Showing papers by "Mario Fernández-Ruiz published in 2009"

Comorbidity negatively influences prognosis in patients with extrahepatic cholangiocarcinoma.

Abstract: AIM: To study the outcome and prognostic factors in a series of patients with extrahepatic cholangiocarcinoma and determine the impact of comorbidity on survival. METHODS: A retrospective analysis of 68 patients with extrahepatic cholangiocarcinoma (perihilar, n = 37; distal, n = 31) seen at a single tertiary-care institution during the period 1999-2003 was performed. Data on presentation, management, and outcome were assessed by chart review. Pathologic confirmation was obtained in 37 cases (54.4%). Comorbidity was evaluated by using the Charlson comorbidity index (CCI). RESULTS: Mean age at diagnosis was 73.4 ± 11.5 years. Jaundice was the most common symptom presented (86.8%). Median CCI score was 1 (range, 0 to 4). Nineteen patients (27.9%) underwent tumor resection. Palliative biliary drainage was performed in 39 patients (57.4%), and 6 patients (8.8%) received only best supportive care. Tumor-free margin status (R0) was achieved in 15 cases (78.9% of resection group). Baseline serum carbohydrate antigen 19-9 (CA 19-9) level was revealed to be an independent predictor of surgical treatment (P = 0.026). Overall median survival was 3.1 ± 0.9 mo, with 1- and 2-year survival rates of 21% and 7%, respectively. In the univariate analysis, tumor resection, CCI score, and serum CA 19-9 levels correlated significantly with outcome. In the multivariate analysis, only resection (HR 0.10; 95% CI, 0.02-0.51, P = 0.005) and a CCI score ≥ 2 (HR 3.36; 95% CI, 1.0-10.9, P = 0.045) were found to independently predict survival. CONCLUSION: Tumor resection and comorbidity emerged as significant prognostic variables in extrahepatic cholangiocarcinoma. Comorbidity evaluation instruments should be applied in the clinical management of such patients.

Multiple primary malignancies in Spanish patients with hepatocellular carcinoma: Analysis of a hospital-based tumor registry

Abstract: Background and Aim: Little is known about the etiological associations and clinical features of extrahepatic primary malignant (EHPM) neoplasms in subjects with hepatocellular carcinoma (HCC). The aim of this study was to characterize this phenomenon in a consecutive series of Spanish patients in order to define its natural history and influence on survival. Methods: A retrospective analysis of 245 patients with HCC during the period 1999–2003 was performed. Subjects identified with a second primary malignancy elsewhere constituted the EHPM group and were compared to patients with HCC alone. Results: Eighteen patients (7.3%) had one or two associated extrahepatic malignancies (mean age 67.7 ± 9.7 years); of these, 17 had double cancer and one patient, triple. Nine of the 19 EHPM occurred before HCC diagnosis. The associated cancers included five cases of colorectal carcinoma, four cases of head and neck carcinoma, three cases of genitourinary cancer, two cases of lymphoproliferative disorder, one lung carcinoma, one skin melanoma, one breast carcinoma, and two cancers of unknown origin. Age and sex distribution, etiology of underlying hepatopathy, and liver function tests did not differ significantly between both groups. There was no difference between the overall survival rates. Conclusions: EHPM is not rare among Spanish patients with HCC, although no specific clinicopathological features were detected in this population. Our results suggest that the association of another primary tumor with HCC does not imply a worse prognosis. The possibility of development of EHPM should be kept in mind when deciding on therapy and follow-up of HCC.

Intramedullary cervical spinal cord abscess by viridans group Streptococcus secondary to infective endocarditis and facilitated by previous local radiotherapy.

Abstract: The risk factors, microbial patterns, and prognosis of intramedullary abscess have varied with time. The development of an intramedullary abscess of the spinal cord (IASC) constitutes an exceptional complication of infective endocarditis (IE) in the post-antibiotic era. We present a case of cervical IASC by viridans group Streptococcus in a patient with mitral valve IE. We hypothesize that previous cervical radiotherapy for non-Hodgkin's lymphoma favoured the occurrence of this uncommon entity. This physiopathologic mechanism has not been previously reported.

Predicción pronóstica en pacientes con carcinoma hepatocelular no subsidiario de tratamiento locorregional

Abstract: Resumen Fundamento y objetivo Los pacientes con carcinoma hepatocelular (CHC) no subsidiarios de tratamiento locorregional presentan una serie de caracteristicas (cirrosis descompensada o extension extrahepatica) que obligan a evaluar de forma especifica la utilidad de los distintos sistemas de estadificacion propuestos para esta entidad. Pacientes y metodo Analizamos 100 pacientes (69 varones) con una edad media (DE) de 70,2 anos (10,7), y establecimos su estadificacion al diagnostico del CHC segun los modelos de Okuda, Cancer of the Liver Italian Program, Barcelona Clinic Liver Cancer (BCLC) y Japan Integrated Staging score. Empleando la mortalidad a los 6 y a los 12 meses como objetivo, calculamos el area bajo la curva (ABC) de caracteristicas operativas del receptor. Resultados El modelo BCLC mostro la mejor capacidad de prediccion, tanto a los 6 (ABC: 0,871) como a los 12 meses (ABC: 0,924), y mantuvo la significacion estadistica en el analisis multivariante de Cox (hazard ratio: 9,14 para el estadio BCLC C frente a A [p Conclusiones El sistema BCLC proporciona el mejor modelo de estratificacion pronostica en pacientes con CHC no subsidiario de tratamiento locorregional.