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Barroso A, Estevinho F, Hespanhol V, Teixeira E, Ramalho-Carvalho J, Araújo A. Management of infusion-related reactions in cancer therapy: strategies and challenges. ESMO Open 2024; 9:102922. [PMID: 38452439 PMCID: PMC10937241 DOI: 10.1016/j.esmoop.2024.102922] [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: 11/14/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Several anticancer therapies have the potential to cause infusion-related reactions (IRRs) in the form of adverse events that typically occur within minutes to hours after drug infusion. IRRs can range in severity from mild to severe anaphylaxis-like reactions. Careful monitoring at infusion initiation, prompt recognition, and appropriate clinical assessment of the IRR and its severity, followed by immediate management, are required to ensure patient safety and optimal outcomes. Lack of standardization in the prevention, management, and reporting of IRRs across cancer-treating institutions represents not only a quality and safety gap but also a disparity in cancer care. The present article, supported by recently published data, was developed to standardize these procedures across institutions and provide a useful tool for health care providers in clinical practice to recognize early signs and symptoms of an IRR and promptly and appropriately manage the event.
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Affiliation(s)
- A Barroso
- Multidisciplinary Unit of Thoracic Tumours, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - F Estevinho
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - V Hespanhol
- Departamento de Medicina Faculty of Medicine, University of Porto, Porto, Portugal; Department of Pulmonology, Centro Hospitalar de São João, Porto, Portugal
| | - E Teixeira
- Lung Cancer Unit, CUF Descobertas, Lisboa, Portugal
| | | | - A Araújo
- Medical Oncology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Oncology Research Unit, UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal.
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Benitez S, Delgado F, Hespanhol V, Boyeras I, Lamot S, Faibischew G, Suarez F, Viola L, Rodriguez M, Trujillo JC, Seijo LM. First Ibero-American Summit on Lung Cancer Screening. Arch Bronconeumol 2024; 60:71-72. [PMID: 37865604 DOI: 10.1016/j.arbres.2023.09.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Affiliation(s)
| | - Franzel Delgado
- Sociedad Venezolana de Neumología y Cirugía de Tórax (SOVETORAX), Spain
| | | | - Iris Boyeras
- Asociación Argentina de Medicina Respiratoria, Spain
| | | | | | | | - Lucia Viola
- Asociación Colombiana de Neumología y Cirugía de Tórax (ASONEUMOCITO), Spain
| | - Maria Rodriguez
- Sociedad Española de Neumología y Cirugía Tóracica (SEPAR), Spain
| | | | - Luis M Seijo
- Sociedad Española de Neumología y Cirugía Tóracica (SEPAR), Spain.
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Espiga de Macedo J, Taveira-Gomes T, Machado JC, Hespanhol V. Implementation of a Pilot Study to Analyze Circulating Tumor DNA in Early-Stage Lung Cancer. ACTA MEDICA PORT 2024; 37:10-19. [PMID: 37489611 DOI: 10.20344/amp.19487] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/04/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Liquid biopsies based on plasma circulating tumour deoxyribonucleic acid (ctDNA) have shown promise in monitoring lung cancer evolution. The expression of ctDNA across time, its relationship with clinicopathological parameters and its association with lung cancer progression through imaging allow us to weigh how useful ctDNA could be in monitoring surgically resectable lung cancer. The aim of this study was to assess the impact of ctDNA analysis implementation in early-stage lung cancer. METHODS A cohort of 47 patients was sequentially recruited. Only 34 patients with early-stage lung cancer were included. All patients had a tissue specimen and five blood samples drawn: at the preoperative stage, from the pulmonary vein, at surgical discharge, at the first follow-up and at the last follow-up. All blood samples were evaluated for ctDNA expression. RESULTS On average, the maximum yield of ctDNA was obtained in liquid biopsies at the surgical discharge of patients when compared with PO, PV, and F1 (p < 0.0001, p < 0.0001, p < 0.0001 respectively). No statistically significant differences were found when comparing the last follow-up to surgical discharge ctDNA expression (p = 0.851). The correlation between ctDNA concentration according to five-time points and the four clinicopathological characteristics showed that patients younger than 70 years had a statistically significant reduction of the concentration of ctDNA at the preoperative and surgical discharge time point [β = -16 734 (-27 707; - 5760); p = 0.003; β = -21 785 (-38 447; -5123); p = 0.010], as opposed to an increase of the concentration of ctDNA at the pulmonary vein and last follow-up time points [β = 8369 (0.359; 16 378); p = 0.041; β = 34 402 (12 549; 56 254); p = 0.002] all with a confidence level of 95%. In the cases where actionable mutations were identified in tissue biopsies, the expected mutation was found in five out of six patients plasma samples at the pre-operatory time point and in two out of six patients plasma samples at the pulmonary vein time point. Two out of six patients with actionable mutations had disease progression. CONCLUSION The results of this pilot study suggest that the maximum yield of ctDNA is obtained at the surgical discharge of the patients and that the pre-operatory timepoint is the one offering the highest sensitivity for the detection of actionable mutations in ctDNA in early-stage lung cancer.
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Affiliation(s)
- Joana Espiga de Macedo
- Medical Oncology Department. Centro Hospitalar de Entre o Douro e Vouga. Santa Maria da Feira. & Faculty of Medicine. Universidade do Porto. Porto. & Institute for Research and Innovation in Health (i3S). Universidade do Porto. Porto. Portugal
| | - Tiago Taveira-Gomes
- Faculty of Medicine. Universidade do Porto. Porto. & Department of Community Medicine. Information and Decision in Health (MEDCIDS). Faculdade de Medicina. Universidade do Porto. Porto. & Faculdade de Ciências Médicas. Universidade Fernando Pessoa. Porto. Portugal
| | - José Carlos Machado
- Institute for Research and Innovation in Health (i3S). Universidade do Porto. Porto. & Institute of Molecular Pathology and Immunology (IPATIMUP). Universidade do Porto. Porto. & Department of Pulmonology. Hospital de São João. Porto. Portugal
| | - Venceslau Hespanhol
- Institute for Research and Innovation in Health (i3S). Universidade do Porto. Porto. & Institute of Molecular Pathology and Immunology (IPATIMUP). Universidade do Porto. Porto. & Department of Pulmonology. Hospital de São João. Porto. Portugal
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Moita J, Brito U, Rodrigues C, Ferreira L, Vieira JR, Catarino A, Morais A, Hespanhol V, Cordeiro CR. Chronic obstructive pulmonary disease exacerbations' management in Portuguese hospitals - EvaluateCOPDpt, a multicentre, observational, prospective study. Pulmonology 2022:S2531-0437(22)00155-6. [PMID: 36115826 DOI: 10.1016/j.pulmoe.2022.07.007] [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: 02/25/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES In order to improve the quality of chronic obstructive pulmonary disease (COPD) patients' care, better knowledge of clinical practice and the factors associated with patient outcomes are needed. This study aimed to evaluate the relation between clinical practice and the outcomes of patients admitted for COPD exacerbations in Portuguese hospitals. MATERIALS AND METHODS Observational, multicentre, prospective study with a 60-days follow-up period, in 11 hospitals, including patients aged ≥ 30 years, admitted to hospital for at least 24 hours due to an acute exacerbation of COPD. Demographic and clinical data were collected, including sex, age, smoking habits, hospitalisations, pulmonary function, comorbidities, COPD symptoms, and treatment. Sixty days after discharge, COPD exacerbations management, outcome measures, and readmission data were evaluated through a structured phone follow-up interview. RESULTS 196 patients were included (85.7% male, mean age 71.2 years), the majority admitted through the emergency service. Ex-smokers and current smokers accounted for 51% and 36%, respectively. On admission, 72.4% were on LAMA, 54.6% on LABA, and 45.5% were on LABA/LAMA. Inhaled corticosteroids (ICS) were used in 37.3% and systemic steroids (SCS) in 10.3%. 35.7 % had had at least one exacerbation, with hospitalisation, in the previous year. There was no spirometry data for 23.2%. On hospitalisation, 98.5% of patients were treated with oxygen and 38.3% with non-invasive ventilation. Additionally, 93.4% used SCS and 60.2% ICS. Antibiotics were administered to 85.2%. 95.4% of patients were discharged; 9 died, 5 of whom had a COPD-related death. The median length of stay was 12 days for discharged patients and 33 days for patients who died. At discharge, 79.1% were prescribed with LAMA, 63.6% SCS, 61.5% LABA and 55.6% LAMA+LABA. 26,2% were prescribed with ICS+LABA+LAMA. At follow-up, 44.4% had a scheduled medical appointment within the 60 days after being discharged, and 28.3% were later readmitted due to exacerbation, of whom 52.8% were hospitalised. CONCLUSIONS The severity of COPD, particularly in exacerbations, is directly related to impaired lung function and quality of life, mortality, and significant health system costs. Knowledge about COPD exacerbations' management in acute hospital admissions in Portugal may help stimulate a national discussion and review of existing data to engage clinicians, policymakers, managers, and patients, raising awareness and promoting action on COPD.
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Affiliation(s)
- J Moita
- Pulmonology Unit, Coimbra Hospital and University Centre, Coimbra, Portugal.
| | - U Brito
- Pulmonology Unit, Algarve Hospital and University Centre, Faro, Portugal
| | - C Rodrigues
- Pulmonology Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - L Ferreira
- Pulmonology Unit, Sousa Martins Hospital, Guarda, Portugal
| | - J R Vieira
- Pulmonology Unit, Garcia de Orta Hospital, Almada, Portugal
| | - A Catarino
- Pulmonology Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - A Morais
- Pulmonology Unit, São João Hospital and University Centre, Porto, Portugal
| | - V Hespanhol
- Pulmonology Unit, São João Hospital and University Centre, Porto, Portugal
| | - C R Cordeiro
- University Clinic of Pulmonology, Faculty of Medicine, University of Coimbra, Portugal; Clinical Academic Centre of Coimbra, Portugal
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Neto SJ, Oliveira AR, Marques JF, Fernandes G, Hespanhol V, Moura CS, Melo SA, Costa JL, Machado JC. Abstract 1099: Resistance to anti-EGFR therapy is transferred horizontally between lung cancer cells through caveolin-associated intercellular trafficking. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite initial benefit from anti-EGFR therapy, patients with EGFR-mutated lung cancer (LC) inevitably relapse. Knowing that the majority of the relapsing cancer cells do not carry the resistance mutation, we hypothesized that resistance to anti-EGFR therapy can be transferred horizontally between LC cells, through intercellular communication. Using a cell culture system that allows communication of secreted molecules and extracellular vesicles, we performed indirect co-culture of Erlotinib-sensitive LC HCC827 cells (S cells) and Erlotinib-resistant LC H1975 cells (R cells, carrying the EGFR T790M resistance mutation), where S cells were treated with conditioned medium from R cells under selective pressure of Erlotinib (EGFR inhibitor). In vivo, immunodeficient mice (Rag2-/-Il2rg-/-) were engrafted with S cells in a single flank (n=12), or with S and R cells in opposite flanks (n=20) and treated with Erlotinib three times a week. Our results showed that resistance to anti-EGFR therapy can be transferred in vitro from R to S cells. Through digital PCR we provide evidence that transfer of resistance is neither due to cell contamination, nor transfer of DNA molecules with the T790M mutation. We also showed that resistance to anti-EGFR therapy can be transferred in vivo from R to S cells, originating “de novo” resistant tumors (SR tumors) and thereby decreasing progression-free survival of the animals. Using DNA fingerprinting we demonstrated that SR tumors do not contain R cells, ruling out cell migration as an explanation for the growth of the SR tumors. Moreover, the acquired resistance phenotype is stable over several in vivo passages of the tumor. We have analyzed the SR tumors with NGS and did not detect any known resistance mutations to anti-EGFR therapy. Through RNA-Seq and pathway analysis we found that SR tumors show significant changes in genes involved in intracellular trafficking, as evidenced by increased expression of CAV1 and CAV2. This increment of caveolins expression was validated in the SR tumors by real-time PCR and immunohistochemistry. CAV1 and CAV2 expression analysis was also performed in human LC biopsies, showing that in a subset of EGFR-mutated LC there is an increase in caveolins expression from the untreated primary to the anti-EGFR-treated relapsing tumor. Our results show that the anti-EGFR resistance phenotype can be transferred from R to S cells both in vivo and in vitro, and that it results in reprogramming of the expression profile of SR cells. Our findings point out a key role for caveolin-associated intercellular trafficking in the acquisition of resistance to targeted therapy in cancer. This challenges the current paradigm of cell division and selection as the sole mechanism underlying transmission of mutation-driven therapy resistance, and reveals an unforeseen level of plasticity in cancer. PhD Scholarship SFRH/BD/115099/2016
Citation Format: Susana Junqueira Neto, Ana Rita Oliveira, Joana Fernandes Marques, Gabriela Fernandes, Venceslau Hespanhol, Conceição Souto Moura, Sónia Almeida Melo, José Luís Costa, José Carlos Machado. Resistance to anti-EGFR therapy is transferred horizontally between lung cancer cells through caveolin-associated intercellular trafficking [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1099.
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Serino M, Freitas C, Martins M, Ferreira P, Cardoso C, Veiga F, Santos V, Araújo D, Novais-Bastos H, Magalhães A, Queiroga H, Fernandes G, Hespanhol V. Predictors of immune-related adverse events and outcomes in patients with NSCLC treated with immune-checkpoint inhibitors. Pulmonology 2022:S2531-0437(22)00076-9. [PMID: 35414494 DOI: 10.1016/j.pulmoe.2022.03.003] [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: 10/24/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To identify predictors of immune-related adverse events (IRAEs) in patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). Assess associations between outcomes and the development of IRAEs. METHODS Retrospective analysis of patients with NSCLC treated with ICIs between 2016 and 2020 in the Pulmonology Department of our hospital. Patients with and without IRAEs were compared. A logistic regression analysis was performed to determine predictors of IRAEs. Progression-free survival (PFS) and overall survival (OS) curves were calculated using the Kaplan-Meier method, and the long-rank test was used to assess survival differences between groups. Univariate and multivariate Cox proportional-hazards regression models were used to identify factors associated with PFS and OS. The value considered statistically significant was p≤0.05. RESULTS A total of 184 patients (77.7% men, mean age 66.9±9.5 years) treated with ICIs were analyzed. During follow-up, 49 (26.6%) patients developed IRAEs and 149 (81.0%) died. According to the multivariate logistic regression analysis, treatment with statins (OR:3.15; p = 0.007), previous systemic corticosteroid therapy (OR:3.99; p = 0.001), disease controlled as response to ICI (OR:5.93; p < 0.001) and higher hemoglobin values (OR:1.28; p = 0.040) were independent predictors for the development of IRAEs. Patients who developed IRAEs had significantly longer medians of PFS (41.0 vs 9.0 weeks, p < 0.001) and OS (89.0 vs 28.0 weeks; p < 0.001). CONCLUSIONS Patients treated with statins, pre-ICI systemic corticosteroids, higher baseline hemoglobin value and controlled disease as initial response to ICI had a higher risk of developing IRAEs. The development of IRAEs was associated with better outcomes.
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Affiliation(s)
- M Serino
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - C Freitas
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Martins
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - P Ferreira
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - C Cardoso
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - F Veiga
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - V Santos
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - D Araújo
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - H Novais-Bastos
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Magalhães
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - H Queiroga
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
| | - G Fernandes
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
| | - V Hespanhol
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
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Froes F, Morais A, Hespanhol V, Nogueira R, Carlos J, Jacinto N, Martins M, Gomes C, Cordeiro C. The Vacinómetro® initiative: an eleven-year monitorization of influenza vaccination coverage rates among risk groups in Portugal. Pulmonology 2022; 28:427-430. [DOI: 10.1016/j.pulmoe.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022] Open
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Silva F, Pereira T, Neves I, Morgado J, Freitas C, Malafaia M, Sousa J, Fonseca J, Negrão E, Flor de Lima B, Correia da Silva M, Madureira AJ, Ramos I, Costa JL, Hespanhol V, Cunha A, Oliveira HP. Towards Machine Learning-Aided Lung Cancer Clinical Routines: Approaches and Open Challenges. J Pers Med 2022; 12:jpm12030480. [PMID: 35330479 PMCID: PMC8950137 DOI: 10.3390/jpm12030480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/07/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
Advancements in the development of computer-aided decision (CAD) systems for clinical routines provide unquestionable benefits in connecting human medical expertise with machine intelligence, to achieve better quality healthcare. Considering the large number of incidences and mortality numbers associated with lung cancer, there is a need for the most accurate clinical procedures; thus, the possibility of using artificial intelligence (AI) tools for decision support is becoming a closer reality. At any stage of the lung cancer clinical pathway, specific obstacles are identified and “motivate” the application of innovative AI solutions. This work provides a comprehensive review of the most recent research dedicated toward the development of CAD tools using computed tomography images for lung cancer-related tasks. We discuss the major challenges and provide critical perspectives on future directions. Although we focus on lung cancer in this review, we also provide a more clear definition of the path used to integrate AI in healthcare, emphasizing fundamental research points that are crucial for overcoming current barriers.
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Affiliation(s)
- Francisco Silva
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
- Correspondence: (F.S.); (T.P.)
| | - Tania Pereira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- Correspondence: (F.S.); (T.P.)
| | - Inês Neves
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- ICBAS—Abel Salazar Biomedical Sciences Institute, University of Porto, 4050-313 Porto, Portugal
| | - Joana Morgado
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
| | - Cláudia Freitas
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Mafalda Malafaia
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FEUP—Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Joana Sousa
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
| | - João Fonseca
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FEUP—Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Eduardo Negrão
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Beatriz Flor de Lima
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Miguel Correia da Silva
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - António J. Madureira
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Isabel Ramos
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - José Luis Costa
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135 Porto, Portugal
| | - Venceslau Hespanhol
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - António Cunha
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- UTAD—University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
| | - Hélder P. Oliveira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
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Santos V, Freitas C, Fernandes MGO, Sousa C, Reboredo C, Cruz-Martins N, Mosquera J, Hespanhol V, Campelo R. Liquid biopsy: the value of different bodily fluids. Biomark Med 2022; 16:127-145. [DOI: 10.2217/bmm-2021-0370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Liquid biopsies have gained an increasing interest in the last years among medical and scientific communities. Indeed, the value of liquid effusions, while less invasive and more accurate techniques, has been markedly highlighted. Peripheral blood comprises the most often analyzed sample, but recent evidences have pointed out the huge importance of other bodily fluids, including pleural and peritoneal fluids, urine, saliva and cerebrospinal fluid in the detection and monitoring of different tumor types. In face to these advances, this review aims to provide an overview of the value of tumor-associated mutations, detectable in different effusions, and how they can be used in clinical practice, namely in prognosis assessment and early disease and minimal disease recurrence detection, and in predicting the treatment response or acquired-resistance development.
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Affiliation(s)
- Vanessa Santos
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
| | - Cláudia Freitas
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
| | - Maria GO Fernandes
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
- Institute for Research & Innovation in Health (I3S), University of Porto, Rua Alfredo Allen, Porto, 4200135, Portugal
- Institute of Molecular Pathology & Immunology of the University of Porto (IPATIMUP), Porto, 4200135, Portugal
| | - Catarina Sousa
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
| | - Cristina Reboredo
- Department of Lung Cancer & Thoracic Tumours, Complejo Hospitalario Universitario de A Coruña, As Xubias, 84, 15006, A Coruña, La Coruña, Spain
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
- Institute for Research & Innovation in Health (I3S), University of Porto, Rua Alfredo Allen, Porto, 4200135, Portugal
| | - Joaquín Mosquera
- Department of Lung Cancer & Thoracic Tumours, Complejo Hospitalario Universitario de A Coruña, As Xubias, 84, 15006, A Coruña, La Coruña, Spain
| | - Venceslau Hespanhol
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200319, Portugal
- Institute for Research & Innovation in Health (I3S), University of Porto, Rua Alfredo Allen, Porto, 4200135, Portugal
- Institute of Molecular Pathology & Immunology of the University of Porto (IPATIMUP), Porto, 4200135, Portugal
| | - Rosário Campelo
- Department of Lung Cancer & Thoracic Tumours, Complejo Hospitalario Universitario de A Coruña, As Xubias, 84, 15006, A Coruña, La Coruña, Spain
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Fernandes MGO, Cruz-Martins N, Machado JC, Costa JL, Hespanhol V. The value of cell-free circulating tumour DNA profiling in advanced non-small cell lung cancer (NSCLC) management. Cancer Cell Int 2021; 21:675. [PMID: 34915883 PMCID: PMC8680243 DOI: 10.1186/s12935-021-02382-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/30/2021] [Indexed: 01/04/2023] Open
Abstract
AbstractLiquid biopsy (LB) has boosted a remarkable change in the management of cancer patients by contributing to tumour genomic profiling. Plasma circulating cell-free tumour DNA (ctDNA) is the most widely searched tumour-related element for clinical application. Specifically, for patients with lung cancer, LB has revealed valuable to detect the diversity of targetable genomic alterations and to detect and monitor the emergence of resistance mechanisms. Furthermore, its non-invasive nature helps to overcome the difficulty in obtaining tissue samples, offering a comprehensive view about tumour diversity. However, the use of the LB to support diagnostic and therapeutic decisions still needs further clarification. In this sense, this review aims to provide a critical view of the clinical importance of plasma ctDNA analysis, the most widely applied LB, and its limitations while anticipating concepts that will intersect the present and future of LB in non-small cell lung cancer patients.
Graphical Abstract
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11
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Martins MR, Freitas C, Coelho D, Sousa C, Santos V, Pereira JM, Souto-Moura C, Hespanhol V. Lung nodules: a diagnosis’ challenge in Pulmonology. Lung Cancer 2021. [DOI: 10.1183/13993003.congress-2021.pa2180] [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: 11/05/2022]
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12
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Serino M, Santos V, Araújo D, Novais-Bastos H, Magalhães A, Fernandes G, Queiroga H, Hespanhol V. Atezolizumab in previously treated non-small-cell lung cancer patients. Lung Cancer 2021. [DOI: 10.1183/13993003.congress-2021.pa2304] [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: 11/05/2022]
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13
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Fernandes MGO, Sousa C, Pereira Reis J, Cruz-Martins N, Souto Moura C, Guimarães S, Justino A, Pina MJ, Magalhães A, Queiroga H, Marques JA, Machado JC, Costa JL, Hespanhol V. Liquid Biopsy for Disease Monitoring in Non-Small Cell Lung Cancer: The Link between Biology and the Clinic. Cells 2021; 10:cells10081912. [PMID: 34440680 PMCID: PMC8394732 DOI: 10.3390/cells10081912] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cell-free DNA (cfDNA) analysis offers a non-invasive method to identify sensitising and resistance mutations in advanced Non-Small Cell Lung Cancer (NSCLC) patients. Next-generation sequencing (NGS) of circulating free DNA (cfDNA) is a valuable tool for mutations detection and disease's clonal monitoring. MATERIAL AND METHODS An amplicon-based targeted gene NGS panel was used to analyse 101 plasma samples of advanced non-small cell lung cancer (NSCLC) patients with known oncogenic mutations, mostly EGFR mutations, serially collected at different clinically relevant time points of the disease. RESULTS The variant allelic frequency (VAF) monitoring in consecutive plasma samples demonstrated different molecular response and progression patterns. The decrease in or the clearance of the mutant alleles was associated with response and the increase in or the emergence of novel alterations with progression. At the best response, the median VAF was 0% (0.0% to 3.62%), lower than that at baseline, with a median of 0.53% (0.0% to 9.9%) (p = 0.004). At progression, the VAF was significantly higher (median 4.67; range: 0.0-36.9%) than that observed at the best response (p = 0.001) and baseline (p = 0.006). These variations anticipated radiographic changes in most cases, with a median time of 0.86 months. Overall, the VAF evolution of different oncogenic mutations predicts clinical outcomes. CONCLUSION The targeted NGS of circulating tumour DNA (ctDNA) has clinical utility to monitor treatment response in patients with advanced lung adenocarcinoma.
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Affiliation(s)
- Maria Gabriela O. Fernandes
- Pulmonology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (C.S.); (A.M.); (H.Q.); (J.A.M.); (V.H.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; (N.C.-M.); (S.G.); (J.C.M.); (J.L.C.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal; (J.P.R.); (A.J.); (M.J.P.)
- Correspondence: ; Tel.: +351-96-574-4014
| | - Catarina Sousa
- Pulmonology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (C.S.); (A.M.); (H.Q.); (J.A.M.); (V.H.)
| | - Joana Pereira Reis
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal; (J.P.R.); (A.J.); (M.J.P.)
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; (N.C.-M.); (S.G.); (J.C.M.); (J.L.C.)
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Conceição Souto Moura
- Pathology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
| | - Susana Guimarães
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; (N.C.-M.); (S.G.); (J.C.M.); (J.L.C.)
- Pathology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
| | - Ana Justino
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal; (J.P.R.); (A.J.); (M.J.P.)
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Maria João Pina
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal; (J.P.R.); (A.J.); (M.J.P.)
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Adriana Magalhães
- Pulmonology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (C.S.); (A.M.); (H.Q.); (J.A.M.); (V.H.)
| | - Henrique Queiroga
- Pulmonology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (C.S.); (A.M.); (H.Q.); (J.A.M.); (V.H.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; (N.C.-M.); (S.G.); (J.C.M.); (J.L.C.)
| | - José Agostinho Marques
- Pulmonology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (C.S.); (A.M.); (H.Q.); (J.A.M.); (V.H.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; (N.C.-M.); (S.G.); (J.C.M.); (J.L.C.)
| | - José Carlos Machado
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; (N.C.-M.); (S.G.); (J.C.M.); (J.L.C.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal; (J.P.R.); (A.J.); (M.J.P.)
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - José Luís Costa
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; (N.C.-M.); (S.G.); (J.C.M.); (J.L.C.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal; (J.P.R.); (A.J.); (M.J.P.)
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Venceslau Hespanhol
- Pulmonology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (C.S.); (A.M.); (H.Q.); (J.A.M.); (V.H.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; (N.C.-M.); (S.G.); (J.C.M.); (J.L.C.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal; (J.P.R.); (A.J.); (M.J.P.)
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
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Coelho DB, Santos V, Araújo D, Bastos HN, Magalhães A, Hespanhol V, Queiroga H, Cruz-Martins N, Fernandes MGO. Management of Coronavirus Disease 2019 Patients With Lung Cancer: Experience From a Thoracic Oncology Center. Front Mol Biosci 2021; 8:639676. [PMID: 34368223 PMCID: PMC8339998 DOI: 10.3389/fmolb.2021.639676] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/11/2021] [Indexed: 01/08/2023] Open
Abstract
Background Cancer patients appear to be at a higher risk of complications from coronavirus disease 2019 (COVID-19). Specific data related to lung cancer (LC) patient management, active treatment, and/or recent diagnosis are still very limited. Here, we aimed to investigate the clinical presentation, baseline features, and clinical outcomes of LC patients with COVID-19. Methods A retrospective case study was performed at Centro Hospitalar Universitário de São Joao, a tertiary hospital in the North of Portugal. Data from LC patients diagnosed with COVID-19 were collected during the first 10 months of the COVID-19 pandemic (March 2020–January 2021). Results Twenty-eight patients with active LC were diagnosed with COVID-19, being adenocarcinoma the most common histological type present (n = 13, 46.4%). Sixteen patients had metastatic stage IV LC (61.5%). Twenty-five patients (89.3%) had relevant comorbidities including hypertension (39.3%) and chronic obstructive pulmonary disease (32.1%). For patients undergoing antineoplastic treatment, the median time from the last chemotherapy administration to COVID-19 diagnosis was of 16 days (interquartile range = 13–41 days). Half of patients were previously on corticosteroid therapy. Twenty patients (71.4%) needed hospitalization, 18 received oxygen therapy (64.3%), 3 (10.7%) of them received high-flow nasal cannula with good tolerability, and 1 (3.6%) needed non-invasive ventilation. Hydroxychloroquine and antibiotics were given to 4 (14.3%) and 12 (42.9%) patients, respectively. Seven patients (25%) died at a median time of 5 days following COVID-19 diagnosis. Conclusion This is one of the first studies reporting the adverse outcomes associated with COVID-19 in LC patients at same time that adds evidence regarding the need to create protocols and guidelines to reduce the infection risk in such patients.
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Affiliation(s)
- David Barros Coelho
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Vanessa Santos
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - David Araújo
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Hélder Novais Bastos
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculdade de Medicina, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
| | - Adriana Magalhães
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Venceslau Hespanhol
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculdade de Medicina, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
| | - Henrique Queiroga
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Natália Cruz-Martins
- Faculdade de Medicina, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.,Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Maria Gabriela O Fernandes
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculdade de Medicina, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
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15
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Pereira T, Morgado J, Silva F, Pelter MM, Dias VR, Barros R, Freitas C, Negrão E, Flor de Lima B, Correia da Silva M, Madureira AJ, Ramos I, Hespanhol V, Costa JL, Cunha A, Oliveira HP. Sharing Biomedical Data: Strengthening AI Development in Healthcare. Healthcare (Basel) 2021; 9:healthcare9070827. [PMID: 34208830 PMCID: PMC8303863 DOI: 10.3390/healthcare9070827] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 01/17/2023] Open
Abstract
Artificial intelligence (AI)-based solutions have revolutionized our world, using extensive datasets and computational resources to create automatic tools for complex tasks that, until now, have been performed by humans. Massive data is a fundamental aspect of the most powerful AI-based algorithms. However, for AI-based healthcare solutions, there are several socioeconomic, technical/infrastructural, and most importantly, legal restrictions, which limit the large collection and access of biomedical data, especially medical imaging. To overcome this important limitation, several alternative solutions have been suggested, including transfer learning approaches, generation of artificial data, adoption of blockchain technology, and creation of an infrastructure composed of anonymous and abstract data. However, none of these strategies is currently able to completely solve this challenge. The need to build large datasets that can be used to develop healthcare solutions deserves special attention from the scientific community, clinicians, all the healthcare players, engineers, ethicists, legislators, and society in general. This paper offers an overview of the data limitation in medical predictive models; its impact on the development of healthcare solutions; benefits and barriers of sharing data; and finally, suggests future directions to overcome data limitations in the medical field and enable AI to enhance healthcare. This perspective is dedicated to the technical requirements of the learning models, and it explains the limitation that comes from poor and small datasets in the medical domain and the technical options that try or can solve the problem related to the lack of massive healthcare data.
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Affiliation(s)
- Tania Pereira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
- Correspondence:
| | - Joana Morgado
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
| | - Francisco Silva
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
| | - Michele M. Pelter
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Vasco Rosa Dias
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
| | - Rita Barros
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
| | - Cláudia Freitas
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Eduardo Negrão
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Beatriz Flor de Lima
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Miguel Correia da Silva
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - António J. Madureira
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Isabel Ramos
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Venceslau Hespanhol
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - José Luis Costa
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- i3S—Institute for Research and Innovation in Health of the University of Porto, 4200-135 Porto, Portugal
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135 Porto, Portugal
| | - António Cunha
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
- UTAD—University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
| | - Hélder P. Oliveira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
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Teixeira E, Araújo A, Hespanhol V, Parente B, Barata F. T790M-EGFR mutation frequency in advanced NSCLC patients on progression from a previous TKI therapy: results from a Portuguese study. Pulmonology 2021; 27:472-473. [PMID: 34172423 DOI: 10.1016/j.pulmoe.2021.01.007] [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: 11/11/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Encarnação Teixeira
- Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
| | - António Araújo
- Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | | | - Fernando Barata
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Fernandes MGO, Sousa C, Jacob M, Almeida L, Santos V, Araújo D, Novais Bastos H, Magalhães A, Cirnes L, Moura CS, Queiroga H, Cruz-Martins N, Hespanhol V. Resistance Profile of Osimertinib in Pre-treated Patients With EGFR T790M-Mutated Non-small Cell Lung Cancer. Front Oncol 2021; 11:602924. [PMID: 34026599 PMCID: PMC8136429 DOI: 10.3389/fonc.2021.602924] [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: 09/04/2020] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Osimertinib efficacy in pre-treated patients with epidermal growth factor receptor (EGFR) T790M-mutated non-small cell lung cancer (NSCLC) has been demonstrated in clinical trials, but real-world data, particularly regarding resistance profile, remains limited. This study aims to analyze the resistance mechanisms acquired after treatment with Osimertinib. Methods: Clinical outcomes and molecular results from re-biopsies at the time of osimertinib progression of EGFR T790M-mutated NSCLC patient were analyzed. Results: Twenty-one patients with stage IV adenocarcinoma were included [median 69 years; 57.1% female; 85.7% never-smokers; 23.8% ECOG performance status (PS) ≥2]. Median PFS and OS were 13.4 (95% CI: 8.0–18.9) and 26.4 (95% IC: 8.9–43.8) months, respectively. At the time of analysis, 10 patients had tumor progression (47.6%). T790M loss occurred in 50%, being associated with earlier progression (median PFS 8.1 vs. 21.4 months, p = 0.011). Diverse molecular alterations were identified, including C797S mutation (n = 1), PIK3CA mutation (n = 2), MET amplification (n = 1), CTNNB1 mutation (n = 1), and DCTN1-ALK fusion (n = 1). Histological transformation into small cell carcinoma occurred in one patient. Conclusions: This real-world life study highlights the relevance of re-biopsy at the time of disease progression, contributing to understand resistance mechanisms and to guide treatment strategies.
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Affiliation(s)
- Maria Gabriela O Fernandes
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Catarina Sousa
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Maria Jacob
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Leonor Almeida
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Vanessa Santos
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - David Araújo
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Hélder Novais Bastos
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
| | - Adriana Magalhães
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Luís Cirnes
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.,Escola Superior de Saúde (ESS), Instituo Politécnico do Porto (IPP), Porto, Portugal
| | | | - Henrique Queiroga
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.,Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Venceslau Hespanhol
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
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Freitas C, Sousa C, Machado F, Serino M, Santos V, Cruz-Martins N, Teixeira A, Cunha A, Pereira T, Oliveira HP, Costa JL, Hespanhol V. The Role of Liquid Biopsy in Early Diagnosis of Lung Cancer. Front Oncol 2021; 11:634316. [PMID: 33937034 PMCID: PMC8085425 DOI: 10.3389/fonc.2021.634316] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 11/27/2020] [Accepted: 03/19/2021] [Indexed: 12/12/2022] Open
Abstract
Liquid biopsy is an emerging technology with a potential role in the screening and early detection of lung cancer. Several liquid biopsy-derived biomarkers have been identified and are currently under ongoing investigation. In this article, we review the available data on the use of circulating biomarkers for the early detection of lung cancer, focusing on the circulating tumor cells, circulating cell-free DNA, circulating micro-RNAs, tumor-derived exosomes, and tumor-educated platelets, providing an overview of future potential applicability in the clinical practice. While several biomarkers have shown exciting results, diagnostic performance and clinical applicability is still limited. The combination of different biomarkers, as well as their combination with other diagnostic tools show great promise, although further research is still required to define and validate the role of liquid biopsies in clinical practice.
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Affiliation(s)
- Cláudia Freitas
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Catarina Sousa
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Francisco Machado
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Mariana Serino
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Vanessa Santos
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Porto, Portugal
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
| | - Armando Teixeira
- Institute for Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Faculty of Engineering, University of Porto, Porto, Portugal
| | - António Cunha
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
- Department of Engineering, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Tania Pereira
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
| | - Hélder P. Oliveira
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
- Faculty of Sciences, University of Porto, Porto, Portugal
| | - José Luís Costa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Venceslau Hespanhol
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
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Freitas C, Veiga F, Costa J, Araújo D, Novais-Bastos H, Santos V, Magalhães A, Hespanhol V, Queiroga H, Fernandes G. P01.15 Immune-Related Adverse Effects of Immunotherapy in Patients With Advanced Non-Small Cell Lung Carcinoma. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.339] [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: 10/21/2022]
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20
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Pereira T, Freitas C, Costa JL, Morgado J, Silva F, Negrão E, de Lima BF, da Silva MC, Madureira AJ, Ramos I, Hespanhol V, Cunha A, Oliveira HP. Comprehensive Perspective for Lung Cancer Characterisation Based on AI Solutions Using CT Images. J Clin Med 2020; 10:E118. [PMID: 33396348 PMCID: PMC7796087 DOI: 10.3390/jcm10010118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/22/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/16/2022] Open
Abstract
Lung cancer is still the leading cause of cancer death in the world. For this reason, novel approaches for early and more accurate diagnosis are needed. Computer-aided decision (CAD) can be an interesting option for a noninvasive tumour characterisation based on thoracic computed tomography (CT) image analysis. Until now, radiomics have been focused on tumour features analysis, and have not considered the information on other lung structures that can have relevant features for tumour genotype classification, especially for epidermal growth factor receptor (EGFR), which is the mutation with the most successful targeted therapies. With this perspective paper, we aim to explore a comprehensive analysis of the need to combine the information from tumours with other lung structures for the next generation of CADs, which could create a high impact on targeted therapies and personalised medicine. The forthcoming artificial intelligence (AI)-based approaches for lung cancer assessment should be able to make a holistic analysis, capturing information from pathological processes involved in cancer development. The powerful and interpretable AI models allow us to identify novel biomarkers of cancer development, contributing to new insights about the pathological processes, and making a more accurate diagnosis to help in the treatment plan selection.
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Affiliation(s)
- Tania Pereira
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
| | - Cláudia Freitas
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- Faculty of Medicine, University of Porto, FMUP, 4200-319 Porto, Portugal;
| | - José Luis Costa
- Faculty of Medicine, University of Porto, FMUP, 4200-319 Porto, Portugal;
- Institute for Research and Innovation in Health of the University of Porto, i3S, 4200-135 Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto, IPATIMUP, 4200-135 Porto, Portugal
| | - Joana Morgado
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
- Faculty of Science, University of Porto, FCUP, 4169-007 Porto, Portugal
| | - Francisco Silva
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
| | - Eduardo Negrão
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Beatriz Flor de Lima
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Miguel Correia da Silva
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - António J. Madureira
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Isabel Ramos
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- Faculty of Medicine, University of Porto, FMUP, 4200-319 Porto, Portugal;
| | - Venceslau Hespanhol
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- Faculty of Medicine, University of Porto, FMUP, 4200-319 Porto, Portugal;
| | - António Cunha
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
- Department of Engineering, University of Trás-os-Montes and Alto Douro, UTAD, 5001-801 Vila Real, Portugal
| | - Hélder P. Oliveira
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
- Faculty of Science, University of Porto, FCUP, 4169-007 Porto, Portugal
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21
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Hespanhol V, Bárbara C. Pneumonia mortality, comorbidities matter? Authors' answer. Pulmonology 2020; 27:85-86. [PMID: 33218853 DOI: 10.1016/j.pulmoe.2020.09.005] [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: 09/04/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- V Hespanhol
- Faculdade Medicina do Porto, Porto, Portugal - Centro Hospitalar e Universitário S. João.
| | - Cristina Bárbara
- Faculdade Medicina de Lisboa - Centro Hospitalar e Universitário Lisboa Norte
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22
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Araújo Barros Coelho DJ, Sousa C, Jacob M, Almeida L, Araújo D, Novais-Bastos H, Magalhães A, Souto Moura C, Cirnes L, Hespanhol V, Queiroga H, Fernandes G. Progression after osimertinib in EGFR T790M-mutated non-small cell cancer patients. Lung Cancer 2020. [DOI: 10.1183/13993003.congress-2020.1694] [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: 11/05/2022]
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23
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Jacob M, Romano J, Araújo D, Pereira JM, Ramos I, Hespanhol V. Predicting lung nodules malignancy. Pulmonology 2020; 28:454-460. [PMID: 32739327 DOI: 10.1016/j.pulmoe.2020.06.011] [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: 02/24/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is critical to developing an accurate method for differentiating between malignant and benign solitary pulmonary nodules. This study aimed was to establish a predicting model of lung nodules malignancy in a real-world setting. METHODS The authors retrospectively analysed the clinical and computed tomography (CT) data of 121 patients with lung nodules, submitted to percutaneous CT-guided transthoracic biopsy, between 2014 and 2015. Multiple logistic regression was used to screen independent predictors for malignancy and to establish a clinical prediction model to evaluate the probability of malignancy. RESULTS From a total of 121 patients, 75 (62%) were men and with a mean age of 64.7 years old. Multivariate logistic regression analysis identified six independent predictors of malignancy: age, gender, smoking status, current extra-pulmonary cancer, air bronchogram and nodule size (p<0.05). The area under the curve (AUC) was 0.8573. CONCLUSIONS The prediction model established in this study can be used to assess the probability of malignancy in the Portuguese population, thereby providing help for the diagnosis of lung nodules and the selection of follow-up interventions.
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Affiliation(s)
- M Jacob
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - J Romano
- Physical Medicine and Rehabilitation Department, Unidade de Saúde Local de Matosinhos, Porto, Portugal
| | - D Araújo
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - J M Pereira
- Radiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - I Ramos
- Radiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - V Hespanhol
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
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24
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Freitas C, Pereira T, Pinheiro G, Dias C, Hespanhol V, Costa J, Cunha A, Oliveira H. THE ROLE OF RADIOGENOMICS IN EGFR AND KRAS MUTATION STATUS PREDICTION AMONG NON-SMALL CELL LUNG CANCER PATIENTS. Chest 2020. [DOI: 10.1016/j.chest.2020.05.019] [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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25
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Duarte-de-Araújo A, Fonte P, Teixeira P, Hespanhol V, Correia-de-Sousa J. Is an Early Diagnosis of COPD Clinically Useful? Arch Bronconeumol 2020; 56:409-410. [PMID: 35373754 DOI: 10.1016/j.arbr.2019.11.012] [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: 09/12/2019] [Accepted: 11/14/2019] [Indexed: 06/14/2023]
Affiliation(s)
- António Duarte-de-Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Respiratory Department, H. Sª Oliveira, Guimarães, Portugal.
| | - Pedro Fonte
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Minho Family Health Unit, Braga, Portugal
| | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Venceslau Hespanhol
- Department of Pneumology, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine (FMUP), University of Porto, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Horizonte Family Health Unit, Matosinhos, Portugal
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Pedro J, Cunha FM, Neto V, Hespanhol V, Martins DF, Guimarães S, Varela A, Carvalho D. Coexistence of DIPNECH and carotid body paraganglioma: is it just a coincidence? Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190141. [PMID: 32408270 PMCID: PMC7274547 DOI: 10.1530/edm-19-0141] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 01/10/2023] Open
Abstract
SUMMARY We describe the case of a 56 year-old woman with the almost simultaneous appearance of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) and a carotid body paraganglioma. Of interest, 6 years earlier, the patient underwent total thyroidectomy due to papillary thyroid carcinoma and, in the meantime, she was submitted to mastectomy to treat an invasive ductal carcinoma of the breast. In order to explain these lesions, an extensive genetic study was performed. Results showed positivity for the presence of the tumor suppressor gene PALB2, whose presence had already been detected in a niece with breast cancer. The patient underwent different procedures to treat the lesions and currently she is symptom-free over 2 years of follow-up. LEARNING POINTS The presence of two rare neoplasms in a single person should raise the suspicion of a common etiology. To the best of our knowledge, this is the first case that shows the coexistence of DIPNECH and paraganglioma. The contribution of the PALB2 gene in the etiology of these rare neoplasms is a possibility.
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Affiliation(s)
- J Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
| | - F M Cunha
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - V Neto
- Department of Pneumology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - V Hespanhol
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
- Department of Pneumology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - D F Martins
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S Guimarães
- Department of Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - A Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - D Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Hespanhol V, Bárbara C. Pneumonia mortality, comorbidities matter? Pulmonology 2020; 26:123-129. [DOI: 10.1016/j.pulmoe.2019.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/11/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022] Open
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Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. COPD: How can evidence from randomised controlled trials apply to patients treated in everyday clinical practice? Pulmonology 2020; 28:431-439. [PMID: 32169297 DOI: 10.1016/j.pulmoe.2020.02.003] [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: 12/10/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To evaluate the degree to which evidence from large clinical trials can be applied to patients treated in a local hospital cohort of COPD outpatients. METHODS The authors selected seventeen RCTs identified in a systematic way from GOLD 2019 consensus document, and applied their inclusion and exclusion criteria to a real-world cohort of a previous cross-sectional study of 303 COPD outpatients included consecutively. RESULTS When the inclusion criteria of the 17 RCTs were applied to a real-world cohort of COPD outpatients, only a small portion of them were eligible to participate in the referred trials, from 4.29% to 60.07%. However, when both the inclusion and the exclusion criteria were applied, only as little as 3.63% to as much as 40.59% of patients were eligible to participate. Hence, only a small fraction of patients from this cohort could benefit from the findings of these RCTs. CONCLUSIONS There is a need to complement the efficacy evidence provided by large RCTs according to the extent to which their results, designed to target significant patient populations, can be applied to typical patients treated in routine clinical practice.
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Affiliation(s)
- António Duarte-de-Araújo
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Venceslau Hespanhol
- Respiratory Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine (FMUP), University of Porto, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Horizonte Family Health Unit, Matosinhos, Portugal
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30
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Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. COPD: Analysing factors associated with a successful treatment. Pulmonology 2020; 26:66-72. [DOI: 10.1016/j.pulmoe.2019.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/15/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022] Open
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31
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Pinheiro G, Pereira T, Dias C, Freitas C, Hespanhol V, Costa JL, Cunha A, Oliveira HP. Identifying relationships between imaging phenotypes and lung cancer-related mutation status: EGFR and KRAS. Sci Rep 2020; 10:3625. [PMID: 32107398 PMCID: PMC7046701 DOI: 10.1038/s41598-020-60202-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
EGFR and KRAS are the most frequently mutated genes in lung cancer, being active research topics in targeted therapy. The biopsy is the traditional method to genetically characterise a tumour. However, it is a risky procedure, painful for the patient, and, occasionally, the tumour might be inaccessible. This work aims to study and debate the nature of the relationships between imaging phenotypes and lung cancer-related mutation status. Until now, the literature has failed to point to new research directions, mainly consisting of results-oriented works in a field where there is still not enough available data to train clinically viable models. We intend to open a discussion about critical points and to present new possibilities for future radiogenomics studies. We conducted high-dimensional data visualisation and developed classifiers, which allowed us to analyse the results for EGFR and KRAS biological markers according to different combinations of input features. We show that EGFR mutation status might be correlated to CT scans imaging phenotypes; however, the same does not seem to hold for KRAS mutation status. Also, the experiments suggest that the best way to approach this problem is by combining nodule-related features with features from other lung structures.
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Affiliation(s)
- Gil Pinheiro
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Tania Pereira
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.
| | - Catarina Dias
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
- Faculty of Engineering, University of Porto, Porto, Portugal
| | - Cláudia Freitas
- Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Venceslau Hespanhol
- Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Luis Costa
- Faculty of Medicine, University of Porto, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | - António Cunha
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
- University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Hélder P Oliveira
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
- Faculty of Science, University of Porto, Porto, Portugal
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Figueiredo A, Almeida M, Almodovar M, Alves P, Araújo A, Araújo D, Barata F, Barradas L, Barroso A, Brito U, Camacho E, Canário D, Cardoso T, Chaves A, Costa L, Cunha J, Duarte J, Estevinho F, Felizardo M, Fernandes J, Ferreira L, Ferreira L, Fidalgo P, Freitas C, Garrido P, Gil N, Hasmucrai D, Jesus E, Lopes J, de Macedo J, Meleiro A, Neveda R, Nogueira F, Pantorotto M, Parente B, Pego A, Rocha M, Roque J, Santos C, Saraiva J, Silva E, Silva S, Simões S, Soares M, Teixeira E, Timóteo T, Hespanhol V. Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC). Pulmonology 2020; 26:10-17. [DOI: 10.1016/j.pulmoe.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
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Araújo AMSDD, Teixeira P, Hespanhol V, Correia-de-Sousa J. Discordance between old and new criteria for stratifying patients with COPD. J Bras Pneumol 2019; 45:e20190183. [PMID: 31618300 PMCID: PMC7447540 DOI: 10.1590/1806-3713/e20190183] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- António Manuel Silva Duarte de Araújo
- . Instituto de Investigação em Ciências da Vida e Saúde - ICVS - Faculdade de Medicina, Universidade do Minho, Braga, Portugal.,. Laboratório Associado ICVS/3B's, Braga/Guimarães, Portugal.,. Departamento Respiratório, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Pedro Teixeira
- . Instituto de Investigação em Ciências da Vida e Saúde - ICVS - Faculdade de Medicina, Universidade do Minho, Braga, Portugal.,. Laboratório Associado ICVS/3B's, Braga/Guimarães, Portugal
| | - Venceslau Hespanhol
- . Departamento de Pneumologia, Centro Hospitalar de São João, Porto, Portugal.,. Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Jaime Correia-de-Sousa
- . Instituto de Investigação em Ciências da Vida e Saúde - ICVS - Faculdade de Medicina, Universidade do Minho, Braga, Portugal.,. Laboratório Associado ICVS/3B's, Braga/Guimarães, Portugal.,. Unidade de Saúde Familiar Horizonte, Centro de Saúde de Matosinhos, Matosinhos, Portugal
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Freitas C, Tavares N, Jacob M, Mendonça D, Oliveira P, Araújo D, Novais-Bastos H, Fernandes G, Magalhães A, Queiroga H, Hespanhol V. P1.04-59 Modified Glasgow Prognostic Score Predict Survival Among Non-Small Cell Lung Cancer Patients Treated with Immune Checkpoint Inhibitors. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.962] [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: 10/25/2022]
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Pinto J, Sousa C, Martins N, Teixeira S, Magalhães A, Fernandes G, Hespanhol V, Queiroga H, Novais E Bastos H. Mutational status of advanced lung adenocarcinoma in a Portuguese cohort. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa4683] [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: 11/05/2022]
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C. Sousa C, Pinto J, Martins N, Teixeira S, Magalhães A, Fernandes G, Hespanhol V, Queiroga H, Novais Bastos H. Characterization of Patients with KRAS-Mutated Advanced Non-Small Cell Lung Cancer. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa4684] [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: 11/05/2022]
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Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. Characterisation of morbidity in a COPD hospital cohort. Pulmonology 2019; 25:200-207. [PMID: 31155471 DOI: 10.1016/j.pulmoe.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To characterise the morbidity of COPD out-patients based on symptoms, acute exacerbations, FEV1 and comorbidities, and to explore the association between different patients' characteristics such as social, demographic, clinical history or exposure. METHODS Stable COPD outpatients over 40 years old diagnosed according to GOLD criteria were included consecutively; the exclusion criteria were only refusal to participate and inability to understand clinical questionnaires. A survey of demographic and clinical data was conducted. Symptoms were evaluated using the CAT and mMRC questionnaires. The number of COPD acute exacerbations reported in the previous year was assessed, and spirometry performed on all participants according to ATS/ERS recommendations. Different variables were collected and then related to each other. RESULTS We studied 303 COPD outpatients, all Caucasians, 79.5% males and mostly elderly. 65.7% of participants reported having low monthly income and 87.8% a low education level. Tobacco smoking was the most common exposure identified but a substantial proportion of COPD patients were non-smokers (26%). Frequent acute exacerbations were reported by 38.0% of patients. The mean post-bronchodilator FEV1 was 53.2%. The distribution of patients according to GOLD 2017 stage and classification was respectively 9.9%, 41.9%, 35.0% and 13.2% from 1 to 4 and 23.1%, 39.6%, 2.3% and 35.0% from GOLD A to D. Only 29 patients (9.5%) presented no comorbid conditions, and the most common were hypertension, heart diseases and dyslipidaemia. CONCLUSIONS Our data confirms COPD as a complex and heterogeneous disorder, with a significant morbidity due to the nature of symptoms, frequent comorbidities and exacerbations. A substantial proportion of COPD patients were never-smokers, mainly women, calling attention to the need for COPD recognition in these cases. COPD in women, in never-smokers and in patients with a previous diagnosis of asthma presented some specific characteristics. Some patient characteristics are associated with frequent acute exacerbations. FEV1 was strongly related both to symptoms and exacerbations.
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Affiliation(s)
- A Duarte-de-Araújo
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - P Teixeira
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - V Hespanhol
- Department of Pneumology, Centro Hospitalar de S. João, Faculty of Medicine (FMUP), University of Porto, Portugal
| | - J Correia-de-Sousa
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Horizonte Family Health Unit, Matosinhos, Portugal
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Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. COPD: misuse of inhaler devices in clinical practice. Int J Chron Obstruct Pulmon Dis 2019; 14:1209-1217. [PMID: 31213798 PMCID: PMC6549399 DOI: 10.2147/copd.s178040] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023] Open
Abstract
Background and objectives: Inhalers mishandling remain an important clinical issue worldwide. The aim of this study was to evaluate inhalation technique in stable COPD out-patients. The variables under study were type of inhaler device (ID), patients’ preference for an inhaler, number of IDs used by each patient, beliefs about inhaler medication and some demographic, clinical and functional patients' characteristics. We aim to assess how they are related to inhalation technique. Methods: A cross-sectional study was conducted in a hospital outpatient respiratory care. COPD patients over 40 years old, diagnosed according to GOLD criteria, and using IDs were included consecutively. The Beliefs about Medicines Questionnaire (BMQ), a demographic and a clinical survey were applied. The number of IDs used by each patient and the patients’ preference for some IDs were recorded. Patients were asked to demonstrate the use of their prescribed inhalation devices, and inhaler technique was assessed by using previously defined checklists, including essential steps and critical errors. A statistics analysis was then performed. Results: We studied 300 subjects performing a total of 521 inhalation manoeuvers with 10 different IDs. At least one step incorrectly performed was found in 48.2% of demonstrations and in 29.9% critical errors were observed. Misuse was related to priming/loading in 6.9%, to inhalation manoeuver in 13.1% and to both in 10%. There was a statistically significant association between critical errors and type of ID (P<0.001). No significant relationship was found between correct performance of key manoeuvers and patients’ preference or number of inhalers used per patient. Misuse due to critical errors was observed in 39.3% of patients and was positively related to female gender, age ≥65, lower education level and lower socioeconomic status (higher Graffar classification score), but not to patients’ clinical or functional characteristics. In the sub-group of patients presenting critical errors when using IDs, there was a statistically significant inverse association between BMQ Necessity score and number of critical errors. Conclusions: Inhalers mishandling remains disappointingly common. A good inhalation technique depends on the type of ID, and failure of inhalation manoeuver was the main cause of ID misuse. It was not associated to multiple inhalers’ use nor to patient’s preference, but to the patient’s beliefs about the necessity to use them. Elderly patients, women and those with lower education level or lower socioeconomic status demonstrate a worse inhalation technique.
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Affiliation(s)
- A Duarte-de-Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Respiratory Department, H. Sª Oliveira, Guimarães, Portugal
| | - P Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - V Hespanhol
- Department of Pneumology, Centro Hospitalar de S. João, Porto, Portugal.,Faculty of Medicine (FMUP), University of Porto, Porto, Portugal
| | - J Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Horizonte Family Health Unit, Matosinhos, Portugal
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Fernandes Marques J, Pereira Reis J, Fernandes G, Hespanhol V, Machado JC, Costa JL. Circulating Tumor DNA: A Step into the Future of Cancer Management. Acta Cytol 2019; 63:456-465. [PMID: 30852572 DOI: 10.1159/000492917] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 07/13/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022]
Abstract
Liquid biopsy was introduced to the oncology field with the promise of revolutionizing the management of cancer patients, minimizing the exposure to invasive procedures such as tissue biopsy, and providing reliable information regarding therapy response and detection of disease relapse. Despite the significant increase in the number of published studies on circulating tumor DNA (ctDNA) in the past years, the emphasis of most studies is on the development of new technologies or on the clinical utility of ctDNA. This leaves a clear gap of knowledge concerning the biology of ctDNA, such as the fundamental mechanisms through which DNA from tumor cells is released into the circulation. Moreover, considering that ctDNA analysis is now currently being applied in clinical practice, the need for rigorous quality control is arising, and with it the necessity to standardize procedures, from sample collection to data analysis. This review focuses on the main aspects of ctDNA, including approaches currently available to evaluate tumor genetics, as well as the points that still require improvement in order to make liquid biopsy a key player in precision medicine.
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Affiliation(s)
- Joana Fernandes Marques
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | - Joana Pereira Reis
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Gabriela Fernandes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
- Department of Pulmonology, Hospital de São João, Porto, Portugal
| | - Venceslau Hespanhol
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
- Department of Pulmonology, Hospital de São João, Porto, Portugal
| | - José Carlos Machado
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Luís Costa
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal,
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal,
- Faculty of Medicine, University of Porto, Porto, Portugal,
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Amorim A, Meira L, Redondo M, Ribeiro M, Castro R, Rodrigues M, Martins N, Hespanhol V. Chronic Bacterial Infection Prevalence, Risk Factors, and Characteristics: A Bronchiectasis Population-Based Prospective Study. J Clin Med 2019; 8:E315. [PMID: 30845638 PMCID: PMC6463080 DOI: 10.3390/jcm8030315] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Few data are available on chronic bacterial infections (CBI) in bronchiectasis patients. Given that CBI seems to trigger longer hospital stays, worse outcomes, and morbimortality, this study was undertaken to assess CBI prevalence, characteristics, and risk factors in outpatients with bronchiectasis. METHODS A total of 186 patients followed in a bronchiectasis tertiary referral centre in Portugal were included. Demographic data and information on aetiology, smoking history, mMRC score, Bronchiectasis Severity Index (BSI) score, sputum characteristics, lung function, exacerbations, and radiological involvement degree were collected. RESULTS Patients included (mean age 54.7 ± 16.2 years; 60.8% females) were followed up for a period of 3.8 ± 1.7 years. The most common cause of bronchiectasis was infection (31.7%) followed by immune deficiencies (11.8%), whereas in 29% of cases, no cause was identified. Haemophilus influenzae (32.3%) and Pseudomonas aeruginosa (30.1%) were the most common CBI-associated possible pathogenic microorganisms. CBI patients presented a higher follow-up time than no-CBI patients (p = 0.003), worse lung function, BSI (p < 0.001), and radiological (p < 0.001) scores, and more prominent daily sputum production (p = 0.002), estimated mean volume (p < 0.001), and purulent sputum (p < 0.001). The number of exacerbations/year (p = 0.001), including those requiring hospital admission (p = 0.009), were also higher in the CBI group. Independent CBI predictors were BSI score (OR 3.577, 95% CI 1.233⁻10.378), sputum characteristics (OR 3.306, 95% CI 1.107⁻9.874), and radiological score (OR 1.052, 95% CI 1.004⁻1.102). CONCLUSION According to the CBI status, two different sub-groups of patients were found on the basis of several clinical outcomes, emphasizing the importance of routine sputum microbiological monitoring. Further studies are needed to better characterize CBI profiles and to define the individual clinical impact of the most prevalent pathogenic microorganisms.
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Affiliation(s)
- Adelina Amorim
- Pulmonology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal.
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
| | - Leonor Meira
- Pulmonology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal.
| | - Margarida Redondo
- Pulmonology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal.
| | - Manuela Ribeiro
- Clinical Pathology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal.
| | - Ricardo Castro
- Radiology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal.
| | - Márcio Rodrigues
- Radiology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal.
| | - Natália Martins
- Pulmonology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal.
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
- Institute for Research and Innovation in Health (i3S), University of Porto, 4200-135 Porto, Portugal.
| | - Venceslau Hespanhol
- Pulmonology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal.
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
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Hespanhol V. Quo Vadis…Pneumonia. Pulmonology 2019; 25:65. [DOI: 10.1016/j.pulmoe.2019.03.004] [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: 11/17/2022] Open
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42
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Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. Teaching inhalation technique in COPD outpatients: Can a sustained improvement be achieved? Pulmonology 2019; 25:53-55. [PMID: 30772262 DOI: 10.1016/j.pulmoe.2018.11.006] [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: 06/28/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- A Duarte-de-Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Respiratory Department, H. Sª Oliveira, Guimarães, Portugal.
| | - P Teixeira
- Department of Pneumology, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine (FMUP), University of Porto, Portugal
| | - V Hespanhol
- Horizonte Family Health Unit, Matosinhos, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Horizonte Family Health Unit, Matosinhos, Portugal
| | - J Correia-de-Sousa
- Horizonte Family Health Unit, Matosinhos, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Abstract
Background and objective Adherence to inhaled medications by COPD patients is a challenging issue, but relatively understudied. The aim of this study is the characterization of adherence to inhaled medications by COPD patients, with a focus on patient-related determinants. Methods Stable COPD outpatients ≥40 years of age from a respiratory unit and diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease criteria were included in a cross-sectional study. The Measure of Treatment Adherence (MTA), the Beliefs about Medications Questionnaire (BMQ) and demographic, clinical, and COPD questionnaires were used. After completing these questionnaires, semi-structured interviews were carried out and participants were encouraged to justify their opinions and behaviors. Field notes were made during the interviews and each interview was analyzed before the next one. Quantitative and qualitative analyses of the variables were then performed. Results A total of 300 out of 319 participants (mean age =67.7 years, 78.1% males) completed the MTA questionnaire. Of these, 31.3% were considered poorly adherent and 16.7% as non-adherent to the inhaled therapy. A statistically significant negative association was found between adherence and current smoking status (P=0.044), and between adherence and FEV1% (P=0.000). The mean BMQ Necessity score was higher in adherent patients (P=0.000), but the the mean Concern score was similar for both (P=0.877). We found nine patterns of poor-adherence, six reasons given for poor-adherence behaviors, five reasons for good-adherence behaviors and three patient-related domains on adherence to medications. Conclusion Adherence is related to need perception and to the functional severity of the disease. A non-adherent patient is usually a current smoker with lower degree of airflow limitation and lower perception of medication necessity. New information obtained was related to the patterns and reasons for different adherence behaviors, which are based on three major groups of patient related-determinants: health-related experiences, health-related behaviors and health-related beliefs.
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Affiliation(s)
- António Duarte-de-Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal,
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal,
| | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal,
| | - Venceslau Hespanhol
- Department of Pneumology, Centro Hospitalar de S. João, Porto, Portugal
- Faculty of Medicine (FMUP), University of Porto, Porto, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal,
- Horizonte Family Health Unit, Matosinhos, Portugal
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Rodrigues M, Padrão E, Hespanhol V, Guimarães S. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia mimicking metastatic disease. Pulmonology 2018; 24:63-65. [PMID: 29589585 DOI: 10.1016/j.pulmoe.2017.12.001] [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: 10/11/2017] [Revised: 12/04/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- M Rodrigues
- Radiology, Centro Hospitalar de S. João, Porto, Portugal.
| | - E Padrão
- Pulmonology, Centro Hospitalar de S. João, Porto, Portugal
| | - V Hespanhol
- Pulmonology, Centro Hospitalar de S. João, Porto, Portugal
| | - S Guimarães
- Pathology, Centro Hospitalar de S. João, Porto, Portugal
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45
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Gouvinhas C, De Mello RA, Oliveira D, Castro-Lopes JM, Castelo-Branco P, Dos Santos RS, Hespanhol V, Pozza DH. Lung cancer: a brief review of epidemiology and screening. Future Oncol 2018; 14:567-575. [PMID: 29417838 DOI: 10.2217/fon-2017-0486] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The global burden of lung cancer has been increasing over the past years, and is still a major threat to public health worldwide, leading to disabilities and premature mortality. Despite multifactorial cause, smoking remains as the major etiological factor, followed by occupational exposure to carcinogens, genetic predisposition and other concomitant diseases. In order to reduce the individual and social burden due to the direct and indirect costs related to the lung cancer treatment, accurate methods of screening are needed. Among those, x-ray with cytological analysis of sputum was first proposed. Nowadays, more sensitive methods such as low-dose computed tomography are being used to improve the early detection. In the future, molecular biomarkers may complement low-dose computed tomography and improve the robustness of early lung cancer detection.
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Affiliation(s)
- Cláudia Gouvinhas
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ramon Andrade De Mello
- Department of Biomedical Sciences & Medicine, Oncology Division, University of Algarve, 8005-139 Faro, Portugal.,Algarve Biomedical Center, University of Algarve, 8005-139 Faro, Portugal.,Department of Medical Oncology, Haroldo Juaçaba Hospital, Ceará Cancer Institute, 60730-155 Fortaleza, CE, Brazil.,Translational Research Center, Haroldo Juaçaba Hospital, Ceará Cancer Institute, 60730-155 Fortaleza, CE, Brazil
| | - Daniela Oliveira
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | | | - Pedro Castelo-Branco
- Department of Biomedical Sciences & Medicine, Oncology Division, University of Algarve, 8005-139 Faro, Portugal.,Algarve Biomedical Center, University of Algarve, 8005-139 Faro, Portugal
| | - Ricardo Sales Dos Santos
- Department of Thoracic Surgery, Hospital Israelita Albert Einstein, 05652-900, São Paulo SP, Brazil
| | - Venceslau Hespanhol
- Departamento de Medicina Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.,Department of Pneumology, Centro Hospitalar de São João, 4200-319 Porto, Portugal
| | - Daniel Humberto Pozza
- Department of Biomedicine, Faculty of Medicine, Faculty of Food Sciences, & I3s, University of Porto, 4200-319 Porto, Portugal
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Aguiar F, Fernandes G, Queiroga H, Machado JC, Cirnes L, Souto Moura C, Hespanhol V. Overall Survival Analysis and Characterization of an EGFR Mutated Non-Small Cell Lung Cancer (NSCLC) Population. Arch Bronconeumol 2017; 54:10-17. [PMID: 29079040 DOI: 10.1016/j.arbres.2017.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 06/02/2017] [Revised: 07/09/2017] [Accepted: 07/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with activating somatic mutations in the Epidermal Growth Factor Receptor (EGFR) have better clinical outcomes when treated with Tyrosine Kinase Inhibitors (TKI) over chemotherapy. However, the impact of the use of TKIs on overall survival outside clinical trials is not well established. OBJECTIVE To characterize and analyze the overall survival of a Caucasian population with NSCLC and EGFR mutations. METHODS A retrospective cohort analysis of patients with NSCLC screened for EGFR mutations (exons 18-21) between October 2009 and July 2013 was conducted. Clinical and pathological characteristics, mutational EGFR status, treatment and overall survival were evaluated. RESULTS From the 285 patients which performed screening for EGFR mutations, 54 (18.9%) had mutations, 25 (46.3%) of which in exon 19 and 20 of which (37.0%) in exon 21. The occurrence of mutations was associated with female sex and non-smoking habits (both, P<.001). The median survival of the global population was 12.0 months, with a better overall survival in mutated than non-mutated patients (20.0 vs 11.0 months, respectively; P=.007). CONCLUSION These data contribute for a better knowledge of our lung cancer population concerning the mutational status and clinical outcomes, confirming a better overall survival for the patients with EGFR TKI sensible mutations.
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Affiliation(s)
| | - Gabriela Fernandes
- Pneumology Department, Centro Hospitalar de São João, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal
| | - Henrique Queiroga
- Pneumology Department, Centro Hospitalar de São João, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal
| | - José Carlos Machado
- Faculdade de Medicina da Universidade do Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | - Luís Cirnes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | | | - Venceslau Hespanhol
- Pneumology Department, Centro Hospitalar de São João, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal
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Duarte-de-Araújo A, Teixeira P, Figueiredo M, Hespanhol V, Correia-de-Sousa J. Understanding patient adherence to inhaled medication: The social representations of COPD. Rev Port Pneumol (2006) 2017; 23:358-359. [PMID: 28993104 DOI: 10.1016/j.rppnen.2017.07.008] [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: 04/19/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- A Duarte-de-Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Respiratory Department, H. Sª Oliveira, Guimarães, Portugal.
| | - P Teixeira
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - M Figueiredo
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal
| | - V Hespanhol
- Department of Pneumology, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine (FMUP), University of Porto, Portugal
| | - J Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Horizonte Family Health Unit, Matosinhos, Portugal
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Jacob M, Santos V, Magalhães A, Morais A, Queiroga H, Costa JL, Cyrnes L, Souto Moura C, Machado JC, Hespanhol V, Fernandes G, Boaventura R. T790M-mutation in EGFR progressive non-small cell lung cancer, role of re-biopsy and ctDNA analysis. Lung Cancer 2017. [DOI: 10.1183/1393003.congress-2017.pa2044] [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: 11/05/2022]
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49
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Meira L, Boaventura R, Araújo D, Cardoso V, Santos V, Morais A, Fernandes G, Magalhães A, Queiroga H, Hespanhol V. Advanced lung cancer – does BMI matter? Lung Cancer 2017. [DOI: 10.1183/1393003.congress-2017.pa4240] [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: 11/05/2022]
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50
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Meira L, Boaventura R, Araújo D, Santos V, Cardoso V, Morais A, Fernandes G, Magalhães A, Queiroga H, Hespanhol V. Metastatic disease in non-small cell lung cancer: is it all the same? Lung Cancer 2017. [DOI: 10.1183/1393003.congress-2017.pa4268] [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: 11/05/2022]
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