Papers by maria-gabriela anitei
Diagnostics, Apr 7, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Purpose: No biomarker to personalize treatment in locally advanced rectal cancer (LARC) is curren... more Purpose: No biomarker to personalize treatment in locally advanced rectal cancer (LARC) is currently available. We assessed in LARC whether a diagnostic biopsy-adapted immunoscore (IS B) could predict response to neoadjuvant treatment (nT) and better define patients eligible to an organ preservation strategy ("Watchand-Wait"). Experimental Design: Biopsies from two independent cohorts (n 1 ¼ 131, n 2 ¼ 118) of patients with LARC treated with nT followed by radical surgery were immunostained for CD3 þ and CD8 þ T cells and quantified by digital pathology to determine IS B. The expression of immune-related genes post-nT was investigated (n ¼ 64 patients). Results were correlated with response to nT and disease-free survival (DFS). The IS B prognostic performance was further assessed in a multicentric cohort (n ¼ 73 patients) treated by Watch-and-Wait. Results: IS B positively correlated with the degree of histologic response (P < 0.001) and gene expression levels for Th1 orientation and cytotoxic immune response, post-nT (P ¼ 0.006). IS B high identified patients at lower risk of relapse or death compared with IS B low [HR, 0.21; 95% confidence interval (CI), 0.06-0.78; P ¼ 0.009]. Prognostic performance of IS B for DFS was confirmed in a validation cohort. IS B was an independent parameter, more informative than pre-(P < 0.001) and post-nT (P < 0.05) imaging to predict DFS. IS B combined with imaging post-nT discriminated very good responders that could benefit from organ preservation strategy. In the "Watch-and-Wait" cohort (n ¼ 73), no relapse was observed in patients with IS B high (23.3%). Conclusions: IS B predicts response to nT and survival in patients with LARC treated by surgery. Its usefulness in the selection of patients eligible for a Watch-and-Wait strategy is strongly suggested.
Chirurgia, 2019
Introducere: În acest studiu, ne propunem să identificăm efectul radioterapiei neoadjuvante asupr... more Introducere: În acest studiu, ne propunem să identificăm efectul radioterapiei neoadjuvante asupra numărului de ganglioni limfatici totali recoltaţi şi pozitivi în piesa operatorie. În plus, am încercat să identificăm impactul chimioterapiei asociate cu radioterapia asupra structurilor menţionate. Pacienţi şi metodă: În cadrul studiului am inclus pacienţi trataţi pentru cancer rectal într-o singură unitate chirurgicală oncologică care deserveşte partea nord-estică a României, pe o perioadă de 5 ani şi jumătate, între mai 2013 şi aprilie 2018. În primul rând, am comparat stadializarea anatomopatologică a ganglionilor limfatici cu stadializarea preterapeutică. În al doilea rând, am comparat valorile ganglionilor limfatici în raport cu schema de tratament. Rezultate: În total, 498 de pacienţi au fost trataţi radical prin intervenţii chirurgicale deschise pentru cancer rectal mediu şi inferior. Am observat o scădere a stadializării N în 218 cazuri, 65 rămânând staţionare şi în 10 crescând stadiul ganglionar pe specimenul chirurgical. Am identificat diferenţe semnificative în numărul total de ganglioni (17.4 vs 24,2, p<0.001), numărul de ganglioni pozitivi (1.4 vs 3.4, p<0.001) şi raportul între numărul de
Jurnal de chirurgie, 2013
BACKGROUND: Despite advances in neoadjuvant treatment, rectal resection remains the gold-standard... more BACKGROUND: Despite advances in neoadjuvant treatment, rectal resection remains the gold-standard treatment for rectal cancer. AIM: The aim of this study was to assess the benefits of anal sphincter preservation and to compare the quality of life in terms of functional outcome in long term survivors who underwent low (or ultra low) anterior resection with total mesorectal excision to patients with abdominoperineal excision for locally advanced rectal cancer with neoadjuvant therapy. MATERIAL AND METHODS: We retrospectively analyzed the medical records of 319 patients who underwent surgery for rectal cancer from 2006 to 2011. Quality of life in 69 eligible patients with preoperative treatment and rectal resection with total mesorectal excision was assessed using the EORTC QLQ C 30 and EORTC QLQ CR29 questionnaires. We evaluated the overall status of quality of life and functional status of these patients symptoms scale. High score for functional scores shows better function whereas high symptom score shows more problems. Results were compared for patients with anal sphincter preservation (SP, 20 patients) versus abdominoperineal excision (APE, 49 patients) using t-Student test for independent samples. RESULTS: The median follow up in 69 patients was 32 months (range 11-74 months, 32±2,3SD). Quality of life for our group is significantly higher than the reference EORTC population (P < 0.001). Physical functioning (P = 0.050), cognitive functioning (P = 0.039), emotional functioning (P = 0.006), physical and social functioning (P = 0.005), constipation (P = 0.018), body image (P = 0.003), abdominal pain (P = 0.004), embarrassment (P = 0.003) were significantly better for patients with SP. There was no significant differences in the general symptoms of the radiochemotherapy treatment (mouth dryness, hair loss, flavor). Most of the symptom scales like sexual interest, impotence, dyspareunia, diarrhoea did not differ. APE patients suffered more from anxiety (P = 0.020). CONCLUSIONS: Patients after APE have restrictions in their postoperative quality of life. Although avoidance of a permanent colostomy is regarded as beneficial for patient´s quality of life by most surgeons, patients undergoing sphincter sparing surgery may develop a number of functional problems.
Jurnal de chirurgie, Oct 10, 2013
Neoadjuvant chemoradiotherapy is the standard treatment in locally advanced rectal cancer and it ... more Neoadjuvant chemoradiotherapy is the standard treatment in locally advanced rectal cancer and it was demonstrated that radiation therapy associated with total mesorectal excision reduces local recurrence rate. It is very important to precisely determine the area that is subjected to radiation, in order to avoid side effects. The clinical target volume (CTV) is dependent on tumor location, lymphatic drainage area and the degree of tumor invasion into nearby organs. The CTV determination must take into account the internal organ motion during the treatment. The radiotherapy simulating is possible due to specialized CT and/or MRI and planning software. Using this method, it is possible to modulate the intensity of radiation on tumor tissue, with minimal effects on normal tissues.
Acta Endocrinologica, 2020
Context.Incidentally discovered solid adrenal tumors must be evaluated from two points of view: t... more Context.Incidentally discovered solid adrenal tumors must be evaluated from two points of view: the risk of malignancy and the secretory feature.Objective.Our aim was to evaluate the surgical technique option in relation with clinical and histopathologic features.Design.We performed a retrospective study that included patients with adrenal gland tumors.Subjects and methods.All patients were operated between 2012 and 2019 by the same surgical team in a single center.Results.The batch included 102 patients with adrenal tumors operated through open surgery (OS, n=41) and laparoscopic surgery (LS, n=61). Tumor localization was especially on the right adrenal gland (n=52, 50.98%). Primary origin of the adrenal gland tumors was in 82 cases (80.39%) and a metastatic origin in 16 cases. Average dimension for surgical resected tumors was 4.02 cm (0.9-12 cm) for the LS group as compared to 7.22 cm (1.3-19 cm) for OS group with a predominant type of surgery represented by adrenalectomy and a conversion rate of 2.94%. The hospital stay was 7.22 days (5-12 days) in the LS group versus 12.72 days (6-57 days) in OS group with significant differences (p<0.01). Also, the postoperative recovery was significantly different (6.5 days versus 2.62 days, p<0.01).Conclusion.Laparoscopic approach represents the gold standard in adrenal gland tumors less than five centimeters in size. Adrenalectomy is mostly performed by LS and adenoma is the most frequent histopathologic type, while pheochromocytoma is operated through OS. LS has a significantly reduced hospitalization and postoperative stay compared to OS.
Jurnal de chirurgie, 2013
Any attempt to define the place of surgery in the treatement of oesophageal cancer should conside... more Any attempt to define the place of surgery in the treatement of oesophageal cancer should consider the major changes that occurred during the last two decades: major shift in histologic type, improved staging methods, spectacular reduction of operative risk, standardization of oncologic principles of resection and the development of multimodality therapeutic strategies. Surgical treatement plays an essential role in management of esophageal cancer and it is prefferable to be done by trained surgical teams in large volume centers. Optimal surgical treatment strategies include appropriate patient selection, accurate staging, and risk assesment, selection of appropriate surgical approach, and the use of multimodality treatement.Esophagectomy remaines the main treatement of esophageal carcinoma, but in half of cases patients are unresectable at the time of diagnosis due to presence of systemic disease.Two major surgical strategies to improve survival rates after esophagectomy have emerged during the past decades: limited (transhiatal esophagectomy) and extended (transthoracic esophagectomy) with two field lymphadenectomy. In the short term, transhiatal esophagectomy is accompanied by less morbidity, in the long term is preferable for tumors at gastro-oesophageal junction without involved lymph nodes of chest. For patiets suitable for surgery, transthoracic esophagectomy with mediastinal and abdominal lymphadenectomy is preferred. This article provides un up-to-date of options for surgical managing of esophageal cancer and outlines of surgical technique.
Jurnal de chirurgie, 2013
Any attempt to define the place of surgery in the treatement of oesophageal cancer should conside... more Any attempt to define the place of surgery in the treatement of oesophageal cancer should consider the major changes that occurred during the last two decades: major shift in histologic type, improved staging methods, spectacular reduction of operative risk, standardization of oncologic principles of resection and the development of multimodality therapeutic strategies. Surgical treatement plays an essential role in management of esophageal cancer and it is prefferable to be done by trained surgical teams in large volume centers. Optimal surgical treatment strategies include appropriate patient selection, accurate staging, and risk assesment, selection of appropriate surgical approach, and the use of multimodality treatement.Esophagectomy remaines the main treatement of esophageal carcinoma, but in half of cases patients are unresectable at the time of diagnosis due to presence of systemic disease.Two major surgical strategies to improve survival rates after esophagectomy have emerged during the past decades: limited (transhiatal esophagectomy) and extended (transthoracic esophagectomy) with two field lymphadenectomy. In the short term, transhiatal esophagectomy is accompanied by less morbidity, in the long term is preferable for tumors at gastro-oesophageal junction without involved lymph nodes of chest. For patiets suitable for surgery, transthoracic esophagectomy with mediastinal and abdominal lymphadenectomy is preferred. This article provides un up-to-date of options for surgical managing of esophageal cancer and outlines of surgical technique.
IS B High Characteristics No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) No. of patients Age .58... more IS B High Characteristics No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) No. of patients Age .58* .12* ≤ 65 years
IS B High Characteristics No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) No. of patients Age .58... more IS B High Characteristics No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) No. of patients Age .58* .12* ≤ 65 years
Purpose: To determine whether the tumor immune infiltrate, as recently evaluated with the Immunos... more Purpose: To determine whether the tumor immune infiltrate, as recently evaluated with the Immunoscore methodology, could be a useful prognostic marker in patients with rectal cancers.Experimental design: The influence of the immune infiltrate on patient's outcome was investigated in patients with or without preoperative chemoradiation therapy (pCRT). The density of total (CD3+) and cytotoxic (CD8+) T lymphocytes was evaluated by immunohistochemistry and quantified by a dedicated image analysis software in surgical specimens of patients with rectal cancer (n = 111) who did not receive pCRT and in tumor biopsies performed before pCRT from additional 55 patients. The results were correlated with tumor recurrence, patient's survival, and response to pCRT.Results: The densities of CD3+ and CD8+ lymphocytes and the associated Immunoscore (from I0 to I4) were significantly correlated with differences in disease-free and overall survival (HR, 1.81 and 1.72, respectively; all P &lt; 0.005). Cox multivariate analysis supports the advantage of the Immunoscore compared with the tumor–node–metastasis (TNM) staging in predicting recurrence and survival (all P &lt; 0.001). Lymph node ratio added information in a prognostic model (all P &lt; 0.05). In addition, high infiltration of CD3+ and CD8+ lymphocytes in tumor biopsies was associated with downstaging of the tumor after pCRT (CD3+ cells; Fisher exact test P = 0.01).Conclusions: The Immunoscore could be a useful prognostic marker in patients with rectal cancer treated by primary surgery. The determination of the immune infiltrate in biopsies before treatment could be a valuable information for the prediction of response to pCRT. Clin Cancer Res; 20(7); 1891–9. ©2014 AACR.
Purpose: To determine whether the tumor immune infiltrate, as recently evaluated with the Immunos... more Purpose: To determine whether the tumor immune infiltrate, as recently evaluated with the Immunoscore methodology, could be a useful prognostic marker in patients with rectal cancers.Experimental design: The influence of the immune infiltrate on patient's outcome was investigated in patients with or without preoperative chemoradiation therapy (pCRT). The density of total (CD3+) and cytotoxic (CD8+) T lymphocytes was evaluated by immunohistochemistry and quantified by a dedicated image analysis software in surgical specimens of patients with rectal cancer (n = 111) who did not receive pCRT and in tumor biopsies performed before pCRT from additional 55 patients. The results were correlated with tumor recurrence, patient's survival, and response to pCRT.Results: The densities of CD3+ and CD8+ lymphocytes and the associated Immunoscore (from I0 to I4) were significantly correlated with differences in disease-free and overall survival (HR, 1.81 and 1.72, respectively; all P &lt; 0.005). Cox multivariate analysis supports the advantage of the Immunoscore compared with the tumor–node–metastasis (TNM) staging in predicting recurrence and survival (all P &lt; 0.001). Lymph node ratio added information in a prognostic model (all P &lt; 0.05). In addition, high infiltration of CD3+ and CD8+ lymphocytes in tumor biopsies was associated with downstaging of the tumor after pCRT (CD3+ cells; Fisher exact test P = 0.01).Conclusions: The Immunoscore could be a useful prognostic marker in patients with rectal cancer treated by primary surgery. The determination of the immune infiltrate in biopsies before treatment could be a valuable information for the prediction of response to pCRT. Clin Cancer Res; 20(7); 1891–9. ©2014 AACR.
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Papers by maria-gabriela anitei