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1.
Int. braz. j. urol ; 47(3): 515-522, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154487

ABSTRACT

ABSTRACT Purpose: To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status. Materials and Methods: We identified patients who underwent partial penectomy due to penile cancer between 2009 and 2014. Clinical and pathological characteristics included patient age at the time of diagnosis, obesity, hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, Eastern Cooperative Oncology Group (ECOG) status, penile shaft length, tumor size, primary tumor stage (pT), clinical nodal status, and local recurrence. Erectile function was assessed prospectively with the International Index of Erectile Function (IIEF-5) at least 3 months after partial penectomy. Results: A total of 81 patients met analysis criteria. At the diagnosis, the median age was 62 years (range from 30 to 88). Median follow-up was 17 months (IQR 7-36). Of total patients, 37 (45%) had T2 or higher disease. Clinically positive nodes were present in 16 (20%) patients and seven (8.6%) developed local recurrence. Fifty patients (62%) had erectile dysfunction (ED) after partial penectomy, 30% had moderate or severe erectile dysfunction scores. Patients with ED versus without ED were similar in baseline characteristics except for age, penile shaft length, and presence of inguinal adenopathy (p <0.05). Multivariate analysis using logistic regression confirmed that older patients, shorter penile shaft length, and clinically positive lymph node were significantly associated with ED. Conclusion: Partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Penile Neoplasms/surgery , Erectile Dysfunction/etiology , Penis/surgery , Penile Erection , Middle Aged , Neoplasm Recurrence, Local
2.
Int. braz. j. urol ; 47(3): 484-494, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154488

ABSTRACT

ABSTRACT Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Quality of Life , Prostatectomy , Salvage Therapy , Lymph Node Excision , Lymph Nodes , Neoplasm Recurrence, Local/surgery
3.
Säo Paulo med. j ; 139(3): 241-250, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1252244

ABSTRACT

ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.


Subject(s)
Humans , Male , Urethral Stricture/surgery , Urethral Stricture/etiology , Urethral Stricture/prevention & control , Cicatrix, Hypertrophic , Postoperative Complications/prevention & control , Prostatectomy/adverse effects , Quality of Life , Urethra/surgery , Cross-Sectional Studies , Retrospective Studies , Constriction, Pathologic , Neoplasm Recurrence, Local/prevention & control
4.
Arch. argent. pediatr ; 119(5): e420-e427, oct. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1292096

ABSTRACT

Introducción. El síndrome de McCune-Albright (SMA) es un trastorno genético caracterizado por displasia ósea fibrosa, manchas cutáneas color "café con leche" e hiperfunción autónoma de uno o varios órganos endocrinos. El SMA es producido por mutaciones activadoras del gen GNAS1. La endocrinopatía más frecuente es la gonadal, que se manifiesta como pubertad precoz periférica. Objetivo. Describir las características clínicas y los estudios de laboratorio e imágenes en el momento del diagnóstico y a lo largo de la evolución de la enfermedad, con énfasis en la tríada clásica del síndrome. Población y métodos. Estudio clínico observacional, descriptivo, retrospectivo de las historias clínicas de pacientes con SMA de la División de Endocrinología del Hospital de Niños Ricardo Gutiérrez desde 1974 hasta 2019. Resultados. Se presentan 12 niñas. Todas tuvieron pubertad precoz periférica (PPP) secundaria a quistes ováricos funcionantes. La edad de presentación fue temprana (2,6 ± 1,3 años). Los niveles de gonadotrofinas estuvieron suprimidos o en rango prepuberal con niveles de estradiol generalmente elevados. Diez niñas tuvieron manchas "café con leche" desde el nacimiento. Durante la evolución se detectó displasia fibrosa poliostótica en todas las pacientes. Los tratamientos utilizados para disminuir la recurrencia de los quistes ováricos y los efectos del hiperestrogenismo mostraron diferente eficacia. Conclusiones. En esta serie, la aparición de PPP contribuyó al diagnóstico temprano del SMA y fue de difícil tratamiento. En la evolución persistió la hiperfunción gonadal y empeoraron las lesiones óseas.


Introduction. McCune-Albright syndrome (MAS) is a genetic disorder defined by fibrous dysplasia of bone, café-au-lait skin spots, and autonomous hyperfunction of one or more endocrine organs. MAS is caused by activating mutations of the GNAS1 gene. The most frequent type of endocrinopathy is gonadal endocrinopathy in the form of peripheral precocious puberty. Objective. To describe the clinical characteristics, laboratory and imaging tests at the time of diagnosis and over the course of the disease, focusing on the classical triad of MAS. Population and methods. Observational, descriptive, retrospective clinical study of patients with MAS seen at the Department of Endocrinology of Hospital de Niños Ricardo Gutiérrez between 1974 and 2019. Results. Twelve girls are described, all of whom developed peripheral precocious puberty (PPP) secondary to functional ovarian cysts. Their age at presentation was early (2.6 ± 1.3 years). Gonadotropin levels were suppressed or in the prepubertal range with generally high estradiol levels. Ten girls had café-au-lait skin spots since birth. During the course of disease, polyostotic fibrous dysplasia was detected in all patients. The treatments used to reduce ovarian cyst recurrence and hyperestrogenism effects showed varied effectiveness. Conclusions. In this series, the onset of PPP helped to make an early diagnosis of MAS and was difficult to treat. The course of disease showed persistent gonadal hyperfunction and worsening of bone injuries


Subject(s)
Humans , Female , Infant , Child, Preschool , Child , Adolescent , Puberty, Precocious/diagnosis , Puberty, Precocious/etiology , Puberty, Precocious/therapy , Fibrous Dysplasia, Polyostotic/complications , Fibrous Dysplasia, Polyostotic/diagnosis , Fibrous Dysplasia, Polyostotic/therapy , Retrospective Studies , Follow-Up Studies , Cafe-au-Lait Spots/diagnosis , Cafe-au-Lait Spots/therapy , Neoplasm Recurrence, Local
5.
Rev. bras. cir. cardiovasc ; 36(1): 112-115, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155784

ABSTRACT

Abstract A 71 year-old male with a history of multiple excisions of an initial Clark's level V melanoma of the breast followed by combined radiation and interferon treatment, as well as a recurrence, 3 years later, of a BRAF-positive tumor of the shoulder, with subsequent therapy with dabrafenib and trametinib, presented again with progressive intracardiac masses causing significant right ventricular outflow obstruction. Additionally, the patient complained of dyspnea and fatigue on exertion, thus he was scheduled for surgical resection.


Subject(s)
Humans , Male , Aged , Skin Neoplasms/surgery , Heart Neoplasms/surgery , Heart Neoplasms/diagnostic imaging , Melanoma/surgery , Melanoma/drug therapy , Mutation , Neoplasm Recurrence, Local
6.
Int. braz. j. urol ; 47(1): 93-99, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134320

ABSTRACT

ABSTRACT Hypothesis: Endoclip can be used as fiducial marker in urology. Objective: To assess the feasibility, cost effectiveness and reliability of endoclips as novel fiducial markers in precision radiotherapy, as part of a trimodality bladder-preserving treatment (TBPT) of muscle-invasive bladder carcinoma. Materials and Methods: This retrospective study was performed at Weifang People's Hospital (Weifang, China) from January 2015 to June 2018. A total of 15 patients underwent TBPT. Endoclips were applied to healthy edges of the resected bladder wall as novel fiducial markers. Radio-sensitizing chemotherapy and routine precision radiotherapy were given. The number and position of the endoclips during radiotherapy sessions were monitored. Complications and tumor recurrence were analyzed. Results: The mean age (±standard deviation) of the patients was 67±10 years (range 46-79). There were 3 females and 12 males. Forty-nine endoclips were applied in all patients (3.3±0.8). The tumor was completely visibly resected in all patients. The number of endoclips remained the same through the planned last radiotherapy session (3.3±0.8), i.e., none were lost. All endoclips were removed after the last radiotherapy session. The average number of follow-up months was 38.9±13.2 (range 11-52). There were no procedure-related complications at discharge or follow-up. At one-year, overall recurrence-free survival was 93.3%. Two patients had recurrences at 18 months and 10 months after TBPT, respectively, and salvage radical cystectomy was performed with no further recurrences. Another patient died due to metastasis 9 months after the completion of therapy. Conclusions: Endoclips are reliable, safe and cost-effective as novel fiducial markers in precision-radiotherapy post-TBPT.


Subject(s)
Humans , Male , Female , Aged , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/radiotherapy , Carcinoma , Urinary Bladder , Cystectomy , China , Feasibility Studies , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Combined Modality Therapy , Fiducial Markers , Middle Aged , Muscles , Neoplasm Invasiveness , Neoplasm Recurrence, Local
7.
Bol. méd. postgrado ; 37(1): 44-49, Ene-Jun 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147879

ABSTRACT

Con el objetivo de describir las recidivas de carcinoma papilar de tiroides (CPT) en pacientes tiroidectomizados atendidos en el Servicio Autónomo Oncológico del estado Lara, se realizó un estudio descriptivo transversal de recolección retrospectiva de datos de 140 historias clínicas de pacientes con diagnóstico de CPT registrados durante el lapso 2006-2017. Los pacientes incluidos se caracterizaron por un promedio de edad de 46,67 ± 13,94 años, siendo los más afectados los grupos de 41-50 años y 51-60 años; se observó un predominio del sexo femenino (86,33%). La intervención quirúrgica más realizada en estos pacientes fue la tiroidectomía total (44,29%) y tiroidectomía total con vaciamiento ganglionar (41,43%); 35,71% de los pacientes recibieron Iodo-131 como tratamiento adyuvante. El porcentaje de recidivas fue de 4,29%, siendo las recidivas más frecuentes la local y regional (33,33%, respectivamente); 66,67% de los casos de recidiva aparecieron en los primeros 5 años. De los pacientes con recidivas, 50% se les practicó tiroidectomía total y recibieron Iodo-131. Con estos resultados se aporta información epidemiológica actual sobre el CPT en nuestro centro con el fin de contribuir en la preparación de los servicios de cirugía y oncología para la atención de este grupo de pacientes(AU)


With the aim of describing the recurrences of papillary thyroid carcinoma in thyroidectomized patients treated at the Autonomous Oncology Service of Lara State, a cross-sectional descriptive retrospective study was conducted examining 140 medical records of patients with a diagnosis of papillary thyroid carcinoma registered during the period 2006-2017. Patients had an average age of 46.67 ± 13.94 years, being the most affected the 41-50 years and 51-60 years groups (26.43%, respectively); a predominance of females was observed (86.33%). The most performed surgical intervention was total thyroidectomy (44.29%) and total thyroidectomy with lymph node dissection (41.43%). Likewise, 35.71% received Iodine-131 as adjuvant treatment. The percentage of recurrences was 4.29%, being the most frequent local and regional with a prevalence of 33.33%, respectively; in addition, 66.67% of recurrences appeared during the first 5 years; 50% of these patients underwent total thyroidectomy and received Iodine-131. With these results, current information is provided in order to contribute to the preparation of surgical and oncological services for the care of cases of papillary thyroid carcinoma. It is important to maintain oncological follow-up in order to evaluate the evolution and prognosis of the different types of recurrences according to the place of appearance(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Thyroidectomy , Thyroid Cancer, Papillary/pathology , Iodine/therapeutic use , Medical Oncology , Neoplasm Recurrence, Local
8.
Article in Chinese | WPRIM | ID: wpr-879848

ABSTRACT

A girl, aged 15 years, was admitted due to sudden convulsion once and multiple pulmonary nodules on lung CT. Acrocyanosis or acropachy/toe deformity was not observed. Laboratory examinations showed an increase in hemoglobin (162 g/L) and a reduction in arterial partial pressure of oxygen (61.5 mm Hg). Lung CT showed irregular slightly high-density nodules in the middle lobe of the right lung, and contrast-enhanced CT scan showed obvious enhancement with thick vascular shadow locally. An investigation of medical history revealed that the girl's mother had a history of epistaxis and resection of pulmonary mass and the girl presented with tongue telangiectasia. The girl was diagnosed with hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformation. she was given interventional embolization therapy. Transcutaneous oxygen saturation reached 98% without oxygen inhalation on the day after surgery. Pulmonary angiography at 3 months after surgery showed the recurrence of pulmonary vascular malformation, and embolization of pulmonary arterial fistula was not performed since the guide wire could not enter the branch artery. There was still a need for long-term follow-up.


Subject(s)
Adolescent , Arteriovenous Fistula , Arteriovenous Malformations , Female , Humans , Multiple Pulmonary Nodules , Neoplasm Recurrence, Local , Pulmonary Artery/diagnostic imaging , Seizures
9.
Article in Chinese | WPRIM | ID: wpr-879828

ABSTRACT

OBJECTIVE@#To study the clinical features of children with recurrent medulloblastoma (MB) and treatment regimens.@*METHODS@#A retrospective analysis was performed on 101 children with recurrent MB who were admitted to the hospital from August 1, 2011 to July 31, 2017. The children were followed up to July 31, 2020. The Kaplan-Meier method was used for survival analysis. The Cox regression model was used for multivariate regression analysis.@*RESULTS@#Of the 101 children, 95 underwent remission induction therapy, among whom 51 had response, resulting in a response rate of 54%. The median overall survival (OS) time after recurrence was 13 months, and the 1-, 3-, and 5-year OS rates were 50.5%±5.0%, 19.8%±4.0%, and 10%±3.3% respectively. There was no significant difference in the 5-year OS rate between the children with different ages (< 3 years or 3-18 years), sexes, pathological types, or Change stages, between the children with or without radiotherapy before recurrence or re-irradiation after recurrence, and between the children with different times to recurrence (< 12 months or ≥ 12 months after surgery) (@*CONCLUSIONS@#As for the recurrence of MB, although remission induction therapy again can achieve remission, such children still have a short survival time. Only reoperation can significantly prolong survival time, and therefore, early reoperation can be considered to improve the outcome of children with recurrent MB.


Subject(s)
Cerebellar Neoplasms/therapy , Child , Humans , Medulloblastoma/therapy , Neoplasm Recurrence, Local , Retrospective Studies , Survival Rate
10.
Rev. bras. cancerol ; 67(2): e-121220, 2021.
Article in Portuguese | LILACS | ID: biblio-1254344

ABSTRACT

Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I²=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto à terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.


Introduction: Hepatitis C is associated with the development of hepatocellular carcinoma (HCC). The interferon-based therapeutic regimen has been replaced by direct-acting antivirals (AAD) to treat HCV virus infection. However, recent studies have shown an unexpected increase in HCC recurrence in patients treated with AAD to resolve hepatitis C. Objective: To assess the risk of hepatocarcinoma recurrence after using AAD in patients with HCV infection. Method: A survey was carried out in PubMed, MEDLINE, and LILACS databases according to the descriptors DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The data statistical analysis was performed through RStudio software. Results: Seven articles were selected resulting in 847 patients. Among those treated with AAD, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of HCC in the group of patients who received AAD was less than the risk evidenced in the control group, although there is no statistical significance (RR 0.71 95% CI [0.55; 0.93] I²=38%, p=0.14). The mean time until the diagnosis of recurrence was 9.35 months in the group exposed to therapy and 13.42 months in the control group. Conclusion: It is suggested that therapy with AAD does not increase the risk of HCC recurrence compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of AAD.


Introducción: La hepatitis C está asociada con el desarrollo de carcinoma hepatocelular (CHC). El régimen terapéutico basado en interferón ha sido reemplazado por antivirales de acción directa (AAD) para tratar la infección por VHC. Sin embargo, estudios recientes han mostrado un incremento inesperado en la recurrencia del CHC en pacientes tratados con AAD para resolución de la hepatitis C. Objetivo: Evaluar el riesgo de recurrencia del hepatocarcinoma después de usar AAD en pacientes con infección por VHC. Método: Se realizó una pesquisa en las bases de datos PubMed, MEDLINE y LILACS según los descriptores DeCS/MeSH ((carcinoma hepatocelular) AND recurrencia) AND antiviral de acción directa. La revisión siguió el protocolo PRISMA y está registrada en la plataforma PROSPERO. El análisis estadístico de los datos se realizó mediante el software RStudio. Resultados: Fueron seleccionados 7 artículos resultando en 847 pacientes. Entre los tratados con AAD, la tasa de recurrencia varió entre el 11,1% y el 42,1% y, en el grupo de control, ocurrió entre el 5% y el 65,6% de los pacientes. El riesgo relativo (RR) de recurrencia del CHC en el grupo de pacientes que recibieron AAD fue inferior que el riesgo evidenciado en el grupo control, aunque no hay significación estadística (RR 0,71; IC del 95% [0,55; 0,93] I²=38%, p=0,14). El tiempo hasta el diagnóstico de recidiva fue de 9,35 meses en el grupo expuesto a terapia y de 13,42 meses en el grupo control. Conclusión: Se sugiere que la terapia con AAD no aumenta el riesgo de recurrencia del CHC en comparación con los grupos control. En los pacientes que desarrollaron recurrencia, esta ocurrió con mayor frecuencia durante el primer año después de la introducción de los AAD.


Subject(s)
Humans , Liver Neoplasms/etiology , Antiviral Agents/therapeutic use , Hepatitis C/complications , Carcinoma, Hepatocellular/etiology , Neoplasm Recurrence, Local
11.
Rev. bras. cancerol ; 67(2): e-121220, 2021.
Article in Portuguese | LILACS | ID: biblio-1254542

ABSTRACT

Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I²=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto à terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.


Introduction: Hepatitis C is associated with the development of hepatocellular carcinoma (HCC). The interferon-based therapeutic regimen has been replaced by direct-acting antivirals (AAD) to treat HCV virus infection. However, recent studies have shown an unexpected increase in HCC recurrence in patients treated with AAD to resolve hepatitis C. Objective: To assess the risk of hepatocarcinoma recurrence after using AAD in patients with HCV infection. Method: A survey was carried out in PubMed, MEDLINE, and LILACS databases according to the descriptors DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The data statistical analysis was performed through RStudio software. Results: Seven articles were selected resulting in 847 patients. Among those treated with AAD, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of HCC in the group of patients who received AAD was less than the risk evidenced in the control group, although there is no statistical significance (RR 0.71 95% CI [0.55; 0.93] I²=38%, p=0.14). The mean time until the diagnosis of recurrence was 9.35 months in the group exposed to therapy and 13.42 months in the control group. Conclusion: It is suggested that therapy with AAD does not increase the risk of HCC recurrence compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of AAD.


Introducción: La hepatitis C está asociada con el desarrollo de carcinoma hepatocelular (CHC). El régimen terapéutico basado en interferón ha sido reemplazado por antivirales de acción directa (AAD) para tratar la infección por VHC. Sin embargo, estudios recientes han mostrado un incremento inesperado en la recurrencia del CHC en pacientes tratados con AAD para resolución de la hepatitis C. Objetivo: Evaluar el riesgo de recurrencia del hepatocarcinoma después de usar AAD en pacientes con infección por VHC. Método: Se realizó una pesquisa en las bases de datos PubMed, MEDLINE y LILACS según los descriptores DeCS/MeSH ((carcinoma hepatocelular) AND recurrencia) AND antiviral de acción directa. La revisión siguió el protocolo PRISMA y está registrada en la plataforma PROSPERO. El análisis estadístico de los datos se realizó mediante el software RStudio. Resultados: Fueron seleccionados 7 artículos resultando en 847 pacientes. Entre los tratados con AAD, la tasa de recurrencia varió entre el 11,1% y el 42,1% y, en el grupo de control, ocurrió entre el 5% y el 65,6% de los pacientes. El riesgo relativo (RR) de recurrencia del CHC en el grupo de pacientes que recibieron AAD fue inferior que el riesgo evidenciado en el grupo control, aunque no hay significación estadística (RR 0,71; IC del 95% [0,55; 0,93] I²=38%, p=0,14). El tiempo hasta el diagnóstico de recidiva fue de 9,35 meses en el grupo expuesto a terapia y de 13,42 meses en el grupo control. Conclusión: Se sugiere que la terapia con AAD no aumenta el riesgo de recurrencia del CHC en comparación con los grupos control. En los pacientes que desarrollaron recurrencia, esta ocurrió con mayor frecuencia durante el primer año después de la introducción de los AAD.


Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C/complications , Carcinoma, Hepatocellular/etiology , Liver Neoplasms/etiology , Neoplasm Recurrence, Local
12.
Clinics ; 76: e2081, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249582

ABSTRACT

OBJECTIVES: Extracellular vesicle microRNAs (EV-miRNAs) have been demonstrated to be reliable candidate biomarkers for clinical applications. However, the clinical application potential of serum EV-miR-215-5p for gastric cancer (GC) remains poorly understood. The goal of our study was to determine the efficacy of serum EV-miR-215-5p in predicting the prognosis of GC. METHODS: Blood samples were collected from 118 patients with GC, 60 patients with benign gastric disease and BGD and 70 healthy controls. The relative levels of serum EV-miR-215-5p were measured using quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Compared to patients with BGD and normal controls, GC patients exhibited remarkably higher serum EV-miR-215-5p level, especially those with early tumor recurrence (ETR). Receiver operating characteristic (ROC) curve analysis showed that serum EV-miR-215-5p was able to distinguish GC patients from BGD patients or healthy controls and GC patients with ETR from those without ETR. In addition, increased serum EV-miR-215-5p levels were notably correlated with invasive depth, TNM stage, and lymph node metastasis. Moreover, serum EV-miR-215-5p levels were greatly decreased after surgical treatment, but increased at the time of ETR. Survival analysis showed that patients with higher serum EV-miR-215-5p had shorter survival. Furthermore, serum EV-miR-215-5p was an independent risk factor for GC. CONCLUSIONS: Serum EV-miR-215-5p might be a novel biomarker for predicting ETR and prognosis of GC.


Subject(s)
Humans , Stomach Neoplasms/genetics , MicroRNAs , Extracellular Vesicles , Prognosis , Biomarkers, Tumor , Neoplasm Recurrence, Local
13.
Clinics ; 76: e2059, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153970

ABSTRACT

OBJECTIVES To evaluate the results of radiotherapy (RT) for follicular lymphoma (FL) under different management scenarios. METHODS We retrospectively assessed consecutive patients with FL who had undergone irradiation between 2010 and 2018. All patients had biopsy-proven FL and were positron emission tomography-staged, although some (35.3%) were reassessed with computed tomography after treatment alone. Rituximab was only available to FL patients after 2016. RESULTS Thirty-four patients were selected, with a mean age at diagnosis of 61.6 years (34-89 years). The median follow-up duration was 49.4 months. Most patients were female (58.8%) and showed good performance on the Eastern Cooperative Oncology Group (ECOG) scale (ECOG 0-55.9%). The mean overall survival (OS) and progression-free survival were 48.7 and 33.6 months, respectively, with four deaths reported. OS rates at 2 and 3 years were 94.1% and 91.2%, respectively. Four patients showed transformation into aggressive lymphomas and underwent rituximab-based systemic treatment. Transformation-free survival was 47.8 months, and all patients with transformed disease were alive at assessment. Five patients had in-field relapse, all of them also relapsed elsewhere, and the mean relapse-free survival time was 40.3 months. No median end points were reached on assessment. CONCLUSION FL is an indolent disease. Our findings show good outcomes for patients treated with radiation, with a low transformation rate and excellent management of relapsed disease. RT is an important part of these results.


Subject(s)
Humans , Male , Female , Lymphoma, Follicular/drug therapy , Lymphoma, Follicular/radiotherapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Retrospective Studies , Treatment Outcome , Disease-Free Survival , Rituximab/therapeutic use , Progression-Free Survival , Neoplasm Recurrence, Local
14.
Article in English | LILACS, INDEXPSI | ID: biblio-1340283

ABSTRACT

Abstract Little is known about the psychological adjustment of parents of children with cancer relapse or remission. This study investigated differences in the psychological adjustment of caregivers of children with different cancer prognosis, by comparing them with a control group. In total, 183 caregivers participated in this study: those with children in relapse/on treatment (n = 32), remission/off treatment (n = 75), and "healthy" (n = 76). The Beck Depression and Anxiety Inventories, the Symptom Check list-90-R, the Norbeck Social Support Questionnaire-Reviewed and the Family Environment Scale were analyzed with Variance Analysis, Student's t-test, Chi-square and Pearson correlations. The results showed that parents of children with cancer relapse presented less psychological adjustment. Furthermore, a protective effect of family cohesion and possible risk factors related to sociodemographic variables were observed. Conclusions highlight the convenience of developing specific interventions for parents of children with cancer relapse.


Resumo Pouco se sabe sobre o ajustamento psicológico de pais de crianças em recidiva de câncer e em remissão. Este estudo investigou diferenças no ajustamento psicológico de cuidadores de crianças com diferentes prognósticos de câncer, comparando-os com um grupo controle. Os participantes foram 183 cuidadores de crianças em recidiva/tratamento (n = 32), remissão/fora de tratamento (n = 75) e "saudáveis" (n = 76). Os Inventários Beck de Depressão e Ansiedade, a Escala de Avaliação de Sintomas 90-R, o Questionário Norbeck de apoio social-revisado e a Family Environment Scale foram analisados com análises de variância, t de Student, Qui-quadrado e correlações de Pearson. Os resultados mostraram que os pais de crianças em recidiva apresentaram menos ajustamento psicológico. Além disto, observou-se um efeito protetor da coesão familiar e possíveis fatores de risco relacionados a variáveis sociodemográficas. Discute-se a conveniência de desenvolver intervenções psicológicas para pais de crianças em recidiva de câncer.


Resumen Poco se conoce sobre el ajuste psicológico de padres de niños en recidiva de cáncer y en remisión. Este estudio investigó las diferencias en el ajuste psicológico de cuidadores de niños con distintos pronósticos de cáncer, comparándolos con un grupo control. Participaron 183 cuidadores de niños en recidiva/en tratamiento (n = 32), remisión/sin tratamiento (n = 75) y "sanos" (n = 76). Se analizaron los Inventarios de Depresión y Ansiedad de Beck, la Escala de Síntomas 90-R, el Cuestionario Norbeck de Apoyo Social Revisado y la Family Environment Scale mediante análisis de varianza, prueba t de Student, test de chi-cuadrado y correlaciones de Pearson. Los resultados mostraron que los padres de niños en recidiva presentaban menos ajuste psicológico. Además, se observó un efecto protector de la cohesión familiar y posibles factores de riesgo relacionados a variables sociodemográficas. Se discute la conveniencia de desarrollar intervenciones psicológicas para padres de niños en recidiva de cáncer.


Subject(s)
Humans , Child , Anxiety , Recurrence , Social Support , Family , Depression , Emotional Adjustment , Neoplasm Recurrence, Local , Neoplasms
15.
ABCD arq. bras. cir. dig ; 34(1): e1562, 2021. tab, graf
Article in English | LILACS | ID: biblio-1248501

ABSTRACT

ABSTRACT Background: Nearly 10% of node negative gastric cancer patients who underwent curative surgery have disease recurrence. Western data is extremely poor on this matter and identifying the risk factors that associate with relapse may allow new strategies to improve survival. Aim: Verify the clinical and pathological characteristics that correlate with recurrence in node negative gastric cancer. Methods: All gastric cancer patients submitted to gastrectomy between 2009 and 2019 at our institution and pathologically classified as N0 were considered. Their data were available in a prospective database. Inclusion criteria were: gastric adenocarcinoma, node negative, gastrectomy with curative intent, R0 resection. Main outcomes studied were: disease-free survival and overall survival. Results: A total of 270 patients fulfilled the inclusion criteria. Mean age was 63-year-old and 155 were males. Subtotal gastrectomy and D2 lymphadenectomy were performed in 64% and 74.4%, respectively. Mean lymph node yield was 37.6. Early GC was present in 54.1% of the cases. Mean follow-up was 40.8 months and 19 (7%) patients relapsed. Disease-free survival and overall survival were 90.9% and 74.6%, respectively. Independent risk factors for worse disease-free survival were: total gastrectomy, lesion size ≥3.4 cm, higher pT status and <16 lymph nodes resected. Conclusion: In western gastric cancer pN0 patients submitted to gastrectomy, lymph node count <16, pT3-4 status, tumor size ≥3.4 cm, total gastrectomy and presence of lymphatic invasion, are all risk factors for disease relapse.


RESUMO Racional: Aproximadamente 10% dos pacientes com câncer gástrico submetidos a operação curativa e sem linfonodos acometidos irão apresentam recorrência da doença. Os dados ocidentais são extremamente pobres sobre este assunto e a identificação dos fatores de risco associados à recidiva podem permitir novas estratégias para melhorar a sobrevida. Objetivo: Identificar as características clínicas e patológicas que se correlacionam com recidiva em pacientes com câncer gástrico pN0. Métodos: Foram considerados todos os pacientes com câncer gástrico submetidos à gastrectomia entre 2009 e 2019 em nossa instituição e que na classificação patológica não apresentaram acometimento linfonodal. Os critérios de inclusão foram: adenocarcinoma gástrico, pN0, gastrectomia com intenção curativa, ressecção R0. Os principais desfechos estudados foram: sobrevida livre de doença e sobrevida global. Resultados: Ao todo 270 pacientes preencheram os critérios de inclusão. A idade média foi de 63 anos e 155 eram homens. A gastrectomia subtotal e a linfadenectomia D2 foram realizadas em 64% e 74,4%, respectivamente. A média de linfonodos ressecados foi de 37,6. Câncer gástrico precoce estava presente em 54,1% dos casos. O seguimento médio foi de 40,8 meses e 19 (7%) apresentaram recidiva. A sobrevida livre de doença e sobrevida global foram de 90,9% e 74,6%, respectivamente. Os fatores de risco independentes para pior sobrevida livre de doença foram: gastrectomia total, lesão ≥3,4 cm, status pT avançado e <16 linfonodos ressecados. Conclusão: Os fatores de risco para recidiva no grupo estudado foram: <16 linfonodos ressecados, status pT3-4, tumor ≥3,4 cm, gastrectomia total e presença de invasão linfática.


Subject(s)
Humans , Male , Female , Middle Aged , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Retrospective Studies , Risk Factors , Gastrectomy , Lymph Node Excision , Lymphatic Metastasis , Neoplasm Recurrence, Local/epidemiology , Neoplasm Staging
16.
Braz. j. med. biol. res ; 54(10): e11409, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285656

ABSTRACT

Obesity has been associated with an increased risk of breast cancer recurrence and death. Some readily available biomarkers associated with systemic inflammation have been receiving attention as potential prognostic indicators in cancer, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). This study aimed to explore the correlation between body mass index (BMI) and invasive breast cancer and the association of NLR, PLR, and BMI with breast cancer outcomes. We undertook a retrospective study to evaluate patients treated for breast cancer over 14 years. Clinicopathological data was obtained before receiving any treatment. Of the 1664 patients included with stage I-III, 567 (34%) were obese (BMI≥30 kg/m2). Obese patients had larger tumors compared to non-obese patients. Higher BMI was associated with recurrence and worse survival only in patients with stage I disease. NLR and PLR were classified into high and low level groups. The NLRhigh (NLR>4) was found to be an independent prognostic factor for recurrence and mortality, while the PLRhigh (PLR>150) group had no impact on survival. A subgroup of patients with NLRhigh and BMIhigh had the worst disease-free survival (P=0.046), breast cancer-specific survival (P<0.001), and overall survival (P=0.006), compared to the other groups. Patients with early-stage breast cancer bearing NLRhigh and BMIhigh had worse outcomes, and this might be explained by the dysfunctional milieu of obesity in adipose tissue and its effects on the immune system. This study highlights the importance of lifestyle measures and the immune system interference with clinical outcomes in the early breast cancer setting.


Subject(s)
Humans , Female , Breast Neoplasms , Neutrophils , Prognosis , Lymphocytes , Retrospective Studies , Neoplasm Recurrence, Local , Obesity/complications
17.
Braz. j. med. biol. res ; 54(11): e11592, 2021. tab, graf
Article in English | LILACS | ID: biblio-1339449

ABSTRACT

Cervical cancer (CC) patients have a poor prognosis due to the high recurrence rate. However, there are still no effective molecular signatures to predict the recurrence and survival rates for CC patients. Here, we aimed to identify a novel signature based on three types of RNAs [messenger RNA (mRNAs), microRNA (miRNAs), and long non-coding RNAs (lncRNAs)]. A total of 763 differentially expressed mRNAs (DEMs), 46 lncRNAs (DELs), and 22 miRNAs (DEMis) were identified between recurrent and non-recurrent CC patients using the datasets collected from the Gene Expression Omnibus (GSE44001; training) and The Cancer Genome Atlas (RNA- and miRNA-sequencing; testing) databases. A competing endogenous RNA network was constructed based on 23 DELs, 15 DEMis, and 426 DEMs, in which 15 DELs, 13 DEMis, and 390 DEMs were significantly associated with disease-free survival (DFS). A prognostic signature, containing two DELs (CD27-AS1, LINC00683), three DEMis (hsa-miR-146b, hsa-miR-1238, hsa-miR-4648), and seven DEMs (ARMC7, ATRX, FBLN5, GHR, MYLIP, OXCT1, RAB39A), was developed after LASSO analysis. The built risk score could effectively separate the recurrence rate and DFS of patients in the high- and low-risk groups. The accuracy of this risk score model for DFS prediction was better than that of the FIGO (International Federation of Gynecology and Obstetrics) staging (the area under receiver operating characteristic curve: training, 0.954 vs 0.501; testing, 0.882 vs 0.656; and C-index: training, 0.855 vs 0.539; testing, 0.711 vs 0.508). In conclusion, the high predictive accuracy of our signature for DFS indicated its potential clinical application value for CC patients.


Subject(s)
Humans , Female , Uterine Cervical Neoplasms/genetics , MicroRNAs/genetics , RNA, Long Noncoding/genetics , RNA, Messenger , Gene Expression Regulation, Neoplastic , Disease-Free Survival , rab GTP-Binding Proteins , Ubiquitin-Protein Ligases , Neoplasm Recurrence, Local/genetics
18.
Frontiers of Medicine ; (4): 155-169, 2021.
Article in English | WPRIM | ID: wpr-880972

ABSTRACT

Hepatic resection represents the first-line treatment for patients with resectable hepatocellular carcinoma (HCC). However, the 5-year recurrence rates of HCC after surgery have been reported to range from 50% to 70%. In this review, we evaluated the available evidence for the efficiency of adjuvant treatments to prevent HCC recurrence after curative liver resection. Antiviral therapy has potential advantages in terms of reducing the recurrence rate and improving the overall survival (OS) and/or disease-free survival of patients with hepatitis-related HCC. Postoperative adjuvant transarterial chemoembolization can significantly reduce the intrahepatic recurrence rate and improve OS, especially for patients with a high risk of recurrence. The efficacy of molecular targeted drugs as an adjuvant therapy deserves further study. Adjuvant adoptive immunotherapy can significantly improve the clinical prognosis in the early stage. Randomized controlled trial (RCT) studies evaluating adjuvant immune checkpoint inhibitors are ongoing, and the results are highly expected. Adjuvant hepatic artery infusion chemotherapy might be beneficial in patients with vascular invasion. Huaier granule, a traditional Chinese medicine, has been proved to be effective in prolonging the recurrence-free survival and reducing extrahepatic recurrence. The efficiency of other adjuvant treatments needs to be further confirmed by large RCT studies.


Subject(s)
Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic , Chemotherapy, Adjuvant , Hepatectomy , Humans , Liver Neoplasms/therapy , Neoplasm Recurrence, Local , Treatment Outcome
19.
Frontiers of Medicine ; (4): 170-177, 2021.
Article in English | WPRIM | ID: wpr-880966

ABSTRACT

Nanosecond pulsed electric field (nsPEF) is a novel, nonthermal, and minimally invasive modality that can ablate solid tumors by inducing apoptosis. Recent animal experiments show that nsPEF can induce the immunogenic cell death of hepatocellular carcinoma (HCC) and stimulate the host's immune response to kill residual tumor cells and decrease distant metastatic tumors. nsPEF-induced immunity is of great clinical importance because the nonthermal ablation may enhance the immune memory, which can prevent HCC recurrence and metastasis. This review summarized the most advanced research on the effect of nsPEF. The possible mechanisms of how locoregional nsPEF ablation enhances the systemic anticancer immune responses were illustrated. nsPEF stimulates the host immune system to boost stimulation and prevail suppression. Also, nsPEF increases the dendritic cell loading and inhibits the regulatory responses, thereby improving immune stimulation and limiting immunosuppression in HCC-bearing hosts. Therefore, nsPEF has excellent potential for HCC treatment.


Subject(s)
Animals , Carcinoma, Hepatocellular/therapy , Cell Line, Tumor , Immunity , Liver Neoplasms/therapy , Neoplasm Recurrence, Local
20.
Article in English | WPRIM | ID: wpr-880860

ABSTRACT

Oral squamous cell carcinoma (OSCC) is one of the most common cancers worldwide, and with 354 864 new cases each year. Cancer metastasis, recurrence, and drug resistance are the main causes to cripples and deaths of OSCC patients. As potent growth factors, fibroblast growth factors (FGFs) are frequently susceptible to being hijacked by cancer cells. In this study, we show that FGF8 is upregulated in OSCC tissues and high FGF8 expression is related with a set of clinicopathologic parameters, including age, drinking, and survival time. FGF8 treatment enhances the invasive capability of OSCC cells. Lentivirus-based FGF8 expression promotes OSCC metastasis in a mouse lung metastasis model. Further, mechanistic study demonstrates that FGF8 induces epithelial-mesenchymal transition (EMT) in OSCC cells. These results highlight a pro-metastatic function of FGF8, and underscore the role of FGF8 in OSCC development.


Subject(s)
Animals , Carcinoma, Squamous Cell , Cell Line, Tumor , Cell Movement , Epithelial-Mesenchymal Transition , Fibroblast Growth Factor 8 , Head and Neck Neoplasms , Humans , Mice , Mouth Neoplasms , Neoplasm Recurrence, Local , Squamous Cell Carcinoma of Head and Neck
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