Current status of laparoscopic and robotassisted nerve-sparing radical cystectomy in male patients

During radical cystectomy(RC),the neurovascular bundles are easily removed or damaged,leading to varying rates of incontinence and erectile dysfunction.The nervesparing technique was developed to preserve urinary and erectile function.The adoption of laparoscopic and robot-assisted technology has improved visualization and dexterity of pelvic surgeries,thus facilitate the nerve-sparing technique.Although nerve-sparing RC is technically similar with nerve-sparing radical prostatectomy,there are still some anatomical differences.There are mainly three different types of nerve-sparing techniques.Pelvic lymph node dissection(PLND)is another important factor to influence erectile function and urinary continence.Nerve-sparing laparoscopic radical cystectomy(LRC)and robot-assisted radical cystectomy(RARC)may be an optimal treatment choice in well-selected younger patients with lowvolume,organ-confined disease.We should attempt to do,whenever possible,a nerve-sparing cystectomy at least on oneside.However,due to the need of a well-refined surgical technique,nerve-sparing LRC and RARC is now being performed only by experienced urological surgeons.

PD-1/L1 inhibitors can improve but not replace chemotherapy for advanced urothelial carcinoma:A systematic review and network meta-analysis

Background:Programmed cell death-1/ligand 1 inhibitors are a new treatment strategy for advanced urothelial carcinoma.Therefore,a comparative evaluation of their efficacy and toxicity compared with chemotherapy is necessary.Methods:We comprehensively searched PubMed,Web of Science,Embase,and Cochrane Library databases and performed a meta-analysis of randomized controlled trials up to July 2021.We considered overall survival as the primary outcome,and progression-free survival,objective response rate,and treatment-related adverse events as secondary outcomes.Results:Overall,3584 patients from five studies were evaluated.Compared with first-line chemotherapy,programmed cell death-1/ligand 1 inhibitors were significantly associated with worse progression-free survival(p<0.001)and adverse objective response rates(p<0.001).However,the treatments were not significantly different in terms of overall survival(p=0.33).Compared with second-line chemotherapy,programmed cell death-1/ligand 1 inhibitors significantly improved overall survival(p<0.001),and there was no statistically significant difference in progression-free survival(p=0.89)or objective response rate(p=0.34).Compared with chemotherapy,programmed cell death-1/ligand 1 inhibitors were well tolerated(first-line chemotherapy:p<0.001;second-line chemotherapy:p<0.001).Conclusions:The efficacy of programmed cell death-1/ligand 1 inhibitors in patients with advanced urothelial carcinoma is not superior to that of first-line platinum-based chemotherapy but is better than second-line chemotherapy;however,programmed cell death-1/ligand 1 inhibitors are safer than first-and second-line chemotherapy and have a broader prospect for use in combination therapy.

A nomogram for individualized estimation of survival among adult patients with adrenocortical carcinoma after surgery:a retrospective analysis and multicenter validation study

Background:Clinical outcome of adrenocortical carcinoma(ACC)varies because of its heterogeneous nature and reliable prognostic prediction model for adult ACC patients is limited.The objective of this study was to develop and externally validate a nomogram for overall survival(OS)prediction in adult patients with ACC after surgery.Methods:Based on the data from the Surveillance Epidemiology,and End Results(SEER)database,adults patients diagnosed with ACC between January 1988 and December 2015 were identified and classified into a training set,comprised of 404 patients diagnosed between January 2007 and December 2015,and an internal validation set,com-prised of 318 patients diagnosed between January 1988 and December 2006.The endpoint of this study was OS.The nomogram was developed using a multivariate Cox proportional hazards regression algorithm in the training set and its performance was evaluated in terms of its discriminative ability,calibration,and clinical usefulness.The nomogram was then validated using the internal SEER validation,also externally validated using the Cancer Genome Atlas set(TCGA,82 patients diagnosed between 1998 and 2012)and a Chinese multicenter cohort dataset(82 patients diag-nosed between December 2002 and May 2018),respectively.Results:Age at diagnosis,T stage,N stage,and M stage were identified as independent predictors for OS.A nomo-gram incorporating these four predictors was constructed using the training set and demonstrated good calibration and discrimination(C-index 95%confidence interval[CI],0.715[0.679-0.751]),which was validated in the internal validation set(C-index[95%CI],0.672[0.637-0.707]),the TCGA set(C-index[95%CI],0.810[0.732-0.888])and the Chi-nese multicenter set(C-index[95%CI],0.726[0.633-0.819]),respectively.Encouragingly,the nomogram was able to successfully distinguished patients with a high-risk of mortality in all enrolled patients and in the subgroup analyses.Decision curve analysis indicated that the nomogram was clinically useful and applicable.Conclusions:The study presents a nomogram that incorporates clinicopathological predictors,which can accurately predict the OS of adult ACC patients after surgery.This model and the corresponding risk classification system have the potential to guide therapy decisions after surgery.