[Pathological prognostic indicators in renal cell carcinoma]. / Indicadores pronósticos anatomopatológicos del cáncer de riñón.

OBJECTIVE: To analyze histological factors not routinely assessed as potential prognostic factors in renal cell carcinoma, such as tumor necrosis, microscopic vascular invasion, and sinus fat invasion. MATERIALS AND METHODS: A retrospective, analytical study was conducted of surgical specimens from 139 patients with localized renal cell carcinoma who underwent nephrectomy from 1993 to 2005. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion were analyzed and compared to the classical factors: TNM classification, Fuhrman grade, and tumor size. For statistical analysis, variables analyzed were categorized as pT1, 2 vs pT3, 4; Fuhrman grade 1, 2 vs 3, 4; tumor size < 7 cm vs >or= 7cm; tumor necrosis vs no tumor necrosis; microvascular invasion of sinus fat vs no invasion. Cancer-specific survival probability and disease-free survival were calculated. A descriptive and analytical statistical analysis was performed using logistic regression for univariate and multivariate analyses. Dependent variables were used to analyze cancer-specific survival rates. Disease-free survival was estimated using a Cox regression model and Kaplan-Meier curves. RESULTS: In the univariate analysis, all variables analyzed had a significant influence on death for renal cell carcinoma. In the multivariate analysis, the variable having the greatest influence was Fuhrman grade (p = 0,032). The variables significantly influencing disease-free survival, estimated by the Cox method, were the pT stage (p = 0.038) and Fuhrman grade (p = 0.048). CONCLUSIONS: In patients with clinically localized renal cell carcinoma undergoing nephrectomy, pT stage and Fuhrman grade are the most important prognostic factors for survival and disease-free survival. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion are prognostic factors for death from renal carcinoma which are associated to TNM classification, Fuhrman grade, and tumor size.

Indicadores pronósticos anatomopatológicos del cáncer de riñón / Pathological prognostic indicators in renal cell carcinoma

Objetivo: analizar el valor pronóstico independiente de supervivencia de factores anatomopatológicos no valorados de modo rutinario, como necrosis tumoral, invasión microvascular e invasión del seno renal. Material y métodos: se realizó un estudio retrospectivo y analítico incluyendo las piezas de 139 cánceres renales, intervenidos entre enero de 1993 y diciembre de 2005, clínicamente localizados. Las variables analizadas fueron: necrosis tumoral, invasión microvascular e invasión del seno renal. Se compararon con los factores clásicos: clasificación TNM, gradación de Fuhrman y tamaño tumoral. Para el análisis estadístico las variables analizadas fueron categorizadas en: pT1,2 frente a pT3,4, Fuhrman 1,2 frente a 3,4, diámetro tumoral < 7 cm frente a diámetro tumoral ≥ 7, necrosis tumoral frente a no necrosis tumoral, invasión microvascular frente a no invasión microvascular e invasión del seno renal frente a no invasión del seno renal. Se calculó la probabilidad de supervivencia cáncer específica y el periodo libre de enfermedad. Se realizó el análisis estadístico descriptivo y analítico con el empleo de regresión logística para análisis univariante y multivariante. El periodo libre de enfermedad se estimó mediante el modelo de regresión de Cox y curvas de Kaplan-Meier. Resultados: en el análisis univariante todas las variables analizadas influyen de forma significativa en la muerte por cáncer de riñón. En el análisis multivariante la variable que más influye es el grado de Fuhrman (p = 0,032). En el periodo libre de enfermedad estimado por el método de Cox las variables que influyen de forma significativa son la categoría pT (p = 0,038) y el grado de Fuhrman (p = 0,048). Conclusión: en pacientes con cáncer renal clínicamente localizado la categoría pT y el grado de Fuhrman son los factores pronósticos anatomopatológicos más importantes en cuanto a la supervivencia y el periodo libre de enfermedad. La invasión microvascular, la necrosis tumoral y la invasión tumoral del seno renal son factores pronósticos de muerte por cáncer renal que se asocian con la categoría TNM, el grado de Fuhrman y tamaño tumoral(AU)

Objective: To analyze histological factors not routinely assessed as potential prognostic factors in renal cell carcinoma, such as tumor necrosis, microscopic vascular invasion, and sinus fat invasion. Materials and methods: a retrospective, analytical study was conducted of surgical specimens from 139 patients with localized renal cell carcinoma who underwent nephrectomy from 1993 to 2005. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion were analyzed and compared to the classical factors: TNM classification, Fuhrman grade, and tumor size. For statistical analysis, variables analyzed were categorized as pT1, 2 vs pT3, 4; Fuhrman grade 1, 2 vs 3, 4; tumor size < 7 cm vs ≥ 7cm; tumor necrosis vs no tumor necrosis; microvascular invasion of sinus fat vs no invasion. Cancer-specific survival probability and disease-free survival were calculated. A descriptive and analytical statistical analysis was performed using logistic regression for univariate and multivariate analyses. Dependent variables were used to analyze cancer-specific survival rates. Disease-free survival was estimated using a Cox regression model and Kaplan-Meier curves. Results: In the univariate analysis, all variables analyzed had a significant influence on death for renal cell carcinoma. In the multivariate analysis, the variable having the greatest influence was Fuhrman grade (p = 0,032). The variables significantly influencing disease-free survival, estimated by the Cox method, were the pT stage (p = 0.038) and Fuhrman grade (p = 0.048). Conclusions: In patients with clinically localized renal cell carcinoma undergoing nephrectomy, pT stage and Fuhrman grade are the most important prognostic factors for survival and disease-free survival. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion are prognostic factors for death from renal carcinoma which are associated to TNM classification, Fuhrman grade, and tumor size(AU)

[Prenatal corticosteroids. Use and attitudes of the gynecology-obstetrics medical staff]. / Corticoesteroides antenatales. Empleo y actitudes del personal médico ginecoobstetra.

OBJECTIVES: 1. To evaluate the frequency of use of antenatal corticosteroids (AC) and the reasons for withholding them. 2. To estimate the knowledge and attitudes, regarding AC, from obstetricians, in a large Women and Babies Hospital. METHODS: Through a prospective, observational and transversal study we evaluated: 1. The frequency of use of AC in pregnant with preterm labor (PL) and in mothers of preterm infants (P1). When AC were not given, the reasons were recorded. 2. With an anonymous inquiry we assessed the knowledge and attitude of obstetricians regarding AC, exploring different concepts such as usefulness, frequency of use, indications, risks and contraindications. Descriptive statistics was used. RESULTS: We studied 364 patients (240 mothers of Pl and 124 pregnant women). The mean gestational age (GA) was 28.9 + 2.4 weeks. The AC were used only in 136 out of 364 (37.4%) women, and diminished to 30.9% (102/330), if are excluded 34 patients who did not receive AC because imminent delivery. Another reasons for not using AC were irregular uterine activity (18.9%), prolonged rupture of membranes without chorioamnioitis (11.4%), and GA lower than 27 weeks (11.4%) and toxemia (9.6%). Only in 43 out of 136 patients (31.6%) who were on tocolytic drugs, received AC. The schedule and doses were correct. According to the inquiry, 48/68 (0.71) of obstetricians considered AC as definitively useful, although only 22/68 (0.32) as very effective. The knowledge level was acceptable, except in signaling with precision the neonatal problems that could be prevented, as well as the lowest gestational age for use the AC. CONCLUSIONS: We considered the use of AC in our institution as suboptimal. We found that the reasons for not using them were not valid in most cases. Physician's attitudes to AC are positive but it is not reflected on their clinical practice. It is necessary a strong promotion of the usefulness of the AC for the preterm infant.