MARCO AURELIO VAMONDES KULCSAR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Prognostic Value of Hematological Parameters in Oral Squamous Cell Carcinoma(2023) TREVISANI, Lorenzo Fernandes Moca; KULCSAR, Isabelle Fernandes; KULCSAR, Marco Aurelio Vamondes; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoIntroduction: Oral squamous cell carcinoma (OSCC) remains a significant public health concern. The variables utilized to determine appropriate treatment for this disease also represent its most unfavorable prognostic factors, with these parameters solely determined by the neoplasm and its behavior. However, a lack of well-established indices is evident in the literature that specifically relate to the patient and indicate a worse prognosis. Objective: To assess the prognostic impact of hematological indices in patients with OSCC. Methods: This retrospective cohort study included patients with oral squamous cell carcinoma (OSCC) who underwent curative-intent treatment. Treatment encompassed surgery, followed by adjuvant therapy, as necessary. Laboratory tests were conducted immediately prior to surgery, and demographic information was obtained from medical records. Results: The cohort comprised 600 patients, with 73.5% being male subjects. Adjuvant treatment was recommended for 60.3% of patients. Throughout the follow-up period, 48.8% of participants died. Univariate analysis indicated that perineural invasion, angiolymphatic invasion, pT4 tumors, lymph node metastases, extranodal extravasation, RDW > 14.3%, NLR (neutrophil-lymphocyte ratio) > 3.38, PLR (platelet-lymphocyte ratio) > 167.3, and SII (systemic inflammatory/immune response index) > 416.1 were factors associated with increased mortality. These threshold values were established through ROC curve analysis. In the multivariate analysis, angiolymphatic invasion (HR = 1.43; 95% CI: 1.076-1.925; p = 0.014), pT4a/b tumors (HR = 1.761; 95% CI: 1.327-2.337; p < 0.001), extranodal extravasation (HR = 1.420; 95% CI: 1.047-1.926; p = 0.024), and RDW (HR = 1.541; 95% CI: 1.153-2.056; p = 0.003) were identified as independent risk factors for decreased overall survival. Conclusions: RDW > 14.3% was proven to be a reliable parameter for assessing overall survival in patients with OSCC. Further studies are required to evaluate the clinical applicability of other hematological indices.
- External validation of the AJCC Cancer Staging Manual, 8th edition, in an independent cohort of oral cancer patients(2017) MATOS, Leandro Luongo; DEDIVITIS, Rogerio Aparecido; KULCSAR, Marco Aurelio Vamondes; MELLO, Evandro Sobroza de; ALVES, Venancio Avancini F.; CERNEA, Claudio RobertoObjectives: To evaluate the new American Joint Committee on Cancer (AJCC) cancer staging manual (8th edition) in an independent cohort of patients surgically treated for oral squamous cell carcinoma in order to determine whether the upstaging of pT and pN classification was indicative of a worse prognosis. Methods: A cohort of 298 patients was analyzed retrospectively. Results: Of these patients, 22.8% received an upstaging when the depth of invasion was included into the pT classification. Similarly, 29.2% of them were upstaged when extracapsular extension was added to pN classification. Twenty-eight of 68 patients (41.2%) that received an upstaging of pT classification died, and 23 (33.8%) experienced disease recurrence compared to 98/229 (42.8%) and 68/229 (29.7%), respectively, for those with the same pT during follow-up. With regard to pN classification, 70.6% of upstaged patients (60/85) died, and 50.6% (43/85) developed recurrence of the disease compared to 63/205 (30.7%) and 42/205 (20.5%), respectively, for those with the same pN during follow-up. Patients who were upstaged in pT classification presented a worse DFS (51.1% versus 80.4%, P = 0.007) and OS (31.5% versus 58.6%, P = 0.017). Similarly, those that were upstaged in pN classification presented a worse DFS (17.1% versus 61.2%, P = 0.001) and OS (8.5% versus 37.9%, P < 0.001). Conclusion: The new AJCC cancer staging manual (8th edition) allows a better stratification of oral SCC patients. By including the depth of invasion to the pT classification and extranodal extension to the pN classification, a worse disease-free and overall survival was assessed for these patients.
- Applied nutritional investigation Effect of age on resting energy expenditure in patients with cancer(2022) SOUZA, Micheline Tereza Pires de; OZORIO, Gislaine Aparecida; OLIVEIRA, Giovanna Nunes de; LOPEZ, Rossana Veronica Mendoza; ALVES-ALMEIDA, Maria Manuela Ferreira; KULCSAR, Marco Aurelio Vamondes; RIBEIRO JR., Ulysses; SINGER, Pierre; WAITZBERG, Dan L.Objective: Because older patients with cancer are at high risk for developing malnutrition, it is critical to understand their energy needs and to feed them appropriately. The aim of this study was to determine whether there are differences in resting energy expenditure between younger and older adults with cancer and in various age groups of older patients. Methods: This retrospective, observational, and descriptive study from a single center included adult ( 60 y) and older ( 0.001). The REE of older patients (1263.3 [234.1] kcal/d) was lower than that of patients 60 y, an REE greater than those for individuals 60 to 69 y, 70 to 79 y, and 0.001). REE in patients 60 to 69 y was greater than for those 0.001). When compared with the Harris-Benedict formula, the REE intraclass correlation coefficient for all older patients was 0.514 (95% confidence interval [CI], 0.064-0.736); for ages 60 to 69 y it was 0.527 (95% CI, 0.126-0.733), and for ages 70 y, it was 0.466 (95% CI,-0.080 to-0.756). Conclusion: Measured REE in patients with cancer decreases with age. This finding is critical for appropriate caloric provision for older patients with cancer. ?? 2022 Elsevier Inc. All rights reserved.
- Risk Factors for Distant Metastasis in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgical Treatment(2017) AIRES, Felipe Toyama; LIN, Chin Shien; MATOS, Leandro Luongo; KULCSAR, Marco Aurelio Vamondes; CERNEA, Claudio RobertoObjective: The aim of this study is to investigate the clinical and pathological factors related to distant metastasis in patients with oral cavity squamous cell carcinoma (OCSCC) undergoing surgery. Study Design: A retrospective data review was conducted on patients who underwent primary surgery for OCSCC at the Instituto do Cancer do Estado de Sao Paulo (ICESP) between 2009 and 2015. Distant metastasis rates were calculated and predictive factors were determined by the Cox proportional-hazards model. Results: There was a total of 274 patients, including 210 (76.6%) men and 64 (23.4%) women, with a mean age of 59.9 +/- 10.9 years. The incidence of distant metastasis was 9.6%, with the lung being the most common site. The mean time interval between surgical treatment and the diagnosis of distant metastasis was 12 months (range 2-40 months). In the multivariate analysis, angiolymphatic invasion (HR = 2,87; p = 0.023), contralateral cervical metastasis (HR = 3.3; p = 0,007), tumor thickness >25 mm (HR = 3.50; p = 0.009), and locoregional recurrence (HR = 6.59; p < 0.0001) were the only independent risk factors for distant metastasis. Conclusion: Patients with OCSCC who have contralateral lymph node metastasis, tumors with a thickness >25 mm, angiolymphatic invasion, or locoregional recurrence after surgical treatment have a greater risk of developing distant metastasis. (C) 2018 S. Karger AG, Basel.
- Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review(2016) GUIMARAES, Andre Vicente; AIRES, Felipe Toyama; DEDIVITIS, Rogerio Aparecido; KULCSAR, Marco Aurelio Vamondes; RAMOS, Daniel Marin; CERNEA, Claudio Roberto; BRANDAO, Lenine GarciaBackground. The role of pectoralis major muscle flap (PMMF) in reducing the rate of pharyngocutaneous fistula after salvage total laryngectomy has not been clearly established. The purpose of this study was to evaluate the impact of PMMF in reducing pharyngocutaneous fistula rates after total laryngectomy. Methods. The analyzed intervention was the use of a PMMF after total laryngectomy. Results. Pharyngocutaneous fistula occurred in 230 cases (global incidence, 30.9%). In the group of patients who underwent PMMFs, there were 49 cases of pharyngocutaneous fistula, compared with 181 cases in the control group. There was a 22% decreased risk of pharyngocutaneous fistula incidence in the PMMF group (p < .001). Patients who underwent a PMMF had lower risk of pharyngocutaneous fistula compared with the control group (p = .008). There were no changes when only patients who underwent total laryngectomy (p < .001) and those who underwent total pharyngolaryngectomy (p = .007) were separately assessed. Conclusion. Prophylactic use of PMMF decreases the incidence of pharyngocutaneous fistula after salvage total laryngectomy. (C) 2015 Wiley Periodicals, Inc.
- Malignant neoplasms of the oral cavity and oropharynx treated in Brazil: what do the hospital cancer registries reveal?(2022) FARIA, Sheilla de Oliveira; NASCIMENTO, Murilo Cesar do; KULCSAR, Marco Aurelio VamondesIntroduction: Head and neck cancer has an impact on the global burden of diseases, representing an important cause of morbidity and mortality in Brazil, as well as worldwide. Objective: To learn and describe the clinical, epidemiological and care configuration provided to patients with cancer of the oral cavity and oropharynx recorded in Brazil, diagnosed from 2007 to 2016. Methods: This is a cross-sectional study, carried out using secondary hospital-based data, using the indirect documentation technique. Results: There were 52,799 hospital records of oral cavity cancer and 34,516 cases of oropharyngeal cancer in the assessed period. There was a predominance of male patients, aged 5059 years, mostly Caucasians, and with a low level of schooling. Throughout the period there was a significant reduction in the positive history of alcohol and tobacco consumption, except for alcoholic beverages in oral cavity cancer. Most patients were diagnosed at an advanced stage of the disease (III or IV). Most patients with oral cavity cancer had no evidence of the disease on follow-up, while most patients with oropharyngeal cancer died. The first most frequent treatment offered to patients with oral cavity cancer was surgery, while for patients with oropharyngeal cancer it chemoradiotherapy predominated. Conclusion: Despite the fact that, in general, there was a reduction in the records of patient alcohol and tobacco consumption, the increase in the number of medical consultations, the predominantly late diagnosis and the patients low level of schooling indicate the need for health education, primary prevention and early diagnosis of cancer of the oral cavity and oropharynx.
- Quality of life among total laryngectomized patients undergoing speech rehabilitation: correlation between several instruments(2020) RAQUEL, Ana Carolina Soares; BUZANELI, Elaine Pires; SILVEIRA, Hevely Saray Lima; SIMOES-ZENARI, Marcia; KULCSAR, Marco Aurelio Valmondes; KOWALSKI, Luiz Paulo; NEMR, KatiaOBJECTIVE: The aim of this study was to correlate several instruments currently used for the assessment of the quality of life of patients who underwent total laryngectomy and speech rehabilitation. METHODS: A cross-sectional, observational study was conducted with 38 patients after total laryngectomy and speech therapy aiming to develop oesophageal speech. The patients were divided into the following two groups (19 participants each): speakers and non-speakers. The quality of life instruments used were as follows: visual analogue scale (VAS); Voice Handicap Index (VHI); Voice-Related Quality of Life (V-RQOL); Functional Assessment of Cancer Therapy - Head & Neck (FACT-H & N); European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck (EORTC QLQ-H & N35); and University of Washington Quality of Life (UW-QOL). RESULTS: The V-RQOL global health domain exhibited a strong correlation with the VHI. The EORTC QLQ-C30 exhibited a moderate to strong correlation with the EORTC QLQ-H&N35 functional domain in both groups. The EORTC QLQ-C30 functional domain exhibited a strong to moderate correlation with all other instruments in both groups. The UW-QOL exhibited a moderate to strong correlation with the VHI and EORTC QLQ-C30 in both groups. CONCLUSION: The EORTC QLQ-C30, EORTC QLQ-H&N35 and UW-QOL were the instruments that most correlated with the remaining instruments, indicating that any of the three can be used to assess the quality of life of the target population regardless of oesophageal voice development.
- Cancer-associated fibroblast regulation by microRNAs promotes invasion of oral squamous cell carcinoma(2020) MATOS, Leandro Luongo; MENDERICO JUNIOR, Gilberto Mendes; THEODORO, Therese Rachell; PASINI, Fatima Solange; ISHIKAWA, Marina de Menezes; RIBEIRO, Andromeda Aryane Bomtempo; MELLO, Evandro Sobroza de; PINHAL, Maria Aparecida da Silva; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio Vamondes; DEDIVITIS, Rogerio Aparecido; CERNEA, Claudio Roberto; KOWALSKI, Luiz PauloThe objective of the present study was to evaluate the role of microRNA-mediated remodeling of the extracellular matrix in the process of tumor invasion of oral squamous cell carcinoma and to evaluate its relationship with the prognosis of these patients. This was a retrospective study on material from the paraffin blocks of patients operated on for oral squamous cell carcinoma, in addition to a group of healthy oral mucosa samples of paired patients. miR-1-3p, miR-133-3p, and miR-21-5p were differentially expressed between the superficial and deep tumor groups. miR-21-5p was the one with the greatest accuracy in the differentiation between superficial and deep tumors. By immunohistochemistry, the group of deep tumors showed greater immunoreactivity to matrix metalloproteinases 2 and 9 and laminin a in tumor-associated fibroblasts, with consequent degradation of the basal membrane, measured by greater loss of continuity of type IV collagen. This process was also associated with lower and higher expression of miR-1-3p and miR-21-5p, respectively. There was also a trend toward better overall and disease-free survival rates in patients with higher miR-133a-3p. The present study showed the interaction between microRNAs and extracellular matrix remodeling in oral squamous cell carcinoma.
- The impact of sentinel lymph node biopsy on the quality of life in patients with oral cavity squamous cell carcinoma(2022) SEFERIN, Marco Roberto; PINTO, Fabio Roberto; LEITE, Ana Kober Nogueira; DEDIVITIS, Rogerio Aparecido; KULCSAR, Marco Aurelio Vamondes; CERNEA, Claudio Roberto; MATOS, Leandro Luongo deIntroduction Sentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown. Objective The present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection. Methods Cross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire. Results The evaluation of the questionnaires showed a late worsening of the domains appearance (p = 0.035) and chewing (p = 0.041), as well as a decrease of about 10% of general quality of life (p = 0.025) in patients undergoing selective neck dissection in comparison to those undergoing sentinel lymph node biopsy. Conclusion Patients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.
- Amelanotic melanoma presenting as a tongue tumor(2021) LEITE, Ana Kober; KULCSAR, Marco Aurelio V.; MATSUURA, Danielli; MATOS, Leandro Luongo; KOWALSKI, Luiz Paulo