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[PMID]:28470686
[Au] Autor:Sideras K; Biermann K; Yap K; Mancham S; Boor PPC; Hansen BE; Stoop HJA; Peppelenbosch MP; van Eijck CH; Sleijfer S; Kwekkeboom J; Bruno MJ
[Ad] Endereço:Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
[Ti] Título:Tumor cell expression of immune inhibitory molecules and tumor-infiltrating lymphocyte count predict cancer-specific survival in pancreatic and ampullary cancer.
[So] Source:Int J Cancer;141(3):572-582, 2017 08 01.
[Is] ISSN:1097-0215
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Understanding the mechanisms of immune resistance in pancreatic and ampullary cancers is crucial for the development of suitable biomarkers and effective immunotherapeutics. Our aim was to examine the expression of the immune inhibiting molecules PD-L1, Galectin-9, HVEM, IDO and HLA-G, as well as CD8+ and FoxP3+ tumor infiltrating lymphocytes (TIL), in pancreatic and ampullary cancers, and to relate their individual, as well as their combined expression, to cancer survival. Tumor tissue from 224 patients with resected pancreatic (n = 148) and ampullary (n = 76) cancer was used to construct tissue-microarrays. Expression of immune inhibitory molecules and TIL was examined by immunohistochemistry. We show that immune inhibitory molecules are prevalently expressed. Moreover, high tumor expression of PD-L1 (p = 0.002), Gal-9 (p = 0.003), HVEM (p = 0.001), IDO (p = 0.049), HLA-G (p = 0.004) and high CD8/FoxP3 TIL ratio (p = 0.006) were associated with improved cancer-specific survival. All immune biomarkers, with the exception of IDO, were individually predictive of cancer-specific survival when adjusted for clinicopathologic characteristics. For every additional immune biomarker present survival was almost two-fold prolonged (HR 0.57 95%CI 0.47-0.69, p < 0.0001). When patients with pancreatic and ampullary cancer were analyzed separately the results were similar. We conclude that pancreas and ampullary cancers are rich in expression of immune-inhibitory molecules. These molecules can be targets for future immunotherapeutics, as well as form powerful immunological biomarkers. We propose that such immune biomarker panels be included in future prospective immunotherapy trials.
[Mh] Termos MeSH primário: Antígeno B7-H1/metabolismo
Neoplasias do Ducto Colédoco/mortalidade
Galanina/metabolismo
Antígenos HLA-G/metabolismo
Indolamina-Pirrol 2,3,-Dioxigenase/metabolismo
Linfócitos do Interstício Tumoral/imunologia
Neoplasias Pancreáticas/mortalidade
Membro 14 de Receptores do Fator de Necrose Tumoral/metabolismo
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Ampola Hepatopancreática/imunologia
Ampola Hepatopancreática/metabolismo
Biomarcadores Tumorais/metabolismo
Neoplasias do Ducto Colédoco/imunologia
Neoplasias do Ducto Colédoco/metabolismo
Feminino
Seres Humanos
Linfócitos do Interstício Tumoral/metabolismo
Linfócitos do Interstício Tumoral/patologia
Masculino
Meia-Idade
Neoplasias Pancreáticas/imunologia
Neoplasias Pancreáticas/metabolismo
Prognóstico
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (B7-H1 Antigen); 0 (Biomarkers, Tumor); 0 (CD274 protein, human); 0 (GAL protein, human); 0 (HLA-G Antigens); 0 (Indoleamine-Pyrrole 2,3,-Dioxygenase); 0 (Receptors, Tumor Necrosis Factor, Member 14); 0 (TNFRSF14 protein, human); 88813-36-9 (Galanin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1002/ijc.30760


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[PMID]:28461144
[Au] Autor:Bourgouin S; Ewald J; Mancini J; Moutardier V; Delpero JR; Le Treut YP
[Ad] Endereço:Aix-Marseille University, APHM La Conception, Department of Surgery and Liver Transplantation, Marseille, France; Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France. Electronic address: stephane_bourgouin@hotmail.fr.
[Ti] Título:Disease-free survival following resection in non-ductal periampullary cancers: A retrospective multicenter analysis.
[So] Source:Int J Surg;42:103-109, 2017 Jun.
[Is] ISSN:1743-9159
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Predictors of recurrence following pancreaticoduodenectomy are well described for ductal periampullary cancers but lack reliability for non-ductal tumors. The purpose of this study is to analyze the disease-free survival (DFS) and to define the predictors of recurrence following resection for ampullary (AC), bile duct (BDC) and duodenal cancers (DC). MATERIALS AND METHODS: Clinico-pathological data of patients operated on between 2001 and 2011 were retrospectively reviewed. The effect of lymphatic invasion was specified using the lymph node ratio (LNR) and the number of positive nodes (NPN), with thresholds calculated with the likelihood ratio. Kaplan-Meier disease-free survival (DFS) curves were compared for all covariates by a log-rank test. Multivariate logistic regression analyses were performed to identify predictors of recurrence. RESULTS: 135 patients were identified. Mean follow-up was 49 ± 35 months. Median DFS was not reached for AC and was 36 and 18 months for DC and BDC, respectively. Five-year DFS was 52%, 43% and 32% for AC, DC and BDC, respectively. Predictors of recurrence were T4 tumors, neural invasion and preoperative biliary drainage for DC, ≥3 positive nodes and ≥4% loss of BMI for AC, and T3-T4 tumors for BDC. CONCLUSION: Loss of BMI ≥4% is a strong predictor of recurrence in AC, and the recurrence risk increases with the total number of lymph nodes invaded (0; 1-3; ≥4). Only T stage influences recurrence for BDC. Considering DC, the adverse effect of preoperative biliary drainage should be validated in randomized series.
[Mh] Termos MeSH primário: Ampola Hepatopancreática
Neoplasias do Ducto Colédoco/cirurgia
Neoplasias Duodenais/cirurgia
Pancreaticoduodenectomia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Ampola Hepatopancreática/cirurgia
Neoplasias do Ducto Colédoco/mortalidade
Neoplasias do Ducto Colédoco/patologia
Intervalo Livre de Doença
Neoplasias Duodenais/mortalidade
Neoplasias Duodenais/patologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29191276
[Au] Autor:Gholami S; Brennan MF
[Ad] Endereço:Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-1272, New York, NY 10065, USA.
[Ti] Título:Preoperative Stenting for Benign and Malignant Periampullary Diseases: Unnecessary if Not Harmful.
[So] Source:Surg Clin North Am;98(1):37-47, 2018 Feb.
[Is] ISSN:1558-3171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Preoperative biliary drainage (PBD) is often performed in patients with jaundice with the presumption that it will decrease the risk of postoperative complications. PBD carries its own risk of complications and, therefore, has been controversial. Multiple randomized controlled trials and metaanalyses have shown that PBD has significantly increased overall complications compared with surgery alone. As such, the routine application of PBD should be avoided except in a subset of clinical situations. This is discussed in detail in this article.
[Mh] Termos MeSH primário: Colangiopancreatografia Retrógrada Endoscópica/métodos
Neoplasias do Ducto Colédoco
Icterícia Obstrutiva/cirurgia
Pancreaticoduodenectomia
Cuidados Pré-Operatórios/métodos
Stents
Procedimentos Desnecessários
[Mh] Termos MeSH secundário: Ducto Colédoco/diagnóstico por imagem
Ducto Colédoco/cirurgia
Neoplasias do Ducto Colédoco/complicações
Neoplasias do Ducto Colédoco/diagnóstico
Neoplasias do Ducto Colédoco/cirurgia
Drenagem/métodos
Seres Humanos
Icterícia Obstrutiva/diagnóstico
Icterícia Obstrutiva/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE


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[PMID]:28870965
[Au] Autor:Kohga A; Yamamoto Y; Sano S; Sugiura T; Okamura Y; Ito T; Ashida R; Ishiwatari H; Matsubayashi H; Sasaki K; Uesaka K
[Ad] Endereço:Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
[Ti] Título:Surgical Strategy for T1 Duodenal or Ampullary Carcinoma According to the Depth of Tumor Invasion.
[So] Source:Anticancer Res;37(9):5277-5283, 2017 09.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:AIM: To investigate the utility of local resection (LR) for T1 duodenal carcinoma and T1 ampullary carcinoma. PATIENTS AND METHODS: Between June 2002 and November 2014, a total of 64 patients with pathological T1 (pT1) ampullary carcinoma (25 patients) and pT1 duodenal carcinoma (39 patients) were treated. Of these, 33 patients underwent local resection (LR group), while the other 31 patients underwent pancreatoduodenectomy (PD group). RESULTS: The LR group had 31 patients with pT1a and 2 patients with pT1b. PD group had 18 patients with pT1a and 13 patients with pT1b. One patient with pT1b duodenal carcinoma (20.0%) and one patient with pT1b ampullary carcinoma (10.0%) developed lymph node metastasis, while none of the patients with pT1a disease developed metastases. CONCLUSION: LR may be considered in the patients preoperatively diagnosed with T1a duodenal carcinoma and T1a ampullary carcinoma.
[Mh] Termos MeSH primário: Ampola Hepatopancreática/patologia
Ampola Hepatopancreática/cirurgia
Neoplasias do Ducto Colédoco/patologia
Neoplasias do Ducto Colédoco/cirurgia
Neoplasias Duodenais/patologia
Neoplasias Duodenais/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Metástase Linfática/patologia
Masculino
Meia-Idade
Invasividade Neoplásica
Estadiamento de Neoplasias
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE


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[PMID]:28815556
[Au] Autor:Kleive D; Sahakyan MA; Berstad AE; Verbeke CS; Gladhaug IP; Edwin B; Fosby B; Line PD; Labori KJ
[Ad] Endereço:Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
[Ti] Título:Trends in indications, complications and outcomes for venous resection during pancreatoduodenectomy.
[So] Source:Br J Surg;104(11):1558-1567, 2017 Oct.
[Is] ISSN:1365-2168
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pancreatoduodenectomy with superior mesenteric-portal vein resection has become a common procedure in pancreatic surgery. The aim of this study was to compare standard pancreatoduodenectomy with pancreatoduodenectomy plus venous resection at a high-volume centre, and to examine trends in management and outcome over a decade for the latter procedure. METHODS: This retrospective observational study included all patients undergoing pancreatoduodenectomy with or without venous resection at Oslo University Hospital between January 2006 and December 2015. Trends were evaluated by assessing preoperative clinical and radiological characteristics, as well as perioperative outcomes in three time intervals (early, intermediate and late). RESULTS: A total of 784 patients had a pancreatoduodenectomy, of whom 127 (16·2 per cent) underwent venous resection. Venous resection resulted in a longer operating time (median 422 versus 312 min; P = 0·001) and greater estimated blood loss (EBL) (median 700 versus 500 ml; P = 0·004) than standard pancreatoduodenectomy. The rate of severe complications was significantly higher for pancreatoduodenectomy with venous resection (37·0 versus 26·3 per cent; P = 0·014). The overall burden of complications, evaluated using the Comprehensive Complication Index (CCI), did not differ (median score 8·7 versus 8·7; P = 0·175). Trends in venous resection over time showed a significant reduction in EBL (median 1050 versus 375 ml; P = 0·001) and duration of hospital stay (median 14 versus 9 days; P = 0·011) between the early and late periods. However, despite an improvement in the intermediate period, severe complication rates returned to baseline in the late period (18 of 43 versus 9 of 42 versus 20 of 42 patients in early, intermediate and late periods respectively; P = 0·032), as did CCI scores (median 20·9 versus 0 versus 20·9; P = 0·041). CONCLUSION: Despite an initial improvement in severe complications for venous resection during pancreatoduodenectomy, this was not maintained over time. Every fourth patient with venous resection needed relaparotomy, most frequently for bleeding.
[Mh] Termos MeSH primário: Veias Mesentéricas/cirurgia
Pancreaticoduodenectomia
Veia Porta/cirurgia
[Mh] Termos MeSH secundário: Idoso
Perda Sanguínea Cirúrgica/estatística & dados numéricos
Neoplasias do Ducto Colédoco/cirurgia
Transfusão de Eritrócitos/estatística & dados numéricos
Feminino
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
Meia-Idade
Duração da Cirurgia
Neoplasias Pancreáticas/cirurgia
Complicações Pós-Operatórias
Reoperação/estatística & dados numéricos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.1002/bjs.10603


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[PMID]:28648977
[Au] Autor:Kwon J; Kim K; Chie EK; Kim BH; Jang JY; Kim SW; Oh DY; Bang YJ
[Ad] Endereço:Department of Radiation Oncology, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, South Korea; Department of Radiation Oncology, Chungnam National University Hospital, Munhwaro 282, Jungku, Daejeon, South Korea.
[Ti] Título:Prognostic relevance of lymph node status for patients with ampullary adenocarcinoma after radical resection followed by adjuvant treatment.
[So] Source:Eur J Surg Oncol;43(9):1690-1696, 2017 Sep.
[Is] ISSN:1532-2157
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Attempts have been made to revise the nodal stage due to simplicity of current N staging system in ampullary adenocarcinoma. However, because of the disease rarity, there have only been a few studies assessing the prognostic impact of lymph node (LN) parameters. METHODS: We retrospectively analyzed 120 patients who underwent radical resection followed by adjuvant chemoradiotherapy for ampullary adenocarcinoma. The effect of LN parameters (number of total harvest LNs, number of metastatic LN (MLN), lymph node ratio (LNR), and log odds of positive LNs (LODDS)) on overall survival (OS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival were evaluated. Cutoff points of MLN, LNR and LODDs were determined using maximal χ method. RESULTS: Fifty-seven patients (48%) were staged as pN1 and their survival was not significantly decreased compared with pN0 patients. There was also no significant difference between patients with MLN 0 vs. 1. In univariate analyses, MLN (0-1 vs. ≥2), LNR (≤17% vs. >17%) and perineural invasion were common prognosticators for OS and LRFS. Distant metastasis-free survival was not influenced by LN status. In addition, multivariate analysis revealed that among the LN parameters, LNR was able to independently predict both OS and LRFS. CONCLUSIONS: LNR performs better than other LN related parameters for predicting survival. After radical resection followed by adjuvant treatment, survival of patients with one positive LN does not seem to differ from patients without LN metastasis.
[Mh] Termos MeSH primário: Adenocarcinoma/secundário
Adenocarcinoma/cirurgia
Ampola Hepatopancreática
Neoplasias do Ducto Colédoco/patologia
Neoplasias do Ducto Colédoco/cirurgia
Excisão de Linfonodo
Linfonodos/patologia
[Mh] Termos MeSH secundário: Adenocarcinoma/tratamento farmacológico
Adulto
Idoso
Fístula Anastomótica/etiologia
Quimiorradioterapia Adjuvante/efeitos adversos
Neoplasias do Ducto Colédoco/tratamento farmacológico
Intervalo Livre de Doença
Feminino
Seres Humanos
Linfonodos/cirurgia
Metástase Linfática
Masculino
Meia-Idade
Invasividade Neoplásica
Estadiamento de Neoplasias
Nervos Periféricos/patologia
Prognóstico
Estudos Retrospectivos
Taxa de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170627
[St] Status:MEDLINE


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[PMID]:28610856
[Au] Autor:Watson RR; Muthusamy VR
[Ad] Endereço:Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
[Ti] Título:Radiofrequency ablation for intraductal extension of ampullary neoplasms: Are we ready to feel the burn?
[So] Source:Gastrointest Endosc;86(1):177-179, 2017 07.
[Is] ISSN:1097-6779
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Ablação por Cateter
Neoplasias do Ducto Colédoco/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Neoplasias Hepáticas/cirurgia
Neoplasias Pancreáticas/cirurgia
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171101
[Lr] Data última revisão:
171101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE


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[PMID]:28524160
[Au] Autor:Strell C; Norberg KJ; Mezheyeuski A; Schnittert J; Kuninty PR; Moro CF; Paulsson J; Schultz NA; Calatayud D; Löhr JM; Frings O; Verbeke CS; Heuchel RL; Prakash J; Johansen JS; Östman A
[Ad] Endereço:Department of Oncology-Pathology, Cancer Center Karolinska (CCK), Karolinska Institutet, Stockholm 17176, Sweden.
[Ti] Título:Stroma-regulated HMGA2 is an independent prognostic marker in PDAC and AAC.
[So] Source:Br J Cancer;117(1):65-77, 2017 Jun 27.
[Is] ISSN:1532-1827
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The HMGA2 protein has experimentally been linked to EMT and cancer stemness. Recent studies imply that tumour-stroma interactions regulate these features and thereby contribute to tumour aggressiveness. METHODS: We analysed 253 cases of pancreatic ductal adenocarcinoma (PDAC) and 155 cases of ampullary adenocarcinoma (AAC) for HMGA2 expression by IHC. The data were correlated with stroma abundance and supplemented by experimental studies. RESULTS: HMGA2 acts as an independent prognostic marker associated with a significantly shorter overall survival in both tumour types. Overall, HMGA2-positivity was more frequent in patients with PDAC than with AAC. The HMGA2 status in tumour cells significantly correlated with the abundance of PDGFRß-defined stroma cells. In vivo co-injection of Panc-1 cancer cells with pancreatic stellate cells increased tumour growth in a manner associated with increased HMGA2 expression. Furthermore, in vitro treatment of Panc-1 with conditioned media from PDGF-BB-activated stellate cells increased their ability to form tumour spheroids. CONCLUSIONS: This study identifies HMGA2 expression in tumour cells as an independent prognostic marker in PDAC and AAC. Correlative data analysis gives novel tissue-based evidence for a heterotypic cross-talk with stroma cells as a possible mechanism for HMGA2 induction, which is further supported by experimental models.
[Mh] Termos MeSH primário: Adenocarcinoma/metabolismo
Carcinoma Ductal Pancreático/metabolismo
Neoplasias do Ducto Colédoco/metabolismo
Proteína HMGA2/metabolismo
Neoplasias Pancreáticas/metabolismo
[Mh] Termos MeSH secundário: Adenocarcinoma/patologia
Idoso
Ampola Hepatopancreática
Animais
Carcinoma Ductal Pancreático/patologia
Linhagem Celular Tumoral
Neoplasias do Ducto Colédoco/patologia
Feminino
Seres Humanos
Imuno-Histoquímica
Masculino
Camundongos
Camundongos SCID
Meia-Idade
Análise Multivariada
Estadiamento de Neoplasias
Transplante de Neoplasias
Neoplasias Pancreáticas/patologia
Células Estreladas do Pâncreas/metabolismo
Prognóstico
Receptor beta de Fator de Crescimento Derivado de Plaquetas/metabolismo
Reação em Cadeia da Polimerase Via Transcriptase Reversa
Células Estromais/metabolismo
Taxa de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (HMGA2 Protein); EC 2.7.10.1 (Receptor, Platelet-Derived Growth Factor beta)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170520
[St] Status:MEDLINE
[do] DOI:10.1038/bjc.2017.140


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[PMID]:28518410
[Au] Autor:Acharya A; Markar SR; Sodergren MH; Malietzis G; Darzi A; Athanasiou T; Khan AZ
[Ad] Endereço:Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.
[Ti] Título:Meta-analysis of adjuvant therapy following curative surgery for periampullary adenocarcinoma.
[So] Source:Br J Surg;104(7):814-822, 2017 Jun.
[Is] ISSN:1365-2168
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Periampullary cancers are uncommon malignancies, often amenable to surgery. Several studies have suggested a role for adjuvant chemotherapy and chemoradiotherapy in improving survival of patients with periampullary cancers, with variable results. The aim of this meta-analysis was to determine the survival benefit of adjuvant therapy for periampullary cancers. METHODS: A systematic review was undertaken of literature published between 1 January 2000 and 31 December 2015 to elicit and analyse the pooled overall survival associated with the use of either adjuvant chemotherapy or chemoradiotherapy versus observation in the treatment of surgically resected periampullary cancer. Included articles were also screened for information regarding stage, prognostic factors and toxicity-related events. RESULTS: A total of 704 titles were screened, of which 93 full-text articles were retrieved. Fourteen full-text articles were included in the study, six of which were RCTs. A total of 1671 patients (904 in the control group and 767 who received adjuvant therapy) were included. The median 5-year overall survival rate was 37·5 per cent in the control group, compared with 40·0 per cent in the adjuvant group (hazard ratio 1·08, 95 per cent c.i. 0·91 to 1·28; P = 0·067). In 32·2 per cent of patients who had adjuvant therapy, one or more WHO grade 3 or 4 toxicity-related events were noted. Advanced T category was associated worse survival (regression coefficient -0·14, P = 0·040), whereas nodal status and grade of differentiation were not. CONCLUSION: This systematic review found no associated survival benefit for adjuvant chemotherapy or chemoradiotherapy in the treatment of periampullary cancer.
[Mh] Termos MeSH primário: Adenocarcinoma/tratamento farmacológico
Adenocarcinoma/cirurgia
Ampola Hepatopancreática/cirurgia
Neoplasias do Ducto Colédoco/tratamento farmacológico
Neoplasias do Ducto Colédoco/cirurgia
Neoplasias Duodenais/tratamento farmacológico
Neoplasias Duodenais/cirurgia
[Mh] Termos MeSH secundário: Adenocarcinoma/mortalidade
Quimiorradioterapia Adjuvante
Quimioterapia Adjuvante
Neoplasias do Ducto Colédoco/mortalidade
Neoplasias Duodenais/mortalidade
Seres Humanos
Taxa de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170519
[St] Status:MEDLINE
[do] DOI:10.1002/bjs.10563


  10 / 3551 MEDLINE  
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[PMID]:28505002
[Au] Autor:Xue Y; Reid MD; Balci S; Quigley B; Muraki T; Memis B; Xia J; Hacihasanoglu E; Bedolla G; Pehlivanoglu B; Kim GE; Tajiri T; Ohike N; Aneja R; Krasinskas AM; Adsay V
[Ad] Endereço:*Department of Pathology, Emory University School of Medicine Departments of †Mathematics and Statistics ¶Biology, Georgia State University, Atlanta, GA ‡Department of Pathology, University of California San Francisco, San Francisco, CA §Department of Pathology, Tokai University Hachioji Hospital, Tokyo ∥Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan.
[Ti] Título:Immunohistochemical Classification of Ampullary Carcinomas: Critical Reappraisal Fails to Confirm Prognostic Relevance for Recently Proposed Panels, and Highlights MUC5AC as a Strong Prognosticator.
[So] Source:Am J Surg Pathol;41(7):865-876, 2017 Jul.
[Is] ISSN:1532-0979
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Recently, immunohistochemistry-based classifications of ampullary carcinomas have been proposed (Ang and colleagues [PMID: 24832159]; Chang and colleagues [PMID: 23439753]). In this study, the prognostic value of Ang/Chang panel markers (CK20, MUC1, MUC2, CDX2) as well as other markers (CK7, MUC5AC, and MUC6) were tested on full-faced sections of 136 ampullary carcinoma resections with substantial (>5 mm) invasion. Immunohistochemistry was correlated with both histologic classification (intestinal [INT], pancreatobiliary [PB], or nontubular based on ≥3/5 observer agreement) and clinical outcome. No prognostic correlation was found with MUC1, CDX2, MUC2 or CK20 despite testing with different quantitative cutoffs. CK7 and CK20 were nonspecific. Ang classification had reasonable correlation with histologic subclassification of tubular cases as INT versus PB with high specificity but low sensitivity and ambiguous category was large (29%) and included also some classical cases. Prognostically, Ang classification approached but did not reach statistical significance, even when their large "ambiguous" group was eliminated and only tubular cases were analyzed (Ang-INT vs. Ang-PB; P=0.08). The Chang panel, in which the definition of the INT subcategory is not clearly defined, only marginally reached prognostic significance when tested as MUC1+/CDX2- versus MUC1-/CDX2+ and only by Wilcoxon test (P=0.0485) but 31% of the cases were "unclassifiable." The only individual marker that was found to have direct and strong correlation with the clinical outcome was MUC5AC (not used in the Ang or Chang panels), with statistically significant survival differences found with various cutoffs tested (for 20% cutoff, 5-y survival, 68% vs. 31%; P=0.0002). In addition, MUC5AC significantly stratified the histologically PB and INT cases (P=0.01 and 0.03, respectively), as well as Ang's ambiguous and Chang's unclassified cases (P=0.006 and 0.007, respectively). In conclusion, the widely used putative lineage markers, MUC1/MUC2/CK7/CK20/CDX2, do not seem to have direct/significant prognostic correlation either individually or in combination of Ang and Chang panels. Ang panel is helpful as an adjunct in determining the cell lineage with a few caveats. MUC5AC proves to be a significant independent prognosticator and should be incorporated into evaluation of ampullary carcinomas.
[Mh] Termos MeSH primário: Adenocarcinoma/diagnóstico
Ampola Hepatopancreática/metabolismo
Biomarcadores Tumorais/metabolismo
Neoplasias do Ducto Colédoco/diagnóstico
Mucina-5AC/metabolismo
[Mh] Termos MeSH secundário: Adenocarcinoma/metabolismo
Adenocarcinoma/mortalidade
Adenocarcinoma/patologia
Adulto
Idoso
Idoso de 80 Anos ou mais
Ampola Hepatopancreática/patologia
Neoplasias do Ducto Colédoco/metabolismo
Neoplasias do Ducto Colédoco/mortalidade
Neoplasias do Ducto Colédoco/patologia
Feminino
Seguimentos
Seres Humanos
Imuno-Histoquímica
Masculino
Meia-Idade
Mucina-6/metabolismo
Prognóstico
Análise de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers, Tumor); 0 (MUC5AC protein, human); 0 (MUC6 protein, human); 0 (Mucin 5AC); 0 (Mucin-6)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170516
[St] Status:MEDLINE
[do] DOI:10.1097/PAS.0000000000000863



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