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INTRODUCTION: Fibroblast growth factor receptor (FGFR) mutations and fusions are relevant biomarkers in metastatic urothelial carcinoma (mUC). However, the prevalence of genomic alterations and their impact on clinical outcomes in a Latin American population remains unknown. This study aimed to explore the prevalence of FGFR mutations and/or fusions in patients with mUC in Latin America (LATAM) and its association with clinicopathological characteristics, Bellmunt's prognostic model, and survival outcomes. PATIENTS AND METHODS: A multicenter retrospective cohort study from 2016 to 2019 of patients with mUC from several LACOG LATAM institutions. FGFR alterations were analyzed by real-time PCR and/or next-generation sequencing in tumor samples and clinicopathologic characteristics and survival outcomes data were collected. The prevalence of FGFR, patient characteristics, and treatment in real-world settings were summarized. Kaplan-Meier survival estimates and Cox regression analyses were used to evaluate the associations of FGFR mutation and/or fusion status with median overall survival (mOS), median time to treatment failure (mTTF), and clinicopathological characteristics. RESULTS: In total, 222 patients were screened. Of these, 196 patients were considered eligible and were included in the analysis. FGFR mutations and/or fusions were found in 35 (17.9%) patients. There was no statistical difference in mOS and mTTF in FGFR-altered and non-altered patients (13.1 vs. 16.8 months, P = .20 and 3.9 vs. 4.1 months, P = .96, respectively). Bellmunt's prognostic model correctly predicted overall survival (P = .049). CONCLUSIONS: This is the largest study evaluating the prevalence of FGFR alterations in patients with mUC in the LATAM population. FGFR alterations in mUC were found in 17.9% of the patients, and the presence of this biomarker was not associated with OS. We validated Bellmunt's prognostic model in this cohort.
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Objective: To analyze marital outcomes, divorce or separation, and its association with demographic, socioeconomic, and clinicopathological factors among breast cancer (BC) survivors after 2-years of diagnosis. Methods: We performed a retrospective analysis of marital status at baseline and at years 1 and 2 of follow-up of women aged ≥ 18 years diagnosed with invasive BC participating in the AMAZONA III (GBECAM0115) study. The BC diagnosis occurred between January 2016 and March 2018 at 23 institutions in Brazil. Results: Of the 2974 women enrolled in AMAZONA III, 599 were married or living under common law at baseline. Divorce or separation occurred in 35 (5.8%) patients at 2 years of follow-up. In the multivariate analysis, public health insurance coverage was associated with a higher risk of marital status change (8.25% vs. 2.79%, RR 3.09, 95% CI 1.39 - 7.03, p = 0.007). Women who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation (8.1% vs. 4.49%, RR 1.97, 95 CI 1.04 - 3.72, p = 0.0366) than those who underwent breast-conserving surgery. Conclusion: Women covered by the public health system and those who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation. This evidence further supports the idea that long-term marital stability is associated with a complex interplay between socioeconomic conditions and stressors, such as BC diagnosis and treatment. ClinicalTrials Registration: NCT02663973.
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Neoplasias da Mama , Divórcio , Humanos , Feminino , Divórcio/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Brasil/epidemiologia , Estado Civil , Fatores Socioeconômicos , Idoso , Fatores de Risco , Sobreviventes de Câncer/estatística & dados numéricosRESUMO
BACKGROUND: There is an ongoing debate as to whether sex could be associated with immune checkpoint inhibitor (ICI) benefit. Existing literature data reveal contradictory results, and data on first-line immune combinations are lacking. METHOD: This was a real-world, multicenter, international, observational study to determine the sex effects on the clinical outcomes in metastatic renal cell carcinoma (mRCC) patients treated with immuno-oncology combinations as first-line therapy. RESULTS: A total of 1827 mRCC patients from 71 cancer centers in 21 countries were included. The median OS was 38.7 months (95% CI 32.7-44.2) in the overall study population: 40.0 months (95% CI 32.7-51.6) in males and 38.7 months (95% CI 26.4-41.0) in females (p = 0.202). The median OS was higher in males vs. females in patients aged 18-49y (36.9 months, 95% CI 29.0-51.6, vs. 24.8 months, 95% CI 16.8-40.4, p = 0.426, with + 19% of 2y-OS rate, 72% vs. 53%, p = 0.006), in the clear cell histology subgroup (44.2 months, 95% CI 35.8-55.7, vs. 38.7 months, 95% CI 26.0-41.0, p = 0.047), and in patients with sarcomatoid differentiation (34.4 months, 95% CI 26.4-59.0, vs. 15.3 months, 95% CI 8.9-41.0, p < 0.001). Sex female was an independent negative prognostic factor in the sarcomatoid population (HR 1.72, 95% CI 1.15 - 2.57, p = 0.008). CONCLUSIONS: Although the female's innate and adaptive immunity has been observed to be more active than the male's, women in the subgroup of clear cell histology, sarcomatoid differentiation, and those under 50 years of age showed shorter OS than males.
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Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/imunologia , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/patologia , Feminino , Masculino , Pessoa de Meia-Idade , Neoplasias Renais/mortalidade , Neoplasias Renais/imunologia , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Adulto , Idoso , Adulto Jovem , Adolescente , Fatores Sexuais , Inibidores de Checkpoint Imunológico/uso terapêutico , Prognóstico , Imunoterapia/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Taxa de Sobrevida , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Systemic treatment with immune combinations is the gold standard for metastatic renal cell carcinoma (mRCC) worldwide. The systemic immune-inflammation index (SII) is a prognostic marker for several types of malignant neoplasms, including mRCC, in the era of tyrosine kinase inhibitor (TKI) treatment. Data regarding the prognostic value of the SII in patients with mRCC treated with immunotherapy are scarce and controversial.⯠METHODS: We retrospectively collected the data of patients with mRCC from 56 centers in 18 countries. SII (Platelet × Neutrophil/Lymphocyte count) was calculated prior to the first systemic treatment and cut-off was defined by a survival receiver operating characteristic (ROC) analysis. The primary objective of our retrospective study was to assess the outcomes of patients treated with first-line immunotherapy.⯠RESULTS: Data from 1034 mRCC patients was collected and included in this analysis. The SII cut-off value was 1265. After a follow-up of 26.7 months, and the overall survival (OS) and progression-free survival (PFS) were 39.8 and 15.7 months, respectively. According to SII (low vs. high), patients with low-SII had longer OS (55.7 vs. 22.2 months, P < .001), better PFS (20.8 vs. 8.5 months, P < .001), and higher overall response rate (52 vs. 37%, P = .033). CONCLUSION: A high SII is associated with poor oncological outcomes in patients with mRCC. SII could be an easily accessible prognostic indicator for use in clinical practice.
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Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/patologia , Estudos Retrospectivos , Neoplasias Renais/patologia , Análise de Sobrevida , Prognóstico , Inflamação/patologiaRESUMO
Abstract Objective To analyze marital outcomes, divorce or separation, and its association with demographic, socioeconomic, and clinicopathological factors among breast cancer (BC) survivors after 2-years of diagnosis. Methods We performed a retrospective analysis of marital status at baseline and at years 1 and 2 of follow-up of women aged ≥ 18 years diagnosed with invasive BC participating in the AMAZONA III (GBECAM0115) study. The BC diagnosis occurred between January 2016 and March 2018 at 23 institutions in Brazil. Results Of the 2974 women enrolled in AMAZONA III, 599 were married or living under common law at baseline. Divorce or separation occurred in 35 (5.8%) patients at 2 years of follow-up. In the multivariate analysis, public health insurance coverage was associated with a higher risk of marital status change (8.25% vs. 2.79%, RR 3.09, 95% CI 1.39 - 7.03, p = 0.007). Women who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation (8.1% vs. 4.49%, RR 1.97, 95 CI 1.04 - 3.72, p = 0.0366) than those who underwent breast-conserving surgery. Conclusion Women covered by the public health system and those who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation. This evidence further supports the idea that long-term marital stability is associated with a complex interplay between socioeconomic conditions and stressors, such as BC diagnosis and treatment. ClinicalTrials Registration: NCT02663973.
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Humanos , Feminino , Neoplasias da Mama , Divórcio , Estado CivilRESUMO
OBJECTIVE: Breast cancer (BC) biomarkers, such as hormone receptors expression, are crucial to guide therapy in BC patients. Antiandrogens have been studied in BC; however, limited data are available on androgen receptor (AR) expression test methodology. We aim to report the core needle biopsy (CNB) accuracy for AR expression in BC. METHODS: Patients diagnosed with stage I-III invasive BC from a single institution were included. Androgen receptor expression was evaluated by immunohistochemistry (IHC) using 1 and 10% cutoff and the AR expression in surgical specimens (SS) was the gold standard. Kappa coefficients were used to evaluate the intraprocedural agreement. RESULTS: A total of 72 patients were included, with a mean age of 61 years old and 84% were Luminal A or B tumors. The prevalence of AR expression in all BC samples was 87.5% using a cutoff ≥ 10% in SS. With a cutoff value ≥ 1%, CNB had an accuracy of 95.8% (Kappa value = 0.645; 95% confidence interval [CI]: 0.272-1.000; p < 0.001) and 86.1% (Kappa value = 0.365; 95% CI: 0.052-0.679; p < 0.001) when ≥ 10% cutoff was used for AR positivity. Androgen receptor expression in CNB (cutoff ≥ 1%) had a sensitivity of 98.5%, specificity of 60%, positive predictive value of 97.0%, and a negative predictive value of 76.9% in the detection of AR expression in SS. CONCLUSION: Core needle biopsy has good accuracy in evaluating AR expression in BC. The accuracy of CNB decreases with higher cutoff values for AR positivity.
OBJETIVO: Biomarcadores, como a expressão de receptores hormonais, são cruciais para guiar a terapia de pacientes com câncer de mama. Apesar de ter sido estudado, poucos dados estão disponíveis sobre o método de testagem. Buscamos avaliar a precisão da biópsia com agulha de grande calibre (CNB, na sigla em inglês) para a expressão de receptores androgênicos (AR, na sigla em inglês) no câncer de mama. MéTODOS: Foram incluídos pacientes de uma única instituição diagnosticados com câncer de mama invasivo estágio I-III. A expressão de AR foi avaliada por imunohistoquímica, com valores de cutoff de 1 e 10%. A expressão de AR em espécimes cirúrgicos foi o padrão ouro. O coeficiente Kappa foi usado para avaliar a concordância entre procedimentos. RESULTADOS: Foi incluído um total de 72 pacientes, com idade média de 61 anos; 84% eram tumores luminais A ou B. A prevalência da expressão de AR em todas as amostras foi de 87.5%, com cutoff ≥ 10%. Com um valor de cutoff ≥ 1%, a CNB teve precisão de 95.8% (Kappa = 0.64; intervalo de confiança [IC] 95%: 0.2721.000; p < 0.001) e 86.1% (Kappa = 0.365; CI95%: 0.0520.679]; p < 0.001) quando um cutoff ≥ 10% foi usado para AR positivo. A expressão de AR na CNB (cutoff ≥ 1%) teve a sensibilidade de 98.5%, especificidade de 60%, valor preditivo positivo de 97.0% e valor preditivo negativo de 76.9% na detecção. CONCLUSãO: |Biópsia com agulha de grande calibre tem uma boa precisão em avaliar a expressão de AR no câncer de mama. A precisão do método cai com valores elevados de cutoff para AR positivo.
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Neoplasias da Mama , Humanos , Pessoa de Meia-Idade , Feminino , Neoplasias da Mama/patologia , Biópsia com Agulha de Grande Calibre , Receptores Androgênicos/metabolismo , Androgênios , Biomarcadores TumoraisRESUMO
Breast cancer (BC) is the most prevalent cancer worldwide. The prognosis and survival of these patients are directly related to the diagnostic stage. Even so, the gold standard screening method (mammography) has a long waiting period, high rates of false positives, anxiety for patients, and consequently delays the diagnosis by core needle biopsy (invasive method). Alternatively, the Attenuated Total Reflection Fourier Transform Infrared (ATR-FTIR) spectroscopy is a noninvasive, low-cost, rapid, and reagent-free technique that generates the spectral metabolomic profile of biomolecules. This makes it possible to assess systemic repercussions, such as the BC carcinogenesis process. Blood plasma samples (n = 56 BC and n = 18 controls) were analyzed in the spectrophotometer in the ATR-FTIR mode. For the exploratory analysis of the data, interval Principal Component Analysis (iPCA) was used, and for predictive chemometric modeling, the Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA) algorithm with validation by leave-one-out cross-validation. iPCA in the region of 1118-1052 cm-1 (predominantly DNA/RNA bands) showed significant clustering of molecular subtypes and control. The OPLS-DA model achieved 100% accuracy with only 1 latent variable and Root Mean Square Error of Cross-Validation (RMSECV) < 0.005 for all molecular subtypes and control. The wavenumbers (cm-1) with the highest iPCA peaks (loadings: 1117, 1089, 1081, 1075, 1057, and 1052) were used as input to MANOVA (Wilks' Lambda, p < 0.001 between molecular subtypes and control). The rapid and low-cost detection of BC molecular subtypes by ATR-FTIR spectroscopy would plausibly allow initial screening and clinical management, improving prognosis, reducing mortality and costs for the health system.
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Neoplasias da Mama , Feminino , Humanos , Neoplasias da Mama/diagnóstico , Análise Discriminante , Análise dos Mínimos Quadrados , Análise Multivariada , Espectroscopia de Infravermelho com Transformada de Fourier/métodosRESUMO
INTRODUCTION: Non-metastatic, castration-resistant prostate cancer (nmCRPC) is an important clinical stage of prostate cancer, prior to morbidity and mortality from clinical metastases. In particular, the introduction of novel androgen-receptor signaling inhibitors (ARSi) has changed the therapeutic landscape in nmCRPC. Given recent developments in this field, we update our recommendations for the management of nmCRPC. METHODS: A panel of 51 invited medical oncologists and urologists convened in May of 2021 with the aim of discussing and providing recommendations regarding the most relevant issues concerning staging methods, antineoplastic therapy, osteoclast-targeted therapy, and patient follow-up in nmCRPC. Panel members considered the available evidence and their practical experience to address the 73 multiple-choice questions presented. RESULTS: Key recommendations and findings include the reliance on prostate-specific antigen doubling time for treatment decisions, the absence of a clear preference between conventional and novel (i.e., positron-emission tomography-based) imaging techniques, the increasing role of ARSis in various settings, the general view that ARSis have similar efficacy. Panelists highlighted the slight preference for darolutamide, when safety is of greater concern, and a continued need to develop high-level evidence to guide the intensity of follow-up in this subset of prostate cancer. DISCUSSION: Despite the limitations associated with a consensus panel, the topics addressed are relevant in current practice, and the recommendations can help practicing clinicians to provide state-of-the-art treatment to patients with nmCRPC in Brazil and other countries with similar healthcare settings.
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Neoplasias de Próstata Resistentes à Castração , Neoplasias de Próstata Resistentes à Castração/diagnóstico , Neoplasias de Próstata Resistentes à Castração/terapia , Humanos , Masculino , Estadiamento de Neoplasias , Antineoplásicos/uso terapêutico , Antagonistas de Receptores de Andrógenos/uso terapêutico , Consenso , Brasil , OsteoclastosRESUMO
Abstract Objective Breast cancer (BC) biomarkers, such as hormone receptors expression, are crucial to guide therapy in BC patients. Antiandrogens have been studied in BC; however, limited data are available on androgen receptor (AR) expression test methodology. We aim to report the core needle biopsy (CNB) accuracy for AR expression in BC. Methods Patients diagnosed with stage I-III invasive BC from a single institution were included. Androgen receptor expression was evaluated by immunohistochemistry (IHC) using 1 and 10% cutoff and the AR expression in surgical specimens (SS) was the gold standard. Kappa coefficients were used to evaluate the intraprocedural agreement. Results A total of 72 patients were included, with a mean age of 61 years old and 84% were Luminal A or B tumors. The prevalence of AR expression in all BC samples was 87.5% using a cutoff ≥ 10% in SS. With a cutoff value ≥ 1%, CNB had an accuracy of 95.8% (Kappa value = 0.645; 95% confidence interval [CI]: 0.272-1.000; p< 0.001) and 86.1% (Kappa value = 0.365; 95% CI: 0.052-0.679; p< 0.001) when ≥ 10% cutoff was used for AR positivity. Androgen receptor expression in CNB (cutoff ≥ 1%) had a sensitivity of 98.5%, specificity of 60%, positive predictive value of 97.0%, and a negative predictive value of 76.9% in the detection of AR expression in SS. Conclusion Core needle biopsy has good accuracy in evaluating AR expression in BC. The accuracy of CNB decreases with higher cutoff values for AR positivity.
Resumo Objetivo Biomarcadores, como a expressão de receptores hormonais, são cruciais para guiar a terapia de pacientes com câncer de mama. Apesar de ter sido estudado, poucos dados estão disponíveis sobre o método de testagem. Buscamos avaliar a precisão da biópsia com agulha de grande calibre (CNB, na sigla em inglês) para a expressão de receptores androgênicos (AR, na sigla em inglês) no câncer de mama. Métodos Foram incluídos pacientes de uma única instituição diagnosticados com câncer de mama invasivo estágio I-III. A expressão de AR foi avaliada por imunohistoquímica, com valores de cutoff de 1 e 10%. A expressão de AR em espécimes cirúrgicos foi o padrão ouro. O coeficiente Kappa foi usado para avaliar a concordância entre procedimentos. Resultados Foi incluído um total de 72 pacientes, com idade média de 61 anos; 84% eram tumores luminais A ou B. A prevalência da expressão de AR em todas as amostras foi de 87.5%, com cutoff ≥ 10%. Com um valor de cutoff ≥ 1%, a CNB teve precisão de 95.8% (Kappa = 0.64; intervalo de confiança [IC] 95%: 0.272-1.000; p< 0.001) e 86.1% (Kappa = 0.365; CI95%: 0.052-0.679]; p< 0.001) quando um cutoff ≥ 10% foi usado para AR positivo. A expressão de AR na CNB (cutoff ≥ 1%) teve a sensibilidade de 98.5%, especificidade de 60%, valor preditivo positivo de 97.0% e valor preditivo negativo de 76.9% na detecção. Conclusão -Biópsia com agulha de grande calibre tem uma boa precisão em avaliar a expressão de AR no câncer de mama. A precisão do método cai com valores elevados de cutoff para AR positivo.
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Humanos , Feminino , Neoplasias da Mama/diagnóstico , Imuno-Histoquímica , Receptores Androgênicos , Biomarcadores Tumorais , Biópsia com Agulha de Grande CalibreRESUMO
Nivolumab, a PD-1 ICI has been recently approved for the adjuvant treatment of high-risk MIUC patients. However, conflicting data from another randomized controlled trial (RCT) with atezolizumab makes the benefit of this treatment uncertain. We performed a systematic review and study-level meta-analysis to evaluate the benefit in terms of disease-free survival (DFS) with ICI adjuvant treatment for patients with high-risk MIUC. Considering the Preferred Reporting Items for Systematic Review statement, a systematic search was performed in PUBMED/MEDLINE, Scopus and EMBASE up to October 30, 2021. The statistical analysis was performed by RevMan 5.4 software in intention-to-treat (ITT) population and in predetermined subgroups. Two RCTRCT, with a total of 1518 patients, met the inclusion criteria. Systemic immunotherapy was atezolizumab for 406 patients and nivolumab for 353 patients. In the ITT population there was a nonsignificant benefit with the systemic adjuvant immunotherapy (HR:0.79, 95% CI 0.62-1.00; z = 2.00) but with high heterogeneity (I2 = 65%). Regarding the subgroups, there was no benefit in PD-L1 negative (HR:0.81, 95% CI 0.70-1.00; z = 1.96, I2 = 0%) and in non-neoadjuvant chemotherapy (HR:0.95, 95% CI 0.78-1.15; z = 0.56, I2 = 0%). Adjuvant treatment with ICI to patients with high-risk MIUC reveals a nonsignificant impact in DFS. The lack of clinical benefit was demonstrated in all subgroups. These data reinforce the need for a careful selection of patients before offering this approach in daily practice.
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Carcinoma de Células de Transição , Inibidores de Checkpoint Imunológico , Antígeno B7-H1 , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Músculos , Nivolumabe/uso terapêutico , Receptor de Morte Celular Programada 1 , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Therapies based on the use of immune checkpoint inhibitors (ICIs), such as nivolumab, pembrolizumab, ipilimumab, atezolizumab, avelumab, and durvalumab, have proven effective in the treatment of metastatic urological neoplasms. Recently, it has been hypothesized that the use of this type of treatment prior to surgery could lead to an increased difficulty in renal and bladder surgeries. The literature concerning this topic, however, is still scarce and non-consensual. In our systematic review, we used the PRISMA guidelines methodology to search the pertinent literature available up to June 18, 2020 in PubMed. Additionally, we searched the related grey literature in the abstracts of the meetings of the American Society of Clinical Oncology (ASCO), American Society of Clinical Oncology Genitourinary (ASCO-GU), European Society of Medical Oncology (ESMO), and American Urological Association (AUA) from 2015 to 2020. We were able to find only 16 publications that addressed the use of ICIs prior to surgery in kidney and bladder neoplasms. The results were conflicting, and usually the issue of surgical difficulties after the use of ICIs was not directly approached. We hope that our publication may raise the awareness towards the need to further investigate the effects of neoadjuvant ICIs on surgical outcomes in urologic cancers.
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Inibidores de Checkpoint Imunológico , Neoplasias da Bexiga Urinária , Feminino , Humanos , Rim , Masculino , Terapia Neoadjuvante , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
BACKGROUND: According to pathologico-clinical features, patients diagnosed with localized prostate cancer (PCa) are stratified into distinct risk groups (low-risk, intermediate-risk or high-risk). Data have demonstrated that 68Gallium-prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET/CT) is superior to conventional radiological exams (CT or MRI and bone scintigraphy) in the primary staging of high-risk localized PCa. However, it is still unknown if in a population of high-risk PCa, there would be a subgroup of patients with a higher probability of identifying metastatic disease by the 68Ga-PSMA PET/CT. MATERIALS AND METHODS: Data from patients with localized PCa who underwent 68GA-PSMA PET/CT for primary staging from four institutions were retrospectively collected. We selected patients with at least one D'Amico classification risk factor (International Society of Urological Pathology ≥ IV and/or prostate-specific antigen > 20 ng/ml). To detect an association between extent of disease and number of risk factors as well as International Society of Urological Pathology prostate cancer grade, contingency tables were used, and Fisher Exact Test was performed. RESULTS: Between 2016 and 2020, 60 patients underwent a 68GA-PSMA PET/CT for primary staging of high-risk localized PCa. Regarding the number of risk factors, 37 patients (62%) had one risk factor, and 23 (38%) had two risk factors. In the subgroup of patients with metastatic disease (n = 22), those with two risk factors had higher incidence of metastatic disease, and it was statistically significant (p = 0.011). CONCLUSION: This retrospective analysis demonstrated that 68GA-PSMA PET/CT was able to identify advanced disease in more than one-third of patients with high-risk disease especially those with two adverse risk factors.
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OBJECTIVE: to study the expression of the tissue factor (TF) and its correlation with prognosis and survival in patients with gastric carcinoma. METHODS: we measured the immunohistochemical expression of TF in 50 specimens of gastric adenocarcinomas from patients submitted to curative surgery. We then compared the intensity of its expression with clinical and pathological data, TNM staging, prognostic factors and survival. RESULTS: all tumors displayed TF expression; the intensity of TF expression was not associated with TNM stage, clinical or pathological variables or general survival. CONCLUSION: TF has a high expression in gastric carcinoma, but that it is not useful as a prognostic marker.
OBJETIVO: estudar a expressão do fator tecidual (FT) e sua correlação com o prognostico e sobrevida em pacientes com carcinoma gástrico. MÉTODOS: verificamos a expressão imuno-histoquímica do FT em 50 espécimes de adenocarcinomas gástricos de pacientes submetidos a tratamento cirúrgico com intenção curativa. A intensidade da sua expressão foi comparada com dados clínicos e patológicos, estadiamento TNM, fatores prognósticos e sobrevida. RESULTADOS: houve expressão do FT em todos os tumores; a intensidade de expressão do FT não foi associada com estágio TNM, variáveis clínicas ou patológicas ou sobrevida geral. CONCLUSÃO: este estudo mostra que o FT tem uma expressão elevada em carcinoma gástrico, mas que este não é útil como marcador de prognóstico.
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Adenocarcinoma/patologia , Neoplasias Gástricas/patologia , Tromboplastina/metabolismo , Adenocarcinoma/metabolismo , Adenocarcinoma/mortalidade , Idoso , Brasil/epidemiologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/mortalidadeRESUMO
Introdução: Atualmente, o câncer de próstata é uma doença bastante prevalente em homens idosos, portanto é com frequência foco de campanhas públicas de conscientização para a sua prevenção. Neste estudo, tem-se como objetivo investigar a utilidade do rastreamento populacional, bem como avaliar o impacto destas campanhas sobre a sociedade. Métodos: As bases de dados Medline foram consultadas com vistas a buscar artigos de maior nível de evidência publicados nos últimos 10 anos. Resultados: os principais estudos sobre rastreamento do câncer de próstata (PLCO e ERSPC) mostraram resultados discordantes sobre o impacto na mortalidade geral e específica. Em metanálise feita pela Cochrane não se encontrou evidência suficiente para afirmar redução da mortalidade específica por Câncer de Próstata. Além disso, o rastreamento está relacionado à sobrediagnóstico. Conclusão: A indicação do rastreamento sistemático da população brasileira masculina pelas campanhas de prevenção contra o câncer de próstata mostrou-se controversa. A individualização da conduta, expondo ao paciente os potenciais riscos e benefícios, mostra-se a conduta mais recomendada por diferentes entidades.
Introduction: Nowadays the prostate cancer is a very prevalent disease, especially in elderly men, therefore is frequently focus of public campaigns of awareness about its prevention. The aim of this study is to investigate the utility of populational screening, as well as evaluate the impact of this campaigns in the society. Methods: Medline database was consulted for articles with the best level of evidence published in the last 10 years. Results: The most important studies about prostate cancer screening (PLCO and ERSPC) had discordant results about the impact in general and specific mortality. A meta-analysis by Cochrane did not found sufficient evidence to affirm reduction in specific mortality due to prostate cancer. Moreover the screening is related to over diagnosis. Conclusion: The indication of systematic screening of Brazilian male population by prostate cancer screening campaigns is controversial, the shared decision, exposing to the patient the potential risks and benefits, is the most recommended recommendation by different medical societies.
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Neoplasias da Próstata , Conscientização , Programas de RastreamentoRESUMO
Introdução: O câncer é um distúrbio genético no qual ocorre a perda do controle da proliferação celular. De maneira geral, podemos dividir os casos de câncer em esporádicos (mutações somáticas restritas ao tumor), que são a maioria, e hereditários (mutações germinativas presentes em todas as células do indivíduo), que em conjunto correspondem a aproximadamente a 10% de todos os casos. É importante compreender o papel da Oncogenética na identificação de pacientes com risco aumentado para desenvolvimento de câncer para possibilitar medidas de detecção precoce, de prevenção e de tratamento, diferenciadas das recomendadas para a população em geral. Métodos: Foi realizada revisão da literatura através dos sites de busca PubMed e Scielo, bem como através de literatura e Guidelines pertinentes à área da Oncogenética. Resultados: A indicação de investigação genética molecular deve ser baseada em uma suspeita de câncer hereditário, sugerida pela história de câncer do paciente e de sua família. Os critérios de indicação variam para as diversas síndromes hereditárias. Assim, torna-se importante o aconselhamento genético pré e pós-teste, a fim de direcionar a investigação mais indicada para cada caso e permitir que o paciente possa realizar escolhas informadas e adaptar-se ao risco e/ou à condição que esse diagnóstico traz à sua vida. Conclusão: A fim de tornar a oncogenética acessível à população em risco, é necessário capacitar mais profissionais no aconselhamento genético, buscar um maior acesso aos exames moleculares especialmente no serviço público de saúde, garantir a qualidade dos testes realizados por diferentes centros e a adequada interpretação de seus resultados.
Introduction: Cancer is a genetic disorder in which occurs a loss of control of cell proliferation. In general, we can divide cancer cases into sporadic (tumor-restricted somatic mutations), which are the majority, and hereditary (germ mutations present in all the cells of the individual), which together account for approximately 10% of all cases. It is important to understand the role of Oncogenetics in identifying patients at increased risk for cancer development in order to enable early detection, prevention and treatment measures, unlike those recommended for the general population. Methods: A review of the literature was performed through PubMed and Scielo databases, as well as through literature and guidelines considered relevant to the area of Oncogenetics. Results: The indication of molecular genetic research should be based on a suspected hereditary cancer, suggested by the patient's and his family's cancer history. The indication criteria vary for the various hereditary syndromes. Thus, pre and post-test genetic counseling becomes important in order to direct the most appropriate investigation for each case, allowing the patient to make informed decisions and to adapt to the risk and / or to the condition this diagnosis brings to his / her life. Conclusion: In order to make Oncogenetics accessible to the population at risk, it is necessary to train more professionals in genetic counseling, to seek greater access to molecular tests, especially in the public health service, to ensure the quality of the tests carried out by different centers and also to provide adequate interpretation of the results.
Assuntos
Neoplasias/genéticaRESUMO
RESUMO Objetivo: estudar a expressão do fator tecidual (FT) e sua correlação com o prognostico e sobrevida em pacientes com carcinoma gástrico. Métodos: verificamos a expressão imuno-histoquímica do FT em 50 espécimes de adenocarcinomas gástricos de pacientes submetidos a tratamento cirúrgico com intenção curativa. A intensidade da sua expressão foi comparada com dados clínicos e patológicos, estadiamento TNM, fatores prognósticos e sobrevida. Resultados: houve expressão do FT em todos os tumores; a intensidade de expressão do FT não foi associada com estágio TNM, variáveis clínicas ou patológicas ou sobrevida geral. Conclusão: este estudo mostra que o FT tem uma expressão elevada em carcinoma gástrico, mas que este não é útil como marcador de prognóstico.
ABSTRACT Objective: to study the expression of the tissue factor (TF) and its correlation with prognosis and survival in patients with gastric carcinoma. Methods: we measured the immunohistochemical expression of TF in 50 specimens of gastric adenocarcinomas from patients submitted to curative surgery. We then compared the intensity of its expression with clinical and pathological data, TNM staging, prognostic factors and survival. Results: all tumors displayed TF expression; the intensity of TF expression was not associated with TNM stage, clinical or pathological variables or general survival. Conclusion: TF has a high expression in gastric carcinoma, but that it is not useful as a prognostic marker.
Assuntos
Humanos , Masculino , Feminino , Idoso , Neoplasias Gástricas/patologia , Tromboplastina/metabolismo , Adenocarcinoma/patologia , Prognóstico , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/mortalidade , Brasil/epidemiologia , Imuno-Histoquímica , Adenocarcinoma/metabolismo , Adenocarcinoma/mortalidade , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
Este artigo destaca aspectos importantes associados ao aconselhamento genético em pacientes portadores de mutações determinantes de risco aumentado para o desenvolvimento de neoplasias e suas indicações.
This article highlights important aspects about genetic counseling in patients with genetic cancer susceptibility conditions and its indications.
Assuntos
Neoplasias/genética , Aconselhamento Genético , Testes GenéticosRESUMO
Este artigo destaca aspectos da avaliação do paciente idoso com câncer, considerando o risco de toxicidade a tratamentos quimioterápicos.
This article highlights the assessment of older patients with cancer regarding their risk of toxicity to chemotherapy.
Assuntos
Antineoplásicos/toxicidade , Idoso , Avaliação GeriátricaRESUMO
O objetivo dos autores é fazer uma revisão sobre as indicações atuais do uso de fatores de crescimento, estimuladores de colônias hematopoéticas, na profilaxia da neutropenia febril, em pacientes submetidos à quimioterapia, avaliando seu custo-benefício.