Prognostic factors associated with overall survival in patients with oral cavity squamous cell carcinoma.

BACKGROUND: Low socioeconomic status, increasing age, and poor lifestyle behaviors are associated with poor survival in patients with oral cavity squamous cell carcinoma (OCSCC). To determine the overall survival (OS) and the risk of OCSCC death by tumor subsite. MATERIAL AND METHODS: A retrospective cohort study of OCSCC patients diagnosed from 2007 to 2009 and treated at a single cancer center in Rio de Janeiro, Brazil. Patient information was obtained from the Hospital Cancer Registry (HCR) database and complemented by individual search of physical and electronic medical records. Descriptive statistics of population characteristics were computed. OS was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression analyses were used to estimate the risk of death by tumor subsite. RESULTS: Seven hundred and three patients with OCSCC were identified. Most patients were men (77.4%) with low levels of education (67.5%), who drank (73.9%) and smoked (79.7%). The most prevalent tumor site was the tongue (45.4%), 73.4% of patients had advanced (clinical stage III or IV) OCSCC at diagnosis and 74.1% died during follow-up. For the entire cohort, the OS was 39.1% at two years and 27.9% at five years. The median survival time was 1.4 years (95%CI: 1.2‒1.5). Non-operative treatment (HR: 3.11; 95%CI: 2.26‒4.29; p<0.001), advanced stage (HR 2.14; 95%CI 1.68-2.74; p<0.001), and age >60 years at diagnosis (HR: 1.37; 95%CI: 1.15‒1.64; p<0.001) were independently associated with the risk of death. However, these factors varied by tumour subsite. CONCLUSION: Analysis of specific subsites of the oral cavity revealed substantial differences in prognostic factors associated with poor survival in OCSCC.

Quality of life after total laryngectomy: impact of different vocal rehabilitation methods in a middle income country.

INTRODUCTION: The impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Total laryngectomy impacts essential functions such as breathing, communication and swallowing, and may influence the quality of life as well as affecting the social life of laryngeal cancer patients. OBJECTIVE: Describe the quality of life and analyze the factors associated with the reduced quality of life in patients who have undergone total laryngectomy. METHOD: Observational cross-sectional study was carried out to evaluate the quality of life of patients who had undergone total laryngectomy due to laryngeal cancer. The fourth version of the UW-QOL Quality of Life Assessment Questionnaire from Washington University, validated for Portuguese, was used. RESULTS: The study population was 95 patients, and the mean composite score of the QOL was 80.4. In the subjective domains the majority of the patients (38.9%) reported they felt much better at present compared to the month before being diagnosed with cancer. When questioned about how they evaluated their health-related quality of life, there was a predominance of those who considered it good (43.2%), and most considered they had a good quality of life (46.3%) considering personal well-being. The overall quality of life was considered good to excellent by 83.2% of the patients. Patients with tracheoesophageal prosthesis reported a better quality of life, compared to patients using an electrolarynx or esophageal voice. CONCLUSION: The high mean value of the composite score for quality of life revealed that the patients assessed their quality of life positively. The absence of vocal emission was the only variable associated with a lower quality of life within the composite score according to the UW-QOL questionnaire.

Delay in breast cancer diagnosis: a Brazilian cohort study.

OBJECTIVES: To evaluate the delay in breast cancer (BC) diagnosis and its risk factors. STUDY DESIGN: A cohort study of BC patients referred to treatment at oncological reference hospital, Brazil. Delay in BC diagnosis was defined as a time interval ≥90 days between the first contact with a care provider and a BC diagnosis. METHODS: The association between independent variables and delay was performed by univariate analysis and multiple logistic regression. RESULTS: Five hundred and twenty-six women were included in the study. Delay was observed in 68.8% and was associated with performing histopathological examination at oncological reference hospital (odds ratio [OR]: 3.96, 95% confidence interval [CI]: 1.91-8.20) or at another public health service (OR: 2.31; 95% CI: 1.50-3.56) and attending gynecological consultations annually (OR: 3.24; 95% CI: 1.97-5.33) or every 2-3 years (OR: 2.86; 95% CI: 1.55-5.28). Patients who presented a lump as the first sign or symptom had a lower chance of delay (OR: 0.43; 95% CI: 0.29-0.65). CONCLUSIONS: Improvements in the structure and access to health services are needed to reduce the time to diagnosis.

Electrospray ionization mass spectrometry, circular dichroism and SAXS studies of the (S)-hydroxynitrile lyase from Hevea brasiliensis.

We report on experiments pertaining to solution properties of the (S)-hydroxynitrile lyase from Hevea brasiliensis (HbHNL). Small angle X-ray scattering unequivocally established the enzyme to occur in solution as a dimer, presumably of the same structure as in the crystal. The acid induced, irreversible deactivation of HbHNL was examined by electrospray ionization mass spectrometry (ESI-MS), circular dichroism (CD) and by measuring the enzyme activity. The deactivation is paralleled by an unfolding of the enzyme. ESI-MS of this 30000 Da per monomer heavy protein demonstrated that unfolding took place in several stages which are paralleled by a decrease in enzyme activity. Unfolding can also be observed by CD spectroscopy, and there is a clear correlation between enzyme activity and unfolding as detected by ESI-MS and CD.