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1.
Medicine (Baltimore) ; 98(43): e17688, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651897

RESUMO

RATIONALE: Oral adenosquamous carcinoma (ASC) is rare and its origins are controversial. We here present a patient with oral ASC that developed after surgery for oral squamous cell carcinoma (SCC). PATIENT CONCERNS: A 70-year-old man with SCC on the oral floor underwent surgical resection. However, the enlarged ulcer presented on the oral floor 9 month after surgery. DIAGNOSES: The biopsy of the ulcer revealed a SCC. Imaging examinations detected enhancement of a large lesion expanded to the tongue, but no evidence of regional lymph node or distant metastasis was shown. Based on these results, local recurrence of the cancer was diagnosed (cT4aN0M0). INTERVENTIONS: The surgery for the recurrent tumor was performed. OUTCOMES: The pathological examination of the surgical specimen indicated recurrent tumor was ASC. Thus, histopathological and immunohistochemical analyses of both the initial SCC and the subsequent ASC were performed in an attempt to explore the origin of the ASC. As the results, pathological review of both tumors suggested the subsequent ASC was developed from the tumor cells with adenoid phenotype in the initial SCC. LESSONS: This report suggests that the oral ASC was origin from the oral SCC, which can contribute to new knowledge for pathogenesis of oral cancer.


Assuntos
Carcinoma Adenoescamoso/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Bucais/patologia , Recidiva Local de Neoplasia/patologia , Idoso , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/cirurgia , Evolução Fatal , Humanos , Masculino , Neoplasias Bucais/cirurgia , Recidiva Local de Neoplasia/cirurgia
3.
Anticancer Res ; 39(8): 4575-4580, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366562

RESUMO

BACKGROUND/AIM: The aim of this study was to examine the clinicopathological features of pancreatic adenosquamous carcinoma (PASC). PATIENTS AND METHODS: Our study included seven patients who underwent resection of PASC. RESULTS: PASC is characterized by large tumors and strong infiltration into the major blood vessels and other organs, forcing many patients to undergo extended resections. In addition, all patients experienced liver metastasis recurrence following surgery, with a very poor prognosis. Histopathologically, a poorly differentiated sarcomatous component existed in all patients in addition to an adenocarcinoma component and squamous carcinoma component. Although P40 staining for the sarcomatous component was positive along with squamous carcinoma, E-cadherin expression disappeared while vimentin was expressed. It has been suggested that it is highly likely that these sarcomatous components are derived from squamous carcinoma and have an impact on prognosis. CONCLUSION: The sarcomatous component may be related to the biological malignancy of PASC.


Assuntos
Carcinoma Adenoescamoso/cirurgia , Neoplasias Pancreáticas/cirurgia , Prognóstico , Idoso , Caderinas/genética , Carcinoma Adenoescamoso/genética , Carcinoma Adenoescamoso/patologia , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patologia
5.
Am J Case Rep ; 20: 961-964, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31273185

RESUMO

BACKGROUND Glassy cell carcinoma of the endometrium is an extremely rare variant of adenosquamous carcinoma, and it has a poor prognosis. In postmenopausal women it typically presents as unprovoked, painless uterine bleeding. Tissue sampling is necessary to establish the diagnosis. CASE REPORT A 58-year-old postmenopausal woman on no hormone replacement therapy experienced 2 months of intermittent uterine bleeding. An office transvaginal ultrasound discovered a 1.7-cm intracavitary leiomyoma, but because the endometrial stripe was not visualized, an endometrial biopsy was performed. She was found to have a Stage 1 A endometrial poorly-differentiated adenosquamous carcinoma, glassy cell carcinoma tumor of 1.5 cm in greatest dimension. She underwent a robotic total hysterectomy, bilateral salpingo-oophorectomy, pelvic lymph node mapping, and bilateral pelvic lymphadenectomy. CONCLUSIONS Glassy cell carcinoma of the endometrium can present as an intracavitary leiomyoma in postmenopausal women.


Assuntos
Carcinoma Adenoescamoso/diagnóstico por imagem , Neoplasias do Endométrio/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Ultrassonografia , Carcinoma Adenoescamoso/cirurgia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Leiomioma/cirurgia , Excisão de Linfonodo , Pessoa de Meia-Idade
6.
Gan To Kagaku Ryoho ; 46(4): 772-774, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31164531

RESUMO

This report describes a case of primary adenosquamous carcinoma of the liver with hepatolithiasis. A 70's man was followed up at a clinic for hepatolithiasis, gallbladder stone, and dilatation of the intrahepatic duct. He visited our hospital for computed tomography(CT)examination. CT showed a 30mm diameter low-density mass in the S2 liver and dilatation of the intrahe- patic duct filled with hepatolithiasis. Blood examination showed elevated levels of tumor markers(CEA 8.0 ng/mL, CA19-9 19,196 U/mL). We diagnosed the tumor as cholangiocellular carcinoma(cT2N1M0, cStage ⅣA)with hepatolithiasis and performed left hepatectomy and lymphadenectomy. In the specimen, a 39×22mm diameter solid tumor was detected and the intrahepatic duct was filled with haptolithiasis. Pathologically, a mixture of adenocarcinoma and squamous cell carcinoma was observed adjacent to the bile duct. Accordingly, a diagnosis of adenosquamous carcinoma was made(pT3N0M0, pStage Ⅲ). Multiple liver metastases were detected 8 months after the operation, and chemotherapy was started. He remains alive 11 months after the operation. We experienced a rare case of adenosquamous carcinoma in the liver with hepatolithiasis.


Assuntos
Neoplasias dos Ductos Biliares , Carcinoma Adenoescamoso , Colangiocarcinoma , Idoso , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Carcinoma Adenoescamoso/diagnóstico , Carcinoma Adenoescamoso/cirurgia , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/cirurgia , Humanos , Masculino
7.
Cells ; 8(5)2019 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-31137590

RESUMO

Patient-derived tumor organoids (PDOs) represent a promising preclinical cancer model that better replicates disease, compared with traditional cell culture models. We have established PDOs from various human tumors to accurately and efficiently recapitulate the tissue architecture and function. Molecular targeted therapies with remarkable efficacy are currently in use against various tumors. Thus, there is a need for in vitro functional-potency assays that can be used to test the efficacy of molecular targeted drugs and model complex interactions between immune cells and tumor cells to evaluate the potential for cancer immunotherapy. This study represents an in vitro evaluation of different classes of molecular targeted drugs, including small-molecule inhibitors, monoclonal antibodies, and an antibody-drug conjugate, using lung PDOs. We evaluated epidermal growth factor receptor and human epidermal growth factor receptor 2 (HER2) inhibitors using a suitable high-throughput assay system. Next, the antibody-dependent cellular cytotoxicity (ADCC) activity of an anti-HER2 monoclonal antibody was evaluated to visualize the interactions of immune cells with PDOs during ADCC responses. Moreover, an evaluation system was developed for the immune checkpoint inhibitors, nivolumab and pembrolizumab, using PDOs. Our results demonstrate that the in vitro assay systems using PDOs were suitable for evaluating molecular targeted drugs under conditions that better reflect pathological conditions.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma Adenoescamoso/tratamento farmacológico , Carcinoma de Células Escamosas/tratamento farmacológico , Avaliação de Medicamentos/métodos , Neoplasias Pulmonares/tratamento farmacológico , Terapia de Alvo Molecular , Organoides/efeitos dos fármacos , Anticorpos Monoclonais Humanizados/farmacologia , Antineoplásicos/farmacologia , Biópsia , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Receptores ErbB/antagonistas & inibidores , Humanos , L-Lactato Desidrogenase/análise , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Receptor ErbB-2/antagonistas & inibidores
8.
Asian J Surg ; 42(6): 711-714, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30871770

RESUMO

Intracystic carcinoma is not common seen in breast malignancy, here we showed a case of intracystic tumor presented in adenosquamoid differentiation. Negative in ER, PR, and HER2 makes treatment out of hormone and target therapy. After simple mastectomy with sentinel lymph node biopsy, we found isolated tumor cell over lymph node. Although AJCC takes ITCs as N0 category, the presence of ITCs is considered as a prognostic factor influencing both the overall and breast cancer-specific survival, thus we gave the patient with adjuvant chemotherapy as locally advanced breast cancer in the NCCN guideline.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Adenoescamoso/diagnóstico , Carcinoma Adenoescamoso/patologia , Idoso , Densidade da Mama , Neoplasias da Mama/genética , Neoplasias da Mama/cirurgia , Carcinoma Adenoescamoso/genética , Carcinoma Adenoescamoso/cirurgia , Feminino , Humanos , Mamografia , Mastectomia Segmentar , Ultrassonografia Mamária
9.
Gan To Kagaku Ryoho ; 46(3): 546-548, 2019 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-30914609

RESUMO

CASE: A man in his 60s reported upper abdominal pain; close examination revealed a tumor in the body-tail of the pancreas that was suspected to be infiltrating the stomach. Multiple liver lesions(S3, S4)were also detected. Histological examination by EUS-FNA showed poorly-differentiated carcinoma; thus, this case was diagnosed with unresectable pancreatic cancer with liver metastases(cT3, cN1[No. 7], cM1[P0, H1], cStage Ⅳ: JPS 7th). After 2 kinds of systemic chemotherapy(9 courses of GEM plus nab-PTX and 9 courses of modified FOLFIRINOX), obvious distant metastases or local progression did not appear and conversion surgery was scheduled. Although a metastatic lesion was identified at S5 of the liver just before the surgery, it was assumed that an R0 resection could be achieved; therefore, the operation(distal pancreatectomy with combined proximal gastrectomy, left adrenalectomy, lymph node dissection, partial hepatectomy of S5, and cholecystectomy)was performed. Histopathological examination showed squamous metaplasia of the epithelial tissue combined with glandular formation. This case was, thus, diagnosed as adenosquamous carcinoma of pancreas. This patient was discharged 90 days after the operation. The patient is still alive 2 years and 2 months since the first diagnosis.


Assuntos
Carcinoma Adenoescamoso , Neoplasias Pancreáticas , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma Adenoescamoso/tratamento farmacológico , Carcinoma Adenoescamoso/cirurgia , Gastrectomia , Humanos , Masculino , Pancreatectomia , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/cirurgia
10.
Rev Col Bras Cir ; 46(1): e2077, 2019 Feb 18.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30785571

RESUMO

OBJECTIVE: to analyze the expression of Vascular Endothelial Growth Factor (VEGF), its receptor (VEGFR-2), age and histological type of advanced cervical carcinomas with respect to the clinical response to neoadjuvant chemotherapy. METHODS: we studied 40 patients with cervical carcinoma (IB2 and IVA) diagnosed by biopsies prior to treatment. All patients underwent neoadjuvant chemotherapy and evaluation for clinical response and expression of VEGF. We considered a tumor regression greater than 50% as a good clinical response. RESULTS: eighteen patients (45%) had good response to chemotherapy, and 22 (55%), poor response. VEGF expression was positive in 16 patients and negative in 24. When analyzed separately for response to chemotherapy, only the positive expression of VEGF was associated with good clinical response (p=0.0157). CONCLUSION: VEGF expression alone was an important marker of good response to neoadjuvant chemotherapy in patients with advanced carcinoma of the cervix.


Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Adenoescamoso/tratamento farmacológico , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias do Colo do Útero/tratamento farmacológico , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Adenocarcinoma/cirurgia , Adulto , Idoso , Biópsia , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Colo do Útero , Cisplatino , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Estudos Prospectivos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
11.
BJOG ; 126(9): 1169-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30663205

RESUMO

OBJECTIVE: To update the oncological results and identify recurrent risk factors in young patients with early stage cervical cancers following abdominal radical trachelectomy (ART). DESIGN: Retrospective study. SETTING: A university-based cancer hospital. POPULATION: Three hundred and thirty-three patients. METHODS: We conducted a retrospective analysis from a prospectively maintained database of patients undergoing ART from April 2004 to December 2017. MAIN OUTCOME MEASURES: Survival rate, clinicopathological factors related to recurrences. RESULTS: Two hundred and seventy-one patients had squamous carcinomas (SCC), 51 had pure adenocarcinomas (AC), and 11 had adenosquamous carcinomas (AS). One hundred thirty-two women (39.6%) had tumours ≥2 cm. With a median follow up of 56 months (range, 6-169), 11 patients (3.3%) had recurrence, and five patients (1.5%) died. The cumulative 5-year recurrence-free survival and overall survival rates were 96.3 and 98.6%, respectively. The recurrence rate in women with tumours ≥2 cm was comparable to that in patients with tumours <2 cm (5.3 versus 2.0%, respectively, P = NS). However, the recurrence rate was significantly higher in patients with AS histology than those with AC and SCC histology (18.2, 3.9, and 2.6%, respectively, P < 0.05). All of the recurrent patients with AS histology had tumours ≥2 cm. Multivariate analysis showed that the only independent risk factor for recurrence was histology type. CONCLUSIONS: This updated series showed a favourable survival rate following ART. These results further supported that ART was a safe option for well-selected patients with stage IB1 cervical cancers ≥2 cm. However, if patients with tumours ≥2 cm have AS histology, they should be advised with great caution when contemplating ART. TWEETABLE ABSTRACT: Abdominal radical trachelectomy could be a safe, fertility-sparing option for strictly selected patients with stage IA1-IB1 cervical cancers ≤4 cm.


Assuntos
Carcinoma/cirurgia , Recidiva Local de Neoplasia/mortalidade , Traquelectomia/mortalidade , Neoplasias do Colo do Útero/cirurgia , Abdome/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Carcinoma/mortalidade , Carcinoma/patologia , Carcinoma Adenoescamoso/mortalidade , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Colo do Útero/patologia , Colo do Útero/cirurgia , Bases de Dados Factuais , Feminino , Preservação da Fertilidade , Humanos , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Traquelectomia/métodos , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Adulto Jovem
12.
J Int Med Res ; 47(1): 281-292, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30501533

RESUMO

OBJECTIVE: To establish new diagnostic criteria for improvement of the accuracy of multi-slice spiral computed tomography (MSCT) in diagnosing the N-stage and lymph node (LN) metastasis of gastric cancer (GC). METHODS: MSCT was performed with plain and triphasic dynamic contrast enhancement. Different regions of LN metastasis and N-staging were determined according to the herein-proposed combined diagnostic criteria and were then correlated with the pathological analysis. The Kappa consistency test was used to study the accuracy of MSCT. RESULTS: The accuracy of MSCT in diagnosing the N-stage as a whole was 86.3%, and that in diagnosing LN metastasis was 79.1% to 98.9%. The Kappa values for stages N0, N1, and N3 ranged from 0.449 to 0.662, indicating good consistency in diagnosing these three stages between MSCT and the postsurgical pathological results. The Ktotal value was 0.567 between MSCT and the postsurgical pathological results in diagnosing LN metastasis. The risk of LN metastasis increased with the progression of lesion infiltrates. CONCLUSIONS: Application of the combined diagnostic criteria increased the diagnostic performance of MSCT in not only judging the N-stage but also diagnosing LN metastasis. This study will provide valuable reference data for surgical planning for patients with GC in the clinical setting.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Carcinoma Adenoescamoso/diagnóstico por imagem , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células em Anel de Sinete/patologia , Carcinoma de Células em Anel de Sinete/cirurgia , Feminino , Gastrectomia/métodos , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada Espiral
13.
Cancer ; 125(4): 575-585, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30427539

RESUMO

BACKGROUND: Although rare in the United States, gallbladder cancer (GBCA) is a common cause of cancer death in some parts of the world. To investigate regional differences in pathogenesis and outcomes for GBCA, tumor mutations were analyzed from a sampling of specimens. METHODS: Primary tumors from patients with GBCA who were treated in Chile, Japan, and the United States between 1999 and 2016 underwent targeted sequencing of known cancer-associated genes. Fisher exact and Kruskal-Wallis tests assessed differences in clinicopathologic and genetic factors. Kaplan-Meier methods evaluated differences in overall survival from the time of surgery between mutations. RESULTS: A total of 81 patients were included. Japanese patients (11 patients) were older (median age, 72 years [range, 54-81 years]) compared with patients from Chile (21 patients; median age, 59 years [range, 32-73 years]) and the United States (49 patients; median age, 66 years [range, 46-87 years]) (P = .002) and had more well-differentiated tumors (46% vs 0% for Chile/United States; P < .001) and fewer gallstone-associated cancers (36% vs 67% for Chile and 69% for the United States; P = .13). Japanese patients had a median mutation burden of 6 (range, 1-23) compared with Chile (median mutation burden, 7 [range, 3-20]) and the United States (median mutation burden, 4 [range, 0-27]) (P = .006). Tumors from Japanese patients lacked AT-rich interaction domain 1A (ARID1A) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutations, whereas Chilean tumors lacked Erb-B2 receptor tyrosine kinase 3 (ERBB3) and AT-rich interaction domain 2 (ARID2) mutations. SMAD family member 4 (SMAD4) was found to be mutated similarly across centers (38% in Chile, 36% in Japan, and 27% in the United States; P = .68) and was univariately associated with worse overall survival (median, 10 months vs 25 months; P = .039). At least one potentially actionable gene was found to be altered in 80% of tumors. CONCLUSIONS: Differences in clinicopathologic variables suggest the possibility of distinct GBCA pathogenesis in Japanese patients, which may be supported by differences in mutation pattern. Among all centers, SMAD4 mutations were detected in approximately one-third of patients and may represent a converging factor associated with worse survival. The majority of patients carried mutations in actionable gene targets, which may inform the design of future trials.


Assuntos
Adenocarcinoma/patologia , Biomarcadores Tumorais/genética , Carcinoma Adenoescamoso/patologia , Neoplasias da Vesícula Biliar/patologia , Mutação , Adenocarcinoma/genética , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Adenoescamoso/genética , Carcinoma Adenoescamoso/cirurgia , Chile , Demografia , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/genética , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida , Estados Unidos
14.
Pathol Oncol Res ; 25(1): 157-167, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29043607

RESUMO

This study was conducted to investigate the expressions of DDR2 and IFITM1 and their clinical and pathological significances in the rare type squamous cell/adenosquamous carcinomas (SC/ASC) and ordinary adenocarcinomas (AC) of gallbladder cancers. DDR2 and IFITM1 expression was examined in 69 SC/ASCs and 146 ACs using EnVision immunohistochemistry. Results showed that the percentage of positive DDR2 and IFITM1 expression was significantly higher in SC/ASC patients with high TNM stage, lymph node metastasis, invasion, and no resection surgery compared to patients with low TNM stages, no lymph node metastasis, no invasion, and resection surgery (P < 0.05 or P < 0.01). The positive rate of DDR2 was significantly higher in SC/ASC patients with large tumor sizes than patients with small tumor sizes (p < 0.05). The percentage of positive DDR2 and IFITM1 expressions was significantly higher in AC patients with high TNM stages that didn't receive resection surgery compared to patients with low TNM stages that did receive resection surgery (P < 0.05 or P < 0.01). The positive rate of IFITM1 was significantly higher in AC patients with lymph node metastasis and invasion than in patients without metastasis and invasion (p < 0.05). Positive DDR2 and IFITM1 expression was closely associated with a decreased overall survival in SC/ASC and AC patients (P < 0.05 or P < 0.01). AUC analysis showed that DDR2 and IFITM1 was sensitive and specific for the diagnosis of SC/ASC (AUC = 0.740 and AUC =0.733, respectively) and AC (AUC = 0.710 and AUC =0.741, respectively). In conclusion, positive DDR2 and IFITM1 expression is a marker for the clinical severity, poor prognosis, and diagnosis of gallbladder SC/ASC and AC.


Assuntos
Adenocarcinoma/secundário , Antígenos de Diferenciação/metabolismo , Biomarcadores Tumorais/metabolismo , Carcinoma Adenoescamoso/secundário , Carcinoma de Células Escamosas/secundário , Receptor com Domínio Discoidina 2/metabolismo , Neoplasias da Vesícula Biliar/patologia , Adenocarcinoma/metabolismo , Adenocarcinoma/cirurgia , Carcinoma Adenoescamoso/metabolismo , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/metabolismo , Neoplasias da Vesícula Biliar/cirurgia , Regulação Neoplásica da Expressão Gênica , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Taxa de Sobrevida
15.
Int J Clin Oncol ; 24(5): 575-582, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30580379

RESUMO

BACKGROUND: The aim of this study was to evaluate the effects of treatment with both three-dimensional radiotherapy (3DRT) and weekly 40-mg/m2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors. METHODS: We conducted a retrospective multi-institutional chart review of postoperative uterine cervical cancer patients with high-risk prognostic factors who had been treated with both 3DRT and weekly 40-mg/m2 cisplatin from 2007 to 2012. Each participating hospital provided detailed information regarding patient characteristics, treatment outcomes, and treatment complications. RESULTS: The eligible 96 patients were analyzed. The median follow-up period was 61 months. The 3-year relapse-free survival, overall survival (OS), and locoregional relapse-free survival (LRFS) rates were 76%, 90%, and 88%, respectively. In multivariate analysis, the histological finding of either adenocarcinoma or adenosquamous carcinoma was a significant risk factor for both OS and LRFS. The percentage of patients with grade ≥ 3 acute hematologic toxicity, acute lower gastrointestinal toxicity (GIT), and late lower GIT were 45%, 19%, and 17%, respectively. CONCLUSIONS: The outcomes of concurrent chemoradiotherapy (CCRT) using weekly 40-mg/m2 cisplatin are similar to those in the previous studies that used several chemotherapy regimens. However, postoperative CCRT using 3DRT had a high level of late GIT.


Assuntos
Quimiorradioterapia/efeitos adversos , Cisplatino/uso terapêutico , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/radioterapia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Adulto , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Carcinoma Adenoescamoso/tratamento farmacológico , Carcinoma Adenoescamoso/mortalidade , Carcinoma Adenoescamoso/radioterapia , Carcinoma Adenoescamoso/cirurgia , Quimiorradioterapia/métodos , Cisplatino/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/cirurgia
16.
N Engl J Med ; 379(20): 1905-1914, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30379613

RESUMO

BACKGROUND: Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS: We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010-2013 period at Commission on Cancer-accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000-2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS: In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000-2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, -0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend). CONCLUSIONS: In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.).


Assuntos
Histerectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Carcinoma Adenoescamoso/mortalidade , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Causas de Morte , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Pontuação de Propensão , Programa de SEER , Análise de Sobrevida , Taxa de Sobrevida , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
17.
N Engl J Med ; 379(20): 1895-1904, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30380365

RESUMO

BACKGROUND: There are limited data from retrospective studies regarding whether survival outcomes after laparoscopic or robot-assisted radical hysterectomy (minimally invasive surgery) are equivalent to those after open abdominal radical hysterectomy (open surgery) among women with early-stage cervical cancer. METHODS: In this trial involving patients with stage IA1 (lymphovascular invasion), IA2, or IB1 cervical cancer and a histologic subtype of squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, we randomly assigned patients to undergo minimally invasive surgery or open surgery. The primary outcome was the rate of disease-free survival at 4.5 years, with noninferiority claimed if the lower boundary of the two-sided 95% confidence interval of the between-group difference (minimally invasive surgery minus open surgery) was greater than -7.2 percentage points (i.e., closer to zero). RESULTS: A total of 319 patients were assigned to minimally invasive surgery and 312 to open surgery. Of the patients who were assigned to and underwent minimally invasive surgery, 84.4% underwent laparoscopy and 15.6% robot-assisted surgery. Overall, the mean age of the patients was 46.0 years. Most patients (91.9%) had stage IB1 disease. The two groups were similar with respect to histologic subtypes, the rate of lymphovascular invasion, rates of parametrial and lymph-node involvement, tumor size, tumor grade, and the rate of use of adjuvant therapy. The rate of disease-free survival at 4.5 years was 86.0% with minimally invasive surgery and 96.5% with open surgery, a difference of -10.6 percentage points (95% confidence interval [CI], -16.4 to -4.7). Minimally invasive surgery was associated with a lower rate of disease-free survival than open surgery (3-year rate, 91.2% vs. 97.1%; hazard ratio for disease recurrence or death from cervical cancer, 3.74; 95% CI, 1.63 to 8.58), a difference that remained after adjustment for age, body-mass index, stage of disease, lymphovascular invasion, and lymph-node involvement; minimally invasive surgery was also associated with a lower rate of overall survival (3-year rate, 93.8% vs. 99.0%; hazard ratio for death from any cause, 6.00; 95% CI, 1.77 to 20.30). CONCLUSIONS: In this trial, minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer. (Funded by the University of Texas M.D. Anderson Cancer Center and Medtronic; LACC ClinicalTrials.gov number, NCT00614211 .).


Assuntos
Histerectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Carcinoma Adenoescamoso/mortalidade , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Prospectivos , Taxa de Sobrevida , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
18.
Kyobu Geka ; 71(11): 948-951, 2018 10.
Artigo em Japonês | MEDLINE | ID: mdl-30310008

RESUMO

A 59-year-old man who had postoperative recurrence of lung adenosquamous cell carcinoma was administered nivolumab as 3rd-line chemotherapy. Although nivolumab was considered effective, bleeding from a metastatic lesion at the jejunum was recognized by double-balloon enteroscopy, and partial resection was performed. Although the re-administration of nivolumab was planned, the patient died of acute respiratory failure 6 days postoperatively.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Carcinoma Adenoescamoso/tratamento farmacológico , Carcinoma Adenoescamoso/secundário , Hemorragia Gastrointestinal/etiologia , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Nivolumabe/administração & dosagem , Doença Aguda , Carcinoma Adenoescamoso/cirurgia , Evolução Fatal , Humanos , Neoplasias do Jejuno/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Insuficiência Respiratória/etiologia
19.
Gen Thorac Cardiovasc Surg ; 66(11): 658-663, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30083866

RESUMO

OBJECTIVES: Although surgical resection after induction therapy (IT) for locally advanced non-small cell lung cancer (NSCLC) is a possible treatment option, pneumonectomy may be avoided owing to high-surgical risks. However, reports exist that pneumonectomy after IT has acceptable safety and favorable outcomes. We reviewed pneumonectomies after IT in terms of surgical outcomes, perioperative management, and complications. METHODS: Between April 2004 and March 2015, 15 consecutive pneumonectomies were performed for locally advanced NSCLC after IT. Surgical outcomes, perioperative management, and complications were retrospectively reviewed. RESULTS: Thirteen patients were men, and 6 pneumonectomies were right-sided. One pneumonectomy was performed after induction chemotherapy and 14 followed induction chemoradiation. In all 15 cases the bronchial stumps were covered with autologous tissues. Pedunculated mediastinal fat pad and pedunculated intercostal muscles were used in 4 and 11 cases, respectively. Although postoperative complications were seen in 12 patients (80.0%), with major complications (Clavien-Dindo classification ≥ IIIa) in 5 patients (33.3%), there were no deaths within 30 days after pneumonectomy. Overall 3- and 5-year survivals were 80.0 and 57.1%, respectively. CONCLUSIONS: Owing to high-surgical risks and complication rates, careful surgical technique and postoperative management are essential for successful pneumonectomy after IT.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma Adenoescamoso/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Adenocarcinoma/patologia , Adulto , Idoso , Carcinoma Adenoescamoso/patologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimiorradioterapia , Feminino , Humanos , Quimioterapia de Indução , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento
20.
J Cardiothorac Surg ; 13(1): 86, 2018 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-29986737

RESUMO

BACKGROUND: Combined resection of a phrenic nerve is occasionally required in T3 primary lung carcinomas invading the phrenic nerve to completely remove a malignant tumour, resulting in diaphragmatic paralysis. We describe the first case of thoracoscopic lobectomy and diaphragmatic plication as a one-stage surgery for lung cancer invading the phrenic nerve. CASE PRESENTATION: A 56-year-old woman with a T3N0M0 primary adenosquamous carcinoma in the left upper lobe presented with suspicious invasion to the anterior mediastinal fat tissue and left phrenic nerve and underwent left upper lobectomy, node dissection, and partial resection of the anterior mediastinal fat tissue with the left phrenic nerve. Furthermore, thoracoscopic diaphragmatic plication was performed as a concomitant procedure. The patient's postoperative course was favourable, without any complications, and respiratory function was preserved for 1 year postoperatively. CONCLUSIONS: Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer invading the phrenic nerve is effective for preservation of postoperative pulmonary function.


Assuntos
Carcinoma Adenoescamoso/cirurgia , Diafragma/cirurgia , Neoplasias Pulmonares/cirurgia , Nervo Frênico/cirurgia , Pneumonectomia/métodos , Carcinoma Adenoescamoso/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Nervo Frênico/patologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Paralisia Respiratória/prevenção & controle , Resultado do Tratamento
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