Tumor histology is an independent prognostic factor in locally advanced cervical carcinoma: A retrospective study.

BACKGROUND: Even with different histologic origins, squamous cell carcinoma (SCC) and adenocarcinoma (AC) are considered a single entity, and the first-line treatment is the same. Locally advanced disease at the diagnosis of cervical cancer is the most important prognostic factor, the recurrence rate is high, making it necessary to evaluate prognostic factors other than clinical or radiological staging; histology could be one of them but continues to be controversial. The aim of this study was to evaluate tumor histology as a prognostic factor in terms of treatment outcomes, disease-free survival (DFS) and overall survival (OS) in a retrospective cohort of patients with Locally Advanced Cervical Carcinoma (LACC). METHODS: The records of 1291patients with LACC were reviewed, all of them were treated with 45-50 Gy of external beam radiotherapy with concurrent chemotherapy and brachytherapy. A descriptive and comparative analysis was conducted. Treatment response was analyzed by the chi-square test; DFS and OS were calculated for each histology with the Kaplan-Meier method and compared with the log-rank test; and the Cox model was applied for the multivariate analysis. RESULTS: We included 1291 patients with LACC treated from 2005 to 2014, of which 1154 (89·4%) had SCC and 137 (10·6%) had AC. Complete response to treatment was achieved in 933 (80·8%) patients with SCC and 113 (82·5%) patients with AC. Recurrence of the disease was reported in 29·9% of SCC patients and 31·9% of AC patients. Five-year DFS was 70% for SCC and 62·2% for AC. The five-year OS rates were 74·3% and 60% for SCC and AC, respectively. The mean DFS was 48·8 months for SCC vs 46·10 for AC (p = 0·043), the mean OS was 50·8 for SCC and 47·0 for AC (p = 0·002). CONCLUSION: Our findings support the hypothesis that SCC and AC are different clinical entities. TRIAL REGISTRATION: NCT04537273 .

Hand metastasis in a patient with cervical cancer: A case report.

INTRODUCTION: Acrometastasis is infrequent and generally indicates a wider spread of metastasis with poor prognosis. The diagnosis is challenging, as it might mimic an infectious, inflammatory, or metabolic disease. Acrometastasis are most commonly found in patients with lung, gastrointestinal, kidney, and breast cancer. Only 3 cases of cervical cancer associated with hand metastasis have been reported in the literature. PATIENT CONCERNS: Herein, we report a 58-year-old patient with locally advanced cervical cancer and recurrence in the right thumb as presentation of widespread disseminated disease. She initially presented with adenocarcinoma of the uterine cervix and was treated with concurrent chemoradiation followed by high-dose rate brachytherapy. Six months later, she developed an insidious onset of pain and swelling in the right thumb, erythema, and edema, mimicking cellulitis. DIAGNOSIS: A biopsy of the soft tissues of the thumb was performed, and the histopathology indicated metastasis of adenocarcinoma to the bone and soft tissues. INTERVENTIONS AND OUTCOMES: The patient rejected further treatment and died of progressive disease 4 months after the diagnosis of the recurrence. CONCLUSION: Metastases in unusual sites are a diagnostic challenge, and there is no standardized treatment. Timely diagnosis and treatment can improve the prognosis of these patients and might preserve their quality of life.

Impact of diabetes and hyperglycemia on survival in advanced breast cancer patients.

PURPOSE: We examined the impact of diabetes and hyperglycemia on cancer-specific survival of patients with metastatic or recurrent breast cancer (BC). METHODS: We performed a retrospective analysis of 265 patients with advanced BC receiving palliative chemotherapy. BC-specific mortality was compared for diabetic and nondiabetic patients as well as for patients that presented hyperglycemia during treatment. RESULTS: No difference was observed between the diabetic and nondiabetic patients in terms of overall survival (OS). A difference in OS was observed between nondiabetic patients and diabetic patients who had hyperglycemia. The OS was greater in diabetic patients with proper metabolic control than diabetic patients with hyperglycemia. The risk of death was higher in patients with mean glucose levels >130 mg/dL during treatment. Several factors were associated with poor OS: tumor stage, hormone-receptor-negative tumors, HER2 negative disease, multiple metastatic sites, presence of visceral metastases, and mean glucose >130 mg/dL. CONCLUSION: Elevated glucose levels are associated with a poor outcome in diabetic and nondiabetic patients in contrast to patients with normoglycemic levels, conferring an elevated risk of death. According to these results, clinicians should monitor glucose levels during treatment for advanced breast cancer disease and take action to maintain normal glucose levels.

[Transhepatic transanastomotic stents for bile duct injuries. Long-term evolution]. / Férula transhepática-transanastomótica en lesiones de las vías biliares. Evolución a largo plazo.

BACKGROUND: With loss of continuity of the bile ducts after injury, surgery is the only feasible treatment option. Roux-en-Y hepatojejunostomy is the best choice. The use of transhepatic and transanastomotic tubes is still controversial. We evaluated patients who were operated on in which a transhepatic, transanastomotic tube was used because the characteristics of the ducts were inadequate. METHODS: We conducted a retrospective, descriptive study between January 1995 and December 2006 for patients with iatrogenic bile duct injuries with a Roux-en-Y hepatojejunostomy and with placement of a transhepatic and transanastomotic tube. Postoperative evolution was analyzed and postoperative cholangitis was considered as failure. RESULTS: We analyzed 74 patients: 66 patients had one tube, five patients had two tubes and three patients had only one but in the right duct. Mean age of patients was 37 years. Twenty portoenterostomies were done. The tube was removed in 55 patients and 11 continued with the tube, having periodic changes with internal-external biliary drainage. In 21% of the cases, a new intervention (either radiological or surgical) was needed. An adequate quality of life was reported by 64.86% of patients. CONCLUSIONS: Anatomic and structural characteristics are unique for each patient. Use of a tube in the reconstructions of bile duct injuries is limited by the surgeon's experience. Characteristics of the ducts are most important. Therefore, selective use is indicated.

Férula transhepática-transanastomótica en lesiones de las vías biliares: evolución a largo plazo / Transhepatic transanastomotic stents for bile duct injuries: long-term evolution

BACKGROUND: With loss of continuity of the bile ducts after injury, surgery is the only feasible treatment option. Roux-en-Y hepatojejunostomy is the best choice. The use of transhepatic and transanastomotic tubes is still controversial. We evaluated patients who were operated on in which a transhepatic, transanastomotic tube was used because the characteristics of the ducts were inadequate. METHODS: We conducted a retrospective, descriptive study between January 1995 and December 2006 for patients with iatrogenic bile duct injuries with a Roux-en-Y hepatojejunostomy and with placement of a transhepatic and transanastomotic tube. Postoperative evolution was analyzed and postoperative cholangitis was considered as failure. RESULTS: We analyzed 74 patients: 66 patients had one tube, five patients had two tubes and three patients had only one but in the right duct. Mean age of patients was 37 years. Twenty portoenterostomies were done. The tube was removed in 55 patients and 11 continued with the tube, having periodic changes with internal-external biliary drainage. In 21% of the cases, a new intervention (either radiological or surgical) was needed. An adequate quality of life was reported by 64.86% of patients. CONCLUSIONS: Anatomic and structural characteristics are unique for each patient. Use of a tube in the reconstructions of bile duct injuries is limited by the surgeon's experience. Characteristics of the ducts are most important. Therefore, selective use is indicated.