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Albuquerque A, Pessegueiro Miranda H, Lopes J, Gandara J, Rodrigues S, Gaspar R, Morais R, Ramalho R, Rodrigues-Pinto E, Cardoso H, Barroca H, Dias CC, Carneiro F, Macedo G. Liver transplant recipients have a higher prevalence of anal squamous intraepithelial lesions. Br J Cancer 2017; 117:1761-1767. [PMID: 29093575 PMCID: PMC5729480 DOI: 10.1038/bjc.2017.370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Anal squamous intraepithelial lesions (ASIL) are precancerous lesions of anal squamous cell carcinoma, with a higher prevalence in immunosuppressed patients. There are some studies in kidney transplant recipients, but there is no information regarding prevalence in liver transplantation. Our aim was to evaluate the prevalence of ASIL in this setting. Methods: Prospective case–control study involving liver transplant recipients without any other known risk factor for ASIL (n=59), which were compared with a healthy control group (n=57). All were submitted to anal cytology and high-resolution anoscopy was performed in those with abnormal results. Results: Ten (17%) of liver transplant recipients had abnormal cytological results, seven patients had atypical squamous cells of undetermined significance (ASC-US), one patient had atypical squamous cells that cannot exclude high-grade (ASC-H) and two patients had high-grade squamous intraepithelial lesions (HSIL). In the control group, one patient (2%) had an ASC-US result (P=0.005). Anal squamous intraepithelial lesions were confirmed in 7 out of 10 of liver transplant patients and 0 out of 1 in the controls (P=0.013) by high-resolution anoscopy with biopsies. Current smoking was the only risk factor for abnormal cytology (odds ratio=5.87, 95% confidence intervals=1.22–28.12, P=0.027). Conclusions: Liver transplant patients have a higher risk of ASIL. Screening should be considered, especially in smokers.
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Affiliation(s)
- A Albuquerque
- Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - H Pessegueiro Miranda
- Liver and Pancreatic Transplant Unit Centro Hospitalar Porto, Porto, Portugal.,Abel Salazar BioMedical Sciences Institute from University of Porto, Porto, Portugal.,Institute of Public Health, University of Porto, Porto, Portugal
| | - J Lopes
- Pathology Department Centro Hospitalar São João, Porto, Portugal
| | - J Gandara
- Liver and Pancreatic Transplant Unit Centro Hospitalar Porto, Porto, Portugal.,Abel Salazar BioMedical Sciences Institute from University of Porto, Porto, Portugal
| | - S Rodrigues
- Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - R Gaspar
- Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - R Morais
- Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - R Ramalho
- Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - E Rodrigues-Pinto
- Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - H Cardoso
- Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - H Barroca
- Pathology Department Centro Hospitalar São João, Porto, Portugal
| | - C C Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal.,Center for Health Technology and Services Research-CINTESIS, Porto, Portugal
| | - F Carneiro
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Pathology Department Centro Hospitalar São João, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) and i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - G Macedo
- Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
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Rodrigues-Pinto E, Pereira P, Coelho R, Andrade P, Ribeiro A, Lopes S, Moutinho-Ribeiro P, Macedo G. Outcome and risk factors assessment for adverse events in advanced esophageal cancer patients after self-expanding metal stents placement. Dis Esophagus 2017; 30:1-6. [PMID: 27629280 DOI: 10.1111/dote.12467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Self-expanding metal stents (SEMS) are the treatment of choice for advanced esophageal cancers. Literature is scarce on risk factors predictors for adverse events after SEMS placement. Assess risk factors for adverse events after SEMS placement in advanced esophageal cancer and evaluate survival after SEMS placement. Cross-sectional study of patients with advanced esophageal cancer referred for SEMS placement, during a period of 3 years. Ninety-seven patients with advanced esophageal cancer placed SEMS. Adverse events were more common when tumors were located at the level of the distal esophagus/cardia (47% vs 23%, P = 0.011, OR 3.1), with statistical significance being kept in the multivariate analysis (OR 3.1, P = 0.018). Time until adverse events was lower in the tumors located at the level of the distal esophagus/cardia (P = 0.036). Survival was higher in patients who placed SEMS with curative intent (327 days [126-528] vs. 119 days [91-147], P = 0.002) and in patients submitted subsequently to surgery compared with those who did just chemo/radiotherapy or who did not do further treatment (563 days [378-748] vs. 154 days [133-175] vs. 46 days [20-72], P < 0.001). Subsequent treatment kept statistical significance in the multivariate analysis (HR 3.4, P < 0.001). SEMS allow palliation of dysphagia in advanced esophageal cancer and are associated with an increased out-of-hospital survival, as long as there are conditions for further treatments. Tumors located at the level of the distal esophagus/cardia are associated with a greater number of adverse events, which also occur earlier.
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Affiliation(s)
- E Rodrigues-Pinto
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - P Pereira
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - R Coelho
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - P Andrade
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - A Ribeiro
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - S Lopes
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - P Moutinho-Ribeiro
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - G Macedo
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
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Coelho R, Rodrigues-Pinto E, Cardoso H, Santos-Antunes J, Marques M, Horta e Vale A, Malheiro L, Macedo G. Severe metabolic acidosis: the presenting sign of an enterovesical fistula. Int J Colorectal Dis 2016; 31:785-6. [PMID: 26105744 DOI: 10.1007/s00384-015-2287-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 02/04/2023]
Affiliation(s)
- R Coelho
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.
| | - E Rodrigues-Pinto
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - H Cardoso
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - J Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - M Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - A Horta e Vale
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - L Malheiro
- Surgery Department, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - G Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
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