Tobacco or human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCC) represent different clinical and epidemiologic entities. This study investigated the prevalence of ...HPV-positive and HPV-negative OPSCC in a reference cancer hospital in Brazil and its association with clinical and demographic data, as well as its impact on overall survival.
HPV infection was determined by p16-IHC in pre-treatment formalin-fixed paraffin-embedded samples from all patients with OPSCC diagnosed at Barretos Cancer Hospital between 2008 and 2018. The prevalence of HPV-positive cases and its temporal trend was assessed, and the association of clinical and demographic data with HPV infection and the impact on patient overall survival was evaluated.
A total of 797 patients with OPSCC were included in the study. The prevalence of HPV-associated tumors in the period was 20.6% 95% confidence interval, 17.5-24.0 with a significant trend for increase of HPV-positive cases over the years (annual percentage change = 12.87). In a multivariate analysis, the variables gender, level of education, smoking, tumor sublocation, region of Brazil, and tumor staging had a significant impact in HPV positivity, and a greater overall survival (OS) was observed in HPV-positive patients (5-year OS: 47.9% vs. 22.0%;
= 0.0001).
This study represents the largest cohort of Brazilian patients with OPSCC characterized according to HPV status. We report significant differences in demographics and clinical presentation according to HPV status, and an increasing trend in prevalence for HPV-induced tumors.
These findings can potentially contribute to a better stratification and management of patients as well as assist in prevention strategies.
Gastropericardial fistula Marasca, Felipe André; Alves, Giordano Rafael Tronco; Pires, Rafael Cardoso ...
The Annals of thoracic surgery,
06/2013, Volume:
95, Issue:
6
Journal Article
Abstract
Introduction
The prevalence of oropharyngeal squamous cell carcinoma (OSCC) related to Human Papillomavirus (HPV) is rising in the whole world.
Objective
To access the prevalence and ...temporal trend of HPV infection in oropharyngeal cancer by analyzing the expression of the p16 protein.
Methods
We conducted a transversal study in a Brazilian reference oncology center. The sample consisted of 254 patients with OSCC. The analyzed period was from 2013 to 2017. All patients underwent p16 immunohistochemistry analysis.
Results
The overall prevalence of HPV-related OSCC was of 31.9%. During the analyzed period, we observed a trend of increasing rates of OSCC that marked positive for p16 immunohistochemistry. The annual prevalence of p16-positive cases was of 20.6% in 2013, 23.9% in 2014, 33.3% in 2015, 38.3% in 2016, and 34.2% in 2017. Most of the patients were stage III and IV (84%). Female patients (odds ratio OR = 2.43; 95% confidence interval CI: 1.003–5.888;
p
= 0.049) and younger patients (OR = 2.919; 95%CI: 1.682–5.067;
p
< 0.005) were associated with a higher risk of HPV-related OSCC. Tobacco consumption had a proportional lower risk of HPV-related OSCC (OR = 0.152; 95%CI: 0063–0.366;
p
< 0.005).
Conclusion
We observed an increasing prevalence of HPV-related OSCC in a specialized cancer hospital in Brazil.
Purpose
The use of tracheoesophageal prostheses has become the gold standard in vocal rehabilitation of patients undergoing total laryngectomy. However, this method also has limitations, such as the ...need for frequent replacement of prostheses due to leakage or other complications. We have designed a study to access the clinical profile of patients using tracheoesophageal prostheses as vocal rehabilitation after total laryngectomy and to determine the average rate of changes, as well as the main causes of prostheses replacement.
Methods
A retrospective cohort study was performed based on patients who underwent rehabilitation with voice prostheses after total laryngectomy between 2008 and 2017.
Results
The sample consisted of 93 patients and 432 vocal prostheses replacement events. The median change of prostheses per patient was 210.25 days, (range 57.33 to 651.50). The most frequent cause of prostheses replacement was leakage through the prostheses, 218 (50.46%). Lower level of education was associated to higher prostheses replacement rate.
Conclusion
The results of this study show that the median of prostheses durability is higher than that presented in the literature, the main cause of replacement was protheses leakage and that low educational level is associated to higher replacement rate.
Peptic ulcer etiology has been changing because of H. pylori decline.
To estimate peptic ulcer prevalence in 10 years-interval and compare the association with H. pylori and use of non-steroidal ...anti-inflammatory drugs. Methods Records assessment in two periods: A (1997-2000) and B (2007-2010), searching for peptic ulcer, H. pylori infection and non-steroidal anti-inflammatory drugs use.
Peptic ulcer occurred in 30.35% in A and in 20.19% in B. H. pylori infection occurred in 73.3% cases in A and in 46.4% in B. Non-steroidal anti-inflammatory drugs use was 3.5% in A and 13.3% in B. Neither condition occurred in 10.4% and 20.5% in A and B respectively. Comparing both periods, we observed reduction of peptic ulcer associated to H. pylori (P=0.000), increase of peptic ulcer related to non-steroidal anti-inflammatory drugs (P=0.000) and idiopathic peptic ulcer (P=0.002). The concurrent association of H. pylori and non-steroidal anti-inflammatory drugs was also higher in B (P=0.002). Rates of gastric ulcer were higher and duodenal ulcer lower in the second period.
After 10 years, the prevalence of peptic ulcer decreased, as well as ulcers related to H. pylori whereas ulcers associated to non-steroidal anti-inflammatory drugs increased. There was an inversion in the pattern of gastric and duodenal ulcer and a rise of idiopathic peptic ulcer.
BACKGROUND: Percutaneous endoscopic gastrostomy performed as proposed by Gauderer et al. in 1980, has been used quite frequently in patients with head and neck tumors. Some authors believe that this ...so-called pull technique would be associated to the risk of a tumor implantation in the wound as well as high levels of peristomal wound infection. Although some alternative techniques provide better results, doubts about their technical applicability in daily practice still persists. AIM: To assess the feasibility, safety and morbidity of percutaneous endoscopic gastrostomy performed through a well-defined and standardized technique in patients with nonresectable or advanced head and neck cancer. METHODS: A consecutive series of patients who had either nonresectable or advanced tumors and were unable to be fed orally were submitted to an oncologic-hospital-based tertiary-referral endoscopy practice. Tubes were implanted through an introducer technique comprised of two main stages. The first consisted of the application of two stitches aiming to fixate the anterior gastric wall to the abdominal wall, and the second being the inserting of the gastrostomy tube. RESULTS: Between February 2003 and May 2004, 129 percutaneous endoscopic gastrostomies were performed. This study included 60 patients. They were all able to receive food on the same day. Operative morbidity was observed in six patients (10%) and one procedure-related mortality was also observed (1.6%). CONCLUSION: Percutaneous endoscopic gastrostomy is both feasible and safe, associated to low morbidity, and to acceptable mortality rates.
RACIONAL: A gastrostomia endoscópica percutânea executada conforme a técnica proposta por Gauderer et al., em 1980, tem sido freqüentemente utilizada em pacientes com tumores de cabeça e pescoço. Diversos autores relatam que ela, conhecida como técnica de “puxar”, está associada a risco de implante de tumor na parede abdominal assim como risco bastante elevado de infecção na ferida operatória. Algumas variantes técnicas proporcionam melhores resultados, contudo existem dúvidas acerca da sua viabilidade técnica na prática diária. OBJETIVO: Verificar a exeqüibilidade, segurança e morbidade da gastrostomia endoscópica percutânea realizada por técnica padronizada e bem definida em pacientes com tumores avançados ou irressecáveis da cabeça e pescoço. MÉTODO: É descrita série consecutiva de pacientes com tumores avançados ou irressecáveis de cabeça e pescoço, incapazes de receber dieta por via oral, submetidos à gastrostomia endoscópica percutânea no setor de endoscopia digestiva de um hospital oncológico de referência terciária. As sondas foram implantadas pela técnica de punção compreendida de duas etapas principais. A primeira, consistiu na aplicação de dois pontos transfixantes com o propósito de fixar a parede anterior do estômago à parede abdominal. A segunda, introdução do tubo de gastrostomia por punção percutânea. RESULTADOS: Foram realizadas 129 gastrostomias endoscópicas percutâneas e incluiu 60 pacientes. Todos foram liberados para receber dieta no mesmo dia. Morbidade operatória ocorreu em seis pacientes (10%) e mortalidade relacionada ao procedimento foi verificada em um paciente (1,6%). CONCLUSÃO: A gastrostomia endoscópica percutânea é exeqüível e segura, além de estar associada à baixa morbidade e aceitável mortalidade.
BACKGROUND: Percutaneous endoscopic gastrostomy performed as proposed by Gauderer et al. in 1980, has been used quite frequently in patients with head and neck tumors. Some authors believe that this ...so-called pull technique would be associated to the risk of a tumor implantation in the wound as well as high levels of peristomal wound infection. Although some alternative techniques provide better results, doubts about their technical applicability in daily practice still persists. AIM: To assess the feasibility, safety and morbidity of percutaneous endoscopic gastrostomy performed through a well-defined and standardized technique in patients with nonresectable or advanced head and neck cancer. METHODS: A consecutive series of patients who had either nonresectable or advanced tumors and were unable to be fed orally were submitted to an oncologic-hospital-based tertiary-referral endoscopy practice. Tubes were implanted through an introducer technique comprised of two main stages. The first consisted of the application of two stitches aiming to fixate the anterior gastric wall to the abdominal wall, and the second being the inserting of the gastrostomy tube. RESULTS: Between February 2003 and May 2004, 129 percutaneous endoscopic gastrostomies were performed. This study included 60 patients. They were all able to receive food on the same day. Operative morbidity was observed in six patients (10%) and one procedure-related mortality was also observed (1.6%). CONCLUSION: Percutaneous endoscopic gastrostomy is both feasible and safe, associated to low morbidity, and to acceptable mortality rates.RACIONAL: A gastrostomia endoscópica percutânea executada conforme a técnica proposta por Gauderer et al., em 1980, tem sido freqüentemente utilizada em pacientes com tumores de cabeça e pescoço. Diversos autores relatam que ela, conhecida como técnica de “puxar”, está associada a risco de implante de tumor na parede abdominal assim como risco bastante elevado de infecção na ferida operatória. Algumas variantes técnicas proporcionam melhores resultados, contudo existem dúvidas acerca da sua viabilidade técnica na prática diária. OBJETIVO: Verificar a exeqüibilidade, segurança e morbidade da gastrostomia endoscópica percutânea realizada por técnica padronizada e bem definida em pacientes com tumores avançados ou irressecáveis da cabeça e pescoço. MÉTODO: É descrita série consecutiva de pacientes com tumores avançados ou irressecáveis de cabeça e pescoço, incapazes de receber dieta por via oral, submetidos à gastrostomia endoscópica percutânea no setor de endoscopia digestiva de um hospital oncológico de referência terciária. As sondas foram implantadas pela técnica de punção compreendida de duas etapas principais. A primeira, consistiu na aplicação de dois pontos transfixantes com o propósito de fixar a parede anterior do estômago à parede abdominal. A segunda, introdução do tubo de gastrostomia por punção percutânea. RESULTADOS: Foram realizadas 129 gastrostomias endoscópicas percutâneas e incluiu 60 pacientes. Todos foram liberados para receber dieta no mesmo dia. Morbidade operatória ocorreu em seis pacientes (10%) e mortalidade relacionada ao procedimento foi verificada em um paciente (1,6%). CONCLUSÃO: A gastrostomia endoscópica percutânea é exeqüível e segura, além de estar associada à baixa morbidade e aceitável mortalidade.
•RRP is a rare and chronic HPV-related disease affecting the respiratory tract.•RRP pulmonary spread can progress to lung carcinoma, even associated to low risk HPV.•Pembrolizumab showed benefit in ...oncology treatment.•Clinical and treatment course were described to add information on RRP progression.
Neoplasms induced by human papillomavirus (HPV) infection are generally associated to high-risk HPV types. Recurrent respiratory papillomatosis (RRP) is a rare and chronic HPV-related disease characterized by papillomatous lesions in the respiratory tract, usually affecting larynx. RRP rarely comprises malignant transformation since the low-risk HPV-6 and/or HPV-11 are the most commonly found in the disease. We described a case of one adult-onset RRP (29-year-old, female) with HPV-6 infection affecting vocal folds and extra-laryngeal sites. Computed tomographic scan of the chest revealed papillomatosis with pulmonary spread showing multiple nodules and cavities. Lung involvement later progressed to squamous cell carcinoma of the lung. Patient’s pregnancy during investigations may have accelerated lung carcinoma development due to immunological changes. Immunohistochemistry revealed PD-L1 high expression in tumor biopsy and, after pregnancy, the oncology treatment included a combination of pembrolizumab (PD-L1 inhibitor) to chemotherapy and also radiotherapy, showing considerable results. Patient died due to lung cancer complications 15 months after cancer diagnosis. RRP management associated with lung involvement and poor prognostic outcome, such as lung carcinoma, is still a big challenge. In this report, we described the clinical and treatment course of RRP progression to highlight the need for attention to future patients.
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