Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.829
Filtrar
1.
Arq Gastroenterol ; 57(2): 172-177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206858

RESUMO

BACKGROUND: Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE: To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS: The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS: Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION: Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.


Assuntos
Neoplasias do Colo/mortalidade , Neoplasias Colorretais/mortalidade , Neoplasias Retais/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Brasil/epidemiologia , Neoplasias do Colo/patologia , Neoplasias do Colo/terapia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Sistema de Registros , Estudos Retrospectivos , Índice de Gravidade de Doença , Sobrevida , Análise de Sobrevida , Taxa de Sobrevida
2.
Crit Rev Oncol Hematol ; 155: 103110, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33038693

RESUMO

Previous meta-analyses on palliative treatment of malignant colorectal obstruction with Self-Expandable Metal Stent (SEMS) or emergency surgery reported contradictory results for morbidity, and frequently included extracolonic obstruction. Therefore, the current meta-analysis aimed to exclusively analyze palliative treatment for primary obstructive colorectal cancer, with early complication rate as a primary outcome. A systematic literature search was performed on studies comparing palliative SEMS and emergency surgery. Corresponding authors were contacted for additional data. Eighteen studies were selected (1518 patients). Early complication rate was 13.6 % for SEMS and 25.5 % for emergency surgery (Odds Ratio (OR) 0.46, 95 % confidence interval (CI) 0.29-0.74). Mortality was 3.9 % and 9.4 % (OR 0.44, 0.28-0.69). Stomas were present in 14.3 % and 51.4 % of patients (OR 0.17, 0.09-0.31). More late complications occurred after SEMS (23.2 % versus 9.8 %, OR 2.55, 1.70-3.83), mostly due to SEMS obstruction. In conclusion, SEMS placement seems the preferred treatment of obstructing colorectal cancer in the palliative setting.


Assuntos
Neoplasias Colorretais , Obstrução Intestinal , Neoplasias Colorretais/complicações , Neoplasias Colorretais/terapia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Metais , Cuidados Paliativos , Estudos Retrospectivos , Stents , Resultado do Tratamento
3.
Bull Cancer ; 107(11): 1138-1147, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33036740

RESUMO

INTRODUCTION: Since the last cancer plan 2014-2019, the assessment of the impact of the disease on caregivers became essential. The quality of caregiving represents an important part of the patient's quality of life. The main objective was to describe the evolution of caregiver's attachment style during the first three years of the disease support. METHODS: Caregivers have been included through the ICE study (Informal Carers of Elderly). They were taking care for one near parent at least 60 years of age with a diagnosis of cancer (breast, prostate, colorectal). Caregivers were interviewed at home within three months of inclusion in the ICE study. This longitudinal research based on recorded semi-structured interviews and used one scale (RSQ) to evaluate the attachment style: secure attachment, detached-type insecure, preoccupied-type insecure or fearful-type insecure. RESULTS: The evolution of attachment styles reflect different relational strategies among the 33 caregivers included. The three first times of the disease are differently lived by the caregivers and are impacted by an insecurity form. The attachment style is different depending on the stage of the disease and the impact of the assistance provided shows that caregivers use more detachment relational strategy in the first year. Then, between 3 and 15 months, the attachment style is evolving towards more preoccupied style. DISCUSSION: Detached-type insecure caregiver tend to minimize their signs of distress in the first time of disease. By contrast, preoccupied-type insecure adults tend to maximize distress signals. It's important to consider the specificity of each step of the process to better support caregivers.


Assuntos
Neoplasias da Mama/psicologia , Cuidadores/psicologia , Neoplasias Colorretais/psicologia , Apego ao Objeto , Neoplasias da Próstata/psicologia , Estresse Psicológico/psicologia , Adaptação Psicológica , Idoso , Neoplasias da Mama/terapia , Neoplasias Colorretais/terapia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/terapia , Pesquisa Qualitativa , Qualidade de Vida , Inquéritos e Questionários , Fatores de Tempo
4.
PLoS One ; 15(10): e0240397, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031464

RESUMO

BACKGROUND: There is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation. OBJECTIVE: To evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change. DESIGN: An online survey of colorectal cancer service change globally in May and June 2020. PARTICIPANTS: Attending or consultant surgeons involved in the care of patients with colorectal cancer. MAIN OUTCOME MEASURES: Changes in the delivery of diagnostics (diagnostic endoscopy), imaging for staging, therapeutics and surgical technique in the management of colorectal cancer. Predictors of change included increased hospital bed stress, critical care bed stress, mortality and world region. RESULTS: 191 responses were included from surgeons in 159 centers across 46 countries, demonstrating widespread service reduction with global variation. Diagnostic endoscopy was reduced in 93% of responses, even with low hospital stress and mortality; whilst rising critical care bed stress triggered complete cessation (p = 0.02). Availability of CT and MRI fell by 40-41%, with MRI significantly reduced with high hospital stress. Neoadjuvant therapy use in rectal cancer changed in 48% of responses, where centers which had ceased surgery increased its use (62 vs 30%, p = 0.04) as did those with extended delays to surgery (p<0.001). High hospital and critical care bed stresses were associated with surgeons forming more stomas (p<0.04), using more experienced operators (p<0.003) and decreased laparoscopy use (critical care bed stress only, p<0.001). Patients were also more actively prioritized for resection, with increased importance of co-morbidities and ICU need. CONCLUSIONS: The COVID-19 pandemic was associated with severe restrictions in the availability of colorectal cancer services on a global scale, with significant variation in behaviours which cannot be fully accounted for by hospital burden or mortality.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos , Alocação de Recursos para a Atenção à Saúde , Pneumonia Viral/epidemiologia , Betacoronavirus/fisiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Gastroenterologia/organização & administração , Gastroenterologia/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pandemias , Segurança do Paciente
5.
Medicine (Baltimore) ; 99(43): e22803, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120800

RESUMO

Routine postoperative surveillance is recommended for the patients with colorectal cancer (CRC). This study aimed to clarify the conditions indicate initial suspicion of CRC recurrence in different preoperative serum carcinoembryonic antigen (CEA) level groups, including positive physical signs/symptoms, elevated CEA level, positive radiologic studies results, and other elevated tumor markers.A total of 2268 patients with recurrence after curative surgery for CRC were enrolled in this study. The patients were classified into 3 groups according to preoperative serum CEA level (low, <2 ng/mL; intermediate, ≥2 and <5 ng/mL; and high, ≥5 ng/mL).Up to 63.6% of recurrence was suspected based on elevated CEA level in the high preoperative serum CEA level group. Patients in the low preoperative serum CEA level group had a higher rate of initial suspicion of recurrence based on positive physical signs or symptoms (36.7% vs 26.9% vs 20.4%, P < .001) and positive radiologic findings (51.4% vs 40.7% vs 29.5%, P < .001) than those in the intermediate and high preoperative serum CEA groups.Conditions indicate initial suspicion of recurrence varied in the different preoperative serum CEA level groups. In patients with low preoperative serum CEA level, the detection of recurrence depend on abnormal CEA level is less sensitive than intermediate and high preoperative serum CEA groups. We suggest that the strategy for CRC surveillance should not depend on serum CEA level alone. The signs or symptoms of patients, changes in postoperative serial CEA level, and ongoing radiologic or imaging findings must be cautiously monitored.


Assuntos
Antígeno Carcinoembrionário/sangue , Neoplasias Colorretais/patologia , Recidiva Local de Neoplasia/sangue , Idoso , Biomarcadores Tumorais , Neoplasias Colorretais/sangue , Neoplasias Colorretais/terapia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Nature ; 585(7826): 509-517, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32968260

RESUMO

Colorectal cancer (CRC) is a heterogeneous disease of the intestinal epithelium that is characterized by the accumulation of mutations and a dysregulated immune response. Up to 90% of disease risk is thought to be due to environmental factors such as diet, which is consistent with a growing body of literature that describes an 'oncogenic' CRC-associated microbiota. Whether this dysbiosis contributes to disease or merely represents a bystander effect remains unclear. To prove causation, it will be necessary to decipher which specific taxa or metabolites drive CRC biology and to fully characterize the underlying mechanisms. Here we discuss the host-microbiota interactions in CRC that have been reported so far, with particular focus on mechanisms that are linked to intestinal barrier disruption, genotoxicity and deleterious inflammation. We further comment on unknowns and on the outstanding challenges in the field, and how cutting-edge technological advances might help to overcome these. More detailed mechanistic insights into the complex CRC-associated microbiota would potentially reveal avenues that can be exploited for clinical benefit.


Assuntos
Neoplasias Colorretais/microbiologia , Neoplasias Colorretais/fisiopatologia , Microbioma Gastrointestinal , Animais , Neoplasias Colorretais/imunologia , Neoplasias Colorretais/terapia , Disbiose/metabolismo , Disbiose/microbiologia , Microbioma Gastrointestinal/imunologia , Humanos , Inflamação/microbiologia , Mutagênese
7.
Am J Clin Oncol ; 43(9): 660-666, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889837

RESUMO

OBJECTIVE: The objective of this study was to assess sexual minority and heterosexual survivors' perceived quality of cancer care and identify demographic, clinical, and psychosocial characteristics associated with patient-centered quality of care. MATERIALS AND METHODS: Four cancer registries provided data on 17,849 individuals who were diagnosed with stage I, II, or III colorectal cancer an average of 3 years prior and resided in predetermined diverse geographic areas. A questionnaire, which queried about sexual orientation and other eligibility criteria was mailed to all cancer survivors. Of these, 480 eligible survivors participated in a telephone survey. Quality of cancer care was defined by 3 measures of interpersonal care (physician communication, nursing care, and coordination of care) and by rating cancer care as excellent. We used generalized linear models and logistic regression with forward selection to obtain models that best explained each quality of care measure. RESULTS: Sexual minority survivors rated physician communication, nursing care, and coordination of care similarly to heterosexual survivors, yet a significantly higher percentage of sexual minority survivors rated the overall quality of their cancer care as excellent (59% vs. 49%). Sexual minority survivors' greater likelihood of reporting excellent care remained unchanged after adjusting for demographic, clinical, and psychosocial characteristics. CONCLUSIONS: Sexual minority survivors' ratings of quality of colorectal cancer care were comparable or even higher than heterosexual survivors. Sexual minority survivors' reports of excellent care were not explained by their interpersonal care experiences.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Neoplasias Colorretais/terapia , Heterossexualidade/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto , Sobreviventes de Câncer/psicologia , Neoplasias Colorretais/enfermagem , Comunicação , Procedimentos Clínicos/normas , Feminino , Pesquisas sobre Serviços de Saúde , Heterossexualidade/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/normas , Relações Médico-Paciente , Sistema de Registros , Minorias Sexuais e de Gênero/psicologia , Estados Unidos , Adulto Jovem
8.
Medicine (Baltimore) ; 99(39): e21796, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991401

RESUMO

Wait time and scheduling for outpatient chemotherapy administration depends on various factors including infusion room hours of operation, availability of oncologists, nursing and pharmacy staffing, and physical space limitations. The aim of this study was to use the electronic event log of patients on health information system (HIS) to map and analyze patient flow in advanced metastatic colorectal patients at an academic cancer center. From January 2009 to December 2014, patients who were diagnosed with metastatic colorectal cancer and received outpatient chemotherapy confined to FOLFIRI (fluorouracil, leucovorin, and irinotecan) or FOLFOX (folinic acid, fluorouracil, and oxaliplatin) were identified. From the HIS, patient flow was mapped by collection of event records including blood collection and pretreatment laboratory test, arrival to outpatient clinics, outpatient session (interview, drug accountability and appointment scheduling), and initiation of chemotherapy. A total of 10,638 patients were analyzed for 136,281 outpatient visits. The total office stay time from outpatient registration to initiation of chemotherapy was 92.58 ±â€Š87.96 (mean ±â€Šstandard deviation) minutes. Each outpatient session lasted 23.75 ±â€Š51.55 minutes. After completing the outpatient session, patients waited 1,657.23 ±â€Š3,027.65 minutes before chemotherapy and 46.66 ±â€Š75.94 minutes within infusion room. Compared to the prior first come first serve rule, the new reservation system showed an improvement in overall waiting time from 2,432.3 ±â€Š4,822.9 to 2,386.7 ±â€Š143.4 minutes; however, waiting time within infusion room slightly increased from 36.68 ±â€Š49.33 to 48.13 ±â€Š46.32 minutes. Our findings indicate that transaction data analytics from HIS can be used to evaluate patient flow within oncology outpatient practice based on real-world hospital data.


Assuntos
Agendamento de Consultas , Institutos de Câncer/estatística & dados numéricos , Neoplasias Colorretais/terapia , Idoso , Feminino , Humanos , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Fatores de Tempo
10.
Bull Cancer ; 107(9): 867-880, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32919610

RESUMO

INTRODUCTION: Few studies have explored the long-term occupational situation after cancer. The aim of our study were to study the employment status among long-term cancer survivors and to compare it to cancer-free controls from the general population at 5, 10 or 15 years after cancer diagnosis. METHODS: From data of a registry-based study, long-term survivors from breast,cervical and colorectal cancer, randomly selected from three tumor registries in France, were compared to cancer-free controls randomly selected from electoral lists. We selected active cancer survivors and cancer-free controls aged less than 60 at the time of the survey. We have studied the employment status of cases vs. controls and the factors associated with employment status. RESULTS: At 5, 10 or 15 years after diagnosis, we did not observe any significant difference in employment status between cases and controls. Among cases, 17% had lost their jobs. Older age, lower incomes, lower education, a short-term employment contract, the presence of co-morbidities, fatigue and a worse quality of life were associated with job loss. DISCUSSION: Although the employment status of the cases was comparable to that of the controls, efforts should be intensified to make it easier for patients diagnosed with cancer to return to work.


Assuntos
Sobreviventes de Câncer , Emprego/estatística & dados numéricos , Adulto , Neoplasias da Mama/terapia , Neoplasias Colorretais/terapia , Estudos Transversais , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Tempo , Neoplasias do Colo do Útero/terapia , Adulto Jovem
11.
Life Sci ; 261: 118368, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32888940

RESUMO

AIMS: Colorectal cancer (CRC) is one of the most common cancers with poor prognosis worldwide. The advent of immunotherapy has greatly improved survival in refractory patients of CRC. In this study, we aimed to identify reliable immune classification and biomarkers that predict immunotherapeutic responses in CRC patients. MATERIALS AND METHODS: Based on transcriptome profiles of two publicly available CRC datasets, we performed single-sample gene set enrichment analysis (ssGSEA) to calculate the relative abundance of 29 immune-related items of each sample. Unsupervised clustering was used to classify CRC patients. Furthermore, an immune prognostic signature was constructed using the least absolute shrinkage and selection operator (LASSO) Cox regression analysis. KEY FINDINGS: The CRC patients were clustered into high, medium, low immune infiltration subtypes based on the immune landscape. There was significant heterogeneity among the three subtypes. The high immune infiltration group showed higher expression of programmed cell death-ligand 1 and better prognosis than the median and low immune infiltration groups. Furthermore, we constructed a 7-immune-related prognostic gene signature and found that the signature had high predictive value and was superior to other clinicopathological parameters. Finally, the correlation analysis of the signature with immune cell infiltration and immune checkpoint molecules suggested that the signature had the potential to assess the immunotherapeutic responses of CRC patients. SIGNIFICANCE: The immune landscape and prognostic signature of CRC contribute to a deeper understanding of the tumor microenvironment and guide accurate immunotherapy.


Assuntos
Neoplasias Colorretais/imunologia , Neoplasias Colorretais/terapia , Imunoterapia , Neoplasias Colorretais/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes , Prognóstico
12.
Ann R Coll Surg Engl ; 102(7): 504-509, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32799666

RESUMO

INTRODUCTION: The aim of the study was to establish the natural history of elderly patients with non-metastatic colorectal cancer who underwent non-operative management in comparison with those who underwent operative management. MATERIALS AND METHODS: A retrospective analysis of patients aged 80 years and above diagnosed with colorectal cancer between 2007 and 2015 in a tertiary care hospital in the Southwest of England was done. Patients were divided into non-operatively managed and operatively managed groups. Clinical demographics, Charlson Comorbidity Index, location of the tumour and overall survival between the two groups were compared. RESULTS: A total of 407 patients were studied; 132 were treated non-operatively and 275 operatively. The non-operative group included fewer right-sided colon cancers (28.7% vs 54.9%), but significantly more rectal cancers were managed non-operatively (43.9 vs 23.6%, respectively). The two and five year overall survival was 38.9% and 11.3% respectively in the non-operative group, significantly lower than patients in the operative group where the two and five year survival was 78.9% and 59.6% respectively (p = .0001). The median Charlson Comorbidity Index was 7.99 for the non-operative group and 7.49 in the operative group (p = 0.109). Patients treated non-operatively were deemed unfit without objective frailty assessment and only 43/132(32.6%) had formal anaesthetic assessment before being deemed unfit for surgery. CONCLUSION: The survival of octa- and nonagenarians with non-metastatic colorectal cancer managed conservatively is significantly less than counterparts managed operatively. Our present strategy of deciding and denying treatment of the elderly patient with colorectal cancer is arbitrary, highlighting the need for robust geriatric and frailty assessment.


Assuntos
Neoplasias Colorretais/terapia , Tratamento Conservador/métodos , Estadiamento de Neoplasias , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Inglaterra/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
13.
Value Health ; 23(7): 898-906, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762992

RESUMO

OBJECTIVES: We evaluated how next generation sequencing (NGS) can modify care pathways in an observational impact study in France. METHODS: All patients with lung cancer, colorectal cancer, or melanoma who had NGS analyses of somatic genomic alterations done in 1 of 7 biomolecular platforms certified by the French National Cancer Institute (INCa) between 2013 and 2016 were eligible. We compared patients' pathways before and after their NGS results. Endpoints consisted of the turnaround time in obtaining results, the number of patients with at least 1 genomic alteration identified, the number of actionable alterations, the impact of the genomic multidisciplinary tumor board on care pathways, the number of changes in the treatment plan, and the survival outcome up to 1 year after NGS analyses. RESULTS: 1213 patients with a request for NGS analysis were included. NGS was performed for 1155 patients, identified at least 1 genomic alteration for 867 (75%), and provided an actionable alteration for 614 (53%). Turnaround time between analyses and results was on average 8 days (Min: 0; Max: 95) for all cancer types. Before NGS analysis, 33 of 614 patients (5%) were prescribed a targeted therapy compared with 54 of 614 patients (8%) after NGS analysis. Proposition of inclusion in clinical trials with experimental treatments increased from 5% (n = 31 of 614) before to 28% (n = 178 of 614) after NGS analysis. Patients who benefited from a genotype matched treatment after NGS analysis tended to have a better survival outcome at 1 year than patients with nonmatched treatment: 258 days (±107) compared with 234 days (±106), (P = .41). CONCLUSIONS: NGS analyses resulted in a change in patients' care pathways for 20% of patients (n = 232 of 1155).


Assuntos
Neoplasias Colorretais/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Neoplasias Pulmonares/genética , Melanoma/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/terapia , Feminino , França , Genômica/métodos , Acesso aos Serviços de Saúde , Humanos , Neoplasias Pulmonares/terapia , Masculino , Melanoma/terapia , Pessoa de Meia-Idade , Terapia de Alvo Molecular , Estudos Retrospectivos , Sobrevida , Fatores de Tempo , Adulto Jovem
16.
Public Health ; 186: 119-124, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32818724

RESUMO

OBJECTIVES: Women with terminal cancer are assumed to choose hospice care over aggressive treatment at the end of life. With new chemotherapy and target therapy options, it becomes more difficult to decide between hospice care and aggressive management. It is also crucial to consider the cost increases leading to severe financial burdens on healthcare systems. To better understand treatment options at the individual level, this study set out to describe trends in end-of-life care for the four leading cancers in women in Taiwan. STUDY DESIGN: This was a population-based retrospective cohort study. METHODS: The data source was obtained between January 1, 2000, and December 31, 2013, from Taiwan's National Health Insurance Research Database. We identified 98,575 women with a diagnosis of breast (18,596), colorectal (23,734), liver and biliary (28,795) or lung (27,450) cancer who had died during the study period. Hospital data for services provided in the last 6 months of life, including hospice services and aggressive managements (chemotherapy, frequent hospitalisation, emergency room [ER] visits, intensive care unit [ICU] admission and endotracheal intubation), were collected. RESULTS: Hospice utilisation increased over the study period, with 25.85%, 25.34%, 21.23% and 26.55% of female patients with breast, colorectal, liver and biliary, and lung cancer receiving hospice care, respectively. However, the number of women undergoing aggressive treatments in the last 6 months of life remained high, with the breast cancer group having the highest chemotherapy rate, the colorectal cancer group having frequent hospitalisation and the liver and biliary cancer group having frequent ER visits and ICU admissions. CONCLUSIONS: Increasing hospice utilisation among women with the four most common cancers in Taiwan indicates that hospice services have gradually become well accepted over the past 13 years; however, the real focus is on the ineffective treatment preceding hospice care, and late referral was also a notable problem.


Assuntos
Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Neoplasias/terapia , Assistência Terminal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/terapia , Neoplasias Colorretais/terapia , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/terapia , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Estudos Retrospectivos , Taiwan , Doente Terminal
17.
Am J Surg Pathol ; 44(9): 1224-1234, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32804454

RESUMO

This study determined the frequency and the clinicopathologic and genetic features of colorectal carcinomas driven by oncogenic fusions of the anaplastic lymphoma kinase gene (ALK). Of the 8150 screened tumors, 12 (0.15%) were immunohistochemically ALK-positive with D5F3 antibody. These cancers harbored CAD-ALK (n=1), DIAPH2-ALK (n=2), EML4-ALK (n=2), LOC101929227-ALK (n=1), SLMAP-ALK (n=1), SPTBN1-ALK (n=4), and STRN-ALK (n=1) fusions, as detected by an RNA-based next-generation sequencing assay. ALK fusion carcinomas were diagnosed mostly in older patients with a 9:3 female predominance (median age: 72 y). All tumors, except a rectal one, occurred in the right colon. Most tumors were stage T3 (n=7) or T4 (n=3). Local lymph node and distant metastases were seen at presentation in 9 and 2 patients. These tumors showed moderate (n=6) or poor (n=3) glandular differentiation, solid medullary growth pattern (n=2), and pure mucinous morphology (n=1). DNA mismatch repair-deficient phenotype was identified in 10 cases. Tumor-infiltrating lymphocytes were prominent in 9 carcinomas. In 4 carcinomas, tumor cells showed strong, focal (n=3), or diffuse programmed death-ligand 1 immunoreactivity. CDX2 expression and loss of CK20 and MUC2 expression were frequent. CK7 was expressed in 5 tumors. Four patients died of disease within 3 years, and 7 were alive with follow-up ranging from 1 to 8 years. No mutations in BRAF, RAS, and in genes encoding components of PI3K-AKT/MTOR pathway were identified. However, 1 tumor had a loss-of-function PTEN mutation. Aberration of p53 signaling, TP53 mutations, and/or nuclear accumulation of p53 protein was seen in 9 cases. ALK fusion colorectal carcinomas are a distinct and rare subtype of colorectal cancers displaying some features of mismatch repair-deficient tumors.


Assuntos
Adenocarcinoma/genética , Quinase do Linfoma Anaplásico/genética , Biomarcadores Tumorais/genética , Neoplasias Colorretais/genética , Fusão Gênica , Rearranjo Gênico , Adenocarcinoma/química , Adenocarcinoma/secundário , Adenocarcinoma/terapia , Idoso , Biomarcadores Tumorais/análise , Neoplasias Colorretais/química , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Análise Mutacional de DNA , Europa (Continente) , Feminino , Predisposição Genética para Doença , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Japão , Metástase Linfática , Masculino , Mutação , Estadiamento de Neoplasias , Fenótipo , Resultado do Tratamento , Estados Unidos
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 516-520, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842435

RESUMO

Colorectal cancer is one of the most common malignant tumors of digestive tract. There are a large number of microorganisms in the digestive tract. Under normal physiological conditions, intestinal microorganisms can help with digestion and absorption, resist pathogen invasion and regulate the proliferation of intestinal mucosal cells. However, intestinal microflora imbalance will affect the intestinal microenvironment and intestinal cell function, and is closely related to the incidence and progression of colorectal cancer. Firstly, this paper introduces the changes of intestinal flora in patients with colorectal cancer, and then summarizes the mode of intestinal flora participating in the occurrence of colorectal cancer from the macro level. Then, we elaborate the involvement of intestinal flora in colorectal cancer from the aspects of cytokine-dependent chronic inflammation, DNA damage of intestinal epithelial cells, carcinogenic metabolites of intestinal flora and cellular enzymes, and changes of intestinal immune system. The pathogenesis of colorectal cancer provides a reference for further study of the pathogenesis of colorectal cancer. Finally, from the perspective of intestinal flora and colorectal cancer treatment, we analyze the significance of probiotics and bacterial flora transplantation for the treatment of colorectal cancer, and provide some new treatment ideas and methods that may be useful for the treatment of colorectal cancer.


Assuntos
Carcinogênese , Neoplasias Colorretais/microbiologia , Microbioma Gastrointestinal/fisiologia , Intestinos/microbiologia , Carcinogênese/genética , Carcinogênese/imunologia , Carcinogênese/metabolismo , Carcinogênese/patologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/terapia , Transplante de Microbiota Fecal , Humanos , Intestinos/patologia , Intestinos/fisiopatologia , Probióticos/uso terapêutico , Microambiente Tumoral/fisiologia
19.
Yi Chuan ; 42(6): 599-612, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32694118

RESUMO

Colorectal cancer (CRC) is a malignant cancer with high incidence and mortality in the world. Immunotherapy targeting neoantigens can induce durable tumor regression in cancer patients, but is almost limited to personalized precision therapy, due to the individual differences of unique neoantigens. With the discovery of many common oncogenic mutations, and such mutation-associated neoantigens could cover more patients, and hence are valuable in clinical field. However, whether the common neoantigens can be identified in CRC is unknown. Combining the somatic mutations data from 321 CRC patients with a filter standard and 7 predicted algorithms, we screened and obtained 25 HLA-A*1101-restricted common neoantigens with a high binding affinity (IC50<50 nmol/L) and presentation score (>0.90). Besides the positive epitope KRAS_G12V8-16, 11 out of 25 common neoantigens specifically induced in vitro pre- stimulated cytotoxic lymphocyte (CTL) to secrete interferon gamma (IFN-γ). Moreover, combining cell-sorting technology and single-cell RNA sequencing, the immune repertoire profiles of C1orf170_S418G413-421 and KRAS_G12V8-16-specific CTL were analyzed and validated. Their related T-cell receptor engineered T cell (TCR-T) cells could also recognize the neoantigens and secrete IFN-γ. Hence, we have established a method to screen for common neoantigens with immunogenicity in CRC based on the public somatic mutation library. It can provide essential peptide and TCR information for immunotherapies, such as peptides, dendritic cells (DC) vaccines, TCR-like antibodies, TCR-T, etc., for the CRC and other cancers, which has practical application value in the clinics.


Assuntos
Antígenos de Neoplasias , Neoplasias Colorretais , Antígenos de Neoplasias/genética , Neoplasias Colorretais/genética , Neoplasias Colorretais/imunologia , Neoplasias Colorretais/terapia , Detecção Precoce de Câncer , Humanos , Mutação , Receptores de Antígenos de Linfócitos T/genética
20.
Zhonghua Wai Ke Za Zhi ; 58(8): 561-585, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727186

RESUMO

Colorectal cancer (CRC) is one of the most common malignant tumors in China. In recent years, the incidence and mortality of CRC in China have been on the rise. According to the China cancer statistics report in 2018, the incidence and mortality of CRC in China ranked the third and fifth among all malignant tumors, with 376,000 new cases and 191,000 deaths. China has become the country with the highest number of new cases and deaths of CRC every year in the world, which seriously threatens the health of Chinese residents. In 2010, the National Ministry of Health organized colorectal cancer expertise of the Chinese Medical Association to write the Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer (2010 edition) and publish it publicly. Since 2010, the National Health and Family Planning Commission has organized experts to revise the protocol in 2015 and 2017, while the National Health Commission revised it in 2020. The revised part of Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer (2020 edition) involves new progress in the field of imaging examination, pathological evaluation, surgery, chemotherapy and radiotherapy. The 2020 edition of the protocol not only referred to the contents of the international guidelines, but also combined with the specific national conditions and clinical practice in China, and also included many evidence-based clinical data in China recently. The 2020 edition of the protocol would further promote the standardization of diagnosis and treatment of CRC in China, improve the survival and prognosis of patients, and benefit millions of CRC patients and their families.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Guias de Prática Clínica como Assunto , China/epidemiologia , Neoplasias Colorretais/epidemiologia , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA