O possível envolvimento da inflamação na carcinogênese colorretal tem potenciais implicações prognósticas, preventivas e terapêuticas. Foi investigado, através de imunoistoquímica, se a proteína C reativa (PCR) é expressa em adenocarcinoma retal primário humano, e avaliada sua relação com achados clínico-patológicos. Acúmulo celular de PCR foi observado em 65 (71%) de 91 pacientes com adenocarcinoma de reto e em todos os 22 controles (p<0,01). Nenhuma diferença significativa foi observada referente aos fatores clínico-patológicos ou taxas de sobrevida, mas uma correlação linear entre a proporção de positividade da PCR e o estágio de Dukes-Turnbull foi observada (p=0,005). Estes dados sugerem que a PCR pode desempenhar um papel na carcinogênese retal, mas parece não afetar o prognóstico. Estudos adicionais são necessários em amostras populacionais maiores. / The possible involvement of inflammation on colorectal carcinogenesis has potential prognostic, preventive and therapeutic implications. We investigated immunohistochemically whether C-reactive protein (CRP) is expressed in human primary rectal adenocarcinoma and assessed its relationship with clinicopathological findings. Cell accumulation of CRP was observed in 65 (71%) out of 91 patients with adenocarcinoma of the rectum and in all 22 control cases (p<0.01). No significant difference was observed with regard to clinicopathological features or survival rates, but a linear correlation between the positivity proportion of CRP and Dukes-Turnbull stage (p=0.005) was observed. These data suggest that CRP might play a role in rectal carcionogenesis, but seems to not affect prognosis. Additional studies are warranted in larger population samples.

No description available.

O possível envolvimento da inflamação na carcinogênese colorretal tem potenciais implicações prognósticas, preventivas e terapêuticas. Foi investigado, através de imunoistoquímica, se a proteína C reativa (PCR) é expressa em adenocarcinoma retal primário humano, e avaliada sua relação com achados clínico-patológicos. Acúmulo celular de PCR foi observado em 65 (71%) de 91 pacientes com adenocarcinoma de reto e em todos os 22 controles (p<0,01). Nenhuma diferença significativa foi observada referente aos fatores clínico-patológicos ou taxas de sobrevida, mas uma correlação linear entre a proporção de positividade da PCR e o estágio de Dukes-Turnbull foi observada (p=0,005). Estes dados sugerem que a PCR pode desempenhar um papel na carcinogênese retal, mas parece não afetar o prognóstico. Estudos adicionais são necessários em amostras populacionais maiores. / The possible involvement of inflammation on colorectal carcinogenesis has potential prognostic, preventive and therapeutic implications. We investigated immunohistochemically whether C-reactive protein (CRP) is expressed in human primary rectal adenocarcinoma and assessed its relationship with clinicopathological findings. Cell accumulation of CRP was observed in 65 (71%) out of 91 patients with adenocarcinoma of the rectum and in all 22 control cases (p<0.01). No significant difference was observed with regard to clinicopathological features or survival rates, but a linear correlation between the positivity proportion of CRP and Dukes-Turnbull stage (p=0.005) was observed. These data suggest that CRP might play a role in rectal carcionogenesis, but seems to not affect prognosis. Additional studies are warranted in larger population samples.

Introdução: O câncer de localização colorretal é o terceiro tipo de câncer mais comumente diagnosticado no mundo. As taxas de incidências do câncer colorretal não são homogêneas, apresentando diferenças entre os países. Não há estudos brasileiros que investiguem a variação geográfica da incidência de câncer colorretal conjuntamente com indicadores socioeconômicos. Esta avaliação pode revelar diferenças locais importantes na ocorrência da doença. Objetivos: Descrever as taxas de incidência e de mortalidade do câncer colorretal no Município de São Paulo, segundo sexo e faixa etária, no período de 1997 a 2009 e realizar análise da distribuição espacial segundo distrito dos casos de câncer colorretal diagnosticados em residentes no Município de São Paulo entre 1997 e 2009. Material e Métodos: Foram analisados os novos casos de câncer colorretal diagnosticados em residentes no Município de São Paulo de 1997 a 2009. Estes dados foram fornecidos pelo Registro de Câncer de Base Populacional de São Paulo (RCBP-SP). A análise dos dados foi realizada em duas etapas: na primeira, com cárater exploratório/descritivo, os dados analíticos foram utilizados para descrever a incidência e mortalidade por câncer colorretal no período pesquisado. Na segunda etapa, os casos de câncer colorretal foram geocodificados, agrupados por distrito administrativo e estudados segundo a metodologia de análise para dados de área. Toda análise foi implementada no software R. Resultados: Com 7,7 por cento e 7,3 por cento dos casos respectivamente em homens e mulheres, câncer colorretal foi o segundo tipo de câncer mais frequente, sendo a quarta (9,0 por cento dos óbitos) e a segunda (11,0 por cento dos óbitos) causa de morte respectivamente em homens e mulheres. Do total de casos incidentes (39.250), 47,50 por cento são do sexo masculino e 52,50 por cento do sexo feminino. Destes, 4.784 (37,7 por cento ) evoluíram a óbito, sendo 48,1 por cento no sexo masculino e 51,9 por cento no sexo feminino. As taxas específicas por sexo e faixa etária de incidência aumentam fortemente com a idade, na faixa etária de 80 ou mais anos chega a 377,9 e 282,9 (por 100 mil hab.) para o sexo masculino e feminino respectivamente, sendo relativamente próximas em ambos os sexos até a idade de 49 anos e maiores para homens nas faixas etárias subsequentes. As taxas específicas por sexo e faixa etária de mortalidade, apresentam comportamento análogo, aumentam fortemente com a idade, na faixa etária de 80 ou mais anos chega a 206,9 e 159,9 (por 100 mil hab.) para o sexo masculino e feminino respectivamente. A taxa anual de incidência ajustada pela população de SEGI (1960) e modificada por DOLL et al. (1966) apresenta-se em torno de 30,0 (por 100 mil hab.) nos três primeiros anos observados (1997-1999), chega a 19,0 (por 100 mil hab.) em 2002, volta a crescer nos anos seguintes (2003-2005), chegando a 31,7 (por 100 mil hab.) e matem-se estável de 2007 a 2009. A taxa anual de mortalidade de câncer colorretal ajustada pela população crescente até 2004, chegando a 15,7 (por 100 mil hab.) e decrescem nos anos seguintes, chegando a aproximadamente 3,6 mortes por 100 mil habitantes em 2009. A média anual da taxa bruta de incidência e os indicadores socioeconômicos apresentam dependência forte dependência espacial, sendo o menor Índice I de Moran observado foi para o índice de exclusão/inclusão dos anos potenciais de vida perdidos (IEX apvp = 0,29), os demais são acima de 0,6. Os indicadores apresentam forte correlação linear com a média anual da taxa bruta de incidência. Conclusões: As distribuições da incidência e da mortalidade apresentam padrões semelhantes ao identificado mundialmente. O Município de São Paulo tem taxas equivalentes às encontradas nas regiões em transição econômica. Foi identificada forte dependência espacial na distribuição da incidência de câncer colorretal no Município de São Paulo, com a formação de clusters nas áreas centrais e periféricas. As maiores taxas são encontradas nas áreas centrais e nas periferias. A distribuição espacial da incidência de câncer colorretal apresenta forte associação com a distribuição dos indicadores de status socioeconômico no Município de São Paulo, em particular apresenta associação positiva com indicadores de renda e escolaridade. / Introduction: Colorectal cancer is the third most common diagnosed cancer worldwide. Colorectal cancer incidence rates are not homogeneous, with differences between countries. No Brazilian studies investigated the geographical variation of colorectal cancer incidence with socioeconomic indicators. This study may reveal important local differences in the occurrence of the disease. Objectives: To describe colorectal cancer incidence and mortality in São Paulo, by sex and age using 1997-2009 data and perform the spatial distribution analysis according to district colorectal cancer cases diagnosed in residents at Municipality of São Paulo between 1997 and 2009. Methods: Colorectal cancer cases diagnosed from 1997 to 2009 in São Paulo residents were analyzed. These data were provided by Population Based Cancer Registry of São Paulo (RCBP-SP). Data analysis was performed in two stages. First, analytical data were used to describe the incidence and mortality from colorectal cancer. Second, colorectal cancer cases were geocoded, grouped by administrative district and studied according data area analysis methodology. All analysis was implemented in software R. Results: 7.7 per cent and 7.3 per cent of observed cases was respectively in men and women, colorectal cancer was the second most common cancer, the fourth (9.0 per cent ) cause of death in men and the second (11.0 per cent ) cause in women. It was diagnosed 39,250 colorectal cancer new cases, 47.50 per cent in men and 52.50 per cent in women. And 4,784 (37.7 per cent ) died, with 48.1 per cent in male and 51.9 per cent in female. The specific incidence rates strongly increase with age, at the 80 years or more age reaches 377.9 and 282.9 (per 100,000 inhabitants) for male and female respectively. The mortality specific rates, have similar behavior, strongly increase with age and at the 80 years or more age reaches 206.9 and 159.9 (per 100,000 inhabitants), for males and female respectively. The annual age adjusted incidence rate was around 30.0 (per 100,000 inhab.) in the first observed years (1997-1999), arrives to 19.0 (per 100,000 inhab.) in 2002, grow back reaching 31.7 (per 100,000 inhab.) and kill stable from 2007 to 2009. The annual age colorectal cancer mortality rate grow reaching 15.7 (per 100,000 inhab.) and decrease in the following years, reaching approximately 3.6 deaths per 100,000 inhabitants in 2009. The average annual the crude incidence rate and the socio-economic indicators show strong spatial dependence, the lowest Moran´s I Index was observed for the exclusion/inclusion potential years of life lost index (IEX apvp = 0.29). The indicators show strong linear correlation with the average annual crude incidence rate. Conclusions: Distributions of incidence and mortality have similar worldwide patterns. The Municipality of São Paulo has equivalent rates founded in regions in economic transition. It was identified strong spatial dependence in the distribution of the incidence of colorectal cancer, with the formation of clusters in the central and peripheral areas of Municipality of São Paulo. The highest rates were found in the central areas and lowest were found in the suburbs. The spatial distribution of colorectal cancer incidence has a strong association with the socioeconomic status indicators distribution in Municipality of São Paulo. It was identified positive association between colorectal cancer incidence with income and education indicators.

Introdução: De acordo com a União Internacional Contra o Câncer um mínimo de 12 linfonodos (LN) deve ser obtido no espécime cirúrgico para o estadiamento do câncer colorretal (CCR). Estudos recentes reportaram que o uso da quimioirradioterapia neoadjuvante (QRN) pode resultar na não obtenção do número mínimo de LN na peça em 30-52% dos pacientes. Objetivo: Identificar os fatores relacionados à redução do número de LN ressecados em pacientes submetidos à neoadjuvancia e a excisão total do mesorreto. Pacientes e métodos: De janeiro de 2012 a março de 2013, 160 pacientes com câncer de reto foram submetidos à QRN (5-FU e 5040 Gys) seguida de excisão total de mesorreto com ligadura dos vasos mesentéricos inferiores nas suas raízes. Foram incluídos pacientes com estadiamento T3, T4 e/ou N+ que distavam até 10cm da borda anal e T2N0 que distavam até 7 cm da borda anal. Foram excluídos pacientes cujo tratamento com quimiorradioterapia neoadjuvante foi incompleto, ou que tiveram atrasos significativos para re-estadiamento e/ou realização da cirurgia. Todos foram estadiados através de toque retal, colonoscopia, TC de tórax e de abdome, e RM de pelve e igualmente re-estadiados 8 semanas após o término da neoadjuvância, operados e submetidos a excisão total do mesorreto. Os pacientes foram divididos em 2 grupos: A) menos de 12 LN, e B) 12 ou mais LN. Foram estudadas as possíveis variáveis relacionadas ao número de LN obtidos: sexo, idade, presença de LN acometidos, tamanho do tumor, localização da altura do tumor no reto, comprimento da peça, preservação esfincteriana, via de acesso, estadiamento inicial, grau de resposta tumoral e resposta patológica à quimiorrradioterapia neoadjuvante. Resultados: Noventa e cinco pacientes (60 masculinos) preencheram os critérios de inclusão e conseguiram ser tratados, re-estadiados e operados dentro das datas pré-estabelecidas. A média de LN ressecados foi 23,2 (3-67). Resposta patológica completa foi obtida em 18 pacientes (19%). Um mínimo de 12 LN foram obtidos em 81 pacientes (85%). Dentre os 14 doentes que obtiveram menos de 12 LN, 7 (50%) eram respostas patológicas completas. De todas as variáveis estudadas apenas resposta patológica completa na peça foi fator associado à não obtenção do número mínimo de 12 LN (p=0,002). Conclusões: Em pacientes submetidos à QRN e ETM, a resposta patológica completa foi o único fator associado a não obtenção de um mínimo de 12 de LN na peça / INTRODUCTION: According to the International Union against Cancer a minimum of 12 lymph nodes (LN) must be obtained from the surgical specimen for staging colorrectal cancer. However, recent studies reported that neoadjuvant chemoradiation may result in failure to obtain a minimum number of LN in 30-52 % of patients. OBJECTIVE: To identify factors associated with decreased number of LN resected in patients undergoing neoadjuvant therapy followed by total mesorectal excision (TEM). METHODS: From January/2012 to March/2013, 160 patients with rectal cancer underwent CRT (5 - FU and Gys 5040) followed by TEM and ligation of inferior mesenteric vessels in the roots. Patients with stage T3, T4 and/or N + within 10cm from anal verge were included. Patients with T2N0 located within 7cm from the anal verge were also included. Patients who were not able to complete the chemoradiation treatment or who presented significant delay on restaging and/or surgery were excluded from analyses. All patients were staged by digital rectal examination, colonoscopy, CT of the abdomen and chest, and MRI of the pelvis. Patients were re-staged 8 weeks after completion of neoadjuvant therapy, and submitted to total mesorectal excision right after that. Patients were stratified according to LN retrieval in two groups: A) less than 12 LN, B) 12 or more LN. Possible factors associated with the decreased number of LN were evaluated: gender, age, presence of metastatic LN, tumor size, tumor location, and length of the specimen, sphincter preservation, surgical access, initial staging, tumor regression grade and pathological response to chemoradiation. RESULTS: Ninety-five patients (60 male) met the inclusion criteria and were able to be treated, re-staged and operated within the pre-established intervals. The mean number of resected LN was 23.2 (3-67). Pathological complete response was achieved in 18 patients (19%). A minimum of 12 LN were obtained from 81 patients (85%). Half of the 14 patients with less than 12 LN presented pathologic complete response. Of all the variables studied only pathologic complete response was associated with less than 12 LN yield (p = 0.002). CONCLUSIONS: In patients submitted to chemoradiation followed by TME the complete pathological response was the only factor associated with failure to obtain a minimum of 12 LN in the specimen

Background: In an aging society, the incidence and relevance of rectal cancer as one of the most frequent gastrointestinal cancers gains in importance. Excellent surgery and up-to-date multimodal treatments are essential for adequate oncological results and good quality of life. Summary: In this review, we describe modern developments in rectal cancer surgery and its embedment in modern multimodal therapy concepts. Key Message: Distinguished interdisciplinary cooperation combined with an outstanding surgical expertise is the basic requirement for an optimal treatment of rectal cancer. Thus, high standards of oncological outcome and patient’s quality of life can be achieved. Due to its localization within the rectum, rectal cancers are divided into tumors of the lower (0–6 cm), middle (6–12 cm), and upper (12–16 cm) third, assessed by rigid rectoscopy measured from the anal verge to the lower tumor margin. This classification is essential for the surgical strategy [2].

No description available.

Perineural spread of pelvic tumors mechanism and diagnosis Abstract Neoplastic lumbosacral plexopathies are infrequent affections of the lumbosacral plexus. Cases with minimal or non-specific finding on imaging can be particularly puzzling to diagnose. We describe a series of patients with perineural spread from the site of the primary tumor along the visceral autonomous nerves to the lumbosacral plexus and further proximally to the spinal nerves and even intradurally and also distally to the sciatic nerve. On series of 17 patients diagnosed with perineural spread of pelvic malignancy we describe characteristic clinical presentation and imaging finding. In many of these cases a tissue biopsy is necessary to finalize the diagnosis. We describe operative technique of targeted fascicular biopsy of the sciatic nerve and our experience with this procedure. On series of 117 patients, we report the outcome and complication: diagnostic yield was 84.8% and complication rate was 2.7 %. If a tissue sample is needed to conclude the diagnosis, targeted fascicular biopsy does increase the yield at an acceptable complication rate. Perineural spread of pelvic cancer is a new clinical-pathological entity with an unknown natural history or ideal treatment strategy. Based on the imaging finding in this group we present a...

Personalized treatment strategies for oncological patient management can improve outcomes of patient populations with heterogeneous treatment response. The implementation of such a concept requires the identification of biomarkers that can precisely predict treatment outcome. In the context of this thesis, we develop and validate biomarkers from multimodal imaging data for the outcome prediction after treatment in patients with locally advanced rectal cancer (LARC) and in patients with newly diagnosed glioblastoma multiforme (GBM), using conventional feature-based radiomics and deep-learning (DL) based radiomics. For LARC patients, we identify promising radiomics signatures combining computed tomography (CT) and T2-weighted (T2-w) magnetic resonance imaging (MRI) with clinical parameters to predict tumour response to neoadjuvant chemoradiotherapy (nCRT). Further, the analyses of externally available radiomics models for LARC reveal a lack of reproducibility and the need for standardization of the radiomics process. For patients with GBM, we use postoperative [11C] methionine positron emission tomography (MET-PET) and gadolinium-enhanced T1-w MRI for the detection of the residual tumour status and to prognosticate time-to-recurrence (TTR) and overall survival (OS). We show that DL models built on MET-PET have an improved diagnostic and prognostic value as compared to MRI.

Background: Early efficacy outcome measures in rectal cancer after total neoadjuvant treatment are increasingly investigated. We examined the prognostic role of pathological complete response (pCR), tumor regression grading (TRG) and neoadjuvant rectal (NAR) score for disease-free survival (DFS) in patients with rectal carcinoma treated within the CAO/ARO/AIO-12 randomized phase 2 trial. Methods: Distribution of pCR, TRG and NAR score was analyzed using the Pearson’s chi-squared test. Univariable analyses were performed using the log-rank test, stratified by treatment arm. Discrimination ability of non-pCR for DFS was assessed by analyzing the ROC curve as a function of time. Results: Of the 311 patients enrolled, 306 patients were evaluable (Arm A:156, ArmB:150). After a median follow-up of 43 months, the 3-year DFS was 73% in both groups (HR, 0.95, 95% CI, 0.63–1.45, p = 0.82). pCR tended to be higher in Arm B (17% vs. 25%, p = 0.086). In both treatment arms, pCR, TRG and NAR were significant prognostic factors for DFS, whereas survival in subgroups defined by pCR, TRG or NAR did not significantly differ between the treatment arms. The discrimination ability of non-pCR for DFS remained constant over time (C-Index 0.58) but was slightly better in Arm B (0.61 vs. 0.56). Conclusion: Although pCR, TRG and NAR were strong prognostic factors for DFS in the CAO/ARO/AIO-12 trial, their value in selecting one TNT approach over another could not be confirmed. Hence, the conclusion of a long-term survival benefit of one treatment arm based on early surrogate endpoints should be stated with caution.