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1.
Acta Ortop Bras ; 32(2): e274225, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38933357

RESUMO

Introduction: Desmoid Tumors (DT) are rare neoplasms with higher incidence in younger women. Methods: Retrospective, single-center analysis of patients with DT. Variables were age, sex, biopsy, treatment and recurrence. The disease-free survival (DFS) was calculated with the Kaplan-Meier method. Results: 242 patients were evaluated, mean age was 34 years, 70.7% women, 44.4% originated in the trunk/abdomen and 54.5% had size > 5cm. Surgery was performed in 70.2%, 31% with negative margin and only 57% with previous biopsy. Recurrence rate was 38% and 1,2,5-year DFS was 75.3%, 64.2%, 57.8%, respectively. Size (p = 0.018) and tumor location in the dorsum (p = 0.001), extremities (p = 0.003) and pelvis (p = 0.003) were related to higher relapse rate. Conclusion: our data reinforces the need to gather data from real world practice and the importance of awareness of DT and medical education about DT behavior and best approach due to the high rates of surgery and elevated number of patients treated without biopsy. Level of Evidence III; Retrospective Comparative Study.


Introdução: Os tumores desmóides (TD) são neoplasias raras com maior incidência em mulheres jovens. Métodos: Trata-se de uma análise retrospectiva, em um único centro, de pacientes com TD. As variáveis foram idade, sexo, biópsia, tratamento e recorrência. A sobrevida livre de doença (SLD) foi calculada pelo método de Kaplan-Meier. Resultados: Foram avaliados 242 pacientes, com idade média de 34 anos, 70,7% mulheres, 44,4% com origem no tronco/abdômen e 54,5% com tamanho > 5 cm. A cirurgia foi realizada em 70,2%, 31% com margem negativa e apenas 57% com biópsia prévia. A taxa de recorrência foi de 38% e a SLD de 1, 2 e 5 anos foi de 75,3%, 64,2% e 57,8%, respectivamente. O tamanho (p = 0,018) e a localização do tumor no dorso (p = 0,001), nas extremidades (p = 0,003) e na pelve (p = 0,003) foram relacionados a uma maior taxa de recidiva. Conclusão: Nossos dados reforçam a necessidade de coletar dados da prática do cenário real e a importância da conscientização da TD e da educação médica sobre o comportamento da TD e a melhor abordagem, devido às altas taxas de cirurgia e ao elevado número de pacientes tratados sem biópsia. Nível de Evidência III; Estudo Comparativo Retrospectivo.

2.
Ann Surg ; 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38747145

RESUMO

OBJECTIVE: To establish globally applicable benchmark outcomes for pelvic exenteration (PE) in patients with locally advanced primary (LARC) and recurrent rectal cancer (LRRC), using outcomes achieved at highly specialised centres. BACKGROUND DATA: PE is established as the standard of care for selected patients with LARC and LRRC. There are currently no available benchmarks against which surgical performance in PE can be compared for audit and quality improvement. METHODS: This international multicentre retrospective cohort study included patients undergoing PE for LARC or LRRC at 16 highly experienced centres between 2018 and 2023. Ten outcome benchmarks were established in a lower-risk subgroup. Benchmarks were defined by the 75th percentile of the results achieved at the individual centres. RESULTS: 763 patients underwent PE, of which 464 patients (61%) had LARC and 299 (39%) had LRRC. 544 patients (71%) who met predefined lower risk criteria formed the benchmark cohort. For LARC patients, the calculated benchmark threshold for major complication rate was ≤44%; comprehensive complication index (CCI): ≤30.2; 30-day mortality rate: 0%; 90-day mortality rate: ≤4.3%; R0 resection rate: ≥79%. For LRRC patients, the calculated benchmark threshold for major complication rate was ≤53%; CCI: ≤34.1; 30-day mortality rate: 0%; 90-day mortality rate: ≤6%; R0 resection rate: ≥77%. CONCLUSIONS: The reported benchmarks for PE in patients with LARC and LRRC represent the best available care for this patient group globally and can be used for rigorous assessment of surgical quality and to facilitate quality improvement initiatives at international exenteration centres.

3.
J Surg Oncol ; 2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38685686

RESUMO

BACKGROUND: Soft tissue sarcomas are rare malignant tumors with significant heterogeneity. The importance of classifying histological grades is fundamental to defining the treatment approach. OBJECTIVE: To evaluate magnetic resonance imaging (MRI) in predicting the histological grade of soft tissue sarcomas. METHODS: A retrospective observational study included patients over 18 years undergoing MRI and primary tumor surgery at AC Camargo Cancer Center from January 2015 to June 2022. Two radiologists evaluated MRI criteria (size, margin definition, heterogeneity of the T2 signal, high-intensity peritumoral signal on T2, and postperitumoral contrast), and a grading prediction score was calculated. χ2 and logistic regression analyses were conducted. RESULTS: Sixty-eight patients were included (38 men; median: 48 years). Moreover, 52 high-grade and 16 low-grade tumors were observed. The MRI criteria associated with histological grade were peritumoral high-intensity T2-weighted signals (p < 0.001) and peritumoral postcontrast enhancement (p = 0.006). Logistic regression confirmed their significance (odds ratio [OR]: 11.8 and 8.8, respectively). Each score point increment doubled the chance of high-grade tumors (OR: 2.0; p = 0.014). CONCLUSION: MRI effectively predicts histological grades of soft tissue sarcomas. Peritumoral high-intensity T2-weighted signals and peritumoral postcontrast enhancement are valuable indicators of high-grade tumors. This highlights MRI's importance in treatment decision-making for sarcoma patients.

5.
J Surg Oncol ; 129(5): 939-944, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38221657

RESUMO

This study presents a new technique for robotic-assisted intracorporeal rectal transection and hand-sewn anastomosis for low anterior resection that overcomes some limitations of conventional techniques. By integrating the advantages of the robotic platform, ensuring standardized exposure during rectal transection, and emphasizing the importance of avoiding complications associated with staple crossings, this innovation has the potential to significantly improve outcomes and reduce costs for patients with lower rectal tumors.


Assuntos
Laparoscopia , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Humanos , Laparoscopia/métodos , Reto/cirurgia , Reto/patologia , Anastomose Cirúrgica/métodos , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia
7.
Ecancermedicalscience ; 17: 1586, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37799958

RESUMO

Background: The standard neoadjuvant therapy for rectal cancer involves fluoropyrimidines and radiotherapy and, most recently, total neoadjuvant therapy (TNT). A drug-drug interaction between fluoropyrimidines and proton-pump inhibitors (PPI) was suggested, with a negative impact on oncological outcomes in breast, colon and gastric cancers. Little is known about such an effect on rectal tumours. We aimed to evaluate the impact of PPI utilisation on the pathological response after chemoradiation for rectal cancer. Materials and methods: Retrospective multicentre study of rectal cancer patients treated with neoadjuvant chemoradiotherapy with capecitabine (cohort 1) or 5-fluororuracil (5-FU) (cohort 2); TNT with oxaliplatin-based regimens was allowed. The pathological response was considered a complete (ypCR) or complete + partial (ypCR + ypPR) according to American Joint Committee on Cancer. PPI use was considered at any time during the neoadjuvant period if concomitant to fluoropyrimidines. Results: From January 2007 to November 2020, 251 patients received capecitabine and 196 5-FU. The rates of PPI use in cohorts 1 and 2 were 20.3% and 26.5%, respectively. TNT was offered to 18.3% in cohort 1. PPI use did not influence ypCR in cohort 1 (yes versus no: 29.4% versus 19.5%; p = 0.13) or 2 (yes versus no: 25.0% versus 26.4%; p = 1.0). Similar ypCR + ypPR were observed in both cohorts 1 (76.5% versus 72.0%; p = 0.60) and 2 (86.5% versus 76.4%; p = 0.16). PPI use was not associated with pathological response in multivariable analysis. PPI users experienced more grade 3 or higher diarrhoea and infections. Conclusion: PPI concomitant to capecitabine/5-FU chemoradiation did not influence the pathological response in rectal cancer but was associated with more treatment-related adverse events.

8.
J Surg Oncol ; 2023 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-37021640

RESUMO

BACKGROUND: Anal canal squamous cell carcinoma (SCC) is a relatively uncommon neoplasia, and it is mostly a local-regional cancer, of low metastatic potential (only 15%), resulting in cure in most cases treated with definitive chemoradiation. On the other hand, its incidence has been steadily increasing over the last decades, which makes it an important public health problem. In an effort to provide surgeons and oncologists who treat patients with anal cancer with the most updated information based on the best scientific evidence, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guideline for the management of anal canal SCC, focused on the main topics related to daily clinical practice. OBJECTIVES: The SBCO developed the present guidelines to provide recommendations on the main topics related to the management of anal canal squamous cell carcinoma (SCC) based on current scientific evidence. METHODS: Between October 2022 and January 2023, 14 experts met to develop the guidelines for the management of anal canal cancer. A total of 30 relevant topics were distributed among the participants. The methodological quality of a final list with 121 sources was evaluated, all the evidence was examined and revised, and the management guidelines were formulated by the 14-expert committee. To reach a final consensus, all the topics were reviewed in a meeting that was attended by all the experts. RESULTS: The proposed guidelines contained 30 topics considered to be highly relevant in the management of anal canal cancer, covering subjects related to screening recommendations, preventive measures, tests required for diagnosing and staging, treatment strategies, response assessment after chemoradiotherapy, surgical technique-related aspects, and follow-up recommendations. In addition, screening and response assessment algorithms, and a checklist were proposed to summarize the important information and offer an updated tool to assist surgeons and oncologists who treat anal canal cancer and in providing the best care to their patients. CONCLUSION: These guidelines summarize recommendations based on the most current scientific evidence on relevant aspects of anal canal cancer management and are a practical guide to help surgeons and oncologists who treat anal canal cancer make the best therapeutic decisions.

9.
Revista Pensar a Prática ; 26(2023)27/02/2023.
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1435788

RESUMO

O objetivo deste estudo foi analisar a existência e a influência do Efeito da Idade Relativa (EIR) em estudantes-atletas de futsal masculino de Mato Grosso de acordo com a categoria etária. A amostra foi composta por 486 estudantes-atletas masculinos de futsal de Mato Grosso das categorias A (15 a 17 anos) e B (12 a 14 anos) que disputaram os Jogos Escolares Mato-grossenses e os Jogos Estudantis de Seleções Mato-Grossenses de 2021. Para análise, foram realizados testes qui-quadrado (χ2) de aderência. Os resultados mostraram a presença do EIR na análise geral e nas categorias A e B, com maior representação de atletas nascidos no primeiro trimestre do ano. Conclui-se que o EIR é um fenômeno presente em estudantes-atletas de futsal masculino do estado de Mato Grosso.


The objective of this study was to analyze the existence and influence of the Relative Age Effect (RAE) in male Mato Grosso's futsal student-athletes according to age category. The sample consisted of 486 male futsal student-athletes from Mato Grosso, in categories A (15 to 17 years old) and B (12 to 14 years old) who competed in the 2021 Mato Grosso School Games and the Mato Grosso Student Selections Games. For analysis, chi-square (χ2) goodness of fit tests were performed. Results showed the presence of RAE in the overall analysis and in categories A and B, with a greater representation of athletes born in the first quarter of the year. It is concluded that RAE is a phenomenon present in male futsal student-athletes in the state of Mato Grosso.


El objetivo de este estudio fue analizar la existencia e influencia del Efecto de la Edad Relativa (EER) en estudiantes-atletas de fútbol sala masculino de Mato Grosso de acuerdo con la categoría de edad. La muestra estuvo compuesta por 486 estudiantes-atletas masculinos de fútbol sala de Mato Grosso de las categorías A (15 a 17 años) y B (12 a 14 años) que compitieron en los Juegos Escolares de Mato Grosso y los Juegos Estudiantiles de Selecciones de Mato-Grosso (Brasil) de 2021. Para el análisis, se realizaron pruebas estadísticas de ajuste chi-cuadrado (χ2). Los resultados mostraron la presencia del EER en el análisis general y en las categorías A y B, con una mayor representación de atletas nacidos en el primer trimestre del año. Se concluye que el EER es un fenómeno presente en estudiantes-atletas de fútbol sala masculino del estado de Mato Grosso.

10.
Br J Surg ; 109(12): 1274-1281, 2022 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-36074702

RESUMO

BACKGROUND: Benchmark comparisons in surgery allow identification of gaps in the quality of care provided. The aim of this study was to determine quality thresholds for high (HAR) and low (LAR) anterior resections in colorectal cancer surgery by applying the concept of benchmarking. METHODS: This 5-year multinational retrospective study included patients who underwent anterior resection for cancer in 19 high-volume centres on five continents. Benchmarks were defined for 11 relevant postoperative variables at discharge, 3 months, and 6 months (for LAR). Benchmarks were calculated for two separate cohorts: patients without (ideal) and those with (non-ideal) outcome-relevant co-morbidities. Benchmark cut-offs were defined as the 75th percentile of each centre's median value. RESULTS: A total of 3903 patients who underwent HAR and 3726 who had LAR for cancer were analysed. After 3 months' follow-up, the mortality benchmark in HAR for ideal and non-ideal patients was 0.0 versus 3.0 per cent, and in LAR it was 0.0 versus 2.2 per cent. Benchmark results for anastomotic leakage were 5.0 versus 6.9 per cent for HAR, and 13.6 versus 11.8 per cent for LAR. The overall morbidity benchmark in HAR was a Comprehensive Complication Index (CCI®) score of 8.6 versus 14.7, and that for LAR was CCI® score 11.9 versus 18.3. CONCLUSION: Regular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.


Assuntos
Cirurgia Colorretal , Protectomia , Neoplasias Retais , Humanos , Benchmarking , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/cirurgia
12.
Front Oncol ; 12: 809441, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35392220

RESUMO

The clinical and pathological responses to multimodal neoadjuvant therapy in locally advanced rectal cancers (LARCs) remain unpredictable, and robust biomarkers are still lacking. Recent studies have shown that tumors present somatic molecular alterations related to better treatment response, and it is also clear that tumor-associated bacteria are modulators of chemotherapy and immunotherapy efficacy, therefore having implications for long-term survivorship and a good potential as the biomarkers of outcome. Here, we performed whole exome sequencing and 16S ribosomal RNA (rRNA) amplicon sequencing from 44 pre-treatment LARC biopsies from Argentinian and Brazilian patients, treated with neoadjuvant chemoradiotherapy or total neoadjuvant treatment, searching for predictive biomarkers of response (responders, n = 17; non-responders, n = 27). In general, the somatic landscape of LARC was not capable to predict a response; however, a significant enrichment in mutational signature SBS5 was observed in non-responders (p = 0.0021), as well as the co-occurrence of APC and FAT4 mutations (p < 0.05). Microbiota studies revealed a similar alpha and beta diversity of bacteria between response groups. Yet, the linear discriminant analysis (LDA) of effect size indicated an enrichment of Hungatella, Flavonifractor, and Methanosphaera (LDA score ≥3) in the pre-treatment biopsies of responders, while non-responders had a higher abundance of Enhydrobacter, Paraprevotella (LDA score ≥3) and Finegoldia (LDA score ≥4). Altogether, the evaluation of these biomarkers in pre-treatment biopsies could eventually predict a neoadjuvant treatment response, while in post-treatment samples, it could help in guiding non-operative treatment strategies.

13.
J Surg Oncol ; 125(2): 194-216, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34585390

RESUMO

BACKGROUND: Colorectal cancer (CRC) is the third leading cause of cancer in North America, Western Europe, and Brazil, and represents an important public health problem. It is estimated that approximately 30% of all the CRC cases correspond to tumors located in the rectum, requiring complex multidisciplinary treatment. In an effort to provide surgeons who treat rectal cancer with the most current information based on the best evidence in the literature, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guidelines for rectal cancer treatment that is focused on the main topics related to daily clinical practice. OBJECTIVES: The SBCO developed the present guidelines to provide recommendations on the main topics related to the treatment of mid-low rectal cancer based on current scientific evidence. METHODS: Between May and June 2021, 11 experts in CRC surgery met to develop the guidelines for the treatment of mid-low rectal cancer. A total of 22 relevant topics were disseminated among the participants. The methodological quality of a final list with 221 sources was evaluated, all the evidence was examined and revised, and the treatment guideline was formulated by the 11-expert committee. To reach a final consensus, all the topics were reviewed via a videoconference meeting that was attended by all 11 of the experts. RESULTS: The prepared guidelines contained 22 topics considered to be highly relevant in the treatment of mid-low rectal cancer, covering subjects related to the tests required for staging, surgical technique-related aspects, recommended measures to reduce surgical complications, neoadjuvant strategies, and nonoperative treatments. In addition, a checklist was proposed to summarize the important information and offer an updated tool to assist surgeons who treat rectal cancer provide the best care to their patients. CONCLUSION: These guidelines summarize concisely the recommendations based on the most current scientific evidence on the most relevant aspects of the treatment of mid-low rectal cancer and are a practical guide that can help surgeons who treat rectal cancer make the best therapeutic decision.


Assuntos
Guias de Prática Clínica como Assunto , Neoplasias Retais/cirurgia , Brasil , Humanos , Excisão de Linfonodo , Procedimentos Cirúrgicos Minimamente Invasivos , Terapia Neoadjuvante , Neoplasias Retais/diagnóstico , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Sociedades Médicas , Oncologia Cirúrgica , Infecção da Ferida Cirúrgica/prevenção & controle
14.
Motriz (Online) ; 28: e10220011521, 2022. tab
Artigo em Inglês | LILACS | ID: biblio-1351124

RESUMO

Abstract Introduction: The relative age effect is prevalent in different elite team sports. However, little is known about this phenomenon in high-level adult male futsal players. Aim: The present study aimed to investigate the prevalence of relative age effect in Brazilian male elite futsal players, and its relationship with playing position and goals scored on Brazil National Futsal Leagues (BNFL) from 2016 to 2020. Methods: The distribution of birth dates, playing positions, and goals scored by male participants of the Brazil National Futsal Leagues were analyzed. Chi-squared tests were used to analyze the birth dates distribution based on quarters and semesters of the year, according to playing position (defender, winger, pivot, and goalkeeper) and scoring performance (high and low). Results: The overall analysis indicated that the relative age effect is prevalent on the pool of athletes analyzed. However, this effect was position-dependent, since relatively older athletes were overrepresented only in wingers and defenders playing positions. On the other hand, scoring performance was not associated with the relative age effect, since this effect was found in both performance levels. Conclusion: Relative age effects are prevalent in Brazilian male elite futsal athletes, especially for defenders and wingers. Considering the high level of competitiveness for spots in elite futsal teams, coaches and sports administrators must be educated about the prevalence of the relative age effect in this sporting context. This is necessary in order to reduce the inequalities generated by age categories based on arbitrary cut-off dates, which may reduce potential talent loss.


Assuntos
Humanos , Masculino , Aptidão , Futebol , Fatores Etários , Atletas , Epidemiologia Descritiva , Estudos Retrospectivos
15.
Exp Gerontol ; 151: 111407, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34022273

RESUMO

BACKGROUND: Aging is often associated with low-grade systemic inflammation and reduced anabolic hormone levels. To investigate whether lifelong exercise training can decrease the age-related low-grade inflammation and anabolic hormone levels, we examined hormonal and inflammatory parameters among highly-trained male masters athletes and age-matched non-athletes. METHODS: From 70 elite power and endurance master athletes - EMA (51.3 ± 8.0 yr), 32 young controls - YC (23.7 ± 3.9 yr) and 24 untrained age-matched controls - MAC (47.2 ± 8.0 yr) venous blood was drawn to measure inflammatory parameters (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α] and interleukin-10 [IL-10]) and circulating hormones (luteinizing hormone [LH], total testosterone, estradiol, sex hormone-binding globulin [SHBG] and free androgen index [FAI]). RESULTS: EMA showed a better anti-inflammatory status than MAC (higher IL-10 and IL-10/IL-6 ratio and lower IL-6), but a lower anti-inflammatory status than YC (higher TNF-α) (p < 0.05). The MAC group had lower testosterone levels compared to the YC and EMA group (p < 0.05), and lower estradiol levels and testosterone/LH ratio compared to YC (p < 0.05). In the control groups (MAC and YC), testosterone correlated negatively with age and proinflammatory parameters, and positively with anti-inflammatory parameters. CONCLUSION: Elite master athletics elevated levels of anti-inflammatory cytokines above that seen in non-athlete peers and mitigated the age-related reduction in testosterone levels.


Assuntos
Exercício Físico , Globulina de Ligação a Hormônio Sexual , Adulto , Atletas , Biomarcadores , Humanos , Masculino , Pessoa de Meia-Idade , Testosterona
16.
J Surg Oncol ; 123(8): 1659-1668, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33684245

RESUMO

BACKGROUND: Cancer patients configure a risk group for complications or death by COVID-19. For many of them, postponing or replacing their surgical treatments is not recommended. During this pandemic, surgeons must discuss the risks and benefits of treatment, and patients should sign a specific comprehensive Informed consent (IC). OBJECTIVES: To report an IC and an algorithm developed for oncologic surgery during the COVID-19 outbreak. METHODS: We developed an IC and a process flowchart containing a preoperative symptoms questionnaire and a PCR SARS-CoV-2 test and described all perioperative steps of this program. RESULTS: Patients with negative questionnaires and tests go to surgery, those with positive ones must wait 21 days and undergo a second test before surgery is scheduled. The IC focused both on risks and benefits inherent each surgery and on the risks of perioperative SARS-CoV-2 infections or related complications. Also, the IC discusses the possibility of sudden replacement of medical staff member(s) due to the pandemic; the possibility of unexpected complications demanding emergency procedures that cannot be specifically discussed in advance is addressed. CONCLUSIONS: During the pandemic, specific tools must be developed to ensure safe experiences for surgical patients and prevent them from having misunderstandings concerning their care.


Assuntos
COVID-19/epidemiologia , Consentimento Livre e Esclarecido , Neoplasias/cirurgia , SARS-CoV-2 , Algoritmos , Humanos , Oncologia Cirúrgica
18.
Int J Sports Med ; 42(10): 889-895, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33684951

RESUMO

This study analyzed the kidney function and biomarkers of health in lifelong-trained sprinters and endurance runners, and compared them to untrained aged-matched and young controls. Sixty-two men (21-66 yr.) were recruited and allocated as master athletes from sprints (n=25), master athletes from endurance events (n=8), untrained middle-aged (n=14) and young controls (n=15). Participants underwent anamnesis, anthropometric measures and blood sampling for biochemical analyses of klotho, FGF23 and estimated glomerular filtration rate. Master sprinters presented better kidney function in relation to endurance athletes and their untrained peers (P<0.0001). A number of biochemical variables were observed that negatively (i. e., GDF-15, TGF-Beta, IL-18) or positively (i. e., klotho/FGF23 ratio and sestrin-2) correlated with eGFR. Sestrin-2 presented the strongest association with eGFR (r=0.5, P=0.03). Results also revealed that lifelong-trained individuals presented the highest probability of having better values for cystatin C and thus an estimated glomerular filtration rate that was 37-49% higher than untrained peers. Master sprinters presented better kidney function in relation to endurance athletes and middle-aged untrained peers. Sestrin-2 may play a role in exercise-induced kidney function protection.


Assuntos
Atletas , Rim/fisiologia , Corrida/fisiologia , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Fator de Crescimento de Fibroblastos 23 , Humanos , Rim/fisiopatologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Cancers (Basel) ; 13(3)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33525546

RESUMO

Desmoplastic small round cell tumor (DSRCT) is an extremely rare, aggressive sarcoma affecting adolescents and young adults with male predominance. Generally, it originates from the serosal surface of the abdominal cavity. The hallmark characteristic of DSRCT is the EWSR1-WT1 gene fusion. This translocation up-regulates the expression of PDGFRα, VEGF and other proteins related to tumor and vascular cell proliferation. Current management of DSRCT includes a combination of chemotherapy, radiation and aggressive cytoreductive surgery plus intra-peritoneal hyperthermic chemotherapy (HIPEC). Despite advances in multimodal therapy, outcomes remain poor since the majority of patients present disease recurrence and die within three years. The dismal survival makes DSRCT an orphan disease with an urgent need for new drugs. The treatment of advanced and recurrent disease with tyrosine kinase inhibitors, such as pazopanib, sunitinib, and mTOR inhibitors was evaluated by small trials. Recent studies using comprehensive molecular profiling of DSRCT identified potential therapeutic targets. In this review, we aim to describe the current studies conducted to better understand DSRCT biology and to explore the new therapeutic strategies under investigation in preclinical models and in early phase clinical trials.

20.
J Surg Oncol ; 123(4): 823-833, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33428790

RESUMO

BACKGROUND: There are limited data on surgical complications for patients that have delayed surgery after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to analyze the surgical outcomes of patients submitted to surgery after recovery from SARS-CoV-2 infection. METHODS: Asymptomatic patients that had surgery delayed after preoperative reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 were matched in a 1:2 ratio for age, type of surgery and American Society of Anesthesiologists to patients with negative RT-PCR for SARS-CoV-2. RESULTS: About 1253 patients underwent surgical procedures and were subjected to screening for SARS-CoV-2. Forty-nine cases with a delayed surgery were included in the coronavirus disease (COVID) recovery (COVID-rec) group and were matched to 98 patients included in the COVID negative (COVID-neg) group. Overall, 22 (15%) patients had 30-days postoperative complications, but there was no statistically difference between groups -16.3% for COVID-rec and 14.3% for COVID-neg, respectively (odds ratio [OR] 1.17:95% confidence interval [CI] 0.45-3.0; p = .74). Moreover, we did not find difference regarding grades more than or equal to 3 complication rates - 8.2% for COVID-rec and 6.1% for COVID-neg (OR 1.36:95%CI 0.36-5.0; p = .64). There were no pulmonary complications or SARS-CoV-2 related infection and no deaths within the 30-days after surgery. CONCLUSIONS: Our study suggests that patients with delayed elective surgeries due to asymptomatic preoperative positive SARS-CoV-2 test are not at higher risk of postoperative complications.


Assuntos
Teste de Ácido Nucleico para COVID-19 , COVID-19/diagnóstico , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias/epidemiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Tempo para o Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Assintomáticas , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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