Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort

ABSTRACT Objective: The 8th TNM system edition (TNM-8) released in 2018 presents significant changes when compared to the 7th edition (TNM-7). The aim of this study was to assess the impact of changing the TNM staging criteria on the outcomes in a Brazilian cohort of differentiated thyroid carcinoma (DTC). Subjects and methods: DTC patients, attending a tertiary, University-based hospital, were classified by TNM-7 and TNM-8. Prediction of disease outcomes status of the two systems was compared in a retrospective cohort study design. Results: Four hundred and nineteen DTC patients were evaluated, comprised by 82% (345/419) women, with mean age at diagnosis of 46.4 ± 15.6 years, 89% (372/419) papillary thyroid carcinoma, with a median tumor size of 2.3 cm (P25-P75, 1.3-3.5). One hundred and sixty patients (38%) had lymph node metastases and 47 (11%) distant metastases at diagnosis. Using the TNM-7 criteria, 236 (56%) patients were classified as Stage I, 50 (12%) as Stage II, 75 (18%) as Stage III and 58 (14%) as Stage IV. When evaluated by the TNM-8, 339 (81%) patients were classified as Stage I, 64 (15%) as Stage II, 2 (0.5%) as Stage III and 14(3%) as Stage IV. After a median follow-up of 4.4years (P25-P75 2.6-6.6), the rate of incomplete biochemical and/or structural response was 54% vs. 92% (P = 0.004) and incomplete structural response was 42% vs. 86% (P = 0.009) for patients classified as stage IV by TNM-7 vs TNM-8, respectively. Only 4 (1%) disease-related deaths were recorded. Conclusions: In our cohort, 37% of DTC patients were down staged with the application of TNM-8 (vs. TNM-7). Additionally, TNM-8 seems to better stratify the risk of structural incomplete response at follow-up.

Relación entre el proceso evolutivo del ser humano y su predisposición al cáncer / Relationship between the human being evolutionary process and cancer predisposition

El cáncer se ha convertido en la primera causa de morbimortalidad en numerosos países. En las últimas décadas se ha asistido a un cambio en el paradigma conceptual de las enfermedades neoplásicas, que ahora se enfoca hacia la perspectiva ecológica-evolutiva de estas. Con el objetivo de analizar, con elementos actualizados, la relación entre el proceso evolutivo del ser humano y su predisposición al cáncer, se realizó una revisión sistemática de la literatura, a partir de tres bases de datos, Medline, Scopus, y SciELO. Se tuvieron en cuenta atributos de consistencia de los artículos revisados, se excluyeron los estudios con niveles IV y V de evidencia y los de calidad insuficiente. Las búsquedas acumuladas actuales sugieren la necesidad de ver a las diversas neoplasias desde la perspectiva de la dinámica de sistemas complejos y sus implicaciones evolutivas. El proceso evolutivo humano posee particularidades biosociales que le predisponen a sufrir tumores malignos. La postura bípeda incrementó vulnerabilidad al efecto oncogénico de las radiaciones ultravioletas. La conducta sexual incrementó el riesgo de contraer infecciones por virus oncogénicos. El paso a una predominantemente cárnica y la introducción de la cocción, se tradujo en la incorporación de agentes xenobióticos cuyo metabolismo deriva agentes carcinógenos. La postergación del envejecimiento humano devino en un mayor tiempo para el acúmulo de mutaciones. Las modificaciones en el patrón sexual y reproductivo en la mujer han influido en su predisposición al cáncer de mama. En la génesis poblacional del cáncer subyacen fundamentos biosociales vinculados al proceso evolutivo de la especie(AU)

Cancer has become the leading cause of morbidity and mortality in many countries. In recent decades there has been a change in the conceptual paradigm of neoplastic diseases, which now focuses on the ecological-evolutionary perspective of these. With the aim of analyzing, with updated elements, the relationship between the evolutionary process of the human being and his predisposition to cancer, a systematic review of the literature was made, based on three databases, Medline, Scopus, and SciELO. Consistency attributes of the reviewed articles were taken into account, studies with levels IV and V of evidence and those of insufficient quality were excluded. The current accumulated searches suggest the need to see the various neoplasms from the perspective of the dynamics of complex systems and their evolutionary implications. The human evolutionary process has biosocial peculiarities that predispose it to suffer malignant tumors. Bipedal posture increased vulnerability to the oncogenic effect of ultraviolet radiation. Sexual behavior increased the risk of contracting oncogenic virus infections. The transition to a predominantly meat and the introduction of cooking, resulted in the incorporation of xenobiotic agents whose metabolism derives carcinogens. The postponement of human aging became in a longer time for the accumulation of mutations. Modifications in the sexual and reproductive pattern in women have influenced their predisposition to breast cancer. In the population genesis of cancer underlying biosocial foundations linked to the evolutionary process of the species(AU)

Factors associated with disease-specific survival of patients with non-small cell lung cancer / Fatores associados à sobrevida doença-específica em pacientes com câncer de pulmão de células não pequenas

ABSTRACT Objective: Lung cancer is a global public health problem and is associated with high mortality. Lung cancer could be largely avoided by reducing the prevalence of smoking. The objective of this study was to analyze the effects of social, behavioral, and clinical factors on the survival time of patients with non-small cell lung cancer treated at Cancer Hospital I of the José Alencar Gomes da Silva National Cancer Institute, located in the city of Rio de Janeiro, Brazil, between 2000 and 2003. Methods: This was a retrospective hospital cohort study involving 1,194 patients. The 60-month disease-specific survival probabilities were calculated with the Kaplan-Meier method for three stage groups. The importance of the studied factors was assessed with a hierarchical theoretical model after adjustment by Cox multiple regression. Results: The estimated 60-month specific-disease lethality rate was 86.0%. The 60-month disease-specific survival probability ranged from 25.0% (stages I/II) to 2.5% (stage IV). The performance status, the intention to treat, and the initial treatment modality were the major prognostic factors identified in the study population. Conclusions: In this cohort of patients, the disease-specific survival probabilities were extremely low. We identified no factors that could be modified after the diagnosis in order to improve survival. Primary prevention, such as reducing the prevalence of smoking, is still the best method to reduce the number of people who will suffer the consequences of lung cancer.

RESUMO Objetivo: O câncer de pulmão é um problema de saúde pública global e é associado a elevada mortalidade. Ele poderia ser evitado em grande parte com a redução da prevalência do tabagismo. O objetivo deste estudo foi analisar os efeitos de fatores sociais, comportamentais e clínicos sobre o tempo de sobrevida de pacientes com câncer de pulmão de células não pequenas atendidos, entre 2000 e 2003, no Hospital do Câncer I do Instituto Nacional de Câncer José Alencar Gomes da Silva, localizado na cidade do Rio de Janeiro. Métodos: Estudo retrospectivo de coorte hospitalar com 1.194 pacientes. As probabilidades de sobrevida doença-específica em 60 meses foram calculadas com o método de Kaplan-Meier para três grupos de estadiamento. A importância dos fatores estudados foi avaliada por um modelo teórico hierarquizado após o ajuste de modelos de regressão múltipla de Cox. Resultados: Foi estimada uma taxa de letalidade doença-específica em 60 meses de 86,0%. A probabilidade de sobrevida doença-específica em 60 meses variou de 25,0%, nos estádios iniciais, a 2,5%, no estádio IV. A situação funcional, a intenção e a modalidade do tratamento inicial foram os principais fatores prognósticos identificados na população estudada. Conclusões: As probabilidades de sobrevida doença-específica estimadas na amostra estudada foram muito baixas, e não foram identificados fatores que pudessem ser modificados após o diagnóstico visando uma melhora da sobrevida. A prevenção primária, como a redução da prevalência do tabagismo, ainda é a melhor forma de evitar que mais pessoas sofram as consequências do câncer de pulmão.

Características de casos de câncer bucal no estado da Bahia, 1999-2012: um estudo de base hospitalar / Characteristics of Cases of Oral Cancer in the State of Bahia, 1999-2012: a Hospital-Based Study

Introdução: O câncer bucal representa um grave problema de saúde pública no Brasil e no mundo. As informações dos casos diagnosticados por câncer, assim como os indicadores de mortalidade por essa doença, traduzem o perfil da população acometida por ela, além de auxiliar na formulação de políticas públicas para a prevenção e controle dessa enfermidade e para a melhoria da assistência oncológica. Objetivo: Descrever o perfil clínico e epidemiológico de indivíduos com câncer bucal atendidos em hospitais de referência do Estado da Bahia. Método: Estudo descritivo, retrospectivo, dos casos de câncer bucal provenientes do Sistema de Informatização de Registros Hospitalares de Câncer. Foi realizada análise descritiva das variáveis sociodemográficas, clínicas e relacionadas ao uso de tabaco e álcool. Resultados: Foram incluídos 3.309 casos, com predomínio de homens (70,16%), idade superior a 54 anos (61,43%), pardos (84,15%), com nível de escolaridade baixo (78,68%) e provenientes do interior do Estado (73,20%). O estadiamento IV foi o mais frequente (55,23%), o tipo histológico foi carcinoma de células escamosas (83,61%) e a localização primária do tumor na língua (31,10%). Ao final do primeiro tratamento, apenas 9,31% encontravam-se sem evidência de doença/em remissão completa, enquanto 32,47% foram a óbito. A maioria dos indivíduos apresentava história de consumo de álcool e uso de tabaco. Conclusão: Na Bahia, o câncer bucal tem sido diagnosticado tardiamente e tem acometido mais homens, acima dos 54 anos, de cor parda, com baixa escolaridade, resultando em um percentual importante de óbitos.

Introduction: Oral cancer is a major public health problem in Brazil and in the world. The information collected from cancer diagnosed cases, as well as its mortality indicators reflect the profile of the population affected by the disease, and assist in the formulation of public policies for the prevention and control of this type of cancer, in addition to improving cancer care. Objective: To describe the clinical and epidemiological profile of patients with oral cancer treated at hospitals in the Brazilian State of Bahia. Method: A retrospective, descriptive study of cases of oral cancer retrieved from the Electronic System of Hospital Cancer Records (Sistema de Informatização de Registros Hospitalares de Câncer). A descriptive analysis of socio-demographic, clinical, and other variables associated with the use of tobacco and alcohol was performed. Results: 3,309 cases were involved in this study. Among these subjects, 70.16% were male, 61.43% were above 54 years old, 84.15% were "pardos", 78.68% had a low level of education, and 73.20% came from the countryside of the state. Stage IV cancer was the most frequent (55.23%); the most common histological type was squamous cell carcinoma (83.61%); and the tongue was the most common primary tumor site (31.10%). At the end of the first treatment, only 9.31% were in complete remission/had no evidence of disease, while 32.47% passed away. Many of the individuals had a history of alcohol consumption and tobacco use. Conclusion: In Bahia, oral cancer cases have been receiving a late diagnose, and the disease affects primarily those over 54 years old; of mixed ethnicity; with low levels of education; and mostly men. A significant percentage of these cases result in death.

Sobrevida das pacientes com câncer de mama na região oeste de Santa Catarina / Survival of patients with breast cancer in westerm Santa Catarina

Correlação da expressão do receptor do fator de crescimento do epitélio vascular - vascular endothelial growth factor (VEGF) e do KI-67, em pacientes com câncer de mama, com variáveis histopatológicas. Introdução: proteínas que influam na proliferação celular, como o VEGF e o KI-67, são alvo de estudos. O VEGF está implicado na angiogênese, que é necessária ao crescimento tumoral. Objetivo: Analisar a correlação do VEGF e do KI-67 com variáveis histopatológicas. Métodos: entre 15/03/2008 e 14/0412009, incluímos 41 pacientes com câncer de mama inicial, rumores T1 e T2, para estudo, usando a coloração H & E na análise do tumor, grau histológico e invasão vascular e a imunoperoxidade para a avaliação imuno-histoquímica com anticorpos específicos para os receptores de VEGF, KI-67, p53 e receptor de estrogênio (RE), usando escore qualitativo até 3+ na avaliação da intensidade da coloração e/ou quantitativo até 5+, para avaliar a expressão percentual das células coradas. O escore total, soma das duas, pode chegar ao máximo de 8+. Apenas o KI-67 foi categorizado pelo percentual de células coradas na IHQ e considerado positivo a partir de 20%. Resultados: O receptor do VEGFR1, tanto no escore intensidade de cor quanto no escore total, apresenta correlação positiva com os tumores T1 (p=.01), com o receptor estrogênico positivo (p=.01) e com a expressão negativa do KI-67 (p=.02). A expressão do KI-67 apresenta correlação positiva com p53 (p=.00) e com o receptor hormonal negativo (RE-) (p=.04) e correlação fraca com a invasão vascular (p=.09) e o grau histológico indiferenciado (G3) (p=.07). Discussão: A avaliação de marcadores tumorais que possam responder à terapia alvo é um objetivo a ser perseguido. A correlação positiva do VEGF com o status do RE ja foi relatada e está de acordo com nossos resultados. A expressão do KI-67 é associada à pobre evento. Os resultados controversos dos marcadores refletem a dificuldade em padronizar as avaliações (reagentes usados)...

Correlation of the expression of the receptor of vascular endothelial growth factor (VEGP) and KI-67 with pathological variables in breast cancer patients. Background: Many studies have been conducted on proteins that have action on cell proliferation, such as VEGP and KI-67. VEGP acts in the angiogenesis required for tumor growth. The KI-67 correlates with proliferation of tumor cells, probably reflecting its aggressiveness. Objective: To analyze the correlation of VEGPR1 and KI-67 with pathological variables. Methods: The study was approved by the Committee on Ethics in research, University Hospital of Porto Alegre (RS). Between March 2008 and April 2009 we included 41 patients with early breast cancer (T1 and T2). We used H & E staining for tumor analysis, histological grade and vascular invasion, and immunohistochemistry evaluation with antibodies specific for VEGP receptors, KI-67, p53, estrogen receptor (ER), using quality score until 3+ of the evaluation of intensity of stain and quantitative untiI 5+, to evaluate the expression percentage of stained cells. The total score, add either, can reach 8+ Only the KI-67 was categorized by percentage of stained cells in the IHC and considered positive above 20%. Statistics: correlation and pearson's chi square and, for the significant variables, used the multivariate analysis. Results: The receptor VEGPR1 in both color intensity score and the total score, correlated positively with T1 tumors (p=.01), with the estrogen receptor positive (p=.01) and negative expression of KI-67 (p=.02). The expression of KI-67 correlates positively with p53 (p=.00) and with estrogen receptor negative (p=.04) and weak correlation with vascular invasion (p=.09) and histological grade undifferentiated (p=.07). Discussion: evaluation of tumor markers that may respond to targeted therapy is a goal to be pursued. The positive correlation of VEGP with the status of ER has been reported and is consistent with our results...

Causas de óbito dos pacientes com câncer de mama diagnosticados e tratados no Hospital Erasto Gaertner de 1995 a 1999: estudo retrospectivo / Causes of death of the patients with breast cancer diagnosed and treated at the Erasto Gaertner Hospital from 1995 to 1999: retrospective study

Introdução: O câncer de mama é a segunda neoplasia mais frequente no mundo e é a principal causa de óbito entre as mulheres. Com o aumento do diagnóstico precoce, espera-se que outras causas, que não a neoplasia mamária, sejam determinantes à morte do paciente. O estudo objetivou verificar as causas de óbito das pacientes com câncer de mama tratadas no Hospital Erasta Gaertner, correlacionando os fatores de risco - estadiamento, idade, hipertensão arterial sistêmica e diabetes mellitus - com as principais causas. Metodologia: Foi realizado estudo retrospectivo através da revisão de prontuários das pacientes diagnosticadas entre 1995 e 1999; tratadas na instituição e que foram a óbito até setembro de 2008. Foram coletados dados referentes à idade da paciente no momento do diagnóstico, estadiamento, presença de comorbidades e causa da morte. Resultados: Faleceram 393 pacientes, com idade média ao diagnóstico de 53,8 anos. Em 30% dos casos, a causa de óbito não foi definida. Entre as causas de óbito conhecidas, progressão da doença à distância foi responsável por 87% dos óbitos, seguida de doenças do aparelho circulatório (6%) e outras neoplasias (2,5%). Conclusão: A principal causa de mortalidade averiguada foi progressão da doença à distância, principalmente nas pacientes com estádios avançados. Nas pacientes diagnosticadas precocemente, foi significativa a ocorrência de óbito por doenças do aparelho circulatório. A presença de HAS, DM e idade superior a 60 anos, mostraram-se como fatores de risco para óbito por outras causas, que não a neoplasia da mama.

Introduction: Breast cancer is the second most frequent neoplasm and the main cause of women's death. It is expected that with the increase in early diagnosis other reasons than breast cancer will determine the patient's death. The objective of this study was to verify the causes of death of patients treated for breast cancer at Erasto Gaertner Hospital, and related the risk factors such as; staging, age, Diabetes Mellitus (DM), and Arterial Hypertension to the main causes of the deaths found. Methods: A retrospective study was conducted through the review of medical records of patients diagnosed between 1995 and 1999, who received treatment at our Institution and died before September 2008. Data related to the patient was collected- patient's age at diagnosis, staging, the existence of comorbidities and cause of death. Results: 393 patients died, the mean age at diagnosis was 53.8 years. In 30% of the cases the cause of death was not defined. Among the causes of death, disease progression at distant sites was responsible for 87% of deaths, followed by cardiovascular diseases (6%) and by other kinds of neoplasm (2.5%). Conclusion: The main cause of mortality observed was the progression of the disease at distance, especially in patients in advanced stages. It was observed on patients who were early diagnosed a significant number of deaths from cardiovascular diseases. The presence of hypertension, DM and age higher than 60 years were considered risk factors for other causes of death apart from breast cancer.

Importância do atendimento integrado em mastologia para redução da mortalidade por câncer de mama / The role of integrated patient care in mastology to reduce breast cancer mortality rate

Após analisar 39.589 mulheres atendidas de julho de 2005 a maio de 2010 no Centro de Referência da Saúde da Mulher (Hospital Estadual Perola Byington), foi observado que o atendimento resolutivo permitiu concluir o diagnóstico em lesões clínicas em 95,4% das pacientes. Cerca de 34,5% das pacientes encaminhadas não tinham nenhuma patologia mamária; destas, mais de 68% tinham realizado exames por imagem solicitados pelo ginecologista. Apenas 7,1% das pacientes encaminhadas apresentavam carcinoma. A porcentagem de pacientes no estádio I aumentou de 12,7 para 23,4%. Igualmente no estádio II, houve aumento de 40,3 para 54,1% das pacientes diagnosticadas. Ao contrário, houve redução no número de tumores avançados (estádio III) de 40,2 para 15,2%. Os resultados obtidos permitem concluir que, no momento do diagnóstico, os tumores nos estádios I e II representaram 77,5% dos casos. Esses resultados mostram de forma clara que a falta de acesso e resolutividade são as mais importantes causas de progressão da doença, pois certamente em três ou seis meses grande parte das neoplasias das pacientes diagnosticadas e tratadas nos Estádio I e II progrediria. A rápida redução no número de casos avançados permite estimar redução de mortalidade de 19,8% pela doença. O modelo de atendimento mostra uma excelente estratégia de custo efetividade voltado para instituições com grande demanda das grandes cidades brasileiras, que tratam mais de 80% dos casos de câncer de mama, permitindo uma rápida redução da taxa de mortalidade.

After examining 39,589 women attended from July, 2005 to May, 2010 in the Reference Center for Women’s Health (Pérola Byington State Hospital), we concluded the diagnosis in one step consultation in 95.4% of patients. About 34.5% of referred patients had no breast pathology; of these, over 68% had undergone imaging studies requested by the gynecologist. We observed that only 7.1% of referred patients had carcinoma. The percentage of patients in stage I increased from 12.7 to 23.4%. Also, in stage II there was an increase from 40.3 to 54.1 % of those diagnosed. Instead, there was reduction in the number of advanced tumors (stage III) from 40.2 to 15.2%. The results showed that at diagnosis, the tumors in stages I and II accounted for 77.5% of the cases. These results clearly show that the lack of access and biopsy to confirm the diagnosis are the most important causes of disease progression, because certainly in three or six months, most tumors of patients diagnose and treated in Stages I and II would progress. The rapid reduction in the number of cases that we have developed allows us to estimate a mortality reduction of 19.8% by the disease. The service model shows an excellent cost effective strategy aimed at institutions with high demands from Large Brazilian cities, treating more than 80% of cases of breast cancer, allowing a rapid reduction of mortality rate.

Pattern of Recurrence after Curative Resection of Local (Stage I and II) Non-Small Cell Lung Cancer: Difference According to the Histologic Type

The aim of the present study was to evaluate the pattern of recurrence after complete resection of pathological stage I, II non-small cell lung cancer, especially according to the cell type. We reviewed the clinical records of 525 patients operated on for pathologic stage I and II lung cancer. The histologic type was found to be squamous in 253 and non-squamous in 229 patients. Median follow-up period was 40 months. Recurrences were identified in 173 (36%) of 482 enrolled patients; distant metastasis in 70%, distant and local recurrence in 11%, and local recurrence in 19%. Distant metastasis was more common in non-squamous than in squamous cell carcinoma (p=0.044). Brain metastasis was more frequently identified in non-squamous mthan in squamous cell carcinoma (24.2% vs. 7.3%. p=0.005). Multivariate analyses showed that cell type is the significant risk factor for recurrence-free survival in stage I and stage II non-small cell lung cancer. Recurrence-free survival curves showed that non-squamous cell carcinoma had similar risks during early periods of follow-up and more risks after 2 yr from the operation compared to squamous cell carcinoma. Pathological stage and histologic type significantly influence recurrence-free survival.

Braquiterapia de alta taxa de dose no tratamento do câncer do colo uterino: resultados de controle local, sobrevida e complicações / High dose rate brachytherapy in the treatment of the uterine cervix cancer: results of local control, survival and complications

Avaliar os resultados de sobrevida, controle local e complicações do tratamento combinado de radioterapia externa e braquiterapia de alta taxa de dose (BATD) em mulheres portadoras de câncer de colo de útero. Foram analisados retrospectivamente 874 pacientes. Foram avaliadas pacientes dos estádios I a IV classificadas de acordo com a FIGO. A sobrevida livre de doença e a global atuariais calculadas pelo método de Kaplan e Meir foi de 67,3 por cento e de 65,3 por cento sem evidência de doença. Das IIA 84,2 por cento. Das IIB 73,2 por cento. Das pacientes IIIA 50,0 por cento. Das IIIB 51,5 por cento, e das IVA 40,0 por cento estavam sem evidência de doença.Evaluate the results of survival, local control and complications of association of external radiation and high dose rate brachytherapy in the treatment of 874 women with cervix carcinoma. The mean age was 53 years. The clinical stage of the patients range from I-IV (FIGO). The disease free survival and the overall survival calculated by the Kaplan and Meier method were 67.3 per cent and 65.3 per cent respectively. Of clinical stage IB patients, 90.9 per cent were disease free. Of the IIA 84.2 per cent. IIB 73.2 per cent. IIIA 50.0 per cent. IIIB 51.5 per cent, and IVA 40.0 per cent. Sixty one patients presented intestinal complications, and 7 (0.8 per cent) required surgery treatment. Thirty patients (3.4 per cent) presented vesical complications...

Cáncer y embarazo: experiencia en el Instituo Nacional de Cancerología de México / Pregnancy and cancer: experience in the Instituto Nacional de Cancerologia de Mexico

Introducción. Cáncer y embarazo es una asociación poco común; sin embargo, constituye una tragedia y un desafío en la oncología. El periodo de la organogénesis es el más crítico del embarazo. Algunas neoplasias pueden además dar metástasis a la placenta o al feto o hacia ambos. Tradicionalmente se ha considerado que el embarazo constituye un estado de inmunosupresión que posiblemente influya en la conducta biológica del tumor hacia el huésped, pudiendo tener estas neoplasias un comportamiento más agresivo. Objetivo. Evaluar los casos asociados a embarazo tratados en el Instituto Nacional de Cancerología, para conocer las neoplasias que más se asociaron y el posible impacto en la conducta biológica del tumor. Material y métodos. Análisis retrospectivo de las pacientes con cáncer y embarazo atendidas en el Instituto Nacional de Cancerología entre 1987 a 1997. Se evaluaron variables clínicas e histopatológicas. Se hizo especial énfasis en lo referente a esquemas de tratamiento y supervivencia de las pacientes y sus productos. Resultados. Identificamos 119 casos de cáncer asociados al embarazo. Entre éstos, sólo se registró un caso, respectivamente, de las siguientes neoplasias: cáncer renal, de pulmón, de endometrio y melanoma; también se identificaron dos casos con cáncer de recto, otros dos con sarcomas y dos más con leucemia; hubo tres casos de cáncer de tiroides, cuatro de enfermedad de Hodgkin y cuatro de no-Hodgkin; se registraron 16 casos de cáncer cervicouterino, 27 de tumores de ovario y, finalmente, 51 de cáncer de mama. En todos los casos, el tratamiento aplicado fue el estándar de acuerdo a la etapa clínica. No se observaron complicaciones de malformaciones, con excepción de dos mujeres con cáncer de mama que recibieron quimioterapia en el primer trimestre del embarazo abortaron, el restro concluyeron sus embarazos con productos de término y normales...

Carcinoma gástrico en pacientes menores de 35 años / Gastric carcinoma in patients under 35 years old of age

Objetivo. Describir la frecuencia, tipo de presentación tratamiento y pronóstico de los pacientes menores de 35 años con carcinoma gástrico en nuestro medio. Sede. Hospital de Especialidades, Centro Médico Nacional Siglo XXI IMSS, México DF (Hospital de referencia de tercer nivel). Material y métodos. Revisión de los expedientes de pacientes menores de 35 años con diagnóstico de carcinoma gástrico, tratados en el Servicio de Cirugía, entre enero de 1986 y junio de 1990. Seguimiento en la consulta externa hasta enero de 1998 o la muerte del enfermo. Resultados. Se identificaron a 11 enfermos menores de 35 años que representaron 13.7 por ciento de 80 enfermos con cáncer gástrico tratados durante un lapso de cuatro años y medio en nuestro hospital. Los pacientes del sexo femenino fueron afectados con mayor frecuencia, con una relación de 1.7 a 1. Un solo caso correspondió al estadio II (9.0 por ciento) y los 10 restantes se presentaron en estadio III o IV. Se efectuaron cinco resecciones gástricas, una gastroenterostomía paliativa, tres laparotomías exploradoras y dos enfermos no fueron intervenidos. De acuerdo con la clasificación de Lauren, 10 casos fueron adenocarcinomas difusos y uno intestinal. La mediana de supervivencia fue de 15.3 meses, y en este momento sólo vive una paciente libre de enfermedad. Conclusiones. En nuestra serie adenocarcinoma gástrico en menores de 35 años es frecuente, se diagnóstica en forma tardía y por ende, tiene muy mal pronóstico

Sobrevida en pacientes oncológicos en una unidad de terapia intensiva / Cancer patients survival in an intensive care unit

Introducción. Los pacientes con cáncer requieren a menudo cuidados intensivos: la falla respiratoria es la causa principal de ingreso y la mortalidad es alta. Objetivo. Determinar las causas de ingreso a la UCI de pacientes con enfermedades oncológicas. Pacientes y métodos. Estudiamos los pacientes que ingresaron a la UCI del hospital ABC, de enero 1993 a junio de 1997 con el diagnóstico de neoplasias en diferente estadio clínico. Se registraron las variables demográficas como edad, tipo de tumor, estadio clínico, metástasis (sitio y número), escala de Karnofsky, diagnóstico de ingreso a la UCI, días de estancia, escala de APACHE II y causa de muerte. Resultados. Se incluyeron 48 pacientes (edad media 56.8 ñ 15.4 años, escala de Karnofsky 61.2 ñ 12.8 puntos y APACHE II 22.5 ñ 6.84 puntos); nueve tuvieron neoplasias hematológicas y 39 tumores sólidos, 27 se clasificaron en estadio IV, 22 ingresaron a la UCI por insuficiencia respiratoria (20 se ventilaron mecánicamente), 28 murieron en la UCI y 11 murieron varios meses después de haberse egresado del hospital. La estancia en la UCI fue de 5.04 ñ 5.12 días. No observamos relación entre el pronóstico y la edad, sexo, tipo de tumor puntaje elevado en la escala APACHE II y la causa más importante de ingreso fue falla respiratoria

Evaluation of staging, cytoreduction and second-look operation of 119 ovarian cancer patients

This study was conducted on patients with ovarian cancer in order to evaluate survival. Design: A retrospective study of 119 cases of avarian cancer from January 1977 to December 1992 with observation until 1993. Location: Department of Gynecology and Obstetrics, Ribeirao Preto School of Medicine, Sao Paulo University. Participants: Of the 119 cases, 70 (58.8 percent) presented epithelial carcinomas and 21 (17.6 percent) tumors of the sexual girdle/stroma. Data source: The data were obtained from the medical records of the patients. Measurement: Statistical analysis of survival time was based on the nonparametric Mann-Whitney test with the level of significance set at P < 0.05. Results: The patients with a negative second look had a mean survival of 79.4 + 48.5 months versus 24.2 + 15.1 months for patients with a positive second look (P < 0.02). Conclusions: It is concluded that patients with a negative second lool present a better prognosis compared to those with residual disease.