Outcomes and Survival for Early-Stage Non-Small Cell Lung Cancer Following Wedge Resection or Lobectomy: A Propensity Score-Matched Analysis Using a Novel Peruvian Registry.

Background: Using a previously unreported Peruvian registry of patients treated for early-stage non-small cell lung cancer (NSCLC), this study explored whether wedge resection and lobectomy were equivalent regarding survival and impact on radiologic-pathologic variables. Methods: This observational, analytical, longitudinal study used propensity score-matched (PSM) analysis of a single-center retrospective registry of 2,570 patients with pathologic stage I-II NSCLC who were treated with wedge resection (n=1,845) or lobectomy (n=725) during 2000-2020. After PSM, 650 cases were analyzed (resection, n=325; lobectomy, n=325) through preoperative and clinical variables, including patients with ≥1 lymph node removed. Kaplan-Meier curves and multivariable Cox proportional hazard models were created for 5-year overall survival (OS), disease-free survival (DFS), and locoregional-recurrence-free survival (LRFS). Results: The principal complication was operative pain persisting >7 days for lobectomy versus wedge resection (58% vs. 23%, p=0.034) and shorter hospital stays for resection than for lobectomy (5.3 days vs. 12.8 days, p=0.009). The 5-year OS (84.3% vs. 81.2%, p=0.09) and DFS (79.1% vs. 74.1%, p=0.07) were similar and statistically insignificant between resections and lobectomies, respectively. LRFS was worse overall following wedge resection than lobectomy (79.8% vs. 91.1%, p<0.02). Nevertheless, in the PSM analysis, both groups experienced similar LRFS when the resection margin was >10 mm (90.9% vs. 87.3%, p<0.048) and ≥4 lymph nodes were removed (82.8% vs. 79.1%, p<0.011). Conclusion: Both techniques led to similar OS and DFS at 5 years; however, successful LRFS required a wedge resection with a surgical margin and adequate lymph node removal to obtain outcomes similar to lobectomy.

The association between referral by specialists in oral diagnosis on survival rates of patients with oral cancer: A retrospective cohort study.

BACKGROUND: To assess the influence of diagnosis and referral provided by specialists in oral diagnosis on disease-free survival and overall survival of patients with oral cancer. METHODS: A cohort of 282 patients with oral cancer treated at a regional cancer hospital from 1998 to 2016 was analyzed retrospectively. The referral register of the patients was analyzed and assigned to two groups: (1) those referred by oral diagnosis specialists (n = 129), or (2) those referred by nonspecialized professionals (n = 153). The cancer treatment evolution was assessed from the patients' records, and the outcome was registered concerning cancer recurrence and death. Sociodemographic and clinicopathological variables were explored as predictors of disease-free survival and overall survival. RESULTS: Group 1 exhibited lower T stages and a reduced incidence of regional and distant metastases. Surgery was performed in 75.2% of cases in Group 1, while in Group 2, the rate was 60.8%. Advanced T stages and regional metastases reduced the feasibility of surgery. Higher TNM stages and tumor recurrence were associated with decreased disease-free survival, while surgical intervention was a protective factor. Higher TNM stage had a negative impact on the overall survival. CONCLUSION: Specialized oral diagnosis did not directly impact disease-free survival and overall survival and did not influence the indication of surgery in oral cancer; however, it was associated with the diagnosis of early tumors and better prognosis.

What is the impact of dynamic contrast-enhancement sequence in the Vesical Imaging, Reporting and Data System (VI-RADS)? A subgroup analysis.

BACKGROUND: A scoring system focusing on the risk of muscle layer invasion by Bladder cancer (BCa) has been released, Vesical Imaging - Radiological and Data System (VI-RADS), with a growing interest in evaluating its diagnostic accuracy. Our goal was to assess the accuracy and reproducibility of the VI-RADS score for assessment of the vesical muscular layer with (multiparametric-mp) and without (biparametric-bp) a dynamic-contrast enhancement (DCE) sequence. METHODS: Retrospective study conducted from July 2018 to July 2020. All patients had suspicions of BCa and underwent Magnetic Resonance Imaging (MRI) before any intervention. MRI was interpreted by two radiologists with different levels of experience, and a VI-RADS score assigned in two different sessions (3 months apart) without and with DCE. After exclusions, 44 patients with 50 lesions were enrolled. The standard of reference was transurethral resection in 18 patients (40.9%) and cystectomy in 26 patients (59.1%). RESULTS: Twenty-five lesions (50%) were muscle-invasive. There was no significant difference between the two groups for gender and presence of a stalk, but mean age of NMIBCa group was significantly higher (p = 0.01). The sizes of lesions were significantly different between groups for both readers at 2.42+/- 1.58 vs. 5.70+/- 2.67 cm for reader 1 (p < 0.0001) and 2.37+/- 1.50 vs. 5.44 +/- 2.90 cm for reader 2 (p = 0.001). The area under the curve (AUC) for muscle invasion with mpVI-RADS, considering all lesions, was 0.885 +/- 0.04 (95% CI-0.79-0.98) for reader 1 and 0.924 +/- 0.04 (0.84-0.99) for reader 2, and for bpVI-RADS was 0.879+/- 0.05 and 0.916 +/- 0.04 (0.85-0.99), respectively, both differences not statistically significant (p = 0.24 and 0.07, respectively). When considering only small lesions (< 3.0 cm), the accuracy for mpVI-RADS was 0.795 +/- 0.11 (0.57-1.0) for reader1, and 0.80 +/- 0.11(0.57-1.0) for reader 2, a non-significant difference (p = 0.56) and for bpVI-RADS was 0.747 +/- 0.12 (0.50-0.99) for reader 1 and 0.80 +/- 0.11(0.57-1.0) for reader 2, a significant difference (p = 0.04). The intraclass correlation coefficient for the final score was 0.81 (0.60-1.0) for mpVI-RADS and 0.85 (0.63-1.0) for bpVI-RADS. CONCLUSION: The VI-RADS system was accurate in demonstrating muscle-invasive BCa, for both experienced and less experienced reader, regardless of the use of a DCE sequence. However, when only small lesions were assessed the difference between the two readers was significant only for the biparametric analysis. The reproducibility was similar between multiparametric and biparametric approach.

Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen's Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen' Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3-4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Is Biopsy of Contralateral Hilar N3 Lymph Nodes With Negative PET-CT Scan Findings Necessary When Performing Endobronchial Ultrasound Staging?

BACKGROUND: Systematic endobronchial ultrasound (EBUS)-guided lung cancer staging starts with hilar N3 nodes, proceeding sequentially to mediastinal N3, N2, and N1 nodes, with sampling of all enlarged nodes (size, ≥ 5 mm) by EBUS. However, procedure time is limited by patient comfort when moderate sedation is used. It is unclear if EBUS staging should start with hilar N3 nodes or whether starting with mediastinal N3 nodes suffices. Knowing the probability of hilar N3 nodes with PET-CT scan negative findings harboring occult metastasis can inform this decision. RESEARCH QUESTION: What proportion of patients with hilar N3 nodes showing negative PET-CT scan findings have malignancy by EBUS? STUDY DESIGN AND METHODS: This retrospective observational, single-center cohort study included consecutive patients with clinical-radiographic T1-3, N0-3, M0 non-small cell lung cancer undergoing systematic EBUS staging with biopsy of hilar N3 nodes with negative PET-CT scan findings. The primary outcome was the proportion of patients with malignant hilar N3 nodes showing negative PET-CT scan findings. Based on expert opinion, a threshold probability of malignancy of less than 5% was considered sufficient to skip hilar N3 nodes. We used the binomial exact test to compare the observed proportion vs threshold probability of 5%. RESULTS: Of 1,737 consecutive patients undergoing EBUS staging, 1,567 showed negative PET-CT scan findings of the hilar N3 nodes. These nodes were enlarged by EBUS and were sampled in 739 patients. Malignancy was found in the hilar N3 nodes of 5 of 739 patients (0.68%; 95% CI, 0.22%-1.57%). The proportion was significantly less than the threshold probability (P < .001). Patients with positive PET scan results of the mediastinal N3 nodes were at higher risk of having occult hilar N3 nodal metastasis (P = .003), found in 3 of 46 patients (6.5%; 95% CI, 1.4%-17.9%) with positive PET scan results of the mediastinal N3 nodes. INTERPRETATION: When using moderate sedation, because time is limited, it is reasonable to start with the mediastinal N3 nodes if the hilar and mediastinal N3 nodes show negative PET scan results. Patients with positive PET scan findings of the mediastinal N3 nodes probably should undergo hilar N3 node sampling.

Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Abstract Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen's Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen' Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3-4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Aspectos tomográficos e histológicos en pacientes con neoplasia exocrina de páncreas / Tomographic and histologic aspects in patients with pancreas exocrine neoplasm

Introducción: El cáncer de páncreas se origina en la glándula pancreática y es una de las neoplasias más invasivas debido a su rápida diseminación, la falta de síntomas específicos en sus inicios y su diagnóstico tardío. Objetivo: Caracterizar a pacientes con cáncer de páncreas según variables de interés. Métodos: Se efectuó un estudio observacional, descriptivo y transversal en el Servicio de Imagenología del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora de la provincia de Santiago de Cuba, desde enero de 2013 hasta diciembre de 2017, de 70 pacientes con diagnóstico tomográfico sugestivo de dicha neoplasia maligna. Resultados: En la serie el tumor exocrino pancreático primó en pacientes mayores de 60 años de edad (37,1 %), del sexo masculino (54,2 %) y de la raza mestiza (61,4 %). El diagnóstico histológico predominante fue el de adenocarcinoma ductal poco diferenciado (47,2 %), en tanto, los factores de riesgo mayormente asociados al proceso neoplásico fueron las comidas grasas (68,6 %), el tabaquismo (61,4 %) y el alcoholismo (50,0 %), y el antecedente patológico personal más frecuente, la diabetes mellitus (37,1 %). Conclusiones: La tomografía axial computarizada proporciona una descripción detallada de las neoplasias pancreáticas y su extensión, lo cual es de gran utilidad para la estadificación de estas y, además, determina la conducta terapéutica a seguir.

Introduction: The pancreas cancer originates in the pancreatic gland and it is one of the more invasive neoplasms due to its quick dissemination, lack of specific symptoms in its beginnings and its late diagnosis. Objective: To characterize patients with pancreas cancer according to variables of interest. Methods: An observational, descriptive and cross-sectional study was carried out in the Imaging Service of Saturnino Lora Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba, from January, 2013 to December, 2017 to 70 patients with suggestive tomographic diagnosis of this malignancy. Results: In the series the pancreatic exocrine tumor prevailed in patients older than 60 years (37.1 %), the male sex (54.2 %) and mixed race (61.4 %). The predominant histologic diagnosis was the ductal adenocarcinoma hardly differentiated (47.2 %), as long as, the risk factors mostly associated with the neoplasm were fatty foods (68.6 %), nicotine addiction (61.4 %) and alcoholism (50.0 %), and the most frequent personal pathological history was diabetes mellitus (37.1 %). Conclusions: The computerized axial tomography provides a detailed description of the pancreatic neoplasms and their extension, which is very useful for the staging of these malignancies and, also, it determines the therapeutic behavior we should follow.

Molecular profiling of key driver genes improves staging accuracy in multifocal non-small cell lung cancer.

OBJECTIVE: Multifocal non-small cell lung cancer has historically been separated into synchronous primary lung cancers or intrapulmonary metastases with the use of histopathology. We hypothesize that using targeted next-generation sequencing of key driver mutations in multifocal non-small cell lung cancer will improve our ability to differentiate intrapulmonary metastases from synchronous primary lung cancers. METHODS: We identified patients who underwent surgery for non-small cell lung cancer between 2013 and 2018 with multifocal tumors. Archived specimens were reviewed with a 4-gene next-generation sequencing panel identifying mutations of EGFR, KRAS, BRAF, and NRAS. Synchronous primary lung cancers were classified as lesions with different histopathologic subtypes or driver mutations. Tests of hypotheses were performed with the Fisher exact test. Calculations were performed in Stata (v13.0; StataCorp LLC, College Station, Tex). RESULTS: A total of 18 patients had non-small cell lung cancer tumor specimens (n = 41) available from 2 or more sites. The pathologic diagnosis was predominantly adenocarcinoma (39/41 specimens). We detected a driver mutation in 68.3% (28/41) of all tumors. The most common mutations observed were in KRAS (n = 17/41) and EGFR (n = 7/41). Eleven patients had synchronous primary lung cancers, and 4 patients had intrapulmonary metastases based on combined histopathologic and molecular profiling results. Three lacked driver mutations in either lesion. Eight synchronous primary lung cancers (8/18, 44%) were downstaged when compared with their original diagnosis (P = .08). Of these, 4 patients received adjuvant chemotherapy unnecessarily in hindsight. CONCLUSIONS: Molecular non-small cell lung cancer profiling using a 4-gene next-generation sequencing panel allows for better distinction between synchronous primary lung cancers and intrapulmonary metastases than histopathology alone. Routine use of next-generation sequencing for multifocal lesions prevents unnecessary adjuvant treatment for patients with histologically similar synchronous primary lung cancers.

A Prediction Model to Help with Oncologic Mediastinal Evaluation for Radiation: HOMER.

Rationale: When stereotactic ablative radiotherapy is an option for patients with non-small cell lung cancer (NSCLC), distinguishing between N0, N1, and N2 or N3 (N2|3) disease is important.Objectives: To develop a prediction model for estimating the probability of N0, N1, and N2|3 disease.Methods: Consecutive patients with clinical-radiographic stage T1 to T3, N0 to N3, and M0 NSCLC who underwent endobronchial ultrasound-guided staging from a single center were included. Multivariate ordinal logistic regression analysis was used to predict the presence of N0, N1, or N2|3 disease. Temporal validation used consecutive patients from 3 years later at the same center. External validation used three other hospitals.Measurements and Main Results: In the model development cohort (n = 633), younger age, central location, adenocarcinoma, and higher positron emission tomography-computed tomography nodal stage were associated with a higher probability of having advanced nodal disease. Areas under the receiver operating characteristic curve (AUCs) were 0.84 and 0.86 for predicting N1 or higher (vs. N0) disease and N2|3 (vs. N0 or N1) disease, respectively. Model fit was acceptable (Hosmer-Lemeshow, P = 0.960; Brier score, 0.36). In the temporal validation cohort (n = 473), AUCs were 0.86 and 0.88. Model fit was acceptable (Hosmer-Lemeshow, P = 0.172; Brier score, 0.30). In the external validation cohort (n = 722), AUCs were 0.86 and 0.88 but required calibration (Hosmer-Lemeshow, P < 0.001; Brier score, 0.38). Calibration using the general calibration method resulted in acceptable model fit (Hosmer-Lemeshow, P = 0.094; Brier score, 0.34).Conclusions: This prediction model can estimate the probability of N0, N1, and N2|3 disease in patients with NSCLC. The model has the potential to facilitate decision-making in patients with NSCLC when stereotactic ablative radiotherapy is an option.

Automatic Staging of Cancer Tumors Using AIM Image Annotations and Ontologies.

A second opinion about cancer stage is crucial when clinicians assess patient treatment progress. Staging is a process that takes into account description, location, characteristics, and possible metastasis of tumors in a patient. It should follow standards, such as the TNM Classification of Malignant Tumors. However, in clinical practice, the implementation of this process can be tedious and error prone. In order to alleviate these problems, we intend to assist radiologists by providing a second opinion in the evaluation of cancer stage. For doing this, we developed a TNM classifier based on semantic annotations, made by radiologists, using the ePAD tool. It transforms the annotations (stored using the AIM format), using axioms and rules, into AIM4-O ontology instances. From then, it automatically calculates the liver TNM cancer stage. The AIM4-O ontology was developed, as part of this work, to represent annotations in the Web Ontology Language (OWL). A dataset of 51 liver radiology reports with staging data, from NCI's Genomic Data Commons (GDC), were used to evaluate our classifier. When compared with the stages attributed by physicians, the classifier stages had a precision of 85.7% and recall of 81.0%. In addition, 3 radiologists from 2 different institutions manually reviewed a random sample of 4 of the 51 records and agreed with the tool staging. AIM4-O was also evaluated with good results. Our classifier can be integrated into AIM aware imaging tools, such as ePAD, to offer a second opinion about staging as part of the cancer treatment workflow.

Hepatocellular carcinoma staging systems: Hong Kong liver cancer vs Barcelona clinic liver cancer in a Western population.

BACKGROUND: Despite being the world's most widely used system for staging and therapeutic guidance in hepatocellular carcinoma (HCC) treatment, the Barcelona clinic liver cancer (BCLC) system has limitations, especially regarding intermediate-grade (BCLC-B) tumors. The recently proposed Hong Kong liver cancer (HKLC) staging system appears useful but requires validation in Western populations. AIM: To evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population, estimating the overall patient survival. METHODS: This was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and 2016. Demographic, clinical, and laboratory data were collected. HCC staging was carried out according to the HKLC and BCLC systems to assess treatment agreement. Overall survival was estimated based on the treatment proposed in each system. RESULTS: A total of 519 HCC patients were assessed. Of these, 178 (34.3%) were HKLC-I; 95 (18.3%) HKLC-IIA; 47 (9.1%) HKLC-IIB; 29 (5.6%) HKLC-IIIA; 30 (5.8%) HKLC-IIIB; 75 (14.4%) HKLC-IV; and 65 (12.5%) HKLC-V. According to the BCLC, 25 (4.9%) were BCLC-0; 246 (47.4%) BCLC-A; 107 (20.6%) BCLC-B; 76 (14.6%) BCLC-C; and 65 (12.5%) BCLC-D. The general agreement between the two systems was 80.0% - BCLC-0 and HKLC-I (100%); BCLC-A and HKLC-I/HKLC-II (96.7%); BCLC-B and HKLC-III (46.7%); BCLC-C and HKLC-IV (98.7%); BCLC-D and HKLC-V (41.5%). When sub-classifying BCLC-A, HKLC-IIB, HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion, 13.4, 66.0, 100 and 36.7%, respectively, of the cases were classified as up-to-7 out. CONCLUSION: In a Western population, the general agreement between the two systems was 80.0%, although in BCLC-B cases the agreement was low, suggesting that some individuals could be candidates for the curative treatment recommended by the HKLC. The authors suggest that the BCLC system should be routinely employed, although for BCLC-B cases it should be associated with the HKLC system.

Differences in Breast Cancer Stage at Diagnosis by Ethnicity, Insurance Status, and Family Income in Young Women in the USA.

PURPOSE: Describe the clinical and epidemiological data from young women with breast cancer and determine the association between ethnicity, insurance status, family income, and breast cancer stage at the diagnosis in this population. METHODS: Women under the age of 40 diagnosed with invasive breast cancer from 2010 to 2014 and identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database were included. Binary logistic regression was applied in order to estimate the odds ratios (ORs) for factors that were potentially predictive for receiving a breast cancer diagnosis at stage I. RESULTS: Of 14,379 young women with invasive breast cancer, 70.9% of the patients were white, 15.9% black, and 13.2% classified as other ethnicity (American Indian, Asian, Pacific Islander). The initial clinical stage at diagnosis was stage I in 28.2%, II in 45.2%, III in 19.0%, and IV in 7.6%. The chi-square test showed a significant association between clinical stage at diagnosis and family income (p < 0.0001), insurance status (p < 0.0001), and ethnicity (p < 0.0001). The ORs for being diagnosed at stage I, regarding different factors, revealed that women with family income higher than US$ 85,000 were more likely to be diagnosed with stage I (OR [95%CI], 1.306 [1.173-1.454]; p value < 0.0001) when compared with patients with family income of less than US$ 60,000. Black women were less likely to be diagnosed with stage I (OR [95%CI], 0.676 [0.605-0.755]; p value < 0.0001), when compared with white women. Uninsured women were less likely to be diagnosed with stage I (OR [95%CI], 0.586 [0.529-0.648]; p value < 0.0001) when compared with women with insurance coverage. CONCLUSION: Among young US women diagnosed with invasive breast cancer, most of them presented early stage disease. Women with black ethnicity, low income, and uninsured are at risk for late-stage presentation. Improvements in strategies to allow earlier breast cancer diagnosis in these at risk population are urged.

BREAST CANCER SURVIVAL IN A BRAZILIAN CANCER CENTER: A COHORT STUDY OF 5, 095 PATIENTS / Sobrevida do câncer de mama em um centro de câncer brasileiro: um estudo de coorte de 5. 095 pacientes

Objectives: To describe the age group, clinical stage at diagnosis, treatment, and survival rates of breast cancer patients treated in a Brazilian specialized Cancer Center. Method: A hospital-based retrospective cohort study is presented herein, on women with breast cancer diagnosed between January 1, 2000 and December 31, 2012. Data were extracted from the Hospital Cancer Registry of the A.C.Camargo Cancer Center. Data on age group, histology of the tumor, TNM classification, clinical stage and treatments were described in absolute and relative frequencies for three periods. Survival curves were estimated with the Kaplan-Meier estimator. Hazard ratio (HR) and 95% confidence interval (95%CI) were calculated for all variables. Results: A total of 5,095 female breast cancer patients were identified, with most stages classified as I and II (60%). The overall survival was 82.7% for the period of 2000­2004, and 89.9% for 2010­2012 (p<0.001). Patients with invasive ductal carcinoma, who were treated with surgery and hormonal therapy, showed a reduction in the risk of death in the most recent period HRadj=0.42 (95%CI 0.34­0.53) (2010­2012). Conclusions: Early stage diagnosis and combined treatment (including HT) are predictive prognostic factors for high survival rates in patients with invasive breast cancer. Specialized cancer centers can provide valuable indications regarding cancer control policies, evaluating overall survival for breast cancer and its associated prognosis.

Objetivos: Descrever as faixas etárias, estadiamento clínico ao diagnóstico, tratamento e sobrevida global das pacientes com câncer de mama tratadas em um centro de câncer brasileiro. Método: Estudo de uma coorte retrospectiva de base hospitalar, com mulheres diagnosticadas de câncer de mama entre 1º de janeiro de 2000 e 31 de dezembro de 2012. Os dados foram extraídos do Registro Hospitalar de Câncer do A. C. Camargo Cancer Center. Faixa etária, tipo histológico, classificação TNM, estadiamento clínico e tratamento foram descritos em frequência absoluta e relativa estratificados em três períodos. As curvas de sobrevida global foram estimadas pelo método de Kaplan-Meier. A Hazard ratio (HR) com intervalo de confiança de 95% foram calculados para todas as variáveis. Resultados: O total de 5.095 pacientes mulheres com câncer de mama foi identificado, a maioria era estágio inicial 60% (I e II). A sobrevida global foi de 82,7% para o período de 2000­2004 e 89,9% para 2010­2012 (p<0,001). Pacientes com carcinoma ductal invasivo que foram tratadas com cirurgia e hormonioterapia, mostraram redução do risco de morte no período mais recente HRaj=0,42 (0,34­0,53 em 2010­2012). Conclusões: Diagnóstico precoce e tratamento combinado (incluindo hormonioterapia) são fatores prognósticos preditivos para altas taxas de sobrevida em pacientes com câncer de mama invasivo. Centros especializados em câncer podem prover informações valiosas sobre as políticas de controle do câncer, avaliando a sobrevida global do câncer de mama e fatores associados ao prognóstico.

Linfadenectomía paraaórtica extraperitoneal por laparoscopia como método clasificatorio en pacientes con diagnóstico de carcinoma de cérvix localmente avanzado: reporte de casos / Laparoscopic extraperitoneal para-aortic lymphadenectomy as a classification method in locally advanced cervical cancer: Report of a series of cases

Resumen Describimos la experiencia quirúrgica de diez pacientes sometidas a linfadenectomía paraaórtica extraperitoneal laparoscópica (LPEL) para clasificación en carcinoma de cérvix localmente avanzado (CCLA) y revisión de la literatura. Métodos: Búsqueda de literatura en MEDLINE y EMBASE usando palabras clave: "Uterine Cervical Neoplasms; Neoplasm Staging; Lymph Nodes; Lymph Node Excision; Laparoscopy; extraperitoneal''. Describimos la técnica quirúrgica para LPEL y resultados obtenidos en 10 pacientes intervenidas. Resultados: Diez pacientes con CCLA fueron sometidas a LPEL, rango de edad entre 29 y 65 años, sangrado operatorio entre 5 y 30cc, recuento ganglionar entre 2 y 11 ganglios; no complicaciones intraoperatorias y estancia hospitalaria entre uno y tres días. Conclusión: Es la primera experiencia reportada de LPEL para el CCLA en Colombia, siendo un procedimiento factible, seguro y útil para identificar compromiso paraaórtico adaptando el tratamiento.

Abstract A description is presented on the surgical experience of 10 patients who underwent laparoscopic extraperitoneal para-aortic lymphadenectomy (LEPL) in order to classify locally advanced cervical carcinoma (LACC), as well as a literature review. Methods: A literature search was performed in MEDLINE and EMBASE using the following keywords:''Uterine Cervical Cancer; Cancer Staging; Lymph Nodes; Lymph Node Excision; Laparoscopy; extraperitoneal''. The surgical technique for LEPL is described, as well as the outcomes of the 10 patients who underwent surgery. Results: A total of 10 patients, with ages between 29 and 65 years and with LACC underwent LPEL. There were surgical blood losses between 5 to 30 cc, a lymph node count between 2 and 11, no surgical complications, and a hospital stay of between 1 and 3 days. Conclusion: This is the first experience reported for LPEL for LACC in Colombia. It is a safe, feasible, and useful procedure to identify para-aortic involvement.

Observaciones críticas en torno al ganglio centinela en el cáncer colorrectal / Critical observations about the sentinel lymph node in colorectal cancer

Introducción: La identificación del ganglio centinela durante el tratamiento quirúrgico del cáncer colorrectal puede ayudar a la correcta estadificación posoperatoria y trascender a la quimioterapia adyuvante en el seguimiento a fin de mejorar la supervivencia de estos enfermos. Objetivo: Identificar las técnicas utilizadas para detectar el ganglio centinela mediante acceso convencional o laparoscópico: tinción o radiotrazador, ex vivo o in vivo así como su influencia en la estadificación posoperatoria y en el tratamiento adyuvante correlacionado con la evolución del cáncer de colon. Material y Métodos: Revisión documental en formato electrónico e impreso de publicaciones actualizadas sobre el tema. Desarrollo: El estudio de los linfáticos supone el factor pronóstico más importante en el cáncer colorrectal sin metástasis. La detección del ganglio centinela es la técnica que mejor predice el estado ganglionar de un paciente y permite realizar estudios intensivos que mejoran la estadificación. Conclusiones: El estudio del ganglio centinela es una práctica reproducible sin aumento significativo del tiempo y costos. En el seguimiento de los enfermos clasificados N0 con ganglio centinela positivo parece haber tendencia a un porcentaje mayor de recidivas, lo que podría trascender a cambios en las pautas de tratamiento adyuvante en aras de mejorar la supervivencia(AU)

Introduction: The identification of the sentinel lymph node during surgical treatment of colorectal cancer can help the correct postoperative staging and go beyond adjuvant chemotherapy in the follow-up of patients with the aim to improve survival of these sick people. Objective: To identify the techniques used to detect the sentinel lymph node through either conventional or laparoscopic approach: staining or radiotracer ex vivo or in vivo, as well as its influence in postoperative staging and the adjuvant treatment correlated with the evolution of colon cancer. Material and Methods: Document review of up-to-date publications about the topic in both electronic and printed formats. Development:The study of lymphatics is considered the most important prognostic factor in the colorectal cancer without metastases. The detection of the sentinel node is the technique that best predicts the lymph node status in a patient, and allows to conduct intensive studies to improve staging. Conclusions:The study of the sentinel lymph node is a reproducible practice without a significant increase in time and costs. The follow-up of patients classified as NO with a positive sentinel lymph node seems to have a tendency to a higher percentage of relapses, which could go beyond changes in the adjuvant treatment guidelines aimed at improving survival(AU)

Utilidad de la resonancia magnética en la estadificación pre operatoria del cáncer de endometrio / Utility of magnetic resonance in preoperative staging of endometrial cancer

Objetivo: Evaluar la utilidad de la Resonancia Magnética (RM) para valorar la infiltración tumoral miometrial y del cérvix en el carcinoma de endometrio. Pacientes y métodos: Se evaluaron retrospectivamente los estudios de RM de 26 pacientes con diagnóstico histológico por biopsia de cáncer de endometrio. Se realizó estadificación prequirúrgica y correlación con la estadificación histológica de la pieza operatoria. Se estudió la concordancia, sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) del método, para la profundización del tumor en el espesor miometrial y la invasión del cérvix. Se analizaron las posibles causas de sobrestimación e infraestimación. Resultados: En la evaluación por RM para la infiltración miometrial por estadío e invasión del cérvix se obtuvieron: S de 72,2%, 75%, 66,7%, E de 75%, 72,2%, 95,7%, VPP de 86,7%, 54,5%, 66,7%, VPN de 54,5%, 86,7%, 95,7% (para estadios IA, IB y II respectivamente). Se sobrestimaron 5 casos para infiltración miometrial y 1 para el cérvix, se infraestimaron 2 casos para infiltración miometrial y 1 caso para el cérvix. Se encontró una concordancia moderada para estadio I y buena para estadio II. Conclusión: La RM es una herramienta útil para la estadificación prequirúrgica del carcinoma de endometrio con una fiabilidad moderada a buena, lo que sumado al tipo y grado histológico ayuda a determinar la estrategia terapéutica.

Objective: Evaluate the usefulness of Magnetic Resonance Imaging (MRI) in order to assess myometrial and cervical tumor infiltration in endometrial carcinoma. Patients and Methods: A retrospective review of 26 patient's MRI studies with histological confirmation of endometrial cancer was conducted (diagnosis by endometrial cancer biopsy). Pre-surgical staging and correlation with the histological staging of the operative piece was performed. Concordance, sensitivity (S), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the method for the deepening of the tumor in the myometrial thickness and the invasion of the cervix were studied. The possible causes of overestimation and underestimation were analyzed. Results: MRI evaluation for the myometrial infiltration by stage and cervix invasion generated these results: S of 72.2%, 75%, 66.7%, SP of 75%, 72.2%, 95.7%, PPV of 86.7%, 54.5%, 66.7%, NPV of 54.5%, 86.7%, 95.7% (for stages IA, IB and II respectively). Five cases were overestimated for myometrial infiltration and 1 for the cervix; 2 cases were underestimated for myometrial infiltration and 1 case for the cervix. A moderate concordance was found for stage I and a good concordance for stage II. Conclusion: MRI is a useful tool for pre-surgical staging of endometrial carcinoma with a moderate to good reliability, which added to the type and histological grade, helps to determine the most appropriate therapeutic strategy.

Incremental value of MRI for preoperative penile cancer staging.

PURPOSE: To evaluate the incremental value of magnetic resonance imaging (MRI), compared to clinical examination, for penile cancer (PC) local staging. MATERIALS AND METHODS: Twenty-five consecutive patients with histologically proven PC were evaluated prospectively. MRI staging was performed on 1.5 and 3.0T scanners using high-resolution T2 -weighted and postcontrast T1 -weighted images. Two blinded observers interpreted MR images. Clinical local staging was performed by experienced urologists. The pathology report was used as the standard of reference. RESULTS: The interobserver agreement for MRI staging, using a kappa test for T-staging was moderate, 0.52 (95% confidence interval [CI] = 0.24-0.78), P = 0.001, although a high correlation for N-staging, 0.72 (95% CI = 0.42-1.00), P = 0.001, was detected. Clinical staging was correct in 52.0% (13/25) of patients. After pathological staging, five (20.0%) lesions were upstaged and seven (28.0%) lesions were downstaged compared to clinical examination. MRI accurately defined T-staging in 18/25 lesions (72.0%). After pathologic staging, five (20.0%) were upstaged and two downstaged (8.0%), compared to MRI. Fifteen patients were submitted to inguinal and pelvic lymphadenectomy and considered for comparison of accuracy of nodal staging by physical examination and MRI. Clinical staging accurately staged 7/15 patients (46.7%). After histopathologic analysis, six cases had nodal staging upgraded and two cases were downgraded. MRI correctly staged 13/15 (86.7%). Using a chi-square for comparison, differences in proportion of corrected staging between clinical examination and MRI were not significant for T-staging (P = 0.14), but were significant for nodal staging (P = 0.02). CONCLUSION: According to our results, MRI improves local staging of PC patients, particularly for those with limited physical examination. LEVEL OF EVIDENCE: 1 J. Magn. Reson. Imaging 2017;45:118-124.

CT scan prior to radiotherapy in unresectable, locally advanced, non-small cell carcinoma of the lung: is it always necessary?

PURPOSE: There is broad consensus regarding evaluating response to chemotherapy (CHT) by means of computerized tomography (CT) in patients with localized or locally advanced non-small cell lung carcinoma (NSCLC). We present a study comparing the usefulness of CT versus chest X-ray (XR) and clinical findings when indicating radiotherapy (RT) following CHT. METHODS: Ninety-eight of 150 subjects with unresectable locally advanced NSCLC were blindly and independently evaluated by XR and CT, with pairs of chest XR and CT (before and after CHT). A null hypothesis (H0) was established of the conditioned probability of detecting progression by CT and not by XR of 10 % or more, with a statistical power of 80 %. RESULTS: Sensitivity, specificity, positive and negative predictive value of XR versus CT were 98, 89, 99, and 80 % respectively. A 4 % (p = 0.0451) probability of improvement of CT versus XR was calculated, enabling the H0 to be ruled out. CONCLUSION: The CT failed to prove to be significantly superior to the chest XR + clinical picture in indicating a change in treatment approach in patients with unresectable locally advanced NSCLC after CHT.

Recurrence and mortality prognostic factors in childhood adrenocortical tumors: Analysis from the Brazilian National Institute of Cancer experience.

Prognostic markers that can help identifying precocious risk of unfavorable outcomes in patients with childhood adrenocortical tumors (ACTs) are still unclear. This observational and retrospective study aimed to identify clinical and pathology prognostic factors of recurrence and death in a tertiary cancer center population. Clinical, pathology, demographic, staging, and therapy data from patients with childhood ACT (median age: 3.6 years) treated at the Brazilian National Institute of Cancer between 1997 and 2015 were assessed. Univariate and bivariate analyses were used to study the association of clinical and pathology characteristics with recurrence and mortality. Recurrence and disease-related mortality were the main outcomes. Twenty-seven patients were included. Complete tumor resection was performed in 21 cases. The median tumor size was 8.2 cm. Mitotane was the most common adjuvant/palliative therapy (n = 13). Recurrence occurred in 6 patients, after a median time of 7.2 months, and was more common among those with larger tumors (P =.008), higher Weiss score (P =.001), and microscopic tumoral necrosis (P =.002). Ten patients died from the disease. Older age (P =.04), larger tumor size (P =.002), metastatic disease (P =.003), previous recurrence (P =.003), incomplete resection (P =.002), intraoperative tumor spillage (P =.005), higher Weiss score (P =.03), microscopic necrosis (P =.005), and capsular invasion (P =.02) were all associated with increased death risk. Even though complete tumor resection was performed in most cases, a considerable number of cases of childhood ACT resulted in recurrence and death. Early identification of unfavorable outcomes is essential to determine ideal therapy and appropriate surveillance.

Therapeutic itinerary of colorectal cancer patients treated in the state of Rio Grande do Sul / Itinerário terapêutico de pacientes com câncer colorretal tratados no interior do Rio Grande do Sul

Objectives: The objective of the study was to evaluate the therapeutic itinerary of patients treated in a specialized center, including its trajectory in seeking treatment and their clinical and epidemiological characteristics. Methods: This is a cross-sectional prospective descriptive study; patients with colorectal cancer aged over 18 years and who signed the consent form were included in the analysis. Tumor characteristics, such as staging and tumor features; epidemiological characteristics such as age, gender, profession and itinerary in the form of the number of clinical visits needed to obtain the diagnosis; the main symptoms; and mean time between diagnosis and onset of treatment were evaluated. Results: 34% of patients initially sought primary care (first level of care in the public health system) and 50% were diagnosed in secondary care (second level of care in the public health system); the mean number of visits until obtaining a diagnosis was 2.5 times; and 52% of patients received palliative therapy and 40% had a stage IV diagnosis. Conclusions: The mean time between the diagnosis and the onset of treatment is in line with the recommendations of the Ministry of Health of Brazil. However, it was found that the patients are unaware of the symptoms of the disease, since the mean time between the onset of symptoms until the decision to visit the doctor was 177 days - which may have been a determining factor for a diagnosis in an advanced stage of disease.

Objetivos: O objetivo do estudo foi avaliar o itinerário terapêutico de pacientes tratados em um centro especializado, compreendendo sua trajetória na busca do tratamento e as características clínicas e epidemiológicas. Métodos: estudo descritivo prospectivo transversal; foram incluídos na análise pacientes portadores de câncer colorretal (CCR) maiores de 18 anos que assinaram o termo de consentimento. Foram avaliadas características tumorais, como estadiamento e características do tumor; características epidemiológicas como idade, sexo e profissão e a trajetória como número de consultas até o diagnóstico, principais sintomas e tempo médio entre o diagnóstico e início do tratamento. Resultados: 34% dos pacientes procuraram inicialmente a atenção primária (primeiro nível de atenção na saúde pública), 50% receberam o diagnóstico na atenção secundária (segundo nível de atenção na saúde pública), a média de consultas até o diagnóstico foi de 2,5 vezes, 52% dos pacientes fizeram terapia paliativa e 40% fizeram diagnóstico em estádio IV. Conclusões: o tempo médio entre o diagnóstico e o início do tratamento está de acordo com o recomendado pelo Ministério da Saúde do Brasil; entretanto, identificou-se que os pacientes desconhecem os sintomas da doença, uma vez que a média de tempo entre o início dos sintomas até a tomada de decisão de procurar um médico foi de 177 dias, o que pode ter sido determinante para um diagnóstico na fase avançada da doença.