Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy

Background: The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN). Materials and methods: All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. Postoperative hemorrhagic complications (HCs) were defined as the occurrence of blood transfusion, hemorrhagic shock, arterial embolization, or re-hospitalization for hematoma. DU was systematically performed between post-op day 4 and 7 for every complex tumor (RENAL score ⩾ 7). DU was considered positive in the presence of pseudoaneurysm (PA) or arteriovenous fistula (AVF). Results: Among 194 patients, 117 underwent DU (60.3%). We reported 22 HCs (11.3%) requiring 8 selective embolization procedures (4.1%). HCs occurred during the hospital stay in 17 patients (77.3%), thus directly diagnosed on a computed tomography scan. Among the five patients (22.7%) with HC occurring after hospital discharge, between day 7 to 15, four had a previously negative systematic DU. Overall, systematic DU was positive in only five patients (4.3%) with only one patient of 194 (0.5%) undergoing preventive embolization of a PA-AVF. The negative predictive values (NPVs) and positive predictive values of DU were respectively 96.5% and 5%, with 20% sensitivity and 96.5% specificity. Conclusions: Our results may suggest offering systematic DU in patients under antiplatelet therapies, with high tumor size (>T1b), or early postoperative hemoglobin variations. A high NPV of DU might be counterbalanced by its low sensibility. Since all secondary HCs occurred between postoperative day 7 to 15, our results may suggest differing DU in selected cases

The Immunoscore in Localized Urothelial Carcinoma Treated with Neoadjuvant Chemotherapy: Clinical Significance for Pathologic Responses and Overall Survival

International audience(1) Background-The five-year overall survival (OS) of muscle-invasive bladder cancer (MIBC) with neoadjuvant chemotherapy and cystectomy is around 50%. There is no validated biomarker to guide the treatment decision. We investigated whether the Immunoscore (IS) could predict the pathologic response to neoadjuvant chemotherapy and survival outcomes. (2) Methods-This retrospective study evaluated the IS in 117 patients treated using neoadjuvant chemotherapy for localized MIBC from six centers (France and Greece). Pre-treatment tumor samples were immunostained for CD3+ and CD8+ T cells and quantified to determine the IS. The results were associated with the response to neoadjuvant chemotherapy, time to recurrence (TTR), and OS. (3) Results-Low (IS-0), intermediate (IS-1-2), and high (IS-3-4) ISs were observed in 36.5, 43.7, and 19.8% of the cohort, respectively. IS was positively associated with a pathologic complete response (pCR; p-value = 0.0096). A high IS was found in 35.7% of patients with a pCR, whereas it was found in 11.3% of patients without a pCR. A low IS was observed in 48.4% of patients with no pCR and in 21.4% of patients with a pCR. Low-, intermediate-, and high-IS patients had five-year recurrence-free rates of 37.2%, 36.5%, and 72.6%, respectively. In the multivariable analysis, a high IS was associated with a prolonged TTR (high vs. low: p = 0.0134) and OS (high vs. low: p = 0.011). (4) Conclusions-This study showed the significant prognostic and predictive roles of IS regarding localized MIBC