RESUMO
INTRODUCTION: baseline neutrophil-to-lymphocyte ratio (NLR) at the time of colorectal cancer (CRC) diagnosis has been proposed as a predictor of long-term survival. The aim of this study was to analyze its usefulness in a homogeneous population with control of the main confounding factors. METHODOLOGY: observational study of 836 patients who underwent surgery for CRC. Patients were divided into two groups: NLR ≤ 3.3 vs NLR > 3.3. To control for confounders, they were matched one-to-one by propensity analysis. A final cohort of 526 patients was included in the study. RESULTS: the two groups were mismatched in terms of age, comorbidity, tumor stage, rectal location, and neoadjuvant therapy. Once matching was performed, baseline NLR was statistically significantly associated with long-term survival (p < 0.001) and behaved as an independent prognostic factor for survival (p = 0.001; HR: 1.99; 95 % CI: 1.32-3.00) when adjusted in a Cox regression model using age (p < 0.001; HR: 1.04; 95 % CI: 1.02-1.06) and the Charlson Comorbidity Index (p < 0.001; HR: 1.40; 95 % CI: 1.27-1.55). Neoadjuvant therapy lost its statistical significance (p = 0.137; HR: 1.59; 95 % CI: 0.86-2.93). CONCLUSIONS: a high baseline NLR (> 3.3) in patients with colorectal cancer at diagnosis represents a poor prognostic factor in terms of survival. Its use in routine practice could intensify therapeutic strategies and follow-up in these patients.
Assuntos
Neoplasias Colorretais , Linfócitos , Neutrófilos , Pontuação de Propensão , Humanos , Neoplasias Colorretais/sangue , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Feminino , Masculino , Idoso , Prognóstico , Pessoa de Meia-Idade , Contagem de Leucócitos , Estudos Retrospectivos , Contagem de Linfócitos , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Postoperative complications after colorectal cancer surgery have been associated with poor long-term prognosis. The aim of the present study was to investigate the prognostic impact of postoperative complications after colorectal cancer surgery assessed by the Comprehensive Complication Index (CCI®) and designing a new prognostic score based on this index. METHODS: This observational longitudinal study included a series of 604 patients who underwent colorectal surgery for cancer. Demographic data, comorbidity measured by Charlson Index, tumor characteristics, surgical data and postoperative complications were recorded as predictors. Univariate and multivariate analysis were performed and long-term survival was the output variable. Based on Hazard Ratios obtained on multivariate analysis, a new score, S-CRC-PC, was created for predicting long-term survival. RESULTS: Two-hundred and twelve (35.1%) patients developed some postoperative complication. The mean CCI was 11.6 (±19.19). Mild complications (CCI <26.2) were detected in 95 (15.7%) patients. Moderate complications (CCI 26.2-42.2) were detected in 64 (10.6%) patients. Severe complications (CCI >42.3) were detected in 53 patients (8.8%) patients. Mortality rate was 1.7%. In multivariate analysis, age (p < 0.001), Charlson score (p = 0.014), CCI (p < 0.001), and TNM stage (p < 0.001) were statistically significantly in relation to long-term survival rate. S-CRC-PC score was statistically associated with survival rate (HR: 1.34-95% CI: 1.27-1.41). Patients with S-CRC-PC values from 0 to 8 points (low risk), 8.1-16 points (medium risk), and scores above 16 points (high risk) had a cumulative survival rate at five-years of 98%, 83%, and 31% respectively. CONCLUSIONS: Postoperative complications after colorectal cancer surgery assessed by CCI are an independent prognostic factor of survival rate. The S-CRC-PC score may be helpful in predicting long-term cancer outcomes.
Assuntos
Neoplasias Colorretais , Complicações Pós-Operatórias , Neoplasias Colorretais/patologia , Humanos , Estudos Longitudinais , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
In relation to the article "A case of mixed adenoneuroendocrine tumor of the colon", we would like to contribute a new case of this exceptional and biphasic clinical entity - the MANEC (mixed adenoneuroendocrine carcinoma). These tumors represent a mix of pathological components, are highly aggressive, and affect the gastrointestinal and pancreatobiliary tract. They are characterized by the dual presence of glandular and neuroendocrine epithelial elements, where each component represents at least 30 % of the tumor.
Assuntos
Adenocarcinoma , Carcinoma Neuroendócrino , Neoplasias Gastrointestinais , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/cirurgia , Colo , HumanosRESUMO
We present the clinical case of a 34-year-old woman with a history of stage IV choriocarcinoma, after her diagnostic debut two years ago, a hysterectomy and resection of the right single pulmonary nodule with anatomopathological confirmation of both as uterine choriocarcinoma and pulmonary nodule compatible with metastatic choriocarcinoma, subsequently the patient received chemotherapy treatment with stability of her disease until now.
Assuntos
Coriocarcinoma , Segunda Neoplasia Primária , Adulto , Coriocarcinoma/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Histerectomia , Jejuno , GravidezRESUMO
In relation to the interesting article published recently in your scientific journal titled "Hirschsprung disease with debut in adult age as acute intestinal obstruction: a case report" , we would like to provide an exceptional case where the evolution of Hirschsprung's disease and an infrequent surgical complication developed in the long term are combined.
Assuntos
Doença de Hirschsprung/complicações , Obstrução Intestinal/etiologia , Emergências , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Gangliocytic paraganglioma is an uncommon entity. The jejunum location is extremely rare: there are only five cases reported in medical literature. We present a case of gangliocytic paraganglioma.