RESUMO
BACKGROUND: Although surgical resection is the only potentially curative treatment for pancreatic cancer (PC), long-term outcomes of this treatment remain poor. The aim of this study is to describe the feasibility of a neoadjuvant treatment with induction polychemotherapy (IPCT) followed by chemoradiation (CRT) in resectable PC, and to develop a machine-learning algorithm to predict risk of relapse. METHODS: Forty patients with resectable PC treated in our institution with IPCT (based on mFOLFOXIRI, GEMOX or GEMOXEL) followed by CRT (50 Gy and concurrent Capecitabine) were retrospectively analyzed. Additionally, clinical, pathological and analytical data were collected in order to perform a 2-year relapse-risk predictive population model using machine-learning techniques. RESULTS: A R0 resection was achieved in 90% of the patients. After a median follow-up of 33.5 months, median progression-free survival (PFS) was 18 months and median overall survival (OS) was 39 months. The 3 and 5-year actuarial PFS were 43.8% and 32.3%, respectively. The 3 and 5-year actuarial OS were 51.5% and 34.8%, respectively. Forty-percent of grade 3-4 IPCT toxicity, and 29.7% of grade 3 CRT toxicity were reported. Considering the use of granulocyte colony-stimulating factors, the number of resected lymph nodes, the presence of perineural invasion and the surgical margin status, a logistic regression algorithm predicted the individual 2-year relapse-risk with an accuracy of 0.71 (95% confidence interval [CI] 0.56-0.84, p = 0.005). The model-predicted outcome matched 64% of the observed outcomes in an external dataset. CONCLUSION: An intensified multimodal neoadjuvant approach (IPCT + CRT) in resectable PC is feasible, with an encouraging long-term outcome. Machine-learning algorithms might be a useful tool to predict individual risk of relapse. A small sample size and therapy heterogeneity remain as potential limitations.
RESUMO
La evaluación de las biopsias cardiovasculares proporciona una visión panorámica actual sobre el avance de la cirugía y patología cardiovascular en nuestro país, especialmente en la Gran Caracas donde se concentran los mayores centros hospitalarios. Evaluar el material de patología quirúrgica cardiovascular y su relación con la situación médica y socioeconómica de nuestro medio. Se analizaron las biopsias cardiovasculares de los últimos 7 años (2001-2007) diagnosticados en la sección de patología cardiovascular del instituto Anatomopatológico (UCV). Se compararon con los 7 años anteriores (1994-2000). Se obtuvo las frecuencias del número total de las biopsias por año (2001-2007) y de los tipos de biopsias según su naturaleza. Se describió los protocolos del estudio anatomopatológico según el tipo de patología y los criterios de diagnóstico. Se demostró un aumento progresivo de las biopsias en los últimos 7 años (n =1550) vs. (n = 669). La distribución del material (2001-2007) según su naturaleza reveló: biopsias vasculares (51,0%), biopsias vasculares (35,0%), tumores cardíacos (5,0%) biopsia pericárdicas (4,0%) y las biopsias endomiocárdicas, congénitos y misceláneas (2,0% c/uno). Este trabajo proporcionó una visión panorámica de algunas enfermedades cardiovasculares quirúrgicas. Se comprobó un predominio de valvulopatías especialmente de las estenosis aórticas y valvulopatías reumáticas así como de los tumores cardíacos y un aumento importante de traumas vasculares por armas de fuego y blancas, así como descenso de las biopsias endomiocárdicas. Estas evidencias apuntan a algunos problemas de salud en relación con la situación socioeconómica de nuestro medio.
The evaluation of the material of cardiovascular biopsies provides a present panoramic vision on the advance of the surgery and cardiovascular pathology in our country, specially in the Great Caracas where the greater centers hospitals are concentrated in which this surgical subspecialty works. It is to evaluate the material of present cardiovascular surgical pathology and its relation with the medical and socioeconomic situation of our means. The annual information of the cardiovascular biopsies of last the 7 years (2001-2007) diagnosed in the Section of Cardiovascular Pathology of Institute of Pathology was analyzed (UCV). They were compared with the numbers of the 7 previous years. (1994-2000). One obtained the frequencies of the total number of the biopsies per year (2001-2007) and of the types of biopsies according to his nature. The protocols of the pathologic study of the material were described according to the type of pathology and the criteria talked about of the diagnostic. One in the last demonstrated to a progressive increase of the biopsies 7 years (n = 1550). The distribution of the material according to its nature revealed: valvular biopsies (51,0%), vascular biopsies (35,0%), cardiac' tumours (5,0%) Pericardial biopsies (4,0%) and the endomycardial biopsies, congenital and miscellaneous material (2,0% c/one). This work provided a panoramic vision of some surgical cardiovascular diseases. A predominance of valvulopathy of the aortic stenosis and rheumatic valvulopathy was verified especially as well as of cardiovascular tumours. A real reduction of the endomiocardicas biopsies was observed and an important increase of injuries you will tilt by gunshot wound and white. These evidences indicate to some problems of health in relation to our socioeconomic situation.
