The congress motto “Knowledge creates evidence, healing and innovation” reflected the key pillar of working for the benefit of patients and emphasized the deep foundations on which daily decisions are made and practical work is built. Only close interdisciplinary cooperation will enable further development for a successful future in uro-oncology.
In patients undergoing surgical treatment for localized high-grade clear cell renal cell carcinoma (ccRCC), it is not known whether the presence of sarcomatoid dedifferentiation is an independent predictor and/or an effect modifier when cancer-specific mortality (CSM) is an endpoint. Therefore, all surgically treated patients with ccRCC treated between 2010 and 2020 were identified in the “Surveillance, Epidemiology, and End Results” database [1]. Univariable and multivariable Cox regression models were used. In 18853 surgically treated patients with localized high-grade (G3 or G4) clear cell renal cell carcinoma, CSM-free 5-year survival was 87%. The presence of sarcomatoid dedifferentiation was an independent predictor of higher CSM. In univariable survival analyses for the prediction of CSM, the presence or absence of sarcomatoid dedifferentiation in G3 or G4: HR 1.0 in the absence of sarcomatoid dedifferentiation in G3; HR 2.7 in the absence of sarcomatoid dedifferentiation in G4; HR 3.9 in the presence of sarcomatoid dedifferentiation in G3; HR 5.1 in the presence of sarcomatoid dedifferentiation in G4. Finally, in multivariable Cox regression analyses, the interaction terms defining the presence vs. absence of sarcomatoid dedifferentiation in G3 vs. G4 were independent predictors of higher CSM. In currently surgically treated patients with localized high-grade clear cell renal cell carcinoma, sarcomatoid dedifferentiation is not only an independent multivariable predictor of higher CSM, but also interacts with tumor grade and leads to an even better predictive ability of CSM.
Cryopreservation for testicular tumors
Men often have to make the decision to undergo cryopreservation quickly before undergoing tumor therapy. A study evaluated the use of sperm cryopreservation in testicular tumor patients before 2021 [2]. Testicular tumor patients treated between 2011 and 2021 completed questionnaires, including EORTC QLQ-TC26, and shared their experiences with sperm cryopreservation. After an average of 5.7 years, 279 of 433 participants (64%) answered the questionnaire. 33% opted for cryopreservation before treatment, of which 11% used it for artificial insemination. In contrast, only 2% of patients who had not undergone cryopreservation stated that they had an unfulfilled desire to have children. Univariate analyses showed that younger patients (30.6 vs. 42.4 years) with lower BMI (24.2 vs. 26.6) were more likely to choose cryopreservation. Multivariate analyses confirmed older age (≥37 years) and lower education as independent factors against cryopreservation. In the quality of life analysis (EORTC QLQ-TC26), low scores for fear of infertility and older age were independent predictors against cryopreservation.
Therapy of prostate carcinoma
Sentinel lymphadenectomy (SLA) has been shown to be highly diagnostic with low invasiveness in prostate cancer (PCa). In order to examine a possible therapeutic benefit, the outcome of PCa patients after SLA and radical prostatectomy (RP) was examined in the long term [3]. The retrospective monocentric analysis included 1718 PCa patients who had undergone RP with SLA and risk-adapted additional extended LA. Kaplan-Meier analysis and multivariate Cox regression were used to examine biochemical recurrence-free (BCR-free) survival (CR), treatment-free time, cancer-specific survival (CSS) and overall survival (OS). A median of 11 lymph nodes (LK) were removed, 6 of which were sentinel (S) LK. Lymph node metastases (LKM) were detected in 357 patients (20.8%). The median follow-up was 5.3 years. The 5-year BCR-free OC, CSS, OS and treatment-free time were 77.3%, 99.1%, 94.1% and 71.9%, respectively. More distant SLK was a positive predictor for BCR-free OC. Negative predictors were presence of LKM, number of distant LK, R1 status and higher categorization by pT category & ISUP group. 16.8% of patients with LKM remained BCR-free without adjuvant therapy. In addition to the high detection rate, the reduced BCR risk suggests a possible therapeutic effect of SLA. This is supported by the proportion of LK-positive patients who remained BCR-free after SLA even in the long term without adjuvant therapy.
Source: Congress of the German Society of Urology (DGU)
Literature:
- Inescu RB, et al: Sarcomatoid dedifferentiation as a predictor of cancer-specific mortality in surgically treated localized renal cell carcinoma. V01 Renal cell carcinoma – organ-limited therapy. 25.09.2024. Congress of the German Society of Urology e.V. (DGU). 25-28.09.2024, Leipzig.
- Menzel V, et al: The use of cryopreservation by testicular tumor patients. V02 Health services research. 25.09.2024. Congress of the German Society of Urology e.V. (DGU). 25-28.09.2024, Leipzig.
- Mähr KL, et al: Outcome of patients with localized prostate carcinoma after radical prostatectomy and sentinel lymphadenectomy: Long-term biochemical recurrence-free survival of lymph node-positive patients without adjuvant therapy. V12 Prostate carcinoma – therapy of localized tumors. 26.09.2024. Congress of the German Society of Urology e.V. (DGU). 25-28.09.2024, Leipzig.
InFo ONKOLOGIE & HÄMATOLOGIE 2024; 12(5): 24 (published on 24.10.24, ahead of print)
