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1.
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
2.
Medicine (Baltimore) ; 97(41): e12455, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313035

RESUMO

BACKGROUND: Digestive system cancers are recognized as associated with high morbidity and mortality. It is generally accepted that N-myc downstream-regulated gene 1 (NDRG1) is aberrantly overexpressed or downregulated in digestive system cancers, and its prognostic value remains controversial. Accordingly, we herein conducted a meta-analysis to explore whether NDRG1 expression is correlated with overall survival (OS) and clinicopathological characteristics of patients with digestive system cancers. METHODS: We systematically searched PubMed, EMBASE, and Web of Science for eligible studies up to June 6, 2017. In all, 19 publications with 21 studies, were included. RESULTS: The pooled results showed that low NDRG1 expression was significantly associated with worse OS in colorectal cancer (pooled HR = 1.67, 95% CI: 1.22-2.28, P < .001) and pancreatic cancer (pooled HR = 1.87, 95% CI: 1-3.5, P < .0001). Moreover, the relationships between low NDRG1 expression and higher OS ratio of patients with liver cancer (pooled HR = 0.44, 95% CI: 0.32-0.62, P = .009) and gallbladder cancer (pooled HR = 0.56, 95% CI: 0.23-1.38, P = .01) were observed. Nevertheless, no significant association was observed between low NDRG1 expression and OS in gastric cancer (pooled HR = 0.81, 95% CI: 0.45-1.43, P = .46) or esophageal cancer (pooled HR = 0.76, 95% CI: 0.26-2.24, P = .62). CONCLUSION: The prognostic significance of NDRG1 expression varies according to cancer type in patients with DSCs. Considering that several limitations existed in this meta-analysis, more studies are required to further assess the prognostic value of NDRG1 expression in patients with DSCs and relevant mechanisms.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma/diagnóstico , Carcinoma/mortalidade , Proteínas de Ciclo Celular/metabolismo , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Carcinoma/metabolismo , Neoplasias do Sistema Digestório/metabolismo , Regulação para Baixo , Humanos , Prognóstico , Análise de Sobrevida , Regulação para Cima
3.
World J Gastroenterol ; 24(17): 1881-1887, 2018 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-29740203

RESUMO

Olfactomedin-4 (OLFM4, GW112, hGC-1) is a glycoprotein belonging to the olfactomedin family. The expression of OLFM4 is strong in the small intestine, colon and prostate, and moderate in the stomach and bone marrow. Previous studies have revealed that OLFM4 is closely associated with many digestive diseases. Up-regulation of OLFM4 has been detected in the Helicobacter pylori (H. pylori)-infected gastric mucosa, inflammatory bowel disease tissue and gastrointestinal malignancies, including gastric cancer, colorectal cancer, pancreatic cancer and gallbladder cancer. Down-regulation of OLFM4 has also been detected in some cases, such as in poorly differentiated, advanced-stage and metastatic tumors. Studies using OLFM4-deficient mouse models have revealed that OLFM4 acts as a negative regulator of H. pylori-specific immune responses and plays an important role in mucosal defense in inflammatory bowel disease. Patients with OLFM4-positive gastric cancer or colorectal cancer have a better survival rate than OLFM4-negative patients. However, the prognosis is worse in pancreatic cancer patients with high levels of expression of OLFM4. The NF-κB, Notch and Wnt signaling pathways are involved in the regulation of OLFM4 expression in digestive diseases, and its role in pathogenesis is associated with anti-inflammation, apoptosis, cell adhesion and proliferation. OLFM4 may serve as a potential specific diagnostic marker and a therapeutic target in digestive diseases. Further studies are required to explore the clinical value of OLFM4.


Assuntos
Neoplasias do Sistema Digestório/patologia , Gastroenteropatias/patologia , Trato Gastrointestinal/patologia , Fator Estimulador de Colônias de Granulócitos/metabolismo , Infecções por Helicobacter/patologia , Animais , Biomarcadores/metabolismo , Neoplasias do Sistema Digestório/tratamento farmacológico , Neoplasias do Sistema Digestório/etiologia , Neoplasias do Sistema Digestório/mortalidade , Regulação para Baixo , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/microbiologia , Glicoproteínas/genética , Glicoproteínas/imunologia , Glicoproteínas/metabolismo , Fator Estimulador de Colônias de Granulócitos/genética , Fator Estimulador de Colônias de Granulócitos/imunologia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/etiologia , Helicobacter pylori/imunologia , Humanos , Camundongos , Terapia de Alvo Molecular/métodos , Prognóstico , Transdução de Sinais , Taxa de Sobrevida , Regulação para Cima
4.
Hepatobiliary Pancreat Dis Int ; 17(2): 163-168, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29567046

RESUMO

BACKGROUND: Postoperative pancreatic fistula (POPF) is a severe complication of the pancreaticoduodenectomy (PD). Recently, we introduced a method of suspender pancreaticojejunostomy (PJ) to the PD. In this study, we retrospectively analyzed various risk factors for complications after PD. We also introduced and assessed the suspender PJ to demonstrate its advantages. METHODS: Data from 335 patients with various periampullary lesions, who underwent the Whipple procedure (classic Whipple procedure or pylorus-preserving) PD by either traditional end-to-side invagination PJ or suspender PJ, were analyzed. The correlation between either perioperative or postoperative complications and corresponding PD approaches was evaluated by univariate analysis. RESULTS: A total of 147 patients received the traditional end-to-side invagination PJ, and 188 patients were given the suspender PJ. Overall, 51.9% patients had various complications after PD. The mortality rate was 2.4%. The POPF incidence in patients who received the suspender PJ was 5.3%, which was significantly lower than those who received the traditional end-to-side invagination PJ (18.4%) (P < 0.001). Univariate analysis showed that PJ approach and the pancreas texture were significantly associated with the POPF incidence rate (P < 0.01). POPF was a risk factor for both postoperative abdominal cavity infection (OR = 8.34, 95% CI: 3.99-17.42, P < 0.001) and abdominal cavity hemorrhage (OR = 4.86, 95% CI: 1.92-12.33, P = 0.001). CONCLUSIONS: Our study showed that the impact of the pancreas texture was a major risk factor for pancreatic leakage after a PD. The suspender PJ can be easily accomplished and widely applied and can effectively decrease the impact of the pancreas texture on pancreatic fistula after a PD and leads to a lower POPF incidence rate.


Assuntos
Neoplasias do Sistema Digestório/cirurgia , Fístula Pancreática/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticojejunostomia/métodos , Idoso , Distribuição de Qui-Quadrado , China/epidemiologia , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fístula Pancreática/diagnóstico por imagem , Fístula Pancreática/etiologia , Fístula Pancreática/mortalidade , Pancreaticoduodenectomia/mortalidade , Pancreaticojejunostomia/efeitos adversos , Pancreaticojejunostomia/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
5.
World J Gastroenterol ; 24(1): 69-75, 2018 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-29358883

RESUMO

AIM: To study the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction. METHODS: Of 272 patients with unresectable distal malignant biliary obstruction, 184 patients under the age of 80 were classified into Group A, and 88 subjects aged 80 years or more were classified into Group B. The safety of metallic stent insertion, metal stent patency period, and the obstruction rate were examined in each group. RESULTS: In Group B, patients had a significantly worse performance status, high blood pressure, heart disease, cerebrovascular disease, and dementia; besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher (P < 0.05). Metallic stents were successfully inserted in all patients. The median patency period was 265.000 ± 26.779 (1-965) d; 252.000 ± 35.998 (1-618) d in Group A and 269.000 ± 47.885 (1-965) d in Group B, with no significant difference between the two groups. Metallic stent obstruction occurred in 82 of the 272 (30.15%) patients; in 53/184 (28.80%) patients in Group A and in 29/88 (32.95%) of those in Group B, showing no significant difference between the two groups. Procedural accidents due to metal stent insertion occurred in 24/272 (8.8%) patients; in 17/184 (9.2%) of patients in Group A and in 7/88 (8.0%) of those in Group B, with no significant difference between the two groups, either. CONCLUSION: These results suggested that metallic stents can be safely inserted to treat unresectable distal malignant biliary obstruction even in elderly patients aged 80 years or more.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colestase/terapia , Neoplasias do Sistema Digestório/complicações , Drenagem/instrumentação , Metais , Stents , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/mortalidade , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/mortalidade , Neoplasias do Sistema Digestório/mortalidade , Drenagem/efeitos adversos , Drenagem/mortalidade , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Dig Dis Sci ; 63(9): 2466-2473, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29218484

RESUMO

BACKGROUND: Both fully covered (FC) and partially covered (PC) self-expandable metal stents (SEMSs) are now commercially available for distal malignant biliary obstruction (MBO). While FCSEMS can be easily removed at the time of re-interventions, it is theoretically prone to migration. However, few comparative data between FC and PC SEMSs have been reported. AIMS: The aim of this study was to compare clinical outcomes of FCSEMS with those of PCSEMS. METHODS: This was a multicenter, prospective study of FCSEMS for unresectable distal MBO with a historical control of PCSEMS, which was previously reported as the WATCH study. The primary outcome was recurrent biliary obstruction (RBO), and secondary outcomes were stent migration, stent removal, stent-related adverse events, and survival. RESULTS: A total of 151 cases with unresectable distal MBO undergoing FCSEMS placement were enrolled and compared with a historical cohort of 141 cases undergoing PCSEMS placement. No significant differences were found in the rate of RBO (29 vs. 33%; P = 0.451), time to RBO (318 vs. 373 days; P = 0.382), and survival (229 vs. 196 days; P = 0.177) between FCSEMS and PCSEMS. The rate of stent migration also did not differ significantly between the two groups (14 vs. 8%; P = 0.113). The removal of FCSEMSs was successful in all 24 attempted cases (100%). CONCLUSIONS: FCSEMSs appeared comparable to PCSEMSs in terms of RBO without a significant increase in stent migration rate in patients with unresectable distal MBO. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000007131.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colestase/terapia , Neoplasias do Sistema Digestório/complicações , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/mortalidade , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/mortalidade , Remoção de Dispositivo , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Feminino , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Desenho de Prótese , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Epidemiology ; 29(1): 31-40, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28991003

RESUMO

BACKGROUND: There is considerable scientific interest in associations between protracted low-dose exposure to ionizing radiation and the occurrence of specific types of cancer. METHODS: Associations between ionizing radiation and site-specific solid cancer mortality were examined among 308,297 nuclear workers employed in France, the United Kingdom, and the United States. Workers were monitored for external radiation exposure and follow-up encompassed 8.2 million person-years. Radiation-mortality associations were estimated using a maximum-likelihood method and using a Markov chain Monte Carlo method, the latter used to fit a hierarchical regression model to stabilize estimates of association. RESULTS: The analysis included 17,957 deaths attributable to solid cancer, the most common being lung, prostate, and colon cancer. Using a maximum-likelihood method to quantify associations between radiation dose- and site-specific cancer, we obtained positive point estimates for oral, esophagus, stomach, colon, rectum, pancreas, peritoneum, larynx, lung, pleura, bone and connective tissue, skin, ovary, testis, and thyroid cancer; in addition, we obtained negative point estimates for cancer of the liver and gallbladder, prostate, bladder, kidney, and brain. Most of these estimated coefficients exhibited substantial imprecision. Employing a hierarchical model for stabilization had little impact on the estimated associations for the most commonly observed outcomes, but for less frequent cancer types, the stabilized estimates tended to take less extreme values and have greater precision than estimates obtained without such stabilization. CONCLUSIONS: The results provide further evidence regarding associations between low-dose radiation exposure and cancer.


Assuntos
Neoplasias/mortalidade , Exposição Ocupacional/estatística & dados numéricos , Radiação Ionizante , Adulto , Neoplasias Ósseas/mortalidade , Neoplasias Encefálicas/mortalidade , Estudos de Coortes , Neoplasias do Colo/mortalidade , Neoplasias do Sistema Digestório/mortalidade , Relação Dose-Resposta à Radiação , Feminino , França/epidemiologia , Humanos , Neoplasias Renais/mortalidade , Neoplasias Laríngeas/mortalidade , Neoplasias Pulmonares/mortalidade , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Método de Monte Carlo , Energia Nuclear , Neoplasias Ovarianas/mortalidade , Neoplasias da Próstata/mortalidade , Doses de Radiação , Análise de Regressão , Neoplasias Cutâneas/mortalidade , Neoplasias Testiculares/mortalidade , Neoplasias da Glândula Tireoide/mortalidade , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Neoplasias da Bexiga Urinária/mortalidade
8.
Diagn Interv Imaging ; 99(4): 237-245, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29102756

RESUMO

PURPOSE: The purpose of this study was to investigate the feasibility and safety of percutaneous transhepatic endobiliary radiofrequency ablation (RFA) combined with biliary stenting in palliative treatment of malignant biliary obstructions. MATERIALS AND METHODS: Twenty-one patients who had undergone percutaneous transhepatic endobiliary RFA as an adjunct to biliary stenting were included. There were 12 men and nine women with a mean age of 67±13.6 (SD) years (range: 34-86 years). Demographic data, procedure details and follow-up data including complications, survival time and stent patency time were documented. The median stent patency time and survival time, as well as the 30- day and 180-day cumulative survival and stent patency rates were estimated using the Kaplan-Meier method. RESULTS: Twenty-four percutaneous transhepatic endobiliary RFA procedures were performed. There were no procedure-related major complications or death. Three patients who had developed stent reocclusion underwent a second endobiliary RFA, without insertion of a new stent. The most common complications were post-procedural pain and cholangitis. Overall survival and stent patency times ranged between 5-542 days and 5-251 days, respectively. The median survival time was 76 days (95%CI: 0-233 days) and stent patency time was 133 days (95% CI: 25-240 days). The 30- and 180- day cumulative stent patency rates were 75% and 34%, respectively. CONCLUSION: Percutaneous transhepatic endobiliary RFA is a feasible, safe and cost-effective method in restoration of biliary drainage in patients with malignant biliary obstruction.


Assuntos
Ablação por Cateter/métodos , Colestase/terapia , Cuidados Paliativos , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Colestase/diagnóstico por imagem , Colestase/etiologia , Neoplasias do Sistema Digestório/complicações , Neoplasias do Sistema Digestório/mortalidade , Estudos de Viabilidade , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Estudos Retrospectivos
9.
J Ayub Med Coll Abbottabad ; 30(4): 571-575, 2018 Oct-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30632340

RESUMO

BACKGROUND: Obstructive jaundice due to malignancies of the biliary tree, gall bladder and pancreas account for a significant number of patients managed by tertiary centres. Management options are curative or palliative, depending on disease stage. This study was performed to see the effectiveness of treatment modalities for these patients and eventual outcome. METHODS: This cross-sectional analytical study was conducted at the Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital Lahore, from January 2015 to June 2016. All adult patients aged 18 and above of either sex presenting with obstructive jaundice secondary to malignant disease originating from the gallbladder, biliary-tree or pancreas were included in the study. The disease was staged after admission. The patients then underwent endoscopic, surgical or percutaneous drainage and were followed up for a period of one year. RESULTS: Two hundred & sixty-two patients presenting with jaundice due to malignancy arising from the biliary tree, gall bladder or pancreas were enrolled between January 2015 and June 2016, 141 (53.8%) males and 121 (46.2%) females. Eighty (30.5%) had cholangiocarcinoma, 70 (26.7%), had gall bladder tumours, 61 (23.3%) pancreatic cancer and 51(19.5%) had ampullary tumours. 31 (11.8%) patients had disease qualifying curative surgical resection. One hundred & eighty-five (70.6%) patients underwent palliative therapy in the form of percutaneous in 86 (32.9%) and endoscopic drainage in 126 (48.1%). Twenty-eight (10.7%) patients refused all treatment. Eighteen (6.9%) patients died before undergoing any therapeutic intervention. Thirty-three (12.6%) died during hospital stay. Survival at 3, 6 and 12 months was 49.2% (129 patients), 28.2% (74 patients) and 8.4% (22 patients), respectively. These 22 included all patients who had undergone curative resection. We attributed the largest number of deaths, 197 (75.2%) patients, to metastatic/advanced disease and associated complications. CONCLUSIONS: The results showed that patients with advanced disease who were only eligible for palliative therapy, at first presentation, constituted the majority of patients. These patients require skilled endoscopy and interventional radiology teams for successful biliary drainage.


Assuntos
Neoplasias do Sistema Digestório/complicações , Neoplasias do Sistema Digestório/mortalidade , Icterícia Obstrutiva/etiologia , Estudos Transversais , Neoplasias do Sistema Digestório/cirurgia , Drenagem , Feminino , Humanos , Icterícia Obstrutiva/terapia , Masculino , Paquistão/epidemiologia , Cuidados Paliativos
10.
Gastroenterology ; 153(4): 910-923, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28807841

RESUMO

Cancer from the gastrointestinal tract and its associated excretory organs will occur in more than 300,000 Americans in 2017, with colorectal cancer responsible for >40% of that burden; there will be more than 150,000 deaths from this group of cancers in the same time period. Disparities among subgroups related to the incidence and mortality of these cancers exist. The epidemiology and risk factors associated with each cancer bear out differences for racial groups in the United States. Esophageal adenocarcinoma is more frequent in non-Hispanic whites, whereas esophageal squamous cell carcinoma with risk factors of tobacco and alcohol is more frequent among blacks. Liver cancer has been most frequent among Asian/Pacific Islanders, chiefly due to hepatitis B vertical transmission, but other racial groups show increasing rates due to hepatitis C and emergence of cirrhosis from non-alcoholic fatty liver disease. Gastric cancer incidence remains highest among Asian/Pacific Islanders likely due to gene-environment interaction. In addition to esophageal squamous cell carcinoma, cancers of the small bowel, pancreas, and colorectum show the highest rates among blacks, where the explanations for the disparity are not as obvious and are likely multifactorial, including socioeconomic and health care access, treatment, and prevention (vaccination and screening) differences, dietary and composition of the gut microbiome, as well as biologic and genetic influences. Cognizance of these disparities in gastrointestinal cancer risk, as well as approaches that apply precision medicine methods to populations with the increased risk, may reduce the observed disparities for digestive cancers.


Assuntos
Grupos de Populações Continentais , Neoplasias do Sistema Digestório/etnologia , Disparidades nos Níveis de Saúde , Estilo de Vida/etnologia , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/terapia , Feminino , Humanos , Incidência , Masculino , Prognóstico , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Fatores de Tempo , Estados Unidos/epidemiologia
11.
Hepatobiliary Pancreat Dis Int ; 16(4): 412-417, 2017 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-28823372

RESUMO

BACKGROUND: Stricture formation at the bilioenteric anastomosis is a rare but important postoperative complication. However, information on this complication is lacking in the literature. In the present study, we aimed to assess its prevalence and predictive factors, and report our experience in managing bilioenteric anastomotic strictures over a ten-year period. METHODS: A total of 420 patients who had undergone bilioenteric anastomosis due to benign or malignant tumors between February 2001 and December 2011 were retrospectively reviewed. Univariate and multivariate modalities were used to identify predictive factors for anastomotic stricture occurrence. Furthermore, the treatment of anastomotic stricture was analyzed. RESULTS: Twenty-one patients (5.0%) were diagnosed with bilioenteric anastomotic stricture. There were 12 males and 9 females with a mean age of 61.6 years. The median time after operation to anastomotic stricture was 13.6 months (range, 1 month to 5 years). Multivariate analysis identified that surgeon volume (≤30 cases) (odds ratio: -1.860; P=0.044) was associated with the anastomotic stricture while bile duct size (>6 mm) (odds ratio: 2.871; P=0.0002) had a negative association. Balloon dilation was performed in 18 patients, biliary stenting in 6 patients, and reoperation in 4 patients. Five patients died of tumor recurrence, and one of heart disease. CONCLUSIONS: Bilioenteric anastomotic stricture is an uncommon complication that can be treated primarily by interventional procedures. Bilioenteric anastomosis may be performed by a surgeon in his earlier training period under the guidance of an experienced surgeon. Bile duct size >6 mm may play a protective role.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Colestase/epidemiologia , Colestase/terapia , Neoplasias do Sistema Digestório/cirurgia , Idoso , Anastomose Cirúrgica , Procedimentos Cirúrgicos do Sistema Biliar/mortalidade , Distribuição de Qui-Quadrado , China/epidemiologia , Colecistectomia/efeitos adversos , Coledocostomia/efeitos adversos , Colestase/diagnóstico , Colestase/mortalidade , Constrição Patológica , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Dilatação , Feminino , Humanos , Jejunostomia/efeitos adversos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevalência , Reoperação , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
12.
Eur Rev Med Pharmacol Sci ; 21(12): 2847-2857, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28682432

RESUMO

OBJECTIVE: The present study is to compare plastic stents (PS) with self-expandable metal stents (SEMS) in patients with malignant bile duct obstruction. PATIENTS AND METHODS: Literature search in PubMed (Medline) and Embase databases was performed for all prospective randomized trials that compared SEMS with PS for the treatment of malignant biliary obstruction between January 1966 and January 2015. Research studies were included in the present meta-analysis if they met the inclusion criteria. In the meta-analysis, summary risk ratio estimates for major outcome were calculated. Forest plots were used to assess overall risk estimate, and funnel plots were used to assess overall publication bias. Meta-analysis was performed using STATA 11.0 software. RESULTS: Ten articles with 810 patients were eligible for inclusion in the present meta-analysis. SEMS is not significantly associated with complications or 30-day mortality when compared with PS (p = 0.069 and 0.167, respectively). Further stratified analysis showed similar results. For other therapeutic effects, SEMS offered 2.27-fold 6-month stent patency rate (95% CI = 1.30-3.95), and 36% reduction in a recurrent obstruction (95% CI = 0.17-0.51), as compared with PS. In addition, SEMS was associated with fewer hospitalization days than PS (p = 0.023) in a random model. With fixed model, the corresponding p-value was less than 0.001. CONCLUSIONS: The present meta-analysis demonstrates that SEMS cannot result in lower risks of complications and mortality, but can provide a lower risk of recurrent obstruction and longer stent patency for the palliation of malignant bile duct obstruction when compared with PS.


Assuntos
Colestase/cirurgia , Neoplasias do Sistema Digestório/complicações , Cuidados Paliativos/métodos , Plásticos , Stents Metálicos Autoexpansíveis , Idoso , Colestase/etiologia , Colestase/mortalidade , Neoplasias do Sistema Digestório/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Stents
13.
Oncotarget ; 8(19): 32332-32344, 2017 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-28415659

RESUMO

Several previous studies have reported the prognostic value of hexokinase 2 (HK2) in digestive system tumors. However, these studies were limited by the small sample sizes and the results were inconsistent among them. Therefore, we conducted a meta-analysis based on 15 studies with 1932 patients to assess the relationship between HK2 overexpression and overall survival (OS) of digestive system malignancies. The relationship of HK2 and clinicopathological features was also evaluated. Hazard ratio (HR) or odds ratio (OR) with its 95% confidence intervals (CI) were calculated to estimate the effect size. Positive HK2 expression showed poor OS in all tumor types (HR = 1.75 [1.41-2.18], P < 0.001). When stratified by tumor type, the impact of HK2 overexpression on poor prognosis was observed in gastric cancer (HR = 1.77 [1.25-2.50], P < 0.001), hepatocellular carcinoma (HR = 1.87 [1.58-2.21], P < 0.001), and colorectal cancer (HR = 2.89 [1.62-5.15], P < 0.001), but not in pancreatic ductal adencarcinoma (HR = 1.11 [0.58-2.11], P = 0.763). Furthermore, high HK2 expression was significantly associated with some phenotypes of tumor aggressiveness, such as large tumor size (OR = 2.03 [1.10-3.74], P = 0.024), positive lymph node metastasis (OR = 2.05 [1.39-3.02], P < 0.001), advanced clinical stage (OR = 2.17 [1.21-3.89], P = 0.009) and high alpha fetoprotein level (OR = 1.47 [1.09-2.02] P = 0.013). In summary, HK2 might act as a prognostic indicator and a potential therapeutic target of these digestive system cancers.


Assuntos
Biomarcadores Tumorais , Neoplasias do Sistema Digestório/genética , Neoplasias do Sistema Digestório/mortalidade , Expressão Gênica , Hexoquinase/genética , Animais , Neoplasias do Sistema Digestório/metabolismo , Neoplasias do Sistema Digestório/patologia , Hexoquinase/metabolismo , Humanos , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Razão de Chances , Prognóstico , Viés de Publicação , Carga Tumoral
14.
Ann Oncol ; 28(7): 1582-1589, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28444105

RESUMO

Background: Incidence of locoregional neuroendocrine tumors (NETs) is rising. However, after curative resection, the patterns and risk factors associated with recurrence remain unknown. Consensus guidelines recommend surveillance every 6-12 months for up to 10 years after surgery for resected, well-differentiated NETs irrespective of patient demographics, site, grade or stage of tumor with few exceptions. Patients and methods: From the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified localized and regional stage NET patients who underwent surgical resection between January 2002 and December 2011. Development of recurrence was identified by capturing at least two claims indicative of metastatic disease until 31 December 2013. Results: Of the 2366 identified patients (median age 73 years), 369 (16%) developed metastatic disease within 5 years and only an additional 1% developed metastases between years 5 and 10 with the majority dying due to unrelated causes. The 5-year risk of developing metastases (hazard ratio, HR) varied significantly (log-rank P < 0.001) by grade: 9.9% versus 25.9% (2.2) versus 48.1% (4.4) for grades 1, 2, and ≥ 3, respectively; stage: 10.3% versus 31.1% (2.8) for localized versus regional; primary tumor size: 7.6% versus 15% (1.3) versus 26.6% (1.5) for <1, 1-2, and > 2 cm, respectively; and site: ranging from 11.3% for colon to 23.9% for pancreas. Conclusions: Contrary to current guidelines, our study suggests that surveillance recommendations should be tailored according to patient and tumor characteristics. Surveillance past 5 years may be avoided in elderly patients with competing morbidities or low risk of recurrence. Pancreatic, lung, higher grade, and regional NETs have a higher risk of recurrence and may be considered for future adjuvant trials.


Assuntos
Carcinoma Neuroendócrino/secundário , Carcinoma Neuroendócrino/cirurgia , Neoplasias do Sistema Digestório/patologia , Neoplasias do Sistema Digestório/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/mortalidade , Diferenciação Celular , Comorbidade , Neoplasias do Sistema Digestório/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Medicare , Gradação de Tumores , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Fatores de Risco , Programa de SEER , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Estados Unidos/epidemiologia
15.
J Occup Environ Med ; 59(5): e84-e90, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28437293

RESUMO

OBJECTIVE: The aim of this study was to examine mortality causes and cancer incidence in a population cohort that have resided in close proximity to highly metal-contaminated sources, characterized by contamination of, in particular, arsenic (As), cadmium (Cd), and lead (Pb). METHODS: Data from Swedish registers were used to calculate standardized mortality and cancer incidence ratios. An attempt to relate cancer incidence to metal contamination levels was made. RESULTS: Significantly elevated cancer incidences were observed for overall malignant cancers in both genders, cancer in the digestive system, including colon, rectum, and pancreas, and cancers in prostate among men. Dose-response relationships between Cd and Pb levels in soil and cancer risks were found. CONCLUSIONS: Cancer observations made, together with previous studies of metal uptake in local vegetables, may imply that exposure to local residents have occurred primarily via oral intake of locally produced foodstuffs.


Assuntos
Neoplasias do Sistema Digestório/epidemiologia , Exposição Ambiental/efeitos adversos , Metais Pesados/toxicidade , Neoplasias da Próstata/epidemiologia , Neoplasias do Sistema Respiratório/mortalidade , Doenças Cardiovasculares/mortalidade , Causas de Morte , Neoplasias do Sistema Digestório/induzido quimicamente , Neoplasias do Sistema Digestório/mortalidade , Exposição Ambiental/análise , Feminino , Vidro , Humanos , Incidência , Masculino , Instalações Industriais e de Manufatura , Neoplasias da Próstata/induzido quimicamente , Sistema de Registros , Doenças Respiratórias/mortalidade , Fatores Sexuais , Solo/química , Suécia/epidemiologia
16.
Oncotarget ; 8(19): 31435-31448, 2017 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-28416756

RESUMO

BACKGROUND: Digestive cancers are common malignancies worldwide, however there are few effective prognostic markers available. In this study we comprehensively investigated the prognostic significance of ZEB1 and ZEB2 in digestive cancers. METHODS: Electronic databases were searched and studies met the selection criteria were included. Study information was recorded and quality assessment was performed according to the REMARK guideline. Hazard ratios and its corresponding 95% confidence intervals were extracted and pooled. Sensitivity analyses, subgroup analyses, cumulative meta-analyses and secondary analyses were also performed to increase the stability and reliability of our results. RESULTS: 24 cohort studies were included in the study. High ZEB1 and ZEB2 levels predicted poor overall survival, meanwhile high ZEB2 levels predicted poor disease free survival for digestive cancer patients. From subgroup analyses we observed ZEB1 was found to be significantly associated with poor overall survival for patients with pancreatic cancer, gastric cancer and colorectal cancer, while ZEB2 was found to be significantly associated with poor overall survival for patients with hepatocellular carcinoma and gastric cancer. Furthermore, by conducting secondary analyses we confirmed both ZEB1 and ZEB2 played important roles in gastric cancer prediction. In addition, we found high ZEB1 and ZEB2 expression were significantly associated with depth of invasion, lymph node metastasis and TNM stage in digestive cancer patients. CONCLUSIONS: The present study validated the prognostic value and clinicopathological association of ZEB1 and ZEB2 in digestive cancers, especially in gastric cancer.


Assuntos
Neoplasias do Sistema Digestório/genética , Neoplasias do Sistema Digestório/mortalidade , Homeobox 2 de Ligação a E-box com Dedos de Zinco/genética , Homeobox 1 de Ligação a E-box em Dedo de Zinco/genética , Biomarcadores Tumorais , Estudos de Coortes , Neoplasias do Sistema Digestório/patologia , Humanos , Estimativa de Kaplan-Meier , Família Multigênica , Razão de Chances , Prognóstico
17.
J Gastroenterol Hepatol ; 32(3): 567-576, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28320060

RESUMO

BACKGROUND AND AIM: The role of octamer-binding transcription factor 4 (Oct4) has been implicated in the clinical prognosis of various kinds of digestive system cancers, but the results remain controversial. The purpose of this meta-analysis is to assess the potential role of Oct4 as a prognostic marker in digestive system tumors. METHODS: Relevant articles were retrieved from Pubmed, Web of Science, and Cochrane Library up to July 2016. The software Stata 12.0 was used to analyze the outcomes, including overall survival (OS), disease-free survival, recurrence-free survival, and clinicopathological characteristics. RESULTS: A total of 13 eligible studies with 1538 patients were included. Elevated Oct4 expression was significantly associated with poor OS (pooled hazard ratio [HR] = 2.183, 95% confidence interval [CI]: 1.824-2.612), disease-free survival (pooled HR = 1.973, 95% CI: 1.538-2.532), and recurrence-free survival (pooled HR = 2.209, 95% CI: 1.461-3.338) of digestive system malignancies. Subgroup analyses showed that cancer type, sample size, study quality, and laboratory detection method did not alter the significant prognostic value of Oct4. Additionally, Oct4 expression was found to be an independent predictive factor for OS (HR = 2.068, 95% CI: 1.633-2.619). No significant association was found between Oct4 and clinicopathological features of digestive system malignancies. CONCLUSION: This study provided evidence of Oct4 and/or its closely related homolog protein as a predictive factor for patients with digestive system cancers. More large-scale clinical studies on the prognostic value of Oct4 are warranted.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias do Sistema Digestório/diagnóstico , Fator 3 de Transcrição de Octâmero/análise , Bases de Dados Bibliográficas , Neoplasias do Sistema Digestório/mortalidade , Expressão Gênica , Humanos , Fator 3 de Transcrição de Octâmero/genética , Valor Preditivo dos Testes , Prognóstico , Taxa de Sobrevida
18.
BMC Surg ; 17(1): 23, 2017 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-28270136

RESUMO

BACKGROUND: Centralisation of specialist surgical services requires that patients are referred to a regional centre for surgery. This process may disadvantage patients who live far from the regional centre or are referred from other hospitals by making referral less likely and by delaying treatment, thereby allowing tumour progression. The aim of this study is to explore the outcome of surgery for peri-ampullary cancer (PC) with respect to referring hospital and travel distance for treatment within a network served by five hospitals. METHODS: Review of a unit database was undertaken of patients undergoing surgery for PC between January 2006 and May 2014. RESULTS: 394 patients were studied. Although both the median travel distance for patients from the five hospitals (10.8, 86, 78.8, 54.7 and 89.2 km) (p < 0.05), and the annual operation rate for PC (2.99, 3.29, 2.13, 3.32 and 3.07 per 100,000) (p = 0.044) were significantly different, no correlation was noted between patient travel distance and population operation rate at each hospital. No difference was noted between patients from each hospital in terms of resection completion rate or pathological stage of the resected tumours. The median survival after diagnosis for patients referred from different hospitals ranged from 1.2 to 1.7 years and regression analysis revealed that increased travel distance to the regional centre was associated with a small survival advantage. CONCLUSION: Although variation in the provision and outcome of surgery for PC between regional hospitals is noted, this is not adversely affected by geographical isolation from the regional centre. TRIAL REGISTRATION: This study is part of post-graduate research degree project. The study is registered with ClinicalTrials.gov (unique identifier NCT02296736 ) November 18, 2014.


Assuntos
Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/mortalidade , Neoplasias do Ducto Colédoco/cirurgia , Bases de Dados Factuais , Neoplasias Duodenais/mortalidade , Neoplasias Duodenais/cirurgia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Encaminhamento e Consulta , Análise de Sobrevida , Resultado do Tratamento , Reino Unido/epidemiologia
19.
J Vasc Interv Radiol ; 28(4): 594-601, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28169138

RESUMO

PURPOSE: To describe outcomes of patients with malignant biliary obstruction who undergo salvage percutaneous biliary drainage after occlusion of endoscopic biliary stents. MATERIALS AND METHODS: A single-center retrospective review was performed of 47 patients (25 men, 22 women) who underwent percutaneous biliary drainage for recurrent obstruction after endoscopic stent placement between 2005 and 2015. Primary malignancies were bile duct (n = 13), colorectal (n = 11), gallbladder (n = 7), pancreas (n = 5), hepatocellular (n = 4), and other (n = 7). Indication for salvage drain placement was infection (n = 19) and jaundice or need to decrease bilirubin (n = 28). Kaplan-Meier and Cox regression methods were used for survival analysis. Logistic and multivariate regressions were employed to identify factors associated with survival. RESULTS: Median survival after salvage biliary drain placement was 1.8 months (95% confidence interval [CI], 1.3-2.7). Elevated international normalized ratio (INR) ≥ 1.5 before drainage was associated with poorer survival after drainage (median survival 0.7 months vs 2.4 months, P < .01). Median survival was shorter in 28 patients (64%) with bilirubin ≤ 2 mg/dL (34.2 µmol/L) after drainage (1.2 months vs 5.4 months, P < .001). Left-sided drain placement, elevated bilirubin, and elevated INR correlated with decreased likelihood of achieving bilirubin ≤ 2 mg/dL (34.2 µmol/L) (odds ratio [OR] 0.13, 95% CI, 0.02-0.71, P = .02; OR 0.18, 95% CI, 0.05-0.69, P = .01; OR 0.10, 95% CI, 0.01-0.90, P = .04). CONCLUSIONS: Survival is limited for most patients who undergo salvage percutaneous biliary drainage. Elevated bilirubin and INR before drainage portend a poor prognosis.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colestase/terapia , Neoplasias do Sistema Digestório/complicações , Drenagem/instrumentação , Terapia de Salvação , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Bilirrubina/sangue , Biomarcadores/sangue , California , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/mortalidade , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/mortalidade , Neoplasias do Sistema Digestório/diagnóstico por imagem , Neoplasias do Sistema Digestório/mortalidade , Drenagem/efeitos adversos , Drenagem/métodos , Drenagem/mortalidade , Feminino , Humanos , Coeficiente Internacional Normatizado , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação/efeitos adversos , Terapia de Salvação/mortalidade , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
20.
J Vasc Interv Radiol ; 28(4): 583-593, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28162906

RESUMO

PURPOSE: To prospectively evaluate safety and efficacy of biliary stent placement with iodine-125 (125I) seeds in patients with malignant obstructive jaundice (MOJ). MATERIALS AND METHODS: From July 2011 to June 2014, 55 patients were enrolled (group A, 11 men and 17 women, mean age 70.93 y ± 8.58; group B, 14 men and 13 women, mean age 70.26 y ± 9.71). All patients were randomly assigned to placement of a biliary stent with 125I seeds (group A) or biliary stent only (group B). After stent placement, outcomes were measured regarding relief of MOJ. Clinical success rate, survival time, and safety were recorded. P < .05 was considered to indicate significant difference. RESULTS: Stents were successfully placed in all 55 patients. MOJ was relieved in all patients, and there were no significant differences in complications related to stent insertion between the 2 groups. Mean and median stent patency were 191 days ± 19.8 (95% confidence interval [CI], 152-230 d) and 179 days ± 191.4 (95% CI, 87-267 d) in group A and 88.3 days ± 16.3 (95% CI, 61-114 d) and 77 days ± 88.2 (95% CI, 65-86 d) in group B (P < .001, log-rank test). Mean and median survival time were 222.6 days ± 21.0 (95% CI, 181-263 d) and 241 days ± 18.2 (95% CI, 179-270 d) in group A and 139.1 days ± 14.5 (95% CI, 110-167 d) and 142 days ± 16.3 (95% CI, 83-177 d) in group B (P < .001, log-rank test). CONCLUSIONS: 125I seeds combined with biliary stent placement could significantly improve stent patency. The procedure seems to be safe and to extend survival compared with self-expandable biliary stent placement.


Assuntos
Braquiterapia , Colestase/terapia , Neoplasias do Sistema Digestório/complicações , Radioisótopos do Iodo/administração & dosagem , Icterícia Obstrutiva/terapia , Stents Metálicos Autoexpansíveis , Idoso , Idoso de 80 Anos ou mais , Ligas , Braquiterapia/efeitos adversos , China , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/mortalidade , Neoplasias do Sistema Digestório/diagnóstico por imagem , Neoplasias do Sistema Digestório/mortalidade , Feminino , Humanos , Radioisótopos do Iodo/efeitos adversos , Icterícia Obstrutiva/diagnóstico por imagem , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/mortalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Prospectivos , Radiografia Intervencionista , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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