Wilson Luiz da Costa

Objectives: The aim of the study was to describe insights into real-world characteristics and clinical outcomes of patients with a history of eosinophilic granulomatosis with polyangiitis (EGPA) across Europe, stratified by disease phase and biologics use. Methods: This was a retrospective, physician-panel chart review study in patients with a history of EGPA from five European countries covering the period January 2015–August 2021 (GSK ID: 214661). Outcomes assessed included: baseline characteristics; treatment patterns; clinical outcomes and healthcare resource utilisation (HCRU), which were stratified post hoc by EGPA disease phase and biologics use. Oral corticosteroid (OCS) use was assessed ≤12 months pre- and post-biologics initiation. Results: Overall, 407 patients were included: disease phase was identified for 381 patients (36 prodromal; 220 eosinophilic; 125 vasculitic); 185 patients received biologics, and 162 had pre-/post-biologics initiation periods identified. Patients in the vasculitic subgroup had the most comorbidities and clinical manifestations, and the greatest proportion of patients with hospitalisation versus the eosinophilic or prodromal subgroups. All subgroups had high OCS use (97.2–99.1%). The biologics-exposed subgroup had high comorbidity and HCRU burden. Post- versus pre-biologics initiation, OCS use was reduced (0.12 versus 0.69 prescriptions per person-year), the proportion of patients experiencing relapses decreased (3.1% (95% confidence interval: 0.4–5.7) versus 11.7% (6.8–16.7)) and remissions increased (26.5% (19.7–33.3) versus 13.0% (7.8–18.1). Conclusion: Although the vasculitic subgroup showed the greatest disease severity, all subgroups demonstrated a substantial disease burden. Results also suggest biologics provide OCS-sparing effects and improve disease control in real-world settings.

Background: The management of gastric cancer has become increasingly complex, highlighting the importance of clinical guidelines to ensure standardized care. The Second Brazilian Consensus on Gastric Cancer was developed to guide clinical practice across the country. Aims: The aim of this study was to evaluate the degree of implementation of the 2nd Brazilian Consensus recommendations in cancer reference centers in Brazil. Methods: This multicenter study involved 18 cancer centers that prospectively collected data over a one-year period. Notably, 21 key statements from the Consensus were assessed. Adherence was defined as following the recommendation in more than 80% of applicable cases. Results: Of the 21 statements, 11 (52.4%) met the predefined adherence threshold. The selective use of endoscopic ultrasound and PET-CT was consistent with the recommendations. However, diagnostic laparoscopy was underutilized, performed in only 24.7% of patients. Preoperative nutritional therapy, another key recommendation, was provided in just 42% of cases. D2 lymphadenectomy was performed in 79.8% of surgeries, but only 63.3% of specimens included ≥25 lymph nodes, the recommended minimum for adequate staging. Minimally invasive surgery (MIS) was performed in approximately 25% of early distal tumors but was rarely used in advanced proximal tumors. Despite not being recommended for early stage tumors, omentectomy and bursectomy were still performed in a significant number of T1/T2 cases. Preoperative chemotherapy was used in 35.4% of distal tumors ≥IB and 54.3% of proximal tumors, showing partial adherence to this recommendation. Conclusions: Just over half of the II Brazilian Consensus recommendations were implemented in routine practice. There was strong adherence to D2 lymphadenectomy and MIS for early distal tumors. However, there is still room for improvement in areas such as diagnostic laparoscopy, nutritional support, adequate lymph node retrieval, and using more neoadjuvant chemotherapy to enhance care and follow national guidelines.

Background: Gastric cancer is the fifth most common neoplasm and the third leading cause of cancer‐related death worldwide. Neoadjuvant chemotherapy is recommended for Stages II–III resectable tumors, but the comparative effectiveness of minimally invasive surgery (MIS) versus open gastrectomy (OG) post‐neoadjuvant therapy has not been adequately investigated.Methods: A retrospective cohort analysis was performed on patients with clinical Stage II and III gastric adenocarcinoma who underwent neoadjuvant chemotherapy followed by either MIS or OG between 2007 and 2020. Propensity score matching was utilized to compare the clinical and surgical outcomes, morbidity, and mortality, and the influence of MIS on 3‐year survival rates was evaluated.Results: After matching, no statistical differences in clinical aspects were noted between the two groups. MIS was associated with increased D2 lymphadenectomy, curative intent, and complete neoadjuvant therapy. Furthermore, this therapeutic approach resulted in reduced transfusion rates and shorter hospital stays. Nonetheless, no significant differences were observed in global, clinical, or surgical complications or mortality between the two groups. Weight loss emerged as a significant risk factor for complications, but MIS did not independently affect survival rates. Extended resection and higher American Society of Anesthesiology scores were independent predictors of reduced survival.Conclusion: MIS after neoadjuvant chemotherapy for gastric cancer appears to be a viable option, with oncological outcomes comparable to those of OG, less blood loss, and shorter hospital stays. Although MIS did not independently affect long‐term survival, it offered potential benefits in terms of postoperative recovery and morbidity. Further studies are needed to validate these findings, especially across diverse populations.

Transthoracic access emerges as an innovative approach to reach lesions in the upper hepatic segments, especially in patients with prior surgeries. This study evaluates transthoracic access for these resections through a retrospective single‐center analysis of demographic data, surgical techniques, and postoperative outcomes of 353 liver surgeries, revealing promising results with minimal complications. Transthoracic access and pneumoperitoneum establishment via the transthoracic route, combined with intercostal trocar insertion, offer a viable alternative for minimally invasive liver surgeries.

Introduction: Hepatectomies associated with vascular resections pose a technical challenge for surgeons, involving multiple reconstruction techniques. Moreover, adding clinical and surgical risks in the postoperative setting of these complex procedures are mainly due to prolonged surgical periods and potential complications inherent to vascular manipulation. Leveraging the expertise of a Cancer Center, we propose an institutional assessment utilizing the case series from A. C. Camargo Cancer Center in hepatectomies associated with vascular resection, evaluating postoperative complications and outcomes while highlighting clinical, laboratory, pathological, and surgical factors that may influence results.Objective: To assess mortality and morbidity associated with hepatectomies involving vascular resection.Materials and Methods: From a prospective database, a study was performed evaluating postoperative survival and morbidity using scoring systems such as Clavien−Dindo through a cohort analysis.Results: From a total of 1021 liver resections for a period of 10 years, 31 cases were evaluated from a unique cancer center in Brazil! Factors such as the performance of major hepatectomies, the need for blood transfusion, and the administration of neoadjuvant or adjuvant systemic therapy did not appear to influence the outcome of morbidity or mortality. However, the resection of the associated bile duct and the type of vascular resection seemed to influence morbidity outcomes with statistical significance (p = 0.006+ …).Conclusion: Hepatectomies associated with vascular resections are safe in selected cases and when performed in referral centers. Factors such as associated bile duct resection and type of vascular resection should be considered for procedure indication.

Background and Objectives: Tumor‐infiltrating lymphocytes (TILs) represent a host‐tumor interaction, frequently signifying an augmented immunological response. Nonetheless, implications with survival outcomes in patients with colorectal carcinoma liver metastasis (CRLM) warrant rigorous validation. The objective was to demonstrate the association between TILs and survival in patients with CRLM.Method: In a retrospective evaluation conducted in a single institution, we assessed all patients who underwent hepatectomy due to CRLM between 2014 and 2018. Comprehensive medical documentation reviews were executed. TILs were assessed by a liver pathologist, blinded to the clinical information, in all surgical slides.Results: This retrospective cohort included 112 patients. Median overall survival (OS) was 58 months and disease‐free survival (DFS) was 12 months for the entire cohort. Comparison between groups showed a median OS of 81 months in the dense TILs group and 40 months in the weak/absent group (p = 0.001), and DFS was 14 months versus 9 months (p = 0.041). Multivariable analysis showed that TILs were an independent predictor of OS (HR 1.95; p = 0.031).Conclusions: Dense TILs are a pivotal prognostic indicator, correlating with enhanced OS. Including TILs information in histopathological evaluations should refine the clinical decision‐making process for this group of patients.

Background: Disparities in gastric cancer (GC) outcomes show a higher disease burden among minorities. We aimed to evaluate the associations between sociodemographic and system‐level factors and guideline‐concordant treatment among GC patients.Methods: Cohort study with GC patients in the National Cancer Data Base (2006–2018) treated with upfront resection or neoadjuvant therapy (NAT). We used logistic regression to identify associations between deviations from guideline‐concordant therapy and patient‐ and system‐level factors, and Cox regression models to assess risk of death.Results: The cohort included 43 597 GC patients treated with endoscopic resection (8.9%), surgery only (47.1%), surgery and adjuvant therapy (20.6%), or NAT followed by surgery (23.5%). A total of 31 470 patients (72.2%) received guideline‐concordant therapy. Relative to Non‐Hispanic Whites (NHWs), Non‐Hispanic Blacks (NHBs) (odds ratio [OR] 1.19, [95% confidence intervals 1.10–1.28]) and Asian/Pacific Islanders (APIs) (OR 1.12 [1.03–1.23]) had an increased risk of deviations from treatment guidelines. Medicare/Medicaid increased the risk of deviations while treatment at high‐volume facilities decreased its risk for all races/ethnicities. Deviations from guidelines were associated with an increased risk of death (hazard ratio 1.56 [1.50–1.63].Conclusions: Racial disparities in the delivery of guideline‐concordant therapy among GC patients are affected by several sociodemographic factors at the patient‐ and system‐level.

PURPOSE: Venous thromboembolism (VTE), especially pulmonary embolism (PE) and lower extremity deep vein thrombosis (LE-DVT), is a serious and potentially preventable complication for patients with cancer undergoing systemic therapy.METHODS: Using retrospective data from patients diagnosed with incident cancer from 2011-2020, we derived a parsimonious risk assessment model (RAM) using least absolute shrinkage and selection operator regression from the Harris Health System (HHS, n = 9,769) and externally validated it using the Veterans Affairs (VA) health care system (n = 79,517). Bootstrapped c statistics and calibration curves were used to assess external model discrimination and fit. Dichotomized risk strata using integer scores were created and compared against the Khorana score (KS).RESULTS: Incident VTE and PE/LE-DVT at 6 months occurred in 590 (6.2%) and 437 (4.6%) patients in HHS and 4,027 (5.1%) and 3,331 (4.2%) patients in the VA health care system. Assessed at the time of systemic therapy initiation, the new RAM included components of the KS with the modified cancer subtype, cancer staging, systemic therapy class, history of VTE, history of paralysis/immobility, recent hospitalization, and Asian/Pacific Islander race. The c statistic was 0.71 in HHS and 0.68 in the VA health care system (compared with 0.65 and 0.60, respectively, for KS). Furthermore, the new RAM appropriately reclassified 28% of patients and increased the proportion of VTEs in the high-risk group from 37% to 68% in the validation data set.CONCLUSION: The novel RAM stratified patients with cancer into a high-risk group with 8%-10% cumulative incidence of VTE and 7% PE/LE-DVT at 6 months ( v 3% and 2%, respectively, in the low-risk group). The model had improved performance over the original KS and doubled the number of VTE events in the high-risk stratum. We encourage additional external validation from prospective studies. [Media: see text]

Background: Neoadjuvant therapy (NAT) improves survival among patients with locally advanced gastric cancer (GC), but it remains unclear whether its benefit is contingent on treatment response.Methods: This is a national cohort study of stage Ib‐III GC patients in the National Cancer Data Base (2006–2015) treated with upfront resection or NAT followed by surgery. Bayesian analysis was used for NAT patients to ascertain staging concordance and to account for down‐staging. We used multivariable Cox regression to evaluate the association between staging concordance, treatment, response to NAT, and survival.Results: The cohort included 13 340 patients treated at 1124 hospitals. Staging concordance ranged from 86.1% for cT3‐4N+ to 34.7% for cT2N0 patients. Relative to accurately staged patients treated with upfront surgery, NAT was associated with a decreased risk of death if there was disease down‐staging among those with cT1‐2N+ (hazard ratio [HR]: 0.43 [0.30–0.61]), cT3‐4N0 (HR: 0.69 [0.54–0.88]), and cT3‐4N+ (HR: 0.51 [0.48–0.58]) tumors, and in the absence of down‐staging among cT3‐4N+ patients (HR: 0.83 [0.74–0.92]). Conversely, NAT without down‐staging increased the risk of death among those with intermediate‐stage disease.Conclusions: NAT is associated with improved survival for GC, but it seems to be contingent on treatment response among patients with intermediate‐stage disease.