BACKGROUND: Pancreatic ductal adenocarcinoma maintains a formidable mortality rate with rising incidence despite extensive research efforts. As of 2021 pancreatic cancer is the third leading cause of cancer-related deaths in the United States despite its incidence representing only 3% of all cancer diagnoses. Given the high mortality rate, research efforts push to improve prognosis by expanding knowledge and tools in the realms of diagnostics, genetics, development of screening modalities, and targeted treatments. Modifications in treatment algorithms have led to only modest improvements in outcome. Current research efforts focus on primary and secondary prevention aimed at modifications of known environmental and hereditary risk factors. Available studies highlight the relationship between relative geography and cancers; however, there is a paucity of research available on the Social Determinants of Health on access to pancreatic cancer care and outcomes. PROPOSED PROJECT: Data will be extracted from the Surveillance, Epidemiology, and End Results (SEER) database and combined with US Census data along with medical record information as relevant over a seven-year period from January 1, 2010, through December 31, 2017. Social Vulnerability Index scores will be derived from the available data as a surrogate for Social Determinant of Health and be assigned to each case of pancreatic cancer from 2010-2017. These scores will be grouped by zip code. Analysis will then be performed to identify the mean stage at time of diagnosis for each zip code. Further analysis will be performed to calculate survival curves for each zip code and cox proportional-hazards will be performed on results to determine statistical significance of SVI with respect to geography. CONCLUSIONS: The proposed study will investigate the impact of geography as a Social Determinant of Health (SDoH) within the United States on the stage at time of diagnosis for pancreatic ductal adenocarcinoma. As a secondary measure, overall survival following diagnosis of pancreatic ductal adenocarcinoma will be examined. SIGNIFICANCE: This study will identify the impact of social determinants of health on geography and correlate the impact on outcomes in pancreatic ductal adenocarcinoma in the United States of America. This study may also identify geographic regions in which the incidence of PDAC is higher than expected which would present a population to investigate for additional screening studies and development of risk prediction models.

While single-cell RNA sequencing provides a remarkable window on pathophysiologic tissue biology and heterogeneity, its high gene-dropout rate and low signal-to-noise ratio challenge quantitative analyses and mechanistic understanding. This thesis addresses this issue by developing PISCES, a pipeline for regulatory network-based single-cell analysis of mammalian tissues. PISCES accurately estimates the mechanistic contribution of regulatory and signaling proteins to cell state implementation and maintenance based on the expression of their lineage-specific transcriptional targets, inferring protein activity for a putative set of transcriptional regulators and cell-state markers. Experimental validation assays – including technical analysis via downsampling of high depth data and biological analysis by assessing concordance with CITE-Seq-based measurements – show a significant improvement in the ability to identify rare subpopulations and to elucidate key lineage markers compared to gene expression analysis. The improved ability to identify biologically meaningful cellular subpopulations makes PISCES an ideal tool to deconvolute heterogeneity in a wide variety of biological contexts. A systematic analysis of single-cell gene expression profiles in the Human Protein Atlas (HPA) by PISCES generated tissue-specific clustering and master regulator analyses across 26 human tissues, as well as a publicly available repository of ready-to-use regulatory networks specific to cell-lineages in each tissue. This resource will allow researchers to access the algorithmic advantages of PISCES without requiring prohibitively expensive or technically challenging computational resources. Additionally, PISCES is able to unravel the heterogeneous stromal environment of Pancreatic Ductal Adenocarcinoma, a malignancy defined by a large and complicated stromal compartment. This analysis reveals several novel candidate subpopulations, including a fibroblast subtype that has never been observed in humans, a potential pro-metastatic population of endothelial cells, and a population of immune-suppressing stellate cells. PISCES is also able to deconvolute more continuous forms of heterogeneity, as demonstrated by an analysis of epithelial cells in the developing murine lung. Here, PISCES is able to computationally reconstruct a developmental trajectory between Sox9+ distal cells and Sox2+ proximal cells, which is then leveraged to identify several novel markers of the critical intermediate population. Subsequent analysis suggests that these transition zone cells may share programs similar to those seen in injury repair and identifies a candidate therapeutic target that can drive cells into or out of this transition state. Finally, protein activity measured by PISCES is used to refine faulty experimental labels through differential density analysis. This analysis lead to the development of a machine learning classifier that accurately predicted increased degrees of stemness in experimentally transduced populations. Additionally, the density analysis paradigm has been extended to unsupervised settings, allowing for the detection of stable cellular populations and transitory trajectories.

Predicting the prognosis of patients with prostate cancer is a clinically important problem. Previous studies have indicated that the expression of haptoglobin-related protein epitopes in samples of breast cancer in early stages was associated with earlier relapses and higher risk for tumor recurrence. Oncogenic antigen 519 (OA-519) is the new marker designation for molecules expressing haptoglobin-related protein epitopes. The objective of this immunohistochemical study was to examine OA-519 expression in prostate cancer samples and its relationship to the established prognostic indicators of tumor grade, tumor volume, and clinical stage. Forty-two consecutive tissue samples of prostate adenocarcinoma were examined using an affinity- purified anti-OA-519 antibody. Twenty specimens (48%) tested positive, whereas 22 (52%) tested negative. No staining was observed in normal or hyperplastic prostate tissue. Staining occurred in 6 of 9 (67%) grade III, 14 of 23 (61%) grade II, and in none of 10 (0%) grade I cases (I vs. II and/or III: Fisher exact test, P < 0.006). Twenty-three of the 42 samples were transurethral resection specimens with cancer; 11 (48%) of these tested positive. The mean percentage of tissue chips with tumor, a measure of tumor volume, was significantly higher in the positive group (57%) than in the negative group (15%) (P = 0.004). The proportion of positively stained cases increased with advancing clinical stage, with 25% of Stage A cases expressing OA-519, and 46%, 67%, and 64% of Stages B, C, and D, respectively, expressing OA-519. OA-519 expression correlates with higher tumor grades, larger tumors, and possibly with advanced stage, and thus, it is potentially of prognostic value in prostate cancer.

No description available.

No description available.

O carcinoma adenóide cístico e o adenocarcinoma polimorfo de baixo grau de malignidade são neoplasias malignas das glândulas salivares que apresentam semelhança nos padrões histológicos, porém com comportamento clínico, tratamento e prognóstico completamente diferentes. A galectina-3 é uma proteína multifuncional da família das lectinas que está envolvida em vários fenômenos biológicos como crescimento celular, adesão celular, diferenciação celular e apoptose. Além disso, tem sido estudada como um marcador de invasão tumoral e metástase. O objetivo deste trabalho foi estudar qualitativamente a expressão imunoistoquímica da galectina-3 em 14 casos de carcinoma adenóide cístico (2 do subtipo tubular, 4 do subtipo sólido e 8 do subtipo cribriforme) e em 12 casos de adenocarcinoma polimorfo de baixo grau de malignidade com padrões histológicos variados, incluindo os padrões lobular, tubular e cribriforme. Espécimes de glândula salivar normal foram também incluídos na amostra. Nas glândulas salivares normais houve forte marcação da galectina-3 no núcleo e no citoplasma das células luminais dos ductos. Nos carcinomas adenóides císticos houve uma maior marcação da galectina-3 no subtipo tubular, localizada apenas nas células luminais das estruturas tubulares. Nos subtipos sólido e cribriforme a marcação foi menor, mas sempre localizada nas células que circundavam espaços luminais. Em todos os casos de carcinomas adenóides císticos estudados a marcação foi predominantemente nuclear. Nos adenocarcinomas polimorfos de baixo grau de malignidade a marcação da galectina-3 foi predominantemente citoplasmática em praticamente todas as células neoplásicas. Diante disso podemos sugerir que, nas neoplasias estudadas, a expressão da galectina-3 parece estar mais relacionada à diferenciação celular do que à progressão tumoral e ao prognóstico. / Adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma are malignant neoplasms of salivary glands which are similar in histologic patterns but very different in clinical behavior, treatment and prognosis. Galectin-3 is a multifunctional protein of a growing family of beta-galactoside-binding animal lectins which is implicated in a variety of biological events such as tumor cell adhesion, proliferation, differentiation and angiogenesis. This protein was found to be implicated in cellular transformation, and a correlation between its expression and cancer progression and metastasis has been described. The aim of this study was to determine the galectin-3 immunoprofile in 14 cases of adenoid cystic carcinoma (2 cases of tubular subtype, 4 cases of solid subtype and 8 cases of cribriform subtype) and in 12 cases of polymorphous low-grade adenocarcinoma with different histologic patterns, included lobular, tubular and cribriform. Moreover, slides of normal salivary glands were included. In normal salivary glands there were strong nuclei and cytoplasmic staining for galectin-3 in ductal luminal cells. Adenoid cystic carcinomas showed specific staining in luminal cells mainly in the nuclei. In the tubular subtype of adenoid cystic carcinoma galectin-3 was strong in the luminal cells of the ductiform structures. The cribriform and solid subtypes showed a few positive cells for galectin-3 only in the luminal cells of small ducts presenting in the cribriform structures and in solid nests respectly. In the cases of polymorphous low-grade adenocarcinoma, independent of the histologic architecture, all tumor cells revealed a positive cytoplasmic reaction with the galectin-3 antibody. Galectin-3 expression seems to be related to cell differentiation more than tumor progression and prognosis in the neoplasms studied.

INTRODUÇÃO: O adenocarcinoma gástrico precoce (AGP) atinge até a camada submucosa em profundidade, independentemente da presença de metástases linfonodais (MLF). Tumores mucosos, bem diferenciados, menores que 20 mm e sem ulceração são candidatos à ressecção endoscópica (RE) por mucosectomia com taxas de MLF praticamente nulas. Com o advento da técnica de dissecção endoscópica da submucosa (ESD) e após observar ausência de MLF em grande série de pacientes no Japão, foi sugerido que os critérios clássicos pudessem ser expandidos, evitando a gastrectomia em alguns pacientes. Em países ocidentais autores e sociedades têm visto com restrição a ESD para critérios expandidos devido à observação de MLF em alguns subgrupos. A análise crítica e validação dos critérios expandidos de RE para tratamento do AGP em coorte brasileira poderá indicar os pacientes com menor risco de metástases linfonodais nesta população, de modo a individualizar o tratamento com excelência e qualidade de vida. OBJETIVO: Avaliar a presença MLF em produtos de gastrectomia com linfadenectomia de pacientes elegíveis à ressecção endoscópica seguindo os critérios clássicos e expandidos. MÉTODO: Inclusão de pacientes com AGP submetidos a tratamento cirúrgico com dissecção linfonodal. Estadiamento linfonodal e avaliação de características clínicas, macroscópicas e histopatológicas segundo critérios de RE. RESULTADOS: Foram incluídos 389 espécimens cirúrgicos de gastrectomia, dentre os quais 135 cumpriam critérios para ressecção endoscópica. Nenhum dos 31 pacientes com critérios clássicos apresentou MLF (N = 31; 0% IC95% 0 - 13,4%). Dos 104 com critérios expandidos, 3 apresentaram MLF (N = 104; 2,9% IC95% 0,7 - 8,6%), todos pertencentes ao grupo de tumores indiferenciados sem ulceração e menores que 20 mm. Dos pacientes com indicação de tratamento cirúrgico houve 50 MLF positivos (N = 254; 19,7% IC95% 15,3 - 25,1%). CONCLUSÃO: Existe risco mínimo de metástases linfonodais quando adotados os critérios expandidos de RE. Este risco é praticamente nulo para os critérios clássicos e quando se exclui o tumor indiferenciado do critério expandido / INTRODUCTION: Early gastric cancer (EGC) is known to present low rate of lymph nodal metastasis (LNM). Gastrectomy with D2 lymphadenectomy is usually curative for EGC. Endoscopic submucosal dissection (ESD) is a well-accepted treatment modality for lesions that meet the classic criteria, a well-differentiated adenocarcinoma measuring less than 20 mm size and without ulceration. Expanded criteria for ESD have been recently proposed, based on null LNM rate from large gastrectomies series coming from Japan. The expanded criteria for ESD are as follows: intramucosal non-ulcerative well-differentiated tumor > 20 mm, intramucosal ulc mo <= 30 mm, intramucosal non-ulcera mo <= 20 mm, or superficially submucosal ( m1) mo <= 30 mm. There is some resistance to adoption of the expanded criteria, since patients with positive LNM have already been reported in western centers. OBJECTIVE: Evaluate LNM staging in patients who met the expanded endoscopic treatment criteria for ESD. METHOD: Evaluation of gastrectomy specimens including LNM staging of patients submitted to gastrectomy for EGC in a 39-year retrospective cohort. A senior pathologist reviewed the histology slides. RESULTS: A total of 389 surgical specimens were included, of whose 135 met criteria for endoscopic resection. None of the 31 patients with classic criteria had LNM. Of the 104 patients with expanded criteria, 3 had LNM (n = 104, 2.9% CI 95% 0.7 - 8.6%), all of them with undifferentiated tumors without ulceration and less than 20 mm. In the patients with surgical criteria there were 50 LNM positive (n = 254; 19.7% CI 95% 15.3 - 25.1%). CONCLUSION: There is minimal risk of LNM in EGC when expanded criteria for ESD are met. This risk is practically nil for the classic criteria and when the undifferentiated tumor is excluded of the expanded criteria. Refinement of the expanded criteria for the risk of LNM may be desirable. Meanwhile the decision to complement the endoscopic treatment with LNM dissection or D2 gastrectomy will have to take into consideration the individual risk of perioperative morbidity and mortality

INTRODUÇÃO: A ressecção de metástases hepáticas (MH) do câncer colorretal (CCR) é considerada segura e potencialmente curativa. Apesar dos avanços no diagnóstico e nas estratégias cirúrgicas até 70% dos pacientes operados vão apresentar recidiva. Os critérios prognósticos clínico-patológicos disponíveis são insuficientes e a utilidade de modelos prognósticos é considerada inconsistente. Deste modo, torna-se necessário o desenvolvimento de novos critérios que se apoiam em outras variáveis biológicas. A disseminação intra-hepática de metástases de câncer colorretal pode ocorrer através de diferentes vias: linfática, sanguínea (vasos portais), através dos sinusóides ou de ductos biliares. Embora estas vias tenham sido bem descritas, o valor prognóstico de cada uma após a ressecção hepática não está completamente definido. O adenocarcinoma colorretal mucinoso (ACM) é um subtipo de carcinoma colorretal com importante produção mucina, e que está associado clinicamente a tumores proximais, estágio avançado no momento do diagnóstico, instabilidade de microssatélites e mutação do gene BRAF. Há controvérsias sobre o impacto prognóstico da histologia mucinosa nos tumores colorretais primitivos e o seu papel nas lesões metastáticas hepáticas permanece desconhecido. O objetivo do nosso estudo foi determinar a frequência e elucidar o impacto prognóstico de quatro vias diferentes de disseminação intra-hepática assim como da histologia mucinosa em uma série consecutiva de pacientes operados por MH de CCR. PACIENTES E MÉTODOS: Os prontuários de 132 pacientes submetidos à ressecção cirúrgica de MH de CCR entre dezembro de 1999 e janeiro de 2010 foram revisados. Os pacientes que faleceram por complicações pós-operatórias (n= 3), aqueles com ressecções incompletas (R2; n= 2), ou nos quais não havia material disponível para o estudo (n= 14) foram excluídos. Os 113 pacientes restantes tiveram suas variáveis clínico-patológicas e resultados (recidiva e sobrevida) avaliados. Os espécimes cirúrgicos foram submetidos à avaliação histológica de rotina e agrupados de acordo com o conteúdo mucinoso da maior lesão hepática da seguinte forma: ACM >50 %; adenocarcinoma mucinoso intermediário (AIM) com componente mucinoso < 50 %; não-MAC (NMA) se ausência de componente mucinoso. A disseminação intra-hepática foi analisada por hematoxilina e eosina e imuno-histoquímica através dos anticorpos anti-D2-40 (vasos linfáticos), anti-CD34 (vasos sanguíneos), anti-CK-7 (epitélio biliar) e anti-CK-20 (epitélio colorretal). RESULTADOS: O tempo médio de seguimento após a ressecção foi de 37 meses. Recidivas foram observadas em 76 pacientes, com um intervalo médio de 13 meses após a ressecção. As porcentagens de sobrevida global e de sobrevida livre de doença (SLD) após a hepatectomia em 3 e 5 anos foram de 62 e 56 %, e 26% e 24%, respectivamente. A disseminação intra-hepática foi classificada em quatro categorias distintas avaliadas separadamente: invasão da veia porta, invasão dos sinusóides, através dos ductos biliares, e através dos vasos linfáticos/espaço perineural. Encontrou-se invasão microscópica intravenosa portal em 49 pacientes, sinusoidal em 43, biliar em 20 e linfática em 33 pacientes. A disseminação intra-hepática através dos vasos linfáticos foi a única via de disseminação independentemente associada ao risco de recidiva hepática (OR= 2,75) e de menor SLD (p= 0,006). Os focos tumorais de invasão angiolinfática intra-hepática foram detectados em um raio de 2mm de distância da lesão principal. As lesões com componente mucinoso (MAC e AIM) estiveram relacionadas à localização proximal do tumor primário e ao sexo feminino. A análise multivariada revelou que as lesões de tipo ACM apresentavam prognóstico desfavorável (RR= 3,13; IC95% 1,30 - 6,68; p= 0,011) quando comparadas às lesões de componente mucinoso < 50% (NMA e AIM). CONCLUSÃO: A presença de invasão angiolinfática intra-hepática é um importante fator prognóstico após a ressecção de MH de CCR. As outras vias de disseminação intra-hepática, embora observadas com freqüência, não estão relacionadas à recidiva da doença ou sobrevida, sugerindo que o sistema linfático possa ser a principal via de disseminação de MH de CCR. Além disso, o uso da imuno-histoquímica na detecção da invasão angiolinfática intra-hepática parece trazer benefícios na prática clínica. As MH de CCR com componente mucinoso > 50% (ACM) estão associadas a um pior prognóstico quando comparadas às lesões sem componente mucinoso (NMA). A presença de mucina pode, em um futuro próximo, influenciar a estratégia terapêutica e deve se tornar um ponto importante para discussão e investigação futuras / BACKGROUND: Resection of colorectal cancer liver metastases (CRCLM) is generally accepted as a safe and potentially curative treatment. Despite advances in diagnosis and surgical strategies, up to 70% of patients will present recurrence of the disease after resection of CRCLM. Clinicopathological prognostic factors are inadequate to determine disease prognosis and the utility of prognostic models on general population is considered highly inconsistent. Herein, future attempts to develop prognostic scores may include additional biologic variables. Intrahepatic spread from CRLM may take place through four different routes: lymphatic vessels, portal vessels, sinusoids and biliary ducts. Although these routes have been well described, their prognostic value after hepatectomy is not completely understood. Colorectal mucinous adenocarcinoma (MAC) is a subtype of colorectal adenocarcinoma with prominent mucin production associated with tumor proximal location, advanced stage at diagnosis, microsatellite instability, and BRAF mutation. There are controversies about the prognostic impact of mucinous histology on colorectal cancer and the prognostic implication of MAC in CRCLM is unknown. The purpose of our study was to determine the frequency and elucidate the prognostic implication of four different routes for intrahepatic dissemination and the mucinous histology in a consecutive series of resected CRCLM. METHODS: Medical records of 132 patients who underwent a first resection of CRCLM between December 1999 and January 2010 were reviewed. Patients who died from postoperative complications (n=3), those with incomplete resections (R2; n=2), or no available tissue for the study (n=14) were excluded. The remaining 113 patients had their clinicopathologic variables and outcome parameters evaluated. Resected specimens were submitted to routine histological evaluation and were grouped according to metastasis mucinous content: > 50%, MAC; < 50%, adenocarcinoma with intermediated mucinous component (AIM); and without any mucinous component, non-MAC (NMA). Intrahepatic dissemination was analyzed by H&E and immunohistochemical staining with D2-40 (lymphatic vessels), CD34 (blood vessels), CK-7 (biliary epithelium), and CK-20 (CRC cells). RESULTS: Mean follow-up after resection was 37 months. Tumor recurrence was observed in 76 patients, with a median interval of 13 months after resection. Overall survival and disease-free survival (DFS) rates after hepatectomy were 62 and 56%, and 26 and 24% at 3 and 5 years, respectively. Intrahepatic spread was classified into discreet categories that were evaluated separately: invasion of the portal vein, sinusoids, bile duct, and lymphatic/perineural space. Intrahepatic microscopic invasion included portal vein in 49 patients, sinusoidal in 43 patients, biliary in 20 patients, and lymphatic in 33 patients. Intra-hepatic lymphatic invasion was the only route of dissemination independently associated with the risk of hepatic recurrence (OR=2.75) and shorter DFS (P= 0.006). All tumor foci of intrahepatic lymphatic invasion were detected within 2mm away from tumor edge. Tumors with mucinous component (AIM and MAC) were related to proximal location of the primary tumor and were more frequently observed in females. Multivariate analysis revealed that MAC was an independent negative prognostic factor (hazard ratio= 3.13; 95% CI, 1.30-6.68; P= 0.011) compared with non-MAC (NMA and AIM). CONCLUSION: Intrahepatic lymphatic invasion is a significant prognostic factor. Other mechanisms of invasion, although frequently observed, are not related to disease recurrence or survival, suggesting that the lymphatic system is the main route for dissemination of CRCLM. Furthermore, immunohistochemical detection of intrahepatic lymphatic invasion might be of value in clinical practice. MAC has an adverse prognostic impact compared with NMA, which may influence therapeutic strategy raising an important subject for discussion and future investigation

INTRODUÇÃO: Tradicionalmente, a omentectomia total (OT) é realizada juntamente com a ressecção gástrica associada à linfadenectomia na cirurgia do câncer gástrico (CG). No entanto, evidências sólidas em relação ao seu benefício oncológico são escassas. Este estudo foi elaborado para avaliar a incidência de metástases em linfonodos (LN) do grande omento em pacientes submetidos à gastrectomia potencialmente curativa por CG, assim como, avaliar os fatores de risco para a ocorrência de linfonodos metastáticos no grande omento e a evolução dos pacientes. PACIENTES E MÉTODOS: Foram avaliados 284 pacientes operados pelo Serviço de Cirurgia de Estômago, Duodeno e Intestino Delgado do HCFMUSP, no período de março de 2009 a abril de 2016, com diagnóstico de adenocarcinoma. Critérios de inclusão: pacientes submetidos a cirurgias potencialmente curativas com ressecção R0, com linfadenectomia a D2 ou D2 modificada conforme preconizado pela Escola Japonesa. Foram excluídos os pacientes que apresentaram doença disseminada ou metástases a distância, mesmo sendo submetidos a ressecções paliativas, assim como, pacientes com invasão macroscópica do grande omento, pacientes com neoplasias sincrônicas ou metacrônicas, neoplasia de coto gástrico, cirurgia com menos de 15 LN ressecados e ausência de tumor na análise anatomopatológica. O tempo de seguimento de todos os pacientes variou entre 1 e 89,5 meses, com mediana de 27,6 meses. O tempo de seguimento mediano dos pacientes livres de doença foi de 34,3 meses (mínimo de 1 e máximo de 89,5). A associação entre o acometimento de LN no omento com variáveis categóricas foram investigadas por testes exatos de Fisher ou teste qui-quadrado e com variáveis numéricas por testes de Wilcoxon-Mann-Whitney. Adotou-se nível de significância de 5%. RESULTADOS: A média de idade foi 61,8 anos (±11,9; entre 25 e 86). Dos 284 pacientes, cinco (1,8%) tinham LN metastáticos no grande omento (um: pT3N3bM0; dois: pT4aN3bM0; um: pT4aN2M0 e um pT4bN3bM0). Quatro deles faleceram e um estava sob tratamento paliativo com quimioterapia devido à recidiva da doença. Os LN metastáticos no grande omento tiveram correlação significativa com o tamanho do tumor, no qual se encontrou o ponto de corte de 5,25cm (área sob a curva ROC: 0,8072; IC95%: 0,6645 - 0,9498), estádio N (p < 0,001), estádio clínico (p=0,022), invasão venosa (p=0,003), recorrência (p=0,006), local de recorrência (peritôneo: p=0,008; fígado: p=0,023; ovário: p=0,035) e óbito (p=0,008). CONCLUSÃO: A incidência de LN metastático no grande omento de pacientes submetidos à gastrectomia radical por CG é baixa. A OT pode ser evitada em tumores menores que 5,25 cm e estádios T1/T2. Entretanto, a presença de metástases linfonodais no grande omento está associada a recidiva no peritônio, fígado, ovário e óbito / BACKGROUND: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit still lacks. The aim of this study was to evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing potentially curative gastrectomy for GC, as well as its risk factors and patients\' outcomes. PATIENTS AND METHODS: In order to perform this analysis, 284 patients with adenocarcinoma operated at the Department of Surgery of Stomach, Duodenum and Small Intestine at HCFMUSP from March 2009 to April 2016 were reviewed. Inclusion criteria was: patients who underwent potentially curative R0 surgery with D2 lymphadenectomy as recommended by the Japanese School. Patients with disseminated disease or distant metastases, even if undergoing palliative resections were excluded from the study. As well as patients with macroscopic omental invasion, synchronic or metachronous neoplasms, gastric stump neoplasia, surgery with less than 15 harvested LN and absence of tumor in pathological analysis. The follow-up period of all patients ranged from 1 to 89.5 months, with a median of 27.6 months. The median follow-up period of disease-free patients was 34.3 months (minimum of 1 and maximum of 89.5 months). The association between omental LN involvement with categorical variables was investigated by Fisher\'s exact tests or chi-square test and numerical variables by Wilcoxon-Mann-Whitney tests. A significance level of 5% was adopted. RESULTS: The mean age was 61.8 years (± 11.9, range 25 - 86). Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor\'s size in which the cut-off found was 5.25cm (area under the ROC curve: 0.8072; IC95%: 0.6645 - 0.9498), N stage (p < 0.001), clinical stage (p=0.022), venous growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008). CONCLUSION: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low and may be avoided in tumors smaller than 5.25cm and T1/T2 tumors. Though, when present is associated with recurrence in peritoneum, liver, ovary and death

O objetivo do presente estudo é avaliar os fatores clínico-patológicos envolvidos na sobrevida dos pacientes portadores de adenocarcinoma pancreático submetidos à ressecção cirúrgica. Foram estudados retrospectivamente 56 pacientes, sendo 32(57,1%) do sexo feminino e 24 (42,8%) do masculino com idade média de 58,1 anos. A duodenopancreatectomia com preservação do piloro foi realizada em 51,8%, seguida da gastroduodenopancreatectomia (41,1%), pancreatectomia total (3,6%) e pancreatectomia corpo-caudal (3,6%). Quatro pacientes eram do estádio IA, sete do IB, 12 do IIA, 29 do IIB e dois do III. A sobrevida média foi de 20,7 meses. Concluiu-se que sexo, tempo de pro-trombina reduzido, ressecção da veia porta, diferenciação tumoral e invasão peri-neural estão associados com a sobrevida / The aim of the present study is to correlate clinical and pathological finding with survival in patients with pancreatic adenocarcinoma treated with surgical resection. Fifty six patients ressected were studied retrospectively. There were 32 females (57,1%) and 24 males (42,8%) with mean age of 58,1 years. Pylorus preserving duodenopancreatectomy were performed in 51,8%, followed by classical duodenopancreatectomy (41,1%), distal pancreatectomy (3,6%) and total pancreatectomy (3,6%). Four patients were stage IA, seven stage IB, 12 stage IIA, 29 stage IIB and two stage III. Mean survival was 20,7 months. It was concluded that sex, pro-trombin time reduction, portal vein resection, tumor differentiation and peri-neural invasion are statistically associated with survival