Acta medica portuguesa最新文献

Surgically resected epidermal growth factor receptor-mutated non-small cell lung cancer continues to carry a substantial risk of recurrence. The aim of this retrospective, single-center study, conducted at a Portuguese tertiary hospital was to evaluate the clinical course of these patients, diagnosed between 2016 and 2020, with the final clinical data review in November, 2024. A total of 48 patients were included, predominantly female (72.9%) and non-smokers (70.8%), most presenting exon 21 L858R or exon 19 deletion mutations. Mutations were identified by Sanger sequencing or next-generation sequencing. Programmed death-ligand 1 expression was < 1% in 58.3% of cases. At a median follow-up of 73.6 months, 31.3% of patients experienced relapse, all progressing to stage IV disease. The five-year disease-free survival and overall survival rates were 70% and 81%, respectively. Staging significantly influenced prognosis, with five-year disease-free survival ranging from 84% in stage IB to 20% in stage III. No significant differences were observed between epidermal growth factor receptor mutation subtypes. These findings are consistent with previous real-world studies and the placebo arm of the ADAURA trial, supporting the use of adjuvant osimertinib to reduce recurrence and improve long-term outcomes, while also emphasizing the need for improved perioperative risk assessment - including staging, histopathologic features, and molecular and genetic profiling - to guide personalized treatment.

Introduction: The prevalence of retropharyngeal lymph node metastases in papillary thyroid carcinoma is low. The objective of this retrospective study was to assess our institutional experience with the management of such metastases and to compare results with other published series.

Methods: We conducted a retrospective analysis of patients diagnosed with papillary thyroid carcinoma and retropharyngeal lymph node metastases who were followed at the Endocrinology Department of the Instituto Português de Oncologia de Lisboa Francisco Gentil. To identify published cases in the literature, a comprehensive search was conducted using the Medline and PubMed databases from January 1970 to June 2025.

Results: We have identified a total of 15 patients. Twelve (80.0%) were women. The median age at initial surgery was 55.7 years (range 20.6 - 84.0 years) and the median duration of follow-up was 9.8 years (range 0.5 - 36.3 years). Five patients (33.3%) were diagnosed with retropharyngeal lymph node metastases during initial tumor staging and 10 (66.7%) in the follow-up, in eight patients (80.0%) due to biochemical persistence of the disease, and in two (20.0%) after cervical lymph node recurrence. Of the 15 patients, seven (46.7%) received no treatment for retropharyngeal lymph node metastases (surveillance group), and eight (53.3%) were treated (therapy group) and, from these, four (26.7%) underwent surgery, two (13.3%) received radiotherapy, one (6.7%) underwent radiosurgery and one (6.7%) underwent both surgery and radiotherapy.

Conclusion: Most patients with retropharyngeal lymph node metastases are diagnosed post-thyroidectomy, due to biochemical persistence of the disease or cervical lymphatic recurrence. Retropharyngeal lymph node metastases are commonly single and located ipsilaterally to the primary tumor and co-occur frequently with distant metastases.