Poorer outcome in Polynesian patients with prostate cancer treated with definitive conformational radiation therapy.

PURPOSE: To compare freedom from biochemical failure (FFBF) of French Polynesian (FP) and Native European (NE) prostate cancer patients after definitive conformal radiotherapy (RT). PATIENTS AND METHODS: Data were reviewed from medical records of 152 consecutive patients (46 FP and 106 NE) with clinically localised prostate cancer treated with definitive RT. Neoadjuvant androgen deprivation therapy (ADT) was used in 22% of cases. Definition for biochemical failure was a rise by 2 ng/mL or more above the nadir prostate-specific antigen (PSA) level. The median follow-up was 34 months. RESULTS: In comparison to NE patients, FP patients were younger (p=0.002) with a higher low-risk proportion (p=0.06). Probability of 5-year FFBF was 77% in the NE cohort and 58.0% in the FP cohort (p=0.017). Univariate analysis showed that FP ethnicity was associated with worse prognosis in high-risk tumours (p=0.004). Cox multivariate analysis showed that factors associated with FFBF were risk category (p<0.017), and FP origin (p=0.03), independently of ADT and radiation dose. CONCLUSION: FP ethnicity was an independent prognostic factor for biochemical relapse after definitive conformal RT for prostate cancer.

Subcutaneous pyelovesical bypass as replacement for standard percutaneous nephrostomy for palliative urinary diversion: prospective evaluation of patient's quality of life.

PURPOSE: To improve the quality of life of patients with palliative definitive percutaneous nephrostomy, we prospectively evaluated a subcutaneous ureteral bypass using a newly designed ureteral prosthesis. PATIENTS AND METHODS: A series of 19 patients receiving 27 subcutaneous tubes in replacement for percutaneous nephrostomy were evaluated. The ureteral prosthesis (Detour), a silicone tube glued inside a polyester tube, is inserted percutaneously into the renal pelvis to replace an established nephrostomy, tunneled subcutaneously, and introduced into the bladder through a small incision. All patients were followed every 3 months for 18 months or until death from tumor. Quality of life was assessed using the EORTC QLC-30 questionnaire; ultrasonography, intravenous urography, or both were used to assess the position and patency of the tubes. RESULTS: There was no failure of insertion and no operative or immediate complication. The mean follow-up was 7.8 months, 6.6 months for the 15 patients who died from their tumors and 1 year for the 4 patients still alive at the end of the study. Suprapubic parietal infection occurred in three patients with altered bladders (radiation cystitis or tumor progression). There was an improvement of the function scale as a result of the elimination of the external percutaneous tube and a parallel worsening of the symptom scale secondary to the progression of disease. Patient ratings of the global quality of life and satisfaction with the urinary diversion were improved because of the absence of the percutaneous tube. CONCLUSION: The subcutaneous pyelovesical bypass provides a better quality of life than a standard percutaneous nephrostomy tube in terminally ill patients by making them external-tube free.

[Prospective study of the quality of life after palliative urinary diversion by subcutaneous pyelovesical bypass (Detour ureteric prosthesis)]. / Etude prospective de la qualité de vie après dérivation urinaire palliative par pontage réno-vésical sous cutané (prothèse urétérale Detour).

OBJECTIVE: To prospectively evaluate the quality of life of cancer patients at the palliative stage after implantation of an extra-anatomical ureteric prosthesis as an alternative to permanent percutaneous nephrostomy (PCN). MATERIAL AND METHODS: A series of 27 prostheses in 19 patients with PCN was prospectively evaluated. The ureteric prosthesis (Detour) consists of two concentric tubes glued to each other. The inner tube is made of silicone and the outer tube is made of polyester. This prosthesis is introduced percutaneously into the renal pelvis as an alternative to nephrostomy. It is tunnelled subcutaneously and is introduced into the bladder via a short incision. Patients were reviewed every three months for 18 months or until death. The EORTC QLQ-C30 self-administered questionnaire was used to evaluate the patients' quality of life. The functioning and position of the prostheses were verified by ultrasound and/or intravenous urography (IVU). RESULTS: There were no failures of prosthesis placement and no intraoperative or early postoperative complications. Injection of the suprapubic incision was observed in 3 cases, in patients with pre-existing bladder disease (radiation cystitis or bladder tumour). The mean follow-up was 7.8 months: 6.6 months for the group of patients who died (15) and 12 months for the 4 patients still alive at the end of the study. Functional scores improved due to elimination of the external nephrostomy tube. In parallel, physical score deteriorated due to disease progression. Overall quality of life and index of satisfaction were improved by elimination of the external diversion. CONCLUSION: Subcutaneous pyelovesical diversion ensures a better quality of life than classical percutaneous nephrostomy in cancer patients at the palliative stage.

[Should frozen section examination be performed systematically as part of conservative surgery for renal cell carcinoma?]. / Faut-il faire un examen extemporané systématique lors d'une chirurgie conservatrice pour carcinome à cellules rénales?

OBJECTIVE: To prospectively assess the value of frozen section examination during conservative surgery for renal cell carcinoma (RCC) in exclusively elective indications and to evaluate the reality of safety margins. MATERIAL AND METHODS: From 1997 to 2001, 220 conservative procedures for RCC were performed in our department, including 104 elective lumpectomies, 61 of which were studied prospectively. The mean age of these 61 patients was 59.4 years (range: 34.2 to 78.5). The mean tumour diameter was 32 mm (range: 12 to 50). Tumours were peripheral in 51 cases and in a juxtahilar position in 10 cases. Resection margins were evaluated macroscopically by the surgeon, and the specimen was systematically sent for frozen section examination. Incomplete margins, i.e. negative but with no safety margin, were distinguished from positive margins on the final histological examination. The thickness of the safety margins was measured on the cortical and deep extremities of the operative specimen. The mean follow-up was 78.5 months (range: 52 to 101). RESULTS: Histological types of RCC comprised conventional clear cell (n = 42), tubulopapillary (n = 17) and chromophobe (n = 2), stage pT1 (n = 57) and pT2 (n = 4), and grade 1 (n = 16), 2 (n = 35) and 3 (n = 10). No positive margins were detected. The mean thickness of the safety margin was 7 mm peripherally and 2 mm in depth with no correlation between these two values. Surgeons concluded on the presence of 51 complete margins and 10 incomplete margins versus 53 and 8 on histological examination, respectively. Frozen section examination never modified the course of the operation. All patients were alive and recurrence free at last follow-up. CONCLUSION: Macroscopic evaluation of resection margins by the surgeon is precise and usually avoids the need for frozen section. However when the margins are considered to be incomplete by the surgeon, frozen section examination is mandatory to avoid positive margins, which must remain the main objective of conservative surgery.

[Left paravesical cystic urothelial tumour: an exceptional case?]. / Tumeur urothéliale kystique para-vésicale gauche: une observation exceptionnelle?

Pelvic cystic masses are frequent in women of childbearing potential and usually arise from the adnexae. The authors report a rare case of paravesical malformative cyst (Gartner cyst) with left silent kidney. In view of the unusual histology, comprising carcinoma in situ and a transitional cell papillary tumour with metastatic lymph node extension, the authors reviewed the literature on this subject and identified only one similar case (5).

Duffy blood group genotyping in French Basques using polymerase chain reaction with allele-specific primers (PCR-ASP).

Blood group antigens such as Duffy represent interesting models for population genetics studies. The distribution of the Duffy blood group was determined using PCR in a sample of Basque (n = 126) and non-Basque (n = 110) patients from the general hospital of the French Basque Country. The frequency of FY*A allele was significantly lower among autochthonous French Basques (P < 0.001). This result, obtained for the first time by PCR analysis in this population, was within the range of previous historical studies in various Basque subpopulations using traditional hemagglutination methods. When compared with European data, our Basque sample demonstrated the lowest FY*A/FY*B ratio, this fact confirming hemotypology data published before the molecular biology era. Our results with FY*X were quite similar to those reported in European populations.