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1.
AMIA Annu Symp Proc ; 2021: 345-354, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34457149

RESUMO

Deep learning models in healthcare may fail to generalize on data from unseen corpora. Additionally, no quantitative metric exists to tell how existing models will perform on new data. Previous studies demonstrated that NLP models of medical notes generalize variably between institutions, but ignored other levels of healthcare organization. We measured SciBERT diagnosis sentiment classifier generalizability between medical specialties using EHR sentences from MIMIC-III. Models trained on one specialty performed better on internal test sets than mixed or external test sets (mean AUCs 0.92, 0.87, and 0.83, respectively; p = 0.016). When models are trained on more specialties, they have better test performances (p < 1e-4). Model performance on new corpora is directly correlated to the similarity between train and test sentence content (p < 1e-4). Future studies should assess additional axes of generalization to ensure deep learning models fulfil their intended purpose across institutions, specialties, and practices.


Assuntos
Aprendizado Profundo , Medicina , Humanos , Idioma , Semântica
2.
Head Neck ; 43(2): 473-484, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33047420

RESUMO

BACKGROUND: To assess the impact of treatment delay on survival of oral/oropharyngeal cancer (OSCC). METHODS: We followed 5743 OSCCs between 2004 and 2009 from a population-based screening program and ascertained death until the end of 2012. RESULTS: The hazard ratios (HRs) of mortality from OSCC were 1.46 (1.30-1.65) and 1.18 (1.04-1.33) in univariable and multivariable analyses, respectively, for treatment delay longer than 6 weeks compared with that shorter than 3 weeks. The corresponding figures were 1.12 (1.01-1.24) and 1.00 (0.91-1.11) for treatment delay between 3 and 6 weeks. Advancing age (1.01), higher stage (stage II: 1.84, stage III: 2.97, stage IV: 6.33), cancer in tongue (1.37), or hard palate (1.63) had higher HR of mortality (P < .05). However, treatment at medical center had a lower mortality (0.83, 0.75-0.91) than local/regional hospital. CONCLUSIONS: Treatment delay longer than 6 weeks for OSCCs detected via a population-based screening program had unfavorable survival.


Assuntos
Neoplasias Bucais , Neoplasias Orofaríngeas , Areca , Detecção Precoce de Câncer , Humanos , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/terapia , Fatores de Risco , Tempo para o Tratamento
3.
Head Neck ; 42(12): 3490-3496, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32776411

RESUMO

BACKGROUND: Clinical course following failure of human papillomavirus (HPV)-positive oropharyngeal cancers (HPV + OPC) is poorly understood. This study aims to characterize disease course following failure after transoral robotic surgery (TORS). METHODS: We identified patients with HPV + OPC-treated upfront with TORS at our institution from 2007 to 2017. HPV status was confirmed with immunohistochemistry or HPV DNA polymerase chain reaction. Patient characteristics, treatment modalities, and post-recurrence outcomes were analyzed for the recurrent cohort. RESULTS: Of the 317 HPV + OPC patients, 28 (8.8%) experienced recurrence, all of HPV 16/18 subtypes. Median post-recurrence survival was 19.8 months (range 2.3-195.8 months) in the 12 locoregional and 16 months (range 2.4-79.5 months) in the 14 distant failures. Sixteen are alive with a median of 39.8 months (range 5.5-209.4 months) after retreatment. CONCLUSION: This is one of the largest series evaluating survival following TORS failure in HPV + OPC. Despite failure, long-term survival and durable remission are possible with single-modal or multiple-modal salvage treatment.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Orofaríngeas , Infecções por Papillomavirus , Procedimentos Cirúrgicos Robóticos , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Humanos , Recidiva Local de Neoplasia , Neoplasias Orofaríngeas/cirurgia , Estudos Retrospectivos
4.
Laryngoscope ; 130(2): 413-417, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31021426

RESUMO

OBJECTIVES/HYPOTHESIS: Squamous cell carcinoma originating in the buccal mucosa and retromolar trigone (RMT) have historically poor outcomes. Difficulties in discriminating tumor origin often result in these subsites being combined in surgical and pathological reports. We aimed to determine if making this anatomical distinction has implications for treatment design and clinical outcomes. STUDY DESIGN: Retrospective case series. METHODS: We identified 27 tumors from either the buccal mucosa patients or RMT patients who underwent surgery followed by radiation. For patients who developed a local failure, we fused the pretreatment imaging, simulation computed tomography, and follow-up imaging to determine the location of failures relative to the radiation field. We calculated the 2-year locoregional control and 2-year disease-free survival. RESULTS: The median time from surgery to radiation was 50 days (range, 32-133 days). The 2-year locoregional control for buccal mucosa versus RMT, respectively, were 35.9% versus 68.4% (P = .252). The 2-year disease-free survival rates were 32.7% versus 68.4%, respectively (P = .196). The median times to failure were 12.00 months (range, 4.9-115.0 months) versus 18.5 months (range, 4.5-61.0 months), respectively. All buccal mucosa failures occurred within the high-dose planning target volume, with a median dose of 60 Gy within the failure region. Following locoregional failure, 10 of the 12 patients have died, with a median time from local failure to death of 3.6 months (range, 1-17.6 months). CONCLUSIONS: Squamous cell carcinomas of the buccal mucosa appear to have a poor prognosis characterized by rapid in-field failure. Therefore, differentiating tumor origin may be important for prognostication and treatment. LEVEL OF EVIDENCE: 3 Laryngoscope, 130:413-417, 2020.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Bucais/radioterapia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/mortalidade , Neoplasias Bucais/cirurgia , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Taxa de Sobrevida , Tempo para o Tratamento , Tomografia Computadorizada por Raios X , Falha de Tratamento
5.
J Gastroenterol Hepatol ; 35(4): 609-616, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31677184

RESUMO

BACKGROUND AND AIM: The aim of this study is to identify gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in Indigenous communities. METHODS: First, we quantified the health disparities in gastric cancer in Indigenous peoples using data from the cancer registries during the period of 2006-2014. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy. RESULTS: Gastric cancer incidence (24.4 vs 12.3 per 100 000 person-years) and mortality rates (15.8 vs 6.8 per 100 000 person-years) were higher in Indigenous than in non-Indigenous, with 2.19-fold (95% confidence interval [CI]: 2.06-2.33) and 2.47-fold (2.28-2.67) increased risk, respectively. In Indigenous communities, H. pylori infection was more prevalent in Indigenous than in non-Indigenous (59.4% vs 31.5%, P < 0.01). Regression analyses consistently showed that either the mountain or plain Indigenous had 1.89-fold (95% CI: 1.34-2.66) and 1.73-fold (95% CI: 1.24-2.41) increased risk for H. pylori infection, respectively, as compared with non-Indigenous, adjusting for other baseline characteristics. The high infection rates were similarly seen in young, middle-aged, and older adults. Program eradication rates using clarithromycin-based triple therapy were suboptimal (73.7%, 95% CI: 70.0-77.4%); the habits of smoking (1.70-fold, 95% CI: 1.01-2.39) and betel nut chewing (1.54-fold, 95% CI: 0.93-2.16) were associated with the higher risk of treatment failure. CONCLUSION: Gastric cancer burden is higher in Indigenous Taiwanese peoples than in their non-Indigenous counterparts. Eliminating the prevalent risk factor of H. pylori infection is a top priority to reduce this health disparity.


Assuntos
Claritromicina/administração & dosagem , Efeitos Psicossociais da Doença , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Disparidades em Assistência à Saúde , Infecções por Helicobacter , Helicobacter pylori , Povos Indígenas/estatística & dados numéricos , Neoplasias Gástricas/prevenção & controle , Areca/efeitos adversos , Quimioterapia Combinada , Gastrite/complicações , Gastrite/epidemiologia , Incidência , Prevalência , Fatores de Risco , Fumar/efeitos adversos , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/mortalidade , Taiwan/epidemiologia
6.
Oral Dis ; 25(4): 1067-1075, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30821883

RESUMO

OBJECTIVE: To investigate the risk for second primary cancer in the hypopharynx and esophagus (SPC-HE) among individuals with an initial oral/oropharyngeal cancer. MATERIALS AND METHODS: Mass screening data from Taiwan (2004-2009) included individuals who were ≥18 years old and smoked cigarettes and/or chewed betel quid. Occurrence of SPC-HE was monitored until December 31, 2014. Results were expressed as adjusted relative risk (aRR) and 95% confidence interval (CI). RESULTS: One hundred and fifty-eight out of 4,494 subjects with oral cancer developed SPC-HE (incidence rate: 6.47 per 1,000 person-years). Relative to patients with primary cancers in the lip, the risk of an SPC-HE was higher in patients with primary cancers in oropharynx (aRR: 19.98, 95% CI: 4.72-84.55), floor of mouth (aRR: 12.13, 95% CI: 2.67-55.15), and hard palate (aRR: 7.31, 95% CI: 1.65-32.37), but not in patients with cancers in tongue (aRR: 3.67, 95% CI: 0.89-15.17) or gum (aRR: 3.99, 95% CI: 0.92-17.35). Regression analyses also showed the risk of an SPC-HE was greater in alcohol drinkers than those who did not (aRR: 1.65, 95% CI: 1.10-2.48). CONCLUSIONS: Compared with the initial cancer in the lip, patients with a cancer in the oropharynx, floor of mouth, and hard palate had a higher risk for the SPC-HE.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/patologia , Neoplasias Hipofaríngeas/patologia , Neoplasias Bucais/patologia , Segunda Neoplasia Primária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/epidemiologia , Feminino , Humanos , Neoplasias Hipofaríngeas/epidemiologia , Hipofaringe , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Taiwan
7.
Head Neck ; 41(5): 1475-1483, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30652378

RESUMO

BACKGROUND: To elucidate the impact of varying anatomic sites on advanced stage of and death from oral cancer. METHODS: A total of 27 717 oral cancers mainly from a population-based visual inspection program in Taiwan from 2004 to 2009 was followed until the end of 2012. RESULTS: Using lip cancer as reference, the odds ratios (95% confidence interval [CI]) of advanced stage of cancer were 2.20 (1.92-2.51) for tongue, 2.60 (2.28-2.97) for buccal, 2.68 (2.20-3.28) for floor of mouth, 2.96 (2.52-3.47) for hard palate, 6.04 (5.17-7.05) for gingiva, and 10.83 (9.20-12.74) for oropharynx. The estimated hazard ratios (95% CI) for oral cancer death increased from 1.48 (1.31-1.67) in buccal, 1.61 (1.43-1.82) in tongue, 1.68 (1.41-1.99) in floor of mouth, 1.79 (1.57-2.05) in gingiva, 1.97 (1.71-2.26) in hard palate, and 2.15 (1.89-2.45) in oropharynx. CONCLUSION: Different anatomic sites had variations in advanced stage of and death from oral cancer and need vigilant surveillance.


Assuntos
Causas de Morte , Detecção Precoce de Câncer/métodos , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Adulto , Idoso , Alcoolismo/complicações , Bochecha/patologia , Estudos de Coortes , Intervalos de Confiança , Intervalo Livre de Doença , Feminino , Gengiva/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Soalho Bucal/patologia , Neoplasias Bucais/terapia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Razão de Chances , Orofaringe/patologia , Palato Duro/patologia , Estudos Prospectivos , Medição de Risco , Fumar/efeitos adversos , Análise de Sobrevida , Taiwan , Adulto Jovem
8.
Oral Oncol ; 87: 58-63, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527244

RESUMO

OBJECTIVES: To elucidate the risk of malignant transformation to invasive oral cancer by subtypes of oral potentially malignant disorders (OPMD) and to examine the independent effects of risk factors, particularly alcohol drinking, by subtype based on a nationwide oral cancer screening program targeting at general population with habits of smoking and/or betel quids chewing. MATERIALS AND METHODS: The total of 8501 subjects diagnosed as different subtypes of OPMDs from the Taiwanese screening program between 2004 and 2009 were followed up over time to ascertain the occurrence of invasive oral cancer. The hazard ratios of malignant transformation were estimated by using Cox proportional hazards regression model. RESULTS: The overall malignant rate (per 1000 person-years) to oral cancer was 8.4 (407 incident cases with an average of 5.7 years of follow-up). The highest rate was noted in exophytic verrucous hyperplasia (33), followed by erythroplakia (11.8), erythroleukoplakia (10.7), oral submucous fibrosis (OSF) (8.6), and leukoplakia (5.4). After adjusting for confounders, exophytic verrucous hyperplasia still had a 5.69 (4.47-7.24) times risk compared with leukoplakia. The corresponding figures for erythroplakia, erythroleukoplakia, and OSF were 2.25 (1.31-3.89), 2.00 (1.13-3.53), and 1.63 (1.29-2.06), respectively. Alcohol drinking elevated the overall risk of malignant transformation by 23% (1-52% and also triggered a higher risk in OSF (aHR = 1.62 (1.06-2.47)). The higher risk attributed to betel quids chewing was noted for exophytic verrucous hyperplasia (aHR = 4.23 (1.55-11.55)). CONCLUSIONS: The risk of malignant transformation to oral cancer varied with the subtypes of OPMD and was elevated in OSF and verrucous hyperplasia attributed to alcohol drinking and betel quids, respectively.


Assuntos
Transformação Celular Neoplásica/patologia , Detecção Precoce de Câncer/estatística & dados numéricos , Leucoplasia Oral/patologia , Neoplasias Bucais/epidemiologia , Lesões Pré-Cancerosas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Areca/efeitos adversos , Feminino , Seguimentos , Humanos , Hiperplasia/epidemiologia , Hiperplasia/etiologia , Hiperplasia/patologia , Incidência , Leucoplasia Oral/epidemiologia , Leucoplasia Oral/etiologia , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/etiologia , Estudos Prospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
9.
Anticancer Res ; 38(3): 1525-1529, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29491081

RESUMO

BACKGROUND/AIM: Current guidelines derived from a pre-human papilloma virus (HPV) era in oropharyngeal cancer do not recommend routine surveillance imaging. We aimed to analyze the method of recurrence detection in HPV+ disease to determine a role for follow-up imaging. PATIENTS AND METHODS: All HPV+ and HPV- oropharyngeal cancer patients treated at our institution from 2005-2016 with biopsy-proven recurrence were identified and their method of recurrence detection was analyzed. RESULTS: A total of 16 HPV+ oropharyngeal cancer patients were identified to have recurrence, 12 (75%) of which experienced distant recurrence and 13 (81.3%) were detected asymptomatically with imaging at a median time of 19.7 months after initial treatment and verifying no residual disease. Twelve (75%) detections were with PET-CT. While HPV- patients (17 patients) also have a high rate of asymptomatic detection (16 patients, 94.1%), their 3-year post-recurrence survival was significantly lower at 6.5% compared to 83.6% for the HPV+ group (p<0.01). CONCLUSION: In HPV+ patients, a large proportion of failures are asymptomatic distant metastases, which occur beyond 6 months following treatment completion, and are detected with whole body imaging alone. In light of long term post-recurrence survival observed, this preliminary data suggests that routine surveillance imaging should be further studied for HPV+ disease.


Assuntos
Neoplasias Orofaríngeas/diagnóstico por imagem , Neoplasias Orofaríngeas/terapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Terapia de Salvação/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Orofaríngeas/complicações , Papillomaviridae/fisiologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Estudos Retrospectivos , Resultado do Tratamento
10.
Adv Radiat Oncol ; 2(2): 159-166, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28740927

RESUMO

OBJECTIVE: There are no randomized data to support the use of postoperative radiation for salivary gland malignancies. This study uses the National Cancer Database (NCDB) to describe the epidemiology of salivary gland cancer patients and to investigate whether treatment with adjuvant radiation improves overall survival. METHODS AND MATERIALS: A total of 8243 patients diagnosed with a major salivary gland cancer were identified from the NCDB. All patients received primary surgical resection of their malignancy. Patients were risk-stratified by adverse features, and overall survival rates were determined. Patients were considered high risk if they had extracapsular extension and/or positive margin after resection. Patients were considered intermediate risk if they did not meet the criteria for high risk but had pT3-T4 disease, pN+ disease, lymphovascular space invasion, adenoid cystic histology, or grade 2-3 disease. Patients who did not meet criteria for high or intermediate risk were considered low risk. Overall patient demographics, disease characteristics, treatment factors, and outcomes were summarized with descriptive statistics and analyzed with STATA. RESULTS: Median follow-up in this cohort was 42.4 months, with the median age of 58 years. Patients in the high-risk group had greater survival (hazard ratio [HR], 0.76; P = .002; 95% confidence interval [CI], 0.64-0.91) if they received adjuvant radiation therapy. In contrast, patients in the intermediate- (HR, 1.01; P = .904; 95% CI, 0.85-1.20) and low-risk groups (HR, 0.85; P = .427; 95% CI, 0.57-1.26) did not experience a survival benefit with adjuvant radiation therapy. CONCLUSIONS: This large analysis compared survival outcomes between observation and adjuvant radiation alone in risk-stratified patients after resection of major salivary glands using a national database. The use of adjuvant radiation for high-risk major salivary gland cancers appears to offer a survival benefit. Although an overall survival benefit was not seen in low- and intermediate-risk salivary gland cancers, this study could not address impact on local control because of the limitations of the NCDB.

11.
Anticancer Res ; 37(4): 1847-1851, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28373450

RESUMO

BACKGROUND/AIM: Elderly patients with HPV+ oropharyngeal cancer (OPC) represent an understudied cohort of the HPV epidemic. We aimed to investigate the clinical presentation, treatment tolerability and outcomes in patient's ≥65 years old with HPV+ OPC. PATIENTS AND METHODS: We identified all patients aged 65 and older treated at our Institution with HPV+ OPC and analyzed patient demographics, disease characteristics, treatment modalities, toxicities, treatment failures, and survival. Charlson comorbidity index was calculated for each patient. RESULTS: 43 patients were identified with a mean age of median age was 70.0 (range 65-86). The mean Charlson comorbidity index score for the cohort was 5.2. In total, 72.1% of patients received what was considered standard-of-care based on stage and pathological features. Nine point three percent of patients required RT-related treatment breaks with the majority being women (75%). Three-year actuarial overall survival was 85.5% (95% CI: 71.4%-100%) and 3-year disease-free survival was 67.3% (95% CI: 49.7-91.0%). CONCLUSION: This study presented one of the largest series to date evaluating HPV-related OPC in patients ≥65. Elderly individuals with HPV+ OPC have favorable overall survival with high treatment tolerability independent of Charlson co-morbidity score. Elderly patients should be considered for stage-appropriate care with omission of specific therapies based on absolute contraindications and patient preference, but not assumptions regarding tolerability.


Assuntos
Carcinoma de Células Escamosas/virologia , Neoplasias Orofaríngeas/virologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Terapia Combinada , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Infecções por Papillomavirus/virologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
12.
Pract Radiat Oncol ; 7(2): 103-108, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28274393

RESUMO

PURPOSE: Acute lymphoblastic leukemia (ALL) has a predilection for CNS involvement. Patients with high-risk ALL are often managed with transplant using a radiation-based conditioning regimen. Historically, a high-dose prophylactic cranial boost (CB) of ≥12 Gy was given to reduce risk of central nervous system (CNS) recurrence. However, the use of CB has fallen out of favor because of toxicity concerns. In high-risk adults undergoing transplant at our institution, we have used a low-dose 6 Gy CB to reduce toxicity while conditioning adults with fully developed brains. The safety, efficacy, and utility of a low-dose CB in adults are poorly studied; herein, we report their outcomes and toxicity. METHODS AND MATERIALS: We identified all high-risk ALL patients undergoing total body irradiation as part of their conditioning regimen. Those who received 6 Gy CB or no CB were included (55 total). Their charts were reviewed and statistical analyses were completed with R, version 2.15.2. RESULTS: In patients undergoing CB, 3-year CNS disease-free survival and overall survival were 94.7% and 62.7%. In those not undergoing CBs, survivals were 81.8% and 51.5%. Notably, within the CB cohort, patients without prior CNS involvement had no CNS failures. In contrast, in the non-CB cohort, there were 2 CNS failures in patients with no history of CNS involvement. In the CB cohort, the only notable acute toxicity was parotitis (2.8%). Late toxicity in the CB cohort included 1 instance of cataracts (2.8%) without any evidence of cognitive impairment or potential radiation induced secondary malignancy. CONCLUSIONS: A dose of 6 Gy CB is well-tolerated in the adult ALL population as part of a radiation-based conditioning regimen. Low-dose CB may be considered in adult patients with high-risk ALL without prior CNS involvement to reduce the likelihood of recurrence.


Assuntos
Transplante de Medula Óssea , Neoplasias do Sistema Nervoso Central/prevenção & controle , Irradiação Craniana/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirurgia , Condicionamento Pré-Transplante/métodos , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , Sistema Nervoso Central/efeitos da radiação , Terapia Combinada/métodos , Irradiação Craniana/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Doses de Radiação , Estudos Retrospectivos , Resultado do Tratamento , Irradiação Corporal Total/efeitos adversos , Irradiação Corporal Total/métodos , Adulto Jovem
13.
Cancer ; 123(9): 1597-1609, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28055109

RESUMO

BACKGROUND: To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. METHODS: A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged ≥ 18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. RESULTS: The overall screening rate was 55.1%. The relative risk of death from oral cancer was 0.53 (95% confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95% CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95% CI, 0.59-0.64), which increased to 0.79 (95% CI, 0.76-0.82) after adjustment for self-selection bias. CONCLUSIONS: An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral cancer. Cancer 2017;123:1597-1609. © 2017 American Cancer Society.


Assuntos
Areca , Leucoplasia Oral/diagnóstico , Neoplasias Bucais/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Sistema de Registros , Fumar , Adolescente , Adulto , Idoso , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Armazenamento e Recuperação da Informação , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Neoplasias Bucais/prevenção & controle , Taiwan , Adulto Jovem
14.
Anticancer Res ; 37(1): 229-232, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-28011496

RESUMO

BACKGROUND/AIM: Computerized tomographic (CT) simulation is used to design precise radiation therapy treatment plans. These scans are not routinely read by radiology and are only used for planning purposes. As radiation oncology departments adopt the addition of intravenous contrast to their CT simulations, there is the potential for identification of post-surgical recurrences. PATIENTS AND METHODS: We identified all biopsy-proven local recurrences of head and neck cancer detected during CT simulation and followed their outcomes. RESULTS: A total of 218 patients with head and neck cancer underwent CT simulation with intravenous contrast since our Department adopted the new technique. There were a total of four recurrences detected during simulation: two of the right tongue, one oral cavity and one laryngeal. Intensified salvage chemoradiotherapy was used for these cases. Two out of the four were successfully salvaged and remain disease-free. CONCLUSION: Recurrences of head and neck cancer following surgical resection can be detected on simulation scans, with the potential for survival after appropriate salvage therapy.


Assuntos
Quimiorradioterapia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/terapia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/terapia , Adulto , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante , Terapia de Salvação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
PLoS One ; 11(12): e0168061, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27930732

RESUMO

BACKGROUND: Current standard of care for oropharyngeal cancers with positive surgical margins and/or extracapsular extension is adjuvant chemoradiotherapy. It is unknown whether HPV+ oropharyngeal cancer benefits from this treatment intensification. OBJECTIVE: To investigate the outcomes of HPV+ patients treated with adjuvant radiotherapy alone when chemoradiotherapy was indicated based on high risk pathological features. They were compared with high risk HPV+ patients treated with adjuvant chemoradiotherapy. METHODS: All high risk HPV+ oropharyngeal cancer patients (9) who received radiotherapy alone were identified. We also identified 17 patients who received chemoradiotherapy as a comparison group. Median follow up time was 37.3 months. RESULTS: No local failures developed in adjuvant radiotherapy group. There was 1 distant recurrence in this cohort and 3 in CRT cohort. Regarding toxicity, 8 (47.1%) chemoradiotherapy patients had >10 lb. weight loss (p = 0.013), despite 75% of them having a percutaneous endoscopic gastrostomy tube placed. No individuals in radiotherapy group experienced a >10 lb. weight loss and none required a gastrostomy tube. CONCLUSIONS: This series provides preliminary evidence suggesting that the omission of concurrent chemotherapy to adjuvant radiotherapy may offer comparative local control rates with a lower toxicity profile in the setting of HPV+ patients with traditional high risk features.


Assuntos
Neoplasias Orofaríngeas/radioterapia , Infecções por Papillomavirus/complicações , Radioterapia Adjuvante , Adulto , Idoso , Quimiorradioterapia Adjuvante , Terapia Combinada , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/etiologia , Neoplasias Orofaríngeas/terapia , Neoplasias Orofaríngeas/virologia , Papillomaviridae , Radioterapia Adjuvante/métodos , Fatores de Risco , Resultado do Tratamento
16.
Soc Sci Res ; 58: 104-121, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27194654

RESUMO

In the aftermath of the 9/11 terrorist attacks, many countries have passed new counterterrorist legislation. One of the common assumptions about such legislation is that it comes with a price: a compromise to practices of human rights. Previous research, looking at a wide range of case studies, suggested that this is indeed the case and that counterterrorist legislation often leads to subsequent repression. However, no large-scale cross-national study has yet assessed this relationship. Relying on a newly assembled database on nation-level counterterrorist legislation for the years 1981-2009, we conduct a cross-national time series analysis of legislation and repression. Our analyses find little evidence for a significant relationships between national counterterrorist legislation and various measures of core human rights in most countries. However, while legislation does not affect repression of physical integrity rights in countries with low and high levels of repression, it is associated with greater state repression in countries with intermediate scores of repression.


Assuntos
Direitos Humanos , Legislação como Assunto , Terrorismo , Comércio , Humanos , Ataques Terroristas de 11 de Setembro
17.
Sci Signal ; 8(370): ra32, 2015 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-25829446

RESUMO

The tumor suppressor PTEN restrains cell migration and invasion by a mechanism that is independent of inhibition of the PI3K pathway and decreased activation of the kinase AKT. PREX2, a widely distributed GEF that activates the GTPase RAC1, binds to and inhibits PTEN. We used mouse embryonic fibroblasts and breast cancer cell lines to show that PTEN suppresses cell migration and invasion by blocking PREX2 activity. In addition to metabolizing the phosphoinositide PIP3, PTEN inhibited PREX2-induced invasion by a mechanism that required the tail domain of PTEN, but not its lipid phosphatase activity. Fluorescent nucleotide exchange assays revealed that PTEN inhibited the GEF activity of PREX2 toward RAC1. PREX2 is a frequently mutated GEF in cancer, and examination of human tumor data showed that PREX2 mutation was associated with high PTEN expression. Therefore, we tested whether cancer-derived somatic PREX2 mutants, which accelerate tumor formation of immortalized melanocytes, were inhibited by PTEN. The three stably expressed, somatic PREX2 cancer mutants that we tested were resistant to PTEN-mediated inhibition of invasion but retained the ability to inhibit the lipid phosphatase activity of PTEN. In vitro analysis showed that PTEN did not block the GEF activity of two PREX2 cancer mutants and had a reduced binding affinity for the third. Thus, PTEN antagonized migration and invasion by restraining PREX2 GEF activity, and PREX2 mutants are likely selected in cancer to escape PTEN-mediated inhibition of invasion.


Assuntos
Neoplasias da Mama/metabolismo , Movimento Celular/fisiologia , Fatores de Troca do Nucleotídeo Guanina/metabolismo , Invasividade Neoplásica/prevenção & controle , PTEN Fosfo-Hidrolase/metabolismo , Proteínas rac1 de Ligação ao GTP/metabolismo , Animais , Linhagem Celular Tumoral , Movimento Celular/genética , Primers do DNA/genética , Imunofluorescência , Técnicas de Inativação de Genes , Vetores Genéticos , Fatores de Troca do Nucleotídeo Guanina/genética , Humanos , Immunoblotting , Imunoprecipitação , Lentivirus , Camundongos , PTEN Fosfo-Hidrolase/genética , Reação em Cadeia da Polimerase , RNA Interferente Pequeno/genética , Estatísticas não Paramétricas
18.
J Vasc Surg ; 39(3): 672-5, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14981467

RESUMO

During endovascular abdominal aortic aneurysm repair, aneurysmal involvement of the common or internal iliac arteries occasionally necessitates elective occlusion of one or both internal iliac arteries. Although elective internal iliac artery occlusion is often well tolerated, it can result in complications such as buttock claudication or rest pain, impotence, and colon ischemia. We report a case of gluteal compartment syndrome following elective unilateral internal iliac artery embolization prior to endovascular abdominal aortic aneurysm repair. On the first postoperative day, the patient developed sciatic nerve palsy, rhabdomyolysis, and renal failure, which promptly resolved after emergent operative exploration of his left buttock and debridement of all grossly necrotic muscle. This case emphasizes the point that, although elective internal iliac artery interruption is usually benign, it can have serious and unexpected complications that necessitate expeditious treatment for complete recovery.


Assuntos
Aneurisma/terapia , Implante de Prótese Vascular/efeitos adversos , Nádegas/irrigação sanguínea , Síndromes Compartimentais/etiologia , Embolização Terapêutica/efeitos adversos , Artéria Ilíaca , Idoso , Aneurisma da Aorta Abdominal/cirurgia , Síndromes Compartimentais/cirurgia , Desbridamento/métodos , Humanos , Masculino , Resultado do Tratamento
19.
J Vasc Surg ; 38(2): 251-6, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12891105

RESUMO

OBJECTIVES: Postoperative infection is one of the most dreaded complications associated with use of synthetic patches for carotid endarterectomy. Although polyester patches were used extensively for carotid patch angioplasty throughout the last decade, few reports detail cases of deep patch infection. We describe our experience with polyester patch infections after carotid endarterectomy. Patients and methods From January 1996 through December 2001 we treated polyester patch infections after carotid endarterectomy in 10 patients. RESULTS: The interval from primary carotid endarterectomy to presentation with infection ranged from 11 days to 30 months. All patients underwent repeat operation that involved tissue debridement, excision of the polyester patch, and either interposition grafting or patch angioplasty with autologous vein. No perioperative stroke or death occurred; however, 1 patient had transient hoarseness, and in 1 patient a pseudoaneurysm developed that required additional surgical repair with a saphenous vein interposition graft. All patients remain well and free of infection with follow-up as long as 56 months. CONCLUSIONS: Infection is a serious and rare complication of carotid patch angioplasty with polyester material. Nonetheless, it can be treated successfully with good results and acceptable morbidity with soft tissue debridement, prosthetic patch excision, and either patch angioplasty or interposition grafting with autologous vein.


Assuntos
Prótese Vascular/efeitos adversos , Endarterectomia das Carótidas/efeitos adversos , Poliésteres/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/terapia , Reoperação , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
20.
J Vasc Surg ; 36(4): 668-73, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12368723

RESUMO

OBJECTIVE: Total occlusion of the contralateral internal carotid artery has often been considered to be a predictor of poor outcome after carotid endarterectomy (CEA) of ipsilateral carotid stenosis. Data from both the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerosis Study have suggested this to be true. However, each of these trials had relatively few patients with contralateral occlusion in the surgical arms of the studies. Recently, advocates of carotid angioplasty and stenting have suggested that this technique may be preferable in patients with a contralateral occlusion because of the perceived poor outcome with surgery. The purpose of this study was to review a large series of CEAs performed in patients with contralateral occlusion to see whether results differed from patients with patent contralateral arteries and to determine whether the presence of preoperative symptoms was an important factor in outcome in these cases. PATIENTS AND METHODS: A review was conducted of a prospectively compiled database of all primary CEAs performed at our institution from 1985 to 1999. Surgery was performed on 2420 patients, of whom 338 (14.0%) had contralateral total occlusion. RESULTS: Patients with contralateral total occlusion were more likely to be symptomatic (65.7% versus 60.1%; P =.1), male (70.9% versus 58%; P <.001), and hypertensive (63.9% versus 58.4%; P =.07) with a positive smoking history (42.6% versus 31.4%; P <.001) than patients with patent contralateral carotid artery. No significant difference was seen in the rates of perioperative neurologic events between patients with contralateral occlusion (3.0%) and those without (2.1%; P =.34). Among the total of 913 asymptomatic patients, of whom 115 had contralateral occlusion, no difference was seen in the rate of perioperative neurologic events (1.8% for contralateral occlusion cases; 1.9% for cases without contralateral occlusion). Among the total of 1507 symptomatic patients, of whom 223 had contralateral occlusion, no significant difference was seen in the rate of perioperative neurologic events (3.7% for contralateral occlusion cases; 2.2% for cases without contralateral occlusion; P =.2). CONCLUSION: The presence of contralateral occlusion does not appear to increase the perioperative risk of CEA. Although the risk of CEA in symptomatic patients with contralateral occlusion may be slightly increased, this must be weighed against the risk with medical treatment alone. CEA can be performed safely in patients with contralateral occlusion, which should not necessarily be considered a high-risk condition for surgery in favor of angioplasty and stenting.


Assuntos
Estenose das Carótidas/patologia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias , Idoso , Estenose das Carótidas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Grau de Desobstrução Vascular
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