Qiang Lu

Backgrounds: Bladder cancer shows pronounced biological heterogeneity that underlies its variable clinical course and prognosis. Our study aims to delineate clinically relevant differences in bladder cancer using an immunohistochemistry-based molecular subtyping approach. Methods: This retrospective study included 590 patients with bladder cancer treated at a single center. Tumors were stratified into luminal versus non-luminal categories according to CK20, GATA3, CK5/6, and CK14. Associations between molecular subtype, histopathological growth patterns, pathological response to neoadjuvant chemotherapy (NAC), and clinical survival endpoints were analyzed. Overall survival (OS), recurrence-free survival (RFS), and progression-free survival (PFS) were evaluated through Kaplan–Meier survival curves together with Cox proportional hazards regression analyses. Results: Non-luminal tumors exhibited significantly more aggressive pathological growth patterns, including higher levels of tumor budding (p = 0.002), a predominance of non-cohesive or spindle/single-cell architecture (p = 0.003), and more frequent disseminated spreading patterns (p = 0.001), whereas luminal tumors more commonly displayed a higher frequency of tertiary lymphoid structures (TLSs; p = 0.041). Among patients receiving NAC, non-luminal tumors achieved a significantly higher pathological complete response (pCR) rate compared with luminal tumors (p = 0.007), while no significant inter-subtype difference was detected in pathological downstaging between subtypes (p = 0.126). Despite inferior pathological response, luminal tumors demonstrated significantly improved OS (p = 0.003), RFS (p = 0.002) and PFS (p < 0.001) compared with non-luminal tumors. In multivariable Cox regression analysis, molecular subtype was identified as an independent predictor of OS, with luminal tumors showing a lower mortality risk (HR = 0.51, 95% CI 0.33–0.79, p = 0.003). Conclusions: These findings indicate that pathological response and long-term survival follow distinct, subtype-dependent trajectories in bladder cancer. Favorable pathological response does not necessarily correspond to improved long-term survival across molecular subtypes.

Lymphovascular invasion (LVI) signifies poor prognosis in bladder cancer, yet reliable preoperative prediction remains challenging, limiting personalized t

Backgrounds: As one of the important liquid biopsy methods in recent years, circulating tumor cells (CTCs) have been proven to be valuable in judging metastasis and prognosis in various tumors. With the advent of immunotherapy, the expression of programmed death-ligand 1 (PD-L1) on CTCs has also attracted researchers’ attention, but its value in bladder cancer has not been fully explored. Methods: This study enrolled patients diagnosed with urothelial carcinoma who were treated in the Department of Urology, The First Affiliated Hospital of Nanjing Medical University from 2020 to 2023. Peripheral blood samples of the patients were collected to detect PD-L1+ CTCs. Meanwhile, the patients’ basic clinical characteristics, pathological data, and follow-up information were collected. The Kaplan–Meier method was used to estimate the overall survival (OS) and progression-free survival (PFS) of the patients, and the log-rank test was employed to evaluate the statistical differences. COX regression analysis and Firth penalized Cox regression analysis were adopted to assess the risk factors. Finally, according to the clinical or pathological characteristics, the effects of PD-L1+/PD-L1− CTCs on different subgroups of the population were evaluated, respectively. Results: According to the inclusion and exclusion criteria, a total of 109 patients were finally enrolled in this study, including 95 males and 16 females, with a median age of 68 years. The expression of PD-L1 on CTC was as follows: 19 patients were PD-L1+ CTC and 90 patients were PD-L1− CTCs. The results showed that the pathological grade of patients with PD-L1+ CTCs was significantly higher than that of patients with PD-L1− CTCs (p = 0.003). With a median follow-up time of 48 months (IQR: 45.8–49.5), prognostic analysis indicated that PD-L1+ CTCs were a risk factor for OS in bladder cancer patients (HR = 4.696 (1.477–13.596), p = 0.011). Subgroup analysis revealed that in patients with non-muscle-invasive bladder cancer (NMIBC) and in the subgroup of patients with high pathological grade, those with PD-L1+ CTCs exhibited significantly poorer prognosis in terms of PFS and OS compared with patients with PD-L1− CTCs. Conclusions: The presence of PD-L1+ CTCs in patients with bladder carcinoma may be closely associated with high-grade disease and poor OS.

Objective: To evaluate the feasibility and preliminary outcomes of prone retroperitoneal robotic-assisted laparoscopic pyeloplasty (prRALP) for ureteropelvic junction obstruction (UPJO), an innovative approach designed to optimize surgical exposure and suturing. Methods: This retrospective cohort study analyzed four patients who underwent prRALP between September 2023 and May 2024. The surgical technique involved prone positioning and multi-port robotic access, enabling direct posterior exposure of the renal pelvis and proximal ureter. Primary outcomes included operation time (OT), estimated blood loss (EBL), complications (Clavien-Dindo classification), and postoperative renal function (eGFR). Success was defined by radiographic resolution of obstruction, symptom relief, and no need for reintervention. Results: All procedures were completed robotically without open conversion and reoperation. Mean OT was 64.6 ± 14.4 min, with minimal blood loss of 27.5 ± 15.0 mL and no transfusions. The mean postoperative hospital stay was 3.3 ± 0.5 days. One minor complication (fever, Clavien 1) occurred (25%). Postoperative eGFR improved by 1.3 ± 14.2 mL/min/1.73 m ² at 90-day follow-up, with all patients achieving obstruction-free recovery and a mean eGFR of 87.2 ± 69.8 mL/min/1.73 m ² being maintained at 1-year postoperatively. Conclusion: prRALP demonstrates feasibility and safety, leveraging prone position to enhance retroperitoneal access and suturing precision. Larger prospective studies are warranted to validate its technical benefits and reproducibility.

To develop and validate a non-invasive imaging-based intratumor heterogeneity (IITH) framework for risk stratification in muscle-invasive bladder cancer (M