To assess the prognostic value of p27 protein expression in clinically localised prostate cancer with respect to biochemical recurrence after radical prostatectomy.
Fifty-two patients (median age 63 ...years) with prostate cancer were treated by radical prostatectomy in an 18-month period. Data recorded: preoperative PSA level, histopathological Gleason grade, pathological stage and status of surgical margins. p27 expression was evaluated in this group of tumors by immunohistochemistry (positivity was defined as > or = 30% positive cells). Biochemical relapse (BR) was defined by a serum PSA level > or = 0.3 ng/ml.
Twenty-two out of 47 patients (47%) with available follow-up showed a low p27 protein expression. p27 expression did not correlate with pathological stage, Gleason score, serum PSA levels or the status of the surgical margins. Patients presented with BR during the follow-up (risk of BR (RBR) at 36 months: 40%). Patients with low p27 expression showed a higher RBR than the others (RBR 36-month 59% vs. 18%, respectively; p = 0.02). In a multivariate analysis, only p27 along with stage maintained the predictive value for biochemical relapse.
p27 expression is a promising prognostic factor in prostate cancer, since it has proved to be a predictor of biochemical relapse.
Resumen La cirugía NOTES (Natural Orifice Transluminal Endoscopic Surgery) es una modalidad quirúrgica que utiliza las vísceras huecas para acceder a la cavidad peritoneal, evitando así incisiones en ...la piel. Si combinamos este tipo de cirugía con la laparoscopia convencional, obtenemos una técnica híbrida que nos permitirá abordar órganos grandes, como el riñón, disminuyendo al máximo las incisiones cutáneas. Presentamos el primer caso de nefrectomía radical híbrida transvaginal por cáncer renal. Para poder realizar este procedimiento, se utilizó el acceso vaginal para la colocación de una cámara deflectable y la asistencia de dos puertos abdominales. La incisión del trócar vaginal se amplió para la extracción de la pieza quirúrgica. La nefrectomía híbrida transvaginal NOTES asistida debe considerarse, una técnica quirúrgica factible y reproducible que debe ser considerada como opción terapéutica en pacientes mujeres candidatas a nefrectomía por cáncer renal.
Intratumoral injection of ilixadencel, consisting of proinflammatory allogeneic dendritic cells, before nephrectomy, followed by sunitinib treatment after nephrectomy showed a trend for improved ...tumor response rate and overall survival, compared with sunitinib monotherapy.
The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial.
To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC.
A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients).
The primary endpoints were 18-mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests.
The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42–1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival.
The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including complete responses, compared with sunitinib monotherapy.
We studied the effects of intratumoral vaccination with ilixadencel followed by sunitinib versus sunitinib only in a randomized phase 2 study. The combination treatment showed numerically higher numbers of confirmed responses, suggesting an immunologic effect.
We determined the incidence and characteristic of synchronous upper urinary tract tumors (UUTTs) in patients with primary superficial bladder carcinoma and evaluated the characteristics of bladder ...tumors related to UUTTs.
We performed a retrospective study of 1,529 patients with primary superficial bladder carcinoma who underwent initial examination of the upper urinary tract with excretory urography. Data were analyzed by multivariate analysis using logistic regression. Variables evaluated and related to the incidence of UUTT were multiplicity, carcinoma in situ, bladder tumor size, localization of tumor in the bladder, and tumor grade and stage.
A total of 28 patients (1.8%) had simultaneous bladder tumor and UUTT. UUTTs showed no preferred location and 17.9% were multiple. Of UUTTs 46% were invasive and almost 87% were grade 2 or 3. The only significant variable related to UUTT was bladder tumor in the trigone (RR 5.8, 95% IC 2.18 to 15.9, p <0.0005). Of 147 tumors located in the trigone 11 (7.5%) were associated with UUTT, corresponding to 41% of the UUTTs first diagnosed. If multiplicity and tumors in the trigone (551 cases) had been considered, 66.7% of tumors would have been diagnosed.
Synchronous UUTT and superficial bladder tumor are uncommon but 46% are invasive. Considering the possible examination of the upper urinary tract only in patients with tumor in the trigone or with multiple bladder tumors 41.4% or 69% of UUTTs, respectively, would have been diagnosed. Patients with tumor in the trigone are at almost 6-fold higher risk for a synchronous tumor in the upper urinary tract.
At the present, the concept of startup has been rapidly and globally spread. Startups are emerging companies with scalable business models, generally linked to innovation and technological ...developments, mass sales oriented and then designed to grow fast. The profitability derived from their development leads a large number of entrepreneurs and investors to participate towards their expansion. However, it is significant the number of startups that are dissolved each year, as only one out of ten emerging companies continue operative after three years of operation, which is mainly due to the value proposition and financial needs inherent to its development. Therefore, in order to promote their growth, several actors have been created, who represent currently the international entrepreneurial ecosystem. The aim of this article is not only to develop the concept of startup, but to study the evolution of investment and its geographical distribution, identifying those agents that have arisen in response to the expansion and development of these new companies.
Abstract Context In the course of the development of minimally invasive surgeries over the past 20 yr, the new concept of scarless surgery has emerged. Laparoendoscopic single-site surgery (LESS) and ...natural orifice transluminal endoscopic surgery (NOTES) are included in this concept, and they are the evolution of laparoscopy towards minimising the impact of surgery on the patient. Objective Describe our experience with NOTES and LESS in the context of the latest publications on these techniques in kidney surgery to identify their role in current urologic practice. Evidence acquisition Over the last 3 yr, we have performed 38 transvaginally NOTES, assisted, laparoscopic nephrectomies; 16 LESS radical nephrectomies; 2 LESS partial nephrectomies; and 1 LESS live-donor nephrectomy. This paper is based on a presentation at the 2011 meeting of the European Society of Oncological Urology; a bibliographic review also was performed to make a structured paper on the most recent advances in scarless renal surgery and to describe the role NOTES and LESS currently have in urology. Evidence synthesis NOTES is a surgical modality that uses empty organs to access the peritoneal cavity. Although pure NOTES is not available for kidney surgery yet, it eliminates abdominal scarring. The combination of NOTES with conventional laparoscopy results in a hybrid technique that maintains most of the advantages of NOTES, making it a very interesting option in kidney surgery in females. LESS concentrates all trocars and extraction incisions in one point, resulting in a small scar. It is feasible in a number of urologic procedures. Conclusions The implementation of new minimally invasive techniques is essential to optimise surgery outcomes and improve patients’ recovery. Both hybrid NOTES and LESS have proven their feasibility in renal surgery; however, we still do not have evidence that they can overcome laparoscopic surgery; prospective trials are required to further elucidate this question.
Background
This study aims to evaluate the feasibility and usefulness of an ovine model in order to perform natural orifice translumenal endoscopic surgery (NOTES) approach and laparoscopic ...nephrectomy for research and training purposes.
Methods
Ten healthy female sheep were used to perform transvaginal NOTES-assisted right laparoscopic nephrectomy using a flexible 12-mm gastroscope through a vaginal access and two additional 5- and 10-mm trocars placed in the abdomen. The renal artery, the renal vein, and the ureter were dissected, and ligation was accomplished by using laparoscopic clips. The right kidney was retrieved transvaginally after enlarging the vaginal trocar incision. All data related with the surgical procedure, perioperative, and postoperative outcomes were recorded. The animals were monitored after surgery for a 30-day period with daily clinical follow-up.
Results
We established a useful animal model of transvaginal NOTES-assisted laparoscopic nephrectomy, performing the transvaginal approach and the abdomen exploration with no complications in any animals. The renal artery, the renal vein, and the ureter were identified, clipped, and transected combining the 5-mm laparoscopic access and the endoscopic vision in the whole group. Mean operative time was 86 ± 14.49 min, estimated blood loss was less than 20 ml in all cases, and there was no bleeding or laceration of adjacent organs. The animals recovered successfully in all cases postoperatively. After 1 month, exploratory laparotomy did not show alterations in abdominal cavity, and the vaginotomy incision healed completely in every animal.
Conclusions
This experiment shows that transvaginal NOTES-assisted laparoscopic nephrectomy in ovine model is feasible and reproducible while offering an innovative possibility to help surgeons with this recent technology in the treatment of renal cancer. Well-managed experimental studies need to be carried out to determine the safety and efficacy of NOTES in the treatment of renal cancer.
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