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

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

Prognostic value of factors associated with hypoxia and lipid metabolism in patients with colorectal cancer

Background: Colorectal cancer (CRC) is a neoplasia with high incidence and mortality rates. It had been suggested that the inflammatory response is an important CRC prognostic factor. The disordered and accelerated proliferation of neoplastic cells decreases the oxygen and nutrient supply, generating a microenvironment characterized by hypoxia, necrosis and inflammation. This study aimed to evaluate the impact of factors associated with hypoxia, such as HIF1A (hypoxia-inducible factor 1-alpha) and VEGF (vascular endothelial growth factor), and with lipid metabolism, including PPARG (peroxisome proliferator-activated receptor-gamma), LXRA (liver X receptor-alpha) and LXRB (liver X receptor-beta), on the overall survival (OS) of CRC patients. Methods: This was a cohort study of 101 patients with high-risk stage II-III (TNM) CRC located above the peritoneal reflection. They were treated between 1990 and 2004 at the AC Camargo Cancer Center. Immunohistochemical analyses of HIF1A, VEGF, PPARG, LXRA and LXRB protein expression were performed using tissue microarrays (TMAs). Results: There was an association between the presence of vascular invasion and the lack of VEGF expression (p = 0. 028) as well as with positive HIF1A expression and lymphatic invasion (p = 0.045). The 5-year and 10-year OS rates were 76.6% and 60.2%, respectively. Patients with PPARG-positive tumors had a higher OS (p = 0.018). There were no correlations between the positive expression of VEGF, HIF1A, LXRA or LXRB and OS. The Cox regression model demonstrated that the risk of death was 2.72-fold higher in patients with PPARG-negative tumors (95% CI = 1.08­6.85). Conclusion: The PPARG expression was an independent prognostic factor for CRC tumors and might be used for risk stratification to stage II and stage III CRC patients (AU)

Surgical complications and metachronous rectal cancer risk in patients with classic familial adenomatous polyposis / Complicações cirúrgicas e risco de câncer retal metacrônico em pacientes com polipose adenomatosa familiar clássica

INTRODUCTION: Familial adenomatous polyposis (FAP), an autosomal dominant disease characterized by development of numerous adenomatous polyps in the colon and rectum, is caused by germline mutations in the Adenomatous Polyposis Coli (APC) gene. METHODS: To determine the surgical morbidity in patients with classical familial adenomatous polyposis and determine the incidence of metachronous colorectal cancer (CRC) in those undergoing total colectomy (TC) with ileorectal anastomosis or restorative total proctocolectomy (TPC) and ileal pouch anal anastomosis. We analyzed patients with familial adenomatous polyposis who received treatment and regular follow-up at the A.C. Camargo Cancer Center from 1994 to 2013. RESULTS: Operative complications occurred in 22 patients (34.3%), 16 (25%) being early complications and 8 (12.5%) late complications. No mortality occurred as a result of postoperative complications. The incidence of metachronous rectal cancer after total proctocolectomy was 2.3% and after total colectomy 18.18% (p = 0.044). CONCLUSIONS: In order to provide better quality of life for individuals with familial adenomatous polyposis, total colectomy is commonly offered, as this simple technique is traditionally associated with lower rates of postoperative complications and better functional outcomes. However, it has become a less attractive technique in patients with familial adenomatous polyposis in its classical or diffuse form, since it has a significantly higher probability of metachronous rectal cancer. (AU)

INTRODUÇÃO: Polipose adenomatosa familiar (PAF), uma doença autossômica dominante caracterizada pela formação de numerosos pólipos adenomatosos no cólon e reto, é causada por mutações da linha germinativa no gene da polipose adenomatosa do cólon (PAC). MÉTODOS: Para determinar a morbidade cirúrgica em pacientes com PAF clássica e determinar a incidência de câncer colorretal (CCR) metacrônico naqueles pacientes submetidos à colectomia total (CT) com anastomose íleo-retal ou submetidos à proctocolectomia restaurativa (PCT) e anastomose bolsa ileal-anal, foram analisados pacientes com PAF que foram tratados e tiveram acompanhamento periódico no A. C. Camargo Cancer Center de 1994 até 2013. RESULTADOS: Ocorreram complicações cirúrgicas em 22 pacientes (34,3%); 16 (25%) tiveram complicações precoces e 8 (12,5%) complicações tardias. Não houve mortes como resultado de complicações pós-operatórias. A incidência de câncer de reto metacrônico após PCT foi de 2,3% e após CT foi de 18,18% (p = 0,044). CONCLUSÕES: A fim de proporcionar melhor qualidade de vida para os pacientes com PAF, CT é comumente oferecida, pois esta técnica simples está tradicionalmente associada com menores percentuais de complicações pós-operatórias e melhores resultados funcionais. No entanto, CT se tornou uma técnica menos atraente em pacientes com PAF em sua forma clássica ou difusa, uma vez que traz consigo uma probabilidade significativamente maior de câncer retal metacrônico. (AU)

Prognostic factors for survival in patients with colorectal liver metastases: experience of a single brazilian cancer center / Fatores prognósticos de sobrevida em pacientes com metástases hepáticas colorretais

CONTEXT: Liver metastases are a common event in the clinical outcome of patients with colorectal cancer and account for 2/3 of deaths from this disease. There is considerable controversy among the data in the literature regarding the results of surgical treatment and prognostic factors of survival, and no analysis have been done in a large cohort of patients in Brazil. OBJECTIVES: To characterize the results of surgical treatment of patients with colorectal liver metastases, and to establish prognostic factors of survival in a Brazilian population. METHOD: This was a retrospective study of patients undergoing liver resection for colorectal metastases in a tertiary cancer hospital from 1998 to 2009. We analyzed epidemiologic variables and the clinical characteristics of primary tumors, metastatic disease and its treatment, surgical procedures and follow-up, and survival results. Survival analyzes were done by the Kaplan-Meier method and the log-rank test was applied to determine the influence of variables on overall and disease-free survival. All variables associated with survival with P<0.20 in univariate analysis, were included in multivariate analysis using a Cox proportional hazard regression model. RESULTS: During the period analyzed, 209 procedures were performed on 170 patients. Postope-rative mortality in 90 days was 2.9% and 5-year overall survival was 64.9%. Its independent prognostic factors were the presence of extrahepatic disease at diagnosis of liver metastases, bilateral nodules and the occurrence of major complications after liver surgery. The estimated 5-year disease-free survival was 39.1% and its prognostic factors included R1 resection, extrahepatic disease, bilateral nodules, lymph node involvement in the primary tumor and primary tumors located in the rectum. CONCLUSION: Liver resection for colorectal metastases is safe and effective and the analysis of prognostic factors of survival in a large cohort of Brazilian patients showed similar results to those pointed in international series. The occurrence of major postoperative complications appears to be able to compromise overall survival and further investigation in needed in this topic.

CONTEXTO: As metástases hepáticas são evento comum na evolução clínica de pacientes com câncer colorretal e são responsáveis por 2/3 dos óbitos por esta doença. Há grande controvérsia entre os dados publicados na literatura quanto a resultados de tratamento cirúrgico e seus fatores prognósticos e não há análise, em casuísticas maiores, destes aspectos em uma grande coorte de pacientes no Brasil. OBJETIVOS: Caracterizar os resultados do tratamento cirúrgico de pacientes com metástases hepáticas de tumores colorretais e estabelecer os fatores prognósticos de sobrevida em uma população. MÉTODO: Estudo retrospectivo de pacientes submetidos a ressecção hepática de metástases colorretais em hospital oncológico terciário, de 1998 a 2009. Foram analisadas variáveis epidemiológicas e dos tumores primários da doença metastática e seu tratamento, dos procedimentos cirúrgicos e do seguimento e os resultados de sobrevidas. Para as análises de sobrevida foram utilizadas as curvas de Kaplan-Meyer e o teste de log-rank foi aplicado para determinar a influência das variáveis estudadas nas sobrevidas global e livre de doença. Aquelas variáveis em que este teste apresentou P<0,20 em análise univariada, foram incluídas em análise multivariada pelo modelo de regressão de Cox. RESULTADOS: No período analisado, 209 procedimentos foram realizados em 170 pacientes. A mortalidade em 90 foi de 2,9%. A sobrevida global em 5 anos foi de 64,9%. Os fatores prognósticos independentes de sobrevida global foram a presença de doença extra-hepática no momento do diagnóstico das metástases hepáticas, de nódulos em ambos os lobos hepáticos e a ocorrência de complicações maiores após a cirurgia. A sobrevida livre de doença estimada em 5 anos foi de 39,1% e seus fatores prognósticos incluíram a ressecção R1, a presença de doença extra-hepática, doença bilobar, a presença de acometimento linfonodal no tumor primário e tumores primários localizados no reto. CONCLUSÃO: A ressecção de metástases hepáticas de câncer colorretal se demonstrou segura e eficaz em nosso meio, com resultados semelhantes aos apresentados por outras grandes séries internacionais. A ocorrência de complicações pós-operatórias parece poder comprometer os resultados de sobrevida global obtidos e investigação mais aprofundada se faz necessária neste sentido.

Um estudo sobre hipertensão arterial sistêmica na cidade de Campo Grande, MS / A study on systemic arterial hypertension in Campo Grande, MS, Brazil

OBJETIVOS: Detectar a real prevalência de hipertensão arterial sistêmica em Campo Grande, MS, e fatores freqüentes. MÉTODOS: Estudo transversal com amostra randomizada da população adulta da cidade de Campo Grande, MS, num total de 892 pessoas. Foi aplicado questionário sobre idade, sexo, escolaridade, tabagismo, etilismo, aspectos sobre o tratamento. Foram colhidos dados antropométricos (peso e altura). Segundo a OMS, foi considerado peso normal: IMC<25 kg/m²; sobrepeso: 25>IMC<30; obeso: IMC> 30. Os critérios para hipertensão foram baseados no VII Joint, com valores de corte de Pressão Arterial de 140 x 90 mmHg. RESULTADOS: A prevalência de hipertensão foi de 41,4 por cento, variando conforme idade (até 29 anos: 11,8 por cento; 30-39: 24,8 por cento; 40-49: 43,3 por cento; 50-59: 42,4 por cento; 60-69: 48,6 por cento e > 70: 62,3 por cento). Houve maior prevalência nos homens (51,8 por cento), enquanto nas mulheres foi de 33,1 por cento. As pessoas com formação escolar de 1° grau primário tendem a apresentar maiores índices pressóricos. Nos indivíduos com sobrepeso e obesidade, observou-se maior prevalência de pressão elevada: IMC normal (27,9 por cento), sobrepeso (45,6 por cento) e obesidade (58,6 por cento). A partir dos 60 anos existe um maior porcentual de hipertensão sistólica isolada, representado por 16,4 por cento (60-69 anos) e de 24,6 por cento (>70 anos). Etilismo diário ou semanal também está relacionado a maior incidência, respectivamente, de 63,2 por cento e 47,2 por cento. Apenas 59,7 por cento eram sabidamente hipertensos. Das pessoas que apresentaram hipertensão, 57,3 por cento fazem algum tratamento. Dos que fazem tratamento regularmente, 60,5 por cento apresentaram hipertensão. CONCLUSÃO: A prevalência de hipertensão foi de 41,4 por cento, ultrapassando a média detectada em alguns trabalhos, alertando para piora epidemiológica e repercussões cardiovasculares, o que evidencia necessidade de maior investimento...

OBJECTIVES: To detect the actual prevalence of systemic hypertension in the city of Campo Grande, MS, Brazil, and frequent factors. METHODS: Cross-sectional study with a randomized sample of the adult population of the city of Campo Grande, MS, in a total of 892 individuals. A questionnaire on age, gender, level of education, smoking, alcohol consumption, and aspects of the treatment was applied. Anthropometric data (weight and height) were collected. According to the WHO, a BMI<25 kg/m² was considered normal weight; 25>BMI<30 overweight; and BMI> 30 obesity. Criteria for hypertension were based on the JNC VII report, with blood pressure cut-off values of 140 x 90 mmHg. RESULTS: The prevalence of hypertension was 41.4 percent, varying with age (up to 29 years: 11.8 percent; 30-39: 24.8 percent; 40-49: 43.3 percent; 50-59: 42.4 percent; 60-69: 48.6 percent and > 70: 62.3 percent). A higher prevalence was observed among men (51.8 percent), whereas among women the prevalence was 33.1 percent.Individuals with basic level of education tended to present higher rates. Among overweight and obese individuals, a higher prevalence of hypertension was observed: normal BMI (27.9 percent), overweight (45.6 percent) and obesity (58.6 percent). Above 60 years of age, a higher percentage of isolated systolic hypertension was observed, with 16.4 percent (60-69 years) and 24.6 percent (>70 years). Daily or weekly alcohol consumption was also related to a higher incidence, of 63.2 percent and 47.2 percent, respectively. Only 59.7 percent were known to be hypertensive. Of the hypertensive individuals, 57.3 percent were undergoing some type of treatment. Of those undergoing regular treatment, 60.5 percent presented hypertension. CONCLUSION: The prevalence of hypertension was 41.4 percent, therefore higher than the average verified in some studies. This calls the attention for worsened epidemiologic conditions and cardiovascular repercussions, thus showing...