RESUMO
BACKGROUND: Colorectal cancer (CRC) accounts for 9.4% of overall cancer deaths, ranking second after lung cancer. Despite the large number of factors tested to predict their outcome, most patients with similar variables show big differences in survival. Moreover, right-sided CRC (RCRC) and left-sided CRC (LCRC) patients exhibit large differences in outcome after surgical intervention as assessed by preoperative blood leukocyte status. We hypothesised that stronger indexes than circulating (blood) leukocyte ratios to predict RCRC and LCRC patient outcomes will result from combining both circulating and infiltrated (tumour/peritumour fixed tissues) concentrations of leukocytes. AIM: To seek variables involving leukocyte balances in peripheral blood and tumour tissues and to predict the outcome of CRC patients. METHODS: Sixty-five patients diagnosed with colon adenocarcinoma by the Digestive Surgery Service of the La Paz University Hospital (Madrid, Spain) were enrolled in this study: 43 with RCRC and 22 with LCRC. Patients were followed-up from January 2017 to March 2021 to record overall survival (OS) and recurrence-free survival (RFS) after surgical interventions. Leukocyte concentrations in peripheral blood were determined by routine laboratory protocols. Paraffin-fixed samples of tumour and peritumoural tissues were assessed for leukocyte concentrations by immunohistochemical detection of CD4, CD8, and CD14 marker expression. Ratios of leukocyte concentration in blood and tissues were calculated and evaluated for their predictor values for OS and RFS with Spearman correlations and Cox univariate and multivariate proportional hazards regression, followed by the calculation of the receiver-operating characteristic and area under the curve (AUC) and the determination of Youden's optimal cutoff values for those variables that significantly correlated with either RCRC or LCRC patient outcomes. RCRC patients from the cohort were randomly assigned to modelling and validation sets, and clinician-friendly nomograms were developed to predict OS and RFS from the respective significant indexes. The accuracy of the model was evaluated using calibration and validation plots. RESULTS: The relationship of leukocyte ratios in blood and peritumour resulted in six robust predictors of worse OS in RCRC: CD8+ lymphocyte content in peritumour (CD8pt, AUC = 0.585, cutoff < 8.250, P = 0.0077); total lymphocyte content in peritumour (CD4CD8pt, AUC = 0.550, cutoff < 10.160, P = 0.0188); lymphocyte-to-monocyte ratio in peritumour (LMRpt, AUC = 0.807, cutoff < 3.185, P = 0.0028); CD8+ LMR in peritumour (CD8MRpt, AUC = 0.757, cutoff < 1.650, P = 0.0007); the ratio of blood LMR to LMR in peritumour (LMRb/LMRpt, AUC = 0.672, cutoff > 0.985, P = 0.0244); and the ratio of blood LMR to CD8+ LMR in peritumour (LMRb/CD8MRpt, AUC = 0.601, cutoff > 1.485, P = 0.0101). In addition, three robust predictors of worse RFS in RCRC were found: LMRpt (AUC = 0.737, cutoff < 3.185, P = 0.0046); LMRb/LMRpt (AUC = 0.678, cutoff > 0.985, P = 0.0155) and LMRb/CD8MRpt (AUC = 0.615, cutoff > 1.485, P = 0.0141). Furthermore, the ratio of blood LMR to CD4+ LMR in peritumour (LMRb/CD4MRpt, AUC = 0.786, cutoff > 10.570, P = 0.0416) was found to robustly predict poorer OS in LCRC patients. The nomograms showed moderate accuracy in predicting OS and RFS in RCRC patients, with concordance index of 0.600 and 0.605, respectively. CONCLUSION: Easily obtainable variables at preoperative consultation, defining the status of leukocyte balances between peripheral blood and peritumoural tissues, are robust predictors for OS and RFS of both RCRC and LCRC patients.
RESUMO
Colorectal cancer (CRC) is the second most deadly and third most commonly diagnosed cancer worldwide. There is significant heterogeneity among patients with CRC, which hinders the search for a standard approach for the detection of this disease. Therefore, the identification of robust prognostic markers for patients with CRC represents an urgent clinical need. In search of such biomarkers, a total of 114 patients with colorectal cancer and 67 healthy participants were studied. Soluble SIGLEC5 (sSIGLEC5) levels were higher in plasma from patients with CRC compared with healthy volunteers. Additionally, sSIGLEC5 levels were higher in exitus than in survivors, and the receiver operating characteristic curve analysis revealed sSIGLEC5 to be an exitus predictor (area under the curve 0.853; cut-off > 412.6 ng/mL) in these patients. A Kaplan-Meier analysis showed that patients with high levels of sSIGLEC5 had significantly shorter overall survival (hazard ratio 15.68; 95% CI 4.571-53.81; p ≤ 0.0001) than those with lower sSIGLEC5 levels. Our study suggests that sSIGLEC5 is a soluble prognosis marker and exitus predictor in CRC.
RESUMO
Se presenta un caso de lipoma cervicotorácico gigante en paciente femenino de 45 años de edad, quien consultó por aumento de volumen cervical, odinodisfagia y disnea. Una radiografía de tórax y tomografía computarizada reveló una masa gigante intratorácica bilateral, ocupando la cavidad torácica izquierda con extensión al mediastino anterosuperior y al cuello, desplazando la tráquea y la faringe hacia la porción anterior y derecha. La paciente se llevó a resección quirúrgica del tumor cervico-torácico, con examen histológico que confirmó el diagnóstico de un lipoma gigante, con peso de 475 gramos y medidas de 30 x 20 cm. Este es el lipoma cervico-torácico más grande documentado en la literatura moderna y con abordaje mixto cervicotomía más toracoscopia
Female patient 45 years old with giant cervicothoracic lipoma, that consulted by increase of cervical volume, odinodysphagia and dyspnea. An x-ray thorax and computerized tomography revealed a bilateral intrathoracic giant mass, occupying the left thoracic cavity extending to the anterosuperior mediastinum and the neck, causing displacement of the trachea and the pharynx towards the previous and right portion. The patient took to surgical resection of the cervical thoracic tumor, with histological examination that confirmed the diagnosis of a giant lipoma, with weight of 475 grams and measures of 30 x 20 cm. It is largest cervical thoracic lipoma documented in modern literature and with cervicotomy and thoracoscopic approach
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Gânglio Estrelado/cirurgia , Gânglio Estrelado/patologia , Lipoma/diagnóstico , Toracoscopia/métodos , Tumores de Células Gigantes/cirurgia , Tumores de Células GigantesRESUMO
Presentar la experiencia en el uso de shunts temporales arteriales en pacientes gravemente lesionados con lesiones vasculares en el Servicio de Cirugía I, Hospital Vargas de Caracas y revición de la literatura. Estudio descriptivo de 2 pacientes, politraumatizados, severamente lesionados, donde el manejo de las lesiones vasculares periféricas se hizo a través de shunt temporales, específicamente en arterias axilar y femoral. Los shunt fueron herramientas invaluables en la cirugía abreviasa de estas enfermos, manteniendo la perfusión distal de los miembros, con reintervención para cirugía definitiva entre las 48 y 72 horas por parte del Servicio de Cirugía Cardiovascular. Todo cirujano debe tener conocimientos en procedimientos vasculares básicos. En casos seleccionados, en el contexto de pacientes severamente lesionados, los shunt temporales son herramientas útiles que permiten la conservación de los miembros y salvar la vida del paciente durante la realización de una cirugía abreviada.