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Liver-first approach of colorectal cancer with synchronous hepatic metastases: A reverse strategy

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World Journal of Hepatology 2015年第11期7卷 1444-1449页

作者： jaques waisberg Ivan Gregorio Ivankovics Department of Surgery ABC Medical School Department of Medicine Rondonia Federal University

Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is sequence in a patient with colorectal cancer and synchronous hepatic metastases resection. To obtain a better patient selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of patients with colorectal tumor stage Ⅳ, since these patients have a systemic disease. The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of colorectal carcinoma, which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for patients with colorectal hepatic metastases who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of rectal carcinoma in the early stage and with limited or advanced synchronous colorectal hepatic metastases or in case of patients with asymptomatic colorectal carcinoma, but with extensive liver metastases. Patients undergoing systemic chemotherapy and with progression of neoplastic disease should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of colorectal synchronous hepatic metastases, despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The patient selection criteria

关键词： Colorectal neoplasms Neoplasm metastasis Liver neoplasms Liver/surgery Hepatectomy Drug therapy Survival Prognosis

Wnt-/-β-catenin pathway signaling in human hepatocellular carcinoma

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World Journal of Hepatology 2015年第26期7卷 2631-2635页

作者： jaques waisberg Gabriela Tognini Saba Department of Surgery Hospital do Servidor Público Estadual de Sao Paulo(IAMSPE) Department of Surgery ABC Medical School

The molecular basis of the carcinogenesis of hepatocellular carcinoma(HCC) has not been adequately clarified, which negatively impacts the development of targeted therapy protocols for this overwhelming neoplasia. The aberrant activation of signaling in the HCC is primarily due to the deregulated expression of the components of the Wnt-/-β-catenin. This leads to the activation of β-catenin/T-cell factor-dependent target genes that control cell proliferation, cell cycle, apoptosis, and cell motility. The deregulation of the Wnt pathway is an early event in hepatocarcinogenesis. An aggressive phenotype was associated with HCC, since this pathway is implicated in the proliferation, migration, and invasiveness of cancer cells, regarding the cell's own survival. The disruption of the signaling cascade Wnt-/-β-catenin has shown anticancer properties in HCC's clinical evaluations of therapeutic molecules targeted for blocking the Wnt signaling pathway for the treatment of HCC, and it represents a promising perspective. The key to bringing this strategy in to clinical practice is to identify new molecules that would be effective only in tumor cells with aberrant signaling β-catenin.

关键词： Carcinoma Hepatocellular Wnt signaling pathway Beta catenin Wnt proteins Receptors

Complications of radiofrequency ablation of hepatic tumors:Frequency and risk factors

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World Journal of Hepatology 2014年第3期6卷 107-113页

作者： Alexandre Zanchenko Fonseca Stephanie Santin Luiz Guilherme Lisboa Gomes jaques waisberg Marcelo Augusto Fontenelle Ribeiro Jr. Department of General Surgery University of Santo Amaro Department of General and Digestive Surgery ABC Medical School

Radiofrequency ablation(RFA)has become an important option in the therapy of primary and secondary hepatic *** resection is still the best treatment option,but only a few of these patients are candidates for surgery:multilobar disease,insufficient liver reserve that will lead to liver failure after resection,extra-hepatic disease,proximity to major bile ducts and vessels,and *** has a low mortality and morbidity rate and is considered to be ***,complications occur and vary widely in the *** are caused by thermal damage,direct needle injury,infection and the patient’s *** type,type of approach,number of lesions,tumor localization,underlying hepatic disease,the physician’s experience,associated hepatic resection and lesion size have been described as factors significantly associated with *** physician in charge should promptly recognize high-risk patients more susceptible to complications,perform a close post procedure follow-up and manage them early and adequately if they *** aim to describe complications from RFA of hepatic tumors and their risk factors,as well as a few techniques to avoid *** way,others can decrease their morbidity rates with better outcomes.

关键词： Radiofrequency ablation Hepatic tumors Complications Risk factors Hepatocellular carcinoma

Detection of anti-Helicobacter pyloriantibodies in serum and duodenal fluid in peptic gastroduodenal disease

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World Journal of Gastroenterology 2004年第20期10卷 2997-3000页

作者： Angelo Locateili Wilson Roberto Catapani Claudio Rufino Gomes Junior Claudilene Battistin Paula Silva jaques waisberg Department of Surgery ABC Faculty of MedicineAvenida Principe de Gales 821Santo AndreSao Paulo09060-650Brazil

AIM:To study the diagnosis of Helicobacter pylori(H pylori) infection through the determination of serum levels of anti- H pylori IgG and IgA antibodies,and the levels of anti-H pylori IgA antibodies in duodenal fluid. METHODS:Data were collected from 93 patients submitted to upper digestive endoscopy due to dyspeptic symptoms. The patients were either negative(group A)or positive (group B)to H pylori by means of both histological detection and urease *** endoscopy,peripheral blood was collected for the investigation of anti-H pylori IgG and IgA *** perform the urease test,biopsies were obtained from the gastric *** the histological evaluation,biopsies were collected from the gastric antrum (greater and lesser curvatures)and the gastric body. Following this,duodenal fluid was collected from the first and second portions of the *** the serological assaying of anti-Hpylori IgG and IgA,and anti-Hpylori IgA in duodenal fluids,the ELISA method was utilized. RESULTS:The concentration of serum IgG showed sensitivity of 64.0%,specificity of 83.7%,positive predictive value of 82.0%,negative predictive value of 66.6% and accuracy of 73.1% for the diagnosis of H pylori *** the same purpose,serum IgA showed sensitivity of 72.0%, specificity of 65.9%,positive predictive value of 72.0%, negative predictive value of 67.4% and accuracy of 69.8%. If the serological tests were considered together,*** both were positive or negative,the accuracy was 80.0%, sensitivity was 86.6%,specificity was 74.2%,positive predictive value was 74.2% and negative predictive value was 86.6%.When values obtained in the test for detecting IgA in the duodenal fluid were analyzed,no significant difference(P=0.43)was observed between the values obtained from patients with or without H pylori infection. CONCLUSION:The results of serum IgG and IgA tests for H pylori detection when used simultaneously,are more efficient in accuracy,sensitivity and negative pred

关键词： Adolescent Adult Aged Antibodies, Bacterial Duodenum Endoscopy, Gastrointestinal Enzyme-Linked Immunosorbent Assay Female Gastric Mucosa Helicobacter Infections Helicobacter pylori purification Humans Immunoglobulin A Immunoglobulin G Male Middle Aged Peptic Ulcer Sensitivity and Specificity Serologic Tests

Prognostic significance of vascular endothelial growth factor polymorphisms in colorectal cancer patients

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World Journal of Gastrointestinal Oncology 2017年第2期9卷 78-86页

作者： Gilmar Ferreira do Espírito Santo Bianca Borsatto Galera Elisabeth Carmen Duarte Elisabeth Suchi Chen Lenuce Azis Amilcar Sabino Damazo Gabriela Tognini Saba Flávia de Sousa Gehrke Ismael Dale Cotrim Guerreiro da Silva jaques waisberg Department of Surgery - Escola Paulista de Medicina Federal University of Sao Paulo Genetic Laboratory Basics Health Sciences Department Medical School of Federal University of Mato Grosso Tropical Medicine Division Medical School of Brasilia University Campus Darcy Ribeiro University Laboratory of Genetics of Morphology and Genetics Department Federal University of Sao Paulo Laboratory of Clinical Analysis ABC Medical School avenida Príncipe de Gales Laboratory of Molecular Gynecology Department of Gynecology Federal University of Sao Paulo rua Pedro de Toledo

AIM To investigate the associations of the genetic polymor-phisms of vascular endothelial growth factor A(VEGF-A)-1498C>T and-634G>C, with the survival of patients with colorectal cancer(CRC). METHODS A prospective cohort consisting of 131 Brazilians patients consecutively operated on with a curative intention as a result of sporadic colorectal carcinoma was studied. DNA was extracted from peripheral blood and its amplification and allelic discrimination for each genetic polymorphism was performed using the technique of polymerase chain reaction(PCR) in real-time. The real-time PCR technique was used to identify the VEGF-A-1498C>T(rs833031) and-634G>C(rs2010963) polymorphisms. Genotyping was validated for VEGF-A-1498C>T polymorphism in 129 patients and for VEGF-A-634G>C polymorphism in 118 patients. The analysis of association between categorical variables was performed using logistic regression, survival by Kaplan-Meier method and multivariate analysis by the Cox regression method. RESULTS In the univariate analysis there was a significant association(OR = 0.32; P = 0.048) between genotype CC of the VEGF-A-1498C>T polymorphism and the presence of CRC liver metastasis. There was no association between VEGF-A-1498C>T polymorphism and VEGF-A-634G>C polymorphism with further clinical or anatomopathologic variables. The genotype CC of the VEGF-A-1498C>T polymorphism was significantly correlated with the 5-year survival(P = 0.032), but not significant difference(P = 0.27) was obtained with the VEGF-A-634G>C polymorphism with the 5-year survival in the univariate analysis. The genotype CT(HR = 2.79) and CC(HR = 4.67) of the polymorphism VEGF-A-1498C>T and the genotype CC(HR = 3.76) of the polymorphism VEGF-A-634C>G acted as an independent prognostic factor for the risk of death in CRC patients. CONCLUSION The CT and CC genotypes of the VEGF-A-1498C>T and the CC genotype of the VEGF-A-634C>G polymorphisms are prognostic factors of survival in Brazilians patients with spora

关键词： Colorectal cancer Genetic polymorphisms Vascular endothelial growth factor-A Colorectal surgery Genetic variation

Antral exfoliative cytology for the detection of Helicobacter pylori in the stomach

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World Journal of Gastroenterology 2005年第18期11卷 2784-2788页

作者： Claudio A.R. Gomes Jr Wilson R. Catapani Ana M.A.A. Mader Angelo Locatelli Claudilene B.P. Silva jaques waisberg Department of Gastroenterology Surgery and Pathology ABC Faculty of Medicine Avenida Príncipe de Gales 821 Santo André S■o Paulo Brazil

AIM: To evaluate the efficacy of antral exfoliative cytology method in the diagnosis of Helicobacter pylori (H pylori)infection in the ***: Fifty patients were submitted to upper digestivetract endoscopy due to complaints of dyspepsia. Thematerial for exfoliative cytology was obtained by extensive brushing of the gastric antral mucosa and Papanicolaou stain was used to identify the bacteria. The authors also performed gastric biopsies to collect material for urease tests and histologic studies, with hematoxylin-eosin and fucsin stains in order to identify the microorganism. The gold standard used to detect the presence of H pylori was an analysis of the combined results from the gastric biopsies by urease test and histological method. RESULTS: Antral exfoliative cytology method exhibited 90.3% sensitivity, 66.6% specificity, accuracy of 81.6%, positive predictive value of 82.3% and negative predictive value of 80.0%, in this population with a prevalence of 63.3%.CONCLUSION: Antral exfoliative cytology was demonstrated to be a sensitive, accurate and easy to perform method for investigating H pylori infection in the stomach.

关键词： H pylori Exfoliative cytology Stomach

Neuroendocrine gastric carcinoma expressing somatostatin: A highly malignant, rare tumor

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World Journal of Gastroenterology 2006年第24期12卷 3944-3947页

作者： jaques waisberg Leandro Luongo de Matos Ana Maria do Amaral Antonio Mader Sérgio Pezzolo Esmeralda Miristene Eher Vera Luiza Capelozzi Manlio Basilio Speranzini Department of Surgery Faculty of Medicine of ABC Santo AndréBrazil Faculty of Medicine of ABC Santo André S(a|~)o PauloBrazil Department of Pathology Faculty of Medicine of ABC Santo AndréBrazil Department of Pathology Faculty of Medicine S(a|~)o Paulo UniversityBrazil

Poorly differentiated gastric neuroendocrine carcinomas, although rare, deserve particular attention, as they are aggressive and have an extremely poor prognosis. In this report we describe a gastric neuroendocrine carcinoma with rapidly fatal outcome. Immunohistological staining of the resected specimens revealed that the tumor was an endocrine carcinoma. The tumor disclosed intense immunoreactivity to pan-neuroendocrine markers and diffuse somatostatin immunoreactivity. There were no psammoma bodies and no demonstrable association with yon Recklinghausen＇s neurofibromatosis. In the gastrointestinal tract, neuroendocrine tumors producing predominantly somatostatin have been described only in the duodenum. To the best of our knowledge, the present report is the second case report of a neuroendocrine gastric carcinoma expressing diffusely somatostatin as the only neuroendocrine regulatory peptide.

关键词： Neuroendocrine carcinoma Neuroendocrinetumors Carcinoid Stomach neoplasms Somatostatin Immunohistochemistry Tumor markers Enterochromaffin-like cells

Biliary carcinoembryonic antigen levels in diagnosis of occult hepatic metastases from colorectal carcinoma

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World Journal of Gastroenterology 2003年第7期9卷 1589-1593页

作者： jaques waisberg Rogério T.Palma Luís Contim Neto Lourdes C.Martins Maurício S.L.Oliveira Carlos A. Nagashima Antonio C.Godoy Fabio S.Goffi Surgical Gastroenterology Department Hospital do Servidor Público EstadualSo PauloBrazil Clinical Laboratory Department Hospital do Servidor Público EstadualSo PauloBrazil

AIM:To prospectively explore the role of carcinoembryonic antigen (CEA) in gallbladder bile in patients with colorectal carcinoma and the morphological and clinical features of neoplasia and the occurrence of hepatic metastases. METHODS:CEA levels in the gallbladder and peripheral blood were studied in 44 patients with colorectal carcinoma and 10 patients with uncomplicated *** samples were collected from the gallbladder bile and peripheral blood during the operation,immediately before extirpating the colorectal neoplasia or cholecystectomy. Values of up to 5 ng/ml were considered normal for bile and serum CEA. RESULTS:In the 44 patients with colorectal carcinoma who underwent operation with curative intent,the average level of serum CEA was 8.5 ng/ml (range:0.1 to 111.0 ng/ ml) and for bile CEA it was 74.5 ng/ml (range:0.2 to 571.0 ng/ml).In the patients with uncomplicated cholelithiasis who underwent cholecystectomy,the average level of serum CEA was 2.9 ng/ml (range:1.0 to 3.5 ng/ml) and for bile CEA it was 1.2 ng/ml (range:0.3 to 2.9 ng/ml). The average duration of follow-up time was 16.5 months (range:6 to 48 months).Four patients who underwent extirpation of the colorectal carcinoma without evidence of hepatic metastasis and with an average bile CEA value of 213.2 ng/ml presented hepatic metastases between three and seventeen months after removal of the primary colorectal *** of them successfully underwent extirpation of the hepatic lesions. CONCLUSION:High CEA levels in gallbladders of patients undergoing curative operation for colorectal carcinoma may indicate the presence of hepatic *** patients must be followed up with special attention to the diagnosis of such lesions.

关键词： Adult Aged Aged, 80 and over Bile Carcinoembryonic Antigen Cholecystectomy Cholelithiasis Colorectal Neoplasms Female Humans Liver Neoplasms Male Middle Aged Predictive Value of Tests Prospective Studies

Hepatocellular carcinoma recurrence after liver transplant:An Australian single-centre study

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World Journal of Transplantation 2025年第1期15卷 105-114页

作者： Matthew G Garas Luis Calzadilla-Bertot Briohny W Smith Luc Delriviere Byron jaques Lingjun Mou Leon A Adams Gerry C MacQuillan George Garas Gary P Jeffrey Michael C Wallace Medical School University of Western AustraliaNedlands 6009Western AustraliaAustralia Department of Hepatology Sir Charles Gairdner HospitalNedlands 6009Western AustraliaAustralia Department of Surgery Sir Charles Gairdner HospitalNedlands 6009Western AustraliaAustralia

BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths *** transplantation(LT)offers the most effective *** recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for *** rate of HCC recurrence is generally reported as 8%-20%in the *** predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian *** To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT *** We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and *** was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of *** survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier *** and multivariate Cox regression was used to determine predictors of HCC recurrence *** Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 *** median time to recurrence was 2.9 years±0.75 *** comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT *** studies are requir

关键词： Liver cancer Recurrence Liver transplantation Hepatocellular carcinoma Predictors Post-transplant survival Australian data