Hospital de Cabueñes

Nonmetastatic (M0) clear cell renal cell carcinoma (ccRCC) recurs in ∼20% of patients within 5yr after surgery. With no biomarkers available, recurrence detection relies on radiological imaging. Urine glycosaminoglycan profiles (GAGomes) were previously associated with M0 ccRCC recurrence. We conducted an observational prospective multicentre diagnostic test cohort study to evaluate GAGomes for postsurgery recurrence detection in M0 ccRCC. Postsurgical M0 ccRCC patients with a Leibovich score of ≥5 points were included. Follow-up imaging up to 18mo assessed radiological recurrence (reference standard). Urine GAGomes were measured every 3mo to compute a GAGome score (index test). Sensitivity and specificity to radiological recurrence were calculated. The lead time between the first positive GAGome score and radiological recurrence was estimated. Bayesian joint modelling estimated recurrence-free survival hazard ratio (HR). Of the 393 patients screened (January 2020 to November 2021), 134 met the inclusion criteria. The median follow-up was 16mo (interquartile range [IQR]: 12-18) for those without recurrence. At the last follow-up visit, 16% had recurred. The GAGome score had 90% sensitivity (95% confidence interval [CI]: 62-100%) and 51% specificity (95% CI: 30-71%) to radiological recurrence. The positive and negative predictive values were 26% (95%CI: 4-46%) and 97% (95% CI: 87-100%), respectively. The median lead time was 4.2mo (IQR: 1.6-6.4). A 10-point GAGome score increase was associated with an HR of 1.62 (95% high density interval: 1.11-2.30) for recurrence. The main limitation was short follow-up time. GAGome score had very high sensitivity to ccRCC recurrence, resulting in a negative predictive value of 97%. External validation foreseen in the study design aims to confirm its utility to personalise follow-up for M0 ccRCC patients.

Objectives: To evaluate the performance of the Tokuhashi, Tomita, SORG machine learning (SORG ML), and OPTImodel algorithms as survival predictors for vertebral metastases in clinical practice. Materials and Methods: A retrospective study (2013–2023) analyzed 573 patients from Cabueñes University Hospital (Asturias, Spain). Thirty-two demographic, epidemiological, clinical, and analytical variables were considered, including diagnosis chronology and survival. Results: Among the 573 patients studied, 272 (47.4%) presented visceral metastases at the time of diagnosis. A total of 362 patients (63.2%) had associated comorbidities. The most frequent primary histological diagnoses in these patients were lung 147, (25.7%), prostate 146 (25.5%), breast 118 (20.6%), kidney 30 (5.2%), and colorectal 29 (5.1%). The median survival of the cohort was 185 days. The accuracy rates for the Tokuhashi, SORG ML, OPTImodel, and Tomita algorithms were 0.5509, 0.4812, 0.3404, and 0.3858, respectively. The models with the highest accuracy rates in specific time segments were Tokuhashi (77.5% for less than 6 months) and OPTImodel (90.8% for more than 1 year). The areas under the curve (AUC) for survival intervals were as follows: Tokuhashi at 42 days (73.19%), 90 days (79.3%), and 365 days (82.73%); Tomita at 42 days (69.27%), 90 days (76.82%), and 365 days (78.79%); SORG ML at 42 days (52.77%), 90 days (51.69%), and 365 days (51.38%). Conclusions: All models showed relatively low accuracy. The newer models (OPTImodel, SORG ML) did not outperform the traditional Tomita and Tokuhashi in predicting survival for vertebral metastases patients.

Abstract Background Factors influencing the exposure to targeted therapies (biologics/JAKi), intestinal resections and hospitalisations in newly diagnosed IBD patients have been scarcely studied. Aim: To identify predictive factors of exposure to biologics/JAKi, surgeries, and hospitalisations within the first five years in IBD patients. Methods Prospective, population-based nationwide registry. Adult patients diagnosed with IBD [Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)] during 2017 in the 17 Spanish regions were included. Patients who consented were followed-up for 5 years after diagnosis. Multivariate analyses were performed to identify the predictive factors for biologics/JAKi use, surgeries, and hospitalisations. To this end, only abdominal surgeries were analysed, and early treatment with immunomodulators or biologics/JAKi drugs were considered if these had been prescribed within the first six months of diagnosis. Results A total of 1,526 patients diagnosed with CD and 1,633 with UC were included (figure 1). The cumulative incidence of exposure to biologics/JAKi drugs, surgeries, and hospitalisations were analysed, and predictive factors were identified. Regarding the predictors of exposure to biologics/JAKi treatments, we observed that younger age, more aggressive phenotype of CD and greater extent of UC were associated with a higher risk of exposure (table 1). Furthermore, smoking was associated with a higher likelihood of exposure to biologics/JAKi drugs in patients with CD (HR=1.33, 95%CI=1.11-1.60) while in UC patients it was associated with a lower risk (HR=0.56, 95%CI=0.35-0.89). Concerning surgeries (table 1), early treatment with immunomodulators was associated with a lower risk in patients with CD (HR=0.33, 95%CI=0.22-0.49), whereas early use of biologics/JAKi drugs was associated with a higher likelihood of surgery in patients with UC (HR=11.86, 95%CI=4.62-30.42). Finally, the exposure to biologics/JAKi drugs was associated with a lower risk of hospital admissions both in patients with CD (HR=0.37, 95%CI=0.24-0.56) and UC (HR=0.45, 95%CI=0.22-0.91) (table 1). Conclusion The exposure to biologics/JAKi drugs is mediated by the more aggressive phenotype of CD, greater extent of UC, and younger patient age. The use of biologics/JAKi drugs, as currently practiced, is associated with a lower risk of hospitalisations but does not reduce the need for surgery, even when administered early. There is an unmet need for more accurate identification of patients who require these treatments to modify the natural course of the disease.

Abstract Purpose Studies focused on the effects of sellar and/or perisellar (S/PS) meningiomas on pituitary function are scarce. We evaluate the clinical characteristics, therapeutic outcomes, and the effects that S/PS meningiomas and their treatments have on pituitary function. Methods A multicenter and retrospective study of patients with S/PS meningiomas attended in 20 tertiary Spanish centers. Results 171 patients, 129 (75.4%) females, with median age of 61.5 [51–71] years were analyzed. At presentation, 118 (69.1%) had visual disturbance, 66 (38.6%) headache, 46 (26.9%) cranial nerve palsy and 35 (25.7%) hypopituitarism. Median tumor diameter was 29 [22-35.5] mm and cavernous sinus infiltration was detected in 99 (59.3%) of which 77 (77.8%) had Knosp grades 3 or 4. As initial treatment, 134 (78.4%) underwent surgery, 25 (14.6%) received radiotherapy and 12 (7%) were clinically and radiologically monitored. Among operated patients, gross total resection (GTR) was achieved in 45 (33.6%), whereas in 89 (66.4%) the tumor was incompletely removed. Overall median follow-up was 5.7 [2.9–9.2] years. After treatments, hypopituitarism increased significantly in the whole series (n = 86, 53.1%) respect to diagnosis (n = 35, 25.7%), p < 0.001. Development of hypopituitarism was not associated with surgery extension (subtotal or GTR), histological subtype, type of radiotherapy or radiation dose received. Conclusions S/PS meningiomas affect the pituitary function in 25% of the cases. However, after the implementation of treatments, hypopituitarism prevails in more than 50% of the cases. They are relatively large tumors and often locally invasive, and GTR is achieved in only one third of the cases.

Anaemia is common in chronic kidney disease (CKD) and has a significant impact on quality of life (QoL), work productivity and outcomes. Current management includes oral or intravenous iron and erythropoiesis-stimulating agents (ESAs), to which hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been recently added, increasing the available therapeutic options. In randomised controlled trials, only intravenous iron improved cardiovascular outcome, while some ESAs were associated with increased adverse cardiovascular events. Despite therapeutic advances, several challenges and unmet needs remain in the current management of anaemia of CKD. In particular, clinical practice does not include an assessment of QoL, which prompted a group of European nephrologists and representatives of patient advocacy groups to revisit the current approach. In this consensus document, the authors propose a move towards a more holistic, personalised and long-term approach, based on existing evidence. The focus of treatment should be on improving QoL without increasing the risk of adverse cardiovascular events, and tailoring management strategies to the needs of the individual. In addition, the authors discuss the suitability of a currently available anaemia of CKD-specific health-related QoL measure for inclusion in the routine clinical management of anaemia of CKD. The authors also outline the logistics and challenges of incorporating such a measure into electronic health records and how it may be used to improve QoL for people with anaemia of CKD.

Ulcerative proctitis (UP) can have a milder, less aggressive course than left-sided colitis or extensive colitis. Therefore, immunosuppressants tend to be used less in patients with this condition. Evidence, however, is scarce because these patients are excluded from randomised controlled clinical trials. Our aim was to describe the characteristics of patients with refractory UP and their disease-related complications, and to identify the need for immunosuppressive therapies. We identified patients with UP from the prospective ENEIDA registry sponsored by the GETECCU. We evaluated socio-demographic data and complications associated with immunosuppression. We defined immunosuppression as the use of immunomodulators, biologics and/or small molecules. We used logistic regression to identify factors associated with immunosuppressive therapy. From a total of 34,716 patients with ulcerative colitis, we identified 6281 (18.1%) with UP; mean ± SD age 53 ± 15 years, average disease duration of 12 ± 9 years. Immunosuppression was prescribed in 11% of patients, 4.2% needed one biologic agent and 1% needed two; 2% of patients required hospitalisation, and 0.5% underwent panproctocolectomy or subtotal colectomy. We identified 0.2% colorectal tumours and 5% extracolonic tumours. Patients with polyarthritis (OR 3.56, 95% CI 1.86-6.69; p < 0.001) required immunosuppressants. Among patients with refractory UP, 11% required immunosuppressant therapy, and 4.2% required at least one biologic agent.