[Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases]. / Respuesta a la quimioterapia adyuvante post-cistectomía en pacientes con tumor de vejiga infiltrante:análisis de 397 casos.

OBJECTIVES: To define the usefulness of adjuvant chemo-therapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease. METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given. RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy significantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) patients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-specific survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality. CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to improve cancer-specific survival, adjuvant chemotherapy may be considered as a "protective factor" (RR=0.651, p=0.08).

Respuesta a la quimioterapia adyuvante post-cistectomía en pacientes con tumor de vejiga infiltrante: Análisis de 397 casos / Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases

OBJETIVO: Conocer la utilidad de la quimioterapia adyuvante en los pacientes con enfermedad pT2, pN0, pT3-4, pN0 y pN+.MÉTODOS: Análisis retrospectivo de 397 pacientes con cáncer transicional de vejiga tratados mediante cistectomía radical entre el año 1986 y 2005. Al 40,2% de los pacientes se les administró quimioterapia adyuvante. Se administraron 3 ciclos de MVAC adyuvante (metotrexate, vinblastina, adriamicina y cisplatino).RESULTADOS: En pacientes con estadio pT3, pN0 (p=0,04) y/o N+ (p=0,001), la quimioterapia adyuvante aumentó la supervivencia cáncer-específica de forma significativa, no siendo así en pacientes pT2N0 (p=0,9) y pT4, pN0 (p=0,6). En el análisis univariante la quimioterapia adyuvante se asoció de forma significativa con una menor supervivencia cáncer-específica (RR 1,452 IC 95%: 1,028- 2,057 p= 0,03) En el análisis multivariante presentó una tendencia (RR: 0,651 IC 95% 0,398-1,065, p=0,08) a la disminución de la mortalidad cáncer-específica.CONCLUSIONES: La quimioterapia adyuvante no demostró mejorar la supervivencia en pacientes con estadio pT0-2, pN0 y pT4, pN0. En cambio, la aumentó en los pacientes con enfermedad extravesical, estadio pT3, pN0 y/o pN+. Debido a la tendencia de la quimioterapia adyuvante a mejorar la supervivencia cáncer específica podemos considerarla como “protectora” (RR=0,651, p=0,08)(AU)

OBJECTIVES: To define the usefulness of adjuvant chemotherapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease.METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given. RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy signifi-cantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) pa-tients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-speci-fic survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality.CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to im-prove cancer-specific survival, adjuvant chemotherapy may be considered as a “protective factor” (RR=0.651, p=0.08)(AU)

Evaluación de la capacidad de irrigación y drenaje de tres sondas de lavado vesical / Evaluation of the irrigation and drainage capacity of 3 bladder irrigation catheters

Objetivo: Realizar una evaluación comparativa de tres tipos de sondas de lavado vesical con el fin de determinar cuál de ellas permitía un mayor flujo de entrada el líquido de lavado y de salida del líquido de la vejiga. Métodos: Se compararon tres tipos de sonda de tres vías, de un calibre 22 F, cuya principal diferencia fue el material de que estaban fabricadas: látex, silicona o polivinilo. Resultados: La sonda de polivinilo mostró una diferencia significativa tanto en el flujo de entrada como de salida del líquido de infusión respecto a los otros dos tipos de sonda (p= 0,000, ANOVA con test post hoc de Sheffe). La sonda de látex mostró además una disminución significativa del flujo de salida al inflar el balón autorretentivo. Conclusiones: La sonda de polivinilo, debido a la rigidez del material con que está fabricada, es la que un mayor flujo de lavado vesical permite (AU)

Objectives: To perform a comparative evaluation of three types of continuous bladder irrigation catheters with the aim of determining which of them allows greater irrigation solution inflow and bladder outflow. Methods: We compared three types of three-way catheters, 22F in caliber, being the material the main difference between them: latex, silicone, or polyvinyl. Results: The polyvinyl catheter showed significant differences both in inflow and outflow in comparison with the other two types of catheters (p =0,000, ANOVA test with Sheffe’s post hoc). Additionally, the latex catheter showed a significant outflow decrease with the insufflation of the self retentive balloon. Conclusions: The polyvinyl catheter, due to material rigidity, is the one that allows better bladder irrigation (AU)