Background/Aim: We investigated the prognostic nutritional index (PNI), comprised of lymphocytes and albumin, as a potential prognosticator of metastatic urothelial carcinoma (mUC) patients receiving pembrolizumab. Patients and Methods: Sixty-five patients were retrospectively enrolled and classified as low (<40) and high (≥40) based on pretreatment PNI. Progression-free survival (PFS), overall survival (OS) and response rates were evaluated. Results: In the low PNI group, significantly shorter PFS and OS were observed. PNI was shown to be an independent predictor of PFS and OS in the multivariate analysis. C-index for both PFS and OS improved with the addition of PNI to the model described in the KEYNOTE-045 study. Significantly more patients experienced initial disease progression in the low PNI group. Conclusion: PNI is a useful predictor of prognosis and disease progression in mUC patients receiving pembrolizumab. Patients and MethodsPatients. This retrospective observational study recruited 67 consecutive patients with mUC or relapsed urothelial carcinoma receiving pembrolizumab after the failure of at least one platinum-1607

Background/Aim: Whether anesthesia can affect oncological outcomes in urothelial carcinoma of the upper urinary tract undergoing radical nephroureterectomy (RNU) is not clear. Patients and Methods: One-hundred an ninetyseven patients who underwent RNU were retrospectively recruited and divided into total intravenous (TIVA, n=90) and volatile inhalation anesthesia (VIA, n=107) groups. A 1:1 propensity score-matching method was employed to minimize selection bias (n=70 each). Cancer-specific (CSS), overall (OS) and metastasis-free (MFS) survival were compared between groups before and after matching. Results: For all survival endpoints, no significant differences were observed between the two study groups, both before (hazard ratio for TIVA: CSS: 0.70, OS: 0.75, MFS: 0.78) and after (hazard ratios for TIV: CSS: 1.21, OS: 0.82, MFS: 0.84) matching. Conclusion: With no survival difference observed according to anesthetic technique for RNU, the choice should be based on factors such as accessibility, prevention of side-effects, or costs.With the growing number of cancer cases, the number of patients undergoing surgery under general anesthesia is also increasing (1). In recent years, hypotheses have emerged that the anesthetic technique during surgery may impact cancer recurrence or survival. Proposed mechanisms involve the characteristics of agents used in volatile inhalation anesthesia (VIA) and total intravenous anesthesia (TIVA). According to previous studies, VIA agents can impair immune function enabling tumor cells to evade natural killer cells (2) and can up-regulate signaling pathways such as the hypoxia-inducible factor 1-alpha (HIF1α) pathway, thereby promoting the proliferation of residual tumors (3). By contrast, propofol used in TIVA may protect from cancer recurrence through its antiinflammatory and antioxidant potentials (4, 5).However, the clinical evidence on this topic remains conflicting. Wigmore et al. reported based on a dataset of mixed malignancy types that the use of TIVA is associated with a lower overall risk of death compared to VIA (6). Several publications found similar results (7-9), but other studies showed no benefit of TIVA over VIA (10)(11)(12). For urothelial carcinoma (UC), Pfail et al. demonstrated that VIA is associated with an increased risk of recurrence compared to TIVA during robot-assisted radical cystectomy for bladder cancer (13). To date, there is no evidence whether the type of anesthetic technique impacts cancer recurrence or survival in patients with UC of the upper tract (UCUT) undergoing radical nephroureterectomy (RNU). As recurrences after RNU, especially in invasive cases, are not rare, understanding of this association is of clinical importance (14).In this context, we aimed to evaluate cancer recurrence and survival of patients by anesthetic type, utilizing propensity score matching to adjust patient characteristics and minimize preoperative selection bias. Patients and MethodsPatient selection and data collection. This retrospective study included 224 consecutiv...

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