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1.
Medicine (Baltimore) ; 100(1): e24062, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429770

RESUMO

ABSTRACT: Colorectal cancer is a heterogeneous disease with multiple epigenetic alterations and different molecular features. The molecular classification is based on 2 major distinct pathways: microsatellite stable pathway and the microsatellite instability pathway. Molecular profiling of colorectal cancer provides important information regarding treatment and prognosis. Aim of the study was to assess the frequency of microsatellite instability in colon cancer and the clinicopathological characteristics of the tumors with high level of microsatellite instability (MSI-H) in our region. The secondary outcome was to assess the frequency of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutations in colon cancer.The study included 129 patients with colon cancer fit for surgery. Demographic data, clinical and pathological data, immunohistochemistry staining pattern (4 mismatch repair proteins were investigated), and BRAF gene mutations were assessed. According to microsatellite instability status by polymerase chain reaction, patients were divided into 3 groups: microsatellite stable (MSS) = 108 patients, high level of microsatellite instability (MSI-H) = 15 patients and low level of microsatellite instability (MSI-L) = 6 patients. Different clinicopathological comparisons between MSS and MSI-H patients, and between MSS and MSI-L patients were performed.Microsatellite instability was found in 16.3% patients: 11.6% had MSI-H and 4.7% had MSI-L. Significantly more patients in the MSI-H group than in the MSS group were female (P = .01) and had a family history of colon cancer (P < .001). MSI-H and MSI-L groups were associated with the ascending colon location of the tumors, were mostly type G3, T2, and stage I whereas MSS tumors were mostly G2, pT3, and stage III. Overall, BRAF mutations were identified in 18/129 patients (13.9%). BRAF mutant tumors were predominantly associated with MSI-H and MSI-L tumors. Immunohistochemistry had a sensitivity of 76% and a specificity of 89% in detecting MSI tumors and an accuracy of 87.6%.The frequency of microsatellite instability in our study was 16.3%. MSI-H is a distinct molecular phenotype of colon cancer with particular features: female gender, family history of colorectal cancer, a predilection for the ascending colon, poorly differentiated, predominantly T2, and stage I. The frequency of BRAF mutations was 13.9% and mutations were more often present in the MSI tumors.


Assuntos
Neoplasias do Colo/genética , Técnicas de Diagnóstico Molecular/métodos , Idoso , Neoplasias do Colo/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular/estatística & dados numéricos , Mutação/genética , Proteínas Proto-Oncogênicas B-raf/análise , Proteínas Proto-Oncogênicas B-raf/genética , Romênia/epidemiologia , Estatísticas não Paramétricas
2.
Ann Intern Med ; 174(2): 157-166, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33315473

RESUMO

BACKGROUND: Early-onset colorectal cancer (EOCRC) incidence rates (IRs) are rising, according to previous cancer registry analyses. However, analysis of histologic subtypes, including adenocarcinoma (the focus of CRC screening and diagnostic testing) and carcinoid tumors (which are classified as "colorectal cancer" in SEER [Surveillance, Epidemiology, and End Results] databases but have a distinct pathogenesis and are managed differently from adenocarcinoma), has not been reported. OBJECTIVE: To assess EOCRC IRs and changes in IRs over time, stratified by histology. DESIGN: Retrospective analysis. SETTING: Yearly IRs according to SEER 18 data from 2000 to 2016 on age-specific colon-only, rectal-only, and combined-site CRC cases, stratified by histology ("overall" CRC [all histologic subtypes], adenocarcinoma, and carcinoid tumors) and age. PATIENTS: 119 624 patients with CRC. MEASUREMENTS: IRs per 100 000 population, changes in 3-year average annual IRs (pooled IRs from 2000 to 2002 vs. those from 2014 to 2016), and annual percentage change (APC) in persons aged 20 to 29, 30 to 39, 40 to 49, and 50 to 54 years. RESULTS: The steepest changes in adenocarcinoma 3-year average annual IRs were for rectal-only cases in persons aged 20 to 29 years (+39% [0.33 to 0.46 per 100 000]; P < 0.050) and 30 to 39 years (+39% [1.92 to 2.66 per 100 000]; P < 0.050) and colon-only cases in those aged 30 to 39 years (+20% [3.30 to 3.97 per 100 000]; P < 0.050). Corresponding APCs were 1.6% (P < 0.050), 2.2% (P < 0.050), and 1.2% (P < 0.050), respectively. In persons aged 40 to 49 years, 3-year average annual IRs increased in both colon-only (+13% [12.21 to 13.85 per 100 000]; P < 0.050) and rectal-only (+16% [7.50 to 8.72 per 100 000]; P < 0.050) subsites. Carcinoid tumors were common, representing approximately 4% to 20% of all colorectal and 8% to 34% of all rectal cancer cases, depending on age group and calendar year. Colon-only carcinoid tumors were rare. Colorectal carcinoid tumor IRs increased more steeply than adenocarcinoma in all age groups, thus affecting the contribution of carcinoid tumors to overall cancer cases over time. These changes were driven by rectal subsites and were most pronounced in persons aged 50 to 54 years, in whom rectal carcinoid tumors increased by 159% (2.36 to 6.10 per 100 000) between 2000 to 2002 and 2014 to 2016, compared with 10% for adenocarcinoma (18.07 to 19.84 per 100 000), ultimately accounting for 22.6% of all rectal cancer cases. LIMITATION: Population-based data. CONCLUSION: These findings underscore the importance of assessing histologic CRC subtypes independently. Doing so may lead to a better understanding of the drivers of temporal changes in overall CRC incidence and a more accurate measurement of outcomes from efforts to reduce adenocarcinoma risk, and can guide future research. PRIMARY FUNDING SOURCE: None.


Assuntos
Adenocarcinoma/epidemiologia , Tumor Carcinoide/epidemiologia , Neoplasias Colorretais/epidemiologia , Adenocarcinoma/patologia , Adulto , Fatores Etários , Idade de Início , Tumor Carcinoide/patologia , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Estudos Retrospectivos , Fatores de Risco , Programa de SEER , Estados Unidos/epidemiologia , Adulto Jovem
4.
Khirurgiia (Mosk) ; (9): 43-50, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030001

RESUMO

OBJECTIVE: To analyze surgical (including minimally invasive) treatment of advanced age patients with colon cancer and severe comorbidities. MATERIAL AND METHODS: Advanced age patients with colon cancer (≥60 years) were compared with younger ones. Concomitant diseases were detected in 94,4% of older patients and in 45,9% of patients in the control group (χ2=51,747; p<0,001). RESULTS: Surgery time, intraoperative blood loss, length of hospital-stay, postoperative morbidity and mortality were similar. CONCLUSION: Severe comorbidities did not significantly affect surgical outcomes in these patients and did not increase postoperative morbidity and mortality.


Assuntos
Neoplasias do Colo , Perda Sanguínea Cirúrgica , Neoplasias do Colo/epidemiologia , Comorbidade , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia
5.
Artigo em Inglês | MEDLINE | ID: mdl-32867168

RESUMO

Background: In Spain, colorectal cancer screening using the fecal occult blood test, targeted towards the 50-69 age bracket, was implemented on different dates. We aim to assess the temporal trend of colorectal cancer (CRC) screening uptake according to the year of screening implementation in each region and to identify predictors for the uptake of CRC screening. Methods: A cross-sectional study with 12,657 participants from the Spanish National Health Surveys 2011 and 2017 was used. Uptake rates were analyzed according to the date that the screening program was implemented. Results: For regions with programs implemented before 2011, the uptake rate increased 3.34-fold from 2011 to 2017 (9.8% vs. 32.7%; p < 0.001). For regions that implemented screening within the 2011-2016 period, the uptake rose from 4.3% to 13.2% (3.07-fold; p < 0.001), and for regions that implemented screening after 2016, the uptake increased from 3.4% to 8.8% (2.59-fold; p < 0.001). For the entire Spanish population, the uptake increased 3.21-fold (6.8% vs. 21.8%; p < 0.001). Positive predictors for uptake were older age, Spanish nationality, middle-to-high educational level, suffering chronic diseases, non-smoking and living in regions where screening programs were implemented earlier. Conclusions: The different periods for the implementation of CRC screening as well as sociodemographic and health inequalities may have limited the improvement in the screening uptake from 2011 to 2017 in Spain.


Assuntos
Neoplasias do Colo , Neoplasias Colorretais , Detecção Precoce de Câncer , Idoso , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/epidemiologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Sangue Oculto , Espanha/epidemiologia
6.
Niger J Clin Pract ; 23(8): 1048-1053, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788480

RESUMO

Aims: To describe the clinical characteristics, colonoscopic features, histological findings, dysplasia patterns, and clinical outcome of endoscopically detected colonic polyps in the Saudi population. Methods: This retrospective record review was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, on patients who underwent colonoscopy between 2005 and 2015. Patients with colorectal cancer were excluded. Data were analyzed using SPSS software. Results: Among 211 patients recruited, 66.8% were males and 66.2% were Saudi. Single polyps were detected in 45.5% of cases, while 29.9%, 18%, and 6.6% had 2, 3, and 4 polyps, respectively. Regarding the size, 81%, 17%, and 2% of the polyps were <1 cm, 1-2 cm, and >2 cm, respectively. The endoscopic examination revealed that 16.4% of the polyps were pedunculated, 82.6% were sessile, and 1% were sessile and pedunculated. About 45%, 30%, 21%, and 6.6% of the polyps were located at the rectum/sigmoid, left colon, right colon, and transverse/ascending colon, respectively. Histologically, 68.6% of polyps were adenomatous and 21.3% were non-adenomatous. Mild dysplasia was detected in almost half of the studied sample (42.3%) while moderate and severe grades of dysplasia were demonstrated in 19.2% and 38.5% of the examined polyps. Surgical intervention was required in 8.1% of cases. Conclusion: Single small-sized sessile polyps of adenomatous type and mild dysplasia are the most common polyps in the Saudi population. Sigmoid/rectum is the most common site affected, and the outcome of polyps is generally favorable.


Assuntos
Adenoma/patologia , Colo Ascendente/diagnóstico por imagem , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Colonoscopia/métodos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Colo Ascendente/patologia , Neoplasias do Colo/epidemiologia , Pólipos do Colo/epidemiologia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/epidemiologia , Estudos Retrospectivos , Arábia Saudita , Distribuição por Sexo
8.
Orv Hetil ; 161(25): 1059-1062, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32516124

RESUMO

COVID-19, caused by the new coronavirus, can lead to acute respiratory failure or even sepsis. Patients with multiple co-morbidities are more likely to develop these severe forms of the disease. The aim of this report is to highlight cases the analysis of which might help discover factors that influence the course and mortality of COVID-19 pneumonia. The past medical history of our elderly patient (75-year-old female) includes rectum resection with intraoperative cardiac arrest and successful resuscitation. In January 2020, the patient was diagnosed with adenocarcinoma of the ascending colon and concomittant pulmonary embolism. Following 6 weeks of therapeutic dose low-molecular-weight heparin (LMWH) treatment, the cancerous colonic section was resected. The patient arrested intraoperatively but was successfully resuscitated. On post-operative day 15, the patient developed arterial anastomosis bleed, which necessitated acute right-sided hemicolectomy. Post-operatively she became pyrexial and COVID-19 was confirmed, but later became apyrexial with symptomatic treatment. Subsequently, the patient developed partial anastomosis insufficiency, which resolved with conservative management. Following three negative SARS-CoV-2 tests, she was successfully discharged from hospital. It is worthy of note that due to the active anastomosis bleed the angiotensin-converting enzyme (ACE)-inhibitor treatment was stopped, and later the patient got infected with SARS-CoV-2. A long-lasting LMWH therapy was performed. The timely management of colorectal carcinoms remains important even during an epidemic. The appropriate treatment of these patients during the pandemic presents a great challenge for all doctors, but, as shown in our case report, surgical treatment of even those with multiple co-morbidities can be successful. Orv Hetil. 2020; 161(25): 1059-1062.


Assuntos
Neoplasias do Colo/cirurgia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Idoso , Neoplasias do Colo/epidemiologia , Feminino , Humanos , Multimorbidade , Resultado do Tratamento
9.
Int J Surg ; 79: 1-5, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32387215

RESUMO

OBJECTIVES: To determine the incidence of right-sided colon cancer in patients aged over 40 years with acute appendicitis. METHODS: We performed a systematic review in accordance with PRISMA statement standards. A search of electronic information sources was conducted to identify all studies reporting the incidence of right-sided colon cancer in patients aged over 40 years with acute appendicitis. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. RESULTS: A total of 8 studies, enrolling 4328 patients, were included. The mean age of patients was 59 (95% CI 53-65); 54% were male (2330 out of 4328). The diagnosis of appendicitis and colon cancer were based on histological assessment only. In patients aged over 40 years the pooled incidence of right-sided colon cancer was 1.043% (95% CI 0.762-1.367); the level of between-study heterogeneity was low (I2 = 0%, P = 0.45). The risk of right-sided colon cancer in patients aged over 40 with acute appendicitis was significantly higher than the risk in general population [standardised risk ratio (SRR): 10.65 95% CI 3.83-29.66, P < 0.0001]. The number needed to treat (NNT) was calculated as 112 patients (95% CI 83-171). The quality of available evidence was moderate. CONCLUSIONS: The risk of right-sided colon cancer in patients aged over 40 years with acute appendicitis is 10 times higher than the risk in general population. This suggests a need for routine preoperative CT scans and postoperative colonic assessment in all patients aged over 40 years presenting with acute appendicitis.


Assuntos
Apendicite/complicações , Neoplasias do Colo/epidemiologia , Doença Aguda , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade
10.
Tunis Med ; 98(1): 60-69, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32395779

RESUMO

BACKGROUND: Insuline-like growth factor I (IGF1) is a peptide growth factor that promotes cell proliferation and inhibits apoptosis. AIM: To examine the association of genetic variants in IGF1 (rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722) with risk of colon cancer in Tunisia. METHODS: The study included 76 formalin-fixed paraffin embedded primary colorectal carcinomas and paired normal colon. The five IGF1 polymorphisms were determined by polymerase chain-restriction fragment length polymorphism (PCR-RFLP). RESULT: A significant differences in genotypes and alleles frequency of the five examined IGF1 polymorphisms was determined between tumor and healthy tissues of colon cancer patients (P<0,01). While, no significant association was found between genetic variation in IGF1 variants and clinic-pathological parameters in tumors tissues. Expect for rs2373722, a statistically significant correlation was detected between tumor localization and the presence of the (A) mutated allele (OR=0,49; 95% CI 0,25-0,99; P=0,03). CONCLUSION: This analysis shows that IGF1gene polymorphisms rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722 are associated with the risk of colon cancer in Tunisian population.


Assuntos
Neoplasias do Colo/genética , Fator de Crescimento Insulin-Like I/genética , Polimorfismo de Nucleotídeo Único , Estudos de Casos e Controles , Neoplasias do Colo/epidemiologia , Neoplasias Colorretais/genética , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Reação em Cadeia da Polimerase/métodos , Polimorfismo de Fragmento de Restrição , Fatores de Risco , Tunísia/epidemiologia
11.
PLoS One ; 15(4): e0231663, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298326

RESUMO

BACKGROUND: Having a physically active lifestyle after cancer diagnosis is beneficial for health, and this needs to be continued into survivorship to optimize long-term benefits. We found that patients, who participated in an 18-week exercise intervention, reported significant higher physical activity (PA) levels 4 years after participation in a randomized controlled trial of supervised exercise delivered during chemotherapy (PACT study). This study aimed to identify social-ecological correlates of PA levels in breast and colon cancer survivors 4 years after participation in the PACT study. METHODS: Self-reported PA levels and potential correlates (e.g. physical fitness, fatigue, exercise history, and built environment) were assessed in 127 breast and colon cancer survivors shortly after diagnosis (baseline), post-intervention and 4 years later. Multivariable linear regression analyses were performed to identify social-ecological correlates of PA 4 years post-baseline. RESULTS: The final model revealed that lower baseline physical fatigue (ß = -0.25, 95% CI -0.26; -0.24) and higher baseline total PA (0.06, 95% CI, 0.03; 0.10) were correlated with higher total PA levels 4 years post-baseline. Higher baseline leisure and sport PA (0.02, 95% CI 0.01; 0.03), more recreational facilities within a buffer of 1 km (4.05, 95% CI = 1.28; 6.83), lower physical fatigue at 4-year follow-up (-8.07, 95% CI -14.00; -2.13), and having a positive change in physical fatigue during the intervention period (0.04, 95% CI 0.001; 0.07) were correlates of sport and leisure PA levels 4 years post-baseline. CONCLUSIONS: This study suggests that baseline and 4-year post-baseline physical fatigue, and past exercise behaviour, were significant correlates of PA 4 years after participation in an exercise trial. Additionally, this study suggests that the built environment should be taken into account when promoting PA. Understanding of socio-ecological correlates of PA can provide insights into how future exercise interventions should be designed to promote long-term exercise behaviour. TRIAL REGISTRATION: Current Controlled Trials ISRCTN43801571, Dutch Trial Register NTR2138. Trial registered on 9 December 2009, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2138.


Assuntos
Neoplasias da Mama/terapia , Neoplasias do Colo/terapia , Terapia por Exercício , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Sobreviventes de Câncer , Neoplasias do Colo/epidemiologia , Terapia por Exercício/métodos , Fadiga/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aptidão Física , Fatores Socioeconômicos , Análise de Sobrevida
12.
J Surg Oncol ; 121(8): 1306-1313, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32227344

RESUMO

BACKGROUND AND OBJECTIVES: Over 104 000 cases of colon cancer are estimated to be diagnosed in 2020. Surgical resection is a critical part of colon cancer treatment and adequate resection impacts prognosis. However, some patients refuse potentially curative surgery. We aimed to identify the rate and predictors of surgery refusal among patients with colon cancer. METHODS: The National Cancer Database (2004-2015) was queried for patients diagnosed with stage I-III colonic adenocarcinoma. Sociodemographic factors, clinical features, and treatment facility characteristics were collected. Patients who underwent surgery with curative intent were compared to those who refused surgery. Multivariable analysis was used to identify factors associated with surgery refusal. Adjusted survival analysis was performed on propensity-matched cohorts. RESULTS: A total of 151 020 patients were included and 1071 (0.71%) refused surgery. In multivariable analysis older age, Black race, higher Charlson comorbidity score, Medicaid, Medicare, or lack of insurance were predictive of refusing surgery. After propensity matching, there was a significant difference in 5-year survival for patients who refused surgery vs those who underwent surgery (P < .001). CONCLUSIONS: There are racial and socioeconomic disparities in the refusal of surgery for colon cancer. Further studies are needed to better understand the drivers behind differences in refusing curative surgery for colon cancer.


Assuntos
Neoplasias do Colo/epidemiologia , Neoplasias do Colo/cirurgia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Bases de Dados Factuais , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pontuação de Propensão , Fatores Sexuais , Fatores Sociológicos , Taxa de Sobrevida , Estados Unidos
13.
Eur J Cancer ; 130: 63-71, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32172199

RESUMO

BACKGROUND: The variability of definitions for time-to-event (TTE) end-points impacts the conclusions of randomised clinical trials (RCTs). The Definition for the Assessment of Time-to-event Endpoints in CANcer (DATECAN) initiative aims to provide consensus definitions for TTE end-points used in RCTs. Here, we formulate guidelines for adjuvant colon cancer RCTs. METHODS: We performed a literature review to identify TTE end-points and events included in their definition in RCT publications. Then, a consensus was reached among a panel of international experts, using a formal modified Delphi method, with 2 rounds of questionnaires and an in-person meeting. RESULTS: Twenty-four experts scored 72 events involved in 6 TTE end-points. Consensus was reached for 24%, 57% and 100% events after the first round, second round and in-person meeting. For RCTs not using overall survival as their primary end-point, the experts recommend using disease-free survival (DFS) rather than recurrence-free survival (RFS) or time to recurrence (TTR) as the primary end-point. The consensus definition of DFS includes all causes of death, second primary colorectal cancers (CRCs), anastomotic relapse and metastatic relapse as an event, but not second primary non-CRCs. Events included in the RFS definition are the same as for DFS with the exception of second primary CRCs. The consensus definition of TTR includes anastomotic or metastatic relapse, death with evidence of recurrence and death from CC cause. CONCLUSION: Standardised definitions of TTE end-points ensure the reproducibility of the end-points between RCTs and facilitate cross-trial comparisons. These definitions should be integrated in standard practice for the design, reporting and interpretation of adjuvant CC RCTs.


Assuntos
Neoplasias do Colo/epidemiologia , Determinação de Ponto Final/métodos , Guias como Assunto , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Projetos de Pesquisa
14.
J Gastroenterol Hepatol ; 35(10): 1738-1745, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32187748

RESUMO

BACKGROUND AND AIM: Whether diminutive or small adenomas detected by fecal immunochemical tests (FITs) are associated with a higher risk of advanced histology remains unknown. We investigated the prevalence of advanced histology in diminutive and small adenomas detected by FIT and compared with that detected by colonoscopy screening. METHODS: We prospectively compared 1860 FIT-positive patients (FIT-positive cohort) and 6691 average-risk patients (screening colonoscopy cohort). Both groups underwent colonoscopies and were shown to have neoplastic lesions. The prevalence of advanced histology was determined, as was the associations with size and FIT positivity. RESULTS: We analyzed 3920 neoplastic lesions from the FIT-positive cohort and 9789 neoplastic lesions from the screening colonoscopy cohort. Eighty (4.3%) diminutive lesions in FIT-positive cohort had advanced histology but without any invasive cancer. Twenty-one patients in the FIT-positive cohort and 49 in the screening colonoscopy cohort with diminutive adenomas displayed advanced histology (3.5% vs 1.2%; adjusted odds ratio [aOR] = 2.99, 95% confidence interval [CI]: 1.77-5.06). Sixteen patients in the FIT-positive cohort (2.7%) with diminutive adenomas might have changed the surveillance interval if a resect-and-discard strategy was applied, with a higher likelihood compared with the screening colonoscopy cohort (aOR = 2.76, 95% CI: 1.53-4.99). CONCLUSIONS: Fecal immunochemical test screening detected more diminutive and small adenomas with advanced histology compared with colonoscopy screening. Its impact on current management of diminutive polyp is limited.


Assuntos
Adenoma/diagnóstico , Neoplasias do Colo/diagnóstico , Detecção Precoce de Câncer/métodos , Fezes/química , Imunoquímica/métodos , Programas de Rastreamento/métodos , Adenoma/epidemiologia , Adenoma/patologia , Idoso , Estudos de Coortes , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos
15.
PLoS One ; 15(2): e0227899, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32012174

RESUMO

BACKGROUND: The Australian National Bowel Cancer Screening Program (NBCSP) provides biennial immunochemical faecal occult blood test (iFOBT) screening for people aged 50-74 years. Previous work has quantified the number of colorectal cancer (CRC) deaths prevented by the NBCSP and has shown that it is cost-effective. With a 40% screening participation rate, the NBCSP is currently underutilised and could be improved by increasing program participation, but the maximum appropriate level of spending on effective interventions to increase adherence has not yet been quantified. OBJECTIVES: To estimate (i) reductions in CRC cases and deaths for 2020-2040 attributable to, and (ii) the threshold for cost-effective investment (TCEI) in, effective future interventions to improve participation in the NBCSP. METHODS: A comprehensive microsimulation model, Policy1-Bowel, was used to simulate CRC natural history and screening in Australia, considering currently reported NBCSP adherence rates, i.e. iFOBT participation (∼40%) and diagnostic colonoscopy assessment rates (∼70%). Australian residents aged 40-74 were modelled. We evaluated three scenarios: (1) diagnostic colonoscopy assessment increasing to 90%; (2) iFOBT screening participation increasing to 60% by 2020, 70% by 2030 with diagnostic assessment rates of 90%; and (3) iFOBT screening increasing to 90% by 2020 with diagnostic assessment rates of 90%. In each scenario, we estimated CRC incidence and mortality, colonoscopies, costs, and TCEI given indicative willingness-to-pay thresholds of AUD$10,000-$30,000/LYS. RESULTS: By 2040, age-standardised CRC incidence and mortality rates could be reduced from 46.2 and 13.5 per 100,000 persons, respectively, if current participation rates continued, to (1) 44.0 and 12.7, (2) 36.8 and 8.8, and (3) 31.9 and 6.5. In Scenario 2, 23,000 lives would be saved from 2020-2040 vs current participation rates. The estimated scenario-specific TCEI (Australian dollars or AUD$/year) to invest in interventions to increase participation, given a conservative willingness-to-pay threshold of AUD$10,000/LYS, was (1) AUD$14.9M, (2) AUD$72.0M, and (3) AUD$76.5M. CONCLUSION: Significant investment in evidence-based interventions could be used to improve NBCSP adherence and help realise the program's potential. Such interventions might include mass media campaigns to increase program participation, educational or awareness interventions for practitioners, and/or interventions resulting in improvements in referral pathways. Any set of interventions which achieves at least 70% iFOBT screening participation and a 90% diagnostic assessment rate while costing under AUD$72 million annually would be highly cost-effective (

Assuntos
Neoplasias do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Intestinos/patologia , Sangue Oculto , Idoso , Austrália/epidemiologia , Neoplasias do Colo/economia , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Colonoscopia/economia , Neoplasias Colorretais/economia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Fezes/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Transplant Proc ; 52(1): 227-232, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32000940

RESUMO

BACKGROUND: Screening for neoplastic lesions is mandatory as a part of the evaluation process of potential candidates for liver transplant (LT). This work aimed at identifying the main findings in screening colonoscopy and their risk factors. METHODS: Endoscopic and pathologic findings of the biopsied lesions of 311 potential candidates for living donor liver transplant were collected and analyzed. RESULTS: Colorectal polyps (8.7%) were the most common colonoscopic finding, of which 4.18% were diagnosed as adenomas. Other findings included hemorrhoids (7.7%), portal hypertensive colopathies (3.5%), angiomatous malformations (2.6%), rectal varices (1.6%), and diverticulosis (1.6%). The univariate analysis revealed that the prevalence of colonic adenoma was significant in patients 50 years and older (P = .03; odds ratio, 1.178; 95% CI, 1.016-1.365) and in patients who had hepatocellular carcinoma (P = .043; odds ratio, 6.5; 95% CI, 1.002-42.172). In the multivariate analysis, age was found to be the single best predictor of the presence of adenoma (P = .044; odds ratio, 1.178; 95% CI, 1.005-1.382). CONCLUSION: We can conclude that a screening colonoscopy prior to liver donor liver transplant should be performed at least in every LT candidate 50 years or older. Colonic polyps were the most common findings on screening colonoscopy prior to LT.


Assuntos
Colonoscopia/estatística & dados numéricos , Transplante de Fígado , Programas de Rastreamento/estatística & dados numéricos , Cuidados Pré-Operatórios/estatística & dados numéricos , Adenoma/diagnóstico , Adenoma/epidemiologia , Idoso , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/epidemiologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/epidemiologia , Colonoscopia/métodos , Feminino , Humanos , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Razão de Chances , Cuidados Pré-Operatórios/métodos , Prevalência , Estudos Retrospectivos , Fatores de Risco
17.
Medicina (Kaunas) ; 56(2)2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32102382

RESUMO

Background and objectives: When resecting colon adenocarcinoma, surgeons decide between the use of laparoscopically assisted and open surgery. Laparoscopic resection is known to have short-term benefits over an open operation. However, researchers are not as unified about the long-term findings. The aim of this research is to elaborate on five-year post-operative differences in survival and cancer recurrence between these two different approaches. Materials and methods: 74 enrolled patients were evaluated five years after a primary operation. We collected dates of deaths of deceased patients and time after operation of possible recurrences. Carcinoma staging was done by a pathologist after operation. Blood samples were taken before surgery in order to measure tumor markers (CA19-9 and CEA). Results: Survival after colonic adenocarcinoma surgery did not differ between the two different surgical approaches (p = 0.151). Recurrence of cancer was not associated with the type of operation (p = 0.532). Patients with recurrence had a 37.6 times greater hazard ratio of dying (95% CI: [12.0, 118]; p < 0.001). Advanced age adversely affected survival: patients aged <65 and 65 years had a 97%, and 57% survival rate, respectively. Patients with elevated tumor markers at operation had a 19.1 greater hazard ratio of dying (95% CI: [5.16, 70.4]; p<0.001). Patients with different TNM stages did not have any statistically significant differences in survival (HRII = 2.49; 95% CI: [0.67, 9.30]; pII = 0.173) (HRIII = 2.18; 95% CI: [0.58, 8.12]; pIII = 0.246) or recurrence (p = 0.097). Conclusion: The obtained results suggest that laparoscopic resection of colon cancer is not inferior from an oncologic point of view and results in a similar long-term survival and disease-free interval. Recurrence of carcinoma, older age at initial operation and elevated tumor markers, above a pre-set threshold at operation, were found to be independent factors of lower survival. We believe that the obtained results will be of benefit when choosing treatment for colon adenocarcinoma.


Assuntos
Neoplasias do Colo/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Laparoscopia/normas , Adulto , Idoso , Distribuição de Qui-Quadrado , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/cirurgia , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida
18.
Cancer Epidemiol ; 64: 101653, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31918179

RESUMO

OBJECTIVES: Cancer recurrence is a meaningful patient outcome that is not captured in population-based cancer surveillance. This project supported National Program of Cancer Registries central cancer registries in five U.S. states to determine the disease course of all breast and colorectal cancer cases. The aims were to assess the feasibility of capturing disease-free (DF) status and subsequent cancer outcomes and to explore analytic approaches for future studies. METHODS: Data were obtained on 11,769 breast and 6033 colorectal cancer cancers diagnosed in 2011. Registry-trained abstractors reviewed medical records from multiple sources for up to 60 months to determine documented DF status, recurrence, progression and residual disease. We described the occurrence of these patient-centered outcomes along with analytic considerations when determining time-to-event outcomes and recurrence-free survival. RESULTS: Disease-free status was determined on all but 3.8 % of cancer cases. Among 14,458 cases that became DF, 6.1 % of breast and 13.0 % of colorectal cancer cases had a documented recurrence. Recurrence-free survival varied by stage; for stage II-III cancers at 48 months, 83.2 % of female breast and 69.2 % of colorectal cancer patients were alive without recurrence. The ability to distinguish between progression and residual disease among never disease-free patients limited our ability to examine progression as an outcome. CONCLUSIONS: This study demonstrated that population-based registries given intense support and resources can capture recurrence and offer a generalizable picture of cancer outcomes. Further work on refining definitions, sampling strategies, and novel approaches to capture recurrence could advance the ability of a national cancer surveillance system to contribute to patient-centered outcomes research.


Assuntos
Neoplasias do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Idoso , Neoplasias do Colo/patologia , Neoplasias do Colo/terapia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Gerenciamento de Dados , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , National Program of Cancer Registries , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Assistência Centrada no Paciente , Vigilância da População , Sistema de Registros , Estados Unidos
19.
Am J Epidemiol ; 189(6): 543-553, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31971226

RESUMO

The purpose of this study was to examine whether the increased risk of colorectal cancer due to cigarette smoking differed by anatomical subsite or sex. We analyzed data from 188,052 participants aged 45-75 years (45% men) who were enrolled in the Multiethnic Cohort Study in 1993-1996. During a mean follow-up period of 16.7 years, we identified 4,879 incident cases of invasive colorectal adenocarcinoma. In multivariate Cox regression models, as compared with never smokers of the same sex, male ever smokers had a 39% higher risk (hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.16, 1.67) of cancer of the left (distal or descending) colon but not of the right (proximal or ascending) colon (HR = 1.03, 95% CI: 0.89, 1.18), while female ever smokers had a 20% higher risk (HR = 1.20, 95% CI: 1.06, 1.36) of cancer of the right colon but not of the left colon (HR = 0.96, 95% CI: 0.80, 1.15). Compared with male smokers, female smokers had a greater increase in risk of rectal cancer with number of pack-years of smoking (P for heterogeneity = 0.03). Our results suggest that male smokers are at increased risk of left colon cancer and female smokers are at increased risk of right colon cancer. Our study also suggests that females who smoke may have a higher risk of rectal cancer due to smoking than their male counterparts.


Assuntos
Adenocarcinoma/epidemiologia , Fumar Cigarros/epidemiologia , Neoplasias Colorretais/epidemiologia , Adenocarcinoma/etnologia , Adenocarcinoma/mortalidade , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Pesos e Medidas Corporais , Fumar Cigarros/etnologia , Estudos de Coortes , Neoplasias do Colo/epidemiologia , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/mortalidade , Escolaridade , Exercício Físico , Feminino , Humanos , Masculino , Menopausa , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Neoplasias Retais/epidemiologia , Medição de Risco , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia
20.
BMC Cancer ; 20(1): 2, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31987032

RESUMO

BACKGROUND: The presence of comorbidity affects the care of cancer patients, many of whom are living with multiple comorbidities. The prevalence of cancer comorbidity, beyond summary metrics, is not well known. This study aims to estimate the prevalence of comorbid conditions among cancer patients in England, and describe the association between cancer comorbidity and socio-economic position, using population-based electronic health records. METHODS: We linked England cancer registry records of patients diagnosed with cancer of the colon, rectum, lung or Hodgkin lymphoma between 2009 and 2013, with hospital admissions records. A comorbidity was any one of fourteen specific conditions, diagnosed during hospital admission up to 6 years prior to cancer diagnosis. We calculated the crude and age-sex adjusted prevalence of each condition, the frequency of multiple comorbidity combinations, and used logistic regression and multinomial logistic regression to estimate the adjusted odds of having each condition and the probability of having each condition as a single or one of multiple comorbidities, respectively, by cancer type. RESULTS: Comorbidity was most prevalent in patients with lung cancer and least prevalent in Hodgkin lymphoma patients. Up to two-thirds of patients within each of the four cancer patient cohorts we studied had at least one comorbidity, and around half of the comorbid patients had multiple comorbidities. Our study highlighted common comorbid conditions among the cancer patient cohorts. In all four cohorts, the odds of having a comorbidity and the probability of multiple comorbidity were consistently highest in the most deprived cancer patients. CONCLUSIONS: Cancer healthcare guidelines may need to consider prominent comorbid conditions, particularly to benefit the prognosis of the most deprived patients who carry the greater burden of comorbidity. Insight into patterns of cancer comorbidity may inform further research into the influence of specific comorbidities on socio-economic inequalities in receipt of cancer treatment and in short-term mortality.


Assuntos
Neoplasias do Colo/epidemiologia , Doença de Hodgkin/epidemiologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Retais/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Inglaterra/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Sistema de Registros , Adulto Jovem
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