Biomarcadores clínico-patológicos y moleculares en cáncer de colon en estadios iniciales: análisis en biopsias líquidas y en tejido tumoral. Implicaciones pronósticas

En España, el CCR es el tercer tumor más prevalente en hombres y el segundo en mujeres, siendo el tumor más prevalente teniendo en cuenta ambos sexos. La detección serológica de autoanticuerpos contra antígenos asociados al tumor ha sido ampliamente estudiada en la búsqueda de potenciales biomarcadores diagnósticos y pronósticos. La baja sensibilidad individual de cada autoanticuerpo hace que no resulten útiles como método diagnóstico del CCR. Hasta el momento, las guías internacionales sólo recomiendan el uso del marcador tumoral CEA en el seguimiento de los pacientes intervenidos, ya que una elevación de su valor en este periodo puede alertar sobre una posible recidiva de la enfermedad. Dos de los objetivos específicos del estudio han sido analizar el valor diagnóstico y pronóstico de la determinación de ARNm de los genes KRT19 y CEA, basándonos en la suposición de que es una metodología más precisa que el análisis del producto proteico final derivado de su transcripción génica (los antígenos tumorales CEA y Ca 19.9). Dicha determinación se ha realizado en 105 pacientes intervenidos de CCR estadios I-III y 32 controles, por un lado, directamente sobre la muestra de sangre periférica y, por otro, sobre una selección positiva de células epiteliales obtenidas de células mononucleares extraídas previamente de la muestra sanguínea (selección de células tumorales circulantes [CTCs]. Los resultados del estudio parecen indicar que la determinación de ARNm en sangre periférica de ambos genes es más sensible como test diagnóstico que sus antígenos tumorales, pero menos específica. Dada la sensibilidad (S) y especificidad (E) del análisis de ARNm del gen CEA obtenida en el diagnóstico del CCR ( S 77% y E 65% en sangre periférica, S 71% y E 79% en CTCs), su inclusión en una firma serológica junto con otros marcadores podría ser de utilidad como método de cribado. Sin embargo, la determinación de ARNm antes y/o después de la cirugía de ninguno de los dos genes analizados parece ser de utilidad como factor pronóstico. Hasta la fecha, la supervivencia y el riesgo de recaída de los pacientes diagnosticados de CCR tras la cirugía sola o combinada con quimioterapia adyuvante viene determinada principalmente por el estadiaje tumoral según la clasificación TNM. Sin embargo, no es suficiente para clasificar adecuadamente a los pacientes. Por ello, en nuestro estudio analizamos en 105 casos de CCR intervenido (estadios I-III), las principales características clínicas, patológicas y moleculares propuestas como posibles factores pronósticos. El análisis univariante de supervivencia muestra el valor pronóstico de los siguientes factores: antígeno CEA pre y postquirúrgico, la extensión del tumor primario (T), la afectación ganglionar (N), el estadio tumoral, la ratio entre el número de nódulos linfáticos afectos y evaluados, la invasión venosa, linfática y perineural, y el estado mutacional de los genes RAS. El análisis multivariante muestra el valor pronóstico independiente de la afectación ganglionar (N), la invasión perineural y el valor del antígeno tumoral CEA postquirúrgico. Al clasificar a los pacientes en función del número de factores pronósticos asociados (0, 1 y ≥ 2) observamos diferencias significativas en la supervivencia libre de enfermedad (SLE) entre los tres grupos de pacientes (p < 0,001), siendo el grupo con 2 o más factores pronósticos asociados el que obtiene peor supervivencia. Por último, proponemos clasificar a los pacientes en 5 subtipos moleculares en función del estado de expresión de sistema de reparación de ADN MMR (mismatch repair system) y del estado mutacional de los genes RAS y BRAF en las muestras del tejido tumoral. Por un lado, se han observado diferencias clínico-patológicas entre los diferentes subtipos propuestos y, por otro, se ha identificado un subtipo molecular (cMMR, RAS/BRAF nativos) con un beneficio en la SLE

Effect of fatigue strength exercise on anterior thigh skin temperature rewarming after cold stress test

Although dynamic thermography skin temperature assessment has been used in medical field, scientific evidence in sports is scarce. The aim of the study was to assess changes in anterior thigh skin temperature in response to a cold stress test after a strength exercise fatiguing protocol. Ten physically active adults performed a familiarization session and two strength exercise sessions, one with dominant and the other with non-dominant lower limb. Participants performed bouts of 10 concentric and eccentric contractions of leg extensions in an isokinetic device until reaching around 30% of force loss. Infrared thermographic images were taken at baseline conditions and after the fatigue level from both thighs after being cooled using a cryotherapy system. ROIs included vastus medialis, rectus femoris, adductor and vastus lateralis. Skin temperature rewarming was assessed during 180s after the cooling process obtaining the coefficients of the following equation: ΔSkin temperature = β0 + β1 * ln(T), being β0 and β1 the constant and slope coefficients, respectively, T the time elapsed following the cold stress in seconds, and ΔSkin temperature the difference between the skin temperature at T respect and the pre-cooling moment. Lower β0 and higher β1 were found for vastus lateralis and rectus femoris in the intervention lower limb compared with baseline conditions (p  0.6). Adductor only showed differences in β0 (p = 0.01 and ES = 0.92). The regressions models obtained showed that β0 and β1 had a direct relationship with age and muscle mass, but an inverse relationship with the number of series performed until 30% of fatigue (R2 = 0.8). In conclusion, fatigue strength exercise results in a lower skin temperature and a faster thermal increase after a cold stress test

Effect of fatigue strength exercise on anterior thigh skin temperature rewarming after cold stress test

Although dynamic thermography skin temperature assessment has been used in medical field, scientific evidence in sports is scarce. The aim of the study was to assess changes in anterior thigh skin temperature in response to a cold stress test after a strength exercise fatiguing protocol. Ten physically active adults performed a familiarization session and two strength exercise sessions, one with dominant and the other with non-dominant lower limb. Participants performed bouts of 10 concentric and eccentric contractions of leg extensions in an isokinetic device until reaching around 30% of force loss. Infrared thermographic images were taken at baseline conditions and after the fatigue level from both thighs after being cooled using a cryotherapy system. ROIs included vastus medialis, rectus femoris, adductor and vastus lateralis. Skin temperature rewarming was assessed during 180s after the cooling process obtaining the coefficients of the following equation: ΔSkin temperature = β0 + β1 * ln(T), being β0 and β1 the constant and slope coefficients, respectively, T the time elapsed following the cold stress in seconds, and ΔSkin temperature the difference between the skin temperature at T respect and the pre-cooling moment. Lower β0 and higher β1 were found for vastus lateralis and rectus femoris in the intervention lower limb compared with baseline conditions (p 0.6). Adductor only showed differences in β0 (p = 0.01 and ES = 0.92). The regressions models obtained showed that β0 and β1 had a direct relationship with age and muscle mass, but an inverse relationship with the number of series performed until 30% of fatigue (R² = 0.8). In conclusion, fatigue strength exercise results in a lower skin temperature and a faster thermal increase after a cold stress test.S

Role of sex on psychological distress, quality of life, and coping of patients with advanced colorectal and non-colorectal cancer

Patients with advanced gastrointestinal cancer must cope with the negative effects of cancer and complications. However, data on psychological distress, quality of life, and coping strategies in patients with advanced colorectal cancer compared to non-colorectal cancer based on sex is lacking. This was a multicenter study conducted in 203 patients that completed questionnaires evaluating psychological distress, quality of life, and coping strategies before starting systemic cancer treatment. Based on these data, the degree of disease acceptance in gastrointestinal malignancies may depend on sex and location of the primary digestive neoplasm

Fatigue, emotional distress, and illness uncertainty in patients with metastatic cancer: results from the prospective NEOETIC_SEOM study

A cancer diagnosis can have a substantial impact on a patient's mental health and quality of life. The aim of this study was to investigate the prevalence of fatigue, emotional distress, and uncertainty and examine the predictive value they have on the quality of life of advanced cancer patients. A prospective, multicenter study was conducted between February 2020 and May 2021 of individuals diagnosed with an advanced, unresectable neoplasm prior to initiating systemic antineoplastic treatment. Participants completed questionnaires to quantify fatigue, emotional distress, disease uncertainty, and quality of life. A linear regression analysis was performed to study the predictive QoL variables. The study population comprised 508 patients, 53.7% of whom were male and had a mean age of 54.9 years. The most common cancers were digestive (40.6%), bronchopulmonary (29.1%), and breast (8.5%); the most frequent histology was adenocarcinoma (63%); and most were stage IV (79.7%). More than half (55.7%) suffered fatigue, and 47.7% exhibited emotional distress; both were more prevalent among women. Fatigue, emotional distress, and disease uncertainty all correlate with diminished quality of life. Similarly, ECOG performance status and the demographic variables of age, sex, and comorbidities impacted quality of life. This patient sample displayed a high prevalence of fatigue and emotional distress, together with illness uncertainty, which are clearly linked to waning quality of life. To decrease the experience of fatigue and improve mental health treatment in cancer patients, interventions based on a biopsychosocial model must be intensified

Stoic attitude in patients with cancer from the NEOcoping study: cross-sectional study

Aim: Stoicism has been applied to describe a wide range of behaviors in the face of disease and influences an individual's use of coping strategies. This study tested the relationship between stoicism and social support, optimism, psychological distress, and coping strategies in patients with cancer. Method: NEOcoping is a multicenter, cross-sectional study. Participants' data were collected using a standardized, self-report form and LSS, MSPSS, Mini-MAC, BSI-18, and LOT-R questionnaires. Linear regression analyses were used to assess the association between stoicism and distress scores in both genders. A total of 932 individuals with non-metastatic, resected cancer were recruited. Results: Males perceived a higher risk of recurrence and toxicity with adjuvant chemotherapy and obtained higher stoic attitude scores than females. Women scored higher on somatization, depression, and anxiety. Patients with high stoicism scores were older and experienced more maladaptive coping (helplessness, anxious preoccupation), and depression, while those with lower stoicism scores had greater perceived social support, optimism, and positive attitude. In both males and females, stoicism correlated negatively with perceived social support, optimism, and positive attitude, and positively with helplessness, anxious preoccupation, and depression. In men, stoicism was directly and negatively associated with social support and optimism, and positively with anxious preoccupation. In women, stoicism was positively associated. In women, stoicism was directly and negatively associated with social support and positively with age and optimism. Stoicism was directly and positively associated with helplessness. Discussion: A stoic attitude was associated with lower social support, reduced optimism, and passive coping strategies (helplessness and anxious preoccupation) in this series of patients with cancer

Motivo de consulta más frecuente del paciente oncológico hospitalizado en el Hospital de Sagunto. Estudio descriptivo.

Estudi descriptiu dels principals motius d´ingrés i símptomes més freqüents del pacient oncològic. S´obtenen dades demogràfiques, clíniques i patològiques del pacient; així com el principal motiu d´ingrés i la simptomatologia que associa. Resultats: El principal motiu d´ingrés han estat les complicacions derivades de la neoplàsia (84 %), sent el dolor mal controlat la principal causa. La simptomatologia més prevalent ha estat l´anorèxia (69 %), dolor (60 %) i la perduda de pes (40 %). El dolor va ser considerat el símptoma principal, no obstant això, el 60 % dels pacients que presentaven dolor, estava mal o molt mal controlat (EVA>4).Estudio descriptivo de los principales motivos de ingreso y síntomas más frecuentes del paciente oncológico. Se obtienen datos demográficos, clínicos y patológicos del paciente; así como el principal motivo de ingreso y la sintomatología que asocia. Resultados: El principal motivo de ingreso han sido las complicaciones derivadas de la neoplasia (84 %), siendo el dolor mal controlado la principal causa. La sintomatología más prevalente ha sido la anorexia (69 %), dolor (60 %) y la pérdida de peso (40 %). El dolor fue considerado el síntoma principal, sin embargo, el 60 % de los pacientes que presentaban dolor, estaba mal o muy mal controlado (EVA>4)

Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer

Colorectal cancer (CRC) is one of the main causes of cancer death in the elderly. The older patients constitute a heterogeneous group in terms of functional status, comorbidities, and aging-related conditions. Therefore, therapeutic decisions need to be individualized. Additionally, a higher toxicity risk comes from the fact that pharmacokinetics and pharmacodynamics of the drugs as well as the tissue tolerance can be altered with aging. Although the chemotherapy efficacy in metastatic colorectal cancer (mCRC) is similar for older and young patients, more toxicity is presented in the elderly. While the mono-chemotherapy provides the same benefit for young and older patients, doublets front-line chemotherapy improves progression-free survival (PFS) but not overall survival (OS) in the elderly. Furthermore, the benefit of the addition of bevacizumab to chemotherapy in older patients has been shown in several clinical trials, while the clinical data for the benefit of anti-epidermal growth factor antibodies are scarcer. Immunocheckpoint inhibitors could be an appropriate option for patients with microsatellite instability (MSI) tumors. A prior geriatric assessment is required before deciding the type of treatment in order to offer the best therapeutic option