HNF4A expression as a potential diagnostic tool to discriminate primary gastric cancer from breast cancer metastasis in a Brazilian cohort.

BACKGROUND: Among the many challenges in cancer diagnosis is the early distinction between metastatic cancer and a secondary tumor. This difficulty stems from the lack of markers that offer high sensitivity and specificity and can be easily applied in routine laboratory work. An example of this challenge is distinguishing gastric metastases originating from breast cancer from a gastric primary tumor. Hepatocyte nuclear factor 4 alpha (HNF4A) has been suggested as a potential marker in these cases. The aim of this study was to analyze the expression of HNF4A, estrogen receptor (ER), progesterone receptor (PR) and gross cystic disease fluid protein 15 (GCDFP-15) in a Brazilian cohort. METHODS: We performed immunohistochemistry analysis of HNF4A, ER, PR and GCDFP-15 in 126 patients divided into three cohorts: primary breast cancer, primary gastric cancer and both types of tumors. RESULTS: Our data confirmed the sensitivity and specificity of the HNF4A marker compared to other currently used clinical markers. CONCLUSION: HNF4A alone could be a gold standard marker for distinguishing primary gastric cancer from breast metastasis, thus validating its potential clinical use, especially in populations with high genetic diversity.

Expression profiling using a cDNA array and immunohistochemistry for the extracellular matrix genes FN-1, ITGA-3, ITGB-5, MMP-2, and MMP-9 in colorectal carcinoma progression and dissemination.

Colorectal cancer dissemination depends on extracellular matrix genes related to remodeling and degradation of the matrix structure. This investigation intended to evaluate the association between FN-1, ITGA-3, ITGB-5, MMP-2, and MMP-9 gene and protein expression levels in tumor tissue with clinical and histopathological neoplastic parameters of cancer dissemination. The expression associations between ECM molecules and selected epithelial markers EGFR, VEGF, Bcl2, P53, and KI-67 have also been examined in 114 patients with colorectal cancer who underwent primary tumor resection. Quantitative real-time PCR and immunohistochemistry tissue microarray methods were performed in samples from the primary tumors. The gene expression results showed that the ITGA-3 and ITGB-5 genes were overexpressed in tumors with lymph node and distant metastasis (III/IV-stage tumors compared with I/II tumors). The MMP-2 gene showed significant overexpression in mucinous type tumors, and MMP-9 was overexpressed in villous adenocarcinoma histologic type tumors. The ECM genes MMP9 and ITGA-3 have shown a significant expression correlation with EGFR epithelial marker. The overexpression of the matrix extracellular genes ITGA-3 and ITGB-5 is associated with advanced stage tumors, and the genes MMP-2 and MMP-9 are overexpressed in mucinous and villous adenocarcinoma type tumors, respectively. The epithelial marker EGFR overactivity has been shown to be associated with the ECM genes MMP-9 and ITGA-3 expression.

A utilização do prontuário eletrônico do paciente por médicos do Hospital Municipal Dr. Munir Rafful: um estudo de caso / The use of electronic health record by doctors at the Dr. Munir Rafful Municipal Hospital: a case study / El uso de la historia clínica electrónica de los médicos en el Hospital Municipal Dr. Munir Rafful: estudio de caso

Objetivos: Caracterizar a utilização do Prontuário Eletrônico do Paciente (PEP) no Hospital Municipal Dr. Munir Rafful, na cidade de Volta Redonda. Método: Pesquisa aplicada. Foram aplicados por amostragem aleatória 60 questionários aos médicos do Hospital Municipal Dr. Munir Rafful, os quais foram respondidos e posteriormente analisados. Resultados: A maior parte dos entrevistados utiliza o Prontuário Eletrônico do Paciente (70%), sendo a maioria em hospitais ou consultórios particulares. A facilidade de leitura foi a principal vantagem apontada pelos médicos (67%) e as falhas no sistema a principal desvantagem (78%). Embora os médicos tenham apontado desvantagens em relação ao sistema, a maioria deles (95%) faria a opção pelo PEP. Conclusão: O funcionamento do Prontuário Eletrônico do Paciente e suas potencialidades, ainda são fonte de dúvidas para a maior parte dos médicos do hospital em questão. O presente estudo demonstra a necessidade da disseminação e discussão de informações a respeito do Prontuário Eletrônico do Paciente junto aos profissionais.

Objectives: To characterize the use of the Electronic Health Record (EHR) at Dr. Munir Rafful Municipal Hospital in the city of Volta Redonda. Method: Applied Research. By random sampling 60 questionnaires were applied to doctors at Dr. Munir Rafful Municipal Hospital, which were answered and subsequently analyzed. Results: The majority of subjects use the Electronic Health Record (70%), mostly in hospitals or private clinics. The ease of reading was the main advantage pointed out by physicians (67%) and the main disadvantage are the errors in the system (78%). Although doctors have pointed out disadvantages with the system, most of them (95%) would make the option for EHR. Conclusion: The operation of the Electronic Health Record and its capabilities are still a source of doubt for most of the doctors in this particular hospital. The present study demonstrates the need for dissemination and discussion of information about the Electronic Health Record with the professionals.

Objetivos: Caracterizar el uso de la Historia Clínica Electrónica (HCE) en el Hospital Municipal Dr. Munir Rafful en la ciudad de Volta Redonda. Método: Investigación Aplicada. Por muestreo aleatorio se aplicaron 60 cuestionarios a los médicos del Hospital Municipal Dr. Munir Rafful, que que luego fueron devueltos y posteriormente analizados. Resultados: La mayoría de los encuestados utiliza el Registro Electrónico de Pacientes (70%), en su mayoría en hospitales o consultorios privados. La facilidad de lectura fue la principal ventaja señalada por los médicos (67%) y los errores en el sistema la desventaja principal con relación a este método (78%). Aunque los médicos han señalado inconvenientes con el sistema, la mayoría de ellos (95%) optarían por el PEP. Conclusión: El funcionamiento del Registro Electrónico de Pacientes y sus capacidades son todavía una fuente de duda para la mayoría de los médicos del hospital en cuestión. El presente estudio demuestra la necesidad de difusión y discusión de información sobre el Registro Electrónico de Pacientes junto a los profesionales.

Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances.

BACKGROUND: A number of conditions compromise the passage of food along the digestive tract. Nasogastric tube (NGT) feeding is a classic, time-proven technique, although its prolonged use can lead to complications such as lesions to the nasal wing, chronic sinusitis, gastro-oesophageal reflux, and aspiration pneumonia. Another method of infusion, percutaneous endoscopy gastrostomy (PEG), is generally used when there is a need for enteral nutrition for a longer time period. There is a high demand for PEG in patients with swallowing disorders, although there is no consistent evidence about its effectiveness and safety as compared to NGT. OBJECTIVES: To evaluate the effectiveness and safety of PEG as compared to NGT for adults with swallowing disturbances. SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE, EMBASE, and LILACS from inception to August 2009, as well as contacting main authors in the subject area. There was no language restriction in the search. SELECTION CRITERIA: We planned to include randomised controlled trials comparing PEG versus NGT for adults with swallowing disturbances or dysphagia and indications for nutritional support, with any underlying diseases. The primary outcome was intervention failures (feeding interruption, blocking or leakage of the tube, no adherence to treatment). DATA COLLECTION AND ANALYSIS: Review authors performed selection, data extraction and evaluation of methodological quality of studies. For dichotomous and continuous variables, we used risk ratio (RR) and mean difference (MD), respectively with the random-effects statistical model and 95% confidence interval (CI). We assumed statistical heterogeneity when I(2) > 50%. MAIN RESULTS: We included nine randomised controlled studies. Intervention failure occurred in 19/156 patients in the PEG group and 63/158 patients in the NGT group (RR 0.24 (95%CI 0.08 to 0.76, P = 0.01)) in favour of PEG. There was no statistically significant difference between comparison groups in complications (RR 1.00, 95%CI 0.91 to 1.11, P = 0.93). AUTHORS' CONCLUSIONS: PEG was associated to a lower probability of intervention failure, suggesting the endoscopic procedure is more effective and safe as compared to NGT. There is no significant difference of mortality rates between comparison groups, and pneumonia irrespective of underlying disease (medical diagnosis). Future studies should include previously planned and executed follow-up periods, the gastrostomy technique, and the experience of the professionals to allow more detailed subgroup analysis.

Evidência em Cirurgia / Evidence in Surgery

Muitas são as incertezas,e várias condutas são empregadas baseadas no conhecimento acumulado a partir da experiência clínica isolada.Análise de decisão é uma ferramenta metodológica que auxilia na tomada de decisão e se baseia na abordagem sistemática de uma questão a fim de prover avaliação crítica do que efetivamente pode ser benéfico.A avaliação criteriosa das informações advindas de diferentes modelos de estudo é a maneira adequada de aproximar a evidência poduzida pela pesquisa prática clínica.Uma boa carga de evidência científica de primeiro nível foi acumulada,particulamente na cirurgia colorretal.Como cirurgiões,devemos desconsiderar nossas tendências herdadas de autonomia clínica absoluta e a prática cirúrgica pela opinião,aceitando o desafio de produzir evidência confiável para sustentar nossas decisões clínicas.

Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials / Impacto da linfadenectomia ampliada na morbidade, mortalidade, recidiva e cinco anos de sobrevida após gastrectomia por câncer: metanálise de ensaios clínicos randomizados

PURPOSE: To compare morbidity, mortality, recurrence and 5-year survival between D1 and D2 or D3 for treatment of gastric cancer. METHODS: Systematic review and meta-analysis of RCTs. Metaview in RevMan 4.2.8 for analysis; statistical heterogeneity by Cochran's Q test (P<0.1) and I² test (P>50 percent). Estimates of effect were calculated using random effects model. RESULTS: D2 or D3 was associated with higher in-hospital mortality, with RR = 2.13, p=0.0004, 95 percent CI, 1.40 to 3.25, I²=0 percent, P=0.63; overall morbidity showed higher incidence in D2 or D3, RR = 1.98, p<0.00001, 95 percent CI, 1.64 to 2.38, I² = 33.9 percent, P=0.20; operating time showed longer duration in D2 or D3, weighted mean difference of 1.05, p<0.00001, 95 percent CI, 0.71 to 1.38, I² = 78.7 percent, P=0.03, with significant statistical heterogeneity; reoperation showed higher rate in D2 or D3, with RR = 2.33, p<0.0001, 95 percent CI, 1.58 to 3.44, I² = 0 percent, P=0.99; hospital stay showed longer duration in the D2 or D3, with weighted mean difference of 4.72, p<0.00001, 95 percent CI, 3.80 to 5.65, I² = 89.9 percent, P<0.00001; recurrence was analyzed showed lower rate in D2 or D3, with RR = 0.89, p=0.02, 95 percent CI, 0.80 to 0.98, I² = 71.0 percent, P = 0.03, with significant statistical heterogeneity; mortality with recurrent disease showed higher incidence in D1, with RR = 0.88, p=0.04, 95 percent CI, 0.78 to 0.99, I² =51.8 percent, P=0.10; 5-year survival showed no significant difference, with RR = 1.05, p=0.40, 95 percent CI, 0.93 to 1.19, I² = 49.1 percent and P=0.12. CONCLUSIONS: D2 or D3 lymphadenectomy procedure is followed by higher overall morbidity and higher in-hospital mortality; D2 or D3 lymphadenectomy shows lower incidence of recurrence and lower mortality with recurrent disease, when analysed altogether with statistical heterogeneity; D2 or D3 lymphadenectomy has no significant impact on 5-year survival.

OBJETIVO: Comparar a morbidade, mortalidade, recidiva e sobrevida de cinco anos entre linfadenectomia D1 e D2 ou D3 no tratamento do câncer gástrico. MÉTODOS: Revisão sistemática metanálise de ensaios clínicos randomizados, programa Metaview, Revman 4.2.8. Heterogeneidade estatística pelo teste Q de Cochrane (P<0,1) e teste I² (P>50 por cento). Estimativas dos efeitos pelo modelo randômico. RESULTADOS: Maior mortalidade hospitalar em D2 ou D3, RR = 2.13, p=0.0004, 95 por cento IC, 1.40 a 3.25, I²=0 por cento, P=0.63; maior morbidade geral em D2 ou D3, RR = 1.98, p<0.00001, 95 por cento IC, 1.64 a 2.38, I² = 33.9 por cento, P=0.20; maior tempo operatório em D2 e D3, diferença de média ponderal de 1.05, p<0.00001, 95 por cento IC, 0.71 a 1.38, I² = 78.7 por cento, P=0.03; número de reoperações maior em D2 e D3, RR = 2.33, p<0.0001, 95 por cento IC, 1.58 a 3.44, I² = 0 por cento, P=0.99; maior tempo de permanência hospitalar em D2 e D3, diferença de média ponderal de 4.72, p<0.00001, 95 por cento IC, 3.80 a 5.65, I² = 89.9 por cento, P<0.00001; recidiva maior nos grupos D2 e D3, RR = 0.89, p=0.02, 95 por cento IC, 0.80 a 0.98, I² = 71.0 por cento, P = 0.03; mortalidade com doença recidivada maior em D1, RR = 0.88, p=0.04, 95 por cento IC, 0.78 a 0.99, I² =51.8 por cento, P=0.10; 5 anos de sobrevida mostrou diferença estatística não significante, RR = 1.05, p=0.40, 95 por cento IC, 0.93 a 1.19, I² = 49.1 por cento e P=0.12. CONCLUSÕES: Linfadenectomia D2 ou D3 está associada a maior morbidade e maior mortalidade intra-hospitalar; D2 ou D3 apresenta menor incidência de recidiva e menor mortalidade com recidiva, analisadas em conjunto, com heterogeneidade estatística; D2 ou D3 não tem impacto na sobrevida de 5 anos.

Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer. Meta-analysis of randomized clinical trials.

PURPOSE: To compare morbidity, mortality, recurrence and 5-year survival between D1 and D2 or D3 for treatment of gastric cancer. METHODS: Systematic review and meta-analysis of RCTs. Metaview in RevMan 4.2.8 for analysis; statistical heterogeneity by Cochran's Q test (P<0.1) and I(2) test (P>50%). Estimates of effect were calculated using random effects model. RESULTS: D2 or D3 was associated with higher in-hospital mortality, with RR = 2.13, p=0.0004, 95% CI, 1.40 to 3.25, I(2)=0%, P=0.63; overall morbidity showed higher incidence in D2 or D3, RR = 1.98, p<0.00001, 95% CI, 1.64 to 2.38, I(2) = 33.9%, P=0.20; operating time showed longer duration in D2 or D3, weighted mean difference of 1.05, p<0.00001, 95% CI, 0.71 to 1.38, I(2) = 78.7%, P=0.03, with significant statistical heterogeneity; reoperation showed higher rate in D2 or D3, with RR = 2.33, p<0.0001, 95% CI, 1.58 to 3.44, I(2) = 0%, P=0.99; hospital stay showed longer duration in the D2 or D3, with weighted mean difference of 4.72, p<0.00001, 95% CI, 3.80 to 5.65, I(2) = 89.9%, P<0.00001; recurrence was analyzed showed lower rate in D2 or D3, with RR = 0.89, p=0.02, 95% CI, 0.80 to 0.98, I(2) = 71.0%, P = 0.03, with significant statistical heterogeneity; mortality with recurrent disease showed higher incidence in D1, with RR = 0.88, p=0.04, 95% CI, 0.78 to 0.99, I(2) =51.8%, P=0.10; 5-year survival showed no significant difference, with RR = 1.05, p=0.40, 95% CI, 0.93 to 1.19, I(2) = 49.1% and P=0.12. CONCLUSIONS: D2 or D3 lymphadenectomy procedure is followed by higher overall morbidity and higher in-hospital mortality; D2 or D3 lymphadenectomy shows lower incidence of recurrence and lower mortality with recurrent disease, when analysed altogether with statistical heterogeneity; D2 or D3 lymphadenectomy has no significant impact on 5-year survival.

Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Systematic review and meta-analysis.

PURPOSE: The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. METHODS: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. RESULTS: Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I2 = 0% for the heterogeneity test. CONCLUSIONS: The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials.

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis / Ileostomia ou colostomia na descompressão temporária de anastomose colorretal: revisão sistemática da literatura e metanálise

PURPOSE: The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. METHODS: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. RESULTS: Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I² = 0 percent for the heterogeneity test. CONCLUSIONS: The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials.

OBJETIVO: A controvérsia entre ileostomia em alça ou colostomia em alça como a melhor forma para a descompressão temporária da anastomose colorretal motivou a realização desta revisão. MÉTODOS: Cinco ensaios clínicos casualizados foram incluídos com 334 pacientes: 168 no grupo de ileostomia e 166 no grupo de colostomia. Os resultados analisaram: 1. Mortalidade; 2. Infecção da ferida; 3. Tempo de formação do estoma; 4. Tempo de fechamento do estoma; 5. Intervalo de tempo entre a formação e o fechamento do estoma; 6. Prolapso do estoma; 7. Retração do estoma; 8. Hérnia parastomal; 9. Fistula parastomal; 10. Estenose; 11. Necrose; 12. Irritação de pele; 13. Íleo; 14. Fístula entérica; 15. Reoperação; 16. Adaptação do paciente; 17. Tempo de internação hospitalar; 18. Deiscência da anastomose colorretal; 19. Hérnia de Incisional; 20. Obstrução intestinal pós-operatória. RESULTADOS: Prolapso do estoma: p = 0.00001, mas com heterogeneidade estatística; a análise de sensibilidade foi aplicada excluindo os estudos que incluíram cirurgias de emergência: p = 0.02 e teste de heterogeneidade: I²=0 por cento. CONCLUSÕES: Os resultados encontrados não foram estatística ou clinicamente significantes, exceto prolapso do estoma. A melhor evidência para a escolha entre ileostomia em alça ou colostomia em alça necessita de maior número de ensaios clínicos.

Analysis of the correlation between p53 and bcl-2 expression with staging and prognosis of the colorectal adenocarcinoma

OBJETIVO: Analisar a correlação entre a expressão da p53 e do bcl-2 com o estadiamento e prognóstico do adenocarcinoma colorretal. MÉTODOS: Foi realizado o estudo de uma série retrospectiva de 125 doentes com adenocarcinoma colorretal (67 mulheres e 58 homens; 30 a 87 anos de idade), que se submeteram ao tratamento cirúrgico com intenção curativa. O tempo médio de seguimento foi de 28,5 meses (variação de 2 a 96 meses). O estadiamento TNM, a recidiva tumoral, a sobrevida e a mortalidade relacionada com o câncer foram analisados. A reação imunohistoquímica utilizada foi o DO& (Dako) para o p53 e o K492 (Dako) para o bcl-2. Tumores com intensidade de coloração citoplásmica para o bcl-2 e nuclear para o p53, acima de 10% de células foram considerados positivos. A análise estatística utilizada foi o teste qui-quadrado de Pearson, log-rank, Wilcoxon e estimativa de sobrevida de Kaplan-Meier (nível de significância : p<0,05). RESULTADOS: p53+ foi encontrado em 11.8% (14/118), bcl-2+ em 50% (58/116) e associados p53+/bcl-2+ em 6.4% (7/109) dos tumores. Não foi encontrado correlação significante entre a expressão tumoral destes marcadores e o estadiamento TNM I, II, III e IV (p=0.385 para a p53; p=0.461 para o bcl-2). Na recidiva tumoral, p53+ foi encontrado em 9.5% (2/21), bcl-2+ em 50% (11/22), e p53+/bcl-2+ associados em 5.2% (1/19) dos tumores (p=0.714, p=1.000 e p=0.960, respectivamente). Na análise de sobrevida, p53+: 57 meses (45.0-68.0), bcl-2+: 78 (37.0-89.0), e p53+/bcl-2+: 62 (56.0-68.0) (p=0.319). Para mortalidade relacionada com câncer, p53+: 8.3% (3/36), bcl-2+: 47.2% (17/36), e p53+/bcl-2+: 5.9% (2/36) dos pacientes (p=0.432, p=0.688 and p=0.907, respectivamente). CONCLUSÃO: Nenhuma correlação significante foi encontrada entre a expressão tumoral da p53 e do bcl-2 com o estadiamento TNM, recidiva, sobrevida e mortalidade relacionada com câncer.

Analysis of the correlation between p53 and bcl-2 expression with staging and prognosis of the colorectal adenocarcinoma.

PURPOSE: To analyze the correlation between p53 and bcl-2 expression and colorectal adenocarcinoma staging and prognosis. METHODS: This was a retrospective series of 125 colorectal adenocarcinoma patients (67 women and 58 men; ages 30-87 years) who underwent surgery with curative intent. The mean follow-up was 28.5 months (range: 2-96 months). TNM staging, tumor recurrence, survival and cancer-related mortality were analyzed. Immunoreactivity was evaluated using DO7 (Dako) for p53 and K492 (Dako) for bcl-2. Tumors with accumulation of staining for cytoplasmic bcl-2 or nuclear p53 in more than 10% of cells were considered positive. Statistical analysis utilized Pearson chi-squared, log-rank and Wilcoxon tests, and Kaplan-Meier survival estimation (significance level: p<0.05). RESULTS: p53+ was found in 11.8% (14/118), bcl-2+ in 50% (58/116) and associated p53+/bcl-2+ in 6.4% (7/109) of the tumors. There was no significant correlation between expression of these biomarkers and TNM I, II, III and IV staging (p=0.385 for p53; p=0.461 for bcl-2). For tumor recurrence, p53+ was found in 9.5% (2/21), bcl-2+ in 50% (11/22), and associated p53+/bcl-2+ in 5.2% (1/19) of the tumors (p=0.714, p=1.000 and p=0.960, respectively). For survival analysis, p53+: 57 months (45.0-68.0), bcl-2+: 78 (37.0-89.0), and p53+/bcl-2+: 62 (56.0-68.0) (p=0.319). For cancer-related mortality, p53+: 8.3% (3/36), bcl-2+: 47.2% (17/36), and p53+/bcl-2+: 5.9% (2/36) of the patients (p=0.432, p=0.688 and p=0.907, respectively). CONCLUSION: No correlation was found between tumor expression of p53 and bcl-2 and the TNM staging, recurrence, survival and cancer-related mortality in colorectal adenocarcinoma.