ABSTRACT Background: Ductal adenocarcinoma of the pancreas is among the most lethal neoplasms of the digestive tract. It is frequently diagnosed at advanced stages and associated with limited overall survival, even after surgical resection with curative intent. Although pathological staging is fundamental for prognostic stratification, patients with similar anatomical stages may have distinct clinical outcomes, suggesting that additional histopathological factors influence disease evolution. Aims: This study aimed to assess the prognostic impact of histopathological variables on the overall survival of patients with ductal adenocarcinoma of the pancreas who underwent surgical resection, with emphasis on lymph node involvement and angiolymphatic invasion. Methods: This observational, retrospective study included patients who underwent surgical resection for ductal adenocarcinoma of the pancreas at a tertiary hospital between 2017 and 2024. Clinical, anatomopathological, and therapeutic data were obtained by reviewing medical records and histopathological reports. Overall survival was estimated using the Kaplan-Meier method, and prognostic factors were analyzed using univariate and multivariate Cox regression models. Results: A total of 58 patients were included. Lymph node metastases were identified in approximately half of the cases, and angiolymphatic invasion was frequently observed. During follow-up, more than half of the patients died. The median overall survival was 19.63 months. In the univariate analysis, lymph node involvement, lymph node ratio, extranodal extension, and angiolymphatic invasion were associated with worse overall survival. In the multivariate analysis, lymph node status maintained an independent association with worse prognosis, with a progressive increase in risk according to nodal stage, as did angiolymphatic invasion. Conclusions: Lymph node involvement and angiolymphatic invasion are independent prognostic factors associated with worse overall survival in resected ductal adenocarcinoma of the pancreas. Systematic evaluation of these histopathological variables can support better prognostic stratification, helping individualize postoperative treatment.
ABSTRACT Background: Gastric cancer ranks fifth in global cancer incidence and fourth in mortality. In patients with gastric adenocarcinoma, perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin, and docetaxel, the FLOT regimen, constitutes the current therapeutic standard. Incorporating immune checkpoint inhibitors into perioperative schemes has emerged as a promising strategy, although its clinical and surgical impact requires critical appraisal in light of current evidence. Aims: To critically analyze contemporary scientific evidence on incorporating perioperative immunotherapy into resectable gastric adenocarcinoma management, evaluating its impact on oncologic outcomes, perioperative safety, and its role within current therapeutic algorithms. Methods: A critical narrative review through systematic searches in PubMed/MEDLINE, Embase, and Cochrane Library using relevant terms of the Medical Subject Headings (MeSH) thesaurus. Results: The MATTERHORN trial demonstrated that the addition of durvalumab to FLOT significantly improves event-free survival (hazard ratio 0.71; 95%CI 0.58–0.86; p<0.001) and overall survival (hazard ratio 0.78; 95%CI 0.63–0.96; p=0.021), with a pathological complete response rate of 19.2% versus 7.2%, without increased surgical morbidity or mortality. The KEYNOTE-585 trial demonstrated improved pathological complete response with pembrolizumab, without significant overall survival benefit. Microsatellite instability-high, human epidermal growth factor receptor 2, and programmed death ligand 1 biomarkers are key determinants in therapeutic selection. Perioperative immune-related adverse events require specific surveillance. Conclusions: Adding durvalumab to FLOT establishes a new perioperative standard with level I evidence. Preoperative molecular characterization is key to decision-making. Integrating immunotherapy does not compromise the feasibility of gastrectomy with extended second-level lymphadenectomy, but requires specific expertise to manage immune-related toxicities.
ABSTRACT Background: Colorectal cancer is a global health problem with high incidence and mortality rates, frequently diagnosed at metastatic stages. Mutations in the KRAS gene play a key role in colorectal cancer progression, significantly influencing treatment resistance and prognosis. Aims: This study investigated the association between clinicopathological characteristics and KRAS mutations in patients with metastatic colorectal cancer. Methods: This retrospective study evaluated medical records of patients with metastatic colorectal carcinoma who underwent KRAS gene mutation testing. A total of 96 patients treated in 2024 were included in the analysis. Results: KRAS mutations were identified in 63.54% of patients, predominantly in codon 12 (70.49%) and codon 13 (14.75%). No significant associations were found between KRAS mutation status and factors such as sex, age, or tumor location. Nevertheless, KRAS mutations were more frequently observed in patients with left-sided colon tumors, contrasting with the findings described in the literature. KRAS mutations were associated with poorer prognosis, higher rates of metastases (particularly to the liver), and higher rates of resistance to conventional treatments, such as chemotherapy. Conclusions: This study highlights the importance of KRAS mutation testing to support personalized, more effective treatment strategies to improve the prognosis of patients with metastatic colorectal cancer.
ABSTRACT Background: Roux-en-Y gastric bypass promotes weight loss in patients with severe obesity and improves type 2 diabetes mellitus, which, in some cases, can lead to remission. The action of enteric hormones is relevant for the initial outcomes and late disease evolution. Aims: To evaluate the influence of enteric hormone secretion on the evolution of type 2 diabetes mellitus three years after Roux-en-Y gastric bypass. Methods: A total of 20 patients were evaluated, divided into 2 groups: group 1, glycated hemoglobin<6%, and group 2, glycated hemoglobin≥6%. Hormone secretion (ghrelin, GLP-1, and GIP) was analyzed at pre-specified time points following a standard meal. Results: Group 1 had higher mean secretion at 30 and 120 minutes ([992.60±806.78 vs. 407.97±186.80, p=0.039, p<0.05] and [418.72±219.11 vs. 240.14±121.11, p=0.037, p<0.05], respectively) than group 2. Group 1 presented higher GLP values at 60 [724 (195–1,483) vs. 214 (67–424), p=0.038, p<0.05], 90 [473 (200–943) vs. 180 (120–318), p=0.016, p<0.05] and 120 minutes [565 (278–770) vs. 163 (81–339), p=0.008, p<0.05] compared to group 2. There was no difference between the groups regarding ghrelin. Conclusions: Higher secretion of GIP and GLP-1 was observed in patients with type 2 diabetes mellitus remission. The incretin factor is important in late disease evolution even in a group of patients with severe diabetes.
ABSTRACT Background: Colorectal cancer is the third most frequently diagnosed cancer worldwide. Colonoscopy is fundamental in reducing its incidence and mortality, provided it follows certain quality parameters. Examples of these quality parameters are the cecal intubation rate, adenoma detection rate (ADT), and the adequate percentage of patients with satisfactory bowel preparation. Aims: To measure the quality parameters of a colonoscopy service in Northeast Brazil. Methods: A cross-sectional, retrospective study, with data collected from electronic medical records, including screening colonoscopies between 2022 and 2024. Results: 565 colonoscopies were included in the study. The overall ADR was 24.78, 21.27% in women and 32.03% in men. The cecal intubation rate was approximately 95%, and most patients (91.3%) had excellent bowel preparation. The polyp detection rate was 39.47%. Conclusions: The cecal intubation rate and the proportion of patients with adequate bowel preparation were satisfactory. However, the polyp detection rate was lower than recommended in the literature. Thus, evaluating these parameters is a way to monitor the quality of colorectal cancer prevention, improving the strategies employed, even in the face of the limitations encountered.
