Inhibitor of differentiation-1 (Id1) might constitute a novel prognostic factor able to differentiate indolent from aggressive prostate tumors. In this study, 2 cohorts of 52 and 79 prostate cancer patients were selected for Id1 expression analysis. Higher levels of Id1 protein in advanced poor-prognosis patients and a correlation of higher Id1 mRNA expression levels with a lower survival in stage I to III patients were observed. Background: In the prostate-specific antigen era, potentially indolent prostate tumors are radically treated, causing overtreatment. Molecular prognostic factors might differentiate indolent from aggressive tumors, allowing avoidance of unnecessary treatment. Patients and Methods: Fifty-two prostate cancer patients (20 organ-confined and 32 metastatic) were selected. All formalin-fixed and paraffin-embedded primary biopsies and matched metastases of 15 of them were evaluated for tumor and endothelial cell Id1 protein expression. Seventy-nine additional patients with organ-confined prostate cancer were selected for Id1 mRNA in silico analysis. Results: Among metastatic cancer subjects, 48% of primary tumors and 38% of metastases showed Id1 tumor cell expression, and 79% of primary tumors and 81% of metastases showed endothelial immunoreactivity. In the organ-confined group none of them showed Id1 protein tumor cell expression and 50% displayed endothelial expression. In the metastatic patients group, lower levels of Id1 protein predicted a nonsignificant longer overall survival (13 months vs. 7 months; P = .79). In the in silico analysis, however, lower levels of Id1 mRNA predicted a longer disease-free survival (61 months vs. not-reached; P = .018) and the hazard ratio for progression was 0.451 (P = .022) in favor of patients showing lower levels. Conclusion: In our cohort, it seems to be a differential epithelial expression of Id1 protein according to the prognostic features (metastatic/poor prognosis vs. organ-confined/good prognosis). In localized tumors treated with radical prostatectomy, higher Id1 mRNA expression levels might predict a higher hazard ratio for progression and a shorter disease-free survival. Further validation of these results in larger prospective series is warranted.

In patients treated with salvage RTP after radical prostatectomy, the preoperative PSA>20 ng/ml and PSA preRTP>0.92 ng/ml shows an independent influence on the response.

En los pT2(+) el pronóstico es significativamente peor cuando la afectación es multifocal. Además pueden diferenciarse claramente dos grupos de pacientes desde el punto de vista de la SLPB según sus variables influyentes. Los datos sugieren que desde el punto de vista del pronóstico el segundo grupo está infra-estadiado mientras que el primero está sobre-estadiado.

Renal cell adenocarcinoma requires different therapeutic pathways because it is one of the most therapy-resistant tumors, on the other hand it is biologically one of the most attractive tumors. Its pathological classification has a genetic base. There is an anomaly of the Von Hippel Lindau gene in 80% of adenocarcinomas, being this fact determinant to know the biological characteristics of tumor initiation and development, as well as the identification of factors susceptible to be used as therapeutic targets. Since 2005 a group of molecules have been used in the treatment of metastatic adenocarcinomas and, even though therapeutic results are significant but not clinically relevant yet, we are sure they are a key way for more efficient future developments. The present study tries to make a tour on the research of the biological anomalies in renal adenocarcinoma with special emphasis in the Von HippelLindau gene.

The limited availability of kidneys for transplantation has been addressed by expanding the criteria for allowing a donor kidney to be transplanted, but this tendency may cause suboptimal kidneys to be implanted and could be associated with greater risk of complications. A retrospective study of 407 kidney transplantations was done to compare complications of transplantation with non-expanded (n = 244) and expanded criteria donors (n = 163). Expanded criteria donors were donors older than 60 years, or donors aged 50-60 years who had a parts per thousand yen2 of the following risk factors: hypertension, diabetes mellitus (type 2), creatinine > 1.5 mg/dL, or death caused by stroke. Compared with transplant recipients from non-expanded criteria donors, transplant recipients from expanded criteria donors had significantly greater frequency of graft loss, delayed graft function, pneumonia, overall surgical complications, early reoperation, wound eventration, hydronephrosis, postoperative hemorrhage, and wound infection. When analyzing surgical complications types, a significant greater frequency of urologic, wound, vascular, early and late surgical complications was found. In terms of severity, expanded donor criteria transplantation was related to Clavien I, III, and IV complications. Transplantation of kidneys from expanded criteria donors is associated with a significant higher risk of medical and surgical complications than kidneys from non-expanded criteria donors.

Este estudio analiza una muestra amplia de pacientes procedente de toda la geografía española y presenta algunos datos importantes que reflejan la evolución que ha sufrido el cáncer de próstata localizado, tanto en lo que respecta al diagnóstico como al pronóstico, en nuestro país en los últimos 20 años.

Fundamento. Estudiar la supervivencia libre de progresión bioquímica (SLPB) que ha obtenido un grupo de pacientes de alto riesgo de acuerdo con la clasificación de D¿Amico mediante prostatectomía radical. Identificar las variables clínico-patológicas influyentes en la supervivencia libre de progresión bioquímica y diseñar con ellas, si es posible, un modelo pronóstico. Material y métodos. Se estudian 232 pacientes, de una serie de 1.054, diagnosticados de cáncer de próstata clínicamente localizado y calificados de alto riesgo en la clasificación de D¿Amico (PSA >20 ng/ml ó Gleason 8-10 ó T3) tratados mediante prostatectomía radical. Se estudia la SLPB y se analizan las variables clínico-patológicas recogidas (PSA, Gleason de la biopsia y de la pieza, estadio clínico y patológico, afectación unilateral o bilateral, márgenes de la pieza de prostatectomía, expresión de Ki-67) para identificar si influyen en la SLPB. Se ha utilizado para el estudio estadístico: tablas de contingencia y para el análisis de la supervivencia: Kaplan-Meyer, Log-rank y modelos de Cox. Resultados. Estudio descriptivo: PSA: 23,3 ng/ml (mediana); cGleason 2-6: 33%; 7: 13%; 8-10: 54%; T2: 58%; Afectación bilateral en la biopsia diagnóstica: 59%; RNM T2: 60%; RNM T3: 40%. pGleason 2-6: 24%; 7: 28%; 8-10: 48%; pT2: 43%; pT3a: 30%; pT3b: 27%; Margen afectado: 51%; N1:13%. Supervivencia libre de progresión: con una media y mediana de seguimiento de 64 meses; el 53% evidencia progresión bioquímica. La mediana hasta progresión: 42 meses. La supervivencia libre de progresión a 5 y 10 años es 43±3% y 26±7%. El estudio multivariado (modelos de Cox) evidencia que las variables influyentes de forma independiente en la SLPB son la afectación de márgenes (HR: 3,5; 95% IC.1,9-6,7; p>0001); y Ki67 >10% (HR: 2,3; 95% IC: 1,2-4,3; P: 0,009). Grupos de riesgo: utilizando las dos variables influyentes y utilizando modelos de Cox se diseñan tres grupos de riesgo como mejor modelo: Grupo 1 (0 variables presentes); Grupo 2 (1 variable); Grupo 3 (2 variables). La supervivencia libre de progresión es de 69±8%; 27±6% y 18±11% a los 5 años. Las diferencias son significativas entre los tres grupos. Conclusión. El grupo de alto riesgo de la clasificación de D¿Amico es heterogéneo en relación con la progresión bioquímica y puede ser desglosado en tres grupos de riesgo utilizando las dos variables de influencia independiente (márgenes afectados y porcentaje de Ki67).

BACKGROUND: To analyze the association between the principal immunosuppressive drugs (mycophenolate mofetil, calcineurin inhibitors and mammalian target of rapamycin [mTOR] inhibitors) used in the routine management of kidney transplant patients and the development of postoperative surgical complications. MATERIALS AND METHODS: We analyzed 415 kidney transplants, studying the influence of various immunosuppressive regimens on the main postoperative surgical complications. RESULTS: The mean follow-up for the entire group was 72.8 months (± 54.2 SD). Patients treated with myeophonolate mofetil (MMF) and cyclosporine (n = 121) experienced a higher frequency of wound eventration odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2-23.5; P = .03) compared with azathioprine and cyclosporine (n = 71). Compared with transplant recipients treated with tacrolimus and MMF (n = 181), transplant recipients treated with cyclosporine and MMF (n = 121) had a significantly greater frequency of wound eventration (OR, 3.7; 95% CI, 1.5-9.5; P = .005), urologic (OR, 2; 95% CI; 1.02-3.9; P = .04), wound (OR; 2.2; 95% CI; 1.07-4.6; P = .03), late (OR, 1.7; 95% CI; 1.01-3.03; P = .04), and Clavien grade 3 surgical complications (OR; 1.9; 95% CI, 1.1-3.37; P = .01). Patients treated with mTOR inhibitors (n = 26) had higher rates of lymphocele (OR, 3.6; 95% CI, (1.1-11.4; P = .002) compared with those who received tacrolimus (n = 197). CONCLUSIONS: New immunosuppressive drugs have improved short-term functional results; however, in some cases they seem to increase surgical complications rates.

Introducción Se han evaluado los factores clínico-patológicos influyentes en el tiempo hasta la progresión bioquímica en una serie homogénea de una única institución. Material y métodos Análisis retrospectivo de 278 pacientes con progresión bioquímica tras prostatectomía. Se consideró progresión bioquímica PSA > 0,4 ng/ml. Se realizó estudio mediante modelo de Cox (univariado y multivariado) y «t» de Student para comparación de medias. Resultados Con una media de seguimiento de 4 años (± 3 DE) el estudio univariado reveló una media hasta la progresión para el score Gleason 2-6 en la biopsia de 824 días y 543 para Gleason 7-10 (p=0,003). Para los márgenes quirúrgicos negativos la media fue 920 días y 545 para los márgenes positivos (p=0,0001). En el caso del score Gleason del espécimen 2-7 la media fue 806 días y 501 para el Gleason 8-10 (p=0,001). Por último, la media para los casos con Ki-67 negativo en el espécimen (< 10%) fue de 649 días y 345 para Ki-67 positivo (> 10%) (p=0,003). En el estudio multivariado Ki-67 (OR 1,028; IC 95% 1-1,01; p=0,0001) y Gleason 8-10 (OR 1,62; IC 95% 1,05-2,45; p=0,026) en el espécimen, y PSA inicial > 10 ng/ml (OR 1,02; IC 95% 1,01-1,04; p=0,0001) fueron variables independientes. Utilizando estas variables se diseña un modelo predictivo con tres grupos. El tiempo hasta la progresión en cada grupo fue de 1.081, 551 y 218 días respectivamente. Conclusión El Gleason 7-10 en la biopsia prostática, la presencia de Ki-67, los márgenes positivos y el Gleason 8-10 en el espécimen y el PSA inicial >10 ng/ml son factores influyentes en el tiempo hasta la progresión bioquímica. Gleason patológico 8-10, PSA > 10 ng/ml y Ki-67 son factores independientes.

There are no differences of graft and recipient survival between patients with a first transplantation and those with a repeat one.

En nuestra experiencia una isquemia fría menor de 18 horas no parece afectar negativamente la supervivencia del injerto.

To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. MATERIAL AND METHODS: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. RESULTS: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5 cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. CONCLUSIONS: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery.

OBJECTIVE: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional. METHODS: We present our case and perform a bibliographic review. RESULTS: To date and in our knowledge , seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia. CONCLUSIONS: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen.

Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival. Materials and methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graf tsurvival. Results: At least one surgical complication occurred in 82(38%)of the 216 transplantations, and 68(31%)required some type of repeat surgery,23 in the early post operative period and 45 more than 3 months after surgery. Mean follow¿up was 48 months(SD þ/ 33.4), and median follow¿up 48 months(range,0¿166months). No recipient or donor factor spredisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3-and 5-year survival rates of 86%(95%CI83%¿89%)and 78%(95%CI73%¿82%)as compared to 92% (95%CI90%¿94%)and 88%(95%CI85%¿91%),p:0.004].Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole groups howed early repeat surgery to bea factor with an independent prognostic value (OR:4.7;95%CI2.2¿10,po0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. Conclusion: Surgical complications have an influence on graft survival.Then eed for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival.

INTRODUCTION: The objectives were to: (1) analyze clinical and pathological features of renal cell carcinoma (RCC) with caval thrombosis in order to indentify independent prognostic factors, and (2) analyze perioperative morbidity and mortality. METHODS: The authors retrospectively analyzed clinical and pathological data of 56 patients treated for RCC with caval thrombosis during a 20-year period. The surgical procedure was essentially unchanged. Independent variables were: TNM, creatinine value, age, histological extent, histological type, adjuvant treatment, and surgical technique; the dependent variable was overall survival. Contingency and logistic regression tables were used. Kaplan-Meier method, log-rank, and Cox models were used to analyze survival rates. RESULTS: There were complications in 15 patients and 2 perioperative deaths. Overall mean (SD) survival rates were 32% (7%) and 24% (6%) at 3 and 5 years, respectively. Multivariate results showed that the significant prognostic indicators of survival were: the size of the tumor > 8 cm (P < .01), the presence of metastasis (P < .04), and lymph node invasion (P < .009). These were also regarded as the relevant variables, independent of patient survival. CONCLUSIONS: The surgical approach for this disorder is challenging and not exempt of complications. Nodal involvement, tumor size, and distant metastases are the most important prognostic factors; thrombus extension has a clear impact on surgical planning and performance.

Objective: To evaluate the response and the free-survival progression in pacients diagnosed of invasive bladder cancer who have been treated with transurethral resection, chemotherapy and radiotherapy. This multimodal treatment is compared with a not random serie of patients treated by radical cistectomy. Material and methods: Retrospective analysis of 43 cases of invasive bladder cancer treated with two schemes of bladder preservation between 1994-2007. They are compared with 145 cases treated with radical cistectomy in the same period of time. Pronostic variables included in the study are clinical stage, grade of differentiation, presence of ureteral obstruction, chemotherapy modality, radiotherapy doses and p53 and ki-67 expression. Results: Mean and median time are 51 and 39 months in patients with multimodal treatment. Complete response is achieved in 72% of cases treated with bladder preservation. Ureteral obstruction is a prognostic factor (OR: 7,3;p:0,02). 72% patients with complete response mantain it at the end of the study. None of analyzed variables are predictors of maintenance of the response. Survival rates with a intact bladder were 69 +/- 7% and 61 +/- 7% at three and five years. Radiotherapy doses greater than 60 Gy (OR: 6,1; p < 0,001) and the absence of ureteral obstruction (OR: 7,5; p < 0,002) were pronostic variables. Free-survival in patients with complete response was 80 7% and 58 +/- 10% at three and five years. At the end of the study, 53,5% of patients had a intact bladder and free-disease. In the same period of time, 145 radical cistectomies were performed due to muscle invasive bladder cancer. Mean and median time in this group were 29 and 18 months respectively. Stadistical analysis reveals a worse clinical stage in the group of patients treated with multimodal treatment (p:0.01). Free-survival was 72 +/- 5% and 63 +/- 7% at 3 and 5 years in the group of radical cistectomies. There was not stadistical significant differences between cistectomies and bladder preservation. Conclusions: Patients treated with bladder preservation have a free-survival similar to those treted with radical cistectomy. Radiotherapy doses greater than 60 Gy and absence of ureteral obstruction were free-survival prognostic variables. (C) 2010 AEU. Published by Elsevier Espana, S.L. All rights reserved.

Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival. Materials and methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graft survival. Results: At least one surgical complication occurred in 82 (38%) of the 216 transplantations, and 68 (31%) required some type of repeat surgery, 23 in the early postoperative period and 45 more than 3 months after surgery. Mean follow-up was 48 months (SD +/-33.4), and median follow-up 48 months (range, 0-166 months). No recipient or donor factors predisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3- and 5-year survival rates of 86% (95% CI 83%-89 %) and 78% (95% CI 73%-82%) as compared to 92% (95% CI 90%-94%) and 88% (95% CI 85%-91%), p:0.004]. Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole group showed early repeat surgery to be a factor with an independent prognostic value (OR: 4.7; 95% CI 2.2-10, p<0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. Conclusion: Surgical complications have an influence on graft survival. The need for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival. (C) 2009 AEU. Published by Elsevier Espana, S.L. All rights reserved.