Background: Since the publication of the first Brazilian Consensus on Gastric Cancer (GC) in 2012 carried out by the Brazilian Gastric Cancer Association, new concepts on diagnosis, staging, treatment and follow-up have been incorporated. Aim: This new consensus is to promote an update to professionals working in the fight against GC and to provide guidelines for the management of patients with this condition. Methods: Fifty-nine experts answered 67 statements regarding the diagnosis, staging, treatment and prognosis of GC with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree A consensus was adopted when at least 80% of the sum of the answers “fully agree” and “partially agree” was reached. This article presents only the responses of the participating experts. Comments on each statement, as well as a literature review, will be presented in future publications. Results: Of the 67 statements, there was consensus in 50 (74%). In 10 declarations, there was 100% agreement. Conclusion: The gastric cancer treatment has evolved considerably in recent years. This consensus gathers consolidated principles in the last decades, new knowledge acquired recently, as well as promising perspectives on the management of this disease.
Background : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. Aim : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. Methods: To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. Conclusion : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.
The usefulness of serology against CagA of Helicobacter pylori as a biomarker to identify high-risk individuals for non-cardia gastric cancer (ncGC) remains unclear among several ethnic populations with a high prevalence of cagA-positive strains. We investigated ethnic differences of CagA serology in two sets of case-control subjects, Japanese-Brazilians (JB) and non-Japanese Brazilians (NJB). We performed a cross-sectional comparison of IgG antibody titers to CagA (CagA-Ab) and the combination of CagA-Ab with conventional surface antigen (Hp-Ab) in 80 JB and 178 NJB ncGC patients and their controls (160 JB and 178 NJB). The level of CagA-Ab titer in cancer cases was significantly higher in NJB than in JB. The strength of the association between CagA-Ab seropositivity ( + + + +) ( ≥ ≥ ≥ ≥10 U/ml) and ncGC was almost 2-fold higher in NJB than in JB [odds ratio (OR) (95% confidence interval), 4.5 (2.6-7.8) and 2.1 (1.2-3.6), respectively]. However, in both JB and NJB, the OR was highest in CagA-Ab( + + + +) subjects with low titer (10-29 U/ml), and decreased inversely with elevating CagA-Ab titer. In addition, the serological status of CagA-Ab ( t is generally accepted that Helicobacter pylori (H. pylori) infection increases the risk of gastric cancer (GC), 1) particularly non-cardia GC (ncGC).2, 3) It is important to find a marker associated with H. pylori in order to identify individuals at high risk for GC. CagA serology is a possible candidate because the cagA pathogenicity island is one of the major virulence factors of H. pylori. 4,5) Clinical subjects with cagA-positive (cagA + ) infection detected by gene amplification have been shown to have more severe gastritis and be at increased risk of developing atrophic gastritis and GC.6, 7) In addition, several studies have shown the clinical relevance of specific antibodies to CagA in GC patients. 3,[8][9][10][11] However, some authors failed to confirm these findings, [12][13][14][15] and the clinical usefulness of CagA serology remains controversial.Four main reasons for these diverse results can be considered. First, the study design, i.e., whether sera were obtained before or after GC onset, is critical because pathological changes in gastric mucosa significantly affect the serological status of H. pylori-associated antigen. Second, ethnic differences influence GC susceptibility in subjects with CagA seropositivity. 8,[16][17][18][19][20] Accumulating evidence shows a close association between CagA serology and clinical outcome in Western populations, 3,8,10) but not some ethnic populations with a high prevalence of cagA + strains, such as Japanese. 13,15,21,22) Third, serological assessment of GC risk depends on the test (antigen) used, and seropositivity is remarkably different among various antigens of CagA. [23][24][25][26][27] Fourth, the association between CagA serology and GC can be different between anatomical subsites of GC, and CagA seropositivity could be inversely associated with the incidence of cardia GC. 28)Recently, we have demonstrated the...
Helicobacter pylori (H. pylori) infection is considered a cause of gastric cancer (GC), though evidence for this association is scarce in high-risk areas. Possible case control and/or ethnic differences were investigated as to the presence of H. pylori and its immunogloblin G antibody titer in the multi-ethnic city of São Paulo, where the incidence of GC is relatively high. We performed a cross-sectional comparison of antibody titers to H. pylori in Japanese Brazilian, and non-Japanese Brazilian GC patients and their controls. Japanese Brazilian patients were matched by age, sex and ethnicity with two controls, while non-Japanese Brazilian patients were matched as above with one control. Among Japanese Brazilians 14) The IARC (International Agency for Research on Cancer) designated H. pylori as group I (definite carcinogen) based on epidemiological investigation in 1994, so that the relation between H. pylori and gastric cancer has now drawn world-wide attention. 15)Although gastric cancer is estimated to be the world's second most common carcinoma, its incidence has significantly declined worldwide in recent decades. 16,17) In Japan, gastric cancer has been the leading cause of cancer mortality, 18) and the prevalence of H. pylori infection is high. 19)However, the incidence and mortality rate of gastric cancer have declined over the last few decades, 18,20) presumably due to environmental factors. 21,22) In many areas of the world outside Japan, including Russia, China, Costa Rica, Colombia and Brazil, the incidence of gastric cancer is higher than that of any other cancer.23) Japanese immigrants to the United States (Hawaii) have exhibited a sharp decline in gastric cancer, notably among first-generation Japanese-Americans.11) The incidence of gastric cancer among Japanese residents (born in Japan) in the city of São Paulo was approximately two times higher than among non-Japanese Brazilians, while the rate was only 15% lower than that of Japanese living in Japan. 24)The above findings suggest that there may be ethnic differences in the presence of serological antibody to H.
mente a CAPES optou por criar um sistema de classificação de periódicos científicos procurando qualificar a produção dos programas de pós-graduação. Os critérios propostos tem provocado intenso debate e até mesmo divergências na comunidade.A pesquisa científica é uma atividade que deve satisfazer três características básicas: ser socialmente relevante, ou seja, seus resultados devem encontrar cedo ou tarde, aplicação na solução de problemas humanos; ser ética, porquanto, acima dos interesses científicos deve estar a preservação da dignidade humana; e, ser pautada no mérito, isto é, ser conduzida com rigor metodológico para que produza conhecimentos verdadeiros.A garantia da relevância social será dada pelo impacto que os conhecimentos produzidos venham a ter na transformação da realidade na busca do aperfeiçoamento. A adequação ética será garantida pela submissão ao julgamento feito pela sociedade acerca dos procedimentos dos cientistas. A produção de conhecimentos verdadeiros depende da correta aplicação do método, mas também do julgamento interpares, ou seja, a verdade é construída e aquilatada no interior da comunidade da qual o cientista faz parte.A publicação dos resultados das pesquisas em periódicos científicos busca cumprir uma dupla função: submeter os conhecimentos produzidos ao julgamento dos pares e criar uma comunidade de interesses em torno de determinada área de investigação.Para cumprir com esses objetivos os periódicos necessitam contar com um sistema adequado de "peer-review" e possibilitar a divulgação ampla dos resultados facilitando desta forma a apropriação pelos outros membros da comunidade.Ao longo destes pouco mais de trinta anos a pós-graduação estrito-senso influenciou de forma expressiva a produção científica no país' contribuindo para seu crescimento.Apesar das críticas eventuais à adequação desse modelo e sua aplicabilidade nas áreas clínicas, ela tem contribuído no aprimoramento dos candidatos à carreira docente. Foi sem dúvida graças a ela que todos passaram a utilizar a mesma linguagem independente da área de atuação. Discute-se metodologia científica, modelos experimentais, epidemiologia clínica, tudo girando em torno das linhas de pesquisas.A pós-graduação foi criada com o objetivo de preparar o professor para a atividade acadêmica, de docência e pesquisa, seja esta experimental ou clínica. Assim, o produto final da pós-graduação estrito senso é o professor pesquisador.Ao longo do tempo foram sendo aprimorados os parâmetros de avaliação, corrigindo deficiências, exigindo qualidade. Houve inquestionável melhora apesar de estarmos longe de um patamar de homogeneidade entre os diferentes programas.A importância crescente atribuída à produção de conhecimentos científicos paulatinamente deslocou o peso da avaliação para os produtos dessa atividade.A produção científica dos docentes responde atualmente por 30% da avaliação dos programas. Os resultados da pesquisa desenvolvida são avaliados quanto à sua coerência com a linha de pesquisa, regularidade, qualidade e quantidade.O grande d...
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