Incidencia y supervivencia del cáncer de colon y recto en la provincia de Tarragona (1980-1998)

Introducción: Se estima que en el año 2000 se diagnosticaron más de 10 millones de cánceres colorectales en el mundo y más de 6 millones murieron por esta causa. En Europa se ha observado un aumento de la incidencia desde los años 60 así como una mejora de la supervivencia. En su etiología, además de una causa genética, se ha evidenciado el estilo de vida occidentalizado y, dentro de él, la dieta como principal factor ambiental. Está en debate la mejor estrategia de cribado a nivel poblacional para este cáncer. El tratamiento de elección es la cirugía. Desde 1990 está demostrado el beneficio de la quimioterapia y radioterapia adyuvantes. Asimismo, la poliquimioterapia en la enfermedad avanzada aumenta la supervivencia. Objetivo:Conocer la incidencia y la supervivencia poblacional del cáncer colorectal en Tarragona por género, edad, sublocalización, histología y estadio.Estudiar la evolución temporal de estos indicadores.Comparar los resultados obtenidos con los de otros registros de cáncer de base poblacional.Construir un patrón epidemiológico del cáncer colorectal para la provinvia de Tarragona.Material y métodos:Se trata de un estudio epidemiológico poblacional descriptivo del cáncer colorectal a partir de la información del Registro de Cáncer de Tarragona desde el año 1980 al 1998. Se estiman las tasas de incidencia brutas, ajustadas por edad a la población mundial estándar, truncadas y acumuladas así como las tasas específicas por edad, global y por género, edad, sublocalización, histología y estadio. Se realiza un análisis de la tendencia temporal utilizando los modelos de regresión de Poisson y de Join Point, y se estiman los porcentajes anuales de cambio y su significación estadística.En cuanto a la supervivencia, se calcula la supervivencia observada global (método no paramétrico de Kaplan y Meier) y la supervivencia relativa global (método de Ederer) por género, edad, sublocalización, histología y estadio. Se determina la asociación de diversas variables con el tiempo de supervivencia utilizando el método de riesgos proporcionales de Cox, y se estudia la evolución de la supervivencia desde 1985 hasta 1998 por períodos. Los resultados de incidencia se han comparado con los publicados por diferentes registros de cáncer de todo el mundo y los de supervivencia con los de registros europeos.Resultados:La tasa bruta de incidencia es de 56,5 para ambos géneros juntos. Las tasas ajustadas son de 61,7 en hombres y 51,3 en mujeres. Las sublocalizaciones por orden de frecuencia son: recto, colon izquierdo y colon derecho en hombres, y colon izquierdo, colon derecho y recto en mujeres. La distribución porcentual por estadios (clasificación de Dukes) es: A 13%, B 27%, C 27% y D 22%. La incidencia ha aumentado un 3,3% anual en hombres y un 2,5% anual en mujeres de forma constante a lo largo de todo en período. El cáncer de colon derecho es el que más aumenta en hombres (6,5% anual) y en mujeres (5,2% anual).La supervivencia observada a 5 años es de 40,4% y la relativa de 49,0% (47,6% en hombres y 50,7% en mujeres). Por edades, las supervivencias relativas a 5 años son: 60% entre los de 35 y 54 años, 53% entre los de 55 y 74 años, y 45% en los mayores de 74 años. Por estadios, la supervivencia a 5 años es: A 90%, B 68%, C 47% y D 3%. El estadio es el factor pronóstico más importante, delante de la edad. La supervivencia relativa a 5 años pasó de 42% entre los casos diagnosticados en el periodo 1985-89 a 49% en el periodo 1990-94.Conclusiones:En Tarragona el cáncer colorectal es el cáncer más frecuente en ambos géneros juntos y presenta una incidencia media-baja con respecto a otros registros de Europa pero con una tendencia rápidamente ascendente y continua, muy probablemente debida a la adopción de un estilo de vida occidentalizado y, sobre todo, al cambio de la dieta. Las tasas de supervivencia alcanzadas se pueden considerar medio-altas en el contexto europeo, y han aumentado de forma similar a la de la mayoría de países de Europa.Introduction: It was estimated, for year 2000, that more than ten million people would be diagnosed of colorectal cancers in the world and more than six million people would die of it. In Europe, the incidence of colorectal cancer has been growing since 1960 and the survival has also improved. In its etiology, next to a genetic base, is the westernized way of life the most important factor (mainly a diet rich in proteins and fats and poor in fruits and vegetables). The adenoma is the precancerous lesion. There's controversy about the best population screening strategy for this cancer. The standard treatment is surgery. Since 1990, is the benefit of adjuvant therapies (chemotherapy and radiotherapie) confirmed. Also, the polichemotherapie has shown a survival benefit for the patients with advanced disease. Objetives:To know the incidence and survival, at a population level, of colorectal cancer in Tarragona according to gender, age, subsite of origin, histology and stage. To study the temporal trends of these sanitary indicators: incidence and survival.To compare our results with the results of other population-based cancer registries of the world.To describe an epidemiological pattern for colorectal cancer in Tarragona.Methods:Descriptive epidemiological study of colorectal cancer in Tarragona between 1980 and 1998. The data come from the population-based Cancer Registry of Tarragona. Incidence rates: normal, rates and standard rates, adjusted to the world population (Segi, 1950) have been calculated, according to gender, age, subsite of origin, histology and stage. For the temporal trends study (1980-1998) we used the Poisson model and the joinpoint model and calculated the anual percentage of change for each category. The data have been compared with the data of other registries published in Cancer Incidence Five Continents.Survival rates: observed survival rate (Kaplan and Meier model) and relative survival rate (Ederer model) have been calculated, according to gender, age, subsite of origin, histology and stage. The Cox model was uded to study the association between the different variables and the time of survival for the years 1996 and 1997. A study of the evolution of survival rates was also made (1985-1998). The data have been compared with the data of other registries published in EUROCARE-3 and the data of the SEER Programm in USA..Resultados:The normal incidence rate is 56,5 cases/100.000 inhabitants*year for both genders together. The adjusted incidence rate is 61,7 for men and 51,3 for women. The most frequent subsite of origin is left colon cancer. After this comes rectal cancer and right colon cancer. The distribution according to stages (Dukes classification) is: A (13%), B (27%), C (27%), D (22%). The incidence rates have grown 3,3% each year in men and 2,5% in women. The trend is constant between 1980 and 1998. The subsite of origin with a fastest growth is right colon cancer (6,5% in men and 5,2% in women). The 5-years observed survival rate is 40,4% and the 5-year relative survival rate is 49%. According to age-groups, the 5-year relative survival rates are: 60% for people between 35-55 years old; 53% for the ones between 55-75 years old and 45% for the people older than 74 years old. According to stages, the 5-year relative survival rates are: A (90%), B (68%), C (47%) and D (3%). The stage is the most important prognostic factor, next to the age. Between 1985 and 1994 the 5-year relative survival rate has improved from 42% to 49%.Conclusions:Colorectal cancer is the most frequent cancer in Tarragona for both genders together and the incidence rates are in the average in comparison to other European countries. The incidence has grown fast and constant. The cause of this change is probably the most westernized way of life with the time (for example: the changes in the diet). The survival rates are also in the average of the European countries and have grow from 1985 till 1994, like in the other countries, probably because of improvements in the therapies

Recurrence after pituitary surgery in adult Cushing's disease: a systematic review on diagnosis and treatment

PURPOSE Recurrence after pituitary surgery in Cushing's disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD. METHODS We systematically screened the literature regarding recurrent and persistent Cushing's disease using the MESH term Cushing's disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review. RESULTS AND CONCLUSIONS Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient

Leukemia escape in immune desert: intraocular relapse of pediatric pro-B-ALL during systemic control by CD19-CAR T cells

Background Relapsed/refractory B-precursor acute lymphoblastic leukemia (BCP-ALL) remains a major therapeutic challenge in pediatric hematology. Chimeric antigen receptor (CAR) T cells targeting CD19 have shown remarkable initial response rates in BCP-ALL patients, while long-term leukemia control rate is only about 50%. So far, main mechanisms of BCP-ALL relapse after CD19-CAR T-cell therapy have been either insufficient CAR T-cell persistence in vivo or loss of surface CD19.Case Report Here, we report an exceptional presentation of BCP-ALL relapse in the eye during the systemic control through CAR T-cell therapy. We report a case of fatal intraocular relapse in a pediatric patient with pro-B-ALL after initial response to CD19-CAR T-cell therapy. One month after CD19-CAR T-cell therapy, remission was documented by bone marrow aspirate analysis with absence of CD19+ cells and CD19-CAR T cells could be detected in both peripheral blood and bone marrow. At the same time, however, the patient presented with progressive visual disturbance and CD19+ cells were found within the anterior chamber of the eye. Despite local and systemic therapy, ocular relapse led to BCP-ALL dissemination and systemic relapse within weeks. The eye represents a rare site for local manifestation of BCP-ALL, but isolated intraocular relapse is a clinically unreckoned presentation of BCP-ALL in the era of CD19-CAR T cells.Conclusion During systemic control of BCP-ALL through CD19-CAR T cells, relapse can emerge in the eye as an immune-privileged organ. Ocular symptoms after CD19-CAR T-cell therapy should guide the clinician to elucidate the etiology in a timely fashion in order to adjust leukemia treatment strategy. Both, local immune escape as well as insufficient CAR T-cell persistence may have contributed to relapse in the reported patient. Mechanisms of relapse in an immune desert under CAR T-cell therapy require future clinical and experimental attention. In particular, ocular symptoms after CAR T-cell therapy should be considered a potentially early sign of leukemia relapse

Evaluation of prognostic factors and role of participation in a randomized trial or a prospective registry in pediatric and adolescent nonmetastatic medulloblastoma: a report from the HIT 2000 trial

Purpose We aimed to compare treatment results in and outside of a randomized trial and to confirm factors influencing outcome in a large retrospective cohort of nonmetastatic medulloblastoma treated in Austria, Switzerland and Germany. Methods and Materials Patients with nonmetastatic medulloblastoma (n = 382) aged 4 to 21 years and primary neurosurgical resection between 2001 and 2011 were assessed. Between 2001 and 2006, 176 of these patients (46.1%) were included in the randomized HIT SIOP PNET 4 trial. From 2001 to 2011 an additional 206 patients were registered to the HIT 2000 study center and underwent the identical central review program. Three different radiation therapy protocols were applied. Genetically defined tumor entity (former molecular subgroup) was available for 157 patients. Results Median follow-up time was 7.3 (range, 0.09-13.86) years. There was no difference between HIT SIOP PNET 4 trial patients and observational patients outside the randomized trial, with 7 years progression-free survival rates (PFS) of 79.5% ± 3.1% versus 78.7% ± 3.1% (P = .62). On univariate analysis, the time interval between surgery and irradiation (≤ 48 days vs ≥ 49 days) showed a strong trend to affect PFS (80.4% ± 2.2% vs 64.6% ± 9.1%; P = .052). Furthermore, histologically and genetically defined tumor entities and the extent of postoperative residual tumor influenced PFS. On multivariate analyses, a genetically defined tumor entity wingless-related integration site-activated vs non-wingless-related integration site/non-SHH, group 3 hazard ratio, 5.49; P = .014) and time interval between surgery and irradiation (hazard ratio, 2.2; P = .018) were confirmed as independent risk factors. Conclusions Using a centralized review program and risk-stratified therapy for all patients registered to the study center, outcome was identical for patients with nonmetastatic medulloblastoma treated on and off the randomized HIT SIOP PNET 4 trial. The prognostic values of prolonged time to RT and genetically defined tumor entity were confirmed