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[Abstract] Introduction: Inadequate social support is associated with higher mortality both in the general population and in patients with chronic diseases. There are no studies that have described social support in liver cirrhosis and its impact on prognosis. Objectives: To analyze the impact social support has in the survival of patients with decompensated cirrhosis. Methods: Prospective multicentric cohort study (2016-2019). Patients with decompensated liver cirrhosis were included. Epidemiological, clinical and social variables were collected, using the validated Medical Outcomes Study Social Support Survey, with a 12-month follow-up. Results: A total of 127 patients were included, of which 79.5% were men. The most common etiology of cirrhosis was alcohol (74.8%), mean age was 60 years (SD 10.29), mean MELD was 15.6 (SD 6.3) and most of the patients had a Child-Pugh B (53.5%) or C (35.4%). In the assessment of social support, we observed that most of the patients (92.2%) had adequate global support. At the end of the follow-up (median 314 days), 70.1% of the patients survived. The 1-year survival rate in patients with inadequate global social support was 30%, compared to 73.5% in the presence of social support. In multivariate Cox regression analysis, inadequate social support predicted survival with an adjusted HR of 5.5 (95% CI 2,3-13,4) independently of MELD (HR 1.1, 95% CI 1-1.2), age (HR 1, 95% CI 1-1.1) and hepatocarcinoma (HR 10.6, 95% CI 4.1-27.4). Conclusion: Adequate social support improves survival in liver cirrhosis, independently of clinical variables. Social intervention strategies should be considered for their management. [Resumen] Introducción. El apoyo social se asocia a mortalidad en población general y en pacientes con enfermedades crónicas. No hay estudios que hayan descrito el apoyo social en cirrosis hepática y su impacto sobre el pronóstico. Objetivo. Analizar el impacto del apoyo social en la supervivencia en cirrosis hepática descompensada. Material y métodos. Estudio multicéntrico prospectivo de cohortes (2016–2019). Se incluyeron pacientes con cirrosis hepática descompensada. Se recogieron variables epidemiológicas, clínicas y sociales mediante la escala validada Medical Outcomes Study Social Support Survey (MOS), realizando un seguimiento de 12 meses. Resultados. Se incluyeron 127 pacientes, el 79,5% eran hombres. La causa más común de la cirrosis hepática fue alcohol (74,8%), la edad media 60 años (DE: 10,29), la media de MELD 15,6 (DE: 6,3) y la mayoría tenían Child-Pugh B (53,5%) o C (35,4%). Se observó que la mayoría de pacientes (92,2%) tenían un apoyo social adecuado (MOS global > 56). Al finalizar el seguimiento (mediana 314 días), el 70,1% de los pacientes sobrevivieron. La supervivencia al año en falta de apoyo social fue del 30%, comparado con el 73,5% en los que el apoyo social era adecuado. En el análisis de regresión multivariante el apoyo social predijo la supervivencia con un HR ajustado de 5,5 (IC 95%: 2,3-13,4) independientemente del MELD (HR: 1,1; IC 95%: 1-1,2), edad (HR: 1; IC 95%: 1-1,1) y hepatocarcinoma (HR: 10,6; IC 95%: 4,1-27,4). Conclusión. El apoyo social inadecuado en pacientes con CH disminuye la supervivencia, independientemente de las variables clínicas. Se deberían plantear estrategias de intervención social para su manejo.

Colorectal cancer (CRC) screening programs produce risks, including those derived from colorectal surgeries. The objective of this analysis is to evaluate the complications associated with the surgery.Retrospective analysis including patients who required colorectal surgery within the population-based CRC screening program in Galicia (May 2013-June 2019). We analyzed the indication for surgery and the rate of in-hospital (mildI-II, severeIII-V, Clavien-Dindo classification) and at discharge complications. We performed a multivariate analysis to determine the variables independently associated.In the analyzed period, 1092 patients underwent surgery (benign lesion 16.5%, pT1 CRC 18.2%, rest of CRC 64.6%) laparoscopic approach in 69.8% of the cases. In-hospital complications were detected in 19.2% of patients (mild: 13.4%; severe: 5.9%; deaths: 0.2%) and at discharge in 159 (14.6%) patients. Male sex was associated with in-hospital complications (OR: 2.0; 95%CI: 1.3-3.0). The variables associated with severe complications were: male sex (OR: 2.6; 95%CI: 1.2-5.5), tertiary hospital (OR: 0.5; 95%CI: 0.2-0.9) and ECOGI (OR: 0.2; 95%CI: 0.05-0.6). The factors associated with complications after discharge were age ≥60years (OR: 1.5; 95%CI: 1.0-2.3), rectal location (OR: 1.6; 95%CI: 1.1-2.3) and in-hospital complications (OR: 2.2; 95%CI: 1.5-3.2).Surgery is the main cause of morbidity and mortality associated with a CRC screening program. These results must be taken into account in the decision making of lesions that are candidates for endoscopic resection.

[Abstract] Background: Colorectal cancer is the second cancer-related cause of death in the world. Tumour stage at diagnosis is the principal prognosis factor of survival. However, the participation in the programme is around 50%. The aim of the study was to identify the benefits and barriers perceived by the population when participating in a colorectal cancer screening programme with faecal occult blood test. Methods: We carried out a cases-controls study with 408 participants. We analyzed epidemiological and social variables associated with lifestyle and behavioural factors based in the Health Belief Model. We conducted a descriptive analysis, and identified variables associated to adherence by a logistic regression. Results: Variables independently associated with the participation in a colorectal cancer screening programme were age (OR 1.06; 95% CI: 1.01-1.11), having a stable partner (OR 1.96; 95% CI: 1.20-3.18), the level of education (OR 1.59; 95% CI: 1.02-2.47) and two of the barriers to participate in the faecal occult blood test screening: "you don't know how to do one" (OR=0.46; 95% CI: 0.23-0.93) and "it is not that important right now" (OR=0.43; 95% CI: 0.24-0.78). Conclusion: The existing barriers for screening with faecal occult blood test are the best factor predicting. This is relevant when designing the intervention programmes, as they should focus on reducing perceived barriers to increase the participation in colorectal cancer screening, thereby reducing colorectal cancer mortality. [Resumen] Antecedentes. El cáncer colorrectal constituye la segunda causa de muerte por cáncer en el mundo. El estadio del tumor al diagnóstico es el principal factor pronóstico de supervivencia. Sin embargo, la participación en el programa está en torno al 50%. El objetivo de este estudio fue identificar los beneficios y las barreras percibidos por la población al participar en un programa de cribado de cáncer de colon mediante el test de sangre oculta en heces. Métodos. Estudio de casos y controles con 408 participantes en el que analizamos variables sociodemográficas, variables asociadas al estilo de vida y factores conductuales basados en el Modelo de Creencias en Salud. Realizamos un análisis descriptivo y, para identificar las variables asociadas a la adhesión al programa de cribado de cáncer colorrectal, una regresión logística. Resultados. Las variables que se asociaron de forma independiente a la participación en el programa fueron la edad (OR 1,06; IC 95% 1,01-1,11), tener pareja estable (OR 1,96; IC 95% 1,20-3,18), el nivel de estudios (OR 1,59; IC 95% 1,02-2,47) y 2 de las barreras para participar en el cribado mediante test de sangre oculta en heces: «no sabe cómo hacerlo» (OR 0,46; IC 95% 0,23-0,93) y «no es un problema importante en el momento actual» (OR 0,3; IC 95% 0,24-0,78). Conclusión. Las barreras existentes para el cribado mediante test de sangre oculta en heces son el mejor factor predictivo de participación. Esto es importante a la hora de diseñar los programas de cribado de cáncer colorrectal, ya que la reducción de las barreras percibidas aumentará la participación en los mismos, reduciendo así la mortalidad por cáncer de colon.

Resumen Introduccion La supervivencia del cancer colorrectal es del 57% a los 5 anos, en parte debido a un diagnostico tardio por una baja participacion en los programas de cribado. Son necesarios instrumentos que analicen las causas de participacion. Objetivo Comprobar la validez y consistencia interna de la version en castellano del cuestionario de Rawl para el cribado de cancer colorrectal con sangre oculta en heces. Tipo de estudio Metodologia de validacion de cuestionarios. Localizacion Tres centros de salud de Valencia. Variables Edad, sexo, estado civil, nivel de estudios, clase social, consumo de tabaco, alcohol, indice de masa corporal, antecedentes personales y familiares de cancer. Resultados Se estudiaron 408 individuos (237 casos y 171 controles). La edad media fue de 59,45 (DE 5,17) anos. La consistencia interna de todas las variables alcanzo una alfa de Cronbach de 0,796. El alfa de Cronbach de la dimension beneficios del cribado fue de de 0,871 y para la dimension barreras al cribado fue de 0,817. Los coeficientes de correlacion intraclase del test-retest para la dimension de los beneficios del cribado fue de 0,809 (IC 95% 0,606-0,913) y de 0,499 (IC 95% 0,126-0,750) para las barreras. Conclusion La version en castellano del cuestionario Rawl es valido, fiable y reproducible. Con lo que disponemos de un elemento validado en Espana con el que objetivar barreras y beneficios percibidos en un programa de cribado poblacional.

Background Optimizing colonoscopy resources is challenging, and information regarding performing diagnostic quantitative faecal immunochemical test (FIT) in daily clinical practice in primary health care is still limited. This study aimed to assess the sensitivity, specificity, positive predictive value and negative predictive value of varying FIT positivity thresholds on colorectal cancer (CRC) detection in primary health care. Methods A retrospective cohort study of 38,675 asymptomatic and symptomatic patients with a FIT (OC-Sensor™) performed between 2012 and 2016 in a primary health-care setting, using a clinical laboratory database of two Spanish areas linked with the National Health System's Hospital Discharge Records Database. The primary outcome was 2-year CRC incidence. Results The mean age of the participants was 63.2 years; 17,792 (46.0%) were male. CRC prevalence was 1.7% (650/38,675). The percentage of patients with a FIT result above the threshold was 20.7% and 14.6% for 10 μg Hb/g faeces and 20 μg Hb/g faeces thresholds, respectively. Sensitivity was 90.5% (95% confidence interval 88.0%–92.5%) at a 10 μg Hb/g faeces threshold, and this decreased by 3.1% when a 20 μg Hb/g faeces threshold was used. The negative predictive value for CRC was at least 99.2% in any subgroup analysed. At a 20 μg Hb/g faeces threshold, less than one additional CRC would be missed per 1000 patients investigated, while approximately 1.3 times more colonoscopy examinations were needed to identify an incidence of CRC using the lowest threshold for any situation analysed. Conclusions In primary health care, a quantitative FIT threshold should be tailored to colonoscopy capacity and CRC prevalence in specific populations. Instituto de Salud Carlos III, España | Ref. PI17/00837

The use of the faecal immunochemical test (FIT) to stratify the risk of colorectal cancer (CRC) in symptomatic patients in primary healthcare enables improved referrals to colonoscopy. However, its effect on diagnostic delays or the prognosis of patients has been poorly evaluated in this setting. We performed a retrospective cohort study that included symptomatic patients with outpatient CRC diagnosis between 2009 and 2017. We identified whether FIT had been analysed between initial healthcare contact and diagnostic confirmation. We included 589 patients (male = 65%, 71.7 ± 11.6 years, TNM IV = 17.1%) in the analysis. FIT was performed in 411 (69.8%) patients with a positive result (≥10 µg/g of faeces) in 96.4% of the evaluated patients. The use of FIT was associated with increased diagnostic delay (yes = 159 ± 277 days, no = 111 ± 172 days; p = 0.01). At five years follow up, 193 (32.8%) patients died (151 due to CRC). Mean survival was not modified by the use of FIT or its result (not performed = 46.8 ± 1.5 months, FIT+ = 48.9 ± 1 months, FIT− = 45.6 ± 5.5 months; p = 0.5) in Kaplan–Meier analysis, and was confirmed later in multivariate Cox regression analysis. In conclusion, FIT determination in symptomatic patients in primary healthcare did not modify CRC prognosis.

[Abstract] Introduction: Colorectal cancer 5-years-survival is 57%, partway due to a low rate of participation in screening programmes. Instruments analyzing causes of low adherence are needed. Objective: To evaluate the validity and internal consistency of the Spanish version of Rawl's Questionnaire for the screening of colorectal cancer by faecal occult blood testing. Type of study: Questionnaire validation methodology. Location: Three Primary Care Centres in Valencia. Variables: Age, sex, civil status, educational level, social class, smoking, alcohol consumption, body mass index, personal and family history of cancer. Results: We analyzed 408 individuals (237 cases and 171 controls). Mean age was 59.45 years (SD 5.17). Internal consistency of all variables reached a Cronbach's alfa of 0.796. The Cronbach's alfa benefit dimension of the screening was 0.871 and for the barrier dimension of the screening it was 0.817. Intraclass correlation coefficients of the test-retest for the benefit dimension of the screening was 0.809 (CI 95% 0.606-0.913) and 0.499 (CI 95% 0.126-0.750) for the barrier dimension. Conclusion: The Spanish version of Rawl's Questionnaire is valid, reliable and reproducible, so we have this validated instrument with which to identify barriers and benefits in a colorectal screening programme in Spain. [Abstract] Introducción. La supervivencia del cáncer colorrectal es del 57% a los 5 años, en parte debido a un diagnóstico tardío por una baja participación en los programas de cribado. Son necesarios instrumentos que analicen las causas de participación. Objetivo. Comprobar la validez y consistencia interna de la versión en castellano del cuestionario de Rawl para el cribado de cáncer colorrectal con sangre oculta en heces. Tipo de estudio. Metodología de validación de cuestionarios. Localización. Tres centros de salud de Valencia. Variables. Edad, sexo, estado civil, nivel de estudios, clase social, consumo de tabaco, alcohol, índice de masa corporal, antecedentes personales y familiares de cáncer. Resultados. Se estudiaron 408 individuos (237 casos y 171 controles). La edad media fue de 59.45 (DE 5.17) años. La consistencia interna de todas las variables alcanzó una alfa de Cronbach de 0.796. El alfa de Cronbach de la dimensión beneficios del cribado fue de de 0.871 y para la dimensión barreras al cribado fue de 0.817. Los coeficientes de correlación intraclase del test-retest para la dimensión de los beneficios del cribado fue de 0.809 (IC 95% 0.606−0.913) y de 0.499 (IC 95% 0.126−0.750) para las barreras. Conclusión. La versión en castellano del cuestionario Rawl es válido, fiable y reproducible. Con lo que disponemos de un elemento validado en España con el que objetivar barreras y beneficios percibidos en un programa de cribado poblacional.

Resumen Objetivo Analizar el efecto de la demora atribuible al sistema sanitario en una cohorte consecutiva de pacientes diagnosticados de forma ambulatoria de cancer colorrectal (CCR) en el area sanitaria de Ourense. Pacientes y metodos Estudio observacional de cohortes retrospectivo en el que se incluyeron los pacientes diagnosticados entre 2009 y 2017. Se definio la demora atribuible al sistema sanitario como el tiempo entre la primera consulta por sintomas y la confirmacion diagnostica. Se determino si existia una relacion independiente entre la demora diagnostica y el CCR estadio IV mediante una regresion logistica. Finalmente, realizamos una regresion de riesgos proporcionales para determinar que variables se asociaban con la mortalidad global y por CCR. Resultados Se incluyeron 575 pacientes (hombres 64.5%, edad 71.9 ± 11.5 anos) con una demora atribuible al sistema sanitario de 115 ± 153 dias. Ninguna de las variables analizadas se asocio con el estadio tumoral al diagnostico. Durante un seguimiento de 30.6 ± 21 meses fallecieron 121 pacientes (79.3% en relacion al CCR). Las variables asociadas de forma independiente con la mortalidad atribuible al CCR fueron el estadio IV al diagnostico (HR 50.65, IC 95% 12.28-209), la edad (HR 1.04, IC 95% 1.02-1.05) y la solicitud de la colonoscopia desde Atencion Primaria (HR 0.55, IC 95% 0.37-0.88). Conclusiones La demora diagnostica atribuible al sistema sanitario no se relaciono ni con el estadio ni con el pronostico del CCR. Sin embargo, la solicitud de la colonoscopia desde Atencion Primaria se asocio a una reduccion en el riesgo de mortalidad.

Resumen Objetivo Analizar el efecto de la demora atribuible al sistema sanitario en una cohorte consecutiva de pacientes diagnosticados de forma ambulatoria de cancer colorrectal (CCR) en el area sanitaria de Ourense. Pacientes y metodos Estudio observacional de cohortes retrospectivo en el que se incluyeron los pacientes diagnosticados entre 2009 y 2017. Se definio la demora atribuible al sistema sanitario como el tiempo entre la primera consulta por sintomas y la confirmacion diagnostica. Se determino si existia una relacion independiente entre la demora diagnostica y el CCR estadio IV mediante una regresion logistica. Finalmente, realizamos una regresion de riesgos proporcionales para determinar que variables se asociaban con la mortalidad global y por CCR. Resultados Se incluyeron 575 pacientes (hombres 64,5%, edad 71,9 ± 11,5 anos) con una demora atribuible al sistema sanitario de 115 ± 153 dias. Ninguna de las variables analizadas se asocio con el estadio tumoral al diagnostico. Durante un seguimiento de 30,6 ± 21 meses fallecieron 121 pacientes (79,3% en relacion al CCR). Las variables asociadas de forma independiente con la mortalidad atribuible al CCR fueron el estadio IV al diagnostico (HR 50,65; IC 95% 12,28-209), la edad (HR 1,04; IC 95% 1,02-1,05) y la solicitud de la colonoscopia desde Atencion Primaria (HR 0,55; IC 95% 0,37-0,88). Conclusiones La demora diagnostica atribuible al sistema sanitario no se relaciono ni con el estadio ni con el pronostico del CCR. Sin embargo, la solicitud de la colonoscopia desde Atencion Primaria se asocio a una reduccion en el riesgo de mortalidad.

BACKGROUND The quantitative faecal immunochemical test for haemoglobin (FIT) has been revealed to be highly accurate for colorectal cancer (CRC) detection not only in a screening setting, but also in the assessment of patients presenting lower bowel symptoms. Therefore, the National Institute for Health and Care Excellence has recommended the adoption of FIT in primary care to guide referral for suspected CRC in low-risk symptomatic patients using a 10 µg Hb/g faeces threshold. Nevertheless, it is unknown whether FIT´s accuracy remains stable throughout the broad spectrum of possible symptoms. AIM To perform a systematic review and meta-analysis to assess FIT accuracy for CRC detection in different clinical settings. METHODS A systematic literature search was performed using MEDLINE and EMBASE databases from inception to May 2018 to conduct a meta-analysis of prospective studies including symptomatic patients that evaluated the diagnostic accuracy of quantitative FIT for CRC detection. Studies were classified on the basis of brand, threshold of faecal haemoglobin concentration for a positive test result, percentage of reported symptoms (solely symptomatic, mixed cohorts) and CRC prevalence (< 2.5%, ≥ 2.5%) to limit heterogeneity and perform subgroup analysis to assess the influence of clinical spectrum on FIT´s accuracy to detect CRC. RESULTS Fifteen cohorts including 13073 patients (CRC prevalence 0.4% to 16.8%) were identified. Pooled estimates of sensitivity for studies using OC-Sensor at 10 µg Hb/g faeces threshold (n = 10400) was 89.6% [95% confidence interval (CI): 82.7% to 94.0%). However, pooled estimates of sensitivity for studies formed solely by symptomatic patients (n = 4035) and mixed cohorts (n = 6365) were 94.1% (95%CI: 90.0% to 96.6%) and 85.5% (95%CI: 76.5% to 91.4%) respectively (P < 0.01), while there were no statistically significant differences between pooled sensitivity of studies with CRC prevalence < 2.5% (84.9%, 95%CI: 73.4% to 92.0%) and ≥ 2.5% (91.7%, 95%CI: 83.3% to 96.1%) (P = 0.25). At the same threshold, OC-Sensor® sensitivity to rule out any significant colonic lesion was 78.6% (95%CI: 75.6% to 81.4%). We found substantial heterogeneity especially when assessing specificity. CONCLUSION The results of this meta-analysis confirm that, regardless of CRC prevalence, quantitative FIT is highly sensitive for CRC detection. However, FIT ability to rule out CRC is higher in studies solely including symptomatic patients.

Faecal immunochemical tests (FITs) are the most widely colorectal cancer (CRC) diagnostic biomarker available. Many population screening programmes are based on this biomarker, with the goal of reducing CRC mortality. Moreover, in recent years, a large amount of evidence has been produced on the use of FIT to detect CRC in patients with abdominal symptoms in primary healthcare as well as in surveillance after adenoma resection. The aim of this review is to highlight the available evidence on these two topics. We will summarize the evidence on diagnostic yield in symptomatic patients with CRC and significant colonic lesion and the different options to use this (thresholds, brands, number of determinations, prediction models and combinations). We will include recommendations on FIT strategies in primary healthcare proposed by regulatory bodies and scientific societies and their potential effects on healthcare resources and CRC prognosis. Finally, we will show information regarding FIT-based surveillance as an alternative to endoscopic surveillance after high-risk polyp resection. To conclude, due to the coronavirus disease 2019 pandemic, FIT-based strategies have become extremely relevant since they enable a reduction of colonoscopy demand and access to the healthcare system by selecting individuals with the highest risk of CRC.

ObjectiveImplementation of faecal immunochemical tests (FIT) as a triage test in primary healthcare may improve the efficiency of referrals without missing cases of colorectal cancer (CRC). We aim to summarise the performance characteristics of FITs for CRC in symptomatic patients presenting to primary healthcare.DesignWe performed a systematic literature review of Medline and EMBASE databases from May 2018 to November 2020. Previous related systematic searches were also adapted to this aim and completed with reference screening. We identified studies performed on adult patients consulting for abdominal symptoms in primary care which reported data such that the FIT diagnostic performance parameters for CRC could be obtained. Bivariate models were used to synthesise available evidence. Meta-regression analysis was performed to evaluate the causes of heterogeneity.ResultsTwenty-three studies (69 536 participants) were included (CRC prevalence 0.3%–6.2%). Six studies (n=34 691) assessed FIT as rule in test (threshold of ≥150 µg Hb/g faeces) showing a sensitivity of 64.1% (95% CI 57.8% to 69.9%) and a specificity of 95.0% (95% CI 91.2% to 97.2%). A threshold of 10 µg/g (15 studies; n=48 872) resulted in a sensitivity of 87.2% (95% CI 81.0% to 91.6%) and a specificity of 84.4% (95% CI 79.4% to 88.3%) for CRC. At a 20 µg Hb/g faeces threshold (five studies; n=24 187) less than one additional CRC would be missed per 1000 patients investigated compared with 10 µg Hb/g faeces threshold (CRC prevalence 2%).ConclusionFIT is the test of choice to evaluate patients with new-onset lower gastrointestinal symptoms in primary healthcare.

BackgroundColorectal cancer is the second cancer-related cause of death in the world. Tumor stage at diagnosis is the principal prognosis factor of survival. However, the participation in the program is around 50%. The aim of the study was to identify the benefits and barriers perceived by the population when participating in a colorectal cancer screening program with faecal occult blood test.MethodsWe carried out a cases-controls study with 408 participants. We analyzed epidemiological and social variables associated with lifestyle and behavioral factors based in the Health Belief Model. We conducted a descriptive analysis, and identified variables associated to adherence by a logistic regression. ResultsVariables independently associated with the participation in a colorectal cancer screening program were age (OR 1.06; 95% CI: 1.01-1.11), having a stable partner (OR 1.96; 95% CI: 1.20-3.18), the level of education (OR 1.59; 95% CI:1.02-2.47) and two of the barriers to participate in the faecal occult blood test screening: “not to know how to do it” (OR=0.46; 95% CI: 0.23-0.93) and “to take the test is currently not a major problem” (OR=0.43; 95% CI: 0.24-0.78).Conclusion The existing barriers for screening with faecal occult blood test are the best factor predicting. This is relevant when designing the intervention programs, as they should focus on reducing perceived barriers to increase the participation in colorectal cancer screening, thereby reducing colorectal cancer mortality.

We aimed to assess the risk of cancer in patients with abdominal symptoms after a complete colonoscopy without colorectal cancer (CRC), according to the carcinoembryonic antigen (CEA) concentration, as well as its diagnostic accuracy. For this purpose, we performed a post-hoc analysis within a cohort of 1431 patients from the COLONPREDICT study, prospectively designed to assess the fecal immunochemical test accuracy in detecting CRC. Over 36.5 &plusmn, 8.4 months, cancer was detected in 115 (8%) patients. Patients with CEA values higher than 3 ng/mL revealed an increased risk of cancer (HR 2.0, 95% CI 1.3&ndash, 3.1), CRC (HR 4.4, 95% CI 1.1&ndash, 17.7) and non-gastrointestinal cancer (HR 1.7, 95% CI 1.0&ndash, 2.8). A new malignancy was detected in 51 (3.6%) patients during the first year and three variables were independently associated: anemia (OR 2.8, 95% CI 1.3&ndash, 5.8), rectal bleeding (OR 0.3, 95% CI 0.1&ndash, 0.7) and CEA level &gt, 3 ng/mL (OR 3.4, 95% CI 1.7&ndash, 7.1). However, CEA was increased only in 31.8% (95% CI, 16.4&ndash, 52.7%) and 50% (95% CI, 25.4&ndash, 74.6%) of patients with and without anemia, respectively, who would be diagnosed with cancer during the first year of follow-up. On the basis of this information, CEA should not be used to assist in the triage of patients presenting with lower bowel symptoms who have recently been ruled out a CRC.

RESUMEN Este documento resume el contenido de la Guía de resección mucosa endoscópica elaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales. ABSTRACT This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.

Resumen Este documento resume el contenido de la Guia de reseccion mucosa endoscopica elaborada por el grupo de trabajo de la Sociedad Espanola de Endoscopia Digestiva (GSEED de Reseccion Endoscopica) y expone las recomendaciones sobre el manejo endoscopico de las lesiones neoplasicas colorrectales superficiales.

BACKGROUND Approximately 5–10% of patients with rhabdomyosarcomas (RMS) are diagnosed during the first year of life, and their clinical characteristics have been well documented. However, because RMS rarely occurs during the neonatal period, little is known about neonatal RMS. METHODS Four patients with neonatal RMS were treated at St. Jude Children's Research Hospital between 1962 and 1999. The authors report the results of a review of these patients and of cases described in the literature. Clinical, radiologic, and pathologic features of these patients and their outcomes were evaluated. RESULTS One patient with embryonal RMS was treated successfully with a combination of systemic chemotherapy and local control measures. The other three patients had alveolar RMS. Two of them had multiple skin and subcutaneous metastatic nodules at the time of diagnosis and developed brain metastases early in their course. In one of these patients, the PAX3-FKHR fusion transcript was detected. Three other similar cases of neonatal alveolar RMS with metastases to the skin and brain have been reported in the literature. CONCLUSIONS A distinct syndrome of neonatal RMS is described. This syndrome is characterized by alveolar histology, multiple skin and subcutaneous metastases, and fatal outcome as the result of early brain metastasis. Cancer 2001;92:1613–20. © 2001 American Cancer Society.