Sentinel Lymph Node Impact on the Quality of Life of Patients with Endometrial Cancer.

OBJECTIVE: Given the improvement in the surgical treatment of endometrial cancer with the inclusion of sentinel lymph node biopsy (SLNB), our aim was to evaluate the impact of this minimally invasive and tailored nodal assessment on patients' quality of life (QoL). METHODS: This was a cross-sectional study conducted in a single-centre, tertiary-level hospital. Patients diagnosed with preoperative early-stage endometrial cancer, who underwent primary surgical treatment between August 2015 and November 2021, were included. The enrolled patients were divided into two cohorts according to the nodal staging performed: the first group underwent only SLNB (SLNB group); the second group underwent pelvic and/or para-aortic lymphadenectomy (LND group). We evaluated the overall QoL using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life core 30-item questionnaire (EORTC QLQ-C30) and a sexual health questionnaire (EORTC SHQ-C20). The scores were compared between the groups. RESULTS: Ninety patients were enrolled in the study: 61 (67.8%) in the SLNB group and 29 (32.2%) in the LND group. In the LND group, 24 (82.7%) patients underwent pelvic and para-aortic LND, while 5 (17.3%) patients underwent pelvic LND. The assessment of the functional scales showed better results for the SLNB group than for the LND group, with a significantly lower impact on physical status (8.2% vs. 25%, respectively; p = 0.031). In terms of the symptom scales, the SLNB group reported a significantly lower negative impact on sleep quality (4.9% vs. 27.6%, respectively; p < 0.01), pain (1.6% vs. 13.8%, respectively; p = 0.019), and dyspnoea (0% vs. 10.3%, respectively; p = 0.011) than the LND group. The SLNB group had better results for all analysed items regarding sexual QoL. CONCLUSIONS: The implementation of a surgical technique with SLNB improved patients' overall QoL by increasing their well-being in the functional and symptom spheres.

Predictive factors of risk of hepatocellular carcinoma in chronic hepatitis C.

OBJECTIVE: To identify risk factors associated with the development of HCC and develop a score to identify high risk subgroups. METHODS: We conducted a follow-up study, with biannual ultrasound and alpha-fetoprotein screening, in an unselected cohort of patients with chronic hepatitis C referred for evaluation from the primary care. RESULTS: 863 patients with chronic hepatitis C were followed for an average of 82 months. 58 patients have developed HCC (7%). 34 (4%) patients were excluded from analysis due to detection of liver cancer at first evaluation. The demographic and clinical variables collected during the first 6 months of evaluation were analyzed retrospectively. Cox proportional multivariate regression analysis identified four independent factors related with HCC risk; age, alpha-fetoprotein level, gammaglobulin level and platelet count below 150,000/ml. A risk score formula (HCC-4) was constructed which lets us identify patients with low (annual incidence of 0.05%), intermediate (annual incidence of 0.6%) and high (annual incidence 2.6%) risk of HCC development with an area under the curve of 0.802. CONCLUSION: The application of the score to the cohort let us identify a high-risk subgroup of patients with an annual HCC incidence of 2.6%, in which the screening would be cost-effective.

Infección de prótesis de aorta ascendente. ¿Es necesario retirar la prótesis siempre? ¿Cuánto tiempo con tratamiento antibiótico? / Infected ascending aorta prostheses. Is prosthesis removal always necessary? How long should antibiotics be given?

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