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1.
J Surg Oncol ; 122(4): 632-638, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32830325

RESUMO

BACKGROUND AND OBJECTIVES: Aggressive resection of buccal cancer simultaneously leaves both oral and lateral facial defects. It is unknown whether a perforator-based chimeric anterolateral thigh (ALT) flap, with a muscular component, is suitable for the reconstruction of these complicated defects. METHODS: In this retrospective study, 48 patients with a buccal carcinoma (T2 N0-1 M0), who underwent extensive surgical resection, were enrolled. Twenty-seven cases underwent reconstruction using the classical ALT perforator flap (classical group), and 21 cases used the chimeric ALT perforator flap with vastus lateralis muscle mass (chimeric group). The incidence of wound infection, lower limb extremity function, facial appearance, survival curves, and quality of life were compared between groups. RESULTS: The incidence of wound infection or effusion was lower in the chimeric group than in the classical group. The aesthetic result achieved in the chimeric group was better than in the classical group. Meanwhile, there was no significant difference in the function of the donor site between groups. CONCLUSIONS: The chimeric ALT perforator flap, with a muscular component, can reconstruct both the oral and lateral face defects accurately. It sustains the profile of the lateral face and decreases the incidence of wound infection.


Assuntos
Carcinoma/cirurgia , Neoplasias Bucais/cirurgia , Retalho Perfurante , Músculo Quadríceps/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Coxa da Perna/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
2.
APMIS ; 128(11): 573-582, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32860265

RESUMO

Human epidermal growth factor receptor 2 (HER2) gene status and overexpression, occurring in ~ 13.6% of primary breast cancers, is essential for identifying patients likely to benefit from biological treatment. In this method of evaluation study, we tested and compared the HER2 gene-protein assay (GPA) with routine HER2 immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). The GPA was evaluated using 67 formalin-fixed paraffin-embedded (FFPE) HER2 equivoval IHC (2+) breast cancer tissue samples. Overall, agreement between GPA silver in situ hybridization (SISH) and FISH was 91.9% (57/62). Regression analysis revealed slightly higher, but non-significant difference in HER2/chromosome enumeration probe 17 (CEP17) ratio for GPA as compared to FISH (p = 0.074). Intraclass correlation coefficients (ICCs) of 0.94 and Spearman´s rank correlation coefficients of 0.93 (p < 0.0001) for FISH and GPA SISH suggested strong inter-observer association for methods with one observer counting on average 0.23 significant higher for GPA SISH (p = 0.014). Intra-observer IHC method reproducibility was 52.6% (κ = 0.3122, p = 0.004) and 79.7% (κ = 0.6428, p = 0.9197), suggesting fair significant and substantial non-significant difference between tests for reviewers. Inter-observer reproducibility for IHC methods was 53%. While inter-observer reproducibility for experienced IHC interpretation suggested significant differences (κ = 0.3636, p = 0.0332), unexperienced interpretation of IHC GPA suggested fair non-significant difference between reviewers (κ = 0.3101, p = 0.0747). Using FISH as reference, the diagnostic indices for GPA SISH were as follows: sensitivity 100%, specificity 95% and accuracy 92%. Inaccuracy between tests was in 80% of cases due to ISH categorization as equivocal by one of the methods. IHC results highlight that it may be beneficial with a method for simultaneously visualization of HER2 gene and protein status.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma/diagnóstico , Receptor ErbB-2/genética , Biomarcadores Tumorais/genética , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma/genética , Carcinoma/patologia , Carcinoma/cirurgia , Feminino , Expressão Gênica , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Metástase Linfática , Variações Dependentes do Observador , Análise Serial de Proteínas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
3.
Artigo em Chinês | MEDLINE | ID: mdl-32668875

RESUMO

Objective: To investigate the distant metastasis after primary treatment of papillary thyroid cancer (PTC) in children and adolescents. Methods: A retrospective analysis of 180 cases (54 boys and 126 girls, with an age range of 6-18 years) with PTC treated at the Chinese Medical Academy Cancer Hospital and Zhejiang Cancer Hospital from January 1, 2001 to December 31, 2014 was performed. Patients' clinical and pathological data were collected. The follow-up results were statistically analyzed. The distant metastasis rate during the follow-up period was analyzed by the Kaplan-Meier method. Log-Rank test was used for univariate analysis and Cox regression model was established in multivariate analysis. Results: Twenty-four cases (13.3%) had distant metastases during following-up with a median of 92 months. The Log-Rank test showed that the younger age ≤15 years old (χ(2)=11.803, P=0.001), the larger tumor diameter >20 mm (χ(2)=5.776, P=0.016), multifocal (χ(2)=11.205, P=0.001), bilateral tumor distribution (χ(2)=19.804, P=0.001), invaded capsule (χ(2)=10.808, P=0.001), and bilateral lymph nodes metastasis (χ(2)=6.278, P=0.012) were risk factors for distant metastasis after initial treatment. The Cox regression analysis showed that age ≤15 years (hazard ratio [95% confidence interval]: 4.08[1.504-11.111], P=0.006) and bilateral tumor distribution (hazard ratio [95% confidence interval]: 4.77[1.903-11.966], P=0.001) were independent risk factors for distant metastasis after initial treatment. The risk factors for local recurrence and distant metastasis were similar, but the local recurrence could not be a significant predictor for distant metastasis. It was indicated that distant metastasis rate was lower in patients with total thyroidectomy in multifocal lesions groups (χ(2)=5.891, P=0.015). Conclusions: Age, tumor size, invaded capsule, bilateral lymph nodes metastasis, multifocal and bilateral lesions are factors for predicting distant metastasis after primary treatment of PTC in children and adolescents. Total thyroidectomy is recommended for patients with multifocal and bilateral lesions.


Assuntos
Carcinoma Papilar , Carcinoma , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Adolescente , Carcinoma/cirurgia , Criança , Feminino , Humanos , Masculino , Metástase Neoplásica , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
4.
In Vivo ; 34(3 Suppl): 1661-1665, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-531488

RESUMO

COVID-19 has been officially declared as a pandemic by the WHO. Italy was the first European country to be strongly affected by this outbreak. All elective and health promotion activities were reduced. Accordingly, Italian Breast Units and breast cancer (BC) screening programs scaled down significantly their activities. The aim of this study was to evaluate measures that could potentially reduce the clinical impact of COVID-19 on BC patients. Temporary recommendations are needed that could assist specialists in preventing COVID-19 infection and optimizing resources for diagnosis and treatment of BC patients.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos/psicologia , Hospitais Universitários , Hospitais Urbanos , Mastectomia/psicologia , Pandemias , Pneumonia Viral , Recusa do Paciente ao Tratamento/psicologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Carcinoma/diagnóstico por imagem , Carcinoma/psicologia , Carcinoma/cirurgia , Carcinoma/terapia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/psicologia , Carcinoma Intraductal não Infiltrante/cirurgia , Terapia Combinada , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Diagnóstico Tardio , Gerenciamento Clínico , Detecção Precoce de Câncer , Estrogênios , Feminino , Humanos , Mamografia , Programas de Rastreamento , Terapia Neoadjuvante , Neoplasias Hormônio-Dependentes/diagnóstico por imagem , Neoplasias Hormônio-Dependentes/psicologia , Neoplasias Hormônio-Dependentes/cirurgia , Neoplasias Hormônio-Dependentes/terapia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Roma , Neoplasias de Mama Triplo Negativas/diagnóstico por imagem , Neoplasias de Mama Triplo Negativas/psicologia , Neoplasias de Mama Triplo Negativas/cirurgia , Neoplasias de Mama Triplo Negativas/terapia
5.
In Vivo ; 34(3 Suppl): 1667-1673, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-527842

RESUMO

BACKGROUND: COVID-19 pandemic required a marked re-allocation of healthcare resources, including at Breast Units. A patient-tailored program was developed to assess its efficacy regarding prevention of COVID-19 infection among patients with breast cancer undergoing surgery and healthcare workers (HCWs). PATIENTS AND METHODS: From March 9th to April 9th 2020, 91 patients were selected for elective surgery by means of: i) Pre-hospital screening aimed at avoiding hospitalization of symptomatic or suspicious COVID-19 patients, and ii) prioritisation of surgical procedure according to specific disease features. RESULTS: Eighty-five patients (93.4%) were fit for surgery, while five patients (5.5%) were temporarily excluded through 'telephone triage'; another two patients were excluded at in-hospital triage. A total of 71 out of 85 patients (83.5%) were diagnosed with invasive cancer, most of whom were undergoing breast-conserving surgery (61 out of 85 patients, 71.8%). The mean in-hospital stay was 2.2 days (SD=0.7 days). After hospital discharge, no patient needed re-admission due to post-operative complications; moreover, no COVID-19 infection among patients or HCWs was detected. CONCLUSION: Safe breast cancer surgery was accomplished for both patients and HCWs by means of a careful preoperative selection of patients and in-hospital preventative measures. This screening program can be transferred to high-volume Breast Units and it may be useful in implementing European Community recommendations for prevention of COVID-19 infection.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma/cirurgia , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Controle de Infecções/métodos , Mastectomia/estatística & dados numéricos , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/enfermagem , Carcinoma/tratamento farmacológico , Carcinoma/epidemiologia , Carcinoma/enfermagem , Técnicas de Laboratório Clínico , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Feminino , Unidades Hospitalares/organização & administração , Humanos , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Metástase Linfática/diagnóstico por imagem , Linfocintigrafia , Mastectomia Segmentar/estatística & dados numéricos , Terapia Neoadjuvante , Alta do Paciente , Equipamentos de Proteção , Biópsia de Linfonodo Sentinela , Avaliação de Sintomas , Telemedicina , Triagem
6.
In Vivo ; 34(3 Suppl): 1661-1665, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503826

RESUMO

COVID-19 has been officially declared as a pandemic by the WHO. Italy was the first European country to be strongly affected by this outbreak. All elective and health promotion activities were reduced. Accordingly, Italian Breast Units and breast cancer (BC) screening programs scaled down significantly their activities. The aim of this study was to evaluate measures that could potentially reduce the clinical impact of COVID-19 on BC patients. Temporary recommendations are needed that could assist specialists in preventing COVID-19 infection and optimizing resources for diagnosis and treatment of BC patients.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos/psicologia , Hospitais Universitários , Hospitais Urbanos , Mastectomia/psicologia , Pandemias , Pneumonia Viral , Recusa do Paciente ao Tratamento/psicologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Carcinoma/diagnóstico por imagem , Carcinoma/psicologia , Carcinoma/cirurgia , Carcinoma/terapia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/psicologia , Carcinoma Intraductal não Infiltrante/cirurgia , Terapia Combinada , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Diagnóstico Tardio , Gerenciamento Clínico , Detecção Precoce de Câncer , Estrogênios , Feminino , Humanos , Mamografia , Programas de Rastreamento , Terapia Neoadjuvante , Neoplasias Hormônio-Dependentes/diagnóstico por imagem , Neoplasias Hormônio-Dependentes/psicologia , Neoplasias Hormônio-Dependentes/cirurgia , Neoplasias Hormônio-Dependentes/terapia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Roma , Neoplasias de Mama Triplo Negativas/diagnóstico por imagem , Neoplasias de Mama Triplo Negativas/psicologia , Neoplasias de Mama Triplo Negativas/cirurgia , Neoplasias de Mama Triplo Negativas/terapia
7.
In Vivo ; 34(3 Suppl): 1667-1673, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503827

RESUMO

BACKGROUND: COVID-19 pandemic required a marked re-allocation of healthcare resources, including at Breast Units. A patient-tailored program was developed to assess its efficacy regarding prevention of COVID-19 infection among patients with breast cancer undergoing surgery and healthcare workers (HCWs). PATIENTS AND METHODS: From March 9th to April 9th 2020, 91 patients were selected for elective surgery by means of: i) Pre-hospital screening aimed at avoiding hospitalization of symptomatic or suspicious COVID-19 patients, and ii) prioritisation of surgical procedure according to specific disease features. RESULTS: Eighty-five patients (93.4%) were fit for surgery, while five patients (5.5%) were temporarily excluded through 'telephone triage'; another two patients were excluded at in-hospital triage. A total of 71 out of 85 patients (83.5%) were diagnosed with invasive cancer, most of whom were undergoing breast-conserving surgery (61 out of 85 patients, 71.8%). The mean in-hospital stay was 2.2 days (SD=0.7 days). After hospital discharge, no patient needed re-admission due to post-operative complications; moreover, no COVID-19 infection among patients or HCWs was detected. CONCLUSION: Safe breast cancer surgery was accomplished for both patients and HCWs by means of a careful preoperative selection of patients and in-hospital preventative measures. This screening program can be transferred to high-volume Breast Units and it may be useful in implementing European Community recommendations for prevention of COVID-19 infection.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma/cirurgia , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Controle de Infecções/métodos , Mastectomia/estatística & dados numéricos , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/enfermagem , Carcinoma/tratamento farmacológico , Carcinoma/epidemiologia , Carcinoma/enfermagem , Técnicas de Laboratório Clínico , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Feminino , Unidades Hospitalares/organização & administração , Humanos , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Metástase Linfática/diagnóstico por imagem , Linfocintigrafia , Mastectomia Segmentar/estatística & dados numéricos , Terapia Neoadjuvante , Alta do Paciente , Equipamentos de Proteção , Biópsia de Linfonodo Sentinela , Avaliação de Sintomas , Telemedicina , Triagem
8.
Rev Col Bras Cir ; 47: e20202406, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491029

RESUMO

OBJECTIVE: to evaluate the clinical characteristics of patients with colorectal cancer under the age of 50 treated at a public hospital in Brasilia over 5 years. METHODS: we conducted a longitudinal, retrospective study, with 184 patients undergoing surgical procedures at the Asa Norte Regional Hospital (HRAN), including those who underwent only biopsy, between January 2013 and January 2018. We divided the patients into two groups: under the age of 50 (n=39) and age equal to or greater than 50 years (n=145). We compared the groups as to age, sex, symptoms, time between symptom onset and diagnosis, family and personal history, tumor location, histopathological characteristics, applied surgical management, staging and mortality. RESULTS: the group of patients under the age of 50 had more individuals with stage III and IV (p=0.041), more frequent poorly differentiated tumors (10.25% versus 3.52%; p=0.153), and higher incidences of compromised surgical margins (p=0.368), angiolymphatic (p=0.07) and perineural (p=0.007) invasion, which denotes more advanced disease in this group of patients. CONCLUSIONS: the study showed the low effectiveness of population screening methods for colorectal cancer currently used in this population, given the high incidence of the disease and late diagnosis in both groups.


Assuntos
Carcinoma/patologia , Neoplasias Colorretais/patologia , Adulto , Fatores Etários , Brasil/epidemiologia , Carcinoma/epidemiologia , Carcinoma/cirurgia , Colo/patologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Int J Gynecol Cancer ; 30(8): 1097-1100, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32487685
10.
Medicine (Baltimore) ; 99(22): e20414, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481436

RESUMO

Endoscopic treatment of duodenal papillary tumors is well described. This study aims to provide new evidence for the treatment of benign papillary tumors through comparisons between endoscopic snare papillectomy (ESP) and endoscopic mucosal resection (EMR).Between May 2010 and December 2017, 72 patients were enrolled. Diagnosis and treatment procedures were ESP and EMR. Endoscopic follow-up evaluation was done periodically as a surveillance measurement for recurrence.Seventy-two patients with ampullary tumors were enrolled, of which 66 had adenomas including 9 high-grade intraepithelial neoplasias and 2 carcinomas in adenoma. Complete resections with tumor-free lateral and basal margins were achieved in all patients. Postoperative complications were bleeding (9.5% in EMR vs 10% in ESP) and pancreatitis (2.4% in EMR and 3.3% in ESP), with no occurrence of perforation, cholangitis or papillary stenosis. Adenoma recurrence was found in 7 patients (14.3% in EMR vs 3.3% in ESP) at 1 year.The ESP procedure is safe and effective for benign ampullary adenoma, high-grade intraepithelial neoplasias, and noninvasive cancer without intraductal tumor growth, which has a shorter procedural duration, as well as lower complication, recurrence rates and hospitalization costs.


Assuntos
Neoplasias Duodenais/cirurgia , Endoscopia Gastrointestinal , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/cirurgia , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Endoscopia Gastrointestinal/economia , Endoscopia Gastrointestinal/métodos , Feminino , Seguimentos , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Orv Hetil ; 161(24): 1002-1011, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32469841

RESUMO

INTRODUCTION AND AIM: This study aimed to describe the modified Regnault "B" oncoplastic technique as a standard volume-displacement level II oncoplastic breast-conserving surgery and the related clinicopathological study. METHOD: A retrospective, single-centre study was performed between April 2012 and October 2018 involving 215 breast-cancer patients. Patient characteristics and postoperative complications were recorded, and the quality of life was rated by questionnaires. Aesthetic outcomes were evaluated with BCCT.core software and a five-point Likert scale. RESULTS: The mean patient age was 53 years (range: 29-81 years), with a median follow-up of 47 months (range: 7-85 months). The average surgery time was 47 min (range: 35-85 min) and the pathological average size of the tumours was 33 mm (range: 18-58 mm). Due to positive surgical margins, 13 (6%) completion re-excisions and 3 (1.4%) mastectomies were performed. In total, 16 complications (7.4%) were recorded. The median Likert scale score was 4.2, and the median overall aesthetic outcome assessed by BCCT.core was 1.3 points. According to the quality of life questionnaire, average points of the results demonstrated a high level of patient satisfaction. CONCLUSION: In medium- to large-breasted patients, the modified Regnault "B" technique is a safe and repeatable level II volume-displacement oncoplastic breast-conservation technique. This technique allows extended removal (20-50% of breast tissue) of T1-T3 tumours from the upper outer quadrant and the border of outer quadrants of the breast with improved aesthetic results. The advantage of this technique is that contralateral symmetrisation is not required, while disadvantage of this technique is the skin incision on the breast skin envelope that can make some difficulties when completion mastectomy is required with immediate reconstruction. Orv Hetil. 2020; 161(24): 1002-1011.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma/cirurgia , Mamoplastia , Mastectomia , Qualidade de Vida/psicologia , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Carcinoma/patologia , Carcinoma/psicologia , Humanos , Mastectomia Segmentar , Estudos Retrospectivos , Resultado do Tratamento
12.
Virchows Arch ; 477(5): 637-649, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32388719

RESUMO

Muscular infiltrating bladder urothelial carcinoma (MIBC) is a highly malignant disease with a poor prognosis. Radical cystectomy is the standard treatment. However, due to surgery and postoperative complications, the quality of life of patients is seriously affected. Therefore, it is increasingly important to find prognostic markers and new therapeutic targets for MIBC. Here, we investigated the expression of PDK1, a key regulator of glucose metabolism, in bladder urothelial carcinoma (BLCA) and its effect on prognosis. The expression pattern of PDK1 was examined by bioinformatics analysis and immunohistochemistry. A total of 101 cases of BLCA were selected for tissue microarrays (TMAs) that contained both tumour and paired normal tissues. We demonstrated that PDK1 expression was correlated with tumour grade and Ki67expression in our TMA cohort (all p values < 0.05). Kaplan-Meier survival analysis showed that patients with MIBC with high PDK1 expression had a worse prognosis than patients with low PDK1 expression (p = 0.016). Multifactor risk analysis showed that increased PDK1 expression was an independent prognostic factor affecting the overall survival of MIBC patients. GSEA showed that the mTOR pathway, HIF pathway, glycolysis, PI3K/AKT/mTOR signalling, etc. were differentially enriched in the PDK1 high expression phenotype. Hence, PDK1 may be a prognostic and therapeutic target for MIBC.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma/enzimologia , Quinase Piruvato Desidrogenase (Transferência de Acetil)/análise , Neoplasias da Bexiga Urinária/enzimologia , Urotélio/enzimologia , Idoso , Biomarcadores Tumorais/genética , Carcinoma/mortalidade , Carcinoma/patologia , Carcinoma/cirurgia , Cistectomia , Bases de Dados Genéticas , Feminino , Humanos , Imuno-Histoquímica , Antígeno Ki-67/análise , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Valor Preditivo dos Testes , Quinase Piruvato Desidrogenase (Transferência de Acetil)/genética , Análise Serial de Tecidos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Urotélio/patologia
13.
J Ayub Med Coll Abbottabad ; 32(1): 13-17, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468747

RESUMO

BACKGROUND: Upper cervical oesophageal and hypo-pharyngeal malignancies pose significant challenges in surgical management. In advanced tumours total laryngopharyngeal esophagectomy (TLPO) and gastric pull up provides excellent result. METHODS: It is a descriptive case series and was conducted from Jan 2010 to Jan 2017. Thirty-five patients underwent TLPO. The inclusion criteria were; tumours of hypo-pharynx which allow tumour free resection margins and cervical oesophageal tumours not involving mediastinal trachea. There were no clinically palpable cervical lymph nodes. Patients with locoregional advanced disease and poor performance status were excluded. All cases underwent standard one stage TLPO with bilateral inter-jugular lymph nodal clearance. Minimal invasive techniques used in three cases. RESULTS: Out of 35 patients, n=21 (60%) of patient had lesion of hypopharynx with post cricoid involvement, n=13 (37.1%) had primary tumour of cervical oesophagus abutting pharynx and cricoid and only one patient had a tumour of hypopharynx with perforation. Histopathological conformation of diagnosis done in all patients preoperatively which showed Well differentiated Squamous cell in n=19 (54.28%), moderately differentiated squamous cell in 28.57% (n=10). Post-operative staging of the patients 74.28% (n=26) fall in stage 3. Operative time was less than 3 hours in 17 patients with two team technique, between 3-4 hours in 8 patients and more than 4 hours in 3 patients. SVT in 14.28% (n=5), Atrial Fibrillation in 5.71% (n=2). Chest complications including pneumothorax in 11.43% (n=4), basal atelectasis in 22.86% (n=8), pulmonary embolism in 2.85% (n=1), aspiration in 8.57% (n=3) and tracheal stenosis in n=1, 5.71% (n=2) cases had anastomotic leak. Postop 28 days mortality was 8.57% (n=3). CONCLUSIONS: TLPO with stomach pull up offer good results in patients with resectable disease with acceptable morbidity and mortality in operable patients.


Assuntos
Carcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Laringectomia , Neoplasias Faríngeas/cirurgia , Faringectomia , Adulto , Idoso , Feminino , Gastroplastia , Humanos , Hipofaringe/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
14.
Ann R Coll Surg Engl ; 102(5): 363-368, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233846

RESUMO

INTRODUCTION: Hypercalcaemic crisis is a rare manifestation of hyperparathyroidism and occurs in 1.6-6% of patients with primary hyperparathyroidism (pHPT). Although such high serum calcium levels (>14mg/dl) are attributed to malignancy, it is also associated with benign disease of the parathyroid glands. The aim of this study was to evaluate the clinical features and treatment modalities of patients with severe hypercalcaemia who underwent surgery for pHPT. METHODS: The medical records of 537 patients who underwent parathyroidectomy in our department for pHPT between 2005 and 2019 were reviewed retrospectively. Twenty-four (4.4%) of the patients were described as having severe hypercalcaemia. RESULTS: Among 24 patients, 71% were female and the mean age was 55.7 years (range: 40-71 years). The mean serum calcium level at time of diagnosis was 15.9mg/dl (range: 14-22.7mg/dl). According to postoperative pathology reports, solitary adenoma, parathyroid cancer and parathyromatosis were diagnosed with the rates of 87.5%, 8.3% and 4.1% respectively. The mean weight of the solitary parathyroid lesions was 14.9g (standard deviation: 8.9g, range: 4-38g). The mean longest diameter was 2.87cm (standard deviation: 1.4cm, range: 1-5.5cm). Serum calcium levels were within the normal range on the first postoperative day in 75% of the cases. CONCLUSIONS: Severe hypercalcaemia is a rare but urgent condition of pHPT and requires prompt management. Accelerated surgery after adequate medical treatment should be performed. It is important to emphasise that giant adenoma, which is a benign disease, may be a more common cause of severe hypercalcaemia than carcinoma, unlike previously thought.


Assuntos
Adenoma/complicações , Carcinoma/complicações , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/etiologia , Neoplasias das Paratireoides/complicações , Adenoma/sangue , Adenoma/cirurgia , Adulto , Idoso , Cálcio/sangue , Carcinoma/sangue , Carcinoma/cirurgia , Difosfonatos/administração & dosagem , Feminino , Furosemida/administração & dosagem , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipercalcemia/terapia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/sangue , Paratireoidectomia , Período Pós-Operatório , Diálise Renal , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(16): e19714, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311956

RESUMO

To validate the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer on the survival of patients who underwent radical hysterectomy for 2009 FIGO stage IB carcinomas.We retrospectively identified and reviewed 251 patients treated with radical hysterectomy for 2009 FIGO stage IB cervical carcinomas from January 2011 to December 2016. The re-staged IB cohort consisted of 2018 FIGO stage IB1 (tumor size <2 cm), IB2 (2-3.9 cm), IB3 (≥4 cm), and IIIC1p (any pelvic nodal metastasis) cervical cancer. The univariate log-rank test and multivariate Cox regression models were performed for all potential clinic pathological risk factors based on cancer stage.On re-staging the 251 patients with 2009 FIGO stage IB using the 2018 FIGO staging system, 96 patients (38.2%) had stage IB1, 109 patients (43.4%) had stage IB2, 28 patients (11.2%) had stage IB3, and 18 patients (7.2%) had stage IIIC1p. The 5-year overall survival (OS) rates of patients with 2018 FIGO stage IB1, IB2, IB3, and IIIC1p were 97.9%, 92.7%, 78.6%, and 61.1%, respectively. The 5-year progression-free survival rates were 97.9%, 92.7%,63.7%, and 20.8%, respectively. Factors significantly affecting OS and disease-free survival were 2018 FIGO stage≥IB3, histologic grade 2-3, and lymph node involvement.The revised 2018 FIGO staging system seemed to accurately reflect the survival rate, with a distinct statistical tendency for poorer 5-year disease-free survival and OS rates with increasing stage. Women with positive lymph nodes in this classification were classified as having stage IIIC disease, which can achieve more realistic survival results than the previous staging system. The prognostic discrimination of histologic grade should be considered when revising the staging system in the future.


Assuntos
Carcinoma/diagnóstico , Carcinoma/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Adulto , Idoso , Carcinoma/patologia , Carcinoma/cirurgia , Feminino , Seguimentos , Humanos , Histerectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem
16.
World Neurosurg ; 139: 266-267, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32289505

RESUMO

A 39-year-old man with a history of recurrent pituitary tumor, Cushing disease, and Nelson syndrome presented with neck stiffness. He previously had bilateral adrenalectomy and hypophysectomy 27 years ago. He subsequently had repeat pituitary surgery, stereotactic radiosurgery, and chemotherapy for recurrent pituitary tumor. During follow-up, he was noted to have rising basal adrenocorticotrophin (ACTH) level. On examination, he was neurologically intact with no signs of myelopathy. Magnetic resonance imaging of the spine showed a large intradural extramedullary lesion causing cord compression at the C2-3 level. He underwent a cervical laminectomy and debulking of the lesion under continuous monitoring of motor-evoked and somatosensory-evoked potentials. He remained neurologically intact postoperatively. Histologic analysis revealed a tumor of pituitary origin with synaptophysin and ACTH expression. Pituitary drop metastasis is a rare entity and should raise a high index of suspicion given this clinical presentation. The radiologic appearance can mimic benign lesions such as meningioma or schwannoma.


Assuntos
Carcinoma/secundário , Neoplasias Hipofisárias/patologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/secundário , Adulto , Carcinoma/cirurgia , Descompressão Cirúrgica , Humanos , Laminectomia , Masculino , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
17.
Ann Thorac Surg ; 110(2): 406-413, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32268141

RESUMO

BACKGROUND: Pulmonary sarcomatoid carcinoma (PSC) is a rare type of lung cancer. This study aimed to explore the appropriate treatment for PSC. METHODS: Two cohorts were used: patients from the Surveillance, Epidemiology, and End Results (SEER) database (1988 to 2014) and Shanghai resident patients at Shanghai Pulmonary Hospital (2009 to 2019) in China. Cox regression analysis was applied to identify prognostic factors for progression-free survival and overall survival (OS). Interaction assessments were performed using likelihood ratio tests to examine relationships between adjuvant chemotherapy and other baseline characteristics. RESULTS: In the SEER cohort, 1640 patients with PSC were identified, with a median survival and a 5-year OS rate of 7 months (95% confidence interval (CI), 6 to 8 months) and 19.5%, respectively. Multivariable Cox analysis of surgically treated patients revealed that adjuvant chemotherapy was significantly associated with better survival (hazard ratio, 0.78; 95% CI, 0.62 to 0.98), and the benefit was more pronounced in T3 to T4 stage (P = .04) and N-positive patients (P < .01). In the Shanghai Pulmonary Hospital cohort (n = 175), the median progression-free survival and OS were 8 months (95% CI, 7 to 12 months) and 12 months (95% CI, 10 to 18 months), respectively, with a 5-year OS rate of 25.1%. Similarly, the survival benefit of adjuvant chemotherapy was confirmed in patients with surgical resection (hazard ratio, 0.50; 95% CI, 0.31 to 0.81), but this benefit was restricted to patients who were younger (age <63 years; P = .02) and had a higher body mass index (>25 kg/m2; P < .01) by interaction assessments. The disease control rate after chemotherapy was 58.62%, and the disease control rate after targeted therapy was 57.14%. CONCLUSIONS: Adjuvant chemotherapy should be recommended for patients with surgically treated PSC, especially for patients with advanced-stage cancer, younger age, or higher body mass index.


Assuntos
Carcinoma/tratamento farmacológico , Carcinoma/cirurgia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Sarcoma/tratamento farmacológico , Sarcoma/cirurgia , Idoso , Quimioterapia Adjuvante , China , Feminino , Hospitais Especializados , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Programa de SEER
19.
Tokai J Exp Clin Med ; 45(1): 18-23, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32219805

RESUMO

A 61-year-old female was diagnosed with multiple endocrine neoplasia type 2A (MEN2A), caused by a heterozygous point mutation in the RET gene (TGC to TAC at codon 634) resulting in the substitution of cytosine with leucine (C634Y). The patient had pheochromocytoma (PCC) in the left adrenal gland and medullary thyroid carcinoma (MTC) with liver metastasis. Primary hyperparathyroidism (PHP) was not evident. Family history data suggested that the RET gene mutation was inherited from the father. The PCC was removed laparoscopically, but the MTC was observed conservatively for 7 years because the status of the MTC was compatible with T1N1M1 and stage IVC; therefore, it was not curable with surgery. The MTC liver metastasis increased in size. Lenvatinib, an oral multi-tyrosine kinase inhibitor, was administered until the patient had received a total dose of 1336mg, and then administration was stopped because of nausea. The reduction rate of the MTC liver metastasis was 31%, which was considered partial response. At this point, the patient was doing well, suggesting that lenvatinib was effective in treating the MTC liver metastasis and may be one of the treatment for advanced MTC caused by C634Y mutation in the RET gene.


Assuntos
Carcinoma/etiologia , Carcinoma/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasia Endócrina Múltipla Tipo 2a/complicações , Compostos de Fenilureia/uso terapêutico , Quinolinas/uso terapêutico , Neoplasias da Glândula Tireoide/etiologia , Carcinoma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 2a/genética , Compostos de Fenilureia/efeitos adversos , Mutação Puntual , Proteínas Proto-Oncogênicas c-ret/genética , Quinolinas/efeitos adversos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia
20.
Am J Gastroenterol ; 115(6): 924-933, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32142485

RESUMO

OBJECTIVES: Guideline-issuing groups differ regarding the recommendation that patients with stage I colon cancer receive surveillance colonoscopy after cancer-directed surgery. This observational comparative effectiveness study was conducted to evaluate the association between surveillance colonoscopy and colon cancer-specific mortality in early stage patients. METHODS: This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Surveillance colonoscopy was assessed as a time-varying exposure up to 5 years after cancer-directed surgery with the following groups: no colonoscopy, one colonoscopy, and ≥ 2 colonoscopies. Inverse probability of treatment weighting was used to balance covariates. The time-dependent Cox regression model was used to obtain inverse probability of treatment weighting-adjusted hazard ratios (HRs), with 95% confidence intervals (CIs) for 5- and 10-year colon cancer, other cancer, and noncancer causes of death. RESULTS: There were 8,783 colon cancer cases available for analysis. Overall, compared with patients who received one colonoscopy, the no colonoscopy group experienced an increased rate of 10-year colon cancer-specific mortality (HR = 1.63; 95% CI 1.31-2.04) and noncancer death (HR = 1.36; 95% CI 1.25-1.49). Receipt of ≥ 2 colonoscopies was associated with a decreased rate of 10-year colon cancer-specific death (HR = 0.60; 95% CI 0.45-0.79), other cancer death (HR = 0.68; 95% CI 0.53-0.88), and noncancer death (HR = 0.69; 95% CI 0.62-0.76). Five-year cause-specific HRs were similar to 10-year estimates. DISCUSSION: These results support efforts to ensure that stage I patients undergo surveillance colonoscopy after cancer-directed surgery to facilitate early detection of new and recurrent neoplastic lesions.


Assuntos
Carcinoma/cirurgia , Neoplasias do Colo/cirurgia , Recidiva Local de Neoplasia/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Carcinoma/patologia , Causas de Morte , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Pesquisa Comparativa da Efetividade , Gerenciamento Clínico , Feminino , Humanos , Armazenamento e Recuperação da Informação , Masculino , Medicare , Gradação de Tumores , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Programa de SEER , Estados Unidos
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