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Resumen Introduccion Existe muy poca literatura espanola que compare resultados oncologicos tras prostatectomia radical (PR) segun la via de abordaje y la metodologia es inadecuada. Objetivo Comparar los resultados oncologicos en cuanto a margenes quirurgicos (MQ) y recidiva bioquimica (RB) entre PR abierta (PRA) y laparoscopica (PRL). Material y metodos Comparacion de 2 cohortes (307 con PRA y 194 con PRL) entre 2007 y 2015. El estado de los MQ se clasificaron como positivos o negativos y la RB como la elevacion del PSA despues de la PR > 0,4 ng/ml. Para el contraste de variables cualitativas se utilizo el test Chi-cuadrado y ANOVA para las cuantitativas. Para evaluar los factores predictores de los MQ se ha realizado un analisis multivariante mediante regresion logistica. Para evaluar los factores predictores de RB se ha realizado un analisis multivariable mediante regresion de Cox. Resultados El 43,5% de pacientes tuvieron un Gleason 7 (3 + 4) en la pieza quirurgica y un 31,7% MQ positivos siendo el estadio patologico mas frecuente pT2c en el 61,9%. No existieron diferencias significativas entre ambos grupos, excepto la afectacion extracapsular (p = 0,001), mas frecuente en la PRL. La mediana de seguimiento fue de 49 meses, evidenciando RB en el 23% de pacientes, sin diferencias significativas entre cohortes. En el analisis multivariable solo el grupo de riesgo D’Amico se comporto como factor predictor independiente de MQ positivos y el score de Gleason y los MQ positivos como factores predictores independientes de RB. Conclusion La via de abordaje no influyo en el estado de MQ ni en la RB.

Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation.Review of the available literature on kidney procurement procedure.Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish.Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time.Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques.

Resumen Objetivo Analizar la supervivencia de los pacientes con cancer de prostata (CP) con factores pronosticos desfavorables (FPD) tratados con PR y radioterapia de rescate (RTR) tras recidiva bioquimica (RB) y persistencia bioquimica (PB). Material y metodo Analisis retrospectivo de 446 pacientes con al menos uno de los siguientes FPD: score de Gleason ≥ 8, estadio patologico ≥ pT3 y/o margenes quirurgicos positivos (MQ + ). El criterio de RB fue la elevacion del PSA por encima de 0,4 ng/ml. Evaluacion de supervivencia mediante Kaplan-Meier y log-rank. Para identificar factores de riesgo con posible influencia en la respuesta a RTR y la supervivencia causa-especifica (SCE) se uso analisis uni y multivariable (regresion de Cox). Resultados Mediana de seguimiento: 72 (rango 37-122) meses, mediana de tiempo hasta RB: 42 (rango 20-112) meses. El 36,3% presentaron RB. Presentaron respuesta bioquimica a la RTR 121 (74,7%) pacientes. La supervivencia libre de recaida (SLR) despues de la RTR a los 3, 5, 8 y 10 anos fue del 95,7, del 92,3, del 87,9 y del 85%, la SG a los 5, 10 y 15 anos fue del 95,6, del 86,5 y del 73,5%. La SCE a los 5, 10 y 15 anos fue del 99,1, del 98,1 y del 96,6%, respectivamente. Solo el tiempo hasta la RB Conclusiones La PR solo consigue control de la enfermedad a los 10 anos en aproximadamente la mitad de los casos. El tratamiento multimodal secuencial (PR + RTR cuando precise) aumenta este control bioquimico hasta > 87%, lograndose una larga SCE. Los pacientes con un tiempo hasta recidiva > 24 meses respondieron mejor al tratamiento de rescate.

Objective Survival analysis of patients with prostate cancer (PCa) with adverse prognostic factors (APF) treated with radical prostatectomy (RP) and salvage radiotherapy (SRT) after biochemical recurrence (BR) or biochemical persistence (BP). Materials and methods Retrospective analysis of 446 patients with at least one of the following APF: Gleason score ≥8, pathologic stage ≥pT3 and/or positive surgical margins. BR criteria used was PSA level over 0.4 ng/ml. A survival analysis using Kaplan–Meier was performed to compare the different variable categories with log-rank test. In order to identify risk factors for SRT response and cancer specific survival (CSS) we performed univariate and multivariate analyses using Cox regression. Results Mean follow up: 72 (IQR 27–122) months, mean time to BR: 42 (IQR 20–112) months, mean PSA level at BR: 0.56 (IQR 0.42–0.96). BR was present in 36.3% of the patients. Biochemical response to SRT was observed in 121 (75.7%) patients. Recurrence-free survival (RFS) rates after SRT at 3, 5, 8 and 10 years were 95.7%, 92.3%, 87.9%, and 85%; overall survival (OS) rates after 5, 10 and 15 years was 95.6%, 86.5% and 73.5%, respectively. CSS rates at 5, 10 and 15 years were 99.1%, 98.1% and 96.6%. Only time to BR Conclusions In these patients, RP only controls the disease in approximately half of the cases. Multimodal sequential treatment (RP + SRT when needed) increases this control, achieving high CSS rates and biochemical control in over 87% of the patients. Patients with time to recurrence >24 months responded better to rescue treatment.

Introduction Recurrence trends after renal cell cancer (RCC) nephrectomy are not clearly defined. Objective To evaluate recurrence trends according to recurrence risk groups (RRG). Methods Retrospective analysis of 696 patients with RCC treated with nephrectomy between 1990−2010. Three RRG were defined according to the presence of anatomopathological variables (pTpN stage, nuclear grade, tumor necrosis (TN), sarcomatoid differentiation (SD), positive resection margin (RM)): - Low RG (LRG):pT1pNx-0 G1–4, pT2pNx-0 G1–2; no TN, SD and/or RM(+) - Intermediate RG (IRG):pT2pNx-0 G3–4;pT3–4pNx-0 G1–2; LRG with TN. - High RG (HRG):pT3–4pNx-0 G3–4;pT1–4pN+;IRG with TN and/or SD; LRG with SD and/or RM (+). The Kaplan-Meier method has been used to evaluate recurrence-free survival as a function of RRG. The log-rank test was used to evaluate differences between survival curves. Results The median follow-up was 105 (IQR 63–148) months. Of the total series, 177 (25.4%) patients presented recurrence: distant 15.9%, local 4.9% and 4.6% distant and local. The recurrence rate varied according to the RRG with values of 72.9% for HRG, 16.9% for IRG and 10.2% for LRG (P = .0001). Most cases in LRG presented single organ recurrence (72.2%) (P = .006). The LRG experienced recurrence as single metastasis in 50% of cases, compared to 30% and 18.6% in IRG and HRG, respectively (P = .009). The most common sites of recurrence were lung and abdomen. Lung recurrence predominated in the HRG (72.9%) (P = .0001) and abdominal, in the LRG (83.3%) with a tendency to significance (P = .15). Conclusions Recurrence rates (especially bone and lung) increase with higher RG. Single organ recurrences and single metastases are more frequent in LRG.

Resumen Introduccion No estan claramente definidos los patrones de recurrencia tras nefrectomia por cancer renal. Objetivo Evaluar patrones de recidiva en funcion del grupo de riesgo de recurrencia (GRR). Material y metodo Analisis retrospectivo de 696 pacientes con carcinoma de celulas renales tratados con nefrectomia entre 1990-2010. Se definieron tres GRR segun la presencia de variables anatomopatologicas (estadio pTpN, grado nuclear, necrosis tumoral [NT], diferenciacion sarcomatoide [DS], margen de reseccion positivo [MR]): -GR bajo (GRB): pT1pNx-0 G1-4, pT2pNx-0 G1-2; no NT, DS y/o MR (+). -GR intermedio (GRI): pT2pNx-0 G3-4;pT3-4pNx-0 G1-2; GRB con NT. -GR alto (GRA): pT3-4pNx-0 G3-4; pT1-4pN + ; GRI con NT y/o DS; GRB con DS y/o MR (+). Para el contraste de variables cualitativas se utilizo el test de la Chi cuadrado. El metodo de Kaplan-Meier se ha utilizado para evaluar la supervivencia libre de recidiva en funcion de los GRR. Para evaluar diferencias entre las curvas de supervivencia se ha utilizado el test de log-rank. Resultados La mediana de seguimiento fue de 105 (IQR 63-148) meses. Del total de la serie recidivaron 177 (25,4%) pacientes: 15,9% a distancia, 4,9% local y 4,6% a distancia y local. La tasa de recurrencia vario segun el grupo de riesgo con tasas del 72,9% en GRA, 16,9% en GRI y 10,2% en GRB (p = 0,0001). La recurrencia en organo unico fue mayoritaria en el GRB (72,2%) (p = 0,006). El GRB presento recidiva en forma de metastasis unica en el 50% de los casos, frente al 30% y 18,6% en GRI y GRA, respectivamente (p = 0,009). Las localizaciones de recurrencia mas habituales fueron pulmon y abdomen. La localizacion pulmonar predomino en el GRA (72,9%) (p = 0,0001) y la abdominal en el GRB (83,3%) con una tendencia a la significacion (p = 0,15). Conclusiones A medida que aumenta el grupo de riesgo aumentan las recurrencias, sobre todo oseas y pulmonares. En el GRB son mas frecuentes las metastasis unicas y en organo unico.

Comparative analysis of postoperative complications and survival between laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) in cT1 renal cell carcinoma (RCC).Retrospective study of patients with two kidneys and single renal tumor cT1 treated in our center between 2005 and 2018 by laparoscopic PN or RN.372 patients met the inclusion criteria for the study. RN was performed in 156 (41.9%) patients and PN in 216 (58.1%). Clavien Dindo III-V complications were observed in 10 (4,6%) PN and 6 (3,9%) RN patients (p = 0.75). The comorbidity Charlson index (CCI) was identified as an independent predictor variable of complications (p = 0.02) and surgical approach did not affect multivariate analysis. Estimated overall survival (OS) was 81.2% and 56.8% at 5 and 10 years in the RN group and 90.2% and 75.7% in the PN group, respectively (p = 0.0001). Obesity (HR 2.77, p = 0.01), CCI ≥ 3 (HR 3.69, p = 0.001) and glomerular filtration rate (GFR)60 mL/min/1.73 mLaparoscopic PN is not inferior to RN in terms of oncologic and surgical safety in cT1 RCC. Nephrectomy approach did not influence patient OS, however, obesity, CCI ≥ 3 and GFR60 mL/min/1.73 m

Resumen Introduccion El objetivo es comparar el rendimiento de la secuencia resonancia magnetica (RM) y biopsia transrectal «cognitiva» (BTRCog) frente a la biopsia transrectal clasica (BTRCl) en pacientes con al menos una biopsia de prostata (BP) negativa. Material y metodo Analisis retrospectivo de 205 pacientes con al menos una BP negativa. A 144 (70,2%) pacientes se les realizo antes de la biopsia una RM y a 61 (29,8%) no. Los nodulos se clasificaron segun la clasificacion PI-RADS v2 agrupando pZa, pZpl y pZpm como zona periferica (ZP), Tza, Tzp y CZ como zona transicional (ZT) y areas AS como zona anterior (ZA). A los pacientes con RM se les realizo BTRCog. A los pacientes sin RM se les realizo una BTRCl de la ZP y de la ZT. Comparacion de variables cualitativas con test de la chi2 y de cuantitativas con t de Student. Analisis multivariante (regresion logistica) para identificar variables predictoras. Resultados La mediana de edad fue 68 (IQR 62-72%) anos, de PSA 8,3 (IQR 6,2-11,7) ng/ml y del numero de biopsias previas fue 1 (IQR 1-2). En 169 (82,4%) el tacto rectal (TR) fue normal, mientras que en 36 (17,6%) sospechoso (cT2a-b en 34 y cT2c en 2). La mediana del volumen prostatico (VP) fue de 48 (IQR 38-65) cc. Existio diferencia en el PSAD (p = 0,03) entre ambos grupos. En la ETR se identifico nodulo hipoecoico en 8 (13,1%) pacientes con BTRCl y en 62(43,1%) (p = 0,0001) con BTRCog. La mediana de cilindros extraidos en BTRCl fue 10 (IQR 10-10) y en el grupo BTRCog fue 11 (IQR 9-13) (p = 0,75). Se diagnostico cancer en 74 (36,1%) pacientes. En BTRCl 10 (16,4%) y en BTRCog 64 (44,4%) (p = 0,0001). Los tumores diagnosticados fueron clasificados: ISUP-1: 34 (45,9%), ISUP-2: 21 (28,4%), ISUP-3: 9 (12,2%), ISUP-4: 7 (9,5%), ISUP-5: 3 (4,1%). No existieron diferencias (p = 0,89). La mediana de cilindros afectados en BTRCl fue 1 (IQR 1-5) frente a 2 (IQR 1-4) en el grupo BTRCog (p = 0,93). Variables predictoras independientes de cancer: edad (OR = 12,05, p = 0,049). TR sospechoso (OR = 2,64, p = 0,04), nodulo hipoecoico en ecografia (OR = 2,20, p = 0,03) y la secuencia RM + BTRCog (OR = 3,49, p = 0,003). Conclusiones La secuencia RMNmp + BTRCog en pacientes con al menos una BP previa negativa multiplica casi por 3,5 (OR = 3,49) la probabilidad de diagnosticar un cancer frente a la BTRCl.

espanolIntroduccion y objetivo Una de las caracteristicas inherentes a los tumores renales es la capacidad de extenderse al interior del sistema venoso como trombos tumorales. El objetivo de este estudio es evaluar en los pacientes con cancer renal en un estadio pT3apN0cM0 si la existencia de afectacion tumoral venosa influye en la recidiva tumoral. Materiales y metodos Analisis retrospectivo de pacientes con cancer renal en estadio pT3apN0cM0 tratados con nefrectomia radical entre 1990-2015. Analisis univariante y multivariante mediante regresion de Cox para identificar variables predictoras y variables predictoras independientes relacionadas con la recidiva. Resultados Se analizaron los resultados de 153 pacientes. La mediana de seguimiento fue de 82 (IQR 36-117) meses. La supervivencia libre de recidiva a los 5 anos fue del 58,9% con una mediana de 97 (IC95% 49,9-144,1) meses. Recidivaron 77 (50,3%) pacientes. En 70 (90,9%) casos las metastasis fueron a distancia, en 17 (14,2%) de estos pacientes se objetivo recurrencia local en el lecho de nefrectomia sincronica. En el analisis multivariable se identificaron como variables predictoras independientes de recidiva tumoral la necrosis tumoral (p=0,0001) y la invasion microvascular (p=0,001). Conclusiones La existencia de extension tumoral venosa no se ha relacionado, en nuestra serie y tras la realizacion del analisis multivariable, con la recidiva. La necrosis tumoral y la infiltracion microvascular si se comportaron como factores predictores independientes de recidiva tumoral. EnglishIntroduction and objective One of the inherent features of kidney tumours is the capacity to spread inside the venous system as tumour thrombi. The aim of this study was to assess in patients with stage pT3apN0cM0 kidney cancer whether venous tumour involvement influenced tumour recurrence. Materials and methods A retrospective analysis of patients with stage pT3apN0cM0 kidney cancer treated with radical nephrectomy between 1990-2015. Univariate and multivariate Cox regression analysis to identify predictive variables and independent predictive variables relating to recurrence. Results The results of 153 patients were studied. The median follow-up was 82 (IQR 36-117) months. Recurrence-free survival at 5 years was 58.9% with a median of 97 (95% CI 49.9-144.1) months. Seventy-seven (50.3%) patients recurred. Seventy cases 70 (90.9%) had distant metastases, 17 (14.2%) of these patients had local recurrence in the bed of nephrectomy. Tumour necrosis (p=.0001), and microvascular invasion (p=.001) were identified as independent predictors of tumour recurrence in the multivariable analysis. Conclusions In our series, after multivariable analysis, venous tumour extension was not related to recurrence. Tumour necrosis and microvascular infiltration did behave as independent predictive factors of tumour recurrence.

Introduction and objective One of the inherent features of kidney tumours is the capacity to spread inside the venous system as tumour thrombi. The aim of this study was to assess in patients with stage pT3apN0cM0 kidney cancer whether venous tumour involvement influenced tumour recurrence. Materials and methods A retrospective analysis of patients with stage pT3apN0cM0 kidney cancer treated with radical nephrectomy between 1990 and 2015. Univariate and multivariate Cox regression analysis to identify predictive variables and independent predictive variables relating to recurrence. Results The results of 153 patients were studied. The median follow-up was 82 (IQR 36–117) months. Recurrence-free survival at 5 years was 58.9% with a median of 97 (95% CI 49.9–144.1) months. Seventy-seven (50.3%) patients recurred. Seventy cases 70 (90.9%) had distant metastases, 17 (14.2%) of these patients had local recurrence in the bed of nephrectomy. Tumour necrosis (p = 0.0001), and microvascular invasion (p = 0.001) were identified as independent predictors of tumour recurrence in the multivariable analysis. Conclusions In our series, after multivariable analysis, venous tumour extension was not related to recurrence. Tumour necrosis and microvascular infiltration did behave as independent predictive factors of tumour recurrence.

Resumen Introduccion Evaluacion de la efectividad de la biopsia cognitiva (BC) en los pacientes con sospecha clinica de cancer de prostata (caP) y al menos una biopsia negativa (BTR). Material y metodo Analisis retrospectivo de 144 pacientes con al menos una BTR y una resonancia magnetica nuclear (RMN) previa. Los nodulos de la RMN se clasificaron segun la clasificacion PI-RADS v2 agrupando pZa, pZpl y pZpm como zona periferica (ZP), Tza, Tzp y CZ como zona transicional (ZT) y areas AS como zona anterior (ZA). Se indico biopsia en nodulos ≥ PI-RADS 3. Se llevo a cabo analisis uni y multivariante (regresion logistica) tratando de identificar variables relacionadas con tumor en biopsia de PI-RADS 3. Resultados La mediana de edad fue de 67 (IQR: 62-72) anos, la de PSA 8,2 (IQR: 6,2-12) ng/ml. Se identifico nodulo en la RMN en la ZP en 97 (67,4%) casos, en la ZT en 29 (20,1%) casos y en ZA en 41 (28,5%) casos. Se diagnostico caP en la biopsia en 64 (44%) pacientes. En PI-RADS 3 se obtuvo un 17,5% (7/40) de cancer, PI-RADS 4 un 47,3% (35/73) y en los PI-RADS 5 un 73,3% (22/29) (p = 0,0001). Analisis multivariable con variables que pudieran influir en el resultado de la biopsia en pacientes con PI-RADS 3: ninguno (edad, PSA, numero de biopsias previas, tacto rectal, PSAD, volumen prostatico ni numero de cilindros extraidos) se comporto como factor predictor independiente de tumor. Conclusiones El rendimiento diagnostico de la BC en pacientes con al menos una biopsia previa negativa fue del 44% incrementandose segun el grado de PI-RADS, siendo en PI-RADS 3 bajo. No se identifico ninguna variable clinica predictora de caP en pacientes con PI-RADS 3.

Introduction Evaluation of the effectiveness of cognitive biopsy (CB) in patients with clinical suspicion of prostate cancer (PC), and at least one negative biopsy (TRB). Material and method Retrospective study of 144 patients with at least one previous TRB and magnetic resonance imaging (MRI). The MRI nodules were classified based on PI-RADS v2 grouping pZa, pZpl and pZpm as the peripheral zone (PZ), Tza, Tzp and CZ as the transitional zone (TZ), and the AS zones as the anterior zone (AZ). A biopsy was indicated for nodules ≥PI-RADS 3. Uni and multivariate analysis was undertaken (logistic regression) to identify variables relating to a PI-RADS 3 tumour on biopsy. Results The median age was 67 (IQR: 62–72) years, the median PSA was 8.2 (IQR: 6.2–12) ng/ml. A nodule was identified on MRI in the PZ in 97 (67.4%) cases, in the TZ in 29 (20.1%), and in the AZ in 41 (28.5%). PC was diagnosed on biopsy in 64 (44%) patients. The cancer rate in the PI-RADS 3 lesions was 17.5% (7/40), in the PI-RADS 4 47.3% (35/73), and in the PI-RADS 5 lesions it was 73.3% (22/29) (p = 0.0001). Multivariable analysis with variables that could influence the biopsy result in patients with PI-RADS 3: none (age, PSA, number of previous biopsies, rectal examination, PSAD, prostate volume or number of extracted cylinders) behaved as an independent tumour predictor. Conclusions The diagnostic performance of CB in patients with at least one previous negative biopsy was 44%, increasing according to the PI-RADS grade, and low in PI-RADS 3. No clinical variable predictive of cancer was found in patients with PI-RADS 3.

Background and objective Surgery on renal tumors with venous tumor thrombus presents a high complication rate and non-negligible perioperative mortality. Our objective was to analyze the postoperative complications, their relationship with the level of the tumor thrombus and its potential predisposing factors. Materials and methods A retrospective analysis was conducted in 101 patients with renal and venous tumor thrombus operated on between 1988 and 2017. Two patients were excluded because of intraoperative pulmonary thromboembolism and exitus (2%). The postsurgical complications were classified according to Clavien–Dindo classification system. To compare the qualitative variables, we employed the chi-squared test. We performed a multivariate analysis using binary logistic regression to identify the independent predictors. Results Some type of postsurgical complication occurred in 34 (34.3%) patients, 11 (11.1%) of which were severe (Clavien III–V). There were significant differences in the total complications (p = 0.003) and severe complications (Clavien ≥ III; p = 0.03) depending on the level of the tumor thrombus.

Resumen Introduccion y objetivo La cirugia de los tumores renales con trombosis venosa esta gravada con un porcentaje elevado de complicaciones y con una mortalidad perioperatoria no despreciable. Nuestro objetivo es analizar las complicaciones postoperatorias, su relacion con el nivel del trombo y sus posibles factores favorecedores. Materiales y metodos Analisis retrospectivo de 101 pacientes con tumores renales con trombosis venosa intervenidos entre 1988 y 2017. Se descartaron 2 pacientes por TEP intraoperatorio y exitus (2%). Las complicaciones posquirurgicas se clasificaron segun Clavien-Dindo. Para el contraste de variables cualitativas se ha utilizado el test de la Chi cuadrado. Se realizo un analisis multivariante mediante regresion logistica binaria para identificar las variables predictoras independientes. Resultados En 34 (34,3%) pacientes se produjo algun tipo de complicacion posquirurgica, siendo en 11 (11,1%) graves (Clavien III-IV). Existen diferencias significativas en las complicaciones totales (p = 0,003) y las graves (Clavien ≥ III) (p = 0,03) segun el nivel del trombo tumoral.

There are very few Spanish studies that compare oncological outcomes following radical prostatectomy (RP) based on surgical approach, and their methodology is not appropriate.To compare oncological outcomes in terms of surgical margins (SM) and biochemical recurrence (BR) between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP).Comparison of two cohorts (307 with ORP and 194 with LRP) between 2007-2015. Surgical margin status was defined as positive or negative, and BR as a PSA rise of0.4 ng/ml after surgery. To compare the qualitative variables, we employed the Chi-squared test, and ANOVA was used for quantitative variables. We performed a multivariate analysis using logistic regression to evaluate the predictive factors of SM, and a multivariate analysis using Cox regression to evaluate the predictive factors of BR.Gleason 7 (3+4) was determined in the surgical specimens of 43.5% of patients, and 31.7% had positive SM. The most frequent pathological stage was pT2c, on the 61.9% of the cases. No significant differences were found between both groups, except for extracapsular extension (p=0.001), more frequent in LRP. The median follow-up was 49 months. BR was seen in the 23% of patients, without significant differences between groups. In the multivariable analysis, only the D'Amico risk group behaved as an independent predictive factor of positive SM, and Gleason score and positive SM acted as independent predictive factors of BR.The surgical approach did not influence SM status or BR.

Recurrence trends after renal cell cancer nephrectomy are not clearly defined.To evaluate recurrence trends according to recurrence risk groups (RRG).Retrospective analysis of 696 patients with renal cell cancer treated with nephrectomy between 1990-2010. Three RRG were defined according to the presence of anatomopathological variables (pTpN stage, nuclear grade, tumor necrosis [TN], sarcomatoid differentiation [SD], positive resection margin [RM]): -Low RG (LRG): pT1pNx-0 G1-4, pT2pNx-0 G1-2; no TN, SD and/or RM (+). -Intermediate RG (IRG): pT2pNx-0 G3-4; pT3-4pNx-0 G1-2; LRG with TN. -High RG (HRG): pT3-4pNx-0 G3-4; pT1-4pN+; IRG with TN and/or SD; LRG with SD and/or RM (+). The Kaplan-Meier method has been used to evaluate recurrence-free survival as a function of RRG. The log-rank test was used to evaluate differences between survival curves.The median follow-up was 105 (IQR 63-148) months. Of the total series, 177 (25.4%) patients presented recurrence: distant 15.9%, local 4.9% and 4.6% distant and local. The recurrence rate varied according to the RRG with values of 72.9% for HRG, 16.9% for IRG and 10.2% for LRG (p=.0001). Most cases in LRG presented single organ recurrence (72.2%) (p=.006). The LRG experienced recurrence as single metastasis in 50% of cases, compared to 30% and 18.6% in IRG and HRG, respectively (p=.009). The most common sites of recurrence were lung and abdomen. Lung recurrence predominated in the HRG (72.9%) (p=.0001) and abdominal, in the LRG (83.3%) with a tendency to significance (p=.15).Recurrence rates (especially bone and lung) increase with higher RG. Single organ recurrences and single metastases are more frequent in LRG.

Evaluation of the effectiveness of cognitive biopsy (CB) in patients with clinical suspicion of prostate cancer (PC), and at least one negative biopsy (TRB).Retrospective study of 144 patients with at least one previous TRB and magnetic resonance imaging (MRI). The MRI nodules were classified based on PI-RADS v2 grouping pZa, pZpl and pZpm as the peripheral zone(PZ), Tza, Tzp and CZ as the transitional zone (TZ), and the AS zones as the anterior zone (AZ). A biopsy was indicated for nodules ≥PI-RADS 3. Uni and multivariate analysis was undertaken (logistic regression) to identify variables relating to a PI-RADS 3 tumour on biopsy.The median age was 67 (IQR: 62-72) years, the median PSA was 8.2 (IQR: 6.2-12) ng/ml. A nodule was identified on MRI in the PZ in 97 (67.4%) cases, in the TZ in 29 (20.1%), and in the AZ in 41 (28.5%). PC was diagnosed on biopsy in 64 (44%) patients. The cancer rate in the PI-RADS 3 lesions was 17.5% (7/40), in the PI-RADS 4 47.3% (35/73), and in the PI-RADS 5 lesions it was 73.3% (22/29) (p=.0001). Multivariable analysis with variables that could influence the biopsy result in patients with PI-RADS 3: None (age, PSA, number of previous biopsies, rectal examination, PSAD, prostate volume or number of extracted cylinders) behaved as an independent tumour predictor.The diagnostic performance of CB in patients with at least one previous negative biopsy was 44%, increasing according to the PI-RADS grade, and low in PI-RADS 3. No clinical variable predictive of cancer was found in patients with PI-RADS 3.

The aim of this study is to compare performance of two biopsy approaches in patients with at least one previous negative prostate biopsy (PB): classical transrectal biopsy (ClTB) versus cognitive registration biopsy (COG-TB).A retrospective study of 205 patients with at least one negative PB. 144 (70.2%) patients underwent a prior mpMRI and 61 (29.8%) patients did not. Nodule classification was carried out according PI-RADS version 2. Peripheral zone (PZ) grouped pZa, pZpl and pZpm areas, transition zone (TZ) Tza, Tzp and Cz areas, and anterior zone (AZ) AS areas. COG-TB was conducted in patients with previous mpMRI (144); while in the remaining 61 (29.8%) patients a ClTB of PZ and TZ was performed. Statistical analysis was performed using Chi square and T-student tests for qualitative and quantitative variables, respectively. Multivariate analysis was carried out in order to identify predictive variables of prostate cancer.Median patient age was 68 (IQR 62-72) years, median PSA was 8.3 (IQR 6.2-11.7) ng/ml and median previous biopsies was 1 (IQR 1-2). Digital rectal examinations (DRE) findings were normal in 169 (82.4%) patients and suspicious in 36 (17.6%) patients (cT2a-b in 34 patients and cT2c in 2). Median prostate volume was 48 (IQR 38-65) cc. Statistically significant differences in PSAD between both groups were found (P=.03). Transrectal ultrasound (TRUS) showed hypoechoic nodules in 8 (13.1%) ClTB patients and in 62 (43.1%) COG-TB patients (P=.0001). The median number of biopsy cylinders per set of prostate biopsies was 10 (IQR 10-10) in ClTB group and 11 (IQR 9-13) in COG-TB group (P=.75). Cancer was diagnosed in 74 (36.1%) patients: of them, 10 (16.4%) were ClTB patients and 64 (44.4%) COG-TB (P=.0001). Tumors classification was as follow: ISUP-1: 34 (45.9%), ISUP-2: 21 (28.4%), ISUP-3: 9 (12.2%), ISUP-4: 7 (9.5%) and ISUP-5: 3 (4.1%). No significant statistical differences were found (P=.89). The median number of biopsy cylinders impaired per set of prostate biopsies was 1 (IQR 1-5) in ClTB group and 2 (IQR 1-4) in COG-TB group (P=.93). Regarding independent predictive variables for prostate cancer the results were: age (OR=12.05; P=.049), suspicious DRE (OR=2.64; P=.04), hypoechoic nodule (OR=2.20; P=.03) and mpMRI +COG-TB sequence (OR=3.49; P=.003).In patients with at least one negative PB, mpMRI +COG-TB sequence improves 3.5 (OR=3.49) times the diagnosis prostate vs. ClTB.

One of the inherent features of kidney tumours is the capacity to spread inside the venous system as tumour thrombi. The aim of this study was to assess in patients with stage pT3apN0cM0 kidney cancer whether venous tumour involvement influenced tumour recurrence.A retrospective analysis of patients with stage pT3apN0cM0 kidney cancer treated with radical nephrectomy between 1990-2015. Univariate and multivariate Cox regression analysis to identify predictive variables and independent predictive variables relating to recurrence.The results of 153 patients were studied. The median follow-up was 82 (IQR 36-117) months. Recurrence-free survival at 5 years was 58.9% with a median of 97 (95% CI 49.9-144.1) months. Seventy-seven (50.3%) patients recurred. Seventy cases 70 (90.9%) had distant metastases, 17 (14.2%) of these patients had local recurrence in the bed of nephrectomy. Tumour necrosis (p=.0001), and microvascular invasion (p=.001) were identified as independent predictors of tumour recurrence in the multivariable analysis.In our series, after multivariable analysis, venous tumour extension was not related to recurrence. Tumour necrosis and microvascular infiltration did behave as independent predictive factors of tumour recurrence.

Resumen Contexto Se pretende evaluar el conocimiento actual acerca del tratamiento del carcinoma de celulas renales (CCR) que afecta al injerto en los pacientes trasplantados de rinon. Adquisicion de evidencia Revision de la literatura actual basada en el analisis de los casos publicados de cirugia conservadora de nefronas en el carcinoma de celulas renales que afecta al injerto renal. Sintesis de evidencia Se han descrito 51 casos de nefrectomia parcial en injerto renal, con una supervivencia del injerto del 88% y un indice de recurrencia del 6%. La mayoria de los pacientes estaban asintomaticos al diagnostico (75%) y el tamano medio de las lesiones fue de 2,8 cm. La tecnica mas utilizada fue la enucleacion. El 77% de las pautas inmunosupresoras incluian ciclosporina A. Seis pacientes fueron tratados mediante radiofrecuencia y 2 recibieron crioablacion percutanea, con una supervivencia del 100% de los injertos y un unico caso de recidiva, que requirio segundo tratamiento. Conclusiones La cirugia conservadora del parenquima renal es una opcion terapeutica empleada ante CCR sobre injerto renal que consigue buen control oncologico y buena supervivencia del injerto. La modificacion de la inmunosupresion con la supresion de ciclosporina A y la introduccion de inhibidores de mTOR podria ser una medida adecuada en estos pacientes y merece futuras investigaciones.

Purpose To evaluate the new treatment strategies in renal cell carcinoma (RCC) that affects the graft in renal recipients. Methods A literature review is made, analyzing all the published cases of conservative surgery in renal graft RCC. Synthesis of evidence A total of 51 partial nephrectomies in renal graft patients have been described, with a graft survival rate of 88% and a recurrence rate of 6%. Most of the patients (75%) were asymptomatic at the time of diagnosis, and the mean lesion size was 2.8 cm. Enucleation was the most frequent technique employed. 77% of all immunosuppressor regimens included cyclosporine A. Six patients with graft RCC were subjected to radiofrequency ablation and two patients underwent percutaneous cryoablation, with a single case of relapse and a graft survival rate of 100%. Conclusions Nephron-sparing surgery is a good management option in renal graft RCC, affording good oncological control and graft survival. Modification of immunosuppression with the withdrawal of cyclosporine A and the introduction of mTOR inhibitors is an adequate measure in such patients.