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1.
BMC Gastroenterol ; 22(1): 173, 2022 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-35395754

RESUMO

BACKGROUND: Primary signet ring cell carcinoma of the colon and rectum (PSRCCR) is rare, usually diagnosed at advanced stage with poor outcomes. We aimed to find possible diagnostic clues in order to help diagnosis. METHODS: A retrospective study of PSRCCR patients from 1993 to 2018 was reviewed at a single tertiary center. Colorectal adenocarcinoma patients as control group with 1:4 ratio was also enrolled. RESULTS: 18 patients with PSRCCR were identified. The prevalence rate was 0.16% (18 of 11,515). The mean age was 50.2 years-old in PSRCCR group and 63 years-old in non-SRCC colorectal cancer patients (p < 0.001). Diagnosis tool depends on colonoscopy were much less in PSRCCR group than control group (44.4% vs 93%, p < 0.001). SRCC patients had higher level of CEA (68.3 vs 17.7 ng/mL, p = 0.004) and lower level of Albumin (3.4 vs 4.3 g/dL, p < 0.001). The majority of PSRCCR tumor configuration was ulcerative and infiltrative. More PSRCCR pathology presented as high-grade carcinoma (66.7 vs 1.4%, p < 0.001) and lymphovascular invasion (77.8 vs 44.4%, p = 0.011) than control group. More PSRCCR patients were diagnosed at advanced stage (88.8 vs 40.3%, p = 0.001). Higher mortality was also noticed in PSRCCR group than control group (72.2 vs 20.8%, p < 0.001). CONCLUSION: For young patients with long segment colonic stenosis and ulcerative/ infiltrative mucosa but endoscopic biopsy failed to identify malignant cells, earlier operation or non-colon site biopsy is suggested for diagnosing the PSRCCR.


Assuntos
Carcinoma de Células em Anel de Sinete , Neoplasias do Colo , Neoplasias Colorretais , Neoplasias Retais , Carcinoma de Células em Anel de Sinete/patologia , Estudos de Casos e Controles , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Reto/patologia , Estudos Retrospectivos
2.
Int J Colorectal Dis ; 37(5): 1209-1214, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35487979

RESUMO

BACKGROUND: The presence of an inguinal hernia has been associated with an increased risk of identifying colon cancer, and therefore colonoscopy is recommended prior to inguinal hernia repair. However, the evidence on the association between the presence of an inguinal hernia and colon cancer is conflicting and uncertain. We performed a systematic review and meta-analysis to synthesize all available evidence on this topic. METHODS: A comprehensive search of PubMed and EMBASE was performed. Any comparative study (case-control or cohort study) comparing the rate of colon cancer detection in patients with and without inguinal hernias who underwent screening colonoscopy or flexible sigmoidoscopy was eligible for inclusion. Data were extracted and pooled under a random effects model. RESULTS: The initial search identified 692 references, of which 4 comparative studies (1462 patients) met the inclusion criteria. The overall risk of bias in the included studies was low. Pooled results showed a statistically non-significant difference in the incidence of detection of colon cancer, with patients with inguinal hernia having a 1.26 times increased likelihood of colon cancer diagnosis compared with patients without inguinal hernia (odds ratio (OR) 1.26; 95% confidence interval (CI) 0.63-2.51; P = 0.51). Although patients with inguinal hernia were also 1.23 times more likely to be diagnosed with colon polyps compared to patients without inguinal hernia, this difference was statistically non-significant (OR 1.23; 95% CI 0.94-1.60; P = 0.12). CONCLUSION: The findings from this first systematic review and meta-analysis show that there is no difference in the incidence of either colon cancer or colon polyps in patients presenting with inguinal hernias compared to those without. Nevertheless, larger prospective studies are needed to further investigate the relationship between the risk of colon cancer or polyps and the presence of inguinal hernia.


Assuntos
Neoplasias do Colo , Hérnia Inguinal , Estudos de Coortes , Neoplasias do Colo/complicações , Neoplasias do Colo/epidemiologia , Colonoscopia , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Telas Cirúrgicas/efeitos adversos
3.
Int J Colorectal Dis ; 37(4): 849-854, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35275279

RESUMO

BACKGROUND: Colorectal cancer (CRC) is the second-leading cause of death in the USA. CRC screening remains underutilized, especially in underinsured populations. Screening has been heavily disrupted during the COVID-19 pandemic. PURPOSE: The goal is to explore the impact of the pandemic on ethnic and gender disparities in CRC screening. METHODS: Patients were identified 1 year before and after COVID-19 precautions began, using March 1, 2020, as the inflection point. The primary inclusion criterion was an ordered colonoscopy. The outcome of interest was a colonoscopy performed. Differences by year and race were assessed using chi-square analysis. A cohort of 1549 patients (899 in pre-COVID; 650 in post-COVID) between age 45 and 75 for whom a colonoscopy was ordered was selected from EHR at a large institution. RESULTS: There was a 51% reduction in screening colonoscopies performed. White patients had a decrease of 49%, and African Americans had a 55% reduction. Stool testing increased from 47% prior to the pandemic to 94% during the pandemic representing a greater than 100% increase in stool testing uptake. CONCLUSION: The true impact of COVID-19 on colorectal cancer is yet to be uncovered as future mortality estimates from CRC are ongoing. Due to the widespread closure of endoscopy centers and delay in screening, we believe that the pandemic worsened the screening disparities most prevalent among minority populations. Our study points to the drastic reduction of screening for all races, especially for African Americans.


Assuntos
COVID-19 , Neoplasias do Colo , Neoplasias Colorretais , Idoso , COVID-19/epidemiologia , Estudos de Coortes , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/epidemiologia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
4.
JAMA Netw Open ; 5(2): e220145, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35191970

RESUMO

Importance: The American Cancer Society and American Institute for Cancer Research recommend that cancer survivors limit intake of red and processed meats. This recommendation is based on consistent associations between red and processed meat intake and cancer risk, particularly risk of colorectal cancer, but fewer data are available on red and processed meat intake after cancer diagnosis. Objectives: To examine whether intake of unprocessed red meat or processed meat is associated with risk of cancer recurrence or mortality in patients with colon cancer. Design, Setting, and Participants: This prospective cohort study used data from participants with stage III colon cancer enrolled in the Cancer and Leukemia Group B (CALGB 89803/Alliance) trial between 1999 and 2001. The clinical database for this analysis was frozen on November 9, 2009; the current data analyses were finalized in December 2021. Exposures: Quartiles of unprocessed red meat and processed meat intake assessed using a validated food frequency questionnaire during and 6 months after chemotherapy. Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for risk of cancer recurrence or death and all-cause mortality. Results: This study was conducted among 1011 patients with stage III colon cancer. The median (IQR) age at enrollment was 60 (51-69) years, 442 patients (44%) were women, and 899 patients (89%) were White. Over a median (IQR) follow-up period of 6.6 (1.9-7.5) years, we observed 305 deaths and 81 recurrences without death during follow-up (386 events combined). Intake of unprocessed red meat or processed meat after colon cancer diagnosis was not associated with risk of recurrence or mortality. The multivariable HRs comparing the highest vs lowest quartiles for cancer recurrence or death were 0.84 (95% CI, 0.58-1.23) for unprocessed red meat and 1.05 (95% CI, 0.75-1.47) for processed meat. For all-cause mortality, the corresponding HRs were 0.71 (95% CI, 0.47-1.07) for unprocessed red meat and 1.04 (95% CI, 0.72-1.51) for processed meat. Conclusions and Relevance: In this cohort study, postdiagnosis intake of unprocessed red meat or processed meat was not associated with risk of recurrence or death among patients with stage III colon cancer.


Assuntos
Neoplasias do Colo , Dieta/estatística & dados numéricos , Carne Vermelha/estatística & dados numéricos , Idoso , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Modelos de Riscos Proporcionais , Estudos Prospectivos
5.
Cancer Epidemiol Biomarkers Prev ; 31(4): 793-803, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35086823

RESUMO

BACKGROUND: Endogenous sex hormones may contribute to higher colorectal cancer incidence rates in men compared with women, but despite an increased number of studies, clear evidence is lacking. METHODS: We conducted a comprehensive nested case-control study of circulating concentrations of sex hormones, sex hormone precursors, and sex hormone binding globulin (SHBG) in relation to subsequent colon cancer risk in European men. Concentrations were measured using liquid LC/MS-MS in prospectively collected plasma samples from 690 cases and 690 matched controls from the European Prospective Investigation into Cancer and Nutrition (EPIC) and the Northern Sweden Health and Disease Study (NSHDS) cohorts. Multivariable conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). In addition, we conducted a meta-analysis of previous studies on men. RESULTS: Circulating levels of testosterone (OR, 0.68; 95% CI, 0.51-0.89) and SHBG (OR, 0.77; 95% CI, 0.62-0.96) were inversely associated with colon cancer risk. For free testosterone, there was a nonsignificant inverse association (OR, 0.83; 95% CI, 0.58-1.18). In a dose-response meta-analysis of endogenous sex hormone levels, inverse associations with colorectal/colon cancer risk were found for testosterone [relative risks (RR) per 100 ng/dL = 0.98; 95% CI, 0.96-1.00; I2 = 22%] and free testosterone (RR per 1 ng/dL = 0.98; 95% CI, 0.95-1.00; I2 = 0%). CONCLUSIONS: Our results provide suggestive evidence for the association between testosterone, SHBG, and male colon cancer development. IMPACT: Additional support for the involvement of sex hormones in male colon cancer.


Assuntos
Neoplasias do Colo , Globulina de Ligação a Hormônio Sexual , Estudos de Casos e Controles , Neoplasias do Colo/epidemiologia , Estradiol , Feminino , Hormônios Esteroides Gonadais , Humanos , Modelos Logísticos , Masculino , Estudos Prospectivos , Fatores de Risco , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona
8.
Crit Rev Oncol Hematol ; 170: 103578, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35007701

RESUMO

Numerous epidemiological studies indicate that physical activity has a protective effect against colon cancer development and progression. Further, the relevant biological mechanisms where physical activity or exercise may improve survival have also been initially examined. In this review, we provide an overview of the epidemiological evidence to date which comprises 16 cohort studies of the effects of physical activity on colon cancer outcomes including cancer recurrence, cancer-specific and overall survival. Moreover, we present four potential mechanisms involving shear pressure, systemic milieu alteration, extracellular vesicles, and immune function by which physical activity and exercise may favorably impact colon cancer. Research currently in progress will provide definitive evidence of survival benefits resulting from exercise and future work will help clarify the role of targeted exercise and the relevant mechanisms involved.


Assuntos
Neoplasias do Colo , Recidiva Local de Neoplasia , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/prevenção & controle , Exercício Físico , Humanos
10.
Support Care Cancer ; 30(1): 439-446, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34302547

RESUMO

PURPOSE: To assess the prevalence and severity of clinically significant symptoms (CSSs) for breast cancer, colon cancer, and leukemia patients undergoing chemotherapy. METHODS: A retrospective review of the Edmonton Symptom Assessment System scores reported by patients from the database of our previous large-scale study, which was collected between May 2018 and January 2019. We described the prevalence of CSSs in proportion and severity in mean ± SD. RESULTS: Of 546 cancer patients, 209 were breast cancer, 159 were colon cancer, and 178 were leukemia. The majority of participants were females 345 (63.2%), and the mean age of the entire study sample was 49.4 ± 13.93. Diminished feeling of well-being was the most prevalent CSS across the three cancers, with a statistically significant difference (p < 0.001). Fatigue (6.59 ± 2.07), pain (6.55 ± 2.01), and loss of appetite were the most distressing CSSs (6.49 ± 1.99) across the whole sample. Loss of appetite (6.34 ± 2.05) was the most distressing CSS in breast cancer, fatigue (6.97 ± 2.07) in leukemia, and pain (7.00 ± 2.11) in colon cancer. Statistically significant differences were found in the severity between the three cancer in pain (p < 0.001), fatigue (p = 0.010), nausea (p = 0.001), and diminished feeling of well-being (p = 0.033). Cancer type, sleeping hours, dependence on caregiver, female gender, level of education, and employment were significantly associated with higher odds of CSS severity. CONCLUSION: Breast and colon cancer and leukemia patients undergoing chemotherapy experience multiple distressing CSSs. Our study validates CSSs as a discrete set of distressing symptoms that may serve and guide quality of care assessment and cancer clinical research, particularly among patients undergoing chemotherapy.


Assuntos
Neoplasias da Mama , Neoplasias do Colo , Leucemia , Neoplasias , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/epidemiologia , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Leucemia/tratamento farmacológico , Leucemia/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Prevalência , Estudos Retrospectivos
11.
Nutrients ; 13(11)2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34836181

RESUMO

Although the effects of coffee consumption and physical exercise on the risk of cancer have been suggested, their interactions have not been investigated. The present cross-sectional study aimed to investigate the correlation of coffee consumption and physical exercise with cancer. Participants ≥40 years old in the Korean Genome and Epidemiology Study 2004-2016 were included (n = 162,220). Histories of gastric cancer, hepatic cancer, colon cancer, breast cancer, uterine cervix cancer, lung cancer, thyroid cancer, prostate cancer, and bladder cancer were analyzed according to the coffee consumption groups using logistic regression models. The odds among individuals in the >60 cups/month coffee group were lower for gastric cancer (adjusted odds ratio (aOR) = 0.80 (95% confidence intervals = 0.65-0.98)), hepatic cancer (0.32 (0.18-0.58)), colon cancer (0.53 (0.39-0.72)), breast cancer (0.56 (0.45-0.70)), and thyroid cancer (0.71 (0.59-0.85)) than for individuals in the no coffee group. Physical exercise of ≥150 min/week was correlated with higher odds for gastric cancer (1.18 (1.03-1.36)), colon cancer (1.52 (1.26-1.83)), breast cancer (1.53 (1.35-1.74)), thyroid cancer (1.42 (1.27-1.59)), and prostate cancer (1.61 (1.13-2.28)) compared to no exercise. Coffee consumption and physical exercise showed an interaction in thyroid cancer (p = 0.002). Coffee consumption was related to a decreased risk of gastric cancer, hepatic cancer, colon cancer, breast cancer, and thyroid cancer in the adult population. Physical exercise was positively correlated with gastric cancer, colon cancer, breast cancer, thyroid cancer, and prostate cancer.


Assuntos
Café , Exercício Físico , Neoplasias/epidemiologia , Neoplasias da Mama/epidemiologia , Estudos de Coortes , Neoplasias do Colo/epidemiologia , Estudos Transversais , Feminino , Humanos , Coreia (Geográfico)/epidemiologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Neoplasias da Próstata/epidemiologia , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Inquéritos e Questionários , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias do Colo do Útero/epidemiologia
12.
Laeknabladid ; 107(9): 398-405, 2021 Sep.
Artigo em Islandês | MEDLINE | ID: mdl-34673541

RESUMO

In this article the incidence and mortality for cancer of the colon and rectum in Iceland is discussed. The two most common screening methods, faecal immunochemical test (FIT) and colonoscopy are compared and an estimate of cost and benefits for the Icelandic society will be made. The incidence of cancer of the colon and rectum has been increasing in Iceland in last decades but mortality has decreased and survival improved. However, more individuals die from cancer of the colon and rectum than from both breast- and cervical cancer added together. It is likely that screening for cancer of the colon and rectum, could prevent at least 6 of the 28 deaths related to those cancers, occurring yearly in Iceland in screening age, given a screening ages of 50-74 years. The extra cost for the Icelandic community due to the implementation of screening for cancer of the colon and rectum will be acceptable due to the lower cost of simpler treatments, lower cancer incidence and reduced mortality.


Assuntos
Neoplasias do Colo , Neoplasias Colorretais , Idoso , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/epidemiologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Humanos , Incidência , Pessoa de Meia-Idade , Reto
13.
Sci Rep ; 11(1): 20481, 2021 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-34650170

RESUMO

Colon medullary adenocarcinoma (MAC) is a rare histologic subtype. Clinical presentation and cancer outcomes of MAC, compared to colon adenocarcinoma (AC), remain incompletely described. Annual age-adjusted incidence rates were computed using Surveillance, Epidemiology, and End Results (2002-2017). A cohort analysis using the National Cancer Database (2010-2016) compared patient characteristics in an unmatched dataset and prognostic characteristics in a 1:1 matched subset. Reported annual age-adjusted incidence of MAC has significantly increased, with an average annual percent change (APC) increase of 23.8% (95% CI: 19.2-28.6); concurrent AC incidence declined (APC: - 2.8, 95% CI: - 3.1 to - 2.8). Analyses of 1018 MAC and 210,784 AC unmatched patients showed that MAC patients were more often older, female, and white, with higher disease stage, poorly-differentiated tumors, right-sided laterality, and lymphovascular invasion (all p < 0.0001). Among those with known microsatellite status, instability was more prevalent among MAC than AC patients (82% vs. 24%, p < 0.0001). Multivariate analyses of the matched dataset revealed that MAC histology was not independently associated with overall survival. However, when stratifying by laterality, left-sided MAC was associated with shorter survival when compared to right-sided MAC (HR 1.66, 95% CI 1.16-2.38) and right-sided AC (HR 1.54, 95% CI 1.12-2.12). The reported incidence of MAC is increasing, in contrast to the declining incidence of AC. MAC clinical and molecular features are distinct from AC and likely account for outcome differences. Overall, left-sided MAC was associated with the shortest OS. Molecular profiling may improve treatment guidelines for MAC.


Assuntos
Carcinoma Medular/epidemiologia , Neoplasias do Colo/epidemiologia , Taxa de Sobrevida , Carcinoma Medular/mortalidade , Carcinoma Medular/patologia , Estudos de Coortes , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Feminino , Humanos , Incidência , Masculino , Prognóstico
14.
Am Surg ; 87(11): 1783-1792, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34666557

RESUMO

BACKGROUND: The purpose of this study was to assess the impact of surgical delays on short- and long-term survival among colon cancer patients. METHODS: Adult patients undergoing surgery for stage I, II, or III colon cancer were identified from the National Cancer Database (2010-2016). After categorization by wait times from diagnosis to surgery (<1 week, 1-3 weeks, 3-6 weeks, 6-9 weeks, 9-12 weeks, and >12 weeks), 30-day mortality, 90-day mortality, and 5-year overall survival were compared between patients both overall and after stratification by pathological disease stage. RESULTS: Among 187 394 colon cancer patients, 24.2% waited <1 week, 30.5% waited 1-3 weeks, 29.0% waited 3-6 weeks, 9.7% waited 6-9 weeks, 3.3% waited 9-12 weeks, and 3.3% waited >12 weeks for surgery. Patients undergoing surgery 3-6 weeks after colon cancer diagnosis exhibited the best 30-day mortality (1.3%), 90-day mortality (2.3%), and 5-year overall survival (71.8%) (P < .001 for all). After risk-adjusting for confounders, all wait times beyond 6 weeks were associated with worse 5-year overall survival (6-9 weeks: HR 1.10, 95% CI 1.06-1.15; 9-12 weeks: HR 1.25, 95% CI 1.18-1.33; >12 weeks: HR 1.43, 95% CI 1.35-1.52; P < .001 for all). Subgroup analysis after stratification by disease stage demonstrated that patients with stage III colon cancer were able to wait up to 9 weeks before exhibiting worse 5-year overall survival, compared to 6 weeks for patients with stage I or II disease. CONCLUSIONS: Colon cancer patients should undergo surgery 3-6 weeks after diagnosis, as all surgical delays beyond 6 weeks were associated with worse 30-day mortality, 90-day mortality, and 5-year overall survival.


Assuntos
Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Neoplasias do Colo/mortalidade , Neoplasias do Colo/cirurgia , Tempo para o Tratamento , Adenocarcinoma/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Estados Unidos/epidemiologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-34639717

RESUMO

Most evidence for an association between excess body weight and cancer risk has been derived from studies of relatively short duration with little reference to the effect on tumor site. This study was designed to evaluate the association between categories of body mass index (BMI: <20, 20-25, 25-30, and >30 kg/m2) and the incidence of colon and lung cancer over 43 years of follow-up (1963-2006), in 10,043 men from the Israeli Ischemic Heart Disease (IIHD) prospective cohort (mean age at baseline 49.3 years, mean BMI 25.7 kg/m2). Data from the Israel National Cancer Registry was linked with the IIHD, and the Cox proportional hazards regression model was applied to analyze the relative risks for lung and colon cancer across BMI categories at baseline. Three hundred cases of lung cancer (2.9%) and 328 cases of colon cancer (3.3%) were diagnosed in the total population. Applying a multivariate model adjusted for age, smoking intensity, and total cholesterol, higher BMI category was associated with an increased risk of colon cancer [HR = 1.22 (95% CI 1.02-1.45)], and with a decreased risk for lung cancer [HR = 0.66 (95% CI 0.56-0.77)]. In this long-term follow-up study over four decades, we observed a consistent dose-response pattern between BMI and increased risk for colon cancer, but decreased risk for lung cancer. Specific associations between excess body weight and cancer risk may suggest different patterns of body fat and cancer incidence at a given site.


Assuntos
Neoplasias do Colo , Índice de Massa Corporal , Peso Corporal , Neoplasias do Colo/epidemiologia , Seguimentos , Humanos , Incidência , Pulmão , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
17.
Dis Colon Rectum ; 64(12): 1511-1520, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34561342

RESUMO

BACKGROUND: Approximately 10% to 20% of patients with ulcerative colitis require surgery during their disease course, of which the most common is the staged restorative proctocolectomy with IPAA. OBJECTIVE: The aim was to compare the rates of anastomotic leaks among all staged restorative proctocolectomy with IPAA procedures. DESIGN: This was a retrospective cohort study. SETTINGS: This study was conducted at a single tertiary care IBD center. PATIENTS: All patients with ulcerative colitis or IBD-unspecified who underwent a primary total proctocolectomy with IPAA for medically refractory disease or dysplasia between 2008 and 2017 were identified. MAIN OUTCOME MEASURES: The primary outcome was anastomotic leak within a 6-month postoperative period. Univariate and multivariate logistic regression were used to compare patients with and without anastomotic leaks. RESULTS: The sample was composed of 584 nonemergent patients, of whom 50 (8.6%) underwent 1-stage, 162 (27.7%) underwent 2-stage, 58 (9.9%) underwent modified 2-stage, and 314 (53.7%) underwent a 3-stage total proctocolectomy with IPAA. The primary indication was medically refractory disease in 488 patients and dysplasia/cancer in 101 patients. Anastomotic leak occurred in 10 patients (3.2%) after 3-stage, 14 patients (8.6%) after 2-stage, 6 patients (10.3%) after modified 2-stage, and 10 patients (20.0%) after a 1-stage procedure. A 3-stage procedure had fewer leaks and additional procedures for leaks compared with 1- and modified 2-stage procedures (p < 0.03). The 3-stage procedure had fewer combined anastomotic leaks and pelvic abscesses than all of the other staged procedures (p < 0.05). LIMITATIONS: This study was limited by its retrospective design and evolving electronic medical charts system. CONCLUSIONS: The 3-stage total proctocolectomy with IPAA is the optimal staged method in ulcerative colitis to reduce leaks and related complications. See Video Abstract at http://links.lww.com/DCR/B693. LENTO Y CONSTANTE GANA LA CARRERA UN CASO SLIDO PARA UN ENFOQUE DE TRES ETAPAS EN LA COLITIS ULCEROSA: ANTECEDENTES:Aproximadamente el 10-20% de los pacientes con colitis ulcerosa requieren cirugía durante el curso de su enfermedad, de los cuales la más común es la proctocolectomía restauradora escalonada con anastomosis con bolsa ileo-anal.OBJETIVO:El objetivo fue comparar las tasas de fugas anastomóticas entre todos los procedimientos de proctocolectomía restauradora por etapas con procedimiento de anastomosis con bolsa ileo-anal.DISEÑO:Este fue un estudio de cohorte retrospectivo.ENTORNO CLÍNICO:Este estudio se llevó a cabo en un único centro de atención terciaria de tercer nivel para enfermedades inflamatorias del intestino.PACIENTES:Se identificaron todos los pacientes con colitis ulcerosa o enfermedad inflamatoria intestinal inespecífica que se sometieron a una proctocolectomía total primaria mas anastomosis con bolsa ileo-anal por enfermedad médicamente refractaria o displasia entre 2008 y 2017.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la fuga anastomótica dentro de un período posoperatorio de seis meses. Se utilizó regresión logística univariante y multivariante para comparar pacientes con y sin fugas anastomóticas.RESULTADOS:La muestra estuvo compuesta por 584 pacientes no emergentes, de los cuales 50 (8,6%) se sometieron a una etapa, 162 (27,7%) se sometieron a dos etapas, 58 (9,9%) se sometieron a modificación en dos etapas y 314 (53,7%) se sometieron a una proctocolectomía total en tres tiempos mas anastomosis con bolsa ileo-anal. La indicación principal fue enfermedad médicamente refractaria en 488 pacientes y displasia / cáncer en 101 pacientes. Se produjo una fuga anastomótica en 10 (3,2%) pacientes después de tres etapas, 14 (8,6%) pacientes después de dos etapas, 6 (10,3%) pacientes después de dos etapas modificadas y 10 (20,0%) pacientes después de una etapa procedimiento. Un procedimiento de tres etapas tuvo menos fugas y procedimientos adicionales para las fugas en comparación con los procedimientos de una y dos etapas modificadas (p <0.03). El procedimiento de tres etapas tuvo menos fugas anastomóticas y abscesos pélvicos combinados que todos los demás procedimientos por etapas (p <0,05).LIMITACIONES:Este estudio estuvo limitado por su diseño retrospectivo y su sistema de registros médicos electrónicos en evolución.CONCLUSIONES:La proctocolectomía total en tres etapas mas anastomosis con bolsa ileo-anal es el método óptimo por etapas en la colitis ulcerosa para reducir las fugas y las complicaciones relacionadas. Consulte Video Resumen en http://links.lww.com/DCR/B693.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/epidemiologia , Colite Ulcerativa/cirurgia , Complicações Pós-Operatórias/epidemiologia , Proctocolectomia Restauradora/efeitos adversos , Abscesso/diagnóstico , Abscesso/epidemiologia , Adulto , Anastomose Cirúrgica/classificação , Estudos de Casos e Controles , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Bolsas Cólicas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Infecção Pélvica/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Proctocolectomia Restauradora/métodos , Procedimentos Cirúrgicos Operatórios/classificação
18.
Exp Mol Pathol ; 122: 104682, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34509500

RESUMO

BACKGROUND: miR-876-3p has been identified to be downregulated in colon cancer, implying the potential biological function in the progression and prognosis of colon cancer. The clinical significance and the biological function of miR-876-3p were investigated in this study to assess the potential of miR-876-3p in acting as a novel biomarker of the progression of colon cancer. METHODS: The expression of miR-876-3p in colon cancer was evaluated by RT-qPCR. The clinical significance of miR-876-3p was assessed by associated its expression level with the clinical features and prognosis of patients. The biological function of miR-876-3p was estimated by the CCK8 and Transwell assay in vitro. RESULTS: The significant downregulation of miR-876-3p was observed in colon cancer tissues and cells, which was closely associated with the lymph node metastasis status, TNM stage, and the perineural invasion of patients. miR-876-3p served as an independent indicator that was negatively associated with the prognosis of patients. In colon cancer cells, miR-876-3p showed significant inhibitory effects on cell proliferation, migration, and invasion, indicating its tumor suppressor role in the progression of colon cancer. CONCLUSION: miR-876-3p might be involved in colon cancer development, which provides a potential therapeutic target for colon cancer treatment.


Assuntos
Proliferação de Células/genética , Neoplasias do Colo/genética , MicroRNAs/genética , Prognóstico , Movimento Celular/genética , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Progressão da Doença , Intervalo Livre de Doença , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade
19.
Sci Rep ; 11(1): 17785, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493755

RESUMO

The prevalence of colorectal adenoma and advanced adenoma (AA) differs between sexes. Also, the optimal age for the first screening colonoscopy is under debate. We, therefore, performed a sex-specific and age-adjusted comparison of adenoma, AA and advanced neoplasia (AN) rates in a real-world screening cohort. In total, 2824 asymptomatic participants between 45- and 60-years undergoing screening colonoscopy at a single-centre in Austria were evaluated. 46% were females and mean age was 53 ± 4 years. A propensity score for being female was calculated, and adenoma, AA and AN detection rates evaluated using uni- and multivariable logistic regression. Sensitivity analyses for three age groups (group 1: 45 to 49 years, n = 521, 41% females, mean age 47 ± 1 years; group 2: 50 to 54 years, n = 1164, 47% females, mean age 52 ± 1 years; group 3: 55 to 60 years, n = 1139, 46% females, mean age 57 ± 2 years) were performed. The prevalence of any adenoma was lower in females (17% vs. 30%; OR 0.46, 95% CI 0.38-0.55; p < 0.001) and remained so after propensity score adjustment for baseline characteristics and lifestyle factors (aOR 0.52, 95% CI 0.41-0.66; p < 0.001). The same trend was seen for AA with a significantly lower prevalence in females (3% vs. 7%; OR 0.38, 95% CI 0.26-0.55; p < 0.001) that persisted after propensity score adjustment (aOR 0.54, 95% CI 0.34-0.86; p = 0.01). Also, all age-group sensitivity analyses showed lower adenoma, AA and AN rates in females. Similar numbers needed to screen to detect an adenoma, an AA or AN were found in female age group 3 and male age group 1. Colorectal adenoma, AA and AN were consistently lower in females even after propensity score adjustment and in all age-adjusted sensitivity analyses. Our study may add to the discussion of the optimal age for initial screening colonoscopy which may differ between the sexes.


Assuntos
Adenocarcinoma/diagnóstico , Adenoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Programas de Rastreamento , Fatores Sexuais , Adenocarcinoma/epidemiologia , Adenoma/epidemiologia , Distribuição por Idade , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Antropometria , Áustria/epidemiologia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/epidemiologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/epidemiologia , Colonoscopia , Neoplasias Colorretais/epidemiologia , Comorbidade , Dieta , Dislipidemias/epidemiologia , Detecção Precoce de Câncer , Feminino , Transtornos do Metabolismo de Glucose/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Distribuição por Sexo , Fumar/epidemiologia
20.
BMC Cancer ; 21(1): 966, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454457

RESUMO

BACKGROUND: Adherence to colorectal cancer screening in the United States is suboptimal, particularly in medically underserved populations due to significant barriers to care. Unique accessible, low-cost, and non-invasive screening tests for this population could greatly benefit current rates. In this article, we assess patient preference and the impact of offering a blood-based test on screening rates in a cost-free health fair setting from April 2017 to April 2019. METHODS: Participants who met colorectal cancer screening eligibility criteria set forth by the United States Preventive Services Task Force were recommended to attend the colon cancer screening station. Those participants who elected to attend were offered various, accepted screening methods, and if they declined, were offered alternative blood-based testing. Screening rates, test outcomes, and the rate of follow up completion of colonoscopy were measured and compared with historic screening outcomes. RESULTS: Of 1401 participants who were recommended to attend, 640 (45.7%) participants were evaluated at the colon cancer screening station, of whom 460 were eligible for testing. Amongst these, none selected colonoscopy, 30 (6.5%) selected fecal immunochemical testing, and 430 (93.5%) selected blood-based testing. Only 2 participants returned the fecal immunochemical tests. In the blood test cohort, 88 were positive and 20 received a follow up colonoscopy. CONCLUSIONS: Based on this assessment, blood-based testing is an effective method to increase screening rates in medically underserved populations, though efforts to further improve access to follow up colonoscopy are necessary.


Assuntos
Neoplasias do Colo/diagnóstico , Detecção Precoce de Câncer/métodos , Testes Hematológicos/métodos , Área Carente de Assistência Médica , Cooperação do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/sangue , Neoplasias do Colo/epidemiologia , Colonoscopia , Feminino , Florida/epidemiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Sangue Oculto , Cooperação do Paciente/psicologia , Prognóstico , Estudos Retrospectivos
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