Boletim epidemiológico: painel oncologia ­ Goiás: tempo do diagnóstico até o início do tratamento oncológico, 2013 a 2020 / Epidemiological bulletin: Oncology Panel ­ Goiás: time from diagnosis to initiation of cancer treatment, 2013 to 2020

Câncer é um conjunto de mais de 100 doenças, incluindo tumores malignos de diferentes locais, que possuem característica comum falha dos mecanismos que regulam o crescimento normal das células, proliferação e morte celular. O prognóstico do tumor pode ser de leve a grave, com invasão de tecidos vizinhos e, eventualmente, espalhando-se para outras áreas do corpo. O Painel-oncologia foi criado em maio de 2019 a fim de monitorar o cumprimento da referida lei e da Portaria MS nº 876/2013, que dispõe sobre a sua aplicação. Não é uma plataforma para inserção de dados, mas para apresentar informações obtidas dos Sistemas de Informações do SUS, apresentando os casos por estado federativo, por tipo de câncer, por ano, como também por intervalo de tempo entre o diagnóstico de neoplasia maligna e o a data do primeiro tratamento realizado no SUS 5,6. Este relatório tem o objetivo de apresentar dados do Painel-oncologia para os cânceres mais incidentes no Estado de Goiás nos anos de 2013 a 2020 e verificar se o período estabelecido pela legislação está sendo cumprido

Cancer is a set of more than 100 diseases, including malignant tumors of different sites, which have a common characteristic of failure of mechanisms that regulate normal cell growth, proliferation and cell death. Tumor prognosis can be mild to severe, with invasion of neighboring tissues and eventually spreading to other areas of the body. The Oncology Panel was created in May 2019 to monitor compliance with the aforementioned law and Ordinance MS nº 876/2013, which provides for its application. It is not a platform for data entry, but to present information obtained from the SUS Information Systems, presenting cases by federal state, by type of cancer, by year, as well as by time interval between the diagnosis of malignant neoplasm and the date. of the first treatment performed in the SUS 5,6. This report aims to present data from the Oncology Panel for cancers more incidents in the State of Goiás in the years 2013 to 2020 and to verify if the period established by the legislation is being fulfilled

The Performance of Colorectal Cancer Screening in Brazil: The First Two Years of the Implementation Program in Barretos Cancer Hospital.

Colorectal cancer is the second most common cancer in Brazil. Yet, a nationally organized colorectal screening program is not implemented. Barretos Cancer Hospital (BCH) is one of the largest Brazilian institution that cares for underserved patients. BCH developed a fecal immunochemical test (FIT)-based organized colorectal cancer screening program to improve colorectal cancer outcomes.This study aims to present the quality/performance measures of the first 2 years of the FIT-based colorectal cancer screening program and its impact on the colorectal cancer disease stage. Between 2015 and 2017, a total of 6,737 individuals attending the Outpatient Department of Prevention or the Mobile Unit of BCH, which visits 18 cities of Barretos county, ages 50 to 65 years, were personally invited by a health agent/nurse practitioner. Exclusion criteria were personal history of colorectal cancer, adenomatous polyps, inflammatory bowel disease, and colonoscopy, or flexible sigmoidoscopy performed in the past 5 years. European Union (EU) guidelines for colorectal cancer screening programs were evaluated. Overall, 92.8% returned the FIT, with an inadequate examination rate of 1.5%. Among the 6,253 adequately tested, 12.5% had a positive result. The colonoscopy compliance and completion rates were 84.6 and 98.2%, respectively. The PPVs were 60.0%, 16.5%, and 5.6% for adenoma, advanced adenoma, and cancer, respectively. Stage distribution of screen-detected cancers shows earlier stages than clinically diagnosed colorectal cancer cancers reported at BCH and Brazilian cancer registries. Our colorectal cancer screening program achieved desirable quality metrics, aligned with the EU guidelines. The observed shift toward earlier colorectal cancer stages suggests an exciting opportunity to improve colorectal cancer-related cancers in Brazil.

Perfil de pacientes diagnosticados com câncer de vesícula biliar / Profile of patients diagnosed with gallbladder cancer

Objetivo: Descrever o perfil clínico-epidemiológico de pacientes diagnosticados com câncer de vesícula e identificar o estadiamento do tumor estabelecido no momento do diagnóstico, bem como o padrão histopatológico no momento da biópsia. Métodos: Trata-se de estudo transversal e descritivo realizado em um serviço de referência em oncologia clínica, baseado em análise secundária de dados correspondentes aos prontuários de indivíduos com diagnóstico de câncer de vesícula biliar atendidos entre janeiro de 2007 e janeiro de 2017. Resultados: A distribuição por sexo foi de cinco mulheres (62,5%) e três homens (37,5%). A idade variou de 47 a 74 anos, com média de 61,1 anos e desvio padrão de ±9,03. Nenhum indivíduo era assintomático ao diagnóstico; seis (75%) apresentaram dor em hipocôndrio direito, dois (25%) perda de peso e dois outros (25%) massa palpável. Dos oito indivíduos, seis (75%) apresentavam estadiamento clínico (EC) IV ao diagnóstico. O perfil histopatológico apresentou 100% de adenocarcinoma, sendo uma amostra com áreas papilíferas, três moderadamente diferenciadas, três metastáticas e uma bem diferenciada. Conclusão: O perfil clínico-epidemiológico estabelecido foi maior prevalência de câncer de vesícula biliar em mulheres, com média de idade na sétima década. Predominou a cólica biliar como sintoma. O padrão de adenocarcinoma foi identificado em todos os indivíduos. Três quartos dos indivíduos apresentavam estágio avançado de doença. (AU)

Objective: to describe the clinical-epidemiological profile of patients diagnosed with gallbladder cancer, and to identify tumor staging established at the time of diagnosis, as well as the histopathological pattern at the biopsy. Methods: This is a cross-sectional and descriptive study, carried out in a reference service of clinical oncology, based on secondary analysis of data corresponding to the medical records of patients diagnosed with Gallbladder cancer seen between January-2007 and January-2017. Results: Gender distribution was of five women (62.5%), and three men (37.5%). Patients' ages ranged from 47-74 years, mean age of 61.1 years and standard deviation of ±9.03). No patient was asymptomatic at diagnosis, six (75%) had right hypochondrium pain, two (25%) showed weight loss, and two others (25%), palpable mass. Of the eight patients, six (75%) had EC IV staging at diagnosis. The histopathological profile showed 100% of adenocarcinoma, with one sample having papilliferous areas, three being moderately differentiated, three metastatic, and one well differentiated. Conclusion: The clinical-epidemiological profile established in this study had a higher prevalence of gallbladder cancer in women, with a mean age of the individual around the 7th decade. The most frequent symptom was biliary colic. The adenocarcinoma pattern was identified in all individuals. Three-quarters of them had advanced disease. (AU)

Level of human development is associated with cervical cancer stage at diagnosis.

The objective was to describe the cervical cancer cases in Brazil by the age-group and stage at diagnosis, and to associate them with the human development index (HDI), where the women live. This was a retrospective study that used data from the Brazilian hospital-based cancer registry from 2005 to 2014. The data were accessed by 5-year age/groups and the federal units. The association between the proportion of cases at Stage I and HDI was estimated in an adjusted linear regression analysis. Among the staged cases, the proportions of cases diagnosed at FIGO Stage I, II, III and IV were 21.2%, 30.7%, 39.9% and 8.2%, respectively. The cases were diagnosed mostly in women aged 45-49 years. There was a significant increase in the proportion of Stage I cases with an increasing HDI (coefficient, 0.46; 95% confidence interval, 0.17-0.76). In conclusion, most of the cases were diagnosed at late stages. The stage at the diagnosis was associated with the human development level. Impact Statement What is already known on this subject? The stage at diagnosis varies according to the level of organisation of the cancer control programme. It is expected that in well-developed programmes there will be a shift to an early stage diagnosis. What the results of this study add? The stage at a diagnosis was associated with the human development level where the women live in Brazil, where most cases were diagnosed at the late stages. What the implications are of these findings for clinical practice and/or further research? This analysis can help with better planning strategies for cancer control. Regional strategies would improve the efficiency of cancer care interventions in countries with large socioeconomic disparities.

Epidemiological and histopathological aspects of primary cutaneous melanoma in residents of Joinville, 2003-2014.

BACKGROUND: The worldwide incidence of cutaneous melanoma (CM) has been continuously increasing over the last decades. Primary and secondary prevention, with attention to risk factors and early diagnosis, remain the cornerstone for reducing the burden of cutaneous melanoma. Detailed information with respect to clinical and pathological data on cutaneous melanoma is scarce in Brazil. OBJECTIVE: The purpose of our study was to analyze epidemiological and pathological characteristics of primary cutaneous melanoma in Joinville, southern Brazil. METHODS: Observational, cross-sectional, retrospective study in which 893 reports of primary cutaneous melanoma from the local population were analyzed in the period 2003-2014. The study was approved by the local Ethics and Research Committee. RESULTS: We observed a female predominance of cutaneous melanoma (56.3%). The age standardized incidence rate of primary cutaneous melanoma for the world population in the period 2003-06 was 11.8 per 100,000 population (CI 95%, 10.3-13.4), and 17.5 (CI 95%, 15.7-19.3) in 2011-14, revealing a significant increase of 48.3% (p < 0,05). Six and a half percent of patients had multiple cutaneous melanomas (mean 2.2 years and a maximum of 10.0 years between diagnoses). We observed significant differences between the location head/neck and cutaneous melanoma in situ, lower limb with Breslow depth S III and upper limb with Breslow depth S I. The comparison of the characteristics of cutaneous melanoma in the elderly and non-elderly (< 60 years old) showed significant differences with respect to all the variables studied. STUDY LIMITATIONS: Using secondary data source. CONCLUSION: Joinville has high incidence coefficients for Brazilian standards, showing an increase in the incidence of cutaneous melanoma.

Epidemiological and histopathological aspects of primary cutaneous melanoma in residents of Joinville, 2003-2014

Abstract: Background: The worldwide incidence of cutaneous melanoma (CM) has been continuously increasing over the last decades. Primary and secondary prevention, with attention to risk factors and early diagnosis, remain the cornerstone for reducing the burden of cutaneous melanoma. Detailed information with respect to clinical and pathological data on cutaneous melanoma is scarce in Brazil. Objective: The purpose of our study was to analyze epidemiological and pathological characteristics of primary cutaneous melanoma in Joinville, southern Brazil. Methods: Observational, cross-sectional, retrospective study in which 893 reports of primary cutaneous melanoma from the local population were analyzed in the period 2003-2014. The study was approved by the local Ethics and Research Committee. Results: We observed a female predominance of cutaneous melanoma (56.3%). The age standardized incidence rate of primary cutaneous melanoma for the world population in the period 2003-06 was 11.8 per 100,000 population (CI 95%, 10.3-13.4), and 17.5 (CI 95%, 15.7-19.3) in 2011-14, revealing a significant increase of 48.3% (p < 0,05). Six and a half percent of patients had multiple cutaneous melanomas (mean 2.2 years and a maximum of 10.0 years between diagnoses). We observed significant differences between the location head/neck and cutaneous melanoma in situ, lower limb with Breslow depth S III and upper limb with Breslow depth S I. The comparison of the characteristics of cutaneous melanoma in the elderly and non-elderly (< 60 years old) showed significant differences with respect to all the variables studied. Study limitations: Using secondary data source. Conclusion: Joinville has high incidence coefficients for Brazilian standards, showing an increase in the incidence of cutaneous melanoma.

Distribución etaria y estadio del cáncer de mama en la ciudad de Córdoba 2004/2010: un enfoque epidemiológico

RESUMEN: La epidemiología y la clínica son imprescindibles para detectar lesionestempranas, además de disminuir el gasto público, contribuyen a una mayorcalidad de vida, disminuyendo la posibilidad de la discapacidad ,al detectar laspatologías en forma temprana. El estudio se realizó en el ámbito público de laCiudad de Córdoba durante el período 2004 al 2010;en las Instituciones que sedetallan a continuación: Hospital Nacional de Clínicas (HNC), HospitalUniversitario de Maternidad y Neonatología (HUMN), Hospital San Roque(HSR), Hospital Misericordia (HM). En tales establecimientos se investigaronlos registros de los Servicios de Anatomía Patológica donde se identificó elnúmero de historias clínicas, como asi también los datos proporcionados por elServicio de Estadística Se estudiaron 1423 historias de mujeres con cáncer demama como primer diagnóstico, el mayor número de pacientes con éstapatología se encontró, proporcionalmente, en el HNC. Las variables de estudiofueron: edad, estadio del cáncer (temprano ó tardío), grado de diferenciacióndel tumor, marcadores tumorales, tendencia de aparición del cáncer de mamadurante el período estudiado, y las características de antecedentes familiaresde las pacientes analizadas. La distribución media de la edad de las pacientesregistradas en total fue de 57,08 ± 0,36 años, con una mínima de 20 años yuna máxima de 96 años. Las mujeres con cáncer de mama, de 39 años o másjóvenes, mostraron una frecuencia mayor que las informadas en otros países.En relación a la edad de primer diagnóstico, el 8,74% de las mujeresestudiadas eran menores o iguales a 39 años, lo cual representa una mayorproporción a los valores informados en la literatura mundial que refieren entreel 5% y 7%. En este estudio , las instituciones que registran mayor cantidad depacientes iguales o menores de 39 años fueron el HUMN y HM...

ABSTRACT: Both epidemiology and clinical studies are essential to detect early lesionsthatin addition to reducing public expenditurethat can be allocated to most neededareas,contribute to a better quality of life, reducing the likelihood of disability bydetectingdiseases at an early stage.The aim of this study, that was carried out in the public setting of the City ofCordoba throughout 2004-2010, was to analyze the age, stage andepidemiological features of breast cancer in those women who attended themedical consultation over the aforementioned period.The hospitals participating in this study were the following:: National ClinicalHospital (NCH), Maternity and Neonatology University Hospital (MNUH), SanRoque Hospital (SRH) and Mercy Hospital (MH). In suchinstitutions, medicalrecords obtained from the Pathological Anatomy and Statistics Servicesconcerning the anatomopathological records of each patient were investigated.One thousand four hundred and twenty three women with breast cancer as theirfirst diagnosis were studied. The largest records of women with this diseasewere, proportionately, found in the NCH. The study variables were: age, cancerstage, (early or late), degree of tumor differentiation, tumor markers, trend ofbreast cancer occurrence during the analyzedperiod and features of familyhistory of patients investigated.The average age distribution of the recorded patients was in all 57,08± 0,36years with a minimum of 20 years and a maximum of 96. Women with breastcancer, 39 years of age or younger showed a higher frequency than thosereported in other countries.Concerning the age of first diagnosis, 8,74% of the studied women were lessthan or equal to 39 years, This represents a greater proportion regarding thevalues reported in the world literature referring between 5% and 7%. In thisstudy, the institutions recording as many patients equal to or less than 39 yearswere the MNUH and the MH...

Clinical and epidemiological characteristics of patients in the head and neck surgery department of a university hospital.

CONTEXT AND OBJECTIVES: Head and neck cancer is the fifth most common type of cancer worldwide. The objective of this study was to evaluate the clinical and epidemiological parameters in a head and neck surgery service. DESIGN AND SETTING: Cross-sectional study using patients' records, developed in otolaryngology and head and neck department of a university hospital in the northwest of the state of São Paulo. METHODS: A total of 995 patients in the head and neck surgery service between January 2000 and May 2010 were evaluated. The variables analyzed included: age, gender, skin color, tobacco and alcohol consumption, primary site, staging and histological tumor type, treatment and number of deaths. RESULTS: The disease was more frequent among men (79.70%), smokers (75.15%) and alcohol abusers (58.25%). The most representative sites were oral cavity (29.65%) and larynx (24.12%) for the primary site; squamous cell carcinoma (84.92%) was the most frequent histological type, and surgery (29.04%) and radiotherapy (14.19%) were the most common treatments. CONCLUSION: The cancer that affects patients assisted by the head and neck surgery service occurs mainly men, smokers and alcohol abusers, and the oral cavity and larynx are the sites with the highest incidence. The high rate of patients with stages III and IV indicates late diagnosis by the treatment centers, which reflects the need for prevention education campaigns for early diagnosis of the disease.

A tomografia por emissão de pósitrons com 2-[18F]-fluoro-2-desoxi-D-glicose é custo-efetiva em pacientes com câncer de pulmão não pequenas células no Brasil / 2-[18F]-fluoro-2-deoxy-D-glucose positron-emission tomography is cost-effective in the initial staging of non-small cell lung cancer patients in Brazil

OBJETIVO: Comparar a acurácia e a custo-efetividade do estadiamento metabólico (EM) com o FDG-PET em relação ao estadiamento convencional (EC) no estadiamento inicial de pacientes com câncer de pulmão não pequenas células (CPNPC). MATERIAIS E MÉTODOS: Noventa e cinco pacientes com diagnóstico inicial de CPNPC foram estadiados antes do início do tratamento. Os resultados do EC e EM foram comparados quanto a definição do tratamento e incidência de toracotomia fútil em cada estratégia. RESULTADOS: O EM com FDG-PET classificou 48,4% dos pacientes como estádio mais avançado e 5,3% como menos avançado. O resultado do EM modificaria o tratamento em 41% dos pacientes. A toracotomia foi considerada fútil em 47% dos pacientes com EC e em 19% dos casos com EM. O custo das toracotomias fúteis em oito pacientes no EM foi de R$ 79.720, enquanto em 31 pacientes no EC seria de R$ 308.915. Apenas esta economia seria mais que suficiente para cobrir os custos de todos os exames de FDG-PET nos 95 pacientes (R$ 126.350) ou de FDG-PET/CT (R$ 193.515). CONCLUSÃO: O EM com FDG-PET tem maior acurácia que o EC em pacientes com CPNPC. A FDG-PET e FDG-PET/CT são custo-efetivas e sua utilização se justifica economicamente na saúde pública no Brasil.

OBJECTIVE: To evaluate the accuracy and cost-effectiveness of metabolic staging (MS) with FDG-PET as compared with the conventional staging (CS) strategy in the preoperative staging of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: A total of 95 patients with initial diagnosis of NSCLC were staged before undergoing treatment. The MS and CS results were compared with regard to treatment definition and incidence of futile thoracotomies with both strategies. RESULTS: Metabolic staging with FDG-PET upstaged 48.4% and downstaged 5.3% of the patients, and would lead to change in the treatment of 41% of cases. Thoracotomy was considered as futile in 47% of the patients with CS, and in 19% of the patients with MS. The cost of futile thoracotomies in eight patients with MS was R$ 79,720, while in 31 patients with CS it would be R$ 308,915. Just such saving in costs would be more than enough to cover the costs of all FDG-PETs (R$ 126,350) or FDG-PET/CTs (R$ 193,515) for the 95 patients. CONCLUSION: The metabolic staging with FDG-PET is more accurate than CS in patients with NSCLC. Both FDG-PET and FDG-PET/CT are cost-effective methods and their utilization is economically justifiable in the Brazilian public health system.

Clinical and epidemiological characteristics of patients in the head and neck surgery department of a university hospital / Características clínicas e epidemiológicas de pacientes do departamento de cirurgia de cabeça e pescoço em um hospital universitário

CONTEXT AND OBJECTIVES: Head and neck cancer is the fifth most common type of cancer worldwide. The objective of this study was to evaluate the clinical and epidemiological parameters in a head and neck surgery service. DESIGN AND SETTING: Cross-sectional study using patients' records, developed in otolaryngology and head and neck department of a university hospital in the northwest of the state of São Paulo. METHODS: A total of 995 patients in the head and neck surgery service between January 2000 and May 2010 were evaluated. The variables analyzed included: age, gender, skin color, tobacco and alcohol consumption, primary site, staging and histological tumor type, treatment and number of deaths. RESULTS: The disease was more frequent among men (79.70%), smokers (75.15%) and alcohol abusers (58.25%). The most representative sites were oral cavity (29.65%) and larynx (24.12%) for the primary site; squamous cell carcinoma (84.92%) was the most frequent histological type, and surgery (29.04%) and radiotherapy (14.19%) were the most common treatments. CONCLUSION: The cancer that affects patients assisted by the head and neck surgery service occurs mainly men, smokers and alcohol abusers, and the oral cavity and larynx are the sites with the highest incidence. The high rate of patients with stages III and IV indicates late diagnosis by the treatment centers, which reflects the need for prevention education campaigns for early diagnosis of the disease.

CONTEXTO E OBJETIVOS: O câncer de cabeça e pescoço é o quinto tipo mais comum entre todas as neoplasias no mundo. O objetivo do estudo foi avaliar os parâmetros clínicos e epidemiológicos em um serviço de cirurgia de cabeça e pescoço. TIPO DE ESTUDO E LOCAL: Estudo transversal com coleta de dados de prontuários, realizado no departamento de otorrinolaringologia e cabeça e pescoço de um hospital universitário do noroeste do estado de São Paulo. MÉTODOS: Um total de 995 pacientes do serviço de cirurgia de cabeça e pescoço foi avaliado entre janeiro de 2000 a maio de 2010. As variáveis analisadas foram: idade, gênero, cor da pele, consumo de álcool e tabaco, sítio primário, estádio e tipo histológico do tumor, tratamento e número de mortes. RESULTADOS: A doença foi mais frequente entre homens (79,70%), tabagistas (75,15%) e etilistas (58,25%). Os locais mais representativos foram: cavidade oral (29,65%) e laringe (24,12%) para sítio primário; carcinoma espinocelular (84,92%) foi o tipo histológico mais frequente e cirurgia (29,04%) e radioterapia (14,19%) foram os tratamentos mais comuns. CONCLUSÃO: O câncer que afeta os pacientes assistidos pelo serviço de cirurgia de cabeça e pescoço ocorre, em sua maioria, entre homens, tabagistas e etilistas, tendo a cavidade oral e a laringe maior incidência. A alta taxa de pacientes com estádios III e IV indica diagnóstico tardio pelos centros de tratamento, o que reflete a necessidade de campanhas de prevenção para o diagnóstico precoce da doença.

Tumor renal maligno: análise das características clínicas, anatomatológicas e sobrevida dos pacientes nefrectomizados / Malignant renal tumor: analyze of clinical characteristics, anatomopathological and survival of nephrectomized patients

Analisar as características dos pacientes nefrectomizados por tumor renal maligno, para avaliar possibilidade de implantação do nomograma desenvolvido pelo Hospital Memorial Sloan-Kettering Cancer Center. Análise dos pacientes nefrectomizados por tumor pelos grupos de Urologia e Oncologia do Hospital Universitário de Taubabé e Hospital Regional do Vale do Paraíba, no período de 1998 a 2003, por análise de prontuário e contato telefônico. Na comparação de percentagens entre o estado atual dos pacientes (83,33 por cento) e a média da sobrevida estimada pelo nomograma (77,18 por cento) não houve significância estatística (p = 1). O nomograma pode ser aplicado para esta população.

In order to analyze the characteristics of the patients with malignant renal tumor submitted the nephrectomy surgery, and evaluate the possibility implantation of the nomogram developed by the Memorial Sloan-Kettering Cancer Center. The analysis of patients who were submitted to surgery for tumor by the group of Urology in Taubaté University Hospital and Vale do Paraíba's Regional Hospital from 1998 to 2003, for handbooks and telephonic contact. There was not significant diference (p = 1) between the actual condition of the patients (83.33 per cent) and the average of survivors estimated by the nomogram (77.18 per cent). The nomogram is applied for this population of this study.

[Esophageal cancer: epidemiological, clinical, and pathological characteristics at Hospital Rebagliati (Lima)]. / Cáncer de esófago: características epidemiológicas, clínicas y patológicas en el Hospital Rebagliati - Lima.

UNLABELLED: Esophageal cancer is one of the most aggressive malignancies of the digestive tract, with high morbidity and mortality. OBJECTIVE: identify the clinical and pathological characteristics of esophageal cancer at Hospital Nacional Edgardo Rebagliati Martins (EsSALUD), in Lima (Peru). MATERIALS AND METHODS: review of hospital charts of patients with histological diagnosis of esophageal cancer from 2001 to 2006. RESULTS: 106 patients with diagnosis of primary esophageal neoplasm were recruited. The most affected age group was between 60 and 80 years old, with predominance of men over women in a 3:1 ratio. Smoking was documented in 39% of patients, 10% showed heavy smoking. Use of alcoholic beverages was observed in 37% of patients, 8% were alcoholics. The mean disease duration was three months, ranging from 1 to 24 months. The predominant clinical characteristics were dysphagia (98%), weight loss (73%), and hyporexia (64%). The most frequent location of tumor was the lower third, followed by the middle third, and cancer was mostly proliferating and stenosing. Histologically, the most frequent types were epidermoid carcinoma (82.1%) and adenocarcinoma (16%). Esophageal resection and gastric pull-up were only feasible in 25% of patients; out of these 11% were at stage I, 37% at stage II, 37% at stage III, and 15% at stage IV. CONCLUSION: At Hospital Rebagliati, epidermoid carcinoma is the most frequent malignancy of the esophagus, and diagnosis is generally determined at advanced stages of the disease.

[Surgical outcome of 801 patients with localized gastric cancer treated with d2 lymphadenectomy]. / Cancer gastrico localizado :resultados quirurgicos de 801 pacientes tratados con linfadenectomia d2.

BACKGROUND: D2 gastrectomy has been regarded as an inconvenient procedure with high morbidity and no survival benefit in the West. Recent studies, however, have shown low mortality and a survival benefit of D2 gastrectomy. In the Instituto de Enfermedades Neoplasicas (INEN) of Lima Peru D2 gastrectomy is performed since 1990 after training of some of the authors in the NCC of Tokyo Japan. Distal Pancreatectomy was performed only if the pancreas was involved.The aim of this study was to evaluate the peri operative mortality and survival in a group of patients who had a standard D2 lymphadenectomy according to the rules of the Japanese Research Society for Gastric Cancer. Data were collected prospectively, and patients were followed for more than 7 years. METHODS: Between 1990 and 1999, 938 patients with localized gastric cancer were registered at INEN. Of these, 801 patients underwent curative resection with extended lymphadenectomy (D2). Postoperative morbidity/mortality, type of gastrectomy, mean of lymph nodes removed, pTNM stages and Survival Time and were analyzed. RESULTS: Sub total distal gastrectomy was performed in 511 patients and total gastrectomy in 290 patients. The mean number of lymph nodes removed was 46.48 per patient (54.91 nodes for total and 41.69 for sub total distal gastrectomy). Hospital mortality was 2.9%. 11% were Stage (TNM) IA, 9.4% stage IB, 19% stage II, 24.6% stage IIIA, 13.1% stage IIIB and 23% stage IV. Five-year actuarial survival was 47.5%. Five-year survival of patients with TNM stages IA, IB, II, IIIA, IIIB and IV were 85.8%, 79.4%, 60%, 46.7% 33% and 14.3% respectively. CONCLUSIONS: Gastrectomy with D2 lymphadenectomy may be performed with low morbidity and mortality if the operation is performed in specialized centers with a strict quality control system, and without removing the pancreas during total gastrectomy unless it is suspected to be involved. This procedure could provide a good probability of long-term survival, even for patients with invaded regional lymph nodes.

Iatrogenic and non-iatrogenic positive margins: incidence, site, factors involved, and time to PSA progression following radical prostatectomy.

INTRODUCTION: There are conflicting data regarding the incidence, site and prognostic significance of positive margins resulting from iatrogenic incision into the prostate (pT2+) or non-iatrogenic inability to excise extraprostatic extension (EPE) of tumor. MATERIALS AND METHODS: The surgical specimens were whole-mount processed. Nerve-sparing, tumor extension and Gleason score were considered possible factors involved in positive margins. Time to PSA progression was studied using a Kaplan-Meier product-limit analysis. RESULTS: Positive margins resulted from iatrogenic incision in 61/230 (26.52%) prostates and from EPE in 34/230 (14.78%) prostates. The site most frequently involved in pT2+ prostates was the posterolateral quadrants (40.98%); in cases with EPE both anterolateral and posterolateral quadrants (67.65%) were most frequently involved. Positive margins occurred equally in patients with and without nerve-sparing in both groups. Tumors were significantly more extensive and with higher Gleason score in patients with EPE. Time to PSA progression was similar in patients with pT2+ versus EPE and no invasion of the seminal vesicle, but was significantly shorter in patients with EPE and invasion of the seminal vesicle. CONCLUSION: The frequency of positive margins in our institution was similar to others with large experience in performing radical prostatectomies. The higher frequency of posterolateral quadrants in iatrogenic positive margins is probably related to the preservation of adjacent vital structures and not to nerve-sparing surgery. A trend for a decreasing frequency of non-iatrogenic surgical margins may be explained by the marked increase of clinical stage T1c in recent years. More-extensive tumors and higher Gleason scores seem to influence only non-iatrogenic positive margins. Biochemical (PSA) progression in EPE must be studied by stratifying the patients into two groups: with and without seminal vesicle invasion.

Interobserver agreement of Gleason score and modified Gleason score in needle biopsy and in surgical specimen of prostate cancer.

INTRODUCTION: Gleason score, which has a high interobserver variability, is used to classify prostate cancer. The most recent consensus valued the tertiary Gleason pattern and recommended its use in the final score of needle biopsies (modified Gleason score). This pattern is considered to be of high prognostic value in surgical specimens. This study emphasized the evaluation of the modified score agreement in needle biopsies and in surgical specimen, as well as the interobserver variability of this score. MATERIALS AND METHODS: Three pathologists evaluated the slides of needle biopsies and surgical specimens of 110 patients, reporting primary, secondary and tertiary Gleason patterns and after that, traditional and modified Gleason scores were calculated. Kappa test (K) assessed the interobserver agreement and the agreement between the traditional and modified scores of the biopsy and of the surgical specimen. RESULTS: Interobserver agreement in the biopsy was K = 0.36 and K = 0.35, and in the surgical specimen it was K = 0.46 and K = 0.36, for the traditional and modified scores, respectively. The tertiary Gleason grade was found in 8%, 0% and 2% of the biopsies and in 8%, 0% and 13% of the surgical specimens, according to observers 1, 2 and 3, respectively. When evaluating the agreement of the traditional and modified Gleason scores in needle biopsy with both scores of the surgical specimen, a similar agreement was found through Kappa. CONCLUSION: Contrary to what was expected, the modified Gleason score was not superior in the agreement between the biopsy score and the specimen, or in interobserver reproducibility, in this study.

Interobserver agreement of gleason score and modified gleason score in needle biopsy and in surgical specimen of prostate cancer

INTRODUCTION: Gleason score, which has a high interobserver variability, is used to classify prostate cancer. The most recent consensus valued the tertiary Gleason pattern and recommended its use in the final score of needle biopsies (modified Gleason score). This pattern is considered to be of high prognostic value in surgical specimens. This study emphasized the evaluation of the modified score agreement in needle biopsies and in surgical specimen, as well as the interobserver variability of this score MATERIALS AND METHODS: Three pathologists evaluated the slides of needle biopsies and surgical specimens of 110 patients, reporting primary, secondary and tertiary Gleason patterns and after that, traditional and modified Gleason scores were calculated. Kappa test (K) assessed the interobserver agreement and the agreement between the traditional and modified scores of the biopsy and of the surgical specimen RESULTS: Interobserver agreement in the biopsy was K = 0.36 and K = 0.35, and in the surgical specimen it was K = 0.46 and K = 0.36, for the traditional and modified scores, respectively. The tertiary Gleason grade was found in 8 percent, 0 percent and 2 percent of the biopsies and in 8 percent, 0 percent and 13 percent of the surgical specimens, according to observers 1, 2 and 3, respectively. When evaluating the agreement of the traditional and modified Gleason scores in needle biopsy with both scores of the surgical specimen, a similar agreement was found through Kappa CONCLUSION: Contrary to what was expected, the modified Gleason score was not superior in the agreement between the biopsy score and the specimen, or in interobserver reproducibility, in this study.

Tumores renales quísticos, correlación clínico patológica y sobrevida / Cystic renel tumours, pathological correlation and survival

El aumento de utilización de imágenes diagnósticas en los últimos años para la evaluación de síntomas abdominales inespecíficos ha aumentado el hallazgo de masas renales asintomáticas. Entre 4 a 12 por ciento de los cánceres renales, corresponde a lesiones quísticas. Se han realizado múltiples estudios descriptivos, siendo el tratamiento de estas lesiones, aún tema en discusión. Objetivos: Los objetivos de este trabajo son: 1) evaluar la correlación de imágenes de tumores renales quísticos, con los resultados en la anatomía patológica; 2) evaluar los resultados y sobrevida en pacientes con cáncer renal quístico y 3) comparar su evolución y pronóstico con un grupo de pacientes con cáncer renal sólido. Materiales y Métodos: Se realizó una revisión retrospectiva de pacientes tratados en el Servicio de Urología del Hospital de la Pontificia Universidad Católica de Chile, por sospecha de cáncer renal quístico, entre los años 1999 y 2005. Los pacientes fueron tratados con nefrectomía parcial o radical. Para ello se evaluaron los datos clínicos, evolución y seguimiento de los enfermos. Se comparó etapa, grado de Fuhrman y sobrevida con un grupo de 47 pacientes con cáncer renal sólido, pareados por edad y sexo. Resultados: La serie está compuesta de 51 pacientes, 4 de los cuales, resultaron ser lesiones benignas. De los pacientes que presentaron cánceres renales quísticos (47 pacientes), la edad promedio de presentación fue de 57 años DE 12,3 (30-84). La distribución por sexo fue 72 por ciento hombres y 28 por ciento mujeres. Las formas de presentación fueron: 72,3 por ciento hallazgo por imágenes, 10,6 por ciento dolor abdominal, 6,3 por ciento hematuria, 2,1 por ciento masa palpable y 2,1 por ciento hematuria asociado a dolor. El tamaño tumoral promedio al TAC y anatomía patológica fue 5,4 y 4,9 cm, respectivamente. A los pacientes, se les realizó nefrectomía radical (57 por ciento) y parcial (43 por ciento). El alta quirúrgica fue en promedio a los 6,1 días. Histología: 92 por ciento carcinoma de células renales, variedad células claras, 4 por ciento mixto (células claras y papilar), 2 por ciento liposarcoma mixoideo de grasa perinefrítica y 2 por ciento indiferenciado...

Estado actual de las pacientes con cáncer de mama en estadio I y II / Present state of the patients with stage I and II breast cancer

Se realizo un estudio retrospectivo para evaluar el comportamiento epidemiológico y la supervivencia en pacientes con cáncer de mama. La muestra estuvo constituida por mujeres afectadas por esta neoplasia en estadios I y II, atendidas en el hospital "Julio Trigo López" desde 1989 hasta 1998. Se aplico el método de Kaplan-Meier para el cálculo de la supervivencia y el intervalo libre de la enfermedad. Entre los resultados más relevantes se destaca una edad promedio de 58 años al momento del diagnóstico. El 23 por ciento de las pacientes tenían el antecedente de algún familiar cercano con la enfermedad. El tiempo de vida promedio fue de 10 años, pero resultó significativamente diferente para las mujeres según el estadio clínico. El intervalo libre de la enfermedad fue mayor para las pacientes en el estadio I de la enfermedad. La opción terapéutica o el tipo histológico del tumor no resultaron factores modificadores de la enfermedad(AU)

Esofagectomía transhiatal en cáncer del tercio medio del esófago / Transhiatal esophagectomy in cancer of the middle third esophagus

Entre los años 1987 y 1999 efectuamos 46 esofagectomías transhiatales en pacientes con cáncer del tercio medio del esófago, 29 eran hombres y 17 mujeres. El promedio de edad fue de 64,4 años (rango, 51-80 años) Cuarenta y tres tumores correspondían a carcinomas epidermoides (93,5 por ciento), 2 a carcinomas adenoescamosos (4,3 por ciento) y 1 a un carcinosarcoma (2,2 por ciento). La esofagectomía y la esofagosgastrostomía cervical se realizó en un solo tiempo en todos los pacientes. El estómago se situó en el mediastino posterior en el 87 por ciento de los pacientes. No hubo muertes intraoperatorias ni tampoco reintervenciones; 32,6 por ciento presentaron complicaciones mientras que 31 pacientes (67,4 por ciento) evolucionaron sin complicaciones y reiniciaron su alimentación oral a partir del 9§ día del postoperatorio. La mortalidad operatoria fue de 6,5 por ciento. El promedio de días de hospitalización postoperatoria fue de 18,6. Tres de estos pacientes estaban en estadio I, 11 en estadio II, 18 en estadio III y 14 en estadio IV. La sobrevida fue de 9,5 por ciento a los 5 años. La esofagectomía es una técnica segura y bien tolerada, asociada con una baja morbilidad y creemos que es el procedimiento de elección para carcinomas del tercio medio del esófago

Reconstrucción faringoesofágica postresección laringofaringoesofágica total: resultados funcionales / Pharynx-esophagus reconstruction after total larynx-pharynx-esophagus resection: functional results

La reconstrucción de defectos funcionales del tracto digestivo superior debido a resecciones completas de laringe, asociada a hipofaringe y esófago cervical por cáncer primario de esta región es compleja y ha estado en constante cambio durante el presente siglo. Diversos métodos de reconstrucción han sido creados a objeto de restaurar el paso de los alimentos hacia el tracto digestivo distal a la lesión; estos métodos han ido desde el desarrollo de colgajo fasciocutáneos locales, colgajos miocutáneos pediculados a distancia hasta llegar a transposición de víscera libres. Desde 1985 hasta diciembre de 1999, se han recibido 435 casos portadores de cáncer de laringe, hipofaringe y esófago cervical, de éstos en 347 casos debió efectuarse algún tipo de cirugía como parte de su tratamiento quirúrgico; en 42 de estos casos la resección oncológica debió ser tan extensa que requirió de un proceso reconstructivo mayor del tubo digestivo: 20 casos se reconstruyeron con un tubo a partir de un colgajo miocutáneo pectoral mayor, 17 casos mediante un tubo de colgajo miocutáneo trapezial lateral, 4 casos mediante el trasplante de un segmento de yeyuno revascularizado y 1 caso mediante un ascenso gástrico. Se tuvo éxito en el logro de crear un buen pasaje alimenticio en 71,4 por ciento de los casos, con 60 por ciento para los casos con pectoral mayor, 82 por ciento para aquellos restaurados con colgajo trapezial y un 75 por ciento para aquellos en quienes se usó yeyuno libre. La mortalidad quirúrgica fue de un 7,1 por ciento para todo el grupo (3/42), siendo de un 15 por ciento para la técnica con colgajo pectoral mayor, 0 por ciento para los casos reconstruidos con trapezio, 0 por ciento para los casos reconstruidos con yeyuno