Câncer colorretal: associação entre variáveis sociodemográficas e a adesão a programas de rastreamento / Colorectal cancer: association between sociodemographic variables and the adherence to cancer screening

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.

Oncologic outcomes of microscopic tumor cut-through in locally advanced oral squamous cell carcinoma

Introduction: The gold standard treatment of oral cavity squamous cell carcinoma (OCSCC) is surgical resection; however, standardization of the margins and the role of frozen section are still debatable. Microscopic tumor cut-thought (MTCT) occurs when the surgeon has an initial positive frozen section margin that is cleared with further resection to negative. Objective: This study aims to determine the impact of MTCT on local recurrence and disease-specific survival in patients with locally advanced T3-T4 OCSCC and compare it with other clinicopathological variables. Methods: A retrospective database analysis of patients diagnosed with locally advanced T3-T4 OCSCC surgically treated and submitted to intraoperative frozen section guiding the margin status. Survival was analyzed using the Kaplan-Meier estimator followed by the Cox model for multivariate analysis. Results: We analyzed 475 patients who met inclusion criteria: MTCT occurred in 29 patients (6.11%) and local recurrence was observed in 131 patients (27.6%). MTCT had an impact on univariate (HR 2.205; 95% CI 1.243 ­ 3.914; p=0.007) and multivariate (HR 1.851; 95% CI 1.285 ­ 2.666; p=0.001) analyses. Similar results were found for disease-specific survival: univariate (HZ 1.669; 95% CI 1.056 ­ 2.635; p=0.028) and multivariate (HZ 1.307; 95% CI 0.816 ­ 2.092; p=0.265) analyses. A total of 231 patients (48.6%) had died of cancer by the end of follow-up. The best predictor for compromised frozen sections was tumor depth of invasion. Conclusion: Even after negative final margins, MTCT is an important factor associated with poorer outcome, and treatment intensification should be considered in these patients.

Characterization of BRAF mutation in patients older than 45 years with well-differentiated thyroid carcinoma / Caracterização da mutação em BRAF em pacientes acima de 45 anos com carcinoma bem diferenciado de tireoide

Abstract Introduction: Papillary thyroid carcinoma is the most frequent endocrine neoplasia and its incidence has tripled over the past 35years. Although papillary thyroid carcinoma carries a good prognosis, 10%-30% of patients still develop recurrence and metastasis. Some clinical and genetic features are associated with worse prognosis. The most frequent mutation is the BRAF p.V600E, which has been associated with many clinical features of poor prognosis. However, many studies have produced controversial results without any association between BRAF mutation and clinicopathological features of poor prognosis. Objective: Since the prognostic value of BRAF mutations remains controversial, this study aims to investigate the importance of this mutation in therapeutic decisions for papillary thyroid carcinoma. Methods: Therefore, we evaluated whether the presence of BRAF mutation is associated with features of poor prognosis in 85 patients with papillary thyroid carcinoma older than 45years treated at A.C. Camargo Cancer Center, from 1980 to 2007. BRAF mutation was evaluated by pyrosequencing. Statistical analysis was performed using SPSS. Results: The mean age of patients was 54 years (range: 45 - 77 years), 73 were women (85.8%) and 12 were men (14.2%). Among them, 39 cases (45.9%) presented extrathyroidal extension and 11 cases had recurrent disease. BRAF mutation was detected in 57 (67%) patients. No significant association was observed between BRAF mutation and gender (p =0.743), age (p = 0.236), N-stage (p =0.423), vascular and perineural infiltration (p =0.085 or multifocality (p = 1.0). Although not statistically significant, the majority of patients with recurrent disease were BRAF positive (9 out of 11) (p =0.325). Patients affected by BRAF mutation are associated with tumors larger than 1 cm (p =0.034) and with extrathyroidal extension (p =0.033). Conclusion: Although BRAF testing is widely available, there are no consistent data to support improvement in outcomes from incorporating it into therapeutic decision for thyroid cancer.

Resumo Introdução: O carcinoma papilífero de tireoide é a neoplasia endócrina mais frequente e sua incidência triplicou nos últimos 35 anos. Embora o carcinoma papilífero de tireoide tenha um bom prognóstico, 1% a 30% dos pacientes desenvolvem recorrência e metástase. Algumas características clínicas e genéticas estão associadas a um pior prognóstico. A mutação mais frequente é a BRAF p.V600E, a qual tem sido associada a muitas características clínicas de pior prognóstico. No entanto, muitos estudos apresentam resultados controversos, sem qualquer associação entre a mutação em BRAF e características clinicopatológicas de pior prognóstico. Objetivo: Uma vez que o valor prognóstico das mutações em BRAF permanece controverso, investigar a importância dessa mutação em decisões terapêuticas para o carcinoma papilífero de tireoide. Método: Foi avaliada a associação da mutação em BRAF com características de pior prognóstico em 85 pacientes com carcinoma papilífero de tireoide acima de 45 anos tratados no A.C. Camargo Cancer Center, de 1980 a 2007. A mutação em BRAF foi avaliada por pirossequenciamento. A análise estatística foi feita com o software SPSS. Resultados: A média de idade dos pacientes foi de 54 anos (variação de 45 - 77), 73 eram mulheres (85,8%) e 12 eram homens (14,2%). Entre eles, 39 casos (45,9%) apresentaram extensão extratireoidiana e 11, doença recorrente. A mutação em BRAF foi detectada em 57 (67%) pacientes. Não foi observada associação significante entre mutação em BRAF e sexo (p = 0,743), idade (p = 0,236), estágio N (p = 0,423), infiltração vascular e perineural (p = 0,085) ou multi-focalidade (p = 1,0). Apesar de não apresentar associação estatística, a maioria dos pacientes com doença recorrente foi positiva para BRAF (9 em 11) (p = 0,325). Os pacientes afetados pela mutação em BRAF estão associados a tumores maiores do que 1 cm (p = 0,034) e com extensão extratireoidiana (p = 0,033). Conclusão: Embora a mutação em BRAF seja amplamente avaliada, não há dados consistentes que demonstrem uma melhor sobrevida ou benefício clínico ao incorporá-la à decisão terapêutica para o câncer de tireoide.

Impacto do tipo de bisturi no tempo operatório e complicações agudas em tireoidectomias / Impact of scalpel type on operative time and acute complications in thyroidectomies

Resumo Introdução: A cirurgia mais comum da região cervical é a tireoidectomia. Atualmente, várias tecnologias estão disponíveis para hemostasia intraoperatória. Objetivo: Comparar o desempenho de três tecnologias (elétrica monopolar e bipolar e ultrassônica) no tempo operatório e complicações pós-operatórias. Método: Pacientes submetidos à tireoidectomia total sem tratamento prévio foram incluídos. Desenho científico usado: estudo de série prospectiva. Resultados: Foram incluídos 834 pacientes, 661 mulheres (79,3%) e 173 homens (20,7%). O diagnóstico foi de neoplasia maligna em 528 pacientes (63,3%) e de doença benigna em 306 pacientes (36,7%). O bisturi elétrico monopolar foi usado em 280 pacientes (33,6%), energia bipolar em 210 (25,2%) e ultrassônica em 344 (41,3%). O tempo operatório foi significantemente menor com bisturi ultrassônico ou bipolar quando comparado com elétrico. Em um modelo de regressão linear, sexo, diagnóstico de malignidade e tipo de energia foram significantes para duração do procedimento. Os pacientes operados com bisturi ultrassônico ou bipolar apresentaram incidência significantemente menor de hipoparatireoidismo. Conclusão: O uso do bisturi ultrassônico ou bipolar reduz de forma significante o tempo operatório e a incidência de hipoparatireoidismo transitório.

Comparison between an immunochemical fecal occult blood test and a Guaiac based fecal occult blood test in detection of adenomas and colorectal cancer

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. Brazil does not have an official well established program for screening colorectal cancer. The aim of this study was to compare Guaiac Based Fecal Occult Blood Test (G-FOBT) to a kind of an Immunochemical Fecal Occult Blood Test (I-FOBT), in search of cancer or advanced adenoma. Methods: Prospective and cross-sectional study. Asymptomatic and average-risk individuals (n = 1500) aged from 50 to 75 years old were invited to participate in the study. The primary endpoint was positivity rate and the secondary endpoints were adherence rate and significant endoscopic findings. All participants received both tests with follow-up colonoscopy if either test was positive. Results: Adherence rate of G- FOBT was 756/1500 (50.4%) while for I- FOBT it was 960/1500(64%). The positivity ratio in the I- FOBT was 94/960 (9.8%) and in the G-FOBT was 20/771 (2.6%). The Positive Predict Value (PPV) for the I- FOBT counted 16/77 (21.0%) while for the G- FOBT it was 6/18 (33.0%), considering significant lesions. Regarding the colorectal cancer findings, the detection in the colonoscopy guided from the positivity of fecal occult blood tests was 5/77 (6.5%) in I- FOBT and 2/18 (11.1%) on the G- FOBT. Conclusions: The positivity, the adherence rate and the capacity to detect significant lesions were higher in I-FOBT. Considering the findings of the study we could conclude that I-FOBT was superior to G- FOBT. Trial registration: This study was reviewed and approved by the Institutional Review Board of A.C.Camargo Cancer Center, São Paulo, Brazil, number: 1877/14

Evolution of nutritional status of patients with head and neck cancer during radiotherapy or radiotherapy concerning chemotherapy / Evolução do estado nutricional de pacientes com câncer de cabeça e pescoço durante radioterapia ou radioterapia relacionada à quimioterapia

Introduction: Tumor resection, chemotherapy and / or radiotherapy are used in the treatment of head and neck neoplasms, and these therapies trigger side effects that interfere with the patient's nutritional status. Nutritional intervention makes it possible to recover nutritional status and contributes to reduce treatment morbidity. Objective: To verify the evolution of the nutritional status of patients with head and neck cancer who followed the treatment and attended the nutrition clinic. Methods: Nutritional status was evaluated based on data collection and weight, height, percentage of weight loss, body mass index, arm circumference, triceps skinfold, nutritional muscular area and nutritional intervention. Results: When comparing the nutritional status of the patients at the beginning and at the final moment of follow-up, we did not observe a statistically significant difference (p=0.261); however, moderate / intense weight loss was observed in 23.6% (n=17) at the end of treatment. When assessing adherence to targeted nutritional therapy and weight loss, it was observed that of the 48 (66.7%) patients who adhered fully to the guidelines, 39 (81.3%) had no significant weight loss (p=0.091). Conclusion: Although the study did not indicate a statistically significant difference in relation to the nutritional status of the patients, 81.3% of those who adhered to the nutritional guidelines did not have significant weight loss corroborating with the results presented in the studies that suggest that individualized nutritional monitoring during radiotherapy and / or radiotherapy concomitant with chemotherapy helps maintain nutritional status.

Introdução: A ressecção tumoral, a quimioterapia e/ou radioterapia são utilizadas no tratamento de neoplasias de cabeça e pescoço, e essas terapias desencadeiam efeitos colaterais que interferem no estado nutricional do paciente. A intervenção nutricional possibilita a recuperação do estado nutricional e contribui para reduzir a morbidade do tratamento. Objetivo: Verificar a evolução do estado nutricional de pacientes com câncer de cabeça e pescoço que acompanharam o tratamento e compareceram à clínica de nutrição. Método: O estado nutricional foi avaliado com base na coleta de dados e peso, altura, percentual de perda de peso, índice de massa corporal, circunferência do braço, prega cutânea tricipital, área muscular nutricional e intervenção nutricional. Resultados: Ao comparar o estado nutricional dos pacientes no início e no momento final do acompanhamento, não observamos diferença estatisticamente significante (p=0,261); no entanto, perda de peso moderada/intensa foi observada em 23,6% (n=17) no final do tratamento. Ao avaliar a adesão à terapia nutricional direcionada e à perda de peso, observou-se que, dos 48 (66,7%) pacientes que aderiram plenamente às orientações, 39 (81,3%) não apresentaram perda de peso significativa (p=0,091). Conclusão: Apesar de o estudo não indicar diferença estatisticamente significante em relação ao estado nutricional dos pacientes, 81,3% daqueles que aderiram às diretrizes nutricionais não apresentaram perda de peso significativa, corroborando com os resultados apresentados em estudos, que sugerem que a monitorização nutricional individualizada durante a radioterapia e/ou radioterapia concomitante à quimioterapia ajuda a manter o estado nutricional.

Retroauricular Endoscope-Assisted Approach to the Neck: Early Experience in Latin America

Abstract Introduction There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery. In this subset, endoscope-assisted and robotic procedures allowed the development of new approaches to the neck, including the retroauricular access, which is now routinely used, especially in Korea. Objectives This study aims to provide a descriptive analysis of our initial experience with retroauricular endoscope-assisted approach assessing feasibility, safety, and aesthetic results. Methods Prospective analysis of the first 11 eligible patients submitted to retroauricular endoscope-assisted approach for neck procedures in the Head and Neck Surgery Department at AC Camargo Cancer Center. Results A total of 18 patients were included in this study, comprising 7 supraomohyoid neck dissections, 8 submandibular gland excisions, 3 thyroid lobectomies, and one paraganglioma excision. There was no significant local complications, surgical accident, or need for conversion into conventional open procedure in this series. Conclusion Our initial experience has shown us that this approach is feasible, safe, oncologically efficient, and applicable to selected cases, with a clear cosmetic benefit.

MicroRNAs em pacientes com história familiar de carcinoma epidermóide de cabeça e pescoço / MicroRNAs profile in patients with family history of head and neck cancer

Apesar da maioria dos casos de câncer de cabeça e pescoço ocorrer de maneira esporádica e geralmente estar relacionada à exposição crônica a álcool e tabaco, a história familiar e a suscetibilidade têm merecido especial interesse nas últimas duas décadas. O objetivo do presente estudo foi caracterizar o perfil clínico e epidemiológico de pacientes portadores de câncer de cabeça e pescoço e história familiar de câncer, avaliar o perfil de expressão dos miRNAs em amostras de sangue periférico de pacientes com carcinoma epidermóide de cabeça e pescoço (CECP) e história familial de câncer com seus respectivos parentes e checar, a partir da utilização de bancos de dados de miRNAs, os principais genes regulados e suas eventuais relações com neoplasias. Foram selecionados 74 casos usando o banco de dados do Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital A.C. Camargo, São Paulo no período de 2003 a 2011. Os critérios utilizados para caracterizar os casos familiais de CECP foram: 1) dois ou mais parentes de primeiro grau acometidos por CECP ou tumores relacionados; 2) Idade de aparecimento do CECP inferior a 45 anos em pelo menos um dos membros da família; 3) Aparecimento do CECP em qualquer idade em casos com ausência de exposição prévia ao tabaco e álcool ou qualquer outro fator etiológico conhecido. Os tumores considerados como relacionados ao CECP foram aqueles associados com o consumo de tabaco (pulmão, esôfago, estômago, pâncreas, fígado, rim, bexiga, útero e medula óssea) ou outros tumores epiteliais como carcinoma colorretal, mama e melanoma. Foram coletadas amostras de sangue periférico dos probandos e, quando possível, de um de seus parentes acometidos por câncer e realizada a análise de expressão de miRNAs por RT-qPCR. O sítio de tumor mais comum nos probandos foi cavidade oral (42%) seguido de laringe (31.5%)...

Although most cases of head and neck cancer (HNSCC) occur sporadically and generally are related to chronic exposure of alcohol and tobacco, family history and genetic susceptibility have earned special interest in the last two decades.The aims of this study were to characterize the clinical and epidemiological profile of patients with head and neck cancer and family history of cancer, evaluate the expression profile of miRNAs in peripheral blood samples from patients with HNSCC and familial history of cancer with their relatives and check, by using miRNAs databases, the main regulated genes and their possible relationship to cancer. A total of 74 cases were selected through pre-existing databases of the Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Hospital, Sao Paulo from 2003 to 2011. The criteria used to characterize the familial cases of HNSCC were: 1) two or more first degree relatives affected by HNSCC or related tumors, 2) Age of onset of HNSCC less than 45 years in at least one of the family members, 3) Appearance of HNSCC at any age if no prior exposure to tobacco and alcohol or any other known etiologic factor. Tumors considered related HNSCC were those related to tobacco consumption (lung, esophagus, stomach, pancreas, liver, kidney, bladder, uterus and bone marrow) or other epithelial tumors such as colorectal carcinoma, breast and melanoma. Then, peripheral blood samples of these patients were collected and, when possible, of one of them relatives affected by cancer. Subsequently, the evaluation of miRNAs expression was did by RT-qPCR. The most common tumor sites of probands were oral cavity, with 31 cases (42%), followed by the larynx, 24 cases (31.5%). Among the 74 families, the number of affected relatives was 171, with 121 of first-degree and 50 of second and third degree. In this group there were 19 different tumor sites and the most common were: head and neck (18.6%), breast (16%), colon (13%), stomach (11%)...