Influence of depression on survival of colorectal cancer patients drawn from a large prospective cohort.

OBJECTIVE: The prevalence of depressive symptoms immediately after the diagnosis of colorectal cancer (CRC) is high and has important implications both psychologically and on the course of the disease. The aim of this study is to analyse the association between depressive symptoms and CRC survival at 5 years after diagnosis. METHODS: This multicentre, prospective, observational cohort study was conducted on a sample of 2602 patients with CRC who completed the Hospital Anxiety and Depression Scale (HADS-D) at 5 years of follow-up. Survival was analysed using the Kaplan-Meier method and Cox regression models. RESULTS: According to our analysis, the prevalence of depressive symptoms after a CRC diagnosis was 23.8%. The Cox regression analysis identified depression as an independent risk factor for survival (HR = 1.47; 95% CI: 1.21-1.8), a finding which persisted after adjusting for sex (female: HR = 0.63; 95% CI: 0.51-0.76), age (>70 years: HR = 3.78; 95% CI: 1.94-7.36), need for help (yes: HR = 1.43; 95% CI: 1.17-1.74), provision of social assistance (yes: HR = 1.46; 95% CI: 1.16-1.82), tumour size (T3-T4: HR = 1.56; 95% CI: 1.22-1.99), nodule staging (N1-N2: HR = 2.46; 95% CI: 2.04-2.96), and diagnosis during a screening test (yes: HR = 0.71; 95% CI: 0.55-0.91). CONCLUSIONS: There is a high prevalence of depressive symptoms in patients diagnosed with CRC. These symptoms were negatively associated with the survival rate independently of other clinical variables. Therefore, patients diagnosed with CRC should be screened for depressive symptoms to ensure appropriate treatment can be provided.

Biological and prognostic differences between symptomatic colorectal carcinomas and those detected by screening.

INTRODUCTION: Few studies have been conducted to establish the relationship between colorectal cancer screening programmes and survival adjusting by stage and, to determine whether there are differences, at a biological level, between the tumours of asymptomatic and symptomatic patients. Accordingly, the aim of this study is to evaluate clinical, biological and survival differences between symptomatic colorectal tumours and those detected by screening. STUDY METHOD: A prospective cohort study was performed of patients subjected to surgical intervention during the period 2010-2012, at different hospitals in Spain. In every case, clinical, pathological, biological and survival-related variables were obtained. RESULTS: A total of 2634 patients from the CARESS-CCR cohort were analysed; of these, 220 were diagnosed through screening. The asymptomatic patients were younger, had a higher Body Mass Index (BMI), a lower degree of perineural invasion and a less advanced T stage and nodular stage, and the tumour was frequently located on the right side of the colon. All of these differences were statistically significant. The serum tumour marker carbohydrate antigen 19.9 (CA 19.9) was found more frequently in the symptomatic patients (p < 0.05). However, no significant differences were found regarding the markers of tumour biology: Ki67 (proliferation), CD105 (angiogenesis) and the Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay (apoptosis). The patients with asymptomatic tumours had a lower mortality at five years than those diagnosed presenting symptoms. CONCLUSIONS: The detection method employed influenced the survival of patients with colorectal cancer and there were no significant biological differences between the study groups.

Clinical-pathological characteristics and short-term follow-up associated with proliferation, apoptosis and angiogenesis in a prospective cohort of patients with colorectal tumours.

We investigate the clinical and pathological features related to variations in colorectal tumour apoptosis, proliferation and angiogenesis and the influence of the latter in short-term mortality (2 years); 551 tumour samples from a prospective cohort of patients with colorectal cancer were examined and tumour biology markers were determined as follows: percentage of apoptotic cells, by the terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling technique; Ki-67 antigen, as a cell proliferation marker and density of microvessels (as a marker of angiogenesis). An increase in the percentage of cellular apoptosis is significantly related to the presence of poorly differentiated tumours, with vascular invasion (p < 0.001). The CD105 angiogenesis marker is not related to any clinical-pathological parameter except that of higher frequency in older patients (p = 0.03). Ki-67 is more frequently expressed in tumours with less nervous invasion (p = 0.05). Neither apoptosis nor angiogenesis present any significant association with short-term survival. The only marker clearly related to 2-year survival is Ki-67, which is shown to be a good prognostic factor in the multivariate analysis (hazard ratio = 0.49; 95% confidence interval = 0.27-0.90). Therefore, in a prospective cohort of colorectal cancer patients, only Ki-67 is a marker of good prognosis in short-term follow-up.

Factors that influence treatment delay in patients with colorectal cancer.

A prospective study was performed of patients diagnosed with colorectal cancer (CRC), distinguishing between colonic and rectal location, to determine the factors that may provoke a delay in the first treatment (DFT) provided.2749 patients diagnosed with CRC were studied. The study population was recruited between June 2010 and December 2012. DFT is defined as time elapsed between diagnosis and first treatment exceeding 30 days.Excessive treatment delay was recorded in 65.5% of the cases, and was more prevalent among rectal cancer patients. Independent predictor variables of DFT in colon cancer patients were a low level of education, small tumour, ex-smoker, asymptomatic at diagnosis and following the application of screening. Among rectal cancer patients, the corresponding factors were primary school education and being asymptomatic.We conclude that treatment delay in CRC patients is affected not only by clinicopathological factors, but also by sociocultural ones. Greater attention should be paid by the healthcare provider to social groups with less formal education, in order to optimise treatment attention.

[Effectiveness of peginterferon alpha-2a or -2b plus ribavirin in naïve patients with hepatitis C infection]. / Efectividad del tratamiento de la hepatitis C con peginterferón alfa (2a o 2b) más ribavirina en pacientes naïve.

INTRODUCTION: Treatment of hepatitis C is based on the combination of peginterferon alfa-2a or -2b plus ribavirin; the more effective peginterferon for this purpose has not been established. The aim of this study is to compare the effectiveness of hepatitis C treatment according to the type of peginterferon used. METHODS: A prospective cohort study was performed from November 2002 to May 2004, with up to 12 months of follow-up in all patients after completion of treatment. The study included naïve monoinfected patients, divided into two groups: Group A: peginterferon alfa-2a plus ribavirin and Group B: peginterferon alfa-2b plus ribavirin. The main variables studied were plasma glutamate pyruvate transferase levels (biochemical response), viral load (virologic response), and treatment effectiveness (biochemical and virologic response). RESULTS: A total of 202 patients were studied (Group A: 87; Group B: 115), there were no significant differences in baseline characteristics between the two groups. Sustained biochemical response: 75.8% vs. 76.2% (P = .908); Sustained virological response: 71.3% vs. 64.3% (P = .293); Effectiveness of treatment: 64.2% vs. 60.87% (P = .628). CONCLUSION: No differences in the sustained virological or biochemical response were found between groups receiving peginterferon alfa-2a or peginterferon alfa-2b plus ribavirin, suggesting that the two types of peginterferon alfa are similarly effective for treating hepatitis C in monoinfected patients.

Gynecological characteristics related to breast cancer in pre and postmenopausal women.

BACKGROUND: The objective of this study was two fold: to identify gynecological characteristics that distinguish women diagnosed with early-stage breast cancer from those at more advanced stages; to identify distinguishing characteristics between premenopausal and postmenopausal women diagnosed with the same stage. POPULATION AND METHOD: 186 incident cases diagnosed with breast cancer were identified out of the 685 patients who were seen to in 2000-2001. The variables to be studied were obtained by means of a specific questionnaire which collected data concerning reproductive characteristics and contraceptive types. RESULTS: Significant differences in the mean age were found, since the early-stage group was younger (57.01+/-12.82 vs. 65.06+/-15.11). Characteristic factors found in pre-menopausal women were: early menopause, they either had no children or a single child, no breastfeeding practice and a more extensive use of contraceptives. Postmenopausal women presented more advanced stages, more pregnancies and less abortions. CONCLUSIONS: By taking the obtained results into consideration, it would be recommendable to bring forward the age at which women are to be included in early detection programmes, and to conduct a follow-up of those women who present such factors to favour an earlier diagnosis of the disease.

Gynecological characteristics related to breast cancer in pre and postmenopausal women

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Background. The objective of this study was twofold: to identify gynecological characteristics thatdistinguish women diagnosed with early-stagebreast cancer from those at more advanced stages;to identify distinguishing characteristics betweenpremenopasual and postmenopausal women diagnosedwith the same stage.Population and method. 186 incident cases diagnosedwith breast cancer were identified out of the685 patients who were seen to in 2000-2001. Thevariables to be studied were obtained by means of aspecific questionnaire which collected data concerningreproductive characteristics and contraceptivetypes.Results. Significant differences in the mean age werefound, since the early-stage group was younger(57.01 ± 12.82 vs. 65.06 ± 15.11). Characteristical factorsfound in pre-menopausal women were: earlymenopause, they either had no children or a singlechild, no breastfeeding practice and a more extensiveuse of contraceptives. Postmenopausal womenpresented more advanced stages, more pregnanciesand less abortions.Conclusions. By taking the obtained results intoconsideration, it would be recommendable to bringforward the age at which women are to be includedin early detection programmes, and to conduct afollow-up of those women who present such factorsto favour an earlier diagnosis of the disease

Prevalencia de malnutrición entre ancianos institucionalizados en la comunidad valenciana / Malnutrition prevalence in institutionalized elderly people in Valencia Community, Spain

FUNDAMENTO: Conocer la prevalencia de malnutrición en población anciana institucionalizada estratificada por percentiles de edad y sexo. PACIENTES Y MÉTODO: Se estudiaron un total de 615 ancianos institucionalizados, con una edad media (DE) de 79,33 (9,07) años. Los parámetros antropométricos medidos fueron peso, talla, distancia rodilla-talón, pliegues tricipital y subescapular, y perímetro del brazo y de la cintura. Se calcularon el perímetro y el área muscular del brazo y la masa grasa. Los parámetros bioquímicos determinados fueron colesterol, triglicéridos, albúmina, prealbúmina, transferrina, proteína fijadora de retinol, C3 y recuento de linfocitos. Se diagnosticó malnutrición cuando al menos dos de los parámetros estudiados eran patológicos, inferiores al percentil 25, y determinaciones analíticas inferiores a la normalidad. RESULTADOS: La prevalencia de malnutrición fue del 26,87 por ciento (IC del 95 por ciento, 23,15-30,86): del 29,08 por ciento (IC del 95 por ciento, 22,82-35,97) en varones y del 25,59 por ciento (IC del 95 por ciento, 25,1-30,61) en mujeres. Los parámetros antropométricos estudiados se encuentran reducidos en todos los casos en los pacientes con malnutrición. Sin embargo, los parámetros bioquímicos no presentan, en general, diferencias significativas entre estos pacientes y los sujetos con buen estado nutricional si se comparan de forma bivariante, pero sí ofrecen diferencias significativas si se aplica un análisis multivariante controlando los parámetros edad y sexo. CONCLUSIÓN: En nuestro estudio encontramos una prevalencia de malnutrición elevada en un rango inferior de lo esperado, según los estudios realizados con grupos de edad similar. Los parámetros antropométricos se encuentran asociados con malnutrición en ancianos, y de los datos bioquímicos destaca el descenso de la prealbúmina (AU)