Celkova incidence NSCLC v CR kolisa, ve srovnani let 2003-2013 vzrostla o 11 %, pokud jde o trend poslednich pěti iet, růst je již jen na urovni 0,4%. Před rokem 1980 byl pokrocilý NSCLC považovan za nador, který chemoterapii odolava. Na přelomu tisicileti se median přežiti nemocných s pokrocilým NSCLC pohyboval v rozmezi 8-10 měsiců. V poslednich letech dochazi k jeho prodlouženi.
Trastuzumab (Herceptin® – H) je v Ceske republice lecebným standardem HER2 dependentniho (HER2+) karcinomu prsu (breast cancer – BC) od roku 2009. Neoadjuvantni aplikace H pomaha zvýsit pocet patologických kompletnich remisi (pathologic complete remission – pCR) a ma tak vliv na prognozu nemocných. Cil: Cilem nasi prace bylo zhodnoceni efektu neoadjuvantni terapie (NAT) s H u pacientek s casným HER2+ BC a korelace lecebneho výsledku s přeživanim (overall survival – OS) nemocných. pCR jsme definovali jako absenci invazivniho karcinomu v tkani prsni žlazy (ypT0) při možne přitomnosti rezidualni nemoci ve formě neinvazivniho karcinomu (ypTis) a absenci nadorových buněk v axilarnich lymfatických uzlinach (ypN0). Pocet pCR jsme korelovali s hormonalni dependenci nadoru, srovnali jsme pocet dosažených pCR u nemocných s hormonalně pozitivnim (estrogenni receptor – ER+) a hormonalně negativnim (ER–) onemocněnim. Výsledky: Do hodnoceni bylo zapojeno 148 žen s HER2+ BC, predominantně ve stadiu II. Celkem 50,7 % z nich bylo v době diagnozy premenopauzalnich, 45,9 % mělo ER– onemocněni. Větsina pacientek byla lecena sekvencně antracyklinem a pote taxanem a H. pCR byla zaznamenana u 50 % nemocných (74/148), ER+ nadory regredovaly castěji do stadia ypTis (24/35), ER– nadory do stadia ypT0ypN0 (26/39). OS 1 rok u pacientek, ktere dosahly pCR, bylo signifikantně lepsi ve srovnani se skupinou pacientek, ktere na NAT nezareagovaly (100,0 vs. 95,3 %; p = 0,009), median OS nebyl u pacientek s pCR dosažen. Zavěr: Pacientky, ktere dosahly pCR, měly lepsi prognozu ve srovnani se ženami, u kterých pCR nebylo dosaženo.
The National Colorectal Cancer Screening Program has been conducted in the Czech Republic since 2000 and serves as an example of interdisciplinary collaboration. Specialists from gastroenterology, general practice, gynecology, and clinical biochemistry are involved in the program. It is based on two primary methods: the screening fecal immunochemical test for occult bleeding (iFOBT, FIT) and preventive colonoscopy (FOBT-positive colonoscopy and screening colonoscopy). The program‘s effectiveness is evidenced by the high number of detected colorectal precancerous and malignant lesions. Between 2006 and 2023, a total of 531,362 preventive colonoscopies were performed, diagnosing 202,575 patients with adenomas (38.1%) and 14,473 patients with cancers (2.7%). Program quality is monitored by indicators focused on both organization (target population coverage) and screening methods. Coverage with screening tests in a 2-year interval has consistently ranged around 30%, except between 2020 and 2021 during the COVID-19 pandemic (27%), reaching 30.0% in 2023. Non-screening tests also affect epidemiological indicators, with total coverage by all relevant methods in a 2-year interval in 2023 amounting to 37.5%. Colonoscopies are evaluated using six parameters (number of examinations, bowel preparation quality, total colonoscopies, and adenoma detection rate in total, in both women and men). In 2023, 72% of screening colonoscopy centers met all of these indicators. FOBT analyzers now must have the regular external quality assessment (EQA), which should help stabilize test positivity, standing at 9.1% in 2023. Thanks to the National Colorectal Cancer Screening Program, favorable epidemiological trends have been observed, with a 32.3% decrease in incidence and a 47.8% decrease in mortality between 2000 and 2022. The future of the program lies in its further optimization, with a goal of both increasing coverage of the target population by examination and quality improvement, ensuring the program’s feasibility and efficiency. Key words: colorectal cancer – adenoma – screening – colonoscopy – fecal immunochemical test – quality indicators
While prostate cancer (PCa) incidence and mortality rates continue to rise, early detection of PCa remains highly controversial, and the research landscape is rapidly evolving. Existing systematic reviews (SRs) and meta-analyses (MAs) provide valuable insights, but often focus on single aspects of early detection, hindering a comprehensive understanding of the topic. We aim to fill this gap by providing a comprehensive SR of contemporary SRs covering different aspects of early detection of PCa in the European Union (EU) and the UK.
Gastrointestinal stromal tumours (GIST) are rare malignant mesenchymal tumours with an incidence of 1 in 100,000. They represent only 5% of gastrointestinal tumours. The GISTs are mainly located in the stomach (60-70%) and in the rectum in < 5% of cases. In the case of localized, resectable tumours, the treatment is surgical resection. Depending on the size and localization of the tumour in the rectum, either a local excision, rectal resection with anastomosis, or abdominoperitoneal amputation with permanent stoma can be performed. In contrast to carcinomas, the metastasis of GISTs into lymph nodes is rare; therefore, from an oncological point of view, lymphadenectomy in the form of mesorectal excision is not required. Neoadjuvant treatment using tyrosine-kinase inhibitors (TKI) is recommended for tumours larger than 5 cm and in case of tumours infiltrating surrounding organs or sphincters in order to achieve complete resectability, less mutilating and continent procedure. In GISTs with a positive resection line, re-resection can be attempted. Adjuvant TKI therapy can be considered in cases of CD117 positivity and after resections of GISTs with medium and high-risk malignant behaviour. The TKI treatment is also indicated in cases of unresectable and metastatic GISTs.Data obtained from the GIST registry by the 1st January 2017, when 10 centres in the Czech Republic were contributing to the registry, were analysed.We analysed 1,095 patients out of which 45 (4.1%) had GIST localized in the rectum. The average age of the patients was 60 years. There were significantly more males (68.9%; p = 0.0007) and symptomatic patients (62.2%; p = 0.034). In total, 82% of the patients underwent surgery. Local excision was performed in 37.8%, resection of the rectum with anastomosis in 29.7%, and Miles operation in 29.7%. In the cohort, most tumours were 2-5 cm in size and almost half of the tumours presented a high risk of malignant behaviour. Systemic treatment was reported in 73% of patients. A complete remission was achieved in 80% of patients with GIST of the rectum. The median survival rate was 11.3 years and the 5-year survival rate is 90.6%.Despite the success of TKI treatment, the only potentially curative method of rectal GISTs is a surgical R0 resection. Given the relatively rare frequency of these tumours, proper diagnosis and treatment is demanding. Therefore, these patients should be preferably treated in specialised centres. This work was supported by grant MH CZ - RVO (FNBr, 65269705). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 19. 12. 2018 Accepted: 2. 2. 2019.
