MicroRNA Signatures in the Upper Urinary Tract Urothelial Carcinoma Scenario: Ready for the Game Changer?

Effectiveness and safety of adjuvant treatment of tislelizumab with or without chemotherapy in patients with high-risk upper tract urothelial carcinoma: a retrospective, real-world study

BACKGROUND

Upper tract urothelial carcinoma (UTUC) is a rare subset of urothelial cancers with poor prognosis. No consensus exists on the benefit of adjuvant immunotherapy for patients with UTUCs after nephroureterectomy with curative intent and the existing studies are limited. Herein, this study aimed to evaluate the effectiveness and safety of adjuvant treatment of tislelizumab with or without chemotherapy in patients with high-risk UTUC.

METHODS

A retrospective study was conducted on 63 patients with high-risk UTUC who received tislelizumab with or without gemcitabine-cisplatin (GC) chemotherapy regimen after surgery between January 2020 and December 2022. Data on demographic and clinical characteristics, surgical, outcomes, prognostic factors, and safety were collected and analyzed.

RESULTS

Among the 63 patients with high-risk UTUC, the median age was 66 years (interquartile range 57-72), with 33 (52%) being male. The majority of patients with staged pT3 (44%) and pN0 (78%) disease. Fifty-one patients (81%) received tislelizumab plus GC chemotherapy, and 12 (19%) were treated with tislelizumab monotherapy. After the median follow-up of 26 months (range 1-47), 49 (78%) patients achieved stable disease. The 2-year disease-free survival (DFS) and 2-year overall survival were 78.68% (95% CI: 60.02-87.07%) and 81.40% (95% CI: 68.76-89.31%), respectively. The cycles of GC chemotherapy were independent prognostic factors for survival, with higher DFS (hazard ratio = 0.68, 95% CI, 0.50-0.93; p = 0.016) observed in the subgroup undergoing ≥ 3 cycles versus < 3 cycles of GC chemotherapy. Fifty-eight patients (92%) experienced at least one treatment-related adverse event (TRAE), with grade 3-4 TRAEs occurring in 13%. The most common grade 3-4 TRAEs were decreased white blood cells, thrombocytopenia, and ulcers.

CONCLUSIONS

The study demonstrates promising clinical benefits and a manageable safety profile of the tislelizumab-based adjuvant regimen for patients with high-risk UTUC. This suggests that adjuvant immunotherapy represents a potential therapeutic strategy for this population.

Development of a machine learning-based predictive model for transitional cell carcinoma of the renal pelvis in White Americans: a SEER-based study

Background

Transitional cell carcinoma (TCC) of the renal pelvis is a rare cancer within the urinary system. However, the prognosis is not entirely satisfactory. This study aims to develop a clinical model for predicting cancer-specific survival (CSS) at 1-, 3-, and 5-year for White Americans with renal pelvic TCC.

Methods

Data of all White American patients diagnosed with TCC of the renal pelvis from 2010 to 2015 were extracted and analyzed from the Surveillance, Epidemiology, and End Results (SEER) database in this retrospective study. Subsequently, after excluding the metastatic group, a subgroup analysis was performed on the data of 1,715 White Americans with non-metastatic renal pelvic TCC. Patients included in this study were randomly divided into the training and validation sets in a ratio of 7:3. In addition, the features in the training set were extracted by the Boruta algorithm. The importance of these features was visualized using the eXtreme Gradient Boosting (XGBoost)-based SHapley Additive exPlanation (SHAP) tool. To improve predictive accuracy, a nomogram model with these identified independent prognostic variables was developed.

Results

A total of 1,887 White American patients with renal pelvic TCC were included in this study. In the training set, the area under the curve (AUC) for CSS nomograms at 1-, 3-, and 5-year were 0.813 [95% confidence interval (CI): 0.774-0.852], 0.738 (95% CI: 0.702-0.774), and 0.733 (95% CI: 0.698-0.768), respectively. Correspondingly, the AUCs for CSS nomograms at the above time points were 0.781 (95% CI: 0.732-0.830), 0.785 (95% CI: 0.741-0.829), and 0.775 (95% CI: 0.729-0.820) in the validation set, respectively. The subgroup analysis results revealed that the AUCs for CSS nomograms at 1-, 3-, and 5-year were 0.788, 0.725, and 0.726 in the training set, respectively, while the AUCs for CSS nomograms at 1-, 3-, and 5-year were 0.831, 0.786, and 0.754 in the training set, respectively.

Conclusions

In this study, a nomogram that predicts CSS in White American patients diagnosed with renal pelvic TCC was efficiently constructed. The application of the nomogram may enhance patient care and assist clinicians in choosing the optimal treatment strategies.

The Clinical and Molecular Features in the VHL Renal Cancers; Close or Distant Relatives with Sporadic Clear Cell Renal Cell Carcinoma?

Von Hippel-Lindau (VHL) disease is an autosomal dominant inherited cancer syndrome caused by germline mutations in the VHL tumor suppressor gene, characterized by the susceptibility to a wide array of benign and malign neoplasms, including clear-cell renal cell carcinoma. Moreover, VHL somatic inactivation is a crucial molecular event also in sporadic ccRCCs tumorigenesis. While systemic biomarkers in the VHL syndrome do not currently play a role in clinical practice, a new promising class of predictive biomarkers, microRNAs, has been increasingly studied. Lots of pan-genomic studies have deeply investigated the possible biological role of microRNAs in the development and progression of sporadic ccRCC; however, few studies have investigated the miRNA profile in VHL patients. Our review summarize all the new insights related to clinical and molecular features in VHL renal cancers, with a particular focus on the overlap with sporadic ccRCC.