ABSTRACT
ABSTRACT BACKGROUND Colorectal cancer (CRC) is a worldwide health problem whose control depends on public policy establishment and effective prevention and screening programs. In Brazil, there are few studies related to adherence to screening methods. AIMS: The aim of this study was to evaluate the association between demographic and socioeconomic to adherence to CRC screening with fecal immunochemical test (FIT) among average-risk individuals for CRC. METHODS: In this prospective cross-sectional study, conducted between March 2015 and April 2016, 1,254 asymptomatic individuals aged 50-75 years, participating in a hospital screening campaign in Brazil, were invited to participate in the study. RESULTS: The adherence rate to FIT was 55.6% (697/1,254). In the multivariable logistic regression analysis, patients aged 60-75 years (odds ratio (OR)=1.30; 95% confidence interval (CI): 1.02-1.66; p=0.03), religious belief (OR=2.04; 95% CI: 1.34-3.11; p<0.01), previous fecal occult blood test (OR=2.07; 95% CI: 1.55-2.76; p<0.01), and full/part-time working status (OR=0.66; 95% CI: 0.49-0.89; p<0.01) were independently associated with adherence to CRC screening. CONCLUSION: The results of the present study highlight the importance of considering the labor aspects when implementing screening programs, suggesting that campaigns conducted in the workplace and repeated over the years may be more effective.
RESUMO RACIONAL: O câncer colorretal (CCR) é um problema de saúde mundial cujo controle depende do estabelecimento de políticas públicas e programas de prevenção e rastreamento eficazes. No Brasil existem poucos estudos relacionados à adesão métodos de rastreamento. OBJETIVO: Avaliar a associação de características sócio-demográficas à realização de testes de sangue oculto nas fezes do tipo imunoquimicomecanizado (FIM) em população de médio risco para o desenvolvimento de câncer colorretal. MÉTODOS: Estudo observacional transversal, com coleta prospectiva de dados. Entre março de 2015 e abril de 2016, 1.254 indivíduos assintomáticos, com idade entre 50 e 75 anos, foram consecutivamente selecionados a partir de uma campanha hospitalar de rastreamento para neoplasias. RESULTADOS: As taxas de adesão ao teste FIM foi 55.6% (697/1254). Na análise de regressão logística múltipla os fatores independentes associados à adesão ao rastreamento do CCR foram: Idade entre 60-75 anos (oddsratio (OR)=1.30; intervalo de confiança de 95% (IC): 1.02-1.66; p=0.03), crença religiosa (OR=2.04; 95%IC: 1.34-3.11; p<0.01), realização prévia de exame de sangue oculto nas fezes (OR=2.07; 95%IC: 1.55-2.76; p<0.01) e vínculo empregatício em período integral ou parcial (OR=0.66; 95%IC: 0.49-0.89; p<0.01). CONCLUSÃO: Este estudo enfatiza a importância de considerar aspectos laborais ao implementar programas de rastreamento do câncer colorretal e sugere que campanhas de rastreamento implantadas no ambiente de trabalho e de maneira repetida ao longo dos anos podem ser mais efetivas.
ABSTRACT
ABSTRACT Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.
RESUMO A cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica emergiu como um importante tratamento das neoplasias peritoneais e é, atualmente, o padrão de atendimento para neoplasias epiteliais do apêndice associadas à síndrome de pseudomixoma peritoneal, bem como para o mesotelioma peritoneal maligno difuso. No mundo, existem algumas variações reconhecidas das técnicas de cirurgia citorredutora e quimioterapia intraperitoneal hipertérmica, entretanto nenhuma técnica até agora demonstrou sua superioridade sobre o outra. Portanto, a padronização destes procedimentos poderia melhorar a prática clínica e permitir a comparação adequada entre os resultados. Neste cenário, a Sociedade Brasileira de Cirurgia Oncológica considera importante a apresentação de uma proposta de padronização de procedimentos de cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica no Brasil, com um foco especial na produção de dados homogêneos para o desenvolvimento do registro brasileiro das neoplasias peritoneais.
Subject(s)
Humans , Appendiceal Neoplasms/therapy , Peritoneal Neoplasms/therapy , Cytoreduction Surgical Procedures/standards , Hyperthermia, Induced/standards , Lung Neoplasms/therapy , Mesothelioma/therapyABSTRACT
Mutations of tumoral suppressor TP53 gene are present in 75% of colorectal cancer (CRC) cases. Immunohistochemistry isa method capable of demonstrating the abnormal accumulation of p53 protein in the cell. Some studies associate p53immunohistochemical positivity and a worse prognosis, while others do not confirm this finding. There are controversiesregarding the prognostic value of p53 in CRC. The same doubts apply to p21 protein, activated by p53, which is the mainresponsible for stopping the cell cycle (checkpoints), both for repair or apoptosis purposes. Objective: The objective of thisstudy is to correlate p53 and p21 immunohistochemical expression both with clinical and anatomopathological variables andwith survival rates of patients with CRC. Materials and Methods: This is a descriptive and retrospective study having asresearch subjects 128 patients affected by CRC and treated surgically from 2000 to 2004, with available surgical specimensfor immunohistochemical analysis using standardized methods. The association among categorical variables was done byPearson chi-square or Fisher exact tests, and the continuous variables were analyzed by t-Student test. Overall survival anddisease-free period rates had been calculated according to Kaplan-Meier method and the associations by log-rank test. Results:Follow-up average time was 35 months. p53 and p21 alterations had been detected, respectively, in 67.2% and 27. 3% ofcases, with a significant association (p<0.05) between p53 and tumors located in rectum (76.0%) and left colon (70.7%), andbetween p21 and right colon (43.2%). p21 positive expression was related to CRC diagnostic at an older median age. Overallsurvival was 54 months, and the significant clinical and pathological related variables were the following: better for curativesurgeries; better for precocious stages; better for well-differentiated tumors; worse for cases with sanguineous or lymphatic...
Subject(s)
Humans , Male , Female , Colorectal Neoplasms , Data Interpretation, StatisticalABSTRACT
Microsatellite instability (MSI) occurs in 90% ofcolorectal cancer (CRC) from HNPCC patients and 15%of sporadic CRC. Patients with CRC and MSI have adistinct phenotype. OBJECTIVE: this study evaluates theisolated clinicopathological significance of BAT26instability by itself in patients with CRC. METHODS:From 1995 to 2000, 184 patients submitted to CRC surgerywere selected at random. Medical records were studiedin order to determine clinical data and BAT26 analysiswas carried out. RESULTS: BAT26 instability was foundin 22 (12%) of the 184 cases and was correlated to proximalcolon tumors (p<0.001); CRC from HNPCC patients(p=0.002); poor cell differentiation (p=0,025); andmucinous component (p=0,007). BAT26 instabilitytumors have shown a slight trend toward absence ofmetastases (p=0,082). The five-year cancer-specificsurvival was 65% and 85% for stable and instable BAT26,respectively, with no statistical significance.CONCLUSION: BAT26 instability should be considereda useful screening method to select CRC patients forMSI.