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Luvián-Morales J, Delgadillo-González M, Castro-Eguiluz D, Oñate-Ocaña LF, Cetina-Pérez L. Quality of life but not cachexia definitions are associated with overall survival in women with cervical cancer: a STROBE-compliant cohort study. Jpn J Clin Oncol 2024; 54:416-423. [PMID: 38146122 DOI: 10.1093/jjco/hyad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Cancer-related cachexia (CRC) has a profound impact on health-related quality of life (HRQL), and both were reported to be associated with overall survival (OS). We hypothesize that HRQL and CRC are associated with OS. This study analyzed the impact of CRC on HRQL and its prognostic value in women with cervical cancer (CC). METHODS A cohort study including consecutive women with CC treated from October 2020 to October 2021 in a cancer center. Cox's model defined the associations of immune, biochemical and nutritional parameters, clinical cachexia classifications and HRQL with OS. RESULTS Two hundred forty-four consecutive women with CC were included. Cachexia classifications and several scales of the QLQ-C30 were associated with OS by bivariate but not by multivariate analysis. QLQ-CX24 scales were not associated with OS. The prognostic nutritional index (PNI) (hazard ratio (HR) 0.828; 95% confidence interval (CI) 0.766-0.896), Food aversion (HR 0.95; 95% CI 0.924-0.976), Eating difficulties (HR 1.041; 95% CI 1.013-1.071), Loss of control (HR 4.131; 95% CI 1.317-12.963), Forced self to eat (1.024; 95% CI 1.004-1.044) and Indigestion (HR 0.348; 95% CI 0.131-0.928) scales of the QLQ-CAX24 were independently associated with OS by multivariate analysis (p = 1.9×10-11). CONCLUSION This model permitted a clear stratification of prognostic subgroups. The PNI and several QLQ-CAX24 scales were associated with OS in women with CC. CRC, defined by several cachexia classifications, was not an independent prognostic factor. These findings require confirmation because of their possible diagnostic, therapeutic and prognostic implications.The prognostic nutritional index and several QLQ-CAX24 scales were associated with overall survival in women with cervical cancer. Cancer-related cachexia, defined by several cachexia classifications, was not an independent prognostic factor, neither The International Federation of Gynecology and Obstetrics (FIGO) stage classifications.
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Affiliation(s)
- Julissa Luvián-Morales
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City
| | - Merari Delgadillo-González
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City
| | - Denisse Castro-Eguiluz
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City
- Investigador por México, CONAHCyT, Mexico City, Mexico
| | - Luis F Oñate-Ocaña
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City
| | - Lucely Cetina-Pérez
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City
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2
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Allende S, Turcott JG, Verástegui E, Rodríguez-Mayoral O, Flores-Estrada D, Pérez Camargo DA, Ramos-Ramírez M, Martínez-Hernández JN, Oñate-Ocaña LF, Pina PS, Cardona AF, Arrieta O. Early Incorporation to Palliative Care (EPC) in Patients With Advanced Non-Small Cell Lung Cancer: The PACO Randomized Clinical Trial. Oncologist 2024:oyae050. [PMID: 38558247 DOI: 10.1093/oncolo/oyae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/16/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Patients with non-small cell lung cancer (NSCLC) experience a considerable disease burden, evident in symptomatic and psychological spheres. Advanced cancer represents a complex scenario for patients and the healthcare team. Early palliative care (EPC) has been proven as a clinically meaningful strategy in this context by several randomized trials but not in a resource-limited setting. This study aimed to evaluate the effect of EPC compared with standard oncological care (SOC) in patients with metastatic NSCLC in Mexico. MATERIALS AND METHODS A prospective, randomized clinical trial was conducted at Instituto Nacional de Cancerologia in Mexico. All patients had histologically confirmed metastatic NSCLC without previous treatment. Patients were randomly assigned (1:1) to receive SOC or SOC + EPC. The EPC group was introduced to the palliative care team at baseline after randomization, which was integrated by psychologists, bachelor's in nutrition, specialized nurses, and physicians. Patients randomized to this arm had programmed visits to meet with the team at baseline and through the 2nd, 4th-, and 6th cycles thereafter. The primary endpoint was overall survival (OS); secondary outcomes included quality of life (QoL), anxiety and depression, and symptom intensity. They were assessed using the instruments EORTC QLQ-C30 questionnaire, Edmonton Symptom Assessment Scale (ESAS), and the Hospital Anxiety and Depression Scale (HADS) (clinicaltrials.gov [NCT01631565]). Questionnaires were completed at baseline, at 2nd, 4th, and 6th cycles of treatment. RESULTS Between March 2012 and June 2015, 201 patients were assessed for eligibility and 146 were enrolled and allocated to receive EPC (73) or SOC (73). Median OS for patients in the EPC vs SOC arm was 18.1 months (95% CI, 7.9-28.4) and 10.5 months (95% CI, 4.7-16.2) (P = .029). Having a poor performance status (HR 1.7 [1.2-2.5]; P = .004) and allocation to the control group (HR 1.5 [1.03-2.3]; P = .034) were independently associated with a worse OS. Those patients with a global QoL > 70 at baseline had a better OS if they were In the EPC arm (38.7 months (95% CI, 9.9-67.6) vs SOC 21.4 months (95% CI, 12.4-30.3)). Mean QoL had a numerical improvement in patients allocated to EPC after 6 cycles of follow-up, nonetheless this difference was not statistically significant (55.1 ± 23.7 vs 56.9 ± 25.3; P = .753). There were no significant differences in anxiety and depression at all study points. CONCLUSIONS EPC is associated with a significant improvement in OS, although, we observed that the greatest benefit of providing EPC was observed in those with a global QoL > 70 at baseline. This study did not identify significant changes in terms of QoL or symptom burden between the study groups after follow-up. Evidence robustly suggests that EPC should be considered part of the multidisciplinary treatment of metastatic NSCLC patients since diagnosis. According to our study, EPC can be implemented in low- or middle-income countries (LMIC).
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Affiliation(s)
- Silvia Allende
- Department of Palliative Care, Instituto Nacional de Cancerología, Mexico City, México
| | - Jenny G Turcott
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, México
| | - Emma Verástegui
- Department of Palliative Care, Instituto Nacional de Cancerología, Mexico City, México
| | | | | | | | | | | | - Luis F Oñate-Ocaña
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, México
| | | | - Andrés F Cardona
- Research and Education Direction, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research, FICMAC and Molecular Oncology and Biology Systems Group, Universidad El Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, México
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3
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Carrillo JF, Carrillo LC, Ramírez-Ortega MC, Pacheco-Bravo I, Ramos-Mayo A, Oñate-Ocaña LF. Wire-guided localization and surgical resection of non-palpable recurrent of thyroid carcinoma: A STROBE-compliant, retrospective cohort study. Eur J Surg Oncol 2024; 50:107306. [PMID: 38048725 DOI: 10.1016/j.ejso.2023.107306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Information on hook-wire guided (HWG) surgery for non-palpable thyroid carcinoma (TC), locoregional-recurrent disease (LRRD) is scarce. We analyze the results of HWG resection compared with the traditional procedure. METHODS Cohort study performed between January 2016 and December 2020. Patients with TC and non-palpable LRRD were included. A "Standard cohort", patients with non-HWG resection and "HWG cohort", with HWG resection of LRRD were defined. Surgical morbidity, re-recurrent/progressive disease (RRD), and re-recurrence-free survival (RRFS) were defined. RESULTS 43 and 23 patients were assigned to the Standard or HWG cohorts, respectively. Complications occurred in 28 % and 17.3 % of cases, in control or HWG cohorts, respectively. HWG cohort, size of primary TC, 131I dose >150 mCi, and thyroglobulin level >1 ng/ml at detection of LRRD were associated with RRD. HWG cohort, thyroglobulin level at LRRD, 131I treatment, and dose were associated with RRFS. CONCLUSIONS HWG surgery of non-palpable TC LRRD had improved results regarding surgical morbidity, RRD, and RRFS.
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Affiliation(s)
| | | | - Margarita C Ramírez-Ortega
- Subdirección de Investigación Básica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - Irlanda Pacheco-Bravo
- Departamento de Imagen, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
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Justo-Garrido M, López-Saavedra A, Alcaraz N, Cortés-González CC, Oñate-Ocaña LF, Caro-Sánchez CHS, Castro-Hernández C, Arriaga-Canon C, Díaz-Chávez J, Herrera LA. Association of SLC12A1 and GLUR4 Ion Transporters with Neoadjuvant Chemoresistance in Luminal Locally Advanced Breast Cancer. Int J Mol Sci 2023; 24:16104. [PMID: 38003293 PMCID: PMC10670992 DOI: 10.3390/ijms242216104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Chemoresistance to standard neoadjuvant treatment commonly occurs in locally advanced breast cancer, particularly in the luminal subtype, which is hormone receptor-positive and represents the most common subtype of breast cancer associated with the worst outcomes. Identifying the genes associated with chemoresistance is crucial for understanding the underlying mechanisms and discovering effective treatments. In this study, we aimed to identify genes linked to neoadjuvant chemotherapy resistance in 62 retrospectively included patients with luminal breast cancer. Whole RNA sequencing of 12 patient biopsies revealed 269 differentially expressed genes in chemoresistant patients. We further validated eight highly correlated genes associated with resistance. Among these, solute carrier family 12 member 1 (SLC12A1) and glutamate ionotropic AMPA type subunit 4 (GRIA4), both implicated in ion transport, showed the strongest association with chemoresistance. Notably, SLC12A1 expression was downregulated, while protein levels of glutamate receptor 4 (GLUR4), encoded by GRIA4, were elevated in patients with a worse prognosis. Our results suggest a potential link between SLC12A1 gene expression and GLUR4 protein levels with chemoresistance in luminal breast cancer. In particular, GLUR4 protein could serve as a potential target for drug intervention to overcome chemoresistance.
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Affiliation(s)
- Montserrat Justo-Garrido
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Alejandro López-Saavedra
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Nicolás Alcaraz
- The Bioinformatics Centre, Department of Biology, University of Copenhagen, 2200 Copenhagen, Denmark;
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Carlo C. Cortés-González
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Luis F. Oñate-Ocaña
- Department of Gastroenterology, National Cancer Institute (INCan), Tlalpan, Mexico City 14080, Mexico;
| | | | - Clementina Castro-Hernández
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Cristian Arriaga-Canon
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - José Díaz-Chávez
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Luis A. Herrera
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
- School of Medicine and Health Sciences-Tecnológico de Monterrey, Mexico City 14380, Mexico
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5
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Cacho-Díaz B, González-González E, Mauricio Bonilla-Navarrete A, Texcocano-Becerra J, Oñate-Ocaña LF. Are neurologic symptoms associated with worse QoL in non-CNS cancer patients? J Clin Neurosci 2023; 111:39-45. [PMID: 36934658 DOI: 10.1016/j.jocn.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/18/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND The burden of having neurologic symptoms (NS) in cancer patients has scantly been studied; therefore, we performed a study whose purpose was to measure the impact of having clinically active (NS) on the quality of life (QoL) of non-primary CNS cancer patients. METHODS Patients with systemic cancer (non-primary CNS cancer) sent for neurological evaluation at a single cancer center (INCAN) were prospectively invited to respond the EORTC-QLQ-C30 and BN20 questionnaires. Associations of the questionnairés items were blindly measured for the following groups: NS+ or not (NS-) and having active cancer (AC+) or not (AC-). RESULTS Of 205 patients aged 55.4 ± 15.4 years, 122 (60%) had NS+ and 107 (52%) AC +. The NS+ group (compared with the NS-) showed a significant worse perception in the following scales/items of the EORTC QLQ-C30: physical functioning (median 86 vs. 92, P = 0.012), role functioning (66 vs. 100, P < 0.001), emotional functioning (75 vs. 83, P = 0.005), cognitive functioning (66 vs. 83, P < 0.001), fatigue (33 vs. 22, P < 0.001), nausea and vomiting (P = 0.021), pain (33 vs. 16, P < 0.001), insomnia (33 vs. 0, P = 0.011), appetite loss (P = 0.021), and global health (66 vs. 75, P = 0.001). CONCLUSION In patients with systemic (non-CNS) cancer, the QoL is significantly worse for patients with active neurologic symptoms.
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Affiliation(s)
- Bernardo Cacho-Díaz
- Neuro-Oncology Unit, Instituto Nacional de Cancerologia, Av., San Fernando 22, Tlalpan, Mexico City, ZC 14080, Mexico.
| | - Ethan González-González
- Neuro-Oncology Unit, Instituto Nacional de Cancerologia, Av., San Fernando 22, Tlalpan, Mexico City, ZC 14080, Mexico
| | | | - Julia Texcocano-Becerra
- Neuro-Oncology Unit, Instituto Nacional de Cancerologia, Av., San Fernando 22, Tlalpan, Mexico City, ZC 14080, Mexico
| | - Luis F Oñate-Ocaña
- Instituto Nacional de Cancerologia, Av., San Fernando 22, Tlalpan, Mexico City, ZC 14080, Mexico
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Gómez-Gallegos AA, Ramírez-Vidal L, Becerril-Rico J, Pérez-Islas E, Hernandez-Peralta ZJ, Toledo-Guzmán ME, García-Carrancá A, Langley E, Hernández-Guerrero A, López-Casillas F, Herrera-Goepfert R, Oñate-Ocaña LF, Ortiz-Sánchez E. CD24+CD44+CD54+EpCAM+ gastric cancer stem cells predict tumor progression and metastasis: clinical and experimental evidence. Stem Cell Res Ther 2023; 14:16. [PMID: 36737794 PMCID: PMC9898964 DOI: 10.1186/s13287-023-03241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is a leading cause of cancer-related deaths worldwide. Specific and thorough identification of cancer cell subsets with higher tumorigenicity and chemoresistance, such as cancer stem cells (CSCs), could lead to the development of new and promising therapeutic targets. For better CSC identification, a complete or extended surface marker phenotype is needed to provide increased specificity for new cell targeting approaches. Our goal is to identify and characterize a putative extended phenotype for CSCs derived from patients with GC before treatment, as well as to evaluate its clinical value. In addition, we aim to ensure that cells with this phenotype have stemness and self-renewal capabilities. METHODS This is a cohort study including 127 treatment-naïve patients with GC who attended the Instituto Nacional de Cancerología. Multiparametric flow cytometry analysis was performed to determine the extended phenotype of cells derived from gastric biopsies. The tumorigenic capability of cells identified in patients was assessed in a zebrafish model. RESULTS CD24+CD44+CD54+EpCAM+ cells were present in all treatment-naïve patients included, with a median abundance of 1.16% (0.57-1.89%). The percentage of CD24+CD44+CD54+EpCAM+ cells was categorized as high or low using 1.19% as the cutoff for the CD24+CD44+CD54+EpCAM+ cell subset. Additionally, a higher TNM stage correlated with a higher percentage of CD24+CD44+CD54+EpCAM+ cells (Rho coefficient 0.369; p < 0.0001). We also demonstrated that a higher percentage of CD24+CD44+CD54+EpCAM+ cells was positively associated with metastasis. The metastatic potential of these cells was confirmed in a zebrafish model. Ultimately, under our conditions, we conclude that CD24+CD44+CD54+EpCAM+ cells are true gastric cancer stem cells (GCSCs). CONCLUSION The CD24+CD44+CD54+EpCAM+ cells present in tissue samples from patients are true GCSCs. This extended phenotype results in better and more specific characterization of these highly tumorigenic cells. The relative quantification of CD24+CD44+CD54+EpCAM+ cells has potential clinical value, as these cells are associated with metastatic disease, making their presence an additional prognostic marker and possibly a target for the design of new antineoplastic treatments in the era of precision oncology. Overall, the extended CD24+CD44+CD54+EpCAM+ phenotype of GCSCs could support their isolation for the study of their stemness mechanisms, leading to the identification of better molecular targets for the development of both new therapeutic approaches such as oncoimmunotherapy and new diagnostic and clinical prognostic strategies for GC.
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Affiliation(s)
- Angel A. Gómez-Gallegos
- Posgrado en Ciencias Biológicas, Unidad de Posgrado, Edificio A, 1° Piso, Circuito de Posgrados, Ciudad Universitaria, C.P. 04510 Coyoacán, Distrito Federal, Mexico ,grid.419167.c0000 0004 1777 1207Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Lizbeth Ramírez-Vidal
- grid.9486.30000 0001 2159 0001Posgrado de Ciencias Biomédicas. Facultad de Medicina, Universidad Nacional Autónoma de México, Circuito Exterior s/n Ciudad Universitaria, Coyoacán, 04510 Mexico City, Mexico
| | - Jared Becerril-Rico
- Posgrado en Ciencias Biológicas, Unidad de Posgrado, Edificio A, 1° Piso, Circuito de Posgrados, Ciudad Universitaria, C.P. 04510 Coyoacán, Distrito Federal, Mexico ,grid.419167.c0000 0004 1777 1207Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Elizabeth Pérez-Islas
- grid.419167.c0000 0004 1777 1207Departamento de Patología, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Zuly J. Hernandez-Peralta
- grid.419167.c0000 0004 1777 1207Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Mariel E. Toledo-Guzmán
- grid.419167.c0000 0004 1777 1207Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Alejandro García-Carrancá
- grid.419167.c0000 0004 1777 1207Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080 Mexico City, Mexico ,grid.9486.30000 0001 2159 0001Unidad de Investigación en Cáncer, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, 04510 Mexico City, Mexico
| | - Elizabeth Langley
- grid.419167.c0000 0004 1777 1207Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Angélica Hernández-Guerrero
- grid.419167.c0000 0004 1777 1207Unidad de Endoscopia, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Fernando López-Casillas
- grid.9486.30000 0001 2159 0001Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Circuito Exterior s/n Ciudad Universitaria, Coyoacán, 04510 Mexico City, Mexico
| | - Roberto Herrera-Goepfert
- grid.419167.c0000 0004 1777 1207Departamento de Patología, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Luis F. Oñate-Ocaña
- grid.419167.c0000 0004 1777 1207Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Elizabeth Ortiz-Sánchez
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080, Mexico City, Mexico.
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7
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Oñate-Ocaña LF, Herrera-Goepfert R, Avilés-Salas A, Cortés CC, González-Trejo S, Carrillo JF, Ruiz-García E, Ochoa-Carrillo FJ, Aiello-Crocifoglio V, García-Cuellar CM. Multivariate Prognostic Models for Patients with Stages I and Ii Colon Carcinoma: a Strobe-Compliant Retrospective Cohort Study. Rev Invest Clin 2023; 75:259-271. [PMID: 37918013 DOI: 10.24875/ric.23000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023]
Abstract
Background Colorectal cancer is the most frequent gastrointestinal malignancy worldwide. The value of adjuvant treatment is controversial in Stages I and II. Objective The aim of this study was to construct post-operative prognostic models applicable to patients with stages I-II colon carcinoma (CC). Methods This is a retrospective cohort study of patients with Stage I-II CC treated over a 25-year period. Exposure was defined as clinical, histopathological, and immunohistochemical factors (including CDX2 and MUC2 expression). Patients were randomly allocated to either a “modeling set” or a “validation set”. Factors associated with recurrence, disease-free survival (DFS), and overall survival (OS) were defined in the “modeling set”. Their performances were tested in the “validation set”. Results From a total of 556 recruited patients, 339 (61%) were allocated to the “modeling set” and 217 (39%) to the “validation set”. Three models explaining recurrence, DFS, and OS were described. Tumor location in the left colon (Hazards ratio [HR] = 1.57; 95% Confidence interval [CI] 0.99-2.48), lymphocyte (HR = 0.46; 96% CI 0.27-0.88) and monocyte (HR = 0.99; 95% CI 0.99-1) counts, neutrophil/platelet ratio (HR = 1.3; 95% CI 0.74-2.3, and HR = 2.3; 95% CI 1.3-4.1; for second and third category, respectively), albumin/monocyte ratio (HR = 0.43; 95% CI 0.21-0.87), and microscopic residual disease after surgery (HR = 8.7; 95% CI 3.1-24) were independently associated with OS. T classification and expression of CDX2 and/or MUC2 were not independently associated with recurrence or prognosis. Conclusion These models are simple and readily available, and distinguish the risk and prognosis in patients with CC stages I and II; these models require cheaper processes than the use of more sophisticated molecular biology techniques. They may guide either the need for adjuvant therapy versus post-operative surveillance only, as well as aid in the design of clinical trials.
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Affiliation(s)
| | | | | | - Carlo C Cortés
- Microscopy Unit, Dirección de Investigación, Mexico City, Mexico
| | | | | | - Erika Ruiz-García
- Medical Oncology Department, Traslational Medicine Laboratory, Mexico City, Mexico
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8
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Luvián-Morales J, Castillo-Aguilar J, Delgadillo-González M, Cisneros-Sánchez A, Bosch-Gutiérrez J, Castro-Eguiluz D, Cetina-Pérez L, Oñate-Ocaña LF. Validation of the QLQ-CAX24 instrument in cervical cancer and its association with cachexia classifications. Jpn J Clin Oncol 2022; 53:304-312. [PMID: 36579766 DOI: 10.1093/jjco/hyac199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/08/2022] [Indexed: 12/30/2022] Open
Abstract
Cancer-related cachexia (CRC) is a common phenomenon in cervical cancer (CC), severely affecting clinical response, drug toxicity and survival. The patients' point of view should be evaluated to quantify the impact of CRC, and adequate instruments to do so are required. Thus, the study aimed to validate the Mexican-Spanish version of the QLQ-CAX24 instrument in women with CC. A cohort of women with CC answered the EORTC QLQ-C30 and QLQ-CAX24 instruments. The psychometric and clinimetric properties of the instruments were assessed. Two hundred and forty-four women were included; the mean age was 50 years (IQR: 41-60) and 188 (77%) were first diagnosed in locally advanced stages. The QLQ-CAX24 internal consistency test demonstrated adequate convergent (Spearman correlation coefficient 0.08-0.709) and divergent validity (Spearman correlation coefficient 0.006-0.471). Cronbach's alpha coefficients of the three multi-item scales were >0.5 (minimum 0.539, maximum 0.84). Patients with decreased handgrip strength, low fat-free mass, or high C-reactive protein levels had worse QLQ-CAX24 scale scores. Cachexia was diagnosed with the SCRINIO, Fearon and Evans criteria, and 31.5, 32.4 and 38.5% of women had cachexia, respectively. Patients with cachexia had the worst scores in terms of quality of life. The test re-test analysis did not show differences between visits in patients without malnutrition. The Mexican-Spanish version of the QLQ-CAX24 instrument is reliable and valid. Low handgrip strength, low fat-free mass and high C-reactive protein levels were associated with poor scale scores.
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Affiliation(s)
- Julissa Luvián-Morales
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Jessica Castillo-Aguilar
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Merari Delgadillo-González
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Amairani Cisneros-Sánchez
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.,Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Julene Bosch-Gutiérrez
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Denisse Castro-Eguiluz
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.,Investigador por México, CONACyT, Mexico City, Mexico
| | - Lucely Cetina-Pérez
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.,Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Luis F Oñate-Ocaña
- Modelo Integral para la Atención del Cáncer Cervicouterino Localmente Avanzado y Avanzado (MICAELA), Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.,Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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9
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Cerrato-Izaguirre D, Chirino YI, Prada D, Quezada-Maldonado EM, Herrera LA, Hernández-Guerrero A, Alonso-Larraga JO, Herrera-Goepfert R, Oñate-Ocaña LF, Cantú-de-León D, Meneses-García A, Basurto-Lozada P, Robles-Espinoza CD, Camacho J, García-Cuellar CM, Sánchez-Pérez Y. Somatic Mutational Landscape in Mexican Patients: CDH1 Mutations and chr20q13.33 Amplifications Are Associated with Diffuse-Type Gastric Adenocarcinoma. Int J Mol Sci 2022; 23:11116. [PMID: 36232418 PMCID: PMC9570354 DOI: 10.3390/ijms231911116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 12/04/2022] Open
Abstract
The Hispanic population, compared with other ethnic groups, presents a more aggressive gastric cancer phenotype with higher frequency of diffuse-type gastric adenocarcinoma (GA); this could be related to the mutational landscape of GA in these patients. Using whole-exome sequencing, we sought to present the mutational landscape of GA from 50 Mexican patients who were treated at The Instituto Nacional de Cancerología from 2019 to 2020. We performed a comprehensive statistical analysis to explore the relationship of the genomic variants and clinical data such as tumor histology and presence of signet-ring cell, H. pylori, and EBV. We describe a potentially different mutational landscape between diffuse and intestinal GA in Mexican patients. Patients with intestinal-type GA tended to present a higher frequency of NOTCH1 mutations, copy number gains in cytobands 13.14, 10q23.33, and 12q25.1, and copy number losses in cytobands 7p12, 14q24.2, and 11q13.1; whereas patients with diffuse-type GA tended to present a high frequency of CDH1 mutations and CNV gains in cytobands 20q13.33 and 22q11.21. This is the first description of a mutational landscape of GA in Mexican patients to better understand tumorigenesis in Hispanic patients and lay the groundwork for discovering potential biomarkers and therapeutic targets.
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Affiliation(s)
- Dennis Cerrato-Izaguirre
- Departamento de Farmacología, Centro de Investigación y de Estudios Avanzados del I.P.N. (CINVESTAV), Avenida Instituto Politécnico Nacional No. 2508, Ciudad de México CP. 07360, Mexico
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Yolanda I. Chirino
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Los Reyes Iztacala, Tlalnepantla de Baz, Estado de México CP. 54090, Mexico
| | - Diddier Prada
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Ericka Marel Quezada-Maldonado
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Luis A Herrera
- Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur No. 4809, Arenal Tepepan, Tlalpan, Ciudad de México CP. 14610, Mexico
| | - Angélica Hernández-Guerrero
- Servicio de Endoscopía, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Juan Octavio Alonso-Larraga
- Servicio de Endoscopía, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Roberto Herrera-Goepfert
- Departamento de Patología, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Luis F. Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - David Cantú-de-León
- Dirección de Investigación, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Abelardo Meneses-García
- Dirección General, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Patricia Basurto-Lozada
- Laboratorio Internacional de Investigación Sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro CP. 76010, Mexico
| | - Carla Daniela Robles-Espinoza
- Laboratorio Internacional de Investigación Sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro CP. 76010, Mexico
- Wellcome Sanger Institute, Hinxton, Cambridgeshire CB10 1SA, UK
| | - Javier Camacho
- Departamento de Farmacología, Centro de Investigación y de Estudios Avanzados del I.P.N. (CINVESTAV), Avenida Instituto Politécnico Nacional No. 2508, Ciudad de México CP. 07360, Mexico
| | - Claudia M. García-Cuellar
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
| | - Yesennia Sánchez-Pérez
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología (INCan), San Fernando No. 22, Tlalpan, Ciudad de México CP. 14080, Mexico
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10
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Carrillo JF, Cruz-Romero C, Avilés-Salas A, Carrillo LC, Ramírez-Ortega MC, Herrera-Goepfert R, Vázquez-Romo R, Figueroa-González G, Altamirano-García JI, Oñate-Ocaña LF. ASO Visual Abstract: The Intensity of LKB-1 Expression, High-Risk Histopathology and TNM Stages are Independent Prognostic Factors in Oral Cavity Carcinoma. Ann Surg Oncol 2022. [PMID: 35378635 DOI: 10.1245/s10434-022-11655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- José F Carrillo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Christian Cruz-Romero
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Alejandro Avilés-Salas
- Departamento de Patología, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Liliana C Carrillo
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Margarita C Ramírez-Ortega
- Subdirección de Investigación Básica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Rafael Vázquez-Romo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Gabriela Figueroa-González
- Unidad de Investigación Multidisciplinaria (UMIEZ), Facultad de Estudios Superiores Zaragoza, UNAM, Mexico City, Mexico
| | | | - Luis F Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
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11
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12
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Carrillo JF, Cruz-Romero C, Avilés-Salas A, Carrillo LC, Ramírez-Ortega MC, Herrera-Goepfert R, Vázquez-Romo R, Figueroa-González G, Altamirano-García JI, Oñate-Ocaña LF. LKB-1 Expression and High-Risk Histopathology are Independent Prognostic Factors for Patients with Oral Cavity Carcinoma. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11544-x. [PMID: 35320428 DOI: 10.1245/s10434-022-11544-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/14/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The expression of liver kinase B1 (LKB-1) has been associated with prognosis in squamous cell carcinoma of the oral cavity (SCCOC). This study aimed to define the prognostic role of LKB-1 expression for patients with SCCOC and the suitability of its integration into a multivariate prognostic model. METHODS A retrospective cohort study of patients with SCCOC was conducted in a cancer center. Expression of LKB-1 was evaluated by immunohistochemistry, and multivariate analysis defined prognostic factors associated with recurrence, recurrence-free survival (RFS), and overall survival (OS). The logistic regression model was used to construct a predictive computer software program. RESULTS Of the 201 patients in this study, 104 (51.7%) experienced recurrence of their disease. Lower expression of LKB-1, high-risk histopathology, and advanced tumor-node-metastasis (TNM) stages were independent factors via multivariate analysis associated with the increased recurrence risk, poor RFS, and poor OS. If lack of LKB-1 expression is considered the reference category, the factors independently associated with recurrence were low (odds ratio [OR], 0.157; 95% confidence interval [CI], 0.044-0.557), intermediate (OR, 0.073; 95% CI, 0.017-0.319), and intense (OR, 0.047; 95% CI, 0.007-0.304) expression of LKB-1. This model permitted construction of a computer software program capable of prediction with receiver operating characteristic analysis (area under the curve, 0.925) and led to the definition of five prognostic groups with a biologic gradient. CONCLUSION These results suggest that LKB-1 expression in patients with SCCOC is of robust prognostic value and complements the TNM staging system. The proposed model requires external validation in prospective observational studies.
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Affiliation(s)
- José F Carrillo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Christian Cruz-Romero
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Liliana C Carrillo
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Margarita C Ramírez-Ortega
- Subdirección de Investigación Básica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Rafael Vázquez-Romo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Gabriela Figueroa-González
- Unidad de Investigación Multidisciplinaria (UMIEZ), Facultad de Estudios Superiores Zaragoza, UNAM, Mexico City, Mexico
| | | | - Luis F Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Mexico.
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13
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Carrillo JF, Avilés-Salas A, Herrera-Goepfert R, Figueroa-González G, Oñate-Ocaña LF. ASO Author Reflections: The Pursuit of Prognostic Factors to Fine-Tune Treatment Decisions in Patients with Oral Cavity Carcinoma. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11598-x. [PMID: 35318518 DOI: 10.1245/s10434-022-11598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/18/2022]
Affiliation(s)
- José F Carrillo
- Departmento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Alejandro Avilés-Salas
- Departmento de Patología, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Gabriela Figueroa-González
- Facultad de Estudios Superiores Zaragoza, Unidad de Investigación Multidisciplinaria (UMIEZ), UNAM, Mexico City, Mexico
| | - Luis F Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
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14
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Luvián-Morales J, Flores-Cisneros L, Jiménez-Lima R, Alarcón-Barrios S, Salazar-Mendoza J, Castro-Eguiluz D, Cetina-Pérez L, Oñate-Ocaña LF. Validation of the QLQ-CX24 questionnaire for the assessment of quality of life in Mexican women with cervical cancer. Int J Gynecol Cancer 2021; 31:1228-1235. [PMID: 34353855 DOI: 10.1136/ijgc-2021-002720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Cervical cancer is the fourth most frequent neoplasm among women in terms of incidence and mortality. Health-related quality of life (HRQL) is an important outcome in oncology. The QLQ-CX24 instrument was developed to measure HRQL in patients with cervical cancer, and its Mexican-Spanish version had not been validated. METHODS Between March 2018 and May 2019, Mexican women older than 18, with any-stage cervical cancer were invited to participate in the study. Patients answered the QLQ-C30 and QLQ-CX24 questionnaires. Current tests for psychometric and clinical validation were performed. RESULTS Three hundred and thirty patients with cervical cancer were included in this study. All women invited to participate accepted and were included. The QLQ-CX24 internal consistency test demonstrated adequate convergent (Spearman correlation coefficient 0.001-0.847) and divergent validity (Spearman correlation coefficient <0.0001-0.45). Cronbach's alpha coefficients of the three multi-item scales were >0.7 (minimum 0.76, maximum 0.89). Four scales of the QLQ-CX24 distinguished patients in different clinical stages. The evaluation of responsiveness demonstrated that the peripheral neuropathy scale was sensitive to change over time during chemo-radiation therapy. Six scales of the QLQ-CX24 instrument were associated with survival. CONCLUSION The Mexican-Spanish version of the QLQ-CX24 questionnaire is reliable and valid for the assessment of HRQL in patients with cervical cancer.
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Affiliation(s)
- Julissa Luvián-Morales
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Tlalpan, Mexico
| | - Laura Flores-Cisneros
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Tlalpan, Mexico
| | - Roberto Jiménez-Lima
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Tlalpan, Mexico
| | - Silvia Alarcón-Barrios
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Tlalpan, Mexico
| | - Jessica Salazar-Mendoza
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Tlalpan, Mexico
| | | | - Lucely Cetina-Pérez
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Tlalpan, Mexico
| | - Luis F Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Tlalpan, Mexico
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15
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Oñate-Ocaña LF, Ponce-Martínez M, Taja-Chayeb L, Gutiérrez-Hernández O, Avilés-Salas A, Cantú-de-León D, Dueñas-González A, Candelaria-Hernández M. A Cohort Study of the Prognostic Impact of Exon-16 EZH2 Mutations in a Mexican-Mestizo Population of Patients with Diffuse Large B-Cell Lymphoma. Rev Invest Clin 2021; 73:362-370. [PMID: 34044429 DOI: 10.24875/ric.21000070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Novel prognostic factors in patients with diffuse large B-cell lymphoma (DLBCL) are required in the era of Rituximab. OBJECTIVE The objective of the study was to study the prognostic impact of exon-16 enhancer-of-zeste homolog-2 (EZH2) mutations in patients with DLBCL. METHODS In a cohort of patients with DLBCL treated between 2015 and 2017, we analyzed the presence of EZH2 mutations and their association with clinical response (CR), relapse, progression-free survival (PFS), and overall survival (OS). RESULTS A total of 198 patients were included; of them, 30 (15.2%) had mutations at codon 641, in exon 16 of EZH2. Response was achieved in 151 patients (76.3%), and 43 (21.7%) relapsed or progressed during follow-up. EZH2 mutations were associated with relapse/progression (risk ratio [RR] 1.18; 95% confidence interval [CI] 0.98-1.42; p = 0.031), while a trend for not achieving a complete response was observed (RR: 0.876; 95%CI 0.74-1.038; p = 0.071). Of note, Tyr641His and Tyr641Ser EZH2 mutations were associated with shorter PFS (hazard ratio 3.234; 95% CI 1.149-9.1; p = 0.026). CONCLUSION The presence of EZH2 mutations was negatively associated with relapse/progression and showed a trend for lack of complete response. Further studies are needed to define better the prognostic significance of these mutations in Mexican-Mestizo DLBCL patients.
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Affiliation(s)
- Luis F Oñate-Ocaña
- Research Division, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Mayra Ponce-Martínez
- Research Division, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Lucia Taja-Chayeb
- Research Division, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Alejandro Avilés-Salas
- Department of Pathology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - David Cantú-de-León
- Department of Pathology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Alfonso Dueñas-González
- Department of Pathology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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16
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Maldonado F, Gonzalez-Ling A, Oñate-Ocaña LF, Cabrera-Miranda LA, Zatarain-Barrón ZL, Turcott JG, Flores-Estrada D, Lozano-Ruiz F, Cacho-Díaz B, Arrieta O. Prophylactic Cranial Irradiation in Patients With High-Risk Metastatic Non-Small Cell Lung Cancer: Quality of Life and Neurocognitive Analysis of a Randomized Phase II Study. Int J Radiat Oncol Biol Phys 2021; 111:81-92. [PMID: 33915217 DOI: 10.1016/j.ijrobp.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/31/2021] [Accepted: 04/14/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To this date, studies regarding the use of prophylactic cranial irradiation (PCI) versus standard of care (SoC) for patients with non-small cell lung cancer have shown limited benefit in survival outcomes, in addition to the potential effects on quality of life (QoL) and neurocognitive function (NCF). This randomized, phase II study evaluated the role of PCI in QoL and NCF, in a population comprised of subjects at a high risk for development of brain metastases (BM). METHODS AND MATERIALS Eligible patients had histologically confirmed non-small cell lung cancer without baseline BM, harboring epidermal growth factor receptor mutations, anaplastic lymphoma kinase rearrangements, or elevated carcinoembryonic antigen (CEA) at diagnosis. Participants were assigned to receive SoC or SoC plus PCI (25 Gy in 10 fractions). Primary endpoint was BM at 24 months (BM-24), for which the study was powered. Secondary endpoints included QoL assessed using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the Lung Cancer module (LC13) and NCF assessed using the Mini Mental State Examination (MMSE). Patients were followed every 3 months for a year for QoL and NCF. RESULTS From May 2012 to December 2017, 84 patients were enrolled in the study, 41 were allocated to PCI while 43 received SoC. Efficacy outcomes are discussed in a separate article. The global health-QoL scores were similar at 3, 6, 9, and 12 months after randomization between both study arms, with no significant differences when comparing by groups. At 1-year postrandomization, median global health QoL scores were 83 (p25-p75: 75-83) and 83 (p25-p75: 75-83) in the control and experimental arms, respectively. There were no significant changes in terms of the mean differences between subjects in either study arm when analyzing the change between baseline and 12-month scores (16.4 ± 19.9 vs 12.9 ± 14.7; P = .385). Seventeen patients were alive at database lockdown in February 2020, without significant differences in median MMSE (30 [p25-75: 29-30] vs 30 [p25-75: 28-30]) or QLQ-C30 scores (75.0 [p25-75: 50-87.2] vs 67.0 [p25-75: 50.0-100.0]). CONCLUSIONS Among a selected high-risk population for developing BM, PCI did not significantly decrease QoL or neurocognitive function as assessed using the MMSE. Future studies are warranted to assess this observation, using more varied and sensitive tools available to date.
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Carrillo JF, Flores JM, Espinoza G, Vázquez-Romo R, Ramírez-Ortega MC, Carrillo LC, Cortés-García BY, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Treatment of Unresectable Differentiated Thyroid Carcinoma With Upfront External Radiotherapy and Salvage Surgery: A STROBE-Compliant Retrospective Cohort Study. Front Oncol 2021; 10:572958. [PMID: 33542898 PMCID: PMC7851046 DOI: 10.3389/fonc.2020.572958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC. METHODS This is a cohort study of patients with initially unresectable DTC who received EBRT. Cohort A received EBRT followed by rescue surgery and cohort B, EBRT only. The Kaplan-Meier method and Cox model were employed for survival analysis. RESULTS Thirty-three patients were included; 69.6% females and 30.3% males. Mean age was 60.6 and mean tumor diameter was 10.4 cm; 17 and 16 patients were included in cohorts A and B, respectively. Belonging to cohort A (Hazard ratio [HR] 0.177, 95% CI 0.05-0.7) and use of intensity modulated radiotherapy (HR 0.177, 95% CI 0.03-1.08) were associated to better PFS, while high-risk histopathology (HR 6.6, 95% CI 0.9-50) and EBRT dose (HR 1.05, 95% CI 1.01-1.08) were independently associated with lower PFS. Patients from cohort A (HR 0.061, 95% CI 0.01-0.3) had improved OS, while high-risk histopathology (HR 5.7, 95% CI 1.1-28.6) and EBRT dose (HR 1.05, 95% CI 1.01-1.09) were independently associated to worse OS. CONCLUSION EBRT, and when feasible, salvage surgery, should be an integral part of the therapeutic strategy in initially unresectable DTC.
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Affiliation(s)
- José F. Carrillo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Jesús Manuel Flores
- Departamento de Radioterapia, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Gilberto Espinoza
- Subdirección de Cirugía, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Rafael Vázquez-Romo
- Subdirección de Cirugía, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Liliana C. Carrillo
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | - Luis F. Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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Gallardo-Rincón D, Toledo-Leyva A, Bahena-González A, Montes-Servín E, Muñoz-Montaño W, Coronel-Martínez J, Oñate-Ocaña LF. Validation of the Mexican-Spanish Version of the EORTC QLQ-OV28 Instrument for the Assessment of Quality of Life in Women with Ovarian Cancer. Arch Med Res 2020; 51:690-699. [PMID: 32768148 DOI: 10.1016/j.arcmed.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is an important outcome measure in Oncology. AIM OF THE STUDY To validate the Mexican-Spanish version of the QLQ-OV28 questionnaire to assess HRQL in women with ovarian cancer (OC). METHODS The QLQ-C30 and QLQ-OV28 instruments were applied to women with OC attending a cancer center in Mexico. The usual psychometric analyses were performed; the Spearman's method was used for correlation analysis, reliability analysis with the Cronbach's alpha, known-group comparisons with the Kruskal-Wallis test, responsiveness was tested employing repeated measures ANOVA, and the association of scale scores and overall survival (OS) were analyzed with the Kaplan-Meier method and Cox's model. RESULTS Two hundred fifty-two women with OC were included in this cohort. The instruments were well accepted and compliance rates were high; patients responded both instruments in <30 min. The QLQ-OV28 internal consistency tests demonstrated good convergent (Correlation coefficients [CC] 0.154‒0.694) and divergent validity (CC 0.003‒0.69). Cronbach's α coefficients of six of eight scales of the QLQ-OV28 instruments were >0.7 (range, 0.567‒0.857). Scales QLQ-OV28 instruments distinguished among clinically distinct groups of patients, particularly after basal serum albumin and basal Ca‒125 levels. The evaluation of responsiveness demonstrated that two scales of the QLQ-OV28 were sensitive to change over time during induction chemotherapy. Six scales of the QLQ-OV28 were associated with OS. CONCLUSIONS The Mexican-Spanish version of the QLQ-OV28 questionnaire is reliable and valid for the assessment of HRQL in patients with OC and can be broadly used in clinical trials.
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Affiliation(s)
- Dolores Gallardo-Rincón
- Programa de Cáncer de Ovario, Instituto Nacional de Cancerología, Ciudad de México, México; Departamento de Oncología Médica, Instituto Nacional de Cancerología, Ciudad de México, México; Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México, A.C., Ciudad de México, México
| | - Alfredo Toledo-Leyva
- Programa de Cáncer de Ovario, Instituto Nacional de Cancerología, Ciudad de México, México
| | - Antonio Bahena-González
- Programa de Cáncer de Ovario, Instituto Nacional de Cancerología, Ciudad de México, México; Departamento de Oncología Médica, Instituto Nacional de Cancerología, Ciudad de México, México; Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México, A.C., Ciudad de México, México
| | | | - Wendy Muñoz-Montaño
- Departamento de Oncología Médica, Instituto Nacional de Cancerología, Ciudad de México, México
| | - Jaime Coronel-Martínez
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Ciudad de México, México
| | - Luis F Oñate-Ocaña
- Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México, A.C., Ciudad de México, México; Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Ciudad de México, México.
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19
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Candelaria M, Oñate-Ocaña LF, Corona-Herrera J, Barrera-Carmona C, Ponce-Martínez M, Gutiérrez-Hernández O, Avilés-Salas A, Cacho-Díaz B. CLINICAL CHARACTERISTICS OF PRIMARY EXTRANODAL VERSUS NODAL DIFFUSE LARGE B-CELL LYMPHOMA: A RETROSPECTIVE COHORT STUDY IN A CANCER CENTER. Rev Invest Clin 2020; 71:349-358. [PMID: 31599881 DOI: 10.24875/ric.19003027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The outcome of patients with primary extranodal diffuse large B-cell lymphoma (PE-DLBCL) varies according to the primary site involved. Primary gastrointestinal, breast, bone, craniofacial, and testicular DLBCL are rare extranodal manifestations of DLBCL. Objective The objective of the study was to describe the clinical course of patients with PE-DLBCL disease in a referral cancer center. Results From 637 patients, 51 (8.77%) were considered as having PE-DLBCL (25 gastrointestinal, 12 craniofacial, 6 breast, 5 bone, and 3 with primary testicular DLBCL). Complete remission was higher in all PE-DLBCL sites (100% in testicular, 92.6% craniofacial, 83.3% breast, 80% bone, and 80% gastrointestinal) compared with 73.3% in nodal DLBCL. Although 2 cases with breast PE-DLBC relapsed, they achieved a complete response with chemotherapy. The overall survival at 5 years was 100%, 80%, 78%, 58%, 58%, and 62% for patients with primary breast, primary bone, gastrointestinal, primary craniofacial, primary testicular, and nodal DLBCL, respectively. Conclusions PE-DLBCLs constitute rare, primary sites of lymphoproliferative disorders in most cases, with localized disease and good prognosis. They require a combined chemoimmunotherapy with radiotherapy in most cases to improve local and systemic disease.
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Affiliation(s)
- Myrna Candelaria
- Clinical Research Division, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Luis F Oñate-Ocaña
- Clinical Research Division, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Mayra Ponce-Martínez
- Clinical Research Division, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Bernardo Cacho-Díaz
- Department of Neuro-Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
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20
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Beltrán L, González-Trejo S, Carmona-Herrera DD, Carrillo JF, Herrera-Goepfert R, Aiello-Crocifoglio V, Gallardo-Rincón D, Meléndez-Ponce NA, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Prognostic Factors and Differences in Survival of Right and Left Colon Carcinoma: A STROBE Compliant Retrospective Cohort Study. Arch Med Res 2019; 50:63-70. [PMID: 31349955 DOI: 10.1016/j.arcmed.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/05/2019] [Accepted: 05/24/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Right-colon cancer (RCC) presents differences with Left-colon cancer (LCC) in terms of Overall survival (OS), but certain reports provide conflicting findings. Our objective is to define differences regarding prognostic factors in RCC and LCC by multivariate analysis. METHODS Retrospective cohort including patients treated from 1992-2016. The Kaplan-Meier and Cox models were used to define prognostic factors. RESULTS 871 patients had RCC and 748 LCC; mean age was 58.1. Location was associated with socioeconomic status, body mass, blood hemoglobin, serum albumin, lymphocyte count and Prognostic nutritional index (PNI). Distribution of TNM stages was similar between groups, as well as gender, age, surgical morbidity/mortality; 72.3% of RCC and 83.2% of LCC were well/moderately differentiated (p <0.0001). Mean surgical lymph-node retrieval was 19.3 (SD14.6) for RCC and 15.7 (SD13.1) for LCC (p <0.0001). Median OS was 5.2 (95% CI 3.9-6.5) for RCC, and 3.2 years (95% CI 2.1-4.4) for LCC (p = 0.426). OS was different between RCC and LCC by stratified analyses within PNI, TNM, differentiation and R classification. RCC presents different OS in stages IIIC, and IVB than LCC. CONCLUSION Differences between RCC and LCC were mainly by immunonutritional variables. Differences in OS were found after stratified analysis of PNI, TNM stages, differentiation degree, and R classification. Location of the neoplasm in the colon should be considered in the design of clinical trials in patients with colon cancer.
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Affiliation(s)
- Leonora Beltrán
- Instituto Nacional de Cancerologia, Ciudad de México, México
| | | | | | - José F Carrillo
- Instituto Nacional de Cancerologia, Ciudad de México, México
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21
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Luvián-Morales J, González-Trejo S, Carrillo JF, Herrera-Goepfert R, Aiello-Crocifoglio V, Gallardo-Rincón D, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study. Cancer Med 2019; 8:3379-3388. [PMID: 31069966 PMCID: PMC6601598 DOI: 10.1002/cam4.2212] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/04/2019] [Accepted: 04/14/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The TNM classification does not completely reflect the prognosis of patients with colorectal cancer (CRC). Several clinical factors have been used to increase its prognostic value, but factors pertaining to the patient's immunonutritional status have not usually been addressed. The aim of this study is to evaluate the role of Prognostic nutritional index (PNI) and other well-known prognostic factors by multivariate analysis in a cohort of patients with CRC. METHODS This is a retrospective cohort study of consecutive patients with CRC managed in a cancer center between January 1992 and December 2016. Cox's model was used to define the association of the PNI and other factors with Overall survival (OS). RESULTS A total of 3301 patients were included: 47.7% were female and 52.3% were male, with a mean age of 58.7 years. By bivariate analysis, PNI was strongly associated with OS (Risk ratio [RR] 0.968, 95% Confidence interval [CI] 0.962-0.974; P < 0.001). On multivariate analysis, PNI was an independent explanatory variable (as continuous variable and as categorized variable; RR 0.732, 95% CI 0.611-0.878; RR 0.656, 95% CI 0.529-0.813 and RR 0.646, 95% CI 0.521-0.802, for quintiles 2, 3, and 4-5, respectively); a biological gradient effect was demonstrated. The final prognostic model included PNI, location of the neoplasia in the colorectum, basal hemoglobin, lymphocyte count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, TNM stage, differentiation degree, R classification, and postoperative complications. CONCLUSIONS PNI is a significant and independent prognostic factor in patients with CRC. Its prognostic value adds precision to the TNM staging system including specific subgroups of patients with CRC; it should be evaluated in prospective clinical studies.
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Affiliation(s)
- Julissa Luvián-Morales
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Sagrario González-Trejo
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - José F Carrillo
- Subdirección de Cirugía, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | - Dolores Gallardo-Rincón
- Departamento de Oncología Médica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Luis F Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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Cacho-Díaz B, Lorenzana-Mendoza NA, Oñate-Ocaña LF. Quality of Life in Brain Cancer: Clinical Validation of the Mexican-Spanish Version of the EORTC QLQ-BN20 Questionnaire. Front Neurol 2019; 10:40. [PMID: 30761074 PMCID: PMC6363944 DOI: 10.3389/fneur.2019.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Overall survival (OS) of patients with Brain Cancer (BC) is slowly increasing. The disease itself and its treatments deeply impact patient Health-related quality of life (HRQL). Therefore, valid and reliable instruments are needed. In this study, the Mexican-Spanish version of the QLQ-BN20 instrument is psychometrically and clinically validated. Methods: Patients with brain cancer (BC) (primary or metastatic) evaluated at a tertiary cancer center, were invited to respond to the questionnaire, as well as the core-module QLQ-C30. Tests to demonstrate the instrument's internal consistency, the association of HRQL scales with clinical variables and OS were investigated. Results: One hundred and nineteen patients were included in this cohort: 77 women and 42 men (mean age, 46.2 years). Patients answered both instruments in < 30 min. Good convergent [all correlation coefficients (CC) > 0.37] and discriminant validity was observed and was associated with significant overlap (CC 0.007–0.68). All four multi-item scales of QLQ-BN20 also demonstrated good reliability (Cronbach α > 0.7). Several scales of the QLQ-BN20 were significantly associated with performance status and a modified Recursive Partition Analysis. Of the possible scale correlations, 40 of 161 (24.8%) scales in both instruments, were significantly (directly or inversely) correlated. Visual disorders, Motor dysfunction, Seizures and Weakness of the legs presented association with OS (p < 0.05). Conclusion: The Mexican-Spanish version of the BN20 instrument is valid and reliable and can be used in clinical trials in patients with BC. Some HRQL scales were associated with OS and could therefore be incorporated in future studies of prognostic models.
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Affiliation(s)
- Bernardo Cacho-Díaz
- Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Luis F Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Mexico
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23
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Carrillo JF, Vázquez-Romo R, Ramírez-Ortega MC, Carrillo LC, Gómez-Argumosa E, Oñate-Ocaña LF. Prognostic Impact of Direct 131I Therapy After Detection of Biochemical Recurrence in Intermediate or High-Risk Differentiated Thyroid Cancer: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2019; 10:737. [PMID: 31736875 PMCID: PMC6828732 DOI: 10.3389/fendo.2019.00737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/11/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Patients treated for intermediate- or high-risk differentiated thyroid carcinoma (DTC) and Thyroglobulin (TG) elevation during follow-up, require a diagnostic whole-body scan (DWBS) and if positive, 131I treatment. This approach can lead to a delay in treatment and increased costs. The purpose of this study is to compare the oncologic outcomes associated to administration of direct therapy with 131I at first biochemical recurrence. Methods: Retrospective cohort study of patients with intermediate- or high-risk DTC treated with total thyroidectomy, 131I ablation and who developed TG elevation during follow-up, between January 2007 and December 2015. Cohort A included patients who underwent a DWBS with 5 mCi of 131I, and if negative an MRI and/or 18FDG PET-CT prior to the therapeutic dosage, and cohort B included those who only received a therapeutic dosage of 131I, without a DWBS or extensive image studies. Main outcomes were second recurrence (SR) and disease-free survival (DFS). The diagnostic accuracy of DWBS was analyzed. Results: Cohorts A and B had 74 and 41 patients, each. By multivariate analysis, age, differentiation grade, TN classification, ablation dose, and performed DWBS (odds ratio 55.1; 95% CI 11.3-269) were associated with SR (p < 0.0001); age, male gender, ablation dose and performed DWBS (hazard ratio 7.79; 95% CI 3.67-16.5) were independent factors associated with DFS (p < 0.0001). DWBS diagnostic accuracy was 36.48%. Conclusion: 131I treatment in patients with DTC biochemical recurrence and no DWBS or extensive image studies is associated with a significantly lower frequency of SR and an increased DFS. The diagnostic accuracy of DWBS is low, and its clinical efficiency should be defined in prospective phase III studies.
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Affiliation(s)
- José F. Carrillo
- Departmento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico, Mexico
| | | | | | - Liliana C. Carrillo
- Departmento de Cuidados Paliativos, Instituto Nacional de Cancerología, Mexico, Mexico
| | - Edgar Gómez-Argumosa
- Departmento de Medicina Nuclear, Instituto Nacional de Cancerología, Mexico, Mexico
| | - Luis F. Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico, Mexico
- *Correspondence: Luis F. Oñate-Ocaña
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24
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Turcott JG, Oñate-Ocaña LF, Soca-Chafre G, Ramírez-Tirado LA, Flores-Estrada D, Zatarain-Barrón ZL, Arrieta O. FAACT-Anorexia Cachexia Scale: Cutoff Value for Anorexia Diagnosis in Advanced Non-Small Cell Lung Cancer Patients. Nutr Cancer 2018; 71:409-417. [DOI: 10.1080/01635581.2018.1506488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jenny Georgina Turcott
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | - Luis F. Oñate-Ocaña
- Clinical Research Division, Surgery Division, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | - Giovanny Soca-Chafre
- Experimental Oncology Laboratory, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | | | - Diana Flores-Estrada
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
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25
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Oñate-Ocaña LF, Cortés V, Castillo-Llanos R, Terrazas A, Garcia-Perez O, Pitalúa-Cortes Q, Ponce M, Dueñas-Gonzalez A, Candelaria M. Metabolic tumor volume changes assessed by interval 18fluorodeoxyglucose positron emission tomography-computed tomography for the prediction of complete response and survival in patients with diffuse large B-cell lymphoma. Oncol Lett 2018; 16:1411-1418. [PMID: 30008818 PMCID: PMC6036479 DOI: 10.3892/ol.2018.8817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/13/2017] [Indexed: 01/19/2023] Open
Abstract
An early discrimination of survival probability is required for patients with diffuse large B cell lymphoma (DLBCL), which may identify patients that require other treatment options, for example clinical trials. To the best of our knowledge, the impact of interim evaluation with 18fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) has not yet been determined in this type of neoplasia. The aim of the present study was to determine the role of changes in metabolic tumor volume (MTV) between baseline and interim 18F-FDG PET/CT scans, following three courses of chemotherapy in order to predict complete response (CR) and overall survival (OS) in patients with DLBCL. Patients with previously untreated DLBCL who had received the standard 6–8 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone were included in the present study. A predictive model was constructed using changes in MTV and other clinical factors including age, gender, East Cooperative Oncology Group (ECOG) status, clinical stage, B symptoms, the presence of bulky disease and elevated lactate dehydrogenase levels, and data were analyzed using logistic regression analysis. In total, 50 patients with DLBCL were included in the present study. The majority of patients presented with stage III/IV disease (64%), B symptoms (72%) and bulky disease (58%). According to the International Prognostic Index score, 44% of patients were in the intermediate-high or high-risk categories for risk of relapse, and therefore considered to have poor prognosis. In total, ≥94% of patients achieving a decrease in total MTV had a 2-year OS rate of 95%, compared with the 58% OS rate of those with a suboptimal response. A multivariate model, including a change in MTV (a decrease of ≥94%), the ECOG performance status ≥2, a change in leukocyte counts and age, was used to predict CR. This model was used to define two groups according to the predicted probability of recurrence (cutoff, 0.69). The 2-year survival rates of the two groups were 95 and 59%, respectively. Analysis of changes in MTV in the interim 18F-FDG PET/CT revealed significant prognostic value for the prediction of CR and OS in patients with DLBCL.
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Affiliation(s)
| | - Violeta Cortés
- Department of Nuclear Medicine, National Cancer Institute, Mexico City 14080, Mexico
| | | | - Andrea Terrazas
- Department of Hematology, National Cancer Institute, Mexico City 14080, Mexico
| | - Osvaldo Garcia-Perez
- Department of Nuclear Medicine, National Cancer Institute, Mexico City 14080, Mexico
| | | | - Mayra Ponce
- Research Division, National Cancer Institute, Mexico City 14080, Mexico
| | - Alfonso Dueñas-Gonzalez
- Research Division, National Cancer Institute, Mexico City 14080, Mexico.,Biomedical Research Unit on Cancer, Institute of Biomedical Research, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Myrna Candelaria
- Research Division, National Cancer Institute, Mexico City 14080, Mexico.,Department of Hematology, National Cancer Institute, Mexico City 14080, Mexico
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Marván ML, Oñate-Ocaña LF, Santillán-Doherty P, Álvarez-del Río A. Facing death in the clinical practice: a view from nurses in Mexico. ACTA ACUST UNITED AC 2017; 59:675-681. [DOI: 10.21149/8417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/08/2017] [Indexed: 11/06/2022]
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27
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González-Trejo S, Carrillo JF, Carmona-Herrera DD, Baz-Gutiérrez P, Herrera-Goepfert R, Núñez G, Ochoa-Carrillo FJ, Gallardo-Rincón D, Aiello-Crocifoglio V, Oñate-Ocaña LF. Baseline serum albumin and other common clinical markers are prognostic factors in colorectal carcinoma: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e6610. [PMID: 28403106 PMCID: PMC5403103 DOI: 10.1097/md.0000000000006610] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to define the prognostic role of baseline serum albumin (BSA) in colorectal cancer (CRC) across tumor-node-metastasis (TNM) stages and other well defined prognostic factors. Many prognostic models in medicine employ BSA to define or refine treatments in very specific settings; in CRC, BSA has been found to be a prognostic factor as well. A retrospective cohort study of consecutive patients with CRC demonstrated by biopsy, who attended a cancer center during a 7-year period. Multivariate analysis was utilized to define prognostic factors associated with overall survival (OS) employing the Cox model. In this retrospective cohort study, 1465 patients were included; 46.6% were females and 53.4% males (mean age, 59.1 years). Mean BSA was inversely correlated with TNM stages. By multivariate analysis, it was an independent explanatory variable. TNM stages, "R" classification, age, lymphocyte count, neutrophil/platelet ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, postoperative morbidity, and BSA were independently associated with OS. Morbidities, surgery type, chemotherapy, and radiotherapy were considered confounders after adjusting by TNM stages. BSA is a significant and independent prognostic factor in patients with CRC, and its effect is maintained across TNM strata and other well known clinical prognostic factors. It can be easily used in prognostic models and should be employed to stratify prognosis in therapeutic randomized clinical trials.
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Affiliation(s)
- Sagrario González-Trejo
- Subdirección de Investigación Clínica
- Facultad de Medicina, Universidad Autónoma Metropolitana (UAM)
| | | | - D. Darlene Carmona-Herrera
- Subdirección de Investigación Clínica
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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Herrera-Goepfert R, Oñate-Ocaña LF, Mosqueda-Vargas JL, Herrera LA, Castro C, Mendoza J, González-Barrios R. Methylation of DAPK and THBS1 genes in esophageal gastric-type columnar metaplasia. World J Gastroenterol 2016; 22:4567-4575. [PMID: 27182166 PMCID: PMC4858638 DOI: 10.3748/wjg.v22.i18.4567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/19/2016] [Accepted: 01/30/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore methylation of DAPK, THBS1, CDH-1, and p14 genes, and Helicobacter pylori (H. pylori) status in individuals harboring esophageal columnar metaplasia.
METHODS: Distal esophageal mucosal samples obtained by endoscopy and histologically diagnosed as gastric-type (non-specialized) columnar metaplasia, were studied thoroughly. DNA was extracted from paraffin blocks, and methylation status of death-associated protein kinase (DAPK), thrombospondin-1 (THBS1), cadherin-1 (CDH1), and p14 genes, was examined using a methyl-sensitive polymerase chain reaction (MS-PCR) and sodium bisulfite modification protocol. H. pylori cagA status was determined by PCR.
RESULTS: In total, 68 subjects (33 females and 35 males), with a mean age of 52 years, were included. H. pylori cagA positive was present in the esophageal gastric-type metaplastic mucosa of 18 individuals. DAPK, THSB1, CDH1, and p14 gene promoters were methylated by MS-PCR in 40 (58.8%), 33 (48.5%), 46 (67.6%), and 23 (33.8%) cases of the 68 esophageal samples. H. pylori status was associated with methylation of DAPK (P = 0.003) and THBS1 (P = 0.019).
CONCLUSION: DNA methylation occurs in cases of gastric-type (non-specialized) columnar metaplasia of the esophagus, and this modification is associated with H. pylori cagA positive infection.
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Montalvo-Javé EE, Olguín-Martínez M, Hernández-Espinosa DR, Sánchez-Sevilla L, Mendieta-Condado E, Contreras-Zentella ML, Oñate-Ocaña LF, Escalante-Tatersfield T, Echegaray-Donde A, Ruiz-Molina JM, Herrera MF, Morán J, Hernández-Muñoz R. Role of NADPH oxidases in inducing a selective increase of oxidant stress and cyclin D1 and checkpoint 1 over-expression during progression to human gastric adenocarcinoma. Eur J Cancer 2016; 57:50-7. [DOI: 10.1016/j.ejca.2015.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/12/2015] [Accepted: 11/17/2015] [Indexed: 12/14/2022]
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Carrillo JF, Carrillo LC, Cano A, Ramirez-Ortega MC, Chanona JG, Avilés A, Herrera-Goepfert R, Corona-Rivera J, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Retrospective cohort study of prognostic factors in patients with oral cavity and oropharyngeal squamous cell carcinoma. Head Neck 2015; 38:536-41. [DOI: 10.1002/hed.23914] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/18/2022] Open
Affiliation(s)
- José F. Carrillo
- Head and Neck Department; Surgery Division; Instituto Nacional de Cancerología (INCan); Mexico City Mexico
| | - Liliana C. Carrillo
- Clinical Research Division; Surgery Division; Instituto Nacional de Cancerología (INCan); Mexico City Mexico
| | - Ana Cano
- Pathology Department; Surgery Division; Instituto Nacional de Cancerología (INCan); Mexico City Mexico
| | | | - Jorge G. Chanona
- Pathology Department; Surgery Division; Instituto Nacional de Cancerología (INCan); Mexico City Mexico
| | - Alejandro Avilés
- Pathology Department; Surgery Division; Instituto Nacional de Cancerología (INCan); Mexico City Mexico
| | - Roberto Herrera-Goepfert
- Pathology Department; Surgery Division; Instituto Nacional de Cancerología (INCan); Mexico City Mexico
| | - Jaime Corona-Rivera
- Head and Neck Department; Surgery Division; Instituto Nacional de Cancerología (INCan); Mexico City Mexico
| | | | - Luis F. Oñate-Ocaña
- Clinical Research Division; Surgery Division; Instituto Nacional de Cancerología (INCan); Mexico City Mexico
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Espinoza-Zamora JR, Portilla-Espinosa CM, Labardini-Méndez JR, Cervera E, Niesvisky R, Oñate-Ocaña LF. Quality of life in multiple myeloma: clinical validation of the Mexican-Spanish version of the QLQ-MY20 instrument. Ann Hematol 2015; 94:1017-24. [DOI: 10.1007/s00277-014-2290-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022]
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Hernández DC, García BO, Aguilar SA, Ochoa-Carrillo FJ, González-Cardín V, Oñate-Ocaña LF. Alteraciones de la imagen corporal en pacientes con cáncer de nariz sometidos a rinectomía. Gaceta Mexicana de Oncología 2015. [DOI: 10.1016/j.gamo.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Herrera-Goepfert R, Vela-Chávez T, Carrillo-García A, Lizano-Soberón M, Amador-Molina A, Oñate-Ocaña LF, Hallmann RSR. High-risk human papillomavirus (HPV) DNA sequences in metaplastic breast carcinomas of Mexican women. BMC Cancer 2013; 13:445. [PMID: 24083491 PMCID: PMC3852771 DOI: 10.1186/1471-2407-13-445] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metaplastic carcinoma, an uncommon subtype of breast cancer, is part of the spectrum of basal-like, triple receptor-negative breast carcinomas. The present study examined 20 surgical specimens of metaplastic breast carcinomas, for the presence of high-risk Human papillomavirus (HPV), which is suspected to be a potential carcinogenic agent for breast carcinoma. METHODS Mastectomy specimens from patients harboring metaplastic breast carcinoma, as defined by the World Health Organization (WHO), and who attended the Instituto Nacional de Cancerologia in Mexico City, were retrieved from the files of the Department of Pathology accumulated during a 16-year period (1995-2008). Demographic and clinical information was obtained from patients' medical records. DNA was extracted from formalin-fixed, paraffin-embedded tumors and HPV type-specific amplification was performed by means of Polymerase chain reaction (PCR). Quantitative Real-time (RT) PCR was conducted in HPV positive cases. Statistically, the association of continuous or categorical variables with HPV status was tested by the Student t, the Chi square, or Fisher's exact tests, as appropriate. RESULTS High-risk HPV DNA was detected in eight (40%) of 20 metaplastic breast carcinomas: seven (87.5%) HPV-16 and one (12.5%) HPV-18. Mean age of patients with HPV-positive cases was 49 years (range 24-72 years), the same as for HPV-negative cases (range, 30-73 years). There were not striking differences between HPV + and HPV- metaplastic carcinomas regarding clinical findings. Nearly all cases were negative for estrogen, progesterone and Human epidermal growth factor receptor 2 (HER2), but positive for Epidermal growth factor receptor (EGFR). CONCLUSIONS High-risk HPV has been strongly associated with conventional breast carcinomas, although the subtle mechanism of neoplastic transformation is poorly understood. In Mexican patients, the prevalence of HPV infection among metaplastic breast carcinomas is higher than in non-metaplastic ones, as so the HPV viral loads; notwithstanding, HPV viral loads show wide variation and remain even lower than cervical and other non-cervical carcinomas, making it difficult to assume that HPV could play a key role in breast carcinogenesis. Further studies are warranted to elucidate the meaning of the presence of high-risk HPVDNA in breast carcinomas.
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Álvarez-Del-Río A, Marván ML, Santillán-Doherty P, Delgadillo S, Oñate-Ocaña LF. Facing Death in Clinical Practice: A View from Physicians in Mexico. Arch Med Res 2013; 44:394-400. [PMID: 23867786 DOI: 10.1016/j.arcmed.2013.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/17/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Asunción Álvarez-Del-Río
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México D.F., Mexico.
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Arrieta Ó, Angulo LP, Núñez-Valencia C, Dorantes-Gallareta Y, Macedo EO, Martínez-López D, Alvarado S, Corona-Cruz JF, Oñate-Ocaña LF. Association of Depression and Anxiety on Quality of Life, Treatment Adherence, and Prognosis in Patients with Advanced Non-small Cell Lung Cancer. Ann Surg Oncol 2013; 20:1941-1948. [DOI: 10.1245/s10434-012-2793-5] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Carrillo JF, Ortiz-Toledo MA, Salido-Noriega Z, Romero-Ventura NB, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Validation of the Mexican Spanish version of the EORTC QLQ-H&N35 instrument to measure health-related quality of life in patients with head and neck cancers. Ann Surg Oncol 2012; 20:1417-26. [PMID: 23108555 DOI: 10.1245/s10434-012-2712-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is an important outcome measurement in oncology. Our aim was to validate the Mexican Spanish version of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-H&N35 questionnaire to measure HRQL in patients with head and neck cancers. METHODS The QLQ-C30 and QLQ-H&N35 instruments were applied to Mexican patients with head and neck cancer at a cancer referral center. Reliability and validity tests were performed. Test-retest was carried out in selected patients. RESULTS One hundred ninety-three patients were included in this cohort; tumor locations included the following: oral cavity 45 (23.3 %); larynx 35 (18.1 %); thyroid carcinoma invasive to aerodigestive tract 32 (16.6 %); oropharynx 17 (8.8 %); hypopharynx 12 (6.2 %); nasal cavity and paranasal sinuses 11 (5.7 %); salivary glands 11 (5.7 %); nasopharynx 8 (4.1 %); eye and adnexa 7 (3.6 %); cervical metastases of unknown origin 5 (2.6 %); primary sarcoma of the head and neck region 5 (2.6 %); maxillary antrum carcinoma 4 (2.1 %); and retinoblastoma 1 (0.5 %). Questionnaire compliance rates were high, and the instrument was well accepted; the internal consistency tests demonstrated good convergent and divergent validity. Cronbach's α coefficients of 8 of 9 multi-item scales of the QLQ-C30 and 6 of 8 scales of the QLQ-H&N35 instruments were >0.7 (range 0.22-0.89). Scales of the QLQ-C30 and QLQ-H&N35 instruments distinguished among clinically distinct groups of patients; some were highly sensitive to change over time. CONCLUSIONS The Mexican Spanish version of the QLQ-H&N35 questionnaire is reliable and valid for the assessment of HRQL in patients with head and neck cancers and can be used in clinical trials in Mexican communities.
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Affiliation(s)
- José F Carrillo
- Departamento de Tumores de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
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Oñate-Ocaña LF. [Recent advances in esophagogastric carcinoma patient management]. Rev Gastroenterol Mex 2012; 77 Suppl 1:100-102. [PMID: 22939499 DOI: 10.1016/j.rgmx.2012.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- L F Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, México
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Sánchez-Lara K, Turcott JG, Juárez E, Guevara P, Núñez-Valencia C, Oñate-Ocaña LF, Flores D, Arrieta O. Association of Nutrition Parameters Including Bioelectrical Impedance and Systemic Inflammatory Response With Quality of Life and Prognosis in Patients With Advanced Non-Small-Cell Lung Cancer: A Prospective Study. Nutr Cancer 2012; 64:526-34. [DOI: 10.1080/01635581.2012.668744] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Arrieta Ó, Núñez-Valencia C, Reynoso-Erazo L, Alvarado S, Flores-Estrada D, Angulo LP, Oñate-Ocaña LF. Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire. Lung Cancer 2012; 77:205-11. [PMID: 22387006 DOI: 10.1016/j.lungcan.2012.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 01/26/2012] [Accepted: 02/04/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lung cancer (LC) is the first cause of cancer-related mortality worldwide and health-related quality of life (HRQL) is a fundamental outcome for evaluating treatment results. Our objective was to validate the Mexican-Spanish versions of the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life QLQ-LC13 disease-specific questionnaire module in Mexican patients with LC; and to explore the possible prognostic role of HRQL data. METHODS Translation procedures followed EORTC guidelines. Both instruments were completed by patients with LC. Tests for reliability and validity were performed. A subset of patients was administered HRQL evaluations before and after chemotherapy. HRQL was associated with prognosis in chemotherapy-naïve patients. The protocol was approved by the Institute's Ethics Committee. RESULTS One hundred fifty three patients (mean age, 60.3 years; 84 females and 69 males) completed both questionnaires. Compliance rates were high, and the questionnaires were well accepted. Nine of 10 multi-item scales of both questionnaires presented Cronbach's alpha coefficients > 0.7. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. Patients with better Karnofsky or Eastern Cooperative Oncology Group (ECOG) performance status reported better functional HRQL scores. Different scales in the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires were accurately related with clinical characteristics. Functional as well as disease-symptom scales improved after chemotherapy, but treatment side-effects scales worsened in test-retest analysis. Better role functioning and absence of thoracic pain scales were associated with longer overall survival (OS) (p = 0.009 and p = 0.035, respectively). CONCLUSION The Mexican-Spanish versions of the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires are reliable and valid for HRQL measurement in Mexican patients with LC and can be used in clinical trials.
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Affiliation(s)
- Óscar Arrieta
- Clínica de Cáncer de Pulmón, Instituto Nacional de Cancerología, Mexico City, Mexico
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Cerezo O, Oñate-Ocaña LF, Arrieta-Joffe P, González-Lara F, García-Pasquel MJ, Bargalló-Rocha E, Vilar-Compte D. Validation of the Mexican-Spanish version of the EORTC QLQ-C30 and BR23 questionnaires to assess health-related quality of life in Mexican women with breast cancer. Eur J Cancer Care (Engl) 2012; 21:684-91. [PMID: 22329843 DOI: 10.1111/j.1365-2354.2012.01336.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- O Cerezo
- Clinical Research Division, Instituto Nacional de Cancerología, Av. San Fernando 22, Mexico City, Mexico
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Oñate-Ocaña LF, Velázquez-Monroy N, Vázquez L, Espinosa-Mireles-de-Villafranca P, Núñez-Rosas E, Ovando-Lezama M, Vilar-Compte D, García-Hubard G, Carrillo JF, Blazeby JM, Aiello-Crocifoglio V. Clinical validation of the EORTC QLQ-OG25 questionnaire for the evaluation of health-related quality of life in Mexican patients with esophagogastric cancers. Psychooncology 2011; 21:745-53. [DOI: 10.1002/pon.1974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 03/12/2011] [Indexed: 11/12/2022]
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Suárez-del-Real Y, Allende-Pérez S, Alférez-Mancera A, Rodríguez RB, Jiménez-Toxtle S, Mohar A, Oñate-Ocaña LF. Validation of the Mexican-Spanish version of the EORTC QLQ-C15-PAL questionnaire for the evaluation of health-related quality of life in patients on palliative care. Psychooncology 2010; 20:889-96. [PMID: 20662106 DOI: 10.1002/pon.1801] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 05/28/2010] [Accepted: 06/10/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is an important outcome in oncology, particularly in the palliative care setting. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire is a brief version of QLQ-C30. Our aim is to validate the Mexican-Spanish version of the QLQ-C15-PAL questionnaire to measure HRQL in patients with terminal cancer. METHODS Consecutive patients with biopsy proven cancer were included in the study. All were treated in a cancer center in Mexico and were referred for palliative care because of far-advanced, recurrent or metastatic cancer. QLQ-C15-PAL questionnaire was applied in the first visit to the Unit and palliative care was offered to all patients depending on their specific necessities. RESULTS Eighty-three patients were enrolled in this study (mean age, 61.2 years). Compliance rates were high; all patients completed to the questionnaire in <20 min and the instrument was well-received. Five missing values in five different items were found. QLQ-C15 scales distinguished between other clinically distinct groups of patients. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. Cronbach's α coefficients were >0.7 in three of four multi-item scales (0.67 in the fourth). Test-retest scores were consistent in some scales, while improve or worsen in others. Better Global health, Dyspnea, Insomnia, Fatigue and Appetite scales were associated with longer survival. CONCLUSION The Mexican-Spanish version of the EORTC QLQ-C15-PAL questionnaire is reliable and valid for HRQL measurement in patients with terminal cancer, and is appropriate for use in clinical trials of Mexican patients.
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Affiliation(s)
- Yolanda Suárez-del-Real
- Unidad de Soporte, Paliación y Dolor en Cáncer, Instituto Nacional de Cancerología, Mexico City, Mexico
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Oñate-Ocaña LF, Ochoa-Carrillo FJ. The GRADE system for classification of the level of evidence and grade of recommendations in clinical guideline reports. CIR CIR 2009; 77:417-419. [PMID: 19944034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There is great inconsistency on how "Clinical Guideline Developers" worldwide rate the quality of evidence and strength of recommendations because there are several classification systems in use. Therefore, medical guideline users face profound challenges in understanding articles on Clinical Guidelines. Many researchers are adopting the GRADE system to classify the quality of the available evidence and the strength of recommendations when preparing a manuscript on Clinical Guidelines. The GRADE system has advantages over previous rating systems including being developed by a representative group of guideline developers, patent separation between quality of evidence and strength of recommendations, explicit evaluation of the importance of outcomes of alternative management strategies, and others. Consequently, in this brief review, we describe the reasons underlying the adoption of GRADE.
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Affiliation(s)
- Luis F Oñate-Ocaña
- Departamento de Gastroenterología, Instituto Nacional de Cancerología, San Fernando 22, Col. Sección XVI, 14080 México, D.F., Mexico.
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Hernández-Ramírez RU, Galván-Portillo MV, Ward MH, Agudo A, González CA, Oñate-Ocaña LF, Herrera-Goepfert R, Palma-Coca O, López-Carrillo L. Dietary intake of polyphenols, nitrate and nitrite and gastric cancer risk in Mexico City. Int J Cancer 2009; 125:1424-30. [PMID: 19449378 DOI: 10.1002/ijc.24454] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
N-nitroso compounds (NOC) are potent animal carcinogens and potential human carcinogens. The primary source of exposure for most individuals may be endogenous formation, a process that can be inhibited by dietary polyphenols. To estimate the risk of gastric cancer (GC) in relation to the individual and combined consumption of polyphenols and NOC precursors (nitrate and nitrite), a population-based case-control study was carried out in Mexico City from 2004 to 2005 including 257 histologically confirmed GC cases and 478 controls. Intake of polyphenols, nitrate and nitrite were estimated using a food frequency questionnaire. High intakes of cinnamic acids, secoisolariciresinol and coumestrol were associated with an approximately 50% reduction in GC risk. A high intake of total nitrite as well as nitrate and nitrite from animal sources doubled the GC risk. Odds ratios around 2-fold were observed among individuals with both low intake of cinnamic acids, secoisolariciresinol or coumestrol and high intake of animal-derived nitrate or nitrite, compared to high intake of the polyphenols and low animal nitrate or nitrite intake, respectively. Results were similar for both the intestinal and diffuse types of GC. Our results show, for the first time, a protective effect for GC because of higher intake of cinnamic acids, secoisolariciresinol and coumestrol, and suggest that these polyphenols reduce GC risk through inhibition of endogenous nitrosation. The main sources of these polyphenols were pears, mangos and beans for cinnamic acids; beans, carrots and squash for secoisolariciresinol and legumes for coumestrol.
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Affiliation(s)
- Raúl U Hernández-Ramírez
- Center of Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Carrillo JF, Ramírez R, Flores L, Ramirez-Ortega MC, Arrecillas MD, Ibarra M, Sotelo R, Ponce-de-León S, Oñate-Ocaña LF. Diagnostic accuracy of fine needle aspiration biopsy in preoperative diagnosis of patients with parotid gland masses. J Surg Oncol 2009; 100:133-8. [DOI: 10.1002/jso.21317] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Galván-Portillo MV, Oñate-Ocaña LF, Pérez-Pérez GI, Chen J, Herrera-Goepfert R, Chihu-Amparan L, Flores-Luna L, Mohar-Betancourt A, López-Carrillo L. Dietary folate and vitamin B12 intake before diagnosis decreases gastric cancer mortality risk among susceptible MTHFR 677TT carriers. Nutrition 2009; 26:201-8. [PMID: 19577428 DOI: 10.1016/j.nut.2009.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 04/27/2009] [Accepted: 05/03/2009] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess gastric cancer survival in relation to dietary intake of methyl donors and the methylenetetrahydrofolate reductase 677C>T (MTHFR 677C>T) polymorphism. METHODS A prospective cohort of 257 incidental, histologically confirmed gastric cancer cases was assembled in January 2004 and followed until June 2006. Patients were recruited from the main oncology and/or gastroenterology units in Mexico City and were queried regarding their sociodemographic information, clinical history, and dietary habits 3 y before the onset of their symptoms. The intake of methyl donors was estimated with a food-frequency questionnaire and the MTHFR 677C>T polymorphisms were determined by polymerase chain reaction/restriction fragment length polymorphism analysis. Cox's multivariate regression models were used to estimate the mortality risk of gastric cancer. RESULTS MTHFR 677TT carriers with low folate and vitamin B12 intakes had the lowest survival rate in cases of gastric cancer. High intakes of folate and vitamin B12 before diagnosis was associated with decreased gastric cancer mortality risk in susceptible MTHFR 677TT carriers (mortality risk for folate 0.14, 95% confidence interval 0.04-0.46, P for trend=0.001; mortality risk for vitamin B12 0.23, 95% confidence interval 0.08-0.66, P for trend=0.008). CONCLUSION Folate and related B vitamins may be used as an intervention strategy to improve the survival outcome of gastric cancer.
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Affiliation(s)
- Marcia V Galván-Portillo
- Center of Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Oñate-Ocaña LF, Becker M, Carrillo JF, Aiello-Crocifoglio V, Gallardo-Rincón D, Brom-Valladares R, Herrera-Goepfert R, Ochoa-Carrillo F, Beltrán-Ortega A. Selection of best candidates for multiorgan resection among patients with T4 gastric carcinoma. J Surg Oncol 2008; 98:336-42. [PMID: 18646043 DOI: 10.1002/jso.21118] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Indications for gastrectomy in T4 gastric carcinoma (GC) remain controversial. Our aim was to define prognostic factors to select those patients with best chance to benefit from multiorgan resection. MATERIALS AND METHODS A cohort of patients with T4 GC treated in a 19-year period. Surgical morbidity-associated factors were identified by logistic regression analysis. Prognostic factors were defined by Kaplan-Meier and Cox methods. RESULTS Seven hundred eighteen patients were included (gastrectomy performed in 169). Surgical morbidity and mortality were 39% and 10.7%, respectively. Surgical morbidity were associated to extent of gastrectomy, age, serum albumin, and lymphocyte count (P = 0.0001). Presence of metastasis (hazard ratio [HR], 1.68; 95% confidence interval [95% CI], 1.19-2.36), albumin <3 g/dl plus lymphocytes <1,000 cells/mm(3) (HR, 2.9; 95% CI, 1.8-4.6), presence of ascites (HR, 2.1; 95% CI, 1.06-4.2), age >or=50 (HR, 1.37; 95% CI, 1.02-1.8), and unresectable disease (HR, 2.6; 95% CI, 1.7-4.1) defined poor survival (P = 0.00001). CONCLUSION Performing a multiorgan resection must be balanced between chances for long-term survival and surviving a potentially fatal operation. Absence of metastases, serum albumin levels >3 g/dl, and accomplishment of R0 resection select patients with high probability of benefit from multiorgan resection.
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Affiliation(s)
- Luis F Oñate-Ocaña
- Clínica de Neoplasias Gástricas, Departamento de Gastroenterología, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
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Oñate-Ocaña LF, Alcántara-Pilar A, Vilar-Compte D, García-Hubard G, Rojas-Castillo E, Alvarado-Aguilar S, Carrillo JF, Blazeby JM, Aiello-Crocifoglio V. Validation of the Mexican Spanish version of the EORTC C30 and STO22 questionnaires for the evaluation of health-related quality of life in patients with gastric cancer. Ann Surg Oncol 2008; 16:88-95. [PMID: 18979141 DOI: 10.1245/s10434-008-0175-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 09/21/2008] [Accepted: 09/21/2008] [Indexed: 01/04/2023]
Abstract
Health-related quality of life (HRQL) is a fundamental outcome in surgical oncology and culturally valid tools are essential for this purpose. Our aim was to validate the Mexican-Spanish versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire QLQ-C30 and the QLQ-STO22 disease-specific questionnaire module in Mexican patients with gastric cancer (GC). The translation procedure followed EORTC guidelines. Both instruments were completed by patients with GC and analyses were performed within three clinically distinct groups: (1) patients undergoing palliative treatment, (2) patients undergoing treatment with curative intent, and (3) GC survivors. Tests for reliability and validity were performed. One hundred and fifty patients (mean age 54.2 years) completed both questionnaires. Sixty-seven, 55, and 28 patients were allocated to groups 1, 2, and 3, respectively. Compliance rates were high, and questionnaires were well-accepted. Survivors of treatment for GC reported better functional HRQL scores and lower symptom scores than patients in group 2 who were currently undergoing treatment. Patients selected for potentially curative treatment had better HRQL than group 1 (palliative treatments). Scales in the QLQ-C30 and QLQ-STO22 distinguished between other clinically distinct groups of patients. Cronbach's alpha coefficients of 14 scales of both questionnaires were >0.7. Multitrait scaling analysis demonstrated good convergent and discriminant validity. Test-retest scores were consistent. We conclude that the Mexican-Spanish versions of EORTC QLQ-C30 and QLQ-C22 questionnaires are reliable and valid for HRQL measurement in patients with GC and are therefore recommended for use in clinical trials of Mexican community.
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Affiliation(s)
- Luis F Oñate-Ocaña
- Departamento de Gastroenterología, Clínica de Neoplasias Gástricas, Instituto Nacional de Cancerología, San Fernando 22, México, D.F., 14080, Mexico.
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Oñate-Ocaña LF, Méndez-Cruz G, Hernández-Ramos R, Becker M, Carrillo JF, Herrera-Goepfert R, Aiello-Crocifoglio V, Ochoa-Carrillo F, Beltrán-Ortega A. Experience of surgical morbidity after palliative surgery in patients with gastric carcinoma. Gastric Cancer 2008; 10:215-20. [PMID: 18095076 DOI: 10.1007/s10120-007-0437-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 10/02/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Indications for palliative surgery in gastric carcinoma (GC) are controversial. Our aim was to describe the results of palliative surgery in GC in terms of operative morbidity and survival. METHODS We conducted a retrospective cohort study of patients with GC, who were divided into three groups: resection with microscopic residual disease (R1), palliative resection with macroscopic residual disease (R2), and gastrojejunostomy. Comparisons were tested with analysis of variance (ANOVA) or chi(2) test, and the Kaplan-Meier method was used for survival analysis. RESULTS One hundred and thirty-two patients were included in the study: 21 had R1, 71 had R2, and 40 had gastrojejunostomy. Surgical morbidity was recorded in 4 patients (19%), 23 patients (32.4%), and 1 patient (2.5%) in each of the three groups, respectively (P = 0.001). Operative mortality occurred in 6 patients (8.5%) from the R2 group and in 1 (2.5%) patient from the gastrojejunostomy group (P = 0.406). Median survivals of the R1, R2, and gastrojejunostomy groups were 22.8 months (95% confidence interval [CI], 16.4-29.3), 12.4 (95% CI, 9.01-15.8) months, and 6.4 months (95% CI, 0-14.6), respectively (P = 0.078) CONCLUSION R1 resections and gastrojejunostomy were associated with low surgical morbidity and mortality, unlike R2 resection; in this group, surgical morbidity and mortality was high. Therefore, the benefit of palliative resection in the presence of extensive residual disease should be balanced against the risk of surgical morbidity.
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Affiliation(s)
- Luis F Oñate-Ocaña
- Clinica de Neoplasias Gástricas, Departamento de Gastroenterología, Instituto Nacional de Cancerología, San Fernando 22, Colonia Sección XVI, Tlalpan, D.F., 14080, Mexico City, Mexico
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Carrillo JF, Albores O, Ramírez-Ortega MC, Aiello-Crocifoglio V, Oñate-Ocaña LF. An audit of nasopharyngeal fibromas. Eur J Surg Oncol 2007; 33:655-61. [PMID: 17329064 DOI: 10.1016/j.ejso.2007.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Accepted: 01/08/2007] [Indexed: 10/23/2022] Open
Abstract
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.
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Affiliation(s)
- J F Carrillo
- Head and Neck Department, Surgery División, Instituto Nacional de Cancerologia, Mexico City, Mexico.
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