RESUMO
Personalization of gastric cancer (GC) treatment is an urgent problem because of the clinical heterogeneity and aggressive course of the disease. Four GC subtypes were isolated based on molecular characteristics by The Cancer Genome Atlas researchers in 2014: Epstein-Barr virus positive (EBV^(+)), microsatellite unstable (MSI), chromosomally unstable (CIN), and genomically stable (GS). There is no unified method to detect the CIN and GS subtypes today, while MSI and EBV status assessments are used routinely and are of great clinical importance. A total of 159 GC samples were tested for MSI, EBV DNA, and somatic mutations in codons 12-13 (exon 2), 61 (exon 3), and 146 (exon 4) of the KRAS gene; codons 597-601 (exon 15) of the BRAF gene; and codons 542-546 (exon 9), 1047-1049 (exon 20) of the PIK3CA gene. EBV^(+) GC was detected in 8.2% of samples; and MSI, in 13.2%. MSI and EBV+ were found to be mutually exclusive. The mean ages at GC manifestation were 54.8 and 62.1 years in patients with EBV^(+) and MSI GCs, respectively. EBV^(+) GC affected men in 92.3% of cases, 76.2% of the patients were older than 50 years of age. Diffuse and intestinal adenocarcinomas were diagnosed in 6 (46.2%) and 5 (38.5%) EBV^(+) cases, respectively. MSI GC equally affected men (n = 10, 47.6%) and women (n = 11, 52.4%). The intestinal histological type was the most prevalent (71.4%); the lesser curvature was affected in 28.6% of the cases. The E545K variant of PIK3CA was observed in one EBV^(+) GC case. A combination of clinically significant variants of KRAS and PIK3CA was found in all MSI cases. The BRAF V600E mutation, which is specific to MSI colorectal cancer, was not detected. The EBV^(+) subtype was associated with better prognosis. The five-year survival rates were 100.0 and 54.7% for MSI and EBV^(+) GCs, respectively.
Assuntos
Neoplasias Colorretais , Infecções por Vírus Epstein-Barr , Neoplasias Gástricas , Feminino , Humanos , Masculino , Classe I de Fosfatidilinositol 3-Quinases/genética , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Infecções por Vírus Epstein-Barr/genética , Herpesvirus Humano 4/genética , Instabilidade de Microssatélites , Repetições de Microssatélites , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologiaRESUMO
OBJECTIVE: To evaluate the immediate and long-term results of surgical and combined treatment of patients with duodenal stromal tumors. MATERIAL AND METHODS: There were 47 patients with duodenal stromal tumors for the period 2002-2019. All patients underwent treatment at the Blokhin National Cancer Research Center. Six patients had metastatic disease, 2 ones - a rare syndrome of duodenal stromal tumor associated with neurofibromatosis type 1, other 39 patients had a localized and locally-advanced disease. Surgical treatment was performed in 37 patients (limited resections (LR) in 24 cases and gastropancreaticoduodenectomy in 13 cases).Incidence of postoperative complications was significantly lower after limited resections compared to gastropancreaticoduodenectomy (22.2% (6/24) vs. 61.5% (8/13), respectively). Severe complications (Clavien-Dindo grade 3) occurred in 4.2% (1/24) vs. 15.3% (2/13) of patients, respectively. Postoperative mortality was absent in both groups. We observed no significant differences in long-term results. Overall 5-year survival was 91% and 70% (p=0.5960), 5-year recurrence-free survival - 65 and 70% (p=0.6226), respectively. CONCLUSION: Considering similar survival rates, lower postoperative morbidity and better quality of life, limited duodenal resections are preferred for duodenal stromal tumors.
Assuntos
Neoplasias Duodenais , Tumores do Estroma Gastrointestinal , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Pancreaticoduodenectomia/efeitos adversos , Qualidade de Vida , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Gastrointestinal stromal duodenal tumors are rare diseases of small intestine. Duodenal GISTs may be giant; these neoplasms can also simulate malignancies of other organs. These features result diagnostic and treatment mistakes. Neoadjuvant therapy with imatinib results tumor shrinkage and ensures organ-sparing surgery. We report duodenal GISTs in patients with primary diagnosis «retroperitoneal tumor¼, «pancreatic cyst¼ and «retroperitoneal abscess¼, who were treated at the Blokhin National Cancer Research Centre in 2019-2020.
Assuntos
Neoplasias Duodenais , Tumores do Estroma Gastrointestinal , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Duodeno , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib , Terapia NeoadjuvanteRESUMO
An association was found between reduced expression of miR-34a, miR-146a with both metastasis to regional lymph nodes (relative risk RR=10.50 and RR=5.25, respectively) and the development of distant metastases (RR=9.50 and RR=4, 40, respectively) in gastric cancer. They are excellent classifiers: AUC>0.9 for both miRNAs. The association of miR-335 expression with metastasis to the lymph nodes is much weaker, but it is also a good classifier for identifying a group with distant metastasis (RR=5.90). A correlation was found between the expression of miR-34a and miR-146a during metastasis, which is absent in non-metastatic tumors. Thus, miR-34a, miR-146a, and miR-335 miRNAs can be proposed as candidates for biomarkers of the risk of gastric cancer metastasis.
Assuntos
Adenocarcinoma/diagnóstico , Biomarcadores Tumorais/genética , MicroRNAs/genética , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia , TranscriptomaRESUMO
OBJECTIVE: To assess severity, safety and functional advisability of distal pancreatectomy using original surgical technique developed in the Blokhin National Medical Research Centre of Oncology. MATERIAL AND METHODS: There were 10 patients with duodenal malignancies who have undergone distal pancreatectomy in the Blokhin National Medical Research Centre of Oncology for the period 2006-2018. Distal pancreatectomy for primary duodenal tumors was performed in 8 patients, 2 patients underwent surgery for external invasion of the duodenum. RESULTS: Postoperative complications Clavien-Dindo grade 1 and 2 occurred in 4 (40%) patients. Surgical complication grade 2 occurred in 1 (10%) patient (pancreatic fistula with effective conservative management). There were no cases of leakage of duodenal stump and duodenojejunostomy, impaired bile flow and stenosis of anastomosis with delayed stomach emptying. CONCLUSION: Distal duodenectomyis associated with low postoperative morbidity, good functionality and quality of life. This procedure is preferred for non-epithelial and neuroendocrine tumors, as well as with secondary malignant duodenal invasion.
Assuntos
Fístula Brônquica/cirurgia , Empiema Pleural/cirurgia , Pneumopatias/cirurgia , Pneumonectomia/efeitos adversos , Fístula Brônquica/diagnóstico , Fístula Brônquica/etiologia , Doença Crônica , Empiema Pleural/diagnóstico , Empiema Pleural/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/diagnóstico , Doenças Pleurais/etiologia , Doenças Pleurais/cirurgia , Pneumonectomia/mortalidade , Recidiva , Reprodutibilidade dos Testes , Fístula do Sistema Respiratório/diagnóstico , Fístula do Sistema Respiratório/etiologia , Fístula do Sistema Respiratório/cirurgia , Retalhos Cirúrgicos/transplanteAssuntos
Dissecação/métodos , Neurilemoma , Neoplasias Retroperitoneais , Adulto , Colectomia/métodos , Feminino , Gastrectomia/métodos , Humanos , Invasividade Neoplásica , Estadiamento de Neoplasias , Nefrectomia/métodos , Neurilemoma/patologia , Neurilemoma/fisiopatologia , Neurilemoma/cirurgia , Pancreatectomia/métodos , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/fisiopatologia , Neoplasias Retroperitoneais/cirurgia , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
AIM: To evaluate the results of surgical treatment in patients with retroperitoneal sarcoma and invasion into great vessels. MATERIAL AND METHODS: For the period 2009-2016 fourteenth patients with retroperitoneal sarcoma underwent resection and repair of great vessels at the abdominal department of N.N. Blokhin Russian Cancer Research Center. In 12 cases circular resection of infrarenal aorta, aortic bifurcation and iliac arteries followed by their replacement was made. 2 patients underwent circular resection of iliac arteries. RESULTS: Postoperative morbidity was 42.8%. There was no postoperative mortality. 10 of 14 patients are alive from 2 to 70 months after surgery. One patient died in 2 months postoperatively from unknown reasons, 3 patients died in 18, 20 and 30 months respectively due to progression of the disease. CONCLUSION: Overall survival and acceptable surgical risk underline the value of en block resection of retroperitoneal sarcoma together with involvement blood vessels.
Assuntos
Artéria Ilíaca , Neoplasias Retroperitoneais , Sarcoma , Aorta Abdominal , Humanos , Artéria Ilíaca/cirurgia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgiaRESUMO
Retrospective analysis of 228 patients with retroperitoneal liposarcoma, operated on in the Russian Oncology Center during 1971-2010, has been done. Of 223 performed operations, 124 were combined, i.e., required multi-organ resection. The kidney was the most frequently removed organ both in cases of primary and recurrent tumors. 10-year survival rate was 26% after combined operations and 35% after surgery, they did not need the multiorgan resection.
Assuntos
Lipossarcoma , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Neoplasias Retroperitoneais , Procedimentos Cirúrgicos Operatórios , Adulto , Feminino , Humanos , Lipossarcoma/mortalidade , Lipossarcoma/patologia , Lipossarcoma/cirurgia , Masculino , Pessoa de Meia-Idade , Moscou , Invasividade Neoplásica , Estadiamento de Neoplasias , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/mortalidade , Prognóstico , Neoplasias Retroperitoneais/mortalidade , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Taxa de SobrevidaRESUMO
The study included 63 patients with relapsing metastatic stromal tumor of the gastrointestinal tract (surgery - 34, tyrosinkinase inhibitors - 29). Cytoreductive surgery is indicated in patients showing positive response to target therapy. The highest survival rates were reported in cases of surgical treatment received in conjunction with pre- and postoperative therapy with tyrosinkinase inhibitors.
Assuntos
Antineoplásicos/uso terapêutico , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Tirosina Quinases/antagonistas & inibidores , Adulto , Idoso , Algoritmos , Quimioterapia Adjuvante , Feminino , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Análise de Sobrevida , Resultado do TratamentoRESUMO
The investigation was undertaken to study the molecular characteristics of Epstein-Barr virus (EBV) LMP1 gene samples amplified from the tumor and intact tissues of patients with EBV-negative forms of gastric carcinoma (GC). The genetic structure of these samples determined by their sequencing was compared with that of the gene samples isolated from the cells of oropharyngeal washing specimens from the same patients with GC, as well as peripheral blood lymphocytes of patients with infectious mononucleosis (IM) and blood donors. The findings suggest that the samples of tumor tissue LMP1 from patients with GC have higher divergence than those from patients with IM and blood donors although no specific variants of the gene for GC were found. Comparison of LMP1 sequences from tumor tissue and cells of oropharyngeal washing specimens from the same patients with EBV-negative GC revealed the common LMP1 variant in 2 cases while they differed in 3 cases. The findings are an initial step in studying the role of EBV in the carcinogenesis of EBV-negative GC that is likely to be established by investigations on representative clinical material, by applying the up-to-date technologies.