Identification of mutations associated with acquired resistance to sunitinib in renal cell cancer.

Sunitinib is one of the most widely used targeted therapeutics for renal cell carcinoma (RCC), but acquired resistance against targeted therapies remains a major clinical challenge. To dissect mechanisms of acquired resistance and unravel reliable predictive biomarkers for sunitinib in RCC, we sequenced the exons of 409 tumor-suppressor genes and oncogenes in paired tumor samples from an RCC patient, obtained at baseline and after development of acquired resistance to sunitinib. From newly arising mutations, we selected, using in silico prediction models, six predicted to be deleterious, located in G6PD, LRP1B, SETD2, TET2, SYNE1, and DCC. Consistently, immunoblotting analysis of lysates derived from sunitinib-desensitized RCC cells and their parental counterparts showed marked differences in the levels and expression pattern of the proteins encoded by these genes. Our further analysis demonstrates essential roles for these proteins in mediating sunitinib cytotoxicity and shows that their loss of function renders tumor cells resistant to sunitinib in vitro and in vivo. Finally, sunitinib resistance induced by continuous exposure or by inhibition of the six proteins was overcome by treatment with cabozantinib or a low-dose combination of lenvatinib and everolimus. Collectively, our results unravel novel markers of acquired resistance to sunitinib and clinically relevant approaches for overcoming this resistance in RCC.

[Design and validation of a satisfaction questionnaire in patients with urolithiasis treated by extracorporeal shock wave lithotripsy (ESWL).] / Diseño y validación de un cuestionario de salud en pacientes con urolitiasis tratados mediante litotricia extracorpórea por ondas de choque (LEOC).

OBJECTIVES: Studying the psychosocial sphere of patients who undergo any treatment allows to have more information about its repercussion and can help the choice of an appropriate and personalized treatment. Due to the absence of specific instruments at present, the objective is to design and validate a health questionnaire regarding the treatment received with ESWL. METHODS: It was carried out in 6 phases using a sampleof 50 patients treated with ESWL in 2015 in ourcenter, whom we interviewed by telephone. In phase1 the items were proposed based on bibliographic review,in phase 2 those that scored below 7 were eliminatedaccording to the evaluation from 0 to 10 on theitems made by specialists. In phase 3, values of 1 to 5were assigned to each item and those with correctedcorrelation more than 0.2 and not significant (p>0.05)discriminant power with U-Mann Whitney were eliminated.In phase 4 the reliability of the questionnaire waschecked with two indexes (Cronbach's alpha and twoGuttman's halves). In phase 5, the factor analysis withVarimax rotation was performed to calculate the constructvalidity and in stage 6, the scores were analyzedto establish reference values. RESULTS: 50 patients (32 men, 18 women). Medianage 59 years (27-79). In phase 1, 35 items were proposed,9 of which were eliminated in phase 2. The initialquestionnaire with 26 items was distributed, with 18being eliminated in phase 3. The final questionnaire wasformed with 8 items. In phase 4 the results of Cronbach'salpha and Guttman's two halves index were 0.44 and0.323 respectively. In phase 5 after factor analysis, wefound 4 factors with 2 items each (background, impactof the acute picture, post-treatment, quality of life) able toexplain 71.19% of the variance. The median scores ofthe scale, extreme values and quartiles studied in phase6 were respectively: P50: 17 (minimum-maximum 9-25),P25: 14 and P75: 20. CONCLUSIONS: The study carried out has provided anew instrument for assessing satisfaction after treatmentwith ESWL with adequate reliability and validity values.Future studies will be necessary to contrast its true clinicalusefulness.

OBJETIVO: Estudiar la esfera psicosocial de los pacientes que se someten a algún tratamiento permite tener más información sobre la repercusión del mismo y puede ayudar a la elección de un tratamiento adecuado y personalizado. Debido a la ausencia deinstrumentos específicos actualmente, el objetivo es diseñary validar un cuestionario de salud en pacientes tratados con LEOC.MATERIAL Y MÉTODOS: Se realizó en 6 fases utilizando una muestra de 50 pacientes tratados con LEOC en 2015 en nuestro centro, a los que entrevistamos por vía telefónica. En la fase 1 se propusieron ítems a partir de revisión bibliográfica. En la fase 2 se eliminaron losque puntuaban por debajo de 7 según la valoración de 0-10 sobre los ítems efectuada por especialistas en la materia. En la fase 3 se asignaron valores de 1 a 5 a cada ítem y se eliminaron aquellos cuya correlación corregida fuera mayor de 0,2 y cuya potencia discriminante con U-Mann Whitney no fuera significativa (p>0,05). En la fase 4 se comprobó la fiabilidad del cuestionario con dos índices (alfa de Cronbach y dos mitades de Guttman). En la fase 5 se realizó el análisis factorial con rotación Varimax para el cálculo de la validez de constructo. Finalmente, en la fase 6 se tipificaron de las puntuaciones para establecer valores de referencia. RESULTADOS: 50 pacientes (32 hombres, 18 mujeres). Mediana edad 59 años (27-79). Fase 1: 35 ítems propuestos. Fase 2: 9 ítems eliminados. Distribución de cuestionario con 26 ítems. Fase 3: 18 ítems eliminados.Cuestionario final constituido por 8 ítems. Fase 4: valores de fiabilidad del cuestionario (alfa de Cronbach 0,44 e índice por técnica de dos mitades de Guttman 0,323). Fase 5: análisis factorial hallando 4 factores con 2 ítems cada uno (antecedentes, repercusión delcuadro agudo, post-tratamiento, calidad de vida) capaces de explicar el 71,19% de la varianza. Fase 6: mediana puntuación  50:17(mínimo-máximo 9-25), P25:14 y P75:20. CONCLUSIONES: El trabajo realizado ha proporcionado un nuevo instrumento de evaluación de salud tras tratamiento con LEOC con valores de fiabilidad y validez adecuados. Serán necesarios futuros estudios para contrastar su verdadera utilidad clínica.

Diseño y validación de un cuestionario de salud en pacientes con urolitiasis tratados mediante litotricia extracorpórea por ondas de choque (LEOC) / No disponible

Objetivo: Estudiar la esfera psicosocial de los pacientes que se someten a algún tratamiento permite tener más información sobre la repercusión del mismo y puede ayudar a la elección de un tratamiento adecuado y personalizado. Debido a la ausencia de instrumentos específicos actualmente, el objetivo es diseñar y validar un cuestionario de salud en pacientes tratados con LEOC. Material y métodos: Se realizó en 6 fases utilizando una muestra de 50 pacientes tratados con LEOC en 2015 en nuestro centro, a los que entrevistamos por vía telefónica. En la fase 1 se propusieron ítems a partir de revisión bibliográfica. En la fase 2 se eliminaron los que puntuaban por debajo de 7 según la valoración de 0-10 sobre los ítems efectuada por especialistas en la materia. En la fase 3 se asignaron valores de 1 a 5 a cada ítem y se eliminaron aquellos cuya correlación corregida fuera mayor de 0,2 y cuya potencia discriminante con U-Mann Whitney no fuera significativa (p>0,05). En la fase 4 se comprobó la fiabilidad del cuestionario con dos índices (alfa de Cronbach y dos mitades de Guttman). En la fase 5 se realizó el análisis factorial con rotación Varimax para el cálculo de la validez de constructo. Finalmente, en la fase 6 se tipificaron de las puntuaciones para establecer valores de referencia. Resultados: 50 pacientes (32 hombres, 18 mujeres). Mediana edad 59 años (27-79). Fase 1: 35 ítems propuestos. Fase 2: 9 ítems eliminados. Distribución de cuestionario con 26 ítems. Fase 3: 18 ítems eliminados. Cuestionario final constituido por 8 ítems. Fase 4: valores de fiabilidad del cuestionario (alfa de Cronbach 0,44 e índice por técnica de dos mitades de Guttman 0,323). Fase 5: análisis factorial hallando 4 factores con 2 ítems cada uno (antecedentes, repercusión del cuadro agudo, post-tratamiento, calidad de vida) capaces de explicar el 71,19% de la varianza. Fase 6: mediana puntuación 50:17(mínimo-máximo 9-25), P25:14 y P75:20. Conclusiones: El trabajo realizado ha proporcionado un nuevo instrumento de evaluación de salud tras tratamiento con LEOC con valores de fiabilidad y validez adecuados. Serán necesarios futuros estudios para contrastar su verdadera utilidad clínica

Objectives: Studying the psychosocial sphere of patients who undergo any treatment allows to have more information about its repercussion and can help the choice of an appropriate and personalized treatment. Due to the absence of specific instruments at present, the objective is to design and validate a health questionnaire regarding the treatment received with ESWL. Methods: It was carried out in 6 phases using a sample of 50 patients treated with ESWL in 2015 in our center, whom we interviewed by telephone. In phase 1 the items were proposed based on bibliographic review, in phase 2 those that scored below 7 were eliminated according to the evaluation from 0 to 10 on the items made by specialists. In phase 3, values of 1 to 5 were assigned to each item and those with corrected correlation more than 0.2 and not significant (p>0.05) discriminant power with U-Mann Whitney were eliminated. In phase 4 the reliability of the questionnaire was checked with two indexes (Cronbach’s alpha and two Guttman's halves). In phase 5, the factor analysis with Varimax rotation was performed to calculate the construct validity and in stage 6, the scores were analyzed to establish reference values. Results: 50 patients (32 men, 18 women). Median age 59 years (27-79). In phase 1, 35 items were proposed, 9 of which were eliminated in phase 2. The initial questionnaire with 26 items was distributed, with 18 being eliminated in phase 3. The final questionnaire was formed with 8 items. In phase 4 the results of Cronbach’s alpha and Guttman’s two halves index were 0.44 and 0.323 respectively. In phase 5 after factor analysis, we found 4 factors with 2 items each (background, impact of the acute picture, post-treatment, quality of life) able to explain 71.19% of the variance. The median scores of the scale, extreme values and quartiles studied in phase 6 were respectively: P50: 17 (minimum-maximum 9-25), P25: 14 and P75: 20. Conclusions: The study carried out has provided a new instrument for assessing satisfaction after treatment with ESWL with adequate reliability and validity values. Future studies will be necessary to contrast its true clinical usefulness

[Assessment and prevalence of urinary incontinence after radical prostatectomy: Analysis of a historical series]. / EVALUACIÓN Y PREVALENCIA DE INCONTINENCIA URINARIA TRAS PROSTATECTOMÍA RADICAL: ANÁLISIS DE UNA SERIE HISTÓRICA.

OBJECTIVES: Prostate cancer can be treated by radical prostatectomy and provoke urinary incontinence as secondary effect. Our aim is to calculate the prevalence of urinary incontinence, characteristics of leakage and influential factors, through a historical series. METHODS: We perform a descriptive, observational and retrospective study of 1310 patients who received treatment for PCa between 1989 and 2011. Prevalence was obtained after 12 months of recovery and using ICS definition. To complete ICIQ-SF and number of pads/day used we perform a cross-sectional study. The series is studied globally and divided in two groups according to oncologic characteristics. We perform a descriptive, comparative and predictive analysis. RESULTS: Prevalence of the series was 23.5%, 296 patients. 279 incontinent patients completed ICIQ-SF with a mean score of 11.1±4.03. 16.4% of the patients use 1 pad/day or none, 69% (11.4% of the total) use compress and 22% diapers. 8% of the total use more than 1 pad/day. Clinico-pathological factors divide series in two groups: 1989-1999 with a prevalence of 24.6% and 2000-2011 with 22.8%. Multivariate analysis shows influential factors: age (65 years) (OR:1.65, p=0.013) and prostate volume (50cc) (OR:1.49, p=0.029). CONCLUSIONS: Urinary incontinence is a disease with some prevalence that varies depending on definition. The most common situation was to leak several times a day (42.2%), a small amount (59.1%), using compress (69%) most of incontinents with a mild (0-7: 88.2%) impact on quality of life. Predictive factors were age (65 years) and prostate volume (50cc). The historical changes does not influence over prevalence.

Evaluación y prevalencia de incontinencia urinaria tras prostatectomía radical: análisis de una serie histórica / Assessment and prevalence of urinary incontinence after radical prostatectomy: analysis of a historical series

OBJETIVO: El tratamiento del cáncer de próstata mediante prostatectomía radical puede ocasionar incontinencia urinaria. Nuestro objetivo es calcular la prevalencia de incontinencia urinaria a través del análisis de una serie histórica, analizar las características de las pérdidas y los factores influyentes en la aparición de incontinencia. MÉTODOS: Estudio descriptivo, observacional y retrospectivo de las variables clinicopatológicas de 1310 pacientes intervenidos entre 1989-2011. La prevalencia se calcula a los 12 meses de la cirugía usando la definición de ICS. Estudio transversal para completar el cuestionario ICIQ-SF y las protecciones usadas. Se estudia la serie completa y en dos grupos según características oncológicas. Se realiza estudio descriptivo, comparativo y predictivo. RESULTADOS: La prevalencia de la serie es de 23.5% con 296 pacientes. 279 incontinentes completaron el cuestionario ICIQ-SF con una media de 11.1±4.03. 16.4% de los pacientes intervenidos usan al menos 1 protección al día, de ellos el 69% usan compresas (11.4% del total), y el 22% pañales clásicos. El 8% usa más de una protección al día. Las características clinicopatológicas dividen la serie en dos grupos distintos: 1989-1999 con una prevalencia de 24.6% y grupo 2000-2011 con 22.8%. El análisis multivariado encontramos la edad (65 años) (OR:1.65, p = 0.013) y volumen prostático (50cc) (OR:1.49, p = 0.029) influyentes de forma independiente. CONCLUSIONES: La incontinencia urinaria es una enfermedad de cierta prevalencia, que varía según la definición que utilicemos. La situación más frecuente en los pacientes incontinentes es tener pérdidas varias veces al día (42.2%), poca cantidad (59.1%), usando protecciones tipo compresa (69%) y afectando la calidad de vida de forma leve-moderada (0-7: 88.2%). Las variables predictivas fueron la edad (65 años) y el volumen prostático (50cc). La evolución histórica de los pacientes no influye en la prevalencia de incontinencia urinaria

OBJECTIVES: Prostate cancer can be treated by radical prostatectomy and provoke urinary incontinence as secondary effect. Our aim is to calculate the prevalence of urinary incontinence, characteristics of leakage and influential factors, through a historical series. METHODS: We perform a descriptive, observational and retrospective study of 1310 patients who received treatment for PCa between 1989 and 2011. Prevalence was obtained after 12 months of recovery and using ICS definition. To complete ICIQ-SF and number of pads/day used we perform a cross-sectional study. The series is studied globally and divided in two groups according to oncologic characteristics. We perform a descriptive, comparative and predictive analysis. RESULTS: Prevalence of the series was 23.5%, 296 patients. 279 incontinent patients completed ICIQ-SF with a mean score of 11.1±4.03. 16.4% of the patients use 1 pad/day or none, 69% (11.4% of the total) use compress and 22% diapers. 8% of the total use more than 1 pad/day. Clinico-pathological factors divide series in two groups: 1989-1999 with a prevalence of 24.6% and 2000-2011 with 22.8%. Multivariate analysis shows influential factors: age (65 years) (OR:1.65, p = 0.013) and prostate volume (50cc) (OR:1.49, p = 0.029). Concluisions: Urinary incontinence is a disease with some prevalence that varies depending on definition. The most common situation was to leak several times a day (42.2%), a small amount (59.1%), using compress (69%) most of incontinents with a mild (0-7: 88.2%) impact on quality of life. Predictive factors were age (65 years) and prostate volume (50cc). The historical changes does not influence over prevalence

Survival analysis of patients with biochemical relapse after radical prostatectomy treated with androgen deprivation: Castration-resistance influential factors.

INTRODUCTION: We evaluate the prognosis of patients with biochemical recurrence (BCR) treated with androgen deprivation therapy (ADT) and to determine the influential factors to castration resistance (CR) and death. METHODS: From a series of 1310 patients with T1-T2 prostate cancer treated with radical prostatectomy between 1989 and 2012, 371 had BCR. Patients with lymph node involvement were excluded. We analyzed only the 159 treated with salvage ADT. At the end of the study, 77 (48%) had developed CR. RESULTS: The median follow-up to CR was 9.2 years. The CR-resistant free survival (RFS) was 76 ± 3%, 62 ± 3% and 43 ± 9% in 5, 10 and 15 years, respectively. The RFS median time was 14 years. In the multivariate study, the prostate-specific antigen (PSA) doubling time (PSA-DT) was <6 months (p = 0.01) (hazard ratio [HR] 3; 95% confidence interval [CI] 1.4-6.8, p = 0.007); seminal vesicle involvement (HR 3.1; 95% CI 1.5-6.2, p = 0.01) and PSA velocity in ng/mL/year (HR 1.3; 95% CI 1.1-1.5, p = 0.002) with better cut-off points of 0.84 ng/mL/year (p = 0.04) (HR 4; 95% CI 1.7-9.4, p = 0.001) were influential variables. Specific survival (SS) at 5, 10 and 15 years since surgery was 96 ± 1, 85 ± 2 and 76 ± 4, respectively. The time of CR to death was 30 ± 6% at 5 years, with the median at 3.2 years. In the multivariate only Ki 67 (HR 1.04; 95% CI 1.005-1.08, p = 0.02) had an independent influence. CONCLUSIONS: In BCR patients treated with ADT, the median to CR was 14 years. PSA-DT <6 months, PSA velocity (ng/mL/year) and seminal vesicle involvement were influential variables. From the CR, the median time to death was 3.2 years. Ki-67 marker was an independent influence.

Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment.

Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney and perinephric space that carries a bad prognosis. Apart from its predisposing clinical entities, diabetes mellitus and immune-incompetence are quite common in patients with this infection. We report a case of a 53-year-old kidney transplant recipient diabetic male, suffering from recurrent fever, abdominal pain and nausea episodes. Immediate broad-spectrum antibiotics were administered and percutaneous drainage was performed after the diagnosis. The bacteria involved were Stahpylococcus epidermidis and Escherichia coli. After 4 weeks of antibiotic treatment and abscesses drainage, the case was resolved. Consecutives urine cultures and ultrasonographies confirm the complete resolution of the disease. We discuss the predisposing factors, clinical presentation and management.

Radical prostatectomy. Detailed surgical margins. Prognostic value of multifocal involvement in pT2 (+).

OBJECTIVES: We intend to analyze the prognostic value of positive surgical margins depending on their number and location in pT2 patients. METHODS: We analyze 448 (34.3%) patients with positive surgical margins from a series of 1,310 T1-T2 patients treated with radical prostatectomy between 1989-2012. Of them 164 are pT2 (+). 119 (72.6% ) have unifocal affectation (41 (34.5%) unifocal in right lobe; 35 (29.4%) unifocal in left lobe, 40 (33.6%) unifocal in apex, 3 (2.5% ) unifocal proximal) and 45 (27.4%) multifocal involvement. RESULTS: Unifocal and multifocal pT2(+)patients have not evidenced significant differences in any of the clinicopathologic variables compared. However the BPFS at 5 and 10 years is significantly worse in the multifocal group, (p<0.000) In the BPFS multivariate study of 164 pT2(+ )influential variables are: multifocal involvement (HR: 3.4; 95%IC 1.7-6.9 p<0.000) and PSA (HR: 1.03; 95%IC 1.02-1.05 p<0.000), being PSA >15 ng/ml )HR: 3.7; 95%IC 2.1-6.6 p<0.000 ( the best cut-off point. Risk groups: Using the independent influence variables, the best model (using Cox models ) includes two risk groups: Group 1 (0 variables): They are pT2(+) with unifocal affectation and PSA<15 ng/ml, (63%). Their BPFS are 81±4% and 77±4% (5 and 10 years). Grupo 2 (1-2 variables): They are pT2 (+) with multifocal involvement, PSA> 15 ng/ml or both of them, (37%). Their BPFS are 46±6% and 26±7% (5 and 10 years). The BPFS differs significantly between the two groups (p<0.000). The Group 1 BPFS is similar to the pT2 (-) patients, (p:0.242). The Group 2 BPFS is similar to the pT3(+) patients, (p:0.637). The model explained significantly better the BPFS than any of the individual variables analyzed. CONCLUSIONS: In pT2(+) patients the prognosis is significantly worse in multifocal involvement. In addition two groups of patients can be clearly distinguished from the BPFS point view according to their influential variables. The data suggest that since the prognostic point view the second group is understaged while the first is overstaged.

Prostatectomía radical. Margen quirúrgico pormenorizado. Valor pronóstico de la multifocalidad en pT2 con márgenes afectados / Radical prostatectomy. Detailed surgical margins. Prognostic value of multifocal involvement in pT2(+)

OBJETIVO: Pretendemos analizar en los pacientes pT2 con márgenes afectados el valor pronóstico real de los márgenes en función de su número y localización. MÉTODOS: Analizamos 448 (34,3%) pacientes con márgenes afectados de una serie de 1.310 pacientes T1-T2 tratados mediante prostatectomía radical entre 1.989-2.012. De ellos 164 son pT2(+), 119 (72,6%) tienen afectación unifocal 41 (34,5%) unifocal en lóbulo derecho; 35 (29,4%) unifocal en lóbulo izquierdo, 40 (33,6%) unifocal en ápex, 3 (2,5%) unifocal proximal) y 45 (27,4%) afectación multifocal. RESULTADOS: Los pT2(+) unifocales y multifocales no evidencian diferencias significativas en ninguna de las variables clínico-patológicas comparadas. Sin embargo la Supervivencia Libre de Progresión Bioquímica (SLPB) a 5 y 10 años es significativamente peor en el grupo multifocal, (p<0,000). En el estudio multivariado son influyentes en la SLPB de los 164 pT2(+): afectación multifocal (HR: 3,4; IC 95% 1,7-6,9 p<0,000) y PSA (HR: 1,03; IC 95% 1,02-1,05 p<0,000) siendo el mejor punto de corte, PSA >15 ng/ml (HR: 3,7; IC 95% 2,1-6,6 p<0,000). Grupos de Riesgo: Utilizando las variables de influencia independiente el mejor modelo utilizando los modelos de Cox incluye dos grupos de riesgo: Grupo 1 (0 variables presentes): Son pT2(+) con afectación unifocal y PSA<15 ng/ml, (63%). Su SLPB es 81±4% y 77±4% (5 y 10 años). Grupo 2 (1-2 variables presentes): Son pT2(+) con afectación multifocal, PSA>15 ng/ml o ambas, (37% restante). Su SLPB es 46±6% y 26±7% (5 y 10 años). La SLPB es significativamente diferente entre ambos grupos (p<0,000). La SLPB del Grupo 1 es similar a la de los pacientes pT2 márgenes (-), (p=0,242). La SLPB del Grupo 2 es similar a la de los pT3 márgenes (+), (p=0,637). El modelo explica significativamente mejor la SLPB que cualquiera de las variables analizadas individualmente (estudio multivariado, modelo de Cox). CONCLUSIONES: En los pT2(+) el pronóstico es significativamente peor cuando la afectación es multifocal. Además pueden diferenciarse claramente dos grupos de pacientes desde el punto de vista de la SLPB según sus variables influyentes. Los datos sugieren que desde el punto de vista del pronóstico el segundo grupo está infraestadiado mientras que el primero está sobreestadiado

OBJECTIVES: We intend to analyze the prognostic value of positive surgical margins depending on their number and location in pT2 patients. METHODS: We analyze 448 (34.3%) patients with positive surgical margins from a series of 1,310 T1-T2 patients treated with radical prostatectomy between 1989-2012. Of them 164 are pT2(+). 119 (72.6%) have unifocal affectation (41 (34.5%) unifocal in right lobe; 35 (29.4%) unifocal in left lobe, 40 (33.6%) unifocal in apex, 3 (2.5%) unifocal proximal) and 45 (27.4%) multifocal involvement. RESULTS: Unifocal and multifocal pT2(+) patients have not evidenced significant differences in any of the clinicopathologic variables compared. However the BPFS at 5 and 10 years is significantly worse in the multifocal group, (p<0.000). In the BPFS multivariate study of 164 pT2(+)influential variables are: multifocal involvement (HR: 3.4; 95%IC 1.7-6.9 p<0.000) and PSA (HR: 1.03; 95%IC 1.02-1.05 p<0.000), being PSA >15 ng/ml (HR: 3.7; 95%IC 2.1-6.6 p<0.000) the best cut-off point. Risk groups: Using the independent influence variables, the best model (using Cox models) includes two risk groups: Group 1 (0 variables): They are pT2(+) with unifocal affectation and PSA<15 ng/ml, (63%). Their BPFS are 81±4% and 77±4% (5 and 10 years). Grupo 2 (1-2 variables): They are pT2(+) with multifocal involvement, PSA>15 ng/ml or both of them, (37%). Their BPFS are 46±6% and 26±7% (5 and 10 years). The BPFS differs significantly between the two groups (p<0.000). The Group 1 BPFS is similar to the pT2(-) patients, (p:0.242). The Group 2 BPFS is similar to the pT3(+) patients, (p:0.637). The model explained significantly better the BPFS than any of the individual variables analyzed. CONCLUSIONS: In pT2(+) patients the prognosis is significantly worse in multifocal involvement. In addition two groups of patients can be clearly distinguished from the BPFS point view according to their influential variables. The data suggest that since the prognostic point view the second group is understaged while the first is overstaged

Radical prostatectomy. Prognostic value of positive surgical margins in pT2 patients.

OBJECTIVES: We intend to assess the prognostic influence of surgical margins on the biochemical progression free survival (BPFS) in patients classified as pT2 after radical prostatectomy. METHODS: We analyze a series of 1,132 T1-T2 patients with prostate cancer treated with radical prostatectomy between 1989-2009. PT3b, pT4 and patients with lymph node involvement were excluded from the series. The clinicopathologic variables and the BPFS of pT2(+), pT2(-) and pT3 patients are compared. The influential clinicopathologic variables in the BPFS are identified in the pT2(+) group and risk groups are designed. RESULTS: Of 1,051 patients evaluated finally: 598 (59,6) were pT2(-) 163 (15,5%) pT2(+)80 (7,6%) pT3a(-) and 210 (20%) pT3(+). Clinical characteristics of pT2(+). It is homogeneous with the pT2(-) group and significantly better than pT3(+) group in all the clinicopathologic variables evaluated. 5 and 10 year BPFS of the pT2(68 ± 3% and 57 ± 5%) is significantly worse than pT2( -)(87 ± 1% and 79 ± 2%), similar to pT3a(-) (75 ± 5% and 64 ± 7%and better than pT3(+) (44 ± 3% and (36 ± 3%) BPFS pT2(+) influential factors: Univariate study : Pathological Gleason score 7-10 (HR:2.1 95% IC: 1.1-4.1), (p=0.02)MRI that indicates T3 (HR:3.2 95%IC: 1.4-7.3), (p=0.04) PSA > 15 ng-ml (HR:4 95% IC: 2-8.2), (p < 0.0001) and high risk D'Amico group (HR:3.3 95%IC: 1.3-8.5), (p=0.01) are influential variables. A risk model with the involved variables can be designed. Each variable present is a point. Two groups are designed : Group 1 (0-1 variable) Group 2 (2-3 variables). 5 and 10 year BPFS for Group 1 are 71±5% and 69 ± 5%, and are 37 ± 12% and 22 ± 11% for Group 2. (p < 0.0001). CONCLUSIONS: Surgical margins in pT2 patients have independent influence in the BPFS. The group is heterogeneous and it can be divided into two risk groups accordingly to the BPFS influential variables: a larger group (86% pT2(+) with worse prognosis than pT2(-), and a smaller group (remaining 14%) with similar prognosis to pT3 (+).It is likely that pT2(+) patients are a mixture of understaged patients with others with iatrogenic margins or false margins due to poor assessment of the surgical specimen.

Prostatectomía radical. Valor pronóstico de los márgenes afectados en pacientes pT2 / Radical prostatectomy. Prognostic value of positive surgical margins in pT2 patients

OBJETIVO: Valorar en pacientes prostatectomizados y calificados como pT2, la influencia pronóstica sobre la Supervivencia Libre de Progresión Bioquímica (SLPB) de los márgenes afectados. MÉTODOS: Analizamos retrospectivamente una serie de 1.132 pacientes con cáncer de próstata T1-T2 tratados con prostatectomía radical entre 1.989-2.009. Se excluyen los pacientes con afectación de vesícula seminal, afectación ganglionar y pT4. Comparamos las variables clínico-patológicas y la SLPB de los pT2 (+) con pT2 (-) y pT3. Identificamos las variables clínico-patológicas influyentes en la SLPB de los pT2 (+) y con ellas diseñamos grupos de riesgo. RESULTADOS: De los 1.051 incluídos finalmente, 598 (59,6%) son pT2 (-); 163 (15,5%) pT2 (+); 80 (7,6%) pT3a (-) y 210 (20%) pT3 (+). Características clínicas de pT2 (+). Es homogéneo con el grupo pT2 (-) y significativamente mejor que los pT3(+) en todas las variables clínico-patológicas evaluadas. La (SLPB) de los pT2 (+) (68±3% y 57±5%) es significativamente peor que la de los pT2 (-) (87±1% y 79±2%), similar a los pT3a(-) (75±5% y 64±7%) y mejor que la de los pT3(+) (44±3% y 36±3%) en 5 y 10 años. Factores influyentes en SLPB en pT2 (+): Estudio univariado. Son influyentes: Gleason patológico 7-10 (HR:2,1; IC 95% 1,1-4,1), (p=0,02); RNM que indica T3 (HR:3,2; IC 95% 1,4-7,3), (p=0,04); PSA>15 ng/ml (HR:4; IC 95% 2-8,2), (p<0,0001) y D’Amico alto riesgo (HR:3,3; IC 95% 1,3-8,5), (p=0,01). Se diseña un modelo de riesgo con las variables implicadas. Cada variable presente es un punto. Se diseñan dos grupos: Grupo 1 (86%)(0-1 variable); Grupo 2 (14%)(2-3 variables). La SLPB del grupo 1 es a 5 y 10 años de 71±5% y 69±5% y la del grupo 2 es de 37±12% y 22±11%.(p<0,0001). CONCLUSIONES: La afectación de márgenes en pacientes pT2 tiene una influencia independiente en la SLPB. El grupo es heterogéneo y puede ser dividido según las variables influyentes en la SLPB en un grupo mayor (86% de pT2 (+)) con peor pronóstico que los pT2 (-), y un grupo menor (14 % restante) con pronóstico similar a pT3 (+). Es probable que los pacientes pT2 (+) sean una mezcla de pacientes infraestadiados con otros con márgenes y atrogénicos o falsos por mala valoración de la pieza operatoria (AU)

OBJECTIVES: We intend to assess the prognostic influence of surgical margins on the biochemical progression free survival (BPFS) in patients classified as pT2 after radical prostatectomy. METHODS: We analyze a series of 1,132 T1-T2 patients with prostate cancer treated with radical prostatectomy between 1989-2009. PT3b, pT4 and patients with lymph node involvement were excluded from the series. The clinicopathologic variables and the BPFS of pT2 (+), pT2 (-) and pT3 patients are compared. The influential clinicopathologic variables in the BPFS are identified in the pT2 (+) group and risk groups are designed.RESULTS: Of 1,051 patients evaluated finally: 598 (59,6%) were pT2 (-); 163 (15,5%) pT2 (+);80 (7,6%) pT3a (-) and 210 (20%) pT 3(+).Clinical characteristics of pT2 (+). It is homogeneous with the pT2(-) group and significantly better than pT3 (+) group in all the clinicopathologic variables evaluated. 5 and 10 year BPFS of the pT2 (+) (68±3% and 57±5%) is significantly worse than pT2 (-) (87±1% and 79±2%), similar to pT3a (-) (75±5% and 64±7%) and better than pT3 (+) (44±3% and 36±3%).BPFS pT2 (+) influential factors: Univariate study: Pathological Gleason score 7-10 (HR:2.1; 95% IC: 1.1-4.1), (p=0.02); MRI that indicates T3 (HR:3.2; 95%IC: 1.4-7.3), (p=0.04); PSA>15 ng/ml (HR:4; 95%IC: 2-8.2), (p<0.0001) and high risk D’Amico group (HR:3.3; 95%IC: 1.3-8.5), (p=0.01) are influential variables. A risk model with the involved variables can be designed. Each variable present is a point. Two groups are designed: Group 1 (0-1 variable); Group 2 (2-3 variables). 5 and 10 year BPFS for Group 1 are 71±5% and 69±5%, and are 37±12% and 22±11% for Group 2 (p <0.0001). CONCLUSIONS: Surgical margins in pT2 patients have independent influence in the BPFS. The group is heterogeneous and it can be divided into two risk groups accordingly to the BPFS influential variables: a larger group (86% pT2(+)) with worse prognosis than pT2(-), and a smaller group (remaining 14%) with similar prognosis to pT3 (+).It is likely that pT2(+) patients are a mixture of understaged patients with others with iatrogenic margins or false margins due to poor assessment of the surgical specimen (AU)

[Prostate adenocarcinoma. Predictive clinical model of seminal vesicle involvement]. / Adenocarcinoma de próstata. Modelo clínico predictivo de afectación de vesícula seminal.

OBJECTIVES: Our aim is to design a predictive model of seminal vesicle involvement. using clinical data. METHODS: We studied 1128 patients with clinically localized adenocarcinoma treated by radical prostatectomy (127 were pT3b). We identified (logistic regression) clinical variables related with pT3b. With the multivariate study influential variables a seminal vesicle involvement risk model is designed. RESULTS: Seminal vesicle involvement related factors: In univariate study: the influential variables are: Gleason 7 (OR:2);Gleason 8-10 (OR:4.5) T2 (OR:2.6); bilateral involvement in biopsy (OR:3.1); PSA 10-20 ng/ml ( OR:3.3); PSA >20 ng/ ml (OR:9.5). In the multivariate study are influential: Gleason 7 (OR:1.56) Gleason 8-10 ( OR: 3.4); T2 (OR:1.9); PSA 10-20 ng/ml (OR:3.1) and PSA >20 ng/,ml (OR:8.8). Predictive model: using multivariate logistic regression the weight of each variable is valued and a value between 1 and 4 is given. Gleason 2-6, T1; PSA<10 ng/ml value 1; Gleason 7; T2 y PSA 10-20 ng/ml value 2; Gleason 8-10 and PSA >20 ng/ml value 4. Each patient has a marker that fluctuates between 3 and 10. 5 Groups are designed with significantly different risks (p<0.05 in all cases ): Group 1 (3 points) (OR:1) (risk: 2.4% 95%IC 0.7%-4.3%) Group 2 (4 points) (OR:2.7) (risk: 6.5% 95%IC 5%-7.9%); Group 3(5-6 points) (OR:7.1)( risk:15% 95%IC 11%-19%) Group 4 ( 7--8 points) (OR:33.4) (risk: 45.5%; 95%IC 30%-59%) Group 5 (9-10 points) (OR:57.3) (risk: 58.8% 95%IC 35%- 82%). CONCLUSION: The clinical model allows an accurate approximation to the seminal vesicles involvement risk.

Adenocarcinoma de próstata. Modelo clínico predictivo de afectación de vesícula seminal / Prostate adenocarcinoma. Predictive clinical model of seminal vesicle involvement

OBJETIVOS: Se pretende diseñar utilizando los datos clínicos un modelo predictivo de afectación de vesícula seminal. MÉTODOS: Se estudian 1.128 pacientes con adenocarcinoma clínicamente localizado tratados mediante prostatectomía radical (127 son pT3b). Se identifican (regresión logística) las variables clínicas relacionadas con pT3b. Con las variables del estudio multivariado se diseña un modelo de riesgo de afectación de vesícula seminal. RESULTADOS: Factores relacionados con afectación de vesícula seminal: En estudio univariado: las variables influyentes son: Gleason 7 (OR:2); Gleason 8-10 (OR:4,5); T2 (OR:2,6); afectación bilateral en biopsia (OR:3,1); PSA 10-20 ng/ml (OR:3,3); PSA >20 ng/ml (OR:9,5). En el estudio multivariado son influyentes: Gleason 7 (OR:1,56); Gleason 8-10 (OR: 3,4); T2 (OR:1,9); PSA 10-20 ng/ml (OR:3,1) y PSA >20 ng/ml (OR:8,8). MODELO PREDICTIVO: mediante regresión logística multivariante se valora el peso de cada variable y se da un valor entre 1 y 4. Gleason 2-6, T1; PSA<10 ng/ml valor 1; Gleason 7; T2 y PSA 10-20 ng/ml valor 2; Gleason 8-10 y PSA >20 ng/ml valor 4. Cada paciente tiene un marcador que oscila entre 3 y 10. Se diseñan 5 grupos con riesgos significativamente diferentes (p<0,05 en todos los casos): Grupo 1 (3 puntos)(OR:1)(riesgo: 2,4%; IC95% 0,7%-4,3%). Grupo 2 (4 puntos) (OR:2,7)(riesgo: 6,5%; IC95% 5%-7,9%). Grupo 3 (5-6 puntos)(OR:7,1) (riesgo:15%; IC95% 11%-19%). Grupo 4 (7-8 puntos)(OR:33,4)(riesgo: 45,5%; IC95% 30%-59%). Grupo 5 (9-10 puntos)(OR:57,3)(riesgo: 58,8%; IC95% 35%-82%). CONCLUSIÓN: El modelo clínico permite una aproximación precisa al riesgo de afectación de vesículas seminales (AU)

OBJECTIVES: Our aim is to design a predictive model of seminal vesicle involvement. using clinical data. METHODS: We studied 1128 patients with clinically localized adenocarcinoma treated by radical prostatectomy (127 were pT3b). We identified (logistic regression) clinical variables related with pT3b. With the multivariate study influential variables a seminal vesicle involvement risk model is designed. RESULTS: Seminal vesicle involvement related factors: In univariate study: the influential variables are: Gleason 7 (OR:2);Gleason 8-10 (OR:4.5); T2 (OR:2.6); bilateral involvement in biopsy (OR:3.1); PSA 10-20 ng/ml (OR:3.3); PSA >20 ng/ml (OR:9.5). In the multivariate study are influential: Gleason 7 (OR: 1.56); Gleason 8-10 (OR: 3.4); T2 (OR:1.9); PSA 10-20 ng/ml (OR:3.1) and PSA >20 ng/ml (OR:8.8). Predictive model: using multivariate logistic regression the weight of each variable is valued and a value between 1 and 4 is given. Gleason 2-6, T1; PSA<10 ng/ml value 1; Gleason 7; T2 y PSA 10-20 ng/ml value 2; Gleason 8-10 and PSA >20 ng/ml value 4. Each patient has a marker that fluctuates between 3 and 10. 5 Groups are designed with significantly different risks (p<0.05 in all cases): Group 1 (3 points) (OR:1)(risk: 2.4%; 95%IC 0.7%-4.3%) Group 2 (4 points) (OR:2.7)(risk: 6.5%; 95%IC 5%-7.9%) Group 3 (5-6 points) (OR:7.1)(risk:15%; 95%IC 11%-19%) Group 4 (7-8 points) (OR:33.4)(risk: 45.5%; 95%IC 30%-59%) Group 5 (9-10 points) (OR:57.3)(risk: 58.8%; 95%IC 35%-82%). CONCLUSION: The clinical model allows an accurate approximation to the seminal vesicles involvement risk (AU)

Recipient and donor risk factors for surgical complications following kidney transplantation.

OBJECTIVE: The aim of this study was to evaluate recipient and donor risk factors that are related to surgical complications after renal transplantation. MATERIAL AND METHODS: In total, 419 kidney transplantations were analysed with regard to the influence of recipient and donor risk factors on the main postoperative surgical complications. RESULTS: The mean follow-up for the entire group was 72.8 months (± 54.2 SD). Vascular complications were independently associated with donor age; and urological complications with recipient age >65 years and cyclosporine rather than tacrolimus therapy. Wound complications were independently associated with recipient age, preoperative dialysis time, recipient body mass index (BMI) and cyclosporine rather than tacrolimus therapy. Collections were independently associated with retransplantation, type 2 diabetes mellitus and wound complications. Overall surgical complications were associated with donor age and delayed graft function. In terms of severity, grade I complications were independently associated with recipient age and surgical revision, grade II with recipient age >50 years, grade III with recipient BMI, and grade IV with donor age. CONCLUSIONS: Recipient characteristics are the primary determinants of wound, urological and minor (Clavien grades I, II and III) complications; however, graft or donor characteristics are the primary risk factors for vascular, overall and major (Clavien grade IV) surgical complications.