43 research outputs found
Prognostic Role of Primary Tumor Location in Non-Metastatic Gastric Cancer: A Systematic Review and Meta-Analysis of 50 Studies
No full textIntroduction. The incidence of gastric cancer (GC) arising in the upper third of the stomach, including the cardia or gastroesophageal junction (GEJ), has increased in the last decades due to established etiological risk factors such as diet, obesity, and gastroesophageal reflux. We conducted a systematic review and meta-analysis to determine the prognostic role of site of origin in patients with proximal versus distal GC. Material and Methods. We conducted a search of the PubMed, Cochrane Library, SCOPUS, Web of Science, EMBASE, Google Scholar, LILACS, and CINAHL databases from inception to September 2016. Studies reporting data on the independent prognostic effect of site in GC and comparing overall survival (OS) in proximal versus distal tumors were eligible. Data were pooled using OS hazard ratios (HRs) of proximal versus distal GC according to fixed- or random-effect model. Results. Overall, 50 studies including 128,268 patients were identified. Cancers located in the upper third of the stomach were associated with a significantly increased risk of all-cause mortality (HR 1.31, 95% confidence interval [CI] 1.17-1.46, p < 0.001, I (2) = 91%). After exclusion of GEJ tumors, prognosis was worse for pure cardia location (HR 1.39, 95% CI 1.22-1.58, p < 0.001, I (2) = 61%) compared with proximal or upper-third GCs without a specific subsite definition (HR 1.18, 95% CI 1.01-1.37, p = 0.04, I (2) = 91%). Conclusions. Location of the primary GC in the upper third of the stomach, particularly at the GEJ/cardia, should be acknowledged as an important prognostic factor. Based on these results, more effective treatment strategies for proximal GCs are needed
[Treatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity and mortality and short-term follow-up]
No full textTreatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity and mortality and short-term follow-u
Tumor regression grade and survival after neoadjuvant treatment in gastro-esophageal cancer: A meta-analysis of 17 published studies
No full textIntroduction: Major pathologic regression after neoadjuvant therapy is a strong and favorable prognostic factor in several types of cancer (breast, rectal and bladder). This information is less clear and has yet to be systematically evaluated in upper gastrointestinal tumors. We performed a meta-analysis to evaluate the prognostic impact of tumor regression after preoperative therapy on disease-free survival (DFS) and overall survival (OS) in gastro-esophageal cancer patients. Methods: we searched for relevant articles in PubMed, SCOPUS, Web of Science, CINAHL, LILACS, Ovid, Cochrane Library, Google Scholar and Embase up to June 2, 2016. Data of tumor regression (complete or near-complete pathologic response) that independently correlated with OS and DFS in multivariate analysis were extracted, and the proper hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs) were pooled according to the random effect model. Results: a total of 17 studies which included 3145 patients were considered in the final analysis. Major pathologic response was significantly related with better OS (HR 0.46, 95% CI 0.32-0.66, P < 0.001) and DFS (HR = 0.40, 95% CI 0.26-0.62, P < 0.001). Pathologic complete response (pCR) or major tumor regression were associated with the same degree of benefit in outcome compared to no or minimal pathologic regression, regardless of histology. Conclusion: major pathologic response is associated with a significant improvement in OS compared to no response or minor pathologic changes after neoadjuvant therapy in gastro-esophageal cancers. This should be considered a robust prognostic factor to guide postoperative treatment and follow-up
cAMP Response Element-Binding Protein Controls the Appearance of Neuron-Like Traits in Chorion Mesenchymal Cells
No full textMesenchymal stromal cells (MSC) from bone marrow have been reported to undergo the initial phases of neural differentiation in response to an increase of intracellular cAMP. We investigated the possibility that a similar effect applies to chorion-derived MSC
Prognostic value of diffuse versus intestinal histotype in patients with gastric cancer : a systematic review and meta-analysis
No full textBackground: There are two distinct types of gastric carcinoma (GC), intestinal, more frequently sporadic and linked to environmental factors, and diffuse (undifferentiated) that is highly metastatic and characterized by rapid disease progression and a poor prognosis. However, there are many conflicting data in the literature concerning the association between histology and prognosis in GC. This meta-analysis was performed to provide demonstration if histology according to Lauren classification is associated with different prognosis in patients with GC. Methods: We searched PubMed, the Cochrane Library, SCOPUS, Web of Science, CINAHL, and EMBASE for all eligible studies. The combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) in terms of overall survival (OS) were evaluated. Results: A total of 73 published studies including 61,468 patients with GC were included in this meta-analysis. Our analysis indicates that GC patients with diffuse-type histology have a worst prognosis than those with intestinal subgroup in all studies (HR 1.23; 95% CI, 1.17-1.29; P < 0.0001), in both loco-regional confined (HR 1.21; 95% CI, 1.12-1.30; P < 0.0001) and advanced disease (HR 1.25; 95% CI, 1.046-1.50; P=0.014), in Asiatic (HR 1.2; 95% CI, 1.14-1.27; P < 0.0001) and Western patients (HR 1.3; 95% CI, 1.19-1.41; P < 0.0001), and in those not exposed (HR 1.15; 95% CI, 1.07-1.24; P < 0.0001) or exposed (HR 1.27; 95% CI, 1.17-1.37; P < 0.0001) to (neo)adjuvant therapy. Conclusions: Our results indicated that histology might be a useful prognostic marker for both early and advanced GC patients, with intestinal-type associated with a better outcome. This information could be used for stratification purpose in future clinical trials
Sentinel node biopsy after neoadjuvant treatment in breast cancer : five-year follow-up of patients with clinically node-negative or node-positive disease before treatment
No full textPurpose: It is controversial whether sentinel node biopsy (SNB) without axillary dissection (AD) should be performed in cN1/2 breast cancer patients who become cN0 after neoadjuvant treatment, since the false negative rate (FNR) may be unacceptably high. We assessed outcomes to address this issue.
Methods: We retrospectively assessed 396 cT1-4, cN0/1/2 patients, who became or remained cN0 after neoadjuvant treatment and underwent SNB with at least one sentinel node (SN) found, and AD not performed if the SN was negative.
Results: After a median follow-up of 61 months (interquartile range 38-82), five-year overall survival was 90.7% (95%CI, 87.7-93.7) in the whole cohort, 93.3% (95%CI, 90.0-96.6) in those initially cN0, and 86.3% (95%CI, 80.6-92.1) in those initially cN1/2 (P = 0.12). Axillary failure occurred in only 1 (0.7%) initially cN1/2 patient who became cN0. In initially cN0 patients, and also initially cN1/2 patients who responded well to neoadjuvant treatment (ypT0/ypTx), SN-negativity was a significant predictor of good outcome, consistent with the known prognostic significance of axillary status, and suggesting that SN status accurately reflected axillary status. By contrast, in initially cN1/2 patients found to be ypT1/2/3, SN status (and whether or not AD was performed) had no influence on survival.
Conclusions: These findings suggest that SNB is acceptable in cN1/2 patients who become cN0 after neoadjuvant therapy
Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry
No full textGastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015–2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien–Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome
SCF-Fbxo42 promotes synaptonemal complex assembly by downregulating PP2A-B56
No full textMeiosis creates genetic diversity by recombination and segregation of chromosomes. The synaptonemal complex assembles during meiotic prophase I and assists faithful exchanges between homologous chromosomes, but how its assembly/disassembly is regulated remains to be understood. Here we report how two major post-translational modifications, phosphorylation and ubiquitination, co-operate to promote synaptonemal complex assembly. We found that the ubiquitin ligase complex SCF is important for assembly and maintenance of the synaptonemal complex in Drosophila female meiosis. This function of SCF is mediated by two substrate recognising F-box proteins, Slmb/βTrcp and Fbxo42. SCF-Fbxo42 downregulates the phosphatase subunit PP2A-B56, which is important for synaptonemal complex assembly and maintenance
Preoperative or perioperative docetaxel, oxaliplatin, and capecitabine (GASTRODOC regimen) in patients with locally-advanced resectable gastric cancer: A randomized phase-II trial
No full textDocetaxel associated with oxaliplatin and 5-fluorouracil (FLOT) has been reported as the best perioperative treatment for gastric cancer. However, there is still some debate about the most appropriate number and timing of chemotherapy cycles. In this randomized multicenter phase II study, patients with resectable gastric cancer were staged through laparoscopy and peritoneal lavage cytology, and randomly assigned (1:1) to either four cycles of neoadjuvant chemotherapy (arm A) or two preoperative + two postoperative cycles of docetaxel, oxaliplatin, and capecitabine (DOC) chemotherapy (arm B). The primary endpoint was to assess the percentage of patients receiving all the planned preoperative or perioperative chemotherapeutic cycles. Ninety-one patients were enrolled between September 2010 and August 2016. The treatment was well tolerated in both arms. Thirty-three (71.7%) and 24 (53.3%) patients completed the planned cycles in arms A and B, respectively (p = 0.066), reporting an odds ratio for early interruption of treatment of 0.45 (95% confidence interval (CI): 0.18–1.07). Resection was curative in 39 (88.6%) arm A patients and 35 (83.3%) arm B patients. Five-year progression-free survival (PFS) was 51.2% (95% CI: 34.2–65.8) in arm A and 40.3% (95% CI: 28.9–55.2) in arm B (p = 0.300). Five-year survival was 58.5% (95% CI: 41.3–72.2) and 53.9% (95% CI: 35.5–69.3) (p = 0.883) in arms A and B, respectively. The planned treatment was more frequently completed and was more active, albeit not significantly, in the neoadjuvant arm than in the perioperative group
Carta Geologica d'Italia, Foglio n°80 Riva del Garda
No full textIl Foglio 80-Riva del Garda copre un’area montuosa del Trentino sud-occidentale, ampia circa 573 km2, e trae il suo nome dal principale centro abitato della sponda N del lago di Garda. Esso occupa una posizione di spicco per la geologia delle coperture mesozoiche e terziarie delle Alpi meridionali centrali, al limite tra le successioni in facies lombarda e quelle venete dell’ “Alto di Trento” . Rilevanti sono anche le valenze ambientali delle aree del Foglio con le zone climatiche dell’alto Garda e gli alti rilievi a S del Gruppo di Brenta, compresi tra la valle del Sarca e la Val d’ Adige.
Il foglio è stato realizzato nell’ambito del Progetto CARG (legge n. 305/89) della Provincia Autonoma di Trento (PAT), sotto la direzione di Mario NARDIN, Luigi VERONESE e Saverio COCCO, responsabili del progetto in tempi successivi, ed è il frutto della proficua collaborazione di studiosi, rilevatori ed allievi delle Università di Bologna, Ferrara, Padova e di altre sedi.
Il rilievo geologico e gli studi connessi sono stati effettuati, unitamente a quelli del contiguo Foglio Tione, nelle estati 1992-98, dai rilevatori G. BOLLETTINARI, L. CANTELLI, A. CASTELLARIN, M.CLAPS, V.PICOTTI, L.TROMBETTA, riportati nel quadro d’unione a margine della carta, coordinati da ALBERTO CASTELLARIN (Università di Bologna) e dai direttori di rilevamento A. BOSELLINI E A. CASTELLARIN (substrato roccioso), A. CARTON, F. MANTOVANI, M. PANIZZA e Gb. PELLEGRINI (coperture quaternarie). Le analisi micro- e macro-paleontologiche sono state aggiornate da parte di A.CASTELLARIN, V. PICOTTI, E A. FERRRARI (Università di Bologna), con la collaborazione di R.BARBIERI (Univ. Di Bologna) per i Foraminiferi e di M. COBIANCHI (Università di Pavia) e di A.NEGRI (Università di Ancona) per il Nannoplancton del Giurassico e del Paleogene rispettivamente. I laureandi E. CASOLARI, G. PIFFER, D. STECCANELLA e C. FILIPPI hanno collaborato a rilievi e ricerche e tratto profitto da questa esperienza.
Il rilevamento è stato effettuato utilizzando, come base topografica, la Carta Tecnica Regionale (CTR) alla scala 1:10.000. La carta degli affioramenti, aggiornata e resa omogenea anche in base allo studio di numerose sezioni sottili, è stata trasferita sulle basi topografiche I.G.M. alla scala 1:25.000 ed informatizzata ad opera della PAT (responsabile: G. TOMMASI).
Tenuto conto delle caratteristiche geologiche, stratigrafiche e strutturali del foglio, il rilievo e la sua rappresentazione sono stati impostati nel modo seguente:
i) le successioni norico-giurassiche, espressione del rifting continentale che precede la nascita della Tetide alpina, sono rappresentative della complessa zona di contrapposizione tra le successioni della Piattaforma di Trento e quelle del Bacino Lombardo. Esse sono state suddivise in Gruppi di Formazioni, Formazioni, Membri e litofacies secondo le norme internazionali e le indicazioni riportate nei quaderni del SGN.
ii) Le successioni cenozoiche durante l’Eocene si sono sviluppate sotto il controllo di una vivace tettonica estensionale e in concomitanza di vulcanismo basaltico (settore orientale del Foglio) che è stato oggetto di attente osservazione che hanno consentito di aggiornare le interpretazioni e di suddividere le successioni vulcaniche secondo i criteri generali esposti nei quaderni del SGN.
iii) Le successioni plio-quaternarie sono state cartografate con particolare accuratezza, tenuto conto della loro rilevanza per il controllo e la tutela del territorio, ed interpretate anche con l’ausilio della foto- interpretazione. La realizzazione della cartografia del Quaternario ha richiesto un notevole impegno per l’applicazione delle norme emanate dal SGN, passando attraverso laboriose fasi di attività, talora defatiganti. Inizialmente la definizione delle unità era stata basata su criteri lito-morfo-genetici: furono così realizzate le carte delle sezioni alla scala 1:10.000. All’inizio del 2000 tale criterio non fu abbandonato, ma ..
