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Abstract Introduction New evidence suggests that the ratio of neutrophils to lymphocytes is associated with the prognosis of other carcinoma, but the ratio of neutrophils to lymphocytes in laryngeal squamous cell carcinoma remains controversial. Objective The objective of this meta-analysis was to clarify the prognostic effectiveness of the ratio of neutrophils to lymphocytes in laryngeal squamous cell carcinoma. Methods According to the meta-analysis of the free guide, we searched EMBASE, Pubmed, the Cochrane Library databases. The ratio of neutrophils to lymphocytes of laryngeal squamous cell carcinoma patients was evaluated using mean standard vehicle and confidence interval. The overall survival, disease-free survival and progression free survival of patients with laryngeal squamous cell carcinoma were expressed by standard mean carrier method and confidence interval. The risk ratio of 95% confidence interval was used as an evaluation index for patients with laryngeal squamous cell carcinoma. Results Eight studies, including 1780 patients, used a variety of different end values to classify the ratio of neutrophils to lymphocytes (range 1.78-4.0). Among the eight studies that reported risk ratio of the overall survival, the higher median value was 2.72, and 2 of 4 studies reported disease-free survival results. The critical value of ratio of neutrophils to lymphocytes and overall survival deterioration (risk ratio = 1.68, 95% confidence interval 1.43-1.99, p< 0.001), disease-free survival (risk ratio = 2.09, 95% confidence interval 1.62-2.6, p< 0.001) and progression free survival (risk ratio = 1.92, 95% confidence interval 1.75-2.10, p< 0.001) was associated with with laryngeal aquamous cell carcinoma. The ratio of neutrophils to lymphocytes had prognostic value for laryngeal squamous cell carcinoma. Conclusion The results of this meta-analysis showed that the increase of neutrophils to lymphocytes ratio was related to poor prognosis of laryngeal squamous cell carcinoma. The neutrophils to lymphocytes ratio may serve as a cost-effective prognostic biomarker of poor prognosis of laryngeal squamous cell carcinoma. More high-quality prospective trials are needed to assess the practicability of evaluating the ratio of neutrophils to lymphocytes in laryngeal squamous cell carcinoma.

Resumo Introdução Novas evidências sugerem que a relação neutrófilo-linfócito está associada ao prognóstico de vários carcinomas, mas a relação neutrófilo-linfócito no carcinoma espinocelular da laringe ainda permanece controversa. Objetivo Esclarecer a eficácia prognóstica da relação neutrófilo-linfócito no carcinoma espinocelular de laringe. Método De acordo com as diretrizes de metanálise, conduzimos uma busca nas bases de dados Embase, PubMed, e Cochrane Library. A relação neutrófilo-linfócito de pacientes com carcinoma espinocelular de laringe foi avaliado com a diferença de médias padronizadas e intervalo de confiança. A sobrevida global, sobrevida livre de doença e sobrevida livre de progressão de pacientes com carcinomaespinocelular de laringe foram expressas pelo método da diferença de médias padronizadas e intervalo de confiança. A razão de risco do intervalo de confiança 95% foi usada como um índice de avaliação para pacientes com carcinoma espinocelular de laringe. Resultados Oito estudos, que incluíram 1.780 pacientes, usaram uma variedade de valores finais diferentes para classificar a relação neutrófilo-linfócito (intervalo de 1,78-4,0). Entre os oito estudos que relataram a razão de risco de sobrevida global, o maior valor médio foi de 2,72 e 2 de 4 estudos relataram resultados com sobrevida livre de doença. O valor crítico de relação neutrófilo-linfócito e deterioração da sobrevida global (razão de risco = 1,68, intervalo de confiança 95% 1,43-1,99, p ˂ 0,001), sobrevida livre de doença (razão de risco = 2,09, intervalo de confiança 95% 1,62-2,6, p ˂ 0,001) e sobrevida livre de progressão (razão de risco = 1,92, intervalo de confiança 95% 1,75-2,10, p ˂ 0,001) foi associado com carcinoma espinocelular de laringe. A relação neutrófilo-linfócito tem valor prognóstico para carcinoma espinocelular de laringe. Conclusão Os resultados da metanálise mostraram que o aumento da relação neutrófilo-linfócito estava relacionado ao mau prognóstico do carcinoma espinocelular de laringe. A relação neutrófilo-linfócito pode servir como um biomarcador custo-efetivo de prognóstico do carcinoma espinocelular de laringe. Entretanto, mais estudos prospectivos de alta qualidade são necessários para avaliar a sua praticabilidade.

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Introducción: el mieloma múltiple (MM) continúa siendo una enfermedad incurable sin embargo, el trasplante autólogo de médula ósea (TAH), y las drogas antineoplásicas han permitido mejorar la sobrevida global (SG) de los pacientes. Materiales y métodos: estudio de cohorte retrospectivo de 50 pacientes con diagnóstico de MM en el hospital Naval Almirante Nef, desde 2005 a 2013. Los pacientes se dividieron en dos cohortes, según la eligibilidad a trasplante, y analizados acordes a la primera línea de tratamiento y la sobrevida global (SG) hasta abril de 2019. Resultados: mediana de edad 73 años (47-88 años), SG 49 meses, y 50% en etapa-II del Sistema de Etapificación Internacional. La SG de los 39 no candidatos a TAH fue 46 meses; con un mayor número de respuestas completas y sobrevida, con el esquema melfalán-prednisona-talidomida. La SG de los 11 candidatos a TAH fue 66 meses, siendo el esquema bortezomib-ciclofosfamida-dexame-tasona el que concentró un mayor número de respuestas completas libres de progresión. Se trasplantó el 45% de los candidatos, con una mediana de sobrevida de 79 meses versus a los 51 meses de aquellos no trasplantados. Tres casos de neuropatía asociada a talidomida y uno a bortezomib. La SG a los seis meses y a los cinco años de todos los pacientes fue 86% y 44%, respectivamente. Conclusión: la incorpo-ración de nuevos fármacos permitió obtener mejores resultados de sobrevida lo que se condice con estudios nacionales e internacionales.

Introduction: Multiple myeloma (MM) is still an incurable disease however, autologous stem cell transplantation (ASCT), and antineo-plastic drugs have allowed improving the overall survival (OS) of patients. Materials and methods: A retrospective cohort study of 50 patients diagnosed with MM at the Hospital Naval Almirante Nef, from 2005 to 2013. The patients were divided into two cohorts according to transplantation eligibility and analyzed about first-line treatment and overall survival (OS) up to April 2019. Results: Median age 73 years (47-88 years), OS 49 months, and 50% in stage-II International Staging System. OS of the 39 non-candidates for ASCT was 46 months: with a higher number of complete responses and survival, with the melphalan-prednisone-thalidomide scheme. The OS of the 11 candidates for ASCT was 66 months, with the bortezomib-cyclophosphamide-dexamethasone scheme being the one with the highest number of progression-free complete responses. Forty-five percent of the candidates were transplanted, with a median survival of 79 months versus 51 months for those not transplanted. Three cases of neuropathy were associated with thalidomide and one with bortezomib. OS at six months and five years for all patients was 86% and 44%, respectively. Conclusion: The incorporation of new drugs allowed to obtain better survival results, which is by national and international studies.

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Introdução: A neoplasia de próstata possui grande relevância na saúde da população, sendo o câncer com maior incidência em homens, e uma das principais causas de mortalidade por câncer entre os homens. Cerca de 70% dos brasileiros não têm acesso à assistência de saúde suplementar, o que afeta o diagnóstico precoce, o acesso a diferentes modalidades de terapias, e, consequentemente, a sobrevida dos pacientes tratados no sistema público. As novas terapias aprovadas nos últimos anos para câncer de próstata (CaP) metastático não foram ainda incorporadas no sistema público de saúde. Objetivo: Avaliar o impacto na sobrevida global de pacientes com CaP metastático tratados no sistema de saúde público versus saúde suplementar. Pacientes e Métodos: foram avaliados 213 pacientes com CaP metastático tratados no A. C. Camargo Cancer Center, através do Sistema Único de Saúde (SUS) ou saúde suplementar, no período de Janeiro de 2014 a Dezembro de 2018. Os dados foram avaliados pelos testes qui-quadrado, ou exato de Fisher, e o método de Kaplan­Meier, para calcular as curvas de sobrevida. A análise multivariada para a sobrevida global foi realizada, com o objetivo de ajustar o tipo de cobertura de saúde para outros fatores prognósticos clínicos Resultados: Dos 213 pacientes incluídos, 147 (69%) foram tratados no sistema suplementar e 66 (31%) no SUS. Entre os dois grupos, houve diferença na idade mediana ao diagnóstico, sendo de 63,4 anos no sistema suplementar, e de 67,2 anos no SUS (p= 0.027). Entre os dois grupos não houve diferença na performance status -ECOG 0-1 versus ECOG 2-4 (p =0.695). Os pacientes do SUS tiveram acesso a menor número linhas de tratamento, com média de 2,59 versus 3,04 linhas no sistema suplementar (p=0.024). Houve maior sobrevida para os pacientes do sistema suplementar, com mediana de 115 meses; e 78 meses para os pacientes do SUS (p = 0.009).Na análise multivariada, pacientes do sistema público tiveram 66% maior chance de óbito do que os pacientes do sistema suplementar. Conclusão: nossos dados demonstraram que os pacientes do SUS tiveram acesso a menos linhas de terapia no CaP metastático e apresentaram uma sobrevida mediana inferior comparado aos pacientes do sistema de saúde suplementar.

Introduction: Prostate cancer (PCa) is an important health public topic. It is the most common type of cancer in men (excluding non- melanoma skin cancer) and one of the main causes of cancer mortality among men in in the world. Around 70% of Brazilians do not have health insurance, consequently the access to diagnosis and treatment is heterogenous between Unified Health System (SUS), the public system, and private system, contributing to distinct patterns in cancer mortality. Besides that recent approved therapies for metastatic PCa have not been incorporated into the SUS. Objective: To evaluate the impact on the overall survival of metastatic PCa patients according to treatment assistance by public or private health system. Patients and Methods: 213 patients with metastatic PCa treated at the A.C. Camargo Cancer Center by SUS or private system, from January 2014 to December 2018, were analyzed. The data were evaluated using the chi-square tests, or Fischer's exact, and the Kaplan ­ Meier method, to calculate survival curves. The multivariate analysis for overall survival was performed, with the aim of adjusting the type of health assistance for other clinical prognostic factors. Results: 213 patients have been included, 147 (69%) from the private system and 66 (31 %) patients from SUS, with a difference in the median age at diagnosis: 63.4 years for private patients and 67.2 years for SUS (p = 0.027). No differences in performance status was observed -ECOG 0-1 versus ECOG 2-4 (p = 0.695). SUS patients had access to fewer treatment lines: 2.59 lines versus 3.04 lines in the private system (p = 0.024). Our data revealed longer median survival for private patients (115 months versus 78 months for SUS patients, (p = 0.009). In the multivariate analysis, the data showed that patients in the public system have 66% higher risk of death than patients in the private system. Conclusion: our data demonstrate that SUS patients have access to less lines of therapy in metastatic prostate cancer, reflecting in shorter median survival compared to patients treated in private system.

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Introducción: El linfoma difuso de células grandes B es el subtipo histológico más común de los linfomas no Hodgkin de curso agresivo. Objetivo: Caracterizar el comportamiento de pacientes adultos con linfoma difuso de células grandes B. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo que incluyó 56 pacientes adultos con linfoma difuso de células grandes B atendidos en el Instituto de Hematología e Inmunología desde enero 1998 hasta diciembre 2018. Resultados: El 55,4 por ciento de los pacientes fueron del sexo masculino; predominó el color de piel blanco (76,8 por ciento) y el grupo de 59 a 78 años (44,6 por ciento). Prevalecieron pacientes con comorbilidades fundamentalmente la hipertensión arterial (35,7 por ciento) y con validismo regular (55,4 por ciento). El 53,6 por ciento de los pacientes estaba en estadio IV al diagnóstico; predominaron los pacientes con síntomas B en 85,7 por ciento y fue más frecuente el grupo de riesgo bajo intermedio en 35,7 por ciento. El esquema más empleado fue R-CHOP, con el que se logró 85,7 por ciento de remisión completa. El 17,9 por ciento de los pacientes fallecieron y 41,1 por ciento recayeron. La sobrevida global a los 3, 5 y 10 años fue de 87,0 por ciento, 83,0 por ciento, y 80,0 por ciento, respectivamente. La sobrevida libre de enfermedad a los 3, 5 y 10 años fue de 74,0 por ciento, 67 por ciento y 56 por ciento, respectivamente. Conclusiones: La sobrevida global y la sobrevida libre de enfermedad de los pacientes fueron altas(AU)

Introduction: Diffuse large B-cell lymphoma is the most common subtype of aggressive non-Hodgkin lymphoma. Objective: Characterize the behavior of adult patients with diffuse large B-cell lymphoma. Methods: An observational retrospective longitudinal descriptive study was conducted of 56 adult patients with diffuse large B-cell lymphoma attending the Institute of Hematology and Immunology from January 1998 to December 2018. Results: Of the patients studied, 55.4 percent were male, and a predominance was found of white skin color (76.8 percent) and the 59-78 years age group (44.6 percent). Patients with comorbidities prevailed, mainly hypertension (35.7 percent) with an ability to perform activities of daily living (55.4 percent). 53.6 percent of the patients were in stage IV at diagnosis. Patients with type B symptoms prevailed with 85.7 (AU) , and the low to intermediate risk group was the most common with 35.7 percent. The regimen most frequently used was R-CHOP, obtaining 85.7 percent complete remission. 17.9 percent of the patients died and 41.1 percent relapsed. Overall survival at 3, 5 and 10 years was 87.0 percent, 83.0 percent and 80.0 percent, respectively. Disease-free survival at 3, 5 and 10 years was 74.0 percent, 67 percent and 56 percent, respectively. Conclusions: Overall and disease-free survival were high(AU)

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El cáncer de mama Estadio IV se define como la diseminación de células tumorales más allá de la mama, la pared torácica y los ganglios linfáticos regionales. Globalmente, 5-10% de las mujeres tienen metástasis al momento del diagnóstico y hasta un 30% de aquellas con estadios tempranos al inicio desarrollará metástasis en algún momento. Se estima una mediana de sobrevida global en cáncer de mama metastásico de 3 años, con un intervalo que va desde pocos meses hasta muchos años, y una sobrevida a 5 años que ronda el 25%. Continúa siendo una enfermedad tratable pero no curable. Los objetivos terapéuticos en enfermedad metastásica principalmente son: prolongación de la sobrevida global y libre de enfermedad, disminución de síntomas y complicaciones asociadas al cáncer y mejoras en la calidad de vida de las pacientes. En la actualidad, estas metas son alcanzadas principalmente con la utilización de terapias sistémicas como la quimioterapia, la hormonoterapia o el uso de agentes biológicos. En algunas circunstancias, el tratamiento locorregional también contribuye a lograr estos objetivos. La elección del tratamiento sistémico está principalmente determinada por la biología tumoral, ya que esto permite el empleo de terapias dirigidas. En los tumores Luminales, deberá emplearse hormonoterapia, sola o en asociación con otros esquemas. En tumores her2+, se indicará, de ser posible, como primera línea de tratamiento doble bloqueo anti-her más quimioterapia. El subgrupo de peor pronóstico está representado por los tumores Triple Negativos, para los cuales no existen blancos terapéuticos dirigidos. En este caso, se utilizará quimioterapia. Se deberá usar terapia de mantenimiento luego de lograr el control de la enfermedad en tumores Luminales y her2+. El rol del tratamiento locorregional en cáncer de mama metastásico continúa siendo un tema de debate. Actualmente, algunos estudios sugieren que podrían obtenerse algunos beneficios, aunque aún hacen falta más datos para sostener su indicación. Deberá garantizarse un abordaje multidisciplinario y un seguimiento cercano de estas pacientes, con el fin de valorar la respuesta al tratamiento, la aparición de toxicidad inaceptable y las condiciones de calidad de vida

Stage IV breast cancer is defined as the spread of tumor cells beyond the breast, chest wall, and regional lymph nodes. Globally, 5-10% of women have metastases at diagnosis, and up to 30% of those with early stages of onset will develop metastases at some point. A median overall survival in metastatic breast cancer of 3 years is estimated, with an interval ranging from a few months to many years, and a 5-year survival of around 25%. It remains a treatable but not curable disease. The therapeutic goals in metastatic disease are mainly: prolongation of global and disease-free survival, decrease in symptoms and complications associated with cancer, and improvements in the quality of life of patients. At present, these goals are mainly achieved with the use of systemic therapies such as chemotherapy, hormonal therapy or the use of biological agents. In some circumstances locoregional treatment also contributes to achieving these goals. The choice of systemic treatment is mainly determined by tumor biology, since this allows the use of targeted therapies. In Luminal tumors, hormone therapy should be used, alone or in association with other schemes. In her2+ tumors, double blocking anti-her plus chemotherapy will be indicated if possible as the first line of treatment. The worst prognosis subgroup is represented by Triple Negative tumors for which there are no targeted therapeutic targets. In this case chemotherapy will be used. Maintenance therapy should be used after achieving control of the disease in Luminal tumors and her2+. The role of locoregional treatment in metastatic breast cancer continues to be a matter of debate. Currently some studies suggest that some benefits could be obtained although more data are still needed to support its indication. A multidisciplinary approach and close monitoring of these patients should be guaranteed in order to assess the response to treatment, the appearance of unacceptable toxicity and quality of life conditions

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Abstract Objective Acute lymphoblastic leukemia is the most common childhood cancer, yet surprisingly, very few studies have reported the treatment outcomes and the relapse rate of patients from low/middle-income countries. Method This study was a 5-year retrospective cohort study. It was conducted at Oncology Center of Mansoura University in Egypt and aimed to estimate the treatment outcomes and the relapse rates of newly diagnosed acute lymphoblastic leukemia in children. Results Two hundred children suffering from acute lymphoblastic leukemia were studied; forty-six patients (23%) died during induction and most of those deaths were related to infection. Forty-one patients (27%) relapsed out of the 152 patients who achieved complete remission. The most common site of relapse was the bone marrow, followed by the isolated central nervous system, 53.7% and 31.7%, respectively. Seventy-eight percent of relapses occurred very early/early rather than later. The majority of relapse patients' deaths were related to infection and disease progression. The 5-year overall survival rate for patients was 63.1% (82.1% for non-relapsed compared to 36.6% for relapsed patients). Conclusion There was a high incidence of induction deaths related to infection and high percentages of very early/early relapses, with high mortalities and low 5-year overall survival rates. These findings suggest the urgent need for modification of chemotherapy regimens to be suitable for the local conditions, including implementation of supportive care and infection control policies. There is also a requirement for antimicrobial prophylaxis during induction period combined with the necessary increase in government healthcare spending to improve the survival of acute lymphoblastic leukemia in Egyptian children.

Resumo Objetivo Estimar os desfechos do tratamento e as taxas de recidiva de crianças recém-diagnosticadas com leucemia linfoblástica aguda. É o câncer infantil mais comum, mas surpreendentemente poucos estudos relataram os desfechos do tratamento e a taxa de recidiva em pacientes de países de renda baixa/média. Método Estudo de coorte retrospectivo de cinco anos. Foi feito no Centro de Oncologia da Universidade de Mansoura, no Egito. Resultados Foram estudadas 200 crianças com leucemia linfoblástica aguda, das quais 46 (23%) morreram durante a indução e a maioria dessas mortes estava relacionada à infecção. Dos 152 pacientes que alcançaram a remissão completa, 41 (27%) apresentaram recidiva. O local mais comum de recidiva foi a medula óssea, seguido pelo sistema nervoso central isolado, com 53,7% e 31,7% dos casos, respectivamente. Das recidivas, 78% ocorreram muito precocemente ou precocemente, em vez de tardiamente. A maioria das mortes de pacientes com recidiva estava relacionada à infecção e progressão da doença. A taxa de sobrevida global em cinco anos para os pacientes foi de 63,1% (82,1% para não recidivados em comparação com 36,6% para os recidivados). Conclusão Houve uma alta incidência de mortes na indução relacionadas à infecção e altos percentuais de recidivas muito precoces ou precoces, com altas taxas de mortalidade e baixas taxas de sobrevida global em cinco anos. Nossos achados sugerem a necessidade urgente de modificação dos esquemas quimioterápicos para adequação às nossas condições locais, implantação de políticas de cuidados de suporte e controle de infecções. Há também a necessidade de profilaxia antimicrobiana durante o período de indução, junto com um aumento necessário nos gastos governamentais com a saúde, para melhorar a capacidade de sobrevivência das crianças egípcias com leucemia linfoblástica aguda.

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OBJECTIVE: Acute lymphoblastic leukemia is the most common childhood cancer, yet surprisingly, very few studies have reported the treatment outcomes and the relapse rate of patients from low/middle-income countries. METHOD: This study was a 5-year retrospective cohort study. It was conducted at Oncology Center of Mansoura University in Egypt and aimed to estimate the treatment outcomes and the relapse rates of newly diagnosed acute lymphoblastic leukemia in children. RESULTS: Two hundred children suffering from acute lymphoblastic leukemia were studied; forty-six patients (23%) died during induction and most of those deaths were related to infection. Forty-one patients (27%) relapsed out of the 152 patients who achieved complete remission. The most common site of relapse was the bone marrow, followed by the isolated central nervous system, 53.7% and 31.7%, respectively. Seventy-eight percent of relapses occurred very early/early rather than later. The majority of relapse patients' deaths were related to infection and disease progression. The 5-year overall survival rate for patients was 63.1% (82.1% for non-relapsed compared to 36.6% for relapsed patients). CONCLUSION: There was a high incidence of induction deaths related to infection and high percentages of very early/early relapses, with high mortalities and low 5-year overall survival rates. These findings suggest the urgent need for modification of chemotherapy regimens to be suitable for the local conditions, including implementation of supportive care and infection control policies. There is also a requirement for antimicrobial prophylaxis during induction period combined with the necessary increase in government healthcare spending to improve the survival of acute lymphoblastic leukemia in Egyptian children.

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Introducción: El linfoma de Hodgkin ha pasado de ser una enfermedad fatal a una de las neoplasias con mayores posibilidades de curación. Objetivo: Caracterizar el comportamiento del linfoma de Hodgkin en los pacientes adultos. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo parcial que incluyó 75 pacientes adultos con linfoma de Hodgkin atendidos en el Instituto de Hematología e Inmunología entre enero de 1987 hasta enero de 2017. Resultados: El 64 por ciento de los pacientes fueron del sexo masculino; predominó el color de piel blanco (85,3 por ciento) y el grupo de 18 a 38 años fue el más frecuente (68 por ciento). Prevalecieron los pacientes sin comorbilidades (65,3 por ciento) y con buen validismo (93,3 por ciento). El 52 por ciento de los pacientes estaba en estadio III al diagnóstico; predominó el grupo pronóstico de avanzado favorable 61.3 por ciento. La variedad histológica más frecuente fue la esclerosis nodular con 48 pacientes y el esquema empleado con mayor frecuencia fue ABVD, con el que se logró 92 por ciento de remisión completa. El 20 por ciento de los pacientes fallecieron y el 18,7 por ciento recayeron. La sobrevida global a los 2, 5 y 10 años fue de 93 por ciento, 83 por ciento y 80 por ciento, respectivamente. La sobrevida libre de enfermedad a los 5 y 10 años fue de 82 por ciento y 73 por ciento, respectivamente. Conclusiones: La sobrevida global y la sobrevida libre de enfermedad de los pacientes fueron altas. Los pacientes tratados con la combinación de quimioterapia y radioterapia mostraron significativamente una mejor supervivencia global(AU)

Introduction: Hodgkin's lymphoma has evolved to be one of the cancers with highest possibilities of cure. Objective: To characterize the behavior of the Hodgkin's lymphoma disease in adult patients. Methods: An observational, descriptive and retrospective study was carried out. It included 75 adult patients with Hodgkin's lymphoma attended in the Institute of Hematology and Immunology since January 1987 to January of 2017. Results: 64 percent of the patients were male; the white color of skin and the group from 18 to 38 years predominated, with 85.3 percent and 68 percent respectively. Patients without comorbidity prevailed, and those who had a good status performance, representing the 65.3 percent and 93.3 percent respectively. The 52 percent of patients were in stage III at diagnosis, the group with advanced favorable disease was predominant, with 61.3 percent of the cases. The most frequent histological type was nodular sclerosis with 48 patients; and ABVD protocol was used more often, achieving 92 percent of complete remission. Twenty percent of the patients died and 18.7 percent relapsed. The overall survival of the patients at 2, 5 and 10 years was 93 percent, 83 percent and 80 percent respectively. The progression-free survival at of 5 and 10 years was 82 percent and 73 percent respectively. Conclusions: The overall survival and the progression-free survival of patients were high, and patients treated with the combination of chemotherapy and radiotherapy showed a significantly better overall survival(AU)

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Introdução: O câncer gástrico (CG) é a principal causa de morte por câncer no Peru e o terceiro entre os homens no Brasil. Portanto, é fundamental estudar fatores relacionados ao prognóstico e evolução de pacientes com CG em nosso continente. Nós visamos avaliar a eficácia do tratamento adjuvante para o CG com estádio clínico (EC) III nos pacientes destes dois países, e correlacioná-la com características clinicas e patológicas. Métodos: Realizou-se uma análise retrospectiva de pacientes com CG EC III tratados com cirurgia e quimiorradioterapia. A quimiorradioterapia foi definido como o protocolo de MacDonald (INT-0116). O desfecho foi a sobrevida global (SG). Resultados: Foram analisados 150 pacientes com CG EC III. O subtipo difuso foi predominante (Brasil: 62,1%; Peru: 57,8%). Em um tempo de seguimento mediano de 26 meses, a SG mediana foi de 53 e 24 meses no Brasil e no Peru, respectivamente (p=0,06). Verificou-se diferença estatisticamente significante na SG mediana na coorte de subtipo difuso (Brasil: 109 vs Peru: 21 meses; p= 0,029). Na análise multivariada, a localização tumoral na transição esofagogástrica (TEG) foi um fator prognóstico independente associado a pior SG (TEG vs gástrico (não TEG); HR = 2,08, IC 95% 1,00-4.31; p=0,048). Não houve associação significativa entre país de origem, subtipo histológico, ou sexo e a sobrevida dos pacientes. Conclusão: Observamos que pacientes com subtipo difuso têm melhor sobrevida no Brasil em relação ao Peru, e que a localização do tumor em TEG é fator de pior prognóstico para SG. Futuras pesquisas em características moleculares do CG são necessárias para compreender melhor a biologia desta doença em nosso continente e para desenvolver abordagens preventivas e terapêuticas potenciais (AU)

Introduction: Gastric cancer (GC) is the leading cause of cancer death in Peru, and the third one among men in Brazil. Therefore, it is fundamental to study factors related to the prognosis and evolution of patients with GC in our continent. We aimed to evaluate the efficacy of adjuvant treatment for Stage III GC in patients from these two countries, and correlate this with clinicopathological features. Methods: A retrospective analysis of stage III GC patients treated with surgery and chemoradiation was carried out. Chemoradiation was defined as MacDonald (INT-0116) protocol. Primary endpoint was overall survival (OS). Results: We analyzed 150 patients with stage III GC. Diffuse subtype was predominant (Brazil: 62.1%; Peru: 57.8%). In a median follow-up time of 26 months, the median OS was 53 and 24 months in Brazil and Peru respectively (p=0.06). We found statistically significant difference in median OS in the diffuse subtype cohort (Brazil: 109 vs Peru: 21 months; p=0.029). In multivariate analysis, tumor location in gastroesophageal junction (GEJ) was an independent prognostic factor associated with worst OS (GEJ vs gastric (non-GEJ); HR=2.08, 95% CI 1.00-4.31; p=0.048). There was no significant association between country of origin, histological subtype, gender and patient survival. Conclusions: We observed that patients with diffuse subtype have better survival in Brazil compared to Peru, and that tumor location is a prognostic factor for OS. Further research in molecular characteristics of GC is warranted to better understand the biology of this disease in our continent and to develop potential preventive and therapeutic approaches (AU)

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Abstract Introduction Increased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty. Objective We aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers. Methods Between 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5 kg/m2 (underweight); (b) 18.5-25 kg/m2 (normal weight); (c) 26-30 kg/m2 (overweight); (d) 31-40 kg/m2 (obese) and (e) >40 kg/m2 (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared. Results Median follow up period was 5.2 years (0.6-10). Mean body mass index was 31.3 kg/m2 (17-72); body mass index 31-40 kg/m2 was predominant (89 patients, 42.6%) followed by 26-30 kg/m2 seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p = 0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival. Conclusion Although body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

Resumo Introdução Sabe-se que o aumento do índice de massa corpórea está associado à alta prevalência de câncer diferenciado de tireoide; entretanto, os dados sobre seu impacto no desfecho de sobrevivência após tireoidectomia e terapia adjuvante são escassos. Objetivo Objetivou-se avaliar o impacto do índice de massa corpórea nas taxas de sobrevida global e sobrevida livre de doença em pacientes com câncer diferenciado de tireoide. Método Entre 2000 e 2011, 209 pacientes com câncer diferenciado de tireoide (papilar/folicular/de células de Hurthle) foram tratados através de tireoidectomia, seguida de tratamento com iodo radioativo-131 adjuvante e supressão de hormônio estimulante da tireoide. Com base no índice de massa corpórea, os pacientes foram divididos em cinco grupos; (a) < 18,5 kg/m2 (baixo peso); (b) 18,5-25 kg/m2 (peso normal); (c) 26-30 kg/m2 (sobrepeso); (d) 31-40 kg/m2 (obesos) e (e) > 40 kg/m2 (obesos mórbidos). Várias características demográficas, clínicas e de tratamento e toxicidade associada e desfechos (sobrevida global e sobrevida livre de doença) foram analisadas e comparadas. Resultados O período médio de acompanhamento foi de 5,2 anos (0,6-10). O índice de massa corpórea médio foi de 31,3 kg/m2 (17-72); o índice de massa corpórea de 31-40 kg/m2 foi predominante (89 pacientes, 42,6%), seguido por 26-30 kg/m2, observado em 58 pacientes (27,8%). Observaram-se 18 recidivas locorregionais (8,6%) e 12 metástases distantes (5,7%). As taxas de sobrevida livre de doença e sobrevida global de 10 anos foram de 83,1% e 58,0%, respectivamente. Não foi encontrado impacto significativo do índice de massa corpórea nas taxas de sobrevida global ou sobrevida livre de doença (p = 0,081). Da mesma forma, a análise multivariada mostrou que o índice de massa corpórea não foi um fator prognóstico independente para sobrevida global e sobrevida livre de doença. Conclusão Embora o índice de massa corpórea possa aumentar o risco de câncer de tireoide, ele não tem impacto no resultado do tratamento; contudo, outros estudos são necessários.

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Resumen Objetivo: describir las características clínicas del grupo de niños diagnosticados con tumor de Wilms en Costa Rica y cuál es la evolución clínica de acuerdo con los diversos tratamientos que reciben en el Servicio de Oncohematología del Hospital Nacional de Niños. Métodos: este es un estudio descriptivo retrospectivo que analiza un periodo de 20 años de pacientes con diagnóstico de tumor de Wilms confirmado por biopsia. Se revisó 69 expedientes de pacientes con edades entre 0 y 13 años, en los cuales se analizaron los datos clínicos, terapéuticos (quimioterapia, radioterapia) y pronósticos (sobrevida global y libre de enfermedad) de cada uno. Los resultados obtenidos se compararon con los de otros estudios latinoamericanos y europeos. Se realizaron modificaciones en el manejo de los pacientes costarricenses, con base en los resultados obtenidos. Resultados: se analizó una muestra total de 69 casos. Entre los resultados se encontró que los pacientes presentaban una edad promedio diagnóstica de 41,3 meses. El seguimiento promedio fue de 7,4 años. La masa abdominal fue el hallazgo clínico predominante (55%). Además, el estadio III fue el más común (31,8%). La nefrectomía total sin ruptura tumoral fue el procedimiento quirúrgico en la mayoría de los casos. El 80% de los pacientes presentó histología favorable en el análisis histopatológico. En el 51% de los casos se utilizó quimioterapia prequirúrgica. Un 17% de los pacientes presentó metástasis pulmonar. La sobrevida global fue del 73,3% y la sobrevida libre de enfermedad, del 69%. Conclusiones: los pacientes costarricenses con tumor de Wilms localizados tuvieron una sobrevida inferior a la de los países desarrollados, y similar en casos metastásicos.

Abstract Objective: to describe the clinical characteristics of the group of children diagnosed with Wilms' tumor in Costa Rica and what was the clinical evolution according to the different treatments received in the Oncohematology Division of the National Children's Hospital. Methods: this is a retrospective descriptive study that analyzed the patients with diagnosis of Wilms tumor confirmed by biopsy in period of 20 years. We reviewed 69 records of patients aged between 0 and 13 years, in which the clinical, therapeutic (chemotherapy, radiotherapy) and prognostic data (global and disease-free survival) of each one were analyzed. Results: a total sample of 69 cases was analyzed. Among the results, it was found that the patients presented an average age of 41.3 months at the moment of diagnosis. The average follow-up was 7.4 years. The presence of an abdominal mass was the predominant clinical finding (55%). In addition, stage III was the most common (31.8%). Total nephrectomy without tumor rupture was the surgical procedure in the majority of cases. 80% of the patients presented favorable histology in the histopathological analysis. In 51% of cases, pre-surgical chemotherapy was used. 17% of the patients presented pulmonary metastasis. Overall survival was 73.3% and disease free survival was 69%. Conclusions: Costa Rican patients with localized Wilms' tumor had poorer results than that of patients in developed countries, but the survival was similar in metastatic cases.

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Abstract Introduction Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer. Objectives The aim of this retrospective study was to evaluate the prognostic value of margin status in 162 consecutive cases of early glottic carcinoma (Tis-T1) treated with CO2 laser endoscopic surgery (Group A) or laryngofissure cordectomy (Group B), and to compare the oncologic and functional results. Methods Clinical prognostic factors, local recurrence rate according to margin status, overall survival and disease-free survival were analyzed. Results Margin status is related to recurrence rate in both groups (p < 0.05) without significant differences between open and laser cordectomy (p > 0.05). The 5 years overall survival and disease-free survival were respectively 90.48% and 85.71% in Group A; 88.14% and 86.44% in Group B (p > 0.05). Lower tracheostomy rate, earlier recovery of swallowing function and shorter hospital stay were observed in Group A (p < 0.05). Conclusions Margin status has a prognostic role in T1a-T1b glottic cancer. Transoral laser surgery showed similar oncologic results of open cordectomy, with better functional outcomes.

Resumo Introdução Cordectomia por laringofissura e cirurgia transoral a laser têm sido propostas para o tratamento do câncer glótico inicial. Objetivos O objetivo desse estudo retrospectivo foi avaliar o valor prognóstico do estado da margem em 162 casos consecutivos de carcinoma glótico inicial (Tis-T1) tratado com cirurgia endoscópica a laser de CO2 (Grupo A) ou cordectomia por laringofissura (Grupo B) e comparar resultados oncológicos e funcionais. Método Foram analisados fatores prognósticos clínicos, taxa de recorrência local de acordo com o estado da margem, sobrevida global e sobrevida livre de doença. Resultados O estado de margem está relacionado à taxa de recorrência em ambos os grupos (p < 0,05) sem diferenças significativas entre cordectomia aberta e cirurgia a laser (p > 0,05). A sobrevida global de cinco anos e a sobrevida livre de doença foram, respectivamente, 90,48% e 85,71% no Grupo A; 88,14% e 86,44% no Grupo B (p > 0,05). Menor taxa de traqueostomia, recuperação mais rápida da função de deglutição e menor tempo de internação foram observados no Grupo A (p < 0,05). Conclusões O estado da margem tem papel prognóstico no câncer glótico T1a-T1b. A cirurgia a laser transoral mostrou resultados oncológicos semelhantes aos da cordectomia aberta, com melhores resultados funcionais.

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INTRODUCTION: Increased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty. OBJECTIVE: We aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers. METHODS: Between 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5kg/m2 (underweight); (b) 18.5-25kg/m2 (normal weight); (c) 26-30kg/m2 (overweight); (d) 31-40kg/m2 (obese) and (e) >40kg/m2 (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared. RESULTS: Median follow up period was 5.2years (0.6-10). Mean body mass index was 31.3kg/m2 (17-72); body mass index 31-40kg/m2 was predominant (89 patients, 42.6%) followed by 26-30kg/m2 seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p=0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival. CONCLUSION: Although body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

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O linfoma folicular (LF) é um dos tipos mais frequentes de linfomas não-Hodgkin, correspondendo a cerca de 35% destes. O prognóstico destas neoplasias baseia-se em parâmetros clínicos e laboratoriais, que resultam em um índice utilizado internacionalmente, de aplicação relativamente fácil, o FLIPI (abreviatura do inglês, Follicular Lymphoma International Prognostic Índex). O objetivo deste estudo retrospectivo foi determinar o valor prognóstico da imunoexpressão de marcadores de proliferação celular: Ki-67 e Top-2a. Os prontuários de 170 pacientes foram revistos para obtenção dos dados clínicos e laboratoriais. Os preparados histológicos foram revistos e graduados em baixo grau (graus 1 ou 2 da OMS) e alto grau (grau 3a ou 3b). Posteriormente, foram submetidos à construção de um microarranjo de tecidos (tissue microarray) e à imunoistoquímica. A avaliação da imunoexpressão desses marcadores foi quantitativa [número de células positivas por µm2]. Os dados obtidos pela quantificação imunoistoquímica dos marcadores de proliferação celular foram relacionados com o grau histológico atribuído classicamente, com o FLIPI, a sobrevida global, sobrevida livre de doença e o risco de transformação para linfoma agressivo. Foi observado que os pacientes com Ki-67> ou = a 7 apresentaram menor sobrevida comparados aos que apresentaram Ki-67<7. Obtivemos também correlação positiva fraca entre Ki-67 e Top-2a. A Top-2a não demonstrou relação com a sobrevida global e a sobrevida livre da doença. Conclui-se que apenas a Ki-67 pode ser um promissor fator prognóstico para LF estabelecida atraves da sua relação com a sobrevida (AU)

Follicular lymphoma (FL) is one of the most common types of non-Hodgkin's lymphoma, accounting about 35%. The prognosis of these neoplasms are based in clinical and laboratory parameters, which result in an internationally index used, relatively easy to use, FLIPI (Follicular Lymphoma International Prognostic Index). The aim of this retrospective study is to determine the prognosis value of immunoexpression of cell proliferation markers: Ki-67 and Top-2a. Patient records of 170 patients were reviewed for clinical and laboratory data. Histological preparations were reviewed and graded in low grade (WHO grade 1 or 2) and high grade (grade 3a or 3b). Subsequently, they were submitted for the construction of a tissue microarray and immunohistochemistry. The immunoexpression evaluation of these markers was quantitative [number of positive cells per µm2]. The data obtained by the immunohistochemical quantification of the cell proliferation markers were related to the histological grade classically attributed to FLIPI, overall survival, disease-free survival rate and the risk of transformation to aggressive lymphoma. It was observed that patients with Ki-67> or = 7 showed lower survival compared to those with Ki-67 <7. We also obtained a weak positive correlation between Ki-67 and Top-2a. Top-2a no showed relation to overall survival rate and disease free survival rate. It is concluded that only Ki-67 may be a promising prognostic factor for FL established through its relation with survival rate (AU)

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Introdução e objetivo: Apesar do aumento da incidência do carcinoma de células renais células claras (CCRcc) localizado, os índices relacionados de mortalidade continuam subindo. Os atuais recursos prognósticos clínicos e patológicos não são suficientemente precisos para distinguir pacientes com baixo ou alto risco de progressão da doença ou morte. A incorporação de biomarcadores moleculares pode ajudar a distinguir neoplasias com diferentes comportamentos, bem como auxiliar na predição de tumores com potencial metastático. Poucos estudos foram focados nos produtos endócrinos do rim. Nosso objetivo foi estudar a expressão imunoistoquímica intratumoral da renina, uma enzima produzida pelas células granulares justaglomerulares no córtex renal, e seu papel como fator prognóstico para a sobrevida ou recidiva do câncer. Material e método: foram selecionados 558 pacientes com CCRcc da base de dados do Latin American Renal Cancer Group, submetidos à nefrectomia radical ou parcial entre 1990 e 2016. Todos os casos foram revisados por uropatologistas experientes e, em cada caso, duas amostras distintas obtidas para a construção do tissue microarray. O método da avidina-biotina-peroxidase foi usado e a leitura realizada manualmente através de microscopia óptica. Taxas de sobrevida global (SG), câncer específica (SCE), e livre de doença (SLD) foram analisados em 10 anos. Resultados: o padrão de expressão nuclear da renina mostrou-se qualitativamente positivo em 402 casos (72%) e negativo em 156 (28%). A baixa expressão de renina associou-se com maior prevalência de tumores com altos graus nas classificações de ISUP e Furhman (p<0,001), invasão venosa microscópica (p=0,046), invasão da veia renal (p=0,026), disseminação linfonodal (p=0,05) e doença metastática ao diagnóstico (p=0,003). Nas análises multivariadas, a ausência de expressão de renina foi fator prognóstico desfavorável para SG (RR=2,008; p=0,018), SCE (RR=2,040; p=0,037) e SLD (RR=2,923; p<0,001). Sobre a expressão quantitativa da renina, a determinação de um ponto de corte ≤35 foi associado independentemente a piores taxas de SLD (RR=4,085; p<0,001). Conclusão: o perfil de expressão imunoistoquímico de renina intratumoral oferece valiosos dados prognósticos em relação à morte e principalmente recorrência relacionadas ao CCRcc (AU)

Introduction and Purpose: Despite the increased incidence of localized clear-cell renal cell carcinoma (ccRCC), its related mortality rates continue to rise. The usual clinical and pathologic prognostic are not sufficiently accurate to distinguish patients with low or high risks for disease progression or death. The incorporation of molecular biomarkers can help in distinguish diseases with different behaviors, as well as help in predicting tumors with metastatic potential. Few studies have been focused in the endocrine products of the kidney. We aimed to study the intratumoral immunohistochemical expression of the renin, an enzyme produced by juxtaglomerular granular cells in the renal cortex, and its role as a prognostic factor for cancer survival or recurrence. Material and method: We selected 558 patients with ccRCC from Latin American Renal Cancer Group database, undergone radical or partial nephrectomy between 1990 and 2016. All cases were revised by expert uropathologists and, from each case, two distinct samples were obtained for the tissue microarray construction. Streptavidin biotine peroxidase method was used and the reading was manual by optical microscope. Ten years overall survival (OS), cancer specific survival (CSS), and disease free survival (DFS) were analyzed. The renin expression was qualitatively classified as negative or positive. For quantitative analysis a cut-point was estimate using the maximum of the standardized log-rank statistic proposed by Lausen and Schumacher. Results: the renin nuclear expression pattern was qualitatively positive in 402 cases (72%) and negative in 156 (28%). The negative renin expression was associated with the prevalence high grade tumors (scored for ISUP and Furhman classifications, both p<0.001), more microscopic venous invasion (p=0.046), renal vein invasion (p=0.026), lymph node (p=0.05) and metastatic disease at presentation (p=0.003). In the multivariate analyzes, the qualitative negative renin expression was an unfavorable prognostic factor for OS (RR=2.008, p=0.018), CSS (RR=2.040, p=0.037) and DFS (RR=2.923, p<0.001). On the quantitative renin expression, the cutoff point ≤35 was associated with worse DFS (RR=4.085, p<0.001). Conclusion: The intratumoral immunohistochemical expression profile of renin in patients with ccRCC, offers valuable prognostic data regarding death and mainly in cancer recurrence odds (AU)

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Resumen El sarcoma de mediastino es un raro tumor que representa menos del 10% de los tumores del mediastino y alrededor del 1-2% de todas las neoplasias malignas en general. Debe abordarse en centros de referencia, donde se evalué multidisciplinariamente y se tengan opciones de manejo multimodal, infraestructura que permita la resección y reconstrucción quirúrgica mayor y estricto seguimiento, teniendo en cuenta la alta recurrencia local, cercana al 30%. Exponemos una serie de casos presentados a lo largo de 20 años de experiencia con la participación de varios departamentos, ajustándonos a la definición y manejo con la literatura actual.

Abstract Mediastinum sarcoma is a rare tumor that represents less than 10% of mediastinal tumors and about 1-2% of all malignancies in general. It should be approached in reference centers with multidisciplinary evaluation and multimodal management options, with an infrastructure that allows surgical resection and reconstruction and strict follow-up, taking into account the high local recurrence that is close to 30%. Therefore, we present a series of cases in 20 years of experience with the participation of several departments and adjusting the definition and management with the current literature.

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INTRODUCTION: Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer. OBJECTIVES: The aim of this retrospective study was to evaluate the prognostic value of margin status in 162 consecutive cases of early glottic carcinoma (Tis-T1) treated with CO2 laser endoscopic surgery (Group A) or laryngofissure cordectomy (Group B), and to compare the oncologic and functional results. METHODS: Clinical prognostic factors, local recurrence rate according to margin status, overall survival and disease-free survival were analyzed. RESULTS: Margin status is related to recurrence rate in both groups (p<0.05) without significant differences between open and laser cordectomy (p>0.05). The 5 years overall survival and disease-free survival were respectively 90.48% and 85.71% in Group A; 88.14% and 86.44% in Group B (p>0.05). Lower tracheostomy rate, earlier recovery of swallowing function and shorter hospital stay were observed in Group A (p<0.05). CONCLUSIONS: Margin status has a prognostic role in T1a-T1b glottic cancer. Transoral laser surgery showed similar oncologic results of open cordectomy, with better functional outcomes.

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Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide. Most cases occur in patients with chronic liver disease who are diagnosed at an advanced stage, and their prognosis is poor. Because HCC is resistant to conventional systemic therapies, molecular therapies have emerged and been established as the standard for advanced forms of the disease. Since the publication of phase III clinical studies on sorafenib, research has searched for new molecular targets. Thus, multiple clinical studies that inhibit relevant molecular pathways have been performed with numerous patients. Many of these trials have had unexpectedly negative results, not only due to patient complexity and the difficulty in evaluating a therapeutic response, quality of life and the survival rate but also because phase II clinical studies, without the selection of molecular targets, have continued on to poor results in phase III studies. This review article aims to evaluate different phase II and phase III clinical studies to understand the clinically relevant molecular pathways and to improve the future management of HCC patients.

El carcinoma hepatocelular (CHC) es uno de los tumores más comunes a nivel mundial. La mayoría de los casos ocurre en pacientes con enfermedad hepática crónica, quienes son diagnosticados en un estado avanzado con muy pobre pronóstico. Terapias moleculares orientadas al tratamiento del CHC han sido destacadas; estas pueden afectar la proliferación celular del tumor, diferenciación celular, angiogénesis, invasión y metástasis, entre otros procesos críticos al desarrollo del tumor. El estándar para el CHC avanzado es la terapia target usando Sorafenib, sin embargo, nuevas moléculas han sido testeadas en estudios fase III de primera línea, tales como sunitinib, brivanib, erlotinib y linifanib, sin superioridad sobre sorafenib. La investigación de nuevos tratamientos es un desafío para investigadores, hepatólogos y oncólogos. Las principales vías moleculares de CHC con relevancia en estudios clínicos fase II y III son: MAP-kinase (MAPK), PI3K/AKT/mTOR, (HGF)/c-Met, cromatina y regulación epigenética, mantenimiento de telómeros, Notch, Hedgehog, Hippo y vía señalizante Jak/STAT. Las terapias futuras en CHC pueden ser orientadas rutinariamente usando sólo objetivos adecuados para terapias moleculares y seleccionando subgrupos de pacientes sobre la base de la expresión de targets moleculares o basados en nuevas clasificaciones definidas por estudios genómicos.

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As preocupações relacionadas ao prognóstico e qualidade de vida das pacientes com estadiamento precoce sem comprometimento linfonodal têm aumentado, especialmente no que se refere à abordagem cirúrgica axilar, devido ao aumento do diagnóstico precoce e avanços no tratamento do câncer de mama. Enquanto a biópsia do linfonodo sentinela (BLS) tem se mostrado eficiente e mais protetora do que a linfadenectomia axilar (LA) na incidência de complicações, ainda existem preocupações relacionadas a sobrevida das pacientes, principalmente na presença das micrometástases linfonodais. Objetivo: Caracterizar a incidência de complicações pós-operatórias em mulheres com câncer de mama classificação T1-T2N0M0, e determinar a sobrevida global (SG) e livre de doença (SLD) de mulheres diagnosticadas e tratadas no Instituto Nacional de Câncer (INCA) entre 2007 a 2009 segundo a abordagem cirúrgica axilar (BLS e LA). Métodos: Trata-se de um estudo observacional de uma coorte de 933 mulheres com diagnóstico clínico T1-2N0M0 atendidas no Hospital de Câncer III do Instituto Nacional de Câncer, no período de Janeiro de 2007 a Dezembro de 2009, e seguidas por um período de 60 meses. A coleta de dados foi realizada com base na análise do Registro Hospitalar de Câncer, dos prontuários físicos e/ou eletrônicos das pacientes e da ficha de avaliação do Serviço de Fisioterapia do HC-III/INCA. Dentre as informações avaliadas, constaram as características sociodemográficas, clínicas, de hábitos de vida, tratamentos empregados e variáveis de desfecho. As variáveis de desfecho serão àquelas referentes às complicações pós-cirúrgicas no membro superior afetado, status da doença (resposta ao tratamento e recidiva) e de status vital...

With increased early detection and advances in treatment of breast cancer, concerns related to the prognosis and quality of life of patients with early stage have increased without lymph node involvement, especially with respect to the axillary approach. However, while the sentinel lymph node biopsy (BLS) it has proved so efficient and more protective than the axillary lymphadenectomy (LA) in the incidence of complications, there are still concerns about the survival of patients, especially in the presence of lymph node micrometastase. Objective: To characterize the incidence of postoperative complications in women with breast cancer classification T1 and T2N0M0, according to axillary surgical approach, and determine overall survival and disease-free survival of women diagnosed and treated at the National Cancer Institute (INCA) between 2007 2009. Methods: Observational study of a cohort of 933 women with clinical diagnosis T1-2N0M0 treated at Hospital Cancer-III of the National Cancer Institute (HC-III / INCA) in 2007-2009, and followed by a period of 60 months. Data collection was based on analysis of the Hospital Registry Cancer, the physical and/or electronic records of patients - HCIII/INCA and clinical evaluation form the Physical Therapy Service of the HC-III/INCA. Among the evaluated information included sociodemographic, clinical, lifestyle habits, implemented treatments and outcome variables. The outcome variables will be those related to post-surgical complications in the affected upper limb, disease status (response to treatment and relapse) and vital status...

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Introdução: O principal objetivo deste estudo foi identificar as características clínicas dos pacientes transplantados na instituição e avaliar os resultados obtidos com a infusão autóloga de células-tronco hematopoiéticas do sangue periférico (CTHSP), a mortalidade relacionada ao transplante (MRT) e a sobrevida global (SG). Métodos: Através da revisão e avaliação retrospectiva dos prontuários dos 120 pacientes submetidos a transplante autólogo no período de dezembro de 1996 a dezembro de 2011. Resultados: Cento e vinte pacientes receberam quimioterapia mieloablativa e resgate com infusões de CTHSP, sendo 78,3% adultos, com mediana de idade de 47 anos e predomínio do sexo masculino. Os diagnósticos foram 32,5% para Mieloma Múltiplo (MM), 35,8% para Linfoma de Hodgkin (LH), 16,7% para Linfoma não Hodgkin (LNH) 4,2% para Leucemia Mieloide Aguda (LMA) e 10,8% para outras neoplasias como Tumor de Wilms, Câncer de Mama Neuroblastoma, Sarcoma de Ewing, Tumor de Testículo, Meduloblastoma, Macroglobulinemia, Amiloidose e Tumor de SNC. A mediana do número de células nucleadas totais infundidas foi de 6,46x108/kg e a de células CD34+ foi de 3,17x106/kg. A mediana de tempo para recuperação de neutrófilos foi de 10 dias e para plaquetas, de 12 dias. Foi encontrada uma correlação entre a quantidade de células CD34+ infundidas e a recuperação de neutrófilos e plaquetas. Para o grupo em geral, a MRT encontrada foi de 5%, e a probabilidade de SG em cinco anos de 55,1%. Conclusão: Os resultados obtidos com os transplantes autólogos em nossa instituição são semelhantes aos descritos na literatura internacional (AU)

Introduction: The aim of this study was to identify the clinical characteristics of patients transplanted in the institution and evaluate the results obtained with the autologous infusion of hematopoietic stem cells from peripheral blood (PBSC), transplant-related mortality (TRM) and overall survival (OS). Methods: A review and retrospective assessment of the charts of 120 patients who underwent autologous transplantation from December 1996 to December 2011. Results: One hundred and twenty patients received myeloablative chemotherapy and rescue with infusions PBSC, of whom 78.3% were adults, with a median age of 47 years and male predominance. The diagnoses were 32.5 % for Multiple Myeloma (MM), 35.8% for Hodgkin lymphoma (HL), 16.7 % for non-Hodgkin lymphoma (NHL), 4.2 % for Acute Myeloid Leukemia (AML ), and 10.8% for other cancers such as Wilms Tumor, breast cancer, neuroblastoma, Ewing's sarcoma, Testicular Tumor, medulloblastoma , macroglobulinemia , amyloidosis and CNS tumor. The median number of total nucleated cells infused was 6.46 x108/kg and of CD34+ cells was 3.17 x106/kg. The median time for neutrophil recovery was 10 days and for platelets 12 days. A correlation was found between number of CD34+ cells infused and recovery of neutrophils and platelets. For the overall group, the MRT was found to be 5% and the probability of OS at five years was 55.1 %. Conclusion: The results obtained with autologous transplantation at our institution are similar to those described in the international literature (AU)

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