RESUMEN
OBJECTIVE: To determine if the extent of lymphadenectomy (number of recovered lymph nodes) was associated with long-term outcome in patients operated on for stage B and C colon cancer. SUMMARY BACKGROUND DATA: Lymphatic spreading is the main prognostic indicator in colon cancer patients, although the optimal extent of lymphadenectomy and its prognostic impact are still unknown. METHODS: In 3,648 patients (median follow-up 3.6 years) enrolled in two consecutive INTACC multicentric trials on adjuvant therapy for colon cancer, we studied the association of the number of recovered nodes with overall survival and relapse free survival by means of univariate and Cox regression analysis. RESULTS: The worst overall survival was related to ages > 65 (risk ratio [RR] = 1.30), higher grading (RR = 1.96). Better overall survival was related to female gender (RR = 0.80) and to higher number of recovered nodes (8-12 nodes, RR = 0.46, 13-17 nodes, RR = 0.76, nodes > or = 18, RR = 0.79). The same pattern was observed for relapse free survival. Longer overall and relapse free survival were related to a higher number of recovered nodes with P =.034 and P =.003 respectively (stratified analysis for absence or presence of positive nodes). Stage B patients with fewer than 7 nodes in the specimen had both shorter overall survival (P =.0000) and relapse free survival (P =.0016) than the other B patients. Outcome of stage C patients was not related to the number of recovered nodes (P =.28 and 0.12 respectively). The interaction test between stage of disease and number of recovered nodes was statistically significant (P =.017). CONCLUSIONS: Stage B patients with a small number of examined nodes may be understaged. Thus, these patients might be considered for adjuvant therapy because of their poorer life expectancy than other stage B patients. For stage C patients, the number of recovered nodes does not seem to affect long-term outcome.
Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/cirugía , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Escisión del Ganglio Linfático , Evaluación de Resultado en la Atención de Salud , Adenocarcinoma/mortalidad , Anciano , Neoplasias del Colon/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Tasa de Supervivencia , Factores de TiempoRESUMEN
OBJETIVOS: Análise retrospectiva de pacientes com infertilidade tubária. CASUISTICA E METODOLOGIA: Apresenta-se os dados clínicos de 51 pacientes com infertilidade de causa tubária primária ou secundária, entre fevereiro de 1991 e março de 1994, em acompanhamento no Setor de Infertilidade do Serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre. Estas foram submetidas à microcirurgia tubária visando à resoluçao da infertilidade. RESULTADOS: Através de rossalpingografia pós-cirúrgica ou gestaçao comprovada, foi observado que em 80,85 por cento dos casos houve permeabilidade uni ou bilateral das tubas uterinas, com um índice de gestaçao de 17,02 por cento. CONCLUSOES: sugere-se que a microcirurgia tubária possa ser método satisfatório para o tratamento de infertilidade de causa tubária.