¿Implica el T0 en la pieza de cistectomía encontrarse libre de tumor a largo plazo?

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"tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "865" "paginaFinal" => "868" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Loizaga Iriarte, Nerea Senarriaga Ruiz de la Illa, Isabel Lacasa Viscasillas, Ainara Rábade Ferreiro, Iñaki Iriarte Soldevilla, Miguel Unda Urzaiz" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Ana Loizaga" "apellidos" => "Iriarte" "email" => array:1 [ 0 => "ana.loizagairiarte@osakidetza.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "Nerea Senarriaga Ruiz" "apellidos" => "de la Illa" ] 2 => array:2 [ "nombre" => "Isabel Lacasa" "apellidos" => "Viscasillas" ] 3 => array:2 [ "nombre" => "Ainara Rábade" "apellidos" => "Ferreiro" ] 4 => array:2 [ "nombre" => "Iñaki Iriarte" "apellidos" => "Soldevilla" ] 5 => array:2 [ "nombre" => "Miguel Unda" "apellidos" => "Urzaiz" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología, Universidad del País Vasco, Hospital de Basurto, Bilbao, Vizcaya, España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Does a pT0 cystectomy specimen imply being tumour-free in the long term?" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-11-20" "fechaAceptado" => "2009-01-04" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec89429" "palabras" => array:4 [ 0 => "Cáncer de vejiga" 1 => "Cistectomía" 2 => "pT0N0" 3 => "Pronóstico" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec89430" "palabras" => array:4 [ 0 => "Bladder tumour" 1 => "Cystectomy" 2 => "pT0N0" 3 => "Prognosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Introducción y objetivosEl objetivo de este estudio fue evaluar la evolución de los pacientes que presentaban un T0 en la pieza de cistectomía para conocer posibles factores que nos ayuden a decidir cuándo hacer preservación vesical. Material y métodosRevisamos 153 cistectomías radicales realizadas por tumor vesical y sin tratamiento neoadyuvante en nuestro centro entre 1995 y 2005, con un seguimiento mínimo de 3 años. Seleccionamos los pacientes con pT0N0. Se tuvieron en cuenta la edad al diagnóstico, el sexo, el estadio y el grado patológico de la resección transuretral (RTU), número de resecciones, características del tumor (multifocalidad, papilar o sólido), tiempo libre de progresión, supervivencia libre de enfermedad y causa de muerte. Realizamos un análisis univariado de los diversos factores estudiados con la progresión de la enfermedad. ResultadosUn 12,8% de las piezas de cistectomías fueron T0N0. La progresión ocurrió en un 35% en un plazo de entre 6 meses y 4 años después de la cistectomía. La supervivencia cáncer específica fue del 75%; 5 pacientes murieron en una media de 18 meses. La causa de la muerte fue en todos ellos progresión tumoral con metástasis a distancia. Los estudios estadísticos en un análisis univariado sólo relacionaban con progresión, el número de RTU previas, probablemente debido al tamaño muestral, aunque la multifocalidad y el grado y el estadio tumoral resultaban destacables. Un 15% de los pacientes con pT0 tenían un fenotipo papilar, y de ellos un 33% murieron. Con fenotipo no papilar murieron un 23,5%. ConclusionesUn pT0N0 en la pieza de cistectomía no define esta cirugía como curativa y nos exige un seguimiento del paciente similar al resto. Es de destacar que no hubo recurrencia local en nuestros casos, sino metástasis a distancia, lo que nos hace pensar que estos pacientes podían haberse beneficiado de un tratamiento con quimioterapia sistémica sin requerir cirugía radical. En nuestra serie, el número de recidivas previas fue el único factor pronóstico con significación estadística." ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesThe aim of this study was to evaluate the progress of patients with a pT0 radical cystectomy specimen in order to know what factors are helpful in deciding when the bladder can be preserved. Material and methodsWe reviewed 153 cases of radical cystectomies performed due to bladder tumours without neoadjuvant therapy between 1995 and 2005 and with a minimum of three years of follow-up. Stage pT0 patients were selected. We considered age at time of diagnosis, sex, pathological stage and grade of the tumour at the time of transurethral resection (TUR), number of resections, surgical factors, tumour characteristics (multifocal, papillary or solid), progression-free survival, cancer-specific survival and cause of death. We ran a univariate analysis of the different factors studied along with disease progression. Results12.8% of cystectomy specimens were pT0N0. Progression occurred in 35% between 6 months and 4 years after the cystectomy. Cancer-specific survival was 75%. Five patients died within an average of 18 months. The cause of death for all of them was tumour progression with distant metastasis. Statistical studies in the univariate analysis were only related to progression and the number of prior TURs, which is probably due to the number of cases, but the tumour multifocality, grade and stage were noteworthy. 15% of the pT0 patients had a papillary phenotype and 33% of them died. Of those with a non-papillary phenotype, 23.5% died. ConclusionsA stage pT0N0 cystectomy specimen does not define this surgery as curative, and these cases require the same follow-up as for the rest of the patients. It is of particular interest that out of all of our cases, there was no local recurrence, but there was distant metastasis. This leads us to believe that these patients could have benefitted from systemic chemotherapy with no need for radical surgery. In our study, the number of previous relapses was the only prognostic factor with statistical significance." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "P0 stage at radical cystectomy for bladder cancer is associated with improved outcome independent of traditional clinical risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Kassouf" 1 => "P.E. Spiess" 2 => "G.A. Brown" 3 => "M.F. Munsell" 4 => "H.B. Grossman" 5 => "A. 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Amiel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0022-5347(05)00995-X" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2006" "volumen" => "175" "paginaInicial" => "1645" "paginaFinal" => "1649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16600721" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/02104806/0000003300000008/v2_201304261001/S0210480609728736/v2_201304261001/es/main.assets" "Apartado" => array:4 [ "identificador" => "6269" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original - Cáncer de vejiga" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02104806/0000003300000008/v2_201304261001/S0210480609728736/v2_201304261001/es/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480609728736?idApp=UINPBA00004N" "pdfAlternativo" => array:1 [ 0 => array:3 [ "idioma" => "en" "documentoPdf" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/file/02104806/addon/S0210480609728736/S300/en/292v33n08a13142628pdf001_2.pdf" "portada" => "292v33n08a13142628pdf001_2.png" ] ]]

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