RESUMO
There are controversial about the application of cancer-directed surgery (CDS) in patients with liver metastases from gastric cancer, with improved responses to chemotherapy and targeted treatments, the role of CDS in metastatic gastric cancer to the liver needs to be revisited. This study aimed to evaluate the effect of CDS on patients with liver metastases from gastric cancer. Data for patients with liver metastases from gastric cancer were extracted from the population-based Surveillance, Epidemiology, and End Results (SEER) database. A total of 958 individuals were enrolled, 285 in the CDS group and 673 in the non-cancer guided surgery (Non-CDS) group. Following propensity score matching (PSM) analysis at 1:1 in the two groups,285 were included in the survival analysis for each group. Kaplan-Meier values and Cox proportional risk models were used to estimate the effect of CDS on patients' prognoses. Compared with the Non-CDS group, the CDS group significantly prolonged the median overall survival from 4 months (95% confidence interval [CI] 3-5) to 11 months (95% CI 8-12), p value < 0.001. Overall survival (OS) at 1 year was higher in the CDS group than in the Non-CDS group, at 44% (95 CI 38-50) and 25% (95 CI 20-30), respectively. OS at 3 years was also higher in the CDS group than in the Non-CDS group, at 24% (95 CI 19-29) and 6% (95 CI 3-9), respectively. Multivariate analysis showed that Non-CDS (hazard ratio[HR] = 2.26, 95% CI 1.88-2.72, p value < 0.001) was an adverse independent prognostic factor for patients. This study concludes that CDS prolonged survival in patients with gastric cancer with liver metastases. Due to the lack of information on the quality of life, biomarkers, targeted therapies, and immunotherapy in the SEER database, the observed improved survival rates following CDS of hepatic metastasis from gastric cancer requires prospective studies that take these factors into account to properly address the survival advantages and impact on quality of life of such a method.
Assuntos
Neoplasias Hepáticas , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/patologia , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Prognóstico , Neoplasias Hepáticas/secundárioRESUMO
BACKGROUND: Chemotherapy (CMT) followed by surgery is recommended by Western countries for advanced gastric cancer (GC). However, cT4 GC usually undergoes upfront surgery, due to symptoms. This study aimed to evaluate if preoperative CMT is a better strategy than upfront surgery in cT4 GC. METHODS: All cT4 GCs who underwent curative gastrectomy were included. Patients were divided according to their initial treatment: upfront surgery (SURG) or CMT + SURG. RESULTS: Among the 226 GC initially staged as cT4, 150 underwent SURG and 76 CMT + SURG. Groups were similar concerning age, comorbidities, American Society of Anesthesiologists, gastrectomy performed, and postoperative complications. The CMT + SURG group had less advanced pTNM. Median overall survival (OS) was 32 and 58.5 months for SURG and CMT + SURG, respectively (p = 0.04). Patients who received perioperative or adjuvant CMT had better OS compared to surgery alone (49.4 vs. 15.9 months, p < 0.001). OS was similar for those receiving preoperative and adjuvant CMT. Non-CMT, pN+, and R1 resection were independent risk factors for worse OS. CONCLUSION: Multimodal treatment associating CMT with surgery, regardless of whether the approach is pre- or postoperative, is essential to improve the survival of cT4 GC. As tolerance to adjuvant treatment is reduced, preoperative CMT is a better strategy than upfront surgery in these patients.
Assuntos
Neoplasias Gástricas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Gastrectomia , Humanos , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgiaRESUMO
Introducción: El cáncer de estómago representa la segunda causa de muerte relacionada con neoplasias en el mundo, es responsable del 8 al 10 por ciento de todas las muertes por cáncer. A pesar de un marcado descenso en su incidencia, constituye una de las principales causas de muerte por cáncer en Cuba y el mundo. Objetivo: Describir el comportamiento clínico epidemiológico en los pacientes con cáncer gástrico. Métodos: Se realizó un estudio observacional, descriptivo, transversal de los pacientes con diagnóstico de cáncer gástrico que acudieron a consulta en el Hospital Universitario General Calixto García, en el período comprendido entre enero de 2014 y diciembre de 2018. El universo estuvo constituido por 146 pacientes. Los datos fueron obtenidos de las historias clínicas y procesados mediante estadística descriptiva. Resultados: De los pacientes estudiados, 67,6 por ciento pertenecían al sexo masculino y tenían entre 60 y 79 años; 51,7 por ciento presentó como factor de riesgo el hábito de fumar. Un total de 124 pacientes padecieron de dolor abdominal. El 100 por ciento de los exámenes complementarios realizados fueron endoscopia y biopsia. Se observó el adenocarcinoma moderadamente diferenciado en un total de 80 pacientes. Al 100 por ciento se le realizó tratamiento quirúrgico. La técnica quirúrgica más empleada fue la gastrectomía subtotal. Conclusiones: Las edades avanzadas de la vida, los antecedentes de úlcera gástrica, el tabaquismo y el alcoholismo son factores epidemiológicos característicos de la población de enfermos aquejados de cáncer gástrico. Los elementos clínicos identificados fueron los habitualmente descritos en la literatura médica. La cirugía en la actualidad es la única modalidad con potencial curativo(AU)
Introduction: Stomach cancer accounts for the second cause of death related to neoplasms worldwide; it is responsible for 8 percent to 10 percent of all cancer deaths. In spite of a marked decrease in its incidence, it constitutes one of the main causes of cancer death in Cuba and worldwide. Objective: To describe the clinical-epidemiological characteristics of patients with gastric cancer. Methods: An observational, descriptive and cross-sectional study was carried out with patients with a diagnosis of gastric cancer who attended consultation at Calixto García General University Hospital in the period from January 2014 to December 2018. The universe consisted of 146 patients. The data were obtained from medical records and processed by descriptive statistics. Results: Of the patients studied, 67.6 percent were male and aged 60-79 years. 51.7 percent presented smoking as a risk factor. A total of 124 patients suffered from abdominal pain. 100 percent of the complementary examinations performed were endoscopy and biopsy. Moderately differentiated adenocarcinoma was observed in a total of 80 patients. The surgical treatment was performed in 100 percent. The most commonly used surgical technique was subtotal gastrectomy. Conclusions: The research suggests that, currently, early diagnosis and surgery is the only modality with curative potential, being able to raise the quality of life, as well as to improve morbidity and mortality rates in the population(AU)
Assuntos
Humanos , Masculino , Feminino , Neoplasias Gástricas/epidemiologia , Fatores de Risco , Endoscopia Gastrointestinal/métodos , Helicobacter pylori/efeitos dos fármacos , Epidemiologia Descritiva , Estudos Transversais , Estudo ObservacionalRESUMO
Gastrointestinal neoplasms (GIN) are uncommon in dogs, but they mainly show malignant behavior and poor prognosis. The types of GIN in dogs and their frequency, as well as their epidemiological and histopathological characteristics were analyzed through a retrospective study of biopsies from 24.711 dogs from 2005 to 2017. Additionally, histological sections of neoplasms were subjected to immunohistochemistry (IHC) using antibodies against pancytokeratin, vimentin, smooth muscle actin, c-Kit, S-100, CD31, CD79αcy, and neuron-specific enolase. Of the total samples from dogs analyzed, 88 corresponded to GIN. Neoplasms occurred more frequently in purebred dogs (64.8%, 57/88), males (53.4%, 47/88), with a median age of 10 years. The intestine was affected by 84.1% (74/88) of the cases. Of these, the large intestine was the most affected (67.6%, 50/74). Most of the neoplasms had malignant behavior (88.6%, 78/88). Regarding the classification of neoplasms, 46.6% (41/88) of the diagnoses corresponded to epithelial, 46.6% (41/88) were mesenchymal, 5.7% (5/88) were hematopoietic, and 1.1% (1/88) was neuroendocrine. The most frequently diagnosed neoplasms were papillary adenocarcinoma (19.3%, 17/88), leiomyosarcoma (17.0%, 15/88), gastrointestinal stromal tumors (GISTs) (12.5%, 11/88), and leiomyoma (5.0%, 8/88). Adenocarcinomas were located mainly in the rectum, whereas leiomyosarcomas and GISTs developed mainly in the cecum. Epithelial neoplasms showed a greater potential for lymphatic invasion whereas mesenchymal neoplasms appeared to be more expansive with intratumoral necrosis and hemorrhage. Immunohistochemistry was found to be an important diagnostic technique for the identification of infiltrating cells in carcinomas and an indispensable technique for the definitive diagnosis of sarcomas.(AU)
Neoplasmas gastrointestinais (NGI) são pouco comuns em cães, mas possuem principalmente comportamento maligno e prognóstico reservado. Os tipos de NGI em cães e sua frequência, bem como características epidemiológicas e histopatológicas foram analisados por meio de um estudo retrospectivo dos exames de biópsias de 24.711 cães entre os anos de 2005 a 2017. Adicionalmente, cortes histológicos de NGI foram submetidos à técnica de imuno-histoquímica (IHQ), utilizando os anticorpos anti-pancitoqueratina, vimentina, actina de músculo liso, c-Kit, S-100, CD31, CD79αcy e enolase neurônio específica. Do total de cães analisados, 88 corresponderam a NGI não linfoides. Os neoplasmas ocorreram com maior frequência em cães de raça pura (64,8%, 57/88), machos (53,4%, 47/88), com mediana de idade de 10 anos. O intestino foi acometido em 84,1% dos casos (74/88). Destes, o intestino grosso foi o segmento mais afetado (67,6%, 50/74). A maior parte dos neoplasmas tinha comportamento maligno (88,6%, 78/88). Quanto à classificação, 46,6% (41/88) dos diagnósticos corresponderam a neoplasmas epiteliais, 46,6% (41/88) mesenquimais, 5,7% (5/88) hematopoiéticos e 1,1% (1/88), neuroendócrino. Os neoplasmas mais frequentemente diagnosticados foram adenocarcinoma papilar (19,3%, 17/88), leiomiossarcoma (17,0%, 15/88), tumor estromal gastrointestinal (GIST) (12,5%, 11/88) e leiomioma (12,5%, 8/88). Adenocarcinomas localizavam-se principalmente no reto, enquanto leiomiossarcoma e GISTs desenvolveram-se principalmente no ceco. Os neoplasmas epiteliais demonstraram um potencial maior de invasão linfática enquanto que os mesenquimais aparentaram ser mais expansivos, com necrose e hemorragia intratumorais. A imuno-histoquímica mostrou ser uma técnica diagnóstica importante para a identificação de células neoplásicas infiltravas no caso dos carcinomas e uma técnica indispensável para o diagnóstico definitivo de sarcomas.(AU)
Assuntos
Animais , Cães , Neoplasias Gástricas/veterinária , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/veterinária , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Intestinais/veterinária , Imuno-Histoquímica/veterinária , Adenocarcinoma Papilar/veterinária , Carcinoma de Células Acinares/veterinária , Adenocarcinoma Mucinoso/veterinária , Neoplasias Gastrointestinais/diagnóstico , Leiomiossarcoma/veterináriaRESUMO
Gastrointestinal neoplasms (GIN) are uncommon in dogs, but they mainly show malignant behavior and poor prognosis. The types of GIN in dogs and their frequency, as well as their epidemiological and histopathological characteristics were analyzed through a retrospective study of biopsies from 24.711 dogs from 2005 to 2017. Additionally, histological sections of neoplasms were subjected to immunohistochemistry (IHC) using antibodies against pancytokeratin, vimentin, smooth muscle actin, c-Kit, S-100, CD31, CD79αcy, and neuron-specific enolase. Of the total samples from dogs analyzed, 88 corresponded to GIN. Neoplasms occurred more frequently in purebred dogs (64.8%, 57/88), males (53.4%, 47/88), with a median age of 10 years. The intestine was affected by 84.1% (74/88) of the cases. Of these, the large intestine was the most affected (67.6%, 50/74). Most of the neoplasms had malignant behavior (88.6%, 78/88). Regarding the classification of neoplasms, 46.6% (41/88) of the diagnoses corresponded to epithelial, 46.6% (41/88) were mesenchymal, 5.7% (5/88) were hematopoietic, and 1.1% (1/88) was neuroendocrine. The most frequently diagnosed neoplasms were papillary adenocarcinoma (19.3%, 17/88), leiomyosarcoma (17.0%, 15/88), gastrointestinal stromal tumors (GISTs) (12.5%, 11/88), and leiomyoma (5.0%, 8/88). Adenocarcinomas were located mainly in the rectum, whereas leiomyosarcomas and GISTs developed mainly in the cecum. Epithelial neoplasms showed a greater potential for lymphatic invasion whereas mesenchymal neoplasms appeared to be more expansive with intratumoral necrosis and hemorrhage. Immunohistochemistry was found to be an important diagnostic technique for the identification of infiltrating cells in carcinomas and an indispensable technique for the definitive diagnosis of sarcomas.(AU)
Neoplasmas gastrointestinais (NGI) são pouco comuns em cães, mas possuem principalmente comportamento maligno e prognóstico reservado. Os tipos de NGI em cães e sua frequência, bem como características epidemiológicas e histopatológicas foram analisados por meio de um estudo retrospectivo dos exames de biópsias de 24.711 cães entre os anos de 2005 a 2017. Adicionalmente, cortes histológicos de NGI foram submetidos à técnica de imuno-histoquímica (IHQ), utilizando os anticorpos anti-pancitoqueratina, vimentina, actina de músculo liso, c-Kit, S-100, CD31, CD79αcy e enolase neurônio específica. Do total de cães analisados, 88 corresponderam a NGI não linfoides. Os neoplasmas ocorreram com maior frequência em cães de raça pura (64,8%, 57/88), machos (53,4%, 47/88), com mediana de idade de 10 anos. O intestino foi acometido em 84,1% dos casos (74/88). Destes, o intestino grosso foi o segmento mais afetado (67,6%, 50/74). A maior parte dos neoplasmas tinha comportamento maligno (88,6%, 78/88). Quanto à classificação, 46,6% (41/88) dos diagnósticos corresponderam a neoplasmas epiteliais, 46,6% (41/88) mesenquimais, 5,7% (5/88) hematopoiéticos e 1,1% (1/88), neuroendócrino. Os neoplasmas mais frequentemente diagnosticados foram adenocarcinoma papilar (19,3%, 17/88), leiomiossarcoma (17,0%, 15/88), tumor estromal gastrointestinal (GIST) (12,5%, 11/88) e leiomioma (12,5%, 8/88). Adenocarcinomas localizavam-se principalmente no reto, enquanto leiomiossarcoma e GISTs desenvolveram-se principalmente no ceco. Os neoplasmas epiteliais demonstraram um potencial maior de invasão linfática enquanto que os mesenquimais aparentaram ser mais expansivos, com necrose e hemorragia intratumorais. A imuno-histoquímica mostrou ser uma técnica diagnóstica importante para a identificação de células neoplásicas infiltravas no caso dos carcinomas e uma técnica indispensável para o diagnóstico definitivo de sarcomas.(AU)
Assuntos
Animais , Cães , Neoplasias Gástricas/veterinária , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/veterinária , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Intestinais/veterinária , Imuno-Histoquímica/veterinária , Adenocarcinoma Papilar/veterinária , Carcinoma de Células Acinares/veterinária , Adenocarcinoma Mucinoso/veterinária , Neoplasias Gastrointestinais/diagnóstico , Leiomiossarcoma/veterináriaRESUMO
ABSTRACT: Gastrointestinal neoplasms (GIN) are uncommon in dogs, but they mainly show malignant behavior and poor prognosis. The types of GIN in dogs and their frequency, as well as their epidemiological and histopathological characteristics were analyzed through a retrospective study of biopsies from 24.711 dogs from 2005 to 2017. Additionally, histological sections of neoplasms were subjected to immunohistochemistry (IHC) using antibodies against pancytokeratin, vimentin, smooth muscle actin, c-Kit, S-100, CD31, CD79cy, and neuron-specific enolase. Of the total samples from dogs analyzed, 88 corresponded to GIN. Neoplasms occurred more frequently in purebred dogs (64.8%, 57/88), males (53.4%, 47/88), with a median age of 10 years. The intestine was affected by 84.1% (74/88) of the cases. Of these, the large intestine was the most affected (67.6%, 50/74). Most of the neoplasms had malignant behavior (88.6%, 78/88). Regarding the classification of neoplasms, 46.6% (41/88) of the diagnoses corresponded to epithelial, 46.6% (41/88) were mesenchymal, 5.7% (5/88) were hematopoietic, and 1.1% (1/88) was neuroendocrine. The most frequently diagnosed neoplasms were papillary adenocarcinoma (19.3%, 17/88), leiomyosarcoma (17.0%, 15/88), gastrointestinal stromal tumors (GISTs) (12.5%, 11/88), and leiomyoma (5.0%, 8/88). Adenocarcinomas were located mainly in the rectum, whereas leiomyosarcomas and GISTs developed mainly in the cecum. Epithelial neoplasms showed a greater potential for lymphatic invasion whereas mesenchymal neoplasms appeared to be more expansive with intratumoral necrosis and hemorrhage. Immunohistochemistry was found to be an important diagnostic technique for the identification of infiltrating cells in carcinomas and an indispensable technique for the definitive diagnosis of sarcomas.
RESUMO: Neoplasmas gastrointestinais (NGI) são pouco comuns em cães, mas possuem principalmente comportamento maligno e prognóstico reservado. Os tipos de NGI em cães e sua frequência, bem como características epidemiológicas e histopatológicas foram analisados por meio de um estudo retrospectivo dos exames de biópsias de 24.711 cães entre os anos de 2005 a 2017. Adicionalmente, cortes histológicos de NGI foram submetidos à técnica de imuno-histoquímica (IHQ), utilizando os anticorpos anti-pancitoqueratina, vimentina, actina de músculo liso, c-Kit, S-100, CD31, CD79cy e enolase neurônio específica. Do total de cães analisados, 88 corresponderam a NGI não linfoides. Os neoplasmas ocorreram com maior frequência em cães de raça pura (64,8%, 57/88), machos (53,4%, 47/88), com mediana de idade de 10 anos. O intestino foi acometido em 84,1% dos casos (74/88). Destes, o intestino grosso foi o segmento mais afetado (67,6%, 50/74). A maior parte dos neoplasmas tinha comportamento maligno (88,6%, 78/88). Quanto à classificação, 46,6% (41/88) dos diagnósticos corresponderam a neoplasmas epiteliais, 46,6% (41/88) mesenquimais, 5,7% (5/88) hematopoiéticos e 1,1% (1/88), neuroendócrino. Os neoplasmas mais frequentemente diagnosticados foram adenocarcinoma papilar (19,3%, 17/88), leiomiossarcoma (17,0%, 15/88), tumor estromal gastrointestinal (GIST) (12,5%, 11/88) e leiomioma (12,5%, 8/88). Adenocarcinomas localizavam-se principalmente no reto, enquanto leiomiossarcoma e GISTs desenvolveram-se principalmente no ceco. Os neoplasmas epiteliais demonstraram um potencial maior de invasão linfática enquanto que os mesenquimais aparentaram ser mais expansivos, com necrose e hemorragia intratumorais. A imuno-histoquímica mostrou ser uma técnica diagnóstica importante para a identificação de células neoplásicas infiltravas no caso dos carcinomas e uma técnica indispensável para o diagnóstico definitivo de sarcomas.
RESUMO
Background: Despite decreasing global incidence trends, gastric cancer is still among the five most incident cancers in the world and the third cancer-related cause of death. In Brazil, differences in incidence and mortality exist depending on the geographic region studied. Objective: To describe the incidence, mortality, trends and age-period-cohort of gastric cancer in three cities of Brazil (Sao Paulo, Belem and Fortaleza), in the period 1990-2012. Mortality for gastric cancer in Brazil overall and by region was described. Methods: 33,462 incident cases of gastric cancer were identified from the population-based cancer registries and 23,424 deaths from mortality information system in residents of the three cities and in Brazil were included in the study. Data for incident cases were extracted from the Population Based Cancer Registries from the National Cancer Institute (INCA). Mortality data on gastric cancer were extracted from Information Technology Department of Brazilian Public Health Care System/Health Ministry (DATASUS/MS). Mortality and incidence age standardized rates were calculated. For trends analysis the Joinpoint Regression and age-period-cohort model were applied. Results: Belem presented the highest incidence rates for gastric adenocarcinoma. Decreasing incidence trends were identified in Sao Paulo (-7.8% in men; -6.3% in women) and in Fortaleza (-1.2% in men). Increasing incidence trends were observed for women in Belem (1.8%) and Fortaleza (1.1%). In Belem (Amazon area), there was an increased risk for gastric cancer in women born after the 1960s. Overall in Brazil mortality for gastric cancer is decreasing. Mortality trends showed significant reduction, for both sexes, in the three Brazilian cities. Conclusion: Incidence of gastric cancer is increasing in women born in the sixties in Belem (Amazon region) and Fortaleza (Northeast region). In Brazil there was increase in mortality in Northeast region and decrease in others regions. More update data on incidence for Amazon and Northeast region is needed.
Assuntos
Adenocarcinoma/epidemiologia , Adenocarcinoma/mortalidade , Mortalidade/tendências , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/mortalidade , Adenocarcinoma/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Demografia , Feminino , Seguimentos , Disparidades nos Níveis de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores Sexuais , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Fatores de Tempo , Adulto JovemRESUMO
Resumen Introducción: el cáncer gástrico es un problema de salud pública; ocupa el quinto y tercer lugar en incidencia y mortalidad mundial, respectivamente. Objetivo: describir las barreras para la atención en salud percibidas por el adulto con cáncer gástrico, su cuidador y el médico tratante en el departamento de Santander, Colombia-etapa exploratoria en el período 2015-2016. Metodología: estudio cualitativo utilizando algunas técnicas del proceso de análisis de la teoría fundamentada a partir de la aplicación de entrevistas semiestructuradas que fueron codificadas y categorizadas con el software N-VIVO 10. Resultados: Emergieron 13 categorías, 182 códigos descritos en 6 ejes: el primero relacionado con el significado del cáncer y sus barreras; el segundo con las principales barreras para la atención en salud, cuyo orden de mayor a menor frecuencia fue: administrativas, económicas, culturales, de conocimiento, de comunicación e institucionales; el tercero es las estrategias para superar las barreras; el cuarto, las estrategias para disminuirlas; el quinto, sentimientos y el rol de la familia; y el sexto, necesidades del paciente. Conclusión: la fragmentación y segmentación del sistema de salud impone barreras que limitan el diagnóstico temprano del cáncer gástrico y su manejo oportuno. Además, amenazan la calidad de vida del adulto enfermo y su familia.
Abstract Introduction: Gastric cancer is a public health problem that ranks fifth in world incidence and third in mortality. Objective: The aim of the exploratory stage of this study was to describe the barriers to health care perceived by adults with gastric cancer, their caregivers, and their attending physicians in the department of Santander, Colombia in 2015 and 2016. Methodology: This is a qualitative study using process techniques and grounded theory analysis based on semi-structured interviews that were codified and categorized with N-VIVO 10. Results: Thirteen categories and 182 codes described along 6 axes emerged. The first axis is related to the meaning of cancer and its barriers. The second is related to the primary barriers to health care which are, in order from most frequent to least frequent: administrative, economic, cultural, knowledge, communication and institutional. The third axis consists of strategies to overcome barriers. The fourth consists of strategies to diminish barriers. The fifth is related to feelings and the role of the family, and the sixth contains the patient's needs. Conclusion: Fragmentation and segmentation of the health care system imposes barriers that limit early diagnosis of gastric cancer and timely management. In addition, they threaten the quality of life of the sick adult and her or his family.
Assuntos
Humanos , Pacientes , Neoplasias Gástricas , Sistemas de Saúde , Atenção à SaúdeRESUMO
OBJECTIVE: The aim of this study was to study the effect of ω-3 supplementation on the nutritional status and the immune and inflammatory profiles of patients with gastric cancer during antineoplastic pretreatment. METHODS: This was a randomized, open, controlled longitudinal study with intervention in outpatient patients with gastric cancer. Sixty-eight patients were randomized into two groups and received either a formula enriched with ω-3 (intervention group [IG]) or standard formula without ω-3 (control group) for 30 d consecutively. Nutritional status (based on patient-generated subjective global assessment, bioimpedance, and anthropometric measurements) and immune and inflammatory parameters were collected before and after supplementation. Results were expressed as frequency, median, and interquartile intervals and were compared by non-parametric test. P < 0.05 was considered statistically significant. RESULTS: Thirty-four patients were included in each group. Of the patients, 64.7% were men, 44.1% were older than 60 years, and 45.6% had stage III disease. There was an increase in C-reactive protein in the control group before and after supplementation, in addition to the worsening in some anthropometric parameters, such as arm muscle area and arm muscle circumference. There was maintenance of the immune profile in both groups. An increase in weight gain was observed in the IG but not in the control group (1.2 [0.9-9] versus 0.7 kg [0.4-1.3]; Pâ¯=â¯0.03), as was a reduction of interleukin-6 (5.7 [4.1-6.4] versus 6.3 pg/mL [5.6-8.6]; Pâ¯=â¯0.03) and a maintenance of nutritional status, after supplementation. CONCLUSIONS: Supplementation with ω-3 leads to weight gain, reduction in the inflammatory profile, and maintenance of the nutritional and immune profiles of these patients, but further studies are needed to examine changes in body composition.
Assuntos
Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Estado Nutricional , Neoplasias Gástricas/sangue , Neoplasias Gástricas/terapia , Adulto , Idoso , Antropometria , Proteína C-Reativa/efeitos dos fármacos , Feminino , Alimentos Formulados , Humanos , Interleucina-6/sangue , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Aumento de Peso/efeitos dos fármacosRESUMO
ABSTRACT Background: The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. Aim: To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. Methods: Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. Results: The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. Conclusion: Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.
RESUMO Racional: O tratamento do câncer gástrico avançado com intenção curativa é essencialmente cirúrgico e a quimiorradioterapia está indicada como neo ou adjuvância para controlar a doença e prolongar a sobrevida. Objetivos: Avaliar a sobrevida dos doentes submetidos à gastrectomia subtotal ou total com linfadenectomia D2 seguidos de quimiorradioterapia adjuvante. Métodos: Foram analisados retrospectivamente 87 gastrectomizados portadores de adenocarcinoma gástrico avançado considerandos estádios IB até IIIC e submetidos à quimiorradioterapia adjuvante (protocolo INT 0116). Foram excluídos os tumores da transição esofagogástrica, com implantes peritoneais, metástases à distância e os que após a operação apresentaram margem cirúrgica comprometida ou óbito precoce. Foram separados quanto à extensão da gastrectomia e analisados em relação ao local e histopatologia do tumor, invasão linfonodal, estadiamento, morbidade e sobrevida. Resultados: O número de doentes que conseguiu completar o esquema adjuvante na sua totalidade foi de 45 (51,7%). Os que iniciaram o tratamento e interromperam por toxicidade, piora relacionada ao tumor, ou perda de seguimento foram 10 (11,5%) e relacionados como adjuvância incompleta. O número de doentes que recusou ou não iniciou o tratamento adjuvante foi de 33 (48,3%). A gastrectomia subtotal foi indicada em 60 (68,9%) e a total em 27 (31,1%) e esta apresentou menor sobrevida. A média de linfonodos ressecados foi de 30,8. O estadiamento e o número de linfonodos acometidos foram preditores de pior sobrevida e quanto mais avançado foi o tumor. Os pacientes submetidos à terapia adjuvante com quimiorradioterapia completa mostraram sobrevida maior quando comparados àqueles que a fizeram de forma incompleta ou submetidos à operação exclusiva. Por outro lado, comparando-se os doentes estádios T4b (IIIB + IIIC) que tiveram adjuvância completa com os submetidos à operação exclusiva ou que não completaram a adjuvância, houve significativa diferença na sobrevida. Conclusão - A quimiorradioterapia adjuvante apresenta ganho de sobrevida para doentes em estádio T4b submetidos ao tratamento cirúrgico com intenção curativa.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias Gástricas/terapia , Quimiorradioterapia Adjuvante , Gastrectomia/métodos , Estudos Retrospectivos , Intervalo Livre de Doença , Excisão de Linfonodo , Estadiamento de NeoplasiasRESUMO
ABSTRACT Background: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit is still scarce. Aim: To evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing curative gastrectomy for GC, as well as its risk factors and patients' outcomes. Methods: All consecutive patients submitted to D2/modified D2 gastrectomy due to gastric adenocarcinoma from March 2009 to April 2016 were retrospectively reviewed from a prospective collected database. Results: Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor's size (p=0.018), N stage (p<0.001), clinical stage (p=0.022), venous invasion growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008). Conclusion: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low. Total omentectomy may be avoided in tumors smaller than 5.25 cm and T1/T2 tumors. However, the presence of lymph node metastases in the greater omentum is associated with recurrence in the peritoneum, liver, ovary and death.
RESUMO Racional: Tradicionalmente a omentectomia total é realizada juntamente com a ressecção gástrica associada à linfadenectomia na cirurgia do câncer gástrico. No entanto, evidências sólidas em relação ao seu benefício oncológico são escassas . Objetivo: Avaliar a incidência de metástases em linfonodos do omento maior em pacientes submetidos à gastrectomia potencialmente curativa por câncer gástrico, assim como, avaliar os fatores de risco para a ocorrência e a evolução dos pacientes. Métodos: Pacientes consecutivos submetidos à gastrectomia D2/D2 modificada devido ao adenocarcinoma gástrico foram analisados retrospectivamente a partir de um banco de dados. Resultados: Dos 284 pacientes, cinco (1,8%) tinham linfonodos metastáticos no omento maior (um pT3N3bM0; dois pT4aN3bM0; um pT4aN2M0 e um pT4bN3bM0). Quatro faleceram e um estava em tratamento paliativo com quimioterapia devido à recidiva da doença. Os linfonodos metastáticos no omento maior tiveram correlação significativa com o tamanho do tumor (p=0,018), estádio N (p<0,001), estádio clínico (p=0,022), invasão venosa (p=0,003), recorrência (p=0,006), local de recorrência (peritônio p=0,008; fígado p=0,023; ovário p=0,035) e óbito (p=0,008). Conclusão: A incidência de linfonodos metastático no omento maior de pacientes submetidos à gastrectomia radical por câncer gástrico é baixa. A omentectomia total pode ser evitada em tumores menores que 5,25 cm e estádios T1/T2. Entretanto, a presença de metástases linfonodais no omento maior está associada à recidiva no peritônio, fígado, ovário e óbito.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Omento/patologia , Neoplasias Gástricas/cirurgia , Metástase Linfática/patologia , Neoplasias Gástricas/patologia , Estudos Retrospectivos , Fatores de Risco , Gastrectomia , Estadiamento de NeoplasiasRESUMO
RACIONAL: A literatura oriental é notável por apresentar taxas de sobrevida para o tratamento cirúrgico do adenocarcinoma gástrico superiores àquelas apresentadas nos países ocidentais. OBJETIVO: Analisar o resultado a longo prazo após a gastrectomia D2 por câncer gástrico. MÉTODOS: Duzentos e setenta e quatro pacientes foram submetidos à gastrectomia com dissecção linfonodal D2 como tratamento exclusivo. Os critérios de inclusão foram: 1) remoção dos linfonodos de acordo com dissecção linfática padronizada Japonesa, 2) operação potencialmente curativa descrita no prontuário como dissecção D2 ou mais linfonodos; 3) invasão tumoral da parede gástrica restrita ao órgão (T1-T3); 4) ausência de metástases à distância (N0-N2/M0); 5) mínimo de cinco anos de acompanhamento. Dados clinicopatológicos incluíam sexo, idade, localização do tumor, classificação de Borrmann do tumor macroscópico, o tipo de gastrectomia, as taxas de mortalidade, tipo histológico, classificação e estadiamento TNM de acordo com a UICC TNM 1997. RESULTADOS: Gastrectomia total foi realizada em 77 casos (28,1%) e subtotal em 197 (71,9%). O tumor foi localizado no terço superior em 28 casos (10,2%), no terço médio em 53 (19,3%), e no terço inferior em 182 (66,5%). Borrmann foi atribuído cinco casos (1,8%) como BI, 34 (12,4%) BII, 230 (84,0%) BIII e 16 (5,9%) BIV. Os tumores foram histologicamente classificados como Laurén tipo intestinal em 119 casos (43,4%) e como o tipo difuso em 155 (56,6%). De acordo com a UICC TNM foram câncer gástrico precoce (T1) foi diagnosticada em 68 casos (24,8%); 51 (18,6%) T2 e 155 (56,6%) T3. Nenhum envolvimento linfonodal (N0) foi observado em 129 casos (47,1%), enquanto 100 (36,5%) eram N1 (1-6 linfonodos) e 45 (16,4%) N2 (7-15 gânglios linfáticos). O número médio de linfonodos dissecados foi de 35. A sobrevida em cinco anos para os estádios de I a III B foi de 70,4%. CONCLUSÃO: Cirurgiões digestivos devem ser estimulados a realizarem gastrectomias ...
BACKGROUND: Eastern literature is remarkable for presenting survival rates for surgical treatment of gastric adenocarcinoma superior to those presented in western countries. AIM: To analyze the long-term result after D2 gastrectomy for gastric cancer. METHODS: Two hundred seventy four underwent gastrectomy with D2 lymph node dissection as exclusive treatment. The inclusion criteria were: 1) lymph node removal according to Japanese standardized lymphatic chain dissection; 2) potentially curative surgery described in medical records as D2 or more lymph node dissection; 3) tumoral invasiveness of gastric wall restricted to the organ (T1 - T3); 4) absence of distant metastasis (N0-N2/M0); 5) a minimum of five years follow-up. Clinical pathological data included sex, age, tumor location, Borrmann's macroscopic tumor classification, type of gastrectomy, mortality rates, hystological type, TNM classification and staging according to UICC TNM 1997. RESULTS: Total gastrectomy was performed in 77 cases (28.1%) and subtotal gastrectomy in 197 (71.9%). The tumor was located in the upper third in 28 cases (10.2%), in the middle third in 53 (19.3%), and in the lower third in 182 (66.5%). Among patients that had their Borrmann's classification assigned, five cases (1.8%) were BI, 34 (12.4%) BII, 230 (84.0%) BIII and 16 (5.9%) BIV. Tumors were histologically classified as Laurén intestinal type in 119 cases (43.4%) and as diffuse type in 155 (56.6%). According to UICC TNM 1997 classification, early gastric cancer (T1) was diagnosed in 68 cases (24.8 %); 51 (18.6%) were T2, and 155 (56.6%) were T3. No lymph node involvement (N0) was observed in 129 cases (47.1%), whereas 100 (36.5%) were N1 (1-6 lymph nodes), and 45 (16.4%) were N2 (7-15 lymph nodes).The median number of lymph nodes dissected was 35. The overall long-term (five-year) survival rate, for stages I to IIIb was 70.4%. CONCLUSION: Digestive surgeons must be stimulated in performing D2 gastrectomies ...
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Gastrectomia/métodos , Excisão de Linfonodo/métodos , Neoplasias Gástricas/cirurgia , Seguimentos , Metástase Linfática , Neoplasias Gástricas/patologiaRESUMO
Objetivo: informar los resultados de la aplicación de la linfadenectomía estándar en el adenocarcinoma gástrico en el Hospital Clinicoquirúrgico Universitario Celia Sánchez Manduley, de Manzanillo, Granma. Métodos: se analizó la supervivencia postoperatoria para 5 años de 132 pacientes operados por adenocarcinoma gástrico, a los cuales se les realizó linfadenectomía de los 2 primeros niveles ganglionares. Se determinaron los resultados de parámetros epidemiológicos y se definió la supervivencia por el método de Kaplan-Mier. Resultados: las infecciones respiratorias, la anemia y la sepsis de la herida fueron las complicaciones más frecuentes, pero la oclusión intestinal mecánica tuvo significación con la mortalidad. La supervivencia fue superior a todos los reportes obtenidos en Cuba y mejor que algunos internacionales. Conclusiones: el empleo de la linfadenectomía estándar en el adenocarcinoma gástrico constituye un elemento esencial para establecer y mejorar el pronóstico en estos pacientes(AU)
Objective: to report the results of the application of the standard lymphadenectomy in cases of gastric adenocarcinoma admitted in the Celia Sánchez Manduley Clinical Surgical University Hospital of Manzanillo, Granma province. Methods: the 5-years postoperative survival of 132 patients operated on due to gastric adenocarcinoma that underwent lymphadenectomy of the two first ganglionic levels. The results of the epidemiological parameters were determined and the survival by Kaplan-Meier method was defined. Results: the respiratory infections, anemia and wound sepsis were the more frequent complications, but the mechanical intestinal occlusion had a significance related to mortality. Survival was higher to all reports obtained in Cuba and better than some internationals. Conclusions: the use of standard lymphadenectomy in cases of gastric adenocarcinoma is an essential element to establish and to improve the prognosis in these patients(AU)
Assuntos
Humanos , Excisão de Linfonodo/métodos , Adenocarcinoma/cirurgia , Neoplasias Gástricas/cirurgia , Infecção da Ferida Cirúrgica/complicações , Epidemiologia Descritiva , Estudos Prospectivos , Estudos LongitudinaisRESUMO
RACIONAL: A gastrectomia total nas neoplasias gástricas é um procedimento não isento de complicações precoces e tardias e o tipo de reconstrução do trato digestivo a ser utilizado é ainda questão controversa na literatura. OBJETIVO: Descrever a técnica de Rosanov modificada, após a gastrectomia total, empregada com o objetivo de minimizar a má absorção intestinal e outras complicações após este tipo de procedimento. MÉTODOS: A modificação técnica consiste de não realizar a ligadura distal à anastomose jejuno-duodenal, fazendo assim com que o trânsito alimentar tenha duas vias de passagens, pelo duodeno e pelo jejuno. RESULTADOS: Não foram registradas complicações e a casuística inicial mostrou vantagens sob os aspectos nutricionais após seis meses de seguimento pós-operatório. CONCLUSÃO: É técnica de fácil execução e os resultados preliminares com o seu emprego foram muito satisfatórios, no entanto outros estudos clínicos devem ser realizados para demonstrar as vantagens da técnica a longo prazo.
BACKGROUND: Total gastrectomy in gastric cancer is a procedure not without early and late complications and type of reconstruction of the digestive tract to be used is still a controversial issue in literature. AIM: To describe a modified Rosanov technique after total gastrectomy, employed with the aim of minimizing the intestinal malabsorption and other complications following this procedure. METHOD: Technical modification is not to hold distal ligature on jejuno-duodenal anastomosis, thereby offering to the food transit two routes by the duodenum and by the jejunum. RESULTS: There were no complications and the initial series showed a benefit in the nutritional aspects after six months of postoperative follow-up. CONCLUSION: It is a simple technique and preliminary results with its use were very satisfactory, although other clinical studies must be conducted to demonstrate the advantages of the technique in the long term.
Assuntos
Anastomose em-Y de Roux , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Síndromes de Malabsorção/cirurgiaRESUMO
Background: Signet ring cell carcinoma of the stomach corresponds to 3 to 39 percent of all gastric malignant tumors, and its prognostic significance is not well known. Aim: To compare the prognosis of signet ring cell carcinoma of the stomach with other types of gastric cancer. Material and Methods: Review of 451 patients operated for gastric carcinoma. Signet ring cell carcinomas were compared with the rest of tumors. Results: One hundred twenty tumors (27 percent) were signet ring cell carcinoma, they were more commonly located in the lower third of the stomach, were less differentiated, bigger and had more lymph nodes involved. Patients with this variety of tumor were younger, more often women and their survival was lower, even when separating incipient and advanced tumors. Conclusions: Signet ring cell carcinoma of the stomach had a worst prognosis that other type of gastric tumors.
Introducción: La incidencia de carcinoma gástrico (CG) de células en anillo de sello (CAS) varía de 3 por ciento a 39 por ciento. Trabajos de supervivencia en pacientes con tumores gástricos reportan resultados contradictorios en cuanto a la importancia pronostica del tipo histológico CAS respecto a los otros tipos histológicos. El objetivo del estudio es describir y evaluar la importancia pronostica del tipo histológico CAS comparado con los carcinomas no anillo de sello (CNAS). Material y Método: Estudio de cohorte retrospectiva. Se estudiaron variables clínicas y morfológicas de 451 pacientes operados por CG en el Hospital Hernán Henríquez Aravena de Temuco entre Enero/1986-Diciembre/2001 agrupándose para el análisis según el diagnóstico histopatológico en CAS y CNAS. Se realizó un análisis exploratorio de los datos y posteriormente se aplicó estadística descriptiva con cálculo de medidas de tendencia central y extrema; y estadísticas analíticas, aplicando Chi cuadrado de Pearson y test exacto de Fisher para variables categóricas, T-Student para variables continuas, Kaplan-Meier y Log-rank test para análisis de supervivencia. Resultados: Un 27 por ciento (120) correspondió a CAS observándose diferencias estadísticamente significativas entre los grupos CAS y CNAS para las siguientes variables: género, edad, localización y tamaño tumoral, grado de diferenciación histológico y compromiso ganglionar linfático. El análisis de supervivencia demostró un peor pronóstico para el grupo de CAS (p = 0,02). En el análisis por separado de tumores incipientes y avanzados respecto del tipo histológico, no observamos diferencias significativas para lesiones incipientes (p = 0,07) mientras que para lesiones avanzadas el CAS se asocia a un pronóstico desfavorable (p < 0,0001). Conclusiones: Observamos en nuestra serie un peor pronóstico asociado al tipo histológico CAS respecto a los otros tipos histológicos (CNAS), información crucial que, aportada al clínico, deberá ser...
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Carcinoma de Células em Anel de Sinete/mortalidade , Carcinoma de Células em Anel de Sinete/patologia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Estudos de Coortes , Carcinoma de Células em Anel de Sinete/cirurgia , Gastrectomia , Metástase Linfática , Neoplasias Gástricas/cirurgia , Prognóstico , Estudos Retrospectivos , Análise de SobrevidaRESUMO
BACKGROUND: Gastric cancer (GC) is a predominately male disease. Usually for every female that suffers from this condition there are two males and occurred an increase in the number of females in last decades. Brazil is poor in data about this issue. AIM: To verify if in Brazil it happened: a) a change in the gender ratio and on the average age of the patients; b) an increase in the number of patients with 70 years of age or more suffering from this disease; c) changes in the gender ratio and in the average age in the several gastric locations during the period of study. METHODS: The medical history of patients diagnosed with primary gastric adenocarcinoma, between 1971 and 1998 were obtained at Hospital das Clínicas of the University of São Paulo, São Paulo, SP, Brazil. Exclusion criteria were: patients suffering from a non epithelial gastric malignancy; adenocarcinoma from the intestinal metaplasia in the distal esophagus invading the proximal stomach and patients submitted to a gastric resection, due to a benign or malignant tumor during the last five years prior to the surgical procedure analyzed in this study. The patients were divided into 10 years age groups and also divided in three groups, according to their ages and time intervals. Interrelationships between gender and age, and with tumor´s location on gastric wall were analyzed. RESULTS: From 1971 to 1998, 1578 patients with GC were hospitalized. Among them, 1021 were treated with gastric resection, corresponding to 64.7 percent of all patients. There was an increase in the proportion of patients older than 70 years, and decrease between 41 and 70 years. There was no statistical significant difference among the average ages and the different locations. There were significant differences for the locations favoring proximal third and stump, both more prevalent in males. CONCLUSIONS: a) Occurred modifications in the ratio between genders: greater number of women and an increase in the number of male patients in the age group between 41 and 70 years; b) it was proved the greater number of occurrences in patients over 70 years of age; c) there was a greater increase in the male predominance in the tumors located in the stomach´s proximal third.
RACIONAL: O câncer gástrico é afecção predominantemente masculina. Para cada mulher há dois homens, mas tem ocorrido aumento de casos em mulheres nas últimas décadas. O Brasil é pobre em dados sobre esse tema. OBJETIVO: Verificar se no Brasil em relação ao câncer gástrico ocorreu: a) mudança na relação entre os sexos; b) aumento no número de pacientes com mais de 70 anos portadores da doença; c) alteração na relação gênero e média de idade nas variadas localizações do tumor. METODOS: Prontuários de pacientes com adenocarcinoma do estômago 1971 e 1998 foram obtidos no Hospital das Clínicas da Universidade de São Paulo, Brasil com os seguintes critérios de exclusão: pacientes portadores de doença não epitelial; adenocarcinoma de metaplasia intestinal no esôfago distal invadindo cárdia e pacientes submetidos à ressecção gástrica durante os últimos cinco anos anteriores ao período de estudo. Foram divididos em intervalos de 10 anos e também em três grupos de acordo com suas idades e intervalo de tempo. Foram analisadas inter-relações entre sexo e idade, e a localização do tumor em relação à parte anatômica do órgão. RESULTADOS: De 1971 a 1998, 1578 pacientes foram hospitalizados com câncer do estômago. Dentre eles, 1021 foram tratados com ressecção gástrica (64,7 por cento). Houve aumento na proporção de pacientes com mais de 70 anos e diminuição entre a faixa de 41 a 70. Não houve diferença estatística entre a idade e as várias localizações. Houve diferença significante favorecendo a localização proximal e coto gástrico, ambas mais prevalentes nos homens. CONCLUSÕES: a) Ocorreram modificações na relação entre os sexos: maior número de mulheres e aumento no número de homens na idade entre 41 e 70; b) demonstrou-se aumento no número de pacientes com mais de 70 anos; c) houve aumento da prevalência de tumores na parte proximal do estômago e maior nos homens.
RESUMO
BACKGROUND: Advanced gastric cancer carries a poor-prognosis. The best extent of the node dissection and the value of postoperative adjuvant treatments remain open questions.AIM: To study the efficacy of adjuvant chemoradiation and the prognostic value of some clinico-pathological variables in gastric cancer previously submitted to surgery.METHODS: Retrospective single institution study of 69 patients with histological diagnoses of gastric adenocarcinoma, consecutively submitted to radical surgery with curative intent in a five years period. Lymph node dissection was either D1 or D2 at the surgeon's description. All patients were submitted to adjuvant chemoradiation according to MacDonald et al.2. Treatment discontinuation and early deaths were considered as serious toxic events. Clinical-pathological variables (the extent D level of the node dissection, T/N-stage, histological subtype, margin status, number of the dissected nodes) were correlated to the results. Overall survival was estimated according to the Kaplan-Meier method and the curves were compared by the log-rank test.RESULTS: Patients characteristics: 48 male/21 female, median age 56,4 y (30-79). In 25 patients, the extent of node dissection was D1, in 41 was D2 and D0 in 3. Staging (n): T2 (16); T3 (49); T4 (4); No (11); N1 (29); N2 (20); N3 (8); Nx (1). Histological subtype: intestinal (45), diffuse (19) and unknown (5). Margins were free in 57 patients, the median number of dissected nodes was 31 (0-120). They were treated with linear acelerator 6 MV photons, AP/PA fields with 45Gy in 5 weeks in 90% of the patients and the treatment was done in a mean time of 19,2 weeks. In the median follow-up of 19,3mo (8-52,5mo), 52 patients with more than 24 months of follow-up occurred 38 deaths. The median overall survival for all patients was 22,2 months. Seven (10%) patients presented serious toxic events and treatment was discontinued...
RACIONAL: Câncer gástrico avançado é sempre acompanhado de pobre prognóstico. A melhor forma de ser realizada a linfadenectomia e o valor da radioquimioterapia adjuvante ainda estão em tela de juízo.OBJETIVO: Estudar a eficácia da terapia adjuvante e o valor prognóstico de algumas variáveis clínico-patológicas nos pacientes submetidos à ressecção cirúrgica de seus tumores.MÉTODOS: Estudo retrospectivo de uma única instituição hospitalar incluindo 69 pacientes com diagnóstico histológico de adenocarcinoma gástrico consecutivamente submetidos à operação radical com intenção curativa no período de cinco anos. Linfadenectomia foi tanto D1 como D2 e em todos os pacientes foi aplicado o protocolo quimioradioterápico proposto por Macdonald et al.2. Interrupção do tratamento bem como mortes precoces foram consideradas eventos tóxicos sérios. Variáveis clínico-patológicas (extensão do D, estadiamento T/N, subtipos histológicos e número de linfonodos ressecados), foram correlacionados com os resultados. A sobrevida total foi estimada de acordo com o método de Kaplan-Meier.RESULTADOS: Foram 48 homens e 21 mulheres, com idade média de 56,4 anos. Em 25 pacientes a extensão da linfadenectomia foi D1; em 41, D2 e em 3, D0. O estadiamento T2 foi em 16 pacientes; T3 em 49; T4 em 4; N0 em 11; N1 em 29; N2 em 20; N3 em 8; Nx em 1. O subtipo histológico intestinal ocorreu em 45; o difuso em 19 e desconhecido em 5. Em 57 pacientes as margens estavam livres de tumor e foram ressecados em média 31 linfonodos. Foram tratados por acelerador linear 6 MV, AP/PA campos com 45Gy em cinco semanas em 90% dos casos com média de tratamento de 19,2 semanas. No tempo médio de seguimento de 19,3 meses, entre 52 pacientes com mais de 24 meses foram observadas 38 mortes. O tempo médio geral de sobrevida do grupo como um todo foi de 22,2 meses. Sete (10%) apresentaram eventos tóxicos sérios e o tratamento foi interrompido...