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Moreno-Zabaleta R, García Torres P, Sayas J, Lujan M. High-Flow Nasal Therapy Trends in Spain: A Survey-Based Perspective. Open Respir Arch 2024; 6:100303. [PMID: 38445229 PMCID: PMC10914575 DOI: 10.1016/j.opresp.2024.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Affiliation(s)
| | | | - J. Sayas
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M. Lujan
- Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain
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Gonzalez-Bermejo J, Hajage D, Durand-Zaleski I, Arnal JM, Cuvelier A, Grassion L, Jaffre S, Lamia B, Pontier S, Prigent A, Rabec C, Raherison-Semjen C, Saint Raymond C, Soler J, Trzepizur W, Winck JC, Aguiar M, Chaves H, Conde B, Guimarães MJ, Lopes P, Mineiro A, Moreira S, Pamplona P, Rodrigues CM, Sousa S, Antón A, Córdoba-Izquierdo A, Embid C, Esteban González C, Ezzine F, Garcia P, González M, Guerassimova I, López D, Lujan M, Martí Beltran S, Martinez JM, Masa F, Pascual N, Peñacoba N, Resano P, Rey L, Rodríguez Jerez F, Roncero A, Sancho Chinesta J, Sayas Catalán J. Respiratory support in COPD patients after acute exacerbation with monitoring the quality of support (Rescue2-monitor): an open-label, prospective randomized, controlled, superiority clinical trial comparing hospital- versus home-based acute non-invasive ventilation for patients with hypercapnic chronic obstructive pulmonary disease. Trials 2020; 21:877. [PMID: 33092618 PMCID: PMC7578582 DOI: 10.1186/s13063-020-04672-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/12/2020] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is expected to be the 3rd leading cause of death worldwide by 2020. Despite improvements in survival by using acute non-invasive ventilation (NIV) to treat patients with exacerbations of COPD complicated by acute hypercapnic respiratory failure (AHRF), these patients are at high risk of readmission and further life-threatening events, including death. Recent studies suggested that NIV at home can reduce readmissions, but in a small proportion of patients, and with a high level of expertise. Other studies, however, do not show any benefit of home NIV. This could be related to the fact that respiratory failure in patients with stable COPD and their response to mechanical ventilation are influenced by several pathophysiological factors which frequently coexist in the same patient to varying degrees. These pathophysiological factors might influence the success of home NIV in stable COPD, thus long-term NIV specifically adapted to a patient's "phenotype" is likely to improve prognosis, reduce readmission to hospital, and prevent death. In view of this conundrum, Rescue2-monitor (R2M), an open-label, prospective randomized, controlled study performed in patients with hypercapnic COPD post-AHRF, will investigate the impact of the quality of nocturnal NIV on the readmission-free survival. The primary objective is to show that any of 3 home NIV strategies ("rescue," "non-targeted," and "targeted") will improve readmission-free survival in comparison to no-home NIV. The "targeted" group of patients will receive a treatment with personalized (targeted) ventilation settings and extensive monitoring. Furthermore, the influence of comorbidities typical for COPD patients, such as cardiac insufficiency, OSA, or associated asthma, on ventilation outcomes will be taken into consideration and reasons for non-inclusion of patients will be recorded in order to evaluate the percentage of ventilated COPD patients that are screening failures. ClinicalTrials.gov NCT03890224 . Registered on March 26, 2019.
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De la Cruz-Ku GA, Chambergo-Michilot D, Valcarcel B, Rebaza P, Möller M, Araujo JM, Enriquez D, Morante Z, Razuri C, Luque R, Saavedra A, Eyzaguirre E, Lujan M, Noel N, Pinto J, Cotrina J, Gomez H. Lymph node ratio as best prognostic factor in triple-negative breast cancer patients with residual disease after neoadjuvant chemotherapy. Breast J 2020; 26:1659-1666. [PMID: 32713113 DOI: 10.1111/tbj.13988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/26/2020] [Accepted: 07/08/2020] [Indexed: 01/10/2023]
Abstract
Although lymph node status (ypN) is one of the most important prognostic factors of survival, the lymph node ratio (LNR) has emerged as an equitable factor. We aimed to compare the prognostic value of both ypN and LNR in patients with residual triple-negative breast cancer (TNBC) after neo-adjuvant chemotherapy (NAC). This was a retrospective cohort study of patients treated in a tertiary care center during the period 2000-2014. We stratified the population based on LNR (≤0.20, 0.20-0.65, and >0.65) and ypN (N1, N2, and N3) status. The overall survival (OS) and progression-free survival (PFS) were estimated with Kaplan-Meier curves and the log-rank + test. We further compared patient mortality and disease recurrence using multivariate Cox regression analysis. We evaluated 169 patients with a median follow-up of 87 months. At 2 years of follow-up, patients with low-risk LNR compared to those with moderate and high risk had a higher PFS (54% vs 31% vs 18%, respectively; P < .001) and OS (74% vs 64% vs 45%, respectively; P < .001). Moreover, ypN1 patients compared to ypN2 and ypN3 showed similar results in PFS (53% vs 35% vs 19%, respectively; P = .001) and OS (73% vs 69% vs 43%, respectively; P < .001). Compared to the low-risk population, patients with moderate (hazard ratio [HR]: 3.50; 95% confidence interval [CI]: 1.41-8.71) and high risk (HR: 6.90; 95% CI: 2.29-20.77) had a worse PFS. Regarding OS, moderate-risk (HR: 2.85; 95% CI: 1.10-7.38) and high-risk patients (HR: 6.48; 95% CI: 2.13-19.76) showed considerably worse outcomes. On the other hand, ypN staging was not associated with PFS or OS in the multivariate analysis. The LNR is a better prognostic factor of survival than ypN. The LNR should be considered in the stratification of risk after NAC in patients with TNBC.
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Affiliation(s)
- Gabriel A De la Cruz-Ku
- Universidad Científica del Sur, Lima, Perú.,Unidad de Investigación Básica y Translacional, Oncosalud-AUNA, Lima, Peru
| | | | - Bryan Valcarcel
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Pamela Rebaza
- Unidad de Investigación Básica y Translacional, Oncosalud-AUNA, Lima, Peru
| | - Mecker Möller
- Division of Surgical Oncology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Jhajaira M Araujo
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Daniel Enriquez
- Department of Hematology and Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Zaida Morante
- Department of Hematology and Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Cesar Razuri
- Division of General Surgery, Hospital Nacional Dos de Mayo, Lima, Peru
| | | | | | | | | | | | - Joseph Pinto
- Unidad de Investigación Básica y Translacional, Oncosalud-AUNA, Lima, Peru
| | - Jose Cotrina
- Division of Surgical Oncology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Henry Gomez
- Unidad de Investigación Básica y Translacional, Oncosalud-AUNA, Lima, Peru.,Department of Breast Surgical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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Rázuri C, De la Cruz-Ku G, Lujan M, Luque R, Dongo P, Salinas Sedó OG. How to Predict the Severity of Nonalcoholic Steatohepatitis in Obese Patients Undergoing Bariatric Surgery. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ku GADLC, Morante Z, Pinto J, Araujo J, Enriquez D, Eyzaguirre E, Saavedra A, Lujan M, Luque R, Rázuri C, Fuentes H, Neciosup S, Moreno HG. Abstract 588: Neutrophil to lymphocyte ratio as strongest predictor of early death in metastatic triple negative breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Metastatic triple-negative breast cancer (mTNBC) is a heterogeneous disease with poor prognosis where recent studies suggest that the immune system plays a critical role the mechanisms of disease progression and metastasis. In the other hand, a high Neutrophil to Lymphocyte Ratio (NLR) is associated with poor survival in patients diagnosed with several types of cancer. Our aim was to evaluate the prognostic value of NLR in mTNBC.
Methods: We retrospectively reviewed 130 patients diagnosed with mTNBC between 2000-2014 at “Instituto Nacional de Enfermedades Neoplasicas”. NLR group was divided in <2.5 and ≥2.5. Sites of metastasis were identified by TAC or magnetic resonance imaging. Survival rates were estimated by the Kaplan-Meier method and differences were calculated by Log-rank test. The Cox Regression was used for prognostic factors.
Results: The median age was 50 years (range: 23-92 years). From our study population, 41.2% were premenopausal, and just 10 patients (9.5%) had a breast-ovary cancer familiar background, 62.5% were diagnosed at clinical stage T3-T4 and 86.1% had lymph node involvement. From 130 patients, 41 and 64 had NLR <2.5 and ≥2.5, respectively, while there was no association between characteristics and NLR, only patients with malnutrition had NLR ≥2.5 (9.1% vs 40.8%, p=0.002) and solid organ involvement (62.4% vs 81.3%, p=0.04). Furthermore, lung and bone were the most frequent sites of metastasis. Those patients with lower ratio (<2.5) had better response to chemotherapy (p <0.001). With a median follow-up of 6.25 years, at 1-year OS was lower among patients with NLR ≥2.5 (59% vs 20%, HR: 2.77, 95%CI:1.77-4.33, p<0.001). In addition, at univariate analysis malnutrition also showed an impact on OS (HR: 1.79, 95%CI: 1.20-2.67, p=0.005). At multivariate analysis, between age, T stage, N stage, NLR and solid organ involvement, just NLR was the best and only predictor of worse OS (HR: 3.12, 95%CI:1.94-5.03, p<0.001).
Conclusion: In mTNBC, an NLR ≥2.5 was a strong and accessible biomarker of poor OS. Lower values of NLR could help us to predict chemotherapy response.
Citation Format: Gabriel A. De la Cruz Ku, Zaida Morante, Joseph Pinto, Jhajaira Araujo, Daniel Enriquez, Eduardo Eyzaguirre, Antonella Saavedra, Maria Lujan, Renato Luque, Cesar Rázuri, Hugo Fuentes, Silvia Neciosup, Henry Gómez Moreno. Neutrophil to lymphocyte ratio as strongest predictor of early death in metastatic triple negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 588.
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Affiliation(s)
| | - Zaida Morante
- 2Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | | | | | | | | | | | | | - Hugo Fuentes
- 2Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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Morante Z, De la Cruz-Ku G, Pinto J, Araujo J, Eyzaguirre E, Saavedra A, Lujan M, Enriquez D, Ramirez M, Fuentes H, Neciosup S, Gomez H. Abstract P3-10-11: Triple negative breast cancer in young Peruvian patients: 15-years' experience in a public hospital. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-10-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The incidence of breast cancer (BC) is low in young women and is characterized by a high prevalence of triple-negative tumors, representing a group of high risk. In this work, we describe the clinicopathological and epidemiological features of triple-negative breast cancer (TNBC) in patients aged ≤35 years.
Methods: We reviewed information of TNBC patients diagnosed at ≤35 years old and treated at the Instituto Nacional de Enfermedades Neoplasicas (between 2000 and 2014). The Cox proportional hazard model was used to identify prognostics factors for DFS and OS.
Results: In total, of 243 out 2007 cases (12.11%) were very young TNBC patients. The median follow-up was 9 years. The median age was 32 years (range: 19-35); 14.8% had obesity. A total of 40 (16.5%) patients had a family history of breast-ovary cancer (FHBOC). Regarding to the clinical-pathological characteristics, 59.4% presented T-Stages 3/4; 65.2% had nodal involvement and 7 patients (2.9%) had bilateral BC. Most of patients were diagnosed at Clinical Stage (CS) III (50.8%). The most common histological subtype the was ductal invasive carcinoma (92.1%), followed by medullar (4.5%) and lobulillar (1.7%). A high histological grade was frequent (84.7%), while 71 cases (49%) were diagnosed with vascular permeation and 55 (48.2%) with macrometastasis in lymph nodes. The majority of patients underwent mastectomy (60.2%) compared to lumpectomy (39.8%). Locoregional relapse and distant metastasis were reported in 30.9% and 49.4% of cases, respectively. The most frequent sites of metastases were lung (14.8%) and brain (11.5%). In the multivariate analysis, only N3 stage was associated with a poor outcome in terms of (N0 vs N3, HR=7.89, 95%CI:2.76-22.56, p<0.001). Variables associated with the risk of death were N stage (P<0.001 for N0 vs N3), neoadjuvant chemotherapy (P<0.027), adjuvant chemotherapy (P<0.001), and radiotherapy (P=0.008).
Conclusions: TNBC in very young Peruvian women was characterized by advanced stage at diagnosis. In these patients, nodal involvement was the most important prognostic factor for DFS. It presents distinctive characteristics and poorer outcomes in terms of DFS and OS.
Table 1. Multivariate Cox Regression Analysis.CharacteristicsPFS OS HR95% CIp valueHR95% CIp valueN0 vs N11.820.74-4.480.191.510.88-2.590.14N0 vs N22.260.69-7.360.183.031.69-5.46<0.001N0 vs N37.892.76-22.56<0.0013.581.83-7.01<0.001Adjuvant chemotherapynsnsns0.340.20-0.55<0.001Neo-Adjuvant Chemotherapynsnsns0.590.37-0.940.027Radiotherapynsnsns0.560.37-0.860.008ns = not significant
Citation Format: Morante Z, De la Cruz-Ku G, Pinto J, Araujo J, Eyzaguirre E, Saavedra A, Lujan M, Enriquez D, Ramirez M, Fuentes H, Neciosup S, Gomez H. Triple negative breast cancer in young Peruvian patients: 15-years' experience in a public hospital [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-11.
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Affiliation(s)
- Z Morante
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - G De la Cruz-Ku
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - J Pinto
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - J Araujo
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - E Eyzaguirre
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - A Saavedra
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - M Lujan
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - D Enriquez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - M Ramirez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - H Fuentes
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - S Neciosup
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
| | - H Gomez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Oncosalud, Lima, Peru; Universidad Cientifica del Sur, Lima, Peru
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Jarrett B, Lujan M. Baseline Clinical and Sonographic Markers of Androgen Status Predict the Ovulatory Response to Weight Loss in Obese Women with PCOS. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Enriquez Vera D, De la Cruz Ku G, Haro Varas J, Rioja P, Morante Cruz Z, Valdiviezo Lama N, Luque R, Eyzaguirre E, Lujan M, Saavedra A, Mayuri Monsefu M, Ferreyros G, Retamozo Alvarado M, Vidal Ayllón J, Neciosup Delgado S, Mas Lopez L. Clinical impact of atypical phenotypes in adult t cell lymphoma/leukemia among HTLV carriers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx373.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lujan M, Sogo A, Pomares X, Monso E, Sales B, Blanch L. Effect of Leak and Breathing Pattern on the Accuracy of Tidal Volume Estimation by Commercial Home Ventilators: A Bench Study. Respir Care 2013; 58:770-7. [DOI: 10.4187/respcare.02010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Burgos J, Lujan M, Falco V, Sanchez A, Puig M, Borrego A, Fontanals D, Planes AM, Pahissa A, Rello J. The Spectrum of Pneumococcal Empyema in Adults in the Early 21st Century. Clin Infect Dis 2011; 53:254-61. [DOI: 10.1093/cid/cir354] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Godoy J, Cardona AF, Cáceres H, Otero JM, Lujan M, Lopera D, Pacheco JO, Spath A, Gis P. Cost-effectiveness analysis of first-line treatment for metastatic renal cell carcinoma (mRCC) in Colombia (ONCOLGroup study). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16150 Background: Renal cell carcinoma has increased its incidence by 126% since 1950. A local study developed a complete economic evaluation of sunitinib versus IFN in first-line treatment of mRCC in Colombia, finding that sunitinib was more cost-useful and cost-effective. Methods: A Markov model was developed using 6-week cycles for evaluating the cost-effectiveness of four interventions (IFN, sunitinib, bevacizumab+IFN, sorafenib) approved as first-line treatment for mRCC in Colombia. The model used the third-party payer perspective and a 5-year time-line; it also presumed that all the patients (pts) continued with active treatment until progression when it became acceptable to continue with a second-line treatment or BSC. Overall survival (OS) and progression-free survival (PFS) curves of IFN were used as reference framework; they were obtained form a published clinical trial. The hazard ratios (HR) for PFS and OS were estimated for comparing new generation medicaments with IFN. The information about frequency of use and health service cost units consumed in Colombia was taken from a series of 24 pts treated in Manizales, Pereira, Medellín and Bogotá. Service costs were requested from an external consultant and corresponded to the average value billed by the EPSs, calculated from 33 sources of information which were representative of the country's market. The cost of the medicaments was obtained from LCLC. The costs and benefits were discounted annually at 3%. (all cost are presented in Colombian pesos Col$ 2008 with an exchange rate 1 USD = 1836.20 Col$). Results: Incremental analysis indicated a difference of 41.1 million Col$ in the average total cost of treatment when Sunitinib was compared to IFN; in contrast, comparing sorafenib and Bevacizumab+INF to sunitinib demonstrated that the average total cost was less for the sunitinib by 8.3 and 104.2 million Col$, respectively. Additionally, the ratios of incremental cost-effectiveness by life years (LY) gained demonstrated sunitinib's simple dominance over sorafenib and the combination of bevacizumab+IFN, and an average by LY gained of 100.5 million Col$ compared to IFN. Conclusions: Sunitinib is the most cost-effective option as first-line treatment for mRCC pts in Colombia. [Table: see text]
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Affiliation(s)
- J. Godoy
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
| | - A. F. Cardona
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
| | - H. Cáceres
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
| | - J. M. Otero
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
| | - M. Lujan
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
| | - D. Lopera
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
| | - J. O. Pacheco
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
| | - A. Spath
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
| | - P. Gis
- Hospital Militar Central, Bogotá, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Pfizer Medical Division, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clínica las Américas Cancer Institute, Medellín, Colombia; Cancer Institute of Manizales, Manizales, Colombia; Hospital de San José, Bogotá, Colombia
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Lujan M, Cardona AF, Yepes A, Carrasco-Chaumel E, Reveiz L, Otero JM. Myelophthisis in solid tumors: Old aspects, new concepts (ONCOLGroup study). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20672 Background: Myelophthisis is a form of bone marrow failure due to replacement of hematopoietic tissue by abnormal tissue, most commonly metastatic carcinomas. This results in extramedullary hematopoiesis, typically in the spleen leading to premature release of hematopoietic cells into the circulation. Peripheral blood findings of myelophthisis may include nucleated red blood cells, tear drop forms, giant platelets, and immature leukocytes. Overall, this picture is usually called leukoerythroblastosis. Methods: This retrospective study included 89 patients (pts) with solid tumors and myelophtisis that had been treated from 1991 to 2006 in a single reference center in Bogotá. We made a detailed analysis of pts characteristics and outcomes. Results: Mean age was 47.5±17.2 years, there was homogeneous gender distribution (F46/M43) and 62% pts had a PS ≥60%. Twenty-seven pts (30%) had breast cancer, pathology followed by primary unknown tumours (21%), rabdomiosarcoma (10%), prostate adenocarcinoma (10%), gastric carcinoma (7%) and others (22%). At the time when myelophtisis was documented 72% and 50% of pts had osseous and visceral metastasis respectively; 81 pts presented anaemia (Hb 9.8 ± 1.2 gr/dl), mean platelet count was 174,000 and mean leukocyte count was 24,283 ± 5,447. Forty-three pts received chemotherapy following the diagnosis of medullar infiltration, and normal leukocyte count was being seen in 40% of them after such treatment. Nine episodes of febrile neutropenia were found; median overall survival (OS) following the diagnosis of neoplasia and myelophtisis were 13.8 months and 2.2 months respectively. The factors related to lower survival rate were the presence of Hb ≤8.5 gr/dl (HR: 0,54, CI95% 0,32–0,95; p = 0.04), >3 metastasis sites (HR: 0,67, CI95% 0,45–0,92; p = 0.03), visceral disease (HR: 0,72, CI95% 0,66–0,89; p = 0.04) and febrile neutropenia caused by chemotherapy (HR: 0,52, CI95% 0,37–0,60; p = 0.02). Conclusions: Myelophtisis is a serious condition modifying the OS of patients having solid tumours. Treatment for this subgroup should be selected bearing in mind its potential haematological toxicity. No significant financial relationships to disclose.
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Affiliation(s)
- M. Lujan
- Clínica las Américas, Medellín, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Foundation Clinical and Molecular Cancer Research, Bogotá, Colombia; Colombian Cochrane Group, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Spain
| | - A. F. Cardona
- Clínica las Américas, Medellín, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Foundation Clinical and Molecular Cancer Research, Bogotá, Colombia; Colombian Cochrane Group, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Spain
| | - A. Yepes
- Clínica las Américas, Medellín, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Foundation Clinical and Molecular Cancer Research, Bogotá, Colombia; Colombian Cochrane Group, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Spain
| | - E. Carrasco-Chaumel
- Clínica las Américas, Medellín, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Foundation Clinical and Molecular Cancer Research, Bogotá, Colombia; Colombian Cochrane Group, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Spain
| | - L. Reveiz
- Clínica las Américas, Medellín, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Foundation Clinical and Molecular Cancer Research, Bogotá, Colombia; Colombian Cochrane Group, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Spain
| | - J. M. Otero
- Clínica las Américas, Medellín, Colombia; Hospital Germans Trias i Pujol, Barcelona, Spain; Foundation Clinical and Molecular Cancer Research, Bogotá, Colombia; Colombian Cochrane Group, Bogotá, Colombia; Fundación Santa Fe de Bogotá, Bogotá, Spain
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Roobol M, Aus G, Auvinen A, Bangma C, Berenguer A, Ciatto S, Denis L, Hugosson J, Lujan M, Nelen V, Tammela T, Zappa M, Schröder F. 284 HOW TO SCREEN FOR PROSTATE CANCER AFTER 2008? PSA AS A BIOPSY INDICATOR, PART II. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1569-9056(09)60289-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Puig V, Romera J, Quevedo J, Cardona CM, Salterain A, Ayesa E, Irizar I, Castro A, Lujan M, Charbonnaud P, Chiron P, Trouvat JL. Optimal predictive control of water transport systems: Arrêt-Darré/Arros case study. Water Sci Technol 2009; 60:2125-2133. [PMID: 19844059 DOI: 10.2166/wst.2009.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper proposes the use of predictive optimal control as a suitable methodology to manage efficiently transport water networks. The predictive optimal controller is implemented using MPC control techniques. The Arrêt-Darré/Arros dam-river system located in the Southwest region of France is proposed as case study. A high-fidelity dynamic simulator based on the full Saint-Venant equations and able to reproduce this system is developed in MATLAB/SIMULINK to validate the performance of the developed predictive optimal control system. The control objective in the Arrêt-Darré/Arros dam-river system is to guarantee an ecological flow rate at a control point downstream of the Arrêt-Darré dam by controlling the outflow of this dam in spite of the unmeasured disturbances introduced by rainfalls incomings and farmer withdrawals.
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Affiliation(s)
- V Puig
- Automatic Control Department and Industrial Robotics Institute, Technical University of Catalonia, Rambla Sant Nebridi, Terrassa, Spain.
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De Mendoza D, Lujan M, Rello J. Mechanical Ventilation for Acute Asthma Exacerbations. Intensive Care Med 2008. [DOI: 10.1007/978-0-387-77383-4_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Lujan M, Paez A, Santonja C, Pascual T, Fernandez I, Berenguer A. Prostate cancer detection and tumor characteristics in men with multiple biopsy sessions. Prostate Cancer Prostatic Dis 2004; 7:238-42. [PMID: 15289810 DOI: 10.1038/sj.pcan.4500730] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSES To address prostate cancer (PCa) detection with respect to the number of biopsy sessions performed, to identify risk factors for detection after a negative biopsy, and to analyze the clinical characteristics of the detected tumors. SCOPE Only biopsied men (sextant) were included. A total of 1011 biopsy sessions were carried out in 770 men; 172 underwent a second prostate biopsy and 51 a third biopsy. During the first biopsy round, 111 cancers were found (14.4%), 27 in the second (15.7%), and five during the third round (9.8%), P=0.156. Only high-grade PIN or atypia were identified as independent predictors or PCa detection in subsequent biopsies (P=0.008). A nonsignificant increase of clinically localized tumors, and a decrease of metastatic and poorly differentiated cases were found when more biopsy sessions were needed for detection. CONCLUSIONS A nonsignificant trend to lower cancer detection rates and less clinical relevance of the tumors detected can be observed when more biopsy rounds are needed for detection.
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Affiliation(s)
- M Lujan
- Urology Department, Hospital Universitario de Getafe, Madrid, Spain
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Abstract
OBJECTIVE To validate the spontaneous hypertensive rat (SHR) model for basic research into benign prostate hyperplasia (BPH), and to assess doxazosin-induced changes in prostatic structure and apoptotic status. MATERIALS AND METHODS Four groups of rats were assessed: group 1, 15 SHRs treated with doxazosin; group 2, 14 SHRs with unilateral excision of the major pelvic ganglion; group 3, 14 untreated SHRs; and group 4, 16 intact Wistar-Kyoto (WKY) rats. The doxazosin mesylate (0.03 mg daily) was given compacted in rat food for 3 months. The prostatic ventral lobe (VL) was excised and weighed. Stereological light microscopy, multiplex reverse transcription-polymerase chain reaction of prostate caspases, and caspase-3 activity (cellular enzymatic assay) were assessed. RESULTS There was more development of the glandular epithelium (P < 0.001) in SHR rats than in controls, which was even greater after doxazosin exposure (P = 0.027). SHR animals had higher caspase expression (P < 0.05) and activity (P = 0.008) than WKY rats, but both were reduced after doxazosin therapy (P < 0.01 and 0.028, respectively). CONCLUSIONS This study confirmed prostate hyperplasia in the SHR model. Doxazosin exposure did not reduce the volume of glandular epithelium and contributed to protecting against caspase-induced apoptosis. The SHR model may be not a valid option to study doxazosin-induced apoptosis in BPH.
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Affiliation(s)
- M Lujan
- Department of Urology, Hospital de Getafe, Madrid, Spain.
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Lujan M, Paez A, Llanes L, Miravalles E, Berenguer A. Prostate specific antigen density. Is there a role for this parameter when screening for prostate cancer? Prostate Cancer Prostatic Dis 2002; 4:146-149. [PMID: 12497032 DOI: 10.1038/sj.pcan.4500509] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2000] [Accepted: 12/26/2000] [Indexed: 11/08/2022]
Abstract
The objective of this paper is to validate prostate specific antigen (PSA) density (PSAD) routine use to enhance PSA specificity in men with normal digital rectal examination and intermediate PSA values. It is a retrospective study of 235 men from a prostate cancer (PCa) screening program. All of them presented PSA values between 4 and 10 ng/ml, normal digital rectal examination, and a transrectal ultrasound (TRUS) guided biopsy available (PSA>/=4 ng/ml as the sole criterion for biopsy). Multivariate analysis failed to demonstrate higher PSAD values in men with PCa. PSAD cutoff points higher than 0.07 ng/ml per cc were considered as unacceptable, with less than 95% sensitivity. When a cutoff point of 0.15 was considered, as many as 30.6% of the cancers were missed. In conclusion we cannot recommend the use of this parameter for the above mentioned purpose.Prostate Cancer and Prostatic Diseases (2001) 4, 146-149.
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Affiliation(s)
- M Lujan
- Department of Urology, Hospital Universitario de Getafe, Madrid, Spain
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Lujan M, Paez A, Sanchez E, Herrero A, Martin E, Berenguer A. Prostate specific antigen variation in patients without clinically evident prostate cancer. J Urol 1999; 162:1311-3. [PMID: 10492186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE We address long-term within individual variation of serum prostate specific antigen (PSA) in men without clinical or biopsy evidence of prostate cancer. MATERIALS AND METHODS We studied 943 men from a prostate cancer screening program with 2 PSA (PSA1 and PSA2) measurements available. A third PSA (PSA3) was obtained from 571 men. Only participants with no clinical evidence of cancer were included in the study. Within individual PSA variability was calculated based on indexes of percent coefficient of variation, ratio difference and PSA velocity. The relationship among these indexes, interval between measurements and number of PSA samples was assessed. RESULTS Mean interval was 670.4 days between PSA1 and PSA2, and 801.8 days between PSA2 and PSA3 (p<0.001). Mean coefficient of variation was 18% after 2 and 15.7% after 3 PSA measurements. Mean ratio differences were -0.047 ng./ml. for 2 and 0.033 ng./ml. for 3 samples. Mean PSA velocity was -0.128 ng./ml. per year for 2 and -0.055 ng./ml. per year for 3 samples, with 95% confidence intervals of 0.634 and 0.315, respectively. Variability was higher if only 2 PSA measurements were done (p<0.001). No clear relationship was found between individual variability and interval between measurements. CONCLUSIONS PSA velocity is within normal limits in almost all men (more than 95%) without clinically relevant prostate cancer. PSA individual variability is not fully dependent on the time between measurements when intervals are long, and can be substantially decreased with a third PSA sample.
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Affiliation(s)
- M Lujan
- Department of Urology, Hospital Universitario de Getafe, Madrid, Spain
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Lujan M, Llorente C, Romero I, Pinto I, Lobato RF, Zarate E, Berenguer A. Application of self-expanding stents in prostate cancer with rectal involvement. Report of two cases and review of the literature. Eur Urol 1997; 31:251-3. [PMID: 9076477 DOI: 10.1159/000474461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Rectal involvement due to local spread from prostate cancer is an uncommon finding. When this condition occurs, prognosis is ominous. Our objective is to report our experience in the use of self-expanding endorectal stents in the management of rectal invasion from prostate cancer. Two cases are presented and a review of the literature is carried out. METHODS AND RESULTS In both cases, self-expanding Wallstent devices were placed (under fluoroscopic control), in order to solve their episodes of bowel obstruction. It was successfully performed in both patients. Therefore, an open surgery procedure was avoided. CONCLUSIONS When facing the evidence of a tumor that invades the rectal wall, it is important to rule out the existence of prostate cancer (the surgical option in these patients carries an ominous prognosis). Therefore, we propose this new procedure whose results could be very satisfactory in certain settings.
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Affiliation(s)
- M Lujan
- Department of Urology, Getafe University Hospital, Madrid, Spain
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Lujan M. [The challenge of integration]. Soins Psychiatr 1994:24-34. [PMID: 7631197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Valencia-Flores M, Campos-Sepulveda E, Galindo-Morales JA, Lujan M, Colotla VA. Behavioral and biochemical correlates of chronic administration of quipazine. Pharmacol Biochem Behav 1990; 36:299-304. [PMID: 2356204 DOI: 10.1016/0091-3057(90)90407-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In Experiment 1 groups of rats received single injections of 1, 3, 10, 20 or 40 mg/kg quipazine, and their total 24-hr food and water intake after a 24-hr deprivation period was recorded; there was a dose-related reduction of both food and water intake. In Experiment 2 a group of 15 rats received 5 mg/kg/day, SC quipazine during 29 days, and a control group received saline injections. During treatment, all animals were exposed to a 24-hr food and water deprivation schedule, alternated with 24 hr of free access. Food and water consumption was measured 2 and 24 hr after drug injection; regional 5-HT concentrations were determined at 1 and 13 treatment days by fluorometric assay. Beginning the first treatment day, food and water intake decreased, but by the 13th day the quipazine group had returned to normal ingestion levels. 5-HT concentrations were increased in cerebellum and cortex in acute conditions, but after 13 days they had decreased in cerebellar samples. In Experiment 3 we found that the effects of quipazine on food and water ingestion were recovered after 14 days of discontinuing chronic drug administration.
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Affiliation(s)
- M Valencia-Flores
- Facultad de Psicología, Universidad Nacional Autónoma de México, D.F
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