OBJECTIVE: To evaluate the concordance between the Gleason scores of prostate biopsies and radical prostatectomy specimens, thereby highlighting the importance of the prostate-specific antigen (PSA) level as a predictive factor of concordance. METHODS: We retrospectively analyzed 253 radical prostatectomy cases performed between 2006 and 2011. The patients were divided into 4 groups for the data analysis and dichotomized according to the preoperative PSA, <10 ng/mL and ≥10 ng/mL. A p-score <0.05 was considered significant. RESULTS: The average patient age was 63.3±7.8 years. The median PSA level was 9.3±4.9 ng/mL. The overall concordance between the Gleason scores was 52%. Patients presented preoperative PSA levels <10 ng/mL in 153 of 235 cases (65%) and ≥10 ng/mL in 82 of 235 cases (35%). The Gleason scores were identical in 86 of 153 cases (56%) in the <10 ng/mL group and 36 of 82 (44%) cases in the ≥10 ng/mL group (p = 0.017). The biopsy underestimated the Gleason score in 45 (30%) patients in the <10 ng/mL group and 38 (46%) patients in the ≥10 ng/mL (p = 0.243). Specifically, the patients with Gleason 3 + 3 scores according to the biopsies demonstrated global concordance in 56 of 110 cases (51%). In this group, the patients with preoperative PSA levels <10 ng/dL had higher concordance than those with preoperative PSA levels ≥10 ng/dL (61% x 23%, p = 0.023), which resulted in 77% upgrading after surgery in those patients with PSA levels ≥10 ng/dl. CONCLUSION: The Gleason scores of needle prostate biopsies and those of the surgical specimens were concordant in approximately half of the global sample. The preoperative PSA level was a strong predictor of discrepancy and might improve the identification of those patients who tended to be upgraded after surgery, particularly in patients with Gleason scores of 3 + 3 in the prostate biopsy and preoperative PSA levels ≥10 ng/mL.

JUSTIFICATIVA E OBJETIVOS: A cirurgia de transplante hepático (TH) continua associada a sangramento importante em 20% dos casos, e diversos autores têm demonstrado os riscos relacionados ao uso de hemocomponentes. O objetivo deste estudo foi avaliar o impacto do uso de hemocomponentes durante toda a hospitalização na sobrevida em cinco anos de pacientes submetidos a TH. MÉTODOS: Um total de 113 pacientes submetidos ao TH foi avaliado retrospectivamente. Diversas variáveis, incluindo uso de hemocomponentes no intraoperatório e durante toda a hospitalização, foram categorizadas e avaliadas por meio de análise univariada, pelo teste de Fisher. O nível de significância adotado foi de 5%. Os resultados com p < 0,2 foram submetidos a uma análise multivariada pelo modelo de regressão logística multinominal. RESULTADOS: Doenças parenquimatosas, disfunção renal pré-operatória e maior tempo de internação no CTI e hospitalar se associaram a maior mortalidade em cinco anos após o TH (p < 0,05). Ao contrário do uso de hemocomponentes no intraoperatório, a transfusão acumulada de concentrado de hemácias, plasma fresco congelado e concentrado de plaquetas durante toda a internação hospitalar foi associada à maior mortalidade em cinco anos após o transplante de fígado (p < 0,01). CONCLUSÕES: O estudo alerta para a relação existente entre o uso de hemocomponentes durante a hospitalização e o aumento da mortalidade em cinco anos após o TH.

BACKGROUND AND OBJECTIVES: Liver transplant (LT) surgery is associated with significant bleeding in 20% of cases, and several authors have demonstrated the risks related to blood components. The objective of the present study was to evaluate the impact of using blood components during hospitalization in five-year survival of patients undergoing LT. METHODS: One hundred and thirteen patients were evaluated retrospectively. Several variables, including the use of blood components intraoperatively and throughout hospitalization, were categorized and evaluated by univariate analysis using Fisher's test. A level of significance of 5% was adopted. Results with p < 0.2 underwent multivariate analysis using multinomial logistic regression. RESULTS: Parenchymal diseases, preoperative renal dysfunction, and longer stay in hospital and ICU are associated with greater five-year mortality after LT (p < 0.05). Unlike the intraoperative use of blood components, the accumulated transfusion of packed red blood cell, frozen fresh plasma, and platelets during the entire hospitalization was associated with greater five-year mortality after liver transplantation (p < 0.01). CONCLUSIONS: This study emphasizes the relationship between the use of blood components during hospitalization and increased mortality in five years after LT.

JUSTIFICATIVA Y OBJETIVOS: La cirugía de transplante hepático (TH), continúa asociada al sangramiento importante en un 20% de los casos, y diversos autores ya han demostrado los riesgos relacionados con el uso de hemoderivados. El objetivo de este estudio fue evaluar el impacto del uso de hemoderivados durante toda la hospitalización en la sobrevida en cinco años de pacientes sometidos a TH. MÉTODOS: Un total de 113 pacientes sometidos a TH fueron evaluados retrospectivamente. Diversas variables, incluyendo el uso de hemoderivados en el intraoperatorio y durante toda la hospitalización, fueron categorizadas y evaluadas por medio de análisis univariado, por el test de Fisher. El nivel de significancia adoptado fue de un 5%. Los resultados con p < 0,2 fueron sometidos a un análisis multivariado por el modelo de regresión logística multinominal. RESULTADOS: Enfermedades parenquimatosas, disfunción renal preoperatoria y un mayor tiempo de internación en UCI y hospitalario, se asociaron a una mayor mortalidad en cinco años después del TH (p < 0,05). Al contrario del uso de hemoderivados en el intraoperatorio, la transfusión acumulada de concentrado de hematíes, plasma fresco congelado y concentrado de plaquetas durante todo el ingreso se asoció a una mayor mortalidad en cinco años posteriores al transplante de hígado (p < 0,01). CONCLUSIONES: El estudio es un alerta sobre la relación existente entre el uso de hemoderivados durante el ingreso y el aumento de la mortalidad en cinco años posteriores al TH.