David Lecumberri

Introduction and objectives: renal cell carcinoma (RCC) with tumor extension to the inferior vena cava (IVC) presents an oncological surgical challenge. The aim of this study was to analyze perioperative outcomes, overall survival (OS), and associated prognostic factors in patients undergoing surgery at a tertiary center. Methods: retrospective study of 34 patients diagnosed between 2001 and 2024, all of whom underwent radical nephrectomy and thrombectomy. Preoperative evaluation was performed using computed tomography (CT) and magnetic resonance imaging (MRI). Clinical, surgical, and survival variables were analyzed using descriptive methods and univariate and multivariate Cox regression models. Results: the mean age at diagnosis was 61.9 ± 8.7 years. The thrombus was classified as level I (23.5 %), II (35.3 %), III (26.5 %), and IV (14.7 %) according to Neves and Zincke. Surgery was performed with curative intent in 91.2 % of cases and cytoreductive intent in 8.8 %. Cardiopulmonary bypass was required in 20.6 %. In multivariate analysis, the need for cardiopulmonary bypass (HR = 0.24; 95 % CI: 0.09–0.66; p = 0.005) and lymph node involvement (HR = 0.33; 95 % CI: 0.11–0.96; p = 0.042) were identified as factors associated with a worse prognosis. Conclusions: colorectal cancer with thrombus in the inferior vena cava presents a surgical challenge. Lymph node involvement and the need for cardiopulmonary bypass are associated with lower survival. Adequate preoperative evaluation and multidisciplinary management are essential to optimize oncological and surgical outcomes.

Background/Objectives: Incisional hernia (IH) is a frequent complication after kidney transplantation, with its risk influenced by both patient-related factors such as obesity, diabetes mellitus, and smoking, and procedure-related factors including surgical technique and immunosuppressive therapy. This study aimed to identify risk factors associated with IH and to evaluate the impact of suture type used for fascial closure in kidney transplant recipients. Methods: We performed a single-center retrospective case–control study including adult kidney transplant recipients who underwent transplantation between January 2014 and January 2024. Patients who developed an IH were identified and matched 1:6 with controls according to year of transplantation. Demographic variables, patient comorbidities, dialysis modality, and type of fascial closure suture were analyzed. Patients were subsequently compared according to the type of fascial closure used, either absorbable barbed polydioxanone sutures or absorbable monofilament polyglyconate loop sutures. Multivariable logistic regression analysis was conducted to identify independent predictors of IH. Results: Among 1586 kidney transplant recipients, 39 patients developed an IH, corresponding to an incidence of 2.5% after a median follow-up of 36 months. On multivariable analysis, age was independently associated with IH development (OR 1.04; p = 0.01), as was obesity (body mass index > 30 kg/m²; OR 2.55; p = 0.01). The overall incidence of IH did not differ significantly between suture types, with rates of 11.4% (10/88) for absorbable barbed polydioxanone sutures versus 15.6% (29/186) for absorbable monofilament polyglyconate loop sutures (p = 0.35). In obese recipients, however, fascial closure with barbed polydioxanone sutures was associated with a significantly lower incidence of IH, at 9.1% (2/22) versus 36.4% (12/33) for loop sutures (p = 0.02). Conclusions: Obesity and older age were the main independent predictors of IH after kidney transplantation in this cohort. In obese recipients, fascial closure using absorbable barbed polydioxanone sutures was associated with a substantially lower IH rate. These findings warrant confirmation in prospective, randomized studies.

Despite advances in the management of advanced clear cell renal cell carcinoma (ccRCC), robust biomarkers for prognosis and therapeutic response prediction remain elusive. Fibroblast activation protein-α (FAP), a marker of activated cancer-associated fibroblasts (CAFs), has emerged as a potential indicator of tumor aggressiveness and resistance to systemic therapies in various solid tumors. This study evaluated the clinical relevance of stromal FAP expression in a cohort of 137 patients with advanced ccRCC and long-term follow-up. FAP immunohistochemistry (IHC) was performed on primary tumor specimens and correlated with key clinicopathological features, disease-free survival (DFS), overall survival (OS), and radiological response to first-line tyrosine kinase inhibitors (TKIs). A significantly higher percentage of FAP-positive CAFs was observed in primary tumors with high histological grade, extensive local invasion (pT3–4), and advanced clinical stage (NCCN stage III–IV). Stromal FAP expression was associated with shorter DFS and OS. Moreover, tumors lacking FAP expression were more likely to achieve complete response to TKI therapy as defined by RECIST criteria. These findings highlight the potential of FAP IHC as a prognostic and predictive tool in advanced ccRCC and support further clinical validation.

Compression of the left renal vein between the abdominal aorta and superior mesenteric artery, known as nutcracker syndrome, can present with subtle, nonspecific symptoms that often delay diagnosis, posing a clinical challenge in daily urology practice and necessitating targeted imaging for accurate identification. We report the case of a 39-year-old patient who presented with isolated hematuria and long-standing pelvic pain and was ultimately diagnosed with nutcracker syndrome. Following the failure of endovascular therapy, the patient underwent renal autotransplantation, resulting in complete resolution of symptoms at follow-up.

A 39-year-old patient presented with a 1-month history of isolated hematuria. Past history included chronic pelvic pain of 8 years’ duration without identifiable organic cause. There was no personal or family history of genitourinary malformations, malignancy, or infection. Physical examination, laboratory tests, cystoscopy, and initial imaging were unremarkable. Computed tomography revealed compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery (SMA), with prestenotic dilatation and an aortomesenteric angle reduced to 14° (Figures A, B). Magnetic resonance imaging showed dilated left pelvic veins (Figure C). Based on clinical and imaging findings, the diagnosis of Nutcracker syndrome was established. Initial embolization of the left gonadal vein failed to provide symptom relief. Subsequently, renal autotransplantation involving laparoscopic nephrectomy and reimplantation into the right iliac fossa was performed. Recovery was uneventful, with complete resolution of symptoms at 12-month follow-up. Nutcracker syndrome is a rare vascular disorder that may present with chronic pelvic pain, hematuria, and, in males, varicocele. It is more commonly observed in young, slender women and represents an important cause of otherwise unexplained hematuria [1]. The underlying mechanism is compression of the left renal vein between the aorta and superior mesenteric artery, particularly when the aortomesenteric angle is reduced to less than 35° [2]. This leads to elevated venous pressure, the development of collateral circulation, and contributes to hematuria through pressure-induced vascular disruption. Diagnosis remains challenging because radiologic findings are often subtle and nonspecific, frequently delaying recognition in daily urologic practice. Endovascular interventions are considered the first-line therapeutic option; however, in refractory cases, surgical approaches—including renal autotransplantation—may be required [3].

Despite advances in the management of advanced clear cell renal cell carcinoma (ccRCC), robust biomarkers for prognosis and therapeutic response prediction remain elusive. Dysregulation of the intrarenal renin–angiotensin system (RAS) has been implicated in renal carcinogenesis but little explored, particularly regarding biomarker discovery and therapeutic innovation. Consequently, this study investigates the immunohistochemical expression and clinical relevance of the Mas-related G-protein-coupled receptor D (MrgD) in patients with ccRCC who developed metastatic disease (mccRCC). A cohort of 132 patients treated between 2008 and 2018 with nephrectomy and tyrosine kinase inhibitor (TKI)-based sequential therapy was analyzed. Treatment response was assessed using both the MASS and RECIST scoring systems. High MrgD expression in primary tumors was significantly associated with larger size, advanced stage, higher histological grade, and worse overall survival. Among 81 patients with metachronous metastases, high MrgD expression independently predicted shorter disease-free survival. High MrgD staining intensity correlated with poorer TKI responses in first-line therapy but improved outcomes with second-line mTORC1 inhibitors. These findings suggest that MrgD may be a useful biomarker of RAS linked to tumor aggressiveness in ccRCC. MrgD holds potential for identifying high-risk patients and guiding treatment selection in advanced disease. Further research is needed to unlock its clinical potential.

(1) Objective: To develop a clinically useful nomogram that may provide a more individualized and accurate estimation of cancer-specific survival (CSS) for patients with clear-cell (CC) metastatic renal cell carcinoma (mRCC) treated with nephrectomy and vascular endothelial growth factor receptor–tyrosine kinase inhibitor (VEGFR-TKI)-based sequential therapy. (2) Methods: A prospectively maintained database of 145 patients with mRCC treated between 2008 and 2018 was analyzed to predict the CSS of patients receiving sunitinib and second- and third-line therapies according to current standards of practice. A nomogram based on four independent clinical predictors (Eastern Cooperative Oncology Group status, International Metastatic RCC Database Consortium score, the Morphology, Attenuation, Size and Structure criteria and Response Evaluation Criteria in Solid Tumors response criteria) was calculated. The corresponding 1- to 10-year CSS probabilities were then determined from the nomogram. (3) Results: The median age was 60 years (95% CI 57.9–61.4). The disease was metastatic at diagnosis in 59 (40.7%), and 86 (59.3%) developed metastasis during follow-up. Patients were followed for a median 48 (IQR 72; 95% CI 56–75.7) months after first-line VEGFR-TKI initiation. The concordance probability estimator value for the nomogram is 0.778 ± 0.02 (mean ± SE). (4) Conclusions: A nomogram to predict CSS in patients with CC mRCC that incorporates patient status, clinical risk classification and response criteria to first-line VEGFR-TKI at 3 months is presented. This new tool may be useful to clinicians assessing the risk and prognosis of patients with mRCC.

(1) Objective: To develop a clinically useful nomogram that may provide a more individualized and accurate estimation of cancer-specific survival (CSS) for patients with clear-cell (CC) metastatic renal cell carcinoma (mRCC) treated with nephrectomy and tyrosine kinase Inhibitor (TKI) based sequential therapy; (2) Methods: A prospectively maintained database of 145 patients with mRCC treated between 2008-2018 was analyzed to predict CSS of patients receiving sunitinib and 2nd and 3rd line therapies according to current standards of practice. A nomogram taking into account four independent clinical predictors (ECOG status, IMDC score, MASS and RECIST response criteria) was calculated. The corresponding 1- to 10-year CSS probabilities were then determined from the nomogram; (3) Results: The median age was 60 years (95% CI 57.9-61.4). Disease was metastatic at diagnosis in 59 (40.7%) and 86 (59.3%) developed metachronous metastasis after nephrectomy. Patients were followed for a median 48 (IQR 72; 95% CI 56-75.7) months after first-line TKI initiation. Concordance probability estimator for the nomogram is 0.778 ± 0.02 (mean ± SE); (4) Conclusions: A nomogram to predict CSS in patients with CC mRCC that incorporates patient status, clinical risk classification and response criteria to first-line TKI at 3 months is presented. This new tool may be useful to clinicians assessing risk and prognosis of patients with mRCC.

Sunitinib has greatly improved the survival of clear cell renal cell carcinoma (ccRCC) patients in recent years. However, 20–30% of treated patients do not respond. To identify miRNAs and genes associated with a response, comparisons were made between biopsies from responder and non-responder ccRCC patients. Using integrated transcriptomic analyses, we identified 37 miRNAs and 60 respective target genes, which were significantly associated with the NF-kappa B, PI3K-Akt and MAPK pathways. We validated expression of the miRNAs (miR-223, miR-155, miR-200b, miR-130b) and target genes (FLT1, PRDM1 and SAV1) in 35 ccRCC patients. High levels of miR-223 and low levels of FLT1, SAV1 and PRDM1 were associated with worse overall survival (OS), and combined miR-223 + SAV1 levels distinguished responders from non-responders (AUC = 0.92). Using immunohistochemical staining of 170 ccRCC patients, VEGFR1 (FLT1) expression was associated with treatment response, histological grade and RECIST (Response Evaluation Criteria in Solid Tumors) score, whereas SAV1 and BLIMP1 (PRDM1) were associated with metachronous metastatic disease. Using in situ hybridisation (ISH) to detect miR-155 we observed higher tumoural cell expression in non-responders, and non-tumoural cell expression with increased histological grade. In summary, our preliminary analysis using integrated miRNA-target gene analyses identified several novel biomarkers in ccRCC patients that surely warrant further investigation.

Introducción: La endocervicosis vesical es una entidad excepcional de naturaleza benigna a tener en cuenta en el diagnóstico diferencial de un tumor vesical, ya que se presenta normalmente como una masa vesical en mujeres jóvenes (en ocasiones relacionada con otras entidades como la endometriosis y/o endosalpingiosis, conocidas globalmente como müllerianosis) o en mujeres de mayor edad con antecedente de cirugía ginecológica previa como cesárea o histerectomía. Habitualmente se manifiesta con una clínica inespecífica y suele ser diagnosticada como hallazgo anatomopatológico incidental tras exéresis de la lesión. Caso clínico: Se presenta el caso clínico de una paciente de 32 años con clínica urinaria inespecífica y hallazgo de masa vesical compatible con endocervicosis, que además presenta endometriosis asociada en resonancia magnética. Se realiza revisión de la literatura. Discusión: Aunque infrecuente, esta entidad ha de tenerse en cuenta en el diagnóstico diferencial de las masas vesicales en mujeres, y ha de confirmarse su diagnóstico anatomopatológicamente. Su tratamiento se basa en la exéresis completa de la lesión mediante resección transuretral o cistectomía parcial, resolviendo los síntomas sin haberse objetivado recidivas ni malignización tras más de 10 años de seguimiento.