Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer.

BACKGROUND AND OBJECTIVE: Neoadjuvant chemotherapy (nCMT) has been increasingly used in advanced gastric cancer (GC). However, the prognostic impact of tumor response remains unclear. This study aimed to evaluate if tumor response at the primary site and lymph nodes (LN) correlate with survival in GC patients after nCMT. METHODS: Patients with gastric adenocarcinoma treated with nCMT followed by gastrectomy were evaluated. Residual tumor was graded from 0% to 100%, defining two groups: poor (PR) and major response (MR). LN regression rate (LNRR) was determined based on tumor/fibrosis examination at each LN and a cutoff value established by receiver operating characteristic curve. RESULTS: Among 62 cases, 20 (32.2%) had MR and 42 (67.7%) PR. Smaller size, diffuse histology, lower ypT status and less advanced stage were associated with the MR group. Based on cutoff value of 57, 45.6% and 54.4% patients were classified as low-LNRR and high-LNRR. High-LNRR correlated with absence of venous, lymphatic and perineural invasion, and less advanced stage. Survival was equivalent between MR and PR (P = .956). High-LNRR had better disease-free survival (DFS) than low-LNRR (P < .001). In multivariate analysis, only LNRR associated with DFS. CONCLUSION: High-LNRR associates with DFS in GC treated with nCMT. Response at the primary site does not correlate with survival.

Tratamento cirúrgico do carcinoma epidermoide da cavidade oral e orofaringe no Instituto do Câncer do Estado de São Paulo (ICESP): perfil dos pacientes tratados e resultados oncológicos iniciais / Surgical treatment of oral cavity and oropharynx squamous cell carcinoma at São Paulo State Cancer Institute (ICESP): profile of treated patients and initial oncological results

Introdução: As neoplasias malignas da cavidade oral e daorofaringe constituem uma parcela significativa dos tumoresda cabeça e pescoço. Em uma instituição oncológica terciáriaé mister avaliar o perfil dos pacientes tratados a fim de traçarestratégias terapêuticas e definir linhas de pesquisa científica.Objetivo: Determinar o perfil dos pacientes submetidos atratamento cirúrgico por carcinoma epidermoide de cavidadeoral e orofaringe no Instituto do Câncer do Estado de São Paulo(ICESP), e os resultados oncológicos iniciais deste tratamento.Casuística e Método: Prontuários eletrônicos dos pacientesoperados no Serviço de Cirurgia de Cabeça e Pescoço do ICESPcom diagnóstico de câncer de cavidade oral (incluindo lábio)e orofaringe no período de abril de 2009 a dezembro de 2010(primeiros 20 meses de atividade do serviço). Foram analisadosretrospectivamente nesses prontuários dados demográficos,histopatológicos e tratamentos adjuvantes e prévios dessespacientes. Determinaram-se também as curvas de sobrevidaglobal, específica e livre de progressão de doença em um períodoinicial de seguimento. Resultados: Foram obtidos 66 casospassíveis de análise. Os sítios mais frequentes do tumor primárioforam língua oral, soalho da boca e loja tonsilar, os quais somadoscorresponderam a 57,5% dos casos. A maioria dos pacientes(83,3%) era virgem de tratamento, sendo o restante, cirurgias deresgate. A maioria dos pacientes foi classificada como estadio IIIe IV (77,8%). Observou-se invasão perineural e angiolinfática em62,3% e 29,5% dos casos, respectivamente. A espessura dostumores primários variou de 0,04cm até 6,8cm, com espessuramédia de 2,18 ± 1,54 cm. Dos 56 casos submetidos a algum tipode esvaziamento cervical, 38 casos foram pN+ (67,9%) com 1 até50 linfonodos comprometidos. Em 37 casos foi possível avaliarextensão extracapsular nos linfonodos metastáticos, a qual ocorreu em 17 pacientes (45,9%). Após a cirurgia, 59,1% dos pacientesforam submetidos à radioterapia e 37,9% à quimioterapia. Emum tempo de seguimento médio de 15 ± 7 meses, não houveperda de seguimento e as sobrevidas global, específica e livrede progressão de doença acumuladas em 30 meses foram,respectivamente, 54,2%, 59,1% e 52%. Aproximadamente93% das recidivas ocorreram nos primeiros 12 meses póstratamentocirúrgico. Conclusão: O perfil dos pacientes tratadoscirurgicamente por câncer de boca e orofaringe nos primeiros 20meses de atividade do Serviço de Cirurgia de Cabeça e Pescoçodo ICESP revela um número expressivo de casos avançados(estadios III e IV) com características anatomopatológicas de mauprognóstico, o que implica nos resultados oncológicos pobresobservados em um período inicial de seguimento.

Effect of glutamine dipeptide on hepatic regeneration in partially hepatectomized malnourished rats.

Glutamine promotes hepatic regeneration in nourished (N) rats. The aim of the present study was to evaluate the effects of glutamine-enriched total parenteral nutrition (TPN) on liver regeneration in malnourished (MN) rats.Seventy-two male Wistar rats ( congruent with 270 g) were assigned to one of two groups: N and MN. Each group was then subdivided into three groups: the first underwent partial hepatectomy (PH) and received standard TPN enriched with L-alanyl-L-glutamine (Ala-Gln); the second also underwent PH and received standard TPN, but enriched with a solution containing proline and alanine (Ala-Pro); and the third underwent no surgical procedure (control group). All experimental groups received isocaloric (188 kcal. kg(-1). d(-1)) and isonitrogenous (1.12 g of nitrogen. kg(-1). d(-1)) TPN for 96 h. All animals were injected with bromodeoxyuridine 2 h before death. The hepatic regeneration index (HRI), hepatic growth percentage (HG) and hepatic morphology were analyzed. In MN rats, HRI and HG were higher with glutamine enrichment (HRI = 81 and HG = 190) than with proline-containing TPN (HRI = 66 and HG = 154; P < 0.05) and HRI was 100 times higher in animals that underwent PH than in control animals. Morphologic analysis of hepatic tissue showed no difference among the six groups.Glutamine-enriched TPN promoted growth of the remnant liver in MN rats after PH, maintained cellular proliferation in the various experimental groups after surgery, and maintained hepatic morphology of MN rats after surgery.