Utilidad del índice nutricional pronóstico como criterio de selección para la vigilancia activa en el cáncer de próstata / Could Prognostic Nutritional Index be a new criteria for active surveillance of prostate cancer?

Objetivo Determinar el valor del índice nutricional pronóstico (INP) en la selección de pacientes para vigilancia activa (VA) en cáncer de próstata. Métodos Entre septiembre de 2020 y junio de 2022, se analizaron retrospectivamente los datos de 125 pacientes que se sometieron a prostatectomía laparoscópica asistida por robot. Todos los pacientes eran candidatos aptos para VA antes de la operación. Con base en los resultados patológicos obtenidos en la prostatectomía laparoscópica asistida por robot, los pacientes fueron asignados a 2 grupos. Los pacientes que cumplían con los criterios para VA se asignaron al grupo 1 y los demás se asignaron al grupo 2. Se compararon datos demográficos, valores de INP y parámetros hematológicos de los grupos. Resultados El 38% (n:48) de los pacientes cumplió los criterios del grupo 1 y el 62% (n:77) cumplió los criterios del grupo 2. Se encontró un incremento de grado y estadio (upgrade y upstage) en 76 (61%) y 26 (21%) pacientes, respectivamente. No hay diferencias significativas entre los grupos en cuanto a edad, IMC, PSA, densidad de PSA, volumen prostático y PI-RADS. El primer grupo obtuvo un valor de INP más alto. El valor de 49,45 se calculó mediante análisis ROC como el valor de corte ideal de INP para predecir la reclasificación a un grado y estadio más alto del cáncer de próstata (p<0,001). De acuerdo con el análisis de regresión tanto univariante como multivariante, se encontró que el INP era un predictor de exclusión de la VA (p<0,001). Conclusión Los incrementos de grado y estadio se detectan con mayor frecuencia en pacientes con valores bajos de INP. El uso del valor INP en la selección de pacientes para VA aumentará la tasa de éxito en la selección de los candidatos óptimos. (AU)

Objective To evaluate the importance of the Prognostic Nutritional Index(PNI) value for patient selection of active surveillance (AS) in prostate cancer. Methods Between September 2020 and June 2022, the data of 125-patients who underwent Robot-Assisted-Laparoscopic-Prostatectomy were retrospectively analyzed. All patients were suitable for AS preoperatively. Using the pathological results of Robot-Assisted-Laparoscopic-Prostatectomy, patients have been divided 2 groups. Patients who met the criteria for AS were defined as the first group, others were defined second. Demographic datas, PNI values and hematological parameters of the groups were compared. Results 38%(n:48) patients were found suitable for the group 1, and 62%(n:77) were found suitable for the group 2. Upgrading and upstaging were found at 76 patients (61%) and 26 (21%), respectively. There is no significant difference between groups on age, BMI, PSA, PSA-density, prostate volume, and PIRADS. PNI value was found higher at first group. The value of 49.45 was calculated by ROC analysis as the ideal PNI cut-off value for predicting upgrading and upstaging of prostate cancer(P<.001).According to the both univariate and multivariate regression analysis, PNI was found a predictor for exclusion from AS (P<.001). Conclusion Upgrading and upstaging are detected at a higher rate in patients with low PNI values. The use of PNI value in the selection of patients to AS will increase the success rate of ideal patient selection. (AU)

Could Prognostic Nutritional Index be a new criteria for active surveillance of prostate cancer?

OBJECTIVE: To evaluate the importance of the Prognotic Nutritional Index(PNI) value for patient selection of active surveillance(AS) in prostate cancer. METHODS: Between September 2020 and June 2022, the data of 125-patients who underwent Robot-Assisted-Laparoscopic-Prostatectomy(RALP) were retrospectively analyzed. All patients were suitable for AS preoperatively. Using the pathological results of RALP, patients have been divided two groups. Patients who met the criteria for AS were defined as the first group, others were defined second. Demographic datas, PNI values and hematological parameters of the groups were compared. RESULTS: 38% (n:48) patients were found suitable for the group1, and 62%(n:77) were found suitable for the group 2. Upgrading and upstaging were found at 76 patients (61%) and 26(21%), respectively. There is no significant difference between groups on age, BMI, PSA, PSA-density, prostate volume, and PIRADS. PNI value was found higher at first group. The value of 49.45 was calculated by ROC analysis as the ideal PNI cut-off value for predicting upgrading and upstaging of prostate cancer (P < ,001). According to the both univariate and multivariate regression analysis, PNI was found a predictor for exclusion from AS (P < ,001). CONCLUSION: Upgrading and upstaging are detected at a higher rate in patients with low PNI values. The use of PNI value in the selection of patients to AS will increase the success rate of ideal patient selection.

Comparación entre el efecto de la nefrolitotomía percutánea miniaturizada vs. convencional en la función renal evaluada mediante gammagrafía renal con DMSA / Comparison of the effect of miniaturized and standard percutaneous nephrolithotomy on renal function assessed with DMSA scintigraphy

Introducción y objetivos Nos propusimos realizar un estudio clínico para comparar los efectos de la nefrolitotomía percutánea (NLP) convencional y miniaturizada sobre la función renal evaluada mediante imágenes de gammagrafía en pacientes con cálculos renales primarios. Materiales y métodos Se incluyeron 104 pacientes en este estudio prospectivo entre mayo de 2014 y febrero de 2017. Los pacientes elegibles se dividieron en dos grupos: NLP miniaturizada (NLPm) y NLP convencional (NLPc) mediante muestras emparejadas (escenario 1:1). Se realizó una gammagrafía cortical con ácido dimercaptosuccínico de tecnecio-99m antes y después de la intervención. Resultados No hubo diferencias entre los dos grupos en cuanto a las tasas de éxito (NLPm [63,5%] frente a NLPc [71,2%], p=0,403), creatinina sérica, tasa de filtración glomerular, funciones renales diferenciales evaluadas antes y después de la intervención (p≥0,05). No hubo relación entre el tipo de procedimiento y la formación de nuevo tejido cicatricial (p=0,780). Las tasas de complicaciones graves (grados 3 y 4 según la clasificación de Clavien-Dindo modificada) fueron más altas en la NLPc (p=0,034). La carga litiásica, el tiempo quirúrgico, el descenso de la hemoglobina, los accesos múltiples, la transfusión de sangre y la angioembolización fueron mayores en los pacientes con riñones cicatrizados (p<0,001, p=0,008, p=0,004, p<0,001, p=0,003, p=0,001, respectivamente). En el análisis multivariante, sólo el acceso múltiple resultó estadísticamente significativo para predecir la formación de tejido cicatricial nuevo (p<0,001, OR: 24,28). Conclusiones La NLP miniaturizada y la convencional son intervenciones fiables y efectivas para el tratamiento de cálculos renales de gran tamaño. No se encontraron diferencias significativas entre los dos procedimientos en cuanto a la disminución de la función renal (AU)

Introduction and Objectives We aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. Materials and Methods One hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. Results There were no differences between the two groups in terms of success rate (mPNL(63.5%) vs. sPNL(71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien-Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR:24.28). Conclusions Miniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function (AU)

Comparison of the effect of miniaturized and standard percutaneous nephrolithotomy on renal function assessed with DMSA scintigraphy.

INTRODUCTION AND OBJECTIVES: We aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. MATERIALS AND METHODS: One hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. RESULTS: There were no differences between the two groups in terms of success rate (mPNL (63.5%) vs. sPNL (71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien-Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR: 24.28). CONCLUSIONS: Miniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function.