Biological and prognostic differences between symptomatic colorectal carcinomas and those detected by screening.

INTRODUCTION: Few studies have been conducted to establish the relationship between colorectal cancer screening programmes and survival adjusting by stage and, to determine whether there are differences, at a biological level, between the tumours of asymptomatic and symptomatic patients. Accordingly, the aim of this study is to evaluate clinical, biological and survival differences between symptomatic colorectal tumours and those detected by screening. STUDY METHOD: A prospective cohort study was performed of patients subjected to surgical intervention during the period 2010-2012, at different hospitals in Spain. In every case, clinical, pathological, biological and survival-related variables were obtained. RESULTS: A total of 2634 patients from the CARESS-CCR cohort were analysed; of these, 220 were diagnosed through screening. The asymptomatic patients were younger, had a higher Body Mass Index (BMI), a lower degree of perineural invasion and a less advanced T stage and nodular stage, and the tumour was frequently located on the right side of the colon. All of these differences were statistically significant. The serum tumour marker carbohydrate antigen 19.9 (CA 19.9) was found more frequently in the symptomatic patients (p < 0.05). However, no significant differences were found regarding the markers of tumour biology: Ki67 (proliferation), CD105 (angiogenesis) and the Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay (apoptosis). The patients with asymptomatic tumours had a lower mortality at five years than those diagnosed presenting symptoms. CONCLUSIONS: The detection method employed influenced the survival of patients with colorectal cancer and there were no significant biological differences between the study groups.

Clinical-pathological characteristics and short-term follow-up associated with proliferation, apoptosis and angiogenesis in a prospective cohort of patients with colorectal tumours.

We investigate the clinical and pathological features related to variations in colorectal tumour apoptosis, proliferation and angiogenesis and the influence of the latter in short-term mortality (2 years); 551 tumour samples from a prospective cohort of patients with colorectal cancer were examined and tumour biology markers were determined as follows: percentage of apoptotic cells, by the terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling technique; Ki-67 antigen, as a cell proliferation marker and density of microvessels (as a marker of angiogenesis). An increase in the percentage of cellular apoptosis is significantly related to the presence of poorly differentiated tumours, with vascular invasion (p < 0.001). The CD105 angiogenesis marker is not related to any clinical-pathological parameter except that of higher frequency in older patients (p = 0.03). Ki-67 is more frequently expressed in tumours with less nervous invasion (p = 0.05). Neither apoptosis nor angiogenesis present any significant association with short-term survival. The only marker clearly related to 2-year survival is Ki-67, which is shown to be a good prognostic factor in the multivariate analysis (hazard ratio = 0.49; 95% confidence interval = 0.27-0.90). Therefore, in a prospective cohort of colorectal cancer patients, only Ki-67 is a marker of good prognosis in short-term follow-up.

Validez del diagnóstico citológico de cáncer de pulmón por punción-aspiración transtorácica con aguja fina guiada por tomografía computarizada en un hospital comarcal. Estudio retrospectivo de 163 casos / The value of cytological diagnosis of lung cancer by computed tomography guided transthoracic fine-needle aspiration in a regional hospital. A retrospective study of 163 cases

Objetivo. El propósito del estudio es demostrar la validez del diagnóstico citológico mediante punción aspiración transtorácica guiada por tomografía computarizada (TC) especialmente en hospitales que no disponen de procedimientos diagnósticos más intervencionistas. Material y métodos. Estudio retrospectivo de 163 casos de punciones transtorácicas con aguja fina en pacientes con sospecha de cáncer de pulmón durante 2000-2009. Resultados. Ciento dieciocho punciones positivas para células malignas, 4 sospechosas, 28 negativas y 13 insuficientes. Sensibilidad: 90,76%; valor predictivo positivo: 100%. Diecisiete neumotórax (10,42%), sin necesidad de ingreso hospitalario. Conclusiones. El diagnóstico citológico de la punción transtorácica guiada por TC es un método fiable y rentable para confirmar la malignidad de nódulos pulmonares superiores a 2cm, especialmente hospitales que no disponen de equipos de cirugía torácica(AU)

Aim. The purpose of this study is to demonstrate the validity of cytological diagnosis by CT-guided transthoracic needle aspiration (TTNA), especially in hospitals that lack more intrusive diagnostic procedures. Materials and methods. A retrospective study of 163 cases of TTNA with fine needle in patients with suspected lung cancer during the period 2000-2009. Results. One hundred and eighteen punctures were positive for malignant cells, 4 suspicious, 28 negative and 13 inadequate. Sensitivity: 90.76%; positive predictive value: 100%. Pneumothorax rate:10.42% (n=17), without hospital admission. Conclusions. The cytological diagnosis of CT-guided TTNA is a reliable and cost effective method to confirm malignancy of pulmonary nodules greater than 2cm, especially in hospitals without thoracic surgery teams(AU)