Registro de evaluación de tratamiento de cáncer gástrico en Chile (REGATE): características clínicas básales de 523 pacientes / Registry of gastric cancer evaluation in Chile (REGATE): basal clinical features of 523 patients

Background: Gastric cancer is one of the leading causes of cancer-related deaths in Chile and worldwide. No consensus exists for therapeutic management. Aim: To assess clinical features and practice patterns of patients with newly diagnosed gastric cancer in Chile. Method: Chilean patients > 18 years old with newly diagnosed primary gastric adenocarcinoma enrolled by thirteen centers from different regions of Chile. Target sample size calculated according to gastric cancer prevalence in Chile. Data collected from two visits within a 10-month timeframe: baseline (patients and tumor features, treatment plan) and end of study (completion of initial treatment). Herein, baseline visit data is presented. Results: Between 2005 and 2008, 523 patients enrolled. Median age 61.3 years. Diagnosis by endoscopy in 98.5 percent patients. Location: body 35.8 percent, proximal 35.4 percent, and antral 23.9 percent. Most frequently used histopathological classification was WHO classification, with tubular adenocarcinoma being most frequent finding (53.1 percent). AJCC/UICC clinical staging (available in 31.1 percent of patients) was: 0 and I - 23.3 percent, II - 18.3 percent, III- 20.8 percent, IV - 37.6 percent. Therapeutic choice based mainly on clinical staging (49.9 percent) and included surgery in 440 patients (84.1 percent). Therapy planned by surgeon (54.9 percent) or multidisciplinary team (42.3 percent). Conclusions: REGATE is the largest prospective multicenter registry study performed in Chile. Basal visit data report that diagnosis is established frequently at advanced stages. Surgery is the most frequent therapeutic choice, (neo-) adjuvant therapies are only planned in one out of four patients. End of study visit data will provide the full scope of diagnosis and treatment of these patients.

Introducción: El cáncer gástrico es una de las principales causas de muerte por cáncer en Chile. No existe consenso acerca del tratamiento. Objetivos: Conocer características clínicas y patrón de tratamiento de pacientes con cáncer gástrico recién diagnosticado. Material y Método: Pacientes chilenos mayores de 18 años con diagnóstico reciente de adenocarcinoma gástrico primario, enrolados en 13 centros de diferentes regiones de Chile. Datos obtenidos en dos visitas dentro de período de 10 meses: basal (características del tumor y paciente, plan de tratamiento) y fin de estudio (tratamiento inicial completado). Se presentan datos de visita basal. Resultados: Entre 2005 y 2008, 523 pacientes enrolados. Mediana edad 61,3 años. Diagnóstico por endoscopia en 98,5 por ciento pacientes. Localización: corporal 35,8 por ciento, proximal 35,4 por ciento y antral 23,9 por ciento. Clasificación histopatológica más usada fue clasificación OMS, y tipo histopatológico más frecuente fue tubular 53,1 por ciento. Etapificación clínica AJCC/UICC (disponible en 37,6 por ciento de pacientes) distribuida en: 0 y I - 23,3 por ciento, II -18,3 por ciento, III - 20,8 por ciento, IV - 37,6 por ciento. Principal característica clínica para elección de terapia planeada fue etapificación clínica (49,9 por ciento). Plan de tratamiento consideró cirugía en 440 pacientes (84,1 por ciento). En mayoría de casos, plan terapéutico decidido por cirujano (54,9 por ciento) o equipo multidisciplinario (42,3 por ciento). Conclusiones: REGATE es el estudio de registro prospectivo multicéntrico más grande desarrollado en Chile. Datos visita basal informan que diagnóstico se establece frecuentemente en etapas avanzadas. Cirugía es alternativa terapéutica más frecuentemente indicada; terapias (neo-) adyuvantes sólo son ofrecidas a uno de cuatro pacientes. Datos visita fin de estudio proveerá visión completa del diagnóstico y tratamiento de estos pacientes.

Valor pronóstico del nuevo sistema de etapificación internacional en mieloma múltiple: Comparación con el sistema de Durie-Salmon / Prognostic value of the new international staging system in multiple myeloma: Comparison with Durie-Salmon staging system

Background: Since 1975, the Durie-Salmon staging system (D&S) has been a widely accepted prognostic classification of multiple myeloma (MM) patients. Recently, the new International Staging System (ISS) was developed using only the values of albumin and betaZ-microglobulin. Aim: To compare survival of patients with MM treated in six medical centers in Chile according to the D&S system and the new ISS. Material and methods: Retrospective analysis of demographic information, clinical features and survival rate of patients treated between 1998 and 2002, and grouped according to both systems. Results: Information of 81 patients aged 38 to 90 years (43 women) was retrieved. According D&S system 11 percent were in stage I 12 percent in stage II and 73 percent in stage III According to ISS, 34 percent were in stage I 35 percent in stage II and 31 percent in stage III Median of survival of all patients was 32 months. Both staging systems had a prognostic value. However, median survival for the three stages of the ISS system was significantly different (67, 29 and 14 months in stages III and III, respectively, p =0.02). Patients in advanced stages II and III of the ISS, had a higher frequency of anemia, hypercalcemia, renal failure and hypoalbuminemia. In stages II and III of ISS the presence of renal failure was associated with a non significantly different lower survival. Conclusions: The ISS is a simple and effective grouping method for patients with MM, that predicts survival. The presence of renal insufficiency might identify a subgroup of patients included in stages II and III of ISS with a higher mortality.

Mieloma múltiple en Chile: características clínicas y sobrevida / Clinical features and survival of Chilean patients with multiple myeloma

Background: Mortality rate records are the only data available in Chile about the prognosis of patients with multiple myeloma (MM). Aim To characterize clinical features, survival rate and factors related to mortality in cases with MM treated in six large medical centers in Chile. Material and Method: Retrospective analysis of demographic data, clinical features and survival rate records of patients with MM, collected between 1998 and 2002. Survival curves were generated and a multivariate analysis of factors associated to early mortality was carried out. Results: Data from 245patients aged 38 to 95years (129 women) was collected. Fifty two percent had an IgG myeloma, 25 percent had and IgA and 6.1 percent had light chains myeloma. According to Durie and Salmon staging system, 8,2 percent were in Stage 112.6 percent in Stage II, 60.5 percent in Stage III and in 18.8 percent the information about staging was not available. Fifty percent had an hemoglobin level below 10 g/dL, 30 percent had a serum creatinine over 2 mg/dL and 28 percent had a serum calcium level over 10.5 mg/dL. Median survival was 33 months. Twenty percent of patients died within the first six months after diagnosis (early mortality). Predictive factors for early mortality were male sex, thrombocytopenia, anemia, renal failure, hypercalcemia, a beta2-microglobulin >5.5 mg/L and a serum albumin level <3.5 g/dL. There was a correlation between the number of bad prognosis factors present and the probability of early mortality. Conclusions: This group of Chilean patients with MM presented a short survival time, and 20 percent died within the first six months after diagnosis. More than a half of cases were diagnosed at an advanced stage (Durie and Salmon Stage III). Several factors were associated to early mortality, two of which (beta 2-microglobulin and serum albumin), are included in the new International Staging System for MM.

Linfoma de Hodkin en Chile: Experiencia de 15 años del Programa Nacional de Cáncer del Adulto / Hodgkin lymphoma in Chile: Experience of the national adult cancer program

Background: Hodgkin lymphoma is a highly curable disease. Aim: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. Patients and methods: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. Results: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61 percent of cases. Age over 40 was an adverse prognostic factor (p <0.001). The rate of PFS at 5 and 10 years for early stages was 73 percent and 66 percent with RT, 80 percent and 74 percent with C-MOPP+RT, 73 percent and 71 percent with C-MOPP/ABV, 59 percent and 59 percent with NOVP+RT, and 81 percent with ABVD+RT, at 5 years, being significantly lower for NOVP (p =0.02). The rate of OS at 5 and 10 years for advanced stages was 82 percent and 70 percent with RT, 82 percent and 76 percent with C-MOPP+RT, 82 percent and 80 percent with C-MOPP/ABV, 68 percent and 60 percent with NOVP, and 85 percent with ABVD at 5 years, also significantly lower for NOVP (p =0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49 percent and 43 percent with C-MOPP, 69 percent and 62 percent with C-MOPP/ABVD or C-MOPP/ABV, and 71 percent at 5 years with ABVD, significantly lower for C-MOPP (p =0.01). The rate of OS at 5 and 10 years was 52 percent and 46 percent with C-MOPP, 70 percent and 63 percent with C-MOPP/ABVD or C-MOPP/ABV and 76 percent with ABVD at 5 years, significantly lower for C-MOPP (p =0.0002). Conclusions: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early...