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1.
J Coll Physicians Surg Pak ; 31(12): 1487-1493, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34794293

RESUMO

OBJECTIVES: To describe the spectrum of small intestine gastrointestinal stromal tumour (GIST) cases; and to analyse prognostic factors. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Turkey, from 2010 to 2020. METHODOLOGY: Forty patients with small intestine GIST followed up between 2010-2020 were included in this study. The demographic information and clinical laboratory, histopathology, and radiology findings of all patients were analysed and compared. Five-year overall survival (OS) rate and five-year disease-free survival (DFS)were calculated. RESULTS: The mean patient age at diagnosis was 58.9 ± 12.6 years (34-79 years). Thirty-seven (92.5%) tumours were in the jejunum and ileum, and three (7.5%) were in the duodenum. The most common symptoms were bleeding (50%) and pain (37.5%). A total of 5% of the patients were asymptomatic, and 67.5% were in the high-risk group. Two patients (5%) died within a 30-day postoperative period, and 13 (32.5%) died during the follow-up period. The five-year overall survival (OS) rate was 54.2%. The mean five-year OS and five-year disease-free survival (DFS) were 47.5 ± 16.8 months and 40.9 ± 25.0 months, respectively. The mortality risk was calculated as 4.5-fold increased in the patients aged over 60 years and as 3.556-fold increased in those with recurrence/metastasis detected in their follow-ups. CONCLUSION: The OS ratio and OS duration were not as high as expected for small intestine GIST cases. Tumour diameter, mitotic index, and risk classification may not provide sufficient information for prognosis prediction in some cases. The frequency of recurrence and/or metastasis was higher than expected - although complete resection was achieved. Key Words: Gastrointestinal stromal tumours, Small intestine, Tumour diameter, Mitotic index.


Assuntos
Tumores do Estroma Gastrointestinal , Neoplasias Intestinais , Idoso , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias Intestinais/cirurgia , Intestino Delgado , Prognóstico , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 100(39): e27389, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596162

RESUMO

RATIONALE: Peutz-Jeghers syndrome (PJS), a rare autosomal dominant disorder, is characterized by mucocutaneous pigmentations, hamartomatous polyps in the gastrointestinal tract, and a high risk of developing various malignancies. To the best of our knowledge, only 1 case of appendiceal carcinoid associated with PJS has been previously reported in the pediatric population. PATIENT CONCERNS: We report a 7-year-old girl who was admitted for severe, intermittent abdominal pain and cramps, nausea, and vomiting. Multiple brown melanotic macules on the lips, buccal mucosa, and the tongue were noted. DIAGNOSIS: A plain abdominal X-ray in a standing position revealed dilated intestinal loops with multiple air-fluid levels. A computed tomography scan of the abdomen showing a "coffee bean" appearance of the jejunal loop with a transition point to the duodenal loop. Axial-contrast-enhanced computed tomography scan of the abdomen showing dilated jejunum loops, filled with fluid with the swirled appearance of mesentery typical for volvulus. The diagnosis of PJS was based on clinical findings along with the histopathologic confirmation of the hamartomatous polyps. INTERVENTIONS: An emergency laparotomy was performed, revealing a jejunojejunal intussusception starting 40 cm from the duodenojejunal flexure. Jejunotomy revealed that a lead-point intussusception was a necrotic hamartomatous polyp. After resecting the involved jejunal necrotic segment, including the polyp, end-to-end jejuno-jejunal anastomosis was performed. Further exploration revealed the presence of a jejunal mass 80 cm from the duodenojejunal flexure identified as another hamartomatous pedunculated polyp. The polyp was resected, and the enterotomy was then closed transversely. The grossly normal appendix was also removed. OUTCOMES: Clinical findings along with the histopathologically confirmed hamartomatous polyps were consistent with PJS. An appendiceal carcinoid (well-differentiated neuroendocrine tumor, European Neuroendocrine Tumor Society stage pT2) was incidentally detected during histological examination of the appendix. The patient and parents were counseled accordingly, focusing on active surveillance and control of symptoms. Two additional hamartomatous polyps (gastric and jejunal) were detected endoscopically and resected in the fourth postoperative week. A regular, 1-year follow-up and surveillance revealed no complications or recurrences. LESSONS: Unusual neoplasms can occasionally be encountered in well-defined syndromes such as PJS. Therefore, active follow-up and surveillance are mandatory for all patients with PJS.


Assuntos
Tumor Carcinoide/etiologia , Neoplasias Intestinais/etiologia , Síndrome de Peutz-Jeghers/complicações , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Criança , Feminino , Humanos , Achados Incidentais , Neoplasias Intestinais/patologia , Neoplasias Intestinais/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/etiologia , Doenças do Jejuno/cirurgia , Síndrome de Peutz-Jeghers/diagnóstico , Tomografia Computadorizada por Raios X
3.
Anticancer Res ; 41(10): 5147-5155, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593466

RESUMO

BACKGROUND/AIM: Metastatic small bowel adenocarcinoma (SBA) is a rare disease with poor prognosis. This study aimed to explore the efficacy and safety of second-line chemotherapy for patients with SBA. PATIENTS AND METHODS: We retrospectively reviewed the clinical characteristics of 27 metastatic patients with SBA after progression on first-line chemotherapy. The patients were divided into Cohort A, receiving second-line chemotherapy, and Cohort B, receiving best supportive care. RESULTS: Patients in Cohort B had higher age, worse performance status, and higher neutrophil-to-lymphocyte ratio compared with those in Cohort A. Cohort A showed significantly better overall survival (OS) compared with Cohort B (median OS, 15.6 vs. 3.4 months; p=0.002). Objective response rate, disease control rate, and median progression-free survival (PFS) for Cohort A were 7%, 74%, and 5.0 months, respectively. Patients who underwent irinotecan-based chemotherapy showed longer PFS and OS compared with those who underwent taxane-based chemotherapy. No significant adverse events were reported. CONCLUSION: Second-line chemotherapy for metastatic SBA demonstrated clinical activity with acceptable toxicities.


Assuntos
Adenocarcinoma/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Intestinais/mortalidade , Intestino Delgado/patologia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/secundário , Adulto , Idoso , Feminino , Seguimentos , Humanos , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/patologia , Intestino Delgado/efeitos dos fármacos , Irinotecano/administração & dosagem , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Taxoides/administração & dosagem
4.
Medicine (Baltimore) ; 100(37): e27276, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664885

RESUMO

ABSTRACT: Patients with neuroendocrine tumors (NET) often go through a long phase between onset of symptoms and initial diagnosis.Assessment of time to diagnosis and pre-clinical pathway in patients with gastroenteropancreatic NET (GEP-NET) with regard to metastases and symptoms.Retrospective analysis of patients with GEP-NET at a tertiary referral center from 1984 to 2019; inclusion criteria: Patients ≥18 years, diagnosis of GEP-NET; statistical analysis using non-parametrical methods.Four hundred eighty-six patients with 488 tumors were identified; median age at first diagnosis (478/486, 8 unknown) was 59 years; 52.9% male patients. Pancreatic NET: 143/488 tumors; 29.3%; small intestinal NET: 145/488 tumors, 29.7%. 128/303 patients (42.2%) showed NET specific and 122/486 (25%) patients other tumor-specific symptoms. 222/279 patients had distant metastases at initial diagnosis (187/222 liver metastases). 154/488 (31.6%) of GEP-NET were incidental findings. Median time from tumor manifestation (e.g., symptoms related to NET) to initial diagnosis across all entities was 19.5 (95% CI: 12-28) days. No significant difference in patients with or without distant metastases (median 73 vs 105 days, P = .42).A large proportion of GEP-NET are incidental findings and only about half of all patients are symptomatic at the time of diagnosis. We did not find a significant influence of the presence of metastases on time to diagnosis, which shows a large variability with a median of <30 days.


Assuntos
Neoplasias Intestinais/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Neoplasias Gástricas/diagnóstico , Fatores de Tempo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Neoplasias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/epidemiologia , Neoplasias Pancreáticas/epidemiologia , Estudos Retrospectivos , Neoplasias Gástricas/epidemiologia , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 198-203, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-34645161

RESUMO

Gastrointestinal cancer peritoneal metastasis(GICPM) is one of the biggest challenges of clinical treatment. The ultimate solution to the problem requires the clinicians to accurately understand cytologic and molecular pathological mechanisms behind GICPM, and apply such knowledge in the clinical decision-making process for diagnosis and treatment of individual patient, so as to realize "prevention" and "treatment" proactively. The core cytopathological mechanisms behind GICPM, which are closely related to clinical treatment decisions, are as follows: (1) free cancer cells or clusters in peritoneal cavity colonize the peritoneum, resulting in irreversible pathological damage to peritoneal mesothelial cells; (2) the colonized cancer cells further invade the specific structure of the peritoneal milky spots and initiate an accelerated invasive growth process; (3) the process of peritoneal interstitial fibrosis aggravates the structural destruction of the peritoneum; (4) the interaction between cancer cells and immune cells in the milk spots forms a permissive immune microenvironment that promotes the growth of peritoneal metastatic cancer. These four core cytopathological mechanisms are mutually causal and promote each other, forming a vicious circle of GICPM development. As long as clinicians accurately understand these four points, it is possible to grasp the opportunity of clinical diagnosis and treatment, change reactive and passive treatment into preventive and proactive treatment, and improve the clinical diagnosis and treatment landscape of GICPM.


Assuntos
Neoplasias Intestinais , Neoplasias Peritoneais , Humanos , Cavidade Peritoneal , Peritônio , Microambiente Tumoral
6.
Gan To Kagaku Ryoho ; 48(10): 1290-1292, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34657067

RESUMO

An 83-year-old woman visited our emergency department with a chief complaint of abdominal pain and vomiting. Abdominal computed tomography showed thickening of the wall of the small intestine in the right middle abdomen and marked bowel dilation and fluid retention in the oral side of the small intestine. The patient was diagnosed with adhesive bowel obstruction and hospitalized for conservative treatment. However, the treatment was unsuccessful, and laparoscopic surgery was performed. The intraoperative findings included thickening of the wall and hardening of the obstructed part, suggestive of an intestinal tumor; thus, this part was resected. A histopathological examination revealed diffuse infiltration of large-sized atypical lymphocytes in the tumor, and diffuse large B-cell lymphoma was diagnosed through immunochemical staining. The postoperative course was uneventful, and the lymphoma has not recurred. Intestinal malignant lymphoma rarely causes bowel obstruction without invagination. Here, we report this case and review the literature.


Assuntos
Neoplasias Intestinais , Obstrução Intestinal , Laparoscopia , Linfoma Difuso de Grandes Células B , Idoso de 80 Anos ou mais , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/cirurgia , Recidiva Local de Neoplasia
8.
Nat Genet ; 53(10): 1434-1442, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34594041

RESUMO

Mutation accumulation in somatic cells contributes to cancer development and is proposed as a cause of aging. DNA polymerases Pol ε and Pol δ replicate DNA during cell division. However, in some cancers, defective proofreading due to acquired POLE/POLD1 exonuclease domain mutations causes markedly elevated somatic mutation burdens with distinctive mutational signatures. Germline POLE/POLD1 mutations cause familial cancer predisposition. Here, we sequenced normal tissue and tumor DNA from individuals with germline POLE/POLD1 mutations. Increased mutation burdens with characteristic mutational signatures were found in normal adult somatic cell types, during early embryogenesis and in sperm. Thus human physiology can tolerate ubiquitously elevated mutation burdens. Except for increased cancer risk, individuals with germline POLE/POLD1 mutations do not exhibit overt features of premature aging. These results do not support a model in which all features of aging are attributable to widespread cell malfunction directly resulting from somatic mutation burdens accrued during life.


Assuntos
DNA Polimerase III/genética , DNA Polimerase II/genética , Mutação em Linhagem Germinativa/genética , Adolescente , Adulto , Idoso , Desenvolvimento Embrionário/genética , Genoma Humano/genética , Humanos , Neoplasias Intestinais/patologia , Intestinos/patologia , Pessoa de Meia-Idade , Mutagênese/genética , Filogenia , Células-Tronco/patologia , Adulto Jovem
9.
Pan Afr Med J ; 39: 259, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34707760

RESUMO

Testicular germ cell tumors are the most common cancers in young men. In most cases, patients may present a painless testicular swelling. However, in 10% the presentation is variable and related to site of metastasis and complications. Clinically apparent gastrointestinal involvement was seen in 5% of cases and dominates by gastrointestinal bleeding. We report a case of testicular choriocarcinoma involving the small intestine revealed by melena and complicated by acute intussusception.


Assuntos
Coriocarcinoma/diagnóstico , Neoplasias Intestinais/diagnóstico , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Testiculares/diagnóstico , Adulto , Coriocarcinoma/patologia , Hemorragia Gastrointestinal/etiologia , Humanos , Neoplasias Intestinais/secundário , Intestino Delgado/patologia , Intussuscepção/etiologia , Masculino , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Testiculares/patologia
10.
Rev Med Chil ; 149(3): 464-468, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34479326

RESUMO

Small intestine neuroendocrine tumors (NET-SI) are relatively rare neoplasms. If encountered, the most common location is the ileum. Symptoms are usually non-specific, delaying the tumors diagnosis. NET-SI are often small in size and can be challenging to recognize on imaging studies. However, they have a tendency to induce a pronounced fibrotic reaction in the mesentery, often accompanied by large calcified mesenteric adenopathies. In some cases, the fibrotic reaction can produce rare complications, such as intestinal obstruction or vascular congestion with occasional secondary ischemia. This case report presents a 79-year-old male with a partial small bowel obstruction caused by a fibrotic reaction and mesenteric adenopathies of a well-differentiated neuroendocrine tumor of the ileum. The patient also presented multiple peritoneal metastases at diagnosis. Characteristic imaging findings of the tumor, allowed an accurate and early diagnosis. Once the acute episode was resolved, the diagnosis was confirmed with an image guided biopsy.


Assuntos
Neoplasias Intestinais , Obstrução Intestinal , Tumores Neuroendócrinos , Idoso , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Intestino Delgado/diagnóstico por imagem , Linfonodos , Masculino , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico por imagem
12.
Front Immunol ; 12: 653319, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34566950

RESUMO

Background: Follicular dendritic cell sarcoma (FDCS) is an uncommon malignant cancer, and there is no standard treatment to date. Resection followed by adjuvant chemotherapy or radiation is considered the most commonly used strategy for treatment. However, the treatment for patients who have progressed after systemic treatment is more controversial. Case summary: In this case report, we describe a 57-year-old man with primary small intestine FDCS where surgery and second-line systemic chemotherapy failed. After disease progression (PD), the patient received sintilimab plus lenvatinib as third-line treatment and achieved a progression-free survival (PFS) with 7 months. Conclusion: This is the first report of a FDCS patient treated with immune checkpoint inhibitors (ICIs) and antiangiogenic agents, sintilimab and lenvatinib, as third-line therapy. Our case provides a potential therapeutic option for patients with FDCS who progressed after multiline therapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Sarcoma de Células Dendríticas Foliculares/tratamento farmacológico , Inibidores de Checkpoint Imunológico/uso terapêutico , Neoplasias Intestinais/tratamento farmacológico , Compostos de Fenilureia/uso terapêutico , Quinolinas/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Terapia de Salvação/métodos
13.
World J Gastroenterol ; 27(32): 5438-5447, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34539143

RESUMO

BACKGROUND: Intestinal lymphoma is a rare tumor. Contrast-enhanced ultrasound (CEUS) findings of intestinal lymphoma have not been reported previously, and the relationship between CEUS and clinicopathological features and prognostic factors is still unknown. AIM: To describe the B-mode US and CEUS features of intestinal lymphoma and investigate the correlation of CEUS and histopathological features. METHODS: This was a single-center retrospective study. Eighteen patients with histologically confirmed intestinal lymphoma underwent B-mode US and CEUS examinations between October 2016 and November 2019. We summarized the features of B-mode US and CUES imaging of intestinal lymphoma and compared the frequency of tumor necrosis in intestinal lymphomas with reference to different pathological subtypes (aggressive or indolent) and clinical stage (early or advanced). The time-intensity curve parameters of CEUS were also compared between patients with normal and elevated serum lactate dehydrogenase. RESULTS: In B-mode imaging, four patterns were observed in intestinal lymphoma: Mass type (12/18, 66.7%), infiltration type (1/18, 5.6%), mesentery type (4/18, 22.2%) and mixed type (1/18, 5.6%). All cases were hypoechoic and no cystic areas were detected. On CEUS, most cases (17/18, 94.4%) showed arterial hyperechoic enhancement. All cases showed arterial enhancement followed by venous wash out. A relatively high rate of tumor necrosis (11/18, 61.1%) was observed in this study. Tumor necrosis on CEUS was more frequent in aggressive subtypes (10/13, 76.9%) than in indolent subtypes (1/5, 20.0%) (P = 0.047). There were no correlations between tumor necrosis and lesion size and Ann Arbor stage. There was no significant difference in time-intensity curve parameters between normal and elevated lactate dehydrogenase groups. CONCLUSION: B-mode US and CEUS findings of intestinal lymphoma are characteristic. We observed a high rate of tumor necrosis, which appeared more frequently in aggressive pathological subtypes of intestinal lymphoma.


Assuntos
Neoplasias Intestinais , Linfoma , Meios de Contraste , Humanos , Neoplasias Intestinais/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia
14.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518183

RESUMO

Small bowel malignant tumours make only 2% of all gastrointestinal (GI) malignancies. Small bowel leiomyosarcoma (LMS) is further rare, accounts for only 0.1%-3% fraction of these tumours. These cases can present as asymptomatic intra-abdominal mass, anaemia due to GI bleed or acute abdomen such as perforation peritonitis, intussusception and bowel ischaemia. Standard of care is surgical resection. Our case presented as large lobulated exophytic ileal LMS measuring 10.8×11×14.7 cm involving multiple small bowel loops and abutting right iliac vessels and uterus. Patient's clinical course was complicated with COVID-19 positivity, deep vein thrombosis and pulmonary thromboembolism. She was managed by preoperative anticoagulation followed by resection of the tumour with end ileostomy.


Assuntos
COVID-19 , Tumores do Estroma Gastrointestinal , Neoplasias Intestinais , Leiomiossarcoma , Adulto , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , SARS-CoV-2
16.
Sci Rep ; 11(1): 17947, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34504148

RESUMO

Neuroendocrine neoplasms are known to have heterogeneous biological behavior. G3 neuroendocrine tumours (NET G3) are characterized by well-differentiated morphology and Ki67 > 20%. The prognosis of this disease is understood to be intermediate between NET G2 and neuroendocrine carcinoma (NEC). Clinical management of NET G3 is challenging due to limited data to inform treatment strategies. We describe clinical characteristics, treatment, and outcomes in a large single centre cohort of patients with gastroenteropancreatic NET G3. Data was reviewed from 26 cases managed at Queen Elizabeth Hospital, Birmingham, UK, from 2012 to 2019. Most commonly the site of the primary tumour was unknown and majority of cases with identifiable primaries originated in the GI tract. Majority of cases demonstrated somatostatin receptor avidity. Median Ki67 was 30%, and most cases had stage IV disease at diagnosis. Treatment options included surgery, somatostatin analogs (SSA), and chemotherapy with either platinum-based or temozolomide-based regimens. Estimated progression free survival was 4 months following initiation of SSA and 3 months following initiation of chemotherapy. Disease control was observed following treatment in 5/11 patients treated with chemotherapy. Estimated median survival was 19 months; estimated 1 year survival was 60% and estimated 2 year survival was 13%. NET G3 is a heterogeneous group of tumours and patients which commonly have advanced disease at presentation. Prognosis is typically poor, though select cases may respond to treatment with SSA and/or chemotherapy. Further study is needed to compare efficacy of different treatment strategies for this disease.


Assuntos
Neoplasias Intestinais/metabolismo , Neoplasias Intestinais/patologia , Antígeno Ki-67/metabolismo , Tumores Neuroendócrinos/metabolismo , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/tratamento farmacológico , Carcinoma Neuroendócrino/metabolismo , Carcinoma Neuroendócrino/mortalidade , Carcinoma Neuroendócrino/patologia , Feminino , Seguimentos , Humanos , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/mortalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tumores Neuroendócrinos/tratamento farmacológico , Tumores Neuroendócrinos/mortalidade , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/mortalidade , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/mortalidade , Adulto Jovem
19.
J Health Care Poor Underserved ; 32(3): 1199-1207, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421025

RESUMO

In the United States, uninsurance remains a major barrier in accessing health care for many citizens and residents. Studies have shown that uninsured patients with many cancers and chronic diseases have worse survival than insured patients. A recent study similarly showed that uninsured patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) have significantly shortened survival. While GEP-NETs are indolent tumors with generally favorable prognosis, comprehensive care involves years of surveillance, imaging, and treatment following resection, all of which carry a large financial burden. In this commentary, we expand on these findings as they relate to insurance-based disparities as well as management and policy implications.


Assuntos
Seguro , Neoplasias Intestinais , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Neoplasias Gástricas , Humanos , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/terapia , Neoplasias Gástricas/terapia , Estados Unidos/epidemiologia
20.
Cancer Sci ; 112(11): 4758-4771, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34449929

RESUMO

Small bowel adenocarcinoma (SBA) is a rare malignancy with a poor prognosis and limited treatment options. Despite prior studies, molecular characterization of this disease is not well defined, and little is known regarding Chinese SBA patients. In this study, we conducted multigene next-generation sequencing and 16S ribosomal RNA gene sequencing on samples from 76 Chinese patients with surgically resected primary SBA. Compared with colorectal cancer and Western SBA cohorts, a distinctive genomic profile was revealed in Chinese SBA cohorts. According to the levels of clinical actionability to targetable alterations stratified by OncoKB system, 75% of patients harbored targetable alterations, of which ERBB2, BRCA1/2, and C-KIT mutations were the most common targets of highest-level actionable alterations. In DNA mismatch repair-proficient (pMMR) patients, significant associations between high tumor mutational burden and specific genetic alterations were identified. Moreover, KRAS mutations/TP53 wild-type/nondisruptive mutations (KRASmut /TP53wt/non-dis ) were independently associated with an inferior recurrence-free survival (hazard ratio [HR] = 4.21, 95% confidence interval [CI] = 1.94-9.14, P < .001). The bacterial profile revealed Proteobacteia, Actinobacteria, Firmicutes, Bacteroidetes, Fusobacteria, and Cyanobacteria were the most common phyla in SBA. Furthermore, patients were clustered into three subgroups based on the relative abundance of bacterial phyla, and the distributions of the subgroups were significantly associated with the risk of recurrence stratified by TP53 and KRAS mutations. In conclusion, these findings provided a comprehensive molecular basis for understanding SBA, which will be of great significance in improving the treatment strategies and clinical management of this population.


Assuntos
Adenocarcinoma/genética , Sequenciamento de Nucleotídeos em Larga Escala , Neoplasias Intestinais/genética , Intestino Delgado , RNA Ribossômico 16S/genética , Adenocarcinoma/microbiologia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Reparo de Erro de Pareamento de DNA , Intervalo Livre de Doença , Neoplasias Duodenais/genética , Neoplasias Duodenais/microbiologia , Neoplasias Duodenais/mortalidade , Feminino , Microbioma Gastrointestinal , Genes BRCA1 , Genes BRCA2 , Genes p53 , Genes ras , Humanos , Neoplasias do Íleo/genética , Neoplasias do Íleo/microbiologia , Neoplasias do Íleo/mortalidade , Neoplasias Intestinais/microbiologia , Neoplasias Intestinais/mortalidade , Intestino Delgado/microbiologia , Neoplasias do Jejuno/genética , Neoplasias do Jejuno/microbiologia , Neoplasias do Jejuno/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Proteínas Proto-Oncogênicas c-kit/genética , Receptor ErbB-2/genética
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