Consumption of processed and ultra-processed foods by patients with stomach adenocarcinoma: a multicentric case-control study in the Amazon and southeast regions of Brazil.

PURPOSE: There is limited information about the dietary habits associated with stomach adenocarcinoma in the Brazilian population, so our purpose is to analyze the consumption of processed and ultra-processed foods by patients with stomach adenocarcinoma in Brazil. METHODS: A multicentric hospital-based case-control study was conducted in São Paulo (southeastern region) and Belém (Amazon region) of Brazil with 1,045 individuals, both sexes, between 18 and 75 years old. In São Paulo, there were 214 cases with stomach adenocarcinoma and 150 controls patients submitted to stomach endoscopy named as Group I (without any pre-malignant gastric disease) and the Healthy Controls (Group 2) comprised 401 individuals matched by age and sex from the prevention unit at A.C .Camargo Cancer Center. In Belém, it has two groups one are cases 140 and second 140 hospital controls, recruited in outpatient clinics. Lifestyle and food frequency questionnaires (FFQ) were administered in cases and controls in both places. Univariate and multivariable binomial logistic regression analyses were performed. RESULTS: In São Paulo, cases reported two times greater consumption of processed meat (adjusted OR 2.56, 95% CI 1.32-4.96) and of sweets (≥ 80 g/day) than Group 1 (endoscopic controls) (adjusted OR 2.25, 95% CI 1.21-4.18). Compared with Group 2, processed food consumption (≥ 44 g/day) as well as ≥ 44 g/day of salted bread increased the odds of having stomach adenocarcinoma (adjusted OR 2.96, 95% CI 1.82-4.81 and adjusted OR 2.03, 95% CI 1.30-3.18), respectively. In Belém, individuals who reported consuming ≥ 166 g/day of fried and roasted meat and fish were more likely to have stomach adenocarcinoma (adjusted OR 2.21, 95% CI 1.13-4.30). CONCLUSIONS: In both cities, consumption of processed and ultra-processed foods, especially salted bread, yellow cheese, fried and roasted meats, fish fried, processed meat, and sweets, was independently associated with the chance of having stomach adenocarcinoma.

Genomics and epidemiology for gastric adenocarcinomas (GE4GAC): a Brazilian initiative to study gastric cancer

Gastric cancer (GC) is the fifth most common type of cancer worldwide with high incidences in Asia, Central, and South American countries. This patchy distribution means that GC studies are neglected by large research centers from developed countries. The need for further understanding of this complex disease, including the local importance of epidemiological factors and the rich ancestral admixture found in Brazil, stimulated the implementation of the GE4GAC project. GE4GAC aims to embrace epidemiological, clinical, molecular and microbiological data from Brazilian controls and patients with malignant and pre-malignant gastric disease. In this letter, we summarize the main goals of the project, including subject and sample accrual and current findings

Avaliação da eficácia da Mitomicina-C nas estenoses refratárias pós tratamento de neoplasia de cabeça e pescoço / Evaluating the efficacy of Mitomycin-C in refractory strictures after treatment of head and neck cancer

Introdução: Tumores de cabeça e pescoço geralmente são diagnosticados em fases avançadas de evolução e seu tratamento multi-modal frequentemente resulta em complicações e sequelas. As estenoses faringoesofágicas resultantes do tratamento desses tumores são freqüentes, ocorrendo em aproximadamente 21% dos casos. O tratamento de escolha é a dilatação endoscópica, mas os resultados são variáveis, com altas taxas de recorrência e necessidade de dilatações repetidas. A aplicação tópica de substâncias que atuam na modulação da resposta cicatricial pode reduzir o índice de reestenose, aumentar o intervalo entre as dilatações ou até fazer com que não seja necessário mais dilatações. Objetivos: O objetivo desse trabalho é estudar a eficácia e a segurança da utilização da Mitomicina-C (MMC) associada a dilatações endoscópicas em pacientes tratados com terapia multi-modal para neoplasias avançadas de Cabeça e Pescoço que evoluíram com estenose faringoesofágica refratária ao tratamento convencional. Metódos: Este estudo piloto prospectivo foi desenhado para incluir 25 pacientes com estenoses faringoesofágicas refratárias. Após a dilatação endoscópica, foi aplicado, em 6 pacientes, topicamente no local da estenose, gaze embebida com 2 a 3ml de MMC (0,5 mg\ ml) por 5 minutos. Todos os pacientes realizaram estudo videofluoroscópico da deglutição pré e pós procedimento, avaliação de qualidade de vida relacionada à disfagia através do questionário de Swall-QOL e consulta clínica mensal para avaliar efeitos colaterais ou outras complicações. O intervalo de tempo decorrido desde o procedimento com MMC até a recorrência dos sintomas foi aferido. Resultados: Com a análise dos resultados dos primeiros 6 pacientes do estudo já foi possível determinar uma diferença estatisticamente significativa entre os períodos "inter-dilatação" pré e pós a utilização da MMC tópica (p= 0,005), sem nenhum tipo de complicação. Este fato nos autorizou a reduzir a amostra e concluir o presente estudo. Conclusão: A MMC foi segura e eficaz ao aumentar o intervalo entre as dilatações, nas estenoses faringoesofágicas refratárias pós tratamento multimodal para neoplasias de cabeça e pescoço avançadas.

Introduction: Head and neck cancers are usually diagnosed in advanced stage and its multi-modal treatment often results in complications and sequels that significantly impair quality of life and increase costs. Pharyngoesophageal strictures after chemoradioterapy and/or surgery for advanced head and neck cancer are common, with incidence rate of approximately 21%. The gold standard treatment is endoscopic dilation but repeat dilation is often required with high rates of disphagia recurrence. The topical use of substances that modulate the healing process, consequently reducing the restenosis rate or increasing the interval between dilations may be a good therapeutic option. Objective: The aim of this study was to assess the efficacy and safety of local application of Mitomycin C (MMC) at the time of dilation in refractory pharyngoesophageal strictures post head and neck multi- modal cancer treatment. MMC is an antiproliferative agent that inhibits fibroblastic proliferation and has been used for non-neoplastic treatments in many different medical fields. Methods: This pilot prospective study was designed to include 25 patients with refractory pharyngoesophageal stenosis. Refractory strictures are defined as any kind of luminal cicatricial or fibrosis that results in clinical symptoms of dysphagia that could not be successfully remediate with endoscopic dilatation over 3 sessions at 3-weeks interval. After an endoscopic dilation MMC (0,5mg\ ml) was applied onto the stenotic segment for 5 minutes. All patients underwent videofluoroscopic study, a swallowing-related quality of life evaluation measured by the Swall-QOL inventory, monthly clinical interview to evaluate undesirable side effects or any other complication, and measure of the interval time until recurrence of dysphagia symptoms after MMC topical application. Results: With 6 patients, there were already a significant difference between the interval time "inter" dilatation (p= 0,005), without any complications. That fact allows us to reduce the sample size and conclude the present study. Descriptive statistical analyses were performed in the Swal-QOL and in the videofluoroscopic study scores with improvement or stability in both of them, when the data before the procedure with topical MMC was compared with the ones after this procedure in spite of the small sample size. Conclusion: MMC was safe and effective in enlarging the interval time between dilatations in refractory pharyngoesophageal stenosis post multimodal head and neck cancer treatment.

Cadherin-catenin adhesion system and mucin expression: a comparison between young and older patients with gastric carcinoma.

BACKGROUND: Young patients are thought to develop gastric carcinomas with a molecular genetic profile that is distinct from that of gastric carcinomas occurring at a later age. The aim of this study was to compare the clinicopathological features and expression patterns of the markers E-cadherin and beta-catenin, and mucins (MUC1, MUC2, MUC5AC, and MUC6) in young and older patients. METHODS: The clinicopathological features and overall survival data of 62 young patients (age 40 years). A tissue microarray method and immunohistochemistry were used in order to analyze marker expression in paraffin-embedded tissue blocks obtained from both groups. RESULTS: The young group presented a higher percentage of diffuse-type tumors in comparison to the older group (P<0.01). The rates of positivity for E-cadherin and beta-catenin membranous expression patterns and mucin (MUC2, MUC5AC and MUC6) positivity were higher in the young group (P<0.01). Although young patients showed a lower frequency of alterations in marker expression and had significantly better survival rates than the older patients, neither age nor the marker expression pattern were found to be independent prognostic factors of survival. Only stage, tumor size, and tumor location persisted as prognostic factors for patients with gastric cancer. CONCLUSION: Biological markers of cellular adhesion and gastric differentiation were differently expressed in young and older patients. Our findings support the hypothesis that young patients develop carcinomas with a different genetic pathway compared to the pathway of tumors occurring at a later age, and we suggest further investigations to assess the prognostic relevance of the markers to specific subgroups.