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Background: Renal cell carcinoma (RCC) is a lethal neoplasia. Data from Latin America are scarce, and the distinct ethnic origins of this population could affect predictive or prognostic factors. Objective: We aim to describe a large cohort of non-metastatic renal cell carcinoma, identifying the demographic, clinical, and pathological prognostic factors for survival. Methods: We used a multi-institutional retrospective cohort involving 5,670 patients who underwent radical or partial nephrectomy across seven Latin American countries and Spain from 1980 to 2016. The variables were compared, and Kaplan–Meier curves were used to estimate the overall survival (OS) and cancer-specific survival (CSS). Results: The clear cell subtype represented 66.7% of RCC, followed by chromophobe (13.7%), papillary (5.2%), and others (14.4%). Furthermore, 72.3% of renal masses were 7 cm (HR: 1.64). Conclusions: Our findings agreed with those reported for some developed countries. We emphasize that ASA and peri-renal fat invasion as prognostic factors deserve further study. Information regarding microvascular invasion should be regularly incorporated in pathological reports.

PURPOSE To assess the effect of clinical and pathological variables on cancer-specific and overall survival (OS) in de novo metastatic patients from a collaborative of primarily Latin American countries. PATIENTS AND METHODS Of 4,060 patients with renal cell carcinoma diagnosed between 1990 and 2015, a total of 530 (14.5%) had metastasis at clinical presentation. Relationships between clinical and pathological parameters and treatment-related outcomes were analyzed by Cox regression and the log-rank method. RESULTS Of 530 patients, 184 (90.6%) had died of renal cell carcinoma. The median OS of the entire cohort was 24 months. American Society of Anesthesiology classification 3-4 (hazard ratio [HR]: 1.64), perirenal fat invasion (HR: 2.02), and ≥ 2 metastatic organ sites (HR: 2.19) were independent prognostic factors for 5-year OS in multivariable analyses. We created a risk group stratification with these variables: no adverse risk factors (favorable group), median OS not reached; one adverse factor (intermediate group), median OS 33 months (HR: 2.04); and two or three adverse factors (poor risk group), median OS 14 months (HR: 3.58). CONCLUSION Our study defines novel prognostic factors that are relevant to a Latin American cohort. With external validation, these easily discerned clinical variables can be used to offer prognostic information across low- and middle-income countries.

espanolAntecedentes: la incidencia del carcinoma de celulas renales (CCR) esta aumentando a nivel mundial debido al envejecimiento de la poblacion y al uso generalizado de estudios de imagenes. Objetivo: El objetivo de este estudio fue describir las caracteristicas y resultados perioperatorios de la cirugia de CCR en pacientes muy ancianos (PEV), ≥ 75 anos. Metodos: se trata de un estudio comparativo retrospectivo de 3656 pacientes que se sometieron al tratamiento por CCR entre 1990 y 2015 en 28 centros de ocho paises de America Latina. Comparamos las caracteristicas basales, asi como los resultados clinicos y perioperatorios segun los grupos de edad ( Resultados: Hubo 410 pacientes con PEV (11,2%). En el analisis bivariado, VEP tuvo un indice de masa corporal mas bajo (p 2 en 26.3% vs 12.4%, p estadio pT2 (OR 1,63, p = 0,04) se asociaron de forma independiente con complicaciones perioperatorias. Conclusiones: La reseccion quirurgica del CCR fue segura y exitosa en PEV. La edad ≥75 anos se asocio de forma independiente con complicaciones perioperatorias a los 30 dias. Sin embargo, la gran mayoria fueron complicaciones de bajo grado. La edad por si sola no debe orientar la toma de decisiones en estos pacientes, y el tratamiento debe adaptarse de acuerdo con el estado funcional y la gravedad de las comorbilidades. (REV INVEST CLIN.2020; 72 (5): 308-15) EnglishBackground: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups ( Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p 2 in 26.3% vs. 12.4%, p pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

Background: Tumor burden and metastatic disease sites are well-established prognostic factors in many malignancies, including metastatic Renal Cell Carcinoma (mRCC). Objective: We aimed to evaluate the impact of bone metastasis (BM) location on clinical outcome of mRCC patients. Methods: This study is a retrospective analysis of 4060 mRCC patients from the Latin American Renal Cancer Group (LARCG) database. Clinico-pathological characteristics, 24-months-survival, overall survival (OS), and BM sites were collected. To estimate the association between BM location and clinical outcomes we used Cox regression method. Results: Out of 4060 patients, 530 (14.5%) had metastatic disease. Among those, we analyzed the fifty-six that had only BM. The median follow-up was 20.8 months (range from 0 to 188 months). Non-spinal BM (NSBM) were identified in 33 (58.9%) patients and spinal BM (SBM) in 23 (41.1%) patients. Median OS was 35 months, and 24-months OS was 76% for patients with NSBM and 46% with SBM (HR: 2.22). In multivariable analysis SBM (HR: 3.08), ASA classification 3-4 (HR: 2.37), non-cc histology (HR: 5.11), and age (HR 1.06) were independent prognostic factors for OS. Conclusions: Our study showed that SBM predicted shorter OS, suggesting that the location of BM may impact the clinical outcome of patients with mRCC.

Objective: To evaluate immunohistochemical erythropoietin (EPO) expression in clear cell renal cell carcinoma (ccRCC), its association with major clinicopathological variables and its prognostic impact. Methods: A total of 220 patients with renal cell carcinoma (RCC) surgically treated between 1989 and 2009 were evaluated in this multi-institutional study. All the cases were reviewed by a single pathologist and the immunohistochemical reactivity to EPO was analysed using tissue microarray. Results: A total of 176 patients with ccRCC were considered, with an average of 48 months of follow-up. Of the tumours evaluated, 47 (26.7%) were negative for EPO expression, and 129 (73.3%) were positive. EPO expression was associated with incidental tumour (p = 0.016), tumour size (p = 0.015), Karnofsky Performance Score (KPS) (p = 0.016), blood transfusion (p = 0.009) and adrenal involvement (p = 0.038). The median ages of the patients with positive and negative EPO expression were 56.2 years and 66.6 years. Immunohistochemical EPO expression affected overall survival (OS) and disease-specific survival (DSS) rates. The DSS rates of the patients whose tissue was positive and negative for EPO expression were 85.3% and 76.1%, respectively (p = 0.044). In a multivariate analysis, the absence of EPO expression proved to be a bad prognostic factor and negatively affected the OS (p

To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

Introduction We evaluated the reproducibility of video endoscopic inguinal lymphadenectomy (VEIL) and we report our initial experience in the treatment of penile cancer with palpable inguinal lymph nodes. Materials and methods From July 2006 to November 2010 were conducted 33 VEIL in 20 patients as complementary treatment for penile cancer in two referral hospitals in Latin America. We analyzed the epidemiological and clinical characteristics of patients and surgical and oncologic outcomes. Results Fifty-five percent of the patients included were clinical stage N0 and 45% were N+. Thirteen patients underwent bilateral VEIL and the remaining seven underwent VEIL unilateral and conventional open surgery in the contralateral limb. The average operative time for VEIL was 119 min and mean resected lymph nodes was 8 per lymphadenectomy. The overall complication rate was 33.2%. No patient had skin necrosis. The lymphatic complication rate was 27.2%. Of the 6 cases in which the saphenous vein was preserved (18.2%) there were no lymphatic complications (p = .2). The overall survival rate was 80% and cancer-specific survival was 90%. Mean follow-up was 20 months. Conclusions VEIL in the adjunctive treatment of penile cancer is safe, reproducible and may be an alternative to conventional lymphadenectomy. Patients with palpable lymphadenopathy also may benefit from this technique. Oncological results seem to be adequate however require longer follow-up to be confirmed.

Resumen Introduccion Evaluamos la reproducibilidad de la linfadenectomia inguinal video endoscopica (VEIL) y relatamos nuestra experiencia inicial en el tratamiento del cancer de pene con ganglios palpables. Material y metodos De julio de 2006 a noviembre de 2010 fueron realizadas 33 linfadenectomias inguinales video endoscopicas en 20 pacientes, como tratamiento complementario del cancer de pene, en 2 hospitales de referencia en Latinoamerica. Fueron analizadas las caracteristicas epidemiologicas y clinicas de los pacientes, asi como los resultados quirurgicos y oncologicos. Resultados De los pacientes incluidos el 55% fueron de estadio clinico N0 y el 45% fueron N+. La VEIL se llevo a cabo de forma bilateral en 13 pacientes y en 7 casos se realizo VEIL unilateral, asociada con la cirugia convencional contralateral. El tiempo operatorio medio de la VEIL fue de 119 min, y la media de adenopatias resecadas fue de 8 por cada linfadenectomia. La tasa global de complicaciones fue del 33,2%. Ningun paciente presento necrosis cutanea. La tasa de complicaciones linfaticas fue del 27,2%. En los 6 casos en que se preservo la vena safena interna (18,2%) no hubo complicaciones linfaticas (p = 0,2). La tasa de sobrevida global fue del 80% y la sobrevida cancer especifica fue del 90%. El seguimiento medio fue de 20 meses. Conclusiones La VEIL en el tratamiento complementario del cancer de pene es un procedimiento seguro y reproducible, siendo una alternativa a la linfadenectomia convencional. Los pacientes con adenopatias palpables tambien se pueden beneficiar con esta tecnica. Los resultados oncologicos son adecuados, aunque se necesita mas tiempo de seguimiento.

Objective: To determine the prognostic value of the American Society of Anesthesiologists (ASA) classification and of the main clinical pathologic variables in renal cell carcinoma (RCC) patients who underwent surgical treatment. Methods: In this international collaborative study, 376 RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) during the period 1989-2009 were assessed. The pathological data were reviewed by a single pathologist, and all of the surgically treated patients had been previously evaluated by a team of anesthesiologists and classified as ASA 1, ASA 2, or ASA 3. Results: In total, 318 patients were included in the study, with a mean followup of 48 months. Incidental tumors represented 47% of the cases, while 11.6% presented with metastases at diagnosis. Among the patients assessed, 38 (11.9%) were classified as ASA 1, 213 (67%) as ASA 2, and 67 (21.1%) as ASA 3. An association between the ASA classification and the main clinicopathological variables of RCC was observed. The univariate analysis for overall survival (OS) revealed significant differences in the survival curves according to the ASA classification (p < 0.001). High-grade neoplasms, the presence of metastasis at diagnosis, clinical stage III/IV, and incidental tumors remained as independent predictors of survival. Moreover, the multivariate analysis revealed a negative impact of the ASA classification on OS (p = 0.001). Conclusions: The present study demonstrated a correlation between the ASA classification and the main prognostic factors of RCC and its impact on survival rates. ASA 3 patients had more aggressive tumors, increased risk of perioperative complications, and worse outcomes compared with ASA1 or ASA 2. Thus, the ASA classification may be considered an additional tool for assessing and planning the treatment of RCC patients.

Prostatic abscess is rare. Its potentially serious course requires a high level of clinical suspicion and prompt and effective treatment. The causative germs are usually either enterobacteria or Enterococcus. The authors highlight the importance of considering epidemiological and clinical aspects in the early diagnosis and treatment. Prostatic abscess due to community-acquired methicillin resistant Staphylococcus has three typical characteristics: skin entry point, periprostatic compromise, and anaemia and low prothrombin.