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
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Depth of invasion applied to oropharynx does not improve prognosis discrimination according to AJCC stage groups for oral cancer(2020) MATOS, Leandro Luongo; PINHEIRO, Renan Aguera; KOWALSKI, Luiz Paulo
- Machine learning for the prediction of toxicities from head and neck cancer treatment: A systematic review with meta-analysis(2023) ARAUJO, Anna Luiza Damaceno; MORAES, Matheus Cardoso; PEREZ-DI-OLIVEIRA, Maria Eduarda; SILVA, Viviane Mariano da; SALDIVIA-SIRACUSA, Cristina; PEDROSO, Caique Mariano; LOPES, Marcio Ajudarte; VARGAS, Pablo Agustin; KOCHANNY, Sara; PEARSON, Alexander; KHURRAM, Syed Ali; KOWALSKI, Luiz Paulo; MIGLIORATI, Cesar Augusto; SANTOS-SILVA, Alan RogerIntroduction: The aim of the present systematic review (SR) is to summarize Machine Learning (ML) models currently used to predict head and neck cancer (HNC) treatment-related toxicities, and to understand the impact of image biomarkers (IBMs) in prediction models (PMs). The present SR was conducted following the guidelines of the PRISMA 2022 and registered in PROSPERO database (CRD42020219304). Methods: The acronym PICOS was used to develop the focused review question (Can PMs accurately predict HNC treatment toxicities?) and the eligibility criteria. The inclusion criteria enrolled Prediction Model Studies (PMSs) with patient cohorts that were treated for HNC and developed toxicities. Electronic database search encompassed PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, LILACS, and Gray Literature (Google Scholar and ProQuest). Risk of Bias (RoB) was assessed through PROBAST and the results were synthesized based on the data format (with and without IBMs) to allow comparison. Results: A total of 28 studies and 4,713 patients were included. Xerostomia was the most frequently investigated toxicity (17; 60.71 %). Sixteen (57.14 %) studies reported using radiomics features in combination with clinical or dosimetrics/dosiomics for modelling. High RoB was identified in 23 studies. Meta-analysis (MA) showed an area under the receiver operating characteristics curve (AUROC) of 0.82 for models with IBMs and 0.81 for models without IBMs (p value < 0.001), demonstrating no difference among IBM-and non-IBM-based models. Discussion: The development of a PM based on sample-specific features represents patient selection bias and may affect a model's performance. Heterogeneity of the studies as well as non-standardized metrics prevent proper comparison of studies, and the absence of an independent/external test does not allow the evaluation of the model's generalization ability. Conclusion: IBM-featured PMs are not superior to PMs based on non-IBM predictors. The evidence was appraised as of low certainty.
- Transoral thyroidectomy (TOETVA): Complications, surgical time and learning curve(2020) LIRA, Renan Bezerra; RAMOS, Andressa Teruya; NOGUEIRA, Ricardo Miguel Ribeiro; CARVALHO, Genival Barbosa de; RUSSELL, Jonathon O.; TUFANO, Ralph P.; KOWALSKI, Luiz PauloBackground: Since 2018, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a true scarless thyroid surgery. In this study, we explore early outcomes and learning curve of this new approach. Methods: A retrospective cohort including conventional thyroidectomies and TOETVAs performed in a cancer center was designed. Learning curve and early surgical outcomes of TOETVA were assessed and compared to conventional thyroidectomy. Results: A total of 56 TOETVAs and 745 conventional thyroid procedures were included. In the TOETVA group, we had a 14.4% total complication rate with no permanent vocal cord paresis or hypocalcemia. The mean surgical time dropped from 167 to 117 min (p = 0.0001) after the 15 first cases. Comparing to conventional procedures, we didn't find any significant difference in complications rate. Operative time was longer in the TOETVA group. Conclusions: In this study, TOETVA was safe and feasible, with a learning curve of 15 cases.
- COVID-19, head and neck cancer, and the need of training of health students and practitioners regarding to tobacco control and patient counseling(2020) LEONEL, Augusto Cesar Leal da Silva; MARTELLI-JUNIOR, Hercilio; BONAN, Paulo Rogerio Ferreti; KOWALSKI, Luiz Paulo; PEREZ, Danyel Elias da Cruz
- Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic(2020) CHAVES, Aline Lauda Freitas; CASTRO, Ana Ferreira; MARTA, Gustavo Nader; JUNIOR, Gilberto Castro; FERRIS, Robert L.; GIGLIO, Raul Eduardo; GOLUSINSKI, Wojciech; GORPHE, Philippe; HOSAL, Sefik; LEEMANS, C. Rene; MAGNE, Nicolas; MEHANNA, Hisham; MESIA, Ricard; NETTO, Eduardo; PSYRRI, Amanda; SACCO, Assuntina G.; SHAH, Jatin; SIMON, Christian; VERMORKEN, Jan B.; KOWALSKI, Luiz Paulo
- Staging and grading of oral squamous cell carcinoma: An update(2020) ALMANGUSH, Alhadi; MAKITIE, Antti A.; TRIANTAFYLLOU, Asterios; BREE, Remco de; STROJAN, Primoz; RINALDO, Alessandra; HERNANDEZ-PRERA, Juan C.; SUAREZ, Carlos; KOWALSKI, Luiz P.; FERLITO, Alfio; LEIVO, IlmoOral squamous cell carcinoma (OSCC) is a common malignancy of the head and neck region. OSCC has a relatively low survival rate and the incidence of the disease is increasing in some geographic areas. Staging and grading of OSCC are established prerequisites for management, as they influence risk stratification and are the first step toward personalized treatment. The current AJCC/UICC TNM staging (8th edition, 2017) of OSCC has included significant modifications through the incorporation of depth of invasion in the T stage and extracapsular spread/extranodal extension in the N stage. Further modifications for AJCC 8 have been suggested. On the other hand, the World Health Organization (WHO) classification (4th edition, 2017) still endorses a simple, differentiation-based histopathologic grading system of OSCC (despite its low prognostic value) and ignores factors such as tumor growth pattern and dissociation, stromal reactions (desmoplasia, local immune response), and tumor-stroma ratio. The various controversies and possible developments of the current staging and grading criteria of OSCC are briefly discussed in this update together with possible applications of artificial intelligence in the context of screening and risk stratification.
- Direct costs associated with the management of mucositis: A systematic review(2021) RODRIGUES-OLIVEIRA, Leticia; KOWALSKI, Luiz Paulo; SANTOS, Marcos; MARTA, Gustavo Nader; BENSADOUN, Rene-Jean; MARTINS, Manoela Domingues; LOPES, Marcio Ajudarte; CASTRO, Gilberto de; WILLIAM, William Nassib; CHAVES, Aline Lauda Freitas; MIGLIORATI, Cesar Augusto; SALLOUM, Ramzi G.; RODRIGUES-FERNANDES, Carla Isabelly; KAUARK-FONTES, Elisa; BRANDAO, Thais Bianca; SANTOS-SILVA, Alan Roger; PRADO-RIBEIRO, Ana CarolinaMucositis is one of the more frequent and costly adverse events following cancer treatment. To evaluate and report the direct economic outcomes associated with the management of mucositis across several cancer treatments we conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE/PubMed, and Embase were searched electronically and a total of 37 relevant studies were included. The costs attributable to mucositis in the hematopoietic stem cell transplantation setting ranged from 1124,47 US dollars (USD) to 299 214,14 USD per patient. The radiotherapy/ chemoradiotherapy/radiotherapy plus molecular targeted therapy accounted for mucositis costs that ranged from 51,23 USD to 33 560,58 USD per patient. Costs for mucositis in the chemotherapy setting ranged from 4,18 USD to 31 963,64 USD per patient. When the cancer treatment was not specified, costs of mucositis ranged from 565,85 USD to as high as 20 279, 12 USD per patient. Mucositis costs from multimodal therapy ranged from 12,42 USD to 5670,46 USD per patient. The molecular targeted therapy setting included only one study and depending on the healthcare providers' perspective of each country evaluated, mucositis' costs ranged from 45,78 USD to 3484,91 USD per patient. Mucositis is associated with increased resource use, consultations, hospitalizations and extended hospitalizations, leading to a substantial incremental cost that exacerbates the economic burden on the patient, health plan and health system across several cancer treatments and diagnosis. More studies with a prospective evaluation of the economic costs associated with mucositis management are needed.
- 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.
- Amelanotic melanoma presenting as a tongue tumor(2021) LEITE, Ana Kober; KULCSAR, Marco Aurelio V.; MATSUURA, Danielli; MATOS, Leandro Luongo; KOWALSKI, Luiz Paulo
- Detection of serum biomarkers of HPV-16 driven oropharynx and oral cavity cancer in Brazil(2024) SICHERO, Laura; GONCALVES, Milena Giulia; BETTONI, Fabiana; COSER, Elisangela Monteiro; MOTA, Giana; NUNES, Rafaella A. L.; MERCANTE, Ana Maria da Cunha; NATALINO, Renato; UNO, Miyuki; ALVES, Maria Jose Ferreira; MATOS, Leandro Luongo; KOWALSKI, Luiz Paulo; KULCSAR, Marco Aurelio Vamondes; ALVARENGA, Gustavo Fernandes de; HOEFLER, Daniela; SCHROEDER, Lea; WATERBOER, Tim; TOMMASINO, Massimo; VILLA, Luisa LinaBackground: HPV-16 driven oropharynx/oral cavity squamous cell carcinomas prevalence varies globally. We evaluated the presence of HPV-16 ctDNA and HPV-16 E6 antibodies in samples obtained from participants treated at the Instituto do Cancer do Estado de Sao Paulo, ICESP, and from whom tumoral HPV DNA, HPV-16 E6*I mRNA, and p16(INK4a) status was also accessed. Methods: HPV was genotyped by PCR-hybridization. All HPV DNA positive and similar to 10 % HPV DNA negative cases underwent p16(INK4a) immunohistochemistry and E6*I RNA testing using a multiplex bead based protocol. HPV-16 ctDNA and anti-E6 antibodies were assessed by ddPCR (digital droplet PCR) and multiplex serology, respectively. Results: The prevalence of HPV-16 in oropharynx carcinoma (OPC) cases was low (8.7 %) when considering solely HPV-16 DNA detection, and even lower (5.2 %) when taken into consideration the concomitant detection of HPV-16 E6*I RNA and/or p16(INK4) (HPV-16 attributable fraction - AF). None of the oral cavity cancer (OCC) cases were detected with HPV-16 DNA. HPV-16 ctDNA was more commonly detected than HPV-16 E6 antibodies (29.8 % versus 10.6 %). Both serum biomarkers attained 100 % sensitivity of detecting HPV-16 AF OPC, however the specificity of the HPV-16 anti-E6 biomarker was higher compared to ctDNA (93.2 % versus 75.0 %). Finally, when both HPV-16 ctDNA and anti-E6 biomarkers were considered together, the sensitivity and specificity for HPV-16 OPC detection was 100 % and about 70 %, respectively, independently of analyzing HPV-16 DNA positive or HPV-16 AF tumors. Conclusions: Our findings corroborate that serum biomarkers are highly sensitive and specific biomarkers for detection of HPV-associated OPC.