RESUMO
Purpose: To compare outcomes of robot-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses. Methods: Data of patients who underwent RAPN or PTA for treatment of completely endophytic (three points for "E" domain of R.E.N.A.L. score) were collected from seven high-volume U.S. and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Meier analysis. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment "quality." Multivariable logistic regression model assessed predictors of trifecta failure. Results: One hundred fifty-two patients (RAPN, n = 60; PTA, n = 92) were included in the analysis. RAPN group was younger (p < 0.001), had lower American Society of Anesthesiologists score (p = 0.002), and higher baseline estimated glomerular filtration rate (p < 0.001). There was no difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall (p < 0.001) and minor (p < 0.001) complications. ΔeGFR at 1 year was statistically higher for RAPN (-15.5 mL/min vs -3.1 mL/min; p = 0.005), no difference in ΔeGFR at last follow-up (p = 0.22) was observed. No difference in recurrences (RAPN, n = 2; PTA, n = 6) and RFS was found (p = 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% vs 58.8%; p = 0.477). R.E.N.A.L. Nephrometry Score resulted predictive of trifecta failure (odds ratio = 1.47; confidence interval = 1.13-1.90; p = 0.004). Conclusions: PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications and good mid-term functional and oncologic outcomes. These outcomes compare favorably with those of RAPN, which seem to be the preferred option for younger and less comorbid patients.
Assuntos
Ablação por Cateter , Neoplasias Renais , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Neoplasias Renais/patologia , Seguimentos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Nefrectomia/métodos , Resultado do TratamentoRESUMO
PURPOSE: We assessed the reporting quality of randomized and nonrandomized, controlled trials presented in abstract form at the European Association of Urology annual meeting in a 10-year period and determined the impact on subsequent publication. MATERIALS AND METHODS: Abstracts presented at the European Association of Urology annual meetings in 1998, 1999, 2008 and 2009 were retrieved and included in analysis. Two 2-year meeting periods were considered, including 1) 1998 and 1999, and 2) 2008 and 2009. Two standardized forms were constructed based on the CONSORT (Consolidated Standards of Reporting Trials) and STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines, each including 15 and 16 items for randomized and nonrandomized, controlled trials, respectively. Reporting quality was assessed by measuring the proportion of items respected by authors when preparing the abstract, defined as the score ratio. Subsequent full-length publication within 2 years after the meeting was also determined by a PubMed® search. Differences between the 2 periods were analyzed by the chi-square and simple t tests. Predictors of subsequent full-length publication were evaluated by multiple logistic regression using meeting period, topic, country of origin, design, multi-institutional study and the proportion of reported items (score ratio). RESULTS: A total of 3,139 abstracts were included in analysis, of which 375 (11.9%) were randomized, controlled trials. Overall oncology represented the main topic (49.2% of all abstracts). The score ratio (proportion of adequately reported items in each abstract) was better for period 1 than 2 for randomized, controlled trials (63% vs 57%) but better for period 2 than 1 for nonrandomized, controlled trials (55.4% vs 53.2%, each p <0.001). Abstracts describing multi-institutional studies were more likely to be followed by full-length publication (OR 1.82, 95% CI 1.44-2.30). Other features, including reporting quality (score ratio), did not predict subsequent publication. CONCLUSIONS: The reporting quality of European Association of Urology meeting abstracts did not improve in a decade. Nevertheless, this factor did not impact subsequent full-length publication. Ultimately, the reporting quality of abstracts remains to be improved by following currently available guidelines.
Assuntos
Indexação e Redação de Resumos/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Congressos como Assunto , Europa (Continente) , Controle de Qualidade , Sociedades Médicas , UrologiaRESUMO
BACKGROUND: Knowledge of baseline factors that influence outcomes for men with benign prostatic hyperplasia (BPH) receiving medical therapy may help to improve outcomes and cost effectiveness. OBJECTIVES: To examine the influence of baseline parameters on changes in International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Q(max)) in men with BPH receiving dutasteride, tamsulosin, or a combination of the two using 2-yr Combination of Avodart and Tamsulosin (CombAT) study data. DESIGN, SETTING, AND PARTICIPANTS: CombAT is an ongoing, 4-yr, multicentre, randomised, double-blind study in 4844 men aged >or=50 yr with clinical diagnosis of BPH, IPSS >or=12, prostate volume >or=30 cm(3), prostate-specific antigen (PSA) 1.5-10 ng/ml, and Q(max) >5 and