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INTRODUCTION: Malignant rhabdoid tumor (MRT) is a highly aggressive disease, mainly affecting infants and small children. MATERIAL AND METHODS: Between January 2007 and May 2021 a retrospective study was conducted at the Hospital de Pediatría J. P. Garrahan in Buenos Aires, Argentina, including 13 patients diagnosed with ERNC-MRT (extra-renal non-cerebral malignant rhabdoid tumor). Event-free survival (EFS) and overall survival (OS) were assessed using the Kaplan-Meier method and compared using the log-rank test. RESULTS: Seven patients were less than 1 year old, all of them died. Four of 13 had metastatic disease, all of them in the lungs, 2 had locoregional lymph node involvement. Six achieved complete remission, 4 of them remained alive. Five received maintenance therapy (MT) with cyclophosphamide/vinorelbine, 4 were alive at last follow-up. Only one was studied for germline mutations, the result was negative. With a median follow-up of 126 months (range: 72-161), 3 and 5-year EFS and OS were 30.7% and 38.4%, respectively. DISCUSSION: Although the sample size is small, survival rates are similar or slightly lower than other series. Age was the main prognostic factor. All but one patient that received MT are alive, suggesting that MT might have a role in ERNC-MRT; however, the prognostic significance is not entirely clear since there are multiple confounding factors.
Introducción: El tumor rabdoide maligno (TRM) es una enfermedad altamente agresiva que afecta principalmente a lactantes y niños pequeños. Materiales y métodos: Entre enero de 2007 y mayo de 2021 se realizóun estudio retrospectivo en el Hospital de Pediatría J. P. Garrahan de Buenos Aires, Argentina, incluyendo 13 pacientes diagnosticados con tumor rabdoide maligno extrarrenal extra-cerebral. La sobrevida libre de eventos (SLE) y la sobrevida global (SG) se evaluaron mediante el método de Kaplan-Meier y se compararon mediante la prueba de rango logarítmico. Resultados: Siete pacientes tenían menos de 1 año al diagnóstico y todos fallecieron. Cuatro de 13 tenían enfermedad metastásica, todos ellos en los pulmones, 2 tenían afectación ganglionar loco-regional. Seis alcanzaron la remisión completa, 4 de ellos sobrevivieron. Cinco recibieron terapia de mantenimiento (TM) con ciclofosfamida/vinorelbine, 4 estaban vivos en el último control. Solo uno fue estudiado para mutaciones de línea germinal, el resultado fue negativo. Con una mediana de seguimiento de 126 meses (rango: 72-161), la SLE y la SG a 3 y 5 años fue de 30.7 % y 38.4 %, respectivamente. Discusión: Aunque el tamaño muestral es pequeño, las tasas de sobrevida son similares o ligeramente inferiores a otras series. La edad fue el principal factor pronóstico. El uso de TM prolongósignificativamente la sobrevida; sin embargo, la importancia pronóstica no está del todo clara ya que existen múltiples factores confundidores.
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Quimioterapia de Manutenção , Tumor Rabdoide , Humanos , Tumor Rabdoide/mortalidade , Tumor Rabdoide/tratamento farmacológico , Estudos Retrospectivos , Masculino , Feminino , Lactente , Pré-Escolar , Quimioterapia de Manutenção/métodos , Criança , Argentina/epidemiologia , Estimativa de Kaplan-Meier , Taxa de SobrevidaRESUMO
OBJECTIVE: This systematic review and meta-analysis aim to consolidate current evidence on the diagnosis, epidemiology, and treatment of urachal carcinoma, a rare malignancy with limited data. MATERIALS AND METHODS: A systematic search of PubMed/MEDLINE was conducted up to September 2024 to identify studies involving patients with urachal carcinoma, reporting clinical epidemiological characteristics, diagnostic strategies, histopathological findings, tumor staging, treatment modalities, and oncological outcomes. Extracted data were systematically synthesized, and statistical analyses, including a single-arm meta-analysis, were performed to comprehensively evaluate oncological outcomes. RESULTS: Our study includes 1,901 cases of urachal carcinoma from 50 studies. The findings support the oncologic advantage of en-bloc resection with umbilectomy in localized disease, demonstrating improved survival outcomes and reduced recurrence rates. In the adjuvant setting, those receiving cisplatin-based therapy presented the best response, with 65.73% with no disease progression; similarly, in the metastatic disease, cisplatin-based regimens seem to have better responses in metastatic disease. The single-arm meta-analysis estimated a 5-year overall survival rate of 51% (95% CI: 0.49-0.54). Tumor recurrence was documented in 35% of cases (95% CI: 0.25-0.45), with local recurrence occurring in 28% (95% CI: 0.18-0.38), with the average time to recurrence of 27.6 months. CONCLUSION: Our study provides the most comprehensive review of urachal carcinoma to date, providing evidence to guide clinical decisions. It underscores the oncologic benefits of en-bloc resection with umbilectomy and specific chemotherapeutic regimens. Emerging alternative therapies also show potential, highlighting the need for further research to optimize patient outcomes.
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Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Taxa de SobrevidaRESUMO
Homeobox A9 promoter methylation (HOXA9) has been reported as a biomarker for early lung adenocarcinoma patients' prognosis. We aim to evaluate its prognostic value, regardless of disease stage. Using droplet digital PCR, we measured HOXA9 methylation in a cohort comprising 161 Brazilian patients. Low HOXA9 methylation was associated with higher cancer-specific survival but showed no significance after adjustment for clinical covariates. While low HOXA9 methylation was associated with earlier stages, no survival association was observed in this subset of patients. Overall, HOXA9 promoter methylation is not an independent prognostic biomarker of cancer-specific survival in Brazilian lung adenocarcinomas patients.
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Adenocarcinoma de Pulmão , Biomarcadores Tumorais , Metilação de DNA , Proteínas de Homeodomínio , Neoplasias Pulmonares , Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/terapia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Brasil/epidemiologia , Proteínas de Homeodomínio/genética , Regiões Promotoras Genéticas , Regulação Neoplásica da Expressão Gênica , Prognóstico , Biomarcadores Tumorais/genética , Estadiamento de Neoplasias , Taxa de Sobrevida , Valor Preditivo dos Testes , Estimativa de Kaplan-Meier , Distribuição por Idade , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Medição de Risco/métodosRESUMO
PURPOSE: We investigated the impact of the funding source (public v private) on the overall survival (OS) of men with prostate cancer in Brazil. METHODS: We retrospectively analyzed patients with prostate cancer from a large hospital registry from the state of São Paulo, Brazil. Patients age 50-99 years diagnosed with prostate acinar adenocarcinoma or adenocarcinoma not otherwise specified (NOS) between January 2014 and December 2017 were eligible. Demographic and clinical features were analyzed alongside the funding source. On the basis of clinical characteristics at diagnosis (lymph node status, distant metastasis, prostate-specific antigen [PSA], and Gleason score), patients were categorized into low-risk, intermediate-risk, high-risk, and metastatic groups. RESULTS: Of 25,009 patients analyzed, 85% had a public funding source. These patients were slightly older, had greater proportion of adenocarcinoma NOS, and higher PSA levels and risk category. There was a significant difference in OS favoring patients with a private funding source (P < .0001). The estimated OS rates at 5 years were 76.2% (95% CI, 75.6 to 76.9) and 86.9% (95% CI, 85 to 88.7) for the public and private groups, respectively (P < .0001). The funding source was significantly associated with OS independent of age, educational level, and receipt of any treatment in the intermediate-risk (hazard ratio [HR], 2.28 [95% CI, 1.58 to 3.30]; P < .001) and high-risk (HR, 1.36 [95% CI, 1.02 to 1.80]; P = .04) groups, but not in the low-risk (HR, 0.85 [95% CI, 0.60 to 1.21]; P = .38) or metastatic groups (HR, 0.84 [95% CI, 0.64 to 1.11]; P = .23). CONCLUSION: The worse OS observed for patients with prostate cancer with a public source of funding underscores the need for actions directed to improve the standards of public health care in Brazil.
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Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/economia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Idoso , Pessoa de Meia-Idade , Brasil/epidemiologia , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Antígeno Prostático Específico/sangue , Taxa de SobrevidaRESUMO
Introduction: Lung cancer is the leading cause of death by cancer worldwide and has a high lethality. The best treatment for patients with localized disease is anatomical surgical resection, granting good average survival in the long term. We did not find Chilean studies focusing on complications, long term survival or potential association with pathological or clinical factors. The aim of this work is to describe clinical characteristics, surgical complications and 5-to-10-year survival of a cohort of lung cancer patients operated in the Clinical Hospital of University of Chile and explore possible prognostic factors influencing in it. Methods: A 107 patient's cohort of operated lung cancer patients in a single center from 2004 to 2015 was analyzed. We included patients with curative intent surgery performed in our hospital and excluded non- primary lung cancer histology or biopsies analyzed in other center. Clinical, perioperative and histopathologic data were collected. 5-10 year overall survival was determined and an exploratory analysis of prognostic factors on survival was performed. Results: We found 107 surgeries fulfilling criteria, with 27% morbidity and 5.6% and 6.5% mortality at 30 and 90 days, respectively. 5- and 10-year overall survival was 44.7% and 32.3%, respectively. Univariate analysis found that gender, age, histology, disease stage, loco-regional dissemination and postoperative complications were factors associated with survival. Multivariate analysis confirmed that gender, age, loco-regional dissemination and postoperative complications were independent factors associated with survival. Conclusions: Surgical results of a cohort of patients operated in a Chilean center show that 30 and 90-days mortality aligned with data reported worldwide. Overall survival in these selected patients is far better than reported in lung cancer patients. Risk factors that may be screened in preoperative analysis were found, which could change prognosis. Those findings suggest that improving preoperative evaluation could optimize patient selection to obtain better performance in surgical results and overall long-term survival.
Introducción: El cáncer pulmonar es la primera causa de muerte por cáncer a nivel mundial, con una alta letalidad. El mejor tratamiento para pacientes con enfermedad localizada es la resección anatómica, que logra buenas sobrevidas promedio a largo plazo. En Chile no encontramos estudios enfocados en esta cirugía en términos de complicaciones, sobrevida a largo plazo, ni su potencial asociación con factores clínicos o patológicos. El objetivo de este trabajo es describir las características clínicas, complicaciones perioperatorias y sobrevida a 5 y 10 años de una cohorte de pacientes con cáncer pulmonar, operados en el Hospital Clínico de la Universidad de Chile, así como explorar posibles factores pronósticos que inciden en ella. Metodología: Se analizó una cohorte de 107 pacientes con cáncer pulmonar operados desde el año 2004 hasta 2015 en un solo centro. El criterio de inclusión fue cirugía de intención curativa realizada en nuestro hospital. Los criterios de exclusión fueron cirugías con otra intención, biopsia no concordante con cáncer primario pulmonar o analizada en otro centro. Se registraron datos clínicos, perioperatorios e histopatológicos. Se estimó la sobrevida global a 5 y 10 años, y se realizó un análisis exploratorio de posibles factores pronósticos que pudieran incidir en la sobrevida. Resultados: Se realizaron 107 cirugías que cumplieron el criterio. Se registró 27% de complicaciones con mortalidad de 5,6% a 30 días y 6,5% a 90 días. La sobrevida global fue de 44,7% a cinco años y 32,3% a 10 años. El análisis univariado mostró que factores con efecto en la sobrevida son sexo, edad, histología del tumor, estadio de la enfermedad, nivel de diseminación regional y la presencia de complicaciones postoperatorias. El análisis multivariado confirma que sexo, edad, nivel de diseminación regional y complicaciones postoperatorias se asocian de manera independiente a sobrevida. Conclusiones: Los resultados quirúrgicos de una cohorte de pacientes operados en un centro chileno muestran una mortalidad a 30 y 90 días similar a otras reportadas en la literatura internacional. La sobrevida global en estos pacientes seleccionados es mucho mayor a la reportada para pacientes con cáncer pulmonar en general. Se encontraron factores de riesgo eventualmente pesquisables en el estudio preoperatorio, que podrían cambiar el pronóstico. Estos hallazgos sugieren que mejorar la evaluación preoperatoria, permitiría optimizar la selección de pacientes para obtener mejores resultados quirúrgicos y de sobrevida a largo plazo.
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Neoplasias Pulmonares , Complicações Pós-Operatórias , Humanos , Masculino , Chile , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Feminino , Idoso , Pessoa de Meia-Idade , Prognóstico , Estudos de Coortes , Taxa de Sobrevida , Complicações Pós-Operatórias/epidemiologia , Idoso de 80 Anos ou mais , Adulto , Hospitais Universitários , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Cholangiocarcinoma (CCA) is a rare neoplasm, with high mortality, originating in the bile ducts. Its incidence is higher in Eastern countries due to the endemic prevalence of liver parasites. Factors such as metabolic syndrome, smoking, and pro-inflammatory conditions are also linked to the disease. Clinical features include asthenia, abdominal pain, cholestasis, and increased serum levels of CEA and CA19-9. AIMS: The aim of this study was to evaluate CCA prevalence, survival, and potential prognostic and therapeutic implications in a patient cohort and assess correlations with clinical laboratory data and possible associated risk factors. METHODS: This is a retrospective study of the clinical and histological data of patients diagnosed with CCA at Santa Casa de Misericórdia in Porto Alegre, Brazil, between 2016 and 2021. RESULTS: There was a 56% prevalence of CCA in women, with intrahepatic localization in 55.4% of cases and unifocality in 85.6% of patients. The mean age of the patients was 63 years (26-89 years), with a mean tumor size of 5.5 cm. The median survival time was 7 months (0 to >50). CA19-9 was altered in 81% of patients, whereas GOT/GPT was altered in 62.5% and gamma-glutamyl transferase/alkaline phosphatase/bilirubin in 69.1% of patients. Mortality was higher among patients with extrahepatic CCA. CONCLUSION: Risk factors such as smoking, cholecystectomy, cirrhosis, intrahepatic lithiasis, and transplantation should be considered individually by the attending physician for radiological monitoring and incidental discovery of the neoplasm. Lack of timely identification by the attending physician can delay diagnosis, increasing mortality.
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Neoplasias dos Ductos Biliares , Colangiocarcinoma , Humanos , Colangiocarcinoma/epidemiologia , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/patologia , Pessoa de Meia-Idade , Feminino , Masculino , Estudos Retrospectivos , Brasil/epidemiologia , Neoplasias dos Ductos Biliares/epidemiologia , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/diagnóstico , Idoso , Adulto , Prognóstico , Idoso de 80 Anos ou mais , Prevalência , Fatores de Risco , Taxa de SobrevidaRESUMO
BACKGROUND: Gastric cancer remains a major global health challenge, ranking fourth in cancer-related deaths. Total gastrectomy with lymphadenectomy is the standard treatment, with advancements in surgery shifting towards minimally invasive techniques to reduce surgical trauma and metabolic response. Esophagojejunal anastomotic leak is a frequent complication of gastrectomy, significantly increasing morbidity and mortality rates by up to 64%. MATERIALS AND METHODS: A retrospective cohort study reviewed adults undergoing total gastrectomy for gastric cancer who developed esophagojejunal anastomotic leaks. The study described patient characteristics, diagnostic methods, and management at Clinica Universitaria Colombia from 2013 to 2023. RESULTS: Among 500 patients who had total gastrectomy, 54 developed esophagojejunal leaks. The cohort was 64.8% male, average age 55.2 years (± 14.87), and average BMI 24.5 kg/m². Notably, 18.5% smoked, 11.1% had lung disease, and 9.3% had heart disease or diabetes. Chest tomography was used in 60% of cases, followed by endoscopy in 35.2%. Endoscopic management with fully covered stents was the main strategy, used in 84% of cases. Average hospitalization was 18 days, with 33% needing intensive care, and overall hospital stay was 23.31 ± 16.33 days. Patients undergoing neoadjuvant and elective laparoscopic surgeries had a significant 30-day mortality risk. CONCLUSIONS: Despite advances in surgical techniques and perioperative management, esophagojejunal anastomotic leaks continue to represent a serious complication, increasing morbidity and mortality. Therefore, early postoperative detection, based on the patient's clinical signs that allow confirmatory studies to be performed, is crucial. This facilitates the implementation of timely treatments, whether conservative, through the use of endoscopic or percutaneous strategies, or surgical procedures. The next step for the scientific community will be to conduct studies with long-term follow-ups to ensure consistency of the high-quality results reported so far.
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Fístula Anastomótica , Gastrectomia , Hospitais com Alto Volume de Atendimentos , Neoplasias Gástricas , Humanos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Seguimentos , Prognóstico , Idoso , Adulto , Colômbia/epidemiologia , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Jejuno/cirurgia , Jejuno/patologia , Esôfago/cirurgia , Esôfago/patologia , Excisão de Linfonodo/efeitos adversos , Taxa de SobrevidaRESUMO
BACKGROUND: High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reducing deaths in this group. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point-of-care dry weight (POC-DW) technique. METHODS: The present observational, prospective study was carried out at the Pafram hemodiafiltration unit in Morona Santiago, Ecuador, and the hemodialysis unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POC-DW for eight weeks. In Group 1, patients whose use of antihypertensive drugs was not required to control systolic blood pressure with a value less than 150 mmHg predialysis, less than 130 mmHg postdialysis, and a peridialytic blood pressure (defined as post-HD minus pre-HD SBP) between 0 and - 20 mmHg were analyzed. In Group 2, patients who required antihypertensive drugs for not meeting the aims of systolic blood pressure were included. The variables included clinical, demographic, mortality, description of the treatment, and routine laboratory tests in dialysis programs. The sample was nonprobabilistic. Survival analysis was performed for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons. RESULTS: The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125-4.158) (P = 0.0243). CONCLUSION: In hemodiafiltration and hemodialysis programs, blood pressure control with active ultrafiltration measures and without using antihypertensives is essential for survival in patients with CKD.
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Anti-Hipertensivos , Hemodiafiltração , Diálise Renal , Insuficiência Renal Crônica , Humanos , Masculino , Estudos Prospectivos , Feminino , Hemodiafiltração/métodos , Pessoa de Meia-Idade , Anti-Hipertensivos/uso terapêutico , Idoso , Insuficiência Renal Crônica/terapia , Insuficiência Renal Crônica/mortalidade , Hipertensão/tratamento farmacológico , Pressão Sanguínea , Taxa de SobrevidaRESUMO
OBJECTIVE: To apply the Toronto Childhood Cancer Staging Guidelines (TG) and Estimate the Observed Survival Probabilities for Pediatric Patients with Leukemia and Lymphoma. METHODS: Staging at diagnosis was conducted according to tier 2 of the TG. The study cohort included patients aged 0 -19 years from the Population-Based Cancer Registry (PBCR) of Mato Grosso, diagnosed with leukemia and lymphoma between 2008 and 2017, with follow-up until December 31, 2022. Observed 60-month survivals were calculated using the Kaplan-Meier method. RESULTS: Staging was assigned in 67.3% of cases (n=239), while in 32.7% (n=116), staging could not be applied due to incomplete data. Among the cases of acute lymphoblastic leukemia (ALL), 70.7% (n=133) were staged as CNS1, with an observed survival probability of 75.0%. For acute myeloid leukemia (AML), 42.2% (n=21) were staged as CNS-, with an estimated survival of 60.0%. Most Hodgkin lymphoma (HL) cases were staged as IIA/B (37.7%, n=23) and IIIA/B (21.3%, n=13), with survival probabilities of 91.3% and 91.7%, respectively. Among non-Hodgkin lymphoma (NHL) cases, 32.1% (n=18) were staged as stage III, with a survival probability of 70.6%. CONCLUSION: The application of TG in the PBCR in Mato Grosso proved feasible, allowing for comparability of survival estimates across different stages. However, collecting tier 2 staging information will be a challenge for the PBCR due to incomplete information in medical records.
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Neoplasias Hematológicas , Estadiamento de Neoplasias , Sistema de Registros , Humanos , Criança , Adolescente , Pré-Escolar , Feminino , Masculino , Brasil/epidemiologia , Lactente , Taxa de Sobrevida , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/epidemiologia , Recém-Nascido , Prognóstico , Seguimentos , Adulto Jovem , AdultoRESUMO
There is a limited information available on the clinical characteristics, treatment patterns and outcomes on older patients diagnosed with Acute Myeloid Leukemia (AML) in Latin-America. This multicenter retrospective study analyzed 269 patients over 60 years of age diagnosed with AML in Colombia, using data from RENEHOC-PETHEMA registry, from 2009 to 2023. The median age at diagnosis was 70 years (Range:60-98), 55% were men, 61% had an ECOG < 2, and 75.5% had de novo AML. FLT3-ITD or NPM1 mutations were performed in 23.4% and 15.6% patients, and detected in 14.3% and 16.7% of cases, respectively. Treatment included intensive chemotherapy (IC) (36.8%), Low-Intensity Regimen Based on Low-Dose Cytarabine (LDAC-based) (12.6%), hypomethylating agents (HMAs, with/without venetoclax) (35.3%), and supportive care (15.2%). The overall survival (OS) rate was 35.2% at 1 year and 5.6% at 5 years (13.7% for IC, 9.4% for LDAC-based, and 0% for other treatments); with median OS of 8.2 months (10.6 months after IC, 8.8 months after non-IC, 8.9 months after azacitidine/decitabine, 8.2 months after azacitidine-venetoclax, and 1.9 months with supportive care). Only 1.5% of patients underwent a transplant in the first line. The Leukemia-free survival (LFS) rate was 45.8% at 1-year and 13.7% at 5-years (22.4% for IC, 9.4% and 0% for other treatments); with median LFS of 9.5 months (17.3 months after IC, 7.4 months after LDAC-based, and 10.8 months after HMA). This study provides new insights into the management of patients in Colombia, highlighting the need for a highly individualized approach in treating AML in elderly patients.
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Leucemia Mieloide Aguda , Nucleofosmina , Humanos , Leucemia Mieloide Aguda/terapia , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/mortalidade , Masculino , Feminino , Colômbia/epidemiologia , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Resultado do Tratamento , Taxa de Sobrevida , Sistema de Registros , Intervalo Livre de DoençaRESUMO
BACKGROUND: Oral squamous cell carcinoma (OSCC) is an aggressive cancer, with prognosis influenced by clinical variables as well grading systems and perineural invasion (PNI), which are associated to poorer outcomes, including higher rates of recurrence and metastasis. This study aims to evaluate OSCC using three grading systems and assess the impact of PNI and clinicopathologic parameters on patient survival. MATERIAL AND METHODS: Eighty-one primary OSCC samples were analyzed. Histopathological evaluations were performed utilizing Malignancy Grading of the Deep Invasive Margins, WHO grading system, and the Histologic Risk Assessment. S-100 immunohistochemistry was used to detect PNI. Five-year disease-specific survival (DSS) curves were generated using the Kaplan-Meier method, and the Cox proportional hazards model analyzed prognostic significance. RESULTS: Advanced clinical stage was significantly associated with reduced survival (p-value <0.001, HR = 4.07). Patients without regional lymph node involvement had better survival (p-value 0.002, HR = 0.37). Higher histologic risk assessment scores were linked to worse outcomes. Multifocal neural invasion significantly correlated with poorer survival compared to unifocal invasion (p-value 0.017, HR = 4.20). Patients undergoing surgery followed by adjuvant therapies had better survival rates. CONCLUSIONS: Besides clinical stage and histological grade, PNI also showed to be a crucial prognostic factor in OSCC, necessitating aggressive treatment strategies.
Assuntos
Carcinoma de Células Escamosas , Neoplasias Bucais , Gradação de Tumores , Invasividade Neoplásica , Humanos , Masculino , Neoplasias Bucais/patologia , Neoplasias Bucais/mortalidade , Feminino , Pessoa de Meia-Idade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/mortalidade , Idoso , Taxa de Sobrevida , Adulto , Análise de Sobrevida , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Nervos Periféricos/patologiaRESUMO
BACKGROUND: GALOP investigators developed a prospective cooperative protocol for localized Ewing sarcoma (ES) incorporating interval-compressed chemotherapy (VDC/IE, vincristine, doxorubicin, cyclophosphamide/ifosfamide and etoposide). After completing conventional treatment, patients were randomized to 1 year of metronomic chemotherapy (vinblastine and cyclophosphamide). METHODS: Phase III randomized prospective trial. Induction consisted of six alternating cycles of VDC/IE every 14 days, followed by local control, and eight cycles of consolidation every 21 days. After consolidation, patients were randomized 1:1 to metronomic chemotherapy or stop treatment, balanced by age (>/< 14 years-old), sex (M/F), site (pelvic/non-pelvic), and size (>/< 8 cm). The results of randomization will be published elsewhere with longer follow-up. RESULTS: Between 2011 and 2019, 315 patients (59.7% male, median age 11.0 years) were recruited across 34 centers in Argentina, Brazil, Chile, and Uruguay. The most frequent localizations were axial (45.1%), extremity (38.1%), and pelvic (16.8%). The median time interval between cycles was 19 and 22 days at induction and consolidation, respectively. There were no unexpected toxicity or toxic deaths related to interval compression. The overall response rate post-induction was 81.6%. Local treatment with surgery (50.8%), radiotherapy (19.7%), or a combination (26%) was performed in 304 (96.5%) patients. With a median follow-up of 50 months (range: 1.67-121.7), the 5-year overall and event-free survivals were 68.6% (SE: 0.030) and 63.7% (SE: 0.029), respectively. CONCLUSION: Implementation of a multi-institutional protocol with the strategy of interval-compressed induction for ES in South America was feasible with favorable results. This success is attributed to rigorous protocol adherence, extensive educational efforts, and a strong emphasis on data quality maintenance, demonstrating a reproducible model for countries with similar resource limitations.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Ósseas , Ciclofosfamida , Doxorrubicina , Etoposídeo , Sarcoma de Ewing , Vincristina , Humanos , Sarcoma de Ewing/tratamento farmacológico , Sarcoma de Ewing/mortalidade , Sarcoma de Ewing/patologia , Masculino , Feminino , Criança , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Adolescente , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Vincristina/administração & dosagem , Vincristina/uso terapêutico , Etoposídeo/administração & dosagem , Estudos Prospectivos , Pré-Escolar , Ifosfamida/administração & dosagem , Taxa de Sobrevida , Seguimentos , América Latina , PrognósticoRESUMO
BACKGROUND: Peritoneal recurrence (PR) remains the most common pattern of relapse in gastric cancer (GC), even after curative resection. Given its dismal prognosis, the identification of risk factors for PR is essential for developing new treatment modalities and selecting a more appropriate subgroup of patients. This study aimed to evaluate the risk factors and survival outcomes of patients with GC who had PR and to develop a risk score to predict PR. METHODS: All patients with GC who underwent curative gastrectomy were included. For analysis, patients were divided into no recurrence (NR), recurrence in other sites (ROS), and PR. Risk factors for PR were analyzed to build a risk score. RESULTS: Among 622 patients with GC, 460 (74.0%) had NR, 98 (15.7%) had ROS, and 64 (10.3%) had PR. Female patients, linitis on computed tomography, depth of tumor invasion, and diffuse/mixed type were associated with PR. Patients with PR had worse overall survival than those with ROS (22.0 vs 29.8 months, respectively; P = .008). The median survival estimates after recurrence were 5.0 months in the PR group and 9.9 months in the ROS group (P < .001). The scoring system developed with 8 variables had an accuracy of 81% in predicting PR. Accordingly, 385 patients (61.9%) were classified as low risk, and 237 patients (38.1%) were classified as high risk. Among the 64 patients with PR, 53 (82.8%) were correctly classified as high risk (P < .001). CONCLUSION: Patients with PR had distinct clinicopathologic characteristics and extremely restricted survival compared with patients with recurrence in other sites. The risk-scoring model was able to identify patients at higher risk of PR.
Assuntos
Gastrectomia , Recidiva Local de Neoplasia , Neoplasias Peritoneais , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/mortalidade , Feminino , Gastrectomia/métodos , Gastrectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/cirurgia , Fatores de Risco , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Idoso , Estudos Retrospectivos , Medição de Risco/métodos , Invasividade Neoplásica , Adulto , Taxa de Sobrevida , Prognóstico , Fatores Sexuais , Idoso de 80 Anos ou maisRESUMO
Background: Mortality due to ischemic heart disease (IHD) is heterogeneously distributed globally, and identifying the sites most affected by it is essential in developing strategies to mitigate the impact of the disease, despite the complexity resulting from the great diversity of variables involved. Objective: To analyze the predictability of IHD mortality using machine learning (ML) techniques in combination with geospatial analysis in southern Brazil. Methods: Ecological study using secondary and retrospective data on mortality due to ischemic heart disease (IHD) obtained from the Mortality Information Systems (SIM-DATASUS) de 2018 a 2022, covering 1,191 municipalities in the states of Paraná (399), Santa Catarina (295), and Rio Grande do Sul (497). Ordinary Least Squares Regression (OLS), Geographically Weighted Regression (GWR), Random Forest (RF), and Geographically Weighted Random Forest (GWRF) analyses were performed to verify the model with the best performance capable of identifying the most affected sites by the disease based on a set of predictors composed by variables of procedures and access to health. Results: In the analyzed period, there were 59,093 deaths, 65% of which were men, 82.7% were white, and 72.8% occurred between 60 and 70 years of age. Ischemic heart disease presented the highest mortality rates in the northwest and north regions of the state of Paraná, and in the central-east, southwest and southeast regions of Rio Grande do Sul, the latter state accounting for 41% of total deaths. The GWRF presented the best performance with R2 = 0.983 and AICc = 2298.4, RMSE: 3.494 and the most important variables of the model in descending order were electrocardiograph rate, cardiac catheterization rate, access index to hemodynamics, access index of pre-hospital mobile units, cardiologists rate, myocardial scintigraphy rate, stress test rate, and stress echocardiogram rate. Conclusion: The GWRF identified spatial heterogeneity in the variation of geographic predictors, contrasting the limitation of linear regression models. The findings showed patterns of vulnerability in southern Brazil, suggesting the formulation of health policies to improve access to diagnostic and therapeutic resources, with the potential to reduce IHD mortality.
Assuntos
Aprendizado de Máquina , Isquemia Miocárdica , Humanos , Isquemia Miocárdica/mortalidade , Brasil/epidemiologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Taxa de Sobrevida/tendências , Fatores de Risco , AdultoRESUMO
INTRODUCTION: Cardiogenic shock carries a mortality rate of 40-50%. In cases that progress unfavorably despite pharmacological treatment, ventricular assist devices such as venoarterial extracorporeal membrane oxygenation play a prominent role. Although two recent controlled clinical trials have been published, the primary source of information remains observational studies, which are notably scarce in Argentina. MATERIALS AND METHODS: A retrospective cohort study was conducted, including patients from January 2012 to April 2023 with refractory cardiogenic shock supported by venoarterial extracorporeal membrane oxygenation. Their baseline characteristics, clinical course, and acute versus chronic presentation were analyzed. RESULTS: 61 patients were supported with venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock. 51% were supported as a bridge to cardiac transplantation. 84% of the patients were in INTERMACS grades 1 or 2 at the time of support initiation. The assisted patients had a survival rate of 44%, similar to results reported by the Extracorporeal Life Support Organization. The most frequent complications were renal replacement therapy (46%) and sepsis (38%). Patients with acute presentation had better survival outcomes. DISCUSSION: Venoarterial extracorporeal membrane oxygenation support is a valid therapy for refractory cardiogenic shock unresponsive to conventional treatments. Experience in Argentina is limited. In this study, survival rates align with international registries, highlighting the therapy's significant value in our institution. Acute presentation of cardiogenic shock correlates with improved survival outcomes.
Introducción: El shock cardiogénico presenta una mortalidad del 40-50%. En los casos que evoluciona desfavorablemente a pesar del tratamiento farmacológico, los dispositivos de asistencia ventricular, como la oxigenación por membrana extracorpórea venoarterial, adquieren un papel protagónico. Si bien recientemente se publicaron dos ensayos clínicos controlados, la mayor fuente de información proviene de estudios observacionales, siendo estos especialmente escasos en Argentina. Materiales y métodos: Se realizó un estudio de cohorte retrospectivo, que incluyó pacientes desde enero del 2012 a abril del 2023 con shock cardiogénico refractario asistidos con oxigenación por membrana extracorpórea venoarterial. Se analizaron sus características basales, evolución y forma de presentación en agudo versus crónica. Resultados: Sesenta y un pacientes fueron asistidos con oxigenación por membrana extracorpórea venoarterial por shock cardiogénico refractario. Al 51% se los asistió como puente a trasplante cardíaco. El 84% de los asistidos se encontraban en grados INTERMACS 1 o 2 al momento de la asistencia. Los pacientes asistidos presentaron una sobrevida del 44%, similar a los resultados publicados por Extracorporeal Life Support Organization. Las complicaciones más frecuentes fueron la terapia de reemplazo renal (46%) y la sepsis (38%). Los pacientes con presentación aguda tuvieron mayor sobrevida. Discusión: La asistencia con oxigenación por membrana extracorpórea venoarterial es una terapia válida para el shock cardiogénico refractario a terapias convencionales. La experiencia en Argentina es escasa. En el presente estudio la sobrevida se asemeja a registros internacionales, siendo esta terapia de gran valor en nuestra institución. La forma de presentación aguda del shock cardiogénico expone una mayor sobrevida.
Assuntos
Oxigenação por Membrana Extracorpórea , Choque Cardiogênico , Humanos , Choque Cardiogênico/terapia , Choque Cardiogênico/mortalidade , Oxigenação por Membrana Extracorpórea/métodos , Estudos Retrospectivos , Masculino , Argentina , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Resultado do Tratamento , Taxa de SobrevidaRESUMO
BACKGROUND: Laparoscopic gastrectomy offers advantages in the postoperative period compared to the open approach. Most studies have been performed on distal gastrectomies; however, laparoscopic total gastrectomy (LTG) is not universally accepted. AIM: The aim of this study was to assess the results of LTG, on postoperative morbidity outcomes and long-term survival. METHODS: This is a retrospective cohort study from a prospective database of patients who underwent LTG, from 2005 to 2022, due to early and advanced gastric cancer. A totally laparoscopic technique was utilized, and the Roux-en-Y reconstruction was performed in all cases. Postoperative complications and long-term survival were evaluated. RESULTS: A total of 100 patients were included (men 57, age 64 years, and body mass index 26). A D2 lymphadenectomy was performed in 68 cases. The postoperative hospitalization period was 8 days (6-62 days). Postoperative complications occurred in 26%, with 7% esophago-jejunal anastomosis leak, 4% abdominal collections, and 2% gastrointestinal bleeding. In 7% of cases, the complication was considered Clavien 3 or greater. Operative mortality was 1%. The pathology findings confirmed advanced gastric cancer in 50 cases. The median lymph node count was 38, and surgery was considered R0 in 99%. The median follow-up was 50 months. Overall 5-year survival was 74%. Survival in T1 cases was 95% at 5 years. For stage I, survival was 95%, and for stages II and III, it was 52% and 43%, at 5 years, respectively. CONCLUSIONS: These results support the feasibility and oncological adequacy of minimally invasive total gastrectomy. Postoperative morbidity has an acceptable rate. Long-term survival was in accordance with the disease stage.
Assuntos
Gastrectomia , Laparoscopia , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/mortalidade , Gastrectomia/métodos , Masculino , Pessoa de Meia-Idade , Laparoscopia/métodos , Feminino , Estudos Retrospectivos , Idoso , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , Taxa de Sobrevida , Adulto , Estadiamento de Neoplasias , Resultado do Tratamento , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE. T: O determine whether tumor size, categorized as >5 cm or ≤5 cm, influences overall survival in patients with primary breast sarcoma. MATERIAL AND METHODS: The study population consisted of patients diagnosed with primary breast sarcoma between January 1, 2010, and December 31, 2020. Patients with histologically confirmed primary breast sarcoma were included and divided into two groups according to tumor size: cases (>5 cm) and controls (≤5 cm). Survival was evaluated throughout the follow-up period ranging from 2 years and 6 months to 3 years and 6 months. RESULTS: Of 2173 breast cancer cases registered during the study period, 20 patients met the inclusion criteria for primary breast sarcoma. Of these, 13 ones had tumors >5 cm, while 7 ones had tumors ≤5 cm. Mean age of patients was 48 years, 70% of patients were older 40 years. Tumors larger than 5 cm represented 65% of cases. However, no significant difference in overall survival was observed between both groups (p=0.37). CONCLUSION: Although a difference in median survival was found between patients with tumors larger and smaller than 5 cm, multivariate analysis did not demonstrate tumors > 5 cm as a significant prognostic factor for decreased survival.
Assuntos
Neoplasias da Mama , Sarcoma , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/patologia , Neoplasias da Mama/mortalidade , Sarcoma/mortalidade , Sarcoma/patologia , Adulto , Estudos de Casos e Controles , Prognóstico , Taxa de Sobrevida , Carga TumoralRESUMO
PURPOSE: Early-onset colorectal cancer (CRC) (EOCRC, < 50 years) has distinct clinicopathological features from late-onset CRC (LOCRC, ≥ 50 years). However, evidence on survival outcomes is contradictory. We aimed to analyse the differences in 5-year overall survival (OS) between EOCRC and LOCRC. METHODS: A retrospective cohort study was conducted during 2018-2022. Individuals aged ≥ 18 years diagnosed with CRC at two hospitals in Medellín, Colombia were included. Clinicopathological and survival data were retrieved from the medical records and a public government database. Patients were categorized into EOCRC and LOCRC groups. Five-year OS rates were calculated using the Kaplan-Meier method and prognostic factors for OS were identified through Cox regression models. RESULTS: Among 1022 patients, 52.5% were female, and 13.5% (n = 138) had EOCRC. Patients with EOCRC showed higher 5-year OS rates than LOCRC patients (54% vs. 32%). Univariable analyses indicated a 37% lower risk of death for EOCRC compared to LOCRC (HR: 0.633, 95%CI: 0.476-0.840, p = 0.002). After multivariable analyses, advanced staging and higher tumour grading were prognostic factors for worse OS (HR: 2.127, 95% CI:1.405-3.220, p = 0.0001; and HR: 12.896, 95%CI: 6.310-26.355, p = 0.000; respectively), and being in the EOCRC group remained as a prognostic factor for higher OS (HR: 0.482, 95% CI: 0.336-0.690, p = 0.000). CONCLUSION: EOCRC is associated with significantly better 5-year OS rates and prognosis compared to LOCRC. Advanced stage and higher tumour grading are predictors of lower OS among all CRC patients. These findings highlight the importance of age-related risk stratification and personalized therapeutic approaches in CRC.
Assuntos
Idade de Início , Neoplasias Colorretais , Humanos , Masculino , Feminino , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Neoplasias Colorretais/epidemiologia , Colômbia/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Adulto , Prognóstico , Taxa de Sobrevida , Estadiamento de Neoplasias , Estimativa de Kaplan-MeierRESUMO
OBJECTIVE: Throughout the COVID-19 pandemic, care protocols were created to apply in hospital units and care for the vulnerable populationin. The objetive was to describe clini- cal manifestations, comorbidity and mortality in cancer patients with SARS CoV-2 infection, as well as sanitary measures carried out in COVID centers. METHOD: Retrospective study of 1752 patients admitted to a respiratory care unit. RESULTS: 5% of the population studied had a previous diagnosis of cancer; 59.1% were solid neoplasms and 40.9% hematologic neoplasms. Patients with cancer showed lower rates of admission to the intensive care unit (ICU) compared to patients without cancer (8% vs. 17.4%), with no differences in survival. CONCLUSIONS: Oncology patients hospitalized with COVID-19 did not have different survival rates and were less likely to require ICU care compared to non-cancer patients, this is likely due to multidisciplinary teamwork during the pandemic.
OBJETIVO: Durante la pandemia de COVID-19 se crearon protocolos de atención para aplicar en unidades hospitalarias y atender a las poblaciones vulnerables, el objetivo fue describir las manifestaciones clínicas, la comorbilidad y la mortalidad en pacientes oncológicos con infección por SARS-CoV-2, así como las medidas sanitarias aplicadas por el personal de salud durante la estancia en unidades COVID. MÉTODO: Estudio retrospectivo de 1752 expedientes clínicos de pacientes que ingresaron a la unidad de cuidados respiratorios de un hospital de tercer nivel en la Ciudad de México de mayo de 2021 a enero de 2022. RESULTADOS: El 5% de la población estudiada contaba con diagnóstico previo de cáncer; el 59.1% eran neoplasias sólidas y el 40.9% hematológicas. Los pacientes con cáncer mostraron tasas más bajas de ingreso en la unidad de cuidados intensivos (UCI) que los pacientes sin cáncer (8% frente a 17.4%), sin diferencias en la supervivencia. CONCLUSIONES: Los pacientes oncológicos hospitalizados con COVID-19 no tuvieron tasas de supervivencia diferentes y fueron menos propensos a requerir cuidados en la UCI en comparación con los pacientes sin cáncer; esto se debe probablemente al trabajo en equipo multidisciplinario durante la pandemia.
Assuntos
COVID-19 , Unidades de Terapia Intensiva , Neoplasias , Humanos , COVID-19/mortalidade , COVID-19/epidemiologia , Neoplasias/mortalidade , Neoplasias/terapia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Unidades de Terapia Intensiva/estatística & dados numéricos , Comorbidade , Adulto , Idoso de 80 Anos ou mais , SARS-CoV-2 , Taxa de Sobrevida , Cuidados Críticos/estatística & dados numéricos , Hospitalização/estatística & dados numéricosRESUMO
BACKGROUND: Some studies have shown that gastrectomy performed by experienced surgeons in high-volume specialized hospitals with the possibility of complete treatment has better results. This study aimed to compare the results of patients who underwent surgery at a reference center with non-specialized centers. METHODS: Patients with gastric adenocarcinoma stage as pTNM II and III who underwent curative gastrectomy and were referred for adjuvant chemotherapy between 2009 and 2018 were included. Patients were divided into two groups: patients operated on in a reference center with complete oncological treatment (Reference Group); and those operated on in an external Hospital and referred for adjuvant treatment at the reference center (External Group). RESULTS: A total of 643 patients were evaluated, 307 in the external group and 336 in the reference group. Patients in the external group were younger (58.9 vs. 62.6 years; p < 0.001) and with fewer comorbidities according to the Charlson-Deyo index (p < 0.001). The pathological result showed more dissected lymph nodes (41.4 vs. 23.5; p < 0.001) and a higher R0 resection rate (98.5% vs. 95.1%; p = 0.013) in the reference group. Patients of the external group underwent more adjuvant radiotherapy (49.5% vs. 33.9%; p < 0.001) with no difference concerning adjuvant chemotherapy (p = 0.066). Peritoneal recurrence was more common in the external group (63.2% vs 38.7%, p < 0.001). The disease-free survival rate was higher in the reference group (p < 0.001) as well as overall survival (p = 0.01). CONCLUSION: Patients who received full oncological treatment at a reference center had better survival outcomes compared to those operated in external services.