Association between radiotherapy and prognosis in patients with small cell carcinoma of the bladder undergoing bladder-sparing surgery.

Background: Small cell carcinoma of the bladder is rare and has a poor prognosis. This study aimed to investigate whether radiotherapy after bladder-sparing surgery could improve the survival benefits of patients. Methods: This population-based retrospective cohort study used data from the Surveillance, Epidemiology, and End Results cohort in the United States to investigate small cell carcinoma of the bladder. Univariate and multivariate Cox regression analyses were used to identify significant risk factors influencing the clinical prognosis. A propensity score matching (PSM) algorithm was used to reduce the interference of confounding factors in each study group. The matched groups underwent Kaplan-Meier survival analysis to assess the potential survival benefits. Results: Univariate regression analysis demonstrated that age (P<0.001), tumour stage (T stage) (P=0.005), node stage (N stage) (P<0.001), chemotherapy (P<0.001), bone metastasis (P<0.001), liver metastasis (P<0.001), lung metastasis (P=0.005), tumour size (P=0.005), and radiotherapy (P<0.001) were related factors affecting survival. Multivariate regression analysis revealed that age (P=0.001), T stage (P=0.054), N stage (P<0.001), radiotherapy (P=0.010), chemotherapy (P<0.001), bone metastasis (P=0.007), and liver metastasis (P<0.001) were independent factors affecting survival. Moreover, survival analysis was performed on the PSM-matched groups, leading to the following findings: (1) the radiotherapy group exhibited a superior survival prognosis compared with the non-radiotherapy group (P<0.001); (2) the survival prognosis of individuals who underwent radiotherapy and chemotherapy was higher than that of those who underwent chemotherapy alone (P<0.001). Conclusion: The findings of this study suggest that radiotherapy improves survival benefits for patients with small cell carcinoma of the bladder who undergo bladder-sparing surgery. Furthermore, radiotherapy combined with chemotherapy demonstrates a greater survival benefit compared with chemotherapy alone. The results underscore the importance of considering radiotherapy as a valuable treatment option for such patients, highlighting its potential benefits in improving their overall prognosis.

Efficacy and safety of a fourth dose of the COVID-19 vaccine in kidney transplant recipients: A systematic review and meta-analysis.

BACKGROUND: Kidney transplant recipients (KTRs) who become infected with SARS-CoV-2 are at greater risk of serious illness and death than the general population. To date, the efficacy and safety of the fourth dose of the COVID-19 vaccine in KTRs have not been systematically discussed. METHODS: This systematic review and meta-analysis included articles from PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wanfang Med Online published before May 15, 2022. Studies evaluating the efficacy and safety of a fourth dose of the COVID-19 vaccine in kidney transplant recipients were selected. RESULTS: Nine studies were included in the meta-analysis, with a total of 727 KTRs. The overall pooled seropositivity rate after the fourth COVID-19 vaccine was 60% (95% CI, 49%-71%, I2 = 87.83%, p > 0.01). The pooled proportion of KTRs seronegative after the third dose that transitioned to seropositivity after the fourth dose was 30% (95% CI, 15%-48%, I2 = 94.98%, p < 0.01). CONCLUSIONS: The fourth dose of the COVID-19 vaccine was well tolerated in KTRs with no serious adverse effects. Some KTRs showed a reduced response even after receiving the fourth vaccine dose. Overall, the fourth vaccine dose effectively improved seropositivity in KTRs, as recommended by the World Health Organization for the general population.