Clinical features and Surgical Outcome of Clear Cell Papillary Renal Cell Tumor: result from a prospective cohort

BACKGROUND

Clear cell papillary renal cell tumor (CCPRCT) was first reported in 2006 a patient with end stage renal disease. After that it was discovered in the kidney without end stage renal disease in the 2010s and started to be mentioned in pathology and urology. The incidence of CCPRCT is low and most of it is discovered incidentally, so there is a lack of reports on clinical characteristics and surgical outcome.

METHODS

This study used clinical data from the Seoul National University Prospectively Enrolled Registry for Renal Cell Carcinoma-Nephrectomy (SUPER-RCC-Nx). Between August 2016 and July 2022, patients who underwent radical or partial nephrectomy with clear cell papillary RCC with pathological finding were included in this study. All patients' pathologic reports were reviewed by 1 pathologist. Clinical characteristics and surgical outcomes were presented through descriptive statistics, and Kaplan-Meier curve used for survival analysis.

RESULTS

Of the 2057 patients, CCPRCT was reported in 36 patients (1.8%). The median follow up period was 26.8 months. The median age was 67 years, and there were 10 females and 26 males. The median tumor size was 1.2 cm. Twenty-nine patients underwent partial nephrectomy. Seven patients with end-stage renal disease underwent radical nephrectomy. The median operative time for patients who underwent partial nephrectomy was 97.5 min and the estimated blood loss was 100 cc. The median hospital days was 4 and 30-day complications were 2 cases with clavien-dindo classification III or higher. During the follow-up period, there was no recurrence and cancer specific mortality.

CONCLUSIONS

The size of CCPRCT was small and there was no advanced stage at that time of diagnosis. There was no recurrence or cancer specific mortality during the follow-up period. A multi-center study with a large scale is needed in the future.

TRIAL REGISTRATION

Seoul National University Hospital (SNUH) Institutional Review Board (IRB) (approval number: 2210-126-1371).

Controversies in terminology associated with management of BCG-unresponsive NMIBC in Asia-Pacific

OBJECTIVES

Examine the understanding of terminologies and management patterns of bacillus Calmette-Guérin (BCG)-unresponsive nonmuscle invasive bladder cancer (NMIBC) in six territories in Asia-Pacific.

METHODS

This study involved two phases: (1) a survey with 32 urologists and 7 medical oncologists (MOs) and (2) a factorial experiment and in-depth interviews with 23 urologists and 2 MOs. All clinicians had ≥8 years' experience managing NMIBC patients in Australia, Hong Kong, Japan, South Korea, Singapore, and Taiwan. Data from Phase 1 were summarized using descriptive statistics; content and thematic analyses applied in Phase 2.

RESULTS

In phase 1, 35% of clinicians defined BCG-unresponsive as BCG-refractory, -relapse and -resistant, 6% defined it as BCG-refractory and -relapse; 22% classified BCG-failure as BCG-refractory, -relapse, -resistant, and when muscle-invasive bladder cancer is detected. If eligible and willing, 50% (interquartile range [IQR], 50%-80%) of BCG-unresponsive patients would undergo radical cystectomy (RC), and 50% (IQR 20%-50%) of RC-eligible patients would receive bladder-sparing treatment or surveillance. In phase 2, we found that 32%, 88%, and 48% of clinicians, respectively, used "BCG-unresponsive," "BCG-refractory," and "BCG-relapse" in clinical practice but with no consistent interpretation of the terms. Compared with EAU definitions, 8%-60% of clinicians appropriately classified 9 tumor types that are persistent or recurrent after adequate BCG. Fifty percent of clinicians mentioned a lack of bladder-preserving treatment that outperforms RC in quality of life as a reason to retreat BCG-unresponsive patients with BCG.

CONCLUSIONS

Our study revealed varied understanding and application of BCG-unresponsive terminologies in practice. There is a need for a uniform and simple definition of BCG-unresponsive disease in Asia-Pacific.

Natural history of incidentally diagnosed prostate cancer after holmium laser enucleation of the prostate

OBJECTIVES

There is no consensus on the management plan for incidental prostate cancer (IPCa) after holmium laser enucleation of the prostate (HoLEP). This study aims to investigate the natural course of this disease and suggest appropriate treatment in real clinical practice.

METHODS

The medical records of a prospective cohort of patients with LUTS/BPH who underwent HoLEP between July 2008 and December 2020 at Seoul National University Hospital were retrospectively reviewed. Patients who underwent HoLEP for palliative purpose of prostate cancer control were excluded. The natural history of IPCa was assessed by the clinician in a descriptive manner for each treatment option.

RESULTS

Among 2630 patients, 141 (5.4%) were diagnosed with IPCa after HoLEP. Pathologic T stage and magnetic resonance imaging results were highly associated with the physician's primary treatment decision-making for IPCa. Active surveillance (AS) was performed in 80% of patients, of whom 90% underwent follow-up without intervention, while the remaining 10% underwent deferred active treatment with a median follow-up of 46.3 months due to International Society of Urological Pathology grade group upgrading or increasing core involvement percentage. Meanwhile, 20% of patients underwent immediate active treatment. With a median follow-up period of 88.3 months after treatment, only one of 25 patients had biochemical recurrence.

CONCLUSIONS

The incidence of IPCa after HoLEP was 5.4%, and among these, approximately 20% proceeded with immediate definitive therapy and an additional 6% ultimately received definitive therapy within a median of 4 years of AS but showed excellent oncological outcomes.

NBCA-Lipiodol Mixture Embolization of Persistent Urine Leakage After Orthotopic Neobladder Formation: Techniques and Outcomes

OBJECTIVE

To show the effective and successful technical approach of percutaneous embolization for persistent urine leakage that occurred after orthotopic neobladder formation.

MATERIALS AND METHODS

We retrospectively reviewed patients who underwent percutaneous embolization of N-butyl cyanoacrylate (NBCA) and lipiodol mixture after orthotopic neobladder formation at the Seoul National University Hospital (Seoul, Korea) from 1 January 2018 to 31 December 2020.

RESULTS

Among total of 182 patients of neobladder formation, five patients (four males and one female) were enrolled in this study, and their median age was 61.0 years (interquartile range (IQR): 42.5-69.5 years). All the patients showed persistent urine leakage at the neobladder-urethral anastomosis site and percutaneous drainage was primarily performed. The median time to perform percutaneous embolization was 40 days (IQR: 31.5-71.5 days) postoperatively. Elective two-staged embolization was performed in three cases for large diameter with a large fluid-filled cavity, while re-embolization was needed for delayed recurrence of urine leakage in two cases. Complete resolution of urine leakage was seen in all the cases and the median time to leakage closure was 55 days (IQR: 27.5-82.5 days). The median follow-up period after leakage closure was 26 months (IQR: 15.5-36.4 months), and embolization material-related bladder stone was a noticeable complication (two cases) during follow-up, which was removed endoscopically within 1 year after embolization. All patients' quality of life (EQ-5D-5L score) was well-maintained during the entire period.

CONCLUSIONS

Persistent urine leakage after neobladder formation can be effectively managed with percutaneous embolization of "dumbbell technique" by reinforcing the closure of leakage tract from inner opening to the outer opening even for large diameter (>1 cm).

Risk stratification and management of non-muscle-invasive bladder cancer: A physician survey in six Asia-Pacific territories

OBJECTIVES

Multiple clinical practice guidelines, conflicting evidence, and physician perceptions result in variations in risk stratification among patients with non-muscle-invasive bladder cancer (NMIBC). This study aims to describe the extent of this variation and its impact on management approaches in the Asia-Pacific region.

METHODS

We conducted a cross-sectional survey involving 32 urologists and seven medical oncologists with ≥8 years of experience managing early-stage bladder cancer patients across Australia, Hong Kong, Japan, South Korea, Singapore, and Taiwan. The physicians completed an anonymous questionnaire that assessed their risk stratification and respective management approaches, based on 19 NMIBC characteristics. For each NMIBC characteristic, they were required to select one risk group, and their most preferred management approach.

RESULTS

Our results demonstrated a higher consensus on risk classification versus management approaches. More than 50% of the respondents agreed on the risk classification of all NMIBC characteristics, but 42% or fewer chose the same treatment option as their preferred choice for all but two characteristics-existence of variant histology (55%) and persistent high-grade T1 disease on repeat resection (52%). Across territories, there was the greatest variation in preferred treatment options (i.e., no treatment, intravesical chemotherapy, or Bacillus Calmette-Guérin [BCG] treatment) for intermediate-risk patients and the highest consensus on the treatment of very high-risk patients, namely radical cystectomy.

CONCLUSIONS

Our study revealed considerable variation in risk stratification and management of NMIBC in the region. It is critical to develop practical algorithms to facilitate the recognition of NMIBC and standardize the treatment of NMIBC patients.

Treatment of advanced urothelial cancer with nivolumab plus chemotherapy versus chemotherapy alone (CheckMate 901 study): a plain language summary

What is this summary about?

This article describes the results of a clinical research study called ‘CheckMate 901’,which was published in The New England Journal of Medicine . CheckMate 901 was a study that looked at a specific type of cancer called urothelial cancer, which impacts parts of the urinary system. Participants in the study had urothelial cancer that was either unresectable (meaning that it cannot be removed by surgery) or metastatic (where the cancer has spread from the urinary system to other parts of the body).

Unresectable or metastatic urothelial cancer is normally treated with chemotherapy (treatment using chemicals to kill fast-growing cancer cells), but researchers are looking for more effective treatment options. The CheckMate 901 study aimed to find out if using a combination of chemotherapy and the drug nivolumab would work better and last longer than chemotherapy alone for people with advanced urothelial cancer. Immunotherapies are a family of cancer treatments that use the body's own immune system to fight the cancer.

What happened in the study?

In the CheckMate 901 study, researchers looked at nivolumab plus chemotherapy given together compared with chemotherapy alone as first-line treatment (the first treatment used) for people with metastatic urothelial cancer. The goal of the study was to see if this combination(nivolumab plus chemotherapy) would work better than chemotherapy alone in terms of how long people survived (lived) and how long they survived without their cancergetting worse. The study also looked at any side effects (undesirable effect of the drug) and other health problems that might come from these treatments.

What do these results mean?

In comparing people who received nivolumab plus chemotherapy together, followed by nivolumab by itself, with people who received chemotherapy alone, the results showed that people in the nivolumab plus chemotherapy group not only survived (lived) longer, but also survived (lived) longer without their cancer getting worse. They were also more likely to have their tumors (an abnormal growth of body tissue) shrink, and were more likely to have their tumors shrink completely (and maintain complete shrinkage for a longer period of time). Also, they experienced no difference in overall health-related quality of life, and had similar side effects to those seen in other studies of nivolumab or chemotherapy.

Survival benefit of neoadjuvant chemotherapy in pathologic T2N0 or lower urothelial carcinoma patients: evidence to support the use of neoadjuvant chemotherapy

BACKGROUND

To evaluate the survival benefit of neoadjuvant chemotherapy (NAC) in pathologic T2N0 or less patients.

METHODS

A total of 526 patients with less than pT2N0 underwent radical cystectomy. Patients were divided into three groups: non-NAC, those who did not receive NAC; partial NAC, those who received less 3 cycles of NAC; and complete NAC, those who received 3 cycles of NAC.

RESULTS

Median follow up was 74.6 (range, 24-311) months. Recurrent-free survival (RFS) was significantly (P=0.041) higher in the non-NAC group than that in the complete NAC group. Overall survival (OS) was significantly (P=0.039) higher in the non-NAC group than that in the complete NAC group. There was no significant difference between the partial NAC group and the complete NAC group. In patients with pT0, the NAC group had higher pT0 ratio than the non-NAC group (33.3% vs. 21.1%). A total of 66.6% of NAC patients were down-staged to less than T2. In univariate and multivariate analyses, recurrence was significantly related to pathologic T stage (P<0.001), concurrent carcinoma in situ (CIS) (P=0.002), and the number of removed lymph nodes (LNs) (P=0.001). Survival was significantly related to pathologic T stage (P<0.001), lymphovascular invasion (LVI) (P=0.002), the number of removed LNs (P<0.001), and the presence of NAC (P=0.047).

CONCLUSIONS

Patients with pT2 or lower underwent NAC showed similar prognosis as patients with pT2 or lower who did not undergo NAC.

Fully automated segmentation and classification of renal tumors on CT scans via machine learning

BACKGROUND

To develop and test the performance of a fully automated system for classifying renal tumor subtypes via deep machine learning for automated segmentation and classification.

MATERIALS AND METHODS

The model was developed using computed tomography (CT) images of pathologically proven renal tumors collected from a prospective cohort at a medical center between March 2016 and December 2020. A total of 561 renal tumors were included: 233 clear cell renal cell carcinomas (RCCs), 82 papillary RCCs, 74 chromophobe RCCs, and 172 angiomyolipomas. Renal tumor masks manually drawn on contrast-enhanced CT images were used to develop a 3D U-Net-based deep learning model for fully automated tumor segmentation. After segmentation, the entire classification pipeline, including feature extraction and subtype classification, was conducted without any manual intervention. Both conventional radiological features (Hounsfield units, HUs) and radiomic features extracted from areas predicted by the deep learning models were used to develop an algorithm for classifying renal tumor subtypes via a random forest classifier. The performance of the segmentation model was evaluated using the Dice similarity coefficient, while the classification model was assessed based on accuracy, sensitivity, and specificity.

RESULTS

For tumors larger than 4 cm, the Dice similarity coefficient (DSC) for automated segmentation was 0.83, while for tumors smaller than 4 cm, the DSC was 0.65. The classification accuracy (ACC) for distinguishing RCC subtypes was 0.77 for tumors larger than 4 cm and 0.68 for tumors smaller than 4 cm. Additionally, the accuracy for benign versus malignant classification was 0.85.

CONCLUSIONS

Our automatic segmentation and classifier model showed promising results for renal tumor segmentation and classification.

Pyuria as an independent predictor of intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial carcinoma

PURPOSE

About one-third of patients who undergo radical nephroureterectomy (RNUx) for upper tract urothelial carcinoma (UTUC) experience intravesical recurrence (IVR). This study investigated whether pyuria is a feasible predictor of IVR after RNUx in patients with UTUC.

MATERIALS AND METHODS

Seven hundred forty-three patients with UTUC who underwent RNUx at a single institute were analyzed in this study. The participants were divided into two groups: those without pyuria (non-pyuria) and those with pyuria. Kaplan-Meier survival analysis was performed, and p-values were assessed using the log-rank test. Cox regression analyses were performed to identify the independent predictors of survival.

RESULTS

The pyuria group had a shorter IVR-free survival period (p=0.009). The five-year IVR-free survival rate was 60.0% in the non-pyuria group vs. 49.7% in the pyuria group according to the Kaplan-Meier survival analysis. After the multivariate Cox regression analysis, pyuria (hazard ratio [HR]=1.368; p=0.041), a concurrent bladder tumor (HR=1.757; p=0.005), preoperative ureteroscopy (HR=1.476; p=0.013), laparoscopic surgery (HR=0.682; p=0.048), tumor multiplicity (HR=1.855; p=0.007), and a larger tumor (HR=1.041; p=0.050) were predictors of risk for IVR. There was no association between pyuria and recurrence-free survival (p=0.057) or cancer-specific survival (p=0.519) in the Kaplan-Meier survival analysis.

CONCLUSIONS

This study concluded that pyuria was an independent predictor of IVR in patients with UTUC after RNUx.

A different female partner does not affect the success of second vasectomy reversal

The aim of the study was to determine whether the pregnancy rate with the same female partner or younger partners was higher compared with different or older partners after undergoing repeated vasectomy reversal. A total of 44 patients were enrolled in the present study. The cause of reversal in patients with the same partner was the desire to have more children in 14 cases, the loss of a child in 7 cases, and the desire for a son in 7 cases. Patients were asked about pregnancy and childbirth during follow-up visits and by telephone or mail. Following microsurgical vasectomy reversal, patency was observed in 38 men (86.4%). Twenty-five of the couples (56.8%) achieved pregnancy without any artificial conception technique. We did not observe a significant difference in the pregnancy rate (57.1% vs 56.3%, P=.954) between patients with the same or a different female partner. In the multivariate model used, partner age was the only independent predictor for pregnancy. Patients with a partner less than 35 years old had a 4.1-fold greater chance (odds ratio, 4.13; 95% confidence interval, 1.06-16.10; P=.041) of pregnancy than those with a partner 35 years old or older. The area under the receiver operating characteristics curve for partner age was 73.0% (95% confidence interval 56.8-89.2, P=.011). Our findings suggest that repeat microsurgical vasectomy reversal still remains a reasonable choice for patients with different female partners. However, it should be considered that the likelihood of achieving pregnancy after repeat vasectomy reversal may decrease with advancing age of the female partner.

Renal function change after radical cystectomy for urothelial carcinoma patients with a solitary kidney may be independent of urinary diversion type

PURPOSE

To compare renal function change by urinary diversion (UD) type (ileal conduit [IC] vs. neobladder [NB]) in patients with a single kidney who underwent radical cystectomy (RC) due to bladder cancer.

MATERIALS AND METHODS

We evaluated the renal function change in 86 patients with a single kidney who underwent RC between January 1999 and August 2022. Renal function was assessed using serum creatinine, serum estimated glomerular filtration rate (eGFR), eGFR difference value (preoperative and follow-up values), and eGFR difference proportion (eGFR difference value/preoperative eGFR) at 1, 3, 6, 12, 24, 36, 48, and 60 months. In addition, multiple definitions of eGFR decline were evaluated: 10 points, 10%, and 20% decline in eGFR. Cox regression models were used to identify risk factors of eGFR decline-free, recurrence-free, overall, and cancer-specific survival rates.

RESULTS

A total of 54 patients (62.8%) underwent IC, whereas 32 (37.2%) underwent NB. Baseline characteristics were similar between the two groups except for age and body mass index. Renal functions over time by various methods did not differ significantly between the IC and NB groups. Furthermore, eGFR decline-free survival rate using different definitions was similar between the IC and NB groups. Overall survival, recurrence-free survival, and cancer-specific-free survival rates were not different between the IC and NB groups.

CONCLUSIONS

UD type (IC vs. NB) did not impact the renal function change of patients with a single kidney who underwent RC. Therefore, patients with a single kidney might be considered to be an indication of NB.

Clinical Implication of Preoperative Renal Function on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy

This study aims to evaluate the impact of preoperative renal function on oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). We performed a retrospective analysis of patients who underwent RNU between 2000 and 2012 at six academic centers. The patients were stratified into two groups based on preoperative renal function: eGFR < 60 mL/min/1.73 m2 (chronic kidney disease; CKD) and eGFR ≥ 60 mL/min/1.73 m2 (non-CKD). We investigated oncological outcomes, including overall survival, cancer-specific survival, and progression-free survival dichotomized by preoperative renal function. Multivariable Cox proportional hazards regression was used to determine if preoperative CKD was associated with oncological outcomes. In total, 1733 patients were eligible for the present study (CKD = 707 and non-CKD = 1026). Significant differences were noted in the clinical and pathologic features among the two groups, including age, sex, tumor localization, pathological T stage, tumor grade, and number of patients who received adjuvant chemotherapy. The estimated five-year overall survival (79.4 vs. 67.5%, log-rank p < 0.001), cancer-specific survival (83.5 vs. 73.6%, log-rank p < 0.001), and progression-free survival (74.6 vs. 61.5%, log-rank p < 0.001) were significantly different between the two groups, longer in the non-CKD group. Upon multivariable analysis, preoperative CKD status was associated with increased risk of overall mortality, cancer-specific mortality, and progression (p = 0.010, p = 0.016, and p = 0.008, respectively). UTUC patients with preoperative CKD had a higher risk of poor overall survival, cancer-specific survival, and progression-free survival after RNU than those without CKD.

CREST: phase III study of sasanlimab and Bacillus Calmette-Guérin for patients with Bacillus Calmette-Guérin-naïve high-risk non-muscle-invasive bladder cancer

Bacillus Calmette-Guérin (BCG) is the standard of care for patients with high-risk non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT). BCG in combination with programmed cell death-1 (PD-1) inhibitors may yield greater anti-tumor activity compared with either agent alone. CREST is a phase III study evaluating the efficacy and safety of the subcutaneous PD-1 inhibitor sasanlimab in combination with BCG for patients with BCG-naive high-risk NMIBC. Eligible participants are randomized to receive sasanlimab plus BCG (induction ± maintenance) or BCG alone for up to 25 cycles within 12 weeks of TURBT. The primary outcome is event-free survival. Secondary outcomes include additional efficacy end points and safety. The target sample size is around 1000 participants.

Predictors for the detection of prostate cancer and clinically significant prostate cancer using TRUS-guided biopsy in patients with negative initial biopsy results

PURPOSE

We aimed to determine the predictors for the detection of prostate cancer and clinically significant prostate cancer in the setting of repeat prostate biopsy using trans-rectal ultrasonography-guided biopsy.

METHODS

A total of 636 patients who underwent repeat prostate biopsy were included. The patients were divided into two groups according to the repeat biopsy results (with vs. without prostate cancer). A multivariable analysis was performed to assess the predictors for the detection of prostate cancer and clinically significant prostate cancer.

RESULTS

Prostate cancer was detected in 98 patients (15.4%). Although there was no difference in the prostate-specific antigen velocity, the prostate-specific antigen density was higher in the patients with prostate cancer at the initial (0.14 vs. 0.17 ng/mL/cc, p = 0.049) and repeat biopsies (0.17 vs. 0.26 ng/mL/cc, p < 0.001). The proportions of the patients who met the active surveillance criteria were as follows: 22.4% (Johns Hopkins), 30.6% (University of Toronto), 32.7% (University of California at San Francisco), 30.6% (Prostate Cancer Research International Active Surveillance), 27.6% (Memorial Sloan Kettering Cancer Center), and 13.3% (University of Miami). In the multivariable analysis, age, hypoechoic lesion on trans-rectal ultrasonography, and prostate-specific antigen density at the repeat biopsy were the significant predictors for prostate cancer and clinically significant prostate cancer.

CONCLUSIONS

Trans-rectal ultrasonography before repeat prostate biopsy and the prostate-specific antigen density are useful for selecting patients with a high probability for prostate cancer if repeat trans-rectal ultrasonography-guided biopsy is considered. In addition, these are also helpful for detecting clinically significant prostate cancer.

Efficacy of Partial Nephrectomy for Renal Tumors &gt;4 cm: Comparison With Renal Tumors ≤4 cm

Partial nephrectomy has become a treatment of choice for clinical T1a renal masses. Some international guidelines suggest that partial nephrectomy can be applied also in clinical T1b tumors. The aim of this study was to evaluate the feasibility of partial nephrectomy for tumors larger than 4 cm. We reviewed the medical records of 1280 patients who underwent partial nephrectomy and had pathologically confirmed malignancy. Patients were categorized into two groups by the size of tumors on computed tomography image, with a cutoff value of 4 cm. The oncologic and functional outcomes were compared between the two groups. Recurrence-free survival after surgery was estimated using the Kaplan-Meier method. Of the 1280 patients, 203 patients (15.9%) had renal tumors larger than 4 cm. There were significantly more exophytic tumors (P &lt; 0.001) and the R.E.N.A.L. scores were significantly higher (P &lt; 0.001) in partial nephrectomy &gt;4 cm. Mean ischemic times were significantly different (P &lt; 0.001). After 24 months, mean creatinine level between partial nephrectomy &gt;4 cm and partial nephrectomy ≤4 cm was not different significantly (P = 0.554). And the percent changes of glomerular filtration rate after partial nephrectomy were not different at last follow-up (P = 0.082). The 5-year recurrence-free survival rates were 96.6% in partial nephrectomy ≤4 cm, and 94.5% in partial nephrectomy &gt;4 cm (P = 0.416). Based on the present findings, partial nephrectomy for tumors larger than 4 cm showed comparable feasibility and safety to partial nephrectomy for tumors ≤4 cm considering oncologic and functional outcomes, despite longer operative and ischemic time.

Risk factors for urinary retention after robot-assisted radical cystectomy with orthotopic neobladder diversion: a multicenter study

To determine risk factors for urinary retention (UR) after robot-assisted radical cystectomy (RALC) with orthotopic neobladder diversion. A total of 269 patients who underwent RALC with orthotopic neobladder diversion from 2008 to 2019 at seven tertiary hospitals were retrospectively analyzed. There were 68 patients who had UR (UR arm) and 201 patients who did not have UR (no-UR arm). UR was defined as voiding dysfunction without catheterization or more than 100 mL of residual urine after voiding. Preoperative demographics, perioperative factors, pathology outcomes, and postoperative complications of UR and no-UR arms were compared and predictors of UR were identified. Among demographic factors, only gender proportion showed a difference, with male proportion being significantly lower in the UR arm than in the no-UR arm (81% vs 92%, p = 0.010). For perioperative outcomes, anastomosis site stricture (27% vs 11%, p = 0.003) and length of hospital stays (23 days vs. 19 days, p = 0.001) were significantly higher in the UR arm than in the no-UR arm. In multiple logistic regression analysis, female (OR 3.32, 95% CI: 1.43-7.72) and body mass index (BMI) (OR 1.10, 95% CI 1.00-1.20) were UR predictors. UR after RALC with orthotopic neobladder diversion is significantly increased in females. Multiple logistic regression analysis identified female and BMI elevation as UR predictors.

Highly efficient nucleic acid encapsulation method for targeted gene therapy using antibody conjugation system

Gene therapy has surfaced as a promising avenue for treating cancers, offering the advantage of deliberate adjustment of targeted genes. Nonetheless, the swift degradation of nucleic acids in the bloodstream necessitates an effective and secure delivery system. The widespread utilization of poly(lactic-co-glycolic acid) (PLGA) nanoparticles as drug delivery systems has highlighted challenges in controlling particle size and release properties. Moreover, the encapsulation of nucleic acids exacerbates these difficulties due to the negatively charged surface of PLGA nanoparticles. In this study, we aimed to improve the encapsulation efficiency of nucleic acids by employing negatively charged microbeads and optimizing the timing of the specific formulation steps. Furthermore, by conjugating PSMA-617, a ligand for the prostate-specific membrane antigen (PSMA), with PLGA nanoparticles, we assessed the antitumor effects and the efficacy of a nucleic acid delivery system on a prostate cancer model. The employed technique within the nucleic acid encapsulation system represents a novel approach that could be adapted to encapsulate various kinds of nucleic acids. Moreover, it enables the attachment of targeting moieties to different cell membrane proteins, thereby unveiling new prospects for precise therapeutics in cancer therapy.