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Parâmetros hematológicos como fatores de prognóstico no câncer esofágico e câncer gástrico
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Abstract(s)
O Câncer origina-se de processos multifatoriais, além dos fatores de risco, anormalidades genéticas influenciam no ciclo celular e metabolismo de células somáticas. O Câncer de Esôfago (CE) e o Câncer Gástrico (CG) tem maior predominância em indivíduos do gênero masculino e em geral, o diagnóstico é realizado tardiamente. O microambiente é importante para manter a homeostase normal do tecido ou favorecer o desenvolvimento do tumor e que o intrigante paradoxo do Sistema Imune e a inflamação está associado aos vários tipos de neoplasias. Estudos apontaram para relação entre o câncer e os valores absolutos de células do sangue periférico como: Leucócitos; Neutrófilos; Linfócitos; Monócitos e Plaquetas, bem como das Razões Plaqueta-Linfócito (RPL); Neutrófilo-Linfócito (RNL) e Monócito-Linfócito (RML), principalmente ao que tange a avaliação da sobrevivência. Revelando a utilização destas células como um potencial biomarcador de baixo custo. No entanto, destaca-se que poucos estudos foram encontrados na literatura relacionando o valor prognostico de células imunoinflamatórias de pacientes com CE e CG submetidos a cirurgia e as Complicações Cirúrgicas (segundo classificação Clavien-Dindo). O significado clínico da contagem destas células e suas relações em pacientes com CE e CG devem ser investigados, buscando relacioná-los com as complicações cirúrgicas e a sobrevivência dos pacientes. Desta forma, este trabalho de pesquisa objetivou investigar a relação do valor prognostico de células imunoinflamatórias citadas anteriormente em pacientes com CE e CG submetidos a cirurgia e as complicações cirúrgicas, bem como a sobrevivência dos pacientes. Foi desenvolvida uma revisão bibliográfica narrativa, bem como uma pesquisa retrospectiva desenvolvida junto ao Grupo de Patologia e Terapêutica Experimental do Centro de Investigação do Instituto Português de Oncologia do Porto. Foram coletados os dados de hemograma de doentes com CE e CG submetidos a cirurgia, no período de 2016 a 2018. Foram destacados 62 pacientes de ambos os gêneros; maiores de 18 anos. Os resultados obtidos no presente estudo assemelham-se ao classicamente presente na literatura. Com média de idade de 67 anos e maior incidência de pacientes do gênero masculino. Nenhum dos parâmetros analisados revelou valores de sensibilidade e especificidade que permitam associar à ocorrência de complicações cirúrgicas. Excetuando-se as Plaquetas em hemogramas em pacientes que realizaram os exames de hemograma superior a 30 dias antes da cirurgia. Quanto a análise de sobrevivência, embora de forma estatisticamente não significativa, foi possível segundo análise dos gráficos associa-los com sobrevivência dos pacientes. No entanto, deve-se realizar mais estudos de forma a explorar o valor prognostico desses biomarcadores a fim de incorpora-los à prática clínica. Destaca-se a importância do hemograma no pré-operatório por trazer informações valiosas sobre o estado do paciente e dispensa procedimentos muito invasivos para sua obtenção, além de ser de baixo custo.
Cancer originates from multifactorial processes, in addition to risk factors, genetic abnormalities influence the cell cycle and metabolism of somatic cells. Esophageal Cancer (EC) and Gastric Cancer (GC) are more prevalent in male individuals and in general, the diagnosis is performed late. The microenvironment is important to maintain normal tissue homeostasis or to favor the development of the tumor and that the intriguing paradox of the Immune System and inflammation is associated with various types of neoplasms. Researchs has pointed to the relation between cancer and the absolute values of peripheral blood cells, such as: Leukocytes; Neutrophils; Lymphocytes; Monocytes and Platelets, as well as Platelet-Lymphocyte Ratio (LPR); Neutrophil-Lymphocyte Ratio (NLR) and Monocyte-Lymphocyte Ratio (MLR), mainly with regard to the assessment of survival, Revealing the use of these cells as a potential low cost biomarker. However, it is noteworthy that few studies have been found in the literature relating the prognostic value of immunoinflammatory cells of patients with EC and GC undergoing surgery and Surgical Complications (according to the Clavien-Dindo classification). The clinical significance of counting these cells and their relationships in patients with EC and GC should be investigated, seeking to relate them to surgical complications and patient survival. Thus, this research work aimed to investigate the relationship between the prognostic value of immunoinflammatory cells previously mentioned in patients with EC and GC submitted to surgery and surgical complications, as well as the patients' survival. A narrative bibliographic review was developed, as well as a retrospective research developed with the Pathology and Experimental Therapeutics Group of the Research Center of the Portuguese Institute of Oncology of Porto. Blood count data were collected from patients with EC and GC who underwent surgery, from 2016 to 2018. 62 patients of both genders were highlighted; older than 18 years. The results obtained in the present study are similar to those classically present in the literature. With a mean age of 67 years and a higher incidence of male patients. None of the analyzed parameters revealed sensitivity and specificity values that could be associated with the occurrence of surgical complications. Except for Platelets in blood counts of patients who underwent the examination more than 30 days before surgery. As for the survival analysis, although not statistically significant, it was possible according to the analysis of the graphs to associate them with patient survival. However, further studies should be carried out in order to explore the prognostic value of these biomarkers in order to incorporate them into clinical practice. The importance of the blood count in the preoperative period is highlighted, as it brings valuable information about the patient's condition and dispenses with very invasive procedures for obtaining it, in addition to being of low cost.
Cancer originates from multifactorial processes, in addition to risk factors, genetic abnormalities influence the cell cycle and metabolism of somatic cells. Esophageal Cancer (EC) and Gastric Cancer (GC) are more prevalent in male individuals and in general, the diagnosis is performed late. The microenvironment is important to maintain normal tissue homeostasis or to favor the development of the tumor and that the intriguing paradox of the Immune System and inflammation is associated with various types of neoplasms. Researchs has pointed to the relation between cancer and the absolute values of peripheral blood cells, such as: Leukocytes; Neutrophils; Lymphocytes; Monocytes and Platelets, as well as Platelet-Lymphocyte Ratio (LPR); Neutrophil-Lymphocyte Ratio (NLR) and Monocyte-Lymphocyte Ratio (MLR), mainly with regard to the assessment of survival, Revealing the use of these cells as a potential low cost biomarker. However, it is noteworthy that few studies have been found in the literature relating the prognostic value of immunoinflammatory cells of patients with EC and GC undergoing surgery and Surgical Complications (according to the Clavien-Dindo classification). The clinical significance of counting these cells and their relationships in patients with EC and GC should be investigated, seeking to relate them to surgical complications and patient survival. Thus, this research work aimed to investigate the relationship between the prognostic value of immunoinflammatory cells previously mentioned in patients with EC and GC submitted to surgery and surgical complications, as well as the patients' survival. A narrative bibliographic review was developed, as well as a retrospective research developed with the Pathology and Experimental Therapeutics Group of the Research Center of the Portuguese Institute of Oncology of Porto. Blood count data were collected from patients with EC and GC who underwent surgery, from 2016 to 2018. 62 patients of both genders were highlighted; older than 18 years. The results obtained in the present study are similar to those classically present in the literature. With a mean age of 67 years and a higher incidence of male patients. None of the analyzed parameters revealed sensitivity and specificity values that could be associated with the occurrence of surgical complications. Except for Platelets in blood counts of patients who underwent the examination more than 30 days before surgery. As for the survival analysis, although not statistically significant, it was possible according to the analysis of the graphs to associate them with patient survival. However, further studies should be carried out in order to explore the prognostic value of these biomarkers in order to incorporate them into clinical practice. The importance of the blood count in the preoperative period is highlighted, as it brings valuable information about the patient's condition and dispenses with very invasive procedures for obtaining it, in addition to being of low cost.
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Keywords
Câncer esôfago Câncer gástrico Biomarcador Populações celulares sanguíneas Prognóstico Microambiente Complicações cirúrgicas Sobrevivência Esophageal cancer Gastric cancer Biomarker Peripheral blood cells Prognosis Microenvironment Survival