ABSTRACT BACKGROUND Colorectal cancer (CRC) is a worldwide health problem whose control depends on public policy establishment and effective prevention and screening programs. In Brazil, there are few studies related to adherence to screening methods. AIMS: The aim of this study was to evaluate the association between demographic and socioeconomic to adherence to CRC screening with fecal immunochemical test (FIT) among average-risk individuals for CRC. METHODS: In this prospective cross-sectional study, conducted between March 2015 and April 2016, 1,254 asymptomatic individuals aged 50–75 years, participating in a hospital screening campaign in Brazil, were invited to participate in the study. RESULTS: The adherence rate to FIT was 55.6% (697/1,254). In the multivariable logistic regression analysis, patients aged 60–75 years (odds ratio (OR)=1.30; 95% confidence interval (CI): 1.02–1.66; p=0.03), religious belief (OR=2.04; 95% CI: 1.34–3.11; p<0.01), previous fecal occult blood test (OR=2.07; 95% CI: 1.55–2.76; p<0.01), and full/part-time working status (OR=0.66; 95% CI: 0.49–0.89; p<0.01) were independently associated with adherence to CRC screening. CONCLUSION: The results of the present study highlight the importance of considering the labor aspects when implementing screening programs, suggesting that campaigns conducted in the workplace and repeated over the years may be more effective.

RESUMO RACIONAL: O câncer colorretal (CCR) é um problema de saúde mundial cujo controle depende do estabelecimento de políticas públicas e programas de prevenção e rastreamento eficazes. No Brasil existem poucos estudos relacionados à adesão métodos de rastreamento. OBJETIVO: Avaliar a associação de características sócio-demográficas à realização de testes de sangue oculto nas fezes do tipo imunoquimicomecanizado (FIM) em população de médio risco para o desenvolvimento de câncer colorretal. MÉTODOS: Estudo observacional transversal, com coleta prospectiva de dados. Entre março de 2015 e abril de 2016, 1.254 indivíduos assintomáticos, com idade entre 50 e 75 anos, foram consecutivamente selecionados a partir de uma campanha hospitalar de rastreamento para neoplasias. RESULTADOS: As taxas de adesão ao teste FIM foi 55.6% (697/1254). Na análise de regressão logística múltipla os fatores independentes associados à adesão ao rastreamento do CCR foram: Idade entre 60–75 anos (oddsratio (OR)=1.30; intervalo de confiança de 95% (IC): 1.02–1.66; p=0.03), crença religiosa (OR=2.04; 95%IC: 1.34–3.11; p<0.01), realização prévia de exame de sangue oculto nas fezes (OR=2.07; 95%IC: 1.55–2.76; p<0.01) e vínculo empregatício em período integral ou parcial (OR=0.66; 95%IC: 0.49–0.89; p<0.01). CONCLUSÃO: Este estudo enfatiza a importância de considerar aspectos laborais ao implementar programas de rastreamento do câncer colorretal e sugere que campanhas de rastreamento implantadas no ambiente de trabalho e de maneira repetida ao longo dos anos podem ser mais efetivas.

ABSTRACT Purpose: Incidence and mortality of prostate cancer (PCa) are still increasing in developing countries. Limited access to the health system or more aggressive disease are potential reasons for this. Ethnic and social differences in developed countries seem to make inappropriate to extrapolate data from other centers. We aim to report the epidemiological profile of a PSA-screened population from a cancer center in Brazil. Materials and Methods: We retrospectively selected 9.692 men enrolled in a PCa prevention program, comprising total PSA level and digital rectal examination at the first appointment, associated with complementary tests when necessary. Men aged over 40 years-old were included after shared decision-making process. Prostate biopsy (TRUS) was performed when clinically suspected for PCa. After the diagnosis, patients underwent appropriate treatment. Results: TRUS was performed in 5.5% of men and PCa incidence was 2.6%. Overall ratio between number of patients who needed to be screened in order to diagnose one cancer was 38.9 patients, with 2.1 biopsies performed to diagnose a cancer. Positive predictive value (PPV) of TRUS biopsy in this strategy was 47.2%, varying from 38.5% (<50 years-old) to 60% (>80 years-old). We evidenced 70 patients (27.9%) classified as low risk tumors, 74 (29.5%) as intermediate risk, and 107 (42.6%) as high-risk disease. Conclusions: PSA-screening remains controversial in literature. In front of a huge miscegenated people and considering the big proportion of high-risk PCa, even in young men diagnosed with the disease, it is imperative to inform patients and health providers about these data particularities in Brazil.

RESUMO Objetivo: avaliar diferenças clínicas e patológicas entre os adenocarcinomas colônicos localmente avançados com aderências entre órgãos ou estruturas adjacentes (LACA) e adenocarcinomas colônicos com outras apresentações clínicas. Métodos: estudo retrospectivo a partir de amostra de conveniência de pacientes com adenocarcinoma colônico, estádio patológico pT3, distribuídos de acordo com características clínicas e patológicas em três grupos: tumores localmente avançados (LACA), tumores pT3 sem aderências ou metástases à distância (SF), e tumores com doença metastática (M1). Foram avaliadas as características clínicas e patológicas, e a expressão de sete marcadores imuno-histoquímicos relacionados à proliferação/apoptose, invasão celular/migração e metástase. Resultados: foram avaliados 101 pacientes: 30 LACA, 44 SF e 27 M1. Tumores localmente avançados apresentaram dimensões maiores e estiveram associados a aumento das taxas de infiltração linfocitária, menores níveis de expressão de bax e de CD 44v6 quando comparados aos grupos SF e M1. Diferenças significantes foram observadas em relação aos LACA e M1 em relação à localização colônica, histologia, estado linfonodal e expressão bax e CD44v6. Diferenças foram observadas em relação aos três grupos frente ao tamanho do tumor e infiltrado linfocítico. A sobrevida foi similar entre os grupos LACA e SF (p=0,66) e foi inferior no grupo M1 (p<0,001). Conclusão: os dados sugerem que os adenocarcinomas colônicos localmente avançados com aderências entre órgãos ou estruturas adjacentes representam uma entidade distinta.

ABSTRACT Objective: to evaluate the clinical and pathological differences between locally advanced colonic adenocarcinomas (LACA) with adhesions between adjacent organs or structures, and colonic adenocarcinomas with other clinical presentations. Methods: we conducted a retrospective study from a convenience sample of patients with colonic adenocarcinoma, pathological stage pT3, distributed according to clinical and pathological characteristics in three groups: locally advanced tumors (LACA), pT3 tumors without adhesions or distant metastases (SF) and tumors with metastatic disease (M1). We evaluated clinical and pathological characteristics and the expression of seven immunohistochemical markers related to proliferation/apoptosis, cell invasion/migration and metastasis. Results: we studied 101 patients: 30 LACA, 44 SF and 27 M1. Locally advanced tumors presented larger dimensions and were associated with increased lymphocyte infiltration rates, lower levels of bax expression, and CD 44v6 when compared with SF and M1 groups. We observed significant differences between LACA and M1 in relation to colonic location, histology, lymph node status and bax and CD44v6 expression. We found differences were observed between the three groups for tumor size and lymphocytic infiltrate. Survival was similar in the LACA and SF groups (p=0.66) and was lower in the M1 group (p<0.001). Conclusion: the data suggest that locally advanced colonic adenocarcinomas with adhesions between adjacent organs or structures represent a distinct entity.

RESUMO A cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica emergiu como um importante tratamento das neoplasias peritoneais e é, atualmente, o padrão de atendimento para neoplasias epiteliais do apêndice associadas à síndrome de pseudomixoma peritoneal, bem como para o mesotelioma peritoneal maligno difuso. No mundo, existem algumas variações reconhecidas das técnicas de cirurgia citorredutora e quimioterapia intraperitoneal hipertérmica, entretanto nenhuma técnica até agora demonstrou sua superioridade sobre o outra. Portanto, a padronização destes procedimentos poderia melhorar a prática clínica e permitir a comparação adequada entre os resultados. Neste cenário, a Sociedade Brasileira de Cirurgia Oncológica considera importante a apresentação de uma proposta de padronização de procedimentos de cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica no Brasil, com um foco especial na produção de dados homogêneos para o desenvolvimento do registro brasileiro das neoplasias peritoneais.

ABSTRACT Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.

INTRODUÇÃO: Polipose adenomatosa familiar (PAF), uma doença autossômica dominante caracterizada pela formação de numerosos pólipos adenomatosos no cólon e reto, é causada por mutações da linha germinativa no gene da polipose adenomatosa do cólon (PAC). MÉTODOS: Para determinar a morbidade cirúrgica em pacientes com PAF clássica e determinar a incidência de câncer colorretal (CCR) metacrônico naqueles pacientes submetidos à colectomia total (CT) com anastomose íleo-retal ou submetidos à proctocolectomia restaurativa (PCT) e anastomose bolsa ileal-anal, foram analisados pacientes com PAF que foram tratados e tiveram acompanhamento periódico no A. C. Camargo Cancer Center de 1994 até 2013. RESULTADOS: Ocorreram complicações cirúrgicas em 22 pacientes (34,3%); 16 (25%) tiveram complicações precoces e 8 (12,5%) complicações tardias. Não houve mortes como resultado de complicações pós-operatórias. A incidência de câncer de reto metacrônico após PCT foi de 2,3% e após CT foi de 18,18% (p = 0,044). CONCLUSÕES: A fim de proporcionar melhor qualidade de vida para os pacientes com PAF, CT é comumente oferecida, pois esta técnica simples está tradicionalmente associada com menores percentuais de complicações pós-operatórias e melhores resultados funcionais. No entanto, CT se tornou uma técnica menos atraente em pacientes com PAF em sua forma clássica ou difusa, uma vez que traz consigo uma probabilidade significativamente maior de câncer retal metacrônico.

INTRODUCTION: Familial adenomatous polyposis (FAP), an autosomal dominant disease characterized by development of numerous adenomatous polyps in the colon and rectum, is caused by germline mutations in the Adenomatous Polyposis Coli (APC) gene. METHODS: To determine the surgical morbidity in patients with classical familial adenomatous polyposis and determine the incidence of metachronous colorectal cancer (CRC) in those undergoing total colectomy (TC) with ileorectal anastomosis or restorative total proctocolectomy (TPC) and ileal pouch anal anastomosis. We analyzed patients with familial adenomatous polyposis who received treatment and regular follow-up at the A.C. Camargo Cancer Center from 1994 to 2013. RESULTS: Operative complications occurred in 22 patients (34.3%), 16 (25%) being early complications and 8 (12.5%) late complications. No mortality occurred as a result of postoperative complications. The incidence of metachronous rectal cancer after total proctocolectomy was 2.3% and after total colectomy 18.18% (p = 0.044). CONCLUSIONS: In order to provide better quality of life for individuals with familial adenomatous polyposis, total colectomy is commonly offered, as this simple technique is traditionally associated with lower rates of postoperative complications and better functional outcomes. However, it has become a less attractive technique in patients with familial adenomatous polyposis in its classical or diffuse form, since it has a significantly higher probability of metachronous rectal cancer.

CONTEXTO E OBJETIVO: Cordoma é um tumor raro e com alto risco de recidiva locorregional. O objetivo deste estudo foi analisar os resultados a longo prazo do tratamento dessa doença.TIPO DE ESTUDO E LOCAL: Estudo de coorte realizado em um único hospital em São Paulo, Brasil.MÉTODOS: Estudo de coorte retrospectivo com 42 pacientes com cordoma tratados de 1980 e 2006 no Hospital A. C. Camargo. Os prontuários foram revistos e foi realizada a análise descritiva das variáveis clínicas e patológicas. As curvas de sobrevida foram estimadas pelo método de Kaplan-Meier e a comparação entre elas, pelo teste de log-rank.RESULTADOS: Dezenove pacientes eram homens e 23, mulheres. Vinte e cinco tumores (59,5%) estavam localizados no sacro, 11 (26,2%) na base do crânio e 6 (14,3%), na coluna móvel. A cirurgia foi realizada em 28 pacientes (66,7%). A ressecção foi considerada como tendo margens negativas em 14 casos e margens comprometidas em 14 pacientes. A sobrevida global (SG) em 5 anos foi de 45,4%. Para os pacientes cirúrgicos, a SG em 5 anos foi de 64,3% (82,2% para as margens negativas e 51,9% de margens positivas). No grupo inoperável, a SG em 24 meses foi de 37,7% e 0% em 5 anos.CONCLUSÃO: A ressecção completa está relacionada com o controle local e, definitivamente, tem impacto positivo na sobrevida a longo prazo.

CONTEXT AND OBJECTIVE: Chordoma is a rare tumor with a high risk of locoregional recurrences. The aim of this study was analyze the long-term results from treating this pathological condition.DESIGN AND SETTING: Cohort study in a single hospital in São Paulo, Brazil.METHODS: This was a retrospective cohort study on 42 patients with chordoma who were treated at Hospital A. C. Camargo between 1980 and 2006. The hospital records were reviewed and a descriptive analysis was performed on the clinical-pathological variables. Survival curves were estimated using the Kaplan-Meier method and these were compared using the log-rank test.RESULTS: Nineteen patients were men and 23 were women. Twenty-five tumors (59.5%) were located in the sacrum, eleven (26.2%) in the skull base and six (14.3%) in the mobile spine. Surgery was performed on 28 patients (66.7%). The resection was considered to have negative margins in 14 cases and positive margins in 14 cases. The five-year overall survival (OS) was 45.4%. For surgical patients, the five-year OS was 64.3% (82.2% for negative margins and 51.9% for positive margins). In the inoperable group, OS was 37.7% at 24 months and 0% at five years.CONCLUSION: Complete resection is related to local control and definitively has a positive impact on long-term survival.

OBJETIVO: avaliar a frequência de deleção do gene PTEN no carcinoma de células renais e o impacto da deleção nas taxas de sobrevida global e livre de doença. MÉTODOS: foram analisados 110 pacientes portadores de carcinoma de células renais submetidos à nefrectomia radical ou parcial entre os anos de 1980 e 2007. Em 53 casos foi possível a análise do gene PTEN pelo método de hibridização in situ fluorescente através da técnica de "tissue microarray". Para a análise estatística, os pacientes foram classificados em dois grupos, de acordo com a presença ou ausência de deleção. RESULTADOS: o tempo médio de seguimento foi de 41,9 meses. Deleção hemizigótica foi identificada em 18 pacientes (33,9%), ao passo que deleção homozigótica esteve presente em três (5,6%). Em aproximadamente 40% dos casos analisados havia deleção. Monossomia e trissomia foram detectadas, respectivamente, em nove (17%) e dois pacientes (3,8%). Em 21 pacientes (39,6%), a análise por hibridização in situ do gene PTEN foi normal. Não houve diferenças estatisticamente significativas nas taxas de sobrevida global (p=0,468) e livre de doença (p=0,344) entre os pacientes portadores ou não de deleção. Foram fatores independentes para a sobrevida global: estádio clínico TNM, sintomatologia ao diagnóstico, alto grau de Fuhrmann performance status (Ecog) e recorrência tumoral. A livre de doença foi influenciada unicamente pelo estádio clínico TNM. CONCLUSÃO: deleção do gene PTEN no CCR foi detectada com frequência de aproximadamente 40% e sua presença não foi determinante de menores taxas de sobrevida, permanecendo os fatores prognósticos tradicionais como determinantes da evolução dos pacientes.

OBJECTIVE: To evaluate the frequency of deletion of the PTEN gene in renal cell carcinoma (RCC) and its impact on the rates of overall and disease-free survival. METHODS: We analyzed 110 patients with renal cell carcinoma who underwent radical or partial nephrectomy between 1980 and 2007. In 53 cases it was possible to analyse the PTEN gene by the method of fluorescent in situ hybridization using the technique of tissue microarray. For statistical analysis, patients were classified in two groups according to the presence or absence of the deletion. RESULTS: The mean follow-up time was 41.9 months. Hemizygous deletion was detected in 18 patients (33.9%), while the homozygous one was present in three (5.6%). Deletion was present in approximately 40% of the analyzed cases. Monosomy and trisomy were detected in nine (17%) and two patients (3.8%), respectively. In 21 patients (39.6%) the analysis of the PTEN gene by in situ hybridization was normal. There were no statistically significant differences in overall (p = 0.468) and disease-free (p = 0.344) survival rates between patients with or without deletion. Factors which were independent for overall survival: TNM clinical stage, symptoms at diagnosis, high Fuhrmann grade, performance status (ECoG) and tumor recurrence. Disease-free survival was influenced only by the clinical TNM stage. CONCLUSION: Deletion of the PTEN gene in RCC was detected with a frequency of approximately 40% and its presence was not determinant of lower survival rates, the traditional prognostic factors remaining as determinants of outcome.

Purpose To evaluate preoperative rectal electrical stimulation in the recovery of urinary continence in patients who undergo radical retropubic prostatectomy. Materials and Methods Patients were divided into 3 randomized groups: control, pelvic exercises, and electrical stimulation. A 1 hour pad-test, the ICIQ-SF, and the SF-36 were performed 1, 3, and 6 months after the surgical procedure. Results Of the 58 patients who were initially included in the study, 9 were excluded due to radiotherapy after surgical intervention, an indwelling urethral catheter for more than 30 days, high surgical risk, loss of follow-up, or incomplete participation in the study routines and spontaneous interruption. Forty-nine patients concluded the study (15 in the control group, 17 in the exercise group, and 17 in the electrical stimulation group). We did not observe any significant difference in the pad test (p > 0.05), the 8 domains of the SF-36, or ICIQ-SF score compared with control groups (control, exercise, and electrical stimulation). Conclusion Preoperative rectal electrical stimulation has no impact on continence status in patients who undergo radical retropubic prostatectomy. There is no difference in the three above mentioned groups with regard to urinary leakage and quality of life.

OBJETIVO: Avaliar a eficácia da biópsia percutânea por agulha grossa (BPAG) de tumores de partes moles guiada por tomografia computadorizada (TC), em relação ao sucesso na obtenção de amostra para análise, e comparar o diagnóstico da BPAG com o resultado anatomopatológico da peça cirúrgica, quando disponível. MATERIAIS E MÉTODOS: Foram revisados os prontuários e laudos diagnósticos de 262 pacientes com tumores de partes moles submetidos a BPAG guiada por TC em um centro de referência oncológico entre 2003 e 2009. RESULTADOS: Das 262 biópsias realizadas, foi possível a obtenção de amostra adequada em 215 (82,1%). Os tumores mais prevalentes foram os sarcomas (38,6%), carcinomas metastáticos (28,8%), tumores mesenquimais benignos (20,5%) e linfomas (9,3%). Foi possível realizar graduação histológica em 92,8% dos pacientes com sarcoma, sendo a maioria (77,9%) classificada como alto grau. Do total de pacientes, 116 (44,3%) realizaram cirurgia para exérese e confirmação diagnóstica. A BPAG mostrou acurácia de 94,6% na identificação de sarcomas, com sensibilidade de 96,4% e especificidade de 89,5%. A graduação histológica teve concordância significativa entre a BPAG e a peça cirúrgica (p < 0,001; kappa = 0,75). CONCLUSÃO: A BPAG guiada por TC demonstrou elevada acurácia diagnóstica na avaliação de tumores de partes moles e na graduação histológica dos sarcomas, permitindo um adequado planejamento terapêutico.

OBJECTIVE: To evaluate the efficacy of percutaneous computed tomography (CT)-guided core needle biopsy of soft-tissue tumors in obtaining appropriate samples for histological analysis, and compare its diagnosis with the results of the surgical pathology as available. MATERIALS AND METHODS: The authors reviewed medical records, imaging and histological reports of 262 patients with soft-tissue tumors submitted to CT-guided core needle biopsy in an oncologic reference center between 2003 and 2009. RESULTS: Appropriate samples were obtained in 215 (82.1%) out of the 262 patients. The most prevalent tumors were sarcomas (38.6%), metastatic carcinomas (28.8%), benign mesenchymal tumors (20.5%) and lymphomas (9.3%). Histological grading was feasible in 92.8% of sarcoma patients, with the majority of them (77.9%) being classified as high grade tumors. Out of the total sample, 116 patients (44.3%) underwent surgical excision and diagnosis confirmation. Core biopsy demonstrated 94.6% accuracy in the identification of sarcomas, with 96.4% sensitivity and 89.5% specificity. A significant intermethod agreement about histological grading was observed between core biopsy and surgical resection (p < 0.001; kappa = 0.75). CONCLUSION: CT-guided core needle biopsy demonstrated a high diagnostic accuracy in the evaluation of soft tissue tumors as well as in the histological grading of sarcomas, allowing an appropriate therapeutic planning.

CONTEXTO: As variáveis tumor de reto inferior, quimiorradioterapia pré-operatória e grandes tumores foram considerados fatores de risco independentes para a inabilidade de identificação de linfonodos sentinela em pacientes com adenocarcinoma colorretal. OBJETIVOS: Determinar se essas variáveis poderiam interferir na precisão e no aumento do estádio proporcionado pelo uso da técnica de identificação de linfonodos sentinela em câncer colorretal. Revisão da precisão da técnica do estádio foi realizada. MÉTODOS: O banco de dados composto por 52 pacientes submetidos a mapeamento linfático usando tecnécio-99m-fitato e azul patente foi revisado. Foram incluídos somente pacientes com tumores menores que 5,0 cm, não submetidos a quimiorradioterapia pré-operatória e sem tumores de reto inferior. RESULTADOS: A taxa de identificação de linfonodos sentinela foi de 100%, com sensibilidade de 100%; valor preditivo negativo de 100%, não houve falso-negativos e a precisão foi de 100%. Os linfonodos sentinela foram os únicos linfonodos metastáticos em 36,4% dos pacientes; micrometástases (<0.2 mm ou somente identificadas com imunoistoquímica) proporcionaram taxa de aumento no estádio de 27,1% e metástases taxa de 9,1%. CONCLUSÕES: A validação dos resultados deste estudo deve ser realizada em estudos prospectivos de identificação de linfonodos sentinela que incluam pacientes com câncer colorretal com as características propostas.

CONTEXT: In a previously published study, the variables lower rectal tumor site, preoperative chemoradiotherapy and large tumors were considered as independent risk factors for the inability of sentinel lymph node identification in patients with colorectal adenocarcinoma. OBJECTIVES: To determine if these variables could interfere in the precision and upstaging benefit of sentinel lymph node mapping in colorectal cancer. METHODS: A database composed of 52 patients submitted to lymphatic mapping using technetium-99m-phytate and patent blue was reviewed. Only patients with tumors smaller than 5.0 cm, not submitted to preoperative chemoradiotherapy and without lower rectal cancer were included. RESULTS: With these parameters, 11 patients remained to be studied. The sentinel lymph node identification rate was 100%, with a sensitivity of 100%, negative predictive value of 100%, no false negatives and accuracy of 100%. Sentinel lymph nodes were the only metastatic nodes in 36.4% of the patients, micrometastases (<0.2 cm or only identified by immunohistochemistry) provided an upstaging rate of 27.1% and metastases an upstaging rate of 9.1%. CONCLUSION: The parameters proposed in this study for selection of colorectal adenocarcinoma patients to be submitted to sentinel lymph node mapping identified optimal accuracy and good upstaging results. As the number of included patients was low, these results could serve as guidance for proper patient selection in further prospective lymph node mapping studies in colorectal cancer patients.

Por ser um procedimento de alta complexidade, a Hemicorporectomia associada a Colostomia úmida em alça deve ser empregada como procedimento de exceção. Por ser uma medida heróica trata-se do último recurso utilizado para tratamento de doenças pélvicas localmente avançadas e sem evidências de metástases à distância. Analisamos retrospectivamente os detalhes da técnica cirúrgica utilizada em um caso de carcinoma epidermóide desenvolvido em ulcera de pressão de região sacra e os resultados da primeira Hemicorporectomia associada a colostomia úmida em alça em um único tempo.

The Hemicorporectomy associated to Double-barreled wet colostomy is a high complex and heroic procedure and is to be used only exceptionally, when it is the last resource for treating locally advanced pelvic diseases in the absence of evidences of distant metastasis. We retrospectively analyzed the surgical technical details and the results from a hemicorporectomy with double-barreled wet colostomy in a single surgical time in a case of epidermoide carcinoma from a coetaneous pressure ulcer.

INTRODUCTION AND OBJECTIVE: Neoadjuvant and adjuvant therapies for soft tissue sarcomas of the extremities are still controversial. The aim of this study was to analyze the results of a protocol of neoadjuvant chemoradiation therapy for extremity sarcomas. METHODS: A retrospective analysis was carried out in a consecutive series of 49 adult patients with advanced extremity soft tissue sarcomas that could not be resected with adequate margins during the primary resection. All patients were treated with a protocol of preoperative radiation therapy at a total dose of 30 Gy, concomitant with doxorubicin (60 mg/m²) chemotherapy. The main endpoints assessed were local recurrence-free survival, metastasis-free survival and overall survival. The median follow-up time was 32.1 months. RESULTS: The five-year local recurrence-free survival, metastasis-free survival and overall survival rates were 81.5%, 46.7% and 58.3%, respectively. For high-grade tumors, the five-year metastasis-free and overall survival rates were only 36.3% and 41.2%, respectively. Severe wound complications were observed in 41.8% of the patients who underwent surgery. These complications precluded adjuvant chemotherapy in 73.7% (14/19) of the patients eligible to receive it. CONCLUSIONS: In this study, neoadjuvant chemoradiation therapy was associated with a good local control rate, but the distant relapse-free rate and overall survival rate were still poor. The high rate of wound complications modified the planning of adjuvant treatment in most patients.

OBJETIVO: Verificar as variáveis associadas às metástases nos linfonodos pélvicos em pacientes com carcinoma do colo do útero nos estádios IB e IIA. MÉTODOS: Estudaram-se 289 pacientes admitidas no Departamento de Ginecologia do Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo com carcinoma invasor do colo do útero (IB e IIA) no período de 1980 a 1999 e que foram submetidas à cirurgia radical. A coleta de dados foi realizada a partir dos prontuários e da revisão de cortes histológicos dos colos de útero e dos linfonodos, sendo registrados dados sociodemográficos (idade ao diagnóstico, cor da pele), clínicos (estádio da doença, taxa de hemoglobina pré-operatória e índice de massa corpórea) e histopatológicos (tipo histológico, grau histológico, índice mitótico, embolização em capilares linfáticos e/ou sangüíneos, invasão perineural, profundidade de invasão do tumor no estroma cervical, intensidade da reação inflamatória no colo do útero, necrose tumoral, tamanho do tumor, invasão dos ligamentos cervicais laterais e do corpo do útero e status linfonodal). A associação entre a presença de metástase linfonodal e as diversas variáveis foi avaliada pelo teste de Qui-quadrado, pelo teste exato de Fisher e pela regressão logística múltipla. RESULTADOS: Encontrou-se metástase nos linfonodos pélvicos em 65 pacientes (22,5%). Foram identificados os seguintes fatores de risco para metástase linfonodal na análise multivariada: taxa de hemoglobina < 10,0 g% (OR=3,6; IC95%:1,210,7), invasão tumoral do terço médio (OR=3,3; IC95%:1,110,7) e profundo do colo do útero (OR=5,4; IC95%:1,717,3), reação inflamatória ausente ou de intensidade leve no colo do útero (OR=2,4; IC95%:1,15,2) e carcinoma epidermóide queratinizante (OR=3,3; IC95%:1,47,6). CONCLUSÕES: Este estudo identificou quatro fatores de risco para metástase nos linfonodos pélvicos em pacientes com carcinoma do colo do útero nos estádios IB e IIA. Destes, três não são habitualmente descritos na literatura como variáveis preditoras de metástase linfonodal (anemia pré-operatória, reação inflamatória ausente ou de intensidade leve e carcinoma epidermóide queratinizante).

OBJECTIVE: To investigate the variables associated with pelvic lymph node metastasis in patients with carcinoma of the uterine cervix at stages IB and IIA. METHODS: The study was carried out with 289 patients with invasive carcinoma of the uterine cervix (IB and IIA) who underwent radical surgery, admitted to the Gynecology Department of the Treatment and Research Center of the Hospital do Câncer A. C. Camargo, between 1980 and 1999. Data were collected from patient's records and from review of the histological sections from the uterine cervices and the lymph nodes, including sociodemographic data (age at diagnosis, skin color), clinical data (disease stage, preoperative hemoglobin level, body mass index) and histopathological data (histological type, histological grade, blood and/or lymphatic capillary embolization, perineural invasion, depth of tumor invasion into cervical stroma, intensity of inflammatory reaction in the uterine cervix, tumor necrosis, tumor size, invasion of the lateral cervical ligaments and uterine body, and lymph node status). Associations between lymph node metastasis and the different variables were evaluated by means of the chi-square test, Fisher's exact test and multiple logistic regression. RESULTS: Pelvic lymph node metastasis was found in 65 patients (22.5%). The following risk factors for lymph node metastasis were identified by multivariate analysis: hemoglobin level <10.0 g% (OR = 3.6; 95% CI: 1.210.7), tumor invasion of the middle third (OR = 3.3; 95% CI: 1.110.7) and deep third of the uterine cervix (OR = 5.4; 95% CI: 1.717.3), absent or slight inflammatory reaction in the uterine cervix (OR = 2.4; 95% CI: 1.15.2) and keratinizing squamous cell carcinoma (OR = 3.3; 95% CI: 1.47.6). CONCLUSIONS: This study identified four risk factors for pelvic lymph node metastasis in patients with carcinoma of the uterine cervix at stages IB and IIA. Of these, three are not usually described in literature as predictive variables for lymph node metastasis (preoperative anemia, absent or slight inflammatory reaction and keratinizing of squamous cell carcinoma).

CONTEXTO E OBJETIVO: A intensidade da reação inflamatória é citada como possível fator de risco para recorrência do carcinoma do colo do útero (CCU). Alguns autores observaram aumento do risco com reação inflamatória fraca, enquanto outros descreveram o oposto. Este estudo procurou avaliar os fatores de risco para recorrência do CCU em estádios iniciais (IB e IIA), considerando na análise a reação inflamatória. TIPO DE ESTUDO E LOCAL: Coorte retrospectiva, no Centro de Tratamento e Pesquisa Hospital A. C. Camargo (Hospital do Câncer). MÉTODOS: Estudaram-se 289 pacientes com diagnóstico de CCU (estádios IB e IIA) submetidas à cirurgia radical entre 1980 e 1999. Realizou-se a coleta de dados nos prontuários. Os cortes histológicos dos tumores e dos linfonodos foram revistos em 247 casos. As taxas de sobrevida livre de doença em cinco anos foram calculadas pelo método de Kaplan-Meier e as curvas comparadas pelo teste de log-rank. Para a análise multivariada empregou-se o modelo de riscos proporcionais de Cox. A estimativa do risco de recorrência foi o hazard ratio (HR). RESULTADOS: Registraram-se 43 recorrências. A análise multivariada identificou os seguintes fatores de risco independentes para recorrência: número de linfonodos pélvicos metastáticos (1 linfonodo: HR = 3,3 [1,3-8,3]; 2 ou 3 linfonodos: HR = 5,3 [1,5-18,6]; 4 ou mais linfonodos: HR=7,6 [1,7 - 33,2]), profundidade de invasão do tumor (terço profundo: HR = 2,1 [1,1-4,1]) e intensidade da reação inflamatória no colo do útero (ausente ou leve: HR = 2,5 [1,1-5,7]). CONCLUSÃO: Este estudo identificou a reação inflamatória ausente ou de intensidade leve como fatores de risco independentes para recorrência. Os outros fatores de risco foram o número de linfonodos pélvicos metastáticos e a invasão do terço profundo do colo do útero.

CONTEXT AND OBJECTIVE: Inflammatory reaction intensity has been indicated as a possible recurrence risk factor in carcinoma of the uterine cervix. Some authors observed greater risk with weak inflammatory reaction, while others described the opposite. This study aimed to evaluate risk factors for initial-stage uterine cervix carcinoma recurrence (IB and IIA), considering inflammatory reaction intensity. DESIGN AND SETTING: Retrospective cohort at Hospital do Câncer A. C. Camargo. METHODS: 289 patients with diagnosed uterine cervix carcinoma (stages IB and IIA) who underwent radical surgery between 1980 and 1999 were studied. Data were collected from medical records. Histological sections from tumors and lymph nodes could be reviewed in 247 cases. Five-year disease-free survival rates were calculated using the Kaplan-Meier method and curves were compared using the log-rank test. Cox's proportional-hazards model was used for multivariate analysis. Recurrence risk was estimated using hazard ratios (HR). RESULTS: Forty-three recurrences were found. Multivariate analysis identified the following independent recurrence risk factors: number of metastatic pelvic lymph nodes (one lymph node: HR = 3.3 [1.3-8.3]; two or three: HR = 5.3 [1.5-18.6]; four or more: HR = 7.6 [1.7-33.2]), tumor invasion depth (deepest third: HR = 2.1 [1.1-4.1]) and inflammatory reaction intensity in the uterine cervix (absent or slight: HR = 2.5 [1.1-5.7]). CONCLUSION: This study identified that absent or slight inflammatory reaction was an independent risk factor for recurrence. The other risk factors were the number of metastatic pelvic lymph nodes and invasion of the deepest third of the uterine cervix.

Primary pelvic tumors are relatively rare, representing no more than 5% of primary bone tumors. We presented a case of a chondrosarcoma of the superior pubic ramus initially managed as an inguinal hernia and then operated under oncological principles. Special attention is attributed to the importance for the correct diagnosis and surgical treatment given the low efficacy of adjuvant treatments for this type of neoplasia.