Frecuencia de PSA indetectable en pacientes con cáncer de próstata N+ baja carga tras prostatectomía radical y linfadenectomía ampliada / Undetectable PSA after radical prostatectomy is more likely in low burden N+ prostate cancer patients when an extended lymph node dissection is performed

Objetivos: Analizar la probabilidad de PSA indetectable (< 0,01 ng/ml) tras disección ampliada de los ganglios linfáticos pélvicos (DGLP-ampliada) versus disección estándar de los ganglios linfáticos (GL) pélvicos (DGLP-estándar) en pacientes pN+. Materiales y métodos: Se realizó una investigación en la base de datos institucional de cáncer de próstata para obtener información sobre pacientes que se sometieron a prostatectomía radical (PR) con DGLP, con hallazgos de 3 o menos metástasis ganglionares entre 2007 y 2017. La DGLP ampliada se definió de acuerdo con el número de GL. Los pacientes con un percentil 75 o superior de ganglios linfáticos extraídos conformaron el grupo DGLPa; los pacientes con un percentil 25 o inferior se adjudicaron al grupo DGLPe (DGLP estándar). Se compararon las variables clínicas y patológicas entre ambos grupos. Se utilizaron la prueba de la t de Student para comparar las variables continuas y la prueba de la chi al cuadrado para las variables categóricas. La regresión logística multivariable evaluó la probabilidad de PSA indetectable al tercer mes desde la operación. El método de Kaplan-Meier estimó la probabilidad de recurrencia bioquímica. Las diferencias entre los grupos se compararon mediante la prueba de log-rank. Resultados: De 1.478 pacientes tratados en el periodo considerado, se seleccionó a 95 con 3 o menos metástasis en los ganglios linfáticos. Tras aplicar los criterios de inclusión, 23 pacientes con una mediana de 11 GL extraídos se incluyeron en el grupo PGLPe (percentil 25) y 23 pacientes con > 27 GL se incluyeron en el grupo PGLPa (percentil 75). El tiempo quirúrgico fue más largo para el grupo de DGLPa. Dieciséis pacientes (69,6%) tratados con DGLPa presentaron PSA indetectable tras la operación. En el análisis multivariable, la probabilidad de PSA indetectable a los 3 meses fue mayor en los pacientes tratados con DGLPa (HR = 5,18; IC del 95%, 1,16-23,11; p = 0,03). Conclusiones: Independientemente de las características de la enfermedad, la DGLPa tiene más probabilidades de predecir un PSA indetectable al tercer mes tras la PR

Objectives: To analyze the likelihood of undetectable PSA (< 0.01 ng/mL) after extended (ePLND) versus standard pelvic lymph-nodes dissection (sPLND) in pN+ patients. Materials and methods: The institutional prospectively maintained Prostate Cancer Database was queried for patients who underwent radical prostatectomy with PLND and were found with 3or less lymph-nodal metastases between 2007 and 2017. The extension of the PLND was defined according to the number of lymph-nodes (LN) removed. Patients in the 75th or higher percentile of lymph-nodes removed were considered as the ePLND group; patients in the 25th or lower percentile in the sPLND group. Groups were compared in clinical and pathological variables. Student T-test was used for comparing continuous variables; chi-square test was used for categorical variables. Multivariable logistic regression assessed the probability of undetectable PSA at 3rd month postoperatively. Kaplan-Meier method estimated the probability of biochemical recurrence. Differences between the groups were compared by Log-rank test. Results: 1478 patients were treated within the time span considered. 95 with 1 to 3 lymph-nodal metastases were extracted. After accounting for inclusion criteria, 23 patients with a median of 11 LN removed were included in the sPLND group (25th percentile); 23 patients with > 27 LN were included in ePLND group (75th percentile). Surgical time was longer for ePLND. Sixteen patients (69.6%) who underwent ePLND had undetectable PSA postoperatively. At multivariable analysis, the probability of undetectable PSA at 3rd month was higher in patients who received an ePLND (HR = 5.18; IC 95% = 1.16-23.11; P = .03). Conclusions: ePLND is more likely to predict undetectable PSA at third month after radical prostatectomy, irrespective of disease characteristics

Undetectable PSA after radical prostatectomy is more likely in low burden N+ prostate cancer patients when an extended lymph node dissection is performed. / Frecuencia de PSA indetectable en pacientes con cáncer de próstata N+ baja carga tras prostatectomía radical y linfadenectomía ampliada.

OBJECTIVES: To analyze the likelihood of undetectable PSA (< 0.01 ng/mL) after extended (ePLND) versus standard pelvic lymph-nodes dissection (sPLND) in pN+ patients. MATERIALS AND METHODS: The institutional prospectively maintained Prostate Cancer Database was queried for patients who underwent radical prostatectomy with PLND and were found with 3or less lymph-nodal metastases between 2007 and 2017. The extension of the PLND was defined according to the number of lymph-nodes (LN) removed. Patients in the 75th or higher percentile of lymph-nodes removed were considered as the ePLND group; patients in the 25th or lower percentile in the sPLND group. Groups were compared in clinical and pathological variables. Student T-test was used for comparing continuous variables; chi-square test was used for categorical variables. Multivariable logistic regression assessed the probability of undetectable PSA at 3rd month postoperatively. Kaplan-Meier method estimated the probability of biochemical recurrence. Differences between the groups were compared by Log-rank test. RESULTS: 1478 patients were treated within the time span considered. 95 with 1 to 3 lymph-nodal metastases were extracted. After accounting for inclusion criteria, 23 patients with a median of 11 LN removed were included in the sPLND group (25th percentile); 23 patients with > 27 LN were included in ePLND group (75th percentile). Surgical time was longer for ePLND. Sixteen patients (69.6%) who underwent ePLND had undetectable PSA postoperatively. At multivariable analysis, the probability of undetectable PSA at 3rd month was higher in patients who received an ePLND (HR=5.18; IC 95%=1.16-23.11; P=.03). CONCLUSIONS: ePLND is more likely to predict undetectable PSA at third month after radical prostatectomy, irrespective of disease characteristics.

[Focal Laser Ablation and Photodynamic Vascular Therapy with soluble TOOKAD® in the treatment of low risk prostate cancer]. / Ablación Focal con Láser y Terapia Vascular Fotodinámica con TOOKAD® soluble, en el tratamiento del cáncer de próstata de bajo riesgo.

The increase of the diagnosis of low risk prostate cancer translates into a new clinical entity, for which active surveillance may not be always enough and conventional therapies are clearly overtreatment. Faced with the necessity of giving a therapeutic answer to these patients, and facilitated by the technological advances in the imaging field and new energy sources, the interest is centered in the clinical development of focal therapies as an alternative with minimal morbidity and oncologically safe. As a part of the review carried out in this monographic issue, this article focus on the features relative to the preclinical and clinical development of laser ablative therapy and the innovative photodynamic vascular therapy with soluble TOOKAD®. With this aim we performed an exhaustive bibliographic search, updated to February 2016, in the greater databases, including original articles and reviews in reference to the object of this review, without restrictions for year of publication. This article reviews the preclinical and clinical development of these innovative ablative techniques in the field of focal therapy for low risk prostate cancer.

[Non-invasive diagnosis of prostate cancer: serum and urine markers]. / Diagnóstico no invasivo del cáncer de próstata; marcadores séricos y en orina.

The great number of biomarkers basic research is presenting in different clinical scenarios of prostate cancer demands the scientific community rigor in their molecular and clinical development for the selection of those which could supply diagnostic and prognostic information for the established nomograms of clinical-pathological factors. Prostate cancer, due to its prevalence and heterogeneity, needs a more directed diagnosis, characterization of malignant potential and monitoring of its multiple therapies. In this review article we try to go over the recent incorporation of new serum and urine markers in the clinical management of this tumor, emphasizing those with greater clinical development.

Diagnóstico no invasivo del cáncer de próstata: marcadores séricos y en orina / Non-invasive diagnosis of prostate cancer: serum and urine markers

El gran número de biomarcadores que la investigación básica plantea en distintos escenarios clínicos de cáncer de próstata (CaP) exige de la comunidad científica un rigor en su desarrollo molecular y clínico para la selección de aquellos que puedan aportar información diagnóstica o pronóstica a los nomogramas de factores clínico-patológicos establecidos. El CaP necesita por su prevalencia y heterogenicidad un diagnóstico más dirigido, la caracterización de su potencial maligno y la monitorización de sus múltiples tratamientos. En este artículo de revisión pretendemos repasar la reciente incorporación de nuevos biomarcadores séricos y en orina en el manejo clínico de este tumor, haciendo hincapié en aquellos con mayor desarrollo clínico (AU)

The great number of biomarkers basic research is presenting in different clinical scenarios of prostate cancer demands the scientific community rigor in their molecular and clinical development for the selection of those which could supply diagnostic and prognostic information for the established nomograms of clinical-pathological factors. Prostate cancer, due to its prevalence and heterogeneity, needs a more directed diagnosis, characterization of malignant potential and monitoring of its multiple therapies. In this review article we try to go over the recent incorporation of new serum and urine markers in the clinical management of this tumor, emphasizing those with greater clinical development (AU)

¿Está justificada la cistectomía radical en pacientes mayores de 75 años? / Is radical cystectomy justified in patients over 75 years old?

Introducción y objetivos: La cistectomía radical es el tratamiento de elección en el tumor vesical infiltrante. Los objetivos de este trabajo son evaluar las complicaciones intraoperatorias y postoperatorias de la cistectomía radical, así como el intervalo libre de enfermedad y supervivencia cáncer especifica en pacientes con edad superior a 75 años y compararlos con los resultados en pacientes de menor edad. Material y Métodos: Entre agosto de 1980 y octubre de 2004, se realizaron 495 cistectomías radicales. De ellas se excluyeron las cirugías realizadas con intención paliativa. Los pacientes fueron divididos en dos grupos: menores de 75 años (grupo control) y pacientes con edad igual o superior (grupo mayores de 75 años). En todos los casos se realizó cistectomía radical y linfadenectomía pélvica. Resultados: Se evaluaron 402 pacientes, de los cuales 39 fueron pacientes mayores de 75 años (edad media: 76 años) y 363 pacientes control (edad media: 62 años), con una media de seguimiento de 38 y 64 meses respectivamente. Treinta y un pacientes mayores de 75 años (80,4%) y 211 pacientes control (58,2%) tuvieron un tumor no-órgano confinado (pT3-pT4) (p=0,0096). Diez pacientes mayores de 75 años (28,6%) y 111 pacientes control (31,4%) tenían ganglios positivos (p=0,84). No hubo diferencias en la tasa de complicaciones quirúrgicas (p=0.08), reintervención (p=0,58) y mortalidad postoperatoria (p=0,28). Once pacientes mayores de 75 años (28%) y 50 pacientes control (13,8%) tuvieron alguna complicación médica postoperatoria (p=0,03). Catorce pacientes mayores de 75 años (35,9%) y 104 pacientes control (39,4%) murieron debido a su tumor (p=0,73), sin diferencias en la supervivencia cáncer específica ni en el tiempo hasta la progresión. Conclusiones: La cistectomía radical es un tratamiento adecuado en pacientes mayores de 75 años, sin diferencias con la población general en relación a las complicaciones quirúrgicas, intervalo libre de enfermedad y supervivencia cáncer específica. No obstante, es necesario evaluar la comorbilidad preoperatoria dado el aumento de complicaciones médicas postoperatorias (AU)

Introduction and objectives: Radical cystectomy is the standard treatment for invasive bladder cancer. The objectives are to evaluate intraoperative and postoperative complications and to determine overall disease-free interval and overall time to progression in patients over tha age of 75 and to compare these with younger patients. Material and methods: Between august 1980 and october 2004 , 495 patients underwent radical cistectomy. Patients with palliative surgery were excluded. Patients were divided in two groups according to age: control group (<75 years old) and elderly group (>=75 years old). Results: Four hundred and two patients were evaluated: 39 patients (35 male and 5 female) in the elderly group and 363 in the control group (321 males and 42 females). Mean age was 76 (range: 75-82) and 62 (range: 35-74) respectively. Mean followup was 38 months in the elderly group and 64 months in the control group. Thirty one patients (80.4%) in the elderly group and 211 patients (58.2%) in the control had non organ-confined tumour in cystectomy specimen (pT3-pT4) (p=0.0096) and ten patients (28.6%) in the elderly and 111 patients (31.4%) in the control group had positive nodes(p=0.84).There were no differences in postoperative surgical complications (p=0.08), postoperative reoperation rate (p=0.58) and postoperative mortality (p=0.28) in both groups. During postoperative time, 11 patients(28%) in the elderly group and 50 patients (13.8%) in the control had medical complications (p=0.03).Fourteen patients (35.9%) in the elderly group and 104 patients (39.4%) in the control group died due to tumour during follow-up(p=0.73). Kaplan-Meier survival curve revealed no differences between two groups in overall disease-free interval and overall time to progression. Conclusions: Radical cystectomy is a safe and effective treatment in elderly patients with invasive bladder cancer. It is necessary to evaluate co-morbidity in this group because there is an increase in postoperative medical complications. There were no differences between the two groups in overall disease-free interval and overall time to progression (AU)

[Radical laparoscopic nephrectomy]. / Nefrectomía radical laparoscópica.

In this article, we review the different surgical approaches to carry out radical laparoscopic nephrectomy: transperitoneal approach, retroperitoneal approach and hand-assisted approach. We describe the advantages and drawbacks of each alternative and summarize the most important references in the medical literature. In spite of this being a relatively new surgical approach, less than 15 years old, it has become a standard treatment and, today, is considered as the elective surgical treatment for T1 and T2 renal tumours in many centres.

Nefrectomía radical laparoscópica / Radical laparoscopic nephrectomy

Revisamos en este artículo los distintas abordajes quirúrgicos para realizar una nefrectomía radical laparoscópica, la vía transperitoneal, la retroperitoneal, así como la mano-asistida. Describimos las ventajas e inconvenientes de cada una de estas alternativas así como resumimos los citas bibliográficas más importantes en la literatura médica con respecto a las mismas. A pesar de que es una cirugía con una corta existencia, menos de 15 años, ha conseguido convertirse en un estándar de tratamiento y hoy puede considerarse en muchos centros como la cirugía de elección en tumores de riñón T1 y T2

In this article, we review the different surgical approaches to carry out radical laparoscopic nephrectomy: transperitoneal approach, retroperitoneal approach and hand-assisted approach. We describe the advantages and drawbacks of each alternative and summarize the most important references in the medical literature. In spite of this being a relatively new surgical approach, less than 15 years old, it has become a standard treatment and, today, is considered as the elective surgical treatment for T1 and T2 renal tumours in many centres

[Treatment of post radical prostatectomy erectile dysfunction with sildenafil in a non-selected group of patients]. / Tratamiento de la disfunción eréctil tras prostatectomía radical con sildenafilo en un grupo no seleccionado de pacientes.

OBJECTIVE: To evaluate erectile disfunction (ED) after radical prostatectomy in a non selected group of patients and their response to sildenafil. METHODS: We included our patients who were operated on between 1998 and 2001. The patients filled in a modification of IIEF (mIIEF) before the RP operation. We tried sildenafil with doses of 100 mg in 3 different periods: 3-6, 12 and 18-24 months after the RP operation. In the event of a complete response they filled in the mIIEF again. RESULTS: The mean age of the patients was 62.8 years old and the mean observation period was 31.7 months. Only 111 (62%) of the total number of patients operated on wanted treatment and only 90 took sildenafil in the proposed protocol; 27 (30%), 18 (20%) and 45 (50%) patients had a complete response, a partial response or no response to the sildenafil respectively. The mIIEF showed 6.5+/-5.7 points less than the mIIEF pre-treatment. In the univariate analysis, the preservation of bundles, the presence of a previous partial response and the presence of the previous tumescence were significantly related to the complete response; however, only tumescence kept its value in the multivariate study. CONCLUSIONS: Urologists must involve themselves in the early rehabilitation of the erectile function even in those patients where preservation of the NVB was not possible. One must always try to preserve, uni or bilaterally, whenever the patient desires preservation of EF. The response to sildenafil is better after the first year and in patients who have previous tumescence.

Tratamiento de la disfunción eréctil tras prostatectomía radical con sildenafilo en un grupo no seleccionado de pacientes / Treatment of post radical prostatectomy erectile dysfunction with sildenafil in a non-selected group of patients

FUNDAMENTO: Conocer la disfunción eréctil (DE) tras prostatectomía radical en un grupo no seleccionado de pacientes y su respuesta al sildenafilo. MÉTODOS: Incluimos a nuestros pacientes operados entre 1998 y 2001. Los pacientes rellenaron una modificación del IIEF (mIIEF) antes de la PR. Probamos sildenafilo a dosis de 100 mg en 3 periodos diferentes: 3-6, 12 y 18-24 meses tras la PR. En caso de respuesta completa volvieron a rellenar el mIIEF. RESULTADOS: La edad media fue de 62,8 años y el seguimiento medio de 31,7 meses. Sólo 111 (62%) del total de pacientes operados quisieron tratamiento y tan solo 90 tomaron sildenafilo en el régimen propuesto; 27 (30%), 18 (20%) y 45 (50%) tuvieron una respuesta completa, parcial o no tuvieron respuesta al sildenafilo respectivamente. El periodo más frecuente de respuesta completa fue entre los 18-24 meses. El mIIEF mostró 6,5±5,7 puntos menos respecto al mIIEF pre tratamiento. En el análisis univariado, la preservación de bandeletas (BNV), la presencia de respuesta parcial previa y la presencia de tumescencia previa se relacionaron significativamente con la respuesta completa; sin embargo, solo la tumescencia mantuvo su valor en el estudio multivariado. CONCLUSIONES: El urólogo debe implicarse en la rehabilitación precoz de la FE incluso en los pacientes en los que no se ha podido realizar preservación de las BNV. Esta se debe intentar uni o bilateralmente siempre que el paciente desee preservar FE. La respuesta al sildenafilo es mejor a partir del primer año y mejor en aquellos que presentan tumescencia previa

OBJECTIVE: To evaluate erectile disfunction (ED) after radical prostatectomy in a non selected group of patients and their response to sildenafil. METHODS: We included our patients who were operated on between 1998 and 2001. The patients filled in a modification of IIEF (mIIEF) before the RP operation. We tried sildenafil with doses of 100 mg in 3 different periods: 3-6, 12 and 18-24 months after the RP operation. In the event of a complete response they filled in the mIIEF again. RESULTS: The mean age of the patients was 62.8 years old and the mean observation period was 31.7 months. Only 111 (62%) of the total number of patients operated on wanted treatment and only 90 took sildenafil in the proposed protocol; 27 (30%), 18 (20%) and 45 (50%) patients had a complete response, a partial response or no response to the sildenafil respectively. The mIIEF showed 6.5±5.7 points less than the mIIEF pre-treatment. In the univariate analysis, the preservation of bundles, the presence of a previous partial response and the presence of the previous tumescence were significantly related to the complete response; however, only tumescence kept its value in the multivariate study. CONCLUSIONS: Urologists must involve themselves in the early rehabilitation of the erectile function even in those patients where preservation of the NVB was not possible. One must always try to preserve, uni or bilaterally, whenever the patient desires preservation of EF. The response to sildenafil is better after the first year and in patients who have previous tumescence

[Usefulness of serum markers in renal cell carcinoma]. / Utilidad de marcadores séricos del carcinoma renal.

OBJECTIVES: To select a group of useful serum markers in renal cell carcinoma (RCC) with investigational purpose in future. MATERIAL AND METHODS: Periodic determination in serum of 21 RCC patients of the following markers: EGR, RPC, hemogram and leucocyte differential count (LDC), standard biochemist parameters, beta-2 microglobuline, CEA, CA 12.5, CA 50, CA 15.3, ferritin, interleukin-6, serum interleukin-2 receptor, TNF-alpha and TPSA. RESULTS: Different elements within the LDC had relations with the presence of symptoms/signs, tumour size, pathological stage and disease progression. There was a significant increase of beta-2 microglobuline and sIL-2 receptor when disease progressed, as well as a similar statistical trend with RPC and alkaline phosphatases. Beta-2 microglobuline and sIL-2 receptor also decreased after treatment of the disease progression. CONCLUSIONS: We will keep analysing hemogram, LDC and standard byochemics, RPC, ferritin, beta-2 microglobuline and sIL-2 receptor only with investigational purposes, obviating the determination of the rest of the tested markers.

Utilidad de marcadores séricos del carcinoma renal / Usefulness of seum markers in renal cell carcinoma

FUNDAMENTO: Seleccionar un grupo de marcadores tumorales útiles en el carcinoma renal (CR) para su ulterior estudio y desarrollo. MÉTODOS: Determinación seriada en suero de 21 pacientes con CR de los siguientes marcadores: VSG, PCR, hemograma y recuento diferencial leucocitario (RDL), bioquímica estándar, ß2-microglobulina, CEA, CA 12.5, CA 50, CA 15.3, ferritina, interleukina-6, receptor de la interleukina-2, factor de necrosis tumoral a y antígeno tisular polipeptídico. RESULTADOS: Diferentes elementos dentro del RDL tuvieron relación con la presencia de clínica, con el tamaño, estadio patológico y la progresión tumoral. Se observa un incremento estadísticamente significativo de los valores de la ß-2 microglobulina y del RIL-2 en el momento de la progresión, así como un aumento con tendencia a la significación de los valores de la PCR y las fosfatasas alcalinas. La ß-2 microglobulina y el RIL-2 decrecen significativamente al tratar la progresión. CONCLUSIONES: Seguiremos determinando el hemograma, RDL y bioquímica estándar, la PCR, la ferritina, la ß-2 microglobulina, y el RIL-2 exclusivamente con el objeto de delimitar su utilidad en el seguimiento de los pacientes con CR, desestimando la determinación del resto de marcadores testados (AU)

OBJECTIVES: To select a group of useful serum markers in renal cell carcinoma (RCC) with investigational purpose in future. MATERIAL AND METHODS: Periodic determination in serum of 21 RCC patients of the following markers: EGR, RPC, hemogram and leucocyte differential count (LDC), standard biochemist parameters, ß-2 microglobuline, CEA, CA 12.5, CA 50, CA 15.3, ferritin, interleukin-6, serum interleukin-2 receptor, TNF- a and TPSA. RESULTS: Different elements within the LDC had relations with the presence of symptoms/signs, tumour size, pathological stage and disease progression. There was a significant increase of ß-2 microglobuline and sIL-2 receptor when disease progressed, as well as a similar statistical trend with RPC and alkaline phosphatases. ß-2 microglobuline and sIL-2 receptor also decreased after treatment of the disease progression. CONCLUSIONS: We will keep analysing hemogram, LDC and standard byochemics, RPC, ferritin, ß-2 microglobuline and sIL-2 receptor only with investigational purposes, obviating the determination of the rest of the tested markers (AU)

[Assessment of the basal membrane status as prognostic factor in renal carcinoma]. / Valoración del estado de la membrana basal como factor pronóstico en el carcinoma renal.

OBJECTIVES: To know the basal membrane (BM) integrity in renal cell carcinoma (RC) and its importance as prognostic factor. MATERIAL AND METHODS: 73 patients with RC were selected. Immunohistochemistry with monoclonal antibodies against basal proteins laminin and collagen IV was performed. Percentage for BM fragmentation in the whole tumour was considered taking 75% as cut off. RESULTS: Follow-up was 6.3 +/- 4.3 years and 27 patients progressed. Correlation between laminin and collagen IV was significative (p = 0.000). A BM fragmentation expressed with laminin bigger than 75% was related to tumoural symptoms (p = 0.019), worse grade (p = 0.004) and necrosis in more than 10% of the tumour (p = 0.000). Fragmentation observed with collagen IV was associated to tumours greater than 7 cm (p = 0.014). Those patients whose tumours displayed more than 75% of BM fragmentation, measured with collagen IV, presented worse survival (p = 0.042). A similar trend was observed in the case of laminin, but it did not reach statistic significance (p = 0.119). In the unvariated analysis grade III-IV, more than 10% of necrosis within the tumour, tumoural symptoms and BM fragmentation bigger than 75% measured with collagen IV were prognostic, while only grade and necrosis did so in the multivariate analysis. CONCLUSIONS: Collagen IV and laminin represent nicely, with a similar expression pattern, the BM fragmentation in RC. Within a battery of immunohistochemical markers to study RC at least one of them should be included because their prognostic implication.

Valoración del estado de la membrana basal como factor pronóstico en el carcinoma renal / Significance of basal membrane status as a prognostic factor in renal carcinoma

FUNDAMENTOS: Conocer el estado de la membrana basal (MB) en el carcinoma renal (CR) y su importancia como factor pronóstico. MATERIAL Y MÉTODOS: Se seleccionaron 73 pacientes con CR. Se realizó inmunohistoquímica con anticuerpos monoclonales contra las proteínas basales laminina y colágeno IV. La valoración de los resultados consideró la integridad de la MB dentro del tumor tomando como punto de corte un 75 por ciento de basales fragmentadas en el tumor.RESULTADOS: El seguimiento fue de 6.3 ñ 4,3 años, durante el cual hubo progresión de la enfermedad en 27 pacientes. La correlación en la expresión de ambas moléculas fue significativa (p=0,000). La fragmentación de la MB en más del 75 por ciento del tumor expresada con laminina se relacionó con una presencia de clínica por el tumor (p=0,019), con un peor grado de diferenciación celular (p=0,004) y con más del 10 por ciento de necrosis (p=0,001). Una fragmentación mayor del 75 por ciento expresada con colágeno IV se asoció a tumores mayores de 7 cm (p=0,014). Se observó una peor supervivencia en aquellos pacientes con tumores con más del 75 por ciento de fragmentación de la MB medida con colágeno IV (p=0,042), mientras que con la laminina se apreció una tendencia similar que no alcanzó la significación estadística (p=0,1 19). En el análisis univariado resultaron factores pronósticos el grado III-IV, la presencia de más de un 10 por ciento de necrosis en el tumor, la presentación clínica del tumor y con una fragmentación de la MB mayor del 75 por ciento analizada con colágeno IV, persistiendo los dos primeros en el análisis multivariado.CONCLUSIONES: Colágeno IV y laminina representan correctamente y de forma paralela el grado de fragmentación de la MB en el CR. Dentro de una batería de factores imnunohistoquímicos en CR se debería incluir al menos una de ellas por su implicación pronóstica (AU)

[Adrenal gland incidentaloma in the oncologic patient: is its histologic study obligatory?]. / Incidentalomas suprarrenales en el paciente oncólogico: es obligado suestudio histólogico?

OBJECTIVES: To analyze the need for histological study in suprarenal incidentalomas in the specific status of the oncological patient. MATERIAL AND METHODS: 21 patients with tumoral suprarenal masses, 12 diagnosed in the initial study and 9 during the follow-up RESULTS: 16 masses were benign in nature and 5 were metastatic. Neither the location nor the staging of the initial tumour, the time of diagnosis, or the hormonal study were of any use to separate the primitive tumour from the metastasis. All metastasis were equal to or greater than 5 cm in size. Radiological study only confirmed the nature of the tumour in a few cases. Percutaneous biopsy was resolutive in 4/8 cases (50%). Suprarenalectomy was performed in 15 occasions, associated in 10 to surgical treatment of the primary therapy with not added morbidity. CONCLUSION: When incidentaloma is detected in tumoral patients at the time of diagnosis, it requires an histological study which in 1 out of 3 cases will modify the therapeutic attitude in the presence of metastasis. If the incidentaloma is detected during follow-up, it may be monitored in terms of evolution as we would only be delaying a palliative treatment.

[Bladder carcinosarcoma. Report of 2 cases]. / Carcinosarcoma vesical. A propósito de dos casos.

Two additional cases of this rare bladder tumor are described. The immunohistochemical analyses confirmed the histological diagnosis of this aggressive tumor type. The choice of treatment for the tumor and its metastasis is influenced by its rarity.

[Results of a randomized, double blind prospective study of intravesical chemoprophylaxis with 2 drugs: adriamycin and mitomycin; and 2 ways of initiating the instillations: early and late. Effect on recurrence and progression]. / Resultados de un estudio de quimioprofilaxis intravesical, prospectivo, doble aleatorio, entre dos drogas: la adriamicina y el mitomicin; y dos modos de iniciar las instilaciones: precoz y tardío. Efecto sobre la recidiva y la progresión.

The results of a double blind prospective study comparing the chemoprophylactic effects of adriamycin and mitomycin C and two modes of instillation (early: 6 hours following transurethral resection; late: 7-14 days later) for superficial carcinoma of the bladder are presented herein. Since the minimum follow up is over 5 years, the effects on tumor progression and mortality achieved by each of the 4 arms of the protocol were also evaluated. Concerning tumor recurrence, early instillation of mitomycin and overall early instillation therapy achieved significantly better results (p < 0.01). No differences, however, were observed relative to tumor progression or mortality.

[Mitoxantrone (MTX) versus mitomycin C (MMC) in the ablative treatment of Ta, T1 superficial bladder tumors. Phase III, randomized prospective study]. / Mitoxantrone (MXT) "versus" mitomycin C (MMC) en el tratamiento ablativo de los tumores vesicales superficiales Ta, T1. Estudio prospectivo y al azar, en fase III.

A prospective randomized study was conducted to determine the ablation capacity of mitoxantrone in Ta-T1 superficial bladder tumors versus mitomycin C, a drug whose intravesical ablation properties are well-known. Fifty-seven patients comprised the study. The tumor was not completely resected when the patient underwent TUR. This residual tumor was used as control. The patients were treated with either 20 mg Mitoxantrone or 40 mg mitomycin C weekly for 8 weeks and two other instillations every 15 days in 50 ml saline solution. Response to therapy was evaluated between the 4th and 8th week and classified as complete response (CR), defined as no gross and microscopic evidence of residual tumor, or no response (NR) or therapeutic failure. CR was observed in 77.7% of the patients treated with mitomycin C and in 50% in those that had been treated with Mitoxantrone. Treatment was discontinued because of side effects in 15% of the patients treated with mitomycin C and in 63.4% of those who received Mitoxantrone. We can conclude from the results of the present study that Mitoxantrone is a useful agent for ablation therapy of superficial bladder tumors, although the high incidence of severe side effects warrants its limited use and at high dilutions.

[Tumor embolization to the lymphatic vessel structures of the bladder wall (L+). Its effect on the course of bladder tumors]. / La embolización tumoral de las estructuras vásculo-linfáticas de la pared vesical (L+). Su influencia en la evolución de los tumores vesicales.

A retrospective study was conducted in patients with bladder tumors equal to or higher than stage T1 to determine the influence on survival of tumor cell invasion of the microscopic lymphatic vessels of the bladder wall. Sixty-two patients were studied (34 recurrent and 28 primary tumors). Evidence of microscopic lymphatic invasion was disclosed following TUR (48 cases) and cystectomy (14 cases). Overall and with a mean follow up of 27 months, 25% of the patients are alive and tumor free, 51.6% had died from the tumor (90% less than 3 years following diagnosis). Forty-five percent had lymph node metastasis and 56.6% node and organ metastases. For a time interval of over 6 months between the diagnosis of L + and definitive treatment, there was an 80% mortality versus 43% when treatment was concurrent with diagnosis. Finally, survival was much better in patients submitted to radical surgery. We can conclude from the present study that evidence of tumor invasion of the lymphatic vessels must be routinely sought by the pathologist in order to identify those patients with a high probability of tumor dissemination.

[Is radical cystectomy indicated for the treatment of patients with bladder carcinoma N+ M0?]. / Está indicada la cistectomía radical (CTR) en el tratamiento de los pacientes con carcinoma vesical (CV) N+ M0?

UNLABELLED: The following parameters were analyzed in 55 patients with N + M0 bladder carcinoma: 1. Extent of lymph node involvement: A significant difference was observed for those with N1 whose 5 year survival rate is 46%, whereas those with N3, N4 did not survive at two years. 2. TREATMENT: 29 patients underwent cystectomy and 26 did not. Of these 26 patients, 14 received polychemotherapy and 11 received only symptomatic treatment. Survivorship was significantly better for those who underwent cystectomy than those who received polychemotherapy, and it was better for this latter patient group than for those who received symptomatic treatment. 3. Finally, we studied the possible effect of changing the chemotherapeutic regimen on patient survival. Although patients treated with CMV or M-VAC have only a short follow-up, patient survival appears to be enhanced.