Combinatorial antiretroviral therapy provided improvement of HIV patients' immune function and a decrease in the incidence of non-Hodgkin lymphoma (NHL). Diffuse large B-cell lymphoma (DLBCL) is one ...of the most common NHL forms affecting HIV+ patients. The present study aimed to evaluate the impact of HIV infection on the prognosis of patients treated for DLBCL in a reference cancer treatment center in Brazil.
A retrospective case-control study was developed with patients followed-up at the Brazilian National Cancer Institute, in which 243 DLBCL patients (91 HIV+ and 152 HIV-) were enrolled. HIV- controls were matched to HIV+ according to date of cancer diagnosis, clinical staging, primary cancer treatment and date of birth. Sociodemographic and cancer treatment data were extracted from medical charts. Kaplan-Meier analyses were carried out to estimate survival, while univariate and multiple Cox regression analyses were used to determine factors associated with mortality.
A total of 98 deaths were observed in a 5-year period after cancer diagnosis. A negative association of HIV infection with both overall and disease-specific survival 1 year after cancer diagnosis was observed hazard ratio (HR) = 1.98 and 1.96, respectively. The negative association with HIV infection with disease-specific survival remained significant for a 5-year period after cancer diagnosis (HR = 1.53). HIV viral load above 1000 copies/ml at study entry was also associated with shorter overall and cancer-specific survival.
HIV infection negatively impacted prognosis and mortality of DLBCL patients irrespective of cancer-related clinical factors.
Abstract Objectives The aim of this study was to evaluate the 1-year survival of elderly patients with cancer and the association between undernutrition and mortality. Research methods & procedures: ...Cohort study with elderly patients ≥65 y admitted in the period from September to October 2014. A nutritionist performed a Mini Nutritional Assessment Short Form (MNA®-SF) for 48 h of hospital admission and collected data about potential confounding variables (comorbidities, stage of cancer, treatment in the past three months and reason for hospitalization). Vital status was determined from the medical records or public records office. Overall survival was estimated using the Kaplan–Meier method. Cox regression was performed to estimate unadjusted hazard ratios. Variables with p-values <0.20 by univariate analysis were selected for multivariate analysis. P-values <0.05 were considered statistically significant. Results Of the 136 patients (mean age, 73.1 years; 52.2% men), 29.4%, 41.2% and 29.4% were classified as normal, at risk of undernutrition and undernutrition, respectively, according to the MNA®-SF. The mortality rate was 31.6% after 12 months. One-year mortality was higher among the undernourished patients, followed by patients at risk of undernutrition. After adjustment for confounding variables, the multivariate regression Cox model showed that being undernourished according to the MNA®-SF increased the risk of death at 1 year (HR 5.59, 95% CI: 1.8 to 17.3; p <0.001). Conclusions The results show that the MNA®-SF can be useful in identifying elderly patients at higher risk of 1-year mortality.
The aim of this study was to evaluate psychometric properties of the Lymphedema Functioning, Disability and Health Questionnaire for lower limb lymphedema (Lymph-ICF-LL) in Brazilian patients with ...secondary lower limb lymphedema after cancer treatment.
A diagnostic test study was performed in 30 patients with lower limb lymphedema. To assess the reliability, the intraclass correlation coefficient (ICC) was analyzed through test-retest, Cronbach alpha coefficient, magnitude of intrasubject variability by standard error of measurement (SEM), and smallest real difference (SRD). To assess the face and content validity, a specific questionnaire was applied to assess the clarity of the scoring system and comprehensiveness of questions. To assess construct validity, correlations between the final Brazilian version of the Lymph ICF-LL and the quality of life questionnaire SF-36 (36-Item Short Form Health Survey Questionnaire) were analyzed. The ICCs and general internal consistency scores of Lymph-ICF-LL were high (ICCs >0.90 and the Cronbach alpha coefficient >0.90, respectively). Measurement variability between the tests was acceptable (SEM 5.9) with SRD of 16.4. Face and content validity were considered excellent by the patients as the scoring system was clear and questions were understandable for 97% and 90% of the patients, respectively. Construct validity was classified as good and all hypotheses for assessing convergent validity were accepted (medium to strong correlation, from -0.69 to -0.84).
The Brazilian version of the Lymph-ICF-LL is a reliable and valuable instrument for assessing Brazilian patients with secondary lower limb lymphedema associated with cancer treatment.
Anal residual tumors are consensually identified within six months of chemoradiotherapy and represent a persistent lesion that may have prognostic value for overall survival. The aim of this study ...was to evaluate the association of HPV and HIV status, p16 expression level and TP53 mutations with the absence of residual tumors (local response) in Squamous Cell Carcinoma (SCC) of the anal canal after chemoradiotherapy.
We performed a study on 78 patients with SCC of the anal canal who submitted to chemoradiotherapy and were followed for a six-month period to identify the absence or presence of residual tumors. HPV DNA was identified by polymerase chain reaction and direct sequencing, HIV RNA was detected by TaqMan amplification, p16 expression was detected by western blotting, and the mutational analysis of TP53 was performed by direct sequencing; additionally, samples carrying mutations underwent fluorescent in sit hybridization. The evaluation of the tumor response to treatment was conducted six months after the conclusion of chemoradiotherapy. The following classifications were used to evaluate the outcomes: a) no response (presence of residual tumor) and b) complete response (absence of residual tumor).
The significant variables associated with the absence of residual tumors were HPV positive, p16 overexpressed, wild-type TP53, female gender, and stages I and II. Only the presence of HPV was independently correlated with the clinical response; this variable increased the chances of a response within six months by 31-fold.
The presence of HPV in tumor cells was correlated with the absence of a residual tumor. This correlation is valuable and can direct future therapeutic approaches in the anal canal.
Papanicolaou test screening remains an effective approach for the control of cervical cancer. However, for successful control of the disease, patients need to have access to the test results and ...complete the treatment. The aim of this study was to investigate the factors associated with lack of access to results from the most recent Papanicolaou test in women living in the municipality of Rio de Janeiro who used the Brazilian Unified Health System. Overall prevalence of lack of access to test results was 18.4%. Access to test results was lower for younger women of Black race/skin color origin, those who had difficulties in making an appointment, those who received no information about when to pick up the test results, and those who evaluated the assistance provided by the health professional who collected the Papanicolaou test. Issues related to the organization and infrastructure of the health unit were the most frequently reported cause by the interviewees. The Brazilian Unified Health Service should improve its knowledge of users and service conditions to prevent interruption of the screening flow.
Deregulation of the MAPK genes signalling caused by somatic mutations have been implied in leukaemia pathogenesis, including RAS mutation (RASmut) in acute myeloid leukaemia (AML), which has been ...associated with intra-uterine chemical exposures. A case-case study was conducted in order to explore maternal and child exposures to tobacco smoking associations with early age leukaemia (EAL).
Covariables of reference were MLL rearrangements (MLL-r), RASmut and NQO1 rs1800566 (C609T). Samples from 150 acute lymphoblastic leukaemia (ALL) and 85 AML were included. Maternal exposures were assessed using a structured questionnaire with demographic, personal habits and residence history information. Restriction fragment length polymorphism and denaturing high performance liquid chromatography were used to screen FLT3, KRAS, and NRAS mutations; direct sequencing was performed to validate the results. NQO1 polymorphism was detected by real-time allelic discrimination technique.
Overall, RASmut were detected in 28.7% of EAL cases; BRAFmut was found only in one AML patient. Higher rate of KRASmut was found in ALL (30.3%) compared to AML (20.8%) with MLL-r; RASmut showed an association with second-hand tobacco smoking exposures (OR, 3.06, 95% CI, 1.03-9.07). A considerable increased risk for EAL with the combination of RASmut and NQO1 609CT (OR, 4.24, 95% CI, 1.24-14.50) was observed.
Our data demonstrated the increased risk association between maternal smoking and EAL with MLL-r. Additionally, suggests that children second-hand tobacco exposures are associated with increased risk of EAL with RASmut modulated by NQO1 rs1800566 (C609T).
To identify and assess predictors of short-term outcomes and a prolonged length of hospital stay after head and neck cancer surgery in older-old and oldest-old patients.
Patients aged ≥75 years with ...head and neck cancer undergoing surgery at the Brazilian National Cancer Institute from January to December 2011 were assessed regarding postoperative complications, mortality, and length of hospital stay.
Over the study period, 67 patients with head and neck cancer underwent surgery, 44.8% of whom developed complications within 30 days of surgery, surgical site and respiratory infections (29.9 and 20.9%, respectively) being the most common. The mean length of hospital stay was 7 days (range: 2-26). In multivariate analysis, previous radiotherapy, dependence in instrumental activities of daily living, and low serum hemoglobin (≤13.2 g/dl) were predictors of complications. In addition, the presence of at least 1 clinical or surgical complication, smoking, and an arm circumference ≤25 cm were independent predictors of a prolonged length of hospital stay.
Complications after head and neck cancer surgery in the elderly are common and related to the prolonged length of hospital stay, both being influenced by previous radiotherapy, smoking, functional dependence in instrumental activities of daily living, and nutritional conditions. Such predictors should be considered in a preoperative assessment of elderly patients as these are modifiable risk factors.
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