Survival trends of patients with oral and oropharyngeal cancer treated at a cancer center in São Paulo, Brazil.

OBJECTIVE: We aimed to estimate the overall survival (OS) and conditional survival (CS) in patients diagnosed with oral and oropharyngeal squamous cell carcinoma (SCC) and to determine their survival trends. METHODS: The study included all consecutive patients treated at the A.C. Camargo Cancer Center for oral or oropharyngeal SCC between 2001 and 2012. Data were obtained from the Hospital Cancer Registry. OS and CS were analyzed using the Kaplan-Meier method to evaluate the probability of survival with Cox predictor models. RESULTS: Data of 505 oral and 380 oropharyngeal SCC patients obtained in 2001-2006 and 2007-2012 were analyzed. Most of the oral SCC (59%) and oropharyngeal SCC (90%) patients had stages III-IV SCC. The 5-year OS for patients with oral SCC was 51.7%, with no significant difference between the first and second periods. The CS rates in 2007-2012 were 65% after the first year and 86% up to the fifth year. For oropharyngeal SCC, the 5-year OS rate was 45.0% in the first period. The survival rate increased to 49.1% from 2007 to 2012, with a reduction in the risk of death (HR=0.69;0.52-09.2). The CS estimates from 2007 to 2012 were 59% after the first year and 75% up to the fifth year. CONCLUSION: Survival across the two time periods remained stable for oral SCC but showed a significant increase for oropharyngeal SCC, possibly because of improvements in the patients' response to radiotherapy, such as intensity-modulated radiation therapy, and the use of more accurate diagnostic imaging approaches.

Survival trends of patients with oral and oropharyngeal cancer treated at a cancer center in São Paulo, Brazil

OBJECTIVE: We aimed to estimate the overall survival (OS) and conditional survival (CS) in patients diagnosed with oral and oropharyngeal squamous cell carcinoma (SCC) and to determine their survival trends. METHODS: The study included all consecutive patients treated at the A.C. Camargo Cancer Center for oral or oropharyngeal SCC between 2001 and 2012. Data were obtained from the Hospital Cancer Registry. OS and CS were analyzed using the Kaplan-Meier method to evaluate the probability of survival with Cox predictor models. RESULTS: Data of 505 oral and 380 oropharyngeal SCC patients obtained in 2001-2006 and 2007-2012 were analyzed. Most of the oral SCC (59%) and oropharyngeal SCC (90%) patients had stages III-IV SCC. The 5-year OS for patients with oral SCC was 51.7%, with no significant difference between the first and second periods. The CS rates in 2007-2012 were 65% after the first year and 86% up to the fifth year. For oropharyngeal SCC, the 5-year OS rate was 45.0% in the first period. The survival rate increased to 49.1% from 2007 to 2012, with a reduction in the risk of death (HR=0.69;0.52-09.2). The CS estimates from 2007 to 2012 were 59% after the first year and 75% up to the fifth year. CONCLUSION: Survival across the two time periods remained stable for oral SCC but showed a significant increase for oropharyngeal SCC, possibly because of improvements in the patients' response to radiotherapy, such as intensity-modulated radiation therapy, and the use of more accurate diagnostic imaging approaches.

The role of surgical treatment in orbital vascular anomalies.

BACKGROUND: The details of the surgical treatment of orbital vascular anomalies (OVAs) are not fully defined in the literature. METHODS: Two hundred forty-nine patients who underwent surgical treatment of OVAs at our institution between January 1995 and December 2005 were included in a consecutive-series study. Each patient's clinical data, technique details, and clinical outcomes were prospectively collected. The aesthetic results were analyzed according to clinical features and treatment by using the χ (2) association test or Fisher's exact test. RESULTS: Thirty-seven percent of the patients had OVAs involving the upper eyelid, 23% the lower lid, and 40% both eyelids. A complete resection was performed in 65.9% of the patients. A total of 379 surgeries were performed to achieve the final result. The majority of patients (98.3%) had no complaints about surgical scars. The majority of patients had no clinical treatment prior to the surgery. One or more clinical deformities were identified in association with the OVA. Those deformities included ptosis, scar sequelae due to ulceration/infection, eyelash or tarsal/ligament distortions, fibroadipose tissue residues, proptosis, or strabism. Bone deformities were present in 11.3% of the patients. A complete functional and aesthetic restoration was achieved in 66.6% of the patients. CONCLUSIONS: Outcomes with a significant relationship to not obtain complete functional and aesthetic restoration included involvement of both eyelids, upper-eyelid involvement, older age, bilateral involvement, diffuse facial pattern OVAs, and OVAs with dimensions greater than one third of the orbit dimension.

Cutaneous angiosarcoma of the head and neck: report of 23 cases from a single institution.

BACKGROUND: To report a single-institution experience in the treatment of cutaneous head and neck angiosarcoma. STUDY DESIGN: Case series. PATIENTS AND METHODS: Twenty-three patients were evaluated: 12 females and 11 males. The primary site of the lesion was the neck in 9 patients, the scalp in 9, and the face in 5. No patient had been submitted to previous treatment but 10 were submitted to incisional biopsy. The lesions' size ranged from 2.5 to 12 cm (median 4 cm). RESULTS: All but one patient were submitted to surgical resection as primary treatment. Twenty-two patients received adjuvant treatment: 8 cases of local recurrence and 12 cases of distant metastasis. Two patients presented synchronous local and distant relapses. The 5-year survival rate was 21.7 percent. In our series, the only factor affecting survival was histological grade (odds ratio = 6.7; 95% confidence interval, 1.6-28.9). CONCLUSION: Our results for 5-year survival are comparable to those in the literature with a treatment based on complete surgical resection. The only significant prognostic factor was tumor histological grade.

Is galectin-3 a good method for the detection of malignancy in patients with thyroid nodules and a cytologic diagnosis of "follicular neoplasm"? A critical appraisal of the evidence.

BACKGROUND: Thyroid nodules are the most common surgical disease of the thyroid. Fine-needle aspiration biopsy (FNAB) is the most commonly employed tool for establishing a diagnosis. However, 15% to 25% of FNAB reports yield inconclusive results. Immunostaining of cytological smears from FNAB with galectin-3 has been proposed as a tool for differentiating between benign and malignant nodules. We performed a systematic review to evaluate the utility of galectin-3. METHODS: Prospective studies of nodules with FNAB reports of "follicular neoplasm" and with a definitive diagnosis confirmed by histopathology were selected. Calculations of individual sensitivity, specificity, and positive and negative likelihood ratios were made. RESULTS: The articles selected were those with the best methodological quality. CONCLUSION: Galectin-3 could be a good tool to guide therapeutic decision in patients with thyroid nodules and FNAB results of follicular neoplasm, but available information has methodological flaws that precludes a definitive answer about galectin-3 utility in the clinical setting.

Avaliaçäo do estado nutricional e respostas imunológicas celular e humoral inespecíficas no câncer do esôfago / Nutritional status evaluation and cellular and humoral unspecific immunological responses in esophageal cancer

Estudou-se o impacto das neoplasias malignas de esôfago sobre o estado nutricional e imunológico dos pacientes e correlacionaram-se os resultados obtidos com o tratamento recebido e a evoluçäo desses pacientes. Foram estudados 38 pacientes portadores de carcinoma espinocelular de esôfago, no Depto. de Cirurgia Torácica do Hospital A. C. Camargo, no período de l983-1984. Medidas antropométricas, laboratoriais e imunológicas foram realizadas. Verificou-se que há uma interaçäo entre a desnutriçäo e a imunoincompetência provocada ou agravada por ela e que se justifica a necessidade de suporte nutricional e imunológico como parte do tratamento multidisciplinar destes tumores

Adenomas de paratiróide: estudo de 6 casos / Parathyroidy adenoma: study of 6 cases

Publicaçöes recentes enfatizam a freqüência com que o hiperparatiroidismo primário se apresenta simulando patologias ósseas, renais, gastrintestinais e neuromusculares, assim como a dificuldade em se fazer o diagnóstico quando näo se suspeita de alteraçöes endócrinas. Estudam-se 6 casos de hiperparatiroidismo primário cuja etiologia foi adenoma de paratiróide. Pretende-se a importância das manifestaçöes ósseas na suspeita da moléstia e descartar as outras condiçöes que envolvam procedimentos mais agressivos que uma cervicotomia. Ilustram-se a fisiopatologia e os diagnósticos diferenciais das diferentes entidades ósseas implicadas; revisam-se os meios diagnósticos e discutem-se as terapêuticas, dando ênfase às condutas cirúrgicas nos casos de adenoma e hiperplasia da paratiróide