Efecto de la pandemia en la cirugía radical del cáncer vesical / Effect of the pandemic on radical surgery for bladder cancer

Objetivo: El advenimiento de la pandemia de síndrome respiratorio agudo por coronavirus 2 (SARS-CoV-2) ha tenido un impacto en el manejo del resto de las patologías por la elevada presión asistencial generada. Por su historia natural, el cáncer vesical susceptible de cistectomía radical (CR) requiere especial atención. Nuestro objetivo es comparar los resultados perioperatorios y oncológicos de estos pacientes durante el estado de alarma respecto a la era pre-COVID en un centro de tercer nivel. Material y métodos: Estudio retrospectivo observacional descriptivo y analítico. Pacientes intervenidos de cistectomía radical por neoplasia entre abril de 2019 y marzo de 2021 divididos en dos grupos, abril 2019-marzo 2020 (n = 42) y abril 2020-marzo 2021 (n = 43). Resultados: Ambos grupos resultaron ser homogéneos. La mediana de espera desde la resección transuretral de vejiga hasta la realización de la CR no aumentó (82,5 vs. 83 días, p = = 0,860). No se observan tampoco diferencias en la estadificación TNM de las piezas quirúrgicas. Los tumores localmente avanzados no aumentaron significativamente (18 vs. 21, p = 0,580). La presencia de afectación ganglionar tampoco presentó diferencias significativas (10 vs. 13, p = 0,675). La estancia media disminuyó en un valor cercano a significación (mediana en días: 11 vs. 8, p = 0,056) sin que ello asociase un mayor número de complicaciones o de reingresos a los 30 días. Conclusión:: En nuestra serie no hemos constatado diferencias significativas en los resultados perioperatorios y oncológicos de pacientes tratados mediante CR durante la pandemia de COVID-19.

Introduction: The advent of the COVID-19 pandemic (caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] has had an impact on the management of other pathologies due to the high healthcare pressure generated. Due to its natural history, bladder cancer amenable to radical cystectomy requires special attention. We aim to compare the perioperative and oncological results of these patients during the alarm state with respect to the pre-COVID era in a tertiary care center. Material and methods: Observational descriptive and analytical retrospective research. Patients who underwent radical cistectomy because of bladder cancer between April 2019 to March 2021, divided in two groups, April 2019-March 2020 (n = 42) and April 2020-March 2021 (n = 43). Results: Both groups turned out to be homogeneous. The median wait time from transurethral resection of the bladder to radical cystectomy did not increase (82.5 vs. 83 days, p = 0.860). No differences were observed in the TNM staging of the surgical specimens. Locally advanced tumors did not increase significantly (18 vs. 21, p = 0.580). The presence of lymph node involvement did not present significant differences either (10 vs. 13, p = 0.675). The average stay decreased by a value close to significance (median in days 11 vs. 8, p = 0.056) without being associated with a greater number of complications or readmissions at 30 days. Conclusion: In our series, we have not found significant differences in the perioperative and oncological results of patients treated by radical cystectomy during the COVID-19 pandem

Standardized incidence ratios and risk factors for cancer in patients with systemic sclerosis: Data from the Spanish Scleroderma Registry (RESCLE).

AIM: Patients with systemic sclerosis (SSc) are at increased risk of cancer, a growing cause of non-SSc-related death among these patients. We analyzed the increased cancer risk among Spanish patients with SSc using standardized incidence ratios (SIRs) and identified independent cancer risk factors in this population. MATERIAL AND METHODS: Spanish Scleroderma Registry data were analyzed to determine the demographic characteristics of patients with SSc, and logistic regression was used to identify cancer risk factors. SIRs with 95% confidence intervals (CIs) relative to the general Spanish population were calculated. RESULTS: Of 1930 patients with SSc, 206 had cancer, most commonly breast, lung, hematological, and colorectal cancers. Patients with SSc had increased risks of overall cancer (SIR 1.48, 95% CI 1.36-1.60; P < 0.001), and of lung (SIR 2.22, 95% CI 1.77-2.73; P < 0.001), breast (SIR 1.31, 95% CI 1.10-1.54; P = 0.003), and hematological (SIR 2.03, 95% CI 1.52-2.62; P < 0.001) cancers. Cancer was associated with older age at SSc onset (odds ratio [OR] 1.22, 95% CI 1.01-1.03; P < 0.001), the presence of primary biliary cholangitis (OR 2.35, 95% CI 1.18-4.68; P = 0.015) and forced vital capacity <70% (OR 1.8, 95% CI 1.24-2.70; P = 0.002). The presence of anticentromere antibodies lowered the risk of cancer (OR 0.66, 95% CI 0.45-0.97; P = 0.036). CONCLUSIONS: Spanish patients with SSc had an increased cancer risk compared with the general population. Some characteristics, including specific autoantibodies, may be related to this increased risk.

Spanish scleroderma risk score (RESCLESCORE) to predict 15-year all-cause mortality in scleroderma patients at the time of diagnosis based on the RESCLE cohort: Derivation and internal validation.

A few scores predicting the short-term risk of mortality in Systemic sclerosis (SSc) have been reported to date. Our study aimed to create a predictive 15-year all-cause mortality score at the time of the diagnosis of SSc. The study was based on the Spanish Scleroderma Registry (RESCLE). The cohort was split up in derivation (DC) and validation cohort (VC). A multivariate analysis to detect variables related to all-cause mortality within the first 15 years from SSc diagnosis was performed, assigning points to the rounded beta values to create the score (RESCLESCORE). 1935 SSc patients were included. The variables in the final model were as follows: age at diagnosis (+2 points > 65 years-old), male gender (+1 point), lcSSc subset (-1 point), mode of onset other than Raynaud's (+1 point), cancer (+1 point) and visceral involvement, such as ILD (+1 point), PAH (+1 point), heart (+1 point) and renal involvement (+2 points). Autoantibodies did not achieve statistical significance in the multivariate analysis. The 3 categories of risk to predict 15-year all-cause mortality at the time of diagnosis were as follows: low risk (5% vs. 7%, p = .189), intermediate risk (26.5% vs. 25.5%, p = .911) and high risk (47.8% vs. 59%, p = .316). The AUC was 0.799 (DC) vs. 0.778 (VC) (p = .530). In conclusion, the RESCLESCORE demonstrated an excellent ability to categorize SSc patients at the time of diagnosis in separate 15-year all-cause mortality risk strata at the time of diagnosis.