RESUMO
Background: Lung cancer in the young is a rare entity of great interest due to the high frequency of targetable mutations. In this study, we explored the genomic landscape of non-small cell lung cancer (NSCLC) in young patients and compared it with genetic alterations in older patients. Methods: Comparative study of the genomic profile of NSCLC young (≤40 years old) vs older patients (>40 years old) from Instituto Nacional de Enfermedades Neoplásicas (INEN) in Lima, Peru. Archival paraffin-embedded tumor samples were profiled with FoundationOne CDx assay to identify short variants alterations (insertions and deletions), copy number variations (CNV), tumor mutational burden and microsatellite instability in 324 driver genes and rearrangements in 28 commonly rearranged genes. A targetable alteration was defined as any alteration in a driver oncogene for which an FDA approved therapy existed at the time of study enrollment. Results: Overall, 62 tumors were profiled, 32 from young and 30 from older patients. All clinicopathological features (smoking status, clinical stage, and histology) were similar between groups, except for gender (65.6% of females in the younger group vs 40% in the older group, P=0.043). At least one actionable mutation was present in 84.4% and 83.3% in younger and older patients, respectively. Alteration rates in the main genes were: BRAF, 3.1%(n=1) vs 0%; EGFR, 46.9% (n=15) vs 43.3% (n=13); ERBB2, 12.5% (n=4) vs 16.7% (n=5); KRAS, 15.6% (n=5) vs 16.7% (n=5); ALK, 6.3% (n=2) vs 3.3% (n=1); RET, 0.0% vs 3.3% (n=1); ROS1, 3.1% (n=1) vs 3.3% (n=1); NTRK1, 0.0% vs 3.3% (n=1) and MET, 3.1% (n=1) vs 13.3% (n=4). Mean TMB was 4.04 Mut/Mb (SD ± 3.98) for young vs 8.06 Mut/Mb (SD ± 9.84) for older patients (P=0.016). There were not significant differences in CNV, frequency of gene rearrangements, or microsatellites instability. Conclusion: NSCLC in the young in our cohort was characterized by a high frequency of actionable genetic aberrations and a low TMB, which was also true for our older patients. The enrichment of actionable mutations in young patients described in other reports might be attributed to differences in the etiology and clinicopathological characteristics between younger and older patients and therefore not be applicable to all populations.
RESUMO
Objetivos: Determinar la tasa de prevalencia de depresión posparto en madres de uno a seis meses de periodo posparto atendidas en establecimientos de salud del primer nivel del MINSA en Lima Metropolitana; determinar además los factores socio demográficos y gineco-obstétricos asociados a ésta. Material y Métodos: Se seleccionaron mujeres en edad fértil, puérperas de Lima Metropolitana que acudían para control postnatal durante el mes de junio del 2004 a los puestos y centros de salud del MINSA. Se utilizó el inventario de predictores de Depresión Posparto (DPP) y la Escala de Depresión Posparto Post natal de Edinburgh (EPDS) como herramientas de tamizaje. Si el puntaje obtenido era mayor de diez se procedía a la entrevista clínica estructurada de DSM IV para desórdenes de depresión posparto con el objetivo de confirmar el diagnostico. Resultados: Se entrevistaron a 261 madres, con un promedio de edad de 27 años. La prevalencia de depresión posparto diagnosticada por medio del test de Edinburgh fue de 33% y con la entrevista semi-estructurada de DSM IV se confirmó una prevalencia de 24.1%. Se encontró además que el 60.9% presentaron factores estresantes, el 8.4% tenían baja autoestima, 23.8% no percibían apoyo social y 50% tuvieron blues posparto. Conclusiones: Se encontró una tasa de prevalencia de depresión posparto en Lima Metropolitana de 24%. Los factores gineco-obstétricos y el estatus socioeconómico son factores de riesgo moderado para el desarrollo de depresión posparto. Es de importancia reconocer los factores relacionales/ satisfacción marital y psicosociales como factores de alto riesgo para el desarrollo de depresión posparto en mujeres dentro de los primeros meses.
Objectives: To determinate the prevalence of Postpartum Depression in mothers between 1 to 6 months of postpartum period in Lima Metropolitana; to assess the correlates socio-demographic, and the correlates gynecologic/obstetric history. Methods: Women of childbearing age and puerperal were selected when they went to their postnatal controls to Health Centers of MINSA of Lima Metropolitana in June, 2004. There were used The Beck Postpartum Depression Predictors Inventory (BPDP) and the Edinburgh Postnatal Depression Scale (EPDS) ; these were screening tools to recognize the women with postpartum depression. If the scale was more than 10, we used the Adaptation of the Structured Clinical Interview for DSM-IV Disorders for assessing depression in women to confirm the Postpartum Depression. Results: 261 mothers were interviewed. The average age of the women was 27. The prevalence diagnosed by the Edinburgh Postnatal Depression Scale was 33%, and with the Adaptation of the Structured Clinical Interview for DSM-IV Disorders for assessing depression in women the prevalence was 24.1%, 60.9% of the women interviewed had stress factors, 8.4% had a lower self-esteem, 23.8% do not perceive social support, and approximately 50% of the women had ôbaby bluesõ. Conclusions: The Postpartum Depression prevalence in Lima Metropolitana is 24%. The Gynecologic/obstetric factors and the socioeconomic status are moderate risk factors to Postpartum Depression development. The marital satisfaction/relationship and psychosocial factors are high risk factors to Postpartum Depression development in women between 1 to 6 months.
