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J. coloproctol. (Rio J., Impr.) ; 41(4): 393-405, Out.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1356431


Background: Anatomopathological staging is the primary method to determine the prognosis of patients with colorectal carcinoma (CRC). However, new tools have been developed that can complement it, such as the analysis of the elevation of systemic inflammatory markers. Objective: To evaluate the impact of the elevation of scores based on inflammatory markers (the neutrophil-to-lymphocyte ratio [NLR], the Glasgow Prognostic Score [GPS], and isolated C-reactive protein [CRP]) in the prognosis of patients diagnosed with CRC and submitted to potentially curative surgery in Hospital de Braga, Portugal, between January 1st, 2005, and December 31st, 2010. Methods: A retrospective analysis of the data of 426 patients was performed, with a collection of several clinico-pathological variables, as well as the levels of lymphocytes, neutrophils, albumin and CRP, in the pre- and postoperative periods, to apply the different scores to the sample. Results: From the analysis of the survival curves, we concluded that patients with increased NLR in the pre- and postoperative periods present a lower cancer-related survival than patients with normal NLR (preoperative period: 93.7 versus 122 months; p<0.001; postoperative period: 112 versus 131 months; p=0.002). Patients with increased NLR in the pre- and postoperative periods also had a lower disease-free survival (preoperative period: 88.0 versus 122 months; p<0.001; postoperative period: 111 versus 132 months; p=0.002). In addition, increased pre- and postoperative NLR was associatedwith a higher risk of death due to CRC (preoperatively: hazard ratio [HR]=2.25; p<0.001; postoperatively: HR=2.18; p=0.003). However, the multivariate analysis shows that only postoperative NLR (ajusted HR =2.66; p=0.002) does so independently of the remaining variables. Conclusion: Regarding the scores applied to the sample, the NLR was the one that most consistently related to the prognosis of the patients. However, it would be useful to develop a prospective study that could confirm this relationship. (AU)

Humans , Male , Female , Prognosis , Colorectal Neoplasms/mortality , C-Reactive Protein/analysis , Colorectal Neoplasms/therapy , Survival Rate , Disease-Free Survival , NLR Proteins/analysis
J. coloproctol. (Rio J., Impr.) ; 41(3): 249-256, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1346430


Background: Globally, 1,096,601, 704,376, and 48,541 new colon, rectum, and anus cancer cases were recorded in 2018, respectively. Besides, 551,269, 310,394 and 19,129 cases of colon, rectum, and anus cancer deaths occurred in the same year. As a result, these cancers ranked in the third level of cancer incidence, and in the second level of cancer mortality. As it is known, all cancer patients are subjected to cancerinduced and therapy-induced nutritional deficiencies (mainly of proteins and calories). The present study aimed to assess proteins level in colorectal cancer (CRC) patients who underwent surgery and chemotherapy. Methods: A combined retrospective and prospective study was performed. The present study enrolled 100 CRC patients with their data on surgical procedures and chemotherapy management. Assessments of the studied samples were conducted as a baseline before receiving chemotherapy and preoperatively as P0, while the period after that was termed as P1. The serum samples were collected to measure protein concentration. Total Protein Kit, Micro was used. Results: The mean age of the patients was 50.7±12.88 years old. Only 8% had a positive CRC family history. Rectosigmoid cancer represented the most frequent site, figured in 41% of the cases, followed by rectum cancer. Multiple sites of CRC metastasis were recorded in 15% of the patients. All patients received chemoradiation. Folinic acid (leucovorin), 5-FU, and oxaliplatin (FOLFOX) was the most used regimen, administered in 40% of the patients. Oxaliplatin and capecitabine (also called Xeloda) (XELOX) were administered in 14% of the patients. Folinic acid (leucovorin), 5-FU, oxaliplatin, and irinotecan (FOLFOXIRI) were administered in 16% of the patients. Single-agent oxaliplatin or carboplatin were administered in 6% of the patients, each. 5-FU plus leucovorin was administered to 12% of the patients. Three patients received irinotecan, and oxaliplatin (IROX). One patient received folinic acid (leucovorin), 5-FU and irinotecan (FOLFIRI). Also, Gemzar was administered to two patients only. A total of 80% of the patients underwent several surgical procedures. Anterior perineal resection (APR) and total mesorectal excision (TME) were the most common two surgeries, performed in 20 and in 30% of the patients, respectively. In P0 status, 44% of the patients suffered from low protein levels, and 13% of the patients were within the normal level. These findings were statistically different (p=0.03). After CRC management (i.e., P1 status), 70% of the patients had protein deficiency. These results have strong significant differences (p=0.000). The mean of protein concentration declined gradually after management, from 8.82±0.9 μg/L to 6.210.78 μg/L, with a strong association between a reduction in proteins levels towards deficiency and surgical procedures and chemotherapy protocols (p=0.000). Conclusion: The incidence of CRC is increasing annually, and the chance of being diagnosed with this type of cancer has risen in recent years. In the present study, the male to female ratio was 1:1.5, and the 5th decade of life was themost common age for the diagnosis of CRC. A negative family history and bowel inflammatory diseases (IBD) history did not exclude people from exposure to the incidence of CRC. Colorectal cancer with localized and moderately differentiated adenocarcinoma were the most common types in the present work. Tumor distance from the anal verge seems to be very important and plays a significant role in the choosing of surgical intervention types and chemoradiation protocols. Colorectal cancer acts as a complex condition and, in addition to its management, nutritional state influences it in different mechanisms. Most patients suffered from hypoproteinemia after surgery and chemoradiation. As a result, alteration in the treatment outcomes, delaying in wound healing, and an increase in postoperative complications may occur. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Protein Deficiency , Colorectal Neoplasms/therapy , Chemoradiotherapy/statistics & numerical data
J. coloproctol. (Rio J., Impr.) ; 41(3): 257-264, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1346426


Introduction: The Covid-19 pandemic has had an important impact on colorectal cancer surgery, for hospital resources had to be redistributed in favour of Covid-19 patients. The aim of the present study is to analyze our results in colorectal oncologic surgery during the Covid-19 pandemic in patients with and without perioperative SARSCoV- 2 infection. Methods: In total, 32 patients (19 male and 13 female patients), with a mean age of 64 years (range: 57.2 to 69.5 years) with colorectal cancer underwent surgery under the recommendations of surgical societies included in a protocol. Data collection included clinical characteristics (gender, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative staging, lymphopenia), data related to SARS-CoV-2 infection (postoperative symptoms, diagnostic tests), operative details (surgical procedure, approach, duration, stoma), pathological outcomes (tumor stage, number of lymph nodes harvested, distal and circumferential radial margins, quality of the total mesorectal excision), and surgical outcomes (morbidity, mortality, hospital stay, and the rates of reoperation and readmission). Results: A total of 3 (9.4%) patients who underwent colorectal surgery during the Covid-19 pandemic were infected by SARS-CoV-2 in the postoperative period. Chronic obstructive pulmonary disease was associated with Covid-19 (6.2% versus 33.3%; p=0.042), and surgical morbidity was higher among Covid-19 patients (100% versus 37.9%; p=0.039). There were not significant differences between COVID-19 patients and non-COVID-19 patients in relation to the rest of the analyzed outcomes. Conclusion: During the Covid-19 pandemic, colorectal cancer surgery should be performed according to the recommendations of surgical societies. However, Covid- 19 patients could present a higher morbidity rate. (AU)

Humans , Male , Female , Middle Aged , Aged , Colorectal Neoplasms/surgery , Colorectal Neoplasms/therapy , Treatment Outcome , COVID-19
Chinese Medical Journal ; (24): 2922-2930, 2021.
Article in English | WPRIM | ID: wpr-921237


Colorectal cancer (CRC) is one of the most prevalent, most lethal cancers in the world. Increasing evidence suggests that the intestinal microbiota is closely related to the pathogenesis and prognosis of CRC. The normal microbiota plays an essential role in maintaining gut barrier function and the immune microenvironment. Recent studies have identified carcinogenic bacteria such as enterotoxigenic Bacteroides fragilis (ETBF) and Streptococcus gallolyticus (S. gallolyticus), as well as protective bacterial such as Akkermansia muciniphila (A. muciniphila), as potential targets of CRC treatment. Gut microbiota modulation aims to restore gut dysbiosis, regulate the intestinal immune system and prevent from pathogen invasion, all of which are beneficial for CRC prevention and prognosis. The utility of probiotics, prebiotics, postbiotics, fecal microbiota transplantation and dietary inventions to treat CRC makes them novel microbe-based management tools. In this review, we describe the mechanisms involved in bacteria-derived colorectal carcinogenesis and summarized novel bacteria-related therapies for CRC. In summary, we hope to facilitate clinical applications of intestinal bacteria for preventing and treating CRC.

Colorectal Neoplasms/therapy , Dysbiosis , Fecal Microbiota Transplantation , Gastrointestinal Microbiome , Humans , Prebiotics , Tumor Microenvironment
Article in Chinese | WPRIM | ID: wpr-880389


The liver is the most common anatomical site for hematogenous metastases of colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment of colorectal cancer. In order to improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised for several times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, improve the resection rate of liver metastases and survival. The revised Guideline version 2020 includes the diagnosis and follow-up, prevention, multidisciplinary team (MDT), surgery and local ablative treatment, neoadjuvant and adjuvant therapy, and comprehensive treatment, with state-of-the-art experience and findings, detailed content, and strong operability.

China , Colorectal Neoplasms/therapy , Combined Modality Therapy , Humans , Liver Neoplasms/therapy , Patient Care Team
Cad. Saúde Pública (Online) ; 37(5): e00214919, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1249435


O câncer de cólon e reto apresenta alta incidência mundialmente, porém a letalidade da doença é maior em países em desenvolvimento. O objetivo deste estudo é analisar fatores sociodemográficos e clínicos associados ao atraso para o início de tratamento de câncer de cólon e reto em hospitais no Brasil. Trata-se de estudo retrospectivo com dados dos registros hospitalares de câncer no Brasil de 2006 a 2015. O desfecho analisado é o tempo para início do tratamento de câncer de cólon e reto e possíveis associações entre variáveis sociodemográficas e referentes a fatores clínicos. Observaram-se disparidades no tempo para início do tratamento de acordo com estratos sociodemográficos e regiões geográficas. Há maior chance de atraso para o início do tratamento de câncer de cólon em pacientes com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,50; IC95%: 1,21-1,84) e parda (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1.50; IC95%: 1,19-1,90) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,25; IC95%: 1,14-1,38). Em pacientes com câncer de reto, há maior chance de atraso para o início do tratamento entre os casos com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,44; IC95%: 1,20-1,72) e parda (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,35; IC95%: 1,25-1,47). Como conclusão, maior atenção deve ser destinada a reduzir o tempo para iniciar o tratamento nas regiões desfavorecidas e nos estratos identificados com barreiras de acesso ao tratamento em tempo oportuno.

Colorectal cancer presents high incidence worldwide, but case-fatality is higher in developing countries. The study's objective was to analyze sociodemographic and clinical factors associated with delay in the initiation of treatment for colorectal cancer in hospitals in Brazil. This is a retrospective study of data from hospital cancer registries in Brazil from 2006 to 2015. The target variable is time to initiation of treatment for colorectal cancer and possible associations between sociodemographic variables and clinical factors. The analysis revealed disparities in time to treatment according to sociodemographic strata and geographic regions. Higher odds of treatment delay were associated with age over 50 years, black race/color (OR = 1.50; 95%CI: 1.21-1.84) and brown race/color (OR = 1.28; 95%CI: 1.17-1.42), illiteracy or low schooling (OR = 1.50; 95%CI: 1.19-1.90), and treatment in a city far from the patient's residence (OR = 1.25; 95%CI: 1.14-1.38). For rectal cancer, higher odds of treatment delay were associated with age over 50 years, black (OR = 1.44; 95%CI: 1.20-1.72) or brown race/color (OR = 1.29; 95%CI: 1.19-1.39), illiteracy or low schooling (OR = 1.71; 95%CI: 1.40-2.09), and treatment in a city far from the patient's residence (OR = 1.35; 95%CI: 1.25-1.47). In conclusion, greater attention should be given to reducing the time to initiation of treatment in underprivileged regions and in social strata identified with barriers to timely treatment access.

El cáncer de colon y recto presenta una alta incidencia mundialmente, pese a que la letalidad de la enfermedad es mayor en países en desarrollo. El objetivo de este estudio fue analizar los factores sociodemográficos y clínicos, asociados al retraso para el inicio del tratamiento de cáncer de colon y recto en hospitales en Brasil. Se trata de un estudio retrospectivo con datos de registros hospitalarios de cáncer en Brasil de 2006 a 2015. El resultado analizado es el tiempo para el inicio del tratamiento de cáncer de colon y recto, así como las posibles asociaciones entre variables sociodemográficas y las relacionadas con factores clínicos. Se observó disparidades en el tiempo para el inicio del tratamiento, según estratos sociodemográficas y regiones geográficas. Existe una mayor oportunidad de retraso para el inicio del tratamiento de cáncer de colon en pacientes con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,50; IC95%: 1,21-1,84) y mulata/mestiza (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1,50; IC95%: 1,19-1,90) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,25; IC95%: 1,14-1,38). En pacientes con cáncer de recto existe una mayor oportunidad de atraso para el inicio del tratamiento entre los casos con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,44; IC95%: 1,20-1,72) y mulata/mestiza (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,35; IC95%: 1,25-1,47). Como conclusión, se debe prestar mayor atención a la reducción del tiempo para comenzar el tratamiento en las regiones desfavorecidas y en estratos identificados con barreras de acceso al tratamiento en el tiempo adecuado.

Humans , Colorectal Neoplasms/therapy , Colorectal Neoplasms/epidemiology , Time-to-Treatment , Socioeconomic Factors , Brazil/epidemiology , Incidence , Retrospective Studies , Middle Aged
Rev. méd. Urug ; 36(4): 455-458, dic. 2020. graf
Article in Spanish | LILACS, BNUY | ID: biblio-1144763


Resumen: La ligadura de una rama de la vena porta constituye un procedimiento con buenos resultados para evitar la falla hepática posoperatoria en caso de hepatectomías extremas al provocar la hipertrofia del hígado contralateral. Sin embargo, la repermeabilización de ésta ha sido demostrada por la presencia de anastomosis porto portales intrahepáticas, pudiendo determinar una disminución de la hipertrofia esperada o necesaria. Como objetivo documentamos un caso clínico de repermeabilización intrahepática de la vena porta, evento no deseado de la hepatectomía en dos tiempos para el tratamiento de metástasis hepáticas bilobares de origen colorrectal y describimos alternativas para evitar o tratar dicha repermeabilización.

Summary: Left or right portal vein ligation to prevent post-operative liver failure in the case of extreme hepatectomy constitutes a procedure with a good prognosis, as it causes contralateral liver hypertrophy. However, its revascularization has been proved by intrahepatic porto-portal anastomoses, which could result in a reduction of the expected or required hypertrophy. The study aims to record a clinical case of intrahepatic revascularization of the portal vein, an unwanted event of the two-stage hepatectomy to treat bilobar hepatic metastasis of colorectal origin, and describe alternatives to avoid or treat such revascularization.

Resumo: A ligadura de um ramo da veia porta é um procedimento com bons resultados para evitar a insuficiência hepática pós-operatória em hepatectomias extremas por causar hipertrofia do fígado contralateral. No entanto, sua repermeabilização tem sido demonstrada pela presença de anastomose porto-portal intra-hepática, que pode determinar diminuição da hipertrofia esperada ou necessária. Como objetivo, documentamos um caso clínico de repermeabilização da veia porta intra-hepática, um evento indesejado de hepatectomia em dois estágios para o tratamento de metástases hepáticas bilobares de origem colorretal, e descrevemos alternativas para evitar ou tratar essa repermeabilização.

Portal Vein , Liver Failure/therapy , Ligation , Colorectal Neoplasms/therapy , Hepatectomy/adverse effects , Liver Neoplasms/therapy , Neoplasm Metastasis
Arq. gastroenterol ; 57(2): 172-177, Apr.-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1131660


ABSTRACT BACKGROUND: Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE: To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS: The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS: Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION: Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.

RESUMO CONTEXTO: Estudos hospitalares recentes têm demonstrado aumento da sobrevida do câncer colorretal e melhor sobrevida para mulheres, jovens e pacientes diagnosticados em estágio precoce da doença. OBJETIVO: Descrever a sobrevida global e analisar os fatores prognósticos de pacientes tratados para câncer colorretal em um centro de oncologia. MÉTODOS: Foram incluídos pacientes com diagnóstico de adenocarcinoma de cólon e reto entre 2000 e 2013, identificados no Registro Hospitalar de Câncer do A.C.Camargo Cancer Center. A sobrevida global aos 5 anos foi estimada pelo método de Kaplan-Meier e os fatores prognósticos foram avaliados pelo modelo de Cox. As razões de risco (HR) são relatadas com intervalos de confiança (IC) de 95%. RESULTADOS: Dos 2.279 casos de câncer colorretal analisados, 58,4% eram de cólon. A taxa de sobrevida global aos 5 anos para pacientes com câncer colorretal foi de 63,5% (65,6% e 60,6% para câncer de cólon e retal, respectivamente). O risco de óbito foi elevado para pacientes na faixa etária de 50-74 anos (HR=1,24; IC95% =1,02-1,51) e ≥75 anos (HR=3,02; IC95% =2,42-3,78), para pacientes com câncer retal (HR=1,37; IC95% =1,11-1,69) e para aqueles cujo tratamento foi iniciado >60 dias após o diagnóstico (HR=1,22; IC95% =1,04-1,43). O risco diminuiu para pacientes diagnosticados em períodos recentes (2005-2009 HR=0,76; IC95% =0,63-0,91; 2010-2013 HR=0,69; IC95% =0,57-0,83). CONCLUSÃO: A sobrevida dos pacientes com câncer colorretal é maior naqueles em estágio inicial e com início do tratamento antes dos 60 dias.. Idade acima de 70 anos foi fator independente preditivo de mau prognóstico. A sobrevida global aumentou para todos os pacientes tratados no período de 2000-2004 a 2010-2013.

Humans , Male , Female , Aged , Aged, 80 and over , Rectal Neoplasms/mortality , Colorectal Neoplasms/mortality , Colonic Neoplasms/mortality , Prognosis , Rectal Neoplasms/pathology , Rectal Neoplasms/therapy , Survival , Severity of Illness Index , Brazil/epidemiology , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Survival Analysis , Registries , Survival Rate , Retrospective Studies , Colonic Neoplasms/pathology , Colonic Neoplasms/therapy , Middle Aged , Neoplasm Staging , Antineoplastic Agents/therapeutic use
Rev. argent. coloproctología ; 31(2): 51-53, jun. 2020.
Article in English, Spanish | LILACS | ID: biblio-1117007


Los contenidos de este capítulo se basan en la 3a edición de las Clínicas Quirúrgicas de Cáncer Colorrectal. C. Vaccaro y N. Peralta. del hospital ediciones 2020 (en prensa)

Colorectal Neoplasms/genetics , Biomarkers, Tumor/genetics , Precision Medicine/trends , Pharmacogenetics/trends , Colorectal Neoplasms/etiology , Colorectal Neoplasms/therapy , Molecular Epidemiology/trends , Mutation , Neoplasm Metastasis/genetics , Neoplasm Metastasis/therapy
São Paulo; s.n; 2019. 148 p. ilust, tabelas, quadros.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1179694


Introdução: A detecção precoce do câncer de cólon proporciona altas taxas de cura, no entanto, há pacientes que apresentam recidiva local e metástase à distância. As células tumorais circulantes (CTCs) e os microêmbolos circulantes (MEs) desempenham um papel importante nestes processos. Objetivo: avaliar o papel de CTCs e MEs em pacientes com câncer de cólon localizado. Material e métodos: foram coletados 10 mL de sangue de pacientes com câncer de cólon pré-cirúrgico, pré-adjuvância e 6 meses após o final do tratamento. As amostras foram processadas no dispositivo ISET® e as CTCs foram fixadas com formaldeído e identificadas por imunocitoquímica. Para detecção de expressão de RNAm, foi realizada a técnica de hibridização in situ cromogênica. O DNA foi extraído das membranas sem formaldeído e analisado por PCR digital em gotas. Resultados: no módulo I, foram incluídos 69 pacientes (18 com estágio I, 15 com estágio II e 36 com estágio III). A taxa de detecção de CTCs na primeira coleta foi de 94,2%, de 94,6% no primeiro seguimento e de 100% no segundo seguimento. Foi observada uma queda global na mediana de CTCs ao longo do tempo. No segundo seguimento, a expressão de ERCC1 e de ß-galactosidase nas CTCs foi mais encontrada em pacientes com estágio III (p= 0,03 e p= 0,04, respectivamente). A expressão de ERCC1 com alto índice de positividade (IP) nas CTCs, no segundo seguimento foi determinante de sobrevida livre de recidiva (SLR) inferior (p= 0,014). Foi encontrada uma correlação positiva entre o nível de CTCs e a porcentagem de células TReg (p= 0,01) e negativa entre o nível de CTCs e a porcentagem de linfócitos CD3+ (p= 0,01). Pacientes com alta Platelet-to-Lymphocyte Ratio (PLR) encontravam-se em sua maioria com estadiamentos patológicos II de alto risco e III (p= 0,014). Alta PLR foi determinante de SLR inferior (p= 0,01). No módulo II (pacientes com tumores de alto risco, submetidos à quimioterapia adjuvante) foi encontrada uma correlação positiva entre os níveis de CTC e CEA nos casos que tiveram recidiva da doença (p= 0,001). Alto IP de ERCC1 no segundo seguimento foi determinante de SLR significantemente inferior (p= 0,013). Conclusões: CTCs foram encontradas em altas taxas nos pacientes com câncer de cólon localmente avançado. A avaliação do sistema imunológico dos pacientes juntamente com as CTCs demonstrou ser uma ferramenta promissora para acompanhamento destes pacientes

Introduction: The early detection of colon cancer provides high cure rates, however, there are patients that present local relapse and distant metastasis. Circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) play a crucial role in these processes. Objectives: to evaluate the role of CTCs and CTM in non-metastatic colon cancer patients. Material and methods: 10 mL of blood were collected from colon cancer patients prior to the surgery, prior to the adjuvant treatment, and 6 months after the treatment end. Samples were processed in the ISET® device and CTCs were formaldehyde-fixed and identified by immunocytochemistry. For mRNA expression in situ hybridization was applied. The DNA was extracted from the non-fixed CTCs and analyzed by droplet digital PCR. Results: there were 69 patients included (18 at stage I, 15 at stage II, and 36 at stage III) at module I. The CTC detection rate at baseline was 94.2%, at first follow-up was 94.6%, and at second follow-up was 100%. It was observed an overall drop in CTC median over time. At second follow-up, ERCC1 and ß-galactosidase expression in CTCs was most commonly found in stage III patients (p= 0.03 and p= 0.04, respectively). High positivity index (PI) of ERCC1 in CTC at second follow-up was determinant of inferior relapse-free survival (RFS) (p= 0.014). It was found a positive correlation between CTC levels and the percentage of TReg cells (p= 0.01) and a negative correlation between CTC levels and the percentage of CD3+ lymphocytes. Patients with high Platelet-to-Lymphocyte Ratio (PLR) were mostly found in high-risk stage II and III patients (p= 0.014). High PLR was determinant of inferior RFS (p= 0.01). At module II (patients with high-risk tumors, treated with adjuvant chemotherapy), it was found a positive correlation between CTC and CEA levels in the cases that shown disease progression (DP) (p= 0.001). High PI of ERCC1 at second follow-up had shown significantly worse RFS (p= 0.013). Conclusions: CTCs were found in high rates in localized colon cancer patients. Additionally, the evaluation of the patient's immune combined with the CTCs showed to be a promising tool to monitoring these patients

Humans , Male , Female , Adult , Middle Aged , Aged , Biomarkers , Colorectal Neoplasms/surgery , Colorectal Neoplasms/therapy , Drug Resistance, Neoplasm , Neoplastic Cells, Circulating , Colorectal Neoplasms/blood , Liquid Biopsy
Rev. argent. coloproctología ; 29(1): 1-6, Sept. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1015082


Introducción: Se diagnostican hasta 13000 nuevos casos de cáncer colorrectal por año, y esto va en aumento. El cáncer de recto debe ser tratado mediante un abordaje multimodal. Luego de la implementación del tratamiento neoadyuvante y de la aparición de la respuesta patológica completa se implementó el manejo no operatorio. Nuestro objetivo es describir nuestra experiencia con el manejo inicial no operatorio de pacientes con cáncer de recto, que recibieron neoadyuvancia y desarrollaron una respuesta clínica completa inicial. Diseño: Estudio observacional, descriptivo, retrospectivo. Pacientes y Métodos: 49 pacientes con diagnóstico de cáncer de recto bajo (< 8 cm), recibieron tratamiento neoadyuvante con radioquimioterapia (RQT). Se realizó radioterapia (RT), a una dosis de 5040 cGy por un total de 5 semanas, y concomitante a esta, quimioterapia (QT) con 5-Fu-leucovorina en las semanas 1 y 5. Aquellos pacientes en los cuales se encontró cCR inicial a la neoadyuvancia, y la cirugía resectiva implicaba alto riesgo quirúrgico debido a sus comorbilidades y/o imposibilidad de la conservación de esfínteres se planteó la posibilidad de tomar una conducta no operatoria. Resultados: Se incluyeron 8 pacientes con cCR. El promedio de edad de los pacientes fue de 70 años (mediana 69,5 años), el promedio de altura del tumor fue de 5,8 cm; todos en estadio IIa. La mediana de seguimiento fue de 72,5 meses. 3 pacientes presentaron recaídas, todas endoluminales, 2 fueron tempranas (9 y 12 meses) y una tardía (18 meses), los cuales fueron operados, 2 de ellos se encuentran actualmente libres de enfermedad y el tercero óbito a los 30 días POP. La sobrevida global de los pacientes fue de un 87,5% y se evitó una cirugía mayor en 5 pacientes (62,5%). Conclusión: La implementación del tratamiento inicial no operatorio del cáncer de recto en aquellos pacientes que desarrollaron cCR luego del tratamiento neoadyuvante puede ser seguro, siempre y cuando estos pacientes estén incluidos en un programa de seguimiento estricto que permita una cirugía de rescate. El tratamiento conservador sin cirugía debe ser reservado para pacientes de alto riesgo quirúrgico o en los que la cirugía implique la necesidad de una cirugía de amputación abdominoperineal. (AU)

Introduction: 13000 new cases of colorectal cases are diagnosed per year. Rectal cancer must be treated with a multimodal approach. After the administration of neoadjuvant treatment and the appearance of a pathologic complete response, nonoperative management was implemented. Our objective is to describe our experience with nonoperative management of patients with rectal cancer that received neoadjuvant therapy and developed an initial complete clinical response. Design: Retrospective descriptive observational study. Patients and Methods: Forty-nine patients with low rectal cancer (< 8 cm) received neoadjuvant radiochemotherapy. Radiotherapy was performed with a total dose of 5040 cGy for 5 weeks, and concomitant 5-FU-leucovorin-based chemotherapy in weeks 1 and 5. Nonoperative management was attempted on patients experiencing initial cCR to neoadjuvant therapy and with a higher surgical risk due to their comorbidity and/or impossibility of conserving the sphincters. Results: Eight patients with cCR were included. The average age of the patients was 70 years; the average height of the tumor was 5.8 cm; all of them at stage IIA. Median follow-up was 72.5 months. Two patients developed an early endoluminal recurrence (after 9 and 12 months) and one had a late recurrence (18 months). All of them had surgery. Two of them are disease-free and one died 30 days after surgery. Conclusion: Implementation of initial nonoperative treatment of rectal cancer in patients that developed cCR after neoadjuvant therapy can be safe, provided that those patients are included in a strict monitoring programme that would allow for a rescue surgery. Conservative treatment without surgery must be reserved for patients with a higher surgical risk or who require an abdominoperineal resection. (AU)

Humans , Male , Female , Middle Aged , Aged , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Colorectal Neoplasms/therapy , Neoadjuvant Therapy , Watchful Waiting , Rectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/epidemiology , Comorbidity , Epidemiology, Descriptive , Retrospective Studies , Follow-Up Studies , Conservative Treatment , Neoplasm Recurrence, Local/surgery
Clinics ; 73(supl.1): e542s, 2018. tab, graf
Article in English | LILACS | ID: biblio-952826


Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status ≥2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations.

Humans , Severity of Illness Index , Colorectal Neoplasms/therapy , Evidence-Based Medicine , Antineoplastic Protocols , Neoplasm Metastasis , Prognosis , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Survival Analysis
Clin. biomed. res ; 37(3): 232-246, 2017. tab, ilus
Article in Portuguese | LILACS | ID: biblio-859838


Introdução: Definido como uma proliferação descontrolada de células malignas, o câncer colorretal (CCR) é um dos tumores malignos mais comuns, e a terceira causa de mortes relacionadas ao câncer. Várias estratégias têm sido estudadas para auxiliar na prevenção e no tratamento coadjuvante dos sintomas do CCR, entre elas a ingestão de probióticos, prebióticos ou simbióticos. Probióticos são microrganismos vivos, que quando administrados em quantidade adequada afetam beneficamente o hospedeiro. Os probióticos são comumente encontrados em alimentos fermentados como em iogurtes por exemplo, ou na forma de suplementos que contém culturas microbianas vivas. Prebióticos são componentes alimentares não digeríveis que afetam beneficamente o hospedeiro, estimulando seletivamente a multiplicação ou atividade de populações microbianas desejáveis no cólon. Já, os simbióticos consistem na associação de probióticos e prebióticos. O objetivo do presente trabalho foi definir a validade do uso dos probióticos, prebióticos ou simbióticos como coadjuvantes no tratamento do CCR por meio de uma revisão sistemática da literatura. Métodos: Foi realizada uma pesquisa nas bases de dados PUBMED, SCIELO, COCHRANE e CLINICAL TRIALS. Os termos de busca foram: "colorectal cancer AND probiotics", "colorectal cancer AND prebiotics". Resultados: Dos 68 artigos elegíveis, 14 foram revisados, com publicação entre 2012 e 2017, escritos no idioma inglês, português ou espanhol. O número amostral variou de 38 a 310 pacientes, com idade entre 18 e 75 anos, a duração do tratamento foi de 3 dias a 3 meses. Em 3 dos estudos foram utilizados simbióticos, em 1 prebióticos, e em 10 probióticos. As cepas de probióticos continham entre 1 e 10 substâncias, prebióticos 4 substâncias e os simbióticos entre 5 e 8. Conclusão: O trabalho possibilitou o reconhecimento dos principais microrganismos que vem sendo estudados no tratamento concomitante do CCR. A maioria dos estudos analisados mostrou efeitos benéficos na diminuição da proteína C reativa, da incidência e severidade da diarreia, risco de complicações pós-operatórias como sepse, ventilação mecânica e vazamento da anastomose, além de propiciar uma recuperação da função intestinal mais rápida. A presente revisão sistemática ressalta a importância dos pré e probióticos concomitante aos tratamentos de CCR, porém o número limitado de artigos dificulta a generalização dos resultados obtidos, sendo necessários futuros estudos de longa duração para elucidar melhor esta relação (AU)

Introduction: Defined as an uncontrolled proliferation of malignant cells, colorectal cancer (CRC) is one of the most common malignancies and the third leading cause of cancer-related deaths. Several strategies have been studied to prevent CRC and/or work as an adjuvant treatment for CRC symptoms, including the use of probiotics, prebiotics or symbiotics. Probiotics are live microorganisms that when administered in adequate amounts result in health benefit to the host. They are commonly found in fermented foods such as yogurts or in the form of supplements that contain live microbial cultures. Prebiotics are nondigestible food components that beneficially affect the host by selectively stimulating the multiplication or activity of desirable microbial populations in the colon. Symbiotics consist of the association of probiotics and prebiotics. The aim of the present study was to define the effectiveness of the use of probiotics, prebiotics and symbiotics as adjuvants to the treatment of CRC by means of a systematic review of the literature. Methods: A search was performed on the PubMed, SciELO, Cochrane and Clinical Trials databases. The search terms were "colorectal cancer AND probiotics", "colorectal cancer AND prebiotics". Results: Of the 68 potentially eligible articles, 14 were revised, published between 2012 and 2017, and written in English, Portuguese or Spanish. The sample size of these studies ranged from 38 to 310 patients, aged between 18 and 75 years. The period of treatment ranged from 3 days to 3 months. Symbiotics were used in three studies, prebiotics were used in one study, and probiotics were used in 10 studies. Probiotic strains contained between one and 10 substances, prebiotics contained four substances, and symbiotics contained between five and eight substances. Conclusions: This study allowed the recognition of the main microorganisms that have been studied in the concomitant treatment of CRC. Most of the studies analyzed showed beneficial effects on the reduction of C-reactive protein, the incidence and severity of diarrhea and the risk of postoperative complications such as sepsis, mechanical ventilation and leakage of anastomosis, in addition to providing a faster recovery of the intestinal function. The present systematic review emphasizes the importance of the use of pre- and probiotics concomitant with CRC treatments, but the limited number of articles makes it difficult to generalize the results obtained. Further long-term studies are needed to elucidate this relationship (AU)

Humans , Colorectal Neoplasms/therapy , Prebiotics , Probiotics , Synbiotics
Rev. latinoam. enferm. (Online) ; 25: e2879, 2017. tab
Article in English | LILACS, BDENF | ID: biblio-845295


ABSTRACT Objective: to identify the time between symptoms, the request for care and the beginning of treatment in patients with stomach and colorectal cancer as well as the factors that interfere in these processes. Method: correlational descriptive study, including 101 patients diagnosed with stomach or colorectal cancer, treated in a hospital specialized in oncology. Results: the 101 patients investigated there was predominance of males, mean age of 61.7 years. The search for medical care occurred within 30 days after the onset of symptoms, in most cases. The mean total time between the onset of symptoms and the beginning of treatment ranged from 15 to 16 months, and the mean time between the search for medical care and the diagnosis was 4.78 months. The family history of cancer (p=0.008) and the implementation of preventive follow-up (p<0.001) were associated with shorter periods between the search for care and the beginning of treatment. Nausea, vomiting, hematochezia, weight loss and pain were associated with faster demand for care. Conclusion: the longer interval between the search for medical care and the diagnosis was possibly due to the non-association between the presented symptoms and the disease.

RESUMO Objetivo: identificar o tempo entre os sintomas, a busca por assistência e o início do tratamento em pacientes com câncer de estômago e colorretal e os fatores que interferem nesses processos. Método: estudo descritivo correlacional, incluindo 101 pacientes com diagnóstico de câncer de estômago ou colorretal, atendidos por um hospital especializado em oncologia. Resultados: dos 101 pacientes investigados, houve predomínio do sexo masculino, média de idade de 61,7 anos. A busca por assistência médica ocorreu em até 30 dias após o início dos sintomas, na maioria dos casos. O tempo médio total entre o aparecimento dos sintomas e o início do tratamento foi de 15,16 meses, sendo que, o tempo médio entre a busca por assistência médica e o diagnóstico foi de 4,78 meses. O histórico familiar de câncer (p=0,008) e a realização de acompanhamento preventivo (p<0,001) estiveram associados a menores períodos entre a busca por assistência e início do tratamento. Naúsea, vômito, hematoquesia, perda ponderal e dor foram associados à procura mais ágil por assistência. Conclusão: o maior intervalo entre a busca por assistência médica e o diagnóstico ocorreu, possivelmente, pela não associação entre os sintomas apresentados e a doença.

RESUMEN Objetivo: identificar el tiempo entre los síntomas, la búsqueda de asistencia y el inicio del tratamiento en pacientes con cáncer gástrico y colorrectal y los factores que interfieren en estos procesos. Método: estudio descriptivo correlacional, incluyendo 101 pacientes con diagnostico de cáncer gástrico o colorrectal, atendidos en un hospital especializado en oncología. Resultados: de 101 pacientes investigados la mayoria eran hombres, con edad media de 61,7 años. La búsqueda de la atención médica se produjo dentro de los 30 días después de la aparición de los síntomas, en la mayoría de los casos. El promedio de tiempo total entre el inicio de los síntomas y el inicio del tratamiento fue de 15,16 meses y el tiempo medio entre la búsqueda de la atención médica y el diagnóstico fue de 4,78 meses. La historia familiar de cáncer (p=0,008) y la realización de seguimiento preventivo (p<0,001) se asociaron con períodos más cortos entre la búsqueda de la atención y el tratamiento temprano. Náuseas, vómitos, hematoquecia, pérdida de peso y dolor se asociaron con la búsqueda más rápida de la asistencia. Conclusión: el intervalo más largo entre la búsqueda de la atención médica y el diagnóstico se produjo posiblemente por asociación negativa entre los síntomas que se presentan y las enfermedades.

Humans , Male , Female , Middle Aged , Stomach Neoplasms/therapy , Colorectal Neoplasms/therapy , Patient Acceptance of Health Care
J. coloproctol. (Rio J., Impr.) ; 36(2): 91-96, Apr-Jun. 2016. tab, graf, ilus
Article in English | LILACS | ID: lil-785862


Objectives: The objective of the study was to evaluate the therapeutic itinerary of patients treated in a specialized center, including its trajectory in seeking treatment and their clinical and epidemiological characteristics. Methods: This is a cross-sectional prospective descriptive study; patients with colorectal cancer aged over 18 years and who signed the consent form were included in the analysis. Tumor characteristics, such as staging and tumor features; epidemiological characteristics such as age, gender, profession and itinerary in the form of the number of clinical visits needed to obtain the diagnosis; the main symptoms; and mean time between diagnosis and onset of treatment were evaluated. Results: 34% of patients initially sought primary care (first level of care in the public health system) and 50% were diagnosed in secondary care (second level of care in the public health system); the mean number of visits until obtaining a diagnosis was 2.5 times; and 52% of patients received palliative therapy and 40% had a stage IV diagnosis. Conclusions: The mean time between the diagnosis and the onset of treatment is in line with the recommendations of the Ministry of Health of Brazil. However, it was found that the patients are unaware of the symptoms of the disease, since the mean time between the onset of symptoms until the decision to visit the doctor was 177 days - which may have been a determining factor for a diagnosis in an advanced stage of disease.

Objetivos: O objetivo do estudo foi avaliar o itinerário terapêutico de pacientes tratados em um centro especializado, compreendendo sua trajetória na busca do tratamento e as características clínicas e epidemiológicas. Métodos: estudo descritivo prospectivo transversal; foram incluídos na análise pacientes portadores de câncer colorretal (CCR) maiores de 18 anos que assinaram o termo de consentimento. Foram avaliadas características tumorais, como estadiamento e características do tumor; características epidemiológicas como idade, sexo e profissão e a trajetória como número de consultas até o diagnóstico, principais sintomas e tempo médio entre o diagnóstico e início do tratamento. Resultados: 34% dos pacientes procuraram inicialmente a atenção primária (primeiro nível de atenção na saúde pública), 50% receberam o diagnóstico na atenção secundária (segundo nível de atenção na saúde pública), a média de consultas até o diagnóstico foi de 2,5 vezes, 52% dos pacientes fizeram terapia paliativa e 40% fizeram diagnóstico em estádio IV. Conclusões: o tempo médio entre o diagnóstico e o início do tratamento está de acordo com o recomendado pelo Ministério da Saúde do Brasil; entretanto, identificou-se que os pacientes desconhecem os sintomas da doença, uma vez que a média de tempo entre o início dos sintomas até a tomada de decisão de procurar um médico foi de 177 dias, o que pode ter sido determinante para um diagnóstico na fase avançada da doença.

Humans , Male , Female , Middle Aged , Health Profile , Colorectal Neoplasms/epidemiology , Therapeutic Itinerary , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/therapy
Brasília; Ministério da Saúde; Versão Preliminar; 2016. 15 p. ilus.
Monography in Portuguese | ColecionaSUS, LILACS, ColecionaSUS | ID: lil-783970


Este material tem como objetivo orientar as equipes que atuam na AB, qualificando o processo de referenciamento de usuários para outros serviços especializados. É uma ferramenta, ao mesmo tempo, de gestão e de cuidado, pois tanto guiam as decisões dos profissionais solicitantes quanto se constitui como referência que modula as avaliações apresentadas pelos médicos reguladores.

Humans , Adult , Primary Health Care/standards , Secondary Care/standards , Colorectal Surgery/standards , Rectal Fistula/diagnosis , Colorectal Neoplasms/diagnosis , Clinical Protocols/standards , Rectal Fistula/therapy , Health Care Coordination and Monitoring , Colorectal Neoplasms/therapy
Rev. bras. ginecol. obstet ; 37(2): 94-99, 02/2015. graf
Article in Portuguese | LILACS | ID: lil-741852


OBJETIVO: Comparar o desempenho de duas técnicas de genotipagem de papilomavírus humano (HPV), Linear Array e PapilloCheck, em mulheres com lesão intra-epitelial de alto grau (LIAG). MÉTODOS: Foram selecionadas 88 mulheres com diagnóstico citopatológico de LIAG em 2 centros de referência em patologia cervical em Salvador, Bahia, no período de julho de 2006 a janeiro de 2009. Após o diagnóstico citopatológico de LIAG, foram realizadas a coleta de células do colo uterino para a genotipagem do HPV e a biópsia sob visão colposcópica para análise histopatológica do fragmento retirado. Posteriormente à confirmação de NIC2+ pelo exame histopatológico, foi realizada a genotipagem do HPV em 41 mulheres pelas técnicas Linear Array e PapilloCheck. RESULTADOS: Os dois testes apresentaram taxa de concordância geral para detecção do vírus HPV de 97,2% (35/36). Das 36 amostras válidas, 35 (97,2%) foram consideradas positivas em ambos os testes e apenas uma amostra (2,8%) foi considerada discordante. Os genótipos do HPV mais prevalentes detectados através da técnica do Linear Array foram: HPV 16, HPV 56, HPV 35, HPV 45 e HPV 70; e pela técnica PapilloCheck foram: HPV 16, HPV 56, HPV 11, HPV 35 e HPV 42. Foi observado índice semelhante de infecção por múltiplos tipos do HPV nos dois testes analisados (72,5% no Linear Array e 75,0% no PapilloCheck). CONCLUSÕES: Os testes de genotipagem Linear Array e PapilloCheck apresentaram um desempenho equivalente na detecção dos tipos de HPV oncogênicos em mulheres com LIAG, tendo o PapilloCheck a vantagem de ser um método que evita a subjetividade da leitura dos genótipos de HPV. .

PURPOSE: The aim of this study was to compare the performance of two human papillomavirus (HPV) genotyping techniques, Linear Array and PapilloCheck, in women with high-grade squamous intraepithelial lesion (HSIL). METHODS: A total of 88 women with cytological diagnosis of HSIL were recruited at 2 reference centers in cervical pathology in Salvador, Bahia, Brazil, from July 2006 to January 2009. After the cytological diagnosis of HSIL, cervix cells were collected to determine the HPV genotype and a biopsy was obtained under colposcopic vision for histopathological analysis. After the confirmation of CIN2+ by histopathology, HPV genotyping was performed on 41 women by the Linear Array and PapilloCheck methods. RESULTS: Both tests showed an overall concordance rate for HPV detection of 97.2% (35/36). Of the 36 valid samples, 35 (97.2%) were positive in both tests and 1 (2.8%) was discordant, with the Linear Array indicating the presence of multiple types. The most prevalent HPV genotypes detected by the Linear Array technique were HPV 16, HPV 56, HPV 35, HPV 45, and HPV 70; and those detected by the PapilloCheck technique were HPV 16, HPV 56, HPV 11, HPV 35, and HPV 42. A similar rate of infection with multiple HPV types was observed with the two tests (72.5% with the Linear Array and 75.0% with the PapilloCheck). CONCLUSIONS: Linear Array genotyping assay and PapilloCheck showed equivalent performance for the detection of oncogenic HPV types in women with HSIL, with PapilloCheck having the advantage of being a method that avoids subjectivity when reading the HPV genotypes. .

Humans , Autophagy/physiology , Colorectal Neoplasms/etiology , Colorectal Neoplasms/therapy , Disease Progression , Prognosis