Publication: Valor del cociente ganglionar como factor pronóstico en el cáncer de recto. Comparación con otros parámetros habituales de supervivencia
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2018-04-13
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Universidad Complutense de Madrid
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Abstract
El cáncer colorrectal es uno de los tumores más prevalentes en la población mundial. En España supone el tercero más frecuente en ambos sexos, después del cáncer de mama y de próstata. En 2015, fue el tipo de cáncer más frecuentemente diagnosticado, con 41 441 nuevos casos. Se estima que el cáncer de recto representa un tercio de este número. Se han identificado factores de riesgo del cáncer colorrectal como la edad, dado que más del 90% de los casos se diagnostican después de los 50 años. Existen numerosos factores dietéticos, del estilo de vida y hereditarios implicados en el desarrollo del cáncer colorrectal. La obesidad es una de las principales causas evitables de desarrollo de tumores, especialmente cáncer colorrectal. En los estudios anatomopatológicos se observa que más del 95% son adenocarcinomas. El pronóstico de los pacientes con cáncer colorrectal depende fundamentalmente de la profundidad de la afectación transmural y de la extensión de la afectación ganglionar. La extensión a través de la pared intestinal y a los órganos vecinos se clasifica de acuerdo al sistema de estadificación TNM (del inglés: tumor, node, metastasis) del American Joint Committee on Cancer (AJCC) y Union International Cancer Control (UICC). Las principales vías de diseminación son hematógena, linfática, por contigüidad y peritoneal. Para la estadificación locorregional, la resonancia magnética nuclear es esencial, tiene una sensibilidad de 66-92% para determinar el estadio T y de 70-85% para detectar las adenopatías. La ecografía endorrectal es la prueba con mayor fiabilidad (95%) para valorar el grado de invasión de la pared rectal y está especialmente indicada para tumores precoces, pero es incapaz de detectar la presencia de ganglios fuera del radio de acción del transductor, como los ilíacos, mesentéricos, inguinales o retroperitoneales. A principios de la década de los 80, las tasas de recidivas locorregionales (RL) oscilaban entre cifras tan dispares como un 4 y un 50%. En 1982, Heald y col. introdujeron la escisión total del mesorrecto, cuya incorporación dentro de una técnica quirúrgica estandarizada significó un descenso de las cifras de RL en todas las Unidades de Coloproctología que la adoptaron, convirtiéndose en el gold standard de la cirugía del cáncer de recto. En 1986, Quirke demostró que la tasa de RL en el cáncer de recto aumentaba cuando el margen de resección circunferencial (MRC) estaba afecto, así como que disminuía la supervivencia global (SG) de estos pacientes. Tras la introducción de la escisión total del mesorrecto (ETM), valoración del MRC, y posteriormente, del tratamiento neoadyuvante, las recidivas disminuyeron drásticamente hasta situarse por debajo del 10% en la actualidad...
Colorectal cancer is one of the most prevalent tumors in the world population. In Spain, it is the third most common in both sexes, after the breast and prostate cancer. In 2015 was the most frequently diagnosed type of cancer with 41 441 new cases. It is estimated that rectal cancer accounts for one-third of this number. Colorectal cancer risk factors have been identified, such as age, as more than 90% of cases are diagnosed after age 50. There are numerous dietary, lifestyle and hereditary factors involved in the development of colorectal cancer. Obesity is one of the leading preventable causes of tumor development, especially colorectal cancer. In anatomopathological studies it is observed that more than 95% are adenocarcinomas. The prognosis of patients with colorectal cancer depends fundamentally on the depth of transmural involvement and the extent of lymph node (LNs) involvement. Extension through the intestinal wall and neighboring organs is classified according to the American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC) staging system TNM (tumor, node, and metastasis). The main routes of dissemination are hematogenous, lymphatic, contiguous and peritoneal. For locoregional staging, nuclear magnetic resonance is essential; it has a sensitivity of 66-92% to determine T stage, but 70-85% to detect lymphadenopathy. Endorectal ultrasound is the most reliable (95%) test to assess the degree of rectal wall invasion and is especially indicated for early tumors, but is unable to detect the presence of nodes outside the transducer's range of action, such as iliac, mesenteric, inguinal or retroperitoneal. In the early 1980s, local recurrence (LR) rates ranged from as many as 4 to 50%. In 1982, Heald et al. introduced total excision of the mesorectum, whose incorporation into a standardized surgical technique meant a decrease in locorregional recurrence numbers in all Coloproctology Units that adopted it, becoming the gold standard of rectal cancer surgery. In 1986, Quirke demonstrated that the rate of LR in rectal cancer increased when the circumferential resection margin (CRM) was affected, as well as that the overall survival (OS) of these patients decreased. After the introduction of total mesorectal excision (TME), assessment of the CRM, and subsequently of neoadjuvant treatment, recurrences drastically decreased to below 10% at present...
Colorectal cancer is one of the most prevalent tumors in the world population. In Spain, it is the third most common in both sexes, after the breast and prostate cancer. In 2015 was the most frequently diagnosed type of cancer with 41 441 new cases. It is estimated that rectal cancer accounts for one-third of this number. Colorectal cancer risk factors have been identified, such as age, as more than 90% of cases are diagnosed after age 50. There are numerous dietary, lifestyle and hereditary factors involved in the development of colorectal cancer. Obesity is one of the leading preventable causes of tumor development, especially colorectal cancer. In anatomopathological studies it is observed that more than 95% are adenocarcinomas. The prognosis of patients with colorectal cancer depends fundamentally on the depth of transmural involvement and the extent of lymph node (LNs) involvement. Extension through the intestinal wall and neighboring organs is classified according to the American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC) staging system TNM (tumor, node, and metastasis). The main routes of dissemination are hematogenous, lymphatic, contiguous and peritoneal. For locoregional staging, nuclear magnetic resonance is essential; it has a sensitivity of 66-92% to determine T stage, but 70-85% to detect lymphadenopathy. Endorectal ultrasound is the most reliable (95%) test to assess the degree of rectal wall invasion and is especially indicated for early tumors, but is unable to detect the presence of nodes outside the transducer's range of action, such as iliac, mesenteric, inguinal or retroperitoneal. In the early 1980s, local recurrence (LR) rates ranged from as many as 4 to 50%. In 1982, Heald et al. introduced total excision of the mesorectum, whose incorporation into a standardized surgical technique meant a decrease in locorregional recurrence numbers in all Coloproctology Units that adopted it, becoming the gold standard of rectal cancer surgery. In 1986, Quirke demonstrated that the rate of LR in rectal cancer increased when the circumferential resection margin (CRM) was affected, as well as that the overall survival (OS) of these patients decreased. After the introduction of total mesorectal excision (TME), assessment of the CRM, and subsequently of neoadjuvant treatment, recurrences drastically decreased to below 10% at present...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 16/06/2017