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Background: Intravesical immunotherapy with bacillus Calmette–Guerin (BCG) is the standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The superiority of any BCG strain over another could not be demonstrated yet. Methods: Patients with NMIBCs underwent adjuvant induction ± maintenance schedule of intravesical immunotherapy with either BCG TICE or RIVM at two high-volume tertiary institutions. Only BCG-naïve patients and those treated with the same strain over the course of follow-up were included. One-to-one (1:1) propensity score matching (PSM) between the two cohorts was utilized to adjust for baseline demographic and tumor characteristics imbalances. Kaplan–Meier estimates and multivariable Cox regression models according to high-risk NMIBC prognostic factors were implemented to address survival differences between the strains. Sub-group analysis modeling of the influence of routine secondary resection (re-TUR) in the setting of the sole maintenance adjuvant schedule for the two strains was further performed. Results: 852 Ta-T1 NMIBCs (n = 719, 84.4% on TICE; n = 133, 15.6% on RIVM) with a median of 53 (24–77) months of follow-up were reviewed. After PSM, no differences at 5-years RFS, PFS, and CSS at both Kaplan–Meier and Cox regression analyses were detected for the whole cohort. In the sub-group setting of full adherence to European/American Urology Guidelines (EAU/NCCN), BCG TICE demonstrated longer 5-years RFS compared to RIVM (68% vs. 43%, p = 0.008; HR: 0.45 95% CI 0.25–0.81). Conclusion: When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. However, no significant differences were detected for PFS and CSS, respectively.

Objectives: To quantify inpatient palliative care use over time and to test whether patient or hospital characteristics represent determinants of inpatient palliative care use in patients with metastatic penile cancer. Methods: Relying on the National Inpatient Sample database (2006–2019), we identified 1017 metastatic penile cancer patients. Estimated annual percentage change analyses and multivariable logistic regression models addressing inpatient palliative care use were fitted. Results: Of 1017 metastatic penile cancer patients, 139 (13.7%) received inpatient palliative care. Over time, the proportion of inpatient palliative care use per year increased from 6.5% in 2006 to 17.8% in 2019 (estimated annual percentage change +6.7%; p = 0.001). In the multivariable logistic regression models, contemporary study years (odds ratio [OR] 1.80; p = 0.003), the presence of bone metastases (OR 1.90; p = 0.002) and the presence of brain metastases (OR 2.60; p = 0.013) independently predicted higher inpatient palliative care use. Conversely, distant lymph node metastases independently predicted lower inpatient palliative care use (OR 0.58; p = 0.022). Finally, hospital admission in the South (OR 2.42; p = 0.007) and in the Northeast (OR 2.34; p = 0.015) was associated with higher inpatient palliative care use than hospital admission in the Midwest. Conclusions: In metastatic penile cancer patients, the proportions of inpatient palliative care use were low but have increased over time. Unfortunately, some geographical regions are more refractory to inpatient palliative care use than others. Finally, specific patient characteristics such as bone metastases and brain metastases represent independent predictors of higher inpatient palliative care use.

Although complete surgical resection provides the only means of cure in adrenocortical carcinoma (ACC), the magnitude of the survival benefit of adrenalectomy in metastatic ACC (mACC) is unknown. This work aimed to assess the effect of adrenalectomy on survival outcomes in patients with mACC in a real-world setting. Patients with mACC aged 18 years or older with metastatic ACC at initial presentation who were treated between 2004 and 2020 were identified within the Surveillance, Epidemiology, and End Results database (SEER 2004-2020), and we tested for differences according to adrenalectomy status. Intervention included primary tumor resection status (adrenalectomy vs no adrenalectomy). Kaplan-Meier plots, multivariable Cox regression models, and landmark analyses were used. Sensitivity analyses focused on use of systemic therapy, contemporary (2012-2020) vs historical (2004-2011), single vs multiple metastatic sites, and assessable specific solitary metastatic sites (lung only and liver only). Of 543 patients with mACC, 194 (36%) underwent adrenalectomy. In multivariable analyses, adrenalectomy was associated with lower overall mortality without (hazard ratio [HR]: 0.39; P < .001), as well as with 3 months' landmark analyses (HR: 0.57; P = .002). The same association effect with 3 months' landmark analyses was recorded in patients exposed to systemic therapy (HR: 0.49; P < .001), contemporary patients (HR: 0.57; P = .004), historical patients (HR: 0.42; P < .001), and in those with lung-only solitary metastasis (HR: 0.50; P = .02). In contrast, no statistically significant association was recorded in patients naive to systemic therapy (HR: 0.68; P = .3), those with multiple metastatic sites (HR: 0.55; P = .07), and those with liver-only solitary metastasis (HR: 0.98; P = .9). The present results indicate a potential protective effect of adrenalectomy in mACC, particularly in patients exposed to systemic therapy and those with lung-only metastases.

Abstract Objective To test the ability of the 2015 modified version of the European Network for the Study of Adrenal Tumors staging system (mENSAT) in predicting cancer-specific mortality (CSM), as well as overall mortality (OM) in adrenocortical carcinoma (ACC) patients of all stages, in a large-scale, and contemporary United States cohort. Methods We relied on the Surveillance, Epidemiology, and End Results (SEER) database (2004–2020) to test the accuracy and calibration of the mENSAT and subsequently compared it to the 8th edition of the American Joint Committee on Cancer staging system (AJCC). Results In 858 ACC patients, mENSAT accuracy was 74.7% for 3-year CSM predictions and 73.8% for 3-year OM predictions. The maximum departures from ideal predictions in mENSAT were +17.2% for CSM and +11.8% for OM. Conversely, AJCC accuracy was 74.5% for 3-year CSM predictions and 73.5% for 3-year OM predictions. The maximum departures from ideal predictions in AJCC were −6.7% for CSM and −7.1% for OM. Conclusion The accuracy of mENSAT is virtually the same as that of AJCC in predicting CSM (74.7% vs 74.5%) and OM (73.7% vs 73.5%). However, calibration is lower for mENSAT than for AJCC. In consequence, no obvious benefit appears to be associated with the use of mENSAT relative to AJCC in US ACC patients.

Background/Objectives: Robot-assisted radical cystectomy (RARC) has demonstrated improved perioperative outcomes and recovery in bladder cancer (BCa) patients. This study compares patient and tumor characteristics, operative time (OT), length of stay (LOS), and complication rates between a historical (2003–2016) and a contemporary cohort (2017–2024) treated at a high-volume robotic center. Methods: Data from 274 BCa patients who underwent RARC at AZORG Hospital, Aalst, Belgium, were analyzed. Perioperative outcomes were compared between cohorts. Multivariable Poisson regression models identified predictors of longer OT and LOS, while multivariable logistic regression models (MLRMs) assessed predictors of higher complication rates. Results: Overall, 274 BCa patients who underwent RARC were identified (38% historical cohort vs. 62% contemporary cohort). The contemporary cohort had a significantly shorter median OT (345 vs. 360 min; p = 0.048) and LOS (8 vs. 12 days; p < 0.001) compared to the historical cohort. Postoperative complications were lower in the contemporary group, with more cases experiencing no complications (60% vs. 41%) and fewer grade 3–4 complications (10% vs. 27%; p < 0.001). In multivariable Poisson regression, the contemporary cohort was an independent predictor of shorter OT (Incidence Rate Ratio [IRR]: 0.94, 95% [Confidence Interval] CI: 0.93–0.96; p = 0.04) and shorter LOS (IRR: 0.65, 95% CI: 0.60–0.69; p < 0.001). In MLRMs predicting complications, the contemporary cohort was associated with lower risk (Odds Ratio: 0.42, 95% CI: 0.23–0.76; p = 0.005). Conclusions: RARC outcomes improved significantly over time, with reduced OT, LOS, and complication rates in the contemporary cohort, highlighting advancements in surgical techniques, perioperative care, and patient safety. These findings reinforce the role of RARC in optimizing BCa treatment.

Introduction: Available guidelines recommend performing nephron-sparing surgery in selected renal cell carcinoma (RCC) patients. Many studies provided robot-assisted partial nephrectomy (RAPN) functional and oncological outcomes, with most of these including a wide timespan and a number of surgeons with different experiences, which might lead to the heterogeneity of the results. In this study, we aim to provide a contemporary report of RAPN patient outcomes performed at two referral centers by experienced surgeons. Materials and Methods: Overall, 333 RAPN patients treated at two European referral centers between 2019 and 2021 were identified. Continuous and categorical variables were reported using medians and proportions. Multi-variable logistic regression (MLR) models were fitted to test predictors of off-clamp technique use and trifecta achievement. Results: The median age was 65 (IQR: 57–73) years. The clinical stage distribution was as follows: 224 (67%) cT1a vs. 89 (26%) cT1b vs. 20 cT2 (7%). The median warm ischemia time was 14 (10–18) minutes, with trifecta being achieved in 74% (n = 240) of patients. In MLR models predicting off-clamp surgery, an increasing R.E.N.A.L. score was independently associated with a lower chance of attempting such a technique (OR: 0.69, p-value < 0.001). In models predicting trifecta achievement, both a higher R.E.N.A.L. score (OR: 0.78, p-value = 0.007) and the presence of multiple lesions (OR: 0.29, p-value = 0.007) were independently associated with lower chances of reaching the outcome. Significant upstaging of chronic kidney disease (CKD) stage was recorded in 9.4% of patients after one year of follow-up. Conclusions: We reported the contemporary outcomes of patients treated with RAPN by highly experienced surgeons from two referral centers. This report represents a valid benchmark that could be used for individual patient counseling in the decision-making process.

Background: Historical external beam radiation therapy (EBRT) for rectosigmoid cancer (RCa) predisposed patients to an increased risk of secondary bladder cancer (BCa). However, no contemporary radiotherapy studies are available. We addressed this knowledge gap. Materials and methods: Within the Surveillance, Epidemiology, and End Results database (2000–2020), we identified non-metastatic RCa patients who either underwent radiotherapy (EBRT+) or did not (EBRT-). Cumulative incidence plots and multivariable competing risk regression models (CRR) were fitted to address rates of BCa after RCa. In the subgroup of BCa patients, the same methodology addressed BCa-specific mortality (BCSM) according to EBRT exposure status. Results: Of the 188,658 non-metastatic RCa patients, 54,562 (29%) were EBRT+ vs. 134,096 (73%) who were EBRT-. In the cumulative incidence plots, the ten-year BCa rates were 0.7% in EBRT+ vs. 0.7% in EBRT- patients (p = 0.8). In the CRR, EBRT+ status was unrelated to BCa rates (multivariable HR: 1.1, p = 0.8). In the subgroup of 1416 patients with BCa after RCa, 443 (31%) were EBRT+ vs. 973 (69%) who were EBRT-. In the cumulative incidence plots, the ten-year BCSM rates were 10.6% in EBRT+ vs. 12.1% in EBRT- patients (p = 0.7). In the CRR, EBRT+ status was unrelated to subsequent BCSM rates (multivariable HR: 0.9, p = 0.9). Conclusion: Although historical EBRT for RCa predisposed patients to higher BCa rates, contemporary EBRT for RCa is not associated with increased subsequent BCa risk. Moreover, in patients with BCa after RCa, exposure to EBRT does not affect BCSM.

Patterns of inpatient palliative care use in patients with metastatic upper urinary tract carcinoma within the United States Why was the study done? Early implementation of palliative care in cancer treatment represents a well-established guideline recommendation for patients with advanced cancers. However, patterns of inpatient palliative care use in patients with metastatic upper urinary tract carcinoma are largely unknown. What did the researchers do? The research team examined temporal trends and predictors of palliative care use among inpatients with metastatic upper tract urinary tract carcinoma in the United States between 2008 and 2019. What did the researchers find? Of 3563 United States inpatients with metastatic upper urinary tract carcinoma, only a minority of 15% received inpatient palliative care. Between 2008 and 2019, the rate of inpatient palliative care significantly increased from 2 to 22%. In particular, the highest average annual increase in inpatient palliative care use was observed in inpatients with multiple metastases as well as those with bone or liver metastases. Even after accounting for other clinical and tumor characteristics, liver metastases, bone metastases, and contemporary years of admission were associated with use of inpatient palliative care. What do the findings mean? In the United States, inpatient palliative care use in metastatic upper urinary tract carcinoma was very low. Moreover, this study identified important differences in inpatient palliative care use according to the number as well as the location of metastatic sites. In consequence, the current observations validate the need to sensitize clinicians towards guideline-recommended implementation of inpatient palliative care use, regardless of the number and location of metastatic sites.

Objective: To test for in-hospital mortality and complication rates in a population-based group of patients with vs. without a history of heart valve replacement undergoing radical prostatectomy (RP). Methods: Relying on the National Inpatient Sample (2000–2019), prostate cancer patients undergoing RP were stratified according to the presence or absence of heart-valve replacement. Multivariable logistics and Poisson regression models addressed adverse hospital outcomes. Results: Within the NIS, 220,358 patients underwent RP. Of those, 694 (0.3%) had a history of heart valve replacement. The patients undergoing heart valve replacement were older (median age 66 vs. 62 years). The proportion of patients with a history of heart valve replacement increases with the Charlson Comorbidity Index (CCI): CCI 0–0.3%, CCI 1–0.4%, and CCI ≥ 2–0.7%. Patients with a history of heart valve replacement exhibited higher rates of postoperative bleeding (<1.5% vs. <0.1%; odds ratio (OR) 16.2; p < 0.001), cardiac complications (7.5% vs. 1.2%; OR 3.9; p < 0.001), infections (<1.5% vs. 0.1%; OR 3.7; p = 0.01), critical care therapy (CCT) use (<1.5% vs. 0.4%; OR 2.5; p = 0.003), intraoperative complications (8.8% vs. 4.1%; OR 1.9; p < 0.001), transfusions (11% vs. 7.2%; OR 1.5; p < 0.001), longer hospital stay (mean 3.39 vs. 2.37 days; rates ratio [RR] 1.4; p < 0.001), and higher estimated hospital cost (median 33,539 vs. 30,716 $USD; RR 1.1; p < 0.001). Conversely, no statistically significant differences were observed in vascular complications (p = 0.3) or concerning in-hospital mortality (p = 0.1). Conclusions: After RP, patients with a history of heart valve replacement exhibited a higher rate of eight out of nine adverse in-hospital outcomes. However, these differences did not translate into higher in-hospital mortality.

Objective The aim of this study was to test for the association between paraplegia and perioperative complications as well as in-hospital mortality after radical cystectomy (RC) for non-metastatic bladder cancer. Methods Perioperative complications and in-hospital mortality were tabulated in RC patients with or without paraplegia in the National Inpatient Sample (2000–2019). Results Of 25,527 RC patients, 185 (0.7%) were paraplegic. Paraplegic RC patients were younger (≤70 years of age; 75 vs. 53%), more frequently female (28 vs. 19%), and more frequently harbored Charlson Comorbidity Index ≥3 (56 vs. 18%). Of paraplegic vs. non-paraplegic RC patients, 141 versus 15,112 (76 vs. 60%) experienced overall complications, 38 versus 2794 (21 vs. 11%) pulmonary complications, 36 versus 3525 (19 vs. 14%) genitourinary complications, 33 versus 3087 (18 vs. 12%) intraoperative complications, 21 versus 1035 (11 vs. 4%) infections, and 17 versus 1343 (9 vs. 5%) wound complications, while 62 versus 6267 (34 vs. 25%) received blood transfusions, 47 versus 3044 (25 vs. 12%) received critical care therapy (CCT), and intrahospital mortality was recorded in 13 versus 456 (7.0 vs. 1.8%) patients. In multivariable logistic regression models, paraplegic status independently predicted higher overall CCT use (odds ratio [OR] 2.1, p  < 0.001) as well as fourfold higher in-hospital mortality ( p  < 0.001), higher infection rate (OR 2.5, p  < 0.001), higher blood transfusion rate (OR 1.45, p  = 0.009), and higher intraoperative (OR 1.56, p  = 0.02), wound (OR 1.89, p  = 0.01), and pulmonary (OR 1.72, p  = 0.004) complication rates. Conclusion Paraplegic patients contemplating RC should be counseled about fourfold higher risk of in-hospital mortality and higher rates of other untoward effects.