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1.
Asian Pac J Cancer Prev ; 20(12): 3643-3647, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31870105

RESUMO

BACKGROUND: Carcinogen metabolism pathway and tumor suppressor gene polymorphisms have been reported to be associated with increased gallbladder cancer risk. However, the association of genetic variants and gallbladder cancer risk in Indians are not well studied. We examined whether genetic polymorphisms of metabolic enzymes cytochrome P450 1A1 and glutathione S-transferase and tumor suppressor gene p53 (TP53) are associated with an increased risk of gallbladder cancer in North Indians. METHODS: This hospital-based case-control study was conducted in 96 gallbladder cancer patients with gallstones (cases) and 93 cholelithiasis patients (controls) at the Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow, India from July 2014 through May 2017. Genomic DNA was extracted from white blood cells of each patient using a simple salting-out procedure. The genotypic frequencies of CYP1A1 rs4646903, CYP1A1 rs1048943, and TP53 rs1042522 polymorphisms were investigated using TaqMan SNP Genotyping Assay and GSTM1 and GSTT1 polymorphisms were analyzed using the multiplex PCR assay. RESULTS: The frequency of CC genotype of TP53 rs1042522 polymorphism was 27.1% (26/96) in cases and 12.9% (12/93) in controls. The CC genotype was associated with an increased risk of gallbladder cancer in North Indians (age- and sex-adjusted odds ratio, 2.81; 95% confidence interval, 1.19-6.61; P = 0.02). No significant differences in genotypic and allelic frequencies of the metabolic pathway gene polymorphisms were found between cases and controls. CONCLUSIONS: Our data provide preliminary evidence that the CC genotype of the TP53 rs1042522 polymorphism may be associated with an increased risk of gallbladder cancer in North Indians.


Assuntos
Citocromo P-450 CYP1A1/genética , Neoplasias da Vesícula Biliar/genética , Glutationa Transferase/genética , Proteína Supressora de Tumor p53/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colelitíase/patologia , Feminino , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/epidemiologia , Cálculos Biliares/patologia , Frequência do Gene , Genes Supressores de Tumor , Predisposição Genética para Doença/genética , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética
2.
Chin Clin Oncol ; 8(4): 31, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31484487

RESUMO

Gallbladder cancer (GBC) is a form of hepatobiliary malignancy that develops from the mucosal lining of the gallbladder. The early development of gallbladder cancer is usually asymptomatic and gallbladder cancer has a high propensity to metastatic dissemination, thus most patients are diagnosed at intermediate to advanced stages for which there is no curative treatment. Consequently, gallbladder cancer is highly lethal. Though the overall global incidence of gallbladder cancer is low, there is marked geographic variation and ethnic communities in Asia as well as Native American populations in both North and South America are affected disproportionately. This article provides a comprehensive overview of the current epidemiology and risk and protective factors associated with gallbladder cancer development. In addition, the current knowledge on environmental and genetic risk associations for gallbladder cancer and the need for additional large-scale genome wide association studies (GWAS) are discussed.


Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/genética , Predisposição Genética para Doença/genética , Feminino , Humanos , Masculino , Fatores de Risco
3.
Chin Clin Oncol ; 8(4): 33, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31484488

RESUMO

India is a high incidence area for gallbladder cancer (GBC) and contributes to about 10% of the global GBC burden. Within India, the incidence is high in North, North-East, Central and Eastern India, and less common in South and West India. The incidence has been on a steady rise in both genders. The presentation is often with advanced disease and carries dismal prognosis. GBC in India usually affects younger patients in the 5th and 6th decade in contrast to the west. Gallstones are present in 80% of the Indian patients with GBC and its presence increases the vulnerability of the GB to mucosal injury. The incidence of GBC is out of proportion to the prevalence of gallstones in the country. Additional co-factors such as older age, lower socio-economic status, chronic Salmonella typhi (S. typhi) infection, Helicobacter pylori (H. pylori) infection, exposure to pollutants, heavy metals, chemicals, adulterated mustard oil and smoking in patients with gallstones have been identified which promote carcinogenesis. These risk factors act in tandem in an additive manner resulting in higher incidence of GBC as well as hasten the development of GBC. Environmental risk factors such as soil and water contamination by industrial wastes, agricultural effluents and human sewage have been identified as putative risk factors. Combination of a toxic environment, vulnerable GB and a susceptible host play a key role in the pathogenesis of GBC in the country. Large multicentric comprehensive studies are required in India to assess the attributable risk of each of the identified putative risk factors. This will help in formulating cost effective national strategies in preventing GBC related mortality in the country. Meanwhile a high index of suspicion to pick up incidental GBC, and improved access to healthcare facilities to manage GS appropriately will help in reducing GBC related mortality.


Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Feminino , Humanos , Índia , Masculino
5.
Chin Clin Oncol ; 8(4): 32, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431040

RESUMO

The incidence and the mortality of gallbladder cancer (GBC) show significant variation worldwide, with high age-standardized rates in western South America (SA). Due to the lack of effective measures for prevention, the late diagnosis and the small benefit of systemic treatment, GBC has an ominous prognosis and became an important public health problem in this part of the continent, where the most important risk factors are gallstone disease, female gender, age, ethnic groups, and low socioeconomic status. Many genetic abnormalities have been described in series from SA, some of them similar and others unique in comparison to gene alterations in GBC from other regions of the world. Prophylactic cholecystectomy (PC) is one of the strategies to decrease the mortality but its cost-effectiveness is questionable. A way to improve the performance of PC is to identify molecular risk factors that in combination with currently known ones detect patients with very high risk for developing GBC. Also, more research studies are required to better understand the epidemiology and molecular biology in order to improve the prevention and treatment of this lethal disease.


Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/prevenção & controle , Feminino , Humanos , Masculino , Fatores de Risco , América do Sul
6.
BMC Public Health ; 19(1): 1025, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366338

RESUMO

BACKGROUND: The mortality-to-incidence ratio (MIR) is a marker that reflects the clinical outcome of cancer treatment. MIR as a prognostic marker is more accessible when compared with long-term follow-up survival surveys. Theoretically, countries with good health care systems would have favorable outcomes for cancer; however, no report has yet demonstrated an association between gallbladder cancer MIR and the World's Health System ranking. METHODS: We used linear regression to analyze the correlation of MIRs with the World Health Organization (WHO) rankings and total expenditures on health/gross domestic product (e/GDP) in 57 countries selected according to the data quality. RESULTS: The results showed high crude rates of incidence/mortality but low MIR in more developed regions. Among continents, Europe had the highest crude rates of incidence/mortality, whereas the highest age-standardized rates (ASR) of incidence/mortality were in Asia. The MIR was lowest in North America and highest in Africa (0.40 and 1.00, respectively). Furthermore, favorable MIRs were correlated with good WHO rankings and high e/GDP (p = 0.01 and p = 0.030, respectively). CONCLUSIONS: The MIR variation for gallbladder cancer is therefore associated with the ranking of the health system and the expenditure on health.


Assuntos
Assistência à Saúde/normas , Neoplasias da Vesícula Biliar/epidemiologia , Saúde Global/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Neoplasias da Vesícula Biliar/mortalidade , Produto Interno Bruto/estatística & dados numéricos , Humanos , Incidência , Organização Mundial da Saúde
8.
Cas Lek Cesk ; 158(2): 52-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31109163

RESUMO

Overview of epidemiology focused on tumors of the bile ducts and gallbladder is based on data of the National Cancer Registry and its newly validated and published data from 2016. In most recent period 2012-2016, 1013 patients were annually (in average) diagnosed with tumors of the bile ducts and gallbladder in the Czech Republic. In the same time, average annual mortality of this disease reached value 836. Prevalence of bile ducts and gallbladder cancer reached 1723 in 2016 and in comparison, with the value measured in 2006, it increased by 28 %. More than 50 % of bile ducts and gallbladder cancers are diagnosed in advanced clinical stages (stage III+) which makes prognosis of patients worse and limits reachable results of therapy.


Assuntos
Neoplasias dos Ductos Biliares , Neoplasias da Vesícula Biliar , Neoplasias dos Ductos Biliares/epidemiologia , República Tcheca/epidemiologia , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Prognóstico
9.
BMC Gastroenterol ; 19(1): 42, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885181

RESUMO

BACKGROUND: The aim of our study was to investigate the prevalence and natural long-term progression of gallbladder polyps in a random sample of the general population. METHODS: Four hundred and thirteen subjects (190 women, 223 men; aged 29-75 years) were studied first in 2002 and again eleven years later in 2013. All subjects were interviewed using a standardised questionnaire, anthropometric data were recorded, and an abdominal ultrasound scan was carried out. RESULTS: The prevalence of gallbladder polyps was 6.1% (115/1880) in the 2002 study and 12.1% (50/413) in the 2013 follow-up study. After eleven years, 36 subjects (8.7%, 36/413) had developed new polyps, thirteen subjects (48.1%, 13/27) no longer had gallbladder polyps, and 14 subjects (51.9%, 14/27) still had polyps. The number of polyps had increased in six of these subjects (43%, 6/14), decreased in a further six (43%, 6/14), and remained unchanged in two (14%, 2/14). The mean polyp size was 4.7 mm (± 2.2 mm, range 2-20 mm) in 2002 and 4.0 mm (± 1.9 mm, range 0.5-11 mm) at follow-up. A decrease in polyp size was noted in seven (50%) of the 14 subjects, an increase in size in five subjects (35.7%), and no change in two subjects (14.3%). The shape of the polyps had changed from pedunculated to sessile in two subjects (14.3%, 2/14) and from sessile to pedunculated in one subject (7.1%, 1/14). CONCLUSIONS: In long-term follow-up, the prevalence of gallbladder polyps increased, with new lesions developing in 8.7% of the population. Polyps persisted in 51.9% of the subjects who had them in the original study and disappeared in the other 48.1%.


Assuntos
Progressão da Doença , Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/patologia , Pólipos/epidemiologia , Pólipos/patologia , Adulto , Idoso , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Prevalência , Ultrassonografia
10.
Acta Med Okayama ; 73(1): 51-59, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30820054

RESUMO

 We investigated the relationship between body mass index (BMI) and postoperative outcomes in 450 gallbladder cancer patients in Japan. We collected patient information, including sex, age, underlying disease, BMI, stage, surgery method, postoperative time to discharge, and postoperative Medicare fees, from the Japanese administrative database associated with the Diagnosis Procedure Combination system. We classified patient BMIs as underweight (BMI<18.5 kg/m2), normal (BMI≥18.5 kg/m2 and <25 kg/m2) or overweight/obese (BMI≥25 kg/m2), then investigated the relationship between these categories and two postoperative outcomes: time to discharge and postoperative Medicare fees. The median postoperative time to discharge was 12 days in all patients, and 12 days in each of the three weight groups (p=0.62, n.s.). The median postoperative Medicare fees from surgery until discharge were (USD): all patients, $5,002; underweight, $5,875; normal weight, $4,797; and overweight/obese, $5,179 (p=0.146, n.s.). A multivariate analysis with adjustment for competing risk factors revealed that BMI was not associated with increased risk of longer postoperative time to discharge (normal weight: HR 1.17, p=0.29; overweight/obese: HR 1.17, p=0.37) or higher postoperative Medicare fees (OR 0.99, p=0.86, n.s.). Thus, high BMI was not found to be a factor for poor postoperative outcomes in Japanese patients with gallbladder cancer.


Assuntos
Índice de Massa Corporal , Neoplasias da Vesícula Biliar/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Feminino , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco
11.
Acta Oncol ; 58(3): 290-295, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30656997

RESUMO

BACKGROUND: This study tested the hypothesis that contemporary menopausal hormonal therapy (MHT) increases the risk of biliary tract cancer. The risk of cancer of the biliary tract (gallbladder and extra-hepatic bile ducts) may be increased following estrogen exposure. MATERIAL AND METHODS: This was a nationwide population-based matched cohort study in Sweden. Data from the Swedish Prescribed Drug Register identified all women exposed to systemic MHT in 2005-2012. Group-level matching (1:3 ratio) was used to select women unexposed to MHT from the same study base, matched for history of delivery, thrombotic events, hysterectomy, age, smoking- and alcohol related diseases, obesity, and diabetes. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Comparing 290,186 women exposed to MHT with 870,165 unexposed, MHT did not increase the OR of biliary tract cancer. The OR of gallbladder cancer was rather decreased in MHT users (OR 0.58, 95% CI 0.43-0.79), but this association became attenuated and statistically non-significant after adjusting for gallstone disease (OR 0.84, 95% CI 0.60-1.15). The OR of extra-hepatic bile duct cancers was 0.83 (95% CI 0.61-1.15). There were no clear differences when the analyses were stratified for estrogen or estrogen/progestogen combinations. MHT increased the risk of gallstone disease (OR 6.95, 95% CI 6.64-7.28). CONCLUSIONS: Contemporary MHT does not seem to increase the risk of biliary tract cancer. The decreased risk of gallbladder cancer may be explained by the increased use of surgery for symptomatic gallstones in MHT users.


Assuntos
Neoplasias do Sistema Biliar/etiologia , Terapia de Reposição de Estrogênios/efeitos adversos , Adulto , Neoplasias do Sistema Biliar/epidemiologia , Estudos de Coortes , Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/etiologia , Cálculos Biliares/epidemiologia , Cálculos Biliares/etiologia , Humanos , Menopausa , Pessoa de Meia-Idade , Fatores de Risco , Suécia/epidemiologia
12.
Indian J Gastroenterol ; 38(1): 61-68, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30628006

RESUMO

BACKGROUND: The incidence of hepatobiliary cancer is steadily increasing. It is unclear if this rise is related to increasing trends in obesity, metabolic syndrome, and lifestyle changes. METHODS: A case-control study was performed using the Health Improvement Network (THIN) database. Cases with a diagnosis of liver, bile duct, and gallbladder cancers were matched in a 1:2 fashion with controls and analyzed for potential associations between hepatobiliary cancer and obesity/metabolic syndrome. RESULTS: Four thousand two hundred and eighty-seven patients (62% male, 38% female) with hepatobiliary cancers were matched with 8574 controls. On univariate analysis, body mass index (BMI), smoking, diabetes, alcohol consumption, ischemic heart disease, and hypertension were associated with hepatobiliary cancer. Statin use and non-smoking status had an inverse association. On multivariate analysis, BMI, diabetes, hypertension, ischemic heart disease, and insulin use were associated with the risk of hepatobiliary cancer. Statin use and non-smoking status were protective. On modeling BMI, each of diabetes and hypertension as a single covariate, there was a significant association with hepatobiliary cancer (1.59 [1.49-1.69], p < 0.001) which persisted despite adjusting for increasing age (1.006 [1005-1.006], p < 0.001) and background liver cirrhosis (1.037 [1.03-1.044], p < 0.001). CONCLUSIONS: Obesity and metabolic syndrome are associated with the risk of hepatobiliary cancer. Statin use seems to be protective.


Assuntos
Neoplasias dos Ductos Biliares/etiologia , Índice de Massa Corporal , Carcinoma Hepatocelular/etiologia , Colangiocarcinoma/etiologia , Complicações do Diabetes , Neoplasias da Vesícula Biliar/etiologia , Hipertensão/complicações , Neoplasias Hepáticas/etiologia , Síndrome Metabólica/complicações , Obesidade/complicações , Idoso , Neoplasias dos Ductos Biliares/epidemiologia , Carcinoma Hepatocelular/epidemiologia , Estudos de Casos e Controles , Colangiocarcinoma/epidemiologia , Feminino , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases , Incidência , Neoplasias Hepáticas/epidemiologia , Masculino , Fumar/efeitos adversos
13.
Cancer ; 125(9): 1489-1498, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30645774

RESUMO

BACKGROUND: Biliary tract cancers (BTCs) are rare but deadly cancers (gallbladder cancer [GBC], intrahepatic cholangiocarcinoma [ICC], extrahepatic cholangiocarcinoma [ECC], and ampulla of Vater cancer [AVC]). A recent US study reported increasing GBC incidence among people younger than 45 years and blacks; however, it did not examine trends for other biliary tract sites. METHODS: This study characterized demographic differences in BTC incidence rates and time trends by anatomic site. Population-based North American Association of Central Cancer Registries data were used to calculate age-adjusted incidence rates, incidence rate ratios (IRRs), and estimated annual percent changes (eAPCs) for 1999-2013 by site and demographic group. For sites with significant differences in eAPC by age group, IRRs were compared by age group. RESULTS: GBC incidence rates declined among women (eAPC, -0.5%/y; P = .01) and all racial/ethnic groups except for non-Hispanic blacks, among whom rates increased (1.8%/y; P < .0001). Although GBC rates increased among 18- to 44-year-olds (eAPC, 1.8%/y; P = .01), they decreased among people 45 years old or older (-0.4%/y; P = .009). Sex (P < .0001) and racial/ethnic differences (P = .003 to .02) in GBC incidence were larger for younger people than older people. During this period, ICC (eAPC, 3.2%/y; P < .0001) and ECC rates (1.8%/y; P = .001) steadily increased across sex and racial/ethnic groups. Although AVC incidence rates increased among younger adults (eAPC, 1.8%/y; P = .03) but not older adults (-0.20%/y; P = .30), sex and racial/ethnic IRRs did not differ by age. CONCLUSIONS: Differential patterns of BTC rates and temporal trends have been identified by anatomic site and demographic groups. These findings highlight the need for large pooling projects to evaluate BTC risk factors by anatomic site.


Assuntos
Neoplasias do Sistema Biliar/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática/patologia , Neoplasias dos Ductos Biliares/epidemiologia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Demografia/tendências , Grupos Étnicos/estatística & dados numéricos , Feminino , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Incidência , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Sistema de Registros , Estados Unidos/epidemiologia , Adulto Jovem
14.
Minerva Gastroenterol Dietol ; 65(2): 166-167, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30488679

RESUMO

Ofosu A, Ramai D, John F, Reddy M, Adler DG. Signet ring cancer of the gall bladder: a SEER database analysis. Minerva Gastroenterol Dietol 2019;65:166-7. DOI: 10.23736/S1121-421X.18.02540-0.


Assuntos
Carcinoma de Células em Anel de Sinete/epidemiologia , Neoplasias da Vesícula Biliar/epidemiologia , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Programa de SEER , Taxa de Sobrevida
16.
Eur J Cancer Prev ; 28(1): 1-9, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28683010

RESUMO

Gallbladder cancer is a rare malignancy in most countries. The racial and sociodemographic factors associated with its incidence and survival are poorly defined. We aimed to investigate population-based gallbladder cancer incidence and survival trends on the basis of clinical characteristics and sociodemographic factors in the USA. Gallbladder cancer incidence and survival data from 2001 to 2012 were obtained from 18 registries of the Surveillance, Epidemiology, and End Results database. Incidence rates and Joinpoint trends were calculated by demographic subgroup. Survival trends were assessed using Cox proportional hazard models. A total of 7769 patients were identified. The overall gallbladder cancer incidence rates did not significantly change during the 2001-2012 period. Incidence rates were three times higher in Hispanics and 1.6 times higher in Blacks compared with Whites. Over the time period, incidence rates significantly increased among Blacks and decreased among Hispanics. Male sex [hazard ratio (HR): 1.10, 95% confidence interval (CI): 1.03-1.17], older age (HR: 1.73, 95% CI: 1.53-1.96), and single and divorced statuses (HR: 1.19, 95% CI: 1.09-1.30 and 1.12, 95% CI: 1.01-1.24) were independently associated with shorter overall survival, whereas higher education (HR: 0.89, 95% CI: 0.82-0.97) and higher income (HR: 0.89, 95% CI: 0.82-0.96) were associated with longer survival. Furthermore, overall survival has improved in all races/ethnicities except for Hispanics and Blacks. The overall incidence rates for gallbladder cancer were stable during 2001-2012. Hispanics have the highest incidence rates, but the incidence rates in Blacks are on the rise.


Assuntos
Bases de Dados Factuais/tendências , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/epidemiologia , Programa de SEER/tendências , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
17.
Rev. esp. enferm. dig ; 110(8): 485-492, ago. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177757

RESUMO

Introducción: el cáncer de vesícula biliar es la neoplasia más frecuente de vías biliares y el sexto de los tumores del aparato digestivo, presentando un pronóstico ominoso, con una supervivencia a cinco años alrededor del 5%. Suele diagnosticarse de forma tardía y la única posibilidad de curación es la resección quirúrgica. Métodos: se realizó un estudio retrospectivo en el cual fueron analizados 92 pacientes (64 mujeres y 28 hombres) diagnosticados por anatomía patológica con cáncer de vesícula entre enero de 2000 y enero de 2016. Resultados: La edad media de la serie fue 72 ± 11 años. Los síntomas de los pacientes al ingreso fueron: dolor abdominal (78%), anorexia (77%), náuseas (76%) e ictericia (45%). La cirugía se indicó en los 92 (100%) pacientes y se realizó una resección con intención curativa en 59 (64%) de ellos. Entre los procedimientos quirúrgicos realizados en la cirugía inicial, la colecistectomía simple se efectuó en 69 (75%) y la colecistectomía extendida, en once (11%) pacientes. La cirugía de rescate se realizó en 15 pacientes después del hallazgo tumoral en la pieza de colecistectomía, realizando una resección curativa R0 en diez pacientes. Además, la terapia adyuvante se utilizó en 30 (33%) pacientes. La mediana de la supervivencia de nuestra serie fue de 12,5 meses, con supervivencias del 57%, 30% y 20% a uno, tres y cinco años, respectivamente. Conclusión: en conclusión, en todos los pacientes se debe plantear el tratamiento quirúrgico con resección tumoral completa, siempre y cuando la situación clínica del paciente lo permita


Introduction: gallbladder cancer is the most common biliary neoplasm and the sixth most common tumor of the digestive system. The disease has an ominous prognosis, with a 5-year survival rate of approximately 5%. It is usually diagnosed late and surgical resection is the only potential cure. Methods: a retrospective study was carried out in 92 patients with a pathological diagnosis of gallbladder cancer from January 2000 to January 2016. Results: the mean age of cases was 72 ± 11 years; 64 subjects were females and 28 were males. Symptoms at admission included abdominal pain (78%), anorexia (77%), nausea (76%) and jaundice (45%). Surgery was indicated in 92 (100%) patients and 59 (64%) underwent a curative/intent resection. The initial surgical procedures included simple cholecystectomy in 69 (75%) cases and extended cholecystectomy in eleven (11%) subjects. Rescue surgery was performed in 15 patients with tumor tissue in the cholecystectomy specimen; ten individuals underwent an R0 curative resection. Adjuvant therapy was administered in 30 (33%) patients. The median survival in our series was 12.5 months, with survival rates of 57%, 30% and 20% at one, three and five years, respectively. Conclusion: to conclude, surgical treatment with a complete tumor resection should be considered for all patients, provided that their clinical status allows it


Assuntos
Humanos , Neoplasias da Vesícula Biliar/cirurgia , Estadiamento de Neoplasias/métodos , Colecistectomia/métodos , Estudos Retrospectivos , Neoplasias da Vesícula Biliar/epidemiologia , Taxa de Sobrevida , Resultado do Tratamento , Fatores de Risco , Metástase Neoplásica/patologia
18.
Asian Pac J Cancer Prev ; 19(7): 1911-1915, 2018 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-30051672

RESUMO

Objective: Gallbladder cancer is the commonest gastrointestinal cancer in northern Indian women. Some studies have examined the association between Helicobacter pylori infection and gallbladder cancer risk, but findings have been inconsistent. We aimed to examine the association between H. pylori infection and gallbladder cancer in Indian people. Materials and Methods: We conducted a hospital-based case-control study including 100 gallbladder cancer patients with gallstones who were 32 to 79 years old (cases; 72 women and 28 men), and 100 cholelithiasis patients aged 14 to 75 years (controls; 65 women and 35 men). All patients had a diagnosis of gallbladder cancer or cholelithiasis at the Sanjay Gandhi Post Graduate Institute of Medical Sciences in Lucknow having a high gallbladder cancer incidence in northern India, from May 2014 through July 2017. Plasma samples were collected from all patients before surgical treatment. Plasma H. pylori antibody titer was measured by the latex agglutination method and an autoanalyzer. H. pylori infection was defined as antibody titer ≥10 U/mL. Plasma antibody titers and H. pylori infection positivity rates were compared between cases and controls. Results: Mean plasma antibody titers (standard deviation, range) were 11.1 U/mL (11.6, 0­78) in cases and 13.6 U/mL (23.0, 1­164) in controls. H. pylori infection positivity rates were 41% and 42% in cases and controls, respectively. No significant differences in antibody titers or H. pylori infection positivity rates were found between cases and controls. Conclusions: We found no evidence of H. pylori infection as an important risk factor for gallbladder cancer in Indian people.


Assuntos
Anticorpos Antibacterianos/sangue , Neoplasias da Vesícula Biliar/virologia , Cálculos Biliares/virologia , Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Adulto , Idoso , Anticorpos Antibacterianos/imunologia , Estudos de Casos e Controles , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/sangue , Neoplasias da Vesícula Biliar/epidemiologia , Cálculos Biliares/sangue , Cálculos Biliares/epidemiologia , Infecções por Helicobacter/imunologia , Helicobacter pylori/patogenicidade , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Adulto Jovem
19.
BMC Cancer ; 18(1): 766, 2018 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-30055582

RESUMO

BACKGROUND: Programmed death ligand 1/2 (PD-L1/PD-L2) expression has been established as a prognostic factor for various solid tumors and as a predictive factor for PD-1 blockade therapy, but scant data on its role in gallbladder cancer (GBC). The aims of this study were to assess the expression of PD-L1/PD-L2 and the density of CD8+ tumor-infiltrating lymphocytes (TIL) from GBC samples and to quantify the association between survival prognosis and these factors. METHODS: CD8+ TILs density and the expression of PD-1, PD-L1, PD-L2 and CD133 were assessed using immunohistochemistry in tumor specimens from 66 patients with gallbladder adenocarcinoma. These indexes were correlated with the clinicopathological features. RESULTS: The rate of PD-L1-positive (PD-L1+) was 54%, which included 18% positivity in tumor cells, and 36% in peritumoral immune stroma. High CD8+ TIL density (CD8high) was observed in PD-L1+ GBC, and PD-L1+ was positively associated with PD-L2+ expression. Regarding prognostic factors, PD-L1+ expression was related to worse overall survival (OS), and CD8high indicated better OS and progression-free survival (PFS). The combination of CD8high with PD-L1+ serves as a prognostic factor for improved OS (P < 0.001) and PFS (P = 0.014). CONCLUSION: Analysis of the tumor immune microenvironment based on CD8+ TIL and PD-L1 expression is a promising independent predictor for the clinical outcome of GBC patients.


Assuntos
Antígeno B7-H1/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Neoplasias da Vesícula Biliar , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno B7-H1/sangue , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/metabolismo , Neoplasias da Vesícula Biliar/mortalidade , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Intervalo Livre de Progressão
20.
Hum Pathol ; 82: 87-94, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30036595

RESUMO

Gallbladder dysplasia can progress to cancer and may be associated with increased cancer risk at other biliary tract sites. Thus, its accurate identification is relevant both for etiologic understanding and for clinical purposes. Data on the frequency and distribution of gallbladder dysplasia are lacking owing to limited gallbladder sampling and inability to visualize dysplasia grossly. An expert pathology group used consensus criteria to review 140 totally sampled consecutive cholecystectomy specimens from Chilean women. Three cases (2%) revealed incidental invasive carcinoma, all T2, along with high-grade dysplasia (HGD). The surface areas covered by dysplasia or cancer in these cases were 9%, 37%, and 87%. Although the first longitudinal ("diagnostic") section of the whole gallbladder captured HGD or cancer in all 3 cases, the deepest focus of invasive carcinoma was not present in this section. Fourteen additional cases (10%) had low-grade dysplasia (LGD), which was typically very focal (covering <5% of the surface) and most often occurred in the fundus. LGD was not present in the diagnostic section of 5 cases (38%) and would have been missed without additional sampling. None of the cancers or dysplasias were grossly visible. Although HGD and carcinoma are likely to be identified in "diagnostic" sections, accurate staging requires total sampling. LGD is typically very focal and would often be missed in routine practice. To identify cancer precursors, additional sampling, particularly of the fundus, may be warranted. The predominance of LGD in the fundus also provides etiologic insight, supporting the contribution of gallstones and chronic inflammation.


Assuntos
Carcinoma/patologia , Neoplasias da Vesícula Biliar/patologia , Vesícula Biliar/patologia , Lesões Pré-Cancerosas/patologia , Adulto , Idoso , Biópsia , Carcinoma/epidemiologia , Carcinoma/cirurgia , Chile/epidemiologia , Colecistectomia , Feminino , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/cirurgia , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco
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