The benefit of resection of liver metastases depends on primary diseases. Neuroendocrine tumors are associated with favorable prognosis after resection of liver metastases. Gastric cancer has worse tumor biology, and resection of gastric liver metastases should be performed in selected patients. A multidisciplinary approach is well established for colorectal liver metastases (CLMs). Resection remains the only curative treatment of CLM. Chemotherapy and molecular-targeted therapy have improved survival in unresectable metastatic colorectal cancer. Understanding of the following two strategies, conversion therapy and two-stage hepatectomy, are important to make this patient group to be candidates for curative-intent surgery.

BACKGROUND:Decisions on the best available treatment in clinical oncology are based on expert opinions in multidisciplinary cancer conferences (MCC). Artificial intelligence (AI) could increase evidence-based treatment by generating additional treatment recommendations (TR). We aimed to develop such an AI system for urothelial carcinoma (UC) and renal cell carcinoma (RCC). METHODS:Comprehensive data of patients with histologically confirmed UC and RCC who received MCC recommendations in the years 2015 - 2022 were transformed into machine readable representations. Development of a two-step process to train a classifier to mimic TR was followed by identification of superordinate and detailed categories of TR. Machine learning (CatBoost, XGBoost, Random Forest) and deep learning (TabPFN, TabNet, SoftOrdering CNN, FCN) techniques were trained. Results were measured by F1-scores for accuracy weights. RESULTS:AI training was performed with 1617 (UC) and 880 (RCC) MCC recommendations (77 and 76 patient input parameters). The AI system generated fully automated TR with excellent F1-scores for UC (e.g. 'Surgery' 0.81, 'Anti-cancer drug' 0.83, 'Gemcitabine/Cisplatin' 0.88) and RCC (e.g. 'Anti-cancer drug' 0.92 'Nivolumab' 0.78, 'Pembrolizumab/Axitinib' 0.89). Explainability is provided by clinical features and their importance score. Finally, TR and explainability were visualized on a dashboard. CONCLUSION:This study demonstrates for the first time AI-generated, explainable TR in UC and RCC with excellent performance results as a potential support tool for high-quality, evidence-based TR in MCC. The comprehensive technical and clinical development sets global reference standards for future AI developments in MCC recommendations in clinical oncology. Next, prospective validation of the results is mandatory.

Patient-Derived Organoids (PDOs) represent a promising technology for therapy prediction in pancreatic cancer, with the potential of enhancing treatment outcomes and allowing more effective, personalized treatment choices. However, classification approaches into sensitive and resistant models remain very variable and are based on single-agent testing only, neglecting interactive effects of multi-drug combinations. Here, we established 13 PDOs and performed both single-agent and multi-drug testing. By comparing different clustering approaches of drug-response metrics and establishing a new classification approach based on pharmacokinetic modelling, we were able to evaluate which score best predicts the clinical response of patients. Our newly developed score considered the Area Under The Curve (AUC) of cell viability curves and reached a prediction accuracy of 85%. Our data supports previous findings for PDOs to constitute an effective platform for translational drug testing. Furthermore, our results suggest that the AUC is a more accurate drug-response metric than the half maximal inhibitory concentration (IC50), and that multi-drug testing yields a higher accuracy than single-agent testing. The methodology and outcomes presented in this study are of critical relevance for future PDO-based translational trials as they allow a new physiology-based approach towards multi-drug testing and classification of organoid response, which improves PDO prediction accuracy.

The goal of this study is to address if detection rates of clinically significant prostate cancer (csPCa) can be increased by additional perilesional biopsies (PB) in magnetic resonance (MR)/ultrasound fusion prostate biopsy in biopsy-naïve men. This prospective, non-randomized, surgeon-blinded study was conducted between February 2020 and July 2022. Patients were included with PSA levels < 20 ng/ml and ≥ one PI-RADS lesion (grades 3–5) per prostate lobe. Prostate biopsy was performed by two urologists. The first performed the MR-fusion biopsy with 3–5 targeted biopsies (TB) and 6 PB in a standardized pattern. The second performed the systematic (12-fold) biopsy (SB) without knowledge of the MR images. Primary outcome of this study is absence or presence of csPCa (≥ ISUP grade 2) comparing TB, PB and SB, using McNemar test. Analyses were performed for each PI-RADS lesion (n = 218). There was a statistically significant difference in csPC detection rate of TB + SB between PI-RADS 3, 4 and 5 lesions (18.0

Introduction: Despite increasing resistance of enterobacteria against fluoroquinolones (FLU), they are still widely used during transrectal prostate biopsy (TRPB). This study was designed to analyse infectious complications and risk factors between FLU, cephalosporines (CEPH) and selective other antibiotics (O-AB) used during TRPB. Methods: 664 patients were included retrospectively (152 FLU, 452 CEPH and 60 O-AB). Infectious complications were defined as fever >38.0 degrees C, the in-house definition of complicated urinary tract infection (cUTI) (if all applied: fever >38.0 degrees C, leucocytosis >11.000/mu L and positive urine dipstick) or postinterventional bacteriuria. Hospitalisation rate, duration and comorbidities were also assessed. chi(2) and Fisher's exact test were used for group comparison. Multivariate regression analysis assessed the association of comorbidities with infectious complications. Results: FLU and CEPH were indifferent regarding infectious complications, however in the O-AB group significantly more common compared to FLU and CEPH (11.6, 13.3, 25%, p < 0.05). Duration of hospital stay in CEPH was significantly shorter compared to FLU and O-AB (4.1 vs. 6.3 vs. 8.2 days, p < 0.05). Arterial hypertension showed increased association with fever (OR 6.002 (1.178; 30.597) p = 0.031) and cUTI (OR 6.006 (1.207; 29.891) p = 0.029). Conclusion: Infectious complications were low and indifferent between FLU and CEPH but significantly more frequent in O-AB. Arterial hypertension was significantly associated with postinterventional fever and cUTI.

BACKGROUND:Analysis of temporal trends of urinary diversion (UD) and identification of predictive factors for continent urinary diversion (CUD) in patients with bladder cancer (BC) is scarce and data on large cohorts are missing. We aimed to describe longitudinal temporal trends and predictive factors for UD among patients with BC receiving radical cystectomy (RC). PATIENTS AND METHODS:We retrospectively analysed institutional data collected from patients undergoing RC from 1986 to 2022 to describe changes in patients' characteristics and UD. Primary end points were patients' characteristics associated with type of UD. Logistic regression analysis was used to determine predictive factors for CUD. RESULTS:In total, 2224 patients (77.16% male, 22.84% female) with a mean age of 66 years [standard deviation (SD), 10.64 years] were included. We observed an increase in mean age from 59.86 (10.8) years (1986-1990) to 69.85 (9.99) years (2016-2022) (p < 0.001). The proportion of CUD gradually declined from 43.72% (94/215; 1986-1990) to 18.38% (86/468; 2016-2022). Patients who were male [odds ratio (OR): 1.92, 95% confidence interval (CI): 1.43-2.57, p < 0.001), younger (OR: 0.88, 95% CI: 0.87-0.89, p < 0.001) and had no hydronephrosis prior to RC (OR: 2.2, 95% CI: 1.66-2.92, p < 0.001) were more likely to receive CUD. CONCLUSIONS:We report the largest European single-center cohort of UD after RC, demonstrating a significant shift from CUD to IUD, accompanied by an increasing age. Finally, our data mirrors the development and extensive experience with the Mainz Pouch-I in the 1980's and 1990's together with other colon pouches.

Artificial intelligence (AI) promises to be the next revolutionary step in modern society. Yet, its role in all fields of industry and science need to be determined. One very promising field is represented by AI-based decision-making tools in clinical oncology leading to more comprehensive, personalized therapy approaches. In this review, the authors provide an overview on all relevant technical applications of AI in oncology, which are required to understand the future challenges and realistic perspectives for decision-making tools. In recent years, various applications of AI in medicine have been developed focusing on the analysis of radiological and pathological images. AI applications encompass large amounts of complex data supporting clinical decision-making and reducing errors by objectively quantifying all aspects of the data collected. In clinical oncology, almost all patients receive a treatment recommendation in a multidisciplinary cancer conference at the beginning and during their treatment periods. These highly complex decisions are based on a large amount of information (of the patients and of the various treatment options), which need to be analyzed and correctly classified in a short time. In this review, the authors describe the technical and medical requirements of AI to address these scientific challenges in a multidisciplinary manner. Major challenges in the use of AI in oncology and decision-making tools are data security, data representation, and explainability of AI-based outcome predictions, in particular for decision-making processes in multidisciplinary cancer conferences. Finally, limitations and potential solutions are described and compared for current and future research attempts.

PURPOSE:We evaluate differences of patient-reported outcome measurements (PROM) based urinary continence and sexual function 12 months after radical prostatectomy (RPE) based on perioperative, surgical, and patient-specific characteristics in a large European academic urology center.MATERIALS AND METHODS:All men enrolled in the Prostate Cancer Outcome Study (PCO) study who were treated with RPE between 2017 and 2021 completed EPIC-26 information surveys before and 12 months after RPE. Survey data were linked to clinical data of our institution. Logistic regression analyses were performed to examine the correlation between individual surgeons, patient characteristics, patient clinical data, and their urinary continence and sexual function.RESULTS:In total, data of 429 men were analyzed: unstratified mean (SD) EPIC-26 domain score for urinary function decreased from 93.3 (0.7) to 60.4 (1.5) one year after RPE, respectively for sexual function from 64.95 (1.6) to 23.24 (1.1). Patients with preoperative adequate urinary function (EPIC-26 score > 80) reported significantly different mean urinary function scores between 53.35 (28.88) and 66.25 (25.15), p= 0.001, stratified by surgeons experience. On binary logistic regression analyses, only nerve sparing techniques (OR: 1,83, 95% CI: 1.01;3.21; p = 0.045) and low body mass index (OR: 0.91, CI: 0.85;0.99, p= 0.032) predicted adequate postoperative urinary function.CONCLUSIONS:The results show how using provider-specific data from a larger cohort study enables to develop institution-specific analysis for functional outcomes after RPE. These models can be used for internal quality improvement as well as enhanced and provider-specific patient communication and shared decision making.

Background Radical cystectomy (RC) is marked by a tremendous potential for short and long-term complications. By introduction of Enhanced Recovery After Surgery (ERAS) protocols serious endeavors have been made in order to reduce postoperative morbidity in favor of a fast-track recovery. In this study, we investigated the impact of our in-house ERAS protocol on postoperative complications and hospital stay. Methods We identified 106 patients who received standard care of treatment post-surgery (non-ERAS group). After implementation of our ERAS protocol, we prospectively recorded data from 53 patients (ERAS group) up to 90 days post-surgery. Non-ERAS patients were matched with ERAS patients with respect to preoperative clinical characteristics. Statistical analysis was conducted by matched-pair analysis and Wilcoxon-Mann-Whitney-Test. Results Altogether 51 patients were matched. Considering patients with a hospital stay of ≤ 30 and ≤ 20 days we noticed a significant difference in favor of ERAS protocol (p = 0.043, p = 0.004) with regards to hospital stay. Removal of single-J stents occurred on day 11 (8–17) in the non-ERAS group and on day 8 (8–15) in the ERAS group post-surgery (p < 0.001). No difference could be identified in overall and 90-day complication rate (p = 0.443). Conclusion Adherence to ERAS protocol achieved a significantly shorter hospital stay in patients with a hospital stay of ≤ 30 and ≤ 20 days with no increase in complication rates. Furthermore, early removal of single-J stents did not result in higher rates of postoperative complications and hospital readmission.

Background: In addition to erectile dysfunction, urinary incontinence is the most common functional limitation after radical prostatectomy (RPE) for prostate cancer (PCa). The German S3 guideline recommends informing patients about possible effects of the therapy options, including incontinence. However, only little data on continence fromroutine care in German-speaking countries after RPE are currently available, which makes it difficult to inform patients. Objective: The aim of this work is to present data on the frequency and severity of urinary incontinence after RPE from routine care. Materials and methods: Information from the PCO (Prostate Cancer Outcomes) study is used, which was collected between 2016 and 2022 in 125 German Cancer Society (DKG)-certified prostate cancer centers in 17,149 patients using the Expanded Prostate Cancer Index Composite Short Form (EPIC-26). Changes in the "incontinence" score before (T0) and 12 months after RPE (T1) and the proportion of patients who used pads, stratified by age and risk group, are reported. Results: The average score for urinary incontinence (value range: 0-worst possible to 100-best possible) was 93 points at T0 and 73 points 12 months later. At T0, 97% of the patients did not use a pad, compared to 56% at T1. 43% of the patients who did not use a pad before surgery used at least one pad a day 12 months later, while 13% use two ormore. The proportion of patients using pads differs by age and risk classification. Conclusion: The results provide a comprehensive insight into functional outcome 12 months after RPE and can be taken into account when informing patients.

Pre-operative assessment of surgical risk is essential for patient counselling in the elderly patient population. Our purpose was to compare validated geriatric assessment scores (GAS) in predicting postoperative morbidity and mortality in patients ≥ 80 years. Overall, eight preoperative GAS were assessed for each patient who received RC from 2016 to 2021. Postoperative morbidity was recorded according to the Clavien-Dindo classification (CDC) of surgical complications. Binary logistic regression analyses were used to determine prediction of 30-d morbidity and 90-d mortality in patients ≥ 80 years. In total, 424 patients were analysed (77.4

e16612 Background: In bladder cancer (BC) patients, pure (SCC) and partial (PSCC) squamous cell carcinomas belong to the most common histologic subtypes with approximately 5% of cases. They are highly aggressive and curative treatment in a local disease stage is typically radical cystectomy (RC). In case of tumor progression or metastatic disease, only limited data on the optimal treatment algorithm and its efficacy exists. In this study, we present clinical characteristics and oncologic outcome in a large patient cohort of SCC and PSCC. Methods: Between 2003 and 2021, we extracted data from patients with SCC and PSCC histology who received RC due to invasive bladder cancer. Clinical characteristics, treatment patterns, progression free- and overall survival were the primary outcome parameters. Kaplan-Meier curves were calculated for PFS and OS and a log rank test was applied to compare survival curves. Results: Overall, 770 patients were screened of which 26 men and 28 women with a mean age of 68.4 (SD 11.7) and 67.9 years (SD 14) years were identified. Twenty-three patients had SCC and 31 PSCC. No neo-adjuvant treatment was applied compared to 16 adjuvant chemotherapy regimens. Urinary diversion was ileal-conduit in 30 cases, Mainz-pouch in nine, ureterocutaneostomy in eleven, ileal neo-bladder in three and transverse conduit of the colon in one patient. The mean number of extirpated lymphnodes were 22.8 (SD 17.7) with a mean positivity of three (SD 8.3) lymphnodes. Mean follow-up was 11.5 months with a PFS of 5.9 and 8.7 mo. and OS of 13.3 mo. (SD 12.2) and 7.5 (SD 7.8) in men and women, respectively. There was no statistically significant survival difference for men and women as well as SCC and PSCC. Conclusions: This contemporary data demonstrated the aggressive nature of SCC of the bladder with IC being the most common urinary diversion. Compared to data from transitional cell carcinoma, PFS and OS was shorter and application of adjuvant Cx was overall low. Structured novel treatment modalities are urgently needed in this highly aggressive bladder cancer population.

Radical cystectomy (RC) is one of the most complex operative procedures in urology, and choice of urinary diversion (UD) has undergone significant changes over the last decades.While several nationwide analyses revealed overall higher rates of continent UD (CUD) in Germany as compared with the United States (U.S.), 1,2 recent large U.S. high-volume centers reported higher rates of CUD in academic high-volume centers compared with smaller hospitals in the U.S. as well as in European cohorts. 3,4Over the past four decades, various CUD and incontinent UD (IUD) techniques have been applied at our department, and the 'Mainz Pouch' (MP-I and -II) was developed, resulting in one of the largest centers for RC in Germany to date. 5 Thus, we sought to evaluate trends in UD over a 36-year time period with historical and contemporary patient groups undergoing RC at our department.

BACKGROUND:Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool.METHODS:Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80-20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models.RESULTS:For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/.CONCLUSION:The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.

IntroductionUnderstanding tumor localization in multiparametric MRI (mpMRI) of the prostate is challenging for urologists but of great importance in mpMRI-fused prostate biopsy or radical prostatectomy. The aim was to evaluate the effectiveness of 3D printed models of the prostate to help urologists to locate tumors.Methods and Participants20 urologists from University Medical Center Mainz (Germany) were asked to plot the location of a cancer suspicious lesion (PI-RADS ≥ 4) on a total of 30 mpMRI on a prostate sector diagram. The following 3 groups (as matched triplets) were divided into: mpMRI only, mpMRI with radiological report and mpMRI with 3D printed model (scaled 1:1). Statistical analysis was performed using one-way and two-way ANOVA (with bonferroni post-test).ResultsOverall, localization of the suspicious lesion was superior with the radiological report (median of max. 10 [IQR]: MRI 2 [IQR 1;5], MRI + report: 8 [6.3;9], MRI + 3D model 3 [1.3;5.8]; p < 0.001). Residents with <1 year of experience had a significantly higher detection rate using a 3D printed model [5 (5;5.8)] compared to mpMRI alone [1.5 (1;3.5)] (p < 0.05). Regarding the estimation of index lesion extension, the 3D model showed a significant benefit (mean percentage difference [95% CI]: MRI alone 234% [17.1;451.5], MRI + report 114% [78.5;149.6], MRI + 3D model 17% [−7.4;41.3] (p < 0.01).ConclusionUrologists still need the written radiological report for a sufficient understanding of tumor localization. The effectiveness of the 3D printed model regarding tumor localization is particularly evident in young residents (<1 year) and leads to a better overall assessment of the tumor extension.

Background: In the treatment of advanced urothelial (aUC) and renal cell carcinoma (aRCC), biomarkers such as PD-1 and PD-L1 are not robust prognostic markers for immunotherapy (IO) response. Previously, a significant association between IO and a change in splenic volume (SV) was described for several tumour entities. To the best of our knowledge, this study presents the first correlation of SV to IO in aUC and aRCC. Methods: All patients with aUC (05/2017–10/2021) and aRCC (01/2012–05/2022) treated with IO at our academic centre were included. SV was measured at baseline, 3 and 9 months after initiation of IO using an in-house developed convolutional neural network-based spleen segmentation method. Uni- and multivariate Cox regression models for overall survival (OS) and progression-free survival (PFS) were used. Results: In total, 35 patients with aUC and 30 patients with aRCC were included in the analysis. Lower SV at the three-month follow-up was significantly associated with improved OS in the aRCC group. Conclusions: We describe a new, innovative artificial intelligence-based approach of a radiological surrogate marker for IO response in aUC and aRCC which presents a promising new predictive imaging marker. The data presented implicate improved OS with lower follow-up SV in patients with aRCC.