Objective
To validate the Cancer of the Bladder Risk Assessment (COBRA) score in patients with urothelial variants.
Methods
Epidemiological, clinical, radiological, and anatomopathological data were ...collected from patients with urothelial carcinoma who underwent radical cystectomy at the Institute of Cancer of São Paulo between May 2008 and December 2022. Patients with the presence of at least 10% of any urothelial variants in the radical cystectomy specimens’ anatomopathological exam were included in the study. The COBRA score and derivatives were applied and correlated with oncological outcomes.
Results
A total of 680 patients 482 men (70.9%) and 198 women (29.1%); 66 years (IQR 59–73) underwent radical cystectomy for bladder tumor, and of these patients, a total of 167 patients presented any type of urothelial variant. The median follow-up time was 28.77 months (IQR 12–85). The three most prevalent UV were squamous differentiation (50.8%), glandular differentiation (31.3%), and micropapillary differentiation (11.3%). The subtypes with the worst prognosis were sarcomatoid with a median survival of 8 months (HR 1.161; 95% CI 0.555–2.432) and plasmacytoid with 14 months (HR 1.466; 95% CI 0.528–4.070). The COBRA score for patients with micropapillary variants demonstrated good predictive accuracy for OS (log-rank
P
= 0.009; 95% IC 6.78–29.21) and CSS (log-rank
P
= 0.002; 95% IC 13.06–26.93).
Conclusions
In our study, the COBRA score proved an effective risk stratification tool for urothelial histological variants, especially for the micropapillary urothelial variant. It may be helpful in the prognosis evaluation of UV patients after radical cystectomy.
•Patients with primary bladder adenocarcinoma associated with hydronephrosis have worse overall survival.•Patients with bladder adenocarcinoma present lymph node involvement in up to 1/3 of cases ...(32%).•Patients with primary bladder adenocarcinoma undergoing radical cystectomy have advanced T staging (T3/T4) (61.7%).
Introduction
Surgical intervention is the treatment of choice in patients with urachal carcinoma. Due to complications and to reduce hospital stay from open surgery, minimally invasive approaches are ...desirable. Nowadays, robotic‐assisted surgery has become increasingly popular, and robot‐assisted cystectomy can be performed in patients with urachal carcinoma with low complication rates.
Methods
We performed a systematic review to search for studies that evaluated patients who underwent robotic‐assisted surgery for urachal carcinoma. The outcomes of interest were the type of cystectomy performed, whether there was umbilicus resection, total operative time, console time, intraoperative complications, estimated blood loss, postoperative complications, time of hospitalisation, positive surgical margins and the presence of documented tumour recurrence.
Results
In this study, we evaluated three cohorts comprising a total of 21 patients. The median follow‐up period ranged from 8 to 40 months. Medium age was between 51 and 54 years, with a majority (63.1%) being male. One patient (5.2%) underwent a radical cystectomy, and 19 patients (94.7%) underwent to partial cystectomy. Umbilical resections were performed in all cases, and pelvic lymphadenectomy in 14 cases (73.6%). Recurrence occurred in three patients at a median of 17 months postoperation, two cases in the trocar insertion site. Additionally, there was one death, which was attributed to postoperative cardiovascular complications.
Conclusion
Robotic‐assisted partial cystectomy has a low incidence of adverse outcomes in patients with urachal carcinoma. Controlled studies, ideally randomised, are warranted to establish the comparative efficacy and safety of the robotic‐assisted cystectomy approach relative to open surgery.
Objective
We aim to create a new score to predict postoperative overall survival in patients with nonmetastatic T3aN0 renal cell carcinoma.
Methods
We reviewed the clinical data of adult patients who ...underwent radical nephrectomy for renal cell carcinoma between December 2007 and January 2022 in a single tertiary oncological institution. Clinical characteristics, clinical‐pathological staging and histopathological characteristics were analysed. Survival analyses were determined using the Kaplan–Meier curve. A nomogram was established using Cox proportional hazard regression to identify the prognostic factors affecting the overall survival. The area under the curve, calibration curves and decision curve analysis were used to evaluate prognostic efficacy.
Results
We analyzed 362 patients classified as pT3aN0M0 stage with a median follow‐up of 40 months. According to Cox univariate and multivariate analyses, weight loss greater than 5% in 6 months before surgery, stage V chronic kidney disease after radical nephrectomy, sarcomatoid pattern, and coagulative tumor necrosis were identified as predictors of overall survival. We developed a score and performed internal and external validation. The time‐dependent receiver operating characteristic curve, area under the curve value and calibration curve analysis showed good prediction ability of the score. The nomogram can effectively predict and stratify overall survival after radical nephrectomy in patients with pT3aN0M0 renal cell carcinoma.
Conclusion
Patients with pT3aN0MO renal cell carcinoma exhibited different characteristics, and those with unfavourable characteristics deserve greater attention during follow‐up. This nomogram provides an accurate prediction of overall survival after radical nephrectomy.
The HoLERBT (Holmium Laser En-bloc Resection of Bladder Tumors) has emerged as an alternative to classical TURBT (Transurethral Resection of Bladder Tumor). Recent randomized trial and meta-analysis ...corroborate with the benefits in pathological analysis, perioperative and long-term oncological outcomes.1-3 However, the treatment of large tumors and the technique of extraction from the bladder is a problem to be overcome.1,4
To describe the laser resection of bladder tumors and demonstrate the feasibility of this procedure even for large tumors throughout a series of cases. It is also discussed the quality of the histopathological analysis.
A series of 8 cases randomized selected to be the pilot for a trial comparing TURBT and HoLERBT in large tumors (>3 cm) in progress was analyzed (Brazilian Registry of Clinical Trials number RBR-67npwrk). The perioperative data and 1-year outcomes were assessed and the quality of histopathological analysis after morcellation was evaluated in terms of histopathology, grade, and stage. The entire procedure of one case is shown in a step-by-step video.
The mean follow-up was 12.6 months. The mean age was 59.6 (42-85) years, and the mean tumor size was 4.7 (4-8) cm. All the resections were En-bloc. There were 2 cases of NMIBC, 4 cases of MIBC, 1 paraganglioma, and 1 adenocarcinoma. The histopathological analysis confirmed the presence of detrusor muscle layer and accurate diagnosis and staging in all cases (100%). There were no perioperative Clavien-Dindo > 1 complications, no blood transfusion, and no bladder perforations. The histopathology analysis reveals excellent quality without artifacts of fulguration.
The holmium laser resection followed by morcellation of large bladder tumors is a feasible procedure. No complications occurred in our series of cases and all cases provided excellent material for histopathological analysis.
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661
Background: An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with worse oncologic outcomes in several malignancies, its prognostic role in kidney cancer, ...specifically in the non metastatic setting is controversial. We aimed to evaluate if an elevated NLR in patients with locally advanced non metastatic clear cell renal cell carcinoma (CCRCC) is associated with a worse survival and/or a higher cancer recurrence rate. Methods: We retrospectively identified 880 nephrectomies performed between 01/2009 to 12/2016 in a single center, reviewed data from 478 consecutive radical nephrectomies (RN) for kidney tumors and identified 187 patients with locally advanced non-metastatic CCRCC patients (pT3-T4 N0M0). The cut-off point of NLR = 2.5 was obtained using the receiver operating curve analysis (ROC). NLR was obtained preoperatively and calculated by dividing absolute neutrophil count by absolute lymphocyte count. Overall survival (OS) and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method. Cox regression models were utilized to evaluate predictors of recurrence and survival. Results: Median follow up was 48.7 months. The 3 year OS was significantly lower for patients with NLR ≥ 2.5 than those with NLR < 2.5 (70% vs 85%, p = 0.049). In patients with a Fuhrman nuclear grade of differentiation of 3-4, the median time to recurrence was significantly shorter for patients with NLR ≥ compared to those with NLR < 4 (24 vs 55 months p 0.045). On multivariable analysis adjusted for NLR ≥ 2.5, microvascular invasion, sarcomatoid differentiation, tumor size and body mass index, only nuclear grade of differentiation was found to be an independent predictor for recurrence (hazard ratio= 2.18; 95% confidence interval CI: 1.07 – 4.92, p = 0.03). Conclusions: Patients with non-metastatic CCRCC with higher nuclear grade of differentiation and a high preoperative NLR have shorter RFS and worse OS compared to patients with lower NLR.
Abstract only
e16056
Background: Partial nephrectomy (PN) is the standard of care in the management of cT1a tumors, while radical nephrectomy (RN) is indicated in more advanced tumors. Recent studies ...provided evidence that PN could be performed in patients with tumors greater that 7 cm with complication rates and oncological outcomes comparable with those undergoing RN. This study compares the recurrence-free survival (RFS), overall (OS) and cancer-specific survival (CSS) of PN and RN in patients with non-metastatic pathological T3a renal cell carcinoma (RCC) with perirenal fat invasion only. Methods: We reviewed 1202 patients undergoing RN (n = 653) and PN (n = 549), at a oncological referral center, from January 2003 to June 2016. Of all patients, we identified 25 RN and 41 PN pT3a tumors with exclusively perirenal fat invasion. None had nodal or distant metastasis at pretreatment clinical staging. Patients characteristics were compared with Mann-Whitney U test and Student t-test for categorical and numeric variables with normal distribution, respectively. Both groups were compared for RFS, OS and CSS with a Kaplan-Meier survival analysis. Results: All patients included had pT3a stage with isolated perirenal fat invasion. Groups undergoing RN and PN were not significantly different regarding Charlson Comorbidity Index (Median 3 for RN vs 4 for PN, p = 0.24) or Age (Mean 65.3 for RN vs 62.0 for PN, p = 0.99). Patients undergoing RN had bigger tumors (7.9 cm vs 4.6, p < 0.001) and higher Fuhrman grade (p = 0.01). Median follow-up was 36 months for RN and 34 months for PN. At the end of follow-up, recurrence was seen in 3 patients undergoing RN (12%) and 2 undergoing PN (5%), p = 0.36. Mortality was similar across groups (16% for RN vs 15% for PN, p = 0.99) as well as Cancer-specific mortality (4% for RN vs. 5% for PN, p = 0.99). At the end of follow-up, RFS was 80% (20/25) for RN and 82% (34/41) for PN. Conclusions: In our data, renal cell carcinoma with T3 stage due to perirenal fat invasion exclusively had similar outcomes when treated with Radical or Partial Nephrectomy. OS as well as RFS were comparable for both surgical modalities, suggesting that, although RN is currently the gold standard for this staging, PN may provide similar oncologic results.
Introdução: A freqüência de complicações do efluxo venoso no transplante de fígado piggyback (Tx) está relacionada com o tipo de reconstrução empregado. Há uma baixa incidência quando são utilizadas ...as três veias hepáticas (DME) do receptor. No entanto, nessa modalidade, existe redução na eficiência do retorno venoso na fase anepática do Tx. A utilização do óstio das veias hepáticas direita e média (DM) propicia menor constrição da veia cava inferior (VCI). Entretanto, esse benefício só se justifica se a via de efluxo venoso obtida não apresentar restrições anatômicas. Objetivo: Comparar a congruência do perímetro da VCI com o das bocas anastomóticas e dos óstios de drenagem na VCI, obtidos nas modalidades DM e DME. Método: Realizou-se estudo prospectivo morfométrico em 16 cadáveres frescos, aferindo-se o perímetro da VCI (PVCI) e, nas reconstruções DM e DME, o perímetro das bocas anastomóticas (PDM e PDME) e dos óstios de desembocadura na VCI (PoDM e PoDME). A análise estatística foi realizada por meio de análise de variância (ANOVA) para medidas repetidas. Resultado: Os valores de PDME (137,2 + 24,3 mm; p<0,001), PDM (123,2 + 20,1 mm; p=0,003) e PoDM (116,6 + 17,5 mm; p=0,027) foram significantemente maiores do que PVCI (107,9 ± 18,8 mm). PDME foi significantemente maior que PDM (p=0,004) e PoDM (p=0,001). Conclusão: A modalidade DM apresenta perímetro maior que o da VCI tanto no sítio de anastomose quanto no óstio de desembocadura na VCI. Em comparação com DME, a modalidade DM apresenta perímetro mais congruente com o da VCI.
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