bluuebunny/crossref_metadata_2025_split huggingface dataset:
Robotic retroperitoneal lymph node dissection: A systematic review and meta-analysis of perioperative outcomes.
Authors: Garg Harshit , Mansour Ahmed M , Psutka Sarah P. , Kim Simon P , Porter James , Gaspard Christine S , Dursun Furkan , Pruthi Deepak K , Wang Hanzhang , Kaushik Dharam 
Published: March 2023

420 Background: Retroperitoneal lymph node dissection (RPLND) forms an integral part of the management of testis cancer. Robotic RPLND (R-RPLND) is a minimally invasive treatment option for this disease. This systematic review assessed the safety and feasibility of R-RPLND and compared the perioperative outcomes of R-RPLND with open RPLND (O-RPLND). Methods: The PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND. Results: The search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4,224 patients (single-arm studies, n=461; comparative studies, n=3,763). Of 461 patients in the single-arm studies, 271 underwent primary R-RPLND and 190 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175-540 minutes and the major complication rate was 3.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134-550 min and the major complication rate was 8.4%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 8.9% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, p=0.0001) and a lower complication rate (18.5% vs 7.8%, p=0.002; Table). Conclusions: R-RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated. [Table: see text]
Relapse-free and overall survival in patients with non-seminomatous testicular germ cell tumours with teratoma-free primaries.
Authors: Paffenholz Pia , Landwehr Georg , Seidel Christoph Alexander , Poch Annika , Bokemeyer Carsten , Cathomas Richard , Pongratanakul Pailin , Hiester Andreas , Albers Peter , Pichler Martin , Krege Susanne , Syring Isabella , Heinzelbecker Julia , Nestler Tim , Pfister David , Heidenreich Axel 
Published: March 2023

421 Background: Characteristics and outcome of non-seminomatous testicular germ cell tumours (NSGCT) with teratoma-containing primaries are still under debate. Methods: We performed a retrospective analysis including 557 patients with metastatic NSGCT as a registry study within the "German Testicular Cancer Study Group". Results: Of the eligible 557 patients with NSGCT, 237 (42%) of all orchiectomy specimens had teratoma-containing primaries, while 320 (58%) were teratoma-free. Teratoma-containing primaries had a significantly higher clinical stage (p=0.002) and worse prognosis (p=0.051) compared to teratoma-free specimens. Lymph node metastasis were significantly larger before (4.5 vs 2.5cm; p<0.001) and after chemotherapy (3.5 vs 2.5 cm; p<0.001) in teratoma-containing primaries. Post-chemotherapy retroperitoneal lymph node dissection was performed in 57% of all patients. As teratoma-containing specimens revealed a significantly lower number of complete responses after chemotherapy, PC-PRLND was more often performed, with teratomatous elements being more often present in the PC-RPLND specimens compared to non-teratoma containing primaries. Kaplan-Meier estimates revealed that 19% of all patients relapsed during a median follow-up of 56 months [29-112] with a median time to relapse of 10 months. Teratoma-containing had a significantly lower relapse-free survival (RFS) compared to teratoma-free NSGCT (relapse rate 24% vs 16%, p=0.020). 8% (45/533) of all patients died due to their disease. There was no difference regarding the tumour-specific survival between teratoma-containing NSGCT and teratoma-free NSGCT when looking at the entire cohort of patients (8% vs. 9%, p=0.563), however median overall survival was not reached. Conclusions: In our study, NSGCT patients with teratoma-containing primaries showed a significantly higher clinical stage and worse prognosis at time of presentation compared to teratoma-free primaries. Furthermore, patients with teratoma-containing primaries showed a significantly worse relapse-free survival. Consequently, treating physicians should be aware of these patients portending a dismal prognosis and the presence of teratomatous elements might act as a reliable stratification tool for treatment decision in TGCT patients.
Primary mediastinal seminoma: Treatment and survival outcomes.
Authors: Hassoun Rebecca , Althouse Sandra K. , King Jennifer , Hanna Nasser H. , Einhorn Lawrence H. , Adra Nabil 
Published: March 2023

422 Background: Primary mediastinal pure seminoma is a rare entity and there is no clear consensus for optimal management. We report treatment and survival outcomes of patients with primary mediastinal seminoma evaluated at our institution. Methods: The Indiana University (IU) testicular cancer database was queried for patients with primary mediastinal seminoma. 21 patients evaluated at IU between 1994-2022 were included in this analysis. Kaplan-Meier methods were used for progression-free (PFS) and overall survival (OS) analysis. Results: Median age at diagnosis was 40.7 (range, 19.4-54.2). 18 (85.7%) patients were IGCCCG good risk and 3 (14.3%) were intermediate risk. Median pre-chemotherapy hCG was 10.3 (range, 0.6-1500). 12 (57.1%) patients had metastatic disease. Metastatic sites included mediastinal/supraclavicular lymph nodes in 9 patients (42.9%), lungs in 3 (14.3%), retroperitoneal lymph nodes in 3 (14.3%), brain in 1 (4.8%), liver in 1 (4.8%), adrenal gland in 1 (4.8%), kidney in 1 (4.8%) and bone in 1 (4.8%). First-line chemotherapy was BEPx3 in 9 (42.9%) patients, EPx4 in 4 (19.0%), BEPx4 in 3 (14.3%), BEPx3 + EPx1 in 2 (9.5%), VIPx4 in 2 (9.5%), and VIPx1 + BEPx3 in 1 (4.8%). With a median follow-up of 4.65 years from first-line chemotherapy start date, 3 (14.3%) patients progressed after first-line chemotherapy. Among patients who progressed, salvage 2nd line therapy was high-dose chemotherapy in 1 patient. 1 patient received more than 2 lines of therapy. 1 patient underwent surgical resection of residual mediastinal mass due to concern for local progression, with pathology revealing necrosis only. The 5-year progression-free survival (PFS) from first-line chemotherapy was 82.4% (95% CI 54.7-93.9). The 5-year overall survival (OS) was 94.1% (95% CI 65.0-99.1). At last follow-up, 20 (95.2%) patients had no evidence of disease, and 1 (4.8%) was dead of disease. Conclusions: Patients with primary mediastinal pure seminoma have high cure rates with risk adapted cisplatin-based combination chemotherapy. Despite residual masses, further surgical resection or radiation is not required in the vast majority of these patients and these residual masses can be safely monitored with surveillance.
Evaluation of miRNA-371a-3p (miR371a) assay to predict final pathohistology in patients undergoing primary nerve-sparing retroperitoneal lymphadenectomy (nsRPLND) for stage IIA/B seminomas and non-seminomas.
Authors: Seelemeyer Felix , Pfister David , Paffenholz Pia , Merkelbach-Bruse Sabine , Pappesch Roberto , Heidenreich Axel 
Published: March 2023

427 Background: NS-RPLND represents a guideline recommended treatment option in marker negative low volume metastatic seminomas and nonseminomas (NSGCT). However, about 30% of clinical stage IIA patients demonstrate equivocal findings of uncertain dignity so that they might undergo unnecessary treatment. Elevated serum concentrations of the molecular marker miR371 have been reported to correlate with the clinical stage even in small volume metastases. It was the purpose of our pilot study to evaluate the predictive accuracy of miR371 in a cohort of patients who underwent nsRPLND for clinical stage IIA/B germ cell tumors of the testis. Methods: Between 1-9/2022, 16 patients with marker negative clinical stage IIA/B seminomas (n=10) and NSGCT (n=6) underwent primary nsRPLND with a modified template resection via an open surgical approach. Blood specimens (20ml) were drawn on the day immediately prior to surgery and processed according to the manufacturer’s protocol. miRNA is extracted and purified with the Maxwell RSC MiRNA Plasma and Serum Kits prior to its transcription into cDNA using cDNA Solution, Reverse Transcriptase and RNase Inhibitor. Subsequently, this cDNA is amplified. Using qPCR techniques, the miRNA 371a is quantified using Roche Lightcycler 480 II. Using the Lightcycler software, the median Cp (CP = crossing points) of the triplicates is calculated and converted into a RQ value (RQ= relative abundance). Results: nsRPND was performed in all patients without significant Clavien-Dindo IIIa-V complications. Mean OR time was 131 (105-195) minutes, mean blood loss was < 150ml, transfusion rate was 0%. Mean number of dissected lymph nodes was 17 (7-32), mean diameter of positive lymph nodes was 2.1 (0.8-4.1) cm. Histology revealed metastatic seminoma or nonseminoma in 12/16 (75%). In 4 patients histology revealed non-malignant disease (n=2), teratoma, and lymphoma. miR371 was positive in all 12 (100%) pts with metastases and it was negative in 3/4 (75%) pts without metastases. One patient with small volume CS IIA seminoma was false negative. Conclusions: This is the first report to demonstrate that miR371can be used as a personalized and individual biomarker to predict the presence of small volume retroperitoneal lymph node metastases in CS IIA/B seminomas and in nonseminomas. Patients with positive findings should undergo active treatment whereas negative findings should result in close follow-up. Date are currently validated in a multi-institutional trial.
Who coauthors Cochrane Reviews related to genitourinary cancers? A 1998-2022 analysis of country and gender diversity.
Authors: Mirza Sahaam , Ozair Ahmad , Kumar Abhishek , R Subash Nishanth , Mirza Moben 
Published: March 2023

436 Background: Women and individuals from low- and lower-middle-income countries (LMICs) are under-represented in urology literature, particularly in high-impact publications. Cochrane, a non-profit collaboration, publishes high‐quality systematic reviews that frequently impact policy and clinical practice worldwide. However, the state of the country and gender diversity amongst authors of urology-related Cochrane Reviews is unknown, which this work sought to determine. Methods: We searched the Cochrane Database, under the filter “Topic: Urology”, for all reviews related to genitourinary cancers, published until 25 July 2022, including both active reviews and those withdrawn for updation. We extracted authorship data and classified the national affiliation of authors into either high- and upper-middle-income countries (HICs) or LMICs based on the World Bank income classification. We treated a collaborative author group belonging to one country as a single-country affiliation. Given the higher accuracy of manual web searches for ascertaining gender over algorithmic estimation, we utilized the former to achieve ≥90% ascertainment. We endeavored to capture at least one webpage that demonstrated their gender, e.g. institutional profile, Google Scholar, ResearchGate, etc. Results: A total of 54 urology-related reviews, co-authored by a total of 324 authors, were included. 53 reviews were published by the Cochrane Urology Group, while one review was by the Incontinence Group. Zero authors were from LMICs. Countries with the highest representation of co-authors were the US (24.1%), UK (25.3%), Germany (23.5%), South Korea (6.8%), Australia (6.2%), Netherlands (3.7%), China (2.8%), Canada (2.5%), Brazil (1.5%). Gender could be ascertained for 94.14% (N=305/324) of co-authors. Women made up 27.5% (N=84/305) of co-authors, 16.0% (N=8/50) of first authors, and 16.89% (N=9/53) of corresponding authors. Conclusions: Women are well-represented in Cochrane Reviews related to genitourinary cancers compared to urology-specific journals and their representation in urology. However, LMICs contributed zero authors, while those from the US, UK, and Germany constitute >70% of authors for one of the highest-quality evidence sources in urology. Equitable authorship representation may help expand both the utilization and the global relevance of recommendations of such high-impact urology literature. Global capacity-building efforts are warranted, particularly in Africa, for enhancing the involvement of LMIC urologists with evidence synthesis.
Survey of keratin 17 (K17) expression in different urothelial malignancies.
Authors: Ecke Thorsten , Wirtz Ralph M. , Barth Gregor , Koch Stefan , Jahanfard Sholeh , Kim Nam W 
Published: March 2023

458 Background: The current non-invasive urine tests tend to display low sensitivity for the detection of urothelial cancers, especially in low-grade cancer. Recent reports suggest that the URO17 test based on the Keratin 17 (K17) biomarker displays high sensitivity and specificity in the detection of urothelial carcinoma in both low-grade and high-grade cancers and show promise as an effective non-invasive test for bladder cancer. The current study aimed to evaluate K17 expression in different histological categories of urological diseases. Methods: Ninety-five urine specimens were collected from 2020-2021 that represented 19 different histological categories of urothelial diseases. These samples were prepared onto slides and tested with the URO17 Bladder Cancer test (KDx Diagnostics Inc.) on DAKO Link48 autostainer using the manufacturer’s recommended procedures. The stained samples were evaluated by a cytopathologist and scored using five K17-positive urothelial cells as a cut-off. Results: K17 was positive in 20/20 (100%) of the urothelial carcinoma, and 23/27 (85%) of Non-invasive papilloma and urothelial carcinomas. K17 was positive in 100% of carcinoma in situ, papillary urothelial carcinoma, sarcoma, and small cell carcinoma, papillary urothelial carcinoma, urothelial papilloma, inverted papilloma, renal-pelvis urothelial carcinoma, and urothelial carcinoma with squamous differentiation. K17 was also expressed in many cystitis, inflammatory myofibroblastic tumors, and PUNLMP, but not in prostate carcinoma. In 19/22 cases (86%) K17 was mostly positive in urine samples from patients with prior history of bladder cancer, but were histologically determined to be benign. The overall sensitivity of K17 in the cancer group was 88.5% (54/61 positive) with K17 being expressed in both high-grade and low-grade cancers. Of the seven false-negative samples, five were low-grade, one was high-grade, and one was from the inflammatory myofibroblastic tumor. Conclusions: Keratin 17 is highly expressed in almost all cases of urothelial carcinoma including those of papillary and squamous characteristics, confirming the high sensitivity of K17 in detecting all categories of urothelial carcinoma. Keratin 17 was also observed in many benign and premalignant conditions such as cystitis, PUNLMP, and metaplasia suggesting the K17 expression can result from a trauma to urothelium that could lead to activation of K17 in regenerating urothelial cells. Additional studies are ongoing to confirm and expand the utility of the K17 biomarker in bladder cancer.
FDG PET-CT imaging in assessing interim response to neoadjuvant cisplatin-based chemotherapy (NAC) in muscle invasive bladder cancer (MIBC): A prospective study.
Authors: Sridhar Srikala S. , Power Nicholas , Breau Rodney H. , Cheng Susanna Y. , Pond Gregory Russell , Chung Peter W. M. , Metser Ur , Levine Mark Norman , Mukherjee Som D. 
Published: March 2023

460 Background: Muscle invasive bladder cancer (MIBC) is an aggressive local disease where initial staging with conventional CT imaging is often suboptimal. To explore the role of PET-CT in both staging MIBC and assessing response to neoadjuvant chemotherapy (NAC), we conducted a prospective multicentre, randomized trial known as PETMUSE. We report here the first results from the neoadjuvant substudy which assessed interim PET-CT response after 2-3 cycles of NAC and how this correlated with disease free survival (DFS) and overall survival (OS). Methods: Patients with MIBC (T2a-4a, N0-3, M0) based on transurethral resection of their bladder tumor and CT staging were randomized 2:1 to PET-CT or no PET-CT. All PET-CT patients, receiving cisplatin-based NAC underwent a second PET-CT after 2 cycles of gemcitabine and cisplatin (GC) or 3 cycles of dose dense methotrexate, vinblastine, adriamycin, cisplatin (ddMVAC) to assess for interim response. Patients were scored (1-5) by 2 independent reviewers according to the extent of metabolic response on PET-CT. Disease-free survival (DFS) and overall survival (OS) were collected. Results: Between 2016 and 2021, 291 patients were enrolled on PETMUSE of which 46 participated in the neoadjuvant substudy. Median age was 68 (51-86); 36 (78%) were male; 26 were ECOG 0 (57%); 31 (68%) were T2, 13 (28%) were T3/T4; and 35 (76%) were node negative. In terms of NAC regimens: 22 (48%) received GC, 17 (37%) split dose GC, 6 (13%) ddMVAC, and 1 (2%) MVAC. On PET-CT, 23 (50%) had a complete metabolic response, 14 (30%) had a partial metabolic response, 5 (11%) had no change or mixed response and 4 (9%) had progressive disease or new lesion on PET scan. Metabolic response on PET-CT was a statistically significant prognostic factor for both DFS and OS (see Table). Conclusions: In MIBC patients receiving cisplatin-based NAC, metabolic response seen on interim PET-CT was correlated with DFS and OS. PET-CT warrants further study in this setting as a potential early indicator of response to NAC. Clinical trial information: NCT02462239 . [Table: see text][Table: see text]
18F-PSMA1007 PET/CT in the context of biochemical recurrence of prostate cancer: An economical experience from a Latin American reference center.
Authors: Mogollon Maria Paula , Caicedo Juan Ignacio , Ramirez Natalia , Rojas Julian , Medina Camilo 
Published: March 2023

47 Background: 25-30% of patients present with biochemical recurrence of prostatic adenocarcinoma (PCa) after primary tumor treatment. One of the options indicated for the study of recurrence is PET/CT PSMA. In our center we use the 18F-PSMA1007, which has a cost of approximately $1,342, while the alternative cost (68Ga-PSMA-11) is $2,422. The aim of this study is to evaluate the performance of 18F-PSMA-1007 PET/CT in patients with biochemical recurrence after definitive therapy. Methods: A cross-sectional study that included patients with a biochemical recurrence and who underwent 18F-PSMA1007 PET/CT in our center of reference between 2020-2022. Biochemical recurrence was defined as a PSA >0.1 ng/dL in prostatectomy and a value of nadir PSA + 2ng/ml in radiotherapy. Descriptive analysis was performed with frequencies for discrete variables, and central tendency and dispersion measures for continuous variables. Detection rates were evaluated according to primary tumor treatment and PSA values. To compare categorical variables, we use Chi-square and t-Test for continuous variables. This analysis was performed using SPSS statistical software. Results: A total of 154 patients were included, 84% (n=129) with radical prostatectomy and 16% (n=25) received management with radiotherapy. Of the first group, 75.2% had evidence of recurrence on 18F-PSMA-1007 PET/CT, while of the second group, 92% had evidence. The descriptive analysis is shown. A statistically significant difference was found in local recurrence and bone metastasis. In terms of metastases, 26,3% of post-surgical patients had bone metastasis and a higher percentage (52%) of those who underwent radiotherapy, with concomitant involvement of both the axial and appendicular skeleton in both groups. In the prostatectomy group, the detection rates for PSA levels <0.25, 0.25 - <0.5, 0.5-< 1, 1-2, 2 - < 5, 5 - <10, ≥10 were 12.5%, 48.3%, 79.2%, 84.2%, 96%,90% and 100% respectively. In the radiotherapy group, the detection rates for PSA levels 2 - <5, 5<10, ≥10 were 87,5%, 100% and 100%, respectively. Conclusions: 18F-PSMA-1007 PET/CT is an alternative option that offers similar detection ranges and is more economical than 68Ga-PSMA-11 in our population, allowing effective detection of biochemical PCa recurrence in central and remote locations, where fluorine is not consistently available. [Table: see text]
Response and outcomes of maintenance avelumab after platinum-based chemotherapy (PBC) in patients (pts) with advanced urothelial carcinoma (aUC): "Real world" experience.
Authors: Bakaloudi Dimitra Rafailia , Talukder Rafee , Makrakis Dimitrios , Agarwal Neeraj , Tripathi Nishita , Bamias Aristotelis , Zakopoulou Roubini , Brown Jason , Korolewicz James , Fulgenzi Claudia A.M. , Jindal Tanya , Murgic Jure , Fröbe Ana , Johnson Jeffrey , Drakaki Alexandra , Rodríguez-Vida Alejo , Rey-Cárdenas Macarena , Alonso Buznego Lucia Andrea , Khaki Ali Raza , Grivas Petros 
Published: March 2023

472 Background: PBC followed by avelumab switch maintenance in non-progressors is the standard first line (1L) aUC treatment. We describe clinical features and outcomes in a ‘real-world’ cohort treated with avelumab maintenance for aUC. We hypothesized that outcomes would be similar with JavelinBladder100 trial data. Methods: This was a retrospective cohort study of pts from 12 sites who received 1L switch maintenance avelumab after no progression to PBC for aUC. We calculated overall response rate (ORR), median overall and progression-free survival (mOS, mPFS) using Kaplan Meier method from avelumab start. We also described OS and PFS for specific subsets using Cox regression. Results: We found 77 pts with aUC (78% pure, 22% mixed UC) with median age 68, 81% men, 91% White, 17% upper tract primary, 66% prior cisplatin, 17% liver metastasis (mets), 80% ECOG PS 0-1 at time of PBC start. There was a median of 6 weeks (range 1-30) from end of PBC to avelumab start; median follow-up time from avelumab start was 22 months (95%CI 16-24). ORR with avelumab maintenance: 28% (complete response [CR] 17%, partial response [PR] 11%), stable disease (SD) 32%; progression as best response 30% (10% unknown); mPFS 7 months (95%CI 5-9), mOS 22 months (95%CI 16-NR). Table shows HR for OS and PFS for specific subsets. Absence (vs presence) of liver mets (p=0.04), ECOG PS 0-1 (vs >1; p=0.01) and CR/PR (vs SD) to 1L PBC (p=0.03) were associated with longer OS. Conclusions:‘Real world’ outcomes with avelumab maintenance in pts with aUC align with JavelinBladder100 trial data (but higher ORR). Good PS, response to PBC and absence of liver mets are favorable prognostic factors. Limitations include moderate sample size, retrospective design, lack of randomization and central scan review, possible selection and confounding biases. Other studies (e.g. PATRIOT-II) can generate more data in pts on maintenance avelumab outside clinical trials. [Table: see text]