Noiver Graciano

Introducción El cáncer colorrectal (CCR) es la tercera neoplasia más frecuente a nivel mundial y la segunda causa de mortalidad relacionada con cáncer. Las metástasis uterinas son sumamente raras, especialmente cuando se restringen al endometrio. Caso clínico Mujer de 68 años con antecedente de carcinoma de tiroides, quien consultó por sangrado digestivo bajo. La colonoscopia mostró una masa ulcerada en ciego y la resonancia abdominal evidenció implantes peritoneales y engrosamiento endometrial anómalo. Las biopsias de colon, peritoneo y endometrio, junto con inmunohistoquímica y estudios moleculares, confirmaron adenocarcinoma bien diferenciado de colon derecho (cT4aN1bM1c, estadio IV), con mutación KRAS G12X y perfil pMMR. La paciente recibió quimioterapia sistémica FOLFOX con respuesta parcial y posteriormente fue sometida a cirugía citorreductora con hemicolectomía derecha, histerectomía, linfadenectomía y omentectomía. El estudio histopatológico confirmó adenocarcinoma de colon metastásico con compromiso peritoneal y endometrial. En el posoperatorio presentó una infección profunda de sitio operatorio, que fue resuelta con antibióticos y drenaje. Actualmente continúa en tratamiento de mantenimiento con fluoropirimidinas y seguimiento oncológico. Conclusión La metástasis endometrial por adenocarcinoma de colon constituye un hallazgo excepcional que puede simular un carcinoma endometrial primario. Su diagnóstico preciso requiere la integración de estudios de imagen, histopatología e inmunohistoquímica, con implicaciones relevantes en el abordaje terapéutico y pronóstico.

Purpose Patients with triple-negative breast cancer (TNBC) who do not achieve pathological complete response (non-pCR) after neoadjuvant chemotherapy (NACT) have a high-risk of relapse. While adjuvant capecitabine (AdjCape) has demonstrated improved overall survival (OS) and disease-free survival (DFS) in Asian populations, its effectiveness in non-Asian settings remains uncertain. We aimed to evaluate the effect of AdjCape on survival outcomes using real-world data from a Latin American population. Methods We conducted a retrospective cohort study (2008–2024) including 360 women with non-metastatic TNBC and non-pCR treated at a single institution. Propensity score matching (PSM) was applied to adjust for baseline differences. Cox regression models assessed the association of AdjCape with OS and DFS, and stratified analyses identified subgroups with differential treatment effects. Results Among 360 patients, 106 (29.4%) received AdjCape. After PSM, 187 patients (72 AdjCape, 115 controls) were analyzed. AdjCape was not associated with improved OS (HR 0.79, 95% CI 0.51–1.23, p = 0.302) or DFS (HR 0.81, 95% CI 0.53–1.23, p = 0.321). However, significant benefit was observed in patients with high residual tumor burden (pT3–pT4: OS HR 0.29, p = 0.020; DFS HR 0.37, p = 0.044) and in those not receiving radiotherapy (DFS HR 0.47, p = 0.038). Conclusions AdjCape did not improve OS or DFS in the overall TNBC non-pCR cohort but may offer benefit in patients with extensive residual disease or those not treated with radiotherapy. These findings highlight the need for individualized treatment strategies and further evaluation of capecitabine in the context of modern therapies.

Purpose: Triple-negative breast cancer (TNBC) is an aggressive, heterogeneous malignancy with poor prognosis. The optimal timing of chemotherapy—neoadjuvant (NACT) versus adjuvant (ACT)—remains controversial. This study assessed real-world outcomes in non-metastatic TNBC patients according to chemotherapy timing. Methods: This retrospective study (2008–2023) evaluated the impact of chemotherapy timing on overall survival (OS) and event-free survival (EFS) in a cohort of 711 patients. Propensity score (PS) matching with preoperative variables was used to adjust for baseline imbalances, and Cox regression models were applied to account for treatment-related variables. Results: NACT was administered to 525 patients (73.8%), with a 37.3% pathological complete response (pCR) rate. PS matching yielded 177 patient pairs; tumor stage, age and histologic grade remained unbalanced. In the unadjusted analysis, NACT was associated with worse OS (HR 1.56, 95% CI1.08–2.25, p = 0.018). However, multivariate analysis adjusting for unmatched and postoperative variables showed a potential benefit of NACT for OS (HR 0.53, 95% CI 0.07–4.13, p = 0.545) and EFS (HR 0.94, 95% CI 0.21–4.17, p = 0.932). Tumor stage acted as an effect modifier, and stratified analyses revealed that NACT was superior to ACT in patients with advanced-stage disease who achieved pCR (HR 0.22, 95% CI 0.07–0.7, p < 0.010). Conclusions: In our TNBC cohort, chemotherapy timing significantly influenced OS and EFS, particularly in relation to initial tumor stage and pCR status. NACT was more beneficial than ACT in patients with advanced disease who achieve pCR, underscoring its role in both prognostic stratification and therapeutic decision-making.