MARINA ALESSANDRA PEREIRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
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- Câncer gástrico em adultos jovens: um grupo de pior prognóstico?(2019) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; SAGAE, Victor Masaro Takamatsu; MESTER, Marcelo; MORRELL, André Luiz Gioia; DIAS, Andre Roncon; ZILBERSTEIN, Bruno; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanABSTRACT Objective: to evaluate the clinical and pathological characteristics and survival of young patients with gastric cancer, regardless of the intention of treatment. Methods: we conducted a retrospective analysis of all gastric cancer patients undergoing any surgical treatment between 2008 and 2017. We considered patients under 45 years old as young adults and those over 45 years old, as of advanced age. Results: of the 875 patients evaluated, 84 (9.6%) were young adults and 791 (90.4%) were older. Younger patients were associated with female gender (p<0.001), lower Charlson score (p=0.002), ASA I/II (p<0.001), diffuse Lauren type (p<0.001) and poorly differentiated tumors (p<0.001). There was no difference between groups regarding treatment intention (palliative versus curative) (p=0.267) and cTNM clinical stage (p=0.120). Disease-free survival was worse in younger individuals (p=0.049), but overall survival was similar between groups (p=0.578). Multivariate analysis identified total gastrectomy, pT3/T4, pN+, and diffuse Lauren type as prognostic factors associated with worse disease-free survival and overall survival. Age was not an independent factor associated with worse prognosis. Conclusion: although younger patients had lower disease-free survival, overall survival was similar between groups, and age was not a significant independent prognostic factor.
conferenceObject Clinicopathological Characteristics and Prognostic Value of HER2, PD-L1 and MSI Expression in Curative Resectable Gastric Cancer Patients(2019) PEREIRA, M. A.; RAMOS, M. F.; FARAJ, S. F.; DIAS, A. R.; CIRQUEIRA, C. D.; CHARRUF, A. Z.; PERROTTA, F. S.; MELLO, E. S.; ZILBERSTEIN, B.; CECCONELLO, I.; YAGI, O. K.; ALVES, V. A.; JUNIOR, U. R.- Expression Profile of Markers for Targeted Therapy in Gastric Cancer Patients: HER-2, Microsatellite Instability and PD-L1(2019) PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; DIAS, Andre Roncon; FARAJ, Sheila Friedrich; RIBEIRO, Renan Ribeiro e; CASTRIA, Tiago Biachi de; ZILBERSTEIN, Bruno; ALVES, Venancio Avancini Ferreira; JR, Ulysses Ribeiro; MELLO, Evandro Sobroza deBackground The assessment of human epidermal growth factor receptor 2 (HER2), microsatellite instability (MSI) and programmed cell death-ligand 1 (PD-L1) expression is relevant for the selection and effectiveness of targeted therapy in gastric cancer (GC). Objective We aimed to investigate the clinicopathological characteristics and prognosis of GC patients according to these profiles. Methods GC patients who underwent gastrectomy with D2 lymphadenectomy were eligible. HER2, MSI status and PD-L1 expression were analyzed by immunohistochemistry (IHC). Patients were grouped as follows: HER2+ group, immunotherapy (IT) group (MSI and/or PD-L1+), and non-targeted therapy (NTT) group (stable microsatellite and HER2/PD-L1-). Results Among 282 patients, 50 (17.7%) were HER2+ and 79 (28%) MSI/PD-L1+. Fifteen had HER2+ and MSI/PD-L1+, while 168 (59.6%) were in the NTT group. HER2+ GCs were related to male gender (p = 0.007), intestinal type (p = 0.001) and less advanced pTNM stage (p = 0.029). Older age (p = 0.003), subtotal gastrectomy (p = 0.025), intestinal type (p = 0.008), pN0 status (p = 0.002) and less advanced pTNM stage (p = 0.001) were associated with the IT group. IT GC had better disease-free survival (DFS) and overall survival than the NTT group (p = 0.015 and p = 0.027, respectively). Concerning patients eligible for the standard adjuvant therapy, the treatment impacted positively on DFS for HER2+ and NTT groups (p = 0.003 and p = 0.042, respectively). No difference in DFS was seen between IT patients who received perioperative/adjuvant therapy and those treated only with surgery (p = 0.160). Conclusions GC patients who exhibited markers that can serve as an indication for known targeted therapy represent 40.4% of cases. The IT group was associated with a better prognosis. No benefit with standard adjuvant treatment appears to be achieved in MSI/PD-L1+ GCs.
- Surgical outcomes of gastrectomy with D1 lymph node dissection performed for patients with unfavorable clinical conditions(2019) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; DIAS, Andre Roncon; YAGI, Osmar Kenji; ZAIDAN, Evelise Pelegrinelli; RIBEIRO-JUNIOR, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBackground: Gastric cancer (GC) patients with advanced age and/or multiple morbidities have limited expected survival and may not benefit from extended lymph node resection. The aim of this study was to evaluate the surgical outcomes of these GC patients who underwent gastrectomy with Dl dissection. Methods: We retrospectively reviewed all GC patients who underwent gastrectomy with curative intent from 2009 to 2017. The decision to perform D1 was based on preoperative multidisciplinary meeting, and/or intraoperative clinical judgment. Results: Among 460 enrolled patients, 73 (15.9%) underwent D1 lymphadenectomy and 387 (84.1%) D2 lymphadenectomy. Male gender, older age, American Society of Anesthesiologists score (ASA) III/IV, higher neutrophil-to-lymphocyte ratio (NLR) and higher Charlson Comorbidity Index (CCI) were more common in the D1 group. Postoperative major complications were significantly higher in D1 group (24.7% vs 12.4%, p < 0.001) and mostly related to clinical complications. Locoregional recurrence was higher in the D1 group (53.8% vs 39.5%, p = 0.330) however, without statistical significance. No difference was found in disease-free survival (DFS) between D1 and D2 patients with positive lymph nodes (p = 0.192), whereas overall survival was longer in the D2 group (p < 0.001). Multivariate analysis showed a statistically significant impact on survival of age >= 70 years, CCI >= 5, total gastrectomy, D1 lymphadenectomy and advanced stages (III/IV). Conclusions: Frail patients had high surgical mortality even when submitted to D1 dissection. DFS was comparable to D2. Extent of lymphadenectomy in high-risk patients should take in account the expectation of a decrease in surgical risk with the possibility of impairment of long-term survival.
- Gastric partitioning for the treatment of malignant gastric outlet obstruction(2019) RAMOS, Marcus Fernando Kodama Pertille; BARCHI, Leandro Cardoso; OLIVEIRA, Rodrigo Jose de; PEREIRA, Marina Alessandra; MUCERINO, Donato Roberto; RIBEIRO JR., Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBACKGROUND Gastric outlet obstruction (GOO) is one of the main complications in stage IV gastric cancer patients. This condition is usually managed by gastrojejunostomy (GJ). However, gastric partitioning (GP) has been described as an alternative to overcoming possible drawbacks of GJ, such as delayed gastric emptying and tumor bleeding. AIM To compare the outcomes of patients who underwent GP and GJ for malignant GOO. METHODS We retrospectively analyzed 60 patients who underwent palliative gastric bypass for unresectable distal gastric cancer with GOO from 2009 to 2018. Baseline clinicopathological characteristics including age, nutritional status, body mass index, and performance status were evaluated. Obstructive symptoms were graded according to GOO score (GOOS). Surgical outcomes evaluated included duration of the procedure, surgical complications, mortality, and length of hospital stay. Acceptance of oral diet after the procedure, weight gain, and overall survival were the long-term outcomes evaluated. RESULTS GP was performed in 30 patients and conventional GJ in the other 30 patients. The mean follow-up was 9.2 mo. Forty-nine (81.6%) patients died during that period. All variables were similar between groups, with the exception of worse performance status in GP patients. The mean operative time was higher in the GP group (161.2 vs 85.2 min, P < 0.001). There were no differences in postoperative complications and surgical mortality between groups. The median overall survival was 7 and 8.4 mo for the GP and GJ groups, respectively (P = 0.610). The oral acceptance of soft solids (GOOS 2) and low residue or full diet (GOOS 3) were reached by 28 (93.3%) GP patients and 22 (75.9%) GJ patients (P = 0.080). Multivariate analysis demonstrated that GOOS 2 and GOOS 3 were the main prognostic factors for survival (hazard ratio: 8.90, 95% confidence interval: 3.3823.43, P < 0.001). CONCLUSION GP is a safe and effective procedure to treat GOO. Compared to GJ, it provides similar surgical outcomes with a trend to better solid diet acceptance by patients.
conferenceObject THE IMPACT OF POSTOPERATIVE COMPLICATIONS ON A RETURN TO INTENDED ONCOLOGIC TREATMENT (RIOT) IN RESECTED GASTRIC CANCER PATIENTS(2019) RAMOS, Marcus F.; CASTRIA, Tiago B. de; PEREIRA, Marina A.; DIAS, Andre R.; ANTONACIO, Fernanda F.; HOFF, Paulo M.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO, UlyssesconferenceObject OUTCOME PREDICTOR SCORE FOR MULTIVISCERAL RESECTION IN T4 GASTRIC CANCER(2019) DIAS, Andre R.; PEREIRA, Marina A.; RAMOS, Marcus F.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO, Ulysses- Esophagojejunal anastomotic fistula: a major issue after radical total gastrectomy(2019) BARCHI, Leandro Cardoso; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; DIAS, Andre Roncon; RIBEIRO-JUNIOR, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanGastric cancer surgery has evolved considerably over the past years, with substantial improvement on outcomes. Meanwhile, esophagojejunal anastomotic fistula (EJF) continues to impair postoperative results. This study aimed to assess EJF regarding its incidence, risk factors, management and the impact on overall survival. We retrospectively analyzed 258 consecutive patients who underwent total or completion gastrectomy for GC from 2009 and 2017. Clinicopathological characteristics analysis was performed comparing patients who developed EJF with patients with other clinical or surgical complications, as well as patients without any postoperative complications. Fifteen (5.8%) patients had EJF and 81 (31.4%) had other complications (including other surgical fistulas). The median time of EJF diagnosis was on the eighth postoperative day (range 3-76). Completion gastrectomy (p = 0.048) and longer hospital stay (p < 0.001) were associated with the occurrence of EJF. The surgical mortality of patients with EJF was higher than in non-EJF patients (26.7% vs. 4.5%; p < 0.001). Nine patients were treated conservatively and six required surgery. The mortality rate of EJF was 11.1% and 50% in patients who underwent conservative and surgical treatment, respectively. Patients with other complications and patients with EJF had worse survival compared to patients without any complication (p = 0.004 and p = 0.013, respectively). Completion gastrectomy is the main risk factor for EJF occurrence. Still, EJF is associated with high postoperative mortality, longer hospital stay and has a negative impact on long-term survival.
conferenceObject CLINICOPATHOLOGICAL CHARACTERISTICS AND PROGNOSIS OF YOUNG PATIENTS WITH GASTRIC CANCER(2019) RAMOS, Marcus F.; PEREIRA, Marina A.; SAGAE, Vitor M.; MESTER, Marcelo; MORRELL, Andre L.; DIAS, Andre R.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO, Ulysses- 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.