P. Bahílo Mateu

Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes

Introduccion: el tratamiento inmunosupresor en pacientes que reciben un trasplante renal favorece el desarrollo de neoplasias. La prevalencia de neoplasias en trasplantados es de 4 a 5 veces mayor que en la poblacion general. Ademas se sabe que los tumores en trasplantados se comportan con una mayor agresividad. Objetivo: evaluar mediante un analisis descriptivo las neoplasias de novo urologicas en pacientes trasplantados renales y analizar la supervivencia de los mismos. Material y metodos: estudio retrospectivo desde enero de 1980 hasta diciembre de 2006 sobre 1.751 pacientes trasplantados. Se excluyeron aquellos en los que la neoplasia aparecio durante el primer ano tras el trasplante. Se consideraron las principales variables: sexo, edad al trasplante, edad al diagnostico de la neoplasia, localizacion, estadio clinico, tratamiento y evolucion. Para el analisis estadistico univariante se utilizo la prueba de Chi cuadrado. La supervivencia fue evaluada mediante el metodo de Kaplan Meier. Resultados: se diagnosticaron 29 (1,6%) neoplasias de novo en un total de 1.751 trasplantados, con una mediana de seguimiento de 35,28 meses (2-121) desde el diagnostico de la neoplasia. La distribucion por sexos fue de 24 varones (82%) frente a 5 mujeres (18%). La mediana de edad en el momento del trasplante fue de 50,8 (17-70) anos y la mediana de edad en el diagnostico de neoplasia fue de 56,4 (19-79) anos. Se diagnostico a 11 pacientes (38%) de cancer prostata, a 7 pacientes (24%) de neoplasias de vejiga a 4 (60%) no musculo invasivas y a tres (40%) de tumor musculo invasivo y en 6 pacientes (20%) se diagnostico un adenocarcinoma renal sobre el rinon primitivo. En 5 sujetos (18%) se detecto una neoplasia del rinon trasplantado. La mediana de supervivencia fue de 75 meses para tumores de vejiga, 82 meses en el cancer de prostata, 59 meses en el rinon primitivo y 86 meses para el rinon trasplantado. Conclusiones: en nuestra serie las neoplasias urologicas de novo en trasplantados renales son mas frecuentes en varones. El cancer de prostata es la neoplasia mas frecuente y el adenocarcinoma renal del rinon primitivo es la de menor supervivencia

De novo urological neoplasms in kidney transplant patients: Experience in 1,751 patients

Abstract Introduction Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. Objective To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. Materials and methods A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. Results Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2–121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17–70) years, and median age at tumor diagnosis was 56.4 (19–79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. Conclusions In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.

Desarrollo de un Modelo Matemático preliminar para la detección de cáncer de próstata en los pacientes con biopsias prostáticas de repetición

A PRELIMINAR MATHEMATICAL MODEL FOR PATIENTS WITH A PREVIOUS NEGATIVE PROSTATE BIOPSY Introduction and objectives: It is usual to identify patients with a negative prostate biopsy who are still at risk of prostate cancer. We try to analyse if the classical variables used in the prostate cancer screening are useful for those patients with a previous negative prostate biopsy, and if there is a possibility for making a nomogram witch would help us in the decision to repeat the biopsy. Material and methods: We studied 179 patients with at least 1 initial negative biopsy. At each biopsy session we recorded: Patient age, serum prostate specific antigen (PSA), free PSA/total PSA, PSA slope, digital rectal examination, prostate volume, PSA density, cancer suspicion in previous transrectal ultrasounds findings, number of negative cores previously obtained, history of precarcinomatous lesions and time between biopsies. Through Logistic regression analy- sis we determined the association of each variable a positive biopsy. A nomogram was constructed using all variables and discrimination was calculated as the concordance index. Results: Overall 46% of patients had cancer at the repeated biopsy session. In the univariate analysis: Age, digital rectal examination, prostate volume, PSA density, cancer suspicion in ultrasounds findings, and precarcinomatous lesions were associated with repeat positive biopsy for cancer (all p <0.05). In the multivariate study, age, digital rectal examination, prostate volume and history of precarcinomatous lesions were associated with repeat positive biopsy. A nomogram was constructed that had a concordance index of 0.80.