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1.
J Invest Surg ; 36(1): 1-10, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36341742

RESUMO

OBJECTIVE: To compare the recurrence rate and prognosis between minimally invasive surgical (MIS) approach and open surgical approach of endometrial carcinoma (EC) patients with different prognostic risk groups. METHODS: A retrospective analysis of all cases undergoing EC surgery between January 2011 and March 2018 was performed. The patients were grouped according to the management guidelines of EC patients jointly formulated by the ESGO/ESTRO/ESP 2020. Different surgical approaches were compared with regard to tumor characteristics, recurrence rate, disease-free survival (DFS), and overall survival (OS). RESULTS: A total of 665 patients met the inclusion criteria of which 196 patients underwent MIS (29.5%), and 469 patients underwent open surgery (70.5%). In the MIS group, there was a significant higher rate of recurrence (17.3% vs 6.6%, P = 0.000) compared to the open surgery group. The recurrence rate of MIS was 7.7% (P = 0.000) in the medium-high risk group and 8.2% (P = 0.014) in the high-risk group. Multivariate logistic regression analysis showed that the independent factors influencing recurrence included prognostic risk grouping, surgical approach and lymph vascular space invasion (LVSI) positivity (P < 0.05). K-M survival analysis revealed that in the intermediate and high-risk group of EC, MIS patients had a significantly lower DFS than those undergoing open surgery (P < 0.05), but no significant difference was found in OS. CONCLUSIONS: For patients with EC at moderate and high prognostic risk, MIS is associated with poorer DFS compared to open surgery, but OS was similar across prognostic risk groups. The application of MIS in patients with moderate and high-risk EC needs further research and analysis.


Assuntos
Neoplasias do Endométrio , Feminino , Humanos , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Intervalo Livre de Doença , Recidiva Local de Neoplasia/epidemiologia
2.
Medicina (Kaunas) ; 58(11)2022 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-36363471

RESUMO

Background and Objectives: During the coronavirus disease 2019 (COVID-19) outbreak, the European Association of Urology (EAU) Guidelines Office Rapid Reaction Group (GORRG) recommended that patients with clinical stage I (CSI) seminoma be offered active surveillance (AS). This meta-analysis aimed to evaluate the efficacy of AS versus adjuvant treatment with chemotherapy or radiotherapy for improving the overall survival (OS) of CSI seminoma patients. Materials and Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed/Medline, EMBASE, and Cochrane Library databases were searched. The primary outcome was 5-year OS, and the secondary outcome was the 5-year relapse-free survival (RFS). The outcomes were analyzed as odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 14 studies were included. Overall, the quality scores were relatively high, and little publication bias was noted. In terms of the 5-year OS, 7 studies were analyzed; there was no significant difference between AS and adjuvant treatment (OR, 0.99; 95% CI, 0.41-2.39; p = 0.97). In terms of 5-year RFS, 12 studies were analyzed. Adjuvant treatment reduced the risk of 5-year recurrence by 85% compared with AS (OR, 0.15; 95% CI, 0.08-0.26; p < 0.001). Conclusions: In terms of the OS in CSI seminoma patients, no intergroup difference was noted, so it is reasonable to offer AS, as recommended by the EAU GORRG until the end of the COVID-19 pandemic. However, since there is a large intergroup difference in the recurrence rate, further research on the long-term (>5 years) outcomes is warranted.


Assuntos
COVID-19 , Seminoma , Neoplasias Testiculares , Urologia , Masculino , Humanos , Seminoma/tratamento farmacológico , Seminoma/radioterapia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/radioterapia , Pandemias , Estadiamento de Neoplasias , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Radioterapia Adjuvante
3.
BMC Ophthalmol ; 22(1): 436, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36376823

RESUMO

BACKGROUND: To investigate the correlation between the clinical and pathological characteristics and outcomes in patients with eyelid malignant tumors underwent wide local excision. METHODS: This retrospective study included 141 cases of eyelid malignant neoplasms from January 2010 to December 2015 in Shanxi eye hospital. Demographic and clinical information were collected. The Kaplan-Meier method was used to calculate survival curves, and the log-rank test method was used to compare survival between groups. Cox proportional regression models were used to calculate the hazard ratios (HR) of total recurrence rate and metastasis rate. RESULTS: Overall, there were 141 eyelid malignant neoplasms cases aged 65.34 ± 9.69 (range, 41-88) years old. The duration time range was from 1 to 828 (61.09 ± 122.21) months. Basal cell carcinoma (BCC) is the most common of all eyelid malignancies, accounting for 84 (59.5%), followed by Sebaceous gland carcinoma (SGC, 41, 29%), Squamous Cell Carcinoma (SCC, 11, 7.8%), Malignant Melanoma (MM, 3, 2.1%)。On cox-regression analysis, pathological classification (HR 1.959; 95% CI 1.012-3.790; p = 0.046) and eyelid tumor surgery history (HR 17.168; 95% CI 1.889-156.011; p = 0.012) were independently associated with recurrence in patients with eyelid malignant neoplasm. Pathological classification (HR 2.177; 95% CI 1.423 -3.331; p < 0.001) was independently associated with metastasis in patients with eyelid malignant neoplasm. Recurrence and metastasis were most likely to occur in 3 years after surgery. CONCLUSION: Wide local excision is an effective and economical treatment for eyelid malignant neoplasms. The prognosis is mainly related to pathological types, eyelid tumor surgical history and TNM stages.


Assuntos
Neoplasias Palpebrais , Neoplasias das Glândulas Sebáceas , Neoplasias Cutâneas , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Palpebrais/cirurgia , Neoplasias Palpebrais/patologia , Estudos Retrospectivos , Recidiva Local de Neoplasia/epidemiologia , Pálpebras/cirurgia , Pálpebras/patologia , China/epidemiologia , Neoplasias das Glândulas Sebáceas/cirurgia , Neoplasias das Glândulas Sebáceas/patologia
4.
J Neuroendocrinol ; 34(10): e13193, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36306194

RESUMO

Neuroendocrine neoplasms (NENs) present with advanced disease at diagnosis in up to 28% of cases, precluding the possibility of curative-intent surgery. Histopathological heterogeneity of this disease can be observed inter-individually as well as intra-individually during disease course. The present study aimed to assess the frequency of Ki-67 change after radical surgery, in a series of patients with radically resected entero-pancreatic neuroendocrine tumors (EP-NETs). We present the analysis of a multicenter, retrospective, series of EP-NETs G1-G2 recurring after radical resection and with histological re-evaluation at disease recurrence (DR). The primary endpoint was the description of Ki-67 change at DR compared to time of surgery. The secondary endpoint was assessment of recurrence-free survival (RFS) rates. In total, 47 patients had a second histological evaluation and could be included in the present study. Median Ki-67 at surgery was 3% (range 1-15%) but, at DR, a significant increase in the value was observed (7%, range 1-30%; p < .01) and involved 66.0% of cases, with a corresponding increase in tumor grading in 34.0% (p = .05). Median RFS of the overall population was 40 months, and was worse when Ki-67 increased at DR vs. stable Ki-67 value (36 vs. 61 months, respectively; p = .02). In conclusion, in more than half of the cases with relapse after radical surgery, a higher proliferative index with a potentially more aggressive potential was observed. Therefore, histological reassessment should be considered on DR because tailored therapeutic strategies may be required for these patients.


Assuntos
Tumores Neuroendócrinos , Neoplasias Pancreáticas , Humanos , Antígeno Ki-67 , Estudos Retrospectivos , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Estadiamento de Neoplasias , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Tumores Neuroendócrinos/cirurgia , Tumores Neuroendócrinos/patologia , Prognóstico
5.
BJS Open ; 6(5)2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36254732

RESUMO

BACKGROUND: The optimal timing of surgery following chemoradiotherapy (CRT) is controversial. This trial aimed to assess disease recurrence and survival rates between patients with locally advanced rectal adenocarcinoma (LARC) who underwent total mesorectal excision (TME) after a waiting interval of 8 weeks or less (classic interval; CI) versus more than 8 weeks (long interval; LI) following preoperative CRT. METHODS: This was a phase III, single-centre, randomized clinical trial. Patients with LARC situated within 12 cm of the anal verge (T3-T4 or N+ disease) were randomized to undergo TME within or after 8 weeks after CRT. RESULTS: Between January 2006 and January 2017, 350 patients were randomized, 175 to each group. As of February 2022, the median follow-up time was 80 (6-174) months. Among the 322 included patients (CI, 159; LI, 163) the cumulative incidence of locoregional recurrence at 5 years was 10.1 per cent in the CI group and 6.9 per cent in the LI group (P = 0.143). The cumulative incidence of distant metastasis at 5 years was 30.8 per cent in the CI group and 18.6 per cent in the LI group (sub-HR = 1.78; 95 per cent c.i. 1.14 to 2.78, P = 0.010). The disease-free survival (DFS) in each group was 59.7 and 69.9 per cent respectively (P = 0.157), and overall survival (OS) rates at 5 years were 73.6 versus 77.9 per cent (P = 0.476). CONCLUSION: Incidence of distant metastasis decreased with an interval between CRT and surgery exceeding 8 weeks, but this did not impact on DFS or OS. REGISTRATION NUMBER: NCT03287843 (http://www.clinicaltrials.gov).


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Quimiorradioterapia/métodos , Humanos , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia
6.
Clin Imaging ; 92: 94-100, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36257084

RESUMO

PURPOSE: To develop machine learning (ML) and multivariable regression models to predict ipsilateral breast event (IBE) risk after ductal carcinoma in situ (DCIS) treatment. METHODS: A retrospective investigation was conducted of patients diagnosed with DCIS from 2007 to 2014 who were followed for a minimum of five years after treatment. Data about each patient were extracted from the medical records. Two ML models (penalized logistic regression and random forest) and a multivariable logistic regression model were developed to evaluate recurrence-related variables. RESULTS: 650 women (mean age 56 years, range 27-87 years) underwent treatment for DCIS and were followed for at least five years after treatment (mean 8.0 years). 5.5% (n = 36) experienced an IBE. With multivariable analysis, the variables associated with higher IBE risk were younger age (adjusted odds ratio [aOR] 0.96, p = 0.02), dense breasts at mammography (aOR 3.02, p = 0.02), and < 5 years of endocrine therapy (aOR 4.48, p = 0.02). The multivariable regression model to predict IBE risk achieved an area under the receiver operating characteristic curve (AUC) of 0.75 (95% CI 0.67-0.84). The penalized logistic regression and random forest models achieved mean AUCs of 0.52 (95% CI 0.42-0.61) and 0.54 (95% CI 0.43-0.65), respectively. CONCLUSION: Variables associated with higher IBE risk after DCIS treatment include younger age, dense breasts, and <5 years of adjuvant endocrine therapy. The multivariable logistic regression model attained the highest AUC (0.75), suggesting that regression models have a critical role in risk prediction for patients with DCIS.


Assuntos
Neoplasias da Mama , Carcinoma Ductal de Mama , Carcinoma Intraductal não Infiltrante , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pré-Escolar , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/terapia , Carcinoma Intraductal não Infiltrante/patologia , Mastectomia Segmentar , Modelos Logísticos , Estudos Retrospectivos , Carcinoma Ductal de Mama/patologia , Aprendizado de Máquina , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia
7.
J Coll Physicians Surg Pak ; 32(10): 1334-1338, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36205281

RESUMO

OBJECTIVE: To review the surgical and oncological outcomes of patients who underwent hepatic resection for hepatocellular carcinoma (HCC). STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of Surgery of the Aga Khan University Hospital Karachi, from 2008 to 2019. METHODOLOGY: Consecutive patients who underwent hepatic resection for HCC at the Hospital were included. The data were collected and analysed on aspects including demographics, liver function status, tumour characteristics, perioperative management, and surgical and oncological outcomes. Survival analyses were performed using the Kaplan-Meier method, and log-rank test was applied to determine the influence of variables on overall and disease-free survival. RESULTS: A total of 59 patients underwent hepatic resection for HCC during the study period including 38(64%) males. The majority of the patients had a single lesion (88%), unilobar disease (95%), underlying cirrhosis (75%) and BCLC stage B (73%). Major hepatic resection was performed in 27(46%) patients. The mean duration of surgery was 288+101 minutes and the mean estimated blood loss was 986+637 mls. Postoperative complications developed in 22(37%) patients including surgical complications in 11(19%), liver decompensation in 4(7%) and systemic complications in 9(15%) patients. The overall 30-day mortality was 7%. With a mean follow-up of 2.8 years, disease recurrence was documented in 25(42%) patients and the median overall survival was 45 months. CONCLUSION: Hepatic resection for HCC is an effective treatment option in this setup. Despite low volumes, surgical and oncological outcomes of hepatic resection for HCC were comparable to the international standards. KEY WORDS: Hepatocellular carcinoma, Liver resection, Cirrhosis.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/patologia , Estudos de Coortes , Países em Desenvolvimento , Intervalo Livre de Doença , Feminino , Hepatectomia/métodos , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/patologia , Masculino , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 101(40): e30831, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36221366

RESUMO

In recent years, postponing childbearing has increased the prevalence of pregnancy-associated breast cancer (PABC). PABC has a poorer prognosis than breast cancer not associated with pregnancy (non-PABC) due to delayed diagnosis and aggressive subtype. Additionally, pregnancy itself predicts a poor prognosis; but, this is a subject of debate. Thus, we analyzed the effects of known prognostic factors and pregnancy on the prognosis of PABC. We retrospectively analyzed women aged 20 to 49 years who were diagnosed with breast cancer (BC) between 1989 and 2014. Patients were distributed into PABC and non-PABC groups, and 1:4 propensity score matching was performed to adjust for baseline characteristics. Primary endpoints were overall survival (OS) and BC-specific survival (BCSS). Secondary endpoint was the difference in prognosis according to BC subtype. Of the 34,970 recruited patients with BC, 410 (1.2%) had PABC. Patients with PABC were younger and tended to have triple-negative BC (TNBC) subtype than non-PABC patients. The 1640 matched non-PABC patients showed a significantly worse mean survival rate than the unmatched non-PABC patients. Patients with PABC had a significantly worse OS and BCSS than those with non-PABC. In multivariate analyses, patients with PABC of luminal B (Ki-67 ≥14.0%) and TNBC subtypes had worse OS and BCSS than patients with non-PABC. Patients with PABC had poorer prognosis than non-PABC patients after adjusting for several prognostic factors. This difference was particularly significant in patients with the luminal B and TNBC subtypes.


Assuntos
Neoplasias da Mama , Complicações Neoplásicas na Gravidez , Neoplasias de Mama Triplo Negativas , Feminino , Humanos , Antígeno Ki-67 , Recidiva Local de Neoplasia/epidemiologia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 101(40): e31076, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36221433

RESUMO

This study evaluated the effect of body composition and pelvic fat distribution on the aggressiveness and prognosis of localized prostate cancer. This study included patients who underwent robot-assisted radical prostatectomy with positive surgical margins. Clinicodemographic data were collected from patients' medical reports. Pretreatment magnetic resonance images (MRI) obtained for cancer staging were reviewed by a single radiologist to calculate pelvic fat distribution and body composition. We correlated these body composition parameters with initial prostate-specific antigen (iPSA), Gleason score, extracapsular tumor extension, and biochemical recurrence (BCR)-free survival. The iPSA was significantly associated with body mass index (BMI; P = .027), pelvic fat volume (P = .004), and perirectal fat volume (P = .001), whereas the Gleason score was significantly associated with BMI only (P = .011). Tumor extracapsular extension was significantly associated with increased periprostatic fat volume (P = .047). Patients with less subcutaneous fat thickness (<2.4 cm) had significantly poor BCR-free survival (P = .039). Pelvic fat distribution, including pelvic fat volume, perirectal fat volume, and periprostatic fat volume, were significantly correlated with prostate cancer aggressiveness. Patients with less subcutaneous fat had an increased risk of BCR after radical prostatectomy.


Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Composição Corporal , Humanos , Masculino , Gradação de Tumores , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/patologia
10.
Radiat Oncol ; 17(1): 165, 2022 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-36229880

RESUMO

INTRODUCTION: The first line of treatment for nonfunctioning pituitary adenoma (NFPA) is surgery. Adjuvant radiotherapy or surveillance and new treatment (second surgical operation or salvage radiotherapy) in case of recurrence are options discussed at the multidisciplinary tumor board. The purpose of this study was to evaluate the therapeutic outcome for each option. METHODS: The records of 256 patients followed with NFPA between 2007 and 2018 were retrospectively reviewed. Mean age at initial surgery was 55 years [18-86]. Post-operative MRI found a residual tumor in 87% of patients. Mean follow-up was 12.1 years [0.8-42.7]. RESULTS: After initial surgery, 40 patients had adjuvant radiotherapy. At 5, 10 and 15 years progression-free survival (PFS) was significantly different after surgery alone (77%, 58% and 40%) compared to surgery and adjuvant radiotherapy (84%, 78% and 78%) (HR = 0.24 [0-0.53] p < 0.0005). Overall, after first, second or third surgical operation, 69 patients had adjuvant radiotherapy and 41 salvage radiotherapy. Five-year PFS was similar for adjuvant (90%) and salvage radiotherapy (97%) (p = 0.62). After a second surgical operation, 62% and 71% of patients were irradiated after 2 and 5 years respectively. The risk of corticotropic and thyrotropic deficiency rates were 38% and 59% after second or third surgical operation and 40% and 73% after radiotherapy. Brain tumors occurred in 4 patients: 1 meningioma present at initial surgery, and after radiotherapy, 1 neurinoma which appeared at 5 years, 1 glioblastoma at 13 years and 1 meningioma at 20 years. CONCLUSION: Among patients treated by surgery for NFPA, a "wait-and-see" attitude should be an option since adjuvant radiotherapy is not superior to salvage radiotherapy. However, in case of recurrence or progression, the authors recommended delivery of salvage radiotherapy to avoid a second surgical operation.


Assuntos
Adenoma , Neoplasias Meníngeas , Meningioma , Neoplasias Hipofisárias , Adenoma/radioterapia , Adenoma/cirurgia , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/radioterapia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Hipofisárias/radioterapia , Neoplasias Hipofisárias/cirurgia , Radioterapia Adjuvante , Estudos Retrospectivos , Resultado do Tratamento
11.
Rev. esp. enferm. dig ; 114(10): 580-585, octubre 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-210772

RESUMO

Background and objectives: this study aimed to determine the risk factors of recurrence beyond Milan criteria inpatients with transplantable early hepatocellular carcinoma(HCC) after the first radiofrequency ablation (RFA).Materials and methods: a total of 95 patients with newlydiagnosed transplantable small HCC with single lesions≤ 3 cm were analyzed retrospectively.Results: during the 39-month median follow-up period, 12(21.8 %) patients with HCC < 2 cm and 22 (56.4 %) patientswith HCC ≥ 2 cm relapsed beyond Milan criteria (p = 0.001).The 1- and 3-year recurrence rates beyond Milan criteriawere 6.3 % and 14.7 % in the HCC < 2 cm group, comparedwith 24.1 % and 55.6 % in the HCC ≥ 2 cm group (p < 0.0001).HCC ≥ 2 cm, red blood cell distribution width-to-lymphocyte ratio (RLR) ≥ 18.3, alpha-fetoprotein (AFP) > 15 ng/ml,and early recurrence after RFA were independent predictorsof recurrence exceeding Milan criteria.Conclusions: close follow-up and early liver transplantationshould be initiated to obtain the best survival benefit forpatients with transplantable early, single, small HCC witha tumor diameter ≥ 2 cm and higher RLR and AFP levelsbefore the first RFA and early recurrence after RFA (recurrence within 2 years). (AU)


Assuntos
Humanos , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Recidiva Local de Neoplasia/epidemiologia , Ablação por Radiofrequência , Resultado do Tratamento , Estudos Retrospectivos , Fatores de Risco
12.
J Plast Reconstr Aesthet Surg ; 75(11): 4160-4168, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36180337

RESUMO

BACKGROUND: Autologous fat grafting (AFG) has become a commonly used procedure for breast reconstruction (BR) after cancer removal. Nevertheless, oncological considerations remain for AFG after breast cancer surgery. OBJECTIVES: This article aims to evaluate the oncological safety of AFG in BR and its effect on disease-free survival (DFS) and local-regional recurrences (LRR). METHODS: A systematic review regarding the use of AFG in BR to identify a difference in incidence rates of LRR and DFS between patients who had AFG and controls was performed using PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus, and Cochrane databases. The protocol was developed following the Preferred Reporting for Items for Systematic Reviews-Protocols (PRISMA-P) guidelines. The included studies had to match predetermined criteria according to the PICOS approach. RESULTS: A total of 11 studies were included. Seven studies reported LRR, and 5 studies reported DFS in 5,886 patients. Our systematic review showed that AFG was not associated with increased LRR and DFS. Pooled hazard ratios (HRs) (95% confidence intervals [CIs]) for LRR and DFS were 1.26 (0.90-1.76) and 1.27 (0.96-1.69), respectively. CONCLUSIONS: AFG can, therefore, be performed safely in BR after breast cancer. Further, randomized controlled trials and related systematic reviews, as well as evidence-based medicine (EBM) studies of level 1, are required to consolidate the results of the studies identified in this systematic review.


Assuntos
Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Neoplasias da Mama/cirurgia , Neoplasias da Mama/complicações , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Tecido Adiposo/transplante , Revisões Sistemáticas como Assunto , Metanálise como Assunto , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos
13.
ESMO Open ; 7(5): 100578, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36116422

RESUMO

BACKGROUND: The role of both hormonal contraception and pregnancy on the outcomes of desmoid-type fibromatosis (DF) is debatable. MATERIALS AND METHODS: In the present study, we selected female patients of childbearing age from the prospective ALTITUDES cohort. The primary study endpoint was event-free survival (EFS), with an event defined as relapse or progression. We estimated the risk of events according to the use of hormonal contraception [estrogen-progestin (EP) and progestin] and pregnancy status using multivariate time-dependent models, controlling for major confounders. RESULTS: A total of 242 patients (median age, 34.7 years) were included in the present study. The abdominal wall was the most common tumor site (51%). Patients were managed by active surveillance (80%) or surgery (20%). Pregnancy occurred within 24 months before, at the time of, and after DF diagnosis in 33%, 5%, and 10% of the cases, respectively. Exposure to hormonal contraception was documented within 24 months before, at the time of, and after diagnosis in 44%, 34%, and 39% of the cases, respectively. The 2-year EFS was 75%. After adjusting for DF location, tumor size, front-line treatment strategy, and hormonal contraception, we observed an increased risk of events occurring at 24 months after pregnancy [hazard ratio (HR) = 2.09, P = 0.018]. We observed no statistically significant association between the risk of events and current EP exposure (HR = 1.28, P = 0.65), recent EP exposure (within 1-24 months, HR = 1.38, P = 0.39), current progestin exposure (HR = 0.81, P = 0.66), or recent progestin exposure (HR = 1.05, P = 0.91). CONCLUSIONS: In our study, a recent history of pregnancy was associated with an increased risk of progression/relapse in patients with newly diagnosed DF, whereas hormonal contraception did not demonstrate an association with progression/relapse.


Assuntos
Anticoncepcionais , Fibromatose Agressiva , Humanos , Gravidez , Feminino , Adulto , Progestinas/efeitos adversos , Fibromatose Agressiva/induzido quimicamente , Estudos Prospectivos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/induzido quimicamente , Estrogênios
14.
JAMA Surg ; 157(11): 1034-1041, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36069821

RESUMO

Importance: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer strongly correlates with overall survival and has become the standard end point in neoadjuvant trials. However, there is controversy regarding whether the definition of pCR should exclude or permit the presence of residual ductal carcinoma in situ (DCIS). Objective: To examine the association of residual DCIS in surgical specimens after neoadjuvant chemotherapy for breast cancer with survival end points to inform standards for the assessment of pathologic complete response. Design, Setting, and Participants: The study team analyzed the association of residual DCIS after NAC with 3-year event-free survival (EFS), distant recurrence-free survival (DRFS), and local-regional recurrence (LRR) in the I-SPY2 trial, an adaptive neoadjuvant platform trial for patients with breast cancer at high risk of recurrence. This is a retrospective analysis of clinical specimens and data from the ongoing I-SPY2 adaptive platform trial of novel therapeutics on a background of standard of care for early breast cancer. I-SPY2 participants are adult women diagnosed with stage II/III breast cancer at high risk of recurrence. Interventions: Participants were randomized to receive taxane and anthracycline-based neoadjuvant therapy with or without 1 of 10 investigational agents, followed by definitive surgery. Main Outcomes and Measures: The presence of DCIS and EFS, DRFS, and LRR. Results: The study team identified 933 I-SPY2 participants (aged 24 to 77 years) with complete pathology and follow-up data. Median follow-up time was 3.9 years; 337 participants (36%) had no residual invasive disease (residual cancer burden 0, or pCR). Of the 337 participants with pCR, 70 (21%) had residual DCIS, which varied significantly by tumor-receptor subtype; residual DCIS was present in 8.5% of triple negative tumors, 15.6% of hormone-receptor positive tumors, and 36.6% of ERBB2-positive tumors. Among those participants with pCR, there was no significant difference in EFS, DRFS, or LRR based on presence or absence of residual DCIS. Conclusions and Relevance: The analysis supports the definition of pCR as the absence of invasive disease after NAC regardless of the presence or absence of DCIS. Trial Registration: ClinicalTrials.gov Identifier NCT01042379.


Assuntos
Neoplasias da Mama , Carcinoma Ductal de Mama , Carcinoma Intraductal não Infiltrante , Adulto , Feminino , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Intraductal não Infiltrante/tratamento farmacológico , Terapia Neoadjuvante , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasia Residual/tratamento farmacológico , Receptor ErbB-2 , Estudos Retrospectivos , Adulto Jovem , Pessoa de Meia-Idade , Idoso
15.
Lancet Gastroenterol Hepatol ; 7(11): 991-1004, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36087608

RESUMO

BACKGROUND: Robotic surgery for rectal cancer is gaining popularity, but evidence on long-term oncological outcomes is scarce. We aimed to compare surgical quality and long-term oncological outcomes of robotic and conventional laparoscopic surgery in patients with middle and low rectal cancer. Here we report the short-term outcomes of this trial. METHODS: This multicentre, randomised, controlled, superiority trial was done at 11 hospitals in eight provinces of China. Eligible patients were aged 18-80 years with middle (>5 to 10 cm from the anal verge) or low (≤5 cm from the anal verge) rectal adenocarcinoma, cT1-T3 N0-N1 or ycT1-T3 Nx, and no evidence of distant metastasis. Central randomisation was done by use of an online system and was stratified according to participating centre, sex, BMI, tumour location, and preoperative chemoradiotherapy. Patients were randomly assigned at a 1:1 ratio to receive robotic or conventional laparoscopic surgery. All surgical procedures complied with the principles of total mesorectal excision or partial mesorectal excision (for tumours located higher in the rectum). Lymph nodes at the origin of the inferior mesenteric artery were dissected. In the robotic group, the excision procedures and dissection of lymph nodes were done by use of robotic techniques. Neither investigators nor patients were masked to the treatment allocation but the assessment of pathological outcomes was masked to the treatment allocation. The primary endpoint was 3-year locoregional recurrence rate, but the data for this endpoint are not yet mature. Secondary short-term endpoints are reported in this article, including two key secondary endpoints: circumferential resection margin positivity and 30-day postoperative complications (Clavien-Dindo classification grade II or higher). The outcomes were analysed according in a modified intention-to-treat population (according to the original assigned groups and excluding patients who did not undergo surgery or no longer met inclusion criteria after randomisation). This trial was registered with ClinicalTrials.gov, number NCT02817126. Study recruitment has completed, and the follow-up is ongoing. FINDINGS: Between July 17, 2016, and Dec 21, 2020, 1742 patients were assessed for eligibility. 502 patients were excluded, and 1240 patients were enrolled and randomly assigned to receive either robotic surgery (620 patients) or laparoscopic surgery (620 patients). 69 patients were excluded (34 in the robotic surgery group and 35 in the laparoscopic surgery group). 1171 patients were included in the modified intention-to-treat analysis (586 in the robotic group and 585 in the laparoscopic group). Six patients in the robotic surgery group received laparoscopic surgery and seven patients in the laparoscopic surgery group received robotic surgery. 22 (4·0%) of 547 patients in the robotic group had a positive circumferential resection margin as did 39 (7·2%) of 543 patients in the laparoscopic group (difference -3·2 percentage points [95% CI -6·0 to -0·4]; p=0·023). 95 (16·2%) of patients in the robotic group had at least one postoperative complication (Clavien-Dindo grade II or higher) within 30 days after surgery, as did 135 (23·1%) of 585 patients in the laparoscopic group (difference -6·9 percentage points [-11·4 to -2·3]; p=0·003). More patients in the robotic group had a macroscopic complete resection than in the laparoscopic group (559 [95·4%] of 586 patients vs 537 [91·8%] of 585 patients, difference 3·6 percentage points [0·8 to 6·5]). Patients in the robotic group had better postoperative gastrointestinal recovery, shorter postoperative hospital stay (median 7·0 days [IQR 7·0 to 11·0] vs 8·0 days [7·0 to 12·0], difference -1·0 [95% CI -1·0 to 0·0]; p=0·0001), fewer abdominoperineal resections (99 [16·9%] of 586 patients vs 133 [22·7%] of 585 patients, difference -5·8 percentage points [-10·4 to -1·3]), fewer conversions to open surgery (10 [1·7%] of 586 patients vs 23 [3·9%] of 585 patients, difference -2·2 percentage points [-4·3 to -0·4]; p=0·021), less estimated blood loss (median 40·0 mL [IQR 30·0 to 100·0] vs 50·0 mL [40·0 to 100·0], difference -10·0 [-20·0 to -10·0]; p<0·0001), and fewer intraoperative complications (32 [5·5%] of 586 patients vs 51 [8·7%] of 585 patients; difference -3·3 percentage points [-6·3 to -0·3]; p=0·030) than patients in the laparoscopic group. INTERPRETATION: Secondary short-term outcomes suggest that for middle and low rectal cancer, robotic surgery resulted in better oncological quality of resection than conventional laparoscopic surgery, with less surgical trauma, and better postoperative recovery. FUNDING: Shenkang Hospital Development Center, Shanghai Municipal Health Commission (Shanghai, China), and Zhongshan Hospital Fudan University (Shanghai, China).


Assuntos
Laparoscopia , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , China , Humanos , Margens de Excisão , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia
16.
Urol Oncol ; 40(10): 457.e1-457.e7, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36088244

RESUMO

PURPOSE: To investigate the local recurrence rates of men treated with Mohs microsurgery (MMS) for penile carcinoma. The secondary outcome was surgical complications from the MMS procedure or the subsequent reconstructive procedures. MATERIALS AND METHODS: All patients from 2010 to 2020 with penile carcinoma at our institution were seen in a multidisciplinary setting. Patients with Ta, Tis, T1, and T2 disease were considered candidates for MMS. Clinical and pathologic data were collected for analysis. Local recurrence rates were stratified by stage and complications reported per the Clavien-Dindo Grade. RESULTS: A total of 43 patients met inclusion criteria. The median age at diagnosis was 64 years. Stage distribution was Ta in 4.7%, Tis in 58.1%, T1a in 14.0%, T1b in 7.0%, and T2 in 16.3%. No patients had a positive surgical margin after MMS. The overall local recurrence rate was 2% (n = 1) at a median of 47 months. Local recurrence rates at 1, 3, and 5 years for Ta, Tis, and T1 patients were 0%. Local recurrence rates for T2 patients were 14% at 1 year. Complications occurred in 12% (n = 5), all of which were Clavien-Dindo ≤ III. CONCLUSIONS: MMS provides effective local control for Ta, Tis, and T1 penile cancer with an overall local recurrence rate of 2% and an acceptable complication rate. A multi-disciplinary team involving urologic oncology, reconstructive urology, and MMS is essential to patient management.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Penianas , Neoplasias Cutâneas , Carcinoma de Células Escamosas/patologia , Humanos , Masculino , Microcirurgia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Neoplasias Penianas/patologia , Neoplasias Penianas/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
17.
Pediatr Surg Int ; 38(12): 2035-2044, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36169670

RESUMO

PURPOSE: The management of pediatric ovarian neoplasms (ON) is based on finding a balance between adequate surgical treatment and future reproductive capacity. We aimed to evaluate long-term results of patients who underwent surgery for ON. METHODS: A retrospective cohort study design was used. Medical records of patients with ON were reviewed. They were invited to participate in a telephone-based survey assessing complaints, menstrual status, and post-surgical recurrence. RESULTS: Eighty-five patients were operated for ON between 1995 and 2015. Median age at surgery was 14.7 years. 62.4% of patients had ovary-sparing surgery (OSS). Median tumor size in oophorectomy group was significantly larger than OSS group (p = 0.029). Median length of follow-up was 5.1 years. Recurrent/metachronous disease was not significantly different between OSS and oophorectomy groups (p = 1.000). In OSS group, irregular menses (p = 0.004) and painful menses (p = 0.002) were significantly higher than oophorectomy group. CONCLUSION: The main goal of treatment in pediatric ON is to find the right balance between adequate and appropriate tumor resection and maximal effort for fertility preservation. Our results showed no difference between oophorectomy and OSS in the terms of recurrence. Although irregular and painful menses were found to be significantly higher in the OSS group, longer follow-up and prospective studies are needed to clarify this issue.


Assuntos
Neoplasias Ovarianas , Criança , Humanos , Feminino , Adolescente , Estudos Retrospectivos , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/patologia , Ovariectomia/métodos , Resultado do Tratamento , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias
18.
Dermatol Surg ; 48(11): 1159-1165, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36095258

RESUMO

BACKGROUND: Perineural invasion (PNI) is considered a high-risk histopathologic feature in many skin cancers. Perineural invasion is a well-known poor prognostic factor of squamous cell carcinoma, but is poorly understood in the context of basal cell carcinoma (BCC). OBJECTIVE: To analyze available demographic, clinical, and treatment data for BCC with PNI and the effect of these variables on recurrence patterns, disease progression, and cancer-specific mortality (CSM). METHODS: A systematic review and pooled-survival analysis was performed using case reports and series of patients with perineural BCC. RESULTS: This review included 159 patients from 49 publications. Of these cases, 57 patients reported at least one recurrence. Where reported, median follow-up time was 31 months for patients without recurrence ( n = 79) and 21 months for patients with recurrence ( n = 32). The cumulative incidence of CSM at 5 years was 8.5% (95% confidence interval [CI] 0.028-0.186) and the overall five-year survival was 90.9% (95% CI 0.796-0.961). CONCLUSION: Male gender, multifocal nerve involvement, presence of clinical symptoms, and PNI detected on imaging are associated with poor prognosis of BCC with PNI. The high rate of disease recurrence and suboptimal cumulative incidence of CSM highlights the importance of early clinical detection, before the onset of symptomatic PNI and multifocal nerve involvement.


Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Humanos , Masculino , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/epidemiologia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Análise de Sobrevida , Prognóstico , Nervos Periféricos/patologia , Estudos Retrospectivos
19.
Dis Colon Rectum ; 65(12): 1514-1521, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36102853

RESUMO

BACKGROUND: Phenolization of pilonidal sinus disease has been shown to have advantages over radical excision with regard to short-term outcome; however, long-term outcomes are essentially lacking. OBJECTIVE: The aim of this randomized controlled trial was to compare the long-term outcome of pit excision and phenolization of the sinus tracts vs radical excision with primary wound closure in pilonidal sinus disease. DESIGN: Single-center, randomized controlled trial. SETTINGS: A primary teaching hospital in the Netherlands. PATIENTS: The study population included patients with primary pilonidal sinus disease presented between 2013 and 2017. INTERVENTIONS: Patients were randomly assigned to either pit excision with phenolization of the sinus tract(s) or excision with primary off-midline wound closure. MAIN OUTCOME MEASURES: The main outcomes included recurrence, quality of life (Short-Form 36), and patient's satisfaction. RESULTS: A total of 100 patients were randomized. Seventy-four patients (77.1%) were available for long-term follow-up. The mean (±SD) time to follow-up was 48.4 (±12.8) months for the phenolization group and 47.8 (±13.5) months for the excision group. No significant difference was found between both groups regarding quality of life. Two patients in the phenolization group (5.6%) and 1 in the excision group (2.6%) developed a recurrence ( p = 0.604). The impact of the whole treatment was significantly less after phenolization ( p = 0.010). LIMITATIONS: The response rate was almost 80% in this young patient population, patients and assessors were not blinded for the type of surgery, and the results are only applicable to primary pilonidal sinus disease. CONCLUSIONS: Because of the previously shown favorable short-term results and the currently reported comparable long-term recurrence rate and quality of life between phenolization and excision, phenolization should be considered the primary treatment option in patients with pilonidal sinus disease. See Video Abstract at http://links.lww.com/DCR/C27 . DUTCH TRIAL REGISTER ID: NTR4043. RESULTADO A LARGO PLAZO DE LA ESCISIN RADICAL FRENTE AL TRATAMIENTO CON FENOL DEL TRACTO SINUSAL EN LA ENFERMEDAD DEL SENO PILONIDAL SACRO COCCGEO PRIMARIO UN ENSAYO ALEATORIO CONTROLADO: ANTECEDENTES:El tratamiento con fenol de la enfermedad del seno pilonidal ha demostrado tener ventajas sobre la escisión radical con respecto al resultado a corto plazo; sin embargo, los resultados a largo plazo aún se encuentran escasos.OBJETIVO:El objetivo de este ensayo aleatorio controlado fue comparar el resultado a largo plazo de la escisión de la fosa del quiste y el tratamiento con fenol de los trayectos sinusales frente a la escisión radical con cierre primario de la herida en la enfermedad del seno pilonidal.DISEÑO:Ensayo aleatorio controlado de un solo centro.AJUSTES:Hospital de enseñanza primaria en los Países Bajos.PACIENTES:Pacientes con enfermedad primaria del seno pilonidal presentados entre 2013 y 2017.INTERVENCIONES:Los pacientes fueron asignados de manera aleatoria a la escisión de la fosa del quiste y posterior administración de fenol de los tractos sinusales o a la escisión con cierre primario de la herida fuera de la línea media.PRINCIPALES MEDIDAS DE RESULTADO:Recurrencia, calidad de vida (Short-Form 36) y satisfacción del paciente.RESULTADOS:Un total de 100 pacientes con enfermedad primaria del seno pilonidal fueron aleatorizados; 50 pacientes fueron sometidos al tratamiento con fenol y 50 a la escisión radical. Eventualmente, 74 pacientes (77,1%) estuvieron disponibles para seguimiento a largo plazo; 36 pacientes después del uso del fenol y 38 después de la escisión. El tiempo medio (± desviación estándar) de seguimiento fue de 48,4 (± 12,8) y 47,8 (± 13,5) meses, respectivamente. No hubo diferencia significativa entre ambos grupos con respecto a la calidad de vida. En el grupo tratado con fenal, dos pacientes (5,6%) desarrollaron recurrencia y un paciente (2,6%) en el grupo de escisión ( p = 0,604). El impacto de todo el tratamiento fue significativamente menor después del uso del fenol (p = 0,010).LIMITACIONES:La tasa de respuesta fue de casi el 80% en esta población de pacientes jóvenes, los pacientes y los evaluadores no estaban cegados por el tipo de cirugía, los resultados son solo aplicables a la enfermedad primaria del seno pilonidal.CONCLUSIONES:Debido a los resultados favorables a corto plazo descritos y a la tasa de recurrencia a largo plazo y la calidad de vida comparables actualmente informadas entre la administración de fenol y la escisión con cierre primario de la herida para la enfermedad primaria del seno pilonidal, la administración de fenol del tracto sinusal debe considerarse como opción de tratamiento primario en pacientes con enfermedad del seno pilonidal. Consulte Video Resumen en http://links.lww.com/DCR/C27 . (Traducción-Dr. Osvaldo Gauto )Registro de prueba holandés-ID:NTR4043.


Assuntos
Fístula , Seio Pilonidal , Humanos , Recidiva Local de Neoplasia/epidemiologia , Seio Pilonidal/cirurgia , Qualidade de Vida
20.
Comput Math Methods Med ; 2022: 8028846, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36110571

RESUMO

Background: The incidence of papillary thyroid microcarcinoma (PTMC) has significantly increased in recent years, and the decision to use radioactive iodine (RAI) ablation in low-risk (LR) and intermediate-risk (IR) patients is controversial. The aim of this study was to evaluate whether RAI ablation can reduce the recurrence rate in LR-IR PTMC patients. Methods: A comprehensive literature search of the PubMed, Embase, Cochrane Library, and Web of Science was conducted according to the PRISMA statement. Results: There were 8 studies in English that fit our search strategy, and a total of 2847 patients were evaluated. The results of the meta-analysis showed RAI ablation in LR-IR PTMC patients did not reduce cancer recurrence (risk radio (RR) 0.56, 95% CI 0.19-1.70, P = 0.31). Nevertheless, we further performed data analysis and found that IR PTMC patients without RAI ablation had a higher rate of cancer recurrence than those who underwent RAI ablation (RR 0.23, 95% CI 0.11-0.49, P = 0.0001). Furthermore, patients with risk factors for lymph node metastasis (RR 0.16, 95% CI 0.06-0.42, P = 0.0002), microscopic extrathyroidal extension (RR 0.19, 95% CI 0.06-0.60, P = 0.005), and multifocality (RR 0.13, 95% CI 0.04-0.45, P = 0.001) in the absence of RAI ablation were more likely to have recurrence. Conclusions: Based on our current evidence, RAI ablation can reduce the cancer recurrence rate over 5 years in IR PTMC patients, especially when patients have some risk factors, such as lymph node metastasis, microscopic extrathyroidal extension, and multifocality.


Assuntos
Iodo , Neoplasias da Glândula Tireoide , Carcinoma Papilar , Humanos , Radioisótopos do Iodo/uso terapêutico , Metástase Linfática , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia
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