RESUMEN
Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiotherapy (RT) is the cornerstone of locoregional treatment of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time.
Asunto(s)
Neoplasias Nasofaríngeas , Humanos , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/patologíaAsunto(s)
Neoplasias Colorrectales/genética , Neoplasias Colorrectales/terapia , Terapia Molecular Dirigida , Antineoplásicos Inmunológicos/uso terapéutico , Transformación Celular Neoplásica/genética , Neoplasias Colorrectales/clasificación , Islas de CpG , Metilación de ADN , Reparación del ADN , Genes Relacionados con las Neoplasias , Genes Supresores de Tumor , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Oncología Médica/tendencias , Inestabilidad de Microsatélites , Biología Molecular/tendencias , Mutación , Síndromes Neoplásicos Hereditarios/genética , Síndromes Neoplásicos Hereditarios/terapia , PronósticoRESUMEN
Research into cancer-associated thrombosis (CAT) entails managing dynamic data that pose an analytical challenge. Thus, methods that assume proportional hazards to investigate prognosis entail a risk of misinterpreting or overlooking key traits or time-varying effects. We examined the AGAMENON registry, which collects data from 2,129 patients with advanced gastric cancer. An accelerated failure time (AFT) multistate model and flexible competing risks regression were used to scrutinize the time-varying effect of CAT, as well as to estimate how covariates dynamically predict cumulative incidence. The AFT model revealed that thrombosis shortened progression-free survival and overall survival with adjusted time ratios of 0.72 and 0.56, respectively. Nevertheless, its prognostic effect was nonproportional and disappeared over time if the subject managed to survive long enough. CAT that occurred later had a more pronounced prognostic effect. In the flexible competing risks model, multiple covariates were seen to have significant time-varying effects on the cumulative incidence of CAT (Khorana score, secondary thromboprophylaxis, high tumor burden, and cisplatin-containing regimen), whereas other predictors exerted a constant effect (signet ring cells and primary thromboprophylaxis). The model that assumes proportional hazards was incapable of capturing the effect of these covariates and predicted the cumulative incidence in a biased way. This study evinces that flexible and multistate models are a useful and innovative method to describe the dynamic effect of variables associated with CAT and should be more widely used.
Asunto(s)
Técnicas de Apoyo para la Decisión , Neoplasias Gástricas/epidemiología , Tromboembolia Venosa/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Progresión de la Enfermedad , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Supervivencia sin Progresión , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Neoplasias Gástricas/sangre , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/mortalidad , Factores de Tiempo , Tromboembolia Venosa/sangre , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/mortalidad , Adulto JovenRESUMEN
Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiotherapy (RT) is the cornerstone of locoregional treatment of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time.
Asunto(s)
Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/patología , Diagnóstico , Terapéutica , Guías de Práctica Clínica como AsuntoRESUMEN
The use of central venous catheters for various applications (administration of chemotherapy, blood products and others) in patients with cancer is increasingly frequent. The association between thrombosis and catheter use has been fully established but aspects such as its causes, diagnosis, prophylaxis and treatment have not. We describe a case of thrombosis in a patient with cancer treated with chemotherapy who carried a central venous catheter. We also perform a review of the risk factors, the role of the prophylaxis and the treatment.
Asunto(s)
Adenocarcinoma/terapia , Cateterismo Venoso Central/efectos adversos , Neoplasias del Colon/terapia , Venas Yugulares , Trombosis de la Vena/etiología , Adenocarcinoma/complicaciones , Neoplasias del Colon/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Trombosis de la Vena/diagnósticoRESUMEN
La utilización de catéteres venosos centrales en pacientes con cáncer para diferentes usos (administración de quimioterapia, productos sanguíneos y otros) es cada vez más frecuente. La asociación de trombosis con catéter está completamente establecida, pero no así aspectos como causas, diagnóstico, profilaxis y tratamiento. Se describe un caso de trombosis en un paciente con cáncer en tratamiento con quimioterapia portador de catéter venoso central y realizamos una revisión de los factores de riesgo, el papel de la profilaxis y el tratamiento (AU)
The use of central venous catheters for various applications (administration of chemotherapy, blood products and others) in patients with cancer is increasingly frequent. The association between thrombosis and catheter use has been fully established but aspects such as its causes, diagnosis, prophylaxis and treatment have not. We describe a case of thrombosis in a patient with cancer treated with chemotherapy who carried a central venous catheter. We also perform a review of the risk factors, the role of the prophylaxis and the treatment (AU)