Factores predictivos del síndrome de retirada de abirateron / Predictive factors for abiraterone withdrawal syndrome

Introducción y objetivo: El síndrome de retirada de abiraterona (SRA) se caracteriza por un descenso transitorio de PSA tras la discontinuación del tratamiento con acetato de abiraterona (AA) en los pacientes diagnosticados de cáncer de próstata resistente a castración metastásico (CPRCm). El objetivo de nuestro estudio es identificar posibles factores predictivos al diagnóstico que puedan influir en el SRA. Materiales y métodos: Se realizó un estudio retrospectivo de los pacientes que recibieron tratamiento con AA en el Institut Català d'Oncologia - L'Hospitalet entre 2015 y 2017, obteniendo una muestra de 70 pacientes. Resultados: Presentaron SRA 11 pacientes. La edad media al diagnóstico fue 65,73 años y la edad media de presentación 74,18 años. El número de ciclo de tratamiento fue el noveno. La mediana de PSA al diagnóstico fue de 30,5ng/ml; la mediana de PSA en el SRA, 33,24 ng/ml; y la mediana de PSA antes de iniciar otro tratamiento, 15,78 ng/ml. La media de seguimiento tras SRA fue de 8,2 meses. Los factores predictivos del SRA serían PSA elevado (p = 0,002), ISUP ≥ 4 (p = 0,002) y estadio IV al diagnóstico (p < 0,001). El estadio T presenta un riesgo elevado, pero sin significación estadística. Se obtuvo una ABC ROC de 0,84, con un IC 95% entre 0,77 y 0,92 (p < 0,001). Conclusiones: La incidencia del SRA no es despreciable, describiendo respuestas prolongadas tras la retirada del AA, incluso la posibilidad de una mejoría en la supervivencia global. Estos resultados podrían suponer un cambio en el esquema de tratamiento del CPRCm

Introduction and objective: Abiraterone withdrawal syndrome (AWS) is characterized by a transient decrease in the PSA after abiraterone acetate (AA) treatment discontinuation in patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC). The aim of our study is to identify the possible predictive factors of AWS at diagnosis. Materials and methods: We performed a retrospective study of 70 patients treated with AA at the Institut Català d'Oncologia - L'Hospitalet between 2015 and 2017. Results: Eleven patients presented AWS. The mean age at diagnosis was 65.73 years and the mean age of presentation was 74.18 years. Patients were in the ninth treatment cycle. The median PSA was: 30.5 ng/ml at diagnosis, 33.24 ng/ml in the AWS, and 15.78 ng/ml before starting another treatment. The median follow-up period after AWS was 8.2 months. The predictive factors of AWS would be: high PSA (p = 0.002), ISUP ≥ 4 (p = 0.002) and stage IV at diagnosis (p<0.001). Patients with a T stage present high risk, but without statistical significance. An AUC of 0.84 was obtained, with a 95% CI between 0.77 and 0.92 (p < 0.001). Conclusions: The incidence of AWS is not negligible, describing prolonged responses after AA withdrawal, including the possibility of increased overall survival. These results could entail new treatment schemes for mCRPC

Predictive factors for abiraterone withdrawal syndrome. / Factores predictivos del síndrome de retirada de abiraterona.

INTRODUCTION AND OBJECTIVE: Abiraterone withdrawal syndrome (AWS) is characterized by a transient decrease in the PSA after abiraterone acetate (AA) treatment discontinuation in patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC). The aim of our study is to identify the possible predictive factors of AWS at diagnosis. MATERIALS AND METHODS: We performed a retrospective study of 70 patients treated with AA at the Institut Català d'Oncologia - L'Hospitalet between 2015 and 2017. RESULTS: 11 patients presented AWS. The mean age at diagnosis was 65.73 years and the mean age of presentation was 74.18 years. Patients were in the ninth treatment cycle. The median PSA was: 30.5ng/ml at diagnosis, 33.24ng/ml in the AWS, and 15.78ng/ml before starting another treatment. The median follow-up period after AWS was 8.2 months. The predictive factors of AWS would be: high PSA (p=.002), ISUP≥4 (p=.002) and stage IV at diagnosis (p<.001). Patients with a T stage present high risk, but without statistical significance. An AUC of 0.84 was obtained, with a 95% CI between 0.77 and 0.92 (p<.001). CONCLUSIONS: The incidence of AWS is not negligible, describing prolonged responses after AA withdrawal, including the possibility of increased overall survival. These results could entail new treatment schemes for mCRPC.

Research designs in clinical epidemiology

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Logistic regression models.

In the health sciences it is quite common to carry out studies designed to determine the influence of one or more variables upon a given response variable. When this response variable is numerical, simple or multiple regression techniques are used, depending on the case. If the response variable is a qualitative variable (dichotomic or polychotomic), as for example the presence or absence of a disease, linear regression methodology is not applicable, and simple or multinomial logistic regression is used, as applicable.

[Management of viral dermatologic lesions primary care]. / Manejo de lesiones dermatológicas virales desde atención primaria.

OBJECTIVE: To describe the characteristics of various viral tumoural lesions and their treatment by family doctors. DESIGN: Descriptive, retrospective study. SETTING: Urban health centre. PATIENTS: 225 patients registered at the centre. INTERVENTIONS: The following variables were collected over two years: sex, age, type of lesion, anatomical location and treatments used. MEASUREMENTS AND MAIN RESULTS: 51% of the sample were men, and 49% women. Almost half were between 15 and 34. The most common pathologies were common verrucas (72%), plantar warts (19%) and Molluscum contagiosum (8%). All the plantar warts were located on the lower limbs; condylomas and bowenoid papulosis on the genitals; 35% of the common verrucas on the head and neck (the rest on upper limbs); and 26% of the Molluscum contagiosum on the head and neck too (37% on the thorax and/or abdomen). All the genital lesions were treated medically. Cryotherapy was the most common treatment, used for all plantar warts, 53% of verrucas and 21% of the Molluscum contagiosum. Curettage was used on 80% of the Molluscum and 30% of the verrucas. 11% of the verrucas were sliced off. CONCLUSIONS: There are no conclusive data in the literature about the choice of technique for treating these lesions. We recommend cryotherapy for multiple lesions and in areas where surgery could have functional repercussions. Curettage seems effective for Molluscum contagiosum and where there is resistance to medical treatment.

Manejo de lesiones dermatológicas virales desde atención primaria / Handling viral skin lesions in primary care

Objetivo. Describir las características de diferentes lesiones tumorales virales y su tratamiento realizado por médicos de familia. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Centro urbano de salud. Pacientes. Un total de 225 pacientes adscritos al centro. Intervenciones. Durante 2 años se recogieron las siguientes variables: sexo, edad, tipo de lesión, localización anatómica y tratamientos utilizados. Mediciones y resultados principales. Un 51 por ciento de la muestra estaba constituida por varones y el 49 por ciento eran mujeres. Casi la mitad tenían 15-34 años. Las patologías más atendidas fueron verrugas vulgares (72 por ciento), verrugas plantares (19 por ciento) y Molluscum contagiosum (8 por ciento). Todas las verrugas plantares se localizaron en extremidades inferiores; los condilomas y papulosis bowenoide en genitales; en cabeza y cuello un 35 por ciento de las verrugas vulgares (el resto en extremidades superiores) y el 26 por ciento de los Molluscum contagiosum (el 37 por ciento en tórax y/o abdomen). El tratamiento médico se aplicó en todas las lesiones genitales. La crioterapia fue el método más empleado, utilizándose en todas las verrugas plantares, el 53 por ciento de las verrugas y el 21 por ciento de los Molluscum contagiosum. El curetaje se usó en el 80 por ciento de los Molluscum contagiosum y el 30 por ciento de las verrugas. El rebanado en el 11 por ciento de las verrugas. Conclusiones. No hay datos concluyentes en la bibliografía referentes a la elección de la técnica para tratar estas lesiones. Recomendamos la crioterapia en lesiones múltiples y en zonas donde la cirugía pueda tener repercusión funcional. El curetaje parece eficaz para el Molluscum contagiosum y en resistencias al tratamiento médico (AU)