Determinación de células tumorales circulantes como factor pronóstico y detector de recidiva en carcinoma broncogénico no microcítico

La alta tasa de mortalidad del cáncer de pulmón hace necesario la investigación de herramientas que pudieran mostrar interés pronóstico, como la determinación de CTCs, y que pudieran ayudar en decisiones terapéuticas y en el seguimiento.Las CTCs son células malignas liberadas desde el tumor primario y desde las metástasis al torrente sanguíneo, con supuesta capacidad metastatizante.En 1869, el Dr Ashworth realizó la primera descripción tras hallar células tumorales similares al tumor primario en la circulación de un paciente metastásico. Desde entonces, más de 50 dispositivos han sido desarrollados para detectar y aislar CTCs, cada uno con diferente metodología y resultados..

Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica

Introduction: the aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). Methods: data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. Results: the incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. Conclusions: the risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection

Multimodal Management of Fecal Incontinence Focused on Sphincteroplasty: Long-Term Outcomes from a Single Center Case Series

The management of patients with fecal incontinence and an external anal sphincter (EAS) defect remains controversial. A retrospective series of overlapping anal sphincteroplasties performed between 1985–2013 from a single center, supplemented by selective puborectalis plication and internal anal sphincter repair is presented. Patients were clinically followed along with anorectal manometry, continence scoring (Cleveland Clinic Incontinence Score—CCS) and patient satisfaction scales. Patients with a suboptimal outcome were managed with combinations of biofeedback therapy (BFT), peripheral tibial nerve stimulation (PTNS), sacral nerve stimulation (SNS) or repeat sphincteroplasty. There were 120 anterior sphincter repairs with 90 (75%) levatorplasties and 84 (70%) IAS repairs. Over a median follow-up of 120 months (IQR 60–173.7 months) there were significant improvements in the recorded CCIS values (90.8% with a preoperative CCIS > 15 vs. 2.5% postoperatively; p < 0.001). There were 42 patients who required ancillary treatment with four repeat sphincteroplasties, 35 patients undergoing biofeedback therapy, 10 patients treated with PTNS and three managed with SNS implants with an ultimate good functional outcome in 92.9% of cases. No difference was noted in ultimate functional outcome between those treated with sphincteroplasty alone compared with those who needed ancillary treatments (97.1% vs. 85.7%, respectively). Overall, 93.3% considered the outcome as either good or excellent. Long-term functional outcomes of an overlapping sphincteroplasty are good. If the initial outcome is suboptimal, response to ancillary treatments remains good and patients are not compromised by a first-up uncomplicated sphincter repair

Factors associated with higher rate of Complete Pathologic Response after Long-Course Neoadjuvant Treatment for Locally Advanced Rectal Cancer Patients – Results from a retrospective cohort study focused on Inflammatory Indexes

BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) has a prognostic value in locally advanced rectal cancer (LARC). This study aimed to evaluate the ability to predict pCR using inflammatory markers, facilitating the selection of the optimal treatment strategy. METHODS: Patients undergoing primary tumor resection after long-cycle NCRT at a single center (2012 to 2018) were retrospectively collected (n=130). Patient demographics, preoperative laboratory measurements, tumor characteristics, treatment strategy, and postoperative anatomopathological variables were collected. The association of factors to pCR was examined using binary logistic regression, odds ratio (OR) (95% confidence interval), and the discriminative capacity with the ROC curve. RESULTS: Out of 130 patients, 42 pCRs occurred, equal to 32.3% of the sample. Variables identified as useful to predict pCR were total neutrophil count (3; OR 7.6), intravenous 5-FU chemotherapy strategy (OR 3.2), and absence of diabetes (OR 3.4). Patients having all three of them had a 55.3% chance of pCR. CONCLUSIONS: The absolute neutrophil count better predicts pCR than other inflammatory indices in selected patients with LARC undergoing long-cycle NCRT. A neutrophil count less than 6400 cells/mm3, absence of diabetes, and intravenous 5-FU NCRT therapy lead to a relative rise in pCR

Resultados de la estadificación clínica ganglionar mediastínica del cáncer pulmonar quirúrgico: datos de la cohorte prospectiva nacional del Grupo Español de Cirugía Torácica Videoasistida

Introducción: El objetivo del estudio es valorar el rendimiento diagnóstico de la tomografía computarizada (TC) y la tomografía por emisión de positrones (PET) en la estadificación clínica mediastínica del cáncer pulmonar quirúrgico según los datos de la cohorte prospectiva del Grupo Español de Cirugía Torácica Videoasistida (GEVATS). Métodos: Se han analizado 2.782 pacientes intervenidos por carcinoma pulmonar primario. Se ha estudiado el acierto diagnóstico en la estadificación mediastínica (cN2). Se ha realizado un análisis bivariante y multivariante de los factores que influyen en el acierto. Se ha estudiado el riesgo de pN2 inesperado en los factores con los que se recomienda una prueba invasiva de estadificación: cN1, tumor central o tamaño mayor de 3cm. Resultados: El acierto global de la TC y PET en conjunto es del 82,9% con VPP y VPN de 0,21 y 0,93. En tumores mayores de 3cm y a mayor SUVmax del mediastino, el acierto es menor, OR de 0,59 (0,44 - 0,79) y 0,71 (0,66 - 0,75), respectivamente. En el abordaje VATS el acierto es mayor, OR de 2,04 (1,52 - 2,73). El riesgo de pN2 inesperado aumenta con el número de los factores cN1, tumor central o tamaño mayor de 3cm: entre el 4,5% (0 factores) y 18,8% (3 factores), pero no hay diferencias significativas con la realización de prueba invasiva. Conclusiones: La TC y PET en conjunto tienen un elevado valor predictivo negativo. Su acierto global es menor en tumores mayores de 3cm y SUVmax del mediastino elevado, y mayor en el abordaje VATS. El riesgo de pN2 inesperado es mayor si cN1, tumor central o mayor de 3cm y no varía significativamente con prueba invasiva