ABSTRACT
Introducción: El cáncer de pulmón ocupa el primer lugar entre las causas de mortalidad por cáncer a nivel mundial y solamente el 15,6 por ciento de los que padecen esta enfermedad sobreviven los 5 años. Objetivo: Evaluar la influencia de los factores pronósticos en la supervivencia de operados por cáncer de pulmón. Métodos: Estudio observacional descriptivo, tipo serie de casos de 107 enfermos operados en el Hospital Universitario General Calixto García en el período 2015-2020. Se utilizaron las variables tipo histológico, estadio clínico, estado físico e intervención quirúrgica. Resultados: Predominó el sexo masculino en edades entre 60-69 años, con antecedentes de hipertensión arterial y tabaquismo. Los síntomas que predominaron fueron la disnea, la tos y el dolor torácico. Las etapas clínicas más frecuentes fueron en orden: IIIA, IIB, IIA y las variantes histopatológicas adenocarcinoma y epidermoide. La técnica quirúrgica más empleada fue la lobectomía. Conclusiones: Los factores pronósticos de mayor significación estadística son la comorbilidad, la presencia de síntomas y el diagnóstico tardío. Los factores pronósticos relacionados con el tumor y el tratamiento quirúrgico con adyuvancia tienen una alta repercusión en la supervivencia(AU)
Introduction: Lung cancer ranks first among the causes of cancer mortality worldwide and only 15.6 percent of those with this disease survive the 5 years. Objective: To assess the influence of prognostic factors on the survival of patients operated on for lung cancer. Methods: A descriptive observational study of case series was carried out with 107 patients operated on at Hospital Universitario General Calixto García in the period 2015-2020. The variables histological type, clinical stage, physical condition and surgical intervention were used. Results: There was a predominance of the male sex, aged 60-69 years, with a history of arterial hypertension and smoking. The predominant symptoms were dyspnea, cough and chest pain. The most frequent clinical stages were IIIA, IIB, IIA, in that order; and the predominant histopathological variants were adenocarcinoma and epidermoid. The most commonly used surgical technique was lobectomy. Conclusions: The prognostic factors of greatest statistical significance are comorbidity, presence of symptoms and late diagnosis. Prognostic factors related to the tumor or the adjuvant surgical treatment have a high impact on survival(AU)
Subject(s)
Humans , Male , Aged , Adenocarcinoma/etiology , Lung Neoplasms/mortality , Pneumonectomy/methods , Epidemiology, DescriptiveABSTRACT
ABSTRACT Objective: To describe the morbidity, mortality, and rate of complete resection associated with robotic surgery for the treatment of non-small cell lung cancer in Brazil, as well as to report the rates of overall survival and disease-free survival in patients so treated. Methods: This was a retrospective study of patients diagnosed with non-small cell lung carcinoma and undergoing resection by robotic surgery at one of six hospitals in Brazil between February of 2015 and July of 2018. Data were collected retrospectively from the electronic medical records. Results: A total of 154 patients were included. The mean age was 65 ± 9.5 years (range, 30-85 years). The main histological diagnosis was adenocarcinoma, which was identified in 128 patients (81.5%), followed by epidermoid carcinoma, identified in 14 (9.0%). Lobectomy was performed in 133 patients (86.3%), and segmentectomy was performed in 21 (13.7%). The mean operative time was 209 ± 80 min. Postoperative complications occurred in 32 patients (20.4%). The main complication was air leak, which occurred in 15 patients (9.5%). The median (interquartile range) values for hospital stay and drainage time were 4 days (3-6 days) and 2 days (2-4 days), respectively. There was one death in the immediate postoperative period (30-day mortality rate, 0.5%). The mean follow-up period was 326 ± 274 days (range, 3-1,110 days). Complete resection was achieved in 97.4% of the cases. Overall mortality was 1.5% (3 deaths), and overall survival was 97.5%. Conclusions: Robotic pulmonary resection proved to be a safe treatment for lung cancer. Longer follow-up periods are required in order to assess long-term survival.
RESUMO Objetivo: Descrever morbidade, mortalidade e completude da ressecção associadas à cirurgia robótica para o tratamento de câncer de pulmão não pequenas células no Brasil, assim como sobrevida global e sobrevida livre de doença. Métodos: Estudo retrospectivo incluindo pacientes com diagnóstico de carcinoma pulmonar de células não pequenas submetidos à ressecção anatômica por cirurgia robótica em seis hospitais brasileiros entre fevereiro de 2015 e julho de 2018. Os dados foram coletados retrospectivamente de prontuários eletrônicos. Resultados: Foram incluídos 154 pacientes. A média de idade foi de 65,0 ± 9,5 anos (variação: 30-85 anos). Adenocarcinoma foi o principal tipo histológico, em 128 pacientes (81,5%), seguido por carcinoma epidermoide, em 14 (9,0%). Lobectomia foi o tipo de cirurgia mais frequente, em 133 pacientes (86,3%), seguida por segmentectomia anatômica, em 21 (13,7%). A média de tempo operatório foi de 209 + 80 min. Complicações pós-operatórias ocorreram em 32 pacientes (20,4%). Fístula aérea foi a principal complicação, em 15 pacientes (9,5%). A mediana (intervalo interquartil) de permanência hospitalar foi de 4 dias (3-6 dias) e a de tempo de drenagem foi de 2 dias (2-4 dias). Houve mortalidade operatória em 1 paciente (0,5%). O tempo médio de seguimento foi de 326 + 274 dias (variação: 3-1.110 dias). A ressecção foi completa em 97,4% dos casos. A mortalidade geral foi de 1,5% (n = 3), com sobrevida global de 97,5%. Conclusões: A ressecção pulmonar anatômica robótica no tratamento do câncer de pulmão demonstrou ser segura. Um maior tempo de seguimento é necessário para avaliar a sobrevida de longo prazo.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/surgery , Thoracic Surgery, Video-Assisted , Robotic Surgical Procedures , Lung Neoplasms/surgery , Retrospective Studies , Treatment Outcome , Carcinoma, Non-Small-Cell Lung/mortality , Disease-Free Survival , Operative Time , Length of Stay , Lung Neoplasms/mortalityABSTRACT
ABSTRACT Objective: To evaluate the prevalence of anorexia and weight loss at diagnosis (pre-treatment), to identify the factors associated with pre-treatment weight loss, and to determine the prognostic role of anorexia and weight loss in the overall survival of patients with stage IV lung cancer. Methods: This was a retrospective observational cohort study. The patients were stratified by the presence/absence of anorexia and of pre-treatment weight loss, which generated a measure composed of four categories, which were the independent variables. Results: Among the 552 patients included in the study, anorexia and pre-treatment weight loss were present in 39.1% and 70.1%, respectively. After adjusting for age, male gender, and Karnofsky performance status, we found that anorexia and tumor size were significantly associated with pre-treatment weight loss. In a Cox multivariate analysis, adjusted for age, male gender and low Karnofsky performance status were found to be independent predictors of worse survival, as was concomitance of anorexia and weight loss. Conclusions: Anorexia and pre-treatment weight loss appear to be relevant problems in the follow-up of patients with advanced (stage IV) lung cancer Specific interventions are of crucial importance in individualized treatment plans, even within the context of palliative care.
RESUMO Objetivo: Avaliar a prevalência de anorexia e perda de peso ao diagnóstico (pré-tratamento), os fatores associados à perda de peso pré-tratamento e o papel prognóstico da anorexia e da perda de peso na sobrevida global de pacientes com câncer de pulmão em estádio IV. Métodos: Estudo de coorte retrospectivo observacional. Os pacientes foram estratificados, dependendo da presença/ausência de anorexia e da presença/ausência de perda de peso pré-tratamento, o que gerou uma medida composta de anorexia e perda de peso de quatro níveis, que foi a variável independente. Resultados: Entre os 552 pacientes incluídos no estudo, as prevalências de anorexia e de perda de peso pré-tratamento foram de 39,1% e 70,1%, respectivamente. Após ajustar para idade, sexo masculino e índice de Karnofsky, a presença de anorexia e o tamanho do tumor foram significativamente associados à perda de peso pré-tratamento. Na análise multivariada de Cox, após ajustar para a idade, as variáveis sexo masculino, presença concomitante de anorexia e perda de peso e índice de Karnofsky reduzido foram preditores independentes de pior probabilidade de sobrevida. Conclusões: O presente estudo demonstrou que a presença de anorexia e de perda de peso pré-tratamento são problemas relevantes no seguimento de pacientes com câncer de pulmão avançado (estádio IV). Intervenções específicas são de crucial importância no plano de assistência individualizada, mesmo dentro da proposta de cuidados paliativos.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Weight Loss , Anorexia/epidemiology , Lung Neoplasms/mortality , Prognosis , Cachexia/diagnosis , Cachexia/etiology , Cachexia/mortality , Anorexia/etiology , Prevalence , Survival Rate , Retrospective Studies , Cohort Studies , Karnofsky Performance Status , Lung NeoplasmsABSTRACT
BACKGROUND@#Although change in the birth cohort effect on cancer mortality rates is known to be highly associated with the decreasing rates of age-standardized cancer mortality rates in Japan, the differences in the trends of cohort effect for representative cancer types among the prefectures remain unknown. This study aimed to investigate the differences in the decreasing rate of cohort effects among the prefectures for representative cancer types using age-period-cohort (APC) analysis.@*METHODS@#Data on stomach, colorectal, liver, and lung cancer mortality for each prefecture and the population data from 1999 to 2018 were obtained from the Vital Statistics in Japan. Mortality data for individuals aged 50 to 79 years grouped in 5-year increments were used, and corresponding birth cohorts born 1920-1924 through 1964-1978 were used for analysis. We estimated the effects of age, period, and cohort on each type of mortality rate for each prefecture by sex. Then, we calculated the decreasing rates of cohort effects for each prefecture. We also calculated the mortality rate ratio of each prefecture compared with all of Japan for cohorts using the estimates.@*RESULTS@#As a result of APC analysis, we found that the decreasing rates of period effects were small and that there was a little difference in the decreasing rates among prefectures for all types of cancer among both sexes. On the other hand, there was a large difference in the decreasing rates of cohort effects for stomach and liver cancer mortality rates among prefectures, particularly for men. For men, the decreasing rates of cohort effects in cohorts born between 1920-1924 and 1964-1978 varied among prefectures, ranging from 4.1 to 84.0% for stomach cancer and from 20.2 to 92.4% for liver cancers, respectively. On the other hand, the differences in the decreasing rates of cohort effects among prefectures for colorectal and lung cancer were relatively smaller.@*CONCLUSIONS@#The decreasing rates of cohort effects for stomach and liver cancer varied widely among prefectures. It is possible that this will influence cancer mortality rates in each prefecture in the future.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cohort Studies , Colorectal Neoplasms/mortality , Japan/epidemiology , Liver Neoplasms/mortality , Lung Neoplasms/mortality , Risk Factors , Stomach Neoplasms/mortalityABSTRACT
SUMMARY OBJECTIVE Lung cancer is the leading cause of cancer-related death. To reduce lung cancer mortality and detect lung cancer in early stages, low dose CT screening is required. A meta-analysis was conducted to verify whether screening could reduce lung cancer mortality and to determine the optimal screening program. METHODS We searched PubMed, Web of Science, Cochrane library, ScienceDirect, and relevant Chinese databases. Randomized controlled trial studies with participants that were smokers older than 49 years (smoking >15 years or quit smoking 10 or 15 years ago) were included. RESULTS Nine RCT studies met the criteria. LDCT screening could find more lung cancer cases (RR=1.58, 95%CI=1.25-1.99, P<0.001) and more stage I lung cancers (RR=3.45, 95%CI=2.08-5.72, P<0.001) compared to chest-X ray or the no screening group. This indicated a statistically significant reduction in lung-cancer-specific mortality (RR=0.84, 95%CI=0.75-0.95, P=0.004), but without a statistically reduction in mortality due to all causes (RR=1.26, 95%CI=0.89-1.78, P=0.193). Annually, LDCT screening was sensitive in finding more lung cancers. CONCLUSIONS Low-dose CT screening is effective in finding more lung cancer cases and decreasing the deaths from lung cancer. Annual low-dose CT screening may be better than a biennial screening to detect more early-stage lung cancer cases.
RESUMO OBJETIVO O câncer de pulmão é a principal causa de mortes relacionadas ao câncer. Para reduzir a mortalidade por câncer de pulmão e encontrar câncer de pulmão em um estágio inicial, é necessária uma triagem por tomografia de baixa dose. Uma meta-análise foi emitida para testemunhar se a triagem poderia reduzir a mortalidade por câncer de pulmão e investigar o melhor programa de triagem. MÉTODOS Pesquisamos PubMed, Web of Science, biblioteca Cochrane, ScienceDirect e relevante banco de dados chinês. Ensaios clínicos controlados aleatórios, em que os participantes eram fumantes com mais de 49 anos (tabagismo >15 anos ou parar de fumar 10 ou 15 anos atrás) foram incluídos. RESULTADOS Nove estudos RCT preencheram os critérios. O rastreamento de LDCT pôde encontrar mais cânceres de pulmão (RR=1,58, IC 95%=1,25-1,99, P<0,001) e mais cânceres de estágio I do pulmão (RR=3,45, IC 95%=2,08-5,72, P<0,001) em comparação com raio X do tórax ou nenhum grupo de triagem. Ele indicou uma redução estatisticamente significativa na mortalidade específica do câncer de pulmão (RR=0,84, IC 95%=0,75-0,95, P=0,004), mas sem uma redução estatisticamente significativa na mortalidade por todas as causas (RR=1,26, IC 95%=0,89-1,78, P=0,193). Anualmente, o rastreamento de LDCT foi sensível em encontrar mais cânceres de pulmão. CONCLUSÕES A triagem de TC de baixa dose é eficaz para encontrar mais cânceres de pulmão e diminuir as mortes por câncer de pulmão. Para encontrar mais cânceres de pulmão em estágio inicial, a triagem anual de tomografia de baixa dose pode ser melhor do que a triagem bianual.
Subject(s)
Humans , Male , Female , Tomography, X-Ray Computed/methods , Lung Neoplasms/mortality , Lung Neoplasms/diagnostic imaging , Mass Screening , Risk Factors , Early Detection of CancerABSTRACT
ABSTRACT BACKGROUND: Lung cancer is the fourth most common cancer in Brazil. In the 2000s, better understanding of molecular pathways led to development of epidermal growth factor receptor (EGFR)-targeted treatments that have improved outcomes. However, these treatments are unavailable in most Brazilian public healthcare services (Sistema Único de Saúde, SUS). OBJECTIVE: To assess the potential number of years of life not saved, the budget impact of the treatment and strategies to improve access. DESIGN AND SETTING: Pharmacoeconomic study assessing the potential societal and economic impact of adopting EGFR-targeted therapy within SUS. METHODS: We estimated the number of cases eligible for treatment, using epidemiological data from the National Cancer Institute. We used data from a single meta-analysis and from the Lung Cancer Mutation Consortium (LCMC) study as the basis for assessing differences in patients' survival between use of targeted therapy and use of chemotherapy. The costs of targeted treatment were based on the national reference and were compared with the amount reimbursed for chemotherapy through SUS. RESULTS: There was no life-year gain with EGFR-targeted therapy in the single meta-analysis (hazard ratio, HR, 1.01). The LCMC showed that 1,556 potential life-years were not saved annually. We estimated that the annual budget impact was 125 million Brazilian reais (BRL) with erlotinib, 48 million BRL with gefitinib and 52 million BRL with afatinib. Their incremental costs over chemotherapy per life-year saved were 80,329 BRL, 31,011 BRL and 33,225 BRL, respectively. A drug acquisition discount may decrease the budget impact by 30% (with a 20% discount). A fixed cost of 1,000 BRL may decrease the budget impact by 95%. CONCLUSION: Reducing drug acquisition costs may improve access to EGFR-targeted therapy for lung cancer.
Subject(s)
Humans , Health Care Costs , Quality-Adjusted Life Years , Protein Kinase Inhibitors/economics , ErbB Receptors/economics , Lung Neoplasms/economics , Quinazolines/economics , Quinazolines/therapeutic use , Brazil , Budgets , Survival Analysis , Cost-Benefit Analysis/economics , Risk Sharing, Financial/methods , Protein Kinase Inhibitors/therapeutic use , Molecular Targeted Therapy/economics , ErbB Receptors/therapeutic use , Health Services Accessibility/economics , Lung Neoplasms/mortality , Lung Neoplasms/drug therapyABSTRACT
ABSTRACT BACKGROUND: Osteosarcoma is the most prevalent malignant bone tumor in children and adolescents. Lung metastases are associated with poor prognosis. OBJECTIVE: The aim here was to explore the prevalence of and risk and prognostic factors for lung metastases in high-grade osteosarcoma patients. DESIGN AND SETTING: Retrospective cohort study based on the Surveillance, Epidemiology and End Results (SEER) database in the United States. METHODS: Data on 1,408 high-grade osteosarcoma patients registered in the SEER database between 2010 and 2015 were extracted. From these, all patients with high-grade osteosarcoma and initial lung metastasis were selected for analysis on risk and prognostic factors for lung metastases. Overall survival was estimated. RESULTS: There were 238 patients (16.90%) with lung metastases at diagnosis. Axial location, tumor size > 10 cm (odds ratio, OR 3.19; 95% confidence interval, CI: 1.58-6.45), higher N stage (OR 4.84; 95% CI: 1.94-12.13) and presence of bone metastases (OR 8.73; 95% CI: 4.37-17.48) or brain metastases (OR 25.63; 95% CI: 1.55-422.86) were significantly associated with lung metastases. Younger age and surgical treatment (hazard ratio, HR 0.46; 95% CI: 0.30-0.71) favored survival. Median survival was prolonged through primary tumor surgery. CONCLUSIONS: The factors revealed here may guide lung metastasis screening and prophylactic treatment for osteosarcoma patients. A primary tumor in an axial location, greater primary tumor size, higher lymph node stage and presence of bone or brain metastases were significantly correlated with lung metastases. The elderly group (≥ 60 years) showed significant correlation with poor overall survival. For improved survival among high-grade osteosarcoma patients with lung metastases, aggressive surgery on the primary tumor site should be encouraged.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Osteosarcoma/pathology , Lung Neoplasms/secondary , Prognosis , Osteosarcoma/surgery , Osteosarcoma/diagnosis , Osteosarcoma/mortality , Survival Analysis , China/epidemiology , Prevalence , Risk Factors , Cohort Studies , Lung Neoplasms/surgery , Lung Neoplasms/diagnosis , Lung Neoplasms/mortalityABSTRACT
Abstract: Objective: To analyze the differences in the clinico-pathological and molecular characteristics of non-small cell lung cancer (NSCLC) as well as the clinical outcome of patients by sex and hormonal status. Materials and methods: We performed a retrospective study among 1 104 NSCLC patients. Clinic-pathologic data was recorded and survival outcomes were compared between male and female sex patients, and further by pre and postmenopausal status in females. Results: Women were significantly more likely to be non-smokers (p<0.001), had higher frequency of wood-smoke exposure (p<0.001), EGFR-sensitizing mutations (p<0.001), had better performance status (p=0.020) and had a better overall survival (OS) compared to men (p=0.021). Differences were found also by hormonal status, postmenopausal women had a longer OS compared to premenopausal women (31.1 vs. 19.4 months p=0.046). Conclusion: Our results support the differences in lung cancer presentation by sex and also by hormonal status.
Resumen: Objetivo: Analizar las diferencias en las características clínico-patológicas, moleculares y en la evolución del cáncer de pulmón de células no pequeñas (CPCNP) por sexo y estadio hormonal. Material y métodos: Estudio retrospectivo (N=1 104) en pacientes con CPCNP. Se recabaron datos clínico-patológicos y desenlaces de sobrevida y se compararon entre hombres y mujeres, y entre mujeres pre y postmenopáusicas. Resultados: Las mujeres de este estudio tuvieron significativamente mayor probabilidad de ser no fumadoras (p<0.001), tener exposición a humo de leña (p<0.001), mutaciones en EGFR (p<0.001), mejor estado funcional (p=0.020), y una mejor sobrevida global (SG) en comparación con los hombres (p=0.021). Estas diferencias también se encontraron en cuestión al estatus hormonal, con las mujeres postmenopáusicas presentando una mayor sobrevida en comparación con las premenopáusicas (31.1 vs. 19.4 meses; p=0.046). Conclusión: Los presentes resultados apoyan las diferencias en la presentación del CPCNP de acuerdo con el sexo y estatus hormonal.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/mortality , Lung Neoplasms/diagnosis , Lung Neoplasms/mortality , Sex Factors , Survival Rate , Retrospective Studies , Premenopause , Postmenopause , MexicoABSTRACT
Resumen: Objetivo: Analizar la tendencia temporal de la incidencia y la mortalidad del cáncer de pulmón, así como los costos asociados con su atención médica. Material y métodos: Se estimó el número de casos incidentes a partir de los egresos hospitalarios de 276 hospitales del Instituto Mexicano del Seguro Social (IMSS) entre 2006 y 2016. Se calcularon tasas de mortalidad crudas y ajustadas. Los costos del tratamiento ambulatorio y hospitalario se calcularon con base en los costos médico-técnicos de referencia o costos estándar de 2015. Resultados: Tanto la incidencia como la mortalidad muestran tendencia descendente. El costo de la atención médica de los 2 539 pacientes de 2017 fue de 42 millones de dólares americanos, con costo promedio por paciente de 16 527 dólares americanos. El gasto promedio anual de pensiones por invalidez es de 97.2 millones de pesos. Conclusiones: Es probable que la reducción del riesgo de enfermar y morir por cáncer de pulmón en derechohabientes del IMSS se deba a las medidas de control del humo de tabaco. Todavía es necesario establecer estrategias para diagnosticar y tratar a los pacientes en estadios tempranos.
Abstract: Objective: To describe temporal trends in lung cancer incidence, mortality and associated health care costs in the Mexican Institute of Social Security. Materials and methods: Incident cases were estimated from hospital discharges in 276 IMSS hospitals between 2006 and 2016. Crude and adjusted mortality rates were calculated. The costs of outpatient and inpatient treatment were calculated based on the medical-technical costs of reference o standard cost. Results: Both incidence and mortality had a decreased time trend. The cost of medical care for the 2 539 patients in 2017 was 42 million US dollars, with an average cost per patient of 16 537 US dollars. The cost per annum of disability pensions is 97.2 million pesos. Conclusions: It is likely that the reduction of the risk of getting sick and dying from lung cancer in IMSS affiliates is due to the control measures of tobacco smoke. It is still necessary to establish strategies to diagnose and treat patients in early stages.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Health Care Costs , Lung Neoplasms/economics , Lung Neoplasms/epidemiology , Social Security , Time Factors , Incidence , Lung Neoplasms/mortality , Lung Neoplasms/therapy , Mexico/epidemiologyABSTRACT
Abstract: Objective: To analyze the mortality trend of lung cancer (LC) in Mexico, according to the municipality marginalization index (MMI) by age group and sex, during the period 1998-2016. Materials and methods: The information on mortality, population and MMI was obtained from the National Institute of Statistics and Geography (INEGI) and the National Council of Population (Conapo). The adjusted LC mortality rate trends were analyzed using the joinpoint regression analysis. A total of 126 132 deaths were included. Results: The adjusted LC mortality rate decreased from 7.83 to 4.97 100 000 inhabitants during the period from 1998-2016, but the decrease was found to be less in women and in areas with very high marginalization. Conclusions: Unequal reduction in LC mortality according to the degree of marginalization are related to early diagnosis, timely treatment and inequity in medical services. This inequity affects mainly the populations of women, highly marginalized groups and older populations.
Resumen: Objetivo: Analizar la tendencia de mortalidad por cáncer de pulmón (CP) en México, según el índice de marginación municipal (IMM) por grupo de edad y sexo, de 1998 a 2016. Material y métodos: La información sobre mortalidad, población e IMM se obtuvo del Instituto Nacional de Estadística y Geografía (INEGI) y del Consejo Nacional de Población (Conapo). Las tendencias de la tasa de mortalidad ajustada para CP se analizaron mediante el análisis de regresión de joinpoint. Se incluyeron 126 132 defunciones. Resultados: La tasa de mortalidad ajustada por CP disminuyó de 7.83 a 4.97 por 100 000 habitantes durante el periodo 1998-2016. Conclusiones: La reducción desigual en la mortalidad por CP, de acuerdo con el grado de marginación, está relacionada con en el diagnóstico temprano, el tratamiento oportuno y la inequidad en los servicios médicos. Esta inequidad afecta principalmente a las mujeres, a los grupos altamente marginados y a las poblaciones más envejecidas.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lung Neoplasms/mortality , Time Factors , Mortality/trends , Social Marginalization , Mexico/epidemiologyABSTRACT
Abstract: Objective: To show lung cancer (LC) mortality and disability-adjusted life years (DALYs) in Mexico. Materials and methods: With the visualization tools at the Global Burden of Disease Study website, we analyzed LC mortality and disability-adjusted life years (DALYs) by state, sex, sociodemographic index (SDI), age, and risk factors between 1990 and 2016. Results: Mortality rate decreased from 13.9 to 9.1 per 100 000 between 1990 and 2016. This reduction is greater among men. However, deaths by LC rose from 5 478 to 8 470. DALYs rate also decreased. Northern states with higher SDI face a larger burden from LC but exhibited greater reductions compared with southern, less developed states. The burden of LC is concentrated among older population. Smoking is the main risk factor for LC. Conclusions: The burden by LC has decreased but is differential between states. LC threatens financially both the health system and individuals, since an important fraction of the population is not protected.
Resumen: Objetivo: Mostrar la mortalidad y los años de vida saludables (Avisas) perdidos por cáncer de pulmón (CP) en México. Material y métodos: Con la herramienta de visualización del estudio de la Carga Global de la Enfermedad, se analizó mortalidad y Avisas por CP según diferentes criterios entre 1990 y 2016. Resultados: La tasa de mortalidad disminuyó de 13.9 a 9.1 por 100 000. Dicha reducción fue mayor entre hombres. Las muertes por CP crecieron de 5 478 a 8 470. La tasa de Avisas se redujo. La carga del CP se concentra en grupos de edad avanzada. Los estados del norte, con mayor nivel sociodemográfico, enfrentan mayor carga, pero presentaron mayores reducciones comparados con estados menos desarrollados. Fumar es el principal factor de riesgo para CP. Conclusiones: La carga por CP ha disminuido pero es diferencial entre estados. El CP amenaza financieramente el sistema de salud y la población, pues una fracción importante no está protegida.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Lung Neoplasms/mortality , Time Factors , Quality-Adjusted Life Years , Global Burden of Disease , Mexico/epidemiologyABSTRACT
Resumen: Objetivo: Actualizar información sobre la tendencia de mortalidad por cáncer de pulmón en México de 1990 a 2016. Material y métodos: Se obtuvieron tasas ajustadas por edad mediante el método directo. Se obtuvo el porcentaje de cambio anual de la mortalidad por cáncer de pulmón, mediante análisis joinpoint a nivel nacional, por región, sexo y estrato rural-urbano y, en estos dos últimos, el efecto de edad-periodo-cohorte. Resultados: Se observó un decremento anual en las tasas de mortalidad por esta neoplasia en los últimos 10 años, significativamente mayor en los hombres (-3.5% IC95% -4.0,-2.9) que en las mujeres (-1.9% IC95% -2.1,-1.7), una brecha generacional entre hombres y mujeres y estrato urbano-rural con tendencia decreciente en el riesgo de muerte. Conclusión: Las tendencias de mortalidad por cáncer de pulmón de 1993 a 2016 presentan una disminución en diferentes magnitudes y periodos específicos.
Abstract: Objective: To update information on the mortality trend due to lung cancer in Mexico from 1990 to 2016. Materials and methods: Age-adjusted rates were obtained using the direct method. The percentage of annual change in the mortality of lung cancer was obtained through joinpoint analysis at the national level, by region, sex and rural-urban stratum, and in the last two the age-cohort-period effect. Results: There was an annual decrease in mortality rates due to this neoplasm in the last 10 years, significantly higher in men (-3.5% CI95% -4.0,-2.9) than in women (-1.9% CI95% -2.1,-1.7), and a generational gap between men and women and urban-rural stratum with a decreasing trend in the risk of death. Conclusion: Mortality trends due to lung cancer from 1993 to 2016 show a decrease in different magnitudes and specific periods.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Lung Neoplasms/mortality , Time Factors , Cohort Effect , Mortality/trends , Age Distribution , Mexico/epidemiologyABSTRACT
ABSTRACT Purpose: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence. Materials and Methods: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival. Results: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 - 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 - year survival. Conclusion: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.
Subject(s)
Humans , Male , Aged , Aged, 80 and over , Urinary Bladder Neoplasms/radiotherapy , Cranial Irradiation/methods , Carcinoma, Small Cell/radiotherapy , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/pathology , Survival Analysis , Retrospective Studies , Carcinoma, Small Cell/mortality , Carcinoma, Small Cell/pathology , Small Cell Lung Carcinoma/pathology , Small Cell Lung Carcinoma/radiotherapy , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Lung Neoplasms/radiotherapyABSTRACT
RESUMEN Introducción: las metástasis cerebrales cuando aparecen en el curso de un cáncer de pulmón reportan una precaria supervivencia al paciente, los tratamientos incluyen la cirugía o radiocirurgía. La radioterapia holocraneal constituye el estándar cuando los tratamientos locales no son posibles. Se han reportado respuestas del cerebro a la quimioterapia a un nivel comparable al de la enfermedad extra craneal, por lo que la terapia sistémica es una opción razonable para los pacientes sin síntomas neurológicos, o con síntomas relativamente controlados. Objetivo: evaluar la supervivencia de los pacientes según esquemas de tratamientos recibidos. Materiales y métodos: se realizó un estudio descriptivo y retrospectivo en pacientes con diagnóstico cito-histológico de cáncer de pulmón y metástasis cerebral, atendidos en la consulta externa del Centro Oncológico Provincial de Matanzas, en el período comprendido desde enero del 2013 a diciembre del 2016. Para obtener los datos de los tratamientos realizados, determinar fecha de fallecimiento o de última noticia del paciente se utilizaron las historias clínicas de los enfermos y las bases de datos del Servicio de Radioterapia del Centro. Resultados: el 86,5% de los pacientes recibieron tratamiento con quimioterapia de primera línea, el 76% radioterapia al cerebro y el 61,5% con nimotuzumab. Conclusiones: la aplicación de la quimioterapia, la radioterapia holocraneal y la inmunoterapia tuvieron un valor significativo, proporcionando un aumento de la supervivencia de los pacientes estudiados.
ABSTRACT Introduction: brain metastasis report a precarious survival when they appear during the course of a lung cancer. The treatments include surgery or radiosurgery. Whole brain radiotherapy is the standard treatment when the local ones are not possible. There are reports of brain answer to chemotherapy at the level of extra brain diseases; therefore, systemic therapy is a reasonable option for the patients without neurological symptoms, or with relatively controlled symptoms. Objective: to assess the patients´ survival according to the schemes of the received treatments. Materials and methods: a retrospective descriptive study was carried out in patients with cytohistological diagnosis of lung cancer and brain metastasis, who attended the external consultation of the Provincial Oncological Center of Matanzas in the period from January 2013 to December 2016. The clinical records and databases of the Radiotherapy Service of the Center were used to obtain the data of the treatments carried out, the patients' date of dead or of the last information about them. Results: 86.5 % of the patients received treatment with front-line chemotherapy, 76 % brain radiotherapy, and 61.5 % with Nimotuzumab. Conclusions: the application of chemotherapy, whole brain radiotherapy and immunotherapy achieved great improvement, increasing the survival of the studied patients.
Subject(s)
Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/mortality , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/drug therapy , Neoplasm Metastasis/radiotherapy , Epidemiology, Descriptive , Prospective StudiesABSTRACT
SUMMARY OBJECTIVE: Extracranial metastases of glioblastoma multiforme (GBM) are rare due to the short survival experienced by the patients. Therefore, the natural history of GBM metastases remains elusive. The identification of clinical factors promoting GBM metastases may help elucidate the mechanisms of tumor cell invasion in the brain. The aims of this study were to perform a meta-analysis evaluating the survival, characteristics, prognostic factors, and predictors of treatment outcome in patients with metastatic GBM and describe a case of metastatic extracranial GBM. METHODS: We report the case of a patient diagnosed with GBM metastatic to the lungs and the results of a meta-analysis of 114 other cases of metastatic GBM identified through a MEDLINE and BIREME search. RESULTS: The mean age of the patients was 38.2±16.1 years and 70.4% were male. The time elapsed between the identification of the metastasis and death was significantly increased in patients undergoing surgery (p=0.019), whereas the time from the diagnosis of the primary tumor to death was significantly increased in patients receiving radiation therapy (p=0.050). The time elapsed from metastasis to death and diagnosis to death was significantly longer in patients receiving chemotherapy (p<0.001 and p=0.027, respectively). The liver was the metastatic site associated with the shortest time elapsed from diagnosis to death (p=0.024). CONCLUSIONS: In GBM, surgical resection is important in reducing the risk of metastasis, and chemotherapy and radiation therapy help to prolong survival in metastatic GBM. Metastases to the liver are associated with shorter survival compared with metastases to other sites.
RESUMO OBJETIVO: Metástases extracranianas do glioblastoma multiforme (GBM) são raras devido à baixa sobrevida dos pacientes. Portanto, a história natural das metástases do GBM permanece incerta. A identificação de fatores clínicos que promovem metástases no GBM pode ajudar a elucidar os mecanismos de invasão das células tumorais no cérebro. O objetivo deste estudo foi realizar uma meta-análise avaliando a sobrevida, características, fatores prognósticos e preditores de desfechos do tratamento em pacientes com GBM metastático e descrever um caso de GBM extracraniano metastático. MÉTODOS: Relatamos o caso de uma paciente diagnosticada com GBM metastático para os pulmões e os resultados de uma meta-análise de 114 outros casos de GBM metastático identificados por meio de uma pesquisa no Medline e Bireme. RESULTADOS: A média de idade dos pacientes foi de 38,2±16,1 anos e 70,4% eram do sexo masculino. O tempo decorrido entre a identificação da metástase e o óbito foi significativamente maior em pacientes submetidos à cirurgia (p = 0,019), enquanto que o tempo do diagnóstico do tumor primário até o óbito aumentou significativamente em pacientes submetidos à radioterapia (p = 0,050). O tempo decorrido da metástase até o óbito e do diagnóstico até o óbito foi significativamente maior nos pacientes que receberam quimioterapia (p < 0,001 e p = 0,027, respectivamente). O fígado foi o local metastático associado ao menor tempo decorrido do diagnóstico até a morte (p = 0,024). CONCLUSÕES: No GBM, a ressecção cirúrgica é importante para redução do risco de metástase, e a quimioterapia e a radioterapia ajudam a prolongar a sobrevida no GBM metastático. Metástases para o fígado estão associadas a uma sobrevida mais curta quando comparadas a metástases para outros locais.
Subject(s)
Humans , Female , Adult , Brain Neoplasms/pathology , Glioblastoma/secondary , Lung Neoplasms/secondary , Time Factors , Brain Neoplasms/mortality , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Glioblastoma/mortality , Glioblastoma/diagnostic imaging , Statistics, Nonparametric , Lung Neoplasms/mortality , Lung Neoplasms/diagnostic imagingABSTRACT
Objetivo: analisar a tendência de mortalidade por câncer de pulmão no Brasil, 2000-2015. Métodos: estudo de série temporal; realizou-se correção dos registros de óbito por câncer de pulmão; utilizaram-se modelos lineares autorregressivos para calcular os coeficientes de regressão (β1) e intervalos de confiança de 95% (IC95%) nas análises de tendência, segundo sexo, em maiores de 30 anos, de 19 regiões metropolitanas (RMs) e interior de 14 estados brasileiros; β1 positivo indica tendência crescente, e negativo, decréscimo. Resultados: aumentos foram observados em homens do interior do Norte e Nordeste, destacadamente no Rio Grande do Norte (β1=1,03 - IC95%0,47;1,58); declínio também foi verificado nesse grupo, notadamente na RM Porto Alegre (β 1=-2,55 - IC95%-2,79;-2,31); em mulheres, maior aumento foi observado no interior do Ceará (β 1=0,86 - IC95%0,79;0,92). Conclusão: foram revelados padrões diferenciados segundo localidade e sexo; medidas de controle do câncer devem ser consideradas, principalmente para mulheres e interior do Brasil.
Objetivo: analizar la tendencia de mortalidad por cáncer de pulmón en Brasil, 2000-2015. Métodos: estudio de serie temporal; se realizó la corrección de los registros de defunciones por cáncer de pulmón; en los análisis de tendencia se utilizaron modelos lineales autorregresivos para calcular los coeficientes de regresión (β 1) e intervalo de confianza de 95% (IC95%), según sexo, mayores de 30 años, 19 regiones metropolitanas (RMs) e interior de 14 estados brasileños; β 1 positivo indica tendencia de aumento y negativo, de decrecimiento. Resultados: fueron observados aumentos en hombres, interior del Norte y Nordeste, destacadamente en Rio Grande do Norte (β 1=1,03 - IC95%0,47;1,58); también se observó disminución en este grupo, particularmente en la RM de Porto Alegre (β 1=-2,55 - IC95%-2,79;-2,31); en mujeres, el mayor aumento fue observado en el interior de Ceará (β 1=0,86 - IC95%0,79;0,92). Conclusión: se revelaron patrones diferenciados según localidad y sexo; el control de cáncer debe ser considerado principalmente para mujeres e interior de Brasil.
Objective: to analyze lung cancer mortality trends in Brazil, 2000-2015. Methods: this was a time series study; lung cancer death records were corrected; linear autoregressive models were used to calculate regression coefficients (β1) and 95% confidence intervals (95%CI) in trend analysis according to sex, in the 30 and over age group, for 19 metropolitan areas (MAs) and the interior regions of 14 Brazilian states; positive β1 indicates upward trends while negative β1 indicates downward trends. Results: increases were found in males from interior regions of North and Northeastern Brazilian states, especially in Rio Grande do Norte state (β1=1.03 - 95%CI0.47;1.58); downward trends were also found in males, notably in the Porto Alegre MA (β1=-2.55 - 95%CI-2.79;-2.31); the highest increase in females was found in the interior of Ceará state (β1=0.86 - 95%CI0.79;0.92). Conclusion: differentiated patterns according to location and sex were revealed; cancer control measures should be considered above all for women and the interior regions of Brazil.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Mortality Registries/statistics & numerical data , Mortality/trends , Lung Neoplasms/mortality , Lung Neoplasms/epidemiology , Brazil/epidemiology , Death Certificates , Time Series Studies , Urban Area , Age and Sex DistributionABSTRACT
ABSTRACT Objective: To evaluate different weight loss (WL) cut-off points as prognostic markers of 3-month survival after diagnosis of stage IV non-small cell lung cancer (NSCLC). Methods: This was a prospective study involving 104 patients with metastatic (stage IV) NSCLC who were admitted to a cancer treatment center in southern Brazil between January of 2014 and November of 2016. We evaluated total WL and WL per month, as well as WL and WL per month in the 6 months preceding the diagnosis. The patients were followed for 3 months after diagnosis. A Cox proportional hazards regression model and Kaplan-Meier curves were used in order to evaluate 3-month survival. Results: The median WL in the 6 months preceding the diagnosis was 6% (interquartile range, 0.0-12.9%). Patients with WL ≥ 5% had a median survival of 78 days, compared with 85 days for those with WL < 5% (p = 0.047). Survival at 3 months was 72% for the patients with WL ≥ 5% (p = 0.047), 61% for those with WL ≥ 10% (p < 0.001), and 45% for those with WL ≥ 15% (p < 0.001). In the multivariate analysis, the hazard ratio for risk of death was 4.51 (95% CI: 1.32-15.39) for the patients with WL ≥ 5%, 6.34 (95% CI: 2.31-17.40) for those with WL ≥ 10%, and 14.17 (95% CI: 5.06-39.65) for those with WL ≥ 15%. Conclusions: WL in the 6 months preceding the diagnosis of NSCLC is a relevant prognostic factor and appears to be directly proportional to the rate of survival at 3 months.
RESUMO Objetivo: Avaliar diferentes pontos de corte da perda de peso (PP) como marcadores prognósticos de sobrevida em 3 meses após o diagnóstico de câncer de pulmão de células não pequenas estádio IV (CPCNP). Métodos: Estudo prospectivo envolvendo 104 pacientes com CPCNP metastático (estádio IV) que foram internados em um centro de tratamento de câncer no sul do Brasil entre janeiro de 2014 e novembro de 2016. Avaliamos a PP total e PP por mês, bem como PP e PP por mês nos 6 meses anteriores ao diagnóstico. Os pacientes foram acompanhados por 3 meses após o diagnóstico. Um modelo de regressão de riscos proporcionais de Cox e curvas de Kaplan-Meier foram utilizados para avaliar a sobrevida em 3 meses. Resultados: A mediana da PP nos 6 meses anteriores ao diagnóstico foi de 6% (intervalo interquartil, 0,0-12,9%). Pacientes com PP ≥ 5% tiveram uma sobrevida mediana de 78 dias, comparados a 85 dias para aqueles com PP < 5% (p = 0,047). A sobrevida em 3 meses foi de 72% para os pacientes com PP ≥ 5% (p = 0,047), 61% para aqueles com PP ≥ 10% (p < 0,001) e 45% para aqueles com PP ≥ 15% (p < 0,001). Na análise multivariada, a taxa de risco para óbito foi de 4,51 (IC95%: 1,32-15,39) para os pacientes com PP ≥ 5%, 6,34 (IC95%: 2,31-17,40) para aqueles com PP ≥ 10%, e 14,17 (IC95%: 5,06-39,65) para aqueles com PP ≥ 15%. Conclusões: A PP nos 6 meses anteriores ao diagnóstico de CPCNP é um fator prognóstico relevante e parece ser diretamente proporcional à taxa de sobrevida em 3 meses.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Weight Loss , Carcinoma, Non-Small-Cell Lung/mortality , Lung Neoplasms/mortality , Prognosis , Time Factors , Proportional Hazards Models , Prospective Studies , Risk Factors , Carcinoma, Non-Small-Cell Lung/pathology , Kaplan-Meier Estimate , Lung Neoplasms/pathology , Neoplasm StagingABSTRACT
The prevalence of relevant oncogenic drivers in lung adenocarcinoma varies in our region and data on clinical outcomes is scarce. The objective of the study was to describe the prevalence of KRAS, BRAF and EGFR mutations and ALK translocations in patients with advanced lung adenocarcinoma, and to depict the clinical outcome according to treatment strategies. Patients with adequate tumor biopsy sampling were included. KRAS, BRAF and EGFR mutations were studied by Sanger sequencing. ALK translocations were studied by fluorescent in situ hybridization (FISH) and immunohistochemistry (IH) with antibodies against ALK with clones D5F3 and 5A4. Informed consent was signed by 118 patients and 84 (72%) with complete molecular analysis were included. KRAS mutations were detected in 16 samples (19%), EGFR in 11 (13%), 9 of them conferring sensitivity to EGFR inhibitors, and BRAF mutations in 1 (1%). ALK translocations were detected in 3 samples (4%). Median follow-up was 42.4 [interquartile range (IQR): 27.0-64.2] months. Globally, median overall survival was 10.3 [IQR: 5.6-20.2] months. Median survival was 10.8 [IQR: 6.0-20.3] months in the group of patients without detectable molecular alteration, 9.6 [IQR: 3.7-16.1] months in KRAS mutant population (HR: 1.08; p = 0.82) and 32.5 [IQR: 19.6-38.4] months in patients with ALK translocations or sensitizing EGFR mutated tumors treated with tyrosine kinase inhibitors (HR: 0.27; p = 0.03). In conclusion, the prevalence of molecular alterations and outcomes in our population is similar to that reported in other studies in Western countries.
La prevalencia de alteraciones en oncogenes en adenocarcinoma de pulmón varía en nuestra región. El objetivo fue describir la prevalencia de mutaciones en KRAS, BRAF y EGFR y las translocaciones de ALK en pacientes con adenocarcinoma de pulmón y estudiar la supervivencia de acuerdo a subtipos moleculares. Se incluyeron pacientes con biopsias adecuadas para el estudio. Se evaluó el estado mutacional de KRAS, BRAF y EGFR por secuenciación con la técnica de Sanger. Las translocaciones de ALK se estudiaron por hibridación in situ por fluorescencia (FISH) e inmunohistoquimica (IHQ) contra ALK (clones D5F3 y 5A4). De 118 pacientes evaluados, se incluyeron 84 (72%) con análisis molecular completo. Se detectaron mutaciones de KRAS en 16 muestras (19%), EGFR en 11 (13%), y BRAF en 1 muestra (1%). Se detectaron rearreglos de ALK en 3 muestras (4%). La mediana de seguimiento de los pacientes fue de 42.4 [rango intercuatilo (RIC): 27.0-64.2] meses. Globalmente, la mediana de supervivencia en la población fue 10.3 [RIC: 5.6-20.2] meses y fue de 10.8 [RIC: 6.0 20.3] meses en pacientes sin alteraciones moleculares detectables. La mediana de supervivencia de los pacientes con mutación en KRAS fue de 9.6 [RIC: 3.7-16.1] meses (HR: 1.08; p = 0.82) y 32.5 [RIC: 19.6-38.4] meses en el grupo con rearreglos de ALK o mutaciones en EGFR tratados con inhibidores de tirosina quinasa (HR: 0.27; p = 0.03). En conclusión, la prevalencia de alteraciones moleculares en nuestra población fue similar a otros países occidentales.