RESUMEN
OBJECTIVE: The aim of this study was to elucidate the impact of pleural lavage cytology positivity on early recurrence in patients operated on non-small cell lung cancer (NSCLC). METHODS: This is a multicentre prospective cohort study of 684 patients undergoing an anatomical lung resection for NSCLC between October 2015 and October 2017 at 12 national centres. A pleural lavage was performed before and after lung resection. The association between the different predictors of early recurrence and PLC positivity was performed using univariate and multivariate logistic regression models. A propensity score analysis was performed by inverse probability weighting (IPSW) using average treatment effect (ATE) estimation to analyse the impact of PLC positivity on early recurrence. RESULTS: Overall PLC positivity was observed in 15 patients (2.2%). After two years, 193 patients (28.2%) relapsed, 182 (27.2%) with a negative PLC and 11 (73.3%) with a positive PLC (p<0.001). Factors associated to early recurrence were adenocarcinoma histology (OR=1.59, 95%CI 1.06-2.38, p=0.025), visceral pleural invasion (OR=1.59, 95%CI 1.04-2.4, p=0.03), lymph node involvement (OR=1.84, 95%CI 1.14-2.96, p=0.013), advanced pathological stage (OR=2.12, 95%CI 1.27-3.54, p=0.004) and PLC positivity (OR=4.14, 95%CI 1.25-16.36, p=0.028). After IPSW, PLC positivity was associated with an increased risk of early recurrence (OR=3.46, 95%CI 2.25-5.36, p<0.001). CONCLUSIONS: Positive pleural lavage cytology was found to be the strongest predictor of early recurrence.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Humanos , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/patología , Estudios Prospectivos , Irrigación Terapéutica , Citología , Estadificación de Neoplasias , Enfermedad Crónica , Recurrencia Local de Neoplasia/epidemiología , PronósticoRESUMEN
INTRODUCTION: Molecular screening is crucial for the care of nonsquamous non-small-cell lung cancer (NSCLC) patients. The coexistence of mutations could have important consequences regarding treatment. We described the mutational patterns and coexistence among patients and their outcomes after targeted treatment. MATERIALS AND METHODS: Data from consecutive patients with newly diagnosed nonsquamous NSCLC were prospectively collected. Next-generation sequencing analysis of mutational hotspots in the EGFR, KRAS, PIK3CA, and BRAF genes and analysis of anaplastic lymphoma kinase (ALK) rearrangement were performed. RESULTS: A total of 326 patients with nonsquamous NSCLC were identified. Of the 326 patients, 240 (73.6%) had EGFR, 141 (43.3%) KRAS, 137 (42.0%) BRAF, 130 (39.9%) PIK3CA mutation and 148 (45.4%) ALK rearrangement determined. Of the 240 with EGFR determination, 24.1% harbored EGFR mutations. Of these, 16.3% were activating mutations (43.6%, exon 19 deletion; 46.1%, exon 21; and 10.3%, exon 18) and 7.9% were nonsensitizing EGFR mutations. Furthermore, 39.0% had KRAS mutations, 2.9% BRAF mutations, 10.0% PIK3CA mutations, and 8.8% ALK rearrangements. Of the 154 stage IV patients with ≥ 1 mutations, analysis showed 19 coexisting cases (12.3%). Of 8 patients receiving targeted treatment, 6 had no response. Both responders to targeted treatment had coexistent PIK3CA mutations. CONCLUSION: Driver mutations can coexist in nonsquamous NSCLC. In our cohort, 12.3% of cases with stage IV disease had multiple mutations. Targeted treatment might not be as effective in patients with coexisting mutations; however, coexistence with PIK3CA might not preclude a response.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Terapia Molecular Dirigida , Adulto , Anciano , Anciano de 80 o más Años , Quinasa de Linfoma Anaplásico , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/terapia , Fosfatidilinositol 3-Quinasa Clase I/genética , Estudios de Cohortes , Receptores ErbB/genética , Femenino , Reordenamiento Génico , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Mutación , Estadificación de Neoplasias , Estudios Prospectivos , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas p21(ras)/genética , Proteínas Tirosina Quinasas Receptoras/genética , EspañaRESUMEN
Glandular structures are well documented to appear in peripheral nerve sheath tumors. These epithelial elements are usually present in malignant peripheral nerve sheath tumors although a few cases of glandular benign peripheral nerve sheath tumors have also been described, most of them being schwannomas. A neurofibroma with glands is considered to be a rare type of divergent differentiation, but a neurofibroma containing gland-like or pseudoglandular structures have not, to our knowledge, been described. We report a 33-year-old patient with a well-demarcated dermal neoplasm, composed of neoplastic Schwann cells, perineurial-like cells and fibroblasts in a matrix with collagen fibers and myxoid areas. A part of the tumor consisted of microcystic gland-like spaces lined by flat cells. These cells were either S100 positive or negative, with no epithelial membrane antigen, cytokeratin or CD31 immunostaining. Recognition of the presence of pseudoglandular elements in neurofibromas is important to distinguish them from other tumoral lesions, some of them with malignant potential.
Asunto(s)
Neoplasias Glandulares y Epiteliales/patología , Neurofibroma Plexiforme/patología , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Glandulares y Epiteliales/diagnóstico , Neoplasias Glandulares y Epiteliales/ultraestructura , Neurilemoma/diagnóstico , Neurilemoma/patología , Neurilemoma/ultraestructura , Neurofibroma Plexiforme/diagnóstico , Neurofibroma Plexiforme/ultraestructuraRESUMEN
Introducción: los carcinomas basocelulares (CB) localizados en zonas periorificiales y de fusión embrionaria se consideran de alto riesgo. Hemos observado que de estas localizaciones, el canto interno del ojo parece tener unas características que dan lugar a un manejo especialmente complicado de los CB. Material y métodos: se seleccionaron como casos 35 carcinomas basocelulares del canto interno del ojo (CBCIO) correspondientes a 30 pacientes y como controles 34 carcinomas basocelulares de la frente, mejillas y sien (CBOL) de 31 pacientes, todos ellos intervenidos con cirugía micrográfica de Mohs. Se evaluaron mediante estudio uni y multivariado las diferencias existentes en los siguientes datos: a) clínicos del paciente: edad y sexo; b) clínicos del tumor: tratamientos previos, tamaño tumoral, tiempo de evolución; c) histología del tumor: tipo, ulceración, estructuras infiltradas; d) cirugía: número de estadios, márgenes extirpados, defecto resultante y características de la reconstrucción, y e) seguimiento: existencia o no de recidiva. Resultados: los CBCIO tenían un menor tamaño tumoral, pero con infiltración más profunda, precisaban de un mayor número de estadios y de reconstrucciones más complejas durante el procedimiento quirúrgico y recurrieron con más frecuencia que los CBOL. Estas diferencias alcanzaron significación estadística. Conclusiones: los carcinomas basocelulares del canto interno del ojo merecen una especial consideración en cuanto a su tratamiento y se debería considerar la cirugía de Mohs como el tratamiento de elección, incluso para los casos aparentemente benignos (AU)