Valor pronóstico de la ploidía del adn en el cáncer de próstata

ObjetiveTo asses the prognostic value of deoxyribonucleic acid (DNA) ploidy in a group of patients with prostate cancer treated with adrogenic blockadeMaterial and methodA retrospective study on 136 patients with prostatic cancer having undergone androgenic blockade was carried out. The prognostic influence of age, T and M categories, Gleason score and flow cytometry-determined DNA ploidy from survival analyses. Univariate survival analysis was carried out following Kaplan-Meier’s method, while for multivariate survival analysis Cox’s proportional hazard model was usedResultsThe univariante analysis showed that T and M categories, Gleason score and DNA ploidy have prognostic value. The Cox’s regression analysis identified DNA ploidy, metastasis and Gleason score as independent variables having prognostic potentialConclusionsDNA ploidy has independent prognostic value in prostate cancer treated with androgenic blockade and improves the predictive potential of classical prognostic factors     

Conducta transfusional perioperatoria en la cirugía del cáncer gástrico: análisis del registro del grupo español EURECCA de cáncer esófago-gástrico

Introduction

This study evaluated allogenic packed red blood cell (aPRBC) transfusion rates in patients undergoing resection for gastric cancer and the implementation of blood-saving protocols (BSP).

Evidencia en seguimiento y pronóstico del cáncer de unión esofagogástrica

Five-year survival of tumors of the esophagogastric junction is 50%, in the most favourable stages and with the most effective adjuvant treatments. More than 40% of patients will have recurrences within a short period, usually the first year after potentially curative surgery. Survival after this recurrence is usually less than 6 months because treatment is not very effective, be it palliative chemotherapy, radiotherapy or surgical excision of single recurrences. As the detection of asymptomatic recurrences allows for earlier and more effective treatments to be used, the type and frequency of follow-up has an influence on survival.     

Nuestra experiencia en el manejo del cáncer de próstata en pacientes trasplantados renales

Introduction and objectives

The management of Prostate cancer (PCa) in renal transplant recipients (RTR) is challenging and remain controversial. Currently there is no consensus about this condition. The aim of the study was to analyse our experience in the diagnosis and management of PCa in RTR.

Valor pronóstico del recuento de leucocitos y plaquetas,en tumores testiculares de células germinales

IntroductionThe immune system plays an essential role in the organism's response to cancer. Several haematological markers can influence prognosis and survival of patients. The objective of this study is to determine their prognostic value in testicular germ cell tumours.Material and methodsRetrospective cohort study on 164 patients with germ cell tumours. Clinical, analytical, histological and evolutionary data were collected. The absolute neutrophil and absolute platelet counts, neutrophil-lymphocyte (NLR), platelet-lymphocyte and lymphocyte-monocyte ratios were estimated at diagnosis. The association that these markers can have with the classic prognostic factors, as well as their effect on prognosis and survival, have been analysed.Results17.7% had NLR >4 and 14.6% ANC >8000/μL. These patients presented higher percentages of residual disease and stage II-III tumours. Patients with elevated absolute neutrophil showed also higher percentages of progression and exitus.7.3% presented absolute platelet  >400000/μL. These patients obtained higher rates of residual disease, nonseminomatous and stage III tumours. 28.4% showed platelet-lymphocyte values >150. This data was associated to higher percentages of residual disease, progression, stage II and III tumours and seminomatous tumours.83.3% had an lymphocyte-monocyte  >3. These patients presented: higher tumour markers in normal range, decreased residual disease rates and higher percentages of stage I and II tumours.The mean survival time was shorter in patients with NLR >4 and absolute neutrophil  >8,000/μL.The ROC curves showed significance in the prediction of progression and values of lymphocyte-monocyte  >3, and prediction of survival and values NLR >4.ConclusionOur results indicate that the analysed haematological markers are associated with poor prognoses at diagnosis. Therefore, their use in daily clinical practice can be a valuable tool in the diagnosis and prognosis of patients with testicular germ cell tumours.     

Valor pronóstico de la invasión microvascular en la predicción de la supervivencia en el carcinoma de células renales

ObjectiveTo assess microvascular tumor invasion and other clinical and histological parameters as potential prognostic factors in surgically treated renal cell carcinoma.Materials and methodsSurgical specimens from 238 consecutive patients who underwent radical or partial surgery between 1990 and 2006 were retrospectively evaluated. The series included clinically localized or metastatic renal cell carcinoma (pT1-4; N0-1; M0-1). Disease-free and cancer-specific survival assessments were the end points with median follow-up of 75 months (range 1-189 months). Variables studied included: age, sex, tumor size, TNM 2010 classification, Fuhrman grade, histological subtype and microvascular tumor invasion.ResultsMicrovascular tumor invasion was observed in 79 patients (33,2%) and was significantly associated with age (P = .010), tumor size (P = .000), Fuhrman grade (P = .000), pT stage 2010 (P = .000), N stage 2010 (P = .000) and M stage 2010 (P = .000). Multivariate analyses determined that sex, Fuhrman grade, pT stage 2010 and histological subtipe were independent prognostic factors of disease-free survival, while sex, Fuhrman grade, pT stage 2010, M stage 2010, histological subtype and microvascular invasion were prognostic factors for cancer-specific survival.ConclusionsOur study shows that microvascular tumor invasion is an independent prognostic factor for cancer-specific survival in surgically treated patients with renal cell carcinoma.     

Factores pronóstico de las metástasis pulmonares de cáncer colorrectal

IntroductionColorectal cancer is the third most common neoplasia and the second cause of death due to cancer in developed countries. Approximately 10% of patients with this diagnosis develop lung metastases, although only 2-4% of them have lung metastases as the only extension location.ObjectiveTo study the prognostic factors of colorectal cancer lung metastases.Patients and methodsA retrospective observational study was conducted on 30 patients with colorectal cancer lung metastases who were operated on in our hospital between January 2003 and December 2007.ResultsOf the 30 patients who received surgery, 19 were males (63%) and 11 were female (37%), with a mean age of 63.37 years (range 35-82 years). The mean overall survival was 36.64 months (range 18.58-54.70 months).A total of 13 pre-, intra-, and postoperative parameters were used in the statistical analysis. In the univariate analysis, the number of metastases greater than 3 (P=.051), whether they were bilateral (P=.001), or bilobar (P<.001), were statistically significant factors of a poor prognosis. In the multivariate analysis, only being bilobar was shown to be a statistically significant factor of a poor prognosis (P=.005).ConclusionsIn our patient series affected by colorectal carcinoma lung metastases, the number of metastases greater than three, whether they are bilobar and bilateral, are factors of a poor prognosis.These factors should be taken into account in the follow-up of these patients, although prospective studies with a larger number of patients are required to confirm these findings.     

Perfil de expresión génica en el cáncer de próstata: identificación de marcadores candidatos para el diagnóstico no invasivo

ObjectiveTo analyze gene expression profiles of prostate cancer (PCa) with the aim of determining the relevant differentially expressed genes and subsequently ascertain whether this differential expression is maintained in post-prostatic massage (PPM) urine samples.Material and methodsForty-six tissue specimens (36 from PCa patients and 10 controls) and 158 urine PPM-urines (113 from PCa patients and 45 controls) were collected between December 2003 and May 2007. DNA microarrays were used to identify genes differentially expressed between tumour and control samples. Ten genes were technically validated in the same tissue samples by quantitative RT-PCR (RT-qPCR). Forty two selected differentially expressed genes were validated in an independent set of PPM-urines by qRT-PCR.ResultsMultidimensional scaling plot according to the expression of all the microarray genes showed a clear distinction between control and tumour samples. A total of 1047 differentially expressed genes (FDR ≤ .1) were indentified between both groups of samples. We found a high correlation in the comparison of microarray and RT-qPCR gene expression levels (r = .928, P < .001). Thirteen genes maintained the same fold change direction when analyzed in PPM-urine samples and in four of them (HOXC6, PCA3, PDK4 and TMPRSS2-ERG), these differences were statistically significant (P < .05).ConclusionThe analysis of PCa by DNA microarrays provides new putative mRNA markers for PCa diagnosis that, with caution, can be extrapolated to PPM-urines.     

Auditoría interna de resultados oncológicos en la cirugía del cáncer gástrico

IntroductionNational information on the oncological results of gastric cancer surgery is scarce, so foreign figures are used, which may completely differ from local ones. The aim of our study is to analyse these results in the patients operated on in our centre.MethodsSurvival results of 134 patients that underwent gastric cancer surgery with curative intent from 2004 to June 2016 were analysed.ResultsA percentage of 76.8 of the patients (103/134) presented in advanced clinical stages (≥ ii). Staging laparoscopy was performed in 67% of them (69/103), an extensive lymphadenectomy (≥ LD1+) was carried out in 89.3% of patients (92/103), and 76.7% (79/103) received perioperative chemotherapy. The distribution by pathological stage 0, i, ii, iii and iv was 8.2, 20.2, 26.1, 37.3, and 8.2%, respectively. Median follow-up was 87 months. Median OS was 68 months and one-, 3- and 5-year OS were 81.2, 62, and 53.8%, respectively. The 5-year OS according to pathological staging was 100% for stage 0, 88.4% for stage i, 62.5% for stage ii, 23.6% for stage iii and 17% for stage iv.ConclusionsOur survival rates are in the high ranges of western literature. These results could not be compared with national ones due to the lack of information regarding oncological outcomes in gastric cancer surgery in our closest environment.     

Evaluación del test PCA3 para el diagnóstico de cáncer de próstata: revisión sistemática y metanálisis

ObjectiveTo assess the efficacy of diagnostic techniques based on PCA3 gene for early detection of prostate cancer. We carried out a systematic review of scientific literature and subsequent meta-analysis.Material and methodsA literature search (2000–09) in MEDLINE, EMBASE, Cochrane Library, CRD, ECRI, Hayes databases and journals of Cancer and Urology. MESH terms used were "Prostatic Neoplasms", Prostate-Specific Antigen", "Antigens, Neoplasm", "Sensitivity and Specificity", "Predictive Value of Tests", and free terms "upm3", "PCA3", "dd3", "aptima PCA3" and "prostate cancer antigen 3". Patients were adults. The intervention was to determine the PCA3 gene, from urine samples for diagnosis of prostate cancer. The quality of the studies was checked according to QUADAS criteria. We calculated diagnostic accuracy rates and developed a meta-analysis to synthesize results.Results14 studies of diagnostic tests were selected, with moderate-high quality. The sensitivity was between 46.9% and 82.3%, specificity ranged from 56.3% to 89%, positive predictive value had a range of 59.4–97.4% and negative predictive value 87.8–98%. The meta-analysis detected the existence of a threshold effect and heterogeneity between studies. Global sensitivity values was 0.85 [CI 0.84–0.87], specificity 0.96 [CI 0.96–0.97], positive likelihood ratio 22.21 [CI 15.12–32.63], and negative of 0.15 [CI 0.13–0.18].ConclusionsDetection techniques have acceptable diagnostic accuracy rates for using in the diagnosis of prostate cancer.     

Valor pronóstico de la invasión de grasa perirrenal y/o del seno en pacientes con carcinoma de células renales pT3a: estudio de cohorte multicéntrico. Grupo LARCG

Introduction and objectivesThe objective of this study is to evaluate overall survival (OS), cancer-specific survival (CSS), relapse-free survival, local and distant (LRFS and DRFS, respectively) rates in patients with pT3a renal cell carcinoma (RCC) considering the perirenal and/or sinus fat infiltration (FI) as prognostic factors.Materials and methodsRetrospective cohort of patients with pT3a RCC who underwent radical or partial nephrectomy. The data were extracted from the LARCG (Latin American Renal Cancer Group) database. The demographic, clinical, pathological and surgical variables were evaluated. FI was divided into 4 groups (vein, perirenal, sinus and both fats infiltration). The Kaplan Meier and Cox regression curves were performed.Results293 patients were included in the study. The mean age was 61.4 years. The median follow-up was 21 months (r: 1-194). CSS, RFS, LRFS and DRFS estimated at 3 years in the group of both fats’ infiltration were 53.1, 45.1, 58.7 and 51.6 months, respectively, and always statistically lower than the rest (P?0.005). In the multivariate analysis, the infiltration of both fats significantly increased specific mortality, overall and local relapse with respect to vein infiltration (HR: 4.5, 2.42 and 8.08, respectively). The Fuhrman grade and renal pelvis infiltration were independent predictors of CSS and RFS.ConclusionsInfiltration of both fats increases the risk of overall and local relapse in pT3a RCC. In the same way, it is associated with a lower cancer-specific survival and should be considered as a factor of poor prognosis.     

Marcadores inflamatorios como factor pronóstico en el cáncer de próstata resistente a la castración metastásico

IntroductionInflammatory markers have prognostic value in various tumors due to the role of inflammatory phenomena at different stages of tumor development. The aim of this study is to demonstrate the prognostic value of these markers, as well as other clinical and analytical variables in patients with metastatic castration-resistant prostate cancer (mCRPC).Material and methodsProspective cohort study carried out on 80 patients diagnosed with mCRPC. Clinical and analytical data were collected, and the following inflammatory markers were estimated: Absolute Neutrophil Count (ANC), Neutrophil-Lymphocyte Ratio (NLR), Total Platelet Count (TPC), Platelet-Lymphocyte Ratio (PLR), Lymphocyte-Monocyte Ratio (LMR) and Systemic Inflammation Index (SII). The values of albumin, hemoglobin (Hb), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were also determined.ResultsPatients with ANC>7500, NLR>3, PLR>150, LMR>3 and/or SII>535,000, presented significantly lower median survival time than the remaining patients, and TPC was the only marker which did not show a significant association. Moreover, NLR, PLR and SII were inversely correlated with survival time. Patients with hypoalbuminemia, anemia, and elevated LDH values had significantly lower median survival time. Albumin and hemoglobin were directly correlated to overall survival time. The need for analgesia was also associated with shorter survival.ConclusionThe values of certain inflammatory markers are associated with shorter survival time in patients with mCRPC, and their use in clinical practice can be considered to evaluate the prognosis and estimate survival.     

Segunda resección transuretral y pronóstico del cáncer de vejiga no músculo-invasivo de alto grado en pacientes que no reciben bacilo de Calmette-Guérin

ObjectiveTo define the natural history of T1G3 bladder tumor not receiving intravesical Bacillus Calmette-Guerin (BCG) and assess the diagnostic and therapeutic value of a second transurethral resection (Re-TUR) in these patients.Patients and methodsRetrospective study on the natural history of 210 patients treated at two institutions for T1G3 bladder carcinoma without associated CIS. In no case was BCG administered; 79 (37.6%) received TUR alone, and 131 (62.4%) Re-TUR 4 to 6 weeks later; 23 (12.4%) underwent cystectomy for tumor progression.ResultsMedian follow-up was 55 (78 IQR) months, male/female ratio 8/1, and mean age 70.6 + 11.8 (range 37-93). 19.5% were free of recurrence at 10 years, and 61.9% free of progression. Independent prognostic factors for progression were solid pattern (HR: 2.71; P = .0004), multiplicity (HR: 2.26; P = .003), and recurrence at 3 months (HR: 3.4; P = .003). Cancer-specific survival was 81.5% at 5 and 69% at 10 years. Independent predictors of survival were: progression during the first year (HR: 17.9; P < .0001), solid pattern (HR: 2.13; P = .02), multiplicity (HR: 2.05; P = .03), and age > 65 years (HR: 2.9; P = .03). Re-TUR avoided under-staging (7.4%), detected T1G3 residual disease (10.7%), reduced recurrence rate at 3 months (11.4 to 4.6%; P = .06), and rate of progression on the 1st year (13.9 to 3.8%; P = .0075). However, in these patients the risk remains and no differences were detected in the long term in terms of recurrence (log-rank, P = .14), progression (P = .91), or cancer death (P = .21) in patients treated with Re-TUR.ConclusionThe recurrence in the first 3 months of a T1G3 tumor not receiving BCG is the main risk factor for progression, and progression of this type of tumors within the first year is the main factor of cancer death. The Re-TUR improves both variables but it does not change the long-term prognosis.     

Evaluación de la biopsia de fusión elástica vs. biopsia sistemática para la detección del cáncer de próstata: resultados de un estudio multicéntrico en 1.119 pacientes

ObjectivesTo assess the accuracy of targeted and systematic biopsies for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in the everyday practice, evaluating the need for additional systematic biopsies at the time of targeted biopsy.Patients and methodsFrom our multicentric database gathering data on 2,115 patients who underwent fusion biopsy with Koelis™ system between 2010 and 2017, we selected 1,119 patients who received targeted biopsies (a median of 3 for each target), followed by systematic sampling of the prostate (12 to 14 cores). Overall and clinically significant cancer detection rate (CDR) of Koelis™ fusion biopsies were assessed, comparing target and systematic biopsies. Secondary endpoint was the identification of predictors of PCa detection.ResultsThe CDR of targeted biopsies only was 48% for all cancers and 33% for csPCa. The performance of additional, systematic prostate sampling improved the CDR of 15% for all cancers and of 12% for csPCa. PCa was detected in 35%, 69%, and 92% of patients with lesions scored as PI-RADS 3, 4 and 5, respectively. Elevated PI-RADS score and positive digital rectal examination were predictors of PCa, whereas biopsy-naïve status was associated with csPCa.ConclusionIn the everyday practice target biopsy with Koelis™ achieves a good CDR for all PCa and csPCa, which is significantly improved by subsequent systematic sampling of the prostate. The outstanding outcomes of fusion biopsy are confirmed also in biopsy-naïve patients. Elevated PI-RADS score and positive digital rectal examination are strongly associated with presence of PCa.     

Factores pronóstico del traumatismo torácico: estudio prospectivo de 500 pacientes

ObjectiveIdentify the factors of greatest impact in patients with chest trauma.Patients and methodsprospective study of 500 patients (425 men and 75 women) with chest trauma treated between January 2006 and December 2008. The parameters assessed include the degree of trauma, the abbreviated injury scale (AIS), the injury severity score (ISS), pre-hospital intubation, duration of mechanical ventilation, stay in the intensive care unit (ICU), number of rib fractures, presence of pulmonary contusion, haemothorax and cardio-pulmonary effects.ResultsThe presence of polytrauma, the number of rib fractures, the presence of flail chest, pulmonary contusion, the delay in mechanical ventilation and age were shown to be effective markers of severity.ConclusionsThoracic injuries have a number of indicators of severity. The mortality risk is associated with an ISS >25, the presence of 3 or more rib fractures with flail chest, pulmonary contusion, the development of ARDS, and with an age >55 years.     

Complicaciones postoperatorias y supervivencia del cáncer de esófago: análisis de dos periodos distintos

Introduction

Nowadays, treatment of esophageal cancer requires a multidisciplinary approach, in which esophagectomy remains the mainstay. The aim of this report is to assess whether multimodal treatment and minimally invasive surgery have led to a lower morbidity rate and an improvement in survival rates.