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The association between the tumor immune microenvironment (TIME) of primary lesions and time to metastasis remains unknown. The aim of our retrospective study was to investigate the differences in the TIME of primary lesions based on time intervals to metastasis, mainly between the synchronous group (SG; metastasis within 3 months) and metachronous group (MG; metastasis after 3 months), and its association with clinicopathological parameters in patients with metastatic renal cell carcinoma (mRCC). SG showed more immunogenic feature of TIME (PD-L1 positivity, CD8+ TIL infiltration) and poor prognostic pathological features (WHO/ISUP grade 4, necrosis, lymphovascular invasion, infiltrative growth pattern, and sarcomatoid differentiation). In addition, we observed that the time to metastasis differed by TIME characteristics (PD-L1 status, immunophenotype), which were associated with the WHO/ISUP grade. The TIME of primary lesions could affect the time to metastasis., Biological or immunological differences in primary lesions between synchronous and metachronous metastatic renal cell carcinoma (mRCC) have been reported. However, the association between the tumor immune microenvironment (TIME) of primary lesions and time to metastasis remains unknown. We investigated the differences in the TIME of primary lesions based on time intervals to metastasis, mainly between the synchronous group (SG; metastasis within 3 months) and metachronous group (MG; metastasis after 3 months), and its association with clinicopathological parameters in patients with mRCC. Overall, 568 patients treated first-line with vascular endothelial growth factor receptor inhibitors comprised the analysis population (SG: N = 307 [54.0%]; MG: N = 261 [46.0%]). SG had a higher proportion of patients with poor prognostic pathological feature tumors: WHO/ISUP grade 4, necrosis, lymphovascular invasion, infiltrative growth pattern, and sarcomatoid differentiation. Regarding the TIME, more immunogenic features were seen in SG than MG, with a higher PD-L1 positivity and a lower proportion of the desert phenotype. This is the first study to examine the differences in the TIME of primary lesions in patients with mRCC based on the time intervals to metastasis. The TIME of primary lesions could affect the time to metastasis.

Second transurethral resection (TUR) is recommended for patients diagnosed with high-risk non-muscle invasive bladder cancer (NMIBC); however, there have been several studies showing conflicting findings regarding the advantage of second TUR. The objective of this study was to investigate the prognostic significance of second TUR using propensity score-matched analysis. This study retrospectively included 164 consecutive patients who underwent initial TUR and were diagnosed with high-risk NMIBC. Of these, 56 subsequently received second TUR, and the remaining 108 underwent initial TUR alone. After adjusting patient variables by propensity score matching, 44 patients were included in each group. There was no significant difference in recurrence-free, progression-free, or overall survival between these two groups. These findings suggested no significant impact of second TUR on the prognosis of high-risk NMIBC patients; therefore, it may be necessary to perform a reassessment focusing on the indication for second TUR by conducting a large-scale prospective study., MINI-ABSTRACT: We investigated the prognostic significance of second transurethral resection for patients with high-risk non-muscle invasive bladder cancer using propensity score-matched analysis. There were no significant impacts on oncological outcomes.