Multivariate Prognostic Models for Patients with Stages I and Ii Colon Carcinoma: a Strobe-Compliant Retrospective Cohort Study.

Background: Colorectal cancer is the most frequent gastrointestinal malignancy worldwide. The value of adjuvant treatment is controversial in Stages I and II. Objective: The aim of this study was to construct post-operative prognostic models applicable to patients with stages I-II colon carcinoma (CC). Methods: This is a retrospective cohort study of patients with Stage I-II CC treated over a 25-year period. Exposure was defined as clinical, histopathological, and immunohistochemical factors (including CDX2 and MUC2 expression). Patients were randomly allocated to either a "modeling set" or a "validation set". Factors associated with recurrence, disease-free survival (DFS), and overall survival (OS) were defined in the "modeling set". Their performances were tested in the "validation set". Results: From a total of 556 recruited patients, 339 (61%) were allocated to the "modeling set" and 217 (39%) to the "validation set". Three models explaining recurrence, DFS, and OS were described. Tumor location in the left colon (Hazards ratio [HR] = 1.57; 95% Confidence interval [CI] 0.99-2.48), lymphocyte (HR = 0.46; 96% CI 0.27-0.88) and monocyte (HR = 0.99; 95% CI 0.99-1) counts, neutrophil/platelet ratio (HR = 1.3; 95% CI 0.74-2.3, and HR = 2.3; 95% CI 1.3-4.1; for second and third category, respectively), albumin/monocyte ratio (HR = 0.43; 95% CI 0.21-0.87), and microscopic residual disease after surgery (HR = 8.7; 95% CI 3.1-24) were independently associated with OS. T classification and expression of CDX2 and/or MUC2 were not independently associated with recurrence or prognosis. Conclusion: These models are simple and readily available, and distinguish the risk and prognosis in patients with CC stages I and II; these models require cheaper processes than the use of more sophisticated molecular biology techniques. They may guide either the need for adjuvant therapy versus post-operative surveillance only, as well as aid in the design of clinical trials.

Treatment of Unresectable Differentiated Thyroid Carcinoma With Upfront External Radiotherapy and Salvage Surgery: A STROBE-Compliant Retrospective Cohort Study.

INTRODUCTION: In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC. METHODS: This is a cohort study of patients with initially unresectable DTC who received EBRT. Cohort A received EBRT followed by rescue surgery and cohort B, EBRT only. The Kaplan-Meier method and Cox model were employed for survival analysis. RESULTS: Thirty-three patients were included; 69.6% females and 30.3% males. Mean age was 60.6 and mean tumor diameter was 10.4 cm; 17 and 16 patients were included in cohorts A and B, respectively. Belonging to cohort A (Hazard ratio [HR] 0.177, 95% CI 0.05-0.7) and use of intensity modulated radiotherapy (HR 0.177, 95% CI 0.03-1.08) were associated to better PFS, while high-risk histopathology (HR 6.6, 95% CI 0.9-50) and EBRT dose (HR 1.05, 95% CI 1.01-1.08) were independently associated with lower PFS. Patients from cohort A (HR 0.061, 95% CI 0.01-0.3) had improved OS, while high-risk histopathology (HR 5.7, 95% CI 1.1-28.6) and EBRT dose (HR 1.05, 95% CI 1.01-1.09) were independently associated to worse OS. CONCLUSION: EBRT, and when feasible, salvage surgery, should be an integral part of the therapeutic strategy in initially unresectable DTC.

Prognostic Factors and Differences in Survival of Right and Left Colon Carcinoma: A STROBE Compliant Retrospective Cohort Study.

BACKGROUND: Right-colon cancer (RCC) presents differences with Left-colon cancer (LCC) in terms of Overall survival (OS), but certain reports provide conflicting findings. Our objective is to define differences regarding prognostic factors in RCC and LCC by multivariate analysis. METHODS: Retrospective cohort including patients treated from 1992-2016. The Kaplan-Meier and Cox models were used to define prognostic factors. RESULTS: 871 patients had RCC and 748 LCC; mean age was 58.1. Location was associated with socioeconomic status, body mass, blood hemoglobin, serum albumin, lymphocyte count and Prognostic nutritional index (PNI). Distribution of TNM stages was similar between groups, as well as gender, age, surgical morbidity/mortality; 72.3% of RCC and 83.2% of LCC were well/moderately differentiated (p <0.0001). Mean surgical lymph-node retrieval was 19.3 (SD14.6) for RCC and 15.7 (SD13.1) for LCC (p <0.0001). Median OS was 5.2 (95% CI 3.9-6.5) for RCC, and 3.2 years (95% CI 2.1-4.4) for LCC (p = 0.426). OS was different between RCC and LCC by stratified analyses within PNI, TNM, differentiation and R classification. RCC presents different OS in stages IIIC, and IVB than LCC. CONCLUSION: Differences between RCC and LCC were mainly by immunonutritional variables. Differences in OS were found after stratified analysis of PNI, TNM stages, differentiation degree, and R classification. Location of the neoplasm in the colon should be considered in the design of clinical trials in patients with colon cancer.

Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study.

BACKGROUND: The TNM classification does not completely reflect the prognosis of patients with colorectal cancer (CRC). Several clinical factors have been used to increase its prognostic value, but factors pertaining to the patient's immunonutritional status have not usually been addressed. The aim of this study is to evaluate the role of Prognostic nutritional index (PNI) and other well-known prognostic factors by multivariate analysis in a cohort of patients with CRC. METHODS: This is a retrospective cohort study of consecutive patients with CRC managed in a cancer center between January 1992 and December 2016. Cox's model was used to define the association of the PNI and other factors with Overall survival (OS). RESULTS: A total of 3301 patients were included: 47.7% were female and 52.3% were male, with a mean age of 58.7 years. By bivariate analysis, PNI was strongly associated with OS (Risk ratio [RR] 0.968, 95% Confidence interval [CI] 0.962-0.974; P < 0.001). On multivariate analysis, PNI was an independent explanatory variable (as continuous variable and as categorized variable; RR 0.732, 95% CI 0.611-0.878; RR 0.656, 95% CI 0.529-0.813 and RR 0.646, 95% CI 0.521-0.802, for quintiles 2, 3, and 4-5, respectively); a biological gradient effect was demonstrated. The final prognostic model included PNI, location of the neoplasia in the colorectum, basal hemoglobin, lymphocyte count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, TNM stage, differentiation degree, R classification, and postoperative complications. CONCLUSIONS: PNI is a significant and independent prognostic factor in patients with CRC. Its prognostic value adds precision to the TNM staging system including specific subgroups of patients with CRC; it should be evaluated in prospective clinical studies.

Baseline serum albumin and other common clinical markers are prognostic factors in colorectal carcinoma: A retrospective cohort study.

The aim of the present study was to define the prognostic role of baseline serum albumin (BSA) in colorectal cancer (CRC) across tumor-node-metastasis (TNM) stages and other well defined prognostic factors. Many prognostic models in medicine employ BSA to define or refine treatments in very specific settings; in CRC, BSA has been found to be a prognostic factor as well. A retrospective cohort study of consecutive patients with CRC demonstrated by biopsy, who attended a cancer center during a 7-year period. Multivariate analysis was utilized to define prognostic factors associated with overall survival (OS) employing the Cox model. In this retrospective cohort study, 1465 patients were included; 46.6% were females and 53.4% males (mean age, 59.1 years). Mean BSA was inversely correlated with TNM stages. By multivariate analysis, it was an independent explanatory variable. TNM stages, "R" classification, age, lymphocyte count, neutrophil/platelet ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, postoperative morbidity, and BSA were independently associated with OS. Morbidities, surgery type, chemotherapy, and radiotherapy were considered confounders after adjusting by TNM stages. BSA is a significant and independent prognostic factor in patients with CRC, and its effect is maintained across TNM strata and other well known clinical prognostic factors. It can be easily used in prognostic models and should be employed to stratify prognosis in therapeutic randomized clinical trials.

Retrospective cohort study of prognostic factors in patients with oral cavity and oropharyngeal squamous cell carcinoma.

BACKGROUND: Prognostic factors in oral cavity and oropharyngeal squamous cell carcinoma (SCC) are debated. The purpose of this study was to investigate the association of prognostic factors with oncologic outcomes. METHODS: Patients with oral cavity and oropharyngeal SCC treated from 1997 to 2012 were included in this retrospective cohort study. Associations of prognostic factors with locoregional recurrence (LRR) or overall survival (OS) were analyzed using the logistic regression and the Cox models. RESULTS: Six hundred thirty-four patients were included in this study; tumor size, surgical margins, and N classification were associated with LRR (p < .0001); considering histopathology: perineural invasion, lymphocytic infiltration, infiltrative borders, and N classification were significant determinants of LRR. Tumor size, N classification, alcoholism, and surgical margins were associated with OS (p < .0001); considering pathologic prognostic factors, perivascular invasion, islands borders, and surgical margins were independently associated with OS (p < .0001). CONCLUSION: Surgical margins, perineural and perivascular invasion, lymphocytic infiltration, and infiltrative patterns of tumor invasion are significant prognostic factors in oral cavity and oropharyngeal SCC.

Validation of the Mexican Spanish version of the EORTC QLQ-H&N35 instrument to measure health-related quality of life in patients with head and neck cancers.

BACKGROUND: Health-related quality of life (HRQL) is an important outcome measurement in oncology. Our aim was to validate the Mexican Spanish version of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-H&N35 questionnaire to measure HRQL in patients with head and neck cancers. METHODS: The QLQ-C30 and QLQ-H&N35 instruments were applied to Mexican patients with head and neck cancer at a cancer referral center. Reliability and validity tests were performed. Test-retest was carried out in selected patients. RESULTS: One hundred ninety-three patients were included in this cohort; tumor locations included the following: oral cavity 45 (23.3 %); larynx 35 (18.1 %); thyroid carcinoma invasive to aerodigestive tract 32 (16.6 %); oropharynx 17 (8.8 %); hypopharynx 12 (6.2 %); nasal cavity and paranasal sinuses 11 (5.7 %); salivary glands 11 (5.7 %); nasopharynx 8 (4.1 %); eye and adnexa 7 (3.6 %); cervical metastases of unknown origin 5 (2.6 %); primary sarcoma of the head and neck region 5 (2.6 %); maxillary antrum carcinoma 4 (2.1 %); and retinoblastoma 1 (0.5 %). Questionnaire compliance rates were high, and the instrument was well accepted; the internal consistency tests demonstrated good convergent and divergent validity. Cronbach's α coefficients of 8 of 9 multi-item scales of the QLQ-C30 and 6 of 8 scales of the QLQ-H&N35 instruments were >0.7 (range 0.22-0.89). Scales of the QLQ-C30 and QLQ-H&N35 instruments distinguished among clinically distinct groups of patients; some were highly sensitive to change over time. CONCLUSIONS: The Mexican Spanish version of the QLQ-H&N35 questionnaire is reliable and valid for the assessment of HRQL in patients with head and neck cancers and can be used in clinical trials in Mexican communities.

Multivariate prediction of the probability of recurrence in patients with carcinoma of the parotid gland.

BACKGROUND: Parotid gland carcinoma is an infrequent tumor, and series that report on these neoplasms are relatively scarce in the literature. The objective of the current study was to identify prognostic factors in patients with parotid gland carcinoma and to develop a method for defining the probability of recurrence. METHODS: Patients with parotid gland carcinoma who were treated at the authors' institution from January 1981 through December 2004 and who completed treatment constituted the study group. Disease-free survival was calculated by using the Kaplan-Meier method. Logistic regression analysis was employed to define the recurrence-associated prognostic factors. RESULTS: One hundred twenty-seven patients were included (64 men and 63 women); their mean age was 53 years. Mucoepidermoid carcinoma was diagnosed in 34.6% of patients, adenoid cystic was diagnosed in 15.7% of patients, adenocarcinoma was diagnosed in 14.3% of patients, and acinic cell carcinoma was diagnosed in 9.4% of patients. The median disease-free survival was 8.3 years (95% confidence interval [95% CI], 4.3-12.2 years). Logistic regression analysis confirmed tumor classification, facial nerve palsy, grade of tumor differentiation, patient age, and surgical margins as recurrence-associated factors (P < .00001). Using this model, 3 postoperative risk groups were defined-high-risk, intermediate-risk, and low-risk-that had recurrence frequencies of 71.4%, 43.1%, and 8.8%, respectively (P = .0001). The 5-year disease-free survival rates for these groups were 18.7%, 53.9%, and 99.9%, respectively (P = .00001). CONCLUSIONS: In this study, the authors identified several significant prognostic factors. Consequently, they have proposed a prognostic score categorization that allows for a straightforward calculation of the risk of recurrence for a given patient that may help to define therapeutic strategies, target patient counseling, and design future trials.

Parámetros de práctica para el manejo del dolor en cáncer: Grupo de Consenso para el Manejo del Dolor en Cáncer / Practice guidelines for cancer pain management: Task Force for Cancer Pain Management

El dolor por cáncer es un problema frecuente en nuestro medio, se presenta en 80 a 90 % de los pacientes y en aproximadamente 90 % de ellos se resuelve con medidas relativamente sencillas. No obstante, aproximadamente 40 % de los pacientes se encuentra insatisfecho con el médico o la enfermera respecto al manejo de su dolor. Por tal motivo, se convocó a un grupo de consenso con la finalidad de generar parámetros de práctica clínica fundamentados en la evidencia publicada y en la opinión de los expertos. Este grupo estuvo integrado por 31 médicos líderes de opinión es este campo, quienes con base en 599 documentos emitieron esta serie de recomendaciones, identificadas cada una según su nivel de evidencia.

Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.

[Importance of genetic counseling and molecular diagnosis testing in families at high risk for cancer]. / Importancia del asesoramiento genético en familias con alta susceptibilidad a cáncer que serán sometidas a pruebas moleculares.

Individuals with a family history of certain cancer types are at higher risk to develop a malignancy during their lifetime. The availability of the family history is a basic component for genetic counseling of these patients to determine illnesses that may affect other family members. The family history can help us to identify some inheritance patterns of cancer transmission among families. Nowadays it is possible to identify by clinical and molecular testing many of these familial cancer syndromes. The objective of this review is to provide a basis to the physician who the patient contacts first, in order to recognize the possibility of illnesses with a genetic transmission. This will allow the treating physician to refer the patient to a genetic specialist for possible molecular diagnosis of the illness.

[Practice guidelines for cancer pain management. Task Force for Cancer Pain Management]. / Parámetros de práctica para el manejo del dolor en cáncer. Grupo de Consenso para el Manejo del Dolor en Cáncer.

Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.

Anterolateral and lateral skull-base approaches for treatment of neoplastic diseases.

PURPOSE: Neoplasms affecting the anterolateral and lateral skull base have different sites of origin and histology, and its resection is technically difficult. The purpose of this study was to describe the surgical outcome and overall and disease-free survival of patients who had anterolateral and lateral skull base procedures for treatment of neoplasms with and without adjuvant therapy. MATERIALS AND METHODS: A retrospective study was performed on 26 patients who underwent anterolateral or lateral skull-base procedures through subcranial approaches such as maxillectomy with ethmoidectomy, osteoplastic maxillotomy, transmandibular, infratemporal, and transtemporal/infratemporal techniques for treatment of neoplastic diseases. Twenty-one cases were malignancies, with no evidence of metastasis. These approaches were combined frequently with a transbasal, pterional, subtemporal, or temporo-occipital craniotomy. Survival and disease-free intervals were evaluated with the Kaplan-Meier product limit method. RESULTS: Nine cases were maxillary antrum malignancies with extension to the middle fossa and/or infratemporal fossa, 7 with nasopharyngeal neoplasms, 3 malignant lesions in the infratemporal fossa, and 3 with auditory canal carcinomas. The rest had miscellaneous diagnosis. Major morbidity occurred in 15% of cases. Perioperative mortality was 0. From 21 cases with malignancies, 4 had recurrences and the overall survival was 78% at 36 months of follow-up. CONCLUSION: Anterolateral and lateral skull-base surgery is done with low morbidity and no operative mortality. The oncologic results are better than those reported in the literature probably because of a stringent selection of cases, although a longer follow-up period is required.

[The role of minimal invasion surgery in the management of patients with gastric carcinoma]. / El papel de la cirugía de invasión mínima en el manejo de pacientes con carcinoma gástrico.

In the last decade, minimal invasion surgery (MIS) has been used in a great variety of diseases and clinical situations. In gastric carcinoma (GC), specific indications in various circumstances have been described. MIS is used to make a diagnosis, for clinical stage classification, and for respectability evaluation, allowing to design a suitable therapy for each patient, because effective neoadjuvant treatments (chemotherapy and radiochemotherapy) are available. MIS has also been used for surgical resection of gastric neoplasia, including endoscopic mucosal resection, wedge resection of gastric wall, subtotal gastrectomy, total gastrectomy or even lymphadenectomy. MIS is used for perform palliative gastrojejunostomy in patients with distal GC, as well as for gastrostomy or jejunostomy for enteral nutrition in specific situations. MIS is still in experimental phase in GC, except in the case of preoperative staging laparoscopy.

Síndromes paraneoplásicos neurológicos / Neurologic paraneoplasic syndromes

Los síndromes paraneoplásicos neurológicos son un grupo de entidades causadas por los efectos a distancia de un tumor, y dado que pueden afectar cualquier porción del sistema nervioso, se presentan como cuadros neurológicos. Estas entidades son condiciones poco frecuentes causadas por respuestas inmunes contra antígenos tumorales que tienen una reacción cruzada con antígenos neuronales. En esta revisión se estudian los mecanismos propuestos para explicar su etiopatogenia, haciendo hincapié en la reacción autoinmune hacia antígenos onconeurales. En esta revisión se analizan las manifestaciones clínicas de los síndromes paraneoplásicos neurológicos, las neoplasias a las que se asocian así como la importancia de establecer un diagnóstico; tratamos de recalcar el valor de estudio de los mismos, pues pueden ser la primera manifestación de malignidad.

Sarcomas de cabeza y cuello en adultos. Estudio clinicopatológico de 27 casos / Head and neck soft tissue sarcomas in adults. Clinical and pathological study of 27 cases

Durante el periodo de 1982 a 1993, 27 pacientes adultos con diagnóstico de sarcoma de cabeza y cuello fueron evaluados en el Instituto Nacional de Cancerología de México(INcan). En 25 casos se revisaron los bloques de parafina para la confirmación del diagnóstico histológico. La edad promedio fue de 36.8 años. El sexo mas afectado fue el femenino (63 por ciento). El sitio de localización más frecuente fue la cabeza (59 por ciento). Las estirpes histológicas más frecuentes fueron el rabdiomiosarcoma y shcwannoma maligno (29.6 por ciento para cada variedad). El 85 por ciento de los tumores eran de alto grado. El tratamiento de elección fue la excisión amplia con o sin radioterapia adyuvante. La supervivencia más prolongada se observó en los pacientes con tumores bien diferenciados o de hasta 5.0 cm de diámetro. El 62.9 por ciento de los casos se presentó con tumores mayores de 5.0 cm. La supervivencia global fue de 36.6 meses, siendo del 59 por ciento y 18.5 a dos y cinco años, respectivamente. La terapia agresiva en estas neoplasias ofrece los mejores resultados de control local a largo plazo

Cáncer gástrico / Gastric cancer

El cáncer gástrico (CG) es una neoplasia frecuente y su mortalidad es sumamente elevada. La mayoría de los pacientes en los países occidentales se presentan en estadios avanzados de la enfermedad, con una baja frecuencia de resecabilidad. En el presente trabajo se detallan aspectos epidemiológicos. Se presentan las principales clasificaciones morfológicas tanto macroscópicas como histopatológicas. Se define la clasificación por estadios TNM y los factores de riesgo reconocidos para CG. Se señalan las principales manifestaciones clínicas, enfatizando la necesidad del diagnóstico temprano como única maniobra capaz de abatir la mortalidad. Se discute la necesidad de realizar estudios diagnósticos y se comparan los estudios de estadificación preoperatoria en cuanto a su valor para predecir resecabilidad y su utilidad en protocolos de investigación de nuevos esquemas terapéuticas. Se analiza el papel de la cirugía radical y la linfadenectomía extendida en el tratamiento definitivo y la utilidad de tratamiento adyuvantes y paliativos y se menciona brevemente la experiencia del Instituto Nacional de Cancerología

Epidemiología descriptiva del cáncer de cavidad bucal en el Instituto Nacional de Cancerología (1985-1992) / Descriptive epidemiology of oral cancer 1985-1992 at the Instituto Nacional de Cancerologia of Mexico

Las características clínicas y los factores de riesgo en cáncer de cavidad bucal en México han sido poco descritos. El objetivo de este estudio fue analizar las caracteristicas clínicas y el hábito tabáquico en los casos con cáncer de cavidad bucal que se presentaron al Instituto Nacional de Cancerología en el período de 1985 a 1992. De los expedientes se obtuvieron los datos sobre edad, sexo, ocupación y hábito tabáquico del paciente, así como ubicación, tamaño y tipo histológico del tumor, y ganglios linfáticos clínicamente evidentes. Se analizaron la frecuencia y distribución de las variables con las pruebas de ji cuadarada y la prueba de t de Student. Del total de 633 casos, el 60.3 por ciento fueron hombres y el 39.7 por ciento mujeres. La edad promedio entre los varones fue de 60.9 años (intervalo de 15 y 98) y en mujeres de 59.5 años (intervalo de 15 a 105). Los sitios más afectados fueron: lengua con una frecuencia de 27.1 y 27.6 por ciento, encía con 17.3 y 22.4 por ciento y glandulas salivales con 16.6 y 21.5 por ciento, en hombres y mujeres respectivamente. El 71 por ciento de los casos fueron variedad histológica epidermoide y cerca del 65 por ciento de los tumores se presentaron en etapas clínicas avanzadas (III y IV). El 83.9 por ciento de los hombres y el 21.6 por ciento mujeres consumían tabaco (p < 0.000). El 67.4 por ciento de los varones y el 38.8 por ciento de las mujeres fumaban 10 o más cigarros al día (p = 0.006). El tiempo de duranción del hábito fue de 37.3 años en hombres y de 30.5 años en mujeres (p = 0.0026). El tiempo de evolución del tumor fue mayor en las mujeres que en los varones (p = 0.003). El cáncer de cavidad bucal es poco frecuente y la mayoría de los casos se presentan en etapas avanzadas. En los hombres, el consumo de tabaco parece ser uno de los factores más importantes para el desarrollo de este tipo de tumor