Lindegaardrindom6370

The majority of data available on MDT concerns retrospective trials, although three prospective randomized trials (STOMP, ORIOLE and POPSTAR) have assessed the safety and feasibility of MDT. Overall, it appears that MDT delays significantly PCa progression and time to systemic therapy. CONCLUSIONS MDT is highly appealing given its potential to delay disease progression and adverse events of systemic therapy. Nonetheless, data remains immature to recommend MDT on a large scale and the selection criteria for patients have yet been defined. Today, MDT should be administered within a clinical trial and results of future research are eagerly awaited.BACKGROUND To examine the predictive value of neutrophil-to-lymphocyte ratio in localized prostate cancer for surgical pathology and recurrence in patients treated by radical prostatectomy. METHODS We evaluated 1 258 patients treated by radical prostatectomy at San Raffaele Hospital between 2011 and 2017 and assessed the association between preoperative neutrophil-to-lymphocyte ratio and surgical pathology (advanced stage, grade group ≥4, nodal involvement, grade discordance between biopsy and surgical pathology) and biochemical recurrence. RESULTS The preoperative neutrophil-to-lymphocyte ratio was not significantly associated with advanced stage (≥T3), International Society of Urological Pathology (ISUP) grade (≥4) or discordance. At multivariable analysis, patients with higher neutrophil-to-lymphocyte ratio had lower risk of nodal involvement at final pathology (odds ratio [OR] 0.77; 95% confidence interval [CI] 0.64, 0.92; P=0.005). The preoperative level of neutrophil-to-lymphocyte ratio was associated with biochemical recurrence on univariate analysis (OR 0.81, 95% CI 0.68, 0.96; P=0.017). Such a relationship was not significant at multivariable analysis adjusting for tumor severity (OR 0.93, 95% CI 0.79, 1.09; P=0.4). CONCLUSIONS Neutrophil-to-lymphocyte ratio does not have clinical utility for the prediction of adverse pathology and biochemical recurrence. Further research should focus on its value for predicting regional lymph node metastasis.INTRODUCTION In recent years, technological advances and new approaches have been developed for the treatment of Benign prostatic obstruction (BPO) in order to reduce complications like bleeding, retrograde ejaculation and risk of infection while obtaining an adequate disobstruction. The most recent surgical approach introduced is the Aquablation system (PROCEPT BioRobotics, Redwood Shores, CA, USA). This intervention is a robotically guided system that uses high-velocity water jets in order to ablate prostatic tissue, with real-time ultrasound guidance. The aim of this review is to summarize the current evidence on Aquablation and its results, compared to the reported outcomes of the gold standard treatment, the transurethral resection of the prostate (TURP). EVIDENCE ACQUISITION A systematic review of the Literature was performed in June 2019 using Medline (via PubMed), Embase (via Ovid), and Cochrane databases. The studies that compared the Aquablation to the standard TURP were included. Moreover, a critice used effectively for prostate volumes up to 150 cc. The major strengths are its high-speed resection time, low complication rate, and potential for sexual function preservation.BACKGROUND The objective of the present work was to analyse the economic impact of PCA (per- cutaneous cryoablation) vs OPN (open partial nephrectomy), as it represents the most common standard of care for SRMs (Small Renal Masses), namely T1a renal cancers ( less then 4 cm), in Italy. METHODS A cost analysis was performed to compare the difference of the total perioperative costs between PCA and OPN, both from the perspective of the National Healthcare System and the hospital. Clinical and resources consumption inputs were retrieved by a non-systematic literature search on scientific databases, complemented by a grey literature research, and validated by expert opinion. Costs calculation for the NHS perspective were based on reference tariffs published by the National Ministry of Health, while for the hospital perspective, unit costs published in the grey literature were used to compare the two alternatives. RESULTS Assuming the NHS perspective, the cost analysis shows there is an economic advantage in using PCA vs OPN (€4,080 vs €7,541) for the treatment of SRMs. Hospitalization time is the driver of the total costs, while the costs of complications are quite negligible in both groups. From the hospital perspective the costs of PCA is slightly higher (+€737) than OPN, with cryoprobes contributing as the greatest cost component. However, this increase is quite restrained and is offset by an inferior use of healthcare resources (surgery room, healthcare personnel, length of stay in the hospital). CONCLUSIONS According to our analysis, PCA results in an advantageous technique compared to OPN respectively in terms of costs and resource consumption from both the NHS and the hospital perspective.BACKGROUND Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy (RC). The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and RC for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC or surgery. METHODS Between 2012 and 2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers. We defined severe sarcopenia as SMI less then 50 cm2/m2 for men and SMI less then 35 cm2/m2 for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models. RESULTS According to the SMI, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients' characteristics between sarcopenic and non- sarcopenic patients were not significantly different except for BMI (p less then 0.001). Among patients non-sarcopenic before NAC, 9 (25.7%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (p=0.02). selleckchem Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (p=0.01 and p=0.03 respectively). CONCLUSIONS We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.