RESUMO
BACKGROUND: Resection of perihilar cholangiocarcinoma (pCCA) is a complex procedure with a high risk of postoperative mortality and early disease recurrence. The objective of this study was to compare patient characteristics and overall survival (OS) between pCCA patients who underwent an R1 resection and patients with localized pCCA who received palliative systemic chemotherapy. METHODS: Patients with a diagnosis of pCCA between 1997-2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS. RESULTS: Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55-1.07). CONCLUSIONS: Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.
RESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Veia Porta/fisiopatologia , Hipertensão Portal/complicações , Trombose Venosa/etiologia , Infecções por HIV/complicações , Melena/etiologiaAssuntos
Infecções por HIV/complicações , Hipertensão Portal/etiologia , Veias Mesentéricas , Veia Porta , Trombose Venosa/complicações , Adulto , Anemia/etiologia , Biópsia , Transfusão de Eritrócitos , Varizes Esofágicas e Gástricas/etiologia , Humanos , Fígado/patologia , Masculino , Melena/etiologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Síndrome Pós-Colecistectomia/diagnóstico , Colecistectomia Laparoscópica , Complicações Pós-Operatórias/diagnóstico , Cálculos Biliares/cirurgiaAssuntos
Doenças dos Ductos Biliares/diagnóstico por imagem , Colelitíase/diagnóstico por imagem , Ducto Cístico/cirurgia , Síndrome Pós-Colecistectomia/etiologia , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/cirurgia , Colangiografia/instrumentação , Colangiografia/métodos , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Colecistectomia Laparoscópica , Colelitíase/etiologia , Colelitíase/cirurgia , Conversão para Cirurgia Aberta , Ducto Cístico/diagnóstico por imagem , Endossonografia , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome Pós-Colecistectomia/diagnóstico por imagemRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose/diagnóstico , Endoscopia , Terapia Biológica/efeitos adversos , Diagnóstico Diferencial , Neoplasias Colorretais/diagnóstico , Espondilartrite/tratamento farmacológicoAssuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Produtos Biológicos/efeitos adversos , Peritonite Tuberculosa/etiologia , Tuberculoma/etiologia , Adalimumab , Adenocarcinoma/complicações , Anticorpos Monoclonais Humanizados/uso terapêutico , Antituberculosos/uso terapêutico , Ascite/etiologia , Produtos Biológicos/uso terapêutico , Carcinoma/diagnóstico , Carcinoma/secundário , Neoplasias Colorretais/complicações , Diagnóstico Diferencial , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/secundário , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/tratamento farmacológico , Espondiloartropatias/complicações , Espondiloartropatias/tratamento farmacológico , Tuberculoma/diagnóstico , Tuberculoma/tratamento farmacológico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
Changes in DNA methylation of tumor suppressors can occur early in carcinogenesis and are potentially important early indicators of cancer. The objective of this study was to assess the methylation of 25 tumor suppressor genes in bladder cancer using a methylation-specific (MS) multiplex ligation-dependent probe amplification assay (MLPA). Initial analyses in bladder cancer cell lines (n = 14) and fresh-frozen primary bladder tumor specimens (n = 31) supported the panel of genes selected being altered in bladder cancer. The process of MS-MLPA was optimized for its application in body fluids using two independent training and validation sets of urinary specimens (n = 146), including patients with bladder cancer (n = 96) and controls (n = 50). BRCA1 (71.0%), WT1 (38.7%), and RARB (38.7%) were the most frequently methylated genes in bladder tumors, with WT1 methylation being significantly associated with tumor stage (P = 0.011). WT1 and PAX5A were identified as methylated tumor suppressors. In addition, BRCA1, WT1, and RARB were the most frequently methylated genes in urinary specimens. Receiver operating characteristic curve analyses revealed significant diagnostic accuracies in both urinary sets for BRCA1, RARB, and WT1. The novelty of this report relates to applying MS-MLPA, a multiplexed methylation technique, for tumor suppressors in bladder cancer and body fluids. Methylation profiles of tumor suppressor genes were clinically relevant for histopathological stratification of bladder tumors and offered a noninvasive diagnostic strategy for the clinical management of patients affected with uroepithelial neoplasias.
