RESUMEN
Current strategies to treat pediatric acute lymphoblastic leukemia rely on risk stratification algorithms using categorical data. We investigated whether using continuous variables assigned different weights would improve risk stratification. We developed and validated a multivariable Cox model for relapse-free survival (RFS) using information from 21199 patients. We constructed risk groups by identifying cutoffs of the COG Prognostic Index (PICOG) that maximized discrimination of the predictive model. Patients with higher PICOG have higher predicted relapse risk. The PICOG reliably discriminates patients with low vs. high relapse risk. For those with moderate relapse risk using current COG risk classification, the PICOG identifies subgroups with varying 5-year RFS. Among current COG standard-risk average patients, PICOG identifies low and intermediate risk groups with 96% and 90% RFS, respectively. Similarly, amongst current COG high-risk patients, PICOG identifies four groups ranging from 96% to 66% RFS, providing additional discrimination for future treatment stratification. When coupled with traditional algorithms, the novel PICOG can more accurately risk stratify patients, identifying groups with better outcomes who may benefit from less intensive therapy, and those who have high relapse risk needing innovative approaches for cure.
Asunto(s)
Linfoma de Burkitt , Leucemia-Linfoma Linfoblástico de Células Precursoras B , Leucemia-Linfoma Linfoblástico de Células Precursoras , Niño , Humanos , Adulto Joven , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/terapia , Pronóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Recurrencia , Medición de Riesgo , Supervivencia sin EnfermedadRESUMEN
El cáncer de recto es una enfermedad frecuente en la población, siendo un problema de salud importante a nivel nacional, con un probable aumento en la incidencia junto con la transición demográfica y epidemiológica de los últimos años. La cirugía ha sido históricamente el pilar fundamental en el tratamiento de esta patología, pero asociándose a una alta tasa de recurrencia, tanto locorregional como a distancia, como único tratamiento. Es por esto que se ha estudiado el agregar terapias adyuvantes a la cirugía, como lo es la radioterapia y quimioterapia. La evidencia ha demostrado que la adyuvancia con radioterapia más quimioterapia se asocia a mayor sobrevida global y menor recurrencia local y a distancia en comparación con la cirugía exclusiva. En el presente artículo se realiza una revisión de los principales estudios que evidencian la ventaja, tanto en sobrevida global como libre de enfermedad, del uso de la adyuvancia con radioterapia más quimioterapia, mencionando la última evidencia disponible sobre el tratamiento del cáncer de recto localmente avanzado y las perspectivas a futuro.
Rectal cancer is a common disease in general population, being a major health problem in our nation, with a likely increase in incidence associated to demographic and epidemiological transition in recent years. Historically, the surgery has been the mainstay in the treatment of this disease, but surgery alone is associated to a high rate of recurrence, both locoregional and distant. This is why it has been studied adding adjuvant therapies to surgery, as is radiotherapy and chemotherapy. The evidence has shown that adjuvant radiotherapy and chemotherapy is associated with increased overall survival and less local and distant recurrence compared to surgery alone. This article is a review of major studies that demonstrate the advantage of using adjuvant radiotherapy and chemotherapy in both overall and disease-free survival, mentioning the last evidence available in treatment of locally advanced rectal cancer.
