RESUMO
BACKGROUND: Information is scarce regarding the impact of treatment on Health-Related Quality of Life (HRQL) of patients with Head and Neck (H&N) cancers. We assessed the effect of treatment on HRQL and its association with prognosis in H&N cancer. PATIENTS AND METHODS: Patients with H&N cancer in whom HRQL was assessed before and after treatment. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-H&N35 instruments were used. Association of changes in patients' HRQL after treatment with Loco-Regional Recurrence (LRR) and Overall Survival (OS) was investigated. RESULTS: One hundred sixty patients were included; scales of the baseline assessment of HRQL were moderately associated with LRR and OS, but the impact of treatment on most HRQL scales was strongly associated with OS. By multivariate analysis, baseline assessment of Global Health, Physical, HN Teeth, HN Dry mouth, and HN Cough scales, and impact of treatment on the Physical and Pain scales comprised independent variables associated with LRR. Male gender, positive lymph nodes, baseline assessment of Role, HN Pain, HN Cough, and impact of treatment on Emotion, Pain, Financial, HN Swallowing, HN Social contact, and the interaction of HN Pain-change in Pain scales were associated with OS. Both multivariate models were adjusted by the neoplasm's site of origin. CONCLUSION: Aside from well-known clinical-pathologic prognostic factors in H&N cancers, HRQL assessment, both prior to and after treatment, provides significant prognostic information and should be measured. Design of therapeutic clinical trials in patients with H&N cancers should consider these novel prognostic factors.
Assuntos
Neoplasias de Cabeça e Pescoço/terapia , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , PrognósticoRESUMO
The aim of this study was to validate the Mexican-Spanish version of The European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR23 questionnaire. The translation procedure followed EORTC guidelines. QLQ-C30 and QLQ-BR23 instruments were completed by Mexican women with breast cancer, attending a teaching referral cancer centre from February 2009 to January 2010. Patients were divided in two groups: (1) Patients with early stage of breast cancer; and (2) Patients with locally advanced breast cancer (LABC). Reliability and validity tests were performed, and validity over time (responsiveness) was conducted in a subset of patients. Two hundred and thirty-four women (mean age, 52.3 years) completed both questionnaires. Convergent and divergent validity was adequate. Cronbach's alpha of all multi-item scales showed values ≥0.7 except for Cognitive and Breast symptoms scales (0.52 and 0.65 respectively). Patients with early stages (n= 77) showed better functional scores and lower symptoms scores than patients with LABC (n= 157). Score means variation after responsiveness analysis demonstrated high sensitivity to change after breast cancer surgery. The Mexican-Spanish version of the EORTC QLQ-BR23 questionnaire is a valid and suitable instrument to estimate HRQL in patients with breast cancer.
Assuntos
Neoplasias da Mama/psicologia , Nível de Saúde , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Idoso , Feminino , Humanos , México , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Perfil de Impacto da DoençaRESUMO
BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor of the nasopharynx. Our aim is to analyze prognostic factors, report results obtained with radiation therapy and propose a staging system. MATERIALS AND METHODS: Retrospective study of patients with JNA. Clinical, radiological and therapeutic data were assessed for recurrence- and disease free survival-associated prognostic factors. Bivariate and multivariate analyses were performed. RESULTS: Fifty-four males were analyzed. Invasion to anterior infratemporal fossae (ITF) +/or to pterygomaxillary fossae, to posterior infratemporal fossae, or intracranial extension were associated with recurrences in 2 of 15, in 8 of 18, and in 8 of 12 cases, respectively. Tumors < or > or =6 cm were associated with zero and with 18 recurrences, respectively (P = 0.006). A staging system is constructed considering extension patterns and size. Multivariate analyses conferred significance (P = 0.002) to a model including this staging system and surgical margins. CONCLUSION: Our system stratifies recurrence risk and disease-free survival efficiently. Since radiotherapy at young age has potential to induce malignancies, it should be used with caution. It could be considered as primary treatment in stage IV cases with major invasion to cavernous sinus or orbital apex. Therapy design may be improved.
Assuntos
Angiofibroma/patologia , Neoplasias Nasofaríngeas/patologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Adolescente , Adulto , Angiofibroma/mortalidade , Angiofibroma/terapia , Intervalo Livre de Doença , Humanos , Masculino , Análise Multivariada , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasofaríngeas/terapia , Recidiva Local de Neoplasia/terapia , Prognóstico , Dosagem Radioterapêutica , Estudos RetrospectivosRESUMO
BACKGROUND: Nasopharyngeal angiofibroma (NA) is a vascular tumor of the nasopharynx of young males which presents rarely. Our aim was to analyse outcome and prognostic factors of a case series of NA. MATERIALS AND METHODS: We conducted a retrospective study of patients with diagnosis of NA treated at a single institution from 1981 to 2003. We evaluated clinical, radiological and therapeutic data for recurrence- and disease-free survival-associated prognostic factors. Bi- and multivariate analyses were performed. RESULTS: Fifty-four males with NA constitute our study group. Age varied from 12 to 35 years (mean, 18.5 years; standard deviation [SD], 4.9). There were 18 recurrences; localization in nasopharynx, nasal fossae or maxillary antrum was not associated with recurrences. Invasion to pterygomaxillary fossae, to infratemporal fossae or to skull base and/or intracranial extension were associated with recurrences in two of 14, in five of 12, and in 11 of 18 cases, respectively. Tumors < or >or=6 cm were associated with zero and with 18 recurrences, respectively (p<0.01). Multivariate analyses conferred statistical significance (p<0.01) to a model including patterns of extension, tumor size in pterygomaxillary or anterior infratemporal fossa invasion, and surgical margins. CONCLUSION: Recurrence factors for NA are defined and consequently treatment design is suggested. Endoscopic approaches could be considered in patients with minor lateral extensions, while wide surgical approaches are indicated in invasive cases. Radiotherapy could be applied alone or combined with surgery for extensive intracranial involvement.
Assuntos
Angiofibroma/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Angiofibroma/terapia , Intervalo Livre de Doença , Seguimentos , Humanos , Masculino , Neoplasias Nasofaríngeas/terapia , Recidiva Local de Neoplasia , Prognóstico , Estudos RetrospectivosRESUMO
AIMS: The aim of the present study is to define prognostic factors, particularly the impact of treatment on paranasal sinus and nasal cavity malignancies. MATERIAL AND METHODS: Retrospective study of patients with maxillary antrum and nasal fossae malignancies. A maxillectomy classification as performed to treat malignancies in our institution is described. Multivariate analysis of prognostic factors was done using the Cox's model. RESULTS: One hundred and nine patients were evaluated. Squamous cell carcinoma was found in 62 cases and in 95 patients the epicentre of the tumour was located in the maxillary antrum. Ten patients were treated with surgery only, 39 patients with surgery and adjuvant radiation therapy, 37 cases received only radiotherapy, and 18 received radiotherapy followed by surgery; in five cases a combination of chemo-radiotherapy was used. Multivariate analysis identified T classification, orbit invasion, N classification, site of origin of tumour in nasal fossae, and no surgical resection as independent prognostic factors (p=0.0001). CONCLUSION: T4 tumours with orbit invasion present bad prognosis as compared to other T4 tumours. Surgical resection should be included in the treatment strategy. Because of the high frequency of lymph-node metastasis, neck treatment should be considered in T4 tumours.
Assuntos
Adenocarcinoma/terapia , Carcinoma de Células Escamosas/terapia , Neoplasias do Seio Maxilar/terapia , Neoplasias Nasais/terapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Terapia Combinada , Humanos , Maxila/cirurgia , Neoplasias do Seio Maxilar/mortalidade , Neoplasias do Seio Maxilar/patologia , Pessoa de Meia-Idade , Cavidade Nasal , Estadiamento de Neoplasias , Neoplasias Nasais/mortalidade , Neoplasias Nasais/patologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Prognóstico , Radioterapia , Estudos Retrospectivos , Análise de SobrevidaRESUMO
BACKGROUND: Early gastric carcinoma (EGC) is defined as a neoplasm confined to the mucosa and submucosa regardless of the presence of metastasis. This lesion is found in approximately 3% of cases in Mexico. The aim of this study is to describe our experience with EGC, emphasizing early detection as the most useful method to decrease mortality. METHODS: Retrospective review of records of patients with EGC treated at an oncologic referral center over a 12-years period. RESULTS: Twenty-one cases of EGC were retrieved. Mean age was 58.1 years (range, 33 to 84). Twelve were women and nine, men. Lymph node or distant metastasis were not found. Overall 5-year survival was 66.4%. Twenty patients underwent radical gastrectomy and only one underwent wedge resection of the gastric wall. Two patients (9.5%) presented recurrence and cancer-related death. Mean follow-up was 8.3 years. CONCLUSION: The prognosis of EGC in our hospital is lower than in countries other than Mexico and this lesion is found with low frequency. Increasing the detection EGC is the best method to reduce GC-related mortality.
Assuntos
Adenocarcinoma/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Gástricas/mortalidade , Taxa de SobrevidaRESUMO
The authors report the case of a 47-year-old female patient referred to the Instituto Nacional de Cancerología with abdominal pain and a focal liver lesion in the left lateral segment. After a careful tumor work-up, a laparoscopic left lateral segmentectomy was performed. The postoperative course was uneventful and the patient was discharged at the 2nd postoperative day. Histologic examination revealed focal nodular hyperplasia. In a search of the literature we find this to be the first case treated by this approach in Mexico.
Assuntos
Hiperplasia Nodular Focal do Fígado/cirurgia , Hepatectomia/métodos , Laparoscopia , Feminino , Humanos , México , Pessoa de Meia-IdadeRESUMO
BACKGROUND: A definite resolution to the controversy on the optimal extension of lymph node dissection (LND) in gastric cancer has not been achieved. Surgical morbidity and survival of D1 and D2 LND are compared by multivariate analysis. METHODS: A retrospective cohort study of 219 patients with gastric cancer and curative resection performed according to Japanese rules. D1 dissection was performed in 106 cases and D2 in 113. The logistic regression model was used to define risk factors for surgical morbidity and the Cox model to determine prognostic factors. RESULTS: Surgical morbidity occurs in 16.9% and 19.5% in D1 and D2 LND, respectively (P = .7). The morbidity determinants were operation blood loss, splenectomy, pancreaticosplenectomy, antrum location, low serum albumin, total gastrectomy, and metastatic nodal ratio (P < .0001), but not D2 LND. Five-year survival was 35.1% for D1 and 64% for D2 LND (P < .039). The prognostic factors were T stage, N stage, serum albumin level, total gastrectomy, D2 LND, and comorbidity (P < .0001). CONCLUSIONS: The increment of surgical morbidity and mortality rates attributed to D2 LND is largely caused by the effect of splenectomy and pancreaticosplenectomy. A significant survival benefit because of D2 LND was found. The results support the value of extended LND in the surgical treatment of gastric cancer.