Surgery is one of the most important steps in most of brain tumors management. In this regard, the extent of resection has been considered as an important prognostic factor. However, the resection may be limited by the presence of functional brain tissue around or in the tumor. Preventing functional damage during brain surgery is essential to keep a good postoperative performance status and for facing the successive steps in brain tumor management (i.e., radio- and/or chemotherapy). This chapter will describe all the procedures around an awake surgery for a brain tumor: from presurgical preparation to postoperative treatments and follow-up. It will not focus only on surgical approaches, but also on the specific aspect of the disciplines that are involved in this procedure.
Background Lung cancer is the second most frequent neoplasm worldwide and the leading cause of cancer death in both sexes. Furthermore, it is the most common origin of brain metastases. The aim of this study is to identify clinical, histological, and molecular variables associated with a higher risk of presenting brain metastases at the moment of diagnosis in patients with lung cancer. Material and Methods A single-center retrospective case series analysis of patients with a new diagnosis of lung cancer (from January 2015 to December 2018) was performed. A total of 723 total patients with a new diagnosis of non-small cell lung cancer (NSCLC) were identified. Only patients with a brain imaging study at the time of diagnosis were included in the analysis. Non-parametric statistical tests were used to compare patients with or without metastases at the moment of diagnosis. A uni- and multivariate analysis were performed to identify risk factors associated with the presence of brain metastases at NSCLC diagnosis. Statistical significance was considered when p<0.05. Results We included 135 patients with a new diagnosis of lung cancer and with brain imaging study at the time of diagnosis (mean age at diagnosis of 64.69 years [SD= 10.34]; 71.9% men). The most common histology was adenocarcinoma (67.1%) followed by squamous carcinoma (25.2%). Brain metastases were present in 40% of patients at diagnosis. No significant differences in clinical, histological and molecular variables was identified between patients with or without brain metastases. In any case, as expected, the survival analysis showed that brain metastasis at diagnosis was associated with a worse overall survival (Log-Rank test, p<0.01).The univariate analysis showed that presenting neurological symptoms (OR=19.5, p<0.0001 CI [7.895-47.65]), histology of adenocarcinoma (OR= 2.113, p<0.014 CI [1.160-3.849]) and the presence of visceral metastases (OR= 14.444, p<0.0001 CI [6.161-33.86]) were associated to the presence of brain metastases at diagnosis. The presence of metastases limited to the thorax (OR= 0.019, p<0.001 CI [0.003-0.146] was associated to be free of brain metastasis at NSCLC diagnosis. However, only neurological symptoms (OR= 20.290, p<0.0001 CI [4.953-83.118]), presenting visceral metastases (OR= 4.451, p<0.010 CI [1.458-13.777]) and/or metastases limited to the thorax (OR= 0.066, p<0.024 CI [0.006-0.010]) reached statistical significance in the multivariate analysis. Conclusion Neurological symptoms and the presence of visceral metastases are independent predictors or presenting brain metastasis at the moment of diagnosis in lung cancer patients. On the other hand, the presence of lung cancer disease confined in the thoracic cavity is associated with a lower risk to present brain metastasis
BACKGROUND Lung cancer (LC) is the second most frequent neoplasm worldwide and it is commonest origin of brain metastases (BM). The aim of this study is to identify clinical, histological and molecular variables associated with a higher risk of BM at diagnosis in LC patients. METHODS A retrospective single-centre case series analysis of patients with a new diagnosis of LC (from 2015 to 2018) was performed. A total of 723 newly diagnosed LC patients were identified and only those with a brain imaging study were included. Non-parametric statistical tests were used to compare patients with or without metastases at diagnosis. Uni- and multivariate analysis was performed to identify risk factors associated with the presence of BM. Statistical significance was considered when p<0.05. RESULTS 185 patients with newly diagnosed LC and brain imaging at diagnosis were included (mean age 64.69 years [SD= 10.34]; 71.9% male). 40% of patients had BM at diagnosis. No significant differences in clinical, histological and molecular variables were identified. In any case, survival analysis showed that BM at diagnosis was associated with worse overall survival (Log-Rank test, p<0.01). Univariate analysis showed that presenting neurological symptoms (OR=19.5, p<0.0001 CI [7.895-47.65]), adenocarcinoma (OR= 2.113, p<0.014 CI [1.160-3.849]), small cell carcinoma (OR=0.372, p<0.008 CI [0. 179-0.773]) and visceral metastases (OR= 14.444, p<0.0001 CI [6.161-33.86]) or metastases limited to the thorax (OR= 0.019, p<0.001 CI [0.003-0.146]) were associated with BM at diagnosis. However, only neurological symptoms (OR= 20.290, p<0.0001 CI [4.953-83.118]), visceral metastases (OR= 4.451, p<0.010 CI [1.458-13.777]) and/or metastases limited to the thorax (OR= 0.066, p<0.024 CI [0.006-0.010]) reached statistical significance in multivariate analysis. CONCLUSIONS Neurological symptoms and the presence of visceral metastases are independent predictors of developing BM at diagnosis in LC patients. However, LC disease confined to the thorax is associated with a lower risk of developing BM.
FOXP2 expression has been associated with the prognosis of some tumors, but the role of FOXP2 in glioblastoma has not been studied in-depth until now. The aim of the present work is to study the role of FOXP2 as a prognostic biomarker in glioblastoma.This is a retrospective observational case series study in which the expression of FOXP2 has been analyzed both at the protein level (immunohistochemistry) and at the mRNA level (RNAseq, in a cohort of glioblastoma patients from The Cancer Genome Atlas [TCGA] database). Other molecular and clinical data have also been included in the study, with special focus on miRNA expression data.Survival analysis using Log-Rank test and COX-regression have been used. Non-parametric statistical tests were also used to study differences between low and high FOXP2 expression groups.Patients with a high expression of FOXP2 protein showed a worse prognosis than those patients with low expression in both, progression free survival (PFS) (HR=1.711; p=0.034) and overall survival (OS) (HR=1.809;p=0.014). These associations were still statistically significant in multivariate analysis.No prognostic association was found with FOXP2 RNA expression. Interestingly, two miRNAs that target FOXP2 (hsa-miR-181a-2-3p and hsa-miR-20a-3p) showed an interaction effect on OS with FOXP2 expression. A low level of these miRNAs expression was associated with a significantly worse prognosis in patients with high FOXP2 RNA expression.Higher expression of FOXP2 at the protein level is associated with a worse prognosis. This protein expression may be regulated by the expression of specific miRNAs that target FOXP2 mRNA: hsa-miR-181a-2-3p and hsa-miR-20a-3p.
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