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1.
JCO Glob Oncol ; 7: 523-529, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33856894

RESUMO

PURPOSE: A group of international urology and medical oncology experts developed and completed a survey on prostate cancer (PCa) in developing countries. The results are reviewed and summarized, and recommendations on consensus statements for very low-, low-, and intermediate-risk PCa focused on developing countries were developed. METHODS: A panel of experts developed more than 300 survey questions of which 66 questions concern the principal areas of interest of this paper: very low, low, and intermediate risk of PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up for very low-, low-, and intermediate-risk PCa in areas of limited resources discussed in this manuscript. RESULTS: The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION: The voting results and recommendations presented in this document can be used by physicians to support management for very low, low, and intermediate risk of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment for very low, low, and intermediate risk of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.


Assuntos
Médicos , Neoplasias da Próstata , Consenso , Países em Desenvolvimento , Humanos , Masculino , Neoplasias da Próstata/terapia
3.
Int J Mol Sci ; 22(3)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33513905

RESUMO

Adrenocortical carcinoma (ACC) is a rare malignancy that is associated with a dismal prognosis. Pan-genomic studies have demonstrated the involvement of ATRX and ZNRF3 genes in adrenocortical tumorigenesis. Our aims were to evaluate the protein expression of ATRX and ZNRF3 in a cohort of 82 adults with ACC and to establish their prognostic value. Two pathologists analyzed immuno-stained slides of a tissue microarray. The low protein expression of ATRX and ZNRF3 was associated with a decrease in overall survival (OS) (p = 0.045, p = 0.012, respectively). The Cox regression for ATRX protein expression of >1.5 showed a hazard ratio (HR) for OS of 0.521 (95% CI 0.273-0.997; p = 0.049) when compared with ≤1.5; for ZNRF3 expression >2, the HR for OS was 0.441 (95% CI, 0.229-0.852; p = 0.015) when compared with ≤2. High ATRX and ZNRF3 protein expressions were associated with optimistic recurrence-free survival (RFS) (p = 0.027 and p = 0.005, respectively). The Cox regression of RFS showed an HR of 0.332 (95%CI, 0.111-0.932) for ATRX expression >2.7 (p = 0.037), and an HR of 0.333 (95%CI, 0.140-0.790) for ZNRF3 expression >2 (p = 0.013). In conclusion, low protein expression of ATRX and ZNRF3 are negative prognostic markers of ACC; however, different cohorts should be evaluated to validate these findings.


Assuntos
Neoplasias do Córtex Suprarrenal/metabolismo , Neoplasias do Córtex Suprarrenal/mortalidade , Carcinoma Adrenocortical/metabolismo , Carcinoma Adrenocortical/mortalidade , Recidiva Local de Neoplasia/metabolismo , Ubiquitina-Proteína Ligases/metabolismo , Proteína Nuclear Ligada ao X/metabolismo , Adolescente , Neoplasias do Córtex Suprarrenal/patologia , Carcinoma Adrenocortical/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Antígeno Ki-67/metabolismo , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Análise de Regressão , Análise Serial de Tecidos
4.
Artigo em Inglês | MEDLINE | ID: mdl-32117062

RESUMO

Objective: Germline ARMC5 mutations are considered to be the main genetic cause of primary macronodular adrenal hyperplasia (PMAH). PMAH is associated with high variability of cortisol secretion caused from subclinical hypercortisolism to overt Cushing's syndrome (CS), in general due to bilateral adrenal nodules and rarely could also be due to non-synchronic unilateral adrenal nodules. The frequency of adrenal incidentalomas (AI) associated with PMAH is unknown. This study evaluated germline allelic variants of ARMC5 in patients with bilateral and unilateral AI and in patients with overt CS associated with bilateral adrenal nodules. Methods: We performed a retrospective multicenter study involving 123 patients with AI (64 bilateral; 59 unilateral). We also analyzed 20 patients with ACTH pituitary independent overt CS associated with bilateral adrenal nodules. All patients underwent germline genotyping analysis of ARMC5; abdominal CT and were classified as normal, possible or autonomous cortisol secretion, according to the low doses of dexamethasone suppression test. Results: We identified only one pathogenic allelic variant among the patients with bilateral AI. We did not identify any pathogenic allelic variants of ARMC5 in patients with unilateral AI. Thirteen out of 20 patients (65%) with overt CS and bilateral adrenal nodules were carriers of pathogenic germline ARMC5 allelic variants, all previously described. The germline ARMC5 mutation was observed in only one patient with bilateral AI; it was associated with autonomous cortisol secretion and showed to be a familial form. Conclusion: The rarity of germline ARMC5 mutations in AI points to other molecular mechanisms involved in this common adrenal disorder and should be investigated. In contrast, patients with overt Cushing's syndrome and bilateral adrenal nodules had the presence of ARMC5 mutations that were with high prevalence and similar to the literature. Therefore, we recommend the genetic analysis of ARMC5 for patients with established Cushing's syndrome and bilateral adrenal nodules rather than patients with unilateral AI.


Assuntos
Neoplasias das Glândulas Suprarrenais/genética , Proteínas do Domínio Armadillo/genética , Síndrome de Cushing/genética , Polimorfismo de Nucleotídeo Único , Doenças das Glândulas Suprarrenais/epidemiologia , Doenças das Glândulas Suprarrenais/etiologia , Doenças das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/epidemiologia , Adulto , Alelos , Estudos de Casos e Controles , Síndrome de Cushing/complicações , Síndrome de Cushing/epidemiologia , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Mutação em Linhagem Germinativa , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
J Endocr Soc ; 3(9): 1682-1692, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31528828

RESUMO

CONTEXT: Von Hippel-Lindau (VHL) disease is an autosomal dominant syndrome caused by germline mutations in the VHL gene. Guidelines recommend pheochromocytoma (PHEO) biochemical screening should start at age 5 years. OBJECTIVE: Genotype-phenotype correlations in VHL, focusing on PHEO penetrance in children, were studied. DESIGN: We retrospectively evaluated 31 individuals (median age at diagnosis was 26 years) with diagnosed VHL disease. RESULTS: PHEO was diagnosed in six children with VHL. A large PHEO (5 cm) was detected in a 4-year-old boy with p.Gly114Ser mutation. PHEO penetrance was 55% starting at age 4 years. VHL missense mutations were identified in 11 of 22 families (50%), frameshift mutations in four (18.2%), stop codon in three (13.6%), splicing site in two (9.1%), and large gene deletion in two (9.1%). The codon 167 (n = 10) was a hotspot for VHL mutations and was significantly associated with PHEO (90% vs. 38%; P = 0.007). PHEOs and pancreatic neuroendocrine tumors (PNETs) were strongly associated with VHL missense mutations compared with other mutations (89.5% vs. 0% and 73.7% vs. 16.7%; P = 0.0001 and 0.002, respectively). In contrast, pancreatic cysts (91.7% vs. 26.3%; P = 0.0001), renal cysts (66.7% vs. 26.3%; P = 0.027), and central nervous system hemangioblastomas (91.7% vs. 47.3%; P = 0.012) were more frequent in VHL with nonmissense mutations. CONCLUSION: VHL missense mutations were highly associated with PHEO and PNETs. Our data support that in children with VHL harboring missense mutations, biochemical screening for PHEO should be initiated at diagnosis.

6.
Mol Cell Endocrinol ; 460: 36-46, 2018 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-28676429

RESUMO

The participation of aberrant receptors and intra-adrenal ACTH in hyperplastic tissue are considered mechanisms that regulate hypercortisolism in PMAH. Additionally, germline ARMC5 mutations have been described as the most frequent genetic abnormality found in patients diagnosed with PMAH. Previous functional studies analyzed ARMC5 role using H295R cells. Therefore, we investigated the role of ARMC5 in cell cultures obtained from PMAH nodules containing steroidogenic cells, aberrant receptors and intra-adrenal ACTH. ARMC5 silencing in non-mutated PMAH cell cultures decreased steroidogenesis-related genes and increased CCNE1 mRNA expression and proliferative capacity without affecting cell viability. Additionally, ARMC5 overexpression induced cell death in PMAH mutated cell cultures, thereby decreasing cell viability. We confirmed the role of ARMC5 as an important pro-apoptotic protein involved in PMAH-related steroidogenesis. We also report for the first time the involvement of ARMC5 in controlling proliferation and regulating cell cycle in PMAH cell cultures; these effects need to be explored further.


Assuntos
Glândulas Suprarrenais/metabolismo , Glândulas Suprarrenais/patologia , Proteínas Supressoras de Tumor/metabolismo , Hormônio Adrenocorticotrópico/metabolismo , Hormônio Adrenocorticotrópico/farmacologia , Idoso , Proteínas do Domínio Armadillo , Células Cultivadas , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Inativação Gênica , Humanos , Hiperplasia , Gotículas Lipídicas/efeitos dos fármacos , Gotículas Lipídicas/metabolismo , Masculino , Pessoa de Meia-Idade , Mutação/genética , Pró-Opiomelanocortina/metabolismo , Progesterona Redutase/genética , Progesterona Redutase/metabolismo , Receptor Tipo 2 de Melanocortina/metabolismo , Receptores Acoplados a Proteínas G/metabolismo , Análise de Sequência de DNA , Coloração e Rotulagem , Esteroide 17-alfa-Hidroxilase/genética , Esteroide 17-alfa-Hidroxilase/metabolismo , Proteínas Supressoras de Tumor/genética , Vasopressinas/farmacologia
7.
J Clin Endocrinol Metab ; 99(8): E1501-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24708098

RESUMO

CONTEXT: Primary macronodular adrenal hyperplasia (PMAH) is a rare cause of Cushing's syndrome, usually characterized by functioning adrenal macronodules and increased cortisol production. Familial clustering of PMAH has been described, suggesting an inherited genetic cause for this condition. OBJECTIVE: The aim of the present study was to identify the gene responsible for familial PMAH. PATIENTS AND METHODS: Forty-seven individuals of a Brazilian family with PMAH were evaluated. A single-nucleotide polymorphism-based genome-wide linkage analysis followed by whole-exome sequencing were then performed in selected family members. Additionally, 29 other patients with PMAH and 125 randomly selected healthy individuals were studied to validate the genetic findings. Moreover, PMAH tissue was also analyzed through whole-exome sequencing, conventional sequencing, and microsatellite analysis. RESULTS: A heterozygous germline variant in the ARMC5 gene (p.Leu365Pro) was identified by whole-exome sequencing in a candidate genomic region (16p11.2). Subsequently, the same variant was confirmed by conventional sequencing in all 16 affected family members. The variant was predicted to be damaging by in silico methods and was not found in available online databases or in the 125 selected healthy individuals. Seven additional ARMC5 variants were subsequently identified in 5 of 21 patients with apparently sporadic PMAH and in 2 of 3 families with the disease. Further molecular analysis identified a somatic mutational event in 4 patients whose adrenal tissue was available. CONCLUSIONS: Inherited autosomal dominant mutations in the ARMC5 gene are a frequent cause of PMAH. Biallelic inactivation of ARMC5 is consistent with its role as a potential tumor suppressor gene.


Assuntos
Síndrome de Cushing/genética , Predisposição Genética para Doença , Mutação de Sentido Incorreto , Proteínas Supressoras de Tumor/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas do Domínio Armadillo , Brasil , Síndrome de Cushing/epidemiologia , Feminino , Frequência do Gene , Ligação Genética , Mutação em Linhagem Germinativa , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem
8.
Scand J Urol ; 47(4): 323-7, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23151176

RESUMO

OBJECTIVE: The aim of this study was to report on the safety and efficacy of 90 consecutive laparoscopic pyeloplasties carried out in a university hospital. MATERIAL AND METHODS: The outcomes of 90 transperitoneal dismembered pyeloplasties that were performed by residents at the hospital from March 2004 to March 2010 were analyzed. All of the surgeries were performed because of symptomatic ureteropelvic junction obstruction. The laparoscopic Anderson-Hynes dismembered technique was used in all cases, and a double-J stent was routinely placed and left in place for 4 weeks. The patients were followed up clinically and with imaging studies. Clinical data, outcomes and complication rates for the patients were retrospectively reviewed using a prospectively maintained database. RESULTS: The mean patient age was 38.9 (10-80) years, and 46 patients (51.1%) were males. The mean operative time was 222.5 (125-400) min. The surgery was completed laparoscopically in 96.6% of cases (87 patients). Conversion was required owing to technical difficulties in three cases. Overall, four (4.4%) patients had major complications. Seventy-six of the 87 patients (87.3%) presented improvements in symptomatology at a median follow-up of 39.7 (6-75) months. CONCLUSION: Laparoscopic pyeloplasty is feasible and associated with high success and low complication rates, even in a residency program.


Assuntos
Hospitais Universitários , Internato e Residência , Laparoscopia/métodos , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Competência Profissional , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Einstein (Säo Paulo) ; 8(4)Oct.-Dec. 2010. tab, graf
Artigo em Inglês, Português | LILACS | ID: lil-571978

RESUMO

Objectives: The aim of this study was to compare the results of laparoscopic donor nephrectomy with open donor nephrectomy. Methods: A non-randomized prospective analysis was conducted of living donor kidney transplantations (118 open donor nephrectomies; 57 laparoscopic donor nephrectomies) between January 2005 and December 2007 in the Kidney Transplantation Unit of Hospital das Clínicas of Faculdade de Medicina of the Universidade de São Paulo. Results: Mean donor operative time, mean donor hospital stay, mean postoperative creatinine values, and rates of complications and graft survival were similar for both groups. A significant statistical difference in warm ischemia time was observed between the open donor nephrectomy and laparoscopic donor nephrectomy groups (p < 0.001). There was only one conversion in the laparoscopic donor nephrectomy group. Conclusions: Laparoscopic donor nephrectomy is a safe procedure for a donor nephrectomy, comparable to an open procedure with similar results despite a longer warm ischemia time.


Objetivos: O objetivo deste estudo foi comparar a nefrectomia radical laparoscópica e a nefrectomia subcostal do doador. Métodos: Foi realizado um estudo prospectivo e não randomizado dos pacientes submetidos entre Janeiro 2005 e Dezembro 2007 a nefrectomia para doação renal na Unidade de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (118 casos de nefrectomia subcostal do doador; 57 casos de nefrectomia radical laparoscópica). Resultados: Tempo cirúrgico, tempo de internação hospitalar do doador, creatinina sérica pós-transplante e taxas de complicação e da sobrevida do rim transplantado foram similares para ambos os grupos. Foi encontrada uma diferença estatisticamente significante no tempo de isquemia quente (p < 0,001). Houve somente uma conversão no grupo submetido a nefrectomia laparoscópica. Conclusões: A nefrectomia laparoscópica do doador é procedimento seguro para doação renal e com resultados similares à nefrectomia subcostal, apesar de maior tempo de isquemia quente.


Assuntos
Humanos , Masculino , Feminino , Rim , Laparoscopia , Nefrectomia
10.
Einstein (Sao Paulo) ; 8(4): 456-60, 2010 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26760329

RESUMO

OBJECTIVES: The aim of this study was to compare the results of laparoscopic donor nephrectomy with open donor nephrectomy. METHODS: A non-randomized prospective analysis was conducted of living donor kidney transplantations (118 open donor nephrectomies; 57 laparoscopic donor nephrectomies) between January 2005 and December 2007 in the Kidney Transplantation Unit of Hospital das Clínicas of Faculdade de Medicina of the Universidade de São Paulo. RESULTS: Mean donor operative time, mean donor hospital stay, mean postoperative creatinine values, and rates of complications and graft survival were similar for both groups. A significant statistical difference in warm ischemia time was observed between the open donor nephrectomy and laparoscopic donor nephrectomy groups (p < 0.001). There was only one conversion in the laparoscopic donor nephrectomy group. CONCLUSIONS: Laparoscopic donor nephrectomy is a safe procedure for a donor nephrectomy, comparable to an open procedure with similar results despite a longer warm ischemia time.

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