TP53 mutation and tumoral PD-L1 expression are associated with depth of invasion in desmoplastic melanomas.

BACKGROUND: Desmoplastic melanoma (DM) is a rare subtype of spindle cell malignant melanoma characterized by frequent local recurrences and hematogenous spread, but without molecular classification. The aim of the study was to investigate in a DM series the incidence of relevant gene alterations in cancer, the programmed death-ligand 1 (PD-L1) expression status and the association with clinicopathological features and melanoma progression. METHODS: A total of 38 patients were included. Clinical follow-up and the histopathological features of all cases were retrospectively collected. PD-L1 expression by immunohistochemistry (IHC) and BRAF genomic alterations by real-time PCR were determined in 34 samples. Additionally, a molecular analysis by next-generation sequencing was performed in 25 DMs. RESULTS: Tumors occurred predominantly in men (76%) and in the head and neck region (50%). Most tumors were pure DMs (66%), containing less than 10% of conventional melanoma. Overall, 48% of our cohort harbored TP53 mutations, most of them showing a molecular signature associated with ultraviolet (UV)-oncogenesis, and 29%, BRAF mutations. A positive correlation between TP53 with depth of invasion (P=0.005) and presence of elastosis (P=0.002) was found. High-expression of PD-L1 in tumor cells was observed in 38% of cases and correlated with depth of tumoral infiltration (P=0.003), TP53 (P=0.016), PD-1 (P<0.001) and tumor-infiltrating lymphocytes (TILS) (P<0.001). PD-L1 expression in immune cells correlated with PD-1 (P=0.006), tumoral PD-L1 expression (P=0.029) and TP53 mutation (P=0.002). Survival correlated with depth of invasion (P=0.003), stage of tumors (P=0.015), positive sentinel lymph node (P=0.004), lymph node metastasis (P=0.024) and distant metastasis (P<0.001). CONCLUSIONS: Our results suggest that progressed DMs with deep tumoral infiltration frequently harbor TP53 mutations, PD-L1 expression and present a high inflammatory response, probably related to adaptive immune resistance in this tumor-type.

Comparison of the initial robot-assisted radical prostatectomy results with laparoscopic radical prostatectomy.

OBJECTIVES: To evaluate and compare the functional results of an established technique, laparoscopic radical prostatectomy(LRP), and the initial learning curve of robot assisted laparoscopic radical prostatectomy (RALRP). METHODS: This is a transversal case-control hybrid studio including all patients undergoing RALRP (39 ) and similar number of patients undergoing LRP (37) from November 2009 to June 2011. We used a transversal phone interrogatory to evaluate functional outcome. RESULTS: The groups were comparable for IMC, age, serum PSA, prostatic ultrasound volume, biopsy Gleason, following time and clinical stage. For operative variables, there was no difference in estimated blood loss, hospital stay, days of drainage, time to catheter removal, transfusion rate and surgical margins. Median operative time was 216 min for RALRP, and 153 min for LRP (p < 0,001). There were no differences in erectile function or continence at 12 months. Mean time to continence was 5.7 weeks in RALRP and 8.9 week in LRP (p < 0,001). There was no difference in time to normal erectile function. CONCLUSIONS: Even in the beginning of RALRP we did obtain results comparable to LRP.

Comparación de los resultados iniciales de la prostatectomía radical robótica frente a la laparoscopia convencional / Comparison of the initial robot-assisted radical prostatectomy results with laparoscopic radical prostatectomy

OBJETIVO: Evaluar y comparar los resultados funcionales entre una técnica estandarizada, la prostatectomía radical laparoscópica (PRL), y la curva de aprendizaje inicial de la prostatectomía radical laparoscópica asistida por robot (PRLaR). MÉTODOS: Este es un estudio de transversal híbrido de casos y controles de todos los pacientes sometidos a PRLaR (39) y un muestreo por densidad de similar número de pacientes sometidos a PRL (37), entre noviembre de 2009 y junio de 2011. Se realizó una encuesta telefónica transversal para evaluar los resultados funcionales. RESULTADOS: Los grupos fueron estadísticamente similares en cuanto a IMC, edad, PSA sérico, volumen prostático por ecografía, Gleason de la biopsia, tiempo de seguimiento y estadio clínico. En cuanto a variables quirúrgicas, no hubo diferencia en estimación de sangrado, estancia hospitalaria, días de drenaje, días de sonda vesical, transfusión sanguínea o márgenes quirúrgicos. El tiempo quirúrgico promedio fue de 216 min para la PRLaR y de 153 min para la PRL, (p<0,001). No hubo diferencia estadística en cuanto a función eréctil y continencia a los 12 meses. El tiempo de recuperación de continencia fue significativamente menor (p<0,001) en la PRLaR (5,7 sem) en comparación con la PRL (8,9 sem). No hubo diferencia en tiempo de recuperación de la función eréctil. CONCLUSIÓN: incluso en el inicio de la PRLaR obtuvimos resultados comparables a la PRL

OBJECTIVES: To evaluate and compare the functional results of an established technique, laparoscopic radical prostatectomy (LRP), and the initial learning curve of robot assisted laparoscopic radical prostatectomy (RALRP). METHODS: This is a transversal case-control hybrid studio including all patients undergoing RALRP (39) and similar number of patients undergoing LRP (37) from November 2009 to June 2011. We used a transversal phone interrogatory to evaluate functional outcome. RESULTS: The groups were comparable for IMC, age, serum PSA, prostatic ultrasound volume, biopsy Gleason, following time and clinical stage. For operative variables, there was no difference in estimated blood loss, hospital stay, days of drainage, time to catheter removal, transfusion rate and surgical margins. Median operative time was 216 min for RALRP, and 153 min for LRP (p<0,001). There were no differences in erectile function or continence at 12 months. Mean time to continence was 5.7 weeks in RALRP and 8.9 week in LRP (p<0,001). There was no difference in time to normal erectile function. CONCLUSIONS: Even in the beginning of RALRP we did obtain results comparable to LRP