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1.
Rev. colomb. cir ; 37(4): 665-672, 20220906. fig
Article in Spanish | LILACS | ID: biblio-1396474

ABSTRACT

Introducción. Las metástasis peritoneales representan un estado avanzado de muchos cánceres intraabdominales y suelen dar un pronóstico ominoso a los pacientes que las desarrollan. Hasta hace poco la única opción terapéutica para este escenario era la quimioterapia paliativa. Sin embargo, la mayoría de los tumores metastásicos al peritoneo continúan siendo relativamente resistentes a las drogas citotóxicas y citostáticas administradas por vía endovenosa y, en general, a las terapias individuales. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, SciELO y Google Scholar utilizando las palabras claves: laparoscopia, carcinomatosis peritoneal, estadificación, citorreducción. Se incluyeron para la revisión los artículos con mayor relevancia publicados en inglés y español. Discusión. La cirugía citorreductiva asociada a técnicas de quimioterapia hipertérmica intraperitoneal se ofrece actualmente a pacientes con indicaciones precisas según el primario subyacente. Es aquí donde la laparoscopia de estadificación realizada de manera correcta y completa juega un papel determinante, puesto que ha demostrado ser un método fiable para realizar una aproximación del compromiso peritoneal. Conclusión. Todos los especialistas quirúrgicos, en especial los cirujanos generales, deben estar familiarizados en cómo realizar de forma completa una laparoscopia de estadificación, de manera que se pueda hacer una mejor aproximación al grado de compromiso peritoneal, contribuyendo en el manejo integral oncológico del paciente.


Introduction. Peritoneal metastases represent an advanced stage of many intra-abdominal neoplasms and often give an ominous prognosis. Recently, the only therapeutic option for this setting was palliative chemotherapy. However, most tumors metastatic to the peritoneum remain relatively resistant to intravenously administered cytotoxic and cytostatic drugs and, in general, to individual therapies. Methods. A literature search was performed in PubMed, SciELO and Google Scholar databases using the keywords: laparoscopy, peritoneal carcinomatosis, staging, cytoreduction. The most relevant articles published in English and Spanish were included in the review. Discussion. Cytoreductive surgery associated with intraperitoneal hyperthermic chemotherapy techniques is currently offered to patients with precise indications according to the underlying primary. It is here where staging laparoscopy performed in a complete and correct manner plays a determining role, since it has proven to be a reliable method for approximating peritoneal involvement. Conclusion. All surgical specialists, especially general surgeons, should be familiar with how to perform a complete staging laparoscopy, leading to a correct approach of the degree of peritoneal involvement and contributing to the integral oncologic management of the patient.


Subject(s)
Humans , Peritoneal Neoplasms , Laparoscopy , Cytoreduction Surgical Procedures , Neoplasm Staging
2.
Rev. cir. (Impr.) ; 74(4): 368-375, ago. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1407938

ABSTRACT

Resumen Objetivos: El sistema linfático del estómago es complejo y multidireccional, siendo difícil predecir el patrón de diseminación linfática en el adenocarcinoma (ADC) gástrico. Los objetivos de este trabajo son determinar si el analizar los grupos ganglionares de la pieza quirúrgica por separado tiene implicaciones en el estadiaje, además estudiar la afectación de diferentes grupos ganglionares. Materials y Método: Estudio observacional retrospectivo de pacientes intervenidos de gastrectomía y linfadenectomía con intención curativa por ADC en un hospital de referencia (2017-2021).,_Se han comparado aquellos pacientes cuya pieza quirúrgica se estudió en su totalidad (grupo A) con aquellos en los que se separaron los grupos ganglionares para su análisis (grupo B). En el grupo B, se ha analizado la afectación ganglionar de diferentes grupos ganglionares en base a la localización tumoral y el estadio pT. Resultados: Se incluyeron 150 pacientes. La media de ganglios analizados fue significativamente mayor cuando se separaron los grupos ganglionares (grupo B) (24,01 respecto a 20,49). La afectación ganglionar fue del 45,8%, 58,3% y 55,5% en los tumores de tercio superior, medio e inferior respectivamente, y los grupos difirieron en base a la localización tumoral. El riesgo de afectación ganglionar fue significativamente mayor y hubo más grupos ganglionares perigástricos afectos cuanto mayor era el estadio pT. Conclusiones: Separar los grupos ganglionares previo a su análisis aumenta el número de ganglios analizados mejorando el estadiaje ganglionar. Existen diferentes rutas de drenaje linfático dependiendo de la localización tumoral y la afectación ganglionar aumenta de forma paralela al estadio pT.


Objectives: The lymphatic system of the stomach is complex and multidirectional, making it difficult to predict the pattern of lymphatic spread in gastric adenocarcinoma (GAC). The aim of this paper is to determine if analyzing the lymph node groups of the surgical specimen separately has implications in the pathological staging, as well as to study the involvement rate of different lymph node groups. Material and Method: Retrospective observational study of patients who underwent curative intent gastrectomy and lymphadenectomy for GAC in a reference hospital (2017-2021). Those patients whose surgical specimen was studied as a whole (group A) were compared with those in whom the lymph node groups were separated by surgeons before analysis (group B). In group B, the involvement of different lymph node groups was analyzed based on tumor location and pT stage. Results: 150 patients were included. The mean number of lymph nodes analyzed was significantly higher when the lymph node groups were separately analyzed (group B) (24.01 compared to 20.49). Lymph node involvement was 45.8%, 58.3%, and 55.5% in tumors of the upper, middle, and lower third, respectively, and the involved groups differed depending on the tumor location. The higher the pT stage was, the risk of lymph node involvement was significantly higher and there were more perigastric lymph node groups affected. Conclusions: Separating lymph node groups prior to their analysis increases the number of lymph nodes analyzed and therefore improves lymph node staging. There are different lymphatic drainage routes depending on the tumor location and lymph node involvement increases in parallel with the pT stage.


Subject(s)
Humans , Male , Aged , Stomach Neoplasms/surgery , Adenocarcinoma/surgery , Retrospective Studies , Lymph Node Excision/methods , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Neoplasm Invasiveness/pathology , Neoplasm Staging
3.
J. coloproctol. (Rio J., Impr.) ; 42(2): 159-166, Apr.-June 2022. tab
Article in English | LILACS | ID: biblio-1394419

ABSTRACT

Introduction: The optimal rectal cancer care is achieved by a multidisciplinary approach, with a high-quality surgical resection, with complete mesorectal excision and adequate margins. New approaches like the transanal total mesorectal excision (TaTME) aim to achieve these goals, maximizing the sphincter preservation ratio, with good oncologic and functional results. This report describes a way to implement TaTME without a proctor, presents the first case series of this approach in a center experienced in rectal cancer, and compares the results with those of the international literature. Methods: We performed a retrospective study of the first 10 consecutive patients submitted to TaTME for rectal cancer at our institution. The primary outcomes were postoperative complications, pathological specimen quality and local recurrence rate. The results and performance were compared with the outcomes of a known structured program with proctorship and with the largest meta-analysis on this topic. Results: All patients had locally advanced cancer; therefore, all underwent neoadjuvant therapy. A total of 30% had postoperative complications, without mortality or re-admissions. In comparison with the structured training program referred, no differences were found in postoperative complications and reintervention rates, resulting in a similar quality of resection. Comparing these results with those of the largest meta-analysis on the subject, no differences in the postoperative complication rates were found, and very similar outcomes regarding anastomotic leaks and oncological quality of resection were registered. Conclusion: The results of this study validate the safety and effectiveness of our pathway regarding the implementation of the TaTME approach, highlighting the fact that it should be done in a center with proficiency in minimally invasive rectal surgery. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Rectal Neoplasms/surgery , Transanal Endoscopic Surgery/methods , Postoperative Period , Recurrence , Treatment Outcome , Operative Time , Neoplasm Staging
4.
J. coloproctol. (Rio J., Impr.) ; 42(2): 131-139, Apr.-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1394418

ABSTRACT

Background: The relative rarity of synchronous para-aortic lymph node (PALN) metastasis (SPM) and metachronous PALN recurrence (MPR) in colorectal carcinoma (CRC) patients leads to a limited number of studies on patient management, and no treatment guidelines have been established to date. Objective: To assess the prognostic, predictive roles, and long-term outcomes of different management strategies for isolated MPR and SPM in CRC patients to establish the best one. Materials and Methods: We included 35 CRC patients with isolated MPR and 25 patients with isolated SPM who underwent curative R0 resection. We performed PALN dissection (PALND) in 15 cases in MPR group and in 10 cases in the SPM group; all remaining patients in both groups underwent chemoradiotherapy (CRT) without further surgical intervention. During the study period of about 5 years, we compared the patients who underwent PALND and those who underwent CRT. Results: The overall survival and recurrence-free survival rates were significantly longer in patients who underwent PALND (p = 0.049 and 0.036 respectively). (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Colorectal Neoplasms/therapy , Lymphatic Metastasis/diagnosis , Prognosis , Recurrence , Colorectal Neoplasms/surgery , Survival Rate , Prospective Studies , Treatment Outcome , Lymphatic Metastasis/pathology , Neoplasm Staging
5.
J. coloproctol. (Rio J., Impr.) ; 42(2): 107-114, Apr.-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1394411

ABSTRACT

Background: Peritoneal carcinomatosis (PC) is a lethal regional progression in patients with colorectal cancer (CRC). Treatment with complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) achieves better local control than systemic palliative chemotherapy. Objectives: To assess the efficacy on the prognosis of CRS and HIPEC compared with CRS only and to identify possible clinicopathological factors associated with the recurrence of PC. Methods: The present retrospective study included all colorectal carcinoma cases with PC subjected to CRS with or without HIPC from January 2009 to June 2018 at the National Cancer Institute (NCI), Cairo University, Cairo, Egypt. The outcome is evaluated in terms of recurrence-free survival (RFS) and its predictors. Results: Out of the 61 patients, 45 patients (73.8%) underwent CRS plus HIPEC, and 16 (26.2%) underwent CRS alone. The 1-year RFS was 55.7%, with a median of 12 months. The risk factors for recurrence identified in the univariate analysis were T4 primary tumor, high-grade, positive lymphovascular invasion (LVI), positive extracapsular nodal spread, and patients treated with CRS only, without HIPEC. In the multivariate analysis, the independent risk factors for recurrence were high grade and patients treated with CRS only. Conclusion: T4 primary tumor, high grade, positive LVI, and positive extracapsular nodal spread seemed to be important predictors of recurrence following the treatment of PC. Our study also demonstrated that the addition of HIPEC to CRS improved the RFS. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Peritoneal Neoplasms/diagnosis , Colorectal Neoplasms , Cytoreduction Surgical Procedures/methods , Recurrence , Hyperthermic Intraperitoneal Chemotherapy , Neoplasm Staging
6.
Rev. chil. obstet. ginecol. (En línea) ; 87(3): 188-193, jun. 2022. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388737

ABSTRACT

OBJETIVO: El cáncer de mama constituye la primera causa de muerte oncológica en mujeres chilenas. Las tasas de incidencia solo han sido estimadas según el registro 2003-2007. Nuestro objetivo fue estimar las tasas de incidencia en un período de 10 años en un servicio de salud y caracterizar dicha población. MÉTODO: Se calcularon las tasas de incidencia del período 2006-2015, por método directo, y se analizó la tendencia por Prais-Winsten. Se caracterizó la población según la edad y la etapa al diagnóstico. RESULTADOS: De 2862 casos, la tasa de incidencia estandarizada promedio fue de 66,6 por 100.000 mujeres. En el período hubo una tendencia al alza del diagnóstico de 0,63/100.000 anualmente (p = 0,5; intervalo de confianza del 95%: −1,73 a 2,99). La mayor tasa de incidencia bruta fue en el grupo de 70 y más años (154,8/100.000). El 49% correspondieron a casos diagnosticados de 50 a 69 años. El 56% se diagnosticó precozmente; la etapa I tuvo la más alta tasa (15,8/100.000). CONCLUSIONES: En este estudio, las tasas de incidencia son mayores que las reportadas en informes nacionales previos. El diagnóstico es mayoritariamente en etapas precoces, lo que difiere del resto de los países de la región. Nuestros datos pueden aportar a mejorar las políticas públicas.


OBJECTIVE: Breast cancer is the leading cause of cancer death in Chilean women. Incidence rates have only been estimated based on population records (2003-2007). Our objective was to estimate the incidence rates in a 10-year period in a health service and portray in words this cohort. METHOD: Incidence rates were calculated between 2006-2015 by direct method and trends were analyzed with the Prais-Winsten model. The population was defined according to age and stage at diagnosis. RESULTS: Of a total of 2862 cases, the average incidence rate was 66.6 out of 100,000 women. Between 2006-2015, the trend rose in breast cancer diagnosis of 0.63/100,000 annually (p = 0.5; 95% confidence interval: −1.73, 2.99). The highest crude rate of incidence was in the group aged 70 and over (154.8/100,000). 49% correspond to cases diagnosed between 50 and 69 years. 56% were in early stages, stage I, being the most frequent (15.8/100,000). CONCLUSIONS: On this research the incidence rates were higher than the ones reported on previous national reports. Diagnosis is mostly in early stages which differs from other countries in the region, our data can help improve public health policies.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Breast Neoplasms/epidemiology , Public Health/statistics & numerical data , Chile , Incidence , Retrospective Studies , Age Distribution , Health Services/statistics & numerical data , Neoplasm Staging
7.
Rev. méd. Urug ; 38(2): e38208, jun. 2022.
Article in Spanish | LILACS-Express | LILACS, BNUY, UY-BNMED | ID: biblio-1389694

ABSTRACT

Resumen: Introducción: el estudio citológico por punción ecoguiada se caracteriza por ser rápido, confiable, mínimamente invasivo y rentable. Permite reducir procedimientos quirúrgicos innecesarios y clasifica apropiadamente a los pacientes con nódulos sospechosos o malignos para una intervención quirúrgica oportuna. Objetivo: el objetivo del presente estudio es evaluar la correlación citológica-anatomopatológica del sistema Bethesda en un centro universitario (Hospital de Clínicas) de Uruguay. Metodología: se realizó un estudio de tipo observacional, retrospectivo, descriptivo, basado el análisis de historias clínicas de pacientes sometidos a cirugía tiroidea en el Hospital de Clínicas, en el período comprendido entre enero de 2008 y diciembre de 2018. Resultados: del total inicial de 119 pacientes, 93 cumplieron los criterios de inclusión. El rango de edad de la muestra fue entre 15 y 79 años. Del total de puncionados 49,5% (46) fueron informados como benignos y 50,5% (47) como malignos. Se calculó en forma global una sensibilidad de 96% (0,96) con IC 1,0-0,90, especificidad de 98% (0,97) con IC 1,0-0,93, un VPP de 98% y VPN de 96%. La sensibilidad diagnóstica para la categoría IV, V y VI fue de 96%, con una especificidad de 100, 94 y 100% respectivamente. Conclusiones: el sistema Bethesda aplicado a las PAAF de nódulos tiroideos potencia la certeza diagnóstica y asiste en la decisión terapéutica. En nuestra institución contamos con una buena correlación citopatológica, similar a otros trabajos reportados en la literatura, lo que permite predecir adecuadamente el riesgo de malignidad y facilitar la toma de decisiones.


Summary: Introduction: the ultrasound-guided fine needle aspiration biopsy (FNAB) study is characterized by being fast, reliable, minimally invasive, and cost-effective. It reduces unnecessary surgical procedures and appropriately classifies patients with suspicious or malignant nodules for timely surgical intervention. Objective: the objective of this study is to evaluate the cytological-pathological correlation of the Bethesda System in a university center (Hospital de Clínicas) in Uruguay. Methodology: an observational, retrospective, descriptive study was carried out, based on the analysis of medical records of patients undergoing thyroid surgery at the Hospital de Clínicas, in the period between January 2008 and December 2018. Results: of the initial total of 119 patients, 93 met the inclusion criteria. The age range of the sample was between 15 and 79 years. Of the total of punctured, 49.5% (46) were reported as benign and 50.5% (47) as malignant. A sensitivity of 96% (0.96) with CI 1.0-0.90, specificity of 98% (0.97) with CI 1.0-0.93, a PPV of 98% and NPV of 96%. The diagnostic sensitivity for categories IV, V and VI was 96% with a specificity of 100, 94 and 100% respectively. Conclusions: the Bethesda system applied to FNA of thyroid nodules enhances diagnostic certainty and assists in the therapeutic decision. In our institution we have a good cytopathological correlation, similar to other works reported in the literature. This makes it possible to adequately predict the risk of malignancy and facilitate decision-making.


Resumo: Introdução: o estudo citológico por punção guiada por ultrassom caracteriza-se por ser rápido, confiável, minimamente invasivo e de baixo custo. Permite reduzir procedimentos cirúrgicos desnecessários e classificar adequadamente pacientes com nódulos suspeitos ou malignos para intervenção cirúrgica oportuna. Objetivo: avaliar a correlação citológico-patológica do Sistema Bethesda em um centro universitário (Hospital de Clínicas) no Uruguai. Metodologia: foi realizado um estudo observacional, retrospectivo, descritivo, baseado na análise de prontuários de pacientes submetidos à cirurgia de tireoide no Hospital de Clínicas, no período janeiro de 2008-dezembro de 2018. Resultados: do total inicial de 119 pacientes, 93 preencheram os critérios de inclusão. A faixa etária da amostra foi entre 15 e 79 anos. Do total de punções, 49,5% (46) foram relatadas como benignas e 50,5% (47) como malignas. No geral, uma sensibilidade de 96% (0,96) com IC 1,0-0,90, uma especificidade de 98% (0,97) com IC 1,0-0,93, um VPP de 98% e VPN de 96%. A sensibilidade diagnóstica para as categorias IV, V e VI foi de 96% com especificidade de 100, 94 e 100%, respectivamente. Conclusões: o sistema Bethesda aplicado à PAAF de nódulos tireoidianos aumenta a certeza diagnóstica e auxilia na decisão terapêutica. Em nossa instituição temos uma boa correlação citopatológica, semelhante a outros trabalhos relatados na literatura. Isso permite prever adequadamente o risco de malignidade e facilitar a tomada de decisão.


Subject(s)
Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , Epidemiology, Descriptive , Retrospective Studies , Observational Studies as Topic , Neoplasm Staging/classification
8.
Rev. cir. (Impr.) ; 74(3): 290-294, jun. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1407924

ABSTRACT

Resumen Introducción: El principal factor pronóstico del cáncer gástrico es la etapa al momento del diagnóstico, siendo indispensable evaluar la mejoría en la obtención de diagnósticos estadios precoces. En Chile no existen estudios focalizados en este punto. Objetivos: Comparar los casos de cáncer gástrico en los períodos 2006-2011 y 2012-2017, en el Hospital Base Osorno y evaluar si se logró una mejora en el estadio al momento del diagnóstico en el segundo período. Materiales y Método: Estudio de cohorte retrospectivo, sobre base de datos prospectiva del Hospital Base San José Osorno. El período de análisis fue enero 2006-diciembre 2017. Los casos recopilados se dividieron en 2 grupos según fecha de diagnóstico: período 2006-2011 (G1) y período 2012-2017(G2). Para realizar el análisis se aplicó test estadístico de Fisher y x2. Resultados: Se incluyeron en total 353 pacientes, 233 (66%) corresponden a sexo masculino, con edad promedio de 64,34 (24-87). 182 (51,55%) pacientes con etapificación patológica y 171 (49,45%) con etapificación clínica. Se evaluaron ambos períodos en cada grupo. No hubo diferencias significativas en las características demográficas. En los pacientes con etapificación patológica el G2 hubo mayor detección de cáncer incipiente pero no fue significativo p 0,201. En los pacientes con etapificación clínica hubo una disminución en la proporción de diagnósticos en etapa IV 59 (49,58%) p < 0,001. Conclusión: Existió un aumento estadísticamente significativo en la detección de adenocarcinoma gástrico en etapificación clínica, se requieren mayores estudios para evaluar nuevos factores.


Background: The main prognostic factor for gastric cancer is the stage at the time of diagnosis, and it is essential to evalúate improvements in obtaining early-stage diagnoses. In Chile there are no studies focused on this point. Aim: To compare the cases of gastric cancer in the periods 2006-2011 and 2012-2017 in the Hospital Base Osorno and to evalúate any improvement in the stage at diagnosis during the second period. Materials and Method: A retrospective cohort study was carried out based on a prospective database from the Hospital Base San Jose Osorno. The analysis period was between January 2006-December 2017.The collected cases were divided into 2 groups according to the date of diagnosis: period 2006-2011 (G1) and period 2012-2017 (G2). Fisher test and x2 were applied. Results: A total of 353 patients were included, 233 (66%) were male, mean age of 64,34 (24-87). 182 (51.55%) patients with pathological staging and 171 (49.45%) with clinical staging. Both periods were evaluated in each group. There were no significant differences in demographic characteristics. In patients with pathological staging, G2 had a higher detection of incipient cancer but it was not significant p 0.201. In patients with clinical staging, there was a decrease in the proportion of stage IV diagnoses 59 (49.58%) p < 0.001. Conclusión: There was a statistically significant increase in the detection of gastric adenocarcinoma in clinical staging. Further studies are required to evaluate new factors.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stomach Neoplasms/diagnosis , Stomach Neoplasms/pathology , Adenocarcinoma , Retrospective Studies , Neoplasm Staging
9.
Säo Paulo med. j ; 140(3): 454-462, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377387

ABSTRACT

ABSTRACT BACKGROUND: Clinical assessment of head and neck cancers is highly challenging owing to the complexity of regional anatomy and wide range of lesions. The diagnostic evaluation includes detailed physical examination, biopsy and imaging modalities for disease extent and staging. Appropriate imaging is done to enable determination of precise tumor extent and involvement of lymph nodes, and detection of distant metastases and second primary tumors. OBJECTIVE: To evaluate the initial staging discrepancy between conventional contrasted computed tomography (CT) and 18F-fluorodeoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and its impact on management plans for head and neck malignancies. DESIGN AND SETTING: Prospective cross-sectional study in two tertiary-level hospitals. METHODS: This study included 30 patients with primary head and neck malignant tumors who underwent contrasted computed tomography and whole-body 18F-FDG PET/CT assessments. The staging and treatment plans were compared with the incremental information obtained after 18F-FDG PET/CT. RESULTS: 18F-FDG PET/CT was found to raise the stage in 33.3% of the cases and the treatment intent was altered in 43.3% of them, while there was no management change in the remaining 56.7%. 18F-FDG PET/CT had higher sensitivity (96% versus 89.2%) and accuracy (93% versus 86.7%) than conventional contrast-enhanced computed tomography. CONCLUSION: Our study demonstrated that 18F-FDG PET/CT had higher sensitivity and accuracy for detecting head and neck malignancy, in comparison with conventional contrast-enhanced computed tomography. 18F-FDG PET/CT improved the initial staging and substantially impacted the management strategy for head and neck malignancies.


Subject(s)
Humans , Positron Emission Tomography Computed Tomography/methods , Head and Neck Neoplasms/therapy , Head and Neck Neoplasms/diagnostic imaging , Cross-Sectional Studies , Prospective Studies , Sensitivity and Specificity , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Positron-Emission Tomography , Neoplasm Staging
10.
Rev. Méd. Inst. Mex. Seguro Soc ; 60(2): 107-115, abr. 2022. tab
Article in Spanish | LILACS | ID: biblio-1367226

ABSTRACT

Introducción: el costo económico del tratamiento de cáncer de mama (CM) y el aumento en su incidencia y prevalencia desafía la estabilidad financiera de cualquier sistema de salud. Objetivo: determinar los costos médicos directos (CMD) del tratamiento de CM y los factores asociados a estos costos. Material y métodos: evaluación económica parcial en una cohorte retrospectiva de 160 pacientes con diagnóstico conf irmado de CM. Se consideraron CMD desde la perspectiva del IMSS. Se utilizó análisis de bootstrapping para tratar incertidumbre y el modelo lineal generalizado para identificar factores asociados a costos. Resultados: el costo promedio anual (CPA) del tratamiento de CM fue de $ 251,018 pesos. En estadio 1, $ 116,123; estadio II, $ 242,132; estadio III, $ 287,946, y estadio IV, $ 358,792 pesos. El CPA fue mayor en progresión del CM ($ 380,117 frente a no progresión $ 172,897), y en pacientes que fallecieron durante el seguimiento ($ 357,579) frente a aquellas que sobrevivieron ($ 218,699). Conclusiones: el CPA del tratamiento de CM fue de $ 251,018 pesos. Los CMD aumentan significativamente conforme las pacientes presentan estadios más avanzados de la enfermedad. Los factores asociados al CMD fueron edad, estadios II, III y la progresión del CM.


Background: The economic cost of breast cancer (BC) treatment and the increase in incidence and prevalence challenges the financial stability of any healthcare system. Objective: To determine direct medical costs (DMC) of BC treatment and factors associated with DMC. Material and methods: Partial economic evaluation in a retrospective cohort of 160 patients with a confirmed diagnosis of BC. DMC was considered from the IMSS perspective. Bootstrapping analysis was used to deal with uncertainty and generalized linear model to identify factors associated with DCM Results: The total average annual cost of BC treatment was $251,018 mexican pesos. In clinical stage I was $116,123, stage II $242,132, stage III $287,946, and stage IV $358,792 pesos. In progression disease, DMC were more elevate ($380,117) vs. without progression ($172,897), (p < 0.0001). In patients who died, DMC were $357,579 mexican pesos compared to those who survived ($218,699) (p < 0.0001). Conclusions: The average annual cost of CM treatment was $251,018 pesos. DMCs increase significantly as patients present more advanced stages of the disease. Factors associated with costs were age, stages II, III and the progression of BC.


Subject(s)
Humans , Female , Adult , Middle Aged , Tertiary Healthcare/economics , Breast Neoplasms/therapy , Costs and Cost Analysis , Social Security/economics , Breast Neoplasms/economics , Retrospective Studies , Follow-Up Studies , Cost-Benefit Analysis , Cost of Illness , Mexico , Neoplasm Staging/economics
11.
Int. braz. j. urol ; 48(2): 303-313, March-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364958

ABSTRACT

ABSTRACT Purpose: To determine independent predictors of inguinal lymph node (ILN) metastasis in patients with penile cancer. Patients and methods: We retrospectively analyzed all patients with penile cancer who underwent surgery at our medical center in the last ten years (n=157). Using univariate and multivariate logistic-regression models, we assessed associations with age, medical-history, phimosis, onset-time, number and maximum diameter of involved ILNs measured by imaging, pathological T stage, degree of tumor differentiation and/or cornification, lymphatic vascular infiltration (LVI), nerve infiltration, and ILN metastases. Interaction and stratified analyses were used to assess age, phimosis, onset time, number of ILNs, cornification, and nerve infiltration. Results: A total of 110 patients were included in the study. Multiple logistic regression analysis showed that the following factors were significantly correlated with ILN metastasis: maximum diameter of enlarged ILNs, T stage, pathological differentiation, and LVI. Among patients with a maximum ILN diameter ≥1.5cm, 50% had lymph node metastasis whereas 30.6% patients with a maximum ILN diameter <1.5cm showed LNM. Among 44 patients with stage Ta/T1, 10 showed ILN metastases, while 47.0% patients with stage T2 showed ILN metastases. Among 40 patients with highly differentiated penile-cancer, eight showed ILN metastasis, while 47.1% patients with low-to-middle differentiation showed ILN metastases. The rate of LNM was 33.3% in the LVI-free group and 64.3% in the LVI group. Conclusion: Our single-center results suggested that maximum ILN diameter, pathological T stage, pathological differentiation, and LVI were independent risk factors for ILN metastases.


Subject(s)
Humans , Male , Penile Neoplasms/surgery , Penile Neoplasms/pathology , Prognosis , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Lymph Node Excision , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Neoplasm Staging
12.
Braz. j. otorhinolaryngol. (Impr.) ; 88(2): 212-219, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1374718

ABSTRACT

Abstract Introduction: Nasopharyngeal carcinoma has the highest metastatic potential of all head and neck cancers. The survival time of patients with nasopharyngeal carcinoma has improved significantly in the last decades due to the use of combination of chemotherapy and radiotherapy, as well as advances in radiotherapy techniques. However, appropriately 30% of patients with nasopharyngeal carcinoma suffer a poor prognosis, mainly due to distant metastasis. Objective: The study aimed to identify the survival and prognostic factors in metastatic nasopharyngeal carcinoma. Methods: A retrospective analysis was conducted in patients treated for synchronous metastatic nasopharyngeal carcinoma or metachronous metastatic nasopharyngeal carcinoma for 14years (2003-2016). Overall survival was analyzed using the Kaplan-Meier method and compared using the log-rank test for the whole population and both groups of patients. Multivariate analysis was performed using the Cox model; p-values < 0.05 were considered to indicate statistical significance. Results: One hundred and twelve patients with metastatic nasopharyngeal carcinoma were included (51 patients with metastatic nasopharyngeal carcinoma, and 61 patients with metachronous metastatic nasopharyngeal carcinoma). In the whole population, the median overall survival was 10 months (1-156 months). In the multivariate analysis, female gender, poor performance status (WHO > 1) and metachronous metastasis were independent prognostic factors. In the metastatic nasopharyngeal carcinoma patients, the median overall survival was 13 months (1-156 months). In multivariate analysis, independent prognostic factors were non-oligometastatic disease, severe (G3-G4) chemotherapy toxicity and the lack of nasopharyngeal and metastatic site irradiation. In the metachronous metastatic nasopharyngeal carcinoma patients, the median overall survival was 7 months (1-41 months). In multivariate analysis, the poor performance status (WHO > 1) was an independent metastatic nasopharyngeal carcinoma prognostic factor. Conclusion: Oligometastatic patients with synchronous metastatic nasopharyngeal carcinoma had better survival. The locoregional treatment of primitive nasopharyngeal carcinoma improved survival in patients with metastatic nasopharyngeal carcinoma who responded to induction chemotherapy. Local irradiation of metastatic sites improved survival of metastatic nasopharyngeal carcinoma patients. Grade 3 or 4 chemotherapy toxicity altered survival among patients with synchronous metastatic nasopharyngeal carcinoma.


Resumo Introdução: O carcinoma nasofaríngeo tem o maior potencial metastático de todos os tipos de câncer de cabeça e pescoço. O tempo de sobrevida dos pacientes com carcinoma nasofaríngeo melhorou significativamente nas últimas décadas devido ao uso combinado de quimioterapia e radioterapia e os avanços nas técnicas de radioterapia. No entanto, aproximadamente 30% dos pacientes com carcinoma nasofaríngeo têm um prognóstico ruim, principalmente devido a metástases a distância. Objetivo: Identificar a sobrevida e os fatores prognósticos no carcinoma nasofaríngeo metastático. Método: Foi feita uma análise retrospectiva de pacientes tratados por carcinoma nasofaríngeo metastático sincrônico ou carcinoma nasofaríngeo metastático metacrônico por 14 anos (2003-2016). A sobrevida global foi analisada pelo método de Kaplan-Meier e comparada pelo teste de log-rank para toda a população e ambos os grupos de pacientes. A análise multivariada foi feita com o modelo de Cox; valores de p < 0,05 foram considerados como significância estatística. Resultados: Foram incluídos 112 pacientes com carcinoma nasofaríngeo metastático (51 com carcinoma nasofaríngeo metastático sincrônico e 61 com carcinoma nasofaríngeo metastático metacrônico). Em toda a população, a mediana da sobrevida global foi de 10 meses (1-156 meses). Na análise multivariada, sexo feminino, baixo status de desempenho (OMS > 1) e metástase metacrônica foram fatores prognósticos independentes. Nos pacientes com carcinoma nasofaríngeo metastático sincrônico, a mediana da sobrevida global foi de 13 meses (1-156 meses). Na análise multivariada, os fatores prognósticos independentes foram doença não oli-gometastática, toxicidade grave à quimioterapia (G3 - G4) e falta de irradiação nasofaríngea e do sítio metastático. Nos pacientes com carcinoma nasofaríngeo metastático metacrônico, a mediana da sobrevida global foi de 7 meses (1-41 meses). Na análise multivariada, o baixo status de desempenho (OMS > 1) foi um fator prognóstico independente. Conclusão: Pacientes oligometastáticos com carcinoma nasofaríngeo metastático sincrônico tiveram melhor sobrevida. O tratamento locorregional do carcinoma nasofaríngeo primário melhorou a sobrevida em pacientes com carcinoma nasofaríngeo metastático sincrônico que responderam à quimioterapia de indução. A irradiação local dos locais metastáticos melhorou a sobrevida dos pacientes com carcinoma nasofaríngeo metastático. A toxicidade de quimioterapia de grau 3 ou 4 alterou a sobrevida entre pacientes com carcinoma nasofaríngeo metastático sincrônico.


Subject(s)
Humans , Female , Nasopharyngeal Neoplasms/pathology , Prognosis , Retrospective Studies , Nasopharyngeal Carcinoma/pathology , Neoplasm Staging
13.
J. coloproctol. (Rio J., Impr.) ; 42(1): 25-31, Jan.-Mar. 2022. tab
Article in English | LILACS | ID: biblio-1375756

ABSTRACT

Objectives Colorectal cancer (CRC) is the second leading cause of cancer death in the world, with survival correlated with the extension of the disease at diagnosis. In many low-/middle-income countries, the incidence of CRC is increasing rapidly, while decreasing rates are observed in high-income countries. We evaluated the anatomopathological profile of 390 patients diagnosed with CRC who underwent surgical resection, over a six-year period, in the state of Paraíba, northeastern Brazil. Results Adenocarcinomas accounted for 98% of the cases of primary colorectal tumors, and 53.8% occurred in female patients. The average age of the sample was 63.5 years, with 81.8% of individuals older than 50 years of age and 6.4% under 40 years of age. The most frequent location was the distal colon; pT3 status was found in 71% of patients, and pT4 status, in 14.4%. Angiolymphatic and lymph-node involvements were found in 48.7% and 46.9% of the cases respectively. Distant metastasis was observed in 9.2% of the patients. Advanced disease was diagnosed in almost half of the patients (48.1%). The women in the sample had poorly-differentiated adenocarcinomas (p=0.043). Patients under 60 years of age had a higher rate of lymph-node metastasis (p=0.044). Tumor budding was present in 27.2% of the cases, and it was associated with the female gender, themucinous histological type, and the depth of invasion (pT3 and pT4). Conclusions We conclude that the diagnosis of advanced disease in CRC is still a reality, with a high occurrence of aggressive prognostic factors, which results in a worse prognosis. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Rectal Neoplasms/diagnosis , Colonic Neoplasms/diagnosis , Rectal Neoplasms/pathology , Adenocarcinoma , Colonic Neoplasms/pathology , Neoplasm Invasiveness/diagnosis , Neoplasm Staging
14.
Rev. cir. (Impr.) ; 74(1): 36-40, feb. 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388916

ABSTRACT

Resumen Introducción: Una terapia emergente para el cáncer de colon es la neoadyuvancia, en casos seleccionados. Dicha selección se basa en el análisis preoperatorio de imágenes mediante tomografía computada. Objetivo: Nuestro objetivo es determinar la exactitud diagnóstica del examen para estadificar el cáncer de colon y su correlación entre radiólogos expertos. Materiales y Método: Estudio de exactitud diagnóstica. Previo cálculo muestral se seleccionaron aleatoriamente 47 pacientes con adenocarcinoma colónico resecado con intención curativa e imágenes hasta 60 días previo cirugía. Se evaluó profundidad de invasión tumoral e invasión linfonodal por 2 radiólogos expertos y ciegos entre sí. Las diferencias fueron auditadas por un tercer radiólogo experto. Se compararon resultados con la biopsia, calculando la sensibilidad, especificidad, valor predictivo negativo, valor predictivo positivo y exactitud diagnóstica del examen. Se calculó la concordancia entre radiólogos mediante el índice de kappa. Resultados: La exactitud para diferenciar tumores T3-T4 de T1-T2 fue del 89,4%. En cambio, la capacidad para diferenciar tumores T4 de los T3 fue de un 65,9%. La exactitud para determinar un N (+) fue de un 66%. La concordancia entre radiólogos fue de 0,929 para identificar tumores T1-2, de 0,602 para T3, de 0,584 para T4. Para determinar un N (+), la concordancia fue de 0,521. Conclusión: La exactitud diagnóstica de la tomografía computada en cáncer de colon es adecuada para distinguir tumores avanzados. Sin embargo, su capacidad para discriminar entre T3 y T4, los N (+) y la baja concordancia entre radiólogos, sugiere la necesidad de buscar técnicas imagenológicas complementarias.


Introduction: Neoadjuvant therapy is an emerging treatment for selected cases of colon cancer. The decision is based on the analysis of preoperative images taken by computed tomography. However, its ability to discriminate those who could benefit from this therapy is unknown. Aim: Our objective is to determine the diagnostic accuracy of computed tomography to evaluate the colon cancer stage and its correlation among expert radiologists. Materials and Method: Diagnostic accuracy study. After sample size calculation, we randomly selected 47 patients who underwent a colonic adenocarcinoma resection with curative intent and had available images up to 60 days after surgery. The depth of tumor and lymph nodal invasion were evaluated by two expert radiologists, blinded to each other. The differences between radiologists were audited by a third one. The results were correlated with biopsy as the gold standard. We calculated sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of computed tomography. The agreement between radiologists was calculated using the kappa index. Results: The accuracy to differentiate T3-T4 tumors from T1-T2 was 89.4%. In contrast, ability to differentiate T4 tumors from T3 tumors was 65.9%. The accuracy to determine an N (+) was 66%. Agreement between radiologists was 0.929 to identify T1-2, 0.602 for T3, 0.584 for T4 tumors. To determine an N (+), the concordance was 0.521. Conclusion: Diagnostic computed tomography accuracy in colon cancer is adequate to differentiate advanced tumors. However, its ability to discriminate between T3 and T4, N (+) and the low agreement between radiologists suggests the need for complementary imaging techniques.


Subject(s)
Humans , Tomography, X-Ray Computed , Colonic Neoplasms/pathology , Colonic Neoplasms/diagnostic imaging , Sensitivity and Specificity , Neoadjuvant Therapy , Neoplasm Staging
15.
Hematol., Transfus. Cell Ther. (Impr.) ; 44(1): 40-48, Jan.-Mar. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364901

ABSTRACT

Abstract Introduction Knowing the information regarding the panorama of lymphoma diagnosis in patients treated in the Brazilian Public Unified Health System from the last 10 years is a challenge for Strategic Health Planning. Objective To characterize the Brazilian population with lymphoma treated in the Brazilian Public Unified Health System between 2008 and 2017 regarding staging, sex, residence site and mortality. Material and methods A descriptive, retrospective, and longitudinal trial with secondary data from DataSUS (SIA/SUS and SIM/SUS) obtained from patients with ICD-10 C81-85. Results There were 70,850 lymphoma cases between 2008 and 2017, of which 55% were male, the median age was 51 years, and 27% had Hodgkin Lymphoma. Most patients (56%) were treated outside the residence city. São Paulo State accounted for 25% of patients. Treatment initiation took more than 60 days in 27% of cases. A total of 45,601 deaths were due to lymphoma (12% Hodgkin Lymphoma and 88% Non-Hodgkin Lymphoma), with a median age 63 years, and were mainly males (55%). Staging data were inadequate in 23% of patients, and analysis was performed only on the valid records. Advanced disease was diagnosed in 58% of patients (60% male; 57% female) and was more common in Non-Hodgkin Lymphoma (62%) versus Hodgkin Lymphoma (49%). Discussion Late diagnosis interferes with mortality rates. Health promotion and cancer prevention campaigns, especially targeting the male public, and training for early diagnosis and early treatment are needed. Conclusion Effective measures for early diagnosis and treatment are urgently needed for lymphoma control.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Hodgkin Disease/diagnosis , Lymphoma/diagnosis , Mortality , Delayed Diagnosis , Neoplasm Staging
16.
Rev. méd. Chile ; 150(1): 7-16, ene. 2022. tab, ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389607

ABSTRACT

Background: Lung cancer is the world's leading cause of cancer death. Aim: To describe the clinical, staging and survival characteristics of lung cancer in a public Chilean regional hospital. Material and Methods: Analysis of a prospective database of a thoracic surgery service, retrieving histologically confirmed lung cancer cases from January 2010 to December 2019 and reviewing their medical records. Cases were re-staged by the TNM-8 system and variables were compared between periods 2010-2014 and 2015-2019. Results: We retrieved 551 lung cancer cases, 333 (60 %) men, with a mean age of 65 years. Distant metastases were found in 72% of cases (excluding lymphatic metastases). Of the non-small cell lung cancers (NSCLC), 50 (10%) cases were in stage I, 18 (4%) in stage II, 81 (16%) in stage III and 347 (70%) in stage IV. Global five-year survival was 18%, 20% for NSCLC, 71% for excised NSCLC, 8% for non-excised NSCLC, 88% for stage I and 92% for subgroup IA. Resective surgery was performed in 81 (14%) cases. When comparing 2010-2014 and 2015-2019 periods, the frequency of resective surgery increased from 7% to 20%. Conclusions: The diagnosis of lung cancer was frequently made in advanced stages. There was a significant increase in early diagnosis and frequency of surgeries with curative intent in the second observation period.


Subject(s)
Humans , Male , Female , Aged , Carcinoma, Non-Small-Cell Lung/surgery , Carcinoma, Non-Small-Cell Lung/epidemiology , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Chile/epidemiology , Hospitals, Public , Neoplasm Staging
17.
Int. braz. j. urol ; 48(1): 89-98, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356281

ABSTRACT

ABSTRACT Purpose: Contrast-enhanced CT scan is the standard staging modality for patients with bladder cancer undergoing radical cystectomy (RC). Involvement of lymph nodes (LN) determines prognosis of patients with bladder cancer. The detection of LN metastasis by CT scan is still insufficient. Therefore, we investigated various CT scan characteristics to predict lymph node ratio (LNR) and its impact on survival. Also, pre-operative CT scan characteristics might hold potential to risk stratify cN+ patients. Materials and Methods: We analyzed preoperative CT scans of patients undergoing RC in a tertiary high volume center. Retrospectively, local tumor stage and LN characteristics such as size, morphology (MLN) and number of loco-regional LN (NLN) were investigated and correlation to LNR and survival was analyzed. CT scan characteristics were used to develop a risk stratification using Kaplan-Maier and multivariate analysis. Results: 764 cN0 and 166 cN+ patients with complete follow-up and imaging data were included in the study. Accuracy to detect LN metastasis and locally advanced tumor stage in CT scan was 72% and 62%. LN larger than 15mm in diameter were significantly associated with higher LNR (p=0.002). Increased NLN correlated with decreased CSS and OS (p=0.001: p=0.002). Furthermore, CT scan based scoring system precisely differentiates low-risk and high-risk profiles to predict oncological outcome (p <0.001). Conclusion: In our study, solely LN size >15mm significantly correlated with higher LNR. Identification of increased loco-regional LN was associated with worse survival. For the first time, precise risk stratification based on computed-tomography findings was developed to predict oncological outcome for clinical lymph node-positive patients undergoing RC.


Subject(s)
Humans , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/diagnostic imaging , Cystectomy , Prognosis , Tomography, X-Ray Computed , Retrospective Studies , Lymph Node Excision , Lymph Nodes/surgery , Lymph Nodes/pathology , Lymph Nodes/diagnostic imaging , Neoplasm Staging
18.
Article in Chinese | WPRIM | ID: wpr-936357

ABSTRACT

OBJECTIVE@#To investigate the expression of aldehyde dehydrogenase 3B1 (ALDH3B1) in gastric cancer and explore its correlation with the pathological parameters and long-term prognosis of the patients.@*METHODS@#We analyzed the clinical data of 101 patients who underwent radical gastrectomy for gastric cancer in our hospital between January, 2013 and November, 2016, and examined the expression of ALDH3B1 in paraffin-embedded samples of gastric cancer tissues and adjacent tissues from these cases by immunohistochemical staining. We evaluated the correlation between ALDH3B1 expressions and histopathological parameters and assessed the predictive value of ALDH3B1 expression for long-term survival of the patients. We also examined the effect of lentivirus-mediated interference and overexpression of ALDH3B1 on the malignant behaviors of MGC-803 gastric cancer cells.@*RESULTS@#The expressions of ALDH3B1 and Ki67 were significantly higher in gastric cancer tissues than in adjacent tissues (P < 0.05). In gastric cancer patients, ALDH3B1 expression was positively correlated with peripheral blood CEA and CA19-9 levels (P < 0.01). The proportion of patients with CEA ≥5 μg/L, CA19-9 ≥37 kU/L, T stage of 3- 4, and N stage of 2-3 was significantly greater in high ALDH3B1 expression group than in low expression group. Kaplan-Meier survival analysis showed that the 5-year survival rate was significantly lower in gastric cancer patients with high ALDH3B1 expressions (P < 0.01). Univariate and Cox multiple regression analyses identified a high expression of ALDH3B1 (P < 0.05, HR= 0.231, 95% CI: 0.064-0.826), CEA≥5 μg/L (P < 0.01, HR=4.478, 95% CI: 1.530-13.110), CA19-9≥37 kU/L (P < 0.01, HR=3.877, 95% CI: 1.625-9.247), T stage of 3-4 (P < 0.01, HR=4.953, 95% CI: 1.768-13.880), and N stage of 2-3 (P < 0.05, HR=2.152, 95% CI: 1.152-4.022) as independent risk factors affecting 5-year survival after radical gastrectomy. The relative ALDH3B1 expression level, at the cut-off point of 4.66, showed a sensitivity of 76.47% and a specificity of 76% for predicting 5-year postoperative death (P < 0.01). In the cell experiment, overexpression of ALDH3B1 obviously promoted the proliferation, migration and invasion of MGC-803 cells.@*CONCLUSION@#As an independent risk factor affecting 5-year survival after radical gastrectomy, ALDH3B1 is highly expressed in gastric cancer and correlated with pathological parameters of the tumor, and a high ALDH3B1 expression may promote proliferation, invasion and metastasis of gastric cancer cells.


Subject(s)
Aldehyde Oxidoreductases , CA-19-9 Antigen , Carcinoembryonic Antigen , Gastrectomy , Humans , Neoplasm Staging , Prognosis , Retrospective Studies , Stomach Neoplasms/pathology
19.
Article in Chinese | WPRIM | ID: wpr-936235

ABSTRACT

Objective: To compare the clinical features and prognoses of patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (SCC) with and without retropharyngeal lymph node metastases. Methods: PubMed, Cochrane, Web of Science, CNKI, VIP and Wanfang databases were searched for published literatures on retropharyngeal lymph node metastasis of oropharyngeal or hypopharyngeal squamous cell carcinoma (1900, 2021), and outcome indicators such as survival rate and related clinical features were extracted. The quality evaluation of the included literatures was carried out. RevMan 5.4 and Stata 16.0 software were used for data analysis. Results: A total of 18 literatures were included. Meta analysis showed that 3-year and 5-year survival rates and 5-year disease-specific survival rate of patients with oropharyngeal or hypopharyngeal squamous cell carcinoma with retropharyngeal lymph node metastases were lower than those without metastases, 46.1% vs. 53.0%, 40.8% vs. 62.5% and 35.9% vs. 53.1%, respectively, and the differences were statistically significant (OR values were 0.26, 0.38, 0.38, and 95%CI were 0.10-0.69, 0.28-0.51, 0.23-0.65, respectively, all P values<0.05). There were statistically significant differences in clinical stage (III-IV), T stage (T3+T4), N stage (N2), positive cervical lymph node metastases and number of lymph node metastases (≥3) between the two groups (OR values were 4.28, 2.20, 2.88, 10.83, 6.53, and 95%CI were 1.70-10.74, 1.35-3.58, 1.90-4.34, 3.57-32.95, 1.75-24.38, respectively, all P<0.05). The sensitivity and specificity of preoperative imaging for diagnosing retropharyngeal lymph nodes metastases were respectively 0.72 (95%CI=0.54-0.85) and 0.98 (95%CI=0.74-1.00), and the area under curve (AUC) of summary receiver operating characteristic curve (SROC) was 0.84 (95%CI=0.80-0.87). Conclusions: The survival rate of patients with oropharyngeal or hypopharyngeal squamous cell carcinoma with retropharyngeal lymph node metastasis is significantly reduced, the clinical stage and T stage are late, and the cervical lymph node metastasis rate is high. Retropharyngeal lymph node metastasis is more insidious, the sensitivity of preoperative imaging diagnosis is not high.


Subject(s)
Head and Neck Neoplasms/pathology , Humans , Hypopharyngeal Neoplasms/pathology , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Neoplasm Staging , Prognosis , Retrospective Studies , Squamous Cell Carcinoma of Head and Neck
20.
Article in Chinese | WPRIM | ID: wpr-936193

ABSTRACT

Objective: To investigate the survival outcomes and prognostic factors of patients with salvage surgery for hypopharyngeal carcinoma after radiotherapy. Methods: A retrospective analysis was performed, including 26 patients treated in Ningbo Medical Center Lihuili Hospital between January 2010 and December 2015. All patients were males, aged 48-83 years, of whom 8 cases were local residual after radiotherapy alone, 8 cases were local recurrence after postoperative radiotherapy, 2 cases were residual of cervical lymph nodes after radiotherapy alone, 2 cases were recurrence of cervical lymph nodes after radiotherapy alone, 2 cases were recurrence of cervical lymph nodes after postoperative radiotherapy and 4 cases were recurrence of tracheal stoma. The salvage operations included: local resection, local resection with neck dissection, simple neck dissection, tumor resection of tracheostomy, and additional repair according to the defect. Chi square test was used for recurrence and metastasis analysis, Kaplan-Meier method for survival analysis, Log-rank test for univariate analysis, and Cox regression model for multivariate analysis. Results: The complication rate of salvage surgery was 23.1% (6/26). The recurrence rate was 65.4% (17/26) and the distant metastasis rate was 42.3% (11/26) in the 5-year follow-up after salvage surgery. Patient's age and tumor invasion extent were correlated with recurrence. Initial treatment, tumor persistence or recurrence after radiotherapy, recurrence location and tumor invasion extent were correlated with distant metastasis (all P<0.05). Overall, 3 year and 5 year survival rates were 42.3% and 23.1% respectively. Age, recurrence location, surgical margin and tumor invasion extent were related to prognosis (χ²=6.56, 10.68, 9.32, and 7.90 respectively, all P<0.05). Multivariate analysis showed that surgical margin and tumor invasion extent were independent risk factors for prognosis (OR (95%CI) = 3.19 (1.03-9.84), 14.37 (2.46-84.08), both P<0.05). Conclusion: Salvage surgery is the first choice for patients with recurrence after radiotherapy for hypopharyngeal carcinoma. Safe surgical margin should be ensured, especially in tumors invading muscle, bone tissue or lymph node capsule.


Subject(s)
Aged , Aged, 80 and over , Carcinoma, Squamous Cell/surgery , Humans , Hypopharyngeal Neoplasms/surgery , Male , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Prognosis , Retrospective Studies , Salvage Therapy , Survival Rate
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