RESUMO
Introduction and objectives: The incidence of cholangiocarcinoma (CCA) has been increasing globally. Although a concomitant increase in the incidence of metabolic disorders might suggest a causal relationship, the data are scarce. We aimed to describe the prevalence of metabolic disorders in patients with CCA and report the clinical features and outcomes. Patients and Methods: Retrospective study including patients with CCA. Patients were divided into: (1) past history of diabetes or/and overweight/obesity ("metabolic disorder group") and (2) without any of these features ("non-metabolic-disorder group"). A Cox regression model was used to determine the prognostic factors. Results: 122 patients were included. In total, 36 (29.5%) had overweight/obesity, 24 (19.7%) had diabetes, and 8 (6.6%) had both. A total of 29 (23.8%) patients had resectable disease and received upfront surgery. A total of 104 (85.2%) received chemotherapy for advanced/recurrent disease. The overall survival of the cohort was 14.3 months (95% CI: 10.1−17.3). ECOG-PS 0 (p < 0.0001), resectable disease (p = 0.018) and absence of vascular invasion (p = 0.048) were independently associated with better prognosis. The "metabolic disorder group" (n = 52) had a median survival of 15.5 months (95% CI 10.9−33.9) vs. 11.5 months (95% CI 8.4−16.5) in the "non-metabolic-disorder group" (n = 70) (HR: 1.10; 95% CI 0.62−1.94). Patients with resectable disease in the "metabolic group" had longer survival than patients in the "non-metabolic group" (43.4 months (95% CI 33.9-NR) vs. 21.8 months (95% CI 8.6−26.9); HR = 0.12, 95% CI 0.03−0.59). Conclusion: Metabolic disorders are frequent among CCA patients. Underlying metabolic comorbidities may be associated with prognosis in resectable CCA. There is a need to explore the mechanism that drives CCA carcinogenesis in a metabolic background.
RESUMO
Resumen (analítico): La mayoría de estudios sobre las implicaciones emocionales y estrategias de afrontamiento de los progenitores ante el nacimiento de un hijo o hija prematuros se centran en la madre. El presente artículo constituye una revisión sistemática a la literatura existente, desde el paradigma cualitativo, acerca de las emociones, sentimientos y estrategias de afrontamiento del padre, y se identifican aspectos relacionados con roles de género en las vivencias y discursos de este. Se constatan diversos perfiles de afrontamiento que generan tres modelos diferenciados de participación en la crianza del neonato prematuro: el equitativo, el desigual y el de rechazo. Se considera que los resultados pueden favorecer la implementación de acciones dirigidas a una mayor inclusión y reconocimiento del padre en los programas de Cuidados Centrados en el Desarrollo de las Unidades de Cuidados Intensivos Neonatales.
Abstract (analytical): Most studies on the emotional implications and confrontations between parents following the birth of premature child focus on the mother. This article details a systematic review of existing literature, from a qualitative paradigm, that cover a father's emotions, feelings and coping strategies. At the same it identifies points related to gender roles in their experiences and discourse. Three coping profiles have been identified, generating three differentiated participation models in the care of a premature child: equal, unequal and rejection. The results of this study could favour the implementation of actions aimed at greater inclusion and recognition of fathers in development-based care in Neo-Natal Intensive Care Units.
Resumo (analítico): A maioria dos estudos sobre as implicações emocionais e as estratégias de enfrentamento dos progenitores perante o nascimento de um filho prematuro centram-se na mãe. O presente artigo constitui uma revisão sistemática da literatura existente, desde o paradigma qualitativo, acerca das emoções, sentimentos y estratégias de enfrentamento do pai e, ao mesmo tempo, identificam-se aspectos relacionados com papéis de gênero nas suas vivências e discursos. Constatam-se diversos perfis de enfrentamento que geram três modelos diferenciados de participação na criação do neonato prematuro: o equitativo, o desigual e o de rejeição. Consideramos que os resultados podem favorecer a implementação de ações dirigidas a uma mais vasta inclusão e reconhecimento do pai nos programas de cuidados centrados no desenvolvimento (CCD) e na família das Unidades de Cuidados Intensivos Neonatais.