Acute bacterial infection negatively impacts cancer specific survival of colorectal cancer patients

AIM:To assess the impact of bacterial infections on cancer-specific survival in patients with colorectal cancer. METHODS:This was a retrospective cohort study of colorectal cancer patients treated at the A.C. Camargo Cancer Center between January 2006 and April 2010. The presence of bacterial infection during cancer treatment,or up to one year after,was confirmed by laboratory tests or by the physician. Infections of the urinary,respiratory or digestive tracts,bloodstream,skin or surgical site were defined by testing within a single laboratory. Criteria for exclusion from the study were:chronically immunosuppressed patients;transplant patients(due to chronic immunosuppression);human immunodeficiency virus carriers;chronic use of corticosteroids or other immunosuppressive drugs;patients with autoimmune disease or primary immunodeficiency;known viral or parasitic infections. Patients with infections that did not require hospitalization were not included in the study because of the difficulty of collecting and tracking data related to infectious processes. In addition,patients hospitalized for pulmonary thromboembolism,stroke,acute myocardial infarction,uncontrolled diabetes,malignant hypercalcemia or other serious non-infectious complications not directly related to infection were also excluded. Survival curves were plotted using the Kaplan-Meier method,and logrank tests(univariate analysis) and a Cox test assuming a proportional hazards model(multivariate analysis) were performed to examine associations between clinical history and characteristics of infection with cancer-specific survival. RESULTS:One-hundred and six patients with colorectal cancer were divided into two groups based on the presence or absence of bacterial infection. Patient ages ranged from 23 to 91 years,with a median of 55 years. The majority of patients were male(57/106,53.77%) with stage Ⅲ colorectal cancer(45/106,44.11%). A total of 86 bacteriologic events were recorded. Results indicate that the presence and number of infections during or after the end of treatment were associated with poorer-cancer specific survivals(P = 0.02). Elevated neutrophil counts were also associated with poorer cancer-specific survival(P = 0.02). Analysis of patient age revealed that patients > 65 years of age had a poorer cancer-specific survival(P = 0.04). A multivariate analysis demonstrated that infection was an independent predictor of poor survival(HR = 2.62,95%CI:1.26-5.45;P = 0.01) along with advanced clinical staging(HR = 2.63,95%CI:1.08-6.39;P = 0.03). CONCLUSION:Infection and high neutrophil counts are associated with a poorer cancer-specific survival in colorectal cancer patients.

Use of the American Society of Anesthesiologists Classification as an Additional Planning Tool for Renal Cell Carcinoma Assessment

Objective: To determine the prognostic value of the American Society of Anesthesiologists (ASA) classification and of the main clinical pathologic variables in renal cell carcinoma (RCC) patients who underwent surgical treatment. Methods: In this international collaborative study, 376 RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) during the period 1989-2009 were assessed. The pathological data were reviewed by a single pathologist, and all of the surgically treated patients had been previously evaluated by a team of anesthesiologists and classified as ASA 1, ASA 2, or ASA 3. Results: In total, 318 patients were included in the study, with a mean followup of 48 months. Incidental tumors represented 47% of the cases, while 11.6% presented with metastases at diagnosis. Among the patients assessed, 38 (11.9%) were classified as ASA 1, 213 (67%) as ASA 2, and 67 (21.1%) as ASA 3. An association between the ASA classification and the main clinicopathological variables of RCC was observed. The univariate analysis for overall survival (OS) revealed significant differences in the survival curves according to the ASA classification (p < 0.001). High-grade neoplasms, the presence of metastasis at diagnosis, clinical stage III/IV, and incidental tumors remained as independent predictors of survival. Moreover, the multivariate analysis revealed a negative impact of the ASA classification on OS (p = 0.001). Conclusions: The present study demonstrated a correlation between the ASA classification and the main prognostic factors of RCC and its impact on survival rates. ASA 3 patients had more aggressive tumors, increased risk of perioperative complications, and worse outcomes compared with ASA1 or ASA 2. Thus, the ASA classification may be considered an additional tool for assessing and planning the treatment of RCC patients.

Performance of the Multiprofessional Team in Cytoreductive Surgeries with Intraperitoneal Hyperthermic Chemotherapy:Experience Reporting

Purpose:This study aims at reporting the experience of a cancer hospital’s multiprofessional team with surgery patients in performing cytoreductive surgeries associated with hyperthermic intraperitoneal chemotherapy.Methods:It is a reporting about the experience of the multiprofessional team at AC Camargo Cancer Center’s surgery center,which operates in cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy,thus guaranteeing the surgery patient’s safety.Results:No safety report for the surgery patient subjected to intraperitoneal hypothermic chemotherapy was found in the literature.Therefore,the surgery center’s multiprofessional team’s practice was based on standards for manipulating chemotherapeutic agents and for safely administering medication.A checklist was elaborated for cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy based on the surgery patient safety protocol and the institution’s multiprofessional team’s experience.Conclusions:From the multiprofessional team’s experiences in cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy,the importance of elaborating a checklist to promote the quality of assistance and guarantee patient safety during the entire intraoperative phase became evident.

Combined Hepatocellular-Cholangiocarcinoma with Stem Cell Features—Case Report

Combined hepatocholangiocarcinoma is a rare and unique form of primary hepatic neoplasm, expressing histopathological and phenotypic aspects of hepatocellularcarcinoma and cholangiocarcinoma in the same tumor. Diagnosis may be performed by imaging, showing typical features of both components. We present a case of a 55-year-old woman presenting with abdominal pain and a hepatic mass. The patient underwent surgery and combined hepatocholangiocarcinoma with stem cells features was confirmed on pathological analysis. There are no signs of recurrence to date. Combined hepatocholangiocarcinoma requires a preoperative diagnosis, since it is a unique entity with higher rates of local and lymph node recurrence, compared to isolated forms.

Evaluation of the Translation,Cross-cultural Adaptation and Properties of Measurement of the FACT-BMT Questionnaire

Various questionnaires have been described which evaluate the quality of life in patients undergoing cancer treatment,but most were originally developed in English and have not been adequately validated for other languages.To evaluate the process of translation and cross-cultural adaptation and the measurement properties of the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation(FACT-BMT)questionnaire,a systematic review was conducted with two independent evaluators.The search for articles was carried out in four databases:MEDLINE,EMBASE,CINAHL and SCIELO,using the terms“questionnaire”,“quality of life”,“oncology”,and“valid”and their descriptors according to MeSH and DeCs.The searches yielded 6,877 studies,of which only three performed the stages of translation,cross-cultural adaptation,and evaluation of the measurement properties of the FACT-BMT questionnaire.The instruments in Arabic,Chinese,Korean and Portuguese showed and presented good methodological quality,but none of the four studies followed all the validation criteria for the questionnaire.The adapted versions of the FACT-BMT have methodological weaknesses in their process of translation and cross-cultural adaptation and evaluation of measurement properties,therefore the questionnaires possibly being used inadequately in other languages.

A remote,fully oriented personalized program of physical exercise for women in follow-up after breast cancer treatment improves body composition and physical fitness

This study aimed to evaluate the efficacy of an individualized remote exercise program on the improvement of body composition and physical fitness of a heterogeneous group of patients who completed breast cancer treatment.This prospective study included 107 women aged 18 to 60,shortly after curative treatment for localized breast cancer,at the Erasto Gaertner Cancer Hospital(HEG)in Curitiba,PR,Brazil.Body composition,maximal oxygen consumption,and muscle resistance were evaluated after nine months of intervention while considering adherence to the program,level of physical activity,presence of binge eating disorder,tumor classification,and treatment type.Seventy-eight women(72.8%)adhered to the training program.Adherent participants showed significant changes in body mass([-4.3±3.6]kg;p<0.0001),body mass index([-1.6±1.5]kg·m^(−2);p<0.0001),body fat(−3.4%±3.1%;p<0.0001),maximal oxygen consumption([7.5±2.0]ml·kg^(−1)·min^(−1));p<0.0001),and abdominal resistance([11.2±2.8]reps;p<0.0001).In contrast,these variables did not change significantly in the non-adherent group.Among the adherent participants,those subclassified in the severe binge group showed a more noticeable reduction in body mass,body mass index,and body fat(p<0.05)than those in the non-binge group.Individualized remotely-guided physical exercise programs can improve the body composition and physical fitness of women undergoing post-breast cancer surveillance,regardless of pathological history or treatment.

Severe dengue in the intensive care unit

Dengue fever is considered the most prolific vector-borne disease in the world,with its transmission rate increasing more than eight times in the last two decades.While most cases present mild to moderate symptoms,5%of patients can develop severe disease.Although the mechanisms are yet not fully comprehended,immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients:increased vascular permeability that may shock and thrombocytopenia,and coagulopathy that can induce hemorrhage.The risk factors of severe disease include previous infection by a different serotype,specific genotypes associated with more efficient replication,certain genetic polymorphisms,and comorbidities such as diabetes,obesity,and cardiovascular disease.The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality.This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.

Update on oral and oropharyngeal cancer staging-International perspectives

Squamous cell carcinoma of the oral cavity and oropharynx have been used synonymously and interchangeably in the world literature in the context of head and neck cancers.As the 21st century progresses,divergence between the two have become more evident,particularly due to evidence related to human papillomavirus-associated oropharyngeal squamous cell carcinoma.As such,the American Joint Committee on Cancer recently published the 8th edition Cancer Staging Manual,serving as a continued global resource to clinicians and researchers.Through changes in staging related to T and N clinical and pathologic classifications,the new system is expected to influence current management guidelines of these cancers that have distinct anatomic and etiopathogenic characteristics.This article aims to review such impactful changes in a time of critical transition of the staging of head and neck cancer and how these changes may affect clinicians and researchers worldwide.

The repertoire of germline variants in patients with early-onset rectal cancer

Dear Editor,The incidence of rectal cancer has increased in patients younger than 50 years old during the last decade.It is well established that young age at cancer onset is a hallmark of hereditary cancer.The prevalence of germline variants among early-onset rectal cancer(EORC)patients is largely unexplored.Here,we aimed to determine the spectrum of germline variants and their clinical impact in EORC patients diagnosed at age 40 or younger.We investigated 71 EORC patients(Supplementary Table S1),one of the largest cohorts to date,using a customized panel with 93 genes(Supplementary Table S2).