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1.
J Surg Oncol ; 120(4): 786-793, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31368160

RESUMO

BACKGROUND AND OBJECTIVES: The single-arm ROSiA study evaluated frontline bevacizumab for advanced ovarian cancer. We explored how discordant surgically and radiologically assessed postoperative residual disease affects outcomes. METHODS: After debulking surgery, 1021 patients received 4 to 8 cycles of carboplatin-paclitaxel plus bevacizumab until progression or up to 24 months. The primary endpoint was safety; progression-free survival (PFS) was a secondary endpoint. We performed post hoc exploratory PFS analyses in four subgroups: surgeon-reported no visible residuum (NVR) without target lesions; surgeon-reported NVR with target lesions; macroscopic (≤1 cm) residuum; and >1 cm residuum. RESULTS: Surgical and radiological assessments were concordant in 94% of patients; 61 patients (6%; 21% of those with surgeon-reported NVR) had NVR with target lesions. Median PFS was numerically longest in patients with concordant surgically/radiologically assessed NVR (35.5 months), intermediate for surgeon-reported NVR with target lesions (31.8 months), and shortest for visible residuum (27.9 and 20.2 months for visible residuum ≤1 and >1 cm, respectively). One-year and 2-year PFS rates showed the same pattern. CONCLUSIONS: These analyses suggest that prognosis is potentially worse in patients with radiologically detected target lesions despite surgeon-reported NVR compared with concordant NVR by both assessment methods. Postsurgical imaging may add valuable prognostic information.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Neoplasia Residual/mortalidade , Neoplasias Ovarianas/mortalidade , Cirurgiões/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma de Células Claras/diagnóstico por imagem , Adenocarcinoma de Células Claras/mortalidade , Adenocarcinoma de Células Claras/patologia , Antineoplásicos Imunológicos/uso terapêutico , Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/mortalidade , Carcinossarcoma/patologia , Feminino , Seguimentos , Humanos , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/patologia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/patologia , Prognóstico , Taxa de Sobrevida
2.
Medicine (Baltimore) ; 98(32): e16578, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393357

RESUMO

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been well-established methods of treating upper gastrointestinal neoplasia. The aim of this study was to identify the safety and effectiveness of endoscopic treatment for gastric neoplasia within a 2-day hospital stay.Between 2004 and 2015, a total of 914 patients with gastric neoplasia were treated with EMR or ESD within 2 days of hospitalization. The neoplasia sites, en bloc resection rates, pathology, local residual neoplasia rates, and major complications were evaluated retrospectively.The mean age was 63.4 years old, and 636 (69.6%) patients were male. Adenoma was the most common final diagnosis (60.9%), followed by adenocarcinoma (28.9%). The first follow-up endoscopy was performed 4.9 ±â€Š1.1 months after the procedure, and an average of 4.4 endoscopic examinations were performed for 7.16 years (range, 2.1 to 10.2 years). Additional surgery was performed in 11 (1.2%) cases based on post-procedure pathology results. On follow-up endoscopy, a mean of 5.9 months after the procedure, there were 18 residual neoplasia cases (EMR = 13, ESD = 5). Only 4 (0.4%) patients returned to the emergency unit with delayed bleeding, but all 4 cases were successfully controlled with endoscopic treatment. There were no other complications such as delayed perforation or aspiration pneumonia during the 2 days in hospital.EMR and ESD within only 2 days in hospital showed safe and effective outcomes in terms of managing early gastric neoplasia with low complication and local residual rates.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Ressecção Endoscópica de Mucosa/estatística & dados numéricos , Mucosa Gástrica/cirurgia , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Mucosa Gástrica/patologia , Gastroscopia/métodos , Gastroscopia/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/patologia , Estudos Retrospectivos , Neoplasias Gástricas/patologia
3.
Anticancer Res ; 39(8): 4581-4588, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366563

RESUMO

BACKGROUND/AIM: Initial treatment of endometrial cancer with surgery and platinum and taxane-based chemotherapy is often successful, but it remains unclear as to whether certain types of the disease relapse. The aim of this study was to identify the clinical features of recurrence in patients without residual tumour in endometrial cancer. PATIENTS AND METHODS: Clinical features, histological type, and time to recurrence were analyzed in 640 endometrial cancer patients without residual tumours. RESULTS: Of 640 patients, 517 were type I and 123 were type II. For type I, early recurrent (ER) disease and late recurrent (LR) disease were noted in 80 and 8 patients, respectively, and 97.5% of ER occurred within 2 years. After recurrence, 76.2% of ER and 50% of LR patients died. In type II, ER and LR were noted in 41 and 1 patients, respectively, and 97.6% of ER occurred within 2 years, of which 75.6% died after recurrence. One LR case died of disease. CONCLUSION: Most patients recurred within 2 years irrespective of clinical stage or type.


Assuntos
Neoplasias do Endométrio/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Neoplasia Residual/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/patologia , Estudos Retrospectivos
4.
Anticancer Res ; 39(8): 4325-4328, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366524

RESUMO

BACKGROUND/AIM: The significance of second transurethral resection (TUR), and identification of predictive factors for residual cancer remain unrevealed. This study aimed to find residual cancer and up-staging rates, as well as predictive factors for residual cancer, in patients who undergo second TUR for non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS: Patients who underwent second TURs for NMIBC between 2015 and 2017, were included in the study and their clinicopathological characteristics were analyzed for predictors of residual cancer. RESULTS: Among 143 Japanese patients whose tumors were initially diagnosed as high-risk NMIBC, residual cancers detected at second TURs were, Tis: n=22 (15.4%), Ta: n=15 (10.5%) and T1: n=29 (20.3%). No patients showed up-staging from NMIBC to MIBC. The presence of carcinoma-in situ at initial TUR was an independent risk factor for any residual cancer (Tis, Ta and T1), non-flat residual cancer (Ta and T1), and flat residual cancer (Tis). CONCLUSION: The presence of carcinoma-in situ is suggested to be an independent predictor of residual cancer. This may help guide decisions to perform second TUR.


Assuntos
Carcinoma in Situ/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasia Residual/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Idoso , Carcinoma in Situ/patologia , Carcinoma in Situ/cirurgia , Cistectomia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos/patologia , Invasividade Neoplásica/genética , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Neoplasia Residual/diagnóstico , Neoplasia Residual/patologia , Fatores de Risco , Resultado do Tratamento , Uretra/patologia , Uretra/cirurgia , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Procedimentos Cirúrgicos Urológicos
5.
Medicine (Baltimore) ; 98(27): e16089, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277105

RESUMO

To establish magnetic resonance imaging (MRI) features that differentiate residual tumors from postoperative surgical changes following the transsphenoidal approach of a pituitary adenoma.We analyzed residual enhancements at the tumor bed in 52 patients who underwent dynamic contrast-enhanced sella MRI within 48 hours after surgery and at 6 to 28 months. Patients were divided into 2 groups defined by either peripheral or nodular enhancement patterns. For each group, we measured the maximum thickness of the residual enhancing portion and compared differences in the residual tumor and postoperative changes.Among the tumors examined in the 52 patients, 19 residual tumors showed nodular (n = 16) and peripheral (n = 3) enhancement patterns, and 33 postoperative changes showed nodular (n = 3) and peripheral (n = 30) enhancement patterns. The mean residual tumor thickness was 7.1 mm (range, 2.9-16.8 mm) and 1.9 mm (range, 1.0-7.4 mm) in the postoperative change. Receiver operating characteristic curve analysis revealed that a 3.9-mm thickness was associated with 89% sensitivity, 97% specificity, and 94% accuracy for diagnosis of residual tumor.On immediate postoperative MRI, residual enhancement with greater than 3.9-mm thickness and nodular pattern suggest residual pituitary adenoma tumor.


Assuntos
Adenoma/patologia , Neoplasia Residual/patologia , Neoplasias Hipofisárias/patologia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adolescente , Adulto , Idoso , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Adulto Jovem
6.
Urol Clin North Am ; 46(3): 389-398, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277733

RESUMO

The introduction of cisplatin-based chemotherapy has revolutionized the care of patients with disseminated testicular germ cell tumors. Although a majority are cured with chemotherapy alone, surgical resection continues to play a role because one-third will have residual mass after chemotherapy. In this article, we review the current indications for postchemotherapy resection in nonseminomatous germ cell tumors, including masses greater than 1 cm, resection after salvage chemotherapy, with elevated markers, after late relapse, and for growing teratoma syndrome. We also highlight technical considerations of this often-challenging surgery, including the need for adjunctive procedures, extraretroperitoneal resections, and modern techniques to minimize morbidity.


Assuntos
Neoplasia Residual/cirurgia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Neoplasias Testiculares/cirurgia , Biomarcadores Tumorais/análise , Intervalo Livre de Doença , Humanos , Laparoscopia/métodos , Excisão de Linfonodo , Metástase Linfática/patologia , Masculino , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/patologia , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Procedimentos Cirúrgicos Robóticos , Terapia de Salvação , Neoplasias Testiculares/tratamento farmacológico
7.
Urol Clin North Am ; 46(3): 399-407, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277734

RESUMO

Seminoma is commonly diagnosed in young men, and it has therefore become a disease of long-term survivors. As the late toxic effects of radiation and chemotherapy are better understood, it is becoming imperative to focus management advancements on reducing exposure to toxic agents. Retroperitoneal lymph node dissection (RPLND) currently is indicated as a salvage procedure in postchemotherapy patients with residual masses. Primary RPLND currently is being further explored in patients with clinical stage IA and clinical stage IB disease in 2 prospective studies.


Assuntos
Neoplasia Residual/cirurgia , Seminoma/cirurgia , Neoplasias Testiculares/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Terapia de Salvação , Seminoma/patologia , Neoplasias Testiculares/patologia
8.
Urol Clin North Am ; 46(3): 419-427, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277736

RESUMO

Growing teratoma syndrome (GTS) is a rare clinical phenomenon in patients with nonseminomatous germ cell cancer defined by growing metastatic mass during ongoing or directly after completed chemotherapy with timely decreasing tumor markers and postpubertal teratoma exclusively after resection. GTS was first described in 1982, and few reports have been published. The limited number of studies and the resulting lack of exact knowledge about development, differentiation, and treatment of GTS leaves several clinical problems regarding treatment and follow-up unsolved. This review provides an overview of clinical diagnosis and disease management and an approach to explain the molecular development of GTS.


Assuntos
Teratoma/patologia , Teratoma/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Terapia Combinada , Diagnóstico Diferencial , Progressão da Doença , Humanos , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Neoplasia Residual/terapia , Prognóstico , Neoplasias Retroperitoneais/secundário , Neoplasias Retroperitoneais/terapia , Síndrome
9.
Anticancer Res ; 39(6): 2919-2926, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177130

RESUMO

BACKGROUND/AIM: We evaluated patients undergoing salvage hysterectomy after brachytherapy (BT) following concomitant chemoradiation (CRT) for locally advanced cervical cancers (LACC), when residual disease was suspected. PATIENTS AND METHODS: From 2004 to 2013, 29 patients had a radical hysterectomy at the Gustave Roussy for suspicion of clinical and/or radiological residual disease. Outcomes, morbidities and the accuracy of the evaluation of response to CRT and BT were evaluated. RESULTS: The rate of complications grade>IIIa was 24%, with no difference between the 14 patients with histological residual disease and the 15 with a complete response. Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) revealed a sensitivity of 92% and 100%, but a poor specificity of less than 40%. Three recurrences occurred in patients with residual disease (brain, rectosigmoid colon, peritoneum and lung). CONCLUSION: The clinical examination, MRI and PET-CT are suboptimal for diagnosing residual disease after CRT and BT. The morbidity of adjuvant hysterectomy is high and does not prevent recurrences.


Assuntos
Histerectomia/métodos , Neoplasia Residual/cirurgia , Terapia de Salvação/métodos , Neoplasias do Colo do Útero/terapia , Adulto , Braquiterapia , Quimiorradioterapia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sensibilidade e Especificidade , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia
10.
J Coll Physicians Surg Pak ; 29(6): 549-552, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31133155

RESUMO

OBJECTIVE: To determine the frequency of cytogenetic type and its significance in the prognostic outcome of the pediatric patients in acute lymphoblastic leukemia (ALL), aged 1 to 15 years, and also determine the importance of minimal residual disease (MRD) in the management of the condition. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Pediatric Oncology Ward, Shaukat Khanum Cancer Hospital, Lahore, from January 2015 to July 2017. METHODOLOGY: Patients aged 1-15 years, diagnosed with ALL, were included. Studied variables were cytogenetic type and MRD outcome in patients with ALL. Patients under one year of age and more than 15 years, or those having comorbidities, were excluded. RESULTS: Total 150 patients' data were retrieved from the Hospital database. One hundred and thirty-three belonged to age 1 to 5 years group (89%) and 17 (11%) were in 5 to 10 years group. The mean age of the patient was 4.3 +3.1 years. One hundred and two (68%) were males; whereas, 48 (32%) were females. Pre B acute lymphoblastic leukemia was diagnosed in 139 (93%) patients and 11(7%) were diagnosed with Pre T acute lymphoblastic leukemia. Standard risk was observed in 120 (80%) patients and 30 (20%) patients were on high risk as per National Cancer Institute (NCI) Guidelines. Regimen A was used in 125 (83.3%), Regimen B in 16 (10.7%), and Regimen C in 9 (6%) patients. BCR-ABL was positive in 2 (1.30%), TEL-AML in 68 (45%), MLL in 5 (3.30%), and normal in 54 (36%). MRD at day 29 was negative in 40 (93%) and positive in 3 (7%). The karyotyping was done in 128 (85%) patients, out of which 68 (53%) were hyperploids, 41 (32%) euploid, and 19 (15%) were hypoploid. Death was observed in 22 (15%) patients. Nineteen (86%) deaths were due to fungal and bacterial sepsis; and disease-related deaths were noted in 3 (14%) patients. CONCLUSION: The role of MRD and cytogenetics in risk assessment has improved in the early prognosis determination.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasia Residual/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Criança , Pré-Escolar , Citogenética , Intervalo Livre de Doença , Feminino , Humanos , Incidência , Lactente , Masculino , Neoplasia Residual/mortalidade , Neoplasia Residual/patologia , Paquistão/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
11.
Chin Clin Oncol ; 8(2): 21, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31070041

RESUMO

Intraductal papillary mucinous neoplasms (IPMN) are pancreatic cystic lesions that can progress to invasive carcinoma. Consensus guidelines indicate surgery for IPMN at high risk of malignant progression, as assessed by specific radiological and clinical criteria, whereas an active radiological surveillance is recommended for IPMN at low risk of malignancy. The management of IPMN is further complicated by the risk of developing a distinct new cyst or a ductal adenocarcinoma in the remnant pancreas, either synchronously or metachronously. Several studies therefore investigated local progression in the remnant pancreas following partial pancreatic resection for IPMN and whether an unstable epithelium at risk for malignant degeneration may exist. Understanding the biological mechanisms behind progression of IPMN will help in identifying patients that would benefit from the resection of the entire pancreas.


Assuntos
Neoplasia Residual/patologia , Pancreatectomia/efeitos adversos , Neoplasias Intraductais Pancreáticas/cirurgia , Progressão da Doença , Humanos , Neoplasia Residual/etiologia , Neoplasias Intraductais Pancreáticas/patologia , Prognóstico
12.
Oncol Rep ; 41(6): 3527-3534, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31002371

RESUMO

Cancer patients who better benefit from neoadjuvant chemotherapy (NeoCh) are those who achieve a successful pathological complete response (pCR) represented by the absence of residual disease. Unfortunately, no highly sensitive and specific tumor biomarkers for predicting the clinical response to NeoCh have yet been defined. The aim of the present study was to ascertain whether miR­145­5p could discriminate between pCR and no­pCR in triple­negative breast cancer patients that received a cisplatin/doxorubicin­based neoadjuvant treatment. miR­145­5p expression was determined in breast tumors by quantitative RT­PCR. Our data showed that miR­145­5p had a significant low expression (P<0.005) in patients that achieved pCR in comparison to the non­responder group. Kaplan Meier analysis indicated that low levels of miR­145­5p were associated with increased disease­free survival. In addition, receiver operating characteristic (ROC) curve analysis suggested that miR­145­5p is a good predictor of pCR (P<0.003, AUC=0.7899, 95% CI, 0.6382­0.9416). Quantitative RT­PCR expression analysis also revealed that miR­145­5p was downregulated in four breast cancer cell lines relative to normal cells. To study the functions of miR­145­5p, its expression was restored in triple­negative MDA­MB­231 cells and its effects in cell proliferation were evaluated by MTT assays and in apoptosis using Annexin V experiments. Data revealed that ectopic expression of miR­145­5p resulted in a significant inhibition of cell proliferation and also induced apoptosis. Moreover, miR­145­5p led to sensitization of breast cancer cells to cisplatin therapy. In addition, western blot assays indicated that miR­145­5p downregulated the TGFßR2 protein. In conclusion, miR­145­5p could be a potential biomarker of clinical response to NeoCh in triple­negative breast cancer. Functionally miR­145­5p may regulate cell proliferation, at least in part, by targeting TGFßR2.


Assuntos
Neoplasias da Mama/tratamento farmacológico , MicroRNAs/genética , Terapia Neoadjuvante/efeitos adversos , Receptor do Fator de Crescimento Transformador beta Tipo II/genética , Adulto , Idoso , Biomarcadores Tumorais/genética , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Proliferação de Células/efeitos dos fármacos , Intervalo Livre de Doença , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/genética , Neoplasia Residual/patologia
13.
Ann Surg Oncol ; 26(5): 1254-1262, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30830538

RESUMO

OBJECTIVE: This study was designed to investigate the presence of residual breast tissue (RBT) after skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) and to analyse patient- and therapy-related factors associated with RBT. Skin-sparing mastectomy and NSM are increasingly used surgical procedures. Prospective data on the completeness of breast tissue resection is lacking. However, such data are crucial for assessing oncologic safety of risk-reducing and curative mastectomies. METHODS: Between April 2016 and August 2017, 99 SSM and 61 NSM were performed according to the SKINI-trial protocol, under either curative (n = 109) or risk-reducing (n = 51) indication. After breast removal, biopsies from the skin envelope (10 biopsies per SSM, 14 biopsies per NSM) were taken in predefined radial localizations and assessed histologically for the presence of RBT and of residual disease. RESULTS: Residual breast tissue was detected in 82 (51.3%) mastectomies. The median RBT percentage per breast was 7.1%. Of all factors considered, only type of surgery (40.4% for SSM vs. 68.9% for NSM; P < 0.001) and surgeon (P < 0.001) were significantly associated with RBT. None of the remaining factors, e.g., skin flap necrosis, was associated significantly with RBT. Residual disease was detected in three biopsies. CONCLUSIONS: Residual breast tissue is commonly observed after SSM and NSM. In contrast, invasive or in situ carcinomas are rarely found in the skin envelope. Radicality of mastectomy in this trial is not associated with increased incidence of skin flap necrosis. ClinicalTrials.gov Identifier NCT03470909.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Neoplasia Residual/patologia , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Pele , Retalhos Cirúrgicos/patologia , Adulto , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
14.
Tumori ; 105(3): 259-264, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30915911

RESUMO

OBJECTIVE: To evaluate the factors predicting oncologic outcomes in low-grade ovarian serous carcinoma (LGOSC). METHODS: Seventy patients with LGOSC were included in the study. According to the residual disease present at the end of the initial cytoreductive surgery (CRS), surgical outcomes are defined as follows: maximal CRS for absence of macroscopic residual tumors, optimal CRS for macroscopic residual tumors with diameters ranging from 0.1 to ⩽1 cm diameter, and suboptimal CRS for macroscopic residual tumors measuring >1 cm in diameter. RESULTS: Five-year disease-free survival (DFS) and cancer-specific survival (CSS) were 61% and 83%, respectively. Surgical outcomes were suboptimal in 3 (4.3%) patients, optimal in 8 (11.4%) patients, and maximal in 59 (84.3%) patients. Stage and surgical outcomes were related to DFS (p < 0.05). Compared with maximal CRS, the presence of residual tumors (suboptimal and optimal debulking) was related to threefold increased risk of disease failure (recurrence or progression) (hazard ratio [95% confidence interval] 3.00 [1.27-7.09]; P=0.012). CSS was associated with disease stage alone (P=0.03). Advanced stage was related with lower DFS and CSS. CONCLUSIONS: Maximal CRS facilitates an improvement in DFS. Achieving no residual disease after the completion of surgery should be a cornerstone of LGOSC management.


Assuntos
Cistadenocarcinoma Seroso/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Cistadenocarcinoma Seroso/patologia , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/patologia , Neoplasia Residual/cirurgia , Neoplasias Ovarianas/patologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Resultado do Tratamento
15.
J Dermatol ; 46(5): 371-375, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30888067

RESUMO

Although infantile hemangiomas (IH) spontaneously involute, some leave more volumetric sequelae than others. Identifying predictors of such sequelae would provide a management reference for IH lesions and help achieve favorable outcomes. Our objective is to explore the correlation between volumetric residue remaining after IH involution and its location and to identify other potential outcome predictors. All IH patients examined at our hospital from 2008 to 2011 were reviewed, and both the degree of volumetric residue after involution and the quantified degree of sequelae were obtained by comparing follow-up photographs with photographs of lesions at their maximum size. We discovered that for children with a defined age at the initial visit, lesions of the perifacial area achieved significantly more volumetric regression than lesions of the central facial (P < 0.0001) and chest areas (P = 0.0002). Perifacial lesions had a significantly higher aesthetic score than those on the central facial area (P < 0.0001), chest (P < 0.0001) and trunk/extremities (P = 0.0226) when the age at initial visit and lesion type were consistent. Our study reveals that lesion location and age at initial visit are contributing factors to volumetric sequelae and the aesthetics of the lesion after involution. The results of this study provide a reference to guide treatment decisions with the aim of achieving a favorable outcome.


Assuntos
Estética , Hemangioma/patologia , Regressão Neoplásica Espontânea , Neoplasias Cutâneas/patologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Tomada de Decisão Clínica , Face , Feminino , Seguimentos , Hemangioma/diagnóstico por imagem , Hemangioma/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/patologia , Neoplasia Residual/prevenção & controle , Fotografação , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/terapia , Tórax , Resultado do Tratamento , Carga Tumoral
16.
J Clin Neurosci ; 63: 134-141, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30712777

RESUMO

Standard-of-care treatment of glioblastomas involves maximal safe resection and adjuvant temozolomide chemo-radiotherapy. Although extent of resection (EOR) is a well-known surgical predictor for overall survival most lesions cannot be completely resected. We hypothesize that in the event of incomplete resection, residual tumor volume (RTV) may be a more significant predictor than EOR. This was a multicenter retrospective review of 147 adult glioblastoma patients (mean age 53 years) that underwent standard treatment. Semiautomatic magnetic resonance imaging segmentation was performed for pre- and postoperative scans for volumetric analysis. Cox proportional hazards regression and Kaplan-Meier survival analyses were performed for prognostic factors including: age, Karnofsky performance score (KPS), O(6)-methylguanine methyltransferase (MGMT) promoter methylation status, EOR and RTV. EOR and RTV cut-off values for improved OS were determined and internally validated by receiver operator characteristic (ROC) analysis for 12-month overall survival. Half of the tumors had MGMT promoter methylation (77, 52%). The median tumor volume, EOR and RTV were 43.20 cc, 93.5%, and 3.80 cc respectively. Gross total resection was achieved in 52 patients (35%). Cox proportional hazards regression, ROC and maximum Youden index analyses for RTV and EOR showed that a cut-off value of <3.50 cc (HR 0.69; 95% CI 0.48-0.98) and ≥84% (HR 0.64; 95% CI 0.43-0.96) respectively conferred an overall survival advantage. Independent overall survival predictors were MGMT promoter methylation (adjusted HR 0.35; 95% CI 0.23-0.55) and a RTV of <3.50 cc (adjusted HR 0.53; 95% CI 0.29-0.95), but not EOR for incompletely resected glioblastomas.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/terapia , Glioblastoma/patologia , Glioblastoma/terapia , Neoplasia Residual/diagnóstico , Temozolomida/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/genética , Quimiorradioterapia Adjuvante , Estudos de Coortes , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/genética , Humanos , Estimativa de Kaplan-Meier , Avaliação de Estado de Karnofsky , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasia Residual/patologia , Estudos Retrospectivos , Carga Tumoral , Adulto Jovem
17.
Tumour Biol ; 41(1): 1010428318823988, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30810094

RESUMO

The objective of this study is to evaluate the relationship between discoidin domain receptor 2 (DDR2) and miR-182 expression with response to platinum-based chemotherapy and survival in women with high-grade serous ovarian cancer (HGSOC). We evaluated 78 women with HGSOC stages I-IV, diagnosed between 1996 and 2013, and followed up until 2016. DDR2 expression was assessed using immunohistochemistry on tissue microarray slides. The microRNAs were evaluated by qRT-PCR. DDR2 expression was high in 11 (14.1%) women. PFS was significantly lower in women with FIGO stage I/II - versus III/IV, post-surgery residual disease and high expression of DDR2. Women with postsurgery residual disease, FIGO stage I/II - versus III/IV and DDR2 expression had worse OS, but only post-surgery residual disease remained an independent prognostic factor for worse OS in multivariable analysis. miR-182 expression levels were significantly lower in patients harboring tumors with higher expression of DDR2 (p < 0.001). In this relatively large cohort of women with HSGOC, higher DDR2 expression was associated with lower miR-182 levels and worse PFS, suggesting that these molecules may be associated with mechanisms of HGSOC progression.


Assuntos
Receptor com Domínio Discoidina 2/genética , MicroRNAs/genética , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/mortalidade , Idoso , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Imuno-Histoquímica/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/genética , Neoplasia Residual/mortalidade , Neoplasia Residual/patologia , Compostos Organoplatínicos/uso terapêutico , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Estudos Retrospectivos
18.
Gynecol Oncol ; 152(3): 568-573, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30642626

RESUMO

OBJECTIVE: A scoring system has been proposed to predict gross residual disease at primary debulking surgery (PDS) for advanced epithelial ovarian cancer. This scoring system has not been assessed in patients undergoing neoadjuvant chemotherapy (NACT). The aim of this study is to assess the reproducibility and prognostic significance of the scoring system when applied to women undergoing NACT followed by interval debulking surgery (IDS). METHODS: A retrospective cohort study was conducted of patients with advanced ovarian cancer who underwent NACT and IDS between 2005 and 2014. Change in tumor burden using computed tomography (CT) at diagnosis (T0) and after initiation of NACT but before IDS (T1) was independently assessed by two radiologists blinded to outcomes using two read criteria: a scoring system utilizing clinical and radiologic criteria and RECIST 1.1. Relationship between CT assessments to surgical outcome, progression free survival (PFS) and overall survival (OS) were evaluated. Reader agreement was measured using Fleiss's kappa (ĸ). RESULTS: 76 patients were analyzed. Optimal surgical outcome was achieved in 69 (91%) of patients. Median progression free survival was 13.2 months and overall survival was 32.6 months, respectively. Predictive score change from T0 to T1 of >1 (denoting an improvement in disease burden) was associated with optimal cytoreduction (p = 0.02 and 0.01 for readers 1 and 2, respectively). Neither predictive score nor RECIST 1.1 assessment was predictive of OS or PFS. Reader agreement was substantial for predictive score (κ = 0.77) and moderate for RECIST (κ = 0.51) assessments. CONCLUSIONS: A change in score before and after neoadjuvant chemotherapy minimizes reader variability and predicts surgical outcome.


Assuntos
Carcinoma Epitelial do Ovário/diagnóstico por imagem , Carcinoma Epitelial do Ovário/terapia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/terapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Epitelial do Ovário/tratamento farmacológico , Carcinoma Epitelial do Ovário/cirurgia , Quimioterapia Adjuvante , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral
19.
Zhonghua Fu Chan Ke Za Zhi ; 54(1): 19-23, 2019 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-30695901

RESUMO

Objective: To investigate the relationship between various loop electrosurgical excision procedure (LEEP) margin status and residual high grade squamous intraepithelial lesion (HSIL) or worse at hysterectomy following conization. Methods: The relevant clinicopathological data were collected in the Obstetrics and Gynecology Hospital, Fudan University from Jan. 2014 to Dec. 2015, including 947 cases who underwent hysterectomy within 6 months of LEEP. The residual HSIL or worse at hysterectomy were analyzed among the groups. (1) Clear margins, involved margins, and without 1 mm negative margins. (2) Only one positive margin, two positive margins and three positive margins. (3) A positive margin of internal ostium of cervix, of external ostium of cervix and of the basement. Results: (1) The histological evaluation of the uterine specimens showed residual HSIL or worse in 234 cases (24.7%, 234/947). The proportion of residual lesions was 7.3% (21/286) in population with clear margins, 33.2% (211/635) with involved margins, 7.7% (2/26) without 1 mm negative margins, respectively. The positive margins group had significant difference at the aspect of residual rate in contrast to the negative margins group and the without 1 mm negative margins group (P<0.01). Further studies conclusively showed that the proportion of residual lesions was very similar between the negative margins group and the without 1 mm negative margins group (P>0.05). (2) The involved margins were interpretable in 621 cases. This was detected in 25.3% (111/438) patients with only one positive margin, 47.4% (74/156) with two positive margins and 77.8% (21/27) among three positive margins, respectively (P<0.01). (3) Furthermore, there were 418 cases only one positive margin was definite, and the proportion of residual lesions was 31.0% (62/200) in population with a positive margin of internal ostium of cervix, 18.2% (31/170) of external ostium of cervix and 33.3% (16/48) of the basement. The residual rates were higher in the endocervical and basal margin groups than that in the ectocervical margin group, and the differences were significant (P<0.05). Conclusions: The risk of residual HSIL or worse is significantly greater with involved margins at hysterectomy following LEEP. Both the positive endocervical and basal margin are excellent predictors of residual diseases, while the without 1 mm negative margin may be not. Clinicians should avoid treating it as positive margin and prevent overtreatment.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Eletrocirurgia/métodos , Histerectomia , Neoplasia Residual/patologia , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Neoplasias do Colo do Útero/cirurgia , Neoplasia Intraepitelial Cervical/patologia , Conização , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia
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