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Rev. salud pública ; 24(1): e203, ene.-feb. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1377216


ABSTRACT Objectives To analyze trends in pancreatic cancer incidence and mortality in Latin American countries. Methods An ecological study with incidence data from the International Agency for Research on Cancer and mortality data from the World Health Organization. The trend of incidence by Joinpoint regression, the variation of the annual average and the 95% confidence interval were analyzed. Results There were increasing trends in incidence in Brazil, in males, aged 40-59 years, and reduction in Costa Rica. In females, there was stability in all age groups. The mortality rates increased in the elderly in Brazil (AAPC: 1.09%; 95% CI: 0.76; 1.42), Peru (AAPC: 1.76%; 95% CI: 0.36; 3.17) and El Salvador (AAPC: 2.88%; 95% CI: 0.38; 5.43), while in Mexico, there was a reduction. In females, this rate increased in Brazil (AAPC: 1.38%; 95% CI: 1.07; 1.69), Peru (AAPC: 2.25%; 95% CI: 0.68; 3.85), Chile (AAPC: 3.62%; 95% CI: 1.96; 5.31), Nicaragua (AAPC: 2.51%; 95% CI: 0.36; 4.71) and Paraguay (AAPC: 1.17%; 95% CI: 0.37; 1.98) and a downward trend was observed in Colombia and Ecuador. Conclusions Pancreatic cancer had a higher incidence in the elderly population of both sexes and an increase of the mortality trend in females was noted.

RESUMEN Objetivo Analizar las tendencias en la incidencia y mortalidad por cáncer de páncreas en los países latinoamericanos. Método Se realizó un estudio ecológico con datos de incidencia de la Agencia Internacional de Investigación sobre Cáncer y datos de mortalidad de la Organización Mundial de la Salud. Se analizó la tendencia de incidencia por regresión de Joinpoint, la variación del promedio anual y el intervalo de confianza del 95%. Resultados Hubo tendencias crecientes en la incidencia en Brasil en varones entre 40 y 59 años, y una reducción en Costa Rica. En las mujeres, hubo estabilidad en todos los grupos de edad. Las tasas de mortalidad aumentaron en los ancianos en Brasil (AAPC: 1,09%; IC 95%: 0,76; 1.42), Perú (AAPC: 1,76%; IC 95%: 0,36; 3,17) y El Salvador (AAPC: 2,88%; 95% IC 0,38; 5,43), mientras que en México hubo una reducción. En las mujeres, esta tasa aumentó en Brasil (AAPC: 1,38%; IC 95%: 1,07; 1.69), Perú (AAPC: 2,25%; IC 95%: 0,68; 3.85), Chile (AAPC: 3,62%; IC 95%: 1,96; 5,31), Nicaragua (AAPC: 2,51%; IC 95%: 0,36; 4,71) y Paraguay (AAPC: 1,17%; IC 95%: 0,37; 1,98) y se observó una tendencia a la baja en Colombia y Ecuador. Conclusiones El cáncer de páncreas tuvo una mayor incidencia en la población anciana de ambos sexos; cabe también señalar que debido a este aumentó su mortalidad en las mujeres.

Rev. Col. Bras. Cir ; 49: e20223150, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1376243


ABSTRACT Objective: the recommendations of the decisions made by the Tumor Board (TB) should be followed to identify barriers that may interfere with the execution of the previously decided, best care for the patient. The aim of this study is to assess whether the TB conduct decision was performed in patients with pancreatic tumors, their life status 90 days after the TB decision, and to analyze the reasons why the conduct was not performed. Methods: we conducted a retrospective study with patients with pancreas tumors, evaluated between 2017 and 2019. We collected data on epidemiological status, whether the TB procedure was performed, the reason for not performing it, life status 90 days after the TB decision, and how many times each patient was discussed at a meeting. We compared categorical variables using the chi square test, numerical variables were presented as means and standard deviation. Results: we studied 111 session cases, in 95 patients, 86 (90.5%) diagnosed with cancer. After 90 days of TB, 83 patients (87.37%) remained alive, 9 had (9.47%) died, and 3 (3.16%) were lost to follow-up. The TB decision was not observed in 12 (10.8%) cases and the reasons were: 25% (3) for loss of follow-up, 8.33% (1) for patient refusal, and 66.67% (8) due to clinical worsening. The cases of patients with metastases had a lower rate of TB conduct compliance (p=0.006). Conclusions: the TB conduct was performed in most cases and the most evident reason for non-compliance with the conducts is the patient's clinical worsening.

RESUMO Objetivo: as recomendações das decisões em Tumor Board (TB) deveriam ser acompanhadas para identificar barreiras que possam interferir na execução do melhor cuidado para o paciente decidido previamente. O objetivo do estudo é avaliar se a decisão de conduta em TB foi realizada em pacientes com tumores pancreáticos, o status de vida 90 dias após TB e analisar os motivos pelos quais a conduta não foi realizada. Métodos: estudo retrospectivo com pacientes com tumores de pâncreas, avaliados entre 2017 a 2019. Dados epidemiológicos, se a conduta de TB foi realizada, o motivo da não realização, o status de vida em 90 dias após decisão de TB e quantas vezes cada paciente foi discutido em reunião foram coletados. As variáveis categóricas foram comparadas pelo teste de qui-quadrado; variáveis numéricas foram apresentadas como médias e desvio padrão. Resultados: 111 casos, 95 pacientes, 86 (90,5%) com diagnóstico de câncer. Após 90 dias de TB, 83 pacientes (87,37%) permaneceram vivos, 9 pacientes (9,47%) faleceram e 3 (3,16%) perderam o seguimento. A conduta do TB não foi realizada em 12 (10,8%) dos casos e os motivos foram: 25% (3) por perda de seguimento, 8,33% (1) por recusa do paciente e 66,67% (8) devido à piora clínica. Os casos de pacientes com metástases tiveram menor execução de conduta de TB (p=0,006). Conclusões: a conduta do TB é realizada na maior parte dos casos e o motivo mais evidente para o não cumprimento das condutas é a piora clínica do paciente.

Journal of Clinical Hepatology ; (12): 409-414, 2022.
Article in Chinese | WPRIM | ID: wpr-920895


Objective To investigate the gene mutations of Chinese patients with pancreatic cancer in the coastal regions of Eastern China, and to provide a basis for individualized treatment. Methods A total of 40 patients who were admitted and diagnosed with malignant pancreatic tumor after surgical treatment in The Affiliated Hospital of Qingdao University, Qingdao Municipal Hospital, Yantaishan Hospital, and Yantai Sino-France Friendship Hospital from January 2017 to June 2019 were enrolled. Next-generation sequencing (NGS) was used to detect gene mutations in tumor tissue and somatic cells, and the map of gene mutations was plotted to analyze genomic alterations. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison between groups. Results Among the 40 patients, 34 (85.0%) had pancreatic ductal adenocarcinoma, 3 (7.5%) had solid pseudopapillary neoplasm of the pancreas, 1 (2.5%) had pancreatic neuroendocrine tumor, and 2 (5.0%) had unclear typing. KRAS (80.0%, 32/40), TP53 (70.0%, 28/40), CDKN2A (32.5%, 13/40), SMAD4 (17.5%, 7/40), and AKT2 (17.5%, 7/40) were the most common mutations, and there was no significant difference in survival time between the patients with these five common gene mutations (all P > 0.05). Conclusion NGS technology can provide comprehensive and accurate information of genomic alterations and may provide novel potential biomarkers for the diagnosis and precise treatment of pancreatic cancer. The analysis of mutant genes also lays a foundation for the individualized treatment of pancreatic cancer.

Journal of Clinical Hepatology ; (12): 236-240, 2022.
Article in Chinese | WPRIM | ID: wpr-913151


As a highly malignant gastrointestinal tumor, pancreatic cancer is highly invasive and metastatic, which leads to the low overall survival rate of patients with pancreatic cancer. Studies have shown that long non-coding RNA (lncRNA) is involved in the development, progression, invasion, and metastasis of pancreatic cancer through epigenetic, transcriptional or post-transcriptional regulation. Dysregulated expression of lncRNA is observed in pancreatic cancer and induces epithelial mesenchymal transition (EMT) through specific regulatory mechanisms, thereby causing the changes in the biological behavior of tumor cells. This article reviews the mechanisms of lncRNA in promoting EMT, regulating tumor biological function as competing endogenous RNA, and affecting the development, invasion, and metastasis of pancreatic cancer via multiple pathways by regulating the ferroptosis, autophagy, and exosome of tumor cells, in order to provide a theoretical basis and new targets for the early diagnosis and treatment of pancreatic cancer.

Journal of Clinical Hepatology ; (12): 1203-1208, 2022.
Article in Chinese | WPRIM | ID: wpr-924808


Pancreatic cancer is one of the fatal malignant tumors, and its dense stroma, which accounts for 90% of the volume of pancreatic tumor, is the main reason for the low survival rate of pancreatic cancer. Cancer-associated fibroblasts (CAFs) are an important group of cells in the tumor stroma of pancreatic cancer, and activated CAFs induce a strong connective tissue interstitial reaction and secretes a variety of soluble molecules to remodel the extracellular matrix, thereby forming a microenvironment that helps with the proliferation, invasion, and metastasis of pancreatic cancer. At present, an increasing number of evidence has shown that CAFs play an important role in the drug resistance of pancreatic cancer, especially in chemotherapy and immunotherapy, and CAFs result in a low response rate of pancreatic cancer treatment by interfering with the metabolism of antitumor drugs, participating in the signaling pathways associated with drug resistance, and forming an immunosuppressive microenvironment. This article elaborates on the specific mechanism of CAFs participating in the drug resistance of pancreatic cancer from the two aspects of chemotherapy and immunotherapy, in order to provide new ideas for identifying new therapeutic targets for pancreatic cancer and improving the response rate of pancreatic cancer treatment.

Journal of Clinical Hepatology ; (12): 1351-1355, 2022.
Article in Chinese | WPRIM | ID: wpr-924709


Objective To investigate the value of ultrasound and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of mass-type autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDAC). Methods A retrospective analysis was performed for the clinical data, ultrasound findings, and CEUS findings of 11 patients with mass-type AIP who were diagnosed in Tangshan Workers' Hospital from January 2015 to December 2020, and their characteristic manifestations were analyzed and compared with the data of 23 patients with PDCA. The chi-square test was used for comparison of categorical data between two groups. Results For the 11 patients with mass-type AIP, CEUS had a diagnostic accuracy of 63.64%, and all of these patients had hypoechoic single lesions; the patients with clear boundaries, regular morphology, pancreatic duct dilatation or cutoff, and blood flow signal accounted for 54.55%, 63.64%, 18.18%, and 36.36%, respectively, while in the PDCA group, such patients accounted for 30.43%, 34.78%, 78.26%, and 21.74%, respectively, and there was a significant difference in the presence or absence of pancreatic duct dilatation or cutoff between the two groups( χ 2 =11.089, P 0.05). For the 11 patients with mass-type AIP, CEUS showed that 7 patients (63.64%) had hyperenhancement and 4 (36.36%) had iso-enhancement in the arterial phase, and 5 patients (45.45%) had hyperenhancement in the arterial phase and 6 (54.55%) had iso-enhancement in the venous phase; for the 23 patients with PDCA, 22 (95.65%) had hypoenhancement of lesions in both arterial and venous phases, and there were significant differences in the enhancement pattern in arterial and venous phases between the two groups ( χ 2 =30.345 and 30.084, both P < 0.05). Conclusion The enhancement pattern of CEUS and the presence or absence of pancreatic duct dilatation or cutoff have a relatively high value in the differential diagnosis of mass-type AIP and PDCA.

Journal of Clinical Hepatology ; (12): 965-968, 2022.
Article in Chinese | WPRIM | ID: wpr-923319


The tumor microenvironment of pancreatic carcinoma is a dense matrix environment with excessive fibrosis containing pancreatic stellate cells, cancer-associated fibroblasts, immune cells, and extracellular matrix, which not only creates an environment to promote the growth and invasion of tumors, but also makes them resistant to chemotherapy and other antitumor drugs. Intensive fibrosis reaction in the matrix and changes of tumors in immune environment are considered the main reasons for treatment failure in pancreatic cancer management. This article reviews the recent research advances in the tumor microenvironment of pancreatic cancer, summarizes its composition and pathogenesis and the targeted therapies for matrix and immune cells, and analyzes the importance of tumor microenvironment in the development and progression of pancreatic cancer and its impact on targeted therapy.

Journal of Clinical Hepatology ; (12): 961-964, 2022.
Article in Chinese | WPRIM | ID: wpr-923318


MicroRNA-200c (miR-200c) is a type of non-coding small molecule RNA, which is involved in the post-transcriptional regulation of genes and is closely associated with the development and progression of tumor. This article introduces the inhibitory effect of miR-200c on the invasion and metastasis of pancreatic cancer and the clinical application value of miR-200c in the early diagnosis and prognostic evaluation of pancreatic cancer. It is pointed out that miR-200c can be used as a tumor suppressor gene and an effective molecular marker for further clinical research.

Journal of Clinical Hepatology ; (12): 622-628, 2022.
Article in Chinese | WPRIM | ID: wpr-922965


Objective To investigate the clinical effect of simultaneous surgical resection of hepatic and pancreatic lesions versus systemic chemotherapy in treatment of resectable pancreatic cancer with liver metastasis (PCLM). Methods A retrospective analysis was performed for related data of the patients with PCLM who were admitted to Shengjing Hospital of China Medical University from January 2013 to May 2020, and the patients with resectable PCLM were screened out and then divided into surgery group and chemotherapy group. The propensity score matching (PSM) method was used to reduce the impact of data bias and confounding factors. The independent samples t -test or the Mann- Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to calculate survival time, and the log-rank test was used for evaluation. The univariate and multivariate Cox regression models were used to investigate the independent risk factors for survival. Results A total of 56 patients with resectable PCLM were screened out, with 33 patients in the surgery group and 23 patients in the chemotherapy group, and there were 15 patients in each group after PSM. The surgery group had a significantly shorter median overall survival time than the chemotherapy group before PSM (6.6 months vs 10.4 months, χ 2 =4.476, P =0.034) and after PSM (6.4 months vs 10.5 months, χ 2 =4.309, P =0.038). The multivariate Cox regression analysis showed that poorly differentiated tumor (hazard ratio [ HR ]=4.945, 95% confidence interval [ CI ]: 1.980-12.348, P =0.001) and absence of postoperative chemotherapy ( HR =3.670, 95% CI : 1.437-9.376, P =0.007) were independent risk factors for poor prognosis in patients with PCLM. Conclusion Compared with chemotherapy, simultaneous surgical resection of hepatic and pancreatic lesions fails to prolong the overall survival time of patients with resectable PCLM. Patients with poorly differentiated tumor and those without postoperative chemotherapy tend to have poor prognosis.

Journal of Clinical Hepatology ; (12): 617-621, 2022.
Article in Chinese | WPRIM | ID: wpr-922964


Objective To investigate the expression of the E3 ubiquitin ligase neural precursor cell expressed developmentally downregulated 4-1 (NEDD4-1) in pancreatic cancer tissue and its clinical significance. Methods Clinical data were collected from 58 patients who underwent surgical treatment in Xuzhou Central Hospital from January 2017 to December 2019 and were diagnosed with pancreatic ductal adenocarcinoma based on pathological examination. Immunohistochemistry was used to measure the expression of NEDD4-1 in pancreatic cancer tissue samples, and the association between the expression of NEDD4-1 and the clinicopathological features of pancreatic cancer was analyzed. Western blot was used to measure the protein expression level of NEDD4-1 in normal pancreatic ductal epithelial HPDE6-C7 cells and pancreatic cancer SW1990, BxPC-3, and PANC-1 cells. The t -test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for survival analysis. The Cox proportional-hazards regression model was used to investigate the factors associated with prognosis. Results The expression level of NEDD4-1 in pancreatic cancer tissue was significantly higher than that in adjacent tissue (79.31% vs 19.05%, χ 2 =35.614, P < 0.01), and the protein expression of NEDD4-1 in pancreatic cancer cells was significantly higher than that in normal pancreatic ductal epithelial cells ( P < 0.01). In the patients with pancreatic cancer, the expression of NEDD4-1 was associated with distant metastasis ( χ 2 =5.089, P =0.040), tumor differentiation ( χ 2 =9.071, P =0.003), and TNM stage ( χ 2 =8.882, P =0.003). The patients with high NEDD4-1 expression had a significantly shorter mean survival time than those with low expression (13.61±0.95 months vs 22.22±2.20 months, P =0.001). The Cox regression analysis showed that NEDD4-1 expression (hazard ratio [ HR ]=2.312, 95% confidence interval [ CI ]: 1.010-5.295, P =0.047), degree of tumor differentiation ( HR =2.981, 95% CI : 1.556-5.712, P =0.001), and lymph node metastasis ( HR =2.144, 95% CI : 1.155-3.979, P =0.016) were independent risk factors for the prognosis of patients with pancreatic cancer. Conclusion There is a significant increase in the expression of NEDD4-1 in pancreatic cancer tissue and cells, and the high expression of NEDD4-1 is associated with poor prognosis. Therefore, it can be used as a prognostic biomarker and a therapeutic target for pancreatic cancer.

Rev. colomb. gastroenterol ; 36(2): 200-205, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1289299


Resumen Introducción y objetivos: El ultrasonido endoscópico con punción-aspiración con aguja fina (USE-PAAF) en lesiones neoplásicas biliopancreáticas suele tener un rendimiento alto, que depende de características de la lesión; aspectos técnicos de la USE-PAAF y la experiencia del endoscopista. De los factores menos estudiados es la presencia de patólogo en sala. Se plantea la realización de USE-PAAF con patólogo en sala para disminuir el número de pases, la tasa de muestras inadecuadas y la necesidad de repetir el procedimiento. Material y métodos: Estudio observacional, retrospectivo, con recolección prospectiva de enero de 2018 a junio de 2019, en pacientes adultos sometidos a USE-PAAF. Las muestras obtenidas fueron extendidas y evaluadas en salas de endoscopia por médico patólogo con coloración Diff-Quick y cuando se obtenía una muestra suficiente se enviaba en frasco con formol para bloque celular o biopsias. Resultados: Se realizaron 48 USE-PAAF biliopancreáticas en individuos con una edad mediana de 64 años. Las indicaciones más frecuentes fueron punciones por masa o pseudomasa pancreática (71 % de casos); Se diagnosticaron 35 malignidades (77 % correspondientes a adenocarcinoma, y 14 % a tumores neuroendocrinos). La mediana de tamaño de lesiones fue de 28 mm; el número de pases promedio fue de 3. Se obtuvieron resultados diagnósticos en 89 % frente a 11 % de falsos negativos. Se presentó 1 complicación menor (2,1 %), que fue dolor abdominal. Conclusiones: La USE-PAAF con patólogo en sala tiene alto rendimiento diagnóstico, con escasos resultados falsos negativos. Se requiere una mediana de pases menor, que podría minimizar los riesgos del procedimiento y la necesidad de repetir la prueba.

Abstract Introduction: Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) of pancreatobiliary neoplastic lesions usually has a high performance that depends on the characteristics of the lesion, technical aspects, and expertise of the endoscopist. One of the least studied factors is rapid on-site evaluation with a pathologist in the room. Objective: To perform EUS-FNA with a pathologist in the endoscopy room to reduce the number of passes, the rate of inadequate samples and the need to repeat the procedure. Material and methods: Observational retrospective study with a prospective data collection approach from January 2018 to June 2019 of adult patients undergoing EUS-FNA. The samples obtained were spread and evaluated in endoscopy rooms by a pathologist with Diff-Quick stain, and when a sufficient sample was obtained, it was sent in a vial with formalin for cell block and/or biopsy. Results: 48 pancreatobiliary EUS-FNA were performed in individuals with a median age of 64 years. The most frequent indication was aspiration due to pancreatic mass (71%); 35 malignancies were diagnosed (77% were adenocarcinomas and 14% were neuroendocrine tumors). The median size of the lesions was 28mm, and the average number of passes was 3. Diagnostic results were obtained in 89% vs. 11% of false negatives. There was 1 minor complication (2.1%), which was abdominal pain. Conclusions: EUS-FNA with an in-room pathologist has a high diagnostic performance, with few false negative results. Also, a lower median number of passes is required, minimizing the risks of the procedure and the need for repeating it.

Arch. pediatr. Urug ; 92(1): e304, jun. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1248850


Resumen: Introducción: el tumor sólido pseudopapilar de páncreas (TSP) es un tumor poco frecuente de bajo potencial de malignidad que afecta principalmente a mujeres jóvenes. Objetivo: reportar una adolescente en quien se documentó un TSP. Caso clínico: paciente de 12 años de sexo femenino, en la cual se confirmó un TSP luego de presentar episodio de dolor abdominal intenso a nivel de hipocondrio izquierdo y vómitos. En su historial destacó la ausencia de antecedentes patológicos y un examen físico sin alteraciones. La resonancia nuclear magnética (RNM) identificó a nivel del sector caudal del páncreas una tumoración mixta sólido quística; por sus características se planteó que podría corresponder a un TSP. Se realizó su resección completa. La anatomía patológica confirmó el planteo diagnóstico. Conclusiones: debe ser considerado su diagnóstico en adolescentes de sexo femenino que presentan una tumoración pancreática e imagen compatible. La resección quirúrgica es el Gold Standard del manejo terapéutico.

Summary: Introduction: solid pseudopapillary tumor (SPT) of the pancreas is a rare low-level malignant tumor which mainly affects young women. Objective: report the case of an adolescent with a SPT. Clinical case: twelve-year old female adolescent diagnosed with a SPT after an episode of severe abdominal pain on the left hypochondriac region and vomiting. Her medical record did not show a pathological history nor were there findings in the physical examination. The MRI showed a mixed cystic and solid tumor in the caudal portion of the head of the pancreas, which was initially thought to be a SPT. A total surgical resection was performed and the anatomical pathology confirmed the diagnosis. Conclusions: SPT diagnosis should be considered in female adolescents who show a pancreatic tumor and compatible image. A total surgical resection is the Gold Standard regarding the SPT's therapeutic management.

Resumo: Introdução: o tumor sólido pseudopapilar do pâncreas (TSPP) é um tumor raro com baixo potencial de malignidade que afeta principalmente mulheres jovens. Objetivo: relatar o caso de uma adolescente diagnosticada com um TSPP. Caso clínico: paciente do sexo feminino, 12 anos de idade, confirmada com TSPP após apresentar episódio de dor abdominal intensa em quadrante superior esquerdo e vômitos. Em seu prontuário, destacou-se a ausência de antecedentes patológicos e um exame físico sem alterações. A ressonância magnética (RM) identificou um tumor cístico sólido misto no setor caudal do pâncreas que, por suas características, sugeriu-se que pudesse corresponder a um TSPP. Realizou-se sua ressecção completa. A anatomia patológica confirmou a abordagem diagnóstica. Conclusões: deve se considerar o diagnóstico de TSPP em adolescentes do sexo feminino que apresentam tumor pancreático e imagem compatível. A ressecção cirúrgica é o padrão ouro para o manejo terapêutico.

Rev. Soc. Bras. Clín. Méd ; 19(1): 2-6, março 2021.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1361676


Objetivo: Estimar a taxa de sobrevida por câncer de pâncreas. Métodos: Trata-se de estudo com delineamento de coorte retrospectiva, realizado no período de 2007 a 2018, em um hospital terciário no Sul do Brasil. A amostra foi composta de 66 indivíduos que realizaram acompanhamento no Hospital Nossa Senhora da Conceição, em Tubarão (SC), cujo sítio primário da doença tenha sido o pâncreas. Resultados: Dos 66 prontuários avaliados, 35 pertenciam a pessoas do sexo masculino (53%), com média de idade de diagnóstico de 64,3 anos. O estádio mais prevalente foi o IV (46 pacientes, correspondente a 69,7%). O tempo médio de sobrevida global foi de 462,02 dias (desvio-padrão de 90,76), e a mediana foi de 320 dias. Conclusão: Identificou-se uma prevalência maior em pessoas do sexo masculino, idosos e caucasianos e em indivíduos no estadiamento IV.

Objective: To estimate the survival rate for pancreatic cancer. Methods: This is aretrospective cohort study conducted from 2007 to 2018 in a tertiary hospital in Southern Brazil. The sample consisted of 66 individuals followed up at Hospital Nossa Senhora da Conceição, in Tubarão (SC), whose primary site of the disease was the pancreas. Results: Of the 66 medical records assessed, 35 were of male (53%) individuals, with a mean age at diagnosis of 64.3 years. The most prevalent stage was IV (46 patients, corresponding to 69.7%). The mean overall survival time was 462.02 days (standard deviation of 90.76) and the median was 320 days. Conclusion: Higher prevalence of males, elderly people, and Caucasians was observed, as well as IV staging.

Rev. Assoc. Med. Bras. (1992) ; 67(2): 292-296, Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287810


SUMMARY OBJECTIVE: To analyze abdominal drain on the first postoperative day and evaluate its predictive nature for the diagnosis of Pancreatic Fistula exclusion, seeking to establish a cutoff point from which lower values demonstrate safety in excluding the possibility of this complication. METHODS: From August 2017 to June 2020, data from 48 patients undergoing pancreatic resection were collected and analyzed from a prospective cohort. The patients were divided into two groups, one group consisting of patients who did not develop PF (Group A), and the other composed of patients who developed PF (Group B). The receiver operation characteristic curve was constructed, and cutoff points were evaluated by calculating sensitivity and specificity. RESULTS: Group A brought 30 patients together (62.5%) and Group B brought 18 patients together (37.5%). The 444 U/L value was the most satisfactory cutoff point for the receiver operation characteristic curve (CI 0.690-0.941), with a sensitivity of 94.4% and a specificity of 60%, thus being able to select 18 of 30 patients who did not succumb to PF. CONCLUSIONS: Abdominal drain on the first postoperative day can be used as a predictive factor in the diagnosis of PF exclusion (CI 0.690-0.941), with the value of 444 U/L being the best performance cutoff point.

Pancreatectomy/adverse effects , Pancreatic Fistula/diagnosis , Pancreatic Fistula/etiology , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Drainage , Predictive Value of Tests , Prospective Studies , Pancreaticoduodenectomy , Amylases
Rev. Col. Bras. Cir ; 48: e20202913, 2021. tab, graf
Article in English | LILACS | ID: biblio-1287885


ABSTRACT Background and Aims: An association between non-alcoholic fatty liver disease (NAFLD) and pancreatic ductal adenocarcinoma (PDAC) has been previously suggested. This study aims at investigating this association and at identifying potential links between variables of the NAFLD spectrum and PDAC. Methods: A cross-sectional case-matched analytical and comparative study was carried out to analyze patients undergoing surgical resection of PDAC and compare them to a control group of individuals undergoing cholecystectomy at a public tertiary teaching hospital, matched by sex, age and BMI. Hepatic histopathological examinations were compared between cases and controls. Results: Of 56 individuals, 36 were male (64.3%) and the median age was 61.5 years old (interquartile range: 57.5 - 70). The participants' median BMI was 24.3 kg/m2 (interquartile range: 22.1-26.2 kg/m2). Microvesicular steatosis (p=0.04), hepatocellular ballooning (p=0.02), fibrosis (p=0.0003) and steatohepatitis (p=0.03) were significantly more frequent in the group of cases. Odds ratios for hepatocellular ballooning (6.2; 95%CI: 1.2-31.8; p=0.03), fibrosis (9.3; 95%CI: 2.5-34.1; p=0.0008) and steatohepatitis (3.9; 95%CI: 1.1-14.3; p=0.04) were statistically significant in relation to the PDAC prevalence. Conclusions: Significant associations were identified between histopathological aspects of NAFLD (microvesicular steatosis, hepatocellular ballooning, fibrosis, and steatohepatitis) and PDAC.

RESUMO Histórico e objetivos: a associação entre a doença hepática gordurosa não alcoólica (DHGNA) e o adenocarcinoma ductal pancreático (ACDP) foi sugerida anteriormente. Este estudo visa investigar esta associação e identificar possíveis ligações entre as variáveis do espectro da DHGNA e o ACDP. Métodos: foi realizado estudo transversal caso-controle analítico e comparativo para analisar pacientes submetidos a ressecção cirúrgica de ACDP e compará-los a grupo controle de indivíduos submetidos a colecistectomia em hospital público terciário de ensino, pareados por sexo, idade e IMC. Os exames histopatológicos hepáticos foram comparados entre casos e controles. Resultados: dos 56 indivíduos, 36 eram do sexo masculino (64,3%) e a idade mediana era de 61,5 anos de idade (intervalo interquartil 57,5-70). A mediana do IMC dos participantes foi de 24,3 kg/m2 (intervalo interquartil 22,1 26,2). Esteatose microvesicular (p = 0,04), balonização hepatocelular (p = 0,02), fibrose (p = 0,0003) e esteato-hepatite (p = 0,03) foram significativamente mais frequentes no grupo de casos. As razões de chances para balonização hepatocelular (6,2; IC 95%: 1,2 - 31,8; p = 0,03), fibrose (9,3; IC 95%: 2,5 - 34,1; p = 0,0008) e esteato-hepatite (3,9; IC 95%: 1,1 - 14,3; p = 0,04) foram estatisticamente significativas em relação à prevalência de ACDP. Conclusões: houve associações significativas entre aspectos histopatológicos de DHGNA (esteatose microvesicular, balonização hepatocelular, fibrose e esteato-hepatite) e a ocorrência de ACDP.

Humans , Male , Pancreatic Neoplasms/epidemiology , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/pathology , Non-alcoholic Fatty Liver Disease/epidemiology , Biopsy , Cross-Sectional Studies , Liver , Liver Cirrhosis/pathology , Middle Aged
ABCD arq. bras. cir. dig ; 34(4): e1628, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1360014


RESUMO -RACIONAL: O adenocarcinoma ductal do pâncreas é a quarta causa de morte associada ao câncer mais comum no mundo ocidental. A presença de células tumorais circulantes (CTCs) pode ser considerada um potencial fator prognóstico, visto que essas células representam a progressão tumoral, permitindo o monitoramento da eficácia terapêutica. OBJETIVOS: explorar as características morfológicas, moleculares e fenotípicas das células tumorais circulantes (CTCs) do sangue de pacientes com carcinoma pancreático e correlacionar os achados com a resposta ao tratamento, sobrevida livre de progressão, sobrevida global (SG) e trombose venosa profunda (TVP). MÉTODOS: o sangue periférico (10mL) foi analisado antes do início do tratamento e após 60 e 120 dias. As CTCs foram detectadas pelo ISET® e caracterizadas por imunocitoquímica. Para análise de miRNAs, leucócitos periféricos dos mesmos pacientes e indivíduos saudáveis foram coletados em paralelo no início do estudo. A expressão de miRNAs foi avaliada usando TaqMan T Array Human MicroRNA Cards v2.0. RESULTADOS: foram incluídos 9 pacientes. As proteínas MMP2 e TGFß-RI foram altamente expressas (77,7%) nas CTCs no início do estudo. No primeiro acompanhamento, MMP2 era predominante (80%) e no segundo acompanhamento, MMP2 e vimentina eram predominantes (50%). Microêmbolos tumorais circulantes (MTC) foram encontrados em dois pacientes e ambos apresentavam TVP. O miR-203a-3p foi altamente expresso em CTCs. miR-203a-3p está envolvido na estimulação da transição epitelio-mesenquima (TEM) e relacionado a pior SG no câncer pancreático (dados TCGA). CONCLUSÃO: Devido ao baixo número de pacientes e curto seguimento, não observamos correlação entre CTCs e resposta ao tratamento. No entanto, houve uma correlação entre MTC e TVP. Além disso, miR-203a-3p foi altamente expresso em CTCs, corroborando os achados de proteínas EMT. Este estudo abre perspectivas sobre a mudança dinâmica no padrão de proteínas expressas ao longo do tratamento e a utilização de miRNAs como novos alvos no carcinoma pancreático.

ABSTRACT - BACKGROUND: Ductal adenocarcinoma of the pancreas is the fourth most common cancer-associated cause of death in the Western world. The presence of circulating tumor cells (CTCs) can be considered a potential prognostic factor, as these cells represent tumor progression, allowing monitoring of therapeutic efficacy. OBJECTIVES: The objectives of this study were to explore the morphological, molecular, and phenotypic characteristics of CTCs from the blood of patients with pancreatic carcinoma and to correlate the findings with response to treatment, progression-free survival, overall survival (OS), and deep vein thrombosis (DVT). METHODS: Peripheral blood (10 mL) was analyzed before the beginning of treatment after 60 and 120 days. CTCs were detected by using ISET® and characterized by immunocytochemistry. For microRNAs (miRNAs) analysis, peripheral leukocytes from the same patients and healthy individuals (controls) were collected in parallel at baseline. The expression of miRNAs was evaluated (in pool) using TaqMan® Array Human MicroRNA Cards v2.0. RESULTS: Only nine patients were included. The proteins, namely, matrix metalloproteinase-2 (MMP2) and TGFβ-RI, were highly expressed (77.7%) in CTCs at baseline; at the first follow-up, MMP2 was predominant (80%) and, at the second follow-up, MMP2 and vimentin were predominant (50%). Circulating tumor microemboli (CTMs) were found in two patients and both presented DVT. The miR-203a-3p was highly expressed in CTCs. The miR-203a-3p is involved in the stimulation of epithelial-to-mesenchymal transition (EMT) and is related to worse OS in pancreatic cancer (TCGA data). CONCLUSION: Due to the low number of patients and short follow-up, we did not observe a correlation between CTCs and response to treatment. However, there was a correlation between CTM and DVT and also miR-203a-3p was highly expressed in CTCs, corroborating the findings of EMT proteins. This study opens the perspectives concerning the dynamic change in the pattern of proteins expressed along with treatment and the use of miRNAs as new targets in pancreatic carcinoma.

Humans , Pancreatic Neoplasms/genetics , Matrix Metalloproteinase 2/genetics , MicroRNAs/genetics , Neoplastic Cells, Circulating
ABCD arq. bras. cir. dig ; 34(4): e1640, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1360008


RESUMO - RACIONAL: Apesar da recomendação atual que o cistoadenoma seroso deva ser tratado de forma conservadora, significativa parte dos pacientes com essa condição ainda é operada por dúvida diagnóstica. OBJETIVO: Analisar causas da baixa acurácia diagnóstica do cistoadenoma seroso. MÉTODOS: Estudo retrospectivo de portadores de cistoadenoma seroso de um banco de dados de dois ambulatórios de cirurgia hepatopancreaticobiliar entre 2006 e 2020. Foram incluídos pacientes com lesões típicas de cistoadenoma seroso aos exames de imagem (tomografia computadorizada, ressonância magnética e ecoendoscopia) e pacientes que o anatomopatológico confirmasse esse diagnóstico. RESULTADOS: 27 pacientes foram incluídos. 85,18% eram do sexo feminino. A idade média foi de 63,4 anos. Apenas um apresentava sintomas típicos de pancreatite. A Ressonância magnética foi o exame mais realizado (62,9%). A lesão era única em 88,9% e o tamanho médio foi 4 cm. O aspecto típico microcístico foi encontrado em 66,6% dos casos, os demais foram considerados atípicos. A ecoendoscopia foi realizada em 29,6%. O valor médio de antígeno carcinoembrionário nos pacientes submetidos à punção do cisto foi de 198,25 ng/mL. O tratamento cirúrgico foi realizado em 10 casos (37%). Em 7, a causa cirúrgica foi a suspeita do cistoadenoma mucinoso mediante identificação de lesões atípicas (unilocular com ou sem septos e macrocística). Em 2, a suspeita de neoplasia papilar intraductal mucinosa com "fatores preocupantes" foi a indicação cirúrgica. O último foi submetido à cirurgia por lesão de aspecto sólido e suspeita de câncer. O índice de complicações > ou = Clavien-Dindo 2 foi 30%, o índice de fístula pancreática clinicamente relevante (B e C) foi 30%. A mortalidade foi nula. CONCLUSÃO: A apresentação morfológica atípica do cistoadenoma seroso, particularmente lesões uniloculares e macrocísticas, é a principal responsável pela indicação cirúrgica. Apenas a implementação de novos, eficientes e reprodutíveis métodos diagnósticos poderá reduzir o número de cirurgias desnecessárias nesses pacientes.

ABSTRACT - BACKGROUND: Many patients with serous cystadenoma of the pancreas (SCP) underwent surgery due to diagnostic doubt. AIM: The aim of this study was to analyze the causes of low accuracy in diagnosing SCP. METHODS: This is a retrospective study of patients with SCP from a database of two hepatopancreatic biliary surgery outpatient clinics between 2006 and 2020. Patients with typical SCP lesions in imaging exams (e.g., tomography, magnetic resonance imaging [MRI], and endoscopic ultrasound [EUS]) and patients whose pathological testing confirmed this diagnosis were included. RESULTS: A total of 27 patients were included in this study. Most patients were women (85.18%), and the mean age was 63.4 years. Only one patient had typical pancreatitis symptoms. MRI was the most performed method (62.9%). The lesion was single in 88.9%, and the average size was 4 cm. The typical microcystic aspect was found in 66.6%. EUS was performed in 29.6% of cases. The mean carcinoembryonic antigen value in patients undergoing cyst puncture was 198.25 ng/mL. Surgical treatment was performed in 10 cases (37%). The cause of surgery in seven of these cases was due to a suspicion of mucinous cystadenoma based on an identification of atypical lesions (unilocular with or without septa and macrocystic) in imaging exams. A suspicion of intraductal papillary mucinous neoplasm with "worrying factors" was the indication for surgery in two cases. The last case underwent surgical treatment for a solid-looking lesion which was suspected of cancer. The complication rate ≥Clavien-Dindo 2 was 30%, and the clinically relevant pancreatic fistula rate (B and C) was 30%. Mortality was nil. CONCLUSION: The atypical morphological presentation of SCP, particularly unilocular and macrocystic lesions, is the main indication for surgery. Only the implementation of new, efficient, and reproducible diagnostic methods can reduce the number of unnecessary surgeries among these patients.

Humans , Female , Cystadenoma, Serous/surgery , Cystadenoma, Serous/diagnostic imaging , Cystadenoma, Mucinous , Pancreas , Magnetic Resonance Imaging , Retrospective Studies , Middle Aged
Autops. Case Rep ; 11: e2020201, 2021. tab, graf
Article in English | LILACS | ID: biblio-1142397


Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UCOGCs) is an extremely rare morphologically and clinically distinct variant of pancreatic ductal adenocarcinoma (PDAC), exhibiting a characteristic component of reactive osteoclast-like giant cells admixed with neoplastic mononuclear cells. Sommers and Meissner first described it in 1954 as an "unusual carcinoma of the pancreas". Later it acquired many different names. In 2010, the WHO classified these tumors as a variant of PDAC under the heading of "undifferentiated carcinoma with osteoclast-like giant cells". Here we describe the first case of pancreatic mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) composed of UCOGC and pancreatic neuroendocrine tumor (NET), which occurred in a 78-year-old man with biliary colic and pancreatitis. The mass did not respond to the chemotherapy, and he soon developed liver metastasis from the NET component, and unfortunately, the patient passed away 10 months later. Since UCOGC is extremely rare, and its association with NET has not been reported yet, our case expands the knowledge regarding its unusual presentation and poor prognosis.

Humans , Male , Aged , Pancreatic Neoplasms/pathology , Neuroendocrine Tumors , Carcinoma, Pancreatic Ductal/pathology , Giant Cells , Fatal Outcome
Rev. bras. cancerol ; 67(1): e-16967, 2021.
Article in Portuguese | LILACS | ID: biblio-1147265


Introdução: A neoplasia maligna de pâncreas configura uma das neoplasias de maior mortalidade em todo o mundo, quase sempre atrelada a um prognóstico sombrio, principalmente quando associada à disseminação linfática e para órgãos distantes. Objetivo: Avaliar a sobrevida global em pacientes com adenocarcinoma de pâncreas atendidos em um centro especializado em oncologia. Método: No período de janeiro de 2011 a dezembro de 2014, foram avaliados retrospectivamente 71 prontuários. Os dados foram analisados pelo software STATA versão 14, utilizando análise de Kaplan-Meier e de regressão de Cox. O intervalo de confiança utilizado foi de 95% e considerado significante p<0,05. Foram preservados os princípios éticos e da confidencialidade. Resultados: Houve predomínio do sexo masculino, raça parda e com idade superior a 61 anos ao diagnóstico. Quanto às características clínicas, 87,8% dos tumores estavam localizados em cabeça de pâncreas. A dor abdominal (92,7%) foi o sintoma mais frequente, seguida de perda progressiva de peso (79,3%) e icterícia (57,3%). A taxa de sobrevida em três meses de acompanhamento foi de 48,4%. Conclusão: O estudo evidencia que o câncer de pâncreas tem uma repercussão extremamente negativa, visto que a maioria dos pacientes recebe o diagnóstico em estágios avançados da doença, dificultando a possibilidade de tratamento curativo.

Introduction: Pancreatic malignant neoplasia represents one of the highest mortality neoplasms worldwide, almost always associated to a dismal prognosis, especially when associated with lymphatic spread and to distant organs. Objective: To assess the global survival in patients with pancreatic adenocarcinoma treated at a specialized oncology center. Method: From January 2011 to December 2014, 71 medical records were retrospectively evaluated. The data were analyzed using the STATA software version 14, using the Kaplan-Meier curve and the Cox regression. The confidence interval used was 95% (p<0.05). Ethical and confidentiality principles have been secured. Results: There was predominance of males, mixed race and over 61 years of age at diagnosis. As for the clinical characteristics, 87.8% of the tumors were located in the head of the pancreas. Abdominal pain (92.7%) was the most frequent symptom, followed by progressive weight loss (79.3%) and jaundice (57.3%). The three-month follow-up survival rate was 48.4%. Conclusion: The study shows that pancreatic cancer has an extremely negative repercussion, since most patients are diagnosed in advanced stages of the disease, hindering the possibility of curative treatment.

Introducción: La neoplasia maligna pancreática representa una de las neoplasias de mortalidad más altas del mundo, casi siempre vinculada a un pronóstico sombrío, especialmente cuando se asocia con diseminación linfática y órganos distantes. Objetivo: Evaluar la supervivencia global en pacientes con adenocarcinoma pancreático tratados en un centro de oncología especializado. Método: Desde enero de 2011 hasta diciembre de 2014, se evaluaron retrospectivamente 71 registros médicos. Los datos se analizaron utilizando el software STATA versión 14, utilizando la curva de Kaplan-Meier y la regresión de Cox. El intervalo de confianza utilizado fue del 95% (p<0,05). Se han preservado los principios éticos y de confidencialidad. Resultados: Predominó el sexo masculino, la raza mixta y los mayores de 61 años en el momento del diagnóstico. En cuanto a las características clínicas, el 87,8% de los tumores se ubicaron en la cabeza del páncreas. El dolor abdominal (92,7%) fue el síntoma más frecuente, seguido de pérdida progresiva de peso (79,3%) e ictericia (57,3%). La tasa de supervivencia de seguimiento a los tres meses fue del 48,4%. Conclusión: El estudio muestra que el cáncer de páncreas tiene un impacto extremadamente negativo, ya que la mayoría de los pacientes reciben el diagnóstico en etapas avanzadas, obstaculizando la posibilidad de tratamiento curativo.

Humans , Male , Female , Adult , Middle Aged , Pancreatic Neoplasms/epidemiology , Survival Analysis , Delayed Diagnosis