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2.
Québec; INESSS; 14 juil. 2020.
Não convencional em Francês | BRISA/RedTESA | ID: biblio-1103261

RESUMO

CONTEXTE: Le présent document a été rédigé en réponse à une interpellation du ministère de la Santé et des Services sociaux (MSSS) dans le contexte de l'urgence sanitaire liée à la maladie à coronavirus (COVID-19) au Québec. L'objectif est de réaliser une recension sommaire des recommandations publiées afin d'appuyer les travaux du MSSS visant à se doter de directives provinciales en matière de prise en charge des patients atteints d'un cancer digestif haut, destinées aux décideurs publics et aux professionnels de la santé et des services sociaux. Vu la nature rapide de cette réponse, les présents travaux ne reposent pas sur un repérage exhaustif des données publiées et une évaluation de la qualité méthodologique des publications avec une méthode systématique. Dans les circonstances d'une telle urgence de santé publique, l'INESSS reste à l'affût de toutes nouvelles publications susceptibles de lui faire modifier cette réponse rapide. PRÉSENTATION DE LA DEMANDE: Dans le présent contexte d'urgence sanitaire, une réorganisation significative des soins destinés aux patients atteints de cancer a été entreprise afin de protéger les patients des risques de contracter la COVID-19 et aussi de permettre une réallocation de certaines ressources à la prise en charge de la COVID-19. Le ministère de la Santé et des Services sociaux a entrepris des travaux dans le but d'orienter les équipes de soins sur ce qui devra être maintenu, délesté ou adapté dans un contexte où le système ne permettrait qu'un accès limité à certains services. Une recension sommaire des principales lignes directrices et prises de position par des associations, des sociétés savantes et des consensus d'experts en lien avec la priorisation des soins en contexte d'urgence sanitaire a été effectuée. Un comité d'experts québécois spécialisés en cancers digestifs hauts a par la suite été formé par le MSSS pour discuter des informations extraites de la littérature et formuler, par consensus, des recommandations en lien avec la priorisation des soins propres au contexte québécois. Le document présente la revue de la littérature qui a appuyé les travaux du groupe d'experts. Les recommandations finales sont disponibles sur le site du MSSS au lien suivant : Priorisation des patients. MÉTHODOLOGIE: Question d'évaluation Quels sont les principales lignes directrices et prises de position des associations, des sociétés savantes et des consensus d'experts en lien avec la priorisation des soins pour le traitement des cancers digestifs hauts en contexte d'urgence sanitaire? Revue de littérature Repérage des publications : Littérature scientifique : La revue de la littérature (langue anglaise et française) a été effectuée entre le 29 mars et le 1er avril 2020, dans PubMed avec les mots clés suivant : COVID, COVID-19, coronavirus, neoplasia, digestive cancer, esophageal cancer, pancreatic cancer, gastric cancer, liver cancer, biliary tract cancer. Les listes de références des documents retenues ont été consultées afin de repérer d'autres publications admissibles. Les liens similar articles et cited by de l'interface PubMed ont été consultés pour chacune des publications scientifiques retenues ainsi que des revues narratives pertinentes. Littérature grise: Une recherche dans google a été faite avec les mots-clés suivants : priorisation, adaptation, recommandations, guides, consensus, cancer du pancréas, cancer de l'œsophage, cancer de l'estomac, cancer des voies biliaires, cancer hépatique (langue française et anglaise). Sélection des publications : Les publications pertinentes (lignes directrices, orientations cliniques, éditoriaux, lettres d'opinion, communications scientifiques ou documents de travail) et spécifiques à la priorisation de cas et à la prise en charge des cancers digestifs hauts en contexte de pandémie de COVID-19 ont été retenues. Certains documents ont été transmis à l'INESSS et au MSSS mais ne sont pas disponibles en ligne. Les recommandations d'ordre général quant aux mesures de protection contre le coronavirus n'ont pas été retenues. La sélection des publications a été effectuée par une professionnelle scientifique en cancérologie selon les critères d'inclusion suivants: Population: patients atteints d'un cancer digestif haut (pancréas, œsophage, estomac, voies biliaires, foie, tumeur neuroendocrine, GIST); Intervention: procédure diagnostique, suivi, imagerie, chirurgie, radiothérapie, radio-chimiothérapie, chimiothérapie, thérapie ciblée. oContexte: priorisation des soins (maintien, délestage ou adaptation thérapeutique) en contexte d'urgence sanitaire liée à la pandémie de COVID19. Extraction des données et synthèse: L'extraction des données a été effectuée par une professionnelle scientifique en cancérologie. Les données extraites comprennent, s'il y a lieu (si applicable et selon la disponibilité de l'information): Caractéristiques de la publication : auteur, date de publication ou de diffusion, source des recommandations, type de publication, juridiction; Recommandations: siège tumoral, situation clinique (stade, grade, symptômes, etc.), intervention, risque de progression de la maladie, alternative de prise en charge proposée (maintien, délestage ou adaptation thérapeutique), technique, source des données probantes en appui à la décision (p. ex. une étude clinique), autres particularités. Les recommandations ont été extraites telles que publiées, et celles rédigées en anglais ont été traduites en français (traduction libre). Les recommandations ont été classées selon les sites tumoraux (pancréas, foie, voies biliaires, œsophage thoracique proximal et moyen, œsophage distal et jonction gastro-œsophagienne, estomac, tumeur neuroendocrine, GIST) et la situation clinique considérée. SOMMAIRE DES RÉSULTATS: Positions des sociétés savantes, associations médicales, consensus ou opinions d'experts: Neuf publications rapportant les prises de position et les lignes directrices relatives à la priorisation des soins selon le contexte d'urgence sanitaire ainsi que les alternatives thérapeutiques proposées concernant la prise en charge des cancers digestifs hauts ont été retenues. L'ensemble des recommandations se trouvent dans le tableau suivant.


Assuntos
Humanos , Padrões de Prática Médica/normas , Infecções por Coronavirus/epidemiologia , Assistência Integral à Saúde/normas , Neoplasias do Sistema Digestório/diagnóstico , Avaliação da Tecnologia Biomédica , Avaliação em Saúde
3.
Zhonghua Zhong Liu Za Zhi ; 42(3): 184-186, 2020 Mar 23.
Artigo em Chinês | MEDLINE | ID: covidwho-589855

RESUMO

Since the outbreak of COVID-19 in December 2019, the diagnosis and treatment of patients with cancer have been facing great challenges. Although oncologists are not fighting on the front line to against the epidemic, during this special period, we should not only protect patients, their families and medical staff from the infection of novel coronavirus, but also minimize the impact of the epidemic on the diagnosis and the treatment of patients with cancer. Combining the guidelines for diagnosis and treatment of tumors with our clinical experience, in this epidemic period, we discuss the strategies for diagnosis, treatment, and follow-up of malignant tumors of the digestive system in this article.


Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Infecção Hospitalar/prevenção & controle , Neoplasias do Sistema Digestório/cirurgia , Surtos de Doenças , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , China , Controle de Doenças Transmissíveis/métodos , Coronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Neoplasias do Sistema Digestório/diagnóstico , Humanos , Hospedeiro Imunocomprometido , Planejamento de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Risco
4.
Zhonghua Zhong Liu Za Zhi ; 42(3): 184-186, 2020 Mar 23.
Artigo em Chinês | MEDLINE | ID: covidwho-3026

RESUMO

Since the outbreak of COVID-19 in December 2019, the diagnosis and treatment of patients with cancer have been facing great challenges. Although oncologists are not fighting on the front line to against the epidemic, during this special period, we should not only protect patients, their families and medical staff from the infection of novel coronavirus, but also minimize the impact of the epidemic on the diagnosis and the treatment of patients with cancer. Combining the guidelines for diagnosis and treatment of tumors with our clinical experience, in this epidemic period, we discuss the strategies for diagnosis, treatment, and follow-up of malignant tumors of the digestive system in this article.


Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Infecção Hospitalar/prevenção & controle , Neoplasias do Sistema Digestório/cirurgia , Surtos de Doenças , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , China , Controle de Doenças Transmissíveis/métodos , Coronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Neoplasias do Sistema Digestório/diagnóstico , Humanos , Hospedeiro Imunocomprometido , Planejamento de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Risco
5.
Zhonghua Zhong Liu Za Zhi ; 42(3): 184-186, 2020 Mar 23.
Artigo em Chinês | MEDLINE | ID: mdl-32112549

RESUMO

Since the outbreak of COVID-19 in December 2019, the diagnosis and treatment of patients with cancer have been facing great challenges. Although oncologists are not fighting on the front line to against the epidemic, during this special period, we should not only protect patients, their families and medical staff from the infection of novel coronavirus, but also minimize the impact of the epidemic on the diagnosis and the treatment of patients with cancer. Combining the guidelines for diagnosis and treatment of tumors with our clinical experience, in this epidemic period, we discuss the strategies for diagnosis, treatment, and follow-up of malignant tumors of the digestive system in this article.


Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Infecção Hospitalar/prevenção & controle , Neoplasias do Sistema Digestório/cirurgia , Surtos de Doenças , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , China , Controle de Doenças Transmissíveis/métodos , Coronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Neoplasias do Sistema Digestório/diagnóstico , Humanos , Hospedeiro Imunocomprometido , Planejamento de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Risco
6.
Medicine (Baltimore) ; 99(11): e19382, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176062

RESUMO

The aim of this study was to evaluate the clinical use of tumor abnormal protein (TAP) in the diagnosis of different cancers.Totally 394 patients were divided into 4 groups, namely 100 healthy volunteers, 167 patients with cancer, 20 subjects with precancerous lesions, and 107 subjects with benign lesions. TAP was detected in 4 groups of research subjects using a TAP testing kit and examination system. We correlated TAP levels with a wide variety of clinical indicators as well as established cancer markers, including alpha fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9). Besides, the changes of TAP level in 51 patients with liver cancer before and after surgery, and overall survival of patients with high or low TAP expression in pancreatic, gallbladder, bile duct, and liver cancers were analyzed.Statistically significant difference was observed in the TAP-positive ratio among subjects with cancer (79.6%) and precancerous lesions (45.0%) compared to the healthy volunteers (4.0%). TAP expression in different cancers was characterized by high sensitivity (79.64%), specificity (89.87%), positive and negative predictive value (85.25% and 85.71%), overall compliance rate (85.53%) but low omission and mistake diagnostic rate (20.36% and 10.13%), Youden index (0.6951). In addition, there was no significant difference among patients with different types of cancer (χ = 2.886, P = .410), and TAP expression was shown to be correlated with AFP in liver cancer (P = .034) but not with CA19-9 in pancreatic cancer (P = .241). Moreover, the overall survival of patients with low expression of TAP in pancreatic, gallbladder, bile duct, and liver cancers were significantly higher than of patients with high expression of TAP. Compared with the preoperative patients with cancer, TAP levels decreased dramatically among postoperative subjects (P < .001).In summary, TAP might hold promise in serving as universal indicator for the diagnosis of different cancers.


Assuntos
Biomarcadores Tumorais/sangue , Antígeno CA-19-9/sangue , Neoplasias do Sistema Digestório/sangue , Neoplasias do Sistema Digestório/cirurgia , Detecção Precoce de Câncer/métodos , Proteínas de Neoplasias/sangue , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Neoplasias do Sistema Digestório/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Valores de Referência , Sensibilidade e Especificidade , Adulto Jovem
7.
Anticancer Res ; 39(12): 6863-6870, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810954

RESUMO

BACKGROUND/AIM: Additional primary malignancy (APM) risk is increasing with improved prognosis of cancer survivors. In order to clarify risk factors and patients susceptible to develop APMs, we investigated the clinical features, prognosis, and approaches for diagnosis and treatment in these patients. PATIENTS AND METHODS: Among 874 patients newly diagnosed with gastrointestinal tract (GIT) or hepato-biliary-pancreatic (HBP) cancers between 2011 and 2014, 124 with a synchronous and/or metachronous APM were identified. Patient characteristics, time interval between the malignancies, clue to detect APMs, treatment approaches, and prognosis were investigated. RESULTS: Patients with APMs were older and predominantly male. Half of the metachronous APMs were detected within 3 years after the first primary malignancy (PM). The main clue to detect synchronous and metachronous APMs was preoperative screening for current PM, and follow-up of prior PM, respectively. There was no significant difference in the overall survival between colon cancer patients with or without APMs. CONCLUSION: Multiple PMs were present in 14.2% of patients. Male and old age were identified to be risk factors for APM. Pre-operative screening and post-operative regular follow-ups are important for detecting synchronous or metachronous APMs.


Assuntos
Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/cirurgia , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Sistema Digestório/patologia , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Neoplasias Primárias Múltiplas/patologia , Prognóstico , Análise de Sobrevida
8.
Surg Clin North Am ; 99(6): 1163-1176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676055

RESUMO

Patients with inflammatory bowel disease (IBD) will often require abdominal surgical intervention for indications not directly related to their IBD. Because these patients often have a history of multiple previous abdominal operations and/or ostomies, they are at increased risk for incisional and parastomal hernias. They may also have develop symptomatic cholelithiasis, chronic pain, or desmoid disease. All of these potentially surgical issues may require special consideration in the IBD population.


Assuntos
Colecistectomia Laparoscópica/métodos , Neoplasias do Sistema Digestório/cirurgia , Hérnia Ventral/cirurgia , Doenças Inflamatórias Intestinais/cirurgia , Reoperação/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Neoplasias do Sistema Digestório/diagnóstico , Feminino , Fibromatose Agressiva/diagnóstico , Fibromatose Agressiva/cirurgia , Hérnia Ventral/diagnóstico , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Medição de Risco , Telas Cirúrgicas , Resultado do Tratamento
9.
Clin Lab ; 65(10)2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31625354

RESUMO

BACKGROUND: Heat shock protein 60 has been reported to have a high diagnostic value for digestive system cancers. We sought to systematically evaluate the diagnostic value of HSP60 in patients with gastric cancer (GC), colorectal cancer (CRC), and hepatocellular carcinoma (HCC). METHODS: Relevant literature was adopted from the online databases. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were pooled using random effects models. Summary receiver operating characteristic curve and the area under the curve (AUC) were used to express the overall test performance. Statistical analysis was performed by STATA 14.0 and Meta-DiSc 1.4 software. RESULTS: We merged 12 studies in a meta-analysis, including 1 GC, 5 CRC, and 6 HCC. Overall, the pooled sensitivity, specificity, and DOR to predict GC/CRC/HCC patients were 70%, 71%, and 8.49, respectively, corresponding to an AUC of 0.81. In subgroup analysis, the 82% specificity prompted a more advanced diagnostic accuracy for diagnosing CRC than HCC. CONCLUSIONS: HSP60 was an advanced biomarker for digestive system cancers and its abnormal expression might have implications for early diagnosis in screening of GC/CRC/HCC.


Assuntos
Biomarcadores Tumorais/metabolismo , Chaperonina 60/análise , Neoplasias do Sistema Digestório/metabolismo , Trato Gastrointestinal/metabolismo , Proteínas Mitocondriais/análise , Neoplasias do Sistema Digestório/diagnóstico , Trato Gastrointestinal/patologia , Humanos , Razão de Chances , Curva ROC , Sensibilidade e Especificidade
10.
Cancer Sci ; 110(12): 3639-3649, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31605436

RESUMO

The digestive system cancers are aggressive cancers with the highest mortality worldwide. In this study, we undertook a systematic investigation of the tumor immune microenvironment to identify diagnostic and prognostic biomarkers. The fraction of 22 immune cell types of patients were estimated using CIBERSORT. The least absolute shrinkage and selection operator (LASSO) analysis was carried out to identify important immune predictors. By comparing immune cell compositions in 801 tumor samples and 46 normal samples, we constructed the diagnostic immune score (DIS), showing high specificity and sensitivity in the training (area under the receiver operating characteristic curve [AUC] = 0.929), validation (AUC = 0.935), and different cancer type cohorts (AUC > 0.70 for all). We also established the prognostic immune score (PIS), which was an effective prognostic factor for relapse-free survival in training, validation, and entire cohorts (P < .05). In addition, PIS provided a higher net benefit than TNM stage. A composite nomogram was built based on PIS and patients' clinical information with well-fitted calibration curves (c-index = 0.84). We further used other cohorts from Gene Expression Omnibus databases and obtained similar results, confirming the reliability and validity of the DIS and PIS. In addition, the unsupervised clustering analysis using immune cell proportions revealed 6 immune subtypes, suggesting that the immune types defined as having relatively high levels of M0 or/and M1 macrophages were the high-risk subtypes of relapse. In conclusion, this study comprehensively analyzed the tumor immune microenvironment and identified DIS and PIS for digestive system cancers.


Assuntos
Neoplasias do Sistema Digestório/imunologia , Idoso , Biomarcadores Tumorais/análise , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Feminino , Humanos , Macrófagos/imunologia , Masculino , Pessoa de Meia-Idade , Nomogramas , Prognóstico , Modelos de Riscos Proporcionais , Microambiente Tumoral
11.
Curr Med Sci ; 39(5): 694-701, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612385

RESUMO

Long noncoding RNA (lncRNA) urothelial carcinoma associated 1 (UCA1) has been reported to be highly expressed in many kinds of cancers. This meta-analysis summarized its potential prognostic value in digestive system malignancies. A meta-analysis was performed through a comprehensive search in PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese National Knowledge Infrastructure (CNKI) for suitable articles on the prognostic impact of UCA1 in digestive system malignancies from inception to June 27, 2019. Pooled hazard ratios (HRs) with 95% confidence interval (95%CI) were calculated to summarize the effect. Sixteen studies were included in the study, with a total of 1504 patients. A significant association was observed between UCA1 abundance and poor overall survival (OS), and shorter disease-free survival (DFS) for patients with digestive system malignancies, with pooled HR of 2.07 (95%CI: 1.74-2.47), and of 2.50 (95%CI: 1.62-3.86). Subgroup analysis and sensitivity analysis suggested the reliability of our findings. It is suggested that UCA1 abundance may serve as a reliable predictive factor for poor prognosis in patients with digestive system malignancies.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias do Sistema Digestório/diagnóstico , Regulação Neoplásica da Expressão Gênica , RNA Longo não Codificante/genética , Biomarcadores Tumorais/metabolismo , Neoplasias do Sistema Digestório/genética , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Modelos de Riscos Proporcionais , RNA Longo não Codificante/metabolismo
12.
Expert Rev Med Devices ; 16(10): 877-889, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31530047

RESUMO

Introduction: At present, cancer imaging examination relies mainly on manual reading of doctors, which requests a high standard of doctors' professional skills, clinical experience, and concentration. However, the increasing amount of medical imaging data has brought more and more challenges to radiologists. The detection of digestive system cancer (DSC) based on artificial intelligence (AI) can provide a solution for automatic analysis of medical images and assist doctors to achieve high-precision intelligent diagnosis of cancers. Areas covered: The main goal of this paper is to introduce the main research methods of the AI based detection of DSC, and provide relevant reference for researchers. Meantime, it summarizes the main problems existing in these methods, and provides better guidance for future research. Expert commentary: The automatic classification, recognition, and segmentation of DSC can be better realized through the methods of machine learning and deep learning, which minimize the internal information of images that are difficult for humans to discover. In the diagnosis of DSC, the use of AI to assist imaging surgeons can achieve cancer detection rapidly and effectively and save doctors' diagnosis time. These can lay the foundation for better clinical diagnosis, treatment planning and accurate quantitative evaluation of DSC.


Assuntos
Inteligência Artificial , Diagnóstico por Imagem , Neoplasias do Sistema Digestório/diagnóstico , Processamento de Imagem Assistida por Computador , Aprendizado Profundo , Humanos , Aprendizado de Máquina
14.
Surgery ; 166(2): 177-183, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160060

RESUMO

BACKGROUND: Certain behavioral traits and inadequate social support are known risk factors for complications after cancer surgery. Despite their importance, it is unclear whether conventional patient preoperative evaluation captures them. This study was conducted to assess concordance between documentation and patient survey of selected risk factors and to determine whether failure to document affected postoperative outcomes. METHODS: Adult patients at a tertiary academic medical center were surveyed before abdominal cancer surgery to assess 6 psychosocial risk factors. Risk factors were also assessed by retrospective chart review and compared with survey results through concordance measures. Thirty-day postoperative complications were abstracted by chart review. Rates of major complications for those with and without clinically missed risk factors were compared. RESULTS: Comparisons between chart review and screening survey revealed poor-to-moderate positive agreement (0%-47%) for 5 risk factors and strong negative agreement (82%-99%) among all risk factors. Kappa analysis demonstrated poor-to-fair agreement among 5 risk factors (κ = 0.112-0.423). The overall complication rate was 36%. The complication rate for patients with at least 1 clinically missed risk factor was 49% vs 24% in those without (P = .021), with a similar effect replicated for each individual risk factor. CONCLUSION: This study shows a high level of discordance between formal screening and routine clinician documentation in a preoperative setting for psychosocial risk factors. There is a significant association between missing these risk factors and worse postoperative outcomes. Future work should examine whether structured screening of psychosocial risk factors may improve preoperative risk stratification through proactive interventions.


Assuntos
Neoplasias do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Cuidados Pré-Operatórios/métodos , Psicologia , Centros Médicos Acadêmicos , Idoso , Estudos de Coortes , Bases de Dados Factuais , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/psicologia , Intervalo Livre de Doença , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Complicações Pós-Operatórias/psicologia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
15.
Chirurgia (Bucur) ; 114(2): 243-250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31060657

RESUMO

Introduction: Neuroendocrine tumors of the gastro-entero-pancreatic system have a variety of components, clinical manifestations and prognostic indices according to their anatomical site. Therefore, their diagnostic and management strategies differ a great deal. Prognosis concerning NETs can be poor due to the degree of differentiation, early metastasizing and the high degree of invasiveness. Material and Methods: For the present study, the patient files were evaluated and the parameters of interest were followed. Results: Over the course of 6 years there were 37 patients diagnosed with and treated for NETs, regardless of primary tumor site. There were 9 patients with NETs of the primite mid- and hindgut thusly: 5 cases with colorectal NETs and 4 cases of small bowel NETs. 6 patients benefited from radical surgical treatment, 2 cases with palliative procedures and only one patient with tumor biopsy. The tumors were evaluated according to the 2010 WHO classification based on the number of mitoses and the Ki67 proliferation index. Adjuvant treatment was adapted according to staging and histopathological parameters. Conclusions: Despite recent progress in managing NETs, there are still many controversial aspects regarding the management of these cases, mainly about timing the right sequence of therapy.


Assuntos
Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/terapia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/terapia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Neoplasias do Sistema Digestório/tratamento farmacológico , Neoplasias do Sistema Digestório/cirurgia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/tratamento farmacológico , Tumores Neuroendócrinos/cirurgia , Prognóstico , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/terapia , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia
16.
Ann Endocrinol (Paris) ; 80(3): 163-165, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31064659

RESUMO

The recent classifications of lung and digestive neuroendocrine neoplasms (NENs) make a fundamental distinction between well- and poorly-differentiated neoplasms. Well-differentiated NENs are termed carcinoids in the lung and neuroendocrine tumors in the gastroenteropancreatic sphere; their risk of malignancy is highly variable; histological grading is used to stratify patients into prognostically significant groups. Poorly-differentiated NENs are termed neuroendocrine carcinoma in both the lung and the digestive sphere; they constantly are of high grade of malignancy; two types are recognized on the basis of tumor cell morphology, the small cell and the large cell types. Recent studies have largely uncovered the genetic landscape of several subsets of well-differentiated NENs (lung, pancreas, small intestine) and of poorly-differentiated NENs. Some molecular markers may help to the differential diagnosis between highly proliferative neuroendocrine tumors and neuroendocrine carcinomas, especially in the pancreas. In well-differentiated tumors, MGMT status is proposed as a predictive marker of the response to temozolomide, but remains to be validated. In poorly-differentiated neoplasms, large cell neuroendocrine carcinoma has been shown to be a heterogeneous category, with some cases presenting the same molecular signature than small cell carcinoma and others the same signature than adenocarcinomas of the same body site. Rb protein has been recently shown to be a potential marker of response to platinum salts in neuroendocrine carcinoma. Much remains to be done to translate the rapid progress in the molecular understanding of NENS into diagnostic, prognostic or predictive markers.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias do Sistema Digestório/classificação , Neoplasias Pulmonares/classificação , Tumores Neuroendócrinos/classificação , Organização Mundial da Saúde , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/patologia , Diagnóstico Diferencial , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/patologia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Prognóstico
17.
Ann Biol Clin (Paris) ; 77(2): 161-168, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30998196

RESUMO

OBJECTIVES: Platelet serotonin and its urinary metabolite 5-HIAA (5-hydroxyindolacetic acid) are the main biomarkers measured for the detection of neuroendocrine tumors (NET). We observe in our laboratory many false positives or false negatives for the 2 assays using threshold values given by the manufacturer. We aim to determine our own local threshold values for a better detection of gastrointestinal NETs. METHODS: We studied patients with measurement of platelet serotonin and/or urinary 5-HIAA in University Hospital of Tours between January 2005 and June 2016. We established an « index ¼ cohort with 75% of patients to determine local threshold value for the 2 parameters. A "validation" cohort constituted with 25% of remaining patients allowed us to compare the performances of manufacturer's values with local threshold values. RESULTS: Two hundred ninety patients were included, with 19 suffering from NETs. Local threshold value for platelet serotonin was determined at 5.13 amol/platelet, the one for urinary 5-HIAA at 3.60 µmol/mmol urinary creatinine. Platelet serotonin specificity was better with local threshold value for identical sensibility (0.75). Urinary 5-HIAA sensibility was improved with local threshold value (1 vs 0.667) for identical specificity (0.902). CONCLUSION: Using our local threshold value for platelet serotonin and urinary 5-HIAA improved diagnostic performances of these biochemical markers to detect NETs.


Assuntos
Análise Química do Sangue/métodos , Plaquetas/química , Neoplasias do Sistema Digestório/diagnóstico , Ácido Hidroxi-Indolacético/urina , Tumores Neuroendócrinos/diagnóstico , Serotonina/análise , Urinálise/métodos , Adulto , Idoso , Biomarcadores/sangue , Biomarcadores/urina , Análise Química do Sangue/normas , Plaquetas/metabolismo , Estudos de Coortes , Neoplasias do Sistema Digestório/sangue , Neoplasias do Sistema Digestório/urina , Feminino , Humanos , Ácido Hidroxi-Indolacético/análise , Neoplasias Intestinais/sangue , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/urina , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/sangue , Tumores Neuroendócrinos/urina , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/urina , Valores de Referência , Estudos Retrospectivos , Serotonina/sangue , Neoplasias Gástricas/sangue , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/urina
18.
BMC Cancer ; 19(1): 177, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808336

RESUMO

BACKGROUND: Previous studies have highlighted cytokine growth differentiation factor 15 (GDF-15) as a potential biomarker for digestive system tumors (DST). This study sought to assess the feasibility of using GDF-15 as a diagnostic and prognostic biomarker in DST. METHODS: Eligible studies from multiple online databases were reviewed. Meta-analyses of diagnostic parameters were carried out using standard statistical methods. Study-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to estimate the strength of the relationship between GDF-15 levels and clinical prognosis. RESULTS: We identified 17 eligible studies comprising 3966 patients with DST. The sensitivity, specificity, and area under the curve (AUC) for the discriminative performance of GDF-15 as a diagnostic biomarker were 0.74 (95% CI: 0.68-0.80), 0.83 (95% CI: 0.75-0.89), and 0.84, respectively. Moreover, increased GDF-15 expression levels were markedly associated with unfavorable overall survival (OS) in patients with DST (HR = 2.34, 95% CI: 2.03-2.70, P < 0.001; I2 = 0.0%) and colorectal cancer (CRC) (HR = 2.27, 95% CI: 1.96-2.63, P < 0.001; I2 = 0.0%). Stratification by cancer type, test matrix, ethnicity, and cut-off setting also illustrated the robustness of the diagnostic value of GDF-15 in DST. CONCLUSION: Collectively, our data suggest that GDF-15 expression level may have value as a diagnostic and prognostic biomarker, independent of other, traditional biomarkers.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/diagnóstico , Neoplasias do Sistema Digestório/diagnóstico , Fator 15 de Diferenciação de Crescimento/metabolismo , Neoplasias Colorretais/mortalidade , Neoplasias do Sistema Digestório/mortalidade , Humanos , Prognóstico , Modelos de Riscos Proporcionais , Análise de Sobrevida
19.
J Thromb Thrombolysis ; 47(2): 316-323, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30560488

RESUMO

Malignancy and surgery are both independent risk factors for venous thromboembolism (VTE) events. The current NCCN guidelines recommend VTE prophylaxis for up to 28 days after major abdominal or pelvic surgery for malignancy. We set out to evaluate the rate and timing of VTEs among patients with gastric, pancreatic, colorectal, and gynecologic malignancies who underwent surgery. We performed a retrospective review of the NSQIP database (2005-2013) focusing on patients with gastric, colorectal, pancreatic, and gynecologic malignancies. Our primary endpoint was a diagnosis of VTE within 30 days of surgery. We analyzed 128,864 patients in this study. On multivariable analysis, patients with pre-operative sepsis (OR 2.36, CI 2.04-2.76, p < 0.001), disseminated cancer (OR 1.73, CI 1.55-1.92, p < 0.001), congestive heart failure (OR 1.69, CI 1.25-2.28, p = 0.001), gastric cancer (OR 1.3, CI 1.09-1.56, p = 0.004), and pancreatic cancer (OR 1.2, CI 1.03-1.30, p = 0.021) were more likely to have a VTE. Of patients who had a VTE event, 34% occurred after discharge from surgery (gastric: 25%, colorectal 34%, pancreatic 31%, gynecologic malignancy 42%). Our study demonstrates that patients who undergo an operation for malignancy with pre-operative sepsis, disseminated cancer, congestive heart failure, gastric cancer, or pancreatic cancer are more likely to develop a VTE within 30 days of their operation. Of those patients who developed a VTE, approximately one-third occurred after discharge during a 30 day post-operative period. This data supports that further studies are needed to determine the appropriate length of post-operative VTE chemoprophylaxis in patients with cancer.


Assuntos
Neoplasias do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Tromboembolia Venosa/epidemiologia , Idoso , Bases de Dados Factuais , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/epidemiologia , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Tromboembolia Venosa/diagnóstico
20.
Neuroendocrinology ; 108(1): 18-25, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30153686

RESUMO

Unmet medical needs are not infrequent in oncology, and these needs are usually of higher magnitude in rare cancers. The field of neuroendocrine neoplasms (NENs) has evolved rapidly during the last decade, and, currently, a new WHO classification is being implemented and several treatment options are available in the metastatic setting after the results of prospective phase III clinical trials. However, several questions are still unanswered, and decisions in our daily clinical practice should be made with limited evidence. In the 2016 meeting of the advisory board of the European Neuroendocrine Tumor Society (ENETS), the main unmet medical needs in the metastatic NENs setting were deeply discussed, and several proposals to try to solve them are presented in this article, including biomarkers, imaging, and therapy.


Assuntos
Pesquisa Biomédica/tendências , Neoplasias do Sistema Digestório , Neoplasias Pulmonares , Tumores Neuroendócrinos , Biomarcadores Tumorais/metabolismo , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/tratamento farmacológico , Desenvolvimento de Medicamentos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/metabolismo , Tumores Neuroendócrinos/terapia
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