Development of an immune-nutritional prognostic index in patients with muscle-infiltrating bladder cancer candidates for radical cystectomy.

INTRODUCTION: Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear. OBJECTIVE: Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1). MATERIAL AND METHODS: A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan-Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis. RESULTS: Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate-poor prognostic groups. CONCLUSION: The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT.

Elaboración de un índice pronóstico inmunonutricional en pacientes con cáncer de vejiga músculo-infiltrante candidatos a cistectomía radical / Development of an immune-nutritional prognostic index in patients with muscle-infiltrating bladder cancer candidates for radical cystectomy

Introducción El tumor vesical músculo-infiltrante (TVMI) tiene una supervivencia libre de recidiva (SLR) del 50% a los cinco años, la quimioterapia neoadyuvante (QTN) ha aumentado la misma un 8%, pero no está claro qué pacientes se pueden beneficiar en mayor grado de la misma. Objetivo Evaluar el valor pronóstico del estado inmunológico-nutricional en los pacientes con TVMI candidatos a cistectomía, y desarrollar un score que permita identificar precistectomía a los pacientes con peor pronóstico (pT3-4 y/o pN0-1). Material y método Se realizó un análisis retrospectivo de 284 pacientes con TVMI tratados con cistectomía radical. Se revisó la analítica preoperatoria y se calcularon índices inmunonutricionales. El método de Kaplan-Meier se utilizó para el cálculo de la SLR. Para el análisis multivariante se utilizó la regresión de Cox. Resultados Mediante análisis univariante se observó una relación estadísticamente significativa con el índice leucocito/linfocito (p = 0,0001), el índice neutrófilo/linfocito (p = 0,02) el índice pronóstico nutricional (p = 0,002), y el ratio plaqueta/linfocito (p = 0,002). En análisis multivariante, el ratio leucocito/linfocito (p = 0,002) y el IPN (p = 0,04) se comportaron como factores pronósticos independientes de disminución de SLR, y se elaboró con ello un score pronóstico que divide a los pacientes en tres grupos pronósticos. El 80% de los pacientes con tumores pT3-4 y/o pN0-1 se encontraban en los grupos de pronóstico medio-malo. Conclusión La incorporación en la práctica clínica de un score inmunonutricional precistectomía ayudaría a seleccionar a un grupo de pacientes con estadio patológico más desfavorable y peor SLR. Creemos que estos pacientes podrían beneficiarse en mayor medida de una QTN (AU)

Introduction Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear. Objective Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1). Material and methods A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan–Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis. Results Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate–poor prognostic groups. Conclusion The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT (AU)

Manejo quirúrgico de tumores en riñón en herradura. Revisión de la literatura y análisis de 2 casos / Surgical management of horseshoe kidney tumors. Literature review and analysis of two cases

Introducción: El riñón en herradura es una anomalía congénita poco frecuente en la población general que combina ectopia renal, malrotación y alteraciones en la vascularización. El tumor que más frecuentemente se desarrolla en estos casos es el carcinoma de células renales (50%).Una de sus características a destacar es la gran variabilidad en su anatomía, sobre todo a nivel vascular.Material y métodosPresentamos 2 casos de pacientes con diagnóstico de tumor renal en riñones en herradura, ambos tratados con nefrectomía parcial laparoscópica, llevados a cabo en nuestro servicio; y realizamos una revisión de la literatura actual.DiscusiónLas indicaciones de tratamiento quirúrgico en tumores en esta enfermedad son las mismas que en los riñones anatómicamente normales. Tradicionalmente, el tratamiento ha sido la cirugía abierta, siendo la heminefrectomía la cirugía de elección. En la actualidad se tiende a defender la cirugía conservadora de nefronas, y el abordaje laparoscópico ha adquirido más importancia progresivamente.ConclusiónEs fundamental realizar un estudio de imagen minucioso para una correcta planificación quirúrgica. (AU)

Introduction: The horseshoe kidney is a rare congenital anomaly in the general population that combines renal ectopia, malrotation and abnormal vascular supply. The most frequently developed tumor in this case is renal cell carcinoma (50%).One of its main characteristics is great anatomical variation, especially in terms of vascular structures.Material and methodsWe present two cases of patients with diagnosis of renal tumor in horseshoe kidneys, both treated with laparoscopic partial nephrectomy in our department. Additionally, we have carried a review of the current literature.DiscussionIndications for surgical treatment in this pathology are the same as in kidneys with normal anatomy. Traditionally, treatment has been open surgery, with heminephrectomy as surgery of choice. The current trend is to advocate nephron-sparing surgery, and the laparoscopic approach has been progressively gaining importance.ConclusionA thorough imaging study is essential for proper surgical planning. (AU)

Surgical management of horseshoe kidney tumors. Literature review and analysis of two cases.

INTRODUCTION: The horseshoe kidney is a rare congenital anomaly in the general population that combines renal ectopia, malrotation and abnormal vascular supply. The most frequently developed tumor in this case is renal cell carcinoma (50%). One of its main characteristics is great anatomical variation, especially in terms of vascular structures. MATERIAL AND METHODS: We present two cases of patients with diagnosis of renal tumor in horseshoe kidneys, both treated with laparoscopic partial nephrectomy in our department. Additionally, we have carried a review of the current literature. DISCUSSION: Indications for surgical treatment in this pathology are the same as in kidneys with normal anatomy. Traditionally, treatment has been open surgery, with heminephrectomy as surgery of choice. The current trend is to advocate nephron-sparing surgery, and the laparoscopic approach has been progressively gaining importance. CONCLUSION: A thorough imaging study is essential for proper surgical planning.