RESUMO
The aim of this study was to assess the validity of protein p16 expression as an indicator of progression in lesions as ASC-US and L-SIL. For this purpose, we examined 246 cytological samples (91 ASC-US, 60 L-SIL, 36 ASC-H, 59 H-SIL) of which 151 were conventional Pap-tests (CC) and 95 in liquid based cytology (LBC) with colposcopic and histology follow-up. The results showed that in the positive p16 Pap-tests a 59% PPV vs CIN2+ in all cytologic diagnoses compared to 43% in cytologic reading alone. 96% of HG cytologic lesions were positive for p16, and the data showed good correlation between positivity for p16 in the cytologic preparations and the presence of CIN2+ lesions in the histologic test (chi-square for trend p < 0.0001). The sensitivity, specificity and NPV were 93%, 52% and 91%, respectively, in all cytologic diagnostic categories. P16 was positive in 46% of ASC-US and 53% of L-SIL. The PPV vs expressed CIN2+ was higher than that observed in cytologic reading (48% vs 26%, and 31% vs 20%, respectively). The sensitivity was 83%, the specificity 67% and 54%, respectively, and the VNP was 92% and 93%. It is possible to design algorithms for colposcopic follow-up that can reduce the need to obtain a follow-up. The future application of this test may allow the creation of a bio-molecular automated pap test.
Assuntos
Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Biomarcadores/metabolismo , Inibidor p16 de Quinase Dependente de Ciclina/genética , Progressão da Doença , Feminino , Humanos , Gravidez , Reprodutibilidade dos Testes , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/metabolismo , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/metabolismo , Displasia do Colo do Útero/patologiaAssuntos
Antieméticos/uso terapêutico , Transplante de Medula Óssea/efeitos adversos , Isoquinolinas/uso terapêutico , Náusea/prevenção & controle , Quinuclidinas/uso terapêutico , Vômito/prevenção & controle , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Náusea/etiologia , Neoplasias/cirurgia , Palonossetrom , Estudos Retrospectivos , Antagonistas da Serotonina/uso terapêutico , Vômito/etiologiaRESUMO
BACKGROUND: Conflicting results have been reported about the prognostic relevance of antecedent myelodysplastic syndrome (MDS) in acute myeloid leukemia (AML) of older adults. PATIENTS AND METHODS: Data from 87 intensively treated AML patients (median age 69 years) were analyzed, with the aim of comparing therapeutic results and toxicity between de novo and AML secondary to a previous MDS (s-AML). Rate of CD34+ cells mobilization and feasibility of autologous stem cell transplantation (ASCT) were also compared. RESULTS: Complete remission rate, death in induction and primary resistance were not statistically different between the two groups. Median time for neutrophil recovery was similar, while s-AML patients required a longer time for platelet recovery (P = 0.04). There was no difference as to eligibility for consolidation as well as for mobilization and feasibility of ASCT. S-AML had negligible impact on overall survival (OS) and disease-free survival (DFS). In the multivariate analysis the only parameter significantly related to either OS or DFS duration was adverse karyotype (P = 0.02 and 0.04, respectively). CONCLUSIONS: A diagnosis of s-AML does not represent a clinically relevant prognostic factor in elderly AML patients treated with aggressive therapy. Furthermore, s-AML patients can be mobilized and autografted with comparable results as opposed to de novo cases.