Filtro de Veia Cava Inferior: Características Clínicas e Prognósticas de Pacientes Oncológicos do INCA / Placement of Inferior Vena Cava Filter: Clinical and Prognostic Characteristics of Cancer Patients at INCA

Introdução: O tromboembolismo venoso é uma condição potencialmente fatal e frequente no paciente oncológico. Muitas vezes, a anticoagulação é inviável, e a colocação do filtro de veia cava (FVC) torna-se uma opção. A indicação clínica, entretanto, é controversa e gera alto custo. Objetivo: Descrever as características demográficas, clínicas e epidemiológicas dos pacientes com colocação de FVC e seu impacto na sobrevida global. Método: Estudo de coorte retrospectiva com pacientes em tratamento oncológico no INCA, que tiveram FVC implantado de janeiro/2015 até abril/2017. Na análise de sobrevida global em cinco anos, foram considerados o tempo entre o diagnóstico de câncer e o óbito por qualquer causa. Realizaram-se análise descritiva, estimativas de sobrevida (Kaplan-Meier) e regressão de Cox. Resultados: Foram incluídos 74 pacientes com média de idade 54 (+-15) anos. Em sua maioria, apresentavam tumores ginecológicos (52,7%) e digestivos (20,3%). O tempo mediano entre o diagnóstico de câncer e a colocação do FVC foi de 3,48 meses (0-203). No seguimento, foram observados 40 óbitos (54,1%) com mediana de tempo de 25 meses (IC 95%; 1,76-47,32). Na análise ajustada, verificou-se risco 5,63 vezes maior de morrer nos pacientes com colocação do FVC em até seis meses após o diagnóstico de câncer (HR=4,99; IC 95%; 2,20-11,33; p<0,001), e risco 2,47 vezes maior entre aqueles que não fizeram no pré-operatório (HR=2,47; IC 95%; 1,08-5,66; p=0,032). Conclusão: A colocação do FVC foi realizada com maior frequência em pacientes com tumores ginecológicos e em até seis meses após o diagnóstico de câncer foi associada a maior risco de óbito.

Introduction: Venous thromboembolism is a potentially fatal condition and frequent in oncologic patients. Quite often full anticoagulation is unfeasible, and placement of an inferior vena cava (IVC) filter becomes an option. Clinical indication, however, is controversial and expensive. Objective: To describe the demographic, clinical and epidemiological characteristics of oncologic patients submitted to IVC filter placement and their impact on global survival. Method: Retrospective cohort study with patients undergoing cancer treatment at INCA submitted to IVC filter placement from January 2015 to April 2017. Time between cancer diagnoses and death from any cause was considered for the analysis of the global 5-years survival. Descriptive analysis, survival estimates (Kaplan-Meyer) and Cox regression were performed. Results: 74 patients with a mean age of 54 (+15) years were included. Most of them had gynecological (52.7%) and digestive (20.3%) tumors. The median time between cancer diagnosis and IVC filter placement was 3.48 months (0-203). In the follow-up, 40 deaths (54.1%) were observed with a median time of 25 months (95% CI; 1.76 to 47.32). In the adjusted analysis, 5.63 times greater risk of death was verified in patients with IVC filter placement within six months after cancer diagnosis (HR=4.99; 95% CI; 2.20-11.33; p<0.001), and 2.47 times greater risk among those who did not do it at pre-operation (HR=2.47; 95% CI; 1.08-5.66; p=0.032). Conclusion: IVC filter placement was performed more frequently in patients with gynecological tumors and in until six months after cancer diagnosis was associated with increased risk of death.

Introducción: El tromboembolismo venoso es una afección potencialmente mortal y frecuente en pacientes con cáncer. La anticoagulación a menudo no es factible, y la colocación de un filtro de vena cava (FVC) se convierte en una opción. Sin embargo, las indicaciones clínicas son controvertidas y generan un alto costo. Objetivo: Describir las características demográficas, clínicas y epidemiológicas de los pacientes con colocación de CVF y su impacto en la supervivencia general. Método: Estudio de cohorte retrospectivo de pacientes sometidos a tratamiento contra el cáncer en INCA a quienes se les implantó FVC entre enero de 2015 y abril de 2017. En el análisis de la supervivencia general a cinco años, el tiempo transcurrido entre el diagnóstico de cáncer y la muerte cualquier causa Se realizó un análisis descriptivo, estimaciones de supervivencia (Kaplan-Meier) y regresión de Cox. Resultados: Se incluyeron 74 pacientes con una edad media de 54 (+-15) años. La mayoría de ellos tenían tumores ginecológicos (52,7%) y digestivos (20,3%). La mediana del tiempo entre el diagnóstico de cáncer y la colocación de FVC fue de 3,48 meses (0-203). En el período de seguimiento, se observaron 40 muertes (54,1%) con una mediana de tiempo de 25 meses (IC 95%: 1,76 a 47,32). En el análisis ajustado, se observó un riesgo de muerte 5,63 veces mayor en pacientes con colocación de FVC dentro de los seis meses posteriores al diagnóstico de cáncer (HR=4,99; IC 95%: 2,20-11,33; p<0,001) y 2,47 veces mayor riesgo entre aquellos que no lo hicieron antes de la operación (HR=2,47; IC 95%; 1,08-5,66; p=0,032). Conclusión: La colocación de FVC se realizó con mayor frecuencia en pacientes con tumores ginecológicos. La colocación de FVC dentro de los seis meses posteriores al diagnóstico de cáncer se asoció con un mayor riesgo de muerte.

Neoplasia maligna ginecológica: incidencia en el nuevo milenio: experiencia del servicio oncológico hospitalario (IVSS) / Gynecological malignant neoplasm: incidence in the new millennium: experience of the hospital oncology service (IVSS)

Conocer los indicadores de salud, como una forma de evaluar calidad del servicio que una institución presta a la población. La incidencia, prevalencia y tasas de mortalidad, son tres elementos básicos a conocer, esto permite planificar priorizar las necesidades de una determinada población, mejorando la optimización de recursos y conocer en que eslabón de la historia natural de la enfermedad se puede actuar. Queremos determinar la incidencia registrada en nuestro servicio, desde el 2000 hasta el 2015, de cada una de las patologías malignas atendidas. Un total de 1 824 historias de un universo de 4 911; las restantes no pudieron ser revisadas, por su desincorporación del archivo activo. Apreciamos que la patología con mayor incidencia fue el cáncer de cuello uterino, con un pequeño orcentaje (10 %) iagnosticado en estadio I. Seguidamente encontramos al cáncer de endometrio representando un 12 % de los casos. Dentro de la patología de ovario, el carcinoma epitelial representó el 75 %. El carcinoma de trompa de Falopio solo el 0,3 % de todas las patologías malignas del área inecológica, similar a lo eportado en la literatura mundial. Igualmente el cáncer de vulva, vagina y sarcoma uterino, representaron un escaso porcentaje de incidencia. Este trabajo constituye una fase inicial de investigaciones futuras, en las cuales se deben calcular tasas de upervivencia y período libre de enfermedad, además de incentivar la actualización anual, para evitar sub-registro por la pérdida de datos.(AU)

To know health indicators, is a way to assess the quality of service an institution provides to the population. The incidence, the prevalence and the mortality rates are three basic known elements, which allow you to plan and prioritize the needs of a given population, the improving resource optimization and know that link the natural history of the disease can act. With our research we want to determine the impact registered in our department from the year 2000 to the year 2015, each of the malignant athologies treated. A total of 1 824 stories of a universe of 4 911 were reviewed; the other could not be reviewed by the divestiture of the active file. However, with the data analyzed appreciate that the disease was highest incidence was the cervical cancer, with a small percentage (8 %) diagnosed with stage I, and then found the endometrial cancer representing 12 % of cases. Within pathology ovarian epithelial carcinoma he represented the most frequent with 75 %. The Fallopian tube carcinoma represented only 0.3 % of all malignant gynecological pathologies area, similar to that reported in the literature. Likewise cancer of the vulva, the vagina and the uterine sarcoma, accounted for a small percentage of incidences. This paper is an initial phase of future investigations, which must be calculated survival rates and the disease-free period, in addition to encouraging the annual update, to avoid underreporting by data loss.(AU)

Critical review of cancer mortality using hospital records and potential years of life lost / Revisão crítica da mortalidade por câncer usando registros hospitalares e anos potenciais de vida perdidos

ABSTRACT Objective To determine and discuss cancer mortality rates in southern Brazil between 1988 and 2012. Methods This was a critical review of literature based on analysis of data concerning incidence and mortality of prostate cancer, breast cancer, bronchial and lung cancer, and uterine and ovarian cancer. Data were collected from the online database of the Brazil Instituto Nacional de Câncer José Alencar Gomes da Silva. Results The southern Brazil is the leading region of cancer incidence and mortality. Data on the cancer profile of this population are scarce especially in the States of Santa Catarina and Paraná. We observed inconsistency between data from hospital registers and death recorded. Conclusion Both cancer incidence and the mortality are high in Brazil. In addition, Brazil has great numbers of registers and deaths for cancer compared to worldwide rates. Regional risk factors might explain the high cancer rates.

RESUMO Objetivo Investigar e discutir os indicadores de mortalidade por câncer na Região Sul do Brasil entre 1988 e 2012. Métodos Revisão crítica da literatura baseada na análise de dados referentes às estimativas de incidência e mortalidade dos cânceres de próstata, mama feminina, brônquios e pulmões, colo de útero e ovário, realizada por meio de consulta na base de dados online do Instituto Nacional de Câncer José Alencar Gomes da Silva. Resultados A Região Sul lidera no país a incidência e a mortalidade das neoplasias estudadas. Há escassez de dados sobre o perfil do câncer nesta população, especialmente nos Estados de Santa Catarina e Paraná. Notou-se, ainda, incoerência entre os dados de registros hospitalares e registros de óbito no período estudado. Conclusão Tanto a incidência quanto a mortalidade decorrentes dos cânceres estudados ainda são muito elevadas no Brasil, com significante número de registros da doença e de óbitos, quando comparado às taxas mundiais. Fatores de risco regionais podem explicar as elevadas taxas.

A Clinical Analysis of Brain Metastasis in Gynecologic Cancer: A Retrospective Multi-institute Analysis

This study analyzes the clinical characteristics of the brain metastasis (BM) of gynecologic cancer based on the type of cancer. In addition, the study examines the factors influencing the survival. Total 61 BM patients of gynecologic cancer were analyzed retrospectively from January 2000 to December 2012 in terms of clinical and radiological characteristics by using medical and radiological records from three university hospitals. There were 19 (31.1%) uterine cancers, 32 (52.5%) ovarian cancers, and 10 (16.4%) cervical cancers. The mean interval to BM was 25.4 months (21.6 months in ovarian cancer, 27.8 months in uterine cancer, and 33.1 months in cervical cancer). The mean survival from BM was 16.7 months (14.1 months in ovarian cancer, 23.3 months in uterine cancer, and 8.8 months in cervical cancer). According to a multivariate analysis of factors influencing survival, type of primary cancer, Karnofsky performance score, status of primary cancer, recursive partitioning analysis class, and treatment modality, particularly combined therapies, were significantly related to the overall survival. These results suggest that, in addition to traditional prognostic factors in BM, multiple treatment methods such as neurosurgery and combined chemoradiotherapy may play an important role in prolonging the survival for BM patients of gynecologic cancer.

Trends in gynecologic cancer mortality in East Asian regions / 부인종양

OBJECTIVE: To evaluate uterine and ovarian cancer mortality trends in East Asian countries. METHODS: For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women > or =20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases. RESULTS: Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has declined since 1993, at an annual percentage change (APC) of -4.8% (95% confidence interval [CI], -5.3 to -4.4). On the other hand, corrected uterine corpus cancer mortality has abruptly increased since 1995 (APC, 6.7; 95% CI, 5.4 to 8.0). Ovarian cancer mortality was stable, except in Korea, where mortality rates steadily increased at an APC of 6.2% (95% CI, 3.4 to 9.0) during 1995 to 2000, and subsequently stabilized. CONCLUSION: Although uterine cancer mortality rates are declining in East Asia, additional effort is warranted to reduce the burden of gynecologic cancer in the future, through the implementation of early detection programs and the use of optimal therapeutic strategies.

Carga del cáncer ginecológico en Cuba / Burden of gynecological cancer in Cuba

Objetivos Describir la carga integral asociada a localizaciones ginecológicas de cáncer como son: mama, cuello de útero, endometrio y ovario, para Cuba, sus provincias y el Municipio Especial Isla de la Juventud, para los años 1990, 1995, 2000 y 2002. Métodos Se utilizó el indicador Años de Vida Ajustados por Discapacidad, obtenido como la suma de los Años de Vida Potencial Perdidos por mortalidad y los Años de Vida Potencial Perdidos por morbilidad. Los primeros se calcularon a partir de los estimados de Esperanza de Vida y los segundos, de las severidades, la incidencia y la duración promedio. Resultados El cáncer localizado en mama mostró la mayor carga por mortalidad y por morbilidad de manera consistente en los cuatro años para el país. La evolución de los Años de Vida Potencial Perdidos por mortalidad prematura por localización, fue ascendente en los años estudiados en las cuatro localizaciones ginecológicas. Las defunciones en edades más tempranas se debieron al cáncer de cuello. Excepto endometrio, el resto de las localizaciones incrementó su carga por morbilidad de 1990 al 2002. La carga integral aumentó en los años estudiados de 3,58 a 4,54, de 1,62 a 2,42, de 1,72 a 2,03 y de 0,86 a 0,88 por 1 000, para mama, cuello, endometrio y ovario, respectivamente. Se identificaron diferencias entre provincias, dentro de las que vale destacar la mayor carga integral por cáncer de mama en Ciudad de La Habana (6,72 por 1 000) y por cáncer de cuello en Camagüey y las provincias orientales. Conclusiones La evolución desfavorable de la carga del cáncer ginecológico en Cuba en los años estudiados fue a expensas tanto de la mortalidad como de la morbilidad.

Objectives To describe the comprehensive burden associated to gynecological cancer locations such as breast, uterine neck, endometrium and ovary for Cuba, its provinces and special municipality Isla de la Juventud during 1990,1995,2000 and 2002. Methods The disability-adjusted life year indicator, taken as the sum of potential years of life lost from mortality and the potential years of life lost from morbidity. The former was calculated on the basis of life expectancy estimates and the latter on the basis of severity, incidence and average duration of disease. Results The breast cancer consistently exhibited the highest burden caused by mortality and morbidity in the four studied years for the whole country. The potential years of life lost (PYLL) from premature death by location were on the rise in the four years for the four gynecological locations. Uterine cancer was responsible for deaths at younger ages. Except for endometrium, the rest of locations increased morbidity burden from 1990 to 2002. The comprehensive burden increased from 3.58 to 4.54; 1.62 to 2.42; 1.72 to 2.03 and 0.86 to 0.88 per 1 000 for breast, uterine neck, endometrium and ovary respectively. There were some differences among the provinces; it is worth to underline the highest comprehensive burden found in Ciudad de la Habana due to breast cancer (6.72 per 1000) and in Camagüey province and the rest of Eastern provinces due to uterine neck cancer. Conclusions Mortality and morbidity were both involved in the unfavorable development of the gynecological cancer burden in the studied years in Cuba.

Gynaecologic cancer incidence, Kingston and St Andrew, Jamaica, 1973-1997, and gynaecologic cancer mortality, Jamaica, 1999

The incidence of gynaecologic cancers in women from Kingston and St Andrew for the period 1973-1997 were reviewed by analyzing data previously published by the Jamaica Cancer Registry. Gynaecologic cancer-related mortality statistics for the entire island for 1999 were compiled from data obtained from the Registrar General's Department (RGD) and the Statistical Institute of Jamaica (STATIN). Data were compared to gynaecologic cancer statistics for women from the United States of America for 1973-1997. A total of 2862 gynaecologic cancers were registered for the years 1973-1997, which represents 26.8 of all female cancers from Kingston and St Andrew. Cervical cancer accounted for 62 of these gynaecologic cancers. The 268 cancer-related deaths (168 due to cervical cancer) registered in Jamaican women for 1999 represent approximately 15 of all female cancer-related deaths. The present incidence (27.9 per 100,000) and mortality rate (15.8 per 100,000) of cervical cancer are much higher than that documented for American women--both African Americans and Caucasians--and signify the limited success, to date, of efforts to decrease the incidence and mortality of cervical cancer by the implementation of cervical cancer screening programmes. For the time period reviewed, an increase was noted in the incidence of cancer of the corpus uteri while decreases were recorded for the incidence of choriocarcinoma, ovarian cancer and cancers arising from the vulva, vagina and fallopian tube

Distribuiçäo espacial da mortalidade por câncer ginecológico no Município de Säo Paulo em 1992 / Spatial distribution of gynecologic cancer mortality in the Säo Paulo city, Brazil, 1992

Analisa a distribuiçäo geográfica da mortalidade por câncer ginecológico no Município de Säo Paulo no ano de 1992, através de informaçöes constantes no banco de dados da Fundaçäo SEADE. O Município de Säo Paulo foi dividido em 4 Zonas Homogêneas a partir de critérios sócio-econômicos. O câncer de mama foi o que apresentou coeficientes de mortalidade mais elevados em todo o município e em seguida aparece o câncer de colo uterino como 2ª localizaçäo e o câncer de ovário como 3ª localizaçäo. Na área com melhores condiçöes de vida, estas duas últimas localizaçöes se invertem, é o câncer de ovário a 2ª causa e o câncer de colo a 3ª. Calculando-se o indicador APVP, também o câncer de mama é o que se apresenta maior. Ressalta que, embora o coeficiente de mortalidade por câncer ginecológico seja maior na área de melhores condiçöes de vida, o APVP é o menor entre todas as áreas. As diferenças na ocorrência dos óbitos mostra que o Município de Säo Paulo apresenta heterogeneidades que precisam ser consideradas quando se planeja açöes de saúde

Realidad de la incidencia y mortalidad en las mujeres con tumores de los órganos genitales femeninos : Costa Rica 1992 / Reality of incidence and mortality in women with genital organ tumors : Costa Rica 1992

Se hace un análisis, de la realidad costarricense, de la incidencia y mortalidad, de los tumores malignos de la mujer. A través del Registro Nacional de Tumores, y con tasas ajustadas a la población femenina, se presetan cifras del último quinquenio 1986-1990. Los tumores malignos de la población femenina de Costa Rica se situó en 163.7 por 100 mil mujeres para el año de 1989 como la más alta tasa registrada. Los grupos de edad más afectada fueron de 30 a 35 años, y superiores a los 60 años. La tasa de mortalidad más alta se situó en 1988 en 74.3 por 100 mil mujeres. La incidencia y mortalidad en los órganos genitales, se asentaron principalmente en cuello, mama y ovarios. Se debe fortalecer los programas de detección, para tratar de disminuir, el impacto médico y social que tienen estas enfermedades en nuesto país