Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 16

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
debated. We studied prognostic factors of survival focusing on
the effect of incidental detection on survival and incidence.
Materials and methods: A retrospective nationwide study of
all living patients diagnosed with RCC in Iceland 1971-2005;
913 patients with mean age 65 years and M/F ratio 1.6. Clinical
information was gathered, histology reviewed and all tumors
staged according to the TNM staging system. Incidentally
diagnosed RCCs were compared to symptomatic tumors and
prognostic factors evaluated using Cox multivariate analysis.
Results: Incidence of RCC increased significantly during the last
5-year period for both sexes, mortality remaining unchanged.
Out of 913 patients, 255 (28%) were diagnosed incidentally, most
often because of abdominal ultrasound (29.1%) or computed
tomography (27.1%). Incidental detection increased from 11.1%
in 1971-75 to 39.2% in 2001-5 (p<0.05). Incidentally detected
tumors were 2.7cm smaller and diagnosed at a lower stage and
lower tumor grades compared to symptomatic tumors. Age,
M/F ratio and histology were similar in both groups. TNM
stage was by far the strongest independent prognostic factor of
survival, nuclear grade, age, calendar year of diagnosis and ESR
also being significant. Furthermore, symptomatic RCC patients
had worse survival than those that were diagnosed incidentally
(HR 1.4; 95% CI 1.02-1.93; p=0.04).
Conclusion: Survival of RCC patients in Iceland has improved
with increased incidence and unchanged mortality. The main
reason for this improvement is a steep rise in incidental detection.
Incidental detection affects survival favorably, a survival benefit
greater than can be explained by lower stage and grade when
compared to patients diagnosed with symptoms.
22 Behaviour-oriented questionnaire on cognitive
function among testicular cancer patients
J Skoogh1-5, G Steineck1-2, A Wallin3, M Gatz4, B Johansson5
'Clinicnl Cancer Epidemiology, The Sahlgrenska Academy, Gothenburg,
Sweden, 2CIinical Cancer Epidemiology/Karolinska Institute, Stockholm,
Sweden, Hnstitute ofNeuroscience and Physiology, The Salilgrenska Academy,
Gothenburg, Siveden, 4Department of Psychology, University ofSouthern
California, Los Angeles, United States, /Karolinska lnstitute, Stockholm,
Sweden, 5Department of Psychology, Gothenburg, Sweden
johanm.skoogh@oncology.gu.se
Aim: To construct a questionnaire measuring experienced
chemotherapy-induced effects on cognitive function among
testicular cancer patients using questions about every-day
behaviour.
Method: During an 18-month qualitative phase we constructed a
study-specific questionnaire based on interviews with 20 cancer
patients who experienced chemotherapy-induced cognitive
decline. Using an open interview we deliberately applied an
unbiased approach, asking about specific behaviour without
references to domains of cognitive function. Patients reported a
variety of problems such as difficulties finding the right words,
being dependent on notes for memory and feeling lack of
energy. When phrasing questions in our questionnaire we tried
to use the wordings given by the patients as exactly as possible.
The final questionnaire included 295 questions that were
tested in a pilot study. After receiving 33 of 36 questionnaires
we proceeded to the main study. The procedures followed the
established routines and the format developed at our division of
Clinical Cancer Epidemiology.
Results: Among the 1175 eligible testicular cancer patients,
960 (82 percent) answered the questionnaire. Before analysing
data an expert panel categorized the questions according to a
judgement of which cognitive domain each of the questions
covered. We identified 59 questions believed to measure
mainly one specific cognitive domain: 6 attention, 26 memory,
5 visuospatial ability, 7 language, 2 speed and 13 questions for
executive function.
Conclusion: A questionnaire, designed to measure cognitive
function based on questions about behaviour in everyday life,
was found to provide valuable information in a population of
testicular-cancer survivors.
23 The importance of stone size, location and JJ-stents
in relation to ESWL of renal calculi
T Nielsen, JB Jensen
Urology Department, Regionshospital Holstebro, Denmark
tommyniel@gmail.com
Aim: To investigate 1) the importance of stone size and location
in relation to ESWL of renal stones 2) whether stone size or
location influence the risk of acute treatment with an uretral
stent (JJ-stent) after ESWL.
Material and methods: Between 1999 and 2007 a total of 461
patients with 589 renal stones were treated with ESWL. A
commercial company (MLS Medical A/S) assisted by the treating
urologist conducted the treatment using a Storz Modulih SLK .
Each stone was retrospectively arranged according to size,
location, number of ESWL treatments and auxiliary procedures.
Results: The overall success rate after lst ESWL was 69% and
this increased to 93% after one or more re-treatments.
A correlation analyses between stone size and overall success
rate demonstrated a significant decrease in success rate as stone
size increased (r = -0.2, p<0,01).
With the exception of upper calyx after re-ESWL (p < 0,05), the
difference in success rate according to stone location did not
prove significant.
A total of 17 patients (2,9%) needed treatment with JJ-stent after
ESWL. No significant difference was observed between stone
size or location and the risk of being treated with a JJ-stent after
ESWL.
Conclusion: A success rate of more then 90% can be obtained
with repeated ESWL of renal stones up to 30 mm, but an inverse
relation between stone size and success rate was observed.
Patients who did not require treatment with JJ-stents prior to
ESWL does rarely need JJ-stents after ESWL.
1 6 LÆKNAblaðið 2009/95