Minerva Urology and Nephrology最新文献

Background: Prostate cancer (PCa) is the second most prevalent cancer globally and a major cause of disability and mortality. Survival rates heavily depend on the stage at which the disease is diagnosed, with substantial geographical variations in the burden of the disease.

Methods: The Global Burden of Disease (GBD) Study 2021 provides detailed national and subnational estimates for the burden of PCa in Italy. This study reports incident cases and age-standardized incidence rates (ASIR), deaths and age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs) and age-standardized DALYs rates (ASDR), as well as the average annual rate of change (ARC). The PCa-related survival is investigated using the mortality-to-incidence ratio (MIR) for 1990 and 2021. Italian estimates were compared with Global and High-middle Socio-Demographic Index (SDI) countries.

Results: GBD 2021 estimated 39,016 new PCa cases, 10,662 deaths, and 173,048 DALYs for Italy in 2021. The average ARC for ASIR was 0.14, while the average ARC for ASMR and ASDR were -0.29 and -0.31, respectively. MIR dropped from 38.0 in 1990 to 23.8 in 2021. At the subnational level, ASIR increased in seven regions, with no regions showing a decrease, while ASMR and ASDR fell significantly in 17 regions. Italy outperformed both global and high-middle SDI countries in reducing PCa mortality and improving survival rates.

Conclusions: PCa remains a critical health issue in Italy. The reduction in ASMR and ASDR indicates progress in early diagnosis and treatment. However, subnational disparities in incidence and mortality highlight the need for targeted healthcare interventions.

Background: In the evolving landscape of nephron-sparing surgery (NSS), the role of minimally invasive redo partial nephrectomy (rMIPN) for solitary renal cancer recurrence (RCR) remains debated, particularly considering its technical demands and perioperative risks. In this dual-institutional study, we aimed to investigate long-term perioperative, oncologic, and functional outcomes of rMIPN, comparing off- versus on-clamp hilar strategies.

Methods: Two prospectively maintained renal cancer databases were queried for patients undergoing rMIPN for ipsilateral solitary RCR between January 2004 and October 2024. Sixty-three patients were included and stratified by hilar control: off-clamp (Group A, N.=41) versus on-clamp (Group B, N.=22). Baseline, surgical, pathological, and renal functional outcomes were compared. Kaplan-Meier analysis assessed overall survival (OS), cancer-specific survival (CSS), and progression to CKD stage ≥3b.

Results: Baseline and perioperative characteristics were comparable between groups (all P>0.01). Overall complication rates were 19.5% and 22.7% (P=0.12), respectively; major complications occurred in 4.9% and 9.1% (P=0.6). Group A exhibited more advanced tumor stage at index NSS (P=0.001). Clear cell renal cell carcinoma predominated in Group B (P<0.001). At a median follow-up of 51 months, OS, CSS, and renal function endpoints were similar (all P>0.3).

Conclusions: Hilar control technique did not significantly influence outcomes following rMIPN. Within the demanding scenario of solitary ipsilateral recurrence, surgical judgment and tailored planning remain essential to preserve function while maintaining oncologic safety at long-term follow-up.

This article was published in Volume 77, issue 1 of publishing year 2025, with a mistake in the "Conflicts of interest", "Funding" and "Acknowledgements" sections. The correct sections are the ones included in this erratum.

Introduction: Treatment of anemia is one of the main goals of supportive care in patients on hemodialysis. In this context, the use of therapy with hypoxia inducible factor inhibitors (HIF-PHI) represents a further promising resource. The main objective is to evaluate the difference in hemoglobin levels after treatment with HIF-PHI compared to placebo/ESA.

Evidence acquisition: We performed a systematic search in PubMed, CINAHL, EMBASE, and Register of Controlled Trials (CENTRAL), looking for randomized controlled trials (RCTs). Eligible studies considered hemodialysis patients older than 18 years with the diagnosis of anemia treated with HIF-PHIs. Protocol was previously published on PROSPERO (CRD42024589848).

Evidence synthesis: Among a total of 126 references, 32 citations were selected by screening of titles and abstracts, for full-text evaluation, and 14 articles referring were included in the review after the screening for full-text articles. Data on hemoglobin differences were reported by all studies and the pooled analysis involving 3890 patients (2267 in the experimental group and 1623 in the control group), network metanalysis did not show significant differences in Delta Hemoglobin among any HIF-PHIs types and ESA/placebo. Similarly, no significant differences were found comparing HIF-PHIs to ESA Splitting (11 studies, N.=3611). However, a significant difference was found comparing HIF-PHIs to Placebo (MD=1.48, 95%CI: 1.15/1.81, P<0.001). The experimental and control groups differed for gastrointestinal adverse events, whereas there were no differences for any other adverse events.

Conclusions: The similar efficiency and safety between HIF-PHIs and ESA care could modify the usual clinical treatment of anemia in hemodialysis patients, and allow personalized therapy.