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- ItemAcesso aberto (Open Access)Escore de risco pré e intra-operatório para predição de metástases linfonodais no câncer do endométrio(Universidade Federal de São Paulo (UNIFESP), 2016-11-25) Teixeira, Andressa Melina Severino [UNIFESP]; Nicolau, Sergio Mancini [UNIFESP]; http://lattes.cnpq.br/9883295167917843; http://lattes.cnpq.br/2739284770069484; Universidade Federal de São Paulo (UNIFESP)Objective: The aim of this study was to identify risk factors to predict lymph node metastasis in patients with endometrial cancer, and to develop a scoring system that guides surgical decision-making regarding the need to perform lymphadenectomy. Methods/materials: A retrospective multicenter study was performed of patients who underwent hysterectomy, bilateral salpingooophorectomy, and lymphadenectomy for endometrial cancer from 2003 to 2014. Pre and intraoperative risk factors for lymph node involvement were analyzed by univariate and multivariate logistic regression. The relevant factors were used to develop a scoring system to predict lymph node metastasis. Results: A total of 329 patients were assessed. The characteristics associated with nodal metastasis in univariate analysis included race, elevated CA-125 level, increased endometrial thickness, preoperative histological grade, and pathologic tumor features (size, extension in myometrium, cervix and adnexa, and lower uterine segment involvement). The following parameters remained significant on multivariate logistic regression analysis: preoperative histological grade, tumor extension, and lower uterine segment involvement. The resulting scoring system showed good accuracy with area under the receiving operating curve of 0.858 (95% confidence interval, 0.80 ? 0.91). With a cut-off of 2 points, the calculated NPV (negative predictive value) of the model was 0.976, which corresponds to approximately 3% probability of positive lymph nodes. Conclusions: A highly accurate scoring system was developed based on three pre and intraoperative risk factors for predicting lymph node metastasis. If further validated, this model could greatly aid clinicians in the surgical management of endometrial cancer. Endometrial cancer; Lymphadenectomy; Lymph node metastasis; Scoring system
- ItemSomente MetadadadosA preoperative and intraoperative scoring system to predict nodal metastasis in endometrial cancer(Wiley, 2017) Teixeira, Andressa M. S. [UNIFESP]; Ribeiro, Reitan; Schmeler, Kathleen M.; Herzog, Thomas J.; Nicolau, Sergio M. [UNIFESP]; Marques, Renato M. [UNIFESP]Objective: To develop a scoring system that guides surgical decision-making regarding the need to perform lymphadenectomy. Methods: A retrospective study was performed of patients who underwent complete surgical staging of endometrial cancer between 2003 and 2014 at three centers in Brazil. Preoperative and intraoperative risk factors were used to develop a scoring system to predict lymph node metastasis. Results: Among 329 patients included, 71 (21.6%) had positive lymph nodes and 259 (78.4%) had negative lymph nodes. The characteristics associated with nodal metastasis in univariate analysis included the level of cancer antigen 125 (P<0.001), preoperative histological grade (P<0.001), endometrial thickness (P=0.012), and pathologic features including tumor size (P<0.001), tumor extension (P<0.001), and lower uterine segment involvement (P<0.001). On multivariate logistic regression analysis, tumor grade, tumor extension, and lower uterine segment involvement remained significantly associated. The resulting scoring system showed good accuracy as demonstrated by an area under the receiver operating characteristic curve of 0.858 (95% confidence interval 0.804-0.913). Conclusion: A highly accurate scoring system for the prediction of lymph node metastasis was developed on the basis of three preoperative and intraoperative risk factors. After validation, this model could greatly aid clinicians in the surgical management of endometrial cancer.
- ItemSomente MetadadadosSeverity scoring of atopic dermatitis: a comparison of two scoring systems(Elsevier B.V., 2008-07-01) Rullo, V. E. V. [UNIFESP]; Segato, A. [UNIFESP]; Kirsh, A. [UNIFESP]; Sole, D. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Atopic dermatitis (AD) is a chronic inflammatory pruritic skin heterogeneous disease, which does not have an objective tool able to permit comparison between patients and to monitor changes due to a specific treatment. Several assessment methods have been developed to evaluate the AD.Objectives: the aim of this study was to investigate the agreement between two observers in the assessment of the severity of AD applying SCORAD index and EASI in infants and young children with AD. the variations of parameters that compose each score, as well as the inter-observer variation for both scores, were also studied.Methods: We evaluated 42 infants and young children admitted and followed in a paediatric allergy centre (UNIFESP-EPM). All children met the diagnostic criteria for clinical AD established by Hanifin and Rajka. Two investigators graded the severity of AD, applying the SCORAD index and EASI. the two scoring systems assessed the variation between baseline evaluation and one month after treatment.Results: Significant correlations were observed comparing both scores for each physician and each evaluation. There were no differences between the mean SCORAD and EASI scores for each physician, in the two evaluations. There was a significant decrease in the mean total SCORAD and EASI score and its components, except for the item Upper Extremities EASIConclusion: Both scoring systems for AD are valid, reproducible and responsive in monitoring AD patients. Further studies will be necessary to investigate the development of AD and the best evaluation. SCORAD showed itself to be an excellent score to detect the development of AD, whereas the EASI are suitable to follow up in drug-effect studies of AD for research purposes.