A Comparative Study of the Triglycerides/HDL Ratio and Pseudocholinesterase Levels in Patients with Bladder Cancer

Background: Lipid alterations may serve as potential tumour biomarkers. The ratio of triglycerides to HDL cholesterol (TG/HDL ratio) is associated with various cancers. Pseudocholinesterase (PChE) activity, involved in TG hydrolysis, plays an important role in the metabolism of lipoprotein. There is scarce data assessing the reliability of both the TG/HDL ratio and PChE levels in correctly classifying patients suffering from bladder cancer. Methods: Three hundred and ninety-six patients undergoing cystoscopy or transurethral resection of the bladder (TURB), broken into two major groups, i.e., patients with histologically confirmed, non-metastatic bladder cancer (n = 208) and without bladder cancer (no bladder cancer, n = 188), formed the study population. The last group was split into two subgroups consisting of a cohort of patients never suffering from bladder cancer but with other bladder diseases (no CaBD, n = 100) and another cohort formed by patients characterised by eradicated bladder cancer after TURB with no recurrence during a three-month follow-up (previous bladder cancer, n = 88). Pieces of information by both metabolic derangement (the presence of type 2 diabetes mellitus), hypertension and lipid profile were retrieved from patient records upon entry to the study. Sensitivity, specificity, areas under the ROC (AUROC) of the TG/HDL ratio, and PChE levels were used in diagnostic decision making. Results: The TG/HDL ratio as well as PChE concentrations of bladder cancer patients were significantly different when compared to those with previous bladder cancer and the no CaBD patients (p = 0.023 and 0.0004, respectively). There was an independent role of both the TG/HDL ratio and PChE levels in predicting the presence of bladder cancer (OR: 1.22 and 0.99, respectively), but the reliability of the TG/HDL ratio (AUROC: 0.587) was superior to that of PChE levels (AUROC: 0.374). The AUROC of a new parameter resulting from the combination of the TG/HDL ratio with PChE levels showed a further increment in the discriminant power of the bladder cancer presence (0.6298), interestingly with a negative predictive value (89%) according to the Bayesian approach. The cut-off of the TG/HDL ratio, the main marker of the present study that better distinguishes bladder cancer from no bladder cancer patients, was 2.147. Discussion and Conclusions: The reliability of the TG/HDL ratio is based on the fact that this parameter likely mirrors the insulin resistance (IR) underlying bladder cancer patients. Furthermore, PChE levels evidence both IR and the associated non-alcoholic fatty liver disease. The TG/HDL ratio and PChE levels as well as their combined use could help physicians to assess/confirm the presence of this very common cancer, where early detection is important to ensure the best therapeutical approach

The Comparison of Imaging and Clinical Methods to Estimate Prostate Volume: A Single-Centre Retrospective Study

Background: Prostate volume (PV) is a useful tool in risk stratification, diagnosis, and follow-up of numerous prostatic diseases including prostate cancer and benign prostatic hypertrophy. There is currently no accepted ideal PV measurement method. Objective: This study compares multiple means of PV estimation, including digital rectal examination (DRE), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI), and radical prostatectomy specimens to determine the best volume measurement style. Methods: A retrospective, observational, single-site study with patients identified using an institutional database was performed. A total of 197 patients who underwent robot-assisted radical prostatectomy were considered. Data collected included age, serum PSA at the time of the prostate biopsy, clinical T stage, Gleason score, and PVs for each of the following methods: DRE, TRUS, MRI, and surgical specimen weight (SPW) and volume. Results: A paired t test was performed, which reported a statistically significant difference between PV measures (DRE, TRUS, MRI ellipsoid, MRI bullet, SP ellipsoid, and SP bullet) and the actual prostate weight. Lowest differences were reported for SP ellipsoid volume (M = -2.37; standard deviation [SD] = 10.227; t[167] = -3.011; and p = 0.003), MRI ellipsoid volume (M = -4.318; SD = 9.53; t[167] = -5.87; and p = 0.000), and MRI bullet volume (M = 5.31; SD = 10.77; t[167] = 6.387; and p = 0.000). Conclusion: The PV obtained by MRI has proven to correlate with the PV obtained via auto-segmentation software as well as actual SPW, while also being more cost-effective and time-efficient. Therefore, demonstrating that MRI estimated the PV is an adequate method for use in clinical practice for therapeutic planning and patient follow-up

The relationship between obstructive sleep apnoea and erectile dysfunction: An underdiagnosed link? A prospective cross-sectional study

This cross-sectional study aimed to investigate the prevalence and clinical characteristics of erectile dysfunction in patients with obstructive sleep apnoea. We enrolled 133 male patients with suspected obstructive sleep apnoea. Ear, nose and throat evaluation, laboratory tests, body mass index, Epworth sleepiness scale, 5-international index of erectile function, overnight ambulatory polygraphy and drug-induced sleep endoscopy patterns were assessed. Eighty patients reported obstructive sleep apnoea. 60% (n = 48) reported erectile dysfunction. Statistically significant correlations were found between 5-International Index of Erectile Function and age, hypertension, diabetes, Epworth sleepiness scale, apnoea-hypopnea index score, O2 saturation-nadir, and oxygen desaturation index. Age, diabetes and O2 saturation-nadir were independent predictors of erectile function. Epworth sleepiness scale, apnoea-hypopnea index score, O2 saturation-nadir, oxygen desaturation index and albumin were higher compared to patients without erectile dysfunction. No statistically significant differences were reported for drug-induced sleep endoscopy patterns and erectile dysfunction. Patients with obstructive sleep apnoea were at significant risk of having erectile dysfunction. Males with obstructive sleep apnoea should be investigated for erectile dysfunction

PD60-10 IMPACT OF PREOPERATIVE CONTROLLING NUTRITIONAL STATUS (CONUT) SCORE ON PERIOPERATIVE MORBIDITY AND SURVIVAL OUTCOMES IN PATIENTS WITH BLADDER CANCER TREATED WITH RADICAL CYSTECTOMY: A MULTICENTER ANALYSIS

INTRODUCTION AND OBJECTIVE: Despite several improvements in surgical technique, radical cystectomy (RC) remains an highly morbid operation and even in contemporary series the combined surgical, medical and disease morbidity results in a low 5-years overall survival (OS). Furthermore, the age of patients undergoing RC has increased and the ability to predict perioperative morbidity is crucial in the preoperative workup of RC. The controlling nutritional status (CONUT), a score based on the serum albumin concentration, lymphocyte count and total cholesterol concentration, is a comprehensive index that could provide an immune response status and long-term nutritional effect of the host. Recently, its prognostic value has been reported in many types of malignancies but it\u2019s never tested in bladder cancer (BC). The aim of the study is to evaluate the role of preoperative CONUT score in the assessment of both oncological outcomes and perioperative morbidity in patients underwent RC for non-metastatic BC. METHODS: We retrospectively evaluated data from 347 patients who underwent RC for BC at ve european high-volume centers between January 2002 and December 2018. Patients were divided into two groups according to the optimal cut-off value of CONUT score. Relationships of CONUT score with clinicopathological characteristics, perioperative complications (according to the Calvien-Dindo system), 30-days readmission, 90-days mortality, cancer-specific mortality (CSM), overall mortality (OM) and progression-free survival (PFS) were analyzed. RESULTS: Cut-off value to discriminate between high and low CONUT score was determined calculating the ROC curve: the area under the curve was 0.72 with an optimal cut-off of 3 points. High preoperative CONUT score was significantly correlated with older age, worse ASA score, advanced pT stage, high grade and node-positive disease, higher median length of stay and 30-days readmission (all p<0.05). At multivariable binomial logistic regression analysis adjusted for age, sex, BMI, ASA score, pT, pN and type of urinary diversion, high CONUT was an independent predictor of perioperative major complications (grade 3-5) (OR 2.9; 95%CI 1.6-5.4; p<0.001) and 30-days readmission(2.5; 95%CI 1.3-4.9; p=0.001). At multivariable Cox's regression analysis adjusted for age, sex, BMI, ASA score, presence of adjuvant therapy, pT, pN, LVI, positive surgical margins and concomitant cis, high CONUT was an independent predictor of CSM(HR 3.6; 95%CI 2.4-5.5; p<0.001), OM(HR 2.5; 95%CI 1.7-3.4; p<0.001) and worse PFS(HR 2.7; 95%CI 1.9-3.9; p<0.001). CONCLUSIONS: Preoperative CONUT score can be used as a simple and inexpensive biomarker to predict perioperative morbidity and survival outcomes in patients with BC after radical cystectomy