LUIZ PAULO KOWALSKI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
10 resultados
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- Implication of the New AJCC pT Classification of SCC of the Lip Comparing With Other Oral Subsites(2021) TOLEDO, Loic Monginet; OLIVEIRA, Adriana Santos de; PINHEIRO, Renan Aguera; LEITE, Ana Kober Nogueira; MELLO, Evandro Sobroza de; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio V.; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoObjective To determine the implication of the new AJCC staging system for pT classification in a cohort of patients with SCC of the lip mucosa and compare it to other oral cavity sites. Methods Retrospective cohort of 744 patients treated between 2002 and 2017, by the Head and Neck Surgery Department of the University of Sao Paulo. Results Of 95 lip patients, 42 had pT upstage (58.1% of pT1 to pT2-3 and 50% of pT2 to pT3). Similar DFS/OS observed for those pT1 maintained or upstaged to pT2-3, pT2 patients upstaged to pT3 presented worse OS (49.4% versus 92.3%, P = .032). The comparison between lip and other mouth topographies, denoted better prognosis for pT1-2, but not for pT3-4a. Lip tumors had lower DOI, rates of perineural/angiolymphatic invasion, nodal metastasis, recurrence, and death. Conclusion The inclusion of DOI to the new pT classification better stratifies patients with SCC of the lip mucosa upstaged to pT3 by assessing inferior OS. Level of Evidence 3 Laryngoscope, 2021
- Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer(2022) TREVISANI, Lorenzo Fernandes Moça; KULCSAR, Isabelle Fernandes; LEITE, Ana Kober Nogueira; KULCSAR, Marco Aurélio Vamondes; LIMA, Graziele Aparecida Simões; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoAbstract Objective: The aim of the present study was to analyze the prognostic relationship of weight loss and preoperative hematological indexes in patients surgically treated for pT4a squamous cell carcinoma of the oral cavity. Methods: A retrospective cohort study. Results: Percent weight loss greater than 10% was identified in 49 patients (28.2%), and any weight loss in relation to the usual weight occurred in 140 patients (78.7%). Percent weight loss greater than 10% (HR = 1.679), Red cell distribution width (RDW) values greater than 14.3% (HR = 2.210) and extracapsular spread (HR = 1.677) were independent variables associated with risk of death. Conclusion: Patients with advanced squamous cell carcinoma of the oral cavity present significant weight loss and as significantly immunocompromised. Increased values of RDW and higher percentages of weight loss in relation to the individual’s usual weight, together with extracapsular spread of metastatic lymph nodes, were risk factors for lower survival, regardless of other clinical and anatomopathological characteristics. Level of evidence: 3.
- Risk factors associated with disease-specific mortality in papillary thyroid cancer patients with distant metastases(2022) NUNES, Kamilla Schmitz; MATOS, Leandro Luongo; CAVALHEIRO, Beatriz Godoi; MAGNABOSCO, Felipe Ferraz; TAVARES, Marcos Roberto; KULCSAR, Marco Aurelio; HOFF, Ana Oliveira; KOWALSKI, Luiz Paulo; LEITE, Ana KoberPurpose Papillary thyroid carcinoma (PTC) is among the most curable cancer types. Even though uncommon, some patients present distant metastatic disease at diagnosis or during the follow-up and most of them have long-term survival. However, there continues to be controversies regarding what clinicopathological features are associated with mortality in these patients. This paper evaluates the factors related to poor disease-specific survival (DSS) in patients with metastatic PTC. Methods A retrospective cohort study included PTC patients with distant metastasis from a tertiary public oncological center. Clinicopathological features, treatment modalities, and outcome were reviewed. Results Between 1986 and 2014, 108 patients were diagnosed with metastatic PTC. In the multivariate analysis male sex (HR = 2.65; 95%CI: 1.08-6.53; P = 0.033), radioiodine refractory disease (HR = 9.50; 95%CI: 1.23-73.38; P = 0.031) and metastasis at multiple sites (HR = 5.91; 95%CI: 1.80-19.32; P = 0.003) were independent risk factors for death in patients with metastatic PTC. Conclusion Male patients with metastatic PTC, with radioiodine refractory disease and metastasis at multiple sites have a high risk of death.
- The Impact of the COVID-19 Pandemic on Head and Neck Surgery Training: A Brazilian National Survey(2021) LEITE, Ana Kober; MATOS, Leandro Luongo; CERNEA, Claudio R.; KOWALSKI, Luiz PauloIntroduction The COVID-19 pandemic has had a high impact on surgical training around the world due to required measures regarding the suspension of elective procedures and the dismissal of nonessential personnel. Objectives To understand the impact the pandemic had on head and neck surgery training in Brazil. Methods We conducted a 29-question online survey with head and neck surgery residents in Brazil, assessing the impact the pandemic had on their training. Results Forty-six residents responded to the survey, and 91.3% of them reported that their residency was affected by the pandemic, but most residents were not assigned to work directly with patients infected with the new coronavirus (71.4%). All residents reported decrease in clinic visits and in surgical procedures, mostly an important reduction of similar to 75%. A total of 56.5% of the residents described that the pandemic has had a negative impact on their mental, health and only 4 (8.7%) do not have any symptoms of burnout. The majority (78.3%) of the residents reported that educational activities were successfully adapted to online platforms, and 37% were personally infected with the virus. Conclusion Most surgical residencies were greatly affected by the pandemic, and residents had an important decrease in surgical training. Educational activities were successfully adapted to online modalities, but the residency programs should search for ways of trying to compensate for the loss of practical activities.
- Impact of the COVID-19 Pandemic on Brazilian Head and Neck Surgery Centers(2023) ALVARENGA, Gustavo Fernandes de; LEITE, Ana Kober Nogueira; LEHN, Carlos Neutzling; DEDIVITIS, Rogerio Aparecido; NAKAI, Marianne Yumi; CAVALHEIRO, Beatriz Godoi; TEIXEIRA, Gilberto Vaz; CICCO, Rafael De; KOWALSKI, Luiz Paulo; MATOS, Leandro Luongo deObjective: The outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers.Methods: An anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April -June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020.Results: The response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n = 19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly.Conclusions: The COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment. Level of evidence: Evidence from a single descriptive study. (c) 2023 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Incidental Node Metastasis as an Independent Factor of Worse Disease-Free Survival in Patients with Papillary Thyroid Carcinoma(2023) PINHEIRO, Renan Aguera; LEITE, Ana Kober; CAVALHEIRO, Beatriz Godoi; MELLO, Evandro Sobroza de; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoSimple Summary Papillary thyroid cancer is treated mainly by thyroidectomy surgery. The surrounding lymph nodes are not usually resected unless it is known before surgery that they are metastatic, and then all adjacent lymph nodes are resected (named the central compartment neck dissection). However, some lymph nodes could be incidentally resected with the thyroid, sometimes containing metastasis, but this does not mean that the central compartment neck dissection was performed properly. This study aimed to test whether these patients with incidental metastatic nodes had higher treatment failure rates. We found that they indeed had higher rates of treatment failure, even when compared to patients with clinically evident central compartment node metastasis that were submitted to proper neck dissection. We suggest that these patients must be closely followed to detect signs of treatment failure early and to provide prompt treatment. Introduction: Papillary thyroid carcinoma (PTC) have high node metastasis rates. Occasionally after thyroidectomy, the pathological report reveals node metastasis unintentionally resected. The present study aimed to evaluate the prognosis of these patients. Methods: A retrospective cohort of patients submitted to thyroidectomy with or without central compartment neck dissection (CCND) due to PTC with a minimum follow-up of five years. Results: A total of 698 patients were included: 320 Nx, 264 pN0-incidental, 37 pN1a-incidental, 32 pN0-CCND and 45 pN1a-CCND. Patients with node metastasis were younger, had larger tumors, higher rates of microscopic extra-thyroidal extension, and angiolymphatic invasion and most received radioiodine therapy. Treatment failure was higher in patients pN1a-incidental and pN1a-CCND (32% and 16%, respectively; p < 0.001-Chi-square test). Disease-free survival (DFS) was lower in patients pN1a-incidental compared to patients Nx and pN0-incidental (p < 0.001 vs. Nx and pN0-incidental and p = 0.005 vs. pN0-CCND) but similar when compared to patients pN1a-CCND (p = 0.091)-Log-Rank test. Multivariate analysis demonstrated as independent risk factors: pT4a (HR = 5.524; 95%CI: 1.380-22.113; p = 0.016), pN1a-incidental (HR = 3.691; 95%CI: 1.556-8.755; p = 0.003), microscopic extra-thyroidal extension (HR = 2.560; 95%CI: 1.303-5.030; p = 0.006) and angiolymphatic invasion (HR = 2.240; 95%CI: 1.077-4.510; p = 0.030). Conclusion: Patients that were pN1a-incidental were independently associated with lower DFS.
- Profile of MicroRNAs Associated with Death Due to Disease Progression in Metastatic Papillary Thyroid Carcinoma Patients(2023) LEITE, Ana Kober; SAITO, Kelly Cristina; THEODORO, Therese Rachell; PASINI, Fatima Solange; CAMILO, Luana Perrone; ROSSETTI, Carlos Augusto; CAVALHEIRO, Beatriz Godoi; ALVES, Venancio Avancini Ferreira; KOWALSKI, Luiz Paulo; PINHAL, Maria Aparecida Silva; KIMURA, Edna Teruko; MATOS, Leandro LuongoPapillary thyroid cancer is not an aggressive cancer, even when metastasis are present; therefore, treatment has been downgraded in recent years. However rare, mortality exists and finding the factors associated with mortality is essential and has not yet been fully accomplished; the answer probably lies in molecular factors. This study aimed to find MicroRNAs related to death in metastatic patients and found that patients who died due to progression of PTC had higher expression levels of miR-101-3p, miR-17-5p, and miR-191-5p compared with those of patients with stable metastatic disease. These findings are new in the literature and may open new doors in differentiating the patients who need more aggressive treatment from those who do not. Papillary thyroid carcinoma (PTC) is the most common neoplasm of the endocrine system and has an excellent long-term prognosis, with low rates of distant metastatic disease. Although infrequent, there are cases of deaths directly related to PTC, especially in patients with metastatic disease, and the factors that could be associated with this unfavorable outcome remain a major challenge in clinical practice. Recently, research into genetic factors associated with PTC has gained ground, especially mutations in the TERT promoter and BRAF gene. However, the role of microRNAs remains poorly studied, especially in those patients who have an unfavorable outcome at follow-up. This paper aims to evaluate molecular markers related to the different pathological processes of PTC, as well as the histological characteristics of the neoplasm, and to compare this profile with prognosis and death from the disease using an analysis of patients treated for metastatic disease in a single tertiary cancer center. Evaluation of microRNA expression in paraffin-embedded tumor specimens was carried out by quantitative PCR using the TaqMan((R)) Low Density Array (TLDA) system. Metastatic patients who died from progression of PTC had higher expressions of miR-101-3p, miR-17-5p, and miR-191-5p when compared to patients with stable metastatic disease. These findings are of great importance but should be considered as preliminary because of the small sample.
- Short-term survival in extensive craniofacial resections(2021) LEITE, Ana Kober N.; ALVARENGA, Gustavo Fernandes de; GONCALVES, Sergio; SANTOS, Alexandre Bezerra dos; NETO, Hugo Sterman; CERNEA, Claudio R.; V, Marco Aurelio Kulcsar; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoOBJECTIVES: Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations. METHODS: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018. RESULTS: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years (+/- 18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003). CONCLUSIONS: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.
- Survival in differentiated thyroid carcinoma: A comparison between the 7th and 8th editions of the AJCC/UICC TNM staging system and the ATA initial risk stratification system(2021) CAVALHEIRO, Beatriz Godoi; MATOS, Leandro Luongo de; LEITE, Ana Kober Nogueira; KULCSAR, Marco Aurelio Vamondes; CERNEA, Claudio Roberto; KOWALSKI, Luiz PauloBackground The AJCC/UICC TNM staging system evaluates the risk of death from cancer. Its 8th edition aimed to increase its accuracy. In turn, the American Thyroid Association proposed an initial risk stratification system (IRSS) focusing on the risk of recurrence in differentiated thyroid carcinoma. The present study intended to analyze their prediction abilities. Methods Six hundred and eighty-five consecutive surgical patients (mean follow-up 71.6 months) were staged. Correlations with disease-free survival (DFS) and overall survival (OS) were carried out. Results IRSS was discriminative for DFS but not for OS. Applying TNM 8th, 36.9% of the cohort was downstaged. Their DFS was shorter, compared with other patients in the same stage, but with no impact on OS. However, all those who died of the disease had been downstaged. Conclusions IRSS was more effective to predict DFS, but not OS. TNM 8th was more appropriate for OS analysis than TNM 7th and IRSS.
- Amelanotic melanoma presenting as a tongue tumor(2021) LEITE, Ana Kober; KULCSAR, Marco Aurelio V.; MATSUURA, Danielli; MATOS, Leandro Luongo; KOWALSKI, Luiz Paulo