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1.
Rev. Assoc. Med. Bras. (1992) ; 68(2): 227-233, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365336

ABSTRACT

SUMMARY OBJECTIVE: The stroma surrounding the tumor cells is important in tumor progression and treatment resistance, besides the properties of tumor cells. Studies on the tumor stroma characteristics will contribute to the knowledge for new treatment approaches. METHODS: A total of 363 breast cancer patients were evaluated for the tumor-stroma ratio. The percentage of stroma was visually assessed on hematoxylin-eosin stained slides. The cases of tumor-stroma ratio more than 50% were categorized as tumor-stroma ratio high, and those less than 50% and below were categorized as tumor-stroma ratio low. RESULTS: Tumor-stroma ratio-high tumors had shorter overall survival (p=0.002). Disease-free survival tended to be shorter in tumor-stroma ratio-high tumors (p=0.082) compared with tumor-stroma ratio-low tumors. Tumor-stroma ratio was an independent prognostic parameter for the total group of patients (p=0.003) and also axillary lymph node metastasis and tumor-stroma ratio was statistically associated (p=0.004). Also, tumor-stroma ratio was an independent prognostic parameter in node-positive Luminal A and B subgroups for overall survival (p<0.001). CONCLUSION: Tumor-stroma ratio is an independent prognostic parameter that can be evaluated quite easily in all molecular subtypes of all breast cancers and does not require extra cost and time to evaluate.


Subject(s)
Humans , Female , Breast Neoplasms/pathology , Triple Negative Breast Neoplasms/pathology , Prognosis , Stromal Cells/pathology , Receptor, ErbB-2 , Disease-Free Survival , Lymphatic Metastasis/pathology
2.
Article in Chinese | WPRIM | ID: wpr-928729

ABSTRACT

OBJECTIVE@#To evaluate the prognosis value of average daily platelet amount increase in children with B-cell acute lymphoblastic leukemia(B-ALL) treated by CCCG-ALL-2015 regimen.@*METHODS@#106 children with primary B-ALL were retrospective analyzed, standardized MRD test protocol was used to detect the MRD level (19 d and 46 d) after chemotherapy. The platelet count was measured by Sysmex XE-2100. Kaplan-Meier survival curve statistics was used to analyze the event free survival(EFS) rate of the children.@*RESULTS@#The trend of negative correlation existed between PPC and TPR (rs=-0.519, P=0.021). The 3-year EFS rate of the patients in Ap>5.4×109/L group was 95.7%, which was significantly higher than those in Ap≤5.4×109/L group(79.5%) (χ2=5.236, P=0.035); multivariate analysis showed that Ap≤5.4×109/L was the independent prognostic factor affecting survival of the patients (RR=3.978; 95%CI: 1.336-11.523, P=0.041). With both MRD and Ap≤5.4×109/L as candidate variables, Ap≤5.4×109/L lost its independent prognostic value (RR=1.225; 95%CI: 0.892-13.696, P=0.089), the correlation between d 19/d 46 MRD levels and Ap>5.4×109/L (χ2=4.318, P=0.038) could explain the phenomenon.@*CONCLUSION@#Ap can reflect the effect of B-ALL chemotherapy and can be used to monitor the curative effect and prognosis of B-ALL children.


Subject(s)
Blood Platelets , Burkitt Lymphoma , Child , Disease-Free Survival , Humans , Neoplasm, Residual/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Prognosis , Retrospective Studies
3.
Article in Chinese | WPRIM | ID: wpr-928723

ABSTRACT

OBJECTIVE@#To analyze the clinical effects of CCLG-AML-2015 protocol on newly diagnosed children with acute myeloid leukemia (AML).@*METHODS@#The clinical data of 60 newly diagnosed AML children in the Department of Hematology and Oncology, Wuhan Children's Hospital from August 2015 to September 2019 were summarized, the effect of chemotherapy using the CCLG-AML-2015 regimen (hereinafter referred to as the 2015 regimen) were retrospectively analyzed. 42 children with AML treated by the AML-2006 regimen (hereinafter referred to as the 2006 regimen) from February 2010 to July 2015 were used as control group.@*RESULTS@#There were no statistical differences between the 2015 regimen group and the 2006 regimen group in sex, age at first diagnosis, and risk stratification (P>0.05). The complete remission rate of bone marrow cytology after induction of 1 course of chemotherapy (84.7% vs 73.1%, P=0.155), and minimal residual disease detection (MRD) negative (42.3% vs 41.4%, P=0.928) in the 2015 regimen group were not statistically different than those in the 2006 regimen group. The bone marrow cytology CR (98.1% vs 80.6%, P=0.004) and MRD negative (83.3% vs 52.8%, P=0.002) in the 2015 regimen group after 2 courses of induction were higher than those in the 2006 regimen group. The 5-year overall survival (OS) rate in the 2015 regimen group (62.3%±6.4% vs 20.6%±6.4%, P=0.001), the 5-year disease-free survival (EFS) rate (61.0%±6.4% vs 21.0% ±6.4% , P=0.001) were better than those in the 2006 regimen group. The 5-year OS and EFS of high-risk transplant patients in the 2015 regimen group were significantly better than those of high-risk non-transplant patients (OS: 86.6%±9.0% vs 26.7%±11.4%, P=0.000; EFS: 86.6%±9% vs 26.7%±11.4%, P=0.000).@*CONCLUSION@#The 2015 regimen can increase the CR rate after 2 courses of induction compared with the 2006 regimen. High-risk children receiving hematopoietic stem cell transplantation can significantly improve the prognosis.


Subject(s)
Child , Disease-Free Survival , Humans , Leukemia, Myeloid, Acute/drug therapy , Prognosis , Remission Induction , Retrospective Studies
4.
Article in Chinese | WPRIM | ID: wpr-928686

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy, survival, and prognosis of autologous hematopoietic stem cell transplantation (ASCT) with new drug chemotherapy in the treatment of newly diagnosed multiple myeloma (NDMM) in the new drug era.@*METHODS@#The clinical data of 149 patients with NDMM treated with new drug induction regimen in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to December 2019 were retrospectively analyzed. Twenty-four patients who received ASCT were in ASCT group, and 125 patients who did not receive ASCT were in non-ASCT group. The median follow-up time was 43 (1-90) months. The propensity score matching (PSM) method was used to balance confounding factors, then depth of response, overall survival (OS), and progression-free survival (PFS) between the two groups were compared and subgroup analysis was performed.@*RESULTS@#After matching, the covariates were balanced between the two groups. Fifty-one patients (15 cases in ASCT group and 36 cases in non-ASCT group) were included. ASCT patients had a better complete response (CR) rate than non-ASCT patients receiving maintenance therapy (93.3% vs 42.3%, P=0.004), while there were no statistical differences in deep response rate and overall response rate (ORR) between the two groups (93.3% vs 65.4%, P=0.103; 93.3% vs 96.2%, P=1.000). Before matching, the 3 and 5-year PFS rate and median PFS (mPFS) in ASCT group and non-ASCT group were [89.6% vs 66.5%, P=0.024; 69.8% vs 42.7%; non-response (NR) vs 51.0 months], and the 3 and 5-year OS rate and median OS (mOS) were (100% vs 70.6%, P=0.002; 92.3% vs 49.6%; NR vs 54.0 months). After matching, the 3 and 5-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.6% vs 61.7%, P=0.182; 62.7% vs 45.7%; NR vs 51.0 months), the 3 and 5-year OS rate and mOS were (100% vs 65.6%, P=0.018; 88.9% vs 46.9%; NR vs 51.0 months). Subgroup analysis showed that patients with mSMART 3.0 high risk stratification, the 3-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.3% vs 41.5%, P=0.091; NR vs 34.0 months), and the 3-year OS rate and mOS were (100% vs 41.5%, P=0.034; NR vs 34.0 months). Patients with mSMART 3.0 standard risk stratification, the 3-year PFS rate and OS rate in ASCT group and non-ASCT group were (83.3% vs 76.8%, P=0.672; 100% vs 87.2%, P=0.155). The 3-year PFS and OS rate in MM patients who achieved deep response within 3 months after transplantation compared with non-ASCT patients who achieved deep response after receiving maintenance therapy were (83.1% vs 56.7%, P=0.323; 100% vs 60.5%, P=0.042), and the 3-year PFS and OS rate in patients who achieved overall response in both groups were (83.1% vs 62.5%, P=0.433; 100% vs 68.1%, P=0.082). After matching, Cox multivariate regression analysis showed that mSMART 3.0 risk stratification and ASCT were independent prognostic factors for OS.@*CONCLUSION@#In the new drug era, ASCT can increase CR rate and prolong OS of NDMM patients. ASCT patients who are mSMART 3.0 high risk stratification or achieved deep response within 3 months after transplantation have better OS than non-ASCT patients receiving new drug chemotherapy. ASCT and mSMART 3.0 risk stratification are independent prognostic factors for OS in NDMM patients.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Disease-Free Survival , Hematopoietic Stem Cell Transplantation , Humans , Multiple Myeloma/drug therapy , Pharmaceutical Preparations , Propensity Score , Retrospective Studies , Stem Cell Transplantation , Transplantation, Autologous , Treatment Outcome
5.
Article in Chinese | WPRIM | ID: wpr-928680

ABSTRACT

OBJECTIVE@#To analyze the clinical characteristics and long-term prognosis of patients with primary bone lymphoma (PBL).@*METHODS@#The clinical data of 21 patients with PBL treated in our center from 2005 to 2018 were analyzed retrospectively, the clinical characteristics and the factors affecting prognosis of the patients were analyzed.@*RESULTS@#The median age of all the 21 newly diagnosed PBL patients was 40(12-71) years old. Ostealgia was the initial symptom in most of the patients (19/21,90.5%). 42.9%(9/21) of the patients showed single bone lesion only. 571% (12/21) of the patients showed diffuse large B cell lymphoma. 28.6% (6/21) of the patients showed anaplastic large cell lymphoma and 9.5% (2/21) of the patients showed T cell lymphoblastic lymphoma. All the patients received chemotherapy (CHOP or CHOP like regimen, 33.3% plus rituximab) with or without radiotherapy and/or autologous hematopoietic stem cell transplantation (ASCT). 18 patients achieved clinical remission (including 15 for CR and 3 for PR). The median follow-up time was 48 months. The 5-year overall survival rate and progression-free survival rate of the patients were was 67.5% and 63.7%, respectively. The single factors analysis showed that ASCT was the important prognostic factor of PFS, while the single or multiple bone lesion was the factors affecting OS of the patients. There were no statistical differences with the effects of age, sex, stage, ECOG score, LDH level, B symptoms and radiotherapy for the prognosis of patients.@*CONCLUSION@#Diffuse large B cell lymphoma is the most common pathological type of PBL. Chemotherapy is the main treatment, which can be combined with radiotherapy and/or ASCT. The ASCT and the number of bone lesion are the factors for long time survival of the patients.


Subject(s)
Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide , Disease-Free Survival , Doxorubicin , Humans , Lymphoma, Large B-Cell, Diffuse/drug therapy , Middle Aged , Prednisone , Prognosis , Retrospective Studies , Rituximab/therapeutic use , Transplantation, Autologous , Vincristine
6.
Article in Chinese | WPRIM | ID: wpr-928663

ABSTRACT

OBJECTIVE@#To analyze the efficacy of children with B-cell acute lymphoblastic leukemia (B-ALL) without prognostic fusion genes treated by CCLG-ALL 2008, and investigate the related factors affecting the recurrence of the patients.@*METHODS@#B-ALL patients without prognostic fusion genes treated by the protocol of CCLG-ALL 2008 in our hospital from March 2008 to December 2012 were retrospectively analyzed. Follow-up time was ended in August 31, 2019. The median follow-up time was 92 months (range 0-136 months). Kaplan-Meier was used to detect the RFS, and COX multivariate regression analysis was employed to identify the independent factors affecting the recurrence of the patients.@*RESULTS@#There were 140 males and 99 females enrolled in this study. The ratio of male to female was 1.41∶1. The median age was 4.4 years old and the median number of WBC at initial stage was 4.98×109/L. There were 77 cases relapsed during the observation while 162 without relapsed, 16 cases lost to follow-up and 72 cases died. The recurrence and mortality rate was 32.22% and 30.1%, respectively, in which 45 cases died of recurrence (62.5% of the total deaths). Univariate analysis showed that the age≥6 years old, WBC >100×109/L, the bone marrow blasts on day 15≥25%, the bone marrow minimal residual disease (MRD) at week 12 >10-4, and the higher risk were the main factors affecting the recurrence of the patients (P<0.05). Multivariate COX regression analysis showed that age≥6 years old, WBC >100×109/L, bone marrow MRD >10-4 at the 12th week were the independent risk factors affecting recurrence of the patients.@*CONCLUSION@#Age, initial WBC, and bone marrow MRD at the 12th week were correlated with recurrence in children with B-ALL without prognostic fusion genes, which can be used as prognostic indices of recurrence risk in clinical.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Child , Child, Preschool , Disease-Free Survival , Female , Humans , Male , Neoplasm, Residual , Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics , Prognosis , Recurrence , Retrospective Studies
7.
Asian Journal of Andrology ; (6): 147-153, 2022.
Article in English | WPRIM | ID: wpr-928543

ABSTRACT

Individualized treatment of prostate cancer depends on an accurate stratification of patients who are sensitive to various treatments. Interleukin-23 (IL-23) was reported to play a significant role in prostate cancer. Here, we aimed to explore the clinical value of IL-23-secreting (IL-23+) cells in prostate cancer patients. We evaluated interleukin-23A (IL-23A) expression in The Cancer Genome Atlas database and retrospectively enrolled 179 treatment-naïve metastatic prostate cancer patients diagnosed in our institute between June 2012 and December 2014. IL-23+ cells were stained and evaluated via immunohistochemistry. Further, survival and multivariate Cox regression analyses were conducted to explore the prognostic value of IL-23+ cells. We found that IL-23A expression correlated with disease progression, while IL-23+ cells were clearly stained within prostate cancer tissue. Patients with higher Gleason scores and multiple metastatic lesions tended to have more IL-23+ cell infiltration. Further analyses showed that patients with higher levels of IL-23+ cells had significantly worse overall survival (hazard ratio [HR] = 2.996, 95% confidence interval [95% CI]: 1.812-4.955; P = 0.001) and a higher risk of developing castration resistance (HR = 2.725, 95% CI: 1.865-3.981; P = 0.001). Moreover, subgroup analyses showed that when patients progressed to a castration-resistant status, the prognostic value of IL-23+ cells was observed only in patients treated with abiraterone instead of docetaxel. Therefore, we showed that high IL-23+ cell infiltration is an independent prognosticator in patients with metastatic prostate cancer. IL-23+ cell infiltration may correlate with abiraterone effectiveness in castration-resistant prostate cancer patients.


Subject(s)
Abiraterone Acetate/therapeutic use , Androstenes , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Disease-Free Survival , Humans , Interleukin-23/metabolism , Male , Prostatic Neoplasms, Castration-Resistant/pathology , Retrospective Studies , Treatment Outcome
8.
Asian Journal of Andrology ; (6): 154-160, 2022.
Article in English | WPRIM | ID: wpr-928527

ABSTRACT

Corticosteroid switching can reverse abiraterone resistance in some patients with metastatic castration-resistant prostate cancer (mCRPC). Here, we investigated the potential biomarkers for predicting the efficacy of corticosteroid switching during treatment with abiraterone acetate (AA). We retrospectively analyzed 101 mCRPC patients receiving corticosteroid switching from West China Hospital and Sun Yat-Sen University Cancer Center between January 2016 and December 2018. All cases received AA plus prednisone as first-line therapy during mCRPC. Primary end points were biochemical progression-free survival (bPFS) and overall survival (OS). The risk groups were defined based on multivariate analysis. A total of 42 (41.6%) and 25 (24.8%) patients achieved 30% and 50% decline in prostate-specific antigen (PSA), respectively, after corticosteroid switching. The median bPFS and median OS on AA plus dexamethasone were 4.9 (95% confidence interval [CI]: 3.7-6.0) months and 18.8 (95% CI: 16.2-30.2) months, respectively. Aldo-keto reductase family 1 member C3 (AKR1C3) expression (hazard ratio [HR]: 2.15, 95% Cl: 1.22-3.80, P = 0.008) and baseline serum alkaline phosphatase (ALP; HR: 4.95, 95% Cl: 2.40-10.19, P < 0.001) were independent predictors of efficacy before corticosteroid switching in the multivariate analysis of bPFS. Only baseline serum ALP >160 IU l-1 (HR: 3.41, 95% Cl: 1.57-7.38, P = 0.002) together with PSA level at switch ≥50 ng ml-1 (HR: 2.59, 95% Cl: 1.22-5.47, P = 0.013) independently predicted poorer OS. Based on the predictive factors in multivariate analysis, we developed two risk stratification tools to select candidates for corticosteroid switching. Detection of serum ALP level, PSA level, and tissue AKR1C3 expression in mCRPC patients could help make clinical decisions for corticosteroid switching.


Subject(s)
Abiraterone Acetate/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Androstenes , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Dexamethasone/therapeutic use , Disease-Free Survival , Humans , Male , Prednisone/therapeutic use , Prostate-Specific Antigen , Prostatic Neoplasms, Castration-Resistant/pathology , Retrospective Studies , Treatment Outcome
9.
J. coloproctol. (Rio J., Impr.) ; 41(4): 393-405, Out.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1356431

ABSTRACT

Background: Anatomopathological staging is the primary method to determine the prognosis of patients with colorectal carcinoma (CRC). However, new tools have been developed that can complement it, such as the analysis of the elevation of systemic inflammatory markers. Objective: To evaluate the impact of the elevation of scores based on inflammatory markers (the neutrophil-to-lymphocyte ratio [NLR], the Glasgow Prognostic Score [GPS], and isolated C-reactive protein [CRP]) in the prognosis of patients diagnosed with CRC and submitted to potentially curative surgery in Hospital de Braga, Portugal, between January 1st, 2005, and December 31st, 2010. Methods: A retrospective analysis of the data of 426 patients was performed, with a collection of several clinico-pathological variables, as well as the levels of lymphocytes, neutrophils, albumin and CRP, in the pre- and postoperative periods, to apply the different scores to the sample. Results: From the analysis of the survival curves, we concluded that patients with increased NLR in the pre- and postoperative periods present a lower cancer-related survival than patients with normal NLR (preoperative period: 93.7 versus 122 months; p<0.001; postoperative period: 112 versus 131 months; p=0.002). Patients with increased NLR in the pre- and postoperative periods also had a lower disease-free survival (preoperative period: 88.0 versus 122 months; p<0.001; postoperative period: 111 versus 132 months; p=0.002). In addition, increased pre- and postoperative NLR was associatedwith a higher risk of death due to CRC (preoperatively: hazard ratio [HR]=2.25; p<0.001; postoperatively: HR=2.18; p=0.003). However, the multivariate analysis shows that only postoperative NLR (ajusted HR =2.66; p=0.002) does so independently of the remaining variables. Conclusion: Regarding the scores applied to the sample, the NLR was the one that most consistently related to the prognosis of the patients. However, it would be useful to develop a prospective study that could confirm this relationship. (AU)


Subject(s)
Humans , Male , Female , Prognosis , Colorectal Neoplasms/mortality , C-Reactive Protein/analysis , Colorectal Neoplasms/therapy , Survival Rate , Disease-Free Survival , NLR Proteins/analysis
10.
Lima; Instituto Nacional de Salud; oct. 2021.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-1354720

ABSTRACT

ANTECEDENTES: El presente informe se efectúa en atención a la solicitud de la Dirección General de Intervenciones estratégicas en Salud Púbica del Ministerio de Salud. El objetivo del presente informe es describir las recomendaciones de los países de la región sobre el tiempo de espera para los post infectados o con exposición conocida a casos confirmados de COVID-19. METODOS: Formulación de la pregunta PICO: En personas post infectados o con exposición conocida a casos confirmados de COVID-19, ¿Cuánto tiempo de espera para poder recibir la vacuna contra el COVID-19? Búsqueda y selección de la literatura científica: Se efectuó una búsqueda electrónica en las páginas oficiales de las principales agencias gubernamentales de la región, sobre los lineamientos técnicos del proceso de vacunación y los casos especiales con fecha límite 14 de octubre de 2021. La búsqueda fue limitada a documentos desarrollados en idioma español o inglés, sin restricción por fecha de publicación. La selección de las publicaciones se realizó a partir de la lectura de título y resumen, así como la selección


Subject(s)
Humans , COVID-19 Vaccines/immunology , SARS-CoV-2/immunology , COVID-19/prevention & control , Efficacy , Cost-Benefit Analysis , Disease-Free Survival
11.
Rev. cuba. hematol. inmunol. hemoter ; 37(3): e1455, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1341398

ABSTRACT

Introducción: La leucemia mieloide aguda es una enfermedad clonal, reconocida como una de las hemopatías malignas más heterogénea en la que determinados biomarcadores clínicos, inmunológicos, citogenéticos y moleculares influyen en la respuesta de los pacientes al tratamiento. Objetivo: Describir la influencia pronóstico de biomarcadores inmunológicos, citogenéticos y moleculares en la respuesta terapéutica en los pacientes adultos menores de 60 años con leucemia mieloide aguda. Métodos: Se realizó una revisión exhaustiva del tema en bases de datos como: Pubmed, Scielo, ScienceDirect, Medline y el motor de búsqueda Google académico; se utilizaron como referencia artículos actualizados publicados principalmente en los últimos cinco años. Análisis y síntesis de la información: La heterogeneidad inmunológica, citogenética y molecular de los pacientes adultos menores de 60 años con leucemia mieloide aguda se relaciona con la variabilidad en la respuesta al tratamiento que tienen los enfermos y repercute en la supervivencia global y libre de enfermedad. Conclusión: Sobre la base a características inmunológicas, citogenéticas y moleculares es posible establecer el pronóstico de los pacientes con leucemia mieloide aguda, lo cual permite seleccionar la terapéutica adecuada para disminuir en lo posible las complicaciones, las recaídas y aumentar la supervivencia global(AU)


Introduction: Acute myeloid leukemia is a clonal disease, recognized as one of the most heterogeneous malignant hemopathy in which certain clinical, immunological, cytogenetic and molecular biomarkers influence the response of patients to treatment. Objective: Describe the prognostic influence of immunological, cytogenetic and molecular biomarkers on the therapeutic response in adult patients under 60 years of age with acute myeloid leukemia. Methods: An exhaustive review was conducted about the topic in the databases as Pubmed, Scielo, ScienceDirect, Medline and Scholar Google, for which papers mainly published in the last five years were used as reference. Analysis and synthesis of the information: The immunological, cytogenetic and molecular heterogeneity of adult patients under 60 years of age with acute myeloid leukemia is related to the variability in the response to treatment that patients have and affects their overall and disease-free survival. Conclusions: Based on the immunological, cytogenetic and molecular characteristics, it is possible to establish the prognosis of patients with acute myeloid leukemia, which allows selecting the appropriate therapy to reduce complications, relapses as much as possible and increase overall survival(AU)


Subject(s)
Humans , Adult , Biomarkers/analysis , Leukemia, Myeloid, Acute , Disease-Free Survival , Cytogenetics , Prognosis
12.
Article in Spanish | LILACS, CUMED | ID: biblio-1341395

ABSTRACT

Introducción: La leucemia linfoide crónica es una neoplasia linfoproliferativa crónica caracterizada por el aumento de una población clonal linfoide disfuncional con inmunofenotipo B (> 95 por ciento) y excepcionalmente T (< 5 por ciento) que afecta sobre todo a personas mayores de 55 años de edad y se incrementa su frecuencia hacia la séptima década de vida. Objetivo: Analizar las principales modalidades terapéuticas para el manejo de la leucemia linfoide crónica. Métodos: Se realizó una revisión de la literatura, en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google académico de artículos publicados en los últimos 5 años. Se hizo un análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: La leucemia linfoide crónica se consideró durante décadas una enfermedad del paciente añoso, en general de curso indolente, con una evolución impredecible e incurable. El tratamiento de esta enfermedad en los últimos 30 años ha sufrido cambios muy significativos que han repercutido favorablemente en el incremento de la supervivencia global y libre de enfermedad de los pacientes que la padecen. Conclusión: Se debe mantener un adecuado seguimiento de los pacientes con leucemia linfoide crónica, pues esto permitirá disminuir en lo posible las complicaciones, la progresión y un aumento de la supervivencia global(AU)


Introduction: Chronic lymphoid leukemia is a chronic lymphoproliferative neoplasm characterized by the increase of a dysfunctional lymphoid clonal population with immunophenotype B (> 95 percent) and exceptionally T (<5 percent), it mainly affects people over 55 years of age, increasing towards the seventh decade of life. Objective: To analyze the main therapeutic modalities for the management of chronic lymphoid leukemia. Methods: A literature review was carried out, in English and Spanish, through the PubMed website and the academic search engine Google for articles published in the last 5 years. An analysis and summary of the revised bibliography was made. Analysis and synthesis of the information: Chronic lymphoid leukemia was considered for decades a disease of the elderly patient, generally of an indolent course, unpredictable and incurable evolution. The treatment of this disease has undergone in the last 30 years very significant changes that have had a favorable impact on the increase in the overall and disease-free survival of patients who suffer from it. Conclusion: Adequate follow-up of patients with chronic lymphoid leukemia must be maintained, as this will make it possible to reduce complications, progression and increase overall survival as much as possible(AU)


Subject(s)
Humans , Middle Aged , Survival , Leukemia, Lymphoid/therapy , Aftercare , Disease-Free Survival
13.
Rev. Assoc. Med. Bras. (1992) ; 67(7): 1015-1020, July 2021. tab, graf
Article in English | LILACS | ID: biblio-1346939

ABSTRACT

SUMMARY OBJECTIVE: Pulmonary metastasectomy for the treatment of metastatic colorectal cancer is essential, but high ranked evidence of survival benefit is lacking. Here, we aimed to examine the prognostic factors after pulmonary metastasectomy in patients with colorectal cancer. METHODS: This is a single-center, retrospective hospital-based observational case series study. We reviewed data for 607 patients with metastatic colorectal cancer (mCRC) who were treated and observed from 2012 to 2019. Of the 607 patients with mCRC, 87 were with solitary lung metastases. Of the 87 patients, 39 were not appropriate for metastasectomy, while 15 patients recognized as suitable candidates by the multidisciplinary thoracic tumor board rejected metastasectomy. Consequently, only 33 patients were included in the final analysis. RESULTS: Rectum was detected as the primary site in 16 (48.5%) patients. Over 80% of patients had metachronous lung metastases, with a median of 29.0 months from initial diagnosis. Video-assisted thoracic surgery with wedge resection was performed in 20 (60.6%) patients. Over 90% of patients had solitary metastasis resected, with 97% of R0 resection. Median tumor size was 23.0 mm (min: 10; max: 90). Adjuvant treatment was given to 31 (93.9%) patients, while neoadjuvant treatment was given only to 8 (25%) patients. Of the 33 patients, there were 25 (75.7%) relapses. The most frequent site of relapse was lung in 15 (45.5%) patients. Interestingly, there were only 4 (12.2%) patients who had a relapse in the liver after lung metastasectomy. We found that median disease-free survival (DFS) and overall survival (OS) were 43.0 (13.0-73.0) and 55.0 (31.6-78.4) months, respectively. CONCLUSIONS: Pulmonary metastasectomy was associated with significantly long-time survival rates in mCRC (43 months of DFS and 55 months of OS). The second relapse occurred in 25 (75.7%) patients, with isolated lung metastases in nearly half of the patients (45.5%). Therefore, lung metastases in mCRC were unique and a multidisciplinary team including a thoracic surgeon should manage these patients.


Subject(s)
Humans , Colorectal Neoplasms/surgery , Metastasectomy , Lung Neoplasms/surgery , Prognosis , Survival Rate , Retrospective Studies , Disease-Free Survival , Thoracic Surgery, Video-Assisted , Neoplasm Recurrence, Local
14.
Int. braz. j. urol ; 47(3): 566-573, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154486

ABSTRACT

ABSTRACT Background: Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center. Materials and Methods: Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model. Results: Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047). Conclusion: Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.


Subject(s)
Humans , Carcinoma, Renal Cell/drug therapy , Kidney Neoplasms/drug therapy , Prognosis , Brazil , Retrospective Studies , Treatment Outcome , Disease-Free Survival , Sunitinib
15.
Rev. Assoc. Med. Bras. (1992) ; 67(2): 185-189, Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287803

ABSTRACT

SUMMARY OBJECTIVE: Colorectal cancer is the most common malignancy of the gastrointestinal tract. It is the third most common tumor in both genders and the second reason of cancer-related deaths. In recent years, tumor location has gained importance as a prognostic indicator. In this study, we aimed to analyze if there was a prognostic effect of tumor location, the pathological features, and the mutation status of patients on survival. METHODS: Two-hundred and ten colorectal cancer patients aged 18 years and older were included into the study. One-hundred and forty-two patients had left-sided tumor and 68 patients had right-sided tumor. Patients who had other malignancies rather than squamous cell skin cancer and in situ cervical cancer were excluded. All statistical tests were carried out using two-sided process, and a p≤0.05 was considered statistically significant. RESULTS: There were 140 men and 70 women in the study. The median age of the patients was 62 years old. There was no statistically significant difference according to tumor location and survival of patients. The overall survival of patients with right-sided tumors was 60.5 months and 47.2 months for left-sided tumors. Disease-free survival of patients was 63.7 months for right-sided tumors and 46 months for left-sided ones. Perineural invasion, grade and stage were crucial prognostic parameters. Disease-free survival was longer for female colorectal cancer patients. CONCLUSION: According to our study, survival of patients was similar regardless of tumor location. This can be explained by the different sequencing of treatment strategies and divergent population genetics.


Subject(s)
Humans , Male , Female , Colorectal Neoplasms/genetics , Prognosis , Retrospective Studies , Disease-Free Survival , Middle Aged , Mutation
16.
Rev. bras. ginecol. obstet ; 43(1): 41-45, Jan. 2021. tab
Article in English | LILACS | ID: biblio-1156074

ABSTRACT

Abstract Objective The aim of the present study was to analyze relapse rates and patterns in patients with endometrial cancer with the aim of evaluating the effectiveness of current follow-up procedures in terms of patient survival, as well as the convenience of modifying the surveillance strategy. Methods Retrospective descriptive study including all patients diagnosed with endometrial cancer relapse at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Insular-Materno Infantil de Canarias, between 2005 and 2014. Results Recurrence was observed in 81 patients (10.04% of the sample); 66.7% of them suffered relapse within 2 years and 80.2% within 3 years after the termination of the primary treatment; 41.9% showed distant metastases while the rest corresponded to local-regional (40.7%) or ganglionar (17.4%) relapse; 42% of these were symptomatic; 14 patients showed more than 1 site of relapse. Relapse was detected mainly through symptoms and physical examination findings (54.3%), followed by elevated serummarker levels (29.6%), computed tomography (CT) images (9.9%) and abnormal vaginal cytology findings (6.2%). No differences in global survival were found between patients with symptomatic or asymptomatic relapse. Conclusion Taking into account that the recurrence rate of endometrial cancer is low, that relapse occurs mainly within the first 3 years post-treatment and that symptom evaluation and physical examination are the most effective follow-up methods, we postulate that a modification of the current model of hospital follow-up should be considered.


Subject(s)
Humans , Female , Clinical Protocols/standards , Endometrial Neoplasms/mortality , Carcinoma, Endometrioid/mortality , Neoplasm Recurrence, Local/mortality , Spain , Women's Health Services , Tomography, X-Ray Computed , Retrospective Studies , Outcome Assessment, Health Care , Endometrial Neoplasms/surgery , Endometrial Neoplasms/pathology , Endometrial Neoplasms/diagnostic imaging , Carcinoma, Endometrioid/surgery , Carcinoma, Endometrioid/pathology , Carcinoma, Endometrioid/diagnostic imaging , Disease-Free Survival , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Staging
17.
Clinics ; 76: e2059, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153970

ABSTRACT

OBJECTIVES To evaluate the results of radiotherapy (RT) for follicular lymphoma (FL) under different management scenarios. METHODS We retrospectively assessed consecutive patients with FL who had undergone irradiation between 2010 and 2018. All patients had biopsy-proven FL and were positron emission tomography-staged, although some (35.3%) were reassessed with computed tomography after treatment alone. Rituximab was only available to FL patients after 2016. RESULTS Thirty-four patients were selected, with a mean age at diagnosis of 61.6 years (34-89 years). The median follow-up duration was 49.4 months. Most patients were female (58.8%) and showed good performance on the Eastern Cooperative Oncology Group (ECOG) scale (ECOG 0-55.9%). The mean overall survival (OS) and progression-free survival were 48.7 and 33.6 months, respectively, with four deaths reported. OS rates at 2 and 3 years were 94.1% and 91.2%, respectively. Four patients showed transformation into aggressive lymphomas and underwent rituximab-based systemic treatment. Transformation-free survival was 47.8 months, and all patients with transformed disease were alive at assessment. Five patients had in-field relapse, all of them also relapsed elsewhere, and the mean relapse-free survival time was 40.3 months. No median end points were reached on assessment. CONCLUSION FL is an indolent disease. Our findings show good outcomes for patients treated with radiation, with a low transformation rate and excellent management of relapsed disease. RT is an important part of these results.


Subject(s)
Humans , Male , Female , Lymphoma, Follicular/drug therapy , Lymphoma, Follicular/radiotherapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Retrospective Studies , Treatment Outcome , Disease-Free Survival , Rituximab/therapeutic use , Progression-Free Survival , Neoplasm Recurrence, Local
18.
Journal of Experimental Hematology ; (6): 1471-1477, 2021.
Article in Chinese | WPRIM | ID: wpr-922281

ABSTRACT

OBJECTIVE@#To investigate the optimal time of monitoring minimal residual disease (MRD) for predicting survival and prognosis in children with T-cell acute lymphoblastic leukemia (T-ALL) after treated by CCLG-ALL2008 chemotherapy.@*METHODS@#96 children with T-ALL receiving CCLG-ALL2008 chemotherapy treated in our hospital from January 2015 to January 2020 were retrospectively summarized. The follow-up time was 9.0-65.0 months, with a median of 43.5 months. Kaplan-Meier survival curve was used to detect the overall event-free survival (EFS) and overall survival (OS) of the patients. The clinical data, MRD levels after 15 d, 33 d and 90 d chemotherapy between EFS group and relapse group, as well as OS group and death group were compared by using univariate analysis. Multivariate Logistic regression analysis was used to screen the main risk factors affecting EFS and OS of the patients. The patients were divided into low, moderate and high-risk according to the MRD level after 15 d, 33 d and 90 d, the differences of EFS and OS between each groups were compared again.@*RESULTS@#By the end of follow-up, 50 patients recurred and other 46 patients non-recurred; 40 patients died and 56 patients survived, the EFS was (49.5±6.3)% and OS was (61.5±5.9)%. Univariate analysis showed that the initial WBC count in EFS group (n=46) was significantly lower than that in relapse group (n=50), and MRD levels after 33 d and 90 d were significantly less also (P0.05), however for 90 d, EFS and OS of the patients in high-risk group were significantly lower than those in medium-risk group, and those in medium-risk group were lower than those in low-risk group (P<0.05).@*CONCLUSION@#The MRD level after 90 days CCLG-ALL2008 chemotherapy may be the best time to predict the survival and prognosis in T-ALL children.


Subject(s)
Child , Disease-Free Survival , Humans , Neoplasm, Residual , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Precursor T-Cell Lymphoblastic Leukemia-Lymphoma , Prognosis , Retrospective Studies , Risk Factors , T-Lymphocytes
19.
Journal of Experimental Hematology ; (6): 1169-1174, 2021.
Article in Chinese | WPRIM | ID: wpr-888534

ABSTRACT

OBJECTIVE@#To investigate the clinical characteristics and prognostic factors of primary follicular lymphoma (FL) patients with grade 3 or large B cell transformation, so as to provide more reference for the subsequent clinical diagnosis and treatment.@*METHODS@#Forty-seven primary FL patients with grade 3 or large B cell transformation from March 2010 to March 2018 were selected, the clinical characteristics and survival of patients were analyzed. Cox regression model were used to evaluate the related prognostic factors.@*RESULTS@#The cumulative progression-free survival rate and cumulative overall survival rate of 47 patients in 3-year follow-up reached to 55.32% (26/47) and 80.85% (38/47) respectively. There were significant differences in cumulative progression-free survival rate and cumulative overall survival rate among different subgroups of IPI, FLIPI-1 and FLIPI-2 in 3-year follow-up (P3 cm lymph node-involved site number≥3, extranodal lesion site number≥2, IPI score=2-3, FLIPI-1 score and FLIPI-2 score≥3 were the risk factors for progression-free survival (P<0.05); LDH≥240 U/ml, IPI score=2-3 and FLIPI-2 score≥3 were risk factors for overall survival (P<0.05). Cox regression model multivariate analysis showed that IPI score=2-3 was the independent risk factor for progression-free survival and overall survival (P<0.05). FLIPI-2 score≥3 was the independent risk factor for overall survival (P<0.05).@*CONCLUSION@#Primary FL patients with grade 3 or large B cell transformation by using the existing treatment regimen might be possibly curable, and the current treatment strategies and IPI score can be used to predict the clinical prognosis of patients.


Subject(s)
B-Lymphocytes , Disease-Free Survival , Humans , Lymphoma, Follicular , Prognosis , Retrospective Studies , Risk Factors , Survival Rate
20.
Journal of Experimental Hematology ; (6): 1163-1168, 2021.
Article in Chinese | WPRIM | ID: wpr-888533

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy of first-line and salvage autologous hematopoietic stem cell transplantation (auto-HSCT) in the treatment of patients with diffuse large B-cell lymphoma (DLBCL).@*METHODS@#The clinical data of 30 patients with DLBCL aged≤60 years old were retrospectively analyzed, and the patients were divided into first-line auto-HSCT group (15 cases) and salvage auto-HSCT group (refractory relapsed patients, 15 cases) according to the timing of transplantation, and the efficacy was analyzed. Anyone of the factors must be followed in patients receiving first-line HSCT: aaIPI score≥2 points, Ann-Arbor stage III-IV, large mass (diameter≥10 cm) or double expression of c-myc/BCL-2.@*RESULTS@#The median follow-up time for all patients after transplantation was 26 (3-103) months. Until the end of follow-up, 23 patients survived and 7 patients died. All the 7 dead patients with multiple organ failure due to the relapse and disease progression. The median survival time of 7 dead patients from transplantation to death was 6 (3-11) months. Among the 15 patients in the first-line auto-HSCT group, there were 2 patients relapsed (13.3%), 1 dead (6.7%), 14 patients survived [overall survival (OS) rate was 93.3%]. Among the 15 patients treated with salvage auto-HSCT, 6 patients died due to disease progression or relapse (40%), 9 cases survived (OS rate was 60%). There was a statistically significant difference in the mortality of patients between the two groups (6.7% vs 40%, P=0.006). The 3-year PFS and OS rates of patients in first-line auto-HSCT group were both 93.3%. The 3-year PFS and OS of patients in salvage auto-HSCT group were 58.7% and 59.2%. The 3-year OS and PFS of patients in the first-line auto-HSCT group were significantly higher than those in the salvage auto-HSCT group (P=0.03, P=0.04). The bone marrow suppression was the most common adverse complication and all patients showed grade III-IV granulocytopenia. Non-hematological adverse reactions were mainly gastrointestinal adverse reactions and oral mucositis. There was no statistically significant difference in adverse reactions between the two groups.@*CONCLUSION@#First-line auto-HSCT can be used as a consolidation treatment for DLBCL patients with poor prognostic factors. Auto-HSCT can further improve the prognosis of salvage chemotherapy-sensitive patients with refractory relapsed DLBCL.


Subject(s)
Disease-Free Survival , Hematopoietic Stem Cell Transplantation , Humans , Lymphoma, Large B-Cell, Diffuse/therapy , Middle Aged , Neoplasm Recurrence, Local , Retrospective Studies , Transplantation, Autologous , Treatment Outcome
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