RESUMEN
For decades, adjuvant hormonal therapy has become the standard treatment of patients with estrogen receptor-positive breast cancer. Currently, the drugs available are GnRH agonists, selective estrogen receptor modulators, and aromatase inhibitors. The use of GnRH agonists represents a potentially reversible treatment that can restore ovarian function after chemotherapy. In premenopausal women, systemic therapy based on selective estrogen receptor modulators administration (e.g., tamoxifen) usually represents the standard adjuvant treatment. There are not sufficient data to recommend the routine addition of GnRH agonists to other endocrine therapies. In postmenopausal women, the disease-free survival was significantly prolonged in patients treated with aromatase inhibitor compared with those treated with tamoxifen, but the survival benefit was modest. Better results were obtained when the two drugs were administered sequentially. According to the ASCO guidelines, after 5 years of tamoxifen treatment, either tamoxifen or aromatase inhibitors therapy should be suggested for an additional 5 years. Unfortunately, most adverse events are consistent with estrogen deprivation and are common to all therapies, and the cumulative toxicity causes discontinuation and nonadherence to therapy in up to 50% of patients. Switching tamoxifen to an aromatase inhibitor may reduce adverse event incidence. Molecular-targeted therapy is useful in patients with advanced, relapsed or hormonal therapy-resistant tumors, usually as second- or third-line treatment. These drugs are usually added to aromatase inhibitors; however, currently, they have not yet been used in patients with early breast cancer.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Antineoplásicos Hormonales/efectos adversos , Antineoplásicos Hormonales/química , Neoplasias de la Mama/patología , Quimioterapia Adyuvante , Humanos , Estructura Molecular , Estadificación de NeoplasiasRESUMEN
Liver and pulmonary metastases (PMs) are relatively common in patients with colorectal cancer. The majority of metastases are suitable for surgical resection, and the effectiveness of metastasectomy is usually assessed based on overall survival (OS). Metastasectomy provides a mean 5-year OS rate of approximately 50%, but the results are better in patients with liver metastases compared to those with PMs. Unfortunately, the presence of bilateral or multiple PMs represents a relative contraindication to surgical metastasectomy. Unresectable PMs can be safely treated with percutaneous radiofrequency ablation or radiotherapy, but the reported results vary widely. Several clinical prognostic factors affecting OS after metastasectomy have been reported, such as number of PMs, hilar or mediastinal lymph node involvement, disease-free interval, age and gender, resection margins, size of the metastases, neoadjuvant chemotherapy administration, and histological type of the primary cancer. The accurate evaluation of all clinical prognostic factors, circulating and immunohistochemical markers, and the study of gene mutational status will lead to a more accurate selection of patients scheduled to metastasectomy, with the aim of improving outcome.
Asunto(s)
Ablación por Catéter , Neoplasias Colorrectales/patología , Neoplasias Pulmonares/secundario , Metastasectomía , Neumonectomía , Biomarcadores de Tumor/genética , Ablación por Catéter/efectos adversos , Ablación por Catéter/mortalidad , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/terapia , Supervivencia sin Enfermedad , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Metastasectomía/efectos adversos , Metastasectomía/mortalidad , Estadificación de Neoplasias , Selección de Paciente , Neumonectomía/efectos adversos , Neumonectomía/mortalidad , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
The approach to the axilla is an evolving paradigm, and recognition of the complexity of breast cancer (BC) biology is changing treatment options. The sentinel lymph node biopsy (SLNB) technique is based on the excision and histological examination of the axillary lymph nodes(s), which is assumed to be the first one draining from the primary tumor. SLNB can accurately stage the axilla, and several trials have shown that there are no significant differences in local recurrence and overall survival between patients treated with or without axillary node dissection (ALND) after a negative SLNB. Surgical morbidity was significantly reduced in terms of rates of lymphedema and neuropathy, with reduced hospital stay and better quality of life after the SLNB procedure. ALND can safely be omitted in patients with ≥2 positive nodes who received conservative surgery and radiotherapy, while ALND is still recommended in clinically N1 BCs, in case of ≥3 positive nodes, and when the number of positive nodes would be crucial for the choice of chemotherapy. Micrometastatic disease can be safely managed with SLNB alone, and additional identification of micrometastases with immunohistochemistry does not affect disease-free survival or overall survival. An appropriate management of the axilla is crucial for the outcome of patients with early BC, and SLNB introduction into the clinical practice dramatically changed the surgical treatment, reducing morbidity without decreasing survival. A tailored approach should be suggested in each patient with BC, considering the biology of the tumor rather than nodal involvement.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Biopsia del Ganglio Linfático Centinela , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática/patología , Estadificación de NeoplasiasRESUMEN
Proteomics allows for better understanding of the function and regulation of cancer cells mediated by intra- and extracellular signaling networks. Integrating such information with clinicopathological characteristics of the tumor may lead to either detection of disease biomarkers useful to differentiate high-from low-risk patients, or to identification of new drug targets. Adjuvant chemotherapy is currently a personalized treatment strategy, especially for breast cancer (BC) patients, and the risk assessment of each patient influences its use because the benefit strictly correlates with the level of risk. Luminal A BCs are endocrine therapy (ET)-sensitive but exhibit low sensitivity to chemotherapy, while luminal B cancers, according to the Ki-67 proliferation rate may require for chemotherapy in addition to ET, and HER2-positive tumors derive benefit from adjuvant chemotherapy containing an anthracycline, a taxane and trastuzumab for one year. Triple-negative BCs have a high degree of genomic instability exhibiting a more aggressive clinical course with respect to other types of BC, and the anthracycline-taxane regimen constitutes the standard approach. Studies considering the use of targeted approaches (drugs), including poly (ADP-ribose) polymerase (PARP-1), vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR) inhibitors, or EFGR and HER2 blockers, are still under evaluation. In the genomic era, promising new targeted-therapies are worthy of further investigation, and mTOR inhibitors have been used for patients with high-risk ER-positive and HER2-negative tumors. In the near future, genetic and molecular profiling of BC will help to better-categorize patients, determine the choice of chemotherapy in low-risk, or intensify the treatment in high-risk cancer patients, eventually revealing new targeted agents.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Quimioterapia Adyuvante/métodos , Medicina de Precisión/métodos , Proteómica/métodos , Neoplasias de la Mama Triple Negativas/tratamiento farmacológico , Adulto , Neoplasias de la Mama/metabolismo , Receptores ErbB/metabolismo , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Antígeno Ki-67/metabolismo , Persona de Mediana Edad , Poli(ADP-Ribosa) Polimerasa-1 , Poli(ADP-Ribosa) Polimerasas/metabolismo , Pronóstico , Receptor ErbB-2/antagonistas & inhibidores , Receptor ErbB-2/metabolismo , Serina-Treonina Quinasas TOR/metabolismo , Trastuzumab/uso terapéutico , Neoplasias de la Mama Triple Negativas/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismoRESUMEN
The lung is a common site of metastases, whose prevalence varies as a function of the primary tumor site, which is usually colorectal cancer (CRC), breast carcinoma, or genitourinary cancers, such as ovary, urinary bladder and renal cell carcinomas. The aim of the present study was to analyze whether the site of primitive tumor affects overall survival (OS) of patients with lung metastases (LMs) who underwent pulmonary metastasectomy. The data of 41 patients with surgically treated CRC (Group A=22 patients) and non-colorectal carcinomas (Group B=19 patients), who developed matachronous LMs and underwent pulmonary metastasectomy with curative intent, were analyzed. The origin of non-colorectal LMs was genitourinary cancer in nine and breast cancer in 10 patients. Overall, there were 22 men and 19 women, with a median age of 65 years (range=31-80); 18 patients had a solitary metastatic tumor, while 23 had two or more LMs. Twenty-nine patients underwent wedge resection, through thoracotomy or video-assisted thoracic surgery, while 12 underwent pulmonary lobectomy. Seventy-five LMs were resected with a 5-tear OS of 48.8%. No difference was found between elderly (≥65 year-old) and younger patients (p=0.26), and between those with solitary or multiple LMs (p=0.62) in terms of survival rate. The female patients had a worse OS (31.6% vs. 63.6%; odds ratio (OR)=3.79, 95% confidence interval (CI)=1.03-13.91, p=0.003) compared to males, independent of the origin of primary cancer. There was no difference in the cumulative survival rates (OR=1.65, 95%CI=0.48-5.69, p=0.42) between Groups and the log-rank test (p=0.75) was not significant. In conclusion, the main pathological characteristics of metastatic lesions and advanced age do not appear to be associated with a poor prognosis in patients with LMs, while the female gender is a negative prognostic factor. Thus, the primary tumor site should not be considered a major criterion in selecting patients for pulmonary metastasectomy.
Asunto(s)
Neoplasias Colorrectales/cirugía , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Metastasectomía , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Pronóstico , Factores de Riesgo , Cirugía Torácica Asistida por Video , Resultado del TratamientoRESUMEN
The molecular mechanism underlying the development of colorectal cancer (CRC) is not yet fully-understood, but there is evidence that inflammation plays a key role. Several circulating tumor and inflammatory markers can be useful for studying patients with CRC. It has been suggested that high serum levels of C-reactive protein (CRP) are associated with elevated risk of various malignancies and that CRP may affect survival of patients with CRC. We analyzed the relationship existing between the stage of the disease and baseline CRP serum levels in a group of 91 patients undergoing surgery for stage III (N=72, 79.1%) and IVa (N=19, 20.9%) CRC. There were 51 (56%) men and 40 (44%) women, with a median age of 66 years. Prior to surgery, all patients underwent quantitative serum CRP measurement. The overall 5-year survival was 37.1 ± 13.0 months. Patients with stage III disease and the sub-group with CRP<3 mg/l (N=43, 47.3%) had a longer survival (p<0.01) than patients with stage IVa and the sub-group with CRP ≥ 3 mg/l (N=48, 52.7%). No relationship between the age of the patients and CRP levels was found (R=-0.005, p=0.96), whilst there was a significant inverse relationship between survival and CRP level (R=-0.37, y=37.5343-0.5868x, p=0.0003). Using multivariate Cox model analysis (forward stepwise method), adjusted for age, CRP and CRC stage were independent parameters related to survival, with a relative risk of 3.5 (95% confidence interval=1.5-8.2) and 8.1 (95% confidence interval=3.0-21.3), respectively. In conclusion, CRP is a sensitive and easily detectable serum marker that can be useful in patients with CRC, allowing their better clinical stratification.
Asunto(s)
Biomarcadores de Tumor/sangre , Proteína C-Reactiva/análisis , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/mortalidad , Anciano , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Periodo Preoperatorio , Modelos de Riesgos Proporcionales , Tasa de SupervivenciaRESUMEN
Cholangiocarcinoma is a malignant tumor of the liver arising from the bile duct epithelium, accounting for 10-25% of all primary hepatic cancers. The clinical presentation of this tumor is not specific and the diagnosis of early cholangiocarcinoma is difficult, especially in patients with other biliary diseases. Measurement of serum carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) are commonly used to monitor response to therapy, but are also useful for confirming the presence of a cholangiocarcinoma. In this setting, other biomarkers have been previously tested, including cytokeratin-19 fragment (CYFRA 21-1) and the matrix metalloproteinase-7 (MMP7). The purpose of this retrospective study was to determine the clinical usefulness of the assay of serum CEA, CA 19-9, CYFRA 21-1 and MMP7, individually and together, as tumor markers for the diagnosis of cholangiocarcinoma. Twenty-four patients (14 men, 10 women, 62.6±8.2 years of age) with histologically-confirmed cholangiocarcinoma (cases) and 25 age- and sex-matched patients with benign liver disease (controls) underwent measurement of these biomarkers. The mean values of all serum markers of patients with cholangiocarcinoma were significantly higher (p<0.01) than that of the controls. No correlation was found between serum tumor markers and total bilirubin, aspartate aminotransferase (AST) and alkaline phosphatase (ALP). The sensitivity, specificity and accuracy were: CEA: 52%, 55%, and 58%; CA 19-9: 74%, 82% and 78%; CYFRA 21-1: 76%, 79% and 78%; MMP7: 78%, 77% and 80%, respectively. The combination of all serum markers afforded 92.0% sensitivity and 96% specificity in detecting cholangiocarcinoma, showing the highest diagnostic accuracy (94%). In conclusion, our preliminary results suggest that the measurement of all four biomarkers together can help in the early detection of cholangiocarcinoma.
Asunto(s)
Antígenos de Neoplasias/sangre , Neoplasias de los Conductos Biliares/sangre , Biomarcadores de Tumor/sangre , Antígeno CA-19-9/sangre , Antígeno Carcinoembrionario/sangre , Colangiocarcinoma/sangre , Queratina-19/sangre , Metaloproteinasa 7 de la Matriz/sangre , Anciano , Neoplasias de los Conductos Biliares/diagnóstico , Conductos Biliares Intrahepáticos/patología , Estudios de Casos y Controles , Colangiocarcinoma/diagnóstico , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios RetrospectivosRESUMEN
The early diagnosis of non-small cell lung carcinoma (NSCLC) is difficult, and 30-40% of patients with NSCLC develop bone metastases (BMs) during the course of their disease. Because the delayed demonstration of skeletal involvement may seriously affect survival, there is a need for early diagnosis of BMs. Unfortunately, the sensitivity of common serum tumor markers is low and they are used mainly for monitoring the efficacy of therapy and detection of recurrence. The aim of this study was to evaluate the utility of a panel of serum biomarkers in patients with NSCLC and BMs. Sixteen patients (11 males, 5 females; median age=64 years, range 54-68 years) with NSCLC and BMs (cases), and 18 age- and stage-matched patients without BMs (controls) underwent measurement of serum carboxy-terminal telopeptide of type I collagen (CTX), tartrate-resistant acid phosphatase isoform type 5b (TRAP5b) and amino-terminal propeptide of type I collagen (PINP), carcinoembryonic antigen (CEA) and fragments of cytokeratin 19 (CYFRA 21-1. CTX (443.7 ± 945.1 vs. 402.7 ± 28.4 pg/ml, p=0.003) and PINP (75.9 ± 11.4 vs. 64.1 ± 7.5 µg/l, p=0.001) were significantly higher in patients with BMs, while the mean value of the other markers did not differ (p=NS) between cases and controls. The sensitivity, specificity and accuracy were 73.3%, 86.7% and 79.4% for CTX; 55.5%, 62.5% and 58.8% for CEA; 65.0%, 78.6% and 70.6% for CYFRA; 30.4%, 76.2% and 67.6% for TRAP5b; and 72.2%, 81.2% and 76.5% for PINP, respectively. The area under the receiver operating characteristic curve (AUC) for CTX was 0.68. In conclusion, CTX and PINP measurement can be useful in monitoring patients with NSCLC during follow-up, with the aim of detecting BMs early.
Asunto(s)
Neoplasias Óseas/secundario , Carcinoma de Pulmón de Células no Pequeñas/metabolismo , Colágeno Tipo I/análisis , Neoplasias Pulmonares/metabolismo , Péptidos/análisis , Fosfopéptidos/análisis , Procolágeno/análisis , Anciano , Biomarcadores de Tumor/análisis , Neoplasias Óseas/diagnóstico , Antígeno Carcinoembrionario/análisis , Carcinoma de Pulmón de Células no Pequeñas/patología , Colágeno Tipo I/metabolismo , Femenino , Humanos , Queratina-19/análisis , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Oligopéptidos/análisis , Péptidos/metabolismo , Sensibilidad y EspecificidadRESUMEN
Splenic hamartoma (SH) is a very rare benign vascular lesion, usually asymptomatic. Although infrequent, it must be differentiated from malignant lesions, such as lymphoma or metastases, or other vascular neoplasms of the spleen. We present the case of a solid lesion of the spleen discovered incidentally in a 42-year-ol women, characterized by an unusual rapid expansive growth during four-month follow-up. The lesion, isoechoic and close to the hilum, was initially suspected to be an accessory spleen, measuring 3.5 cm in size. Four months later, magnetic resonance imaging revealed a 9-cm expansive nonhomogeneous mass in the antero-superior margin of the spleen, dislocating the stomach. The lesion exhibited central necrosis with hyper- and hypointense signal both in T1 and T2-weighted images. Due to the risk of spontaneous rupture and because malignancy could not be ruled out, the patient underwent hand-assisted laparoscopic splenectomy. Macroscopically, the spleen measured 15×12×4 cm and weighed 890 g. Cut sections revealed a single nodule of dark-red tissue sized 8.5 cm. The lesion exhibited a network of irregularly arranged and tortuous vascular channels lined by endothelium similar to splenic sinus lining cells, surrounded by aggregates of lymphocytes and macrophages resembling the pulp cords. On immunohistochemical staining the tissue was CD34 - and CD8 + and the final diagnosis was SH. In conclusion, when SH is suspected and malignancy cannot be ruled out, hand-assisted splenectomy should be considered the procedure of choice. Partial splenectomy should be preferred in children, to avoid potential risks of total splenectomy.
Asunto(s)
Hamartoma , Bazo/patología , Neoplasias del Bazo , Adulto , Diagnóstico Diferencial , Femenino , Hamartoma/diagnóstico , Hamartoma/diagnóstico por imagen , Hamartoma/patología , Hamartoma/cirugía , Humanos , Imagen por Resonancia Magnética , Esplenectomía , Neoplasias del Bazo/diagnóstico , Neoplasias del Bazo/diagnóstico por imagen , Neoplasias del Bazo/patología , Neoplasias del Bazo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Malignant pleural effusion (MPE) is common in most patients with advanced cancer, especially in those with lung cancer, metastatic breast carcinoma and lymphoma. This complication usually leads patients to suffer from significant dyspnea, which may impair their mobility and reduce their quality of life. In patients with MPE, several interventions have been shown to be useful for palliation of the symptoms, including talc pleurodesis. The aim of this study was to evaluate prognostic factors for survival of patients with symptomatic MPE who underwent palliative video-assisted thoracoscopic (VATS) talc pleurodesis. Thirty-five patients with MPE underwent VATS, evacuation of the pleural fluid and talc pleurodesis with large-particle talc. There were 22 (62.9%) males and 13 (37.1%) females, with an overall median age of 69 years (range 42-81 years). The main causes of MPE were non-small cell lung carcinoma, breast or ovarian cancer and malignant pleural mesothelioma. The age did not differ (p=0.88) between men (68.6±11.6 years) and women (68.0±8.7 years). The mean quantity of pleural effusion was 2005.7±1078.9 ml, while the overall survival was 11.2±8.9 months. We did not find any relationship between survival and gender (log-rank test, p=0.53) or underlying malignancy associated with MPE (p=0.89, 0.48 and 0.36 for secondary cancer, lung cancer and mesothelioma, respectively). Similarly, no correlation was found between survival and age of the patients (Cox's regression, p=0.44) or quantity of pleural effusion (p=0.88). Our results show that the prognosis of patients after talc pleurodesis is independent of age, gender, type of malignancy and amount of pleural effusion, thus, suggesting the utility of treating all patients with symptomatic MPE early.
Asunto(s)
Cuidados Paliativos/métodos , Derrame Pleural Maligno/tratamiento farmacológico , Pleurodesia/métodos , Talco/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/mortalidad , Derrame Pleural Maligno/etiología , Derrame Pleural Maligno/mortalidad , Cirugía Torácica Asistida por Video , Resultado del TratamientoRESUMEN
Malignant pleural effusion (MPE) is a common, debilitating complication of several types of advanced malignancy, which may significantly reduce the quality of life of patients. There are several options to treat MPE, including thoracentesis, placement of a long-term indwelling pleural catheter and chemical pleurodesis. The best treatment is still debated, but talc remains the agent of choice to achieve pleurodesis. Forty-six patients (28 men and 18 women; median age 67 years, range 47-82 years) with MPE related to different malignancies underwent video-assisted thoracoscopy talc pleurodesis. There were 26 (56.5%) patients with non-small cell lung cancer, 8 (17.4%) with breast cancer, 7 (15.2%) with pleural mesothelioma and 5 (10.9%) with other malignancies. The average operative time was 28±8 minutes, and the duration of chest tube drainage was 9.4±4.1 days. Side-effects were mild (temporary pain, fever for 2-3 days), affecting only three (12%) patients. Two patients (8%) died during hospitalization, due to progression of disease. Overall, pre- and postoperative Karnofsky performance index (KI) and Medical Research Council (MRC) dyspnea score were 62.1±12.2 vs. 71.3±13.2 (p=0.014), and 4.2±0.8 vs. 2.7±1.0 (p<0.001), respectively. A significant relationship between total amount of preoperative pleural effusion and both KI (R=-0.54, p=0.002) and MRC (R=0.64, p=0.0001) was found. No correlation (p=NS, log-rank test) was found between preoperative KI or MRC and underlying malignancy related to MPE. In conclusion, thoracoscopic large-particle talc pleurodesis is a feasible and effective treatment for MPE, significantly improving quality of life of patients.
Asunto(s)
Derrame Pleural Maligno/terapia , Pleurodesia/métodos , Calidad de Vida , Talco/administración & dosificación , Cirugía Torácica Asistida por Video , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , NeoplasiasRESUMEN
In patients with colorectal cancer (CRC) several independent prognostic factors are well-supported in the literature, including TNM stage, histological type and grade, and serum levels of carcinoembryonic antigen (CEA). All cancer cells express high levels of tissue proliferation markers, such as Ki-67 and p53, which are currently considered prognostic markers for patients with several types of cancers. We retrospectively studied 31 men (median age 65, range 48-75 years) with confirmed Dukes' B colorectal adenocarcinoma. The following parameters were recorded: age of the patients (years), baseline CEA serum levels (ng/ml), Ki-67 and p53 expression (%), and survival (months). The mean overall survival was 37.3 ± 13.7 months. The mean baseline CEA serum level was 79 ± 7.4 ng/ml, while the percentage positivity for Ki-67 and p53 in cancer tissues was 46.9 ± 19.2 and 48.7 ± 14.2, respectively. There was a significant correlation between Ki-67 and p53 expression (R=0.82, p<0.001) and an inverse relationship between survival and the expression of both Ki-67 (R=-0.67, p<0.001) and p53 (R=-0.64, p<0.001). No significant correlation was found between survival and age (R=0.22, p=0.22) or CEA (R=0.08, p=0.67). There was no relationship between CEA and age (R=0.34, p=0.06), Ki-67 (R=-0.021, p=0.90) or p53 (R=0.03, p=0.87). In conclusion, our preliminary results showed that both Ki-67 and p53 overexpression in CRC are associated with a worse outcome. In this selected group of patients, these prognostic markers were independent of age, and the preoperative CEA serum levels did not have any relationship with survival.
Asunto(s)
Adenocarcinoma/metabolismo , Neoplasias Colorrectales/metabolismo , Antígeno Ki-67/biosíntesis , Proteína p53 Supresora de Tumor/biosíntesis , Adenocarcinoma/sangre , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Antígeno Carcinoembrionario/sangre , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Pronóstico , Estudios RetrospectivosRESUMEN
Sentinel lymph node biopsy (SLNB) is currently the suggested axillary staging procedure in patients with early-stage breast cancer (BC) and usually requires intraoperative frozen-section (FS) examination of the removed nodes. However, other techniques, such as touch imprint cytology (IC), real-time reverse transcriptase-polymerase chain reaction and rapid cytokeratin immunostaining on FS may be used. The aim of this preliminary study was to assess the usefulness of intraoperative IC and FS section analysis together in improving the accuracy of sentinel lymph node evaluation in patients with early BC, who underwent SLNB. A series of 126 consecutive women (median age 52, range 34-71 years) with T1 (≤20 mm) BC, were prospectively enrolled in the study. A total of 221 axillary nodes were processed for both IC and FS intraoperative evaluation. Final pathology revealed 74 out of 221 (33.5%) nodes with metastasis, out of which 51 (68.9%) had macrometastases. Overall, 31 out of 126 (24.6%) patients were staged as having pN1mi or pN1a. The sensitivity, specificity, and accuracy in detecting metastases were 75.7%, 100% and 91.9% for FS, 70.3%, 98.6% and 89.1% for IC, and 89.2%, 100% and 96.0% for IC+FS together, respectively. The sensitivity of FS and IC did not differ significantly (p=0.46), while the combination of FS+IC showed a higher sensitivity (p=0.03), and similar accuracy. Our preliminary data confirm that IC is a simple and rapid technique with good sensitivity, suggesting that the combination of FS and IC may be useful in all patients requiring intraoperative SLNB evaluation.
Asunto(s)
Neoplasias de la Mama/patología , Secciones por Congelación , Biopsia del Ganglio Linfático Centinela , Adulto , Anciano , Femenino , Humanos , Cuidados Intraoperatorios , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
Several serum tumor markers (STMs) have been proposed for the diagnosis of colorectal cancer (CRC), but their detection should be combined to increase accuracy. The measurement of a serum biomarker panel may improve the diagnostic value of single STM and a multianalyte immunoassay approach can shorten assay time and lower sample consumption. The aim of this study was to determine whether the simultaneous multianalyte immunoassay is useful for early detection of CRC. We measured a panel of five STMs namely, carcinoembryonic antigen (CEA), cancer antigen (CA) 19-9 and 72-4, cytokeratin fragment (CYFRA) 21-1, and osteopontin, in a selected homogeneous population of 102 consecutive patients (median age 66 years, range 42-75 years) with Dukes B, G1-2, colorectal adenocarcinoma (cases) and in a group of 99 age- and sex-matched patients suffering from confirmed benign colorectal diseases (controls). Overall, 141 (70.1%) men and 60 (29.9%) women were studied. The highest sensitivity was 45.1% (osteopontin), while the highest specificity was 90.9% (CEA). The accuracy was lower, ranging from 24.9% (CA 19-9) to 67.2% (CEA). CYFRA 21-1 and CA 72-4 had similar sensitivity (35.3% and 31.4%, respectively), but a significantly different specificity (37.4% vs. 89.9%). A combination of the five markers achieved 74.1% sensitivity and 94.3% specificity. In conclusion, in patients with CRC all single STMs show low sensitivity and specificity, while the simultaneous measurement of a panel of STMs may increase the diagnostic accuracy. When the sample volume is limited, the multianalyte immunoassay can be a reliable tool for studying patients undergoing laboratory screening for CRC.
Asunto(s)
Biomarcadores de Tumor/sangre , Neoplasias Colorrectales/diagnóstico , Inmunoensayo/métodos , Adulto , Anciano , Neoplasias Colorrectales/sangre , Humanos , Persona de Mediana EdadRESUMEN
Lung cancer represents the most common malignancy in Western countries and the presence of bone metastasis (BMs) may significantly worsen the prognosis. Several urinary and serum markers are altered in patients with BMs from non-small cell lung cancer (NSCLC). The aim of this study was to assess the usefulness of two serum markers of bone remodeling in patients with NSCLC and BMs. Thirty-five patients (24 men, 11 women, median age 63 years, range 51-72 years) with NSCLC were examined. There were 16 patients with confirmed BMs (Group A), and 19 age-matched (63.5±4.9 vs. 63.7±4.4 years; p=0.88) patients without BMs (Group B). Serum levels of bone resorption marker cross-linked amino-terminal telopeptide of type I collegen (NTx), and bone formation marker bone alkaline phosphatase (BAP) were measured in both groups by enzyme-linked immunosorbent assay. Both NTx (33.5±7.2 vs. 25.6±3.1 nM bone collagen equivalent, BCE/l) and BAP (51.7±6.0 vs. 40.7±7.3 U/l) serum levels were significantly (p<0.001) different between groups (A vs. B). Using a cut-off value of 30 nM BCE/l (TNx) and 50 U/l (BAP), the sensitivity was 56.2% and 37.5%, respectively (Odds ratio, OR=0.47, 95% confidence interval, CI 0.11-1.91, p=0.48), while the specificity was 89.5% and 84.2% (OR=0.62, 95% CI 0.09-4.26, p=0.50), respectively. No correlation was found between age and both NTx (R=-0.34, p=0.08) and BAP (R=-0.10, p=0.61) among patients with BMs. In conclusion, in patients with NSCLC and BMs both NTx and BAP are specific markers of bone remodeling, but their usefulness is limited in early diagnosis of metastatic disease.
Asunto(s)
Fosfatasa Alcalina/sangre , Biomarcadores/análisis , Neoplasias Óseas/secundario , Carcinoma de Pulmón de Células no Pequeñas/secundario , Colágeno Tipo I/sangre , Neoplasias Pulmonares/patología , Péptidos/sangre , Anciano , Neoplasias Óseas/sangre , Remodelación Ósea , Resorción Ósea , Carcinoma de Pulmón de Células no Pequeñas/sangre , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Neoplasias Pulmonares/sangre , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
The aim of this study was to analyse whether preoperative serum levels of CEA and CA 15-3 correlate with oestrogen (ER) and progesterone (PR) receptor rate and MIB-1 score in elderly (>65 years) women with breast cancer (BC). Data from a series of 349 women (median age 61 years, range 26-89) with pT1-2 BC who underwent curative surgery were reviewed. Patients were divided into two groups: Group A, 237 (60.2%) women <65 years, and Group B, 157 (39.8%) women >64 years. Size of the tumour, ER, PR, CEA and CA 15-3 preoperative serum levels were higher in older patients, while the MIB-1 rate was lower. In both groups, a significant (p<0.05) inverse correlation between ER and MIB-1 was found, while there was a relationship between MIB-1 and both PG and CA 15-3 only in younger patients. These data suggest that only MIB-1 index should be considered an effective parameter for assessing tumour proliferation.
Asunto(s)
Anticuerpos Antinucleares/metabolismo , Anticuerpos Monoclonales/metabolismo , Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/metabolismo , Antígeno Carcinoembrionario/sangre , Mucina-1/sangre , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Técnicas para Inmunoenzimas , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
This study investigated whether preoperative carcinoma-associated antigen (CA) 15-3 and carcinoembryonic antigen (CEA) serum levels are predictive markers of reduced disease-free (DF) survival in women with breast cancer (BC) who have undergone curative surgery A series of 363 consecutive postmenopausal women (median age 63 years, range 47-89 years) with pT1-2, N0-1 and M0 BC who underwent curative surgery and were followed-up for at least 36 months after lumpectomy or mastectomy were reviewed retrospectively. Two groups of patients were considered: Group 1 (age 47-64 years), 203 (55.9%) patients; Group 2 (age >64 years), 160 (44.1%) patients. None of the parameters (age, size of the tumour, CA 15-3 and CEA baseline serum levels, ER and PgR rate, MIB-1 labelling index) differed between the groups. During follow-up (36-60 months) 62 (17.1%) patients developed relapse (DR) of the disease (41 and 21 among Groups 1 and 2, respectively), while 301 (82.9%) were DF. The differences were as follows (DF vs. DR): Group 1: CA 15-3 (25.0+/-11.4 vs. 31.4+/-14.6 U/l; p=0.003) and CEA serum levels (5.7+/-4.8 vs. 7.4+/-6.4 ng/ml; p=0.048). Group 2: CA 15-3 (27.9+/-13.2 vs. 20.4+/-6.5 U/l; p=0.012) and CEA serum levels (6.6+/-5.2 vs. 3.7+/-2.5 ng/ml; p=0.013). Surprisingly, in the subgroup of patients aged >65 years who developed relapse, both CA 15-3 and CEA baseline serum levels were lower than in the subgroup of DF patients. In conclusion, although serum tumour markers levels may be useful during follow-up, their baseline levels are not useful in predicting relapse in elderly patients with BC.
Asunto(s)
Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Antígeno Carcinoembrionario/sangre , Mucina-1/sangre , Recurrencia Local de Neoplasia/sangre , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/cirugía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: The objective of this study was to evaluate the relationship between oxygen partial pressure (pO(2)), awake oxymetric saturation (SpO(2)), body mass index (BMI), and percentage of excess weight loss (EWL) in extremely severe obesity (BMI >50 kg m(-2)) and hypoxemia, before and after laparoscopic Roux-en-Y gastric bypass. PATIENTS AND METHODS: A group of 11 obese patients aged 41.2 + or - 10.2 years (4 men, 7 women, median BMI=52.3 kg/m(2), range 50.2-57.1) were prospectively enrolled in the study. BMI, arterial blood gas measurements, and spirometry were obtained before and after (6 and 12 months) surgery. RESULTS: The main preoperative parameters were SpO(2)=88.3 + or - 3.9%, predicted forced vital capacity (FVC)=84.5 + or - 8.3%, predicted forced expiratory volume exhaled in one second (FEV1)=79.9+/-10.1%. No relationship (p>0.01) was found between BMI, SpO(2), and FEV1. A significant correlation between SpO(2) and both paO(2) (R=0.74, p=0.009) and EWL (R=-0.75, p=0.008) was found. Three, 6, and 12 months after surgery EWL was 18.9%, 26.4%, and 39.6% (p<0.001), respectively. At one-year follow-up SpO(2), FVC, and FEV1 were 96.2 + or - 3.2% (p<0.001), 112.3 + or - 9.9% (p<0.001), and 101.6 + or - 18.8% (p=0.003), respectively. CONCLUSION: In patients with extremely severe obesity, bariatric surgery may improve significantly both SpO(2) and spirometric parameters, and EWL represents the factor that impacted the results.
Asunto(s)
Cirugía Bariátrica , Hipoxia/cirugía , Síndrome de Hipoventilación por Obesidad/cirugía , Obesidad Mórbida/cirugía , Adulto , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Hipercapnia/etiología , Hipercapnia/cirugía , Hipoxia/etiología , Laparoscopía , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Oxígeno/sangre , Estudios Prospectivos , Espirometría , Resultado del Tratamiento , Capacidad Vital , Pérdida de PesoRESUMEN
The aim of this study was to compare the incidence of lymphoedema after different treatments of the axilla in patients with breast cancer (BC). Medical records of 205 women (median age 61 years, range 26-72 years) who underwent curative surgery for primary BC were reviewed. According to the treatment of the axilla, the study population was divided into four age- and stage-matched groups of patients: Group A (N=54 patients), sentinel node biopsy (SLNB) alone; Group B (N=48 patients), SLNB followed by axillary node (AN) sampling using ultrasound scissors (harmonic scalpel); Group C (N=53 patients), AN dissection using ultrasound scissors; Group D (N=50 patients), traditional AN dissection. The median follow-up was 22 months (range 18-28 months). The intraoperative frozen section of SLNB (Groups A and B) showed 32 out of 102 (31.4%) patients with metastasis to AN, while final pathology showed AN metastases in 20, 17, 16 and 17 patients of groups A, B, C and D, respectively (p=NS). The sensitivity of SLNB alone was 80% and that of SLNB followed by AN sampling was 95% (p=NS). At follow-up patients with lymphoedema were 2 (3.7%), 2 (4.2%), 3 (5.6%) and 8 (16%) in groups A, B, C and D, respectively (p=NS). In conclusion, AN sampling is a sensitive and low-morbidity procedure which, in conjunction with the use of harmonic scalpel, may reduce the onset of arm lymphoedema.