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Objective To analyze the risk factors for biochemical recurrence in prostate cancer patients after radical prostatectomy (RP) and establish a risk prediction model for the recurrence. Methods A retrospective cohort study was conducted on 279 patients who underwent RP surgery in our hospital from September 2007 to March 2022. There were 21 clinical indicators collected and analyzed. After time factors were included, Lasso regression was applied to screen the indicators, Kaplan-Meier method was used to draw survival curve, univariate and multivariate Cox proportional risk regression models were employed to analyze the risk factors and establish a prediction model. Then receiver operating characteristic (ROC) curve were plotted to evaluate the discriminative performance of the model. Then a nomogram was draw based on the obtained risk factors. Calibration curve was used to evaluate the accuracy of prediction, and decision curve was employed to assess the clinical benefit. Results During a median follow-up time of 37.10 (17.60, 61.30) months, 86 cases (30.8%), at a median age of 68.00 (65.00, 72.00) years, experienced biochemical recurrence. Univariate analysis showed that 12 indicators were strongly associated with biochemical recurrence after RP (P < 0.05), and Lasso regression screening indicated 7 representative indicator sets, including nutritional risk index (NRI), clinical T-stage, pathological Gleason score, pathological T-stage, positive surgical margin, lymph node invasion, and seminal vesicle invasion. Further multifactorial analysis revealed that pathological high stage (≥pT3 stage) (HR=1.895, 95%CI: 1.045~3.435, P=0.035), positive surgical margin (HR=1.808, 95%CI: 1.006~3.25, P=0.048), lymph node invasion (HR=2.161, 95% CI: 1.118~4.175, P=0.022) and NRI ≤106.9 (HR=0.598, 95% CI: 0.378~0.946, P=0.028) were independent risk factors for biochemical recurrence. The predictive equation was established with an AUC of 0.743 (95% CI: 0.677~0.810, P < 0.001), a sensitivity of 0.826 and a specificity of 0.534. And the established nomogram has a C-index of 0.741 (95%CI: 0.677~0.805; P < 0.001), with good agreement indicated by calibration curve. Clinical decision curve displayed that there was a net benefit when the threshold probability was 15%~85%. Conclusion High pathological stage (≥pT3 stage), positive surgical margin, lymph node invasion, and NRI ≤106.9 are independent risk factors for biochemical recurrence of prostate cancer after RP. Our prediction model can make effective judgments and provide references for clinical decision making.

Purpose: Upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of the bladder (UCB) share histomorphological and therapeutic features but distinct epidemiologic and clinicopathologic characteristics. We examined alterations of chromatin regulatory genes in molecular subtypes, clonal relatedness, and T‐cell receptor (TCR) diversity in UTUC and UCB. Materials and Methods: Targeted next‐generation sequencing or whole‐exome DNA sequencing and TCR sequencing were conducted with 34 UTUC and 49 UCB specimens from 63 patients. Tumors were subtyped based on the expression of CK5 and GATA3. Results of tissue microarray of 78 muscle‐invasive bladder cancer (MIBC) samples were used as prognostic factors of different subtypes of MIBC. Results: Chromatin regulatory genes were frequently mutated in both UTUC and UCB. Rapid relapse and progression of non‐MIBC are correlated with alterations of KMT2C and EP300. Frequency of alterations in chromatin regulatory genes is higher in UTUC patients with SBS22 and SBS2 signatures and lower in UCB patients with SBS2 and SBS6 signatures. GATA3 and CK5 double‐positive patients with higher frequencies of SMARCA4, ARID1A, and EP300 mutations have better prognoses than patients with basal subtypes. Although UTUC and UCB in the same patient can be either clonally related or developed independently, mutated genes in chromatin pathway were enriched in the related clones. Compared to UTUC, UCB had more deleterious mutations in DNA damage repair (DDR) genes, higher levels of tumor mutation burden (TMB) and copy number variations (CNVs), as well as higher TCR clonality and lower TCR diversity. Conclusions: Since genetic alterations of the chromatin pathway genes are important in both UTUC and UCB, they could serve as potential biomarkers for predicting disease progression and therapeutic targets. Differences in mutation frequencies of DDR pathway, TMB, CNV, and TCR might be the contributing factors for the distinct responses to immune checkpoint inhibitor (ICI) between UTUC and UCB. [ABSTRACT FROM AUTHOR]