RESUMEN
To evaluate certain risk and protective factors for colon cancer in our population, we conducted a paired case-control study where cases were all people diagnosed with colon cancer who were registered at the Cancer Data Exchange Systems of the Community of Madrid between January 1995 and December 1996, and controls were randomly taken from electoral lists. The study population consisted of 424 persons. Using SPSS for Windows, variables were adjusted by multiple logistic regression. The results indicate that lack of physical exercise is associated with an increased risk of colon cancer, with an odds ratio (OR) of 2.8 (95% confidence interval (CI) 1.28-6.21) as compared with moderate activity 1-2 days a week. The risk decreases linearly with increasing physical exercise, and this association remains after stratifying the analysis for the existence of constipation. The consumption of is associated with a reduced risk of colon cancer in constipated patients, with an OR of 0.094 (0.014-0.639), as is aspirin use, with an OR of 0.980 (0.898-0.999). These results were obtained after adjusting all the ORs for diet, smoking, alcohol consumption, family history and socio-demographic factors such as marital status and educational level.
Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Aspirina/administración & dosificación , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/fisiopatología , Ejercicio Físico/fisiología , Fitoterapia , Plantago , Psyllium/administración & dosificación , Anciano , Estudios de Casos y Controles , Neoplasias del Colon/epidemiología , Estreñimiento/tratamiento farmacológico , Estreñimiento/epidemiología , Estreñimiento/fisiopatología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Preparaciones de Plantas/administración & dosificación , Valor Predictivo de las Pruebas , Factores de Riesgo , España/epidemiología , Estadística como Asunto , Encuestas y CuestionariosRESUMEN
The objective of this study was to support our hypothesis that surgical resection of abdominal metastases of melanoma, regardless of symptomatology, could provide prolonged palliation and improved survival. We performed a retrospective chart review at M.D. Anderson Cancer Center. A series of 251 melanoma patients (stages I, II, or III at registration) who developed intraabdominal metastases during follow-up were studied. Altogether, 96 patients underwent 119 laparotomies; 51 underwent endoscopic or percutaneous procedures; and 116 patients were treated medically. Surgery was associated with a median survival of 11 months, significantly longer than that with other treatment (p < 0.001). Tumor was extirpated during 37% of the first laparotomies, and in an additional 33% very good palliation was achieved with incomplete resection. Tumor extirpation was associated with 10-month symptom-free survival (SFS), significantly longer than that with any other approach (p < 0.0001). In the nonsurgically treated patients, good palliation was achieved in 8% to 17% of patients with no complete response. The median SFS after surgery was 5 months, but 23% of patients were symptom-free more than 12 months; 87 patients with minimal symptoms; and 72 severely symptomatic patients underwent surgery. Complete resection was feasible in 42% and 34%, respectively. Surgery was associated with 12 months median survival in both groups. There was a significant survival benefit from surgery in patients with gastrointestinal (GI) tract metastases in contrast to those who had non-GI metastases. For the 96 surgically treated patients, a time interval of more than 4 years between diagnosis of the primary lesion and the abdominal recurrence predicted decreased risk of death (p = 0.038). The 30-day postoperative complication and mortality rates were 19.0% and 3.3%, respectively. Complete surgical resection of melanoma metastases in the abdomen is associated with median and symptom-free survival benefits. Symptomatic and asymptomatic patients benefit equally, especially if abdominal metastases appear more than 4 years after the initial diagnosis and do not involve non-GI viscera. Less than complete resection can provide durable palliation.
Asunto(s)
Neoplasias Abdominales/secundario , Neoplasias Abdominales/cirugía , Melanoma/secundario , Neoplasias Cutáneas/patología , Neoplasias Abdominales/mortalidad , Adulto , Femenino , Neoplasias Gastrointestinales/mortalidad , Neoplasias Gastrointestinales/secundario , Neoplasias Gastrointestinales/cirugía , Humanos , Masculino , Melanoma/mortalidad , Persona de Mediana Edad , Cuidados Paliativos , Estudios Retrospectivos , Análisis de SupervivenciaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Adulto , Factores de Edad , Neoplasias de la Mama/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Ciclofosfamida/administración & dosificación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Metotrexato/administración & dosificación , Persona de Mediana Edad , Historia Reproductiva , Análisis de SupervivenciaRESUMEN
We report on 21 patients surgically treated for intraparenchymal brain metastasis from sarcoma, including six osteosarcomas, four leiomyosarcomas, three malignant fibrous histiocytomas, two alveolar soft-part sarcomas, two Ewing's bone sarcomas, one extraskeletal osteosarcoma, one extraskeletal Ewing's sarcoma, and two unclassified sarcomas. Median survival after craniotomy was 11.8 months. Patients with a preoperative Karnofsky performance score of > 70 survived for 15.7 versus 6.6 months for those with a Karnofsky performance score < or = 70. Patients. undergoing complete resection survived 14.0 versus 6.2 months for patients undergoing incomplete resection. Patients with evidence of lung metastases at the time of surgery survived 11.8 months, which was similar to the 10.5-month survival for patients with disease limited to the brain. The two patients with alveolar soft-part sarcoma are alive at 16 and 25 months after surgery. We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain and that patients with metastasis from alveolar soft-part sarcoma may have a relatively good prognosis if they are surgically treated. The complete removal of all brain metastases and a Karnofsky performance score > 70 are associated with a favorable prognosis, whereas the presence of concurrent lung metastases is not a contraindication to surgery.
Asunto(s)
Neoplasias Óseas/cirugía , Neoplasias Encefálicas/secundario , Sarcoma/secundario , Neoplasias de los Tejidos Blandos/cirugía , Adolescente , Adulto , Anciano , Neoplasias Óseas/mortalidad , Neoplasias Óseas/radioterapia , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Corteza Cerebral/cirugía , Terapia Combinada , Irradiación Craneana , Craneotomía , Femenino , Estudios de Seguimiento , Humanos , Estado de Ejecución de Karnofsky , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Sarcoma/mortalidad , Sarcoma/radioterapia , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/mortalidad , Neoplasias de los Tejidos Blandos/radioterapia , Tasa de SupervivenciaRESUMEN
Breast cancer in women under 30 years old carries a poor prognosis, for reasons that have not been identified. This study aimed to identify prognostic factors in this age group. Special attention was paid to the history of pregnancy. The clinical presentation and course of breast cancer was documented for 407 women, aged 20-29 years, who registered between 1978 and 1988 at one of nine cancer centres. Eligible patients had histologically confirmed local or regional invasive breast carcinoma, and received part or all of their initial therapy at the participating hospital. For patients whose breast cancers were diagnosed during pregnancy, the risk of dying from breast cancer was significantly greater than that of women who had never been pregnant (relative risk 3.26 [95% CI 1.81-5.87], p = 0.0004). Adjustment for number of axillary nodes affected and tumour diameter reduced the relative risk only slightly (2.83 [1.24-6.45], p = 0.023). For each 1-year increment in the time between the latest previous pregnancy and breast cancer diagnosis, the risk of dying decreased by 15% (relative risk 0.85, p = 0.011). Thus concurrent or recent previous pregnancy adversely affects survival of breast cancer in young women. The size of the effect is such that it probably contributes substantially to the poor prognosis of breast cancer in this age group as a whole.
Asunto(s)
Neoplasias de la Mama/mortalidad , Complicaciones Neoplásicas del Embarazo/mortalidad , Historia Reproductiva , Adulto , Factores de Edad , Neoplasias de la Mama/patología , Femenino , Humanos , Metástasis Linfática , Embarazo , Complicaciones Neoplásicas del Embarazo/patología , Pronóstico , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
Of the 4,554 patients who registered at The University of Texas M. D. Anderson Cancer Center, Houston, Texas from 1965 to 1988 with a diagnosis of carcinoma of the breast and who underwent surgical treatment of at least one carcinoma of the breast at this institution, 142 had either a history of a prior carcinoma of the breast (metachronous; n = 55) or a contralateral carcinoma of the breast detected within four months of registration (synchronous; n = 87). We retrospectively studied the records of these 142 patients and found that the occurrence of bilateral carcinoma of the breast was low (3.1 percent), the frequency of metachronous carcinoma of the breast remained relatively constant over time, the nodal status of the second carcinoma of the breast correlated with the method of discovery rather than the stage of the first carcinoma of the breast and survival rates from the second carcinoma of the breast were similar for metachronous and synchronous disease. These data support the role of vigilant surveillance of the contralateral breast with screening at the time of initial diagnosis and during follow-up evaluation. Because the likelihood of detecting a second carcinoma of the breast at an early stage is high, with subsequent good survival rates, the use of prophylactic mastectomy should be very selective and based on the emotional needs of the patient.
Asunto(s)
Neoplasias de la Mama/epidemiología , Adulto , Anciano , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Metástasis de la Neoplasia/diagnóstico , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/epidemiología , Pronóstico , Tasa de Supervivencia , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE/METHODS: To determine the clinical behavior and outcome of breast cancer in the elderly, a series of 184 women older than age 69 years who received treatment for locoregional breast cancer at The University of Texas M. D. Anderson Cancer Center between 1976 and 1985 were studied for a median of 80 months. RESULTS: The results indicate that elderly women can tolerate standard surgical therapy and survive disease-free for many years; the breast cancer-specific survival rate of patients in this study was 79% at 7 years. Although 33% of patients had stage I disease, only 10% underwent breast conservation surgery. Despite 46% of patients having stage II and 21% having stage III breast cancer, fewer than 13% received systemic adjuvant therapy. Noncompliance with breast screening guidelines was evident in that only 3% of patients had tumors detected by routine screening mammograms and only 12% by routine physical examinations. CONCLUSIONS: Women with breast cancer should be informed of treatment options and the advantages and disadvantages of each choice based on physiologic rather than chronologic age.
Asunto(s)
Neoplasias de la Mama/cirugía , Factores de Edad , Anciano , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Estadificación de Neoplasias , Resultado del TratamientoRESUMEN
BACKGROUND: Adrenocortical carcinoma is a rare and aggressive disease with a poor prognosis. Adjuvant mitotane administration has been suggested as a strategy that might improve the outcome of patients with localized disease. METHODS: The authors analyzed the clinical outcome of patients with localized or regional adrenocortical cancer. The study included 19 patients who were registered at M.D. Anderson Cancer Center during a 3-year period and who had localized or regional disease at the time of surgery. Of these, eight patients received mitotane postoperatively and continued the drug until their last contact or recurrence (Group A, adjuvant); five patients began taking mitotane after surgery but discontinued it after 2-12 months for reasons unrelated to the disease (Group P, postoperative); and six patients did not receive mitotane (Group N, no mitotane). All patients have been followed for at least 12 months. RESULTS: The treatment groups differed significantly in their time to recurrence; the disease-free interval was shortest in Group A (P = 0.0055, by log-rank test). There was no statistical difference in survival among the groups, but the profile remained unfavorable for Group A. The 2-year survival rate was 100% for Groups N and P but only 43% for Group A. Of the potentially confounding factors, gender, age, steroid hypersecretion, and tumor size, none had any influence on recurrence or survival rates. CONCLUSIONS: These findings do not support the conclusion that adjuvant mitotane is beneficial in patients with localized or regional adrenocortical cancer. Neither the disease-free interval nor survival was improved by the drug. The authors suggest that alternative therapeutic strategies be explored for the management of these patients.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/tratamiento farmacológico , Carcinoma/tratamiento farmacológico , Mitotano/uso terapéutico , Neoplasias de la Corteza Suprarrenal/cirugía , Adulto , Anciano , Carcinoma/cirugía , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Análisis de SupervivenciaRESUMEN
Elderly women have the same right as their younger counterparts to be a part of the decision-making process of their health care. Women with breast cancer should be informed of treatment options and the advantages and disadvantages of each choice as it applies to their individual circumstance. Clinical judgment should be used in patients with poor performance status and known limited life expectancy as to the optimal approach that will provide the best quality of life for the maximum duration but with acceptable risks to the patient.
Asunto(s)
Neoplasias de la Mama/terapia , Geriatría/métodos , Salud de la Mujer , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/epidemiología , Causas de Muerte , Comorbilidad , Femenino , Geriatría/normas , Humanos , Esperanza de Vida , Mastectomía , Tamoxifeno/uso terapéuticoRESUMEN
BACKGROUND: Hypercalcemia is a serious and not infrequent complication of malignant diseases; precise information about the incidence of hypercalcemia is not readily available. The study was designed to determine the incidence of hypercalcemia in patients with cancer. METHODS: Retrospective analysis was done of laboratory data from 7667 patients registered at M.D. Anderson Cancer Center for the first time during 1989 for whom serum calcium levels were determined during the first 2 months after registration. RESULTS: Severe hypercalcemia (serum calcium level of more than 12.0 mg/100 ml) was present in 40 patients (0.52%); it occurred most often in patients with renal cell cancer (1.42%) and non-small cell lung cancer (1.03%). Less frequent diagnoses were multiple myeloma (0.79%), leukemia (0.63%), non-Hodgkin lymphoma (0.26%), and cancer of the gastrointestinal tract (0.20%). Moderate hypercalcemia (calcium levels of 10.8-12.0 mg/100 ml) was present in 48 patients (0.63%); it occurred most often in patients with renal cell cancer (3.30%) and multiple myeloma (2.38%). Less frequent diagnoses were non-small cell lung cancer (0.89%), non-Hodgkin lymphoma (0.79%), leukemia (0.63%), and cancer of the gastrointestinal tract (0.51%). The presence of hypercalcemia was associated with increased frequency of distant metastases, bone metastases, and increased mortality consistent with other studies of the prognostic effect of this complication. CONCLUSIONS: Hypercalcemia may appear as a frequent complication in patients with cancer at some time during the course of their disease, but its incidence is relatively low.
Asunto(s)
Hipercalcemia/epidemiología , Neoplasias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Calcio/sangre , Instituciones Oncológicas , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Carcinoma de Células Renales/epidemiología , Niño , Preescolar , Femenino , Humanos , Hipercalcemia/sangre , Incidencia , Lactante , Neoplasias Pulmonares , Masculino , Persona de Mediana Edad , Mieloma Múltiple/epidemiología , Metástasis de la Neoplasia , Neoplasias Primarias Desconocidas/epidemiología , Neoplasias del Sistema Respiratorio/epidemiología , Estudios Retrospectivos , Texas/epidemiología , Neoplasias Urológicas/epidemiologíaRESUMEN
BACKGROUND: Because of the relative rarity of breast cancer in males, data have not been sufficient to support a definitive analysis of pertinent prognostic factors. Remarkably, no studies of male patients with breast cancer have presented survival information based on the number of histologically positive axillary nodes, the most sensitive single indicator of prognosis in women with breast cancer. METHODS: In this study, the clinical course of breast cancer was documented for 335 male patients registered from 1965 through 1986. For patients to be eligible, diagnoses had to be made within 3 months of registration and the patients had to have histologic confirmation and receive part or all of their initial treatment at 1 of 11 cancer centers participating in the International Patient Data Exchange System. RESULTS: The survival rate at 10 years was 84% for patients with histologically negative nodes, 44% for those with one to three positive nodes, and 14% for the group with four or more histologically positive nodes. The survival rates at 5 years were 90%, 73%, and 55%, respectively. In a multivariable analysis, the risk of death due to breast cancer for a patient with four or more histologically positive nodes was 6.75 times that of a patient with negative nodes. CONCLUSIONS: The findings of the authors indicate the following: (1) The number of histologically positive axillary nodes and, to a lesser degree, tumor diameter are significant prognostic factors for breast cancer in male patients. (2) The prognosis of breast cancer is the same in male and female patients when compared on the basis of the number of histologically positive nodes.
Asunto(s)
Neoplasias de la Mama/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Invasividad Neoplásica , Pronóstico , Sistema de Registros , Factores Sexuales , Tasa de SupervivenciaAsunto(s)
Instituciones Oncológicas/estadística & datos numéricos , Bases de Datos Factuales , Neoplasias/epidemiología , Sistema de Registros , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/clasificación , Neoplasias/diagnóstico , Neoplasias/patología , Control de Calidad , Proyectos de Investigación , Terminología como AsuntoRESUMEN
A review was conducted of 264 consecutive patients who underwent surgical treatment for nodal metastases of the groin area from a primary melanoma of the lower extremity. We found no significant difference in survival or regional control created by the extent of node dissection performed, whether or not surgical treatment was a superficial femoral (n = 133) or an iliac and femoral node dissection (n = 131). We also determined that the age and sex of the patient, the location of the primary melanoma and the time that elapsed before the development of nodal metastases were not significant factors. However, the extent of tumor burden (the number of positive nodes and presence of extranodal disease) was useful in predicting patient survival and subsequent nodal basin relapse. Future improvement in survival rates will require effective systemic regimens rather than radical surgical treatment alone.
Asunto(s)
Escisión del Ganglio Linfático , Metástasis Linfática , Melanoma/patología , Neoplasias Cutáneas/patología , Adolescente , Adulto , Anciano , Niño , Femenino , Ingle , Humanos , Pierna , Masculino , Melanoma/mortalidad , Persona de Mediana Edad , Neoplasias Cutáneas/mortalidad , Tasa de SupervivenciaRESUMEN
The clinical and pathologic records of 95 patients with primary cutaneous melanoma isolated to the scalp and regional lymph nodes treated at the MD Anderson Cancer Center between 1976 and 1985 were reviewed to assess the effect of lesion location on the prognosis of scalp melanoma. The scalp was defined as an area bounded by the supraorbital ridges, superior nuchal line, zygoma, and mastoid, thereby including a large non-hair-bearing area. Patients were grouped according to lesion location: hair-bearing or non-hair-bearing; anterior or posterior to the mid-tragal line; and parietal versus frontal, temporal, or occipital. There was a similar distribution of prognostic factors between the anatomic subsites. Analysis by univariate and multivariate methods demonstrated that, in a hair-bearing area, in an area posterior to the mid-tragal line, or in the parietal region, lesion location was highly predictive of the patient's survival. For example, the 5-year, melanoma-specific survival rate was 65% overall, 86% for patients with lesions located in non-hair-bearing regions and 47% for those with lesions in hair-bearing regions (p = 0.0019).
Asunto(s)
Melanoma/mortalidad , Cuero Cabelludo , Neoplasias Cutáneas/mortalidad , Femenino , Humanos , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Factores de Riesgo , Neoplasias Cutáneas/cirugía , Análisis de Supervivencia , Tasa de Supervivencia , Texas/epidemiologíaRESUMEN
This investigation was undertaken to assess the apparent poor survival of older patients with Hodgkin's disease. The clinical course of Hodgkin's disease in 136 patients, 60 to 79 years of age, was compared with that of 223 patients, 40 to 59 years of age. The patients registered from November 1977 through December 1983 had not been previously treated, and were treated at eight cancer centers. When the prognosis of all patients was examined by age, a definite change in the pattern of survival first appeared in the 60- to 69-year-old cohort. The entire older group (60 to 79 years) experienced twice the risk of dying from Hodgkin's disease and four times the risk of dying from other causes than did the younger group. In both groups, stage of disease was the strongest factor in predicting adjusted survival. Delay in treatment and advanced stage at presentation were not characteristic of Hodgkin's disease in older patients as has been postulated. Older patients responded to therapy with a similar complete remission rate (84% v 88% in the younger group, P = .24). From this study, we conclude that (1) Hodgkin's disease in the older adult does not have a different natural history, its major risk factors are similar to those known in other age groups, and thus should be amenable to existing therapeutic approaches; and (2) the prognosis of older patients with Hodgkin's disease has been obscured in previous studies by the inclusion of deaths due to other causes in survival estimates.
Asunto(s)
Enfermedad de Hodgkin/mortalidad , Adulto , Factores de Edad , Anciano , Causas de Muerte , Femenino , Estudios de Seguimiento , Enfermedad de Hodgkin/patología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Recurrencia , Inducción de Remisión , Tasa de SupervivenciaRESUMEN
To explore the potential role that ribonucleic acid (RNA) content analysis may have in the assessment of primary renal cell carcinomas (RCC), biparametric flow cytometric (acridine orange) measurements for DNA/RNA were obtained on 108 fresh neoplastic specimens. RNA content was divided into low and high groups, based on the average RNA content in normal kidney controls. High RNA content was significantly correlated with aneuploidy, high proliferative index, high nuclear grade, cytoplasmic granularity, and large tumor size. No correlation was found between RNA content and patients' sex, race, and clinical stage of the carcinomas. When diploid RCCs were separately analyzed, high RNA content was correlated with high nuclear grade, large tumor size, high clinical stage, and cytoplasmic granularity. There was no correlation between RNA content and the patient's sex or race or the neoplasm's proliferative index. Of the 16 patients that relapsed (5 diploid and 11 aneuploid), four of the diploid and all 11 aneuploid neoplasms displayed high RNA content. The authors' data show that RNA may be a valuable objective and quantitative parameter in the clinicopathologic assessment of RCC.