ABSTRACT
BACKGROUND: Soft tissue sarcomas are rare malignant tumors with significant heterogeneity. The importance of classifying histological grades is fundamental to defining the treatment approach. OBJECTIVE: To evaluate magnetic resonance imaging (MRI) in predicting the histological grade of soft tissue sarcomas. METHODS: A retrospective observational study included patients over 18 years undergoing MRI and primary tumor surgery at AC Camargo Cancer Center from January 2015 to June 2022. Two radiologists evaluated MRI criteria (size, margin definition, heterogeneity of the T2 signal, high-intensity peritumoral signal on T2, and postperitumoral contrast), and a grading prediction score was calculated. χ2 and logistic regression analyses were conducted. RESULTS: Sixty-eight patients were included (38 men; median: 48 years). Moreover, 52 high-grade and 16 low-grade tumors were observed. The MRI criteria associated with histological grade were peritumoral high-intensity T2-weighted signals (p < 0.001) and peritumoral postcontrast enhancement (p = 0.006). Logistic regression confirmed their significance (odds ratio [OR]: 11.8 and 8.8, respectively). Each score point increment doubled the chance of high-grade tumors (OR: 2.0; p = 0.014). CONCLUSION: MRI effectively predicts histological grades of soft tissue sarcomas. Peritumoral high-intensity T2-weighted signals and peritumoral postcontrast enhancement are valuable indicators of high-grade tumors. This highlights MRI's importance in treatment decision-making for sarcoma patients.
ABSTRACT
ABSTRACT BACKGROUND Colorectal cancer (CRC) is a worldwide health problem whose control depends on public policy establishment and effective prevention and screening programs. In Brazil, there are few studies related to adherence to screening methods. AIMS: The aim of this study was to evaluate the association between demographic and socioeconomic to adherence to CRC screening with fecal immunochemical test (FIT) among average-risk individuals for CRC. METHODS: In this prospective cross-sectional study, conducted between March 2015 and April 2016, 1,254 asymptomatic individuals aged 50-75 years, participating in a hospital screening campaign in Brazil, were invited to participate in the study. RESULTS: The adherence rate to FIT was 55.6% (697/1,254). In the multivariable logistic regression analysis, patients aged 60-75 years (odds ratio (OR)=1.30; 95% confidence interval (CI): 1.02-1.66; p=0.03), religious belief (OR=2.04; 95% CI: 1.34-3.11; p<0.01), previous fecal occult blood test (OR=2.07; 95% CI: 1.55-2.76; p<0.01), and full/part-time working status (OR=0.66; 95% CI: 0.49-0.89; p<0.01) were independently associated with adherence to CRC screening. CONCLUSION: The results of the present study highlight the importance of considering the labor aspects when implementing screening programs, suggesting that campaigns conducted in the workplace and repeated over the years may be more effective.
RESUMO RACIONAL: O câncer colorretal (CCR) é um problema de saúde mundial cujo controle depende do estabelecimento de políticas públicas e programas de prevenção e rastreamento eficazes. No Brasil existem poucos estudos relacionados à adesão métodos de rastreamento. OBJETIVO: Avaliar a associação de características sócio-demográficas à realização de testes de sangue oculto nas fezes do tipo imunoquimicomecanizado (FIM) em população de médio risco para o desenvolvimento de câncer colorretal. MÉTODOS: Estudo observacional transversal, com coleta prospectiva de dados. Entre março de 2015 e abril de 2016, 1.254 indivíduos assintomáticos, com idade entre 50 e 75 anos, foram consecutivamente selecionados a partir de uma campanha hospitalar de rastreamento para neoplasias. RESULTADOS: As taxas de adesão ao teste FIM foi 55.6% (697/1254). Na análise de regressão logística múltipla os fatores independentes associados à adesão ao rastreamento do CCR foram: Idade entre 60-75 anos (oddsratio (OR)=1.30; intervalo de confiança de 95% (IC): 1.02-1.66; p=0.03), crença religiosa (OR=2.04; 95%IC: 1.34-3.11; p<0.01), realização prévia de exame de sangue oculto nas fezes (OR=2.07; 95%IC: 1.55-2.76; p<0.01) e vínculo empregatício em período integral ou parcial (OR=0.66; 95%IC: 0.49-0.89; p<0.01). CONCLUSÃO: Este estudo enfatiza a importância de considerar aspectos laborais ao implementar programas de rastreamento do câncer colorretal e sugere que campanhas de rastreamento implantadas no ambiente de trabalho e de maneira repetida ao longo dos anos podem ser mais efetivas.
ABSTRACT
Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. Brazil does not have an official well established program for screening colorectal cancer. The aim of this study was to compare Guaiac Based Fecal Occult Blood Test (G-FOBT) to a kind of an Immunochemical Fecal Occult Blood Test (I-FOBT), in search of cancer or advanced adenoma. Methods: Prospective and cross-sectional study. Asymptomatic and average-risk individuals (n = 1500) aged from 50 to 75 years old were invited to participate in the study. The primary endpoint was positivity rate and the secondary endpoints were adherence rate and significant endoscopic findings. All participants received both tests with follow-up colonoscopy if either test was positive. Results: Adherence rate of G- FOBT was 756/1500 (50.4%) while for I- FOBT it was 960/1500(64%). The positivity ratio in the I- FOBT was 94/960 (9.8%) and in the G-FOBT was 20/771 (2.6%). The Positive Predict Value (PPV) for the I- FOBT counted 16/77 (21.0%) while for the G- FOBT it was 6/18 (33.0%), considering significant lesions. Regarding the colorectal cancer findings, the detection in the colonoscopy guided from the positivity of fecal occult blood tests was 5/77 (6.5%) in I- FOBT and 2/18 (11.1%) on the G- FOBT. Conclusions: The positivity, the adherence rate and the capacity to detect significant lesions were higher in I-FOBT. Considering the findings of the study we could conclude that I-FOBT was superior to G- FOBT. Trial registration: This study was reviewed and approved by the Institutional Review Board of A.C.Camargo Cancer Center, São Paulo, Brazil, number: 1877/14
Subject(s)
Humans , Male , Female , Colorectal Neoplasms , Adenoma , Mass Screening , Early Detection of Cancer , Occult BloodABSTRACT
Background: Colorectal cancer (CRC) is a neoplasia with high incidence and mortality rates. It had been suggested that the inflammatory response is an important CRC prognostic factor. The disordered and accelerated proliferation of neoplastic cells decreases the oxygen and nutrient supply, generating a microenvironment characterized by hypoxia, necrosis and inflammation. This study aimed to evaluate the impact of factors associated with hypoxia, such as HIF1A (hypoxia-inducible factor 1-alpha) and VEGF (vascular endothelial growth factor), and with lipid metabolism, including PPARG (peroxisome proliferator-activated receptor-gamma), LXRA (liver X receptor-alpha) and LXRB (liver X receptor-beta), on the overall survival (OS) of CRC patients. Methods: This was a cohort study of 101 patients with high-risk stage II-III (TNM) CRC located above the peritoneal reflection. They were treated between 1990 and 2004 at the AC Camargo Cancer Center. Immunohistochemical analyses of HIF1A, VEGF, PPARG, LXRA and LXRB protein expression were performed using tissue microarrays (TMAs). Results: There was an association between the presence of vascular invasion and the lack of VEGF expression (p = 0. 028) as well as with positive HIF1A expression and lymphatic invasion (p = 0.045). The 5-year and 10-year OS rates were 76.6% and 60.2%, respectively. Patients with PPARG-positive tumors had a higher OS (p = 0.018). There were no correlations between the positive expression of VEGF, HIF1A, LXRA or LXRB and OS. The Cox regression model demonstrated that the risk of death was 2.72-fold higher in patients with PPARG-negative tumors (95% CI = 1.086.85). Conclusion: The PPARG expression was an independent prognostic factor for CRC tumors and might be used for risk stratification to stage II and stage III CRC patients (AU)
Subject(s)
Humans , Male , Female , Prognosis , Immunohistochemistry , Colorectal Neoplasms , Survival Analysis , Cohort Studies , Lipid Metabolism , HypoxiaABSTRACT
Family adenomatous polyposis (FAP) is a dominant autossomic disease responsible for nearly 1% of colorectal cancer (CRC) cases caused by mutations in gene APC and nearly complete penetrance. The identification of germinative mutations can be useful in the definition of the therapeutic conduct by means of the correlation genotype-phenotype. Objective: To describe clinical and molecular characteristics of families with FAP or attenuated FAP. Method: The study included families registered in the Hereditary Colorectal Cancer Registry of A.C.Camargo Hospital. Cancer records were registered and heredograms were created. Data were collected and stored in a database. Results: From 1992 to 2007 22 families were registered that had FAP, 16 with classic FAP, nine with Gardner Syndrome, and 6 with attenuated FAP. From 604 individuals, 120 had polyposis, 62 CRC, 10 desmoid tumors, three breast tumors, two tumors of the stomach, two thyroid tumors and one with prostate tumor. From 22 families, three were submitted to molecular analysis and mutations were identified in gene APC. Discussion: Half of the individuals presented CRC concomitant to polyposis, which can indicate a late diagnostic of the disease; three identified mutations presented correlations genotype-phenotype as predicted by the literature. Follow-up of patients with FAP, although they account for less than 1% of CRC cases, is vital for early cancer diagnosis.
Subject(s)
Humans , Colon , Heredity , Neoplasms , Adenomatous Polyps , RectumABSTRACT
P16 and p27 are inhibiting proteins of cyclin-dependent kinases (CDKIs) that act in the restriction points of the cellular cycle, and it avoids its progression to DNA verification and repair by the cellular apparatus. This way, there should be, physiologically, an inverse relation between the expression of these proteins and cellular proliferation. However, what is really observed are changeable amounts of p27 in normal and tumor tissues. P16 participation in tumorigenesis is controversial. The expression of p16 and p27 as a prognostic factor in colorectal cancer (CRC) patients is controversial. Objetive: To establish a correlation between p16 and p27 immunohistochemical expressions with clinical and anatomopathological variable from patients with CRC. Material and methods: descriptive and retrospective study, with 128 CRC patients, treated surgically between 2000 and 2004, with available material for immunohistochemical analysis through standardized methods. The association between categorical variables was done using Chi-square, Pearson or Fisher?s Exact tests, and the continuous variables were analyzed by t-Student. Global survival and disease-free period were calculated according to Kaplan-Meier method and the associations through log-rank test. Results: The average follow-up time of patients was 35 months. Positivity of p16 was detected in 100% of cases. Negativity of p27 in 6.3% (n=8) of cases, with a significant association (p30.05) between p27 negative and tumors located in right colon (62.5%, n=5) and mucinous (62.5%, n=5). The average global survival was 54.8 months, and the significant clinical and pathological variables associated to survival were: better for curative surgeries; better for early stages; better for well-differentiated tumors; worse for cases with sanguineous or vascular lymphatic invasion; worse for perineural invasion. Conclusions: p27 negative is more frequent in right colon...
Subject(s)
Humans , Adult , Colorectal Neoplasms , Colorectal Neoplasms/diagnosis , Immunohistochemistry , SurvivalABSTRACT
Introduction: the correct evaluation of lymph node disease influences the therapeutical decisions of colon and rectal cancer(CRC) patients. The number of dissected lymph nodes is a variable that have prognostic value and serves as an indicator of thequality of oncology treatment. For a correct evaluation of N stage to be accepted, the minimum number of dissected lymphnodes considered must be 12. In rectal cancer patients submitted to neoadjuvant radiochemotherapy, the interpretation of thenumber of dissected lymph nodes remains inconclusive. Objective: is to evaluate the number of dissected lymph nodes in CRCpatients submitted to curative surgery and determine this latter impact in oncologic treatment results. In cases of rectalcancer, to study the effect of neoadjuvant radiochemotherapy in dissected lymph nodes count. Method: in the period 1991-2004, 852 CRC patients were treated in Hospital A. C. Camargo . Patients with metastases at the time of diagnosis,synchronous and metachronic tumors, total colectomy or total proctocolectomy and hereditary colorectal cancer were excluded.The sample was constituted by 423 patients with sporadic colorectal adenocarcinoma who undergone curative radical surgery(168 colon primary tumors and 255 rectal tumors). Colon cancer patients, treated primarily by surgery, had also receivedadjuvant chemotherapy (5-FU) according to risk criteria. Rectal cancer patients with fixed or half-fixed injuries or clinicallycompromised lymph nodes (T3, T4 or N+) had received neoadjuvant radiochemotherapy, followed by surgery and chemotherapy(5-FU). Results: the median of the number of dissected lymph nodes in colon cancer patients was 17. In the case of rectalcancer patients, the median of dissected lymph nodes in the groups with and without neoadjuvant radiochemotherapy had beenrespectively 9 and 15 (p<0.001). 5-year specific survival rates for colon and rectal cancer patients were respectively...
Subject(s)
Humans , Male , Female , Colorectal Neoplasms , Rectal Neoplasms , Colorectal Surgery , Oncology Service, HospitalABSTRACT
Introdução - A Síndrome de Lynch é uma doença hereditária que predispõe aos tumores colorretais, entre outros tumores, em idade precoce, com padrão de herança autossômica dominante, representando a principal causa de hereditária de câncer intestinal. Os genes de reparo defeituosos são responsáveis pela síndrome e podem ser identificados através dos testes de seqüenciamento dos genes. Os genes MLH1 e MSH2 são responsáveis por mais de 85% das mutações germinativas encontradas nestas famílias. O restante são causadas por outros genes de menor incidência, MSH6 e PMS2. A correlação clínico-molecular foi avaliada mais extensivamente em populações norte-americanas, com poucos estudos com a população brasileira. Objetivos - Este estudo tem como objetivo avaliar a correlação clínico-molecular de dados referentes aos pacientes com suspeita de SL, assim como de dados de membros da família com câncer relacionados à síndrome. Materiais e métodos foram estudados 43 pacientes probandos e os familiares selecionados a partir de casuística do Hospital A.C. Camargo que preenchiam os critérios clínicos para SL, Amsterdam I ou II e também pacientes com critérios de Bethesda que apresentassem mutação em qualquer dos genes de reparo. Todos os pacientes foram submetidos a pesquisa de mutações, por seqüenciamento direto, nos genes MLH1 e MSH2 e nos casos inconclusivos foram avaliados também para os genes MSH6 e PMS2. As variáveis clínicas, anatomopatológicas e dados familiares foram correlacionados com as informações obtidas dos estudos moleculares. Para a averiguação de associações entre variáveis foi realizada análise univariada, através do teste qui-quadrado ou exato de Fisher, e a sobrevida dos pacientes probandos através do método de Kaplan-Meier. Resultados - A freqüência de identificação de mutação patogênica nos genes de reparo foi de 60,2%, em 26 probandos...
Subject(s)
Humans , Immunohistochemistry , Neoplasms , Colorectal Neoplasms, Hereditary NonpolyposisABSTRACT
O câncer colorretal se destaca entre as neoplasias malignas mais incidentes no Brasil e no mundo. Estratégias de rastreamento incluem a pesquisa de sangue oculto nas fezes ou a colonoscopia, aplicadas às populações sob maior risco. A sintomatologia é pouco específica e a colonoscopia é o método ideal para diagnóstico, sendo indicada sempre que houver sinais e sintomas intestinais. O estadiamento define as modalidades de tratamento e é direcionado para as vias mais comuns da disseminação da doença: linfática, hematogênica, contiguidade e implantes. Quando o diagnóstico se faz em estádios iniciais, o tratamento do câncer colorretal proporciona elevadas taxas de cura. Este artigo resume de forma esquemática as modalidades atuais de tratamento, estratificadas em função do estadiamento.
Subject(s)
Humans , Neoplasm Metastasis/therapy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/therapyABSTRACT
OBJECTIVE: to describe preliminary results ofcytoreductive surgery and intraperitoneal hyperthermicchemotherapy in the treatment of peritonealcarcinomatosis from a brazilian single institution.MATERIALS AND METHODS: a short cohort study wascarried out. 26 patients and 28 procedures wereperformed consecutively between March 2001 and June2005. 17 patients (65.4%) were treated for pseudomyxomaperitonei, 4 patients had mesothelioma, 2 carcinomatosisfrom colorectal cancer origin, 2 from ovary cancer and 1had peritoneal sarcomatosis. All cases were treated withclosed perfusion technique. The Completeness ofCytoreduction Score was used to classify the radicalityof the procedure and the NIH Commom Toxicity Criteriawas used to classify the complications. RESULTS: CC0and CC1 resections were achieved in 24 cases (85.7%).Grade 3 or 4 toxicity were observed in 5 cases (17.8%)and two patients died (7.1%). Severe complications weresignificant associated with the duration of surgery (morethan 10 hours). CONCLUSION: this radical treatment ofperitoneal carcinomatosis envolves high morbidity andmortality rates and must be conducted in referral centerswith multiprofessional teams and carefully selection ofpatients.
Subject(s)
Humans , Male , Female , Drug Therapy , Peritoneal Neoplasms , Carcinoma , Colorectal Neoplasms , Fever/therapyABSTRACT
Cerca de 4 por cento a 15 por cento dos tumores colorretais são hereditários e divididos em dois grupos: polipose adenomatosa familiar (FAP) e câncer colorretal hereditário sem polipose (HNPCC). Ambas são doenças autossômicas dominantes, com transmissão vertical, geração após geração, sem preferência por sexo. A FAP tem penetrância praticamente completa, caracterizada por mais de cem pólipos adenomatosos no intestino grosso, que aparecem em geral após a puberdade e se transformam em câncer em todos os casos não tratados, levando o paciente ao óbito em torno dos 45 anos de idade. Manifestações extracolônicas são comuns, tais como: pólipos em estômago e duodeno, sarcomas abdominais, pigmentação de retina, osteomas, entre outras. A FAP é causada por mutação no gene APC, que está localizado no cromossomo 5q. Seu tratamento é basicamente cirúrgico, com retirada do intestino grosso, podendo-se preservar o reto, se este não apresentar muitos pólipos. O HNPCC tem penetrância em torno de 80 por cento e não apresenta os pólipos benignos como na FAP, que permitem identificar pacientes com o fenótipo da doença. Geralmente, o diagnóstico da lesão colônica é realizado já na fase maligna, em torno dos 45 anos de idade, com preferência para o lado direito do cólon. Pode haver associação com tumores de endométrio na mulher, estômago, pâncreas, entre outros. É causada por mutação em genes de reparo do DNA (hMSH2, hMLH1, hPMS1, hPMS2, hMSH6/GTBP). A colectomia total deve ser realizada em pacientes com câncer de cólon e HNPCC. Se o tumor estiver localizado no reto, a proctocolectomia total pode ser uma opção. Em indivíduos portadores do defeito genético predisponente ao HNPCC, porém, assintomáticos, a indicação de cirurgias profiláticas é controversa. Atualmente, podem-se identificar indivíduos portadores de defeito genético herdado tanto na FAP como no HNPCC. Esses testes baseiam-se no estudo direto dos genes responsáveis pela respectiva doença ou pela proteína produto dos mesmos. É de suma importância uma abordagem multidisciplinar de pacientes portadores de FAP ou HNPCC, pois existe uma preocupação ética muito grande na realização dos testes genéticos de predisposição, considerando suas consequências psicológicas e sociais
Subject(s)
Colorectal Neoplasms, Hereditary Nonpolyposis , Adenomatous Polyposis Coli/etiology , Adenomatous Polyposis Coli/surgeryABSTRACT
Background: The authors report the treatment of three female patients with severe actinic rectitis, with stenosis of perforation, submitted to anterior proctosigmoidectomy and transanal coloanal anastomosis. methods: In all cases surgery consisted of total proctosigmoidectomy, mucosectomy of the anal canal, lowering of the left colon through the pelvis and tansanal anastomosis performed manually at the level of the pectineal line using separate absorbable sutures. A protective intestinal shunt was performed in all cases. Results: The three patients did not present transoperative or immediate postoperative complications, but the first patient developed deep venous thrombosis of the leg that was submitted to successful clinical treatment. The intestinal shunts were later closed in all three cases. Sphincter function was considered very good in the first case and regular in the remaining two. Conclusion: The surgical technique utilized was considered to be adequate for the cases reported and is the first option for the maintenance of transit in patients with severe actinic rectitis since the anastomosis is performed using non-irradiated colon with the pectineal line, practically outside the pelvis.
Subject(s)
Female , Aged , Middle Aged , Humans , Proctitis/surgery , Rectum/surgery , Colon, Sigmoid/surgery , Carcinoma, Squamous Cell/surgery , Urogenital Neoplasms/surgery , Anastomosis, Surgical/methods , Carcinoma, Squamous Cell/radiotherapy , Urogenital Neoplasms/radiotherapy , Treatment Outcome , Laparoscopy/methodsABSTRACT
Hemipelvectomia utilizando retalho miocutâneo anterior é indicada para tumores extensos da região glútea e parte posterior proximal da coxa. Um paciente do sexo masculino com 49 anos apresentou-se para tratamento de tumor ulcerado e infectado com crescimento progressivo há 3 anos em região glútea esquerda, originado de uma área de ulceração e cicatrização crônicas provocadas pela aplicação de múltiplas injeções de drogas ilícitas no local. O tumor infiltrava a pele, tecido celular subcutâneo e musculatura glútea, estando fixo ao osso ilíaco, articulação coxo-femural e trocanter maior. A tomografia computadorizada da pelve confirmou os achados do exame físico. A biópsia aberta foi realizada e revelou um carcinoma de células escamosas. Hemipelvectomia externa foi a opção escolhida para o tratamento. Um grande defeito foi criado após ressecção da extremidade inferior, hemipélvis e glúteo. Um retalho miocutâneo anterior do músculo quadríceps femural, adutores, sartório, pectíneo e grácil com pele e tecido celular subcutâneo sobrejacentes foi realizado. Os vasos femurais foram utilizados para manter o retalho viável. A recuperação pós-operatória aconteceu sem intercorrências e o retalho permaneceu totalmente viável. Alguns aspectos da técnica são apresentados.
Subject(s)
Male , Middle Aged , Humans , Carcinoma, Squamous Cell/surgery , Hemipelvectomy , Pelvic Neoplasms/surgery , Surgical Flaps , ThighABSTRACT
O objetivo principal deste estudo foi avaliar os resultados da cirurgia isolada ou associada a radioterapia préoperatória em pacientes portadoresde adenocarcinoma do reto. Foram analisados retrospectivamente 96 pacientes submetidos a cirurgias curativas entre 1972 e 1993. A análise visou, principalmente, comparar as taxas de sobrevida global em cinco anos e de recidiva local. Quarenta e seis pacientes tratados por cirurgias isoladas tiveram taxas de sobrevida em cinco anos e de recidiva local de 51,7 por cento e 26,9 por cento, respectivamente, nos estádios II e III. Cinquenta pacientes submeteram-se a radioterapia pré-operatória na dosagem de 4.500 cGy, em 25 sessões de 180 cGy, com taxas de sobrevida em cinco anos e de recidiva local de 60,8 por cento e 18,2 por cento, respectivamente, nos estádios II e III. As diferenças entre os dois grupos terapêuticos não foram estatisticamente significativas. A análise multivariada demonstrou que o estadiamento da neoplasia, principalmente com relação à presença ou não de linfonodos regionais metastáticos, foi o fator prognóstico mais importante, independentemente do grupo terapêutico analisado. Baseados nos resultados apresentados, discutimos que a indicação da radioterapia em câncer do reto deve ser mais seletiva, com realização de cirurgia imediata em pacientes portadores de tumores retais móveis, mesmo infiltrativos na parede, irradiando no pós-operatório apenas os casos com maior risco de recidiva, de acordo com o resultado do exame anatomopatológico da peça cirúrgica. Pacientes portadores de tumores com mobilidade reduzida em relação às paredes pélvicas devem ser irradiados no pré-operatório com a finalidade de facilitação do ato cirúrgico e diminuição do risco de disseminação de células tumorais no intra-operatório e consequente diminuição das taxas de recidiva local