DANIEL JOSE SZOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
10 resultados
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- Prognostic Role of Neutrophil/Lymphocyte Ratio in Resected Gastric Cancer: A Systematic Review and Meta-analysis(2018) SZOR, Daniel Jose; DIAS, Andre Roncon; PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO-JUNIOR, UlyssesHigh levels of inflammatory markers and the neutrophil-lymphocyte ratio appear to be associated with worse overall survival in solid tumors. However, few studies have analyzed the role of the neutrophil-lymphocyte ratio in gastric cancer patients scheduled to undergo curative resection. In the present study, a systematic review and meta-analysis was performed to analyze the relationship between the neutrophil-lymphocyte ratio and overall survival in patients with gastric cancer submitted to curative resection and to identify the clinicopathological features (age, gender, tumor depth, nodal involvement and tumor differentiation) that are correlated with high neutrophil-lymphocyte ratios. A literature search of PubMed, Scopus, Cochrane and EMBASE through November 2017 was conducted. Articles that included gastric cancer patients submitted to curative resection and preoperatory neutrophil-lymphocyte ratio values were included. A total of 7 studies comprising 3264 patients from 5 different countries were included. The meta-analysis revealed an association of high neutrophil-lymphocyte ratios with older age, male gender, lower 5-year overall survival, increased depth of tumor invasion, positive nodal involvement but not with histological differentiation. Evaluation of the neutrophil-lymphocyte ratio is a cost-effective method that is widely available in preoperatory settings. Furthermore, it can effectively predict prognosis, as high values of this biomarker are related to more aggressive tumor characteristics. This ratio can also be used to stratify risk in patients within the same disease stage and may be used to assist in individualized follow-up and treatment.
- Multivisceral resection vs standard gastrectomy for gastric adenocarcinoma(2020) DIAS, Andre R.; PEREIRA, Marina A.; OLIVEIRA, Rodrigo J.; RAMOS, Marcus F. K. P.; SZOR, Daniel J.; RIBEIRO, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanIntroduction Multivisceral resection (MVR) is potentially curative for selected gastric cancer patients, supposedly at the cost of increased complications. However, current data comparing MVR to standard gastrectomy (SG) is lacking. Objectives Compare complications and survival after MVR and SG. Methods In a retrospective cohort of 1015 patients with gastric adenocarcinoma, 58 underwent MVR and 466 SG. Groups were compared concerning their characteristics, complications, and survival. Results One hundred seventy-six patients had postoperative complications. Major complications were more frequent after MVR (P = .002). Surgical mortality was 8.6% and 4.9% for MVR and SG (P = .221). Older age, higher morbidities, and MVR were independent risk factors for major complications. The odds ratio for major complications was 5.89 for MVR with one or two organs and 38.01 for MVR with three or more organs. The pancreas was the most commonly removed organ and pT4b disease were confirmed in 34 (58.6%) of the MVR cases. Disease-free survival (DFS) was lower in MVR patients (51% vs 77.8%; P < .001), being worse according to the number of organs resected. In pN+ patients, DFS was worse after MVR. DFS was equivalent to pT4b and non-pT4b in the MVR group. Conclusions Increased morbidity and lower survival are expected for gastric cancer patients undergoing MVR.
- Reply to: ""Association between neutrophil-lymphocyte ratio and prognosis after potentially curative resection for gastric cancer""(2018) SZOR, Daniel J.; DIAS, Andre R.; PEREIRA, Marina A.; RAMOS, Marcus F. K. P.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO JR., Ulysses
- Neutrophil-lymphocyte ratio change after curative gastrectomy for gastric cancer: a subgroup analysis(2020) SZOR, Daniel Jose; DIAS, Andre Roncon; PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; ZLBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO JUNIOR, UlyssesObjective: To evaluate the impact of neutrophil-lymphocyte ratio change after curative surgery for gastric cancer. Methods: A retrospective analysis of patients with gastric cancer who underwent curative surgery between 2009 and 2017 was performed. A cutoff value was established for the neutrophil-lymphocyte ratio in the pre- and postoperative periods, according to the median value, and four subgroups were formed (low-low/low-high/high-low/high-high). Clinical-pathological and survival data were analyzed and related to these subgroups. Results: A total of 325 patients were included in the study. The cutoff values of the neutrophil-lymphocyte ratio were 2.14 and 1.8 for the pre and postoperative periods, respectively. In patients with stages I and II, the high-high subgroup presented worse overall survival (p=0.016) and disease-free survival (p=0.001). Complications were higher in the low-high subgroup of patients. Conclusion: The neutrophil-lymphocyte ratio is a low cost, efficient and reproducible marker. The prognosis individualization can be performed according to the identification of subgroups at a higher risk of complications and worse prognosis.
- ROBOTIC GASTRECTOMY: TECHNIQUE STANDARDIZATION(2020) DIAS, Andre Roncon; RAMOS, Marcus Fernando Kodama Pertille; SZOR, Daniel Jose; ABDALLA, Ricardo; BARCHI, Leandro; YAGI, Osmar Kenji; RIBEIRO-JUNIOR, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBackground: Robotic gastrectomy is gaining popularity worldwide. It allows reduced blood loss and lesser pain. However, it widespread use is limited by the extensive learning curve and costs. Aim: To describe our standard technique with reduced use of robotic instruments. Methods: We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and meticulous surgical description. Results: After standardizing the procedure, 28 patients were operated with this budget technique. For each procedure material used was: 1 (Xi model) or 2 disposable trocars (Si) and 4 robotic instruments. Stapling and clipping were performed by the assistant through an auxiliary port, limiting the use of robotic instruments and reducing the cost. Conclusion: This standardization helps implementing a robotic program for gastrectomy in the daily practice or in one's institution.
- Neutrophil-lymphocyte ratio is associated with prognosis in patients who underwent potentially curative resection for gastric cancer(2018) SZOR, Daniel Jose; DIAS, Andre Roncon; PEREIRA, Marina A.; RAMOS, Marcus F. K. P.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO, UlyssesBackground and ObjectivesThe role of inflammation in cancer development is a well-known phenomenon that may be represented by the neutrophil-lymphocyte ratio (NLR). The present research intends to determine the impact of NLR on the survival outcome of patients with gastric cancer (GC), and to evaluate its use as a stratification factor for the staging groups. MethodsData regarding clinical characteristics, surgery, pathology, and follow-up were retrospectively collected from our single-center prospective database. Blood samples were obtained before surgery. ResultsA total of 383 patients (231 males) who underwent gastrectomy with lymphadenectomy were evaluated between 2009 and 2016. NLR established cutoff was 2.44, and patients were divided in NLR 2.44 (hNLR) and <2.44 (lNLR). hNLR patients (38.4% of the cases) had lower disease-free survival and overall survival (OS) compared to lNLR patients (P=0.047 and P=0.045, respectively). Risk stratification according to NLR value was done in same tumor depth (T4 and
- Stem cell factor receptor gene mutation: Achalasia, mastocytosis and gastrointestinal stromal tumors(2020) TUSTUMI, Francisco; SZOR, Daniel Jose; SALLUM, Rubens Antonio Aissar; CECCONELLO, Ivan
- Remnant gastric cancer: An ordinary primary adenocarcinoma or a tumor with its own pattern?(2021) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; DIAS, Andre Roncon; DANTAS, Anna Carolina Batista; SZOR, Daniel Jose; JR, Ulysses Ribeiro; ZILBERSTEIN, Bruno; CECCONELLO, IvanBACKGROUND Remnant gastric cancer (RGC) is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis. However, there little information available regarding RGCs and their prognostic factors and survival. AIM To evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease. METHODS Patients who underwent curative resection for primary gastric cancer (GC) at our institute between 2009 and 2019 were retrospectively evaluated. All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study. Primary proximal GC (PGC) who underwent total gastrectomy was selected as the comparison group. Clinical and pathological data were collected from a prospective medical database. RESULTS A total of 41 patients with RGC and 120 PGC were included. Older age (P = 0.001), lower body mass index (P = 0.006), hemoglobin level (P < 0.001), and number of resected lymph nodes resected (LN) (P < 0.001) were associated with the RGC group. Lauren type, pathological tumor-node-metastasis, and perioperative morbimortality were similar between RGC and PGC. There was no difference in disease-free survival (P = 0.592) and overall survival (P = 0.930) between groups. LN status was the only independent factor related to survival. CONCLUSION RGC had similar clinicopathological characteristics to PGC. Despite the lower number of resected LN, RGC had a similar prognosis.
- Laparoscopic D2 Gastrectomy for Gastric Cancer: Mid-Term Results and Current Evidence(2019) DIAS, Andre Roncon; JACOB, Carlos Eduardo; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; SZOR, Daniel Jose; YAGI, Osmar Kenji; BARCHI, Leandro Cardoso; RIBEIRO JR., Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanIntroduction: Although the first laparoscopic gastrectomy was performed in 1991, there was a long delay until it was incorporated into the regular practice of western surgeons. In Brazil, there are only few case series reported and data on its safety and efficacy along with mid- and long-term results are desired. Objective: Present the mid-term results of laparoscopic gastrectomy with curative intent in the treatment of gastric adenocarcinoma and review the current evidence on the therapy of this neoplasia with the laparoscopic access. Methods: Patients who underwent D2 laparoscopic gastrectomy for gastric adenocarcinoma were retrospectively reviewed. Results: Sixty-nine patients met the inclusion criteria. The mean age was 59.2 years and the mean body mass index was 24.2 kg/m(2). Subtotal gastrectomy was performed in 73.9%. The mean number of harvested lymph nodes was 36.7, increased lymph node count and shorter operative time were observed in the last 34 cases. Median hospital stay was 8 days. Postoperative complications occurred in 22 (31.9%) cases. Surgical mortality was 4.3%. Conclusion: Laparoscopic gastrectomy can be performed safely with excellent short- and mid-term results. As experience increases, surgical duration is reduced and lymph node count rises.
- Duodenal fistula: The most lethal surgical complication in a case series of radical gastrectomy(2018) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; BARCHI, Leandro Cardoso; YAGI, Osmar Kenji; DIAS, Andre Roncon; SZOR, Daniel Jose; ZILBERSTEIN, Bruno; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, IvanBackground: Despite all advances regarding the surgical treatment of gastric cancer (GC), duodenal stump fistula (DF) continues to negatively affect postoperative outcomes. This study aimed to assess DF regarding its incidence, risk factors, management and impact on overall survival. Methods: We retrospectively analyzed 562 consecutive patients who underwent gastrectomy for GC between 2009 and 2017. Clinicopathological characteristics analysis was performed comparing DF, other surgical fistulas and patients with uneventful postoperative course. Results: DF occurred in 15 (2.7%) cases, and 51 (9%) patients had other surgical fistulas. Tumor located in the lower third of the stomach (p=0.021) and subtotal gastrectomy (p=0.002) were associated with occurrence of DF. The overall mortality rate was 40% for DF and 15.7% for others surgical fistulas (p=0.043). The median time of DF onset was on postoperative day 9 (range 1-75). Conservative approach was performed in 8 patients and surgical intervention in 7 cases. Age (OR 7.41, p=0.012) and DF (OR 9.06, p=0.020) were found to be independent risk factors for surgical mortality. Furthermore, patients without fistula had better long-term survival outcomes comparing to patients with any type of fistulas (p=0.006). Conclusion: DF is related with distal tumors and patients submitted to subtotal gastrectomy. It affects not only the postoperative period with high morbidity and mortality rates, but may also have a negative impact on long-term survival.