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Perfil epidemiológico y molecular de pacientes con cáncer de pulmón en un centro oncológicoreferencialdeLima,Perú
No full textBackground: According to GLOBOCAN estimates, in 2020, lung cancer was the second most frequent cancer and epidemiological information is needed in Latin American countries. The objective w a s t o d e s c r i b e t h e e p i d e m i o l o g i c a l a n d m o l e c u l a r characteristics of lung cancer patients from a referral clinic in Lima, Peru. Material and methods: A retrospective cohort study was conducted to characterize the epidemiological and molecular profile of lung cancer patients attended at a referral cancer center in Peru during 2018 to 2021. Variables such as age, sex, histology, staging and mutation were reported. In the descriptive analysis, frequencies and percentages were shown for categorical variables. For numerical variables, the best measure of central tendency and dispersion was reported. Results: A total of 225 patients with a diagnosis of lung cancer were observed. EGFR gene mutation was the most frequently detected (45.3%); and within them exon 19 deletion (55.7%). The most frequent histological type was adenocarcinoma with 180 patients (85.7%). Of the total number of patients with EGFR mutation, 77.8% received treatment with a tyrosine kinase inhibitor (osimertinib, erlotinib, afatinib) and 15.9% received immunotherapy (pembrolizumab, atezolizumab, nivolumab). Conclusions: The predominant mutation was EGFR, the most frequent histologic type was adenocarcinoma and most patients received treatment with a tyrosine kinase inhibitor. © 2023 Medical Body of the Almanzor Aguinaga Asenjo National Hospital. All rights reserved
Epidemiological Features and Outcomes of HTLV-1 Carriers Diagnosed with Cancer: A Retrospective Cohort Study in an Endemic Country
No full textPURPOSEHuman T-lymphotropic virus type 1 (HTLV-1) is an endemic virus in Latin America that is directly linked to adult T-cell leukemia/lymphoma (ATL). Previous studies have suggested an oncogenic role of HTLV-1 in non-ATL neoplasms and have found higher mortality in HTLV-1 carriers without ATL.METHODSIn this retrospective cohort study, HTLV-1 carriers were identified through screening at a tertiary cancer center between 2006 and 2019. We compared the overall survival (OS) outcomes of patients with ATL with those with other solid or hematologic malignancies by sex stratification.RESULTSWe identified 1,934 HTLV-1 carriers diagnosed with cancer. The median age at diagnosis was 62 (range 20-114) years, 76% were female, 60% had no or elementary school education, and 50% were born in the Andean highlands. The most common non-ATL neoplasm was cervical cancer (50%) among females and non-ATL non-Hodgkin lymphoma (26%) among males. With a median follow-up of 66 months, the 5-year OS of HTLV-1 carriers with non-ATL neoplasms (26%-47% for females and 22%-34% for males) was inferior to those reported in the general population. As expected, patients with ATL had a worse prognosis (5-year OS: 10% for females and 8% for males).CONCLUSIONHTLV-1 carriers with cancer were middle age and from underprivileged settings, suggesting an undetected transmission among vulnerable populations, especially females. Survival estimates of HTLV-1 carriers with non-ATL neoplasms were lower than the regional outcomes. Future research should ascertain how the biology of HTLV-1 and health care disparities affect the outcomes of HTLV-1 carriers, as well as determine the burden of HTLV-1 infection in the cancer population to recommend screening in the outpatient setting of endemic regions
Enfermedad de Paget extramamario primario de vulva concurrente con Lesión intraepitelial escamosa vulvar: reporte de caso
No full textExtramammary Paget's disease and intraepithelial vulvar neoplasia are common lesions in the vulva. However, their simultaneous occurrence is extremely rare. We present the case of a 77 year-old woman who presented with a 16 month history of pruritus and a rash in the vulvar region with gradually increasing bleeding. She underwent a right hemivulvectomy and a left simple vulvectomy. The histopathology revealed a coexistence of both Paget's disease and high grade intraepithelial vulvar neoplasia
The COVID-19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in resource-limited hospitals
No full textBackground: The COVID-19 pandemic impacted healthcare delivery worldwide, including pediatric cancer care, with a disproportionate effect in resource-limited settings. This study evaluates its impact on existing quality improvement (QI) programs. Methods: We conducted 71 semi-structured interviews of key stakeholders at five resource-limited pediatric oncology centers participating in a collaborative to implement Pediatric Early Warning System (PEWS). Interviews were conducted virtually using a structured interview guide, recorded, transcribed, and translated into English. Two coders developed a codebook of a priori and inductive codes and independently coded all transcripts, achieving a kappa of 0.8–0.9. Thematic analysis explored the impact of the pandemic on PEWS. Results: All hospitals reported limitations in material resources, reduction in staffing, and impacts on patient care due to the pandemic. However, the impact on PEWS varied across centers. Identified factors that promoted or limited ongoing PEWS use included the availability of material resources needed for PEWS, staff turnover, PEWS training for staff, and the willingness of staff and hospital leaders to prioritize PEWS. Consequently, some hospitals were able to sustain PEWS; others halted or reduced PEWS use to prioritize other work. Similarly, the pandemic delayed plans at all hospitals to expand PEWS to other units. Several participants were hopeful for future expansion of PEWS post-pandemic. Conclusion: The COVID-19 pandemic created challenges for sustainability and scale of PEWS, an ongoing QI program, in these resource-limited pediatric oncology centers. Several factors mitigated these challenges and promoted ongoing PEWS use. These results can guide strategies to sustain effective QI interventions during future health crises
Patients Age 40 Years and Younger with Multiple Myeloma Have the Same Prognosis as Older Patients: An Analysis of Real-World Patients' Evidence from Latin America
No full textPURPOSEMultiple myeloma (MM) is a highly heterogeneous, incurable disease most frequently diagnosed in the elderly. Therefore, data on clinical characteristics and outcomes in the very young population are scarce.PATIENTS AND METHODSWe analyzed clinical characteristics, response to treatment, and survival in 103 patients with newly diagnosed MM age 40 years or younger compared with 256 patients age 41-50 years and 957 patients age 51 years or older.RESULTSThere were no statistical differences in sex, isotype, International Scoring System, renal involvement, hypercalcemia, anemia, dialysis, bony lesions, extramedullary disease, and lactate dehydrogenase (LDH). The most used regimen in young patients was cyclophosphamide, bortezomib, dexamethasone, followed by cyclophosphamide, thalidomide, dexamethasone and bortezomib, thalidomide, dexamethasone. Of the patients age 40 years or younger, only 53% received autologous stem-cell transplant (ASCT) and 71.1% received maintenance. There were no differences in overall survival (OS) in the three patient cohorts. In the multivariate analysis, only high LDH, high cytogenetic risk, and ASCT were statistically associated with survival.CONCLUSIONIn conclusion, younger patients with MM in Latin America have similar clinical characteristics, responses, and OS compared with the elderly. © American Society of Clinical Oncology
On the risk of further excluding outcast patient populations in South America
No full textIt is with great interest that we read the article by Farah and colleagues on the epidemiological transition at work regarding risk factors for hepatocellular carcinoma (HCC) in South America [1]. In this study, the authors compiled data from 339 patients seen between 2019 and 2021 in six countries of the region, with Peruvian patients accounting for the most significant proportion, i.e., 125 HCC cases (37%) collected at one general services hospital
Prognostic factors in Latin American patients with localized and advanced renal cell carcinoma: a literature review
No full textBackground and Objective: Some countries in Latin America (LA) may have the greatest increase in the incidence of renal cell carcinoma (RCC) in both sexes in the coming decades, according to some projections. Increasing efforts to study prognostic factors related to RCC may shorten the regional discrepancies, particularly in the scenario of scarce literature in LA, in comparison to Europe or North America. The evaluation of RCC prognosis allows a greater capacity to anticipate outcomes, in addition to a better understanding of tumor biology and the orientation of the proposed treatment. Herein, we provide a review of the main prognostic factors described in different stages of the disease, considering the progress of publications on kidney cancer in LA. Methods: The PubMed database was used to identify studies on this theme, particularly those from LA. Studies by the Latin American Renal Cancer Group (LARCG) and the Latin American Cooperative Oncology Group (LACOG) were included. Key Content and Findings: Overall, tumor-related factors such as pathological stage, tumor size, nuclear grade, and histological subtype had the most important independent prognostic impact. Nevertheless, grouping these data with clinical, demographic, and biomolecular parameters can lead to a better prognosis analysis. Finally, the authors acknowledge the efforts of some nonprofit regional organizations in the activities and studies of RCC in different settings. Conclusions: Anatomical and histological prognostic factors for RCC have been widely studied for decades. In recent years, biomolecular factors have attracted considerable attention
Temporal Variation of Treatment Patterns and Survival Outcomes of Triple-Negative Breast Cancer Patients: A Real-World Experience From 2000 to 2014
No full textBackground: Previous studies have reported a higher prevalence of triple-negative breast cancer (TNBC) in US Hispanic/Latina populations. However, survival outcomes and treatment approaches over time in Latin American females are scarcely reported. We aimed to evaluate the temporal variation in treatment patterns and overall survival (OS) outcomes of females with TNBC according to cancer stage. Materials and Methods: We performed a single-center retrospective cohort study on 1840 females from 2000 to 2014. Patients were classified in 3 calendar periods (2000-2004, 2005-2009, and 2010-2014). The Kaplan-Meier method and multivariable regression analyses were employed. Results: Stage III cancer was identified in half of the population. Five-year OS estimates for cancer stages I, II, and IV remained unchanged across all calendar periods. However, we found worsening 5-year OS estimates in stage III females (49% in 2000-2004 and 31% in 2010-2014; P < .001). Despite increased uptake of overall use of neoadjuvant therapy in stage III females, the time from diagnosis to treatment initiation (P = .013) and time to complete the planned cycles (P < .001) increased over time. Fifty-sex percent of stage IV patients were untreated. Females aged ≥70 years were less likely to receive treatment. Conclusions: Survival estimates were lower than those reported in high-income countries. Most females were diagnosed with advanced disease, and the OS for stage III females worsened over time. Our outcomes show difficulties in delivering timely neoadjuvant therapy in an overwhelmed healthcare system. Public health authorities should improve screening practices, develop regional clinical guidelines, and expand trial enrollment
MILACC study: could undetected lymph node micrometastases have impacted recurrence rate in the LACC trial?
No full textObjective The etiology of inferior oncologic outcomes associated with minimally invasive surgery for early-stage cervical cancer remains unknown. Manipulation of lymph nodes with previously unrecognized low-volume disease might explain this finding. We re-analyzed lymph nodes by pathologic ultrastaging in node-negative patients who recurred in the LACC (Laparoscopic Approach to Cervical Cancer) trial. Methods Included patients were drawn from the LACC trial database, had negative lymph nodes on routine pathologic evaluation, and recurred to the abdomen and/or pelvis. Patients without recurrence or without available lymph node tissue were excluded. Paraffin tissue blocks and slides from all lymph nodes removed by lymphadenectomy were re-analyzed per standard ultrastaging protocol aimed at the detection of micrometastases (>0.2 mm and ≤2 mm) and isolated tumor cells (clusters up to 0.2 mm or <200 cells). Results The study included 20 patients with median age of 42 (range 30-68) years. Most patients were randomized to minimally invasive surgery (90%), had squamous cell carcinoma (65%), FIGO 2009 stage 1B1 (95%), grade 2 (60%) disease, had no adjuvant treatment (75%), and had a single site of recurrence (55%), most commonly at the vaginal cuff (45%). Only one patient had pelvic sidewall recurrence in the absence of other disease sites. The median number of lymph nodes analyzed per patient was 18.5 (range 4-32) for a total of 412 lymph nodes. A total of 621 series and 1242 slides were reviewed centrally by the ultrastaging protocol. No metastatic disease of any size was found in any lymph node. Conclusions There were no lymph node low-volume metastases among patients with initially negative lymph nodes who recurred in the LACC trial. Therefore, it is unlikely that manipulation of lymph nodes containing clinically undetected metastases is the underlying cause of the higher local recurrence risk in the minimally invasive arm of the LACC trial
The Helicobacter pylori Genome Project: insights into H. pylori population structure from analysis of a worldwide collection of complete genomes
No full textHelicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics