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1.
Oncología (Ecuador) ; 31(3): 201-212, 30-diciembre-2021.
Article in Spanish | LILACS | ID: biblio-1352465

ABSTRACT

Introducción: La supervivencia relativa a los cinco años para pacientes con cáncer colorrectal (CCR) se presenta entre el 60% en América del Norte y de 40% o menos en Argelia y Estonia. Es objetivo del presente estudio establecer la supervivencia a nivel local y determinar los factores asociados en un estudio de un centro nacional de referencia en Quito, Ecuador. Metodología: El presente estudio observacional se realizó en el Hospital de Especialidades Eugenio Espejo de la ciudad de Quito-Ecuador, en el período de enero del 2010 a diciembre del 2016. Se incluyeron pacientes con cáncer colorrectal. Las variables fueron descriptivas demográficas, variables clínicas y mortalidad. La muestra fue no probabilística, tipo censo. La variable mortalidad, fue estudiada con las variables Independientes clínicas, epidemiológicas con análisis actuarial de supervivencia. Resultados: Se incluyeron 395 casos, el 62.3% mujeres, con una edad 60 años (16 a 94). El 7.1% de casos refirieron algún tipo de exposición de riesgo relacionado a CCR. La supervivencia global fue del 56%, con una tasa de mortalidad del 7%. Casos con CCR estadio I sobrevida a los 6 años de 100%, con estadio II 96.5%, en el estadio III el 84%, estadio IV de 63% (P=0.001). Pacientes con instrucción secundaria o superior con supervivencia del 95% versus 88% en pacientes con instrucción primaria/analfabetos (P=0.048). La supervivencia es mayor en pacientes con diagnóstico temprano esta-dios (I y II) (P=0.007). Conclusión: La supervivencia en el presente estudio se asoció al nivel de instrucción de los pacientes, al estadiaje del cáncer, y al diagnóstico temprano sobre todo en pacientes con comorbilidades. No se evidenció relación con factores de riesgo como tabaco, alcohol, presencia de pólipos, etc.


Introduction: The five-year relative survival for patients with colorectal cancer (CRC) is between 60% in North America and 40% or less in Algeria and Estonia. The objective of this study is to estab-lish survival at the local level and determine the associated factors in a study of a national referral center in Quito, Ecuador. Methodology: The present observational study was carried out at the Eugenio Espejo Specialty Hospital in the city of Quito-Ecuador, in the period from January 2010 to December 2016. Patients with colorectal cancer were included. The variables were descriptive demographic, clinical variables and mortality. The sample was non-probabilistic, census type. The mortality variable was studied with the independent clinical and epidemiological variables with actuarial survival analysis. Results: A total of 395 patients were analyzed, 62.3% women, aged 60 years (16 to 94). 7.1% of cases referred to some type of risk exposure related to CRC. Overall survival was 56%, with a mortality rate of 7%. Cases with stage I CRC survival at 6 years of 100%, with stage II 96.5%, in stage III 84%, stage IV of 63% (P = 0.001). Patients with secondary education or higher with survival of 95% versus 88% in patients with primary education / illiterate (P= 0.048). Survival is higher in patients with early diagnosis stages (I and II) (P = 0.007). Conclusion: Survival in the present study was associated with the level of education of the patients, the staging of the cancer, and early diagnosis, especially in patients with comorbidities. There was no evidence of a relationship with risk factors such as tobacco, alcohol, presence of polyps, etc.


Subject(s)
Humans , Male , Female , Adult , Survival Analysis , Risk Factors , Colonic Neoplasms , Colorectal Neoplasms , Early Detection of Cancer , Life Style
2.
Infectio ; 25(4): 276-283, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1286722

ABSTRACT

Resumen Objetivo: Describir la supervivencia a siete años y los principales factores asociados a esta, en las personas con VIH que fueron atendidas en el sistema de salud colombiano entre 2011 a 2018. Métodos: Análisis de supervivencia de una cohorte de 64 039 personas diagnosticadas con VIH en Colombia. Se aplicó el método de Kaplan-Meier para estimar la probabilidad de supervivencia a partir de la fecha del diagnóstico. Se ajustó un modelo de supervivencia paramétrico flexible de Royston Parmar. Resultados: La estimación de la supervivencia global a 7 años fue de 94,8% (IC 95%: 94,5-95,2). El mayor riesgo de muerte se presentó en los hombres (HR: 1,2; IC 95%: 1,1-1,4; p: 0,010); en personas ≥50 años de edad (HR: 3,1; IC 95%: 1,6-6,3; p: 0,002); en el régimen subsidiado (HR: 2,2; IC 95%: 1,9-2,5; p: <0,001); en la etapa sida (HR: 2,8; IC 95%: 2,1-3,7; p: <0,001); en quienes presentaron la última carga viral detectable (HR: 7,1; IC 95%: 6,0-8,3; p: <0,001); y en quienes mostraron conteo de linfocitos T CD4+ <350 células/μL (HR: 1,9; IC 95%: 1,4-2,4; p: <0,001). Conclusión: La probabilidad de la supervivencia de las personas que viven con VIH aumenta al ser diagnosticados en edades jóvenes, en quienes presenten un recuento de linfocitos T CD4+ ≥350 células/μL, una carga viral indetectable (< 50 copias/mL) y no se encuentren en etapa sida.


Summary Objective: to describe the seven-year survival and predictors of mortality among people with HIV who were treated in the Colombian health system between 2011 and 2018. Methods: 64 039 people diagnosed with HIV in Colombia were included. Kaplan-Meier analysis estimated the probability of survival from the date of diagnosis. A Royston Parmar flexible parametric survival model was fitted. Results: The overall survival at 7 years was 94.8% (95% CI: 94.5-95.2). Survival was related to sex (men, HR: 1.2; 95% CI: 1.1-1.4; p: 0.010); people ≥50 years of age (HR: 3.1; 95% CI: 1.6-6.3; p: 0.002); subsidized regime (HR: 2.2; 95% CI: 1.9-2.5; p: <0.001); AIDS stage (HR: 2.8; 95% CI: 2.1-3.7; p: <0.001); a detectable viral load (HR: 7.1; 95% CI: 6.0-8.3; p: <0.001); and a CD4+ Lymphocyte count <350 cells/μL (HR: 1.9; 95% CI: 1.4-2.4; p: <0.001). Conclusion: The probability of survival of people living with HIV increases when they are diagnosed at a young age, in those with a CD4+ T Lymphocyte count ≥350 cells/μL, an undetectable viral load (<50 copies/mL) and are not in the AIDS stage.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Survival Analysis , Acquired Immunodeficiency Syndrome , Sex , T-Lymphocytes , Probability , HIV , Colombia , Lymphocyte Count , Viral Load , Survivorship
3.
Rev. cuba. hematol. inmunol. hemoter ; 37(3): e1505, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1341404

ABSTRACT

Introducción: Con el protocolo LPM-TOA para el tratamiento de la leucemia promielocítica se obtienen excelentes resultados, se prolonga la sobrevida global y es posible la curación de los enfermos. En la de inducción a la remisión se utilizan dos drogas, una antraciclina y trióxido de arsénico, y en la consolidación los enfermos reciben de nuevo una dosis elevada de arsénico. Objetivo: Evaluar la toxicidad hepática tardía en pacientes con leucemia promielocítica tratados según el protocolo LPM-TOA. Métodos: Se realizó estudio longitudinal prospectivo que incluyó20 pacientes tratados con dicho protocolo, todos con más de dos años de haberlo suspendido. Se revisaron las historias clínicas para evaluar mediante los valores iniciales y evolutivos de las enzimas hepáticas, la función hepática inicial y evolutiva. Se determinó el índice de Ritis para predecir evolución a la cronicidad de existir daño hepático. Resultados: Hombres y mujeres se presentaron con la misma frecuencia y la media para la edad del sexo masculino fue 36,39 y para el femenino 39, con desviación estándar de ±14,02 y ±9,43, respectivamente. La variedad morfológica más frecuente fue la hipergranular, el promedio del índice de Ritis fue de solo 1,006 con desviación estándar de 0,745. Conclusiones: No hubo evidencias clínica ni enzimática de toxicidad hepática tardía en los pacientes estudiados(AU)


Introduction: With the LPM-TOA protocol for the treatment of acute promyelocytic leukemia, excellent results are obtained, overall survival is prolonged and the patients are cured, in the induction to remission two drugs are used, an anthracycline and arsenic trioxide, and in consolidation the patients again receive a high dose of arsenic. Objective: To assess late liver toxicity in patients with promyelocytic leukemia treated according to the PML-TOA protocol. Methods: A prospective longitudinal study was carried out that included 20 patients treated with this protocol, all with more than two years of having suspended treatment. The clinical histories were reviewed and by means of the initial and evolutionary values of liver enzymes, the initial and evolutionary liver function was evaluated and the Ritis index was determined to predict evolution to chronicity if there is liver damage. Results: Men and women presented with the same frequency and the mean age for males was 36.39 and for females it was 39, with a standard deviation of ± 14.02 and ± 9.43 respectively. The most frequent morphological variety was hypergranular, the average Ritis index was only 1.006 with a standard deviation of 0.745. Conclusions: There was no clinical or enzymatic evidence of late liver toxicity in the patients studied(AU)


Subject(s)
Humans , Leukemia, Promyelocytic, Acute/drug therapy , Chemical and Drug Induced Liver Injury/prevention & control , Arsenic Trioxide/toxicity , Survival Analysis , Prospective Studies , Longitudinal Studies
4.
Infectio ; 25(3): 176-181, jul.-set. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1250089

ABSTRACT

Abstract Objective: To determine the mortality and survival of COVID-19 cases in Colombia between March and July 2020. Materials and methods: A retrospective cohort study in the Colombian population between March 6 to July 8, 2020, with the data reported to the National Institute of Health. Survival analysis was performed considering the real-time PCR results, died or recovered, the onset of symptoms until the date of death, or the final time of the cohort. The actuarial variation and Long-Rank test were applied for survival. Risk factors were determined by Cox regression. Results: The overall survival rate was 100%, 98%, 97%, and 95% for day 1, 10, 20 and 30, respectively. Differences were found in survival in age, sex, region, and hospitaliza tion time spending (p <0.01), the 30-day survival rate was 96% and 95% for females and males, respectively. The region with the highest survival was Antioquia with 99% and the lower Barranquilla with 93%. The age group with the lowest survival was ≥80 years of age with 60%, and being hospitalized represented a survival rate of 68%. Conclusions: This study is one of the first to estimate survival in the Colombian population diagnosed with COVID-19.


Resumen Objetivo: determinar la mortalidad y supervivencia de casos de COVID-19 en Colombia entre marzo y julio de 2020. Materiales y métodos: Estudio de cohorte retrospectivo en población colombiana entre el 6 de marzo al 8 de julio de 2020, con los datos reportados al Instituto Nacional de Salud. El análisis de supervivencia se realizó considerando los resultados de la PCR en tiempo real, fallecido o recuperado, el inicio de los síntomas hasta la fecha del fallecimiento o el momento final de la cohorte. Para la supervivencia se aplicó la variación actuarial y la prueba de rango largo. Los factores de riesgo se determinaron mediante regresión de Cox. Resultados: La tasa de supervivencia general fue del 100%, 98%, 97% y 95% para los días 1, 10, 20 y 30, respectivamente. Se encontraron diferencias en la su pervivencia en cuanto a edad, sexo, región y tiempo de hospitalización (p <0,01), la tasa de supervivencia a 30 días fue del 96% y 95% para mujeres y hombres, respectivamente. La región con mayor supervivencia fue Antioquia con 99% y la Baja Barranquilla con 93%. El grupo de edad con menor supervivencia fue el ≥80 años con 60%, y la hospitalización representó una tasa de supervivencia del 68%. Conclusiones: Este estudio es uno de los primeros en estimar la supervivencia en la población colombiana diagnosticada con COVID-19.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Survival Analysis , COVID-19 , Survival Rate , Risk Factors , Cohort Studies , Mortality , Colombia , Survivorship , Methods
5.
Femina ; 49(7): 444-448, 20210731. tab
Article in Portuguese | LILACS | ID: biblio-1290595

ABSTRACT

A exenteração pélvica pode curar pacientes com câncer de colo do útero com recorrência central após radioterapia e quimioterapia. A avaliação pré-operatória é essencial para excluir doença metastática e evitar cirurgias desnecessárias nesse cenário. O objetivo do presente estudo é avaliar a sobrevida de uma série de casos de pacientes submetidas à exenteração pélvica em clínica privada de Teresina. Este é o resultado parcial de um estudo observacional, retrospectivo, transversal e descritivo, realizado em uma clínica privada especializada no tratamento do câncer em Teresina, PI, Brasil, de junho de 2002 a fevereiro de 2020. Cinco pacientes foram incluídas no estudo, com idades entre 29 e 62 anos. No presente estudo, a sobrevida mediana foi de 44,8 meses. Duas pacientes estão vivas e sem doença com seguimento de 201 e 5 meses, respectivamente.(AU)


Pelvic exenteration can heal patients with cervical cancer with central recurrence after radiotherapy and / or chemotherapy. Preoperative evaluation is essential to exclude metastatic disease and to avoid unnecessary surgery in this scenario. The objective of the present study is to evaluate the survival of a series of cases of patients submitted to pelvic exenteration in a private clinic in Teresina. This is the partial result of an observational, retrospective, cross-sectional and descriptive study, conducted at a private clinic specialized in cancer treatment in Teresina, Brazil, from June 2002 to February 2020. Five patients were included in the study, aged between 29 and 62 years. In the present study, the median survival was 44,8 months. Two patients are alive and without disease with a follow-up of 201 and 5 months, respectively.(AU)


Subject(s)
Humans , Female , Pelvic Exenteration/statistics & numerical data , Survival Analysis , Uterine Cervical Neoplasms/surgery , Neoplasm Recurrence, Local/epidemiology , Survival , Brazil/epidemiology , Cross-Sectional Studies
6.
Oncol. (Guayaquil) ; 31(1): 35-45, Abril 30, 2021.
Article in Spanish | LILACS | ID: biblio-1222457

ABSTRACT

Introducción: El cáncer de próstata constituye la segunda neoplasia más frecuente después del cáncer pulmonar. Es la Primera causa de incidencia de cáncer en la población ecuatoriana, mientras que la mortalidad ocupó el segundo lugar. Enzalutamida retrasa significativamente la necesidad de quimioterapia y la disminución de la calidad de vida. En algunos estudios se ha encontrado disminu-ción del riesgo de muerte y retraso en el inicio de la quimioterapia así como aumento de la supervi-vencia post-quimioterapia con su uso. El objetivo del presente estudio fue caracterizar la evolución clínica de pacientes con cáncer de próstata metastásico resistente a la castración (mCRPC) tratados con enzalutamida. Metodología: Se recopiló información de pacientes atendidos en el servicio de Urología de Solca - Guayas del año 2013 al 2019. Se incluyeron todos los casos con cáncer de próstata metastásico resistente a la castración. Resultados: El promedio de edad fue de 77.3 ± 9.9 años. El tamaño inicial prostático fue de 59.9 ± 43.7 g. Los síntomas con mayor frecuencia registrados fueron: hematuria 18,8%, disminución del chorro miccional 18.8%, polaquiuria y poliuria con 14.6% cada uno. . La supervivencia global fue del 80% en los casos tratados con enzalutamida. Ninguna muerte estuvo asociada con el uso de enzalu-tamida. En el 66,6% se registraron eventos adversos. De todos los eventos adversos registrados el 82.3% fueron leves. Conclusión: La supervivencia global en el grupo estudiado estuvo acorde a los reportes de supervivencia en pacientes tratados con enzalutamida. La terapia con enzalutamida fue bien tolerada.


Introduction: Prostate cancer is the second most common neoplasm after lung cancer. It is the leading cause of cancer incidence in the Ecuadorian population, while mortality ranked second. En-zalutamide significantly delays the need for chemotherapy and decreases the quality of life. Some studies have found a decrease in the risk of death and a delay in the start of chemotherapy, as well as an increase in post-chemotherapy survival with its use. The aim of this study was to characterize the clinical course of patients with metastatic castration resistant prostate cancer (mCRPC) treated with enzalutamide. Methodology: Information was collected from patients treated in the Urology services of Solca - Guayas from 2013 to 2019. All cases with metastatic castration-resistant prostate cancer were in-cluded. Results: The mean age was 77.3 ± 9.9 years. The initial prostate size was 59.9 ± 43.7 g. The symp-toms with the highest frequency recorded were: hematuria 18.8%, decreased voiding stream 18.8%, frequency and polyuria with 14.6% each. Overall survival was 80% in the cases treated with enzalu-tamide. No deaths were associated with the use of enzalutamide. Adverse events were recorded in 66.6%. Of all the adverse events recorded, 82.3% were mild. Conclusion: The overall survival in the studied group was consistent with the survival reports in patients treated with enzalutamide. Enzalutamide therapy was well tolerated.


Subject(s)
Prostatic Neoplasms, Castration-Resistant , Androgen Antagonists , Neoplasm Metastasis , Prostatic Neoplasms , Survival Analysis
7.
Arq. bras. med. vet. zootec. (Online) ; 73(2): 438-444, Mar.-Apr. 2021. graf
Article in English | ID: biblio-1248947

ABSTRACT

In this case, a 12-year-old female domestic cat with chronic renal failure (CRF), which had lived longer than the mean survival time for cats with that condition, was monitored to evaluate the effects of treatment and mean gray value (MGV) changes. The cat has lived for nearly four years since the diagnosis. Probiotics have been used as an additional, classical supportive therapy since the beginning of treatment. The temporal changes in renal MGV were statistically evaluated in the last year of the four-year period. The cat had a comfortable existence and good body condition all her life and probiotic therapy may have had a positive influence post-CRF diagnosis. Ultrasonography (US) examination is a commonly used tool for monitoring the CRF situation, but it is not particularly sensitive. Therefore, MGV may be more useful for the quantitative evaluation of the extent of renal failure. Also, to the best of our knowledge, this is the first report for a long-term clinical evaluation of MGV in a cat with CRF. The aim of this case report was the evaluation of the relationship between MGV and clinical and biochemical changes in a cat with chronic renal failure.(AU)


No presente caso, uma gata doméstica de 12 anos com insuficiência renal crônica (IRC), que viveu mais do que o tempo médio de sobrevivência para gatos nessa condição, foi monitorada para avaliar os efeitos do tratamento e as alterações do valor cinza médio (MGV). A gata viveu quase quatro anos desde o diagnóstico. Os probióticos têm sido usados como uma terapia de suporte clássica adicional desde o início do tratamento. As alterações temporais do MGV renal foram avaliadas estatisticamente no último ano do período de quatro anos. A gata teve uma existência confortável e boas condições corporais durante toda a vida e a terapia com probióticos pode ter tido uma influência positiva após o diagnóstico de IRC. O exame de ultrassonografia (US) é uma ferramenta comumente usada para monitorar a situação da IRC, mas não é particularmente sensível. Portanto, o MGV pode ser mais útil para a avaliação quantitativa da extensão da insuficiência renal. Além disso, até onde se sabe, este é o primeiro relatório de uma avaliação clínica de longo prazo de MGV em um gato com IRC. O objetivo deste relato de caso foi avaliar a relação entre o MGV e as alterações clínicas e bioquímicas em um gato com insuficiência renal crônica.(AU)


Subject(s)
Animals , Cats , Prognosis , Probiotics/therapeutic use , Renal Insufficiency, Chronic/therapy , Renal Insufficiency, Chronic/veterinary , Survival Analysis
8.
Arch. med ; 21(1): 35-44, 2021/01/03.
Article in Spanish | LILACS | ID: biblio-1148355

ABSTRACT

Objetivo: identificar las variables clínicas que impactan en la mortalidad de los pacientes con falla cardiaca implantados con desfibrilador automático. La terapia con cardiodesfibrilador implantable busca prevenir la muerte súbita cardiaca por arritmias malignas colapsantes. Material y métodos: estudio de cohorte retrospectiva. Se incluyó a pacientes con implante de desfibrilador entre los años 2010-2012, con dispositivo funcional, historia clínica y disponibilidad de seguimiento hasta el primer trimestre del 2014. Resultados: un total de 30 pacientes fueron incluidos, con una supervivencia del 77% a los cuatro años de seguimiento. El 82,7% de los pacientes presentó cardiopatía isquémica y el promedio de la fracción de eyección ventricular izquierda fue 27,8 ± 6,3. El tiempo promedio de uso del desfibrilador fue de 2,1 años, la tasa de peligro mayor reportada fue del 6% para los días 759 y 760. Se encontró una asociación entre una duración del QRS mayor a 120 ms (HR= 7,7, IC 90%= 1,77- 33,6; p=0,022), fibrilación auricular (HR= 4,2, IC 90%=1,13-15,68; p=0,072) y el uso de beta-bloqueadores (HR= 0,15, IC 90%= 0,03 ­ 0,64; p=0,031) con el tiempo de supervivencia. Discusión: la prevención de muerte súbita está condicionada por la optimización farmacológica, así como las anomalías estructurales y de la conducción eléctrica, por lo cual se debe aumentar el seguimiento en estos casos y el ajuste de la terapia farmacológica. Conclusiones: el uso de beta bloqueadores en pacientes con falla cardiaca con fibrilación auricular y duración del QRS mayor de 120 ms es un factor protector..Au


Objective: to identify the clinical variables that impact on the mortality of patients with heart failure implanted with cardioverter defibrillator. Implantable cardioverter defibrillator therapy seeks to prevent sudden cardiac death by collapsing malignant arrhythmias. Material y methods: retrospective cohort study. Patients with a defibrillator implant from the year 2010 to the year 2012 were included, with functional device, clinical history and availability of follow-up until the first quarter of 2014. Results: a total of 30 patients were included, with a 77% survival at four years of follow-up. 82.7% of the patients presented with ischemic heart disease and the mean left ventricular ejection fraction was 27.8 ± 6.3. The mean time of use of the defibrillator was 2.1 years, the reported mayor danger rate was 6% for days 759 and 760. An association was found between a QRS mayor duration at 120 ms (HR = 7.7, 90% CI = 1.77-33.6, p = 0.022), atrial fibrillation (HR = 4.2, 90% CI = 1.13-15.68, p = 0.072), and beta- blockers (HR = 0.15, 90% CI = 0.03-0.64, p = 0.031) with survival time. Discussion: the prevention of death is conditioned by pharmacological optimization, as well as structural and electrical conduction anomalies, so the monitoring and adjustment of pharmacological therapy should be increased. Conclusions: the use of beta-blockers in patients with atrial fibrillation and QRS duration greater than 120 ms is a protective factor..Au


Subject(s)
Humans , Survival Analysis , Defibrillators, Implantable
9.
Article in Chinese | WPRIM | ID: wpr-880111

ABSTRACT

OBJECTIVE@#To explore the clinical features, prognosis and survival of patients with IgD multiple myeloma (MM).@*METHODS@#The clinical data of 20 patients with IgD MM was analyzed retrospectively. The prognostic factors and survival analysis was carried out. We summarized their clinical characteristics. The survival analysis was carried out by Kaplan-Meier method, and the prognostic factor were analyzed by using log-rank test for single factor analysis of observation index. Variables of P<0.15 in single factor analysis were enrolled in multifactor cox regression analysis.@*RESULTS@#IgD MM patients accounted for 4.3% of all MM patients in the same period, among which 80% were male, the median age of patients was 57.5(35-77) years old, 90% of the patients belongs to λ light chain type. At the time of diagnosis, 18 patients (90%) were in DS-Ⅲ stages, while 10 patients were in ISS-Ⅲ stage. The first clinical manifestations were fatigue, bone pain, kidney function impairment, anemia (Hb<100 g/L) in 14 cases (70%), 12 cases (60%) with osteolytic bone destruction≥3, combined with renal impairment in 8 cases (40%), and elevated blood calcium in 11 cases (51.4%). In only 5 patients the ratio of albumin to globntin was inverted, hypoalbuminemia accounted for 40%, and globulin increase accounted for only 15%. FISH results showed that the positive rate of 1q21 amplification (50%) was the highest, and it was easy to occur at the same time as other cytogenetic abnormalities. Extramedullary infiltration occurred in 4 cases (20%). The analysis of prognostic factors showed that only the increase of lactate dehydrogenase (LDH) level was an independent poor prognostic factor for IgD MM patients. Extramedullary infiltration and various cytogenetic abnormalities were found in 2 IgD MM patients with primary drug resistance, suggesting that extramedullary infiltration and various cytogenetic abnormalities may be prognostic factors, but the difference was not statistically significant, Which maybe related to the small sample size. All 20 patients were treated with bortezomib-containing regimen, of which 19 patients were evaluated, 17 patients (89.4%) showed effective, including CR+VGPR (52.6%), PR (31.5%), MR (5.3%), 2 patients primary drug resistance. The median PFS and OS was 9.5 and 10.5 months, respectively.@*CONCLUSION@#IgD MM is a rare and invasive disease. Increased LDH is an independent prognostic factor. Bortizomib-containing regimen can improve the prognosis of IgD MM patients.


Subject(s)
Aged , Disease-Free Survival , Female , Humans , Immunoglobulin D , Male , Middle Aged , Multiple Myeloma , Prognosis , Retrospective Studies , Survival Analysis , Treatment Outcome
10.
Article in English | LILACS | ID: biblio-1342994

ABSTRACT

Objective: this study aimed to evaluate long-term survival and prognostic factors in patients with oral squamous cell carcinoma (OSCC) in an economically poor region of Brazil. Methods: the data were obtained from analysis of medical and mortality records of 210 patients with OSCC treated at an oncology hospital providing services to the Brazilian Unified National Health System in a State of northeastern Brazil between January 2006 and December 2008. Sociodemographic and clinical information, treatment performed, recurrence and evolution were collected. Survival curves were estimated by the Kaplan-Meier method and the log rank and Cox regression tests were used to compare the curves. Results: the median survival in the study period was 47.4 months (95% CI = 38.2 - 56.7). The overall survival rates at 5 and 10 years were 29% and 19.8%, respectivelly. Individuals over 60 years of age (HR = 1.70; 95% CI = 1.06 - 2.73), presence of regional metastasis (HR = 2.51; 95% CI = 1.55 - 4.08), presence of recurrence (HR = 3.18; 95% CI = 1.88 - 5.39) and no surgical treatment (HR = 2.10; 95% CI = 1.31 - 3.35) had a worse prognosis. Conclusions: advanced age, presence of regional metastasis, tumor recurrence and non-surgical treatment predict poorer survival in patients diagnosed with OSCC.


Objetivo: este estudo objetivou avaliar a sobrevida a longo prazo e fatores prognósticos de pacientes com carcinoma espinocelular bucal em uma região pouco desenvolvida economicamente do Brasil. Métodos: os dados foram obtidos a partir da análise de registros médicos de 210 pacientes com carcinoma espinocelular bucal tratados em um hospital especializado em oncologia que presta serviços ao Sistema Único de Saúde em um estado do Nordeste brasileiro entre janeiro de 2006 e dezembro de 2008. Informações clínicas, sociodemográficas e referentes aos tratamentos realizados, recidivas e evoluções foram coletadas. As curvas de sobrevida foram estimadas pelo método de Kaplan-Meier, sendo utilizado o teste de Log-rank para comparar as curvas. Resultados: a sobrevida média no estudo foi de 47.4 meses (95% IC = 38.2 - 56.7). As taxas de sobrevida global em 5 e 10 anos foram de 29% e 19.8%, respectivamente. Indivíduos com idade superior a 60 anos (RR = 1.70; 95% IC = 1.06 - 2.73), que apresentaram metástases regionais (RR = 2.51; 95% IC = 1.55 - 4.08), recidivas tumorais (RR = 3.18; 95% IC = 1.88 - 5.39) e que foram tratados apenas não cirurgicamente (RR = 2.10; 95% IC = 1.31 - 3.35) tiveram pior prognóstico. Conclusões: idade avançada, presença de metástases regionais, recidivas tumorais e tratamento apenas não cirúrgico foram preditores de pior sobrevida em pacientes diagnosticados com carcinoma espinocelular bucal.


Subject(s)
Humans , Male , Female , Carcinoma, Squamous Cell , Prognosis , Mouth Neoplasms , Survival Analysis , Oral Medicine
12.
Rev. gaúch. enferm ; 42: e20190509, 2021. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1149948

ABSTRACT

ABSTRACT Objective: To analyze ten-year specific survival of women with breast cancer in Great Cuiaba, Mato Grosso, Brazil. Methods: A population-based cohort of 61 women diagnosed with breast cancer in 2008 and 2009, in Great Cuiabá, Mato Grosso, followed by 2018 in the regional mortality database. Specific survival was analyzed through the Kaplan-Meier curve, with adjustment of the Weibull model and Log-Weibull Regression. The survival curves of the variables were compared using the log-rank test which were statistically significance (p<0.05). Results: The mean time to death is approximately 51.1 months. Women aged ≤ 50 years and of white race/color presented the worst survival. Conclusion: We found out that age, race/color affect specific survival and there is a need for reviewing the control plan for breast cancer in order to increase the survival of women diagnosed with this pathology.


RESUMEN: Objetivo: Analizar la supervivencia específica en 10 años de las mujeres con cáncer de mama en el Gran Cuiabá, Mato Grosso, Brasil. Método: Cohorte poblacional de 61 mujeres diagnosticadas con cáncer de mama en los años de 2008 y 2009, en el Gran Cuiabá, Mato Grosso, seguidas hasta 2018 en el banco regional de mortalidad. La supervivencia específica se analizó utilizando curvas de Kaplan-Meier, con ajuste del modelo Weibull y Regresión Log-Weibull. Las curvas de supervivencia de las variables que fueron estadísticamente significativas (p <0.05) se compararon mediante la prueba de log-rank. Resultados: El tiempo promedio hasta la muerte es de aproximadamente 51.1 meses. Las mujeres de ≤ 50 años y de raza/blanca presentaron peor supervivencia. Conclusión: Descubrimos que la edad y la raza/color afectan la supervivencia específica y que es necesario revisar el Plan de control del cáncer de mama para aumentar la supervivencia de las mujeres diagnosticadas con esta enfermedad.


RESUMO Objetivo: Analisar a sobrevida específica em 10 anos para o câncer de mama feminino na Grande Cuiabá, Mato Grosso, Brasil. Métodos: Coorte de base populacional composta por 61 mulheres diagnosticadas com câncer de mama, período 2008-2009, na Grande Cuiabá, Mato Grosso, seguidas até 2018 no banco de mortalidade regional. A sobrevida foi analisada por meio das curvas de Kaplan-Meier, com ajuste do modelo Weibull e Regressão Log-Weibull. Compararam-se as curvas de sobrevida por meio do teste log-rank e as diferenças estatísticas foram significantes com p<0,05. Resultados: O tempo médio até a morte por câncer de mama foi de aproximadamente 51,1 meses. Apresentaram pior sobrevida as mulheres com idade ≤ 50 anos e raça/cor branca. Conclusão: Evidenciou-se que a idade e a raça/cor afetaram a sobrevida específica para este câncer. Há necessidade de revisão da política oncológica do estado para aumentar a sobrevida das mulheres com essa patologia.


Subject(s)
Humans , Female , Breast Neoplasms , Survival Analysis , Brazil , Adaptation, Psychological , Cohort Studies , Women's Health
13.
Rev. patol. trop ; 50(3)2021. ilus
Article in English | LILACS | ID: biblio-1292484

ABSTRACT

Tuberculosis is the leading cause of death amongst adults with human immunodeficiency virus (HIV) infection. The lifetime risk of tuberculosis disease for a person with latent infection is estimated at 5-10% with most cases occurring within five years of initial infection. The World Health Organization recommends isoniazid preventive therapy (IPT) for latent tuberculosis treatment, amongst other strategies. The aim was to assess tuberculosis incidence, survival (free of tuberculosis) and associated factors in HIV-positive patients. IPT was offered to participants with a positive (≥5mm) tuberculin skin test. Participants were followed from February 2003-December 2016. Kaplan-Meier was used for survival analysis. Variables with p-value ≤ 0.2 in the univariate analysis entered into the multivariate Cox-Model, keeping those with p-value ≤ 0.05. The 95% confidence interval of incidence of tuberculosis was estimated using Poisson distribution. One hundred nineteen patients completed the IPT and were followed for a median duration of 110.7 months (IQR 93.1-121.0). The probability of developing tuberculosis (10 years post-IPT) was 5.4%. Tuberculosis incidence was 0.58/100 patient/years (CI 95% 0.213-1.264). IPT over 6 months provided long-term protection against tuberculosis. AIDS-defining illness was the only statistically significant variable (HR=5.67) in the multivariate model.


Subject(s)
Humans , Survival Analysis , HIV , Latent Tuberculosis , Isoniazid
14.
Rev. latinoam. enferm. (Online) ; 29: e3412, 2021. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1289787

ABSTRACT

Objective: to identify breastfeeding patterns, survival of exclusive breastfeeding and factors associated with its interruption, in the first six months of life of babies seen by Lactation Consulting. Method: a prospective cohort, with 231 mother-babies in a Baby-Friendly Hospital. An initial questionnaire was applied after 24 hours of birth, after consulting, as well as a follow-up questionnaire, applied by telephone at 15, 30, 60, 120 and 180 days, with sociodemographic and obstetric variables, maternal habits, father's schooling, birth data and baby feeding. Survival Analysis was carried out. Results: at 180 days of age, exclusive breastfeeding was 12.7% and the probability was 19.6% in the analysis of the survival curve. The factors associated with its interruption were smoking during pregnancy (HR 1.66; CI 1.05 - 2.61), age ≥ 35 years old (HR 1.73; CI 1.03 - 2.90), difficulty in breastfeeding after hospital discharge (HR 2.09; CI 1.29 - 3.41), search for professional assistance (HR 2.45; CI 1.69 - 3.54) and use of a pacifier (HR 1.76; IC 1.21 - 2.58). Conclusion: lactation consultancy contributed to the improvement of the exclusive breastfeeding rates, although there are opportunities for advances.


Objetivo: identificar padrões de amamentação, sobrevida do aleitamento materno exclusivo e fatores associados à sua interrupção, nos seis primeiros meses de vida de bebês atendidos por Consultoria em Lactação. Método: coorte prospectiva, com 231 mãe-bebê em Hospital Amigo da Criança. Utilizou-se questionário inicial aplicado após 24 horas do nascimento, depois da consultoria, e de seguimento, aplicado por telefone aos 15, 30, 60, 120 e 180 dias, com variáveis sociodemográficas, obstétricas, hábitos maternos, escolaridade paterna, dados do nascimento e alimentação do bebê. Procedeu-se à Análise de Sobrevivência. Resultados: aos 180 dias de vida, o aleitamento materno exclusivo foi 12,7% e probabilidade de 19,6% na análise da curva de sobrevivência. Os fatores associados à sua interrupção foram tabagismo na gestação (HR 1,66; IC 1,05 - 2,61), idade ≥ 35 anos (HR 1,73; IC 1,03 - 2,90), dificuldade na amamentação pós-alta hospitalar (HR 2,09; IC 1,29 - 3,41), busca por auxílio profissional (HR 2,45; IC 1,69 - 3,54) e uso de chupeta (HR 1,76; IC 1,21 - 2,58). Conclusão: a consultoria em lactação contribuiu para melhoria das taxas de aleitamento materno exclusivo, embora existam oportunidades de avanços.


Objetivo: identificar patrones de lactancia materna, supervivencia de la lactancia materna exclusiva y factores asociados a su interrupción, en los primeros seis meses de vida de los bebés atendidos por Consultoría de Lactancia. Método: cohorte prospectiva, con 231 madres-bebés en el Hospital Amigo del Niño. Se aplicó un cuestionario inicial a las 24 horas del nacimiento, previa consultoría, y de seguimiento, aplicado por teléfono a los 15, 30, 60, 120 y 180 días, con variables sociodemográficas, obstétricas, hábitos maternos, educación del padre, datos de nacimiento y alimentación del bebé. Se llevó a cabo un Análisis de Supervivencia. Resultados: a los 180 días de vida, la lactancia materna exclusiva fue del 12,7% y la probabilidad del 19,6% en el análisis de la curva de supervivencia. Los factores asociados a su interrupción fueron el tabaquismo en la gestación (HR 1,66; IC 1,05 - 2,61), edad ≥ 35 años (HR 1,73; IC 1,03 - 2,90), dificultad para amamantar después del alta hospitalaria (HR 2,09; IC 1,29 - 3,41), búsqueda de asistencia profesional (HR 2,45; IC 1,69 - 3,54) y uso de chupete (HR 1,76; IC 1, 21-2,58). Conclusión: la consultoría en lactancia contribuyó a la mejora de las tasas de lactancia materna exclusiva, aunque existen oportunidades de avances.


Subject(s)
Humans , Female , Infant , Adult , Breast Feeding , Lactation , Survival Analysis , Cohort Studies , Consultants , Educational Status , Nursing Care
15.
Rev. bras. cancerol ; 67(1): e-01841, 2021.
Article in Portuguese | LILACS | ID: biblio-1146871

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Vena Cava Filters/adverse effects , Venous Thromboembolism/mortality , Neoplasms/mortality , Prognosis , Time Factors , Survival Analysis , Retrospective Studies , Venous Thromboembolism/surgery , Venous Thromboembolism/complications , Genital Neoplasms, Female/complications , Genital Neoplasms, Female/mortality , Neoplasms/complications
16.
Rev. bras. cancerol ; 67(1): e-16967, 2021.
Article in Portuguese | LILACS | ID: biblio-1147265

ABSTRACT

Introdução: A neoplasia maligna de pâncreas configura uma das neoplasias de maior mortalidade em todo o mundo, quase sempre atrelada a um prognóstico sombrio, principalmente quando associada à disseminação linfática e para órgãos distantes. Objetivo: Avaliar a sobrevida global em pacientes com adenocarcinoma de pâncreas atendidos em um centro especializado em oncologia. Método: No período de janeiro de 2011 a dezembro de 2014, foram avaliados retrospectivamente 71 prontuários. Os dados foram analisados pelo software STATA versão 14, utilizando análise de Kaplan-Meier e de regressão de Cox. O intervalo de confiança utilizado foi de 95% e considerado significante p<0,05. Foram preservados os princípios éticos e da confidencialidade. Resultados: Houve predomínio do sexo masculino, raça parda e com idade superior a 61 anos ao diagnóstico. Quanto às características clínicas, 87,8% dos tumores estavam localizados em cabeça de pâncreas. A dor abdominal (92,7%) foi o sintoma mais frequente, seguida de perda progressiva de peso (79,3%) e icterícia (57,3%). A taxa de sobrevida em três meses de acompanhamento foi de 48,4%. Conclusão: O estudo evidencia que o câncer de pâncreas tem uma repercussão extremamente negativa, visto que a maioria dos pacientes recebe o diagnóstico em estágios avançados da doença, dificultando a possibilidade de tratamento curativo.


Introduction: Pancreatic malignant neoplasia represents one of the highest mortality neoplasms worldwide, almost always associated to a dismal prognosis, especially when associated with lymphatic spread and to distant organs. Objective: To assess the global survival in patients with pancreatic adenocarcinoma treated at a specialized oncology center. Method: From January 2011 to December 2014, 71 medical records were retrospectively evaluated. The data were analyzed using the STATA software version 14, using the Kaplan-Meier curve and the Cox regression. The confidence interval used was 95% (p<0.05). Ethical and confidentiality principles have been secured. Results: There was predominance of males, mixed race and over 61 years of age at diagnosis. As for the clinical characteristics, 87.8% of the tumors were located in the head of the pancreas. Abdominal pain (92.7%) was the most frequent symptom, followed by progressive weight loss (79.3%) and jaundice (57.3%). The three-month follow-up survival rate was 48.4%. Conclusion: The study shows that pancreatic cancer has an extremely negative repercussion, since most patients are diagnosed in advanced stages of the disease, hindering the possibility of curative treatment.


Introducción: La neoplasia maligna pancreática representa una de las neoplasias de mortalidad más altas del mundo, casi siempre vinculada a un pronóstico sombrío, especialmente cuando se asocia con diseminación linfática y órganos distantes. Objetivo: Evaluar la supervivencia global en pacientes con adenocarcinoma pancreático tratados en un centro de oncología especializado. Método: Desde enero de 2011 hasta diciembre de 2014, se evaluaron retrospectivamente 71 registros médicos. Los datos se analizaron utilizando el software STATA versión 14, utilizando la curva de Kaplan-Meier y la regresión de Cox. El intervalo de confianza utilizado fue del 95% (p<0,05). Se han preservado los principios éticos y de confidencialidad. Resultados: Predominó el sexo masculino, la raza mixta y los mayores de 61 años en el momento del diagnóstico. En cuanto a las características clínicas, el 87,8% de los tumores se ubicaron en la cabeza del páncreas. El dolor abdominal (92,7%) fue el síntoma más frecuente, seguido de pérdida progresiva de peso (79,3%) e ictericia (57,3%). La tasa de supervivencia de seguimiento a los tres meses fue del 48,4%. Conclusión: El estudio muestra que el cáncer de páncreas tiene un impacto extremadamente negativo, ya que la mayoría de los pacientes reciben el diagnóstico en etapas avanzadas, obstaculizando la posibilidad de tratamiento curativo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pancreatic Neoplasms/epidemiology , Survival Analysis , Delayed Diagnosis
17.
São Paulo; s.n; 2021. 43 p. tab.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1348778

ABSTRACT

Os métodos de imagem são de fundamental importância para o manejo de pacientes com câncer de mama, especialmente no diagnóstico precoce de lesões mamárias não-palpáveis. Os principais exames de imagem utilizados neste contexto são a mamografia (MMG), ultrassonografia (US) e ressonância magnética (RM). Para as lesões classificadas como baixo, médio ou intermediário potencial de malignidade, métodos mais avançados como a RM têm permitido melhores resultados na especificidade para lesões malignas. O objetivo principal deste trabalho foi avaliar a taxa de malignidade e características de imagem das lesões mamárias classificadas na categoria BI-RADS® 4 pela RM, a fim de criar um modelo para subcategorizar estas lesões nas categorias 4A, 4B e 4C, de acordo com o risco de malignidade pelos critérios do Léxico BI-RADS®. Foi realizado um estudo observacional, com a avaliação das lesões mamárias com indicação de biópsia percutânea ou cirúrgica em exames de RM realizados no período de 2016 e 2017 no Departamento de Imagem do A.C.Camargo Cancer Center. Para avaliação da validade diagnóstica o resultado histológico foi considerado comopadrão-ouro e, nos casos negativos para malignidade, foi realizado acompanhamento por pelo menos 2 anos. Foram incluídas 166 pacientes com 199 lesões classificadas com BI-RADS®4. 14 (7,5%) não foram biopsiadas, porém apresentaram estabilidade por pelo menos 2 anos ou não se confirmaram em exames subsequentes, inferindo benignidade. Foram avaliadas por biópsia 185 lesões resultando em 140 (75,6%) lesões benignas e 45 (24,3%) lesões malignas. Apresentaram associação estatisticamente significativa com maior risco de malignidade na análise univariada: composição da mama, realce de fundo do parênquima, morfologia, margens e curva cinética (fases inicial e tardia) das lesões nodulares e na análise multivariada, para os realces nodulares apenas o realce de fundo do parênquima, as margens e a curva cinética (fase inicial) confirmaram significância estatística. Os VPP das classificações subjetiva e objetiva foram, respectivamente, para BI-RADS 4 A 0,0% e 4,3%, 4B 11,8% e 21,4% e 4C 62,2% e 78,9%. Nossos resultados afirmam que a subclassificação pode ajudar a diferenciar as lesões quanto a suspeição de malignidade e demonstrou ser viável, tanto através da avaliação subjetiva dos avaliadores, como através da avaliação objetiva utilizando o modelo desenvolvido a partir do valor preditivo positivo dos diferentes descritores utilizados.


Imaging methods are of fundamental importance for the management of patients with breast cancer, especially in the early diagnosis of non-palpable breast lesions. The main imaging tests used in this context are mammography (MMG), ultrasonography (US) and magnetic resonance imaging (MRI). For lesions classified as low, mild or intermediate malignancy potential, more advanced methods such as MRI have allowed better results in specificity for malignancy. The main objective of this study was to evaluate the malignancy rate and imaging characteristics of breast lesions classified in category BI-RADS® 4 by MRI, in order to create a model to subcategorize these lesions into categories 4A, 4B and 4C, according to the risk of malignancy by the criteria of the BI-RADS® Lexicon. An observational study was carried out, with the evaluation of breast lesions with indication for percutaneous or surgical biopsy in the MRI examination carried out in the period of 2016 and 2017 at the Imaging Department of the ACCamargo Cancer Center. To assess the diagnostic validity, the histological result was considered as the gold standard and in cases negative for malignancy, it was followed for at least 2 years. A total of 166 patients with 199 lesions classified as BI-RADS® 4 were included.14 (7.5%) were not biopsied but were stable for at least 2 years or were not confirmed in subsequent examinations, inferring benignity. 185 lesions were evaluated by biopsy resulting in 140 (75.6%) benign lesions and 45 (24.3%) malignant lesions. They presented a statistically significant association with higher risk of malignancy in the univariate analysis: breast composition, background parenchymal enhancement, morphology, margins and kinetic curve (early and late stages) of nodular lesions and in the multivariate analysis, for nodular enhancements only the enhancement of the parenchyma background, the margins and the kinetic curve (initial phase) confirmed statistical significance. The PPV of the subjective and objective classifications were, respectively, for BI-RADS 4A 0.0% and 4.3%, 4B 11.8% and 21.4% and 4C 62.2% and 78.9%. Our results affirm that the subclassification can help to differentiate the lesions as the suspicion of malignancy and it proved to be feasible, both through the subjective evaluation of the evaluators, as through the objective evaluation using the model developed from the positive predictive value of the different descriptors used.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Breast Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Survival Analysis
18.
São Paulo; s.n; 2021. 52 p.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1348838

ABSTRACT

Introdução: O câncer de mama é a neoplasia mais comum em mulheres. A maioria deles é diagnosticada em estágios iniciais, quando o tratamento visa a cura. Mas apesar dos avanços no tratamento, metástases à distância podem ocorrer. A biópsia das lesões metastáticas é recomendada para confirmar o status do receptor de estrogênio (RE), receptor de progesterona (RP) e receptor do fator de crescimento epidérmico humano 2 (HER2), por ocorrerem discrepâncias nesses padrões entre tumores primários e metástases em até 40% dos casos. As células tumorais circulantes (CTCs) estão relacionadas às evoluções clínicas do câncer de mama e podem potencialmente desempenhar um papel substituto aos procedimentos invasivos de rebiópsia de metástase. A tecnologia ISET® (Isolation by SizE of Tumor Cells, Rarecells-Diagnostics, Paris, França) não é usualmente empregada para detectar CTCs em pacientes com câncer de mama, embora seja reconhecida como uma ferramenta útil em alguns outros tumores. Existem dados emergentes de que a caracterização da expressão proteica das CTC pode refinar seu valor prognóstico. Sabe-se que o fator de transformação de crescimento (TGF-ß) desempenha um papel na progressão e invasividade do câncer de mama. Objetivos: Comparar a expressão de RE, RP e HER2 em tumores primários, CTCs, metástases e avaliar a expressão do receptor TGF-ß tipo 1 (TGF-ß RI) em CTCs como fator prognóstico para sobrevida global. Metodologia: Estudo realizado no A.C.Camargo Cancer Center, Brasil. As amostras de sangue foram coletadas antes da biópsia guiada por tomografia computadorizada de lesões metastáticas suspeitas e processadas pela metodologia ISET®. Os níveis de expressão proteica das CTCs foram comparados aos de tumores primários e metástases e correlacionados aos resultados clínicos. Todos os dados clínicopatológicos foram obtidos dos prontuários médicos. Resultados: Dos 39 pacientes inicialmente incluídos, 27 tiveram tanto a biópsia de metástases quanto a coleta de sangue e foram considerados para análise. As taxas de concordância para a expressão de RE, RP e HER2 entre tumores primários e metástases foram altas. Não foi observada nenhuma perda de expressão de HER2 nas metástases e os tumores triplo negativos mantiveram o mesmo padrão em todas as metástases (p <0,0001). Quando as metástases e CTCs foram classificadas como triplo negativo (TN) ou não ­ TN, as CTCs determinaram alta especificidade (93%), acurácia (84,2%) e valor preditivo negativo (88%). A sobrevida global mediana de pacientes sem expressão de TGF-ß RI em CTCs foi de 42,6 x 20,8 meses para os positivos, clinicamente relevante, porém sem significância estatística (p> 0,05). Conclusões: No câncer de mama, o papel das CTCs detectadas pelo ISET® ainda não está estabelecido. Com este estudo, sugerimos que esta metodologia possa ser útil para avaliar metástases em casos de tumores não TN, assim como a expressão de TGF-ß RI em CTCs, o que pode impactar a sobrevida. Devido à limitação da amostra, estudos futuros devem se concentrar em subtipos específicos de câncer de mama, ampliando a coorte.


Introduction: Breast cancer (BC) is the most common neoplasm in women. Most of BC are diagnosed in early stages, when treatment aims cure. Despite advances in BC treatment, distant metastases may develop. Biopsy of metastatic lesions is recommended to confirm estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status, due to discrepancies in these patterns between primary tumors/metastasis in up to 40% of cases. Circulating Tumor Cells (CTCs) are related to breast cancer outcomes and could potentially play a role surrogating invasive procedures of metastasis rebiopsy. ISET® (Isolation by SizE of Tumor Cells, Rarecells-Diagnostics, Paris, France) technology is not currently employed to detect CTCs in breast cancer patients, although recognized as a useful tool in some other tumors. There are emerging data that characterization of CTC protein expression can refine its prognostic value. Transforming growth factor (TGF)-ß play a role in progression/invasiveness of BC. Objectives: To compare ER, PR and HER2 expression in primary tumors, CTCs, metastases and to evaluate TGF-ß type 1 receptor (TGF- ß RI) expression in CTCs as prognostic factor for overall survival. Methods: Study conducted at the A.C.Camargo Cancer Center, Brazil. Blood samples were processed in ISET® before computed tomography­guided biopsy of suspected metastatic lesions. Protein expression levels in CTCs were compared to those in primary tumors/metastases and correlated to clinical outcomes. All clinicopathological data were obtained from medical records. Results: From the 39 patients initially included, 27 had both biopsy of metastases and blood collection and were considered for analysis. Concordance rates for ER, PR and HER2 expression between primary tumors/metastases were high. No loss of HER2 expression at any metastasis site and retention of the same pattern in all triplenegative (TN) tumors (p <0.0001) were observed. When metastases/CTCs were classified as TN/non­TN, CTCs showed high specificity (93%), accuracy (84.2%) and negative predictive value (88%). The median overall survival of patients with no TGF-ß RI expression in CTCs was 42.6 x 20.8 months for positive ones, clinically relevant but not statistically significant (p>0.05). Conclusions: In BC, the role of CTCs detected by ISET® is not yet established. Here, we could suggest that this methodology may be useful to evaluate metastasis in non-TN cases as also TGF-ß RI expression in CTCs, which may impact survival. Due to sample limitation, future studies must focus on specific subtypes of BC, expanding the cohort.


Subject(s)
Female , Breast Neoplasms , ErbB Receptors , Neoplastic Cells, Circulating , Neoplasm Metastasis , Prognosis , Receptors, Progesterone , Receptors, Estrogen , Survival Analysis , Transforming Growth Factor beta1
19.
Rev. Col. Bras. Cir ; 48: e20202723, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155363

ABSTRACT

ABSTRACT Objectives: the surgical approach persists as the main treatment for esophageal cancer. This study compares the patients of the same institution over time at three different times. Methods: this is a retrospective, observational, descriptive study comparing the surgical outcomes obtained by the Division of Surgical Oncology of Erasto Gaertner Hospital. The sample was divided into Period 1 (1987-1997), Period 2 (1998-2003) and Period 3 (2007-2015). Survival rates and disease-free survival were estimated by the Kaplan-Maier method. Survival predictors were identified with Cox regression. ANOVA test was used for comparison between groups. Data were analyzed with SPSS 25.0 and STATA 16, and p<0.05 was considered statistically significant. Results: a total of 335 patients underwent esophagectomy or esophagogastrectomy. When the clinical characteristics of the 3 groups were compared, there was no statistically significant difference. Neoadjuvance was significantly higher in Period 3 (55.4% of patients). We found a histological change in the diagnosis over time, with a significant increase in adenocarcinoma. Morbidity and mortality rates were higher in Period 3. The main complications were pulmonary and anastomotic fistulas. Overall survival in 5 years increased over time, reaching 59.7% in Period 3. Conclusions: better neoadjuvant treatment contributed to increase the global survival of patients, despite greater rate of immediate complications to surgery.


RESUMO Objetivo: A abordagem cirúrgica persiste como tratamento principal para o câncer de esôfago. O presente estudo compara as casuísticas da mesma instituição ao longo do tempo, em três momentos diferentes. Métodos: Estudo descritivo retrospectivo comparativo observacional dos resultados cirúrgicos obtidos pelo Serviço de Cirurgia Oncológica do Hospital Erasto Gaertner. A amostra foi dividida em: Período 1 (1987-1997), Período 2 (1998-2003) e Período 3 (2007-2015). Taxas de sobrevida e sobrevida livre de doença foram estimadas pelo método de Kaplan-Maier. Preditores de sobrevida foram identificados com regressão de Cox. Para a comparação entre os grupos foi utilizado teste ANOVA. Os dados foram analisados com os programas SPSS 25.0 e STATA 16, sendo p<0,05 considerado estatisticamente significativo. Resultados: Ao todo, 335 doentes foram submetidos a esofagectomia ou esofagogastrectomia. Quando comparadas as características clínicas dos 3 grupos não houve diferença estatística significativa. A realização de neoadjuvância foi significativamente maior no Período 3 (55,4% dos pacientes). Verificamos uma mudança histológica do diagnóstico no decorrer do tempo, com um aumento significativo do adenocarcinoma. As taxas de morbimortalidade foram superiores no Período 3. As principais complicações foram pulmonares e de fistulas anastomóticas. A sobrevida global em 5 anos foi aumentando no decorrer do tempo, atingindo 59,7% no Período 3. Conclusões: Melhor tratamento neoadjuvante contribuiu para aumentar a sobrevida global dos pacientes, apesar de maior incidência de complicações imediatas à cirurgia.


Subject(s)
Humans , Esophageal Neoplasms/surgery , Adenocarcinoma/surgery , Brazil , Survival Analysis , Retrospective Studies , Treatment Outcome , Esophagectomy , Neoadjuvant Therapy
20.
Rev. Col. Bras. Cir ; 48: e20202671, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155362

ABSTRACT

ABSTRACT Introduction: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. Objectives: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. Methods: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero's staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. Results: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero's staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. Conclusion: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.


RESUMO Introdução: a síndrome de transfusão feto-fetal (STFF), definida pela combinação polidrâmnio-oligohidrâmnio, é a mais prevalente (5 a 35%) das anormalidades associadas às anastomoses vasculares placentárias e tem a maior letalidade (80 a 100%) se não tratada. A ablação a laser destes vasos por via fetoscópica com a técnica de Solomon é o tratamento de escolha atual para a interrupção das anastomoses vasculares. Objetivo: apresentar a experiência inicial do Serviço de Cirurgia Fetal do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) e comparar nossos resultados com os da literatura. Métodos: foram revisados os prontuários de todas as pacientes submetidas ao procedimento de ablação a laser, sendo analisados os dados referentes ao estadiamento de Quintero, à idade gestacional ao diagnóstico e ao procedimento, à posição placentária, à sobrevida imediata pós-procedimento e sobrevida após o período neonatal. Os dados foram então comparados com os mais recentes disponíveis na literatura. Resultados: dez casos de STFF foram analisados. Todos diagnosticados antes da 26a semana (mediana 20,79) e o intervalo diagnóstico-tratamento teve mediana de 9,5 dias. A distribuição pelo estadiamento de Quintero foi: três casos no estádio II, cinco casos no III e dois casos no IV. Em 50% das gestações pelo menos um dos fetos sobreviveu ao período neonatal. Conclusão: o tratamento da STFF no HC-UFPR impactou positivamente a sobrevida dos fetos acometidos. Entretanto, nossos resultados estão aquém dos reportados na literatura, possivelmente pelo demora no referenciamento das pacientes, com intervalo aumentado entre diagnóstico e tratamento.


Subject(s)
Humans , Female , Pregnancy , Twins, Monozygotic , Laser Coagulation/methods , Fetofetal Transfusion/surgery , Fetoscopy , Pregnancy Trimester, Second , Pregnancy Outcome , Survival Analysis , Survival Rate , Retrospective Studies , Gestational Age , Treatment Outcome , Fetofetal Transfusion/mortality , Pregnancy, Twin , Hospitals
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