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Introdução: O câncer de mama representa 24,5% dos novos casos de neoplasias em mulheres no mundo. A quimioterapia neoadjuvante é uma importante ferramenta no tratamento dessa patologia, possibilita cirurgias menos agressivas na mama e axila, além de minimizar sequelas. Objetivo: Analisar a possibilidade de se evitar a realização da biópsia do linfonodo sentinela em pacientes com câncer de mama submetidas à quimioterapia neoadjuvante que apresentem resposta patológica completa no tumor primário e na axila, tratadas em uma instituição de referência no Nordeste brasileiro. Método: Estudo prospectivo, observacional, de coorte em pacientes com câncer de mama submetidas à quimioterapia neoadjuvante e operadas no Hospital Haroldo Juaçaba, no período de março de 2019 a julho de 2021. Resultados: Foram incluídas no estudo 45 pacientes, com média de idade de 52,6 anos, sendo todas do sexo feminino. Após quimioterapia neoadjuvante, nove pacientes (21,4%) apresentaram resposta patológica completa na mama e 17 (40,5%), resposta patológica completa nos linfonodos. Os pacientes com resposta completa na mama apresentaram uma prevalência de resposta completa em linfonodo 20,44 vezes superior aos pacientes que não tiveram a mesma resposta. Conclusão: A resposta patológica completa na mama à quimioterapia neoadjuvante mostra uma tendência em predizer uma resposta patológica nos linfonodos axilares, reforçando que, com essa condição, a biópsia do linfonodo sentinela poderia ser evitada sem causar prejuízos ao controle local do câncer de mama.
Introduction: Breast cancer represents 24.5% of new cases of cancer in women worldwide. Neoadjuvant chemotherapy is an important tool in the treatment of this pathology, allowing less aggressive surgeries at the breast and axilla, minimizing sequelae. Objective: Analyze the possibility of avoiding sentinel lymph node biopsy in patients with breast cancer who have undergone neoadjuvant chemotherapy and who present complete pathological response at the primary tumor and axilla, treated at a reference institution in Brazil's Northeast. Method: Prospective, observational, cohort study in patients with breast cancer, undergoing neoadjuvant chemotherapy and operated at the Hospital Haroldo Juaçaba, from March 2019 to July 2021. Results: Forty-five female patients were enrolled in the study, with a mean age of 52.6 years. After neoadjuvant chemotherapy, nine patients (21.4%) had complete pathologic response at the breast and 17 (40.5%), complete pathologic response at the lymph nodes. Patients with complete response at the breast had a prevalence of complete response at lymph node 20.44 times higher than patients who did not have the same response. Conclusion: The complete pathologic response to neoadjuvant chemotherapy at the breast shows a tendency to predict the pathologic response at the axillary lymph nodes, raising the doubt that, with this condition, sentinel lymph node biopsy could be avoided without causing harm to the local control of breast cancer.
Introducción: El cáncer de mama representa el 24,5% de los nuevos casos de neoplasias en mujeres de todo el mundo. La quimioterapia neoadyuvante es una herramienta importante en el tratamiento de esta patología, permitiendo cirugías menos agresivas en la mama y la axila, minimizando las secuelas. Objetivo: Analizar la posibilidad de evitar la biopsia del ganglio centinela en pacientes con cáncer de mama, sometidas a quimioterapia neoadyuvante, con respuesta patológica completa en el tumor primario y en la axila, tratadas en una institución de referencia del nordeste del Brasil. Método: Estudio prospectivo, observacional, de cohorte en pacientes con cáncer de mama, sometidas a quimioterapia neoadyuvante y operadas en el Hospital Haroldo Juaçaba, en el período de marzo de 2019 a julio de 2021. Resultados: Se incluyeron 45 pacientes en el estudio, con una edad media de 52,6 años, y todos eran mujeres. Tras la quimioterapia neoadyuvante, nueve pacientes (21,4%) mostraron respuesta patológica completa en la mama y 17 (40,5%), respuesta patológica completa en los ganglios linfáticos. Las pacientes con respuesta completa en la mama presentaron una prevalencia de respuesta completa en el ganglio linfático 20,44 veces mayor que las pacientes que no tuvieron la misma respuesta. Conclusión: La respuesta patológica completa en la mama a la quimioterapia neoadyuvante muestra una tendencia a predecir una respuesta patológica en los ganglios linfáticos axilares, reforzando que, con esta condición, la biopsia del ganglio linfático centinela podría evitarse sin causar daño al control local del cáncer de mama.
Subject(s)
Humans , Male , Female , Breast Neoplasms , Neoadjuvant Therapy , Sentinel Lymph Node BiopsyABSTRACT
BACKGROUND: Penile cancer is one of the most aggressive male tumors. Although it is preventable, the main etiologic causes are lifestyle behaviors and viral infection, such as human papillomavirus (HPV). Long-term epigenetic changes due to environmental factors change cell fate and promote carcinogenesis, being an important marker of prognosis. We evaluated epidemiological aspects of penile squamous cell carcinoma (SCC) and the prevalence of HPV infection using high-risk HPV (hrHPV) and p16INK4A expression of 224 participants. Global DNA methylation was evaluated through 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC). RESULTS: The incidence of HPV was 53.2% for hrHPV and 22.32% for p16INK4a. hrHPV was not related to systemic or lymph node metastasis and locoregional recurrence, nor influenced the survival rate. P16INK4a seems to be a protective factor for death, which does not affect metastasis or tumor recurrence. Lymph node and systemic metastases and locoregional recurrence increase the risk of death. An increased 5mC mark was observed in penile SCC regardless of HPV infection. However, there is a reduction of the 5hmC mark for p16INK4a + (P = 0.024). Increased 5mC/5hmC ratio (> 1) was observed in 94.2% of penile SCC, irrespective of HPV infection. Despite the increase in 5mC, it seems not to affect the survival rate (HR = 1.06; 95% CI 0.33-3.38). CONCLUSIONS: P16INK4a seems to be a good prognosis marker for penile SCC and the increase in 5mC, an epigenetic mark of genomic stability, may support tumor progression leading to poor prognosis.
Subject(s)
Alphapapillomavirus , Carcinoma, Squamous Cell , Papillomavirus Infections , Penile Neoplasms , Male , Humans , Penile Neoplasms/genetics , Penile Neoplasms/epidemiology , Penile Neoplasms/pathology , Papillomavirus Infections/complications , Papillomavirus Infections/genetics , Papillomavirus Infections/epidemiology , Cyclin-Dependent Kinase Inhibitor p16/genetics , Prognosis , 5-Methylcytosine , DNA Methylation , Neoplasm Recurrence, Local/genetics , Papillomaviridae/genetics , Carcinoma, Squamous Cell/metabolism , Alphapapillomavirus/genetics , Biomarkers, Tumor/genetics , Biomarkers, Tumor/metabolism , Epigenesis, Genetic , DNA, ViralABSTRACT
ABSTRACT BACKGROUND AND OBJECTIVES: Mastectomy with lymphadenectomy is a surgery associated with moderate to severe pain in the immediate postoperatory. Several safe adjuvant drugs that provide good analgesia with few adverse effects have been researched. Pregabalin and magnesium sulfate are drugs that promote analgesia with few adverse effects. The objective of the present study was to evaluate the analgesic effect of pregabalin and magnesium sulfate in the postoperatory of mastectomy with axillary lymphadenectomy. METHODS: Double-blinded, randomized study involving 80 patients submitted to mastectomy with axillary lymphadenectomy under general anesthesia. The patients were distributed into 4 groups: Control (CG, did not receive the proposed adjuvant drug); Magnesium+Placebo (MG, received magnesium sulfate during anesthesia); Pregabalin+Magnesium (P+MG, received magnesium added to pregabalin 150 mg before and 12 h after surgery); and Pregabalin+Placebo (PG, received pregabalin). All patients completed the Self-Report Questionnaire 20 (SRQ-20) to screen for possible mental disorders and had their physical status monitored at 1 h, 12 h, and 24 h after surgery, through anamnesis, pain questionnaire, opioid consumption, and presence of complications and/or adverse events such as nausea, vomiting, and sleepiness. Randomization was performed using sealed opaque envelopes without the knowledge of the anesthesiologist (researcher) and the patient. RESULTS: For each group, twenty patients were randomized, which were analyzed at the end of the study. The number of patients presenting absent/mild pain in P+MG was significantly higher than in CG, MG and PG after one hour. After 12 hours, P+MG and PG had more patients with absent/mild pain than CG and MG. At 24 hours postoperatively, all patients in all evaluated groups had no moderate/severe pain. There was no diference in the frequency of patients presenting nausea or vomiting, nor in the scores of the sleep evaluation after surgery in the four groups. CONCLUSION: The combination of magnesium sulfate and pregabalin provided satisfactory analgesia in the first hour after mastectomy with axillary lymphadenectomy. Nevertheless, magnesium sulfate isolated presented no analgesic beneft for the patients, and pregabalin isolated was only slightly effective at the first hour after surgery.
RESUMO JUSTIFICATIVA E OBJETIVOS: Mastectomia com linfadenectomia é uma cirurgia que causa dor moderada ou intensa no pós-operatório imediato. Muitos fármacos adjuvantes, seguros, que promovem boa analgesia e com poucos efeitos adversos têm sido pesquisados. A pregabalina e o sulfato de magnésio são fármacos que promovem analgesia com poucos efeitos adversos. O objetivo deste estudo foi avaliar o efeito analgésico da pregabalina e do sulfato de magnésio no pós-operatório de mastectomia com linfadenectomia axilar. MÉTODOS: Estudo randomizado e duplo-cego envolvendo 80 pacientes submetidas à mastectomia com linfadenectomia axilar sob anestesia geral. As pacientes foram divididas em quatro grupos: Controle (GC, não receberam o fármaco adjuvante proposto); Magnésio+Placebo (GM, receberam sulfato de magnésio durante a anestesia); Pregabalina+Magnésio (GP+M, receberam magnésio adicionado a pregabalina 150 mg antes e 12 h após a cirurgia); e Pregabalina+Placebo (GP, receberam a pregabalina). Todas as pacientes responderam o Self-Report Questionnaire 20 (SRQ-20) para rastrear possível transtorno mental e foram seguidas, monitorando o estado físico 1h, 12h e 24h após a cirurgia, através de anamnese, questionário de dor, consumo de opioides e presença de complicações e/ou eventos adversos como náusea, vômito e sonolência. A randomização foi realizada por meio de envelopes opacos e selados sem o conhecimento do anestesiologista (pesquisador) e do paciente. RESULTADOS: Foram randomizadas 20 pacientes para cada grupo, as quais foram analisadas ao fim do estudo. O número de pacientes apresentando dor ausente/leve no GP+M foi significantemente maior que nos GC, GM e GP após uma hora. Após 12 horas, GP+M e GP apresentaram maior número de pacientes com dor ausente/leve que GC e GM. Em 24 horas do pós-operatório, todos os pacientes de todos os grupos avaliados não apresentaram dor moderada/severa. Não houve diferença na frequência de pacientes apresentando náusea ou vômito, nem nos escores da avaliação do sono após a cirurgia nos quatro grupos. CONCLUSÃO: A associação de sulfato de magnésio e pregabalina causa boa analgesia de mastectomia com linfadenectomia axilar na primeira hora do pós-operatório. No entanto, o uso isolado do sulfato de magnésio não trouxe benefício para analgesia nestas pacientes, assim como a pregabalina sozinha se mostrou pouco efetiva na primeira hora de avaliação.
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BACKGROUND: Risk assessment is important when planning treatment for prostatic adenocarcinoma. Gleason score is a strong predictor of disease progression, despite the possibility of mismatches between biopsy and prostatectomy. In order to increase the accuracy of Gleason scores, several markers have been proposed. One of these, FUS (fused in sarcoma), plays a role in RNA processing, chromosome stability and gene transcription. PATIENTS AND METHODS: Non-neoplastic tissue and Gleason pattern 3, 4 and 5 adenocarcinoma samples were submitted to tissue microarrays. Gleason pattern 3 and 4 were compared to the final Gleason score. We also conducted univariate and multivariate tests to probe the association between FUS expression in adenocarcinoma samples and outcome: biochemical persistence and biochemical recurrence (separately or pooled as biochemical progression), biochemical failure after salvage radiotherapy, and systemic progression. RESULTS: Our cohort consisted of 636 patients. Non-neoplastic tissue stained less frequently (36.5%) than neoplastic tissue (47.4%), with expression increasing from Gleason pattern 3 towards pattern 5. FUS-positive Gleason pattern 3 was significantly associated with final Gleason scores >6 (HR = 1.765 [1.203-2.589]; p = 0.004). Likewise, FUS-positive Gleason pattern 4 was significantly associated with final Gleason scores ≥7 (4 + 3). The association between FUS positivity and biochemical persistence and recurrence observed in the univariate analysis was not maintained in the multivariate analysis (HR = 1.147 [0.878-1.499]; p = 0.313). CONCLUSION: Non-neoplastic tissue was less frequently FUS-positive than neoplastic tissue. FUS positivity in Gleason pattern 3 and 4 increased the risk of high grade adenocarcinoma and was associated with clinical/laboratory progression in the univariate, but not in multivariate analysis.
Subject(s)
Adenocarcinoma/metabolism , Neoplasm Grading/statistics & numerical data , RNA-Binding Protein FUS/genetics , Adenocarcinoma/diagnosis , Biomarkers, Tumor/metabolism , Biopsy , Disease Progression , Humans , Male , Neoplasm Grading/methods , Neoplasm Recurrence, Local/metabolism , Neoplasm Recurrence, Local/pathology , Prognosis , Prostatectomy/methods , Prostatic Neoplasms/pathology , RNA-Binding Protein FUS/metabolism , Retrospective Studies , Salvage Therapy , Tissue Array Analysis/methodsABSTRACT
BACKGROUND: Retrospectively to evaluate the influence of radiochemotherapy (RCT) in the treatment of surgically and non-surgically treated Oral Squamous Cell Carcinoma (OSCC). MATERIAL AND METHODS: We analysed 934 patients treated in Hospital Haroldo Juaçaba (2000-2014; 15 years of study) by extraction of data type of cancer, localization of tumour, sex, age, race, education level, risk factors (smoking and alcohol use), year of diagnosis, TNM stage, therapeutic approach, health system used (public or private) and overall survival (OS). Surgically and non-surgically treated OSCC were compared by chi-square and Fisher's exact tests, and their prognostic factors were analysed by log-rank Mantel-Cox plus Cox regression tests (SPSS 20.0, p<0.05). RESULTS: Non-surgically treated OSCC patients had a lower OS than surgically treated OSCC patients (p<0.001), but an increase in OS was shown in both groups. Although the 2010-2014 period (p=0.003), education level (p=0.032), tongue/mouth floor/palate localization (p=0.023) and TNM stage (p<0.05) were important in non-surgically treated OSCC OS, the major prognostic factors were node metastasis (p=0.003) and non-use of RCT (p=0.039) (multivariate analysis). In surgically treated OSCC patients, higher OS was shown in the 2010-2014 period (p<0.001), females (p=0.012), non-drinkers (p=0.011), non-smokers (p=0.009) and those with lower TNM stage (p<0.05), but the major prognostic factor was the 2010-2014 period (p=0.004) (multivariate analysis), which was directly associated with an increase in RCT indication (p<0.001). CONCLUSIONS: The increase in RCT improved the OS in this large cohort of surgically and non-surgically treated OSCC patients. Key words:Mouth neoplasms, neck, radiotherapy, drug therapy, combination.
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OBJECTIVES: To describe a patient with BRCA1 mutation, mucoepidermoid parotid, multiple breasts, and thyroid cancers. CASE REPORT: A women was diagnosed at 33-years-age with a triple-negative breast cancer (right breast), at 43-years-age with a triple-negative breast cancer in left breast and at 53-years-age with a primary papillary-thyroid carcinoma. At 55-years-age, she was diagnosed with a primary mucoepidermoid carcinoma in right parotid, and concomitantly, her right nipple was affected by Paget's disease and a recurrent carcinoma in right breast (HR + /HER2 = 3 +). At 57-years-age, after the recurrence of a triple-negative breast cancer (left breast), a geneticist evaluated the patient's family history, including one stomach, one non-smoking-related lung, and two smoking-related laryngeal cancers. Genetic testing revealed a BRCA1 mutation (Chr17:41:251.867). The patient's daughter (a non-cancer patient) tested negative for the mutation. Both remain under medical supervision. CONCLUSIONS: We suggest that BRCA1 mutations are associated with non-breast and non-ovarian cancers such as salivary gland cancer.
Subject(s)
Breast Neoplasms , Carcinoma, Mucoepidermoid , Parotid Neoplasms , Adult , BRCA1 Protein , Breast Neoplasms/genetics , Carcinoma, Mucoepidermoid/genetics , Carcinoma, Mucoepidermoid/surgery , Female , Humans , Middle Aged , Mutation , Neoplasm Recurrence, Local , Parotid Gland , Parotid Neoplasms/geneticsABSTRACT
INTRODUCTION: Identifying carriers of genetic mutations that increase the risk of developing cancer allows to adopt timely risk-reducing strategies. However, due to the elevated cost of genetic testing, few oncogenetics services are available in the Brazilian public health care system, especially in economically disadvantaged areas. OBJECTIVE: To describe the implementation of an oncogenetics service for patients suspected of hereditary cancer syndromes (HBOC and HNPCC) at a philanthropic referral oncology hospital in Northeastern Brazil, funded by the Ministry of Health's National Oncology Care Support Program (PRONON). METHODS: The service was implemented with the PDCA method (Plan, Do, Check and Act). RESULTS: During the first year of operation (starting in August 2018), 675 individuals were examined, of whom 272 patients and 98 family members were submitted to genetic testing. This included the collection of 338 DNA samples of which 300 were sequenced. The analysis identified 48 (17.1%) mutations for HBOC and 19 (6.8%) for HNPCC. CONCLUSION: In one year, the oncogenetics service was able to benefit over 300 families by generating advanced molecular data which may be used for tailoring cancer prevention and management.
Subject(s)
Genetic Testing , Neoplasms/genetics , Oncogenes , Public Health Administration , Brazil/epidemiology , Genetic Predisposition to Disease , Humans , Mutation , Neoplasms/epidemiology , Neoplasms/psychology , Specimen HandlingABSTRACT
BACKGROUND: Emotional distress associated with genetic testing for hereditary breast and ovarian cancer syndrome (HBOC) is reported to interfere with adherence to treatment and prophylactic measures and compromise quality of life. OBJECTIVES: To determine levels of anxiety, depression, and quality of life in patients tested for pathogenic BRCA1/2 mutations and identify risk factors for the development of adverse psycho-emotional effects. METHODS: Cross-sectional observational trial involving 178 breast or ovarian cancer patients from a referral cancer hospital in Northeastern Brazil. Information was collected with the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization (WHO) Quality of Life (QoL) questionnaire (WHOQOL-BREF). RESULTS: Patients suspected of HBOC had higher levels of anxiety than depression. The presence of (probably) pathogenic BRCA1/2 mutations did not affect levels of anxiety and depression. High schooling, history of psychiatric disease, and use of psychotropic drugs were directly associated with high anxiety. High schooling was too inversely associated with QoL as such a breast tumor. Anxiety and depression were directly correlated and both reduced significantly QoL. CONCLUSION: Our results highlight the importance of psychological support and screening of risk factors for anxiety and depression and low QoL in HBOC patients at the time of testing.
Subject(s)
Anxiety/psychology , Depression/psychology , Genetic Testing/methods , Hereditary Breast and Ovarian Cancer Syndrome/psychology , Quality of Life/psychology , Cross-Sectional Studies , Female , Hereditary Breast and Ovarian Cancer Syndrome/genetics , Humans , Middle Aged , Surveys and QuestionnairesABSTRACT
Introduction: There has been a substantial increase worldwide in the number of women with unilateral breast cancer who undergo bilateral mastectomy. Possible contributing factors include the advent of nipple-sparing mastectomy (NSM) and an improvement in breast reconstruction techniques. This study evaluated the trend in bilateral mastectomy at the Ceará Cancer Institute in Brazil. Methods: Patients with unilateral breast cancer who underwent mastectomy and immediate breast reconstruction were evaluated retrospectively between 2009 and 2018. Clinical, pathological and surgical factors were analyzed to determine their possible effects on the type of surgery performed. Results: Of 121 patients, 77 (63.6%) were submitted to unilateral mastectomy, while 44 (36.4%) underwent bilateral mastectomy. Most were treated with NSM (n = 66; 54.5%), with this technique being significantly associated with bilateral mastectomy (p < 0.001). Bilateral mastectomy increased significantly over the period (p = 0.009; r2 = 0.592), but unilateral mastectomy did not (p = 0.417; r2 = 0.084). Age < 45 years (p = 0.007) and negative axilla (p = 0.003) were also associated with bilateral mastectomy, while axillary dissection was associated with unilateral mastectomy (p = 0.028). Multivariate analysis showed the 2016-2018 period to be an independent factor associated with bilateral mastectomy. Conclusions: These results corroborate the international literature. From 2010 onwards, there was a trend towards an increase in bilateral mastectomy with breast reconstruction. These data may contribute to multidisciplinary debates, facilitating the establishment of guidelines. Further studies are required to improve understanding of this phenomenon in Brazil.
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BACKGROUND: Colorectal carcinoma (CRC) is widely treated by chemotherapy based on an intensely neurotoxic drug: oxaliplatin (OXL). We objective to evaluate prospectively the orofacial neurotoxicity during FLOX (fluorouracil + leucovorin + OXL) chemotherapy. METHODS: So, 46 patients with CRC were prospectively evaluated during FLOX chemotherapy by 3 cycles (C) of 6 weeks (W) each. We weekly applied the orofacial section of the Acute and Chronic Neuropathy Questionnaire of Common Toxicity Criteria for Adverse Events of the National Cancer Institute of the United States of America (Oxaliplatin-specific neurotoxicity scale). Patients were asked the following concerning the severity (scores 0-5) of orofacial symptoms: jaw pain, eyelids drooping, throat discomfort, ear pain, tingling in mouth, difficulty with speech, burning or discomfort of the eyes, loss of any vision, feeling shock/pain down back and problems breathing. We summed the scores (0-50) and evaluated the clinicopathological data. Friedman/Dunn, Chi square and multinomial regression logistic tests were used (SPSS 20.0, p < 0.05). RESULTS: There was a significant increase in sum of orofacial neurotoxicity from baseline to C1.W3, C2.W1 and C3.W5 (p < 0.001) due increase in scores of jaw pain (p < 0.001), eyelids drooping (p = 0.034), throat discomfort (p < 0.001), ear pain (p = 0.034), tingling in mouth (p = 0.015), burning/discomfort of your eyes (p < 0.001), loss of any vision (p < 0.001), feeling shock/pain down back (p < 0.001), problems with breathing (p = 0.045), but not difficulty with speech (p = 0.087). Women (p = 0.021) and young patients (p = 0.027) had significant higher prevalence of orofacial neurotoxicity. CONCLUSIONS: FLOX-related orofacial neurotoxicity begins acutely and remains long term with increased incidence in women and younger patients.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Colorectal Neoplasms/drug therapy , Neurotoxicity Syndromes/etiology , Peripheral Nervous System Diseases/chemically induced , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colorectal Neoplasms/pathology , Face , Female , Fluorouracil/administration & dosage , Humans , Incidence , Leucovorin/administration & dosage , Longitudinal Studies , Male , Middle Aged , Mouth/drug effects , Neurotoxicity Syndromes/epidemiology , Oxaliplatin/administration & dosage , Peripheral Nervous System Diseases/epidemiology , Prospective StudiesABSTRACT
BACKGROUND: The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15-20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients. METHODS: Data from a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 13 European and American urological centers (Hospital "Sant'Andrea", Sapienza University, Roma, Italy; "G.D'Annunzio" University, Chieti and ASL 2 Abruzzo, Hospital "S. Pio da Pietrelcina", Vasto, Italy; Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Hospital of Budapest, Hungary; Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Italy; Hospital "Spedali Civili", Brescia, Italy; Istituto Europeo di Oncologia, University of Milan, Milan, Italy; University of Modena & Reggio Emilia, Modena, Italy; Hospital Universitario La Paz, Madrid, Spain; Ceara Cancer Institute, Fortaleza, Brazil; Virginia Commonwealth University, Richmond, VA, USA; Aristotle University of Thessaloniki, Thessaloniki, Greece; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland) between 2010 and 2016 were used. Medical records of patients who specifically underwent radical penectomy were reviewed to identify main clinical and pathological variables. Kaplan-Meier method was used to estimate 1- and 5-year OS and DFS. RESULTS: Of the entire cohort of 425 patients, 72 patients (16.9%) treated with radical penectomy were extracted and were considered for the analysis. The median age was 64.5 (IQR, 57.5-73.2) years. Of all, 41 (56.9%) patients had pT3/pT4 and 31 (43.1%) pT1/pT2. Moreover, 36 (50.0%) were classified as pN1-3 and 5 (6.9%) M1. Furthermore, 61 (84.7%) had a high grade (G2-G3) with 6 (8.3%) positive surgical margins. The 1- and 5-year OS rates were respectively 73.3% and 59.9%, while the 1- and 5-year DFS rates were respectively 67.3% and 35.1%. CONCLUSIONS: PC is an aggressive cancer particularly in more advanced stage. Overall, more than a third of patients do not survive at 5 years and more than 60% report a disease recurrence, despite the use of a radical treatment.
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Introduction: Breast cancer is the most common malignant tumor in the world, with the exception of cases of non-melanoma skin cancer. In Brazil, more than 56,000 cases were estimated for 2016. The expected mortality rate remains high because of late diagnosis. Nowadays, conservative surgery is the gold standard treatment. Objective: To evaluate the locoregional recurrence of conservative surgery practiced at the Ceará Institute of Cancer, between 2002 and 2012. Method: A cross sectional study with a descriptive approach using secondary data obtained from the medical records of patients with breast cancer operated at the Ceará Institute of Cancer. Results: The study population consisted of 360 patients. Invasive ductal carcinoma was the most common type (72.8%), followed by ductal carcinoma in situ (16.4%) and invasive lobular carcinoma (4.7%). The other histological types represent 6.4% (cribriform, 0.5%, medullary, 0.6%, micro invasive, 0.3%, mucinous, 1.1%, papillary, 3.1% 8%; and tubular, 0.8%). In the sample, 25 patients had some type of recurrence: 13/360 (3.6%), local or locoregional; and 12/360 (3.3%), distant recurrence. Conclusion: From the data analysis, we can conclude that the conservative surgery practiced at the Ceará Institute of Cancer showed data on recurrence compatible with the international literature
Introdução: O câncer de mama é o tumor maligno que mais acomete mulheres em todo o mundo, excetuando-se os casos de pele não melanoma. No Brasil, estimavam-se mais de 56.000 casos para 2016. A mortalidade esperada ainda é alta devido ao diagnóstico tardio. Na atualidade, a cirurgia conservadora é o padrão-ouro. Objetivo: Avaliar a recidiva locorregional da cirurgia conservadora praticada no Instituto do Câncer do Ceará, no período entre 2002 a 2012. Método: Estudo transversal e descritivo, utilizando dados secundários obtidos nos prontuários médicos de pacientes com câncer de mama operadas no Instituto do Câncer do Ceará. Resultados: A população em estudo foi de 360 pacientes. O carcinoma ductal invasivo foi o tipo mais comum (72,8%), seguido do carcinoma ductal in situ (16,4%) e do carcinoma lobular invasivo (4,7%). Os outros tipos histológicos representam 6,4% (cribiforme, 0,5%; medular, 0,6%; microinvasor, 0,3%; mucinosos, 1,1%; papilífero, 3,1%; e tubular, 0,8%). Na amostra, 25 pacientes tiveram algum tipo de recidiva: 13/360 (3,6%), local ou locorregional; e 12/360 (3,3%), recidiva a distância. Conclusão: Da análise dos dados, podemos concluir que a cirurgia conservadora praticada no Instituto do Câncer do Ceará tem dados de recorrência compatíveis com a literatura internacional
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INTRODUCTION: We aimed to evaluate adherence to the EAU guidelines (GL) on penile cancer (PC) with regard to primary surgical treatment and management of lymph nodes and to estimate the influence of adherence to GL on clinical outcome. MATERIALS AND METHODS: This is a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 12 European and American centers between 2010 and 2016. Adherence to the EAU GL on the surgical management of the primary penile tumor and lymphadenectomy was evaluated. Descriptive analyses were performed, and survival curves were estimated. RESULTS: Data on 425 patients were considered for the analysis. The EAU GL on surgical treatment of the primary tumor and lymphadenectomy were respected in 74.8% and 73.7% of cases, respectively. Survival analysis showed that adherence to the GL on primary penile surgery was significantly associated with a good overall survival [adjusted HR 0.40 (95% CI 0.20-0.83, p value = 0.014)]. Also, the adherence to the GL on lymphadenectomy was statistically significantly associated with overall survival [adjusted HR 0.48 (95% CI 0.24-0.96, p value = 0.038)]. Limited follow-up and retrospective design represent limitations of this study. CONCLUSIONS: Our findings suggest that there is a good adherence to the EAU GL on PC. However, this should be further reinforced, endorsed and encouraged as it might translate into better clinical outcomes for PC patients.
Subject(s)
Guideline Adherence/statistics & numerical data , Penile Neoplasms/surgery , Aged , Europe , Humans , Lymph Node Excision , Lymphatic Metastasis , Male , Middle Aged , Penile Neoplasms/pathology , Retrospective Studies , Societies, Medical , Urologic Surgical Procedures, Male/standards , UrologyABSTRACT
The purpose of this meta-analysis is to evaluate the association of Epstein-Barr virus (EBV) with oral squamous cell carcinoma (OSCC). We searched the electronic scientific databases of PubMed and Scopus and included a total of 53 studies that were published from 1990 to 2019. The analysis yielded a 45.37% (95% confidence interval [CI]: 38.90-51.84; p < 0.001) overall pooled prevalence of EBV. Studies that used the applied methods of in situ hybridization, polymerase chain reaction, immunology, or RNA microarray showed the following pooled prevalence: 46.08%, 40.32, 54.97%, and 74.89%, respectively. EBV-infected individuals have a 2.5 higher risk for developing OSCC (odds ratio: 2.57; 95% CI: 1.23% to 5.36%; p < 0.001). The present meta-analysis supports the hypothesis of EBV association with OSCC, pointing to this virus as a risk factor for neoplasia. Our findings also suggest that EBV latent transcripts (latent membrane protein 1, EBV nuclear antigen 1 and 2, and EBV-encoded small RNAs) have an important role in this process. Furthermore, novel advancements could arise from large and standardized studies that are constructed to probe for other latent gene expression, eliminate confounding factors (tobacco, alcohol, and high-risk human papillomavirus infection), and define the relationship between EBV and oral carcinomas.
Subject(s)
Carcinoma, Squamous Cell/physiopathology , Epstein-Barr Virus Infections/physiopathology , Herpesvirus 4, Human/physiology , Mouth Neoplasms/physiopathology , Alcohol Drinking/adverse effects , Alcohol Drinking/epidemiology , Alcohol Drinking/physiopathology , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/virology , Epstein-Barr Virus Infections/epidemiology , Humans , Mouth Neoplasms/epidemiology , Mouth Neoplasms/virology , Smoking/adverse effects , Smoking/epidemiology , Smoking/physiopathologyABSTRACT
Epstein-Barr virus (EBV) and human papillomavirus (HPV) have been implicated in 38% of all virus-related cancers. Over the past three decades, both have been detected in anogenital and head-and-neck squamous cell carcinomas (HNSCC), with evidence of involvement in tumor genesis and progression. Very little has been published on HPV/EBV coinfection. In this chapter, we review the literature on the role of these viruses in oral carcinoma and draw parallels with other HNSCCs and anogenital carcinomas, with emphasis on their interplay and potential signaling pathways. EBV infection seems to create an environment that favors HPV latency, supporting the claim that EBV is a cofactor in HPV-related carcinomas. In turn, under certain circumstances, HPV appears to be able to induce EBV to switch to the latent or replicative state. The main viral oncogenes expressed in these malignancies are EBNA1, EBNA2, LMP1, EBERs, and the high-risk HPV oncogenes E6 and E7. The most well-documented human proteins involved are p53, pRb, p16INK4a, p19ARF, Myc, E-cadherin, ß-catenin, EGFR, MLH1, and COX-2. These proteins are directly associated not only with viral products but also with one another in the development of malignancy. Knowledge of the molecular machinery behind carcinomas coinfected with HPV and EBV may help understand how these viruses trigger carcinogenesis and subsidize the development of new biomarkers of tumor aggressiveness and prognosis, alternative surrogate virus markers, and possible therapeutic targets.
Subject(s)
Anus Neoplasms/physiopathology , Epstein-Barr Virus Infections/physiopathology , Herpesvirus 4, Human/physiology , Mouth Neoplasms/physiopathology , Papillomaviridae/physiology , Urogenital Neoplasms/physiopathology , Anus Neoplasms/epidemiology , Carcinogenesis , Epstein-Barr Virus Infections/epidemiology , Female , Humans , Male , Mouth Neoplasms/epidemiology , Papillomavirus Infections/epidemiology , Papillomavirus Infections/physiopathology , Urogenital Neoplasms/epidemiologyABSTRACT
BACKGROUND: Though strongly suggestive of metastasis, focal lesions on liver scans of oncological patients require histological confirmation for the prescription of adequate treatment. OBJECTIVE: To evaluate the safety and efficacy of US-guided percutaneous core liver biopsy. METHODS: Descriptive, cross-sectional study based on secondary data from 171 patients submitted to US-guided percutaneous core liver biopsy at the diagnostic radiology service of the Ceará Cancer Institute (ICC, Brazil) between February 2010 and March 2015. Quantitative data were expressed in absolute numbers or percentages, with emphasis on the rate of complications observed within six hours after the procedure. RESULTS: The overall accuracy was 96.4%. The overall rate of complications was 2.3%, three quarters of which was due to hemorrhage. Age over 50 years was positively associated with accuracy. No deaths occurred within the period of observation. CONCLUSION: Our findings support the claim that the use of thick biopsy needles improves diagnostic accuracy. The few complications observed were non-lethal and predominantly hemorrhagic.
Subject(s)
Image-Guided Biopsy/methods , Liver Neoplasms/pathology , Liver/pathology , Ultrasonography, Interventional/methods , Adult , Aged , Aged, 80 and over , Biopsy, Large-Core Needle , Cross-Sectional Studies , Female , Humans , Image-Guided Biopsy/adverse effects , Liver/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Male , Middle Aged , Neoplasm Metastasis , Postoperative Complications , Reproducibility of Results , Ultrasonography, Interventional/adverse effectsABSTRACT
Surgical treatment of breast cancer has changed considerably over the past four decades, culminating in the substitution of conservative approaches for Halsted's paradigm from 1894. In parallel, many breast reconstruction techniques have been proposed for patients requiring mastectomy with loss of the nipple-areola complex (NAC). Myocutaneous flaps were once the most common form of reconstruction, but recently the use of implants and nipple-sparing mastectomy (NSM) in one or two stages has gained popularity. In this descriptive and cross-sectional study, we evaluated a sample of 31 NSM procedures with periareolar incision and two-stage reconstruction (tissue expander followed by implant) conducted between 2013 and 2017, with emphasis on the rate of complications after at least 3 months of follow-up, local disease control and cosmesis measured on the Harvard scale. Five complications (16%) were observed, all of which related to the first stage: seroma (n = 1; 3.2%), treated with needle aspiration, NAC necrosis (n = 3; 9.6%), one case of which required debridement, and dehiscence (n = 1; 3.2%), treated with resuture. Cosmesis was classified as excellent by the surgeon in 96.8% (n = 27). At the time of writing, no local recurrence had been observed. In conclusion, NSM with periareolar incision and two-stage reconstruction was found to be technically feasible and associated with few complications and satisfactory esthetic outcomes.
Subject(s)
Mammaplasty/methods , Mastectomy, Segmental/methods , Nipples/surgery , Adult , Breast Implants , Cross-Sectional Studies , Female , Humans , Mastectomy, Segmental/adverse effects , Middle Aged , Postoperative Complications/etiology , Tissue Expansion DevicesABSTRACT
ABSTRACT BACKGROUND: Though strongly suggestive of metastasis, focal lesions on liver scans of oncological patients require histological confirmation for the prescription of adequate treatment. OBJECTIVE: To evaluate the safety and efficacy of US-guided percutaneous core liver biopsy. METHODS: Descriptive, cross-sectional study based on secondary data from 171 patients submitted to US-guided percutaneous core liver biopsy at the diagnostic radiology service of the Ceará Cancer Institute (ICC, Brazil) between February 2010 and March 2015. Quantitative data were expressed in absolute numbers or percentages, with emphasis on the rate of complications observed within six hours after the procedure. RESULTS: The overall accuracy was 96.4%. The overall rate of complications was 2.3%, three quarters of which was due to hemorrhage. Age over 50 years was positively associated with accuracy. No deaths occurred within the period of observation. CONCLUSION: Our findings support the claim that the use of thick biopsy needles improves diagnostic accuracy. The few complications observed were non-lethal and predominantly hemorrhagic.
RESUMO CONTEXTO: Lesões focais nos exames de imagem do fígado em pacientes oncológicos, embora sejam achados fortemente sugestivos de envolvimento metastático, permanece a necessidade de confirmação histológica, a fim de que se institua uma terapia apropriada. OBJETIVO: Verificar a segurança e a eficácia do procedimento de biópsia hepática percutânea guiada por ultrassom, realizado pelo serviço de Radiologia e Diagnóstico por Imagem do Instituto do Câncer do Ceará (ICC). MÉTODOS: Estudo transversal, descritivo, baseado em dados secundários de 171 pacientes, submetidos a biópsias hepáticas percutâneas, guiadas por ultrassonografia, realizadas no ICC, de fevereiro de 2010 a março de 2015. Os dados quantitativos obtidos foram apresentados em forma de números absolutos ou percentuais, com ênfase nas taxas de complicações, ocorridas nas primeiras seis horas de observação hospitalar. RESULTADOS: A acurácia geral foi de 96,4%. Encontramos uma taxa global de complicações de 2,3%, sendo que 75% delas foram de natureza hemorrágica. Não verificamos a ocorrência de óbitos dentro do período de observação pós-biópsia. CONCLUSÃO: A utilização de agulhas calibrosas, parece, de fato, estar relacionada à melhoria na acurácia diagnóstica, com baixas taxas de complicações, sobretudo as hemorrágicas, contudo não letais. No presente trabalho, a idade mostrou-se um fator modificador da acurácia.
Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Ultrasonography, Interventional/methods , Image-Guided Biopsy/methods , Liver/pathology , Liver Neoplasms/pathology , Postoperative Complications , Cross-Sectional Studies , Reproducibility of Results , Ultrasonography, Interventional/adverse effects , Biopsy, Large-Core Needle , Image-Guided Biopsy/adverse effects , Liver/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Middle Aged , Neoplasm MetastasisABSTRACT
OBJECTIVES: Human papillomavirus (HPV) has been implicated as a major factor in cervical carcinogenesis. However, many pieces of evidence gathered over the last two decades suggest Epstein-Barr virus (EBV) plays a secondary role in this process. The purpose of the present meta-analysis was to determine whether the presence of EBV infection increases the risk of cervical carcinoma. METHODS: Based on 25 articles, the analysis yielded a 33.44% overall pooled prevalence of EBV. RESULTS: The pooled prevalence was higher in patients with carcinoma (43.63%) than in healthy patients (19.0%) or patients with cervical intraepithelial neoplasia 1 (CIN1) (27.34%) or CIN2/3 (34.67%). Co-infection with EBV and HPV displayed a similar pattern. EBV infection was significantly and positively associated with lesion grade in cervical epithelia and was more prevalent in malignant lesions. Moreover, cervical carcinoma occurred four times as often among EBV positive women as in women without EBV infection (OR=4.01 [1.87-8.58]; p<0.001). CONCLUSIONS: The existence of EBV(+)HPV(-) carcinomas, the confirmed expression of latent oncoproteins (EBNA1, EBNA2, LMP1) and EBERs in tumor cells, and the association of EBV with the integration of high-risk-HPV DNA in malignant specimens point to EBV as a co-factor (so far underestimated) in the genesis and/or progression of cervical carcinoma. However, further studies are necessary before the link between EBV and cervical carcinoma can be established.
Subject(s)
Epstein-Barr Virus Infections/complications , Uterine Cervical Dysplasia/virology , Uterine Cervical Neoplasms/virology , Coinfection/complications , Female , HIV Infections/complications , Herpesvirus 4, Human , HumansABSTRACT
OBJECTIVE: to evaluate the risk factors for the presence of non-sentinel axillary metastatic disease in patients with breast cancer and positive sentinel node biopsy. Methods: retrospective cross-sectional study of women with breast cancer operated at the Cancer Institute of Ceará between 2002 and 2012 and submitted to sentinel lymph node biopsy. RESULTS: Among 946 breast cancer patients, 331 underwent sentinel lymph node biopsy, which was positive in 83. These patients underwent axillary lymphadenectomy and 39 (46%) had metastases in other axillary lymph nodes. The variables that were significant for additional axillary disease included Ki67>14 (p=0.043), angiolymphatic invasion (p=0.01) and tumor size (p=0.027). No association was observed with estrogen, progesterone, tumor grade and Her-2 receptors. DISCUSSION: the presence of angiolymphatic invasion and tumor size have also been related to additional axillary metastasis in other studies. In addition to these variables, the same predictive effect was observed when we evaluated Ki67. The validation of these results may allow the customization of breast cancer treatment, which may reduce its morbidity. CONCLUSION: angiolymphatic invasion, tumor size (T3/T4) and Ki67>14 were factors predictive of axillary metastasis involvement in addition to the sentinel lymph node.
OBJETIVO: avaliar os fatores de risco para presença de doença metastática axilar não sentinela em pacientes com câncer de mama e biópsia do linfonodo sentinela positiva. MÉTODOS: estudo transversal, retrospectivo, de mulheres com câncer mamário operadas no Instituto do Câncer do Ceará, entre os anos de 2002 e 2012 e submetidas à biópsia de linfonodo sentinela. RESULTADOS: de 946 pacientes com câncer de mama, 331 foram submetidas à biópsia de linfonodo sentinela, que foi positiva em 83. Estas foram submetidas à linfadenectomia axilar e 39 (46%) apresentaram metástases em outros linfonodos axilares. As variáveis que foram significantes para doença axilar adicional foram Ki67>14 (p=0,043), presença de invasão angiolinfática (p=0,01) e tamanho tumoral (p=0,027). Não foi observado associação com receptores de estrogênio, progesterona, grau tumoral e Her-2. DISCUSSÃO: a presença de invasão angiolinfática e tamanho tumoral tambémjáforam relacionados à metástase axilar adicional em outros estudos. Além destas variáveis observou-se o mesmo efeito preditivo quando avaliamos o Ki67. A validação destes resultados poderá permitira customização do tratamento do câncer de mama, podendo reduzir sua morbidade. CONCLUSÃO: invasão angiolinfática, tamanho tumoral (T3/T4) e Ki67>14 foram fatores preditivos de acometimento de metástase axilar além do linfonodo sentinela.
