Haruki Kume

Objectives: To characterize mid‐term oncological outcomes after nephrectomy for renal cell carcinoma (RCC) in Japan using the National Clinical Database (NCD). Methods: We retrospectively analyzed patients with RCC who underwent nephrectomy between April and December 2018 and had at least 5 years of follow‐up recorded in the NCD. Age, sex, nephrectomy type, operative approach, and pathological T category were evaluated. Disease‐free survival (DFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared with the log‐rank test. Results: Of 16 786 patients registered at 759 institutions, 9065 with available 5‐year follow‐up were analyzed. Patients aged ≥ 75 years comprised 24.7% of the cohort. Radical and partial nephrectomy were performed in 55.0% and 45.0% of patients, respectively. Median DFS and OS were not reached. Older age and male sex were associated with shorter DFS and OS. Radical nephrectomy and open surgery were also associated with shorter survival. Both DFS and OS decreased significantly with advancing pathological stage, with earlier recurrence in pT3–4 disease. Conclusions: This nationwide NCD‐based study provides descriptive mid‐term survival data for patients with RCC undergoing nephrectomy in Japan. Age, sex, nephrectomy type, operative approach, and pathological stage were associated with survival differences. These findings provide real‐world outcome data for patients with available long‐term follow‐up and a basis for future risk‐adjusted analyses.

Aims: To determine the prevalence and characteristics of urinary catheter blockage in older patients using objective indicators and to characterize obstructive materials and microbiota. Design: A cross‐sectional study. Methods: Patients aged ≥ 65 years with an indwelling catheter for ≥ 24 h were recruited from a long‐term care hospital. Blockage was defined using objective indicators including residual urine volume, leakage, reinsertion urine volume and resistance to saline injection. Samples were analysed for composition and microbiota. Results: Among 77 patients, 29.9% experienced catheter blockage. Blockage was associated with shorter catheterization duration and greater intraluminal narrowing. Proteus mirabilis and Campylobacter ureolyticus were more abundant. Most blockages occurred at the catheter tip (81.0%), with struvite as the predominant material (71.4%). Microbiota varied by material composition. Conclusion: Catheter blockage occurred in 29.9% of patients, mainly at the catheter tip and associated with struvite. Microbiota differed by blockage status and material composition. Implications for the Profession and/or Patient Care: Objective identification of catheter blockage supports early detection and targeted management and provides a basis for research on mechanisms. These findings provide a foundation for future research to develop and evaluate evidence‐based nursing interventions for preventing catheter blockage in older adults. Impact: This study addressed the lack of objective criteria and limited understanding of catheter blockage. It showed that about 30% of patients experienced blockage and identified distinct microbiota and material characteristics. These findings may improve catheter management and support future research on mechanisms and prevention. Reporting Method: STROBE checklist. Patient or Public Contribution: Patients contributed to data collection by providing information on symptoms related to catheter blockage through structured assessments, while nurses during the study period facilitated data collection and conducted clinical assessments.

Introduction: Adrenal oncocytomas are rare, nonfunctioning tumors composed of eosinophilic oncocytic cells whose nonspecific imaging often impedes preoperative diagnosis. We report a case of a large nonfunctioning adrenal oncocytoma with borderline malignant potential, incidentally discovered during cardiac symptom evaluation. Case Presentation: A 77‐year‐old man with an incidentally discovered retroperitoneal tumor was referred to Urology for further evaluation. Contrast‐enhanced CT revealed a 93‐mm lobulated mass with heterogeneous enhancement abutting the left kidney's upper pole. Given the tumor's size, open left nephrectomy and adrenalectomy were performed. Gross and histopathology revealed a yellowish, solid adrenal tumor composed predominantly of oncocytic cells with no invasion of the kidney. Immunohistochemistry revealed a low Ki‐67 index (approximately 2%). The tumor was classified as having borderline malignant potential (Lin–Weiss–Bisceglia criteria). Conclusion: We present a rare case of nonfunctioning adrenal oncocytoma with borderline malignant potential. Long‐term follow‐up is recommended due to the uncertain malignant potential.

Objectives: To evaluate real‐world biochemical recurrence‐free survival (BCRFS) after radical prostatectomy (RP) for prostate cancer in Japan using nationwide data from the National Clinical Database (NCD). Methods: This study included patients who underwent RP between April and December 2018 and were registered in the NCD from 647 participating institutions. BCRFS was estimated using the Kaplan–Meier method. Outcomes were evaluated according to surgical approach and clinicopathological factors without adjustment for baseline characteristics. Results: A total of 14 992 patients with available 5‐year postoperative follow‐up data were included in the analysis. Robot‐assisted RP accounted for the majority of procedures (73.2%), followed by open RP (16.0%) and laparoscopic RP (10.8%). The overall 5‐year BCRFS rate was 81%. BCRFS was comparable across age groups and surgical approaches. In contrast, pathological factors strongly influenced prognosis. Five‐year BCRFS decreased with increasing pathological stage (pT2, 86%; pT3, 65%; pT4, 41%) and was lower in patients with nodal metastasis (pN0, 81%; pN1, 59%). The International Society of Urological Pathology (ISUP) Grade Group demonstrated a stepwise association with prognosis, with 5‐year BCRFS declining from 92% in grade group 1 to 60% in grade group 5. Five‐year BCRFS was lowest in the extended lymph node dissection group (73%), followed by the obturator lymph node dissection group (80%) and the no‐dissection group (87%). Conclusions: Current nationwide data delineate the real‐world oncological outcomes following RP in Japan. Pathological tumor characteristics—rather than patient age or surgical approach—were the predominant determinants of postoperative prognosis. These findings may provide essential benchmarks to guide clinical decision‐making.

Background: Triplet therapy with darolutamide and docetaxel has reshaped the treatment landscape of metastatic castration-sensitive prostate cancer (mCSPC). However, real-world evidence regarding its oncological outcomes and toxicity remains limited. Methods: We retrospectively reviewed 112 consecutive patients with mCSPC who were treated with triplet therapy. A deep prostate-specific antigen (PSA) response was defined as a PSA level < 0.2 ng/ml or a ≥ 90% decline from baseline. Castration-resistant prostate cancer (CRPC)-free survival was used as the survival endpoint. Clinicopathological factors associated with CRPC-free survival were analysed using a Cox proportional hazards model. Treatment-related adverse events (AEs) were comprehensively documented by type and grade. Results: During a median follow-up of 17.1 months, 15 patients developed CRPC and four died of prostate cancer; 1-year CRPC-free survival and overall survival rates were 89.8% (95% confidence interval, 83.9%–96.0%) and 98.8% (96.5%–100%), respectively. A deep PSA response was achieved in 73.2% of patients (PSA nadir <0.2 ng/ml) and in 96.4% (PSA ≥ 90% decline). In both the univariable and multivariable analyses, no baseline factor was significantly associated with CRPC-free survival. Grade ≥ 3 hematologic AEs occurred in 75.0% of patients. Among the 31 patients who discontinued docetaxel, 26 discontinued due to non-hematologic AEs. Conclusions: Triplet therapy demonstrated substantial clinical activity in real-world patients with mCSPC, with high rates of deep PSA response despite frequent AEs. These findings support the feasibility of triplet therapy in routine practice. Given the substantial toxicity burden, careful patient selection and proactive AE management remain important.

Objective: To describe real‐world disease‐free survival (DFS) and overall survival (OS) after radical cystectomy (RC) for muscle‐invasive bladder cancer (MIBC) in Japan using nationwide data from the National Clinical Database (NCD). Methods: This nationwide descriptive study included patients with MIBC who underwent RC and were registered in the NCD in 2020. Demographic and clinical characteristics, including age, sex, surgical approach, neoadjuvant chemotherapy (NAC), and pathological stage, were summarized. DFS and OS were estimated using the Kaplan–Meier method. Survival outcomes were descriptively compared across age groups, sex, NAC status, and surgical approach without adjustment for baseline characteristics. Results: A total of 3773 patients were analyzed. The cohort showed an advanced age distribution, with 41% aged ≥ 75 years. Robotic‐assisted RC was the most frequently performed approach (44%), and NAC was administered in 52% of patients. Survival declined progressively with increasing age, with the poorest outcomes observed in patients aged ≥ 80 years. Female sex and nonreceipt of NAC were associated with modestly lower DFS and OS in unadjusted analyses. Robotic‐assisted and laparoscopic RC demonstrated comparable DFS and OS, whereas open RC was associated with less favorable survival outcomes. Conclusions: This nationwide descriptive analysis provides a comprehensive snapshot of real‐world survival after RC for MIBC in Japan. This nationwide data reveal marked heterogeneity in patient characteristics, treatment patterns, and outcomes, and provide a foundation for identifying clinically relevant hypotheses for future risk‐adjusted analyses.

Supplementary Table 1. Data summary of patients on dialysis. Supplementary Table 2. Significantly mutated genes in tumor in patients on dialysis. Supplementary Table 3. Data summary of patients not on HD. Supplementary Table 4. Genes sepcific to ACD. Supplementary Table 5. Gene list of pure PT cells. Supplementary Table 6. Genes sepcific to the cyst cluster. Supplementary Table 7. Recurrently mutated genes detected in LMD.

Supplementary Figure 1: a, Frequencies of mutations identified in ACD-RCC (left), ESRD-ccRCC (middle), and sporadicccRCC (right). Supplementary Figure 2: a, UMAP plot of the transcriptomes of tumours from HD patients. Supplementary Figure 3: a, eGFR in the expression-defined cluster groups. The green and pink groups correspond to the groups shown in Figure 3a. Supplementary Figure 4: a, Representative images of each marker via mIHC. Supplementary Figure 5: a, Spatial expression patterns of PT genes and DT genes in the renal cortex of patients not on HD. Scale bar, 2 mm.