Resultados oncológicos en enfermedad N1 posterior a la prostatectomía radical

ResumenAntecedentesLa prostatectomía radical+linfadenectomía pélvica puede mejorar la supervivencia libre de progresión y supervivencia cáncer-específica en la enfermedad ganglionar.ObjetivoAnalizar las características de los pacientes con enfermedad ganglionar en el análisis histopatológico de la prostatectomía radical.Material y métodosEstudio retrospectivo de pacientes sometidos a prostatectomía radical con enfermedad ganglionar metastásica de 1988 a 2015.ResultadosSe incluyeron 25 pacientes, de 66.5 años (DE±6.5); antígeno prostático específico medio de 20.17ng/dL (RIC: 18); con una mediana de seguimiento en 63 meses (RIC: 86). Clasificación de riesgo por D’Amico, 15 (60%) pacientes de alto, 8 (32%) intermedio y 2 (8%) de riesgo bajo. Se encontraron márgenes positivos en 15 casos (60%); estadio tumoral T2 en 4 (16%), T3A en 3 (12%), T3B en 17 (68%) y T4 en 1 (4%); cantidad de ganglios positivos, uno en 14 (56%), 2 en 3 (12%) y más de 2 en 8 (32%) casos. Recibieron radioterapia 3 pacientes (16%) y bloqueo hormonal 24 (96%). La supervivencia libre de progresión fue de 105 meses y la supervivencia cáncer-específica fue del 86 y 45% a 5 y 10 años respectivamente. El HR para progresión bioquímica fue significativo en márgenes positivos (HR: 9.5, IC95%: 0.99-91.5, p=0.50) y ≥2 ganglios positivos (HR: 8.5, IC95%: 1.1-61.9, p=0.34). La afectación≥2 ganglios predijo progresión con una OR de 7.2 (IC95% 1.06-48.6, p=0.043).ConclusionesLa supervivencia media a 5 años es superior al 80%. El número de ganglios positivos podría ser un factor predictor de progresión bioquímica.AbstractBackgroundRadical prostatectomy+pelvic lymph node dissection can improve progression-free survival and cancer-specific survival in lymph node disease.AimTo analyze the characteristics of patients with lymph node disease in the histopathologic findings of the radical prostatectomy and lymph node dissection.Material and methodsA retrospective study was carried out on patients that underwent radical prostatectomy with metastatic lymph node disease within the time frame of 1988 to 2015.ResultsThe study included 25 patients with a mean 66.5 years of age (SD±6.5), a mean prostate-specific antigen of 20.17ng/dl (IQR: 18), and a median follow-up period of 63 months (IQR: 86). According to the D’Amico classification, 15 (60%) patients were high-risk, 8 (32%) were intermediate-risk, and 2 (8%) were low-risk. Positive margins were found in 15 cases (60%); 4 (16%) patients had T2 tumor stage, 3 (12%) had T3A, 17 (68%) had T3B, and one patient (4%) had T4. Fourteen (56%) patients had one positive lymph node, 3 (12%) patients had 2 positive lymph nodes, and 8 (32%) patients had more than 2 positive lymph nodes. Three (16%) patients received radiotherapy and 24 (96%) underwent hormone blockade. Progression-free survival was 105 months and cancer-specific survival was 86% at 5 years and 45% at ten years. The HR for biochemical progression was significant in positive margins (HR: 9.5, 95% CI: 0.99-91.5, P=.50) and when there were≥2 positive lymph nodes (HR: 8.5, 95% CI: 1.1-61.9, P=0.34). Involvement of≥2 lymph nodes predicted progression with an odds ratio of 7.2 (95% CI: 1.06-48.6, P=.043).ConclusionsThe average 5-year survival was above 80%. The number of positive lymph nodes could be a predictive factor for biochemical progression

Transitioning from conformal radiotherapy to intensity-modulated radiotherapy after radical prostatectomy: Clinical benefit, oncologic outcomes and incidence of gastrointestinal and urinary toxicities

AimThe purpose of this study was to review genitourinary (GU) and gastrointestinal (GI) toxicity associated with high-dose radiotherapy (RT) delivered with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) or volumetric arc therapy (VMAT) following radical prostatectomy (RP).BackgroundRP is a therapeutic option for the management of prostate cancer (PrCa). When assessing postoperative RT techniques for PrCa, the published literature focuses on patients treated with 2-dimensional conventional methods without reflecting the implementation of 3D-CRT, IMRT, or VMAT.Materials and methodsA total of 83 patients were included in this analysis; 30 patients received 3D-CRT, and 53 patients received IMRT/VMAT. Acute and late symptoms of the GU and lower GI tract were retrospectively graded according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer radiation toxicity grading systems. The relapse failure-free rate and overall survival were also evaluated.ResultsThe rate of acute GU toxicity was 9.4% vs. 13.3% for the IMRT/VMAT and 3D-CRT groups (p = 0.583). The 5-year actuarial rates of late GI toxicity for IMRT/VMAT and 3D-CRT treatments were 1.9% and 6.7%, respectively. The rate of late GU toxicity for the IMRT/VMAT and 3D-CRT treatment groups was 7.5% and 16.6%, respectively (p = 0.199). We found no association between acute or late toxicity and the RT technique in univariate and multivariate analyses.ConclusionPostprostatectomy IMRT/VMAT and 3D-CRT achieved similar morbidity and cancer control outcomes. The clinical benefit of highly conformal techniques in this setting is unclear although formal analysis is needed

Predictive models for suicidal thoughts and behaviors among Spanish University students: rationale and methods of the UNIVERSAL (University & mental health) project.

BACKGROUND: Suicide is a leading cause of death among young people. While suicide prevention is considered a research and intervention priority, longitudinal data is needed to identify risk and protective factors associate with suicidal thoughts and behaviors. Here we describe the UNIVERSAL (University and Mental Health) project which aims are to: (1) test prevalence and 36-month incidence of suicidal thoughts and behaviors; and (2) identify relevant risk and protective factors associated with the incidence of suicidal thoughts and behaviors among university students in Spain. METHODS: An ongoing multicenter, observational, prospective cohort study of first year university students in 5 Spanish universities. Students will be assessed annually during a 36 month follow-up. The surveys will be administered through an online, secure web-based platform. A clinical reappraisal will be completed among a subsample of respondents. Suicidal thoughts and behaviors will be assess with the Self-Injurious Thoughts and Behaviors Interview (SITBI) and the Columbia-Suicide Severity Rating Scale (C-SSRS). Risk and protective factors will include: mental disorders, measured with the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) and Screening Scales (CIDI-SC), and the Epi-Q Screening Survey (EPI-Q-SS), socio-demographic variables, self-perceived health status, health behaviors, well-being, substance use disorders, service use and treatment. The UNIVERSAL project is part of the International College Surveys initiative, which is a core project within the World Mental Health consortium. Lifetime and the 12-month prevalence will be calculated for suicide ideation, plans and attempts. Cumulative incidence of suicidal thoughts and behaviors, and mental disorders will be measured using the actuarial method. Risk and protective factors of suicidal thoughts and behaviors will be analyzed by Cox proportional hazard models. DISCUSSION: The study will provide valid, innovative and useful data for developing prevention programs for youth suicide and for improving early identification for high-risk students. The longitudinal design of this study will improve causal interpretation of analyzed associations, needed for generating and validating predictive models. It will represent the first results about suicidal thoughts and behaviors in the Spanish university population. The World Mental Health Survey collaboration will permit accurate cross-national comparisons.Fondo de Investigación Sanitaria, Instituto de Salud Carlos III - FEDER PI13/00343, ISCIII (Río Hortega, CM14/00125), ISCIII (Sara Borrell, CD12/00440);Ministerio de Sanidad, Servicios Sociales e Igualdad, PNSD (Exp. 2015I015);DIUE Generalitat de Catalunya (2014 SGR 748