Publicaciones
2025
Comprehensive histopathological analysis of gastric cancer in European and Latin America populations reveals diferences in PDL1, HER2, p53 and MUC6 expression
Gastriccancer(GC)burdeniscurrentlyevolvingwithregionaldifferencesassociatedwithcomplexbehavioural, environmental, and genetic risk factors. The LEGACy study is a Horizon 2020-funded multi-institutional research project conducted prospectively to provide comprehensive data on the tumour biological characteristics of gastroesophageal cancer from European and LATAM countries.
2024
Beyond tobacco: genomic disparities in lung cancer between smokers and never-smokers
Tobacco use is one of the main risk factors for Lung Cancer (LC) development. However, about 10-20% of those diagnosed with the disease are never-smokers. For Non-Small Cell Lung Cancer (NSCLC) there are clear differences in both the clinical presentation and the tumor genomic profiles between smokers and never-smokers.
Global Assessment of Palliative Care Need: Serious Health-Related Suffering Measurement Methodology
Inequities and gaps in palliative care access are a serious impediment to health systems especially in low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care need and was originally developed by The Lancet Commission on Global Access to Palliative Care and Pain Relief. In 2015, the first iteration - SHS 1.0 - was estimated at over 61 million people worldwide experiencing at least 6 billion days of SHS annually as a result of life-limiting and life-threatening conditions.
Improving Efficiency in Healthcare: Lessons from Successful Health Policies in Chile
Chile has successfully implemented policies in its health sys- tem that have an impact on efficiency and population health. These expe- riences can be replicated in countries facing similar challenges, using the Chilean experience as a benchmark.
Community preparedness for natural hazards in two Chilean coastal cities
Chile is a country with high exposure to earthquakes and tsunamis. However, cities present different levels of community preparedness. Understanding the decision- making process for adopting preparedness measures is essential to motivating community participation while considering the local needs of each city. Considering the Protective Action Decision Model (PADM) to understand community preparedness, this study explores the role of risk perception, risk awareness, and trust in authorities in community preparedness in two coastal cities in Chile.
Comorbilidad entre obesidad y tabaquismo, y su asociación con factores de riesgo cardiometabólicos: Resultados de la Encuesta Nacional de Salud 2016-2017
La comorbilidad CDT-obesidad general se asocia con mayor frecuencia, que la comorbilidad CDT-medidas de obesidad central, con los factores de riesgo cardiometabólicos explorados. La cesación de tabaquismo puede ser una intervención costo-efectiva en esta comorbilidad de riesgo.
National health examination surveys; a source of critical data
The aim of this paper is to contribute technical arguments to the debate about the importance of health examination surveys and their continued use during the post-pandemic health financing crisis, and in the context of a technological innovation boom that offers new ways of collecting and analysing individual health data (e.g. artificial intelligence)
Cholecystectomy and digestive cancer in Chile: Complementary results from interrupted time series and aggregated data analyses
Gallbladder cancer (GBC) mortality in Chile is among the highest worldwide. In 2006, the Chilean government launched a programme guaranteeing access to gallbladder sur- gery (cholecystectomy) for patients aged 35–49 years. We evaluated the impact of this programme on digestive cancer mortality
Statin use is not associated with inflammation among Chilean women of Mapuche and non-Mapuche ancestry with gallstones
Statins are associated with lower risk of gallstones due to anti-inflammatory effects. We assessed whether statins impact circulating inflammation among Chilean women with gallstones.
Cyclooxygenase-2 Blockade Is Crucial to Restore Natural Killer Cell Activity before Anti-CTLA-4 Therapy against High-Grade Serous Ovarian Cancer
Chronic inflammation influences the tumor immune microenvironment (TIME) in high-grade serous ovarian cancer (HGSOC). Specifically, cyclooxygenase-2 (COX-2) overexpression promotes cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) expression. Notably, elevated COX-2 levels in the TIME have been associated with reduced response to anti-CTLA-4 immunotherapy. However, the precise impact of COX-2, encoded by PTGS2, on the immune profile remains unknown.
Implementation of cancer prevention practices in primary care: results of a cohort study in Chile 2018 - 2022
Implementation practices for cancer prevention in a Chilean primary care cohort are high for immunisation and very low for brief counselling and screening practices. A comprehensive non-medical-based model is needed to improve cancer prevention in primary care.
Breast cancer diagnosis and staging in Chile: A non- randomized survey-based study to assess frequency and delays
Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.
Gene content, phage cycle regulation model and prophage inactivation disclosed by prophage genomics in the Helicobacter pylori Genome Project
We investigated population evolutionary dynamics through phylogenetic and pangenome analyses. Additionally, we identified genome rearrangements and assessed the impact of prophage presence on bacterial gene disruption and methylome. We found that 29.5% (298) of the HpGP genomes contain prophages, of which only 32.2% (96) were complete, minimizing the burden of prophage carriage.
Clinical and Genomic Characterization of ERBB2-Altered Gallbladder Cancer: Exploring Differences Between an American and a Chilean Cohort
The prevalence of lithiasis seems to be higher in Chilean versus US patients with GBC. A similar prevalence of ERBB2 alterations of overall 14% and better OS suggests that a proportion of them could benefit from human epidermal growth factor receptor type 2-targeted therapies. The smaller cohort of Chile, where the disease prevalence is higher, is a reminder and invitation for the need of more robust next-generation sequencing analyses globally.
Assessing the Occurrence and Influence of Cancer Chemotherapy- Related Pharmacogenetic Alleles in the Chilean Population
This study provides the first comprehensive pharmacogenetic characterization of cancer therapy-related SNPs and highlights significant disparities in SNP frequencies within the Chilean population. Our findings underscore the necessity for inclusive research and personalized therapeutic strategies to ensure the equitable and effective application of precision medicine across diverse global communities.
Exploring the impact of MiR-92a-3p on FOLFOX chemoresistance biomarker genes in colon cancer cell lines
Studies have indicated a direct association between elevated levels of miR-92a-3p and the progression, metastasis, and chemoresistance observed in CRC. We proposed that miR-92a-3p impairs FOLFOX (fluorouracil/oxaliplatin) chemotherapy response by upregulating the expression of chemoresistance biomarker genes through the activation of β-catenin and epithelial-mesenchymal transition (EMT)
A Comprehensive Analysis of the Effect of A>I(G) RNA-Editing Sites on Genotoxic Drug Response and Progression in Breast Cancer
Dysregulated A>I(G) RNA editing, which is mainly catalyzed by ADAR1 and is a type of post-transcriptional modification, has been linked to cancer. A low response to therapy in breast cancer (BC) is a significant contributor to mortality. However, it remains unclear if there is an association between A>I(G) RNA-edited sites and sensitivity to genotoxic drugs. To address this issue, we employed a stringent bioinformatics approach to identify differentially RNA-edited sites (DESs) associated with low or high sensitivity (FDR 0.1, log2 fold change 2.5) according to the IC50 of PARP inhibitors, anthracyclines, and alkylating agents using WGS/RNA-seq data in BC cell lines.
Harnessing Health Technology Assessment in Latin America and the Caribbean: Keeping the Region on Course
We highlight five considerations that need to be taken into account to realize the full potential of HTA in the LAC region: i) explicitly link HTA to decision-making and anchor it in legal frameworks, ii) systematically incorporate the opportunity cost as a core principle into HTA activities informing coverage decisions, iii) make the internationally available evidence more fit for purpose for low- and middle-income countries (LMICs), iv) incorporate pragmatism as a key principle of HTA activities in the region, and v) institutionalize the monitoring of HTA processes and results.
Challenges for gene therapy in the financial sustainability of health systems: a scoping review
This scoping review provides an overview of financing strategies for gene therapies. Gene therapies can cure rare or previously intractable diseases, but their high cost can make access difficult. Publishing experiences with these models can help evaluate their use and gather more evidence for their effectiveness.
LINC00662 Promotes Aggressive Traits by Modulating OCT4 Expression through miR-335-5p in Gallbladder Cancer Cells
In this article, we hypothesize that LINC00662 has an important role in the acquisition of aggressiveness traits such as a stem-like phenotype, invasion, and chemoresistance in gallbladder cancer. Here, we show that LINC00662 is associated with larger tumor size and lymph node metastasis in patients with gallbladder cancer.
Quadruple therapies show a higher eradication rate compared to standard triple therapy for Helicobacter pylori infection within the LEGACy consortium. A multicenter observational study in European and Latin American countries
Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations.
Comparison of OLGA and OLGIM as predictors of gastric cancer in a Latin American population: the ECHOS Study
We read with great interest the article by Lee et al1 evaluating the risk of progres- sion from chronic atrophic gastritis (CAG) with intestinal metaplasia (IM) to high-grade dysplasia (HGD) or gastric adenocarcinoma (GA), according to the Operative Link on Gastric Intestinal Meta- plasia (OLGIM) staging system.
Overexpression of REST Represses the Epithelial–Mesenchymal Transition Process and Decreases the Aggressiveness of Prostate Cancer Cells
The RE-1 silencing transcription factor (REST) is a repressor factor related to neuroendocrine prostate cancer (PCa) (NEPC), a poor prognostic stage mainly associated with castration-resistant PCa (CRPC). NEPC is associated with cell transdifferentiation and the epithelial–mesenchymal transition (EMT) in cells undergoing androgen deprivation therapy (ADT) and enzalutamide (ENZ).
Estrategias para la prevención primaria y secundaria del cáncer gástrico: consenso chileno de panel de expertos con técnica Delfi
El cáncer gástrico (CG) es la primera causa de muerte oncológica en Chile y la sexta en América Latina y el Caribe (LAC). Helicobacter pylori (H. pylori) es el principal carcinógeno gástrico y su tratamiento reduce la incidencia y mortalidad por CG. La endoscopia digestiva alta (EDA) permite la detección de condiciones premalignas y CG incipiente. No existen programas de búsqueda masiva de la infección por H. pylori ni cribado de las condiciones premalignas ni CG incipiente en LAC. El objetivo de este estudio es establecer recomendaciones para la prevención primaria y secundaria de CG en población asintomática de riesgo estándar en Chile.
Cancer advocacy in residency education: From principles to competencies
The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020–2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians.
Barriers to the use of tests for early detection of colorectal cancer in Chile
Colorectal cancer (CRC) is a significant health issue globally, representing over 10% of all cancer diagnoses. Incidence rates vary geographically, with higher rates in developed countries. By 2035, 2.5 million new cases of CRC will be diagnosed worldwide. A lifestyle-related disease, CRC can be prevented by changes in habits, such as maintaining a healthy diet, physical activity, and avoiding smoking and alcohol.
Distinct Driver Pathway Enrichments and a High Prevalence of TSC2 Mutations in Right Colon Cancer in Chile: A Preliminary Comparative Analysis
Colorectal cancer (CRC) is the third most common type of cancer in incidence and the second in mortality worldwide, with incidence rates rising among South American countries over the last few years. Among the risk factors are lifestyle behaviors such as diet, physical activity, obesity, alcohol consumption, and tobacco use.
A contemporary review of breast cancer risk factors and the role of artificial intelligence
Breast cancer continues to be a significant global health issue, necessitating advancements in prevention and early detection strategies. This review aims to assess and synthesize research conducted from 2020 to the present, focusing on breast cancer risk factors, including genetic, lifestyle, and environmental aspects, as well as the innovative role of artificial intelligence (AI) in prediction and diagnostics.
Desafíos en la vigilancia de todos los casos de cáncer en Chile: Registro Nacional de Cáncer
El cáncer causa millones de muertes a nivel mundial por lo que su registro es fundamental, existiendo registros clínicos, hospitalarios y poblacionales. Estos últimos son el estándar de oro para la información sobre incidencia y supervivencia de cáncer en una región definida.
Effects on Quality of Life of a Telemonitoring Platform amongst Patients with Cancer (EQUALITE): A Randomized Trial Protocol
Este informe describe la metodología de un ensayo aleatorio que tiene como objetivo investigar si aprovechar una aplicación para teléfonos inteligentes llamada Contigo para el seguimiento de enfermedades mejora la calidad de vida autoinformada entre pacientes con diversos cánceres sólidos en comparación con la atención estándar.
Differential Effects of a Telemonitoring Platform in the Development of Chemotherapy-Associated Toxicity: A Randomized Trial Protocol
La quimioterapia requiere un seguimiento cuidadoso, pero los enfoques de seguimiento tradicionales enfrentan desafíos importantes. De ahí que surgió la exploración de la telemonitorización como alternativa. El objetivo es evaluar el impacto de una plataforma de telemonitoreo que proporciona datos clínicos a los médicos que atienden a pacientes con tumores sólidos, para mejorar la experiencia de atención.
The legal path for priority setting in Chile: a critical analysis to improve health planning and stewardship
Sostenemos que la autoridad sanitaria necesita recuperar el control de la planificación sanitaria mediante procesos de establecimiento de prioridades mejorados, coherentes, sistemáticos y transparentes. Recomendamos crear un nuevo organismo independiente a cargo de la evaluación de tecnologías sanitarias y la calidad de la atención, como guías clínicas, protocolos y otras normas correspondientes.
2023
A Novel Gemcitabine-Resistant Gallbladder Cancer Model Provides Insights into Molecular Changes Occurring during Acquired Resistance
Nuestro estudio describe los cambios del transcriptoma y las vías de señalización alteradas que ocurren en las células de cáncer de vesícula biliar resistentes a gemcitabina, lo que amplía enormemente nuestra comprensión de los mecanismos subyacentes de la resistencia adquirida a los medicamentos en el cáncer de vesícula biliar.
Long Non-Coding RNAs (lncRNAs) as Regulators of the PI3K/AKT/mTOR Pathway in Gastric Carcinoma
Esta revisión describe temas importantes sobre algunos ARN largos no codificantes que han sido descritos como reguladores de la vía de señalización PI3K/AKT/mTOR y, por tanto, su potencial papel oncogénico en el desarrollo de esta neoplasia maligna.
“Appagalo” a Customized Mobile Health Intervention (mHealth) for Smoking Cessation in Women: A Randomized Controlled Trial
La aplicación "Appagalo" es una herramienta eficaz para ayudar a las mujeres jóvenes a dejar de fumar. Es una alternativa sencilla de mHealth para dejar de fumar que puede contribuir a mejorar la salud de las mujeres en las Américas y en todo el mundo.
Comparison of OLGA and OLGIM as predictors of gastric cancer in a Latin American population: the ECHOS Study
Los pacientes con OLGIM III-IV tuvieron un riesgo sustancialmente mayor de HGD/GA, con una mediana de tiempo hasta la progresión de 22,7 meses, mientras que los pacientes con OLGIM II tuvieron un riesgo intermedio. Estos hallazgos demuestran un mayor riesgo de progresión neoplásica entre los pacientes con Operative Link on Gastritis Assessment (OLGA) III-IV, pero no con OLGA II.
High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Se observó una alta carga de colonización de BGN resistente a los antimicrobianos en esta muestra de adultos hospitalizados y que viven en la comunidad, lo que sugiere que la comunidad es una fuente relevante de resistencia a los antibióticos. Se necesitan esfuerzos para comprender la relación entre las cepas resistentes que circulan en la comunidad y los hospitales.
Implementation of the updated Sydney system biopsy protocol improves the diagnostic yield of gastric preneoplastic conditions: Results from a real-world study
El cumplimiento rutinario de la USSBP aumenta las tasas de detección de afecciones preneoplásicas, incluidas CAG, GIM y AIG. Se debe considerar la implementación estandarizada de USSBP en poblaciones con alto riesgo de cáncer gástrico.
The socioeconomic distribution of life expectancy and healthy life expectancy in Chile
La distribución de la esperanza de vida, la esperanza de vida ajustada por calidad y la esperanza de vida ajustada en salud en Chile muestra un gradiente claro que favorece a las poblaciones más acomodadas y que disminuye a lo largo de la vida de las personas. Las diferencias en esperanza de vida que favorecen a las mujeres contrastan con las diferencias en la esperanza de vida ajustada por calidad y la esperanza de vida ajustada en salud que favorecen a los hombres, lo que sugiere la necesidad de implementar políticas centradas en el género para abordar la complejidad de la combinación de casos. La magnitud de las desigualdades es mayor que en otros países de altos ingresos y puede explicarse por desigualdades sociales estructurales y desigualdades en el acceso a la atención médica.
Healthcare should be the same for everyone”: perceived inequities in therapeutic trajectories of adult patients with lung cancer in Chile, a qualitative study
Los hallazgos del estudio sugieren que ser una mujer con baja educación, del sistema de salud público y residiendo fuera de la región Metropolitana podría representar una de las intersecciones más poderosas para experimentar barreras para una atención sanitaria efectiva en CL en Chile. Es necesario monitorear las trayectorias terapéuticas de las pacientes desde una perspectiva de los determinantes sociales de la salud para garantizar los derechos de acceso, oportunidad, calidad y protección financiera.
Influence of SARS-CoV-2 mRNA Vaccine Booster among Cancer Patients on Active Treatment Previously Immunized with Inactivated versus mRNA Vaccines: A Prospective Cohort Study
Los pacientes con cáncer que reciben quimioterapia tienen una respuesta inmune más baja a las vacunas contra el SARS-CoV-2. Por lo tanto, a través de un estudio de cohorte prospectivo de pacientes con tumores sólidos que reciben quimioterapia, nuestro objetivo fue determinar la inmunogenicidad de un refuerzo de la vacuna de ARNm (BNT162b2) entre pacientes previamente inmunizados con una vacuna contra el SARS-CoV-2 inactivada (CoronaVac) u homóloga (BNT162b2)
Recommendations for gastric cancer prevention and control in the Americas
Una proporción significativa de casos y muertes por cáncer gástrico se puede evitar si se toman intervenciones preventivas. En consecuencia, proponemos un marco estratégico para lograr una prevención y control efectivos del CG en las Américas. Esta información se puede utilizar como recurso para decisiones de políticas públicas y desarrollo de prioridades de financiamiento. Nuestras recomendaciones se basan en la mejor evidencia disponible y en la opinión de expertos.
The Clinical Impact and Cost-Effectiveness of Surveillance of Incidentally-Detected Gastric Intestinal Metaplasia: A Microsimulation Analyses
La metaplasia intestinal gástrica (GIM) se asocia con un mayor riesgo de adenocarcinoma gástrico (AG) intestinal no cardiaco. El objetivo de este estudio fue estimar los beneficios, las complicaciones y la rentabilidad de por vida de la vigilancia del GIM mediante esofagogastroduodenoscopia (EGD).
Body Composition and Metabolic Dysfunction Really Matter for the Achievement of Better Outcomes in High-Grade Serous Ovarian Cancer
Aunque los trastornos metabólicos asociados a la obesidad tienen un impacto negativo en varios tipos de cáncer, dicha evidencia sigue siendo controvertida en el caso del cáncer de ovario. Aquí, nuestro objetivo fue evaluar el impacto de la composición corporal (BC) y los trastornos metabólicos en los resultados del cáncer de ovario seroso de alto grado (HGSOC).
Eosinophilic Cholecystitis and Eosinophils in Gallbladder Injuries: A Clinicopathological Analysis of 1050 Cholecystectomies
Los eosinófilos forman parte de lesiones especialmente subagudas en la vesícula biliar. Por lo general, se condensan en las áreas de curación y parecen indicar un estado distintivo de lesión en el que hay erosiones que conducen a una exposición lenta o sostenida de los tejidos murales al contenido de bilis que induce una lesión química o recluta eosinófilos.
Overexpression of REST Represses the Epithelial–Mesenchymal Transition Process and Decreases the Aggressiveness of Prostate Cancer Cells
Los resultados se expresaron como la media + DE de tres experimentos independientes (prueba U de Mann-Whitney, prueba de Kruskal-Wallis, prueba de Tukey). REST se comporta como un supresor de tumores, disminuyendo la agresividad de las células 22rv1, probablemente a través de la represión de EMT y el fenotipo neuroendocrino. Además, REST podría representar un marcador de respuesta a ENZ en pacientes con CaP.
Targeting hypoxia-inducible factor-1 alpha suppresses Helicobacter pylori-induced gastric injury via attenuation of both cag-mediated microbial virulence and proinflammatory host responses
Los resultados de este estudio sugieren que la inhibición de la prolil hidroxilasa protege contra las respuestas patológicas mediadas por H. pylori y está mediada, en parte, mediante la atenuación de la virulencia mediada por cag de H. pylori y la supresión de las respuestas proinflamatorias del huésped.
Barriers to the use of tests for early detection of colorectal cancer in Chile
Con este estudio, buscamos identificar posibles barreras y facilitadores para la implementación futura de la detección de cáncer colorrectal basada en pruebas inmunoquímicas fecales (FIT) en un sistema de salud pública en un país de ingresos medios con una creciente incidencia y mortalidad por CCR.
El costo esperado de cáncer en Chile
Chile ha implementado diversas políticas públicas en cáncer en los últimos años. Sin embargo, a pesar de los diagnósticos realizados, no se dispone de una estimación actualizada de su costo. Contar con esta estimación, permite dimensionar el esfuerzo financiero del sistema de salud en cáncer y otorga una línea base que permitirá futuras comparaciones. El presente estudio tuvo como objetivo estimar el costo esperado anual total del cáncer en Chile.
Co-design of a mobile application for engaging breast cancer patients into reporting health experiences: Qualitative case study
Documentamos el proceso de identificación de las necesidades de información de pacientes con cáncer de mama y profesionales de la salud durante el tratamiento. El estudio tiene como objetivo identificar los requisitos de información de los pacientes para la integración en una aplicación móvil que los acompañe durante su tratamiento y al mismo tiempo proporcione funciones para informar síntomas adversos.
Design of an Electronic Health Record for Treating and Monitoring Oncology Patients in Chile
En Chile, la necesidad de contar con registros médicos electrónicos (HCE) en oncología solo se ha abordado brevemente, lo que ha resultado en una insuficiente información actualizada y sistematizada sobre los pacientes oncológicos. En este trabajo proponemos el diseño de una HCE oncológica que gestione variables y procesos críticos para el tratamiento y seguimiento de pacientes con cáncer en Chile.
NEWSLETTER
