Sentinel lymph node biopsy as a prognostic factor in non-metastatic colon cancer: a prospective study.

PURPOSE: Around a third of node-negative patients with colon cancer experience a recurrence after surgery, suggesting poor staging. Sentinel lymph node techniques combined with immunochemistry could improve colon cancer staging. We prospectively assessed the effect of Sentinel node mapping on staging and survival in patients with non-metastatic colon cancer. METHODS: An observational and prospective study was designed. 105 patients with colon cancer were selected. Patients were classified according to node involvement as: N1, with node invasion detected by the conventional techniques; up-staged, with node invasion detected only by sentinel node mapping; and N0, with negative lymph node involvement by both techniques. Five-year survival and disease-free survival rates were analysed. Multivariate regression analyses were performed to identify prognostic factors for disease-free and overall survival. RESULTS: Sentinel node mapping was successfully applied in 78 patients: 33 % were N1; 24.5 % were up-staged (18 patients with isolated tumour cells and 1 patient with micrometastases); and 42.5 % were N0. N1 patients had the poorest overall 5-year survival (65.4 %) and 5-year disease-free survival (69.2 %) rates compared with the other two groups. No significant 5-year survival differences were observed between N0 patients (87.9 %) and up-staged patients (84.2 %). CONCLUSIONS: Patients up-staged after sentinel node mapping do not have a poorer prognosis than patients without node involvement. Detection of isolated cancer cells was not a poor prognosis factor in these patients.

Sexual dysfunction and related risk factors in a cohort of middle-aged Ecuadorian women.

Sexuality is a complex phenomena that can be affected by psychological and physiological influences, among them the climacteric. The present study aimed to assess the incidence of sexual dysfunction and related risk factors in a cohort of low socioeconomic middle-aged Ecuadorian women. For this, 385 healthy sexually active women between 40 and 65 years old accompanying patients being attended at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital of Guayaquil, Ecuador were asked to take part in the study. Subjects were surveyed using DSM IV criteria to assess sexual dysfunctions and record coital frequency over the past 12 months. Mean age of the sample was 47 +/- 5.6 years (median: 46), 43.1% were postmenopausal and a 17.9% of them were on hormone therapy (HT). A total of 53.5% maintained at least four sexual intercourses per month. Masculine erectile dysfunction and premature ejaculation was present in 21.3% and 59.2%, respectively. Female sexual dysfunction was present in a 78.4% of women included in the study. Desire dysfunction was the most frequent disorder (62.6%). The incidence of sexual dysfunction increased from 71.6% in the 40 - 44 year group, to 92.3% in the 60 - 64 year group (p < 0.05). The risk of sexual dysfunction was increased 7.6-fold when male erectile dysfunction was present (CI: 1.7 - 33.8), 5.8 in cases of premature ejaculation (CI: 2.9 - 11.3), 2.9 by marital status (married) (CI: 1.5 - 5.7) and 4.1 by antidepressant therapies (CI: 1 - 15.7), whereas schooling > or =12 years, having only one sexual partner and > or =4 intercourses per month were factors that decreased sexual dysfunction risk. In conclusion, the incidence of sexual dysfunction in this low socioeconomic Ecuadorian women cohort was higher than expected. Male sexual dysfunctions, marital status and antidepressant use were the most important predicting risk factors.