[Prognostic of older age for patients with invasive-muscle-bladder cancer and treated by radical cystectomy]. / L'âge avancé est-il un facteur de mauvais pronostic pour les patients atteints de tumeur de vessie infiltrant le muscle et traités par cystectomie ?

INTRODUCTION: Bladder tumor is a disease of older persons, but can also occur in young adults, because certainly an influence of environmental factors and a change of lifestyle. The aim of our retrospective analysis is to assess and evaluate the extent of the prognostic impact of age on the carcinological prognosis of invasive-muscle-bladder cancer treated by total cystotomy. METHODS: To evaluate the association of patient age with pathological characteristics and recurrence-free and disease survival, we retrospectively reviewed 345 patients with invasive bladder cancer between January 2000 and January 2015. RESULTS: We divided our patients into two groups: patients under 65 years of age=150 cases (group 1), patients aged 65 years and over=195 cases (group 2). The 3-year survival rates for patients according to the age groups were 88% and 64% respectively, end the recurrence-free survival 66% and 28%. When age was analysed as a categorical variable, was associated with hydronephrosis (P=0.001), advanced pathological stage (P=0.034), high grade (P=0.026), nodal involvement (P=0.011) and lymphovascular invasion (P=0.008). The multivariate Cox model analysis showed that hydronephrosis and pathological stage was prognostic factors of survival (P=0.012 and P=0.035, respectively). Higher age is significantly associated with the risk of pathologically advanced disease and poorer global survival. CONCLUSION: This work allowed us to assert that advanced chronological age is significantly associated with an advanced pathological stage of the disease (volume, pT, grade, lymph nodes) and a low overall survival rate. This could be useful for selecting subjects who would require adjuvant therapy, as well as for planning early complementary therapies. LEVEL OF EVIDENCE: 3.

Terapia de oxígeno hiperbárico complementaria al desbridamiento en el control de la gangrena de Fournier: utilidad de la puntuación de un índice de severidad en la predicción de la gravedad de la enfermedad y la supervivencia del paciente / Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier’s gangrene: usefulness of a severity index score in predicting disease gravity and patient survival

Introducción: La terapia de oxígeno hiperbárico (TOHB) concomitante con la cirugía ha demostrado una mejora en la reducción de la mortalidad por gangrena de Fournier (GF) en comparación con la aplicación exclusiva de desbridamiento quirúrgico. La mayoría de los datos provienen de centros con un número relativamente reducido de pacientes, y en los que se emplea solamente un procedimiento quirúrgico. El objetivo planteado consistía en evaluar la eficiencia del desbridamiento agresivo con TOHB complementaria, así como evaluar el valor predictivo del índice de puntuación de gravedad de la gangrena de Fournier (IGGF). Material y métodos: 70 gangrenas de Fournier (GF) tratadas con desbridamiento quirúrgico y TOHB. Los datos evaluados fueron los resultados de las exploraciones físicas, los análisis de laboratorio tanto en el momento del ingreso como los finales, la extensión del desbridamiento quirúrgico y el antibiótico utilizado. Los pacientes recibieron TOHB complementaria. Se desarrolló un IGGF con el fin de adjudicar una puntuación que describiese la gravedad de la enfermedad. Este índice tiene en cuenta las constantes vitales de los pacientes, los parámetros metabólicos (niveles de sodio, potasio, creatinina y bicarbonato, así como recuento de linfocitos) y calcula una puntuación relativa a la gravedad de la enfermedad en ese momento. Se evaluaron los datos en función de la supervivencia o no del paciente. Todos los pacientes fueron sometidos a desbridamiento quirúrgico, realizándose el desbridamiento de la herida de forma periódica en el periodo postoperatorio. Resultados: De un total de 70 pacientes fallecieron 8 (el 11,4%) y sobrevivieron 62 (el 88,5%). La diferencia de edad entre los supervivientes (edad media 50,0 años) y no supervivientes (edad media 54,5 años) no fue significativa (p = 0,321). La extensión media del área del cuerpo afectada por el proceso de necrosis en los pacientes que sobrevivieron y en los que no sobrevivieron era del 2,4 y del 4,9%, respectivamente (p = 0,001). Excepto en lo referente a la albúmina, no se encontraron diferencias significativas entre supervivientes y no supervivientes. Las puntuaciones medias en el IGGF en el momento del ingreso de los supervivientes y de los no supervivientes fueron de 2,1±2,0 y de 4,2±3,8, (p = 0,331). Conclusión: La puntuación del IGGF no resultó ser un factor de predicción de la gravedad, de la enfermedad ni de la supervivencia del paciente. Sin embargo, tanto las alteraciones metabólicas como la extensión de la enfermedad aparecieron como factores significativos de riesgo en cuanto a predicción de la gravedad de la GF y la supervivencia del paciente (AU)

Introduction: Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier’s gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier’s gangrene severity score index (FGSI) predictive value. Material and methods: 70 Fournier’s gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed toa ssign a score describing the acuity of disease, was used. This index presents patients’ vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period. Results: Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p = 0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p = 0.001). Except for albumin, no significant differences were found between survivors and non survivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p = 0.331).Conclusion: FGSI score did not predict disease severity and the patient’s survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival (AU)

[Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier's gangrene: usefulness of a severity index score in predicting disease gravity and patient survival]. / Terapia de oxígeno hiperbárico complementaria al desbridamiento en el control de la gangrena de Fournier: utilidad de la puntuación de un índice de severidad en la predicción de la gravedad de la enfermedad y la supervivencia del paciente.

INTRODUCTION: Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier's gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier's gangrene severity score index (FGSI) predictive value. MATERIAL AND METHODS: 70 Fournier's gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed to assign a score describing the acuity of disease, was used. This index presents patients' vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period. RESULTS: Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p=0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p=0.001). Except for albumin, no significant differences were found between survivors and nonsurvivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p=0.331). CONCLUSION: FGSI score did not predict disease severity and the patient's survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival.