Posts made in November, 2017

The effect of AST/ALT (De Ritis) ratio on survival and its relation to tumor histopathological variables in patients with localized renal cell carcinoma

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0173


Lütfi Canat 1, Hasan Anil Ataly 1, Samir Agalarov 1, İlter Alkan 1, Fatih Alturende 1
1 Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey



Purpose: To assess the relationship between De Ritis (aspartate aminotransaminase [AST]/Alanine aminotransaminase [ALT]) ratio and pathological variables and whether it is an independent prognostic factor.

Materials and Methods: We analyzed 298 consecutive patients who underwent radical or partial nephrectomy for non-metastatic renal cell carcinoma (RCC) between 2006 and 2015. The association between De Ritis ratio and pathological variables including tumor size, presence of renal vein invasion, vena cava invasion, renal capsule infiltration, Gerota fascia invasion, renal sinus involvement, renal pelvic invasion, angiolymphatic invasion, adrenal gland involvement, lymph node involvement, tumor necrosis, and Fuhrman’s grade was tested. Multivariable Cox analysis was performed to evaluate the impact of this ratio on overall survival and cancer-specific survival.

Results: An increased preoperative De Ritis ratio was significantly associated with renal vein invasion, renal capsule infiltration and renal pelvis involvement (p<0.05) in non-metastatic RCC. On multivariate analysis we found that tumor size, Fuhrman grade and lymph node involvement were independent prognostic factors for cancerspecific survival. AST/ALT ratio had no influence on the risk of overall and cancerspecific survival.

Conclusion: An increased preoperative AST/ALT ratio had a significant association with renal vein...

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Efficacy of targeted therapy for advanced renal cell carcinoma: a systematic review and meta-analysis of randomized controlled trials

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0315


Chao Wei 1, 2, Shen Wang 1 ,2, Zhangqun Ye 1, 2, Zhiqiang Chen 1, 2
1 Department of Urology and 2 Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China



We conducted a systematic review and meta-analysis of the literature on the efficacy of the targeted therapies in the treatment of advanced RCC and, via an indirect com­parison, to provide an optimal treatment among these agents. A systematic search of Medline, Scopus, Cochrane Library and Clinical Trials unpublished was performed up to Jan 1, 2015 to identify eligible randomized trials. Outcomes of interest assessing a targeted agent included progression free survival (PFS), overall survival (OS) and ob­jective response rate (ORR). Thirty eligible randomized controlled studies, total twenty-fourth trails (5110 cases and 4626 controls) were identified. Compared with placebo and IFN-α, single vascular epithelial growth factor (receptor) tyrosine kinase inhibitor and mammalian target of rapamycin agent (VEGF(r)-TKI & mTOR inhibitor) were as­sociated with improved PFS, improved OS and higher ORR, respectively. Comparing sorafenib combination vs sorafenib, there was no significant difference with regard to PFS and OS, but with a higher ORR. Comparing single or combination VEGF(r)-TKI & mTOR inhibitor vs BEV + IFN-α, there was no significant difference with regard to PFS, OS, or ORR. Our network ITC meta-analysis also indicated a superior PFS of axitinib and everolimus compared to sorafenib. Our data suggest that targeted therapy with VEGF(r)-TKI & mTOR inhibitor is associated with superior efficacy for treating advanced RCC with improved PFS, OS and higher ORR compared to placebo and...

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Editorial: Anthony J. Thomas Jr.

Vol. 43 (6): 1012-1012, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2017.06.01

EDITORIAL in This Issue

In November, 5th, 2017, on the day Dr. Anthony J. Thomas Jr. would turn 74, he passed away. He was an internationally recognized reputed urologist, that popularized microsurgery in the urological community.

Tony was a great friend of Brazilian Urology. He opened the doors of the Cleveland Clinic Foundation to Brazilian urologists. When he introduced me to his colleagues during meetings, he always stressed that I was his first fellow at Cleveland Clinic; he joined the Clinic in 1982, and worked there for more than 30 years. During that period, many other Brazilians attended fellowship under his guidance.

He always supported SBU and many times helped us bring several American experts to our Congresses without costs. He himself attended several Brazilian Congresses of Urology, and many national courses on Infertility.

But Tony’s main quality was that he was a Family man. He involved his heart in all his actions. His patients firstly were persons that deserved his greater respect. He was a very thoughtful person, always with a nice and pleasant word for all. His concern with his fellows was touching. My car was very old, and he always would catch me when we had meetings together, since he was afraid that I would not make it due to mechanical problems. And I lived in the other side of the city! Probably he was the most honest, ethical and professional man that I have ever met.

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Focal therapy will be the next step on prostate cancer management? | Opinion: Yes

Vol. 43 (6): 1013-1016, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2017.06.02


Stênio de Cássio Zequi 1,2
1 Editor Associado, International Braz J Urol; 2 Divisão de Urologia do A.C. Camargo Cancer Center Fundação A. Prudente, São Paulo, Brasil

Keywords: Therapeutics; Prostatic Neoplasms; Disease Management; Kidney Neoplasms

In the last decades, the main goal of the treatment of several solid malignancies was the maintenance of high cure rates, along with morbidity reduction. As occurred with the drastic reduction of radical mastectomies for breast cancer and popularization of nephron sparing surgeries for kidney cancer, winds for reducing the radicality of prostate cancer (PC) treatment are blowing the candles.

Despite of recent recommendations against PC screening, the high rates of overdiagnosis and overtreatment of PC patients are still observed and relevant. Nowadays, many of PC cases are diagnosed in early stages, comprising no more than 5 or 10% of the gland, and much of them are low or intermediate risk PC (1-3). However, for decades, the accepted treatments for all localized PC cases have not changed and were based in whole gland therapies (WGT), for example: radical prostatectomy, or radical external beam radiotherapy, brachytherapy, cryotherapy, HIFU or androgen deprivation (1-3).

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Focal therapy will be the next step on prostate cancer management? | Opinion: No

Vol. 43 (6): 1017-1020, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2017.06.03


Wagner Eduardo Matheus 1, Ubirajara Ferreira 2
1 Departamento de Cirurgia, Departamento de Uro-oncologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil; 2 Departamento Urologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil

Keywords: Therapeutics; Prostatic Neoplasms; Disease Management; Kidney Neoplasms

Several procedures are being described to treat prostate cancer (PCa) using minimally invasive methods (MIM), in order to achieve total cure of the disease, lower side effects and preservation of quality of life. However, we must pay maximum attention to existing scientific studies, verifying follow-up time, number of patients treated and well-designed comparative studies.

In spite of all technological advances, curative surgery is still the most important treatment for localized PCa. Alternatives to radical prostatectomy include active surveillance (for minimum volume or indolent tumors), radiotherapy and focal treatment.

Evidences obtained by randomized controlled studies show that there are very few differences among active surveillance, surgery and radiotherapy, regarding global and specific survival of low risk localized PCa in a medium follow up of 10 years. Choice of treatment by patients many times is related to urinary and rectal side effect rates presented (1-5), and cultural, economic, psychological and emotional aspects.

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