of China (No. 61871004); National key research and development program of China (No. 2018YFC0115900) and Peking University Medicine Fund of Fostering Young Scholars’ Scientific & Technological Innovation and the Fundamental Research Funds for the Central Universities (No. BMU2020PYB002). Funds were used for the collection and analysis of data © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e982 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jian Lu More articles by this author Ji De He More articles by this author Ye Yan More articles by this author Xue Hua Zhu More articles by this author Ze Nan Liu More articles by this author Hai Zhui Xia More articles by this author Hai Bi More articles by this author Bin Yang More articles by this author Run Zhuo Ma More articles by this author Wei He More articles by this author Zhi Ying Zhang More articles by this author Yu Ting Zhang More articles by this author Lu Lin Ma More articles by this author Xiao Fei Hou More articles by this author Expand All Advertisement PDF DownloadLoading ...

To develop and validate a predictive model include magnetic resonance imaging (MRI) parameters preoperatively which can assess the risk of incontinence after laparoscopic radical prostatectomy (LRP) accurately. We retrospectively reviewed and included 170 patients with prostate cancer who underwent LRP between July 2015 and June 2018 in our institution. All 170 patients were randomly resampled and divided into training set (n = 124) and verification set (n = 46) according to the ratio of 7:3. The Nomogram prediction model of the risk of incontinence after LRP was established through the training set and verified by the verification set. Baseline patient characteristics were obtained, including age, body mass index, and prostate volume. Perioperative characteristics such as pre-biopsy prostate specific antigen, biopsy Gleason score, clinical staging, and NVB sparing status were also collected. MRI parameters preoperatively including membranous urethral length (MUL), prostate apex depth ratio (PADR), and intravesical prostatic protrusion length (IPPL) were obtained. The C index and visual inspection of calibration curve were used to evaluate the discrimination and calibration of the model. According to the urinary incontinence (UI) at 3 months postoperatively, the patients were divided into 104 cases (61.2

Background: Germline pathogenic mutations associated with pheochromocytoma (PHEO) are present in most patients with hereditary bilateral PHEOs. Adenomatous polyposis coli (APC) gene has previously been identified as a tumor suppressor gene in familial adenomatous polyposis and colorectal cancers, but not PHEO. Methods: A father and a son from Tibet were clinically diagnosed with bilateral synchronous PHEOs. The son underwent staged retroperitoneal laparoscopic bilateral total adrenalectomy, and the father underwent retroperitoneal laparoscopic left adrenalectomy. A pedigree investigation was performed with a follow-up of 4 years. Whole-exome sequencing was performed to reveal the susceptibility genes in the pedigree. Results: The adrenal masses in the father and son were pathologically diagnosed as hereditary bilateral synchronous PHEOs. A pedigree investigation of 26 family members spanning 3 generations was performed. Multiple endocrine gland–related tumors, including PHEO, pancreatic neuroendocrine tumor, and pituitary adenoma, were diagnosed in the family. DNA sequencing identified a novel heterozygous germline missense mutation (c.896C>G) of the APC gene in the proband. The same heterozygous germline mutation of the APC gene was also present in the pedigree. Conclusions: We reported a pedigree from Tibet with hereditary bilateral synchronous PHEOs, which revealed a novel heterozygous germline missense mutation of the APC gene that may predispose to PHEO.

Purpose: This study aims to develop and validate a nomogram based on a novel platelet index score (PIS) to predict prognosis in patients with renal cell carcinoma (RCC). Patients and methods: We retrospectively analyzed the data of 759 consecutive patients with RCC. The Kaplan-Meier curves were performed to analyze the platelet parameters and PIS was established. The patients were randomly divided into training (N=456, 60%) and validation cohorts (N=303, 40%). The nomogram was created based on the factors determined by multivariable Cox proportional hazard regression of the training cohort. We assessed the discrimination and calibration of our nomogram in both training and validation cohorts. And then the nomogram was compared with other reported models. Results: High platelet count (PLT>285×109/L) and low platelet distribution width (PDW≤10.95fL) were associated with shorter progression-free survival (PFS). Thus, PLT and PDW were incorporated in a novel score system called PIS. On multivariable analysis of training cohort, PIS, American Joint Committee on Cancer (AJCC) stage, and sarcomatoid differentiation were independent prognostic factors, which were all selected into the nomogram. The nomogram exhibited good discrimination in both training (C-index: 0.835) and validation cohorts (C-index: 0.883). The calibration curves also showed good agreement between prediction and observation in both cohorts. The C-index of the nomogram (C-index: 0.810~0.902) for predicting 2-year, 3-year, and 4-year PFS were significantly higher than Leibovich (C-index: 0.772~0.813), SSIGN (C-index: 0.775~0.876), Cindolo (C-index: 0.642~0.798), Yaycioglu (C-index: 0.648~0.804), MSKCC (C-index: 0.761~0.862), Karakiewicz (C-index: 0.747~0.851), and AJCC stage models (C-index: 0.759~0.864). Conclusion: The nomogram based on a novel PIS could offer better risk stratification in patients with RCC.

Introductions: The objective of this study was to determine the prognostic value of positive lymph nodes (LNs) in patients with renal cell carcinoma (RCC) and tumor thrombus (TT) and to explore risk factors predicting LNs metastasis. Methods: We retrospectively analyzed 216 patients with RCC and TT treated at a single institution from January 2015 to December 2019. Overall survival (OS) and progression-free survival (PFS) was estimated using the Kaplan-Meier curves divided by pathological LN status. Associations between clinicopathological features and survival outcomes were evaluated using Cox regression models. Logistic regression model was performed to determine risk factors associated with LN metastasis. Results: We identified 216 patients with RCC and TT including 85 (39.4%) who did and 131 (60.6%) who did not undergo lymph node dissection. Pathologically positive LNs were found in 18 (8.3%) cases. pN1 had significant worse OS (median: 21 vs. 41 and 56 months, p < 0.001) and PFS (median:14 vs. 29 and 33 months, p < 0.001) than pN0 and pNx respectively. However, survival outcomes of OS and PFS were similar between pNx-0/M1 and pN1/M0 group and between 1- and ≥2-node-positive group. Non-CCRCC (p = 0.001), sarcomatoid differentiation (p < 0.001), and pathologically positive LNs (p = 0.025) were independent prognostic predictors predicting worse OS while distance metastasis (p = 0.009), non-CCRCC (p = 0.023), necrosis (p = 0.014), sarcomatoid differentiation (p = 0.003), and pathologically positive LNs (p = 0.007) were independent prognostic indicators predicting worse PFS. Clinically positive LNs (p = 0.014) and sarcomatoid differentiation (p = 0.009) were predictors of positive LNs. Conclusions: LNs metastasis independently associated with worse survival outcomes in RCC and TT populations, with similar survival outcomes compared to distance metastasis. Therefore, more accurate risk stratification is warranted for guiding postoperative surveillance and adjuvant therapy.

Background: Various prediction tools have been developed to predict biochemical recurrence (BCR) after radical prostatectomy (RP); however, few of the previous prediction tools used serum prostate-specific antigen (PSA) nadir after RP and maximum tumor diameter (MTD) at the same time. In this study, a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival (BCRFS). Methods: A total of 337 patients who underwent RP between January 2010 and March 2017 were retrospectively enrolled in this study. The maximum diameter of the index lesion was measured on magnetic resonance imaging (MRI). Cox regression analysis was performed to evaluate independent predictors of BCR. A nomogram was subsequently developed for the prediction of BCRFS at 3 and 5 years after RP. Time-dependent receiver operating characteristic (ROC) curve and decision curve analyses were performed to identify the advantage of the new nomogram in comparison with the cancer of the prostate risk assessment post-surgical (CAPRA-S) score. Results: A novel nomogram was developed to predict BCR by including PSA nadir, MTD, Gleason score, surgical margin (SM), and seminal vesicle invasion (SVI), considering these variables were significantly associated with BCR in both univariate and multivariate analyses (P < 0.05). In addition, a basic model including Gleason score, SM, and SVI was developed and used as a control to assess the incremental predictive power of the new model. The concordance index of our model was slightly higher than CAPRA-S model (0.76 vs. 0.70, P = 0.02) and it was significantly higher than that of the basic model (0.76 vs. 0.66, P = 0.001). Time-dependent ROC curve and decision curve analyses also demonstrated the advantages of the new nomogram. Conclusions: PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR. By incorporating PSA nadir and MTD into the conventional predictive model, our newly developed nomogram significantly improved the accuracy in predicting BCRFS after RP.

To the Editor: Renal cell carcinoma (RCC) accounts for approximately 3% of all malignancies in adults.[1] Locally advanced RCC has a relatively distinct and adverse prognosis with a 5-year cancer specific survival (CSS) rate ranging from 28% to 67% after curative surgery.[2] It is important to accurately stratify the risk of disease recurrence for locally advanced RCC. Several prognostic models like Stage, Size, Grade, and Necrosis (SSIGN), Leibovich, Cindolo, Yaycioglu, Memorial Sloan Kettering Cancer Center (MSKCC), Kattan, and Karakiewicz have been developed to predict the prognosis of localized RCC and the concordance index (C-index) has been found to range from 0.65 to 0.84.[3,4] To our knowledge, these models have mainly been developed based on the data from low-risk patients with RCC. In an external prospective cohort comprising patients with intermediate or high-risk RCC, the performances of these models were found to be sharply decreased (C-index range from 0.587 to 0.69).[4] Thus, in this study, we aimed to develop a more accurate prognostic model for better risk stratification in locally advanced RCC. Patients were identified from a retrospective, single-center database consisting of 759 patients who had undergone nephrectomy for RCC from January 2015 to December 2017 at Peking University Third Hospital. The study was approved by the Peking University Third Hospital Medical Science Research Ethics Committee. According to the 8th Tumor-Node-Metastasis (TNM) classification, patients with T3-4N0M0 or T1-4N1M0 RCC were defined as having locally advanced RCC. Thus, patients who were diagnosed with locally advanced RCC and underwent curative-intent surgery were included in our study cohort. Patients with bilateral or recurrent tumors, severe comorbidities, and incomplete data, and those who had undergone cytoreductive surgery were excluded. Based on the inclusion and exclusion criteria, a total of 215 patients were enrolled in our study and formed the analytical cohort. Patient demographic and clinicopathological data were collected, including sex, age, symptoms at presentation, body mass index, medical comorbidities, surgical approach, surgical time, inter-operative blood loss, tumor side, and tumor size, and pathologic data including histologic subtype, nuclear grade, necrosis, sarcomatoid and rheumatoid differentiation, lymphovascular invasion, renal sinus invasion, perirenal fat invasion, urinary collecting system invasion, venous tumor thrombus, lymph node invasion, and adrenal invasion. The total points of the SSIGN, Leibovich, Cindolo, Yaycioglu, MSKCC, Kattan, and Karakiewicz models were calculated for each patient. Disease progression was defined as any evidence of recurrence or metastasis, or tumor progression in the pre-existing metastatic site. Progression-free survival (PFS) was defined as the time from the date of surgery to disease progression. Patients were advised to not receive any post-operative adjuvant therapy until disease progression. Categorical variables are reported as numbers and proportions, and continuous variables are reported as mean ± standard deviations or median and interquartile range (IQR). The associations of relevant clinicopathological data with PFS were assessed using Cox proportional hazards regression models. The backward stepwise selection was used to identify the independent factors for multivariable Cox proportional hazards regression models. Selected independent factors and important clinical factors were incorporated in the nomograms to predict the probability of 2-, 3-, and 4-year PFS. The performance of the nomogram was measured using the C-index, which ranges from 0.5 (no predictive power) to 1 (perfect prediction). Calibration was evaluated using a calibration curve, which assessed the outcomes between the observed outcome probabilities and the nomogram-predicted probabilities with a bootstrapped resampling of 1000 times. Nomogram establishment and calibration were conducted using R software (Version 4.0.3) using the “rms” package, and other statistical analyses were performed using SPSS (Version 26, IBM, Armonk, NY, USA). All tests were two sided, and P < 0.05 was considered statistically significant. Patients’ characteristics are shown in [Supplementary Table 1, https://links.lww.com/CM9/A807]. The mean age of the 215 patients in this study was 59.33 ± 11.42 years and most patients were male (N = 151, 70.2%). The median time of follow-up was 36 months (IQR: 27–40 months). Sixty-four patients (29.8%) were found to have disease progression during follow-up. The median PFS of the study cohort was 46 months (IQR: 38–57 months). Univariable and multivariable Cox regression analysis is shown in Supplementary Table 2, https://links.lww.com/CM9/A807. In the multivariable analysis, nuclear grade (HR: 1.892 for III–IV, P = 0.019), lymph node invasion (HR: 3.817, P = 0.004), and venous tumor thrombus (HR: 1.809, P = 0.036) were independent factors. Symptoms at presentation (HR: 1.622, P = 0.080) remained in the multivariable model, although it was not statistically significant. Considering the clinical importance of the symptoms at presentation, we established a nomogram based on nuclear grade, lymph node invasion, venous tumor thrombus, and symptoms at presentation [Figure 1].Figure 1: The nomogram to predict PFS was created based on symptoms at present, nuclear grade, venous tumor thrombus, and lymph node invasion. PFS: Progression-free survival.The discrimination of the nomogram was relatively high and had a C-index of 0.751 to 0.783 for our cohort. Calibration curves were developed using a 1000 bootstrap resampling method and good agreement was found between the predicted and actual probabilities [Supplementary Figure 1, https://links.lww.com/CM9/A806]. The 2-, 3-, and 4-year predicted accuracy of our nomogram, SSIGN, Leibovich, Cindolo, Yaycioglu, MSKCC, Kattan, and Karakiewicz models is shown in Supplementary Table 3, https://links.lww.com/CM9/A807. The Karakiewicz model was found to perform the best (C-index: 0.673–0.781) and the Kattan model was determined to perform the worst (C-index: 0.566–0.624). Our nomogram exhibited better accuracy than the SSIGN, Leibovich, Cindolo, Yaycioglu, MSKCC, Kattan, and Karakiewicz models. In this study, we analyzed 215 consecutive patients diagnosed with locally advanced RCC and reported several noteworthy findings. First, we found that nuclear grade, venous tumor thrombus, and lymph node invasion were independent prognostic factors among these patients. Second, we established a nomogram that exhibited good discrimination and calibration when used in our study cohort. Third, compared with other conventional models, our nomogram was found to be slightly but significantly superior for risk stratification of locally advanced RCC. To the best of our knowledge, locally advanced RCC is pathologically heterogeneous, which groups perirenal fat invasion, renal sinus invasion, urinary collecting system invasion, and segmental renal vein invasion as T3 stage; tumor invasion beyond Gerota fascia as T4 stage; and lymph node invasion as N1 stage. Previous studies report that the prognosis varies depending on the pathologic features even if it is the same stage.[5] We found that among these, venous tumor thrombus and lymph node invasion were independent prognostic factors that correlated with PFS in locally advanced RCC. Besides, the nuclear grade was also an independent prognostic factor in our study cohort, which suggested that the current TNM staging system may not be sufficient to provide satisfactory risk stratification in patients with locally advanced RCC. Owing to the shortcomings of the current TNM staging system, several models have been reported to predict prognosis in patients with RCC. However, the performances of current models were found to sharply decrease in the prospective clinical trial cohort comprising patients with intermediate or high-risk localized RCC.[4] We speculated that in the development cohort, the patients were mainly grouped as low-risk RCC. Thus, in the intermediate or high-risk RCC cohorts, the predicted accuracy of these models was limited. Considering this speculation, we developed a nomogram based on a group of patients with locally advanced RCC. Notably, our nomogram was found to be superior compared with other conventional models. Besides, our nomogram only incorporated four simple variables including the symptoms at presentation, nuclear grade, venous tumor thrombus, and lymph node invasion, all of which were easy to obtain post-operatively. Our study has several limitations. First, the C-index of our nomogram was 0.751 to 0.783 and slightly higher than that of the other models, which suggested moderate, but not optimal, predicted accuracy of the model. Thus, the potential prognostic factors of locally advanced RCC were extremely complex and could not be thoroughly revealed based on these four simple factors. A multi-parameter model coupled with clinical and gene information should be investigated in future studies to improve the predicted accuracy of prognosis in these patients. Second, our nomogram was developed, and internal validation was performed based on data from a single-center cohort. Further studies are needed to externally validate the proposed nomograms. To summarize, we developed a nomogram with good discrimination and calibration to predict the prognosis of locally advanced RCC. Our nomogram was superior to other conventional models in predicting the 2-, 3-, and 4-year PFS, indicating its ability of better risk stratification in these patients. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Conflicts of interest None.

PURPOSE:To evaluate the impact of preoperative magnetic resonance imaging anatomic features on urinary continence recovery after laparoscopic radical prostatectomy (LRP).METHODS:We retrospectively analyzed 150 consecutive prostate cancer patients who underwent LRP between July 2015 and June 2018 in our institution. Patients reporting freedom from using safety pad (0 pads/day) were defined as urinary continent. We evaluated the association of urinary continence recovery after LRP and the perioperative variables, including age, prostatic volume (PV), intravesical prostatic protrusion length (IPPL), membranous urethral length (MUL), and neurovascular bundle (NVB) sparing status. Kaplan-Meier and log-rank tests were used to compare urinary continence rates between groups. Univariate and multivariate Cox proportional hazards regression analyses were used to identify independent predictors for urinary continence recovery.RESULTS:60.6% (91/150), 83.3% (125/150), and 96.0% (144/150) of the patients experienced urinary continence recovery at 3, 6, and 12 months, respectively. There was significant difference in PV, IPPL, MUL, and NVB sparing between groups stratified by urinary continence status at 3, 6, and 12 months. Kaplan-Meier curves of urinary continence rates showed significant differences between groups stratified by PV (<50 mL vs. ≥50 mL, p < 0.001), IPPL (<5 mm vs. ≥5 mm, p < 0.001), MUL (≥15 mm vs. <15 mm, p < 0.001), and NVB sparing status (yes vs. no, p = 0.003), respectively. On univariate analysis, PV, IPPL, MUL, and NVB sparing were significantly associated with urinary continence recovery (all, p < 0.05). On multivariate analysis, only IPPL (HR = 0.94, p = 0.003) and MUL (HR = 1.10, p < 0.001) were independent predictors for urinary continence recovery.CONCLUSION:Patients with larger IPPL and shorter MUL have higher chances of delayed recovery of urinary continence after LRP. IPPL and MUL were reliable morphometric parameters for predicting urinary continence.

Background Sarcomatoid differentiation in renal cell carcinoma (RCC) with vena caval tumour thrombus has been shown to be associated with aggressive behaviours and poor prognosis; however, evidence of the impact of rhabdoid differentiation on prognosis is lacking. This study evaluated the impact of sarcomatoid differentiation and rhabdoid differentiation on oncological outcomes for RCC with vena caval tumour thrombus treated surgically. Methods We retrospectively analysed patients treated surgically for RCC with vena caval tumour thrombus at our institute from Jan 2015 to Nov 2018. Prognostic variables were evaluated for associations with progression-free survival (PFS) and cancer-specific survival (CSS) by Kaplan–Meier survival analysis and log-rank test. Univariate and multivariate analyses were performed to determine independent prognostic variables. Results We identified 125 patients with RCC and vena caval tumour thrombus, including 17 (13.6%) with sarcomatoid differentiation alone, 8 (6.4%) with rhabdoid differentiation alone and 3 (2.4%) with both sarcomatoid and rhabdoid differentiation. Compared to pure RCC, patients with sarcomatoid differentiation but not rhabdoid differentiation have worse PFS ( p = 0.018 and p = 0.095, respectively). The univariate and multivariate analyses both showed sarcomatoid differentiation as a significant predictor of PFS. Compared to pure RCC, patients with sarcomatoid differentiation ( p = 0.002) and rhabdoid differentiation ( p = 0.001) both had significantly worse CSS. The univariate analysis showed sarcomatoid differentiation, rhabdoid differentiation, metastasis and blood transfusion as significant predictors of CSS (All, p < 0.05). In the multivariate analysis, sarcomatoid differentiation (HR 3.90, p = 0.008), rhabdoid differentiation (HR 3.01, p = 0.042), metastasis (HR 3.87, p = 0.004) and blood transfusion (HR 1.34, p = 0.041) all remained independent predictors of CSS. Conclusions Sarcomatoid differentiation and rhabdoid differentiation are both independent predictors of poor prognosis in RCC with vena caval tumour thrombus treated surgically.

Background: Although the impact of tumor complexity on peri-operative outcomes has been well established using several nephrometry scoring systems, the impact of adherent perirenal fat remains poorly defined. This study aimed to develop a novel nephrometry scoring system for predicting the peri-operative outcomes of laparoscopic partial nephrectomy (LPN) by integrating and optimizing the RENAL score (RNS) and Mayo adhesive probability (MAP) score. Methods: We retrospectively evaluated 159 patients treated with retroperitoneal LPN. The patients' demographic parameters, RNSs, and MAP scores were evaluated as potential predictors of perioperative outcomes, including operation time, estimated blood loss (EBL), and margin, ischemia, and complication (MIC) achievement rate. The independent predictors were used to develop a novel nephrometry scoring system. The predictive value and inter-observer agreement for the novel nephrometry scoring system were evaluated. Results: Tumor radius (R score), nearness to the renal sinus or collecting system (N score), and posterior perinephric fat thickness were independent predictors of peri-operative outcomes and were used to develop the RNP score. The univariate analysis revealed that the RNP score was significantly associated with operation time, EBL, and MIC achievement rate (P < 0.050). The RNP score was an independent predictor of operation time (P < 0.001), EBL (P = 0.018), and MIC achievement rate (P = 0.023) in the multivariate analysis. The RNP score was not inferior to RNS in the area under the curve for predicting peri-operative outcomes and performed better in inter-observer agreement (76.7% vs. 57.8%) and kappa value (0.804 vs. 0.726). Conclusion: The RNP score, combining the advantages of the RNS and MAP score, demonstrated a good predictive value for the peri-operative outcomes of retroperitoneal LPN and better inter-observer agreement.