BRUNO ZILBERSTEIN
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
4 resultados
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- INTRAPERITONEAL CHEMOTHERAPY FOR GASTRIC CANCER WITH PERITONEAL CARCINOMATOSIS: STUDY PROTOCOL OF A PHASE II TRIAL(2023) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; CHARRUF, Amir Zeide; VICTOR, Carolina Ribeiro; GREGORIO, Joao Vitor Antunes Marques; ALBAN, Luciana Bastos Valente; MONIZ, Camila Motta Venchiarutti; ZILBERSTEIN, Bruno; MELLO, Evandro Sobroza De; HOFF, Paulo Marcelo Gehm; JUNIOR, Ulysses Ribeiro; DIAS, Andre RonconBackground: Peritoneal carcinomatosis in gastric cancer is considered a fatal disease, without expectation of definitive cure. As systemic chemotherapy is not sufficient to contain the disease, a multimodal approach associating intraperitoneal chemotherapy with surgery may represent an alternative for these cases.Aims: The aim of this study was to investigate the role of intraperitoneal chemotherapy in stage IV gastric cancer patients with peritoneal metastasis.Methods: This study is a single institutional single-arm prospective clinical trial phase II (NCT05541146). Patients with the following inclusion criteria undergo implantation of a peritoneal catheter for intraperitoneal chemotherapy: Stage IV gastric adenocarcinoma; age 18-75 years; Peritoneal carcinomatosis with peritoneal cancer index<12; Eastern Cooperative Oncology Group 0/1; good clinical status; and lab exams within normal limits. The study protocol consists of four cycles of intraperitoneal chemotherapy with paclitaxel associated with systemic chemotherapy. After treatment, patients with peritoneal response assessed by staging laparoscopy undergo conversion gastrectomy.Results: The primary outcome is the rate of complete peritoneal response. Progression-free and overall survivals are other outcomes evaluated. The study started in July 2022, and patients will be screened for inclusion until 30 are enrolled.Conclusions: Therapies for advanced gastric cancer patients have been evaluated in clinical trials but without success in patients with peritoneal metastasis. The treatment proposed in this trial can be promising, with easy catheter implantation and ambulatory intraperitoneal chemotherapy regime. Verifying the efficacy and safety of paclitaxel with systemic chemotherapy is an important progress that this study intends to investigate.
- Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy(2023) SZOR, Daniel Jose; PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; TUSTUMI, Francisco; DIAS, Andre Roncon; ZILBERSTEIN, Bruno; RIBEIRO, UlyssesBACKGROUNDAlbumin-bilirubin (ALBI) score is an indicator of liver dysfunction and is useful for predicting prognosis of hepatocellular carcinomas. Currently, this liver function index has been used to predict prognosis in other neoplasms. However, the significance of ALBI score in gastric cancer (GC) after radical resection has not been elucidated.AIMTo evaluate the prognostic value of the preoperative ALBI status in patients with GC who received curative treatment.METHODSPatients with GC who underwent curative intended gastrectomy were retrospectively evaluated from our prospective database. ALBI score was calculated as follows: (log10 bilirubin x 0.660) + (albumin x -0.085). The receiver operating characteristic curve with area under the curve (AUC) was plotted to evaluate the ability of ALBI score in predicting recurrence or death. The optimal cutoff value was determined by maximizing Youden's index, and patients were divided into low and high-ALBI groups. The Kaplan-Meier curve was used to analyze the survival, and the log-rank test was used for comparison between groups.RESULTSA total of 361 patients (235 males) were enrolled. The median ALBI value for the entire cohort was -2.89 (IQR -3.13; -2.59). The AUC for ALBI score was 0.617 (95%CI: 0.556-0.673, P < 0.001), and the cutoff value was -2.82. Accordingly, 211 (58.4%) patients were classified as low-ALBI group and 150 (41.6%) as high-ALBI group. Older age (P = 0.005), lower hemoglobin level (P < 0.001), American Society of Anesthesiologists classification III/IV (P = 0.001), and D1 lymphadenectomy P = 0.003) were more frequent in the high-ALBI group. There was no difference between both groups in terms of Lauren histological type, depth of tumor invasion (pT), presence of lymph node metastasis (pN), and pathologic (pTNM) stage. Major postoperative complication, and mortality at 30 and 90 days were higher in the high-ALBI patients. In the survival analysis, the high-ALBI group had worse disease-free survival (DFS) and overall survival (OS) compared to those with low-ALBI (P < 0.001). When stratified by pTNM, the difference between ALBI groups was maintained in stage I/II and stage III CG for DFS (P < 0.001 and P = 0.021, respectively); and for OS (P < 0.001 and P = 0.063, respectively). In multivariate analysis, total gastrectomy, advanced pT stage, presence of lymph node metastasis and high-ALBI were independent factors associated with worse survival.CONCLUSIONThe preoperative ALBI score is able to predict the outcomes of patients with GC, where high-ALBI patients have worse prognosis. Also, ALBI score allows risk stratification of patients within the same pTNM stages, and represents an independent risk factor associated with survival.
- PREOPERATIVE CHEMOTHERAPY VERSUS UPFRONT SURGERY FOR ADVANCED GASTRIC CANCER: A PROPENSITY SCORE MATCHING ANALYSIS(2023) HONG, Stefany; PEREIRA, Marina Alessandra; VICTOR, Carolina Ribeiro; GREGORIO, Joao Vitor Antunes; ZILBERSTEIN, Bruno; RIBEIRO JUNIOR, Ulysses; D'ALBUQUERQUE, Luiz Augusto Carneiro; RAMOS, Marcus Fernando Kodama PertilleBACKGROUND: Surgical resection remains the main curative therapeutic modality for RESUMO -Racional: O tratamento de escolha para pacientes com hipertensao portal advanced gastric cancer. Recently, the association of preoperative chemotherapy has allowed the improvement of results without increasing surgical complications. AIMS: To evaluate the surgical esquistossomotica com sangramento de varizes e a desconexao azgo-portal mais and oncological outcomes of preoperative chemotherapy in a real-world setting. METHODS: A esplenectomia (DAPE) associada a trai doscopica. Porem, estudos ostrm aumento retrospective review of gastric cancer patients who underwent gastrectomy was performed. do calibre das varizes em alguns pacientes durante segimento em lngo prazo. Objetivo: Patients were divided into two groups for analysis: upfro nt surgery and preoperative chemotherapy. Avaliar o impacto da DAPE e tratamento endoscopico pos-operatorio no comportameno The propensity score matching analysis, including 9 variables, was applied to adjust for potential das varizes esofagicas e recidiva hemorragica, de pacientes esquistossomoticos. Metodos: confounding factors. RESULTS: Of the 536 patients included, 112 (20.9%) were referred for preoperative chemotherapy. Before the propensity score matching analysis, the groups were Foram estudados 36 pacientes com seguimento superior a cinco anos, distribuidos em different in terms of age, hemoglobin level, node metastasis at clinical stage-status, and extent dois grupos: queda da pressao portal abaixo de 30% e acima de 30% comparados com o of gastrectomy. After the analysis, 112 patients were stratified for each group. Both were similar calibre ds varize esofagicas no pos-operaorio precoce tardio ale do indice de reciiva for all variables assigned in the score. Patients in the preope rative chemotherapy group had less hemorragica. Resultados advanced postoperative p staging (p=0.010), postoperative n staging (p<0.001), and pTNM stage esofagicas que, durante o seguimento aumentaram de calibre e foram controladas com (p<0.001). Postoperative complications, 30-and 90-days mortality were similar between both groups. Before the propensity score matching analysis, there was no difference in survival between the groups. After the analysis, patients in the preoperative chemotherapy group had better overall o comportamento do calibre das varizes no pos-operatorio precoce nem tardio nm os survival compared to upfront surgery group (p=0.012). Multivariate analyses demonstrated that indices de recidiva hemorragica. Conclusao American Society of Anesthesiologists III/IV category and the presence of lymph node metastasis were factors significantly associated with worse overall survival. CONCLUSIONS: Preoperative operatorios precoces ou tardios. A comparacao entre a queda de pressao do portal e as chemotherapy was associated with increased survival in gastric cancer. There was no difference in the postoperative complication rate and mortality compared to upfront surgery.
- Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer(2023) KAWAKAMI, Lucas Eiki; BONOMI, Pedro Barzan; PEREIRA, Marina Alessandra; CARVALHO, Fabricio Oliveira; JR, Ulysses Ribeiro; ZILBERSTEIN, Bruno; SAMPAIO, Luciana Ribeiro; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto; RAMOS, Marcus Fernando Kodama PertilleBACKGROUNDGastric cancer (GC) is still a prevalent neoplasm around the world and its main treatment modality is surgical resection. The need for perioperative blood transfusions is frequent, and there is a long-lasting debate regarding its impact on survival.AIMTo evaluate the factors related to the risk of receiving red blood cell (RBC) transfusion and its influence on surgical and survival outcomes of patients with GC.METHODSPatients who underwent curative resection for primary gastric adenocarcinoma at our Institute between 2009 and 2021 were retrospectively evaluated. Clinicopathological and surgical characteristics data were collected. The patients were divided into transfusion and non-transfusion groups for analysis.RESULTSA total of 718 patients were included, and 189 (26.3%) patients received perioperative RBC transfusion (23 intraoperatively, 133 postoperatively, and 33 in both periods). Patients in the RBC transfusions group were older (P < 0.001), and had more comorbidities (P = 0.014), American Society of Anesthesiologists classification III/IV (P < 0.001), and lower preoperative hemoglobin (P < 0.001) and albumin levels (P < 0.001). Larger tumors (P < 0.001) and advanced tumor node metastasis stage (P < 0.001) were also associated with the RBC transfusion group. The rates of postoperative complications (POC) and 30-d and 90-d mortality were significantly higher in the RBC transfusion group than in the non-transfusion group. Lower hemoglobin and albumin levels, total gastrectomy, open surgery, and the occurrence of POC were factors associated with the RBC transfusion. Survival analysis demonstrated that the RBC transfusions group had worse disease-free survival (DFS) and overall survival (OS) compared with patients who did not receive transfusion (P < 0.001 for both). In multivariate analysis, RBC transfusion, major POC, pT3/T4 category, pN+, D1 lymphadenectomy, and total gastrectomy were independent risk factors related to worse DFS and OS.CONCLUSIONPerioperative RBC transfusion is associated with worse clinical conditions and more advanced tumors. Further, it is an independent factor related to worse survival in the curative intent gastrectomy setting.