El desabastecimiento de BCG para instilación intravesical se asocia a la recidiva tumoral precoz en pacientes con tumor vesical no-músculo invasor de alto riesgo / BCG shortage for intravesical instillation is associated with early tumor recurrence in patients with high-risk non-muscle-invasive bladder tumors

Introducción Durante 2019 se produjo una escasez mundial de cepas de BCG para instilación intravesical, limitando la disponibilidad de esquemas de dosis completas para la fase de mantenimiento. El objetivo principal del estudio fue analizar el impacto del desabastecimiento de BCG sobre la recidiva tumoral en nuestro centro. Los criterios de valoración secundarios incluyeron las tasas de recidiva y supervivencia libre de progresión y las características específicas de la recidiva tumoral. Métodos Estudio de cohortes retrospectivo que incluye a 158 sujetos (64 tratados durante 2019 y 94 durante 2017) con cáncer vesical no infiltrante de alto riesgo y tratados con una combinación de resección transuretral de vejiga (RTUV) seguida de instilación intravesical de BCG adyuvante en un hospital terciario de España. Se analizaron las características basales de ambos grupos. El periodo transcurrido hasta el evento de interés (recaída; incluyendo recurrencia o progresión) se estimó con el análisis de supervivencia de Kaplan-Meier. Las tasas de supervivencia libre de enfermedad se analizaron mediante un modelo multivariable de regresión de Cox de riesgos proporcionales. Resultados La mediana del tiempo de seguimiento fue de 24 y 50 meses en las muestras de 2019 y 2017, respectivamente, con una mediana del número de instilaciones de 8 y 12, respectivamente. Se observó una mediana de tiempo hasta la recurrencia de 285 días (145-448) durante 2019 y de 382 días (215-567) en 2017 (log-rank p=0,025). Un análisis multivariable adicional reveló un HR proporcional para la tasa de supervivencia libre de enfermedad de 1,87 (IC 95%: 1,04-3,37 p=0,036). No se observaron diferencias estadísticamente significativas en las características de la recaída tumoral (AU)

Introduction During 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression–free survival rates and tumoral relapse specific characteristics. Methods Retrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain. Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan-Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. Results Median follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145-448) during 2019 and 382 days (215-567) in 2017 were observed (logRank P=.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04-3.37 P=.036). No statistically significant differences in tumoral relapse characteristics were observed. Conclusion BCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses (AU)

BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours.

INTRODUCTION: During 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression-free survival rates and tumoral relapse specific characteristics. METHODS: Retrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain. Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan-Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. RESULTS: Median follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145-448) during 2019 and 382 days (215-567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04-3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. CONCLUSION: BCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

[Inverted urothelial papilloma: our clinical experience]. / Papiloma invertido urotelial: nuestra experiencia clínica.

UNLABELLED: A study of inverted urothelial papilloma in our area. METHODS: A study was conducted of inverted urothelial papillomas diagnosed at our center from January 1994 to December 2007. This was a retrospective and prospective study with a descriptive statistical analysis: urological history, reason for consultation, diagnostic methods, tumor focality, follow-up method, prognosis, and recurrence. SPSS software version 13 was used for statistical analysis. RESULTS: Fourteen inverted papillomas were diagnosed in the study period in patients with a median age of 59 years. The presenting complaint was hematuria in 7 patients (50%), followed by low back pain in 2 patients (14.28%), and irritative syndrome in 1 patient (7.14%). The tumor was incidentally diagnosed in 4 patients (28.5%). A single relapse/recurrence occurred in a low-grade tumor during the follow-up period. CONCLUSIONS: Prognosis, recurrence, and malignant potential of this tumor are unclear, and controversy exists in the literature on this subject. Thus, although we think this is a benign tumor, we advise follow-up as if it were a low-grade urothelial tumor.

Papiloma invertido urotelial: nuestra experiencia clínica / Inverted urothelial papilloma: Our clinical experience

Estudio de los papilomas invertidos uroteliales en nuestra área. Material y métodos: Realizamos un estudio de los papilomas invertidos uroteliales diagnosticados en nuestro centro entre enero de 1994 y diciembre de 2007. Se realizó un estudio retrospectivo y prospectivo con análisis estadístico descriptivo: antecedentes urológicos, motivo de consulta, método diagnóstico, focalidad tumoral, método de seguimiento, pronóstico y recurrencia. Se realizó un estudio estadístico con el software SPSS versión 13. Resultados: En el período de estudio se han diagnosticado 14 papilomas invertidos, con una mediana de 59 años. El motivo de consulta fue hematuria en 7 enfermos (50%), seguido de dolor lumbar en 2 enfermos (14,28%) y de síndrome irritativo en 1 enfermo (7,14%), fue diagnosticado en 4 enfermos (28,5%) de manera incidental. Durante el período de seguimiento sólo se produjo una recidiva/recurrencia en un tumor de bajo grado. Conclusiones: El pronóstico, la recurrencia y el potencial de malignización de este tumor no están claros, existiendo controversias en la literatura médica mundial, hecho por el cual aunque desde nuestro punto de vista su naturaleza es benigna, aconsejamos un seguimiento como si se tratase de un tumor urotelial de bajo grado (AU)

A study of inverted urothelial papilloma in our area. Methods: A study was conducted of inverted urothelial papillomas diagnosed at our center from January 1994 to December 2007. This was a retrospective and prospective study with a descriptive statistical analysis: urological history, reason for consultation, diagnostic methods, tumor focality, follow-up method, prognosis, and recurrence. SPSS software version 13 was used for statistical analysis. Results: Fourteen inverted papillomas were diagnosed in the study period in patients with a median age of 59 years. The presenting complaint was hematuria in 7 patients (50%), followed by low back pain in 2 patients (14.28%), and irritative syndrome in 1 patient (7.14%). The tumor was incidentally diagnosed in 4 patients (28.5%). A single relapse/recurrence occurred in a low-grade tumor during the follow-up period. Conclusions: Prognosis, recurrence, and malignant potential of this tumor are unclear, and controversy exists in the literature on this subject. Thus, although we think this is a benign tumor, we advise follow-up as if it were a low-grade urothelial tumor (AU)

[Penile cutaneous horn. Report of a case and review of the literature]. / Cuerno cutáneo peneano. A propósito de un caso y revisión de la literatura.

OBJECTIVE: To describe an additional case of cutaneous penile horn, an uncommon lesion that has been associated with penile neoplasia, particularly epidermoid carcinoma. METHODS/RESULTS: Herein we describe a patient with cutaneous horn of the penis that had presented several years earlier. The patient underwent wide resection and biopsy of the tumor site. To date, no signs of tumor recurrence have been observed. The literature is reviewed. CONCLUSIONS: Cutaneous horn of the penis is an uncommon lesion, but it must be emphasized that it can progress to squamous cell carcinoma. Biopsy of the tumor site should be performed carefully and patients should undergo regular control evaluation.