Barbas-Bernardos, G. (Guillermo)
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- Survival analysis of patients with prostate cancer and unfavorable risk factors treated with radical prostatectomy and salvage radiotherapy after biochemical recurrence and persistence(Elsevier, 2020) Barbas-Bernardos, G. (Guillermo); Subirá-Ríos, D. (D.); Caño-Velasco, J. (J.); Moralejo-Gárate, M. (M.); Herranz-Amo, F. (F.); Mayor-de-Castro, J. (J.); Hernández-Fernández, C. (C.); Aragón-Chamizo, J. (J.); González-San-Segundo, C. (C.)Objetivo: Analizar la supervivencia de los pacientes con cáncer de próstata (CP) con factores pronósticos desfavorables (FPD) tratados con PR y radioterapia de rescate (RTR) tras recidiva bioquímica (RB) y persistencia bioquímica (PB). Material y método: Análisis retrospectivo de 446 pacientes con al menos uno de los siguientes FPD: score de Gleason ≥ 8, estadio patológico ≥ pT3 y/o márgenes quirúrgicos positivos (MQ+). El criterio de RB fue la elevación del PSA por encima de 0,4 ng/ml. Evaluación de supervivencia mediante Kaplan-Meier y log-rank. Para identificar factores de riesgo con posible influencia en la respuesta a RTR y la supervivencia causa-específica (SCE) se usó análisis uni y multivariable (regresión de Cox). Resultados: Mediana de seguimiento: 72 (rango 37-122) meses, mediana de tiempo hasta RB: 42 (rango 20-112) meses. El 36,3% presentaron RB. Presentaron respuesta bioquímica a la RTR 121 (74,7%) pacientes. La supervivencia libre de recaída (SLR) después de la RTR a los 3, 5, 8 y 10 anos ˜ fue del 95,7, del 92,3, del 87,9 y del 85%, la SG a los 5, 10 y 15 anos ˜ fue del 95,6, del 86,5 y del 73,5%. La SCE a los 5, 10 y 15 anos ˜ fue del 99,1, del 98,1 y del 96,6%, respectivamente. Solo el tiempo hasta la RB < 24 meses (HR = 2,55, p = 0,01) se comportó como un factor predictor independiente de SLR después de RTR. Conclusiones: La PR solo consigue control de la enfermedad a los 10 anos ˜ en aproximadamente la mitad de los casos. El tratamiento multimodal secuencial (PR + RTR cuando precise) aumenta este control bioquímico hasta > 87%, lográndose una larga SCE. Los pacientes con un tiempo hasta recidiva > 24 meses respondieron mejor al tratamiento de rescate
- NUM-score: A clinical-analytical model for personalised imaging after urinary tract infections(John Wiley & Sons, 2024) Barbas-Bernardos, G. (Guillermo); López-López, R. (Rosario); García-Suárez, L. (Leire); González-Bertolín, I. (Isabel); Calvo, C. (Cristina); Zarauza-Santoveña, A. (Alejandro); Plata Gallardo, M. (Marta); Miguel-Cáceres, C. (Cristina) deAim: To identify predictive variables and construct a predictive model along with a decision algorithm to identify nephrourological malformations (NUM) in children with febrile urinary tract infections (fUTI), enhancing the efficiency of imaging diagnostics. Methods: We performed a retrospective study of patients aged <16 years with fUTI at the Emergency Department with subsequent microbiological confirmation between 2014 and 2020. The follow-up period was at least 2 years. Patients were categorised into two groups: 'NUM' with previously known nephrourological anomalies or those diagnosed during the follow-up and 'Non-NUM' group. Results: Out of 836 eligible patients, 26.8% had underlying NUMs. The study identified six key risk factors: recurrent UTIs, non-Escherichia coli infection, moderate acute kidney injury, procalcitonin levels >2 μg/L, age <3 months at the first UTI and fUTIs beyond 24 months. These risk factors were used to develop a predictive model with an 80.7% accuracy rate and elaborate a NUM-score classifying patients into low, moderate and high-risk groups, with a 10%, 35% and 93% prevalence of NUM. We propose an algorithm for approaching imaging tests following a fUTI. Conclusion: Our predictive score may help physicians decide about imaging tests. However, prospective validation of the model will be necessary before its application in daily clinical practice.
- First-line management of metastatic urothelial cancer: Current and future perspectives after the EV-302 and CcheckMate-901 studies(Elsevier, 2023) Barbas-Bernardos, G. (Guillermo); Fata, F.R. (Fernando Ramón) de; Perez-Gracia, J.L. (Jose Luis); Aristu-Mendioroz, J.J. (José Javier); Andrés, G. (Guillermo); Fenor-de-la-Maza, M.D. (Maria Dolores); Gurpide, A. (Alfonso); Villacampa, F. (Felipe); Villacampa, G. (Guillermo); Cambeiro, M. (Mauricio); González-Padilla, D.A. (Daniel A.); Sanz, J. (Julián); Miñana, B. (Bernardino)The standard of care for the first-line management of metastatic urothelial carcinoma has been recently challenged, with the combination of pembrolizumab and enfortumab vedotin (P-EV) strongly arising as a practice-changing option from classical platinum-based chemotherapies. With this paradigm shift on the horizon new questions, including the most suitable second line of treatment for these patients, and the role that the molecular characterization of these tumours will have when selecting these therapies will inevitably arise. Furthermore, after the negative results of the Keynote 361 and IMvigor 130 trials, the combination of nivolumab with platinum-based chemotherapy followed by nivolumab maintenance (Nivo GC-Nivo) has also shown positive results when compared with chemotherapy alone. Translational studies at a molecular, cellular, and functional level will be key to better explain these discordant results. In this Current Perspective, we discuss the potential impact of these results in clinical practice and propose specific guidance for prospective translational research.
- What is the impact of post‐radical prostatectomy urinary incontinence on everyday quality of life? Linking Pad usage and International Consultation on Incontinence Questionnaire Short‐Form (ICIQ‐SF) for a COMBined definition (PICOMB definition)(Wiley, 2021) Barbas-Bernardos, G. (Guillermo); Díez-Caballero, F. (Fernando); Boville, G.A. (Guillermo Andrés); Fata, F.R. (Fernando Ramón) de; Rosell, D. (David); Miñana-López, B. (Bernardino); Doménech-López, P. (Pablo); Gutierrez, C. (Cristina); Torres, M. (Marcos); Colombas, J. (J.); Velis, J.M. (José María); Guillen-Grima, F. (Francisco); Villacampa, F. (Felipe); Pascual-Piedrola, J.I. (Juan Ignacio); García-Cortés, Á. (Ángel); Chiva-San-Román, S. (Santiago); Hevia, M. (Mateo); Merino, I. (Imanol); Robles-Garcia, J.E. (José Enrique); Ancizu-Marckert, J. (Javier)Aims: To identify the definition for urinary continence (UC) after radical prostatectomy (RP) which reflects best patients' perception of quality of life (QoL). Methods: Continence was prospectively assessed in 634 patients, 12 months after RP using the International Consultation on Incontinence Questionnaire Short‐Form (ICIQ‐SF) and the number of pads employed in a 24‐hour period (pad usage). We used the one‐way ANOVA technique with posthoc pairwise comparisons according to Scheffé's method (homogeneous subsets) for assessing the degree of QoL deficit related to urinary incontinence (UI). Results: The continence prevalence is 64.4%, 74.1%, 88.3%, and 35.8% using “0 pads,” “1 safety pad,” “1 pad,” and “ICIQ score 0” definitions, respectively. Pad usage is moderately strongly associated with ICIQ 1, 2, and 3 (ρ = 0.744, 0.677, and 0.711, respectively; p < 0.001). Concordance between classical UC definitions is acceptable between “0 pads—ICIQ score 0” (K = 0.466), but poor for “1 safety pad” and “1 pad” (K = 0.326 and 0.137, respectively). Patients with “0 pad usage” have better QoL related to urine leakage than patients with “1 safety pad” or “1 pad” (1.41 vs. 2.44 and 3.11, respectively; p < 0.05). There were no significant differences found regarding QoL between patients with ICIQ score 0 and ICIQ score 2 (1.01 vs. 1.63; p = 0.63).Conclusions: Pad usage and the ICIQ‐SF's answers provide useful information. We propose a combined definition (0 pads and ICIQ score ≤2) as it is the definition with the least impact on daily QoL.
- Focal therapy of prostate cancer index lesion with irreversible electroporation. A prospective study with a median follow-up of 3 years(Wolters Kluwer Health Inc, 2023) Barbas-Bernardos, G. (Guillermo); Díez-Caballero, F. (Fernando); Boville, G.A. (Guillermo Andrés); Fata, F.R. (Fernando Ramón) de; Benito-Boíllos, A. (Alberto); Miñana-López, B. (Bernardino); Labairu-Huerta, L. (Luis); Torres, M. (Marcos); Gallardo-Madueño, G. (Guillermo); Villacampa, F. (Felipe); Abengozar-Muela, M. (Marta); Sanz, J. (Julián); Alcázar, A. (Andrés); Ancizu-Marckert, J. (Javier)Purpose: Our aim was to assess oncologic, safety, and quality of lifeerelated outcomes of focal therapy with irreversible electroporation in men with localized prostate cancer. Materials and Methods: This was a single-center, phase II study. Inclusion criteria: prostate cancer International Society of Urological Pathology grade 1-2, prostate specific antigen 15 ng/ml, cT2b. Patients were selected based on multiparametric magnetic resonance imaging and transperineal systematic and targeted magnetic resonance imagingeultrasound fusioneguided biopsy. Ablation of index lesions with safety margin was performed. Primary end point was cancer control, defined as the absence of any biopsy-proven tumor. A control transperineal biopsy was planned at 12 months and when suspected based on prostate specific antigen and/or multiparametric magnetic resonance imaging information. Quality of life was assessed using Expanded Prostate Cancer Index Composite Urinary Continence domain, International Index of Erectile Function, and International Prostate Symptom Score. Results: From November 2014 to July 2021, 41 consecutive patients were included with a median follow-up of 36 months. Thirty patients (73%) had International Society of Urological Pathology grade 1 tumors, 10 (24%) grade 2, and 1 (2.4%) grade 3. Recurrence was observed in 16 of 41 (39%) of the whole cohort, and 16 of 33 (48.4%) who underwent biopsy. In-field recurrence was detected in 5 (15%) and out-of-field in 11 (33.3%). Ten of 41 (24.6%) including 3 of 5 (60%) with in-field recurrences had significant tumors (Gleason pattern 4-5; more than 1 core or any >5 mm involved). Median recurrence-free survival was 32 months (95% CI 6.7-57.2). Twentysix patients (63.4%) were free from salvage treatment. All patients preserved urinary continence. Potency was maintained in 91.8%. Conclusions: Irreversible electroporation can achieve satisfactory 3-year in-field tumor control with excellent quality of life results in selected patients.
- Blood analysis for screening of electrolyte and kidney function alterations in patients with febrile urinary tract infection(Wiley, 2023) Barbas-Bernardos, G. (Guillermo); López-López, R. (Rosario); García-Suárez, L. (Leire); Martín-Espín, I. (Irene); González-Bertolín, I. (Isabel); Barcia-Aguilar, C. (Cristina); Calvo, C. (Cristina)Aim To describe the prevalence, severity, risk factors, and clinical relevance of electrolyte disturbances and acute kidney injury (AKI) during febrile urinary tract infection (fUTI). Methods Retrospective observational study of well/fair-appearing patients between 2 months and 16 years, with no previous relevant medical history, diagnosed with fUTI in the paediatric emergency department (PED) with subsequent microbiological confirmation. Analytical alteration (AA) data were considered: AKI (creatinine elevation × 1.5 the median for age), plasma sodium alteration (≤130 or ≥150 mEq/L), and potassium alteration (≤3 or ≥6 mEq/L). Results We included 590 patients, 17.8% presented AA (13 hyponatremia, 7 hyperkalaemia, and 87 AKI). No patient presented severe analytic alterations or a higher frequency of symptoms potentially attributable to these alterations (seizures, irritability, or lethargy). Risk factors associated with these AA were clinical dehydration (OR = 3.5 95% CI: 1.04–11.7; p = 0.044) and presenting a temperature >39°C (OR = 1.9 95% CI: 1.14–3.1; p = 0.013). Conclusions Electrolyte and renal function disturbances are infrequent in the previously healthy paediatric population with a fUTI. If present, they are asymptomatic and not severe. Based on our results, performing systematic blood analysis to rule out AA appears no longer justified, especially in the absence of risk factors.
- Hyponatremia and other potential markers of ultrasound abnormalities after a first febrile urinary tract infection in children(Springer Link, 2023) Barbas-Bernardos, G. (Guillermo); López-López, R. (Rosario); Bote-Gascón, P. (Patricia); García-Suárez, L. (Leire); González-Bertolín, I. (Isabel); Garcia-Sanchez, P. (P.); Calvo, C. (Cristina)Urinary tract infections are the initial manifestation in 30% of urinary tract malformations. Identifying these patients, who could benefit from a specific treatment, is still challenging. Hyponatremia during urinary tract infection has been proposed as a urinary tract malformation marker. We evaluate the prevalence of hyponatremia during febrile urinary tract infections and its association with subjacent urinary tract malformations. We performed a retrospective study of healthy patients under 16 years, diagnosed with a first episode of febrile urinary tract infection, who had undergone blood testing in the acute episode and at least one renal ultrasound during follow-up (January 2014-November 2020). Hyponatremia was defined as (serum sodium≤130 mEq/L). According to imaging findings, we classified patients into three groups: normal kidney ultrasound, mild pelviectasis, and significant urinary tract malformation. We performed logistic regression models to identify independent risk factors for urinary tract malformation and mild pelviectasis. We included 492 patients and 2.8% presented hyponatremia. We identified normal ultrasound in 77%, mild pelviectasis in 10.8%, and urinary tract malformation in 12% of patients. We found an association between mild pelviectasis and hyponatremia [OR 6.6 (CI95% 1.6–26.6)]. However, we found no association between hyponatremia and urinary tract malformation. The parameters that were associated with malformations were presenting a non-E. coli infection, C-reactive-protein levels over 80 mg/L, and bacteremia. Conclusion: Hyponatremia during the first episode of febrile urinary tract infection is present in 2.8% of patients and is associated with mild pelviectasis in imaging. However, hyponatremia does not indicate a greater need for complementary tests to screen for urinary tract malformations.