Persistent high levels of carcinoembryonic antigen after tumor resection are associated with poorer survival outcomes in patients with resected colon cancer.

BACKGROUND: Interindividual survival and recurrence rates in cases of locoregional colon cancer following surgical resection are highly variable. The aim of the present study was to determine whether elevated pre-operative and post-operative CEA values are useful prognostic biomarkers for patients with stage I-III colon cancer who underwent surgery with curative intent. METHODS: We conducted a retrospective study in patients with histologically confirmed stage I-III primary colonic adenocarcinoma who underwent radical surgical resection at Mexico's National Cancer Institute, between January 2008 and January 2020. We determined pre-operative and post-operative CEA and analyzed the association of scores with poorer survival outcomes in patients with resected colon cancer, considering overall survival (OS) and disease-free survival (DFS). RESULTS: We included 640 patients with stage I-III colon cancer. Pre-operative CEA levels were in the normal range in 460 patients (group A) and above the reference value in the other 180. Of the latter, 134 presented normalized CEA levels after surgery, but 46 (group C) continued to show CEA levels above the reference values after surgery. Therefore, propensity score matching (PSM) was carried out to reduce the bias. Patients were adjusted at a 1:1:1 ratio with 46 in each group, to match the number in the smallest group. Median follow- up was 46.4 months (range, 4.9-147.4 months). Median DFS was significantly shorter in Group C: 55.5 months (95% CI 39.6-71.3) than in the other two groups [Group A: 77.1 months (95% CI 72.6-81.6). Group B: 75.7 months (95% CI 66.8-84.5) (p-value < 0.001)]. Overall survival was also significantly worse in group C [57.1 (95% CI 37.8-76.3) months] than in group A [82.8 (95% CI 78.6-86.9 months] and group B [87.1 (95% CI 79.6-94.5 months] (p-value = 0.002). To identify whether change in CEA levels operative and post-surgery was an independent prognostic factor for survival outcomes, a Cox proportional hazard model was applied. In multivariate analysis, change in CEA level was a statistically significant, independent prognostic factor for overall survival (p-value = 0.031). CONCLUSIONS: When assessed collectively, pre-operative and post-operative CEA values are useful biomarkers for predicting survival outcomes in patients with resected colon cancer. Prognoses are worse for patients with elevated pre-operative and post-surgical CEA values, but similar in patients with normal post-surgical values, regardless of their pre-surgery values.

Prevalencia de glucosa alterada en ayuno y dislipidemia entre pacientes mexicanos con VIH naïve a tratamiento antirretroviral.

BACKGROUND: Metabolic complications have become more relevant in the care of patients with HIV. However, little is known about the incidence and risk factors for these disorders among HIV-infected antiretroviral treatment naïve (ARTn) patients. OBJECTIVE: To recognize the prevalence of Impaired Fasting Glucose (IFG) and dyslipidemia among HIV-infected ARTn Mexican individuals and identify associated risk factors. METHOD: A retrospective study was conducted in HIV-1-infected ART-N patients, referred for attention to a general hospital in Mexico City, between 2009 and 2019. We collected information for anthropometric, clinical, biochemical and HIV status variables. RESULTS: We included 221 patients, 97% were males, mean age 30 years (interquartile range [IQR]: 25-38); median CD4 count was 250 cells/mm3 (IQR: 120.25-391) and median log10 HIV viral load was 4.69 HIV-1 RNA copies/ml (IQR: 3.64-5.25). Prevalence of IFG was 22.6% and was associated with overweight-obesity (odds ratio [OR]: 2.75; 95% confidence interval [95% CI]: 1.36-5.55; p-value < 0.05). Hypoalphalipoproteinemia was the most frequent dyslipidemia: 69.46%. An association between count CD4 < 250 and lower HDL cholesterol levels was found (OR: 3.23; 95CI%: 1.61-6.5; p-value < 0.05). CONCLUSIONS: IFG and dyslipidemia are highly prevalent among HIV-infected ART-naïve Mexican patients, therefore, screening for glucose and lipids abnormalities always should be considered among ARTn patients.

ANTECEDENTES: Las alteraciones metabólicas se han vuelto más relevantes en el cuidado de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Existe poca información sobre estas alteraciones en pacientes naïve a tratamiento antirretroviral (nTAR). OBJETIVO: Identificar la prevalencia de glucosa alterada en ayuno y dislipidemia entre individuos mexicanos con VIH nTAR e identificar los factores asociados. MÉTODO: Estudio retrospectivo en pacientes con VIH nTAR valorados en un hospital general de la Ciudad de México de 2009 a 2019. Se recabaron datos antropométricos, clínicos, bioquímicos y relacionados con el estado del VIH. RESULTADOS: Se incluyeron 221 pacientes, el 97% hombres, con mediana de edad 30 años (rango intercuartil [RIC]: 25-38), cuenta de linfocitos CD4 250 células/mm3 (RIC: 120.25-391) y carga viral log10 4.69 copias/ml (RIC: 3.64-5.25) de VIH-1 ARN. La prevalencia de glucosa alterada en ayuno fue del 22.6% y presentó asociación con sobrepeso-obesidad (razón de momios [RM]: 2.75; intervalo de confianza del 95% [IC95%]: 1.36-5.55; p < 0.05). La dislipidemia más frecuente fue la hipoalfalipoproteinemia (69.46%), asociada con CD4 < 250 (RM: 3.23; IC95%: 1.61-6.5; p < 0.05). CONCLUSIONES: Las alteraciones en el metabolismo de los lípidos y de la glucosa son frecuentes entre individuos mexicanos con VIH nTAR; por lo tanto, es importante una adecuada evaluación antes de iniciar el tratamiento.