Prevalencia del cáncer del tracto urinario. Análisis de la cohorte española del estudio IDENTIFY / Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study

Introducción Los tumores malignos del tracto urinario están asociados a gran morbimortalidad siendo su prevalencia variable a nivel global. Recientemente el estudio IDENTIFY ha publicado resultados sobre la prevalencia del cáncer del tracto urinario a nivel internacional. Este estudio evalúa la prevalencia de cáncer dentro de la cohorte española del estudio IDENTIFY para determinar si los resultados publicados son extrapolables a nuestra población. Material y métodos Se realizó un análisis de los datos de la cohorte de pacientes españoles del estudio IDENTIFY. Se trata de una cohorte prospectiva de pacientes derivados al hospital con sospecha de cáncer, predominantemente por hematuria. Los pacientes fueron reclutados entre diciembre de 2017 y diciembre de 2018. Resultados En total 706 pacientes procedente de 9 centros españoles fueron analizados. Doscientos setenta y siete pacientes (39,2%) fueron diagnosticados de cáncer, 259 (36,7%) de cáncer vejiga, 10 (1,4%) de tracto urinario superior, 9 (1,2%) renal y 5 (0,7%) de próstata. El aumento de la edad (OR: 1,05; IC 95%: 1,03-1,06; p<0,001), presencia de hematuria visible (OR: 2,19; IC 95%: 1,13-4,24; p=0,02) y el hábito tabáquico (exfumadores: OR: 2,11; IC 95%: 1,30-3,40; p=0,002; fumadores: OR: 2,36; IC 95%: 1,40-3,95; p=0,001) se asocia con mayor probabilidad de cáncer vesical. Conclusión Este estudio resalta el riesgo que existe en pacientes con HV y hábito tabáquico de presentar cáncer de vejiga. El cáncer de vejiga presentó la mayor prevalencia, siendo esta mayor que la expuesta en series previas y la presentada en el estudio IDENTIFY. Trabajos futuros deben evaluar otros factores asociados que permitan crear modelos de predicción de cáncer para seguir aumentando la detección de estos en nuestros pacientes. (AU)

Introduction Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. Patients and methods An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. Results A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR: 1.05; 95% CI: 1.03-1.06; P<.001), visible hematuria (VH) OR: 2.19; 95% CI: 1.13-4.24; P=.02)and smoking (ex-smokers: OR: 2.11; 95% CI: 1.30-3.40; P=.002); (smokers: OR: 2.36; 95% CI: 1.40-3.95; P=.001) were associated with higher probability of bladder cancer. Conclusion This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients. (AU)

Conservative management of high-grade renal trauma.

INTRODUCTION: Renal trauma is the most common of urological trauma and accounts for up to 5% of all. The AAST scale is the most widely used to assess renal trauma. This study focuses on high-grade trauma, whose treatment has evolved towards a conservative approach, with techniques such as angioembolization. The aim is to describe the evolution in the management of high-grade renal trauma in all patients treated at La Paz University Hospital from 2001 to 2022. METHODS: A descriptive retrospective study was conducted on patients treated at the hospital. The study was divided into two periods (2001-2010 and 2011-2022). A total of 285 patients with renal trauma were collected, of which 54 were high grade. The main variable is the type of management, conservative (embolization) or interventional through nephrectomy. RESULTS: In the completed series, there was a decrease in radical nephrectomy in high-grade renal trauma from 50% to 13.8% over time, with an increase in embolization from 23,1% to 44,8%. In patients with isolated renal trauma, those treated with embolization increased from 28.6% to 69.2%, while those undergoing radical/partial nephrectomy decreased from 42.8% to 7.69%. CONCLUSION: The management of renal trauma has evolved over the years in our center. The number of patients treated by embolization has increased, while the number of complications and nephrectomies has decreased.

Randomized clinical trial on the use of IMAGE1 S LIGHT (SPIES) vs. white light in the prevention of recurrence during transurethral resection of bladder tumors: Analysis after 12-month follow-up.

INTRODUCTION: The improved image resolution of IMAGE1 S technology will increase tumor detection, achieve a greater number of complete resections, and would probably have an impact on the reduction of recurrences. AIM: The primary objective was to compare the recurrence rates of IMAGE1 S vs. white light during transurethral resection of the bladder (TUR); the secondary objective was to compare the complication rates according to Clavien-Dindo (CD) at 12 months of follow-up. METHODS: Prospective, randomized 1:1, blinded clinical trial. Recurrence and complication rates according to CD were analyzed using chi-square/U Mann-Whitney tests and recurrence-free survival (RFS) using Kaplan-Meier curves. The European Association of Urology (EAU) 2021 scoring model was used. RESULTS: The analysis included 103 participants; 49 were assigned to the IMAGE1 S group and 54 to the white light group. Recurrence rates were 12.2% and 25.9%, respectively (P = .080). The low and intermediate risk group had a lower recurrence rate with IMAGE1 S (7.7% vs. 30.8%, P = .003) and a higher RFS with IMAGE1 S (85.2% vs. 62.8% Log Rank: 0.021), with a Hazard Ratio of 0.215 (95% CI: 0.046-0.925). No differences were observed in the high and very high-risk groups. Complications were mostly grade I and rates were similar between both groups (IMAGE1 S 20.4% vs. white light 7.4% P = .083). CONCLUSIONS: There were no differences in the recurrence rates between groups. However, the low and intermediate risk group had a lower recurrence rate with IMAGE1 S. In addition, perioperative complication rates were not higher.

Vagus nerve dysfunction in the post-COVID-19 condition: a pilot cross-sectional study.

OBJECTIVES: The post-COVID-19 condition (PCC) is a disabling syndrome affecting at least 5%-10% of subjects who survive COVID-19. SARS-CoV-2 mediated vagus nerve dysfunction could explain some PCC symptoms, such as dysphonia, dysphagia, dyspnea, dizziness, tachycardia, orthostatic hypotension, gastrointestinal disturbances, or neurocognitive complaints. METHODS: We performed a cross-sectional pilot study in subjects with PCC with symptoms suggesting vagus nerve dysfunction (n = 30) and compared them with subjects fully recovered from acute COVID-19 (n = 14) and with individuals never infected (n = 16). We evaluated the structure and function of the vagus nerve and respiratory muscles. RESULTS: Participants were mostly women (24 of 30, 80%), and the median age was 44 years (interquartile range [IQR] 35-51 years). Their most prevalent symptoms were cognitive dysfunction 25 of 30 (83%), dyspnea 24 of 30 (80%), and tachycardia 24 of 30 (80%). Compared with COVID-19-recovered and uninfected controls, respectively, subjects with PCC were more likely to show thickening and hyperechogenic vagus nerve in neck ultrasounds (cross-sectional area [CSA] [mean ± standard deviation]: 2.4 ± 0.97mm2 vs. 2 ± 0.52mm2 vs. 1.9 ± 0.73 mm2; p 0.08), reduced esophageal-gastric-intestinal peristalsis (34% vs. 0% vs. 21%; p 0.02), gastroesophageal reflux (34% vs. 19% vs. 7%; p 0.13), and hiatal hernia (25% vs. 0% vs. 7%; p 0.05). Subjects with PCC showed flattening hemidiaphragms (47% vs. 6% vs. 14%; p 0.007), and reductions in maximum inspiratory pressure (62% vs. 6% vs. 17%; p ≤ 0.001), indicating respiratory muscle weakness. The latter findings suggest additional involvement of the phrenic nerve. DISCUSSION: Vagus and phrenic nerve dysfunction contribute to the complex and multifactorial pathophysiology of PCC.

Mid-Perineal Scrotal Flap for the Repair of Urorectal Fistulas: A New Technique.

Rectourethral fistula (RUF) is an infrequent but severe complication of the treatment of prostate cancer. Herein, we describe a new surgical approach used successfully in 3 patients that incorporates a partially de-epithelialized mid-perineal scrotal flap (MPSF), used as interposition flap, that can be used in almost every patient with RUF after radiotherapy, regardless of having or not a concomitant posterior urethra or bladder neck stricture or contracture that might require a simultaneous urethroplasty. The interposition flap includes well vascularized subcutaneous fat tissue by distal vascular branches of the internal pudendal vessels that reaches without tension the deep perineum up to the posterior bladder neck. The MPSF is a time efficient procedure that allows excellent access to the bulbar urethra and to the surgical plane between rectum and prostate and it does not require a separate incision for the flap harvesting procedure when required.

Quality of Life in Patients with High-grade Non-muscle-invasive Bladder Cancer Undergoing Standard Versus Reduced Frequency of Bacillus Calmette-Guérin Instillations: The EAU-RF NIMBUS Trial.

Background: Adverse events induced by intravesical bacillus Calmette-Guérin (BCG) to treat high-grade non-muscle-invasive bladder cancer (NMIBC) often lead to treatment discontinuation. The EAU-RF NIMBUS trial found a reduced number of standard-dose BCG instillations to be inferior with the standard regimen. Nonetheless, it remains important to evaluate whether patients in the reduced BCG treatment arm had better quality of life (QoL) due to a possible reduction in toxicity or burden. Objective: To evaluate whether patients in the EAU-RF NIMBUS trial experienced better QoL after a reduced BCG instillation frequency. Design setting and participants: A total of 359 patients from 51 European sites were randomized to one of two treatment arms between December 2013 and July 2019. The standard frequency arm (n = 182) was 6 weeks of BCG induction followed by 3 weeks of maintenance at months 3, 6, and 12. The reduced frequency arm (n = 177) was BCG induction at weeks 1, 2, and 6, followed by maintenance instillations at weeks 1 and 3 of months 3, 6, and 12. Outcome measurements and statistical analysis: Analyses were performed using an intention-to-treat analysis and a per-protocol analysis. QoL was measured using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 version 3.0 (QLQ-C30 v.03) prior to the first and last instillations of each BCG cycle. Group differences were determined using linear regression corrected for QoL at baseline. Differences in QoL over time were tested for significance using a linear mixed model. Side effects were recorded by the treating physician using a standardized form. Chi-square tests were used to compare the side-effect frequency between the arms. Results and limitations: There were no significant differences in the means of each QoL scale between the two arms. There were also no significant changes over time in all QoL domains for both arms. However, differences in the incidence of general malaise at T1 (before the last induction instillation), frequency, urgency, and dysuria at T7 (before the last maintenance instillation) were detected in favor of the reduced frequency arm. Conclusions: Reducing the BCG instillation frequency does not improve the QoL in NMIBC patients despite lower storage symptoms. Patient summary: In this study, we evaluated whether a reduction in the number of received bacillus Calmette-Guérin instillations led to better quality of life in patients with high-grade non-muscle-invasive bladder cancer. We found no difference in the quality of life between the standard and the reduced bacillus Calmette-Guérin instillation frequency. We conclude that reducing the number of instillations does not lead to better quality of life in patients with high-grade non-muscle-invasive bladder cancer.

Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study.

INTRODUCTION: Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. PATIENTS AND METHODS: An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. RESULTS: A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer. CONCLUSION: This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

Prostatitis: A Review.

PURPOSE OF REVIEW: Pathologies of the prostate in men are one of the most prevalent clinical conditions today [1]. Specifically, pelvic inflammatory disease such as prostatitis can cause symptoms and syndromes different from urological ones, such as bowel or nervous system manifestations. This has a largely negative impact on the quality of life of patients. Therefore, it is convenient to know and update the information about the therapeutic approach to prostatitis, which is a challenge that involves different medical specialties. The aim of this article is to provide summarized and focused evidence to help in the therapeutic approach of patients with prostatitis. A computer-based search of the PubMed and Cochrane Library databases was used to perform a comprehensive literature review on prostatitis, with special interest in recent findings and latest therapeutic guideline recommendations. RECENT FINDINGS: Recent discoveries about the epidemiology and clinical classifications of prostatitis seem to incur in an increasingly individualized and directed management, with the aim of covering all the confluent factors in prostatic inflammatory pathology. In addition, the role of new drugs and combination with phytotherapy open up a range of new treatment possibilities, although future randomized studies will be necessary to better understand how to use all treatment modalities. Despite all the knowledge acquired about the pathophysiology of prostate diseases, and due to their interrelation with other pelvic systems and organs, there are still gaps that make it difficult for us to provide an optimal and standardized treatment in many of our patients. Being aware of the influence of all the factors potentially involved in prostate symptoms is crucial for a correct diagnosis and establishing an effective treatment plan.

Genital Mutilation in Males.

PURPOSE OF THE REVIEW: Genital mutilation in males can range from minor injuries (cuts from a blade) to severe urological emergencies (testicular or penile amputation). Due to the rarity of these events, there is a lack of extensive reports, as most of the available literature is regarding single cases. Genital mutilation has been associated with psychotic and non-psychotic causes, psychiatric conditions, drug consumption, sexual practices, or even cultural or religious beliefs. It is crucial to perform a psychiatric evaluation of these patients to obtain the best therapeutic approach. This manuscript serves as a review of the currently available knowledge regarding male genital mutilation. RECENT FINDINGS: A great variety of reasons have been associated with genital mutilation. Previous authors have distinguished between those that present with a clear mental health precursor from cases with no psychotic background. Nevertheless, sometimes, it is difficult to make this distinction. Recently, reconstructive techniques for amputation cases have moved towards a microsurgical approach in order to improve outcomes. A holistic therapeutic approach must be performed to increase the chances of effective treatment. Close collaboration between urologists, psychiatrists, and emergency doctors is essential to ensure the best care for patients performing genital mutilation. Future publications must evaluate differences in treatment options and the impact that these have on the long-term well-being of patients undergoing genital self-mutilation.

CyTOF analysis identifies unusual immune cells in urine of BCG-treated bladder cancer patients.

High grade non-muscle-invasive bladder tumours are treated with transurethral resection followed by recurrent intravesical instillations of Bacillus Calmette Guérin (BCG). Although most bladder cancer patients respond well to BCG, there is no clinical parameter predictive of treatment response, and when treatment fails, the prognosis is very poor. Further, a high percentage of NMIBC patients treated with BCG suffer unwanted effects that force them to stop treatment. Thus, early identification of patients in which BCG treatment will fail is really important. Here, to identify early stage non-invasive biomarkers of non-responder patients and patients at risk of abandoning the treatment, we longitudinally analysed the phenotype of cells released into the urine of bladder cancer patients 3-7 days after BCG instillations. Mass cytometry (CyTOF) analyses revealed a large proportion of granulocytes and monocytes, mostly expressing activation markers. A novel population of CD15+CD66b+CD14+CD16+ cells was highly abundant in several samples; expression of these markers was confirmed using flow cytometry and qPCR. A stronger inflammatory response was associated with increased cell numbers in the urine; this was not due to hematuria because the cell proportions were distinct from those in the blood. This pilot study represents the first CyTOF analysis of cells recruited to urine during BCG treatment, allowing identification of informative markers associated with treatment response for sub-selection of markers to confirm using conventional techniques. Further studies should jointly evaluate cells and soluble factors in urine in larger cohorts of patients to characterise the arms of the immune response activated in responders and to identify patients at risk of complications from BCG treatment.

An Integrative Analysis of DNA Methylation Pattern in Myotonic Dystrophy Type 1 Samples Reveals a Distinct DNA Methylation Profile between Tissues and a Novel Muscle-Associated Epigenetic Dysregulation.

Myotonic dystrophy type 1 (DM1) is a progressive, non-treatable, multi-systemic disorder. To investigate the contribution of epigenetics to the complexity of DM1, we compared DNA methylation profiles of four annotated CpG islands (CpGis) in the DMPK locus and neighbouring genes, in distinct DM1 tissues and derived cells, representing six DM1 subtypes, by bisulphite sequencing. In blood, we found no differences in CpGi 74, 43 and 36 in DNA methylation profile. In contrast, a CTCF1 DNA methylation gradient was found with 100% methylation in congenital cases, 50% in childhood cases and 13% in juvenile cases. CTCF1 methylation correlated to disease severity and CTG expansion size. Notably, 50% of CTCF1 methylated cases showed methylation in the CTCF2 regions. Additionally, methylation was associated with maternal transmission. Interestingly, the evaluation of seven families showed that unmethylated mothers passed on an expansion of the CTG repeat, whereas the methylated mothers transmitted a contraction. The analysis of patient-derived cells showed that DNA methylation profiles were highly preserved, validating their use as faithful DM1 cellular models. Importantly, the comparison of DNA methylation levels of distinct DM1 tissues revealed a novel muscle-specific epigenetic signature with methylation of the CTCF1 region accompanied by demethylation of CpGi 43, a region containing an alternative DMPK promoter, which may decrease the canonical promoter activity. Altogether, our results showed a distinct DNA methylation profile across DM1 tissues and uncovered a novel and dual epigenetic signature in DM1 muscle samples, providing novel insights into the epigenetic changes associated with DM1.

[Usefulness of the g8 questionnaire in predicting frailty in elderly patients with metastatic or castration-resistant prostate cancer.] / Utilidad de cuestionario G8 en la predicción de fragilidad en pacientes ancianos con cáncer de próstata metastásico o resistente a castración.

OBJECTIVE: to assess the capacityof the G8 questionnaire for the detection of frailty inpatients over 75 years of age with metastatic or castrationresistant prostate cancer and the relationshipof the results of this questionnaire with clinical variables,laboratory data, quality of life, functional statusand comorbidity. MATERIAL AND METHODS: Patients over the ageof 75 with metastatic or castration-resistant prostatecancer were evaluated using the G8 questionnaire.Those with a G8 15 were subjected to comprehensivegeriatric assessment in order to evaluate the abilityof this questionnaire to predict frailty. We studiedthe relationship between G8 score and functionalstatus (ECOG), comorbidity (Charlson index), qualityof life (FACT-P and EQ5D 3L questionnaires), diseasecharacteristics and common analytical variables. RESULTS: 64 patients were included in the study,of whom 26 scored 15 in the G8 questionnaireand were referred to geriatrics. 89% (23/26) of thepatients with a G8 score pre-fragile and 7 fragile) and only 11% (3/26) wereconsidered robust. The multivariate model showsthat the Charlson index and the EQ5D 3L score areindependent predictors of frailty. The Charlson index(OR=1.68, p=0.022) increases the probability thatthe patient has a G8 score the EQ5D-3L score (OR-0.64, p-0.021) decreases thatprobability. Both quantitative variables were recodedinto binary variables from the most predictivepoint obtained from the ROC curves and included ina model: patients with Charlson index ≥4 (OR=3.17,p=0.047) and those with EQ5D- 3L score (OR=3.35, p=0.037) increased the likelihood of obtaininga G8 scoreconditions (neither Charlson ≥4 nor EQ5D-3L score 15. However, the presence of the two conditions increasesthe probability to 71.5%. CONCLUSIONS: The score obtained in the G8questionnaire is a good predictor of frailty in elderlypatients with advanced prostate cancer. Comorbidity,as measured by Charlson's index, and quality of life,as measured by the EQ5D-3L questionnaire, are independentpredictors of frailty (score on the G8 questionnairebelow 15).

OBJETIVO: Valorar la capacidad delcuestionario G8 para la detección de fragilidad enpacientes mayores de 75 años con cáncer de próstatametastásico o resistente a castración y la relación de losresultados de este cuestionario con variables clínicas,datos de laboratorio, calidad de vida, estado funcionaly comorbilidad.MATERIAL Y MÉTODOS: Se evaluó a pacientes ≥ 75años con cáncer de próstata metastásico o resistente acastración mediante el cuestionario G8. Aquellos conuna puntuación menor de 15 fueron sometidos a valoracióngeriátrica integral. Se evaluó la capacidad dedicho cuestionario para predecir fragilidad y se relacionaronlos hallazgos con el estado funcional (ECOG),comorbilidad (índice de Charlson), calidad de vida(cuestionarios FACT-P y EQ5D 3L), características de laenfermedad y variables analíticas habituales. RESULTADOS: Se incluyeron en el estudio 64 pacientes,de los cuales 26 obtuvieron una puntuación inferior a 15 en el cuestionario G8 y fueron remitidosal servicio de geriatría. El 89% (23/26) de los pacientescon una puntuación en el G8 por debajo de 15 presentabandatos de fragilidad (11 prefrágiles y 7 frágiles) ysolo el 11% (3/26) fueron considerados robustos. Elmodelo multivariado muestra, que de manera independiente,el índice de Charlson (OR=1,68, p=0,022)aumenta la probabilidad de que el paciente tenga unapuntuación en el cuestionario G8 por debajo de 15 y lapuntuación en el EQ5D-3L (OR=0,64, p=0,021) disminuyadicha probabilidad. Ambas variables cuantitativasse recodificaron en variables de tipo binario a partir delpunto más predictivo obtenido de las curvas ROC y seincluyeron en un modelo en el cual se objetivó, que pacientescon índice de Charlson ≥4 (OR= 3,17, p=0,047)y aquellos con puntuación en el cuestionario EQ5D-3Lde presentar una puntuación en el cuestionario G8Los pacientes que no presentan ninguna de estas condiciones(ni Charlson ≥4 ni EQ5D-3L score un 19% de probabilidad de presentar una puntuaciónen el cuestionario G8 condiciones aumenta la probabilidad hasta el 71,5%. CONCLUSIONES: La puntuación obtenida en elcuestionario G8 es un buen predictor de fragilidad enpacientes con cáncer de próstata avanzado con edad≥ 75 años. La comorbilidad, medida por el índice deCharlson, y la calidad de vida, medida por el cuestionarioEQ5D-3L, son predictores independientes de fragilidad,entendida como la obtención de una puntuaciónen el cuestionario G8 por debajo de 15.

[Analysis of renal tumor size as a predictive factor of oncological aggressiveness.] / Análisis del tamaño del tumor renal como factor predictivo de agresividad oncológica.

INTRODUCTION: The increased incidenceof diagnosis of kidney tumours has driveninvestigation in the area. It is known that the risk ofmalignancy is correlated with tumour size, but thereare still no specific and objective parameters to characterizethe degree of aggressiveness and to be ableto guide a treatment reliably. OBJECTIVE: To identify the relationship betweenrenal tumour size and the incidence of tumour aggressivecharacteristics. PATIENTS AND METHODS: A retrospective analysisof our series of renal cancers operated between 1998and 2018 was performed. The specific and cumulativeincidence of aggressive characteristics was studied.The following where considered as aggressive characteristics:Presence of sarcomatoid or epidermoiddifferentiation, tumour necrosis, stage pT3-4, histologicalhigh grade (3-4) and the presence of histologicalaggressive variants. RESULTS: A total of 651 patients that had undergonerenal mass surgery were analysed. In tumours below2 cm the appearance of aggressive characteristicsoccurred in less than 5%. For renal masses greaterthan 2 cm, each centimetre increase correlated with arise in cumulative incidence of 2-3% for each characteristicstudied. CONCLUSIONS: In tumours below 2cm and patientswith significant comorbidities active surveillance maybe a reliable alternative to surgery.

INTRODUCCIÓN: El aumento de incidenciade diagnóstico de tumores renales ha conllevadoun mayor estudio y conocimiento de los mismos.Se conoce que el riesgo de malignidad se correlacionacon el tamaño tumoral, pero seguimos sin tener parámetrosespecíficos y objetivos para caracterizar elgrado de agresividad de los mismos y poder orientarun tratamiento de forma fiable. OBJETIVO: Identificar la relación que existe entre eltamaño tumoral y la incidencia de características deagresividad.MATERIAL Y MÉTODOS: Análisis retrospectivo denuestra serie de cáncer renal intervenido quirúrgicamenteen el periodo entre 1998 y 2018. Se estudia laincidencia específica y acumulada de las característicasde agresividad en dichas lesiones y su relación conel tamaño tumoral. Se consideraron característicasde agresividad: la presencia diferenciación sarcomatoiode epidermoide, necrosis tumoral, estadio pT3-4,grado histológico alto (3-4) y la presencia de variantesde histología agresiva. RESULTADOS: Se analizan un total de 651 pacientesintervenidos por cáncer renal. En tumores por debajode 2 cm la aparición de características de agresividadse observó en menos del 5%. A partir de ese tamaño, laincidencia acumulada se incrementa en un 2-3% paracada característica con cada centímetro que aumentael tamaño tumoral. CONCLUSIONES: Este análisis demuestra que conformeaumenta el tamaño de los tumores renales, aumentala incidencia de características de agresividadde los mismos. En tumores por debajo de 2 cm y pacientescon comorbilidades importantes la vigilanciaactiva puede ser una alternativa con cierta seguridad.

Utilidad del cuestionario g8 en la predicción de fragilidad en pacientes ancianos con cáncer de próstata metastásico o resistente a castración / Usefulness of the g8 questionnaire in predicting frailty in elderly patients with metastatic or castration-resistant prostate cancer

OBJECTIVE: to assess the capacityof the G8 questionnaire for the detection of frailty inpatients over 75 years of age with metastatic or castration resistant prostate cancer and the relationshipof the results of this questionnaire with clinical variables, laboratory data, quality of life, functional statusand comorbidity.MATERIAL AND METHODS: Patients over the ageof 75 with metastatic or castration-resistant prostatecancer were evaluated using the G8 questionnaire.Those with a G8 < 15 were subjected to comprehensive geriatric assessment in order to evaluate the ability of this questionnaire to predict frailty. We studiedthe relationship between G8 score and functionalstatus (ECOG), comorbidity (Charlson index), qualityof life (FACT-P and EQ5D 3L questionnaires), diseasecharacteristics and common analytical variables.RESULTS: 64 patients were included in the study,of whom 26 scored < 15 in the G8 questionnaireand were referred to geriatrics. 89% (23/26) of thepatients with a G8 score <15 had fragility data (11pre-fragile and 7 fragile) and only 11% (3/26) wereconsidered robust. The multivariate model showsthat the Charlson index and the EQ5D 3L score areindependent predictors of frailty. The Charlson index(OR=1.68, p=0.022) increases the probability thatthe patient has a G8 score <15 and on the contrarythe EQ5D-3L score (OR-0.64, p-0.021) decreases thatprobability. Both quantitative variables were recoded into binary variables from the most predictivepoint obtained from the ROC curves and included ina model: patients with Charlson index ≥4 (OR=3.17,p=0.047) and those with EQ5D- 3L score <0.87(OR=3.35, p=0.037) increased the likelihood of obtaining a G8 score<15. Patients without any of theseconditions (neither Charlson ≥4 nor EQ5D-3L score<0.87) have a 19% chance of presenting a G8 score< 15. However, the presence of the two conditions increases the probability to 71.5%.

OBJETIVO: Valorar la capacidad delcuestionario G8 para la detección de fragilidad enpacientes mayores de 75 años con cáncer de próstatametastásico o resistente a castración y la relación de losresultados de este cuestionario con variables clínicas,datos de laboratorio, calidad de vida, estado funcionaly comorbilidad.MATERIAL Y MÉTODOS: Se evaluó a pacientes ≥ 75años con cáncer de próstata metastásico o resistente acastración mediante el cuestionario G8. Aquellos conuna puntuación menor de 15 fueron sometidos a valoración geriátrica integral. Se evaluó la capacidad dedicho cuestionario para predecir fragilidad y se relacionaron los hallazgos con el estado funcional (ECOG),comorbilidad (índice de Charlson), calidad de vida(cuestionarios FACT-P y EQ5D 3L), características de laenfermedad y variables analíticas habituales.RESULTADOS: Se incluyeron en el estudio 64 pacientes, de los cuales 26 obtuvieron una puntuación inferior a 15 en el cuestionario G8 y fueron remitidosal servicio de geriatría. El 89% (23/26) de los pacientescon una puntuación en el G8 por debajo de 15 presentaban datos de fragilidad (11 prefrágiles y 7 frágiles) ysolo el 11% (3/26) fueron considerados robustos. Elmodelo multivariado muestra, que de manera independiente, el índice de Charlson (OR=1,68, p=0,022)aumenta la probabilidad de que el paciente tenga unapuntuación en el cuestionario G8 por debajo de 15 y lapuntuación en el EQ5D-3L (OR=0,64, p=0,021) disminuya dicha probabilidad. Ambas variables cuantitativasse recodificaron en variables de tipo binario a partir delpunto más predictivo obtenido de las curvas ROC y seincluyeron en un modelo en el cual se objetivó, que pacientes con índice de Charlson ≥4 (OR= 3,17, p=0,047)y aquellos con puntuación en el cuestionario EQ5D-3L<0,87. (OR=3,35, p=0,037) aumentaban la probabilidadde presentar una puntuación en el cuestionario G8<15.Los pacientes que no presentan ninguna de estas condiciones (ni Charlson ≥4 ni

Análisis del tamaño del tumor renal como factor predictivo de agresividad Oncológica / Analysis of renal tumor size as a predictive factor of oncological aggressiveness

INTRODUCCIÓN: El aumento de incidencia de diagnóstico de tumores renales ha conllevado un mayor estudio y conocimiento de los mismos.Se conoce que el riesgo de malignidad se correlacionacon el tamaño tumoral, pero seguimos sin tener parámetros específicos y objetivos para caracterizar elgrado de agresividad de los mismos y poder orientarun tratamiento de forma fiable.OBJETIVO: Identificar la relación que existe entre eltamaño tumoral y la incidencia de características deagresividad.MATERIAL Y MÉTODOS: Análisis retrospectivo denuestra serie de cáncer renal intervenido quirúrgicamente en el periodo entre 1998 y 2018. Se estudia laincidencia específica y acumulada de las características de agresividad en dichas lesiones y su relación conel tamaño tumoral. Se consideraron característicasde agresividad: la presencia diferenciación sarcomatoiode, epidermoide, necrosis tumoral, estadio pT3-4,grado histológico alto (3-4) y la presencia de variantesde histología agresiva.RESULTADOS: Se analizan un total de 651 pacientesintervenidos por cáncer renal. En tumores por debajode 2 cm la aparición de características de agresividadse observó en menos del 5%. A partir de ese tamaño, laincidencia acumulada se incrementa en un 2-3% paracada característica con cada centímetro que aumentael tamaño tumoral.CONCLUSIONES: Este análisis demuestra que conforme aumenta el tamaño de los tumores renales, aumenta la incidencia de características de agresividadde los mismos. En tumores por debajo de 2 cm y pacientes con comorbilidades importantes la vigilanciaactiva puede ser una alternativa con cierta seguridad. (AU)

INTRODUCTION: The increased incidence of diagnosis of kidney tumours has driveninvestigation in the area. It is known that the risk ofmalignancy is correlated with tumour size, but thereare still no specific and objective parameters to characterize the degree of aggressiveness and to be ableto guide a treatment reliably. OBJECTIVE: To identify the relationship betweenrenal tumour size and the incidence of tumour aggressive characteristics.PATIENTS AND METHODS: A retrospective analysisof our series of renal cancers operated between 1998and 2018 was performed. The specific and cumulativeincidence of aggressive characteristics was studied.The following where considered as aggressive characteristics: Presence of sarcomatoid or epidermoiddifferentiation, tumour necrosis, stage pT3-4, histological high grade (3-4) and the presence of histologicalaggressive variants.RESULTS: A total of 651 patients that had undergone renal mass surgery were analysed. In tumours below 2 cm the appearance of aggressive characteristicsoccurred in less than 5%. For renal masses greaterthan 2 cm, each centimetre increase correlated with arise in cumulative incidence of 2-3% for each characteristic studied.CONCLUSIONS: In tumours below 2cm and patientswith significant comorbidities active surveillance maybe a reliable alternative to surgery. (AU)