No abstract

BACKGROUNDHepatocellular carcinoma (HCC) is a malignant neoplasm associated with liver cirrhosis, with an annual incidence of 3% to 9%, which is one of the main causes of death in patients with cirrhosis. Viral hepatitis is associated with an increased risk of HCC, probably due to an inflammatory reaction. Colchicine is an antiinflammatory agent that inhibits the formation of intracellular microtubules, affecting mitosis and fibrogenesis. Diverse clinical studies have failed to demonstrate the benefit of colchicine over the progression of fibrosis in patients with liver cirrhosis; nevertheless, to the authors' knowledge there are no studies that evaluate its effect in the development of HCC.METHODSThe effect of the administration of colchicine on the development of HCC was evaluated in 186 patients with hepatitis virus‐related liver cirrhosis in a retrospective cohort study. The minimum follow‐up time was 3 years (median, 84 months ± 2.8 months). One hundred sixteen patients received treatment with colchicine. The characteristics of both groups were similar.RESULTSThe percentage of patients who developed HCC was significantly smaller in the colchicine group when compared with the noncolchicine group (9% vs. 29%; P = .001). On multivariate analysis, an α‐fetoprotein level ≥5 ng/dL (P = .03), a platelet count <100,000 at diagnosis (P = .05), alanine aminotransferase ≥52 IU (P = .006), and a lack of treatment with colchicine (P = .0001) were found to be associated with an earlier development of HCC. The average time for the development of HCC was 222 months ± 15 months and 150 months ± 12 months in the patients who received and who did not receive colchicine, respectively. CONCLUSIONSThe results suggest that treatment with colchicine prevents and delays the development of HCC in patients with hepatitis virus‐related cirrhosis. The protective mechanisms of colchicine over the development of HCC could be related to antiinflammatory properties and inhibition of mitosis. Prospective studies to confirm this observation with a greater number of patients and long‐term follow‐up may be indicated. Cancer 2006. © 2006 American Cancer Society.

Purpose: After colorectal cancer (CCR) treatment, adequate follow-up is recommended to improve overall survival. We aimed to assess the adherence to the National Comprehensive Cancer Network clinical practice guidelines on post-treatment surveillance for CRC at the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, Mexico. Methods: We included patients with stage I-III CRC treated between January 2014 and December 2016. We evaluated adherence to surveillance during the first three years after completion of CRC treatment or until recurrence, whichever came first. We defined adequate compliance with guidelines as ≥2 physician visits annually for three years, ≥2 serum carcinoembryonic antigen blood tests annually for two years, and at least one colonoscopy during the three-year surveillance period. Results: Overall-three-year adherence to surveillance recommendations was 53.8% (n=49). Colonoscopy was the component with the highest adherence with 91.2% (n=83) of the patients, followed by medical visits with 71.4% (n=65) of the patients. During the three-year period of follow-up, 23% (n=21) of patients lost follow-up. Three-year recurrence rate was 6.6% (n=6). In a bivariate analysis, we did not find any significant association between clinical and demographic factors and adherence to surveillance.Conclusions: At our institution, compliance to the guidelines on post-treatment surveillance is higher than the reported at similar centers in other world regions, though there is a decreasing trend in adherence during the study period. More evidence is needed to understand the potential barriers to surveillance and implement strategies to improve compliance to surveillance and the survival of patients.

PURPOSE Cancer treatment during the COVID-19 pandemic represents a challenge. Hospital visits to receive treatment and interaction with health care workers (HCW) represent potential contagious events. We aimed to determine SARS-CoV-2 infection rate among patients with cancer and HCW of a chemoradiotherapy unit localized in a center designated as a COVID-19 priority facility in Mexico City. We also determined the diagnostic performance of a clinical questionnaire (CQ) as a screening tool and anti–SARS-CoV-2 antibody seroconversion rate. METHODS HCW and patients with solid tumors attending the chemoradiotherapy unit signed informed consent. To determine SARS-CoV-2 infection rate prospectively, a nasopharyngeal swab for SARS-CoV-2 real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) was performed every 2 weeks in asymptomatics. An electronic CQ interrogating COVID-19–related symptoms was sent daily. Anti–SARS-CoV-2 immunoglobulin G (IgG) antibodies were measured at baseline and at the end of the study period. RESULTS From June to September 2020, we included 130 asymptomatic participants, 44.6% HCW and 55.4% patients with cancer. During a median follow-up of 85 days, 634 nasopharyngeal swabs were performed. Average SARS-CoV-2 monthly incidence was 4.6% (3.15%-7.47%), and cumulative infection rate was 13.8% (18 of 130). Cases were mostly asymptomatic (66%), and no hospitalizations or deaths were recorded. The CQ as a screening tool provided a sensitivity of 27.7%, a positive predictive value of 26.3%, and a positive likelihood ratio of 12. SARS-CoV-2 IgG seroconversion rate was 27.7% among those with a positive RT-PCR. CONCLUSION Patients with cancer on treatment can have uncomplicated COVID-19 outcomes. Biweekly RT-qPCR testing detects asymptomatic infections, prevents transmission, and should be implemented in units to increase patient safety. CQ increase RT-qPCR diagnostic yield and may prioritize testing in resource-deprived settings. Post-infection IgG seroconversion is unreliable.

4646 Background: Hepatocellular carcinoma (HCC) represents >90% of primary liver neoplasms and develops mainly in patients with liver cirrhosis. Risk factor identification for development of HCC in patients with cirrhosis is of great relevance due to its high incidence and poor prognosis when detected at advanced stages. The aim of our study was to identify HCC development-associated risk factors in a cohort of patients with hepatitis virus-related chronic liver disease and cirrhosis. Materials and Methods: Patients with diagnosis of hepatitis virus-related cirrhosis from January 1980 to January 2000 were included. Patients were followed with abdominal US and determination of AFP levels, physical examination, and biochemical tests every 3–6 months. The endpoint in this study was defined as development of HCC. Liver histology was evaluated according to the METAVIR. Results: 282 patients met the inclusion criteria; most (86%) had a serologic diagnosis of hepatitis C virus, and only 14% had hepatitis B virus at the time of diagnosis of cirrhosis, while 56 and 37% were classified as Child A and B, respectively; only 7% as Child C. Histological activity was mild in 59% of patients; moderate and severe in 41%. Mean annual incidence was 1.87%; 22 and 35% of patients developed HCC at 10 and 15 years of follow-up, respectively. Diagnosis of HCC was made by histopathology in 37% and by tumoral lesion-associated AFP elevation confirmed by imaging studies in 63%. In multivariate analysis, 3 variables were associated with HCC: moderate to severe histological activity; platelet count <105 103/mm3, and alpha- fetoprotein >5 ng/mL. We divided patients into two groups according to regression coefficient: low and high-risk; patients assigned to the low-risk group showed 5, 10, and 15-year HCC incidences of 3.4, 6.4, and 6.4%, respectively, in contrast to patients from the high-risk group, who showed incidences of 17.8, 33.5, and 56.8%, respectively. Conclusions: We found three HCC-associated variables: histological activity; platelet count and alpha-fetoprotein levels. Patients considered as high-risk for developing hepatocellular carcinoma must be considered candidates for closer follow-up. No significant financial relationships to disclose.

No abstract

Background: Adrenocortical carcinoma (ACC) is an exceedingly rare and aggressive cancer, with an incidence of 1-2 cases/ million-year; there are limited ACC data in the Mexican population. Herein we present our experience with ACC at a referral center per a retrospective cohort study. All medical records of consecutive patients with a histological diagnosis of ACC evaluated at our Institution from January, 1 st 2000 until August 31 st , 2018 were reviewed. Clinical, pathological and laboratory variables were recorded. Results: Sixteen patients with ACC were identified. Median age at diagnosis was 49 years (range, 19-71 years) and 13 were women (81%). Mode of discovery were hormonal excess syndrome (8, 50%) or local symptoms (8, 50%), with none found incidentally. Biochemical proven hormonal excess occurred in 9 (56%), 4 co-secreting corticosteroids and androgens, 2 corticosteroids only, 2 androgens only and 1 aldosterone only. Median tumor size at diagnosis was 12.8 cm (range, 5.9-21 cm) and all had unenhanced CT attenuation >10 Hounsfield units (median HU 33, range 20-39). Initial staging per ENSAT (European Network for the Study of Adrenal Tumors) was: stage II (50%), III (19%) and IV (31%). All patients with localized disease (stage II-III) had a curative intention resection (n=11). For those with advanced disease (stage IV; n=5), cytotoxic chemotherapy was only given to 2 patients. For individuals with initial localized disease, recurrences occurred in 4/11 (36%) and 3 of these were treated with chemotherapy; platinum plus etoposide was the usual regimen. None of the study patients received mitotane, but hormonal blocking therapy was given to 55% (5/9); 4/6 with hypercortisolism. Median follow-up was 13 months (range, 1-139) and at last contact 9 (56%) patients were alive (4 with no evidence of disease). The median overall survival (OS) was 35.5 months (CI 95%, 8.0-62.9). Conclusions: Our data are consistent with other published series; ACC occurs rarely, at ~50 years of age, mostly in women, and commonly as large-sized tumors (~13 cm). Surprisingly none of the cases from our institution were diagnosed incidentally, in contrast to previous studies (~15% incidental). Unfortunately, mitotane was not accessible to our patients given its absence in the Mexican market and patients at our institution are uninsured and cannot gain access to this drug. Nonetheless, the median OS was comparable to the estimated OS of 3-4 years for all ACC patients.

No abstract