Recovering records on cancer of the larynx from anonymous health information databases / Recuperação de registros de câncer de laringe de bancos de dados anônimos de saúde

ABSTRACT: Objective: To develop a linkage algorithm to match anonymous death records of cancer of the larynx (ICD-10 C32X), retrieved from the Mortality Information System (SIM) and the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in Brazil. Methodology: Death records containing ICD-10 C32X codes were retrieved from SIM and SIH-SUS, limited to individuals aged 30 years and over, between 2002 and 2012, in the state of São Paulo. The databases were linked using a unique key identifier developed with sociodemographic data shared by both systems. Linkage performance was ascertained by applying the same procedure to similar non-anonymous databases. True pairs were those having the same identification variables. Results: A total of 14,311 eligible death records were found. Most records, 10,674 (74.6%), were exclusive to SIM. Only 1,853 (12.9%) deaths were registered in both systems, representing true pairs. A total of 1,784 (12.5%) cases of laryngeal cancer in the SIH-SUS database were tracked in SIM with different causes of death. The linkage failed to match 167 (9.4%) records due to inconsistencies in the key identifier. Conclusion: The authors found that linking anonymous data from mortality and hospital records is a feasible measure to track missing records and may improve cancer statistics.

RESUMO: Objetivo: Desenvolver um algoritmo de vinculação de registros para parear registros de óbito por câncer de laringe (CID-10 C32X), recuperados do Sistema de Informação de Mortalidade (SIM) e do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) do Brasil. Métodos: Foram filtrados registros de óbitos contendo códigos CID-10 C32X do SIM e do SIH-SUS, de indivíduos de mais de 30 anos, entre 2002 e 2012, no Estado de São Paulo. As bases de dados foram vinculadas por meio de um identificador único e de variáveis sociodemográficas comuns a ambos os sistemas. O desempenho da vinculação de dados foi aferido aplicando-se o mesmo procedimento em bancos de dados nominais. Os pares verdadeiros apresentavam os mesmos valores nas variáveis de identificação. Resultados: Ao todo, 14.311 registros elegíveis de óbito foram encontrados. A maioria dos registros, 10.674 (74.6%), era exclusiva do SIM. Apenas 1.853 (12.9%) óbitos foram registrados em ambos os sistemas, representando pares verdadeiros. Um total de 1.784 (12.5%) casos de câncer de laringe presentes no SIH-SUS constavam com diferentes causas de óbito no SIM. Houve falha na vinculação em 167 (9.4%) registros, devido a inconsistências na chave de identificação. Conclusão: Constatou-se que a vinculação de dados anônimos de registros hospitalares e registros de óbito é viável e pode auxiliar na melhoria de estatísticas de câncer.

Laryngeal Cancer Attributable Factors and the Influence on Survival Rates: A Single Brazilian Institution Experience

Abstract Introduction Epidemiological studies focused on prognostic factors associated with laryngeal cancer in the Brazilian population are poorly reported in the literature. Objective To evaluate the influence of certain risk factors on the survival rates of patients with squamous cell carcinoma (SCC) of the larynx. Methods This retrospective study was conducted on adult patients who were admitted to the outpatient clinic of the head and neck department in a tertiary care hospital. Evaluation of the influence of risk factors on the survival rates of patients registered in the hospital with laryngeal SCC was performed based on age, sex, initial stage, time of evolution, habits, educational levels and relapse and death. Overall survival (OS), disease-free survival (DFS) and clinical-demographic data were analyzed using the Kaplan-Meier method, Log-rank test and Cox regression. Results A total of 107 patients with a mean age of 59.8 years (range 19-81) were included in this study. Stages III and IV were associated with decreased DFS (p = 0.02) and OS (p = 0.02). Smoking patients had a greater period of disease evolution than non-smoking patients (p = 0.003). Alcohol consumption in smokers increased the risk of death by 2.8 (p = 0.002) compared with non-drinking smokers. Male patients presented lower DFS average when compared with female patients (p = 0.04). Conclusion Our study confirms that male gender, smoking habit combined with alcohol consumption, and advanced stages were strongly associated with poor prognosis.

The Incidence of Thyroid Gland Invasion in Patients with Carcinoma of the Larynx who Underwent Total Laryngectomy

@#Introduction: Total thyroidectomy or at least hemithyroidectomy is routinely performed alongside total laryngectomy in patients with advanced carcinoma of the larynx. Life-threatening hypocalcaemia and hypothyroidism are common sequelae especially with adjuvant radiation. The study aims to determine the incidence of microscopic thyroid gland invasion and challenge the idea of routine thyroidectomy in advanced carcinoma of the larynx. Materials and Methods: This study was a retrospective observational study. It was done in two tertiary centres in Malaysia between 2003 and 2013 for a total duration of 11 years. A total of 72 patients were included in this study. Data from medical records, operative notes, and histopathological reports were collected and analysed. Results: Three patients (4.2%) had the presence of microscopic thyroid gland invasion. There were no significant associations between microscopic thyroid gland invasion and tumour subsites, histological types of a tumour nor T staging (p>0.05) Conclusion: The incidence of microscopic thyroid gland invasion in advance carcinoma of the larynx is low, disavowing routine thyroidectomy. Limitations: Some factors such as cartilage invasion on CT imaging and central lymph node treatment were not considered due to limitations in case documentation.

Microcirugía transoral láser en cáncer de laringe: experiencia en el Complejo Asistencial Barros Luco: 2003-2009 / Transoral laser microsurgery of cancer of the larynx: Barros Luco Medical Center: experience 2003-2009

Introducción: El cáncer de laringe es la segunda neoplasia maligna más frecuente en cabeza y cuello, existiendo varias alternativas terapéuticas para su manejo entre las que destaca el uso de láser para los estadios tempranos. Objetivo: Evaluar los resultados oncológicos de los pacientes con diagnóstico de cáncer de laringe que se trataron mediante microcirugía transoral láser en el Hospital Barros Luco. Material y método: Estudio retrospectivo de 30 pacientes operados en el Hospital Barros Luco desde el año 2003 al año 2009. Resultados: Para los pacientes con tumor T1 se obtuvo una sobrevida global (ajustada), control local inicial y final de 100 por ciento. En los pacientes T2 se observó una sobrevida global de 100 por ciento con un control local inicial y final de 81,8 por ciento. Los pacientes T3 también describieron una sobrevida global de 100 por ciento pero sin lograr control local inicial y final en ninguno de los pacientes. Discusión: Los resultados de control oncológico obtenidos en nuestro Servicio para estadios tempranos son similares a lo descrito en la literatura. Conclusiones: La cirugía transoral láser es un procedimiento seguro y con resultados oncológicos aceptables para el manejo de pacientes con patología neoplásica de laringe en estadios tempranos.

Introduction: Laryngeal cancer is the second most common malignancy in head and neck, and there are several treatment options for their management, wherein the use of lasers for early stages. Aim: To evaluate the oncological results of patients with a diagnosis of laringeal cancer, they were treated by transoral laser microsurgery at Hospital Barros Luco. Material and method: Retrospective study of 30 medical records of patients operated at the Barros Luco Hospital from 2003 to 2009. Results: For patients with T1 tumor overall survival (adjusted) initial and final local control of 100 percent was obtained. In T2 patients overall survival was 100 percent with an initial and final local control of 81.8 percent. Patients T3 described a 100 percent overall survival but without achieving local control and final control in none of the patients. Discussion: Cancer control results obtained in our service for early stages are similar to those described in the literature. Conclusions: Transoral laser surgery is a safe procedure with acceptable oncological outcomes in management of patients with neoplastic disease of the larynx in early stages.

Cáncer de laringe en pacientes menores de 40 años / Laryngeal cancer in patients younger than 40 years

Objetivo: describir los datos demográficos de pacientes < 40 años de edad con diagnóstico de cáncer de laringe, y los resultados obtenidos después del tratamiento. Material y métodos: se revisaron los expedientes en forma retrolectiva, de una base de datos de 500 pacientes con cáncer de laringe atendidos entre 1989 y 2004; se incluyeron los pacientes < 40 años de edad al momento del diagnóstico, en quienes se corroboró el diagnóstico de carcinoma epidermoide. Resultados: fueron encontrados 15 pacientes (4.4 % de esta serie): nueve hombres (60 %) y seis mujeres (40 %), con una relación de 1.5:1, respectivamente. El promedio de edad para el grupo fue de 35 años. El tiempo promedio de evolución a la fecha del diagnóstico fue de 14.4 meses. El tabaquismo estuvo presente en 60 % y el alcoholismo en 40 %; la disfonía fue el síntoma cardinal en 87 %. La localización más frecuente fue la glotis (73 %). Los tumores bien diferenciados representaron 53 %. El tratamiento inicial fue cirugía en cuatro (27 %) pacientes y radioterapia en cinco (33 %), con un promedio de 63.44 Gy; un paciente (7 %) fue tratado con quimiorradioterapia concomitante con gemcitabine, cuatro (27 %) con quimioterapia neoadyuvante seguida de radioterapia, y un paciente no recibió tratamiento. El tiempo promedio de recurrencia después del primer tratamiento fue de 19.57 meses; cuatro pacientes fueron catalogados con persistencia. El tiempo promedio de supervivencia fue de 32 meses. La preservación de órgano al final fue de 28.5 %. Conclusiones: el cáncer epidermoide de laringe fue una patología rara en los pacientes < 40 años revisados. La relación de acuerdo con el sexo fue similar, con ligero predominio del masculino. Los factores de riesgo clásicos estuvieron presentes en 60 %. El pronóstico de los pacientes en esta serie estuvo determinado por el estadio clínico inicial.

BACKGROUND: We undertook this study to report demographic data of laryngeal cancer patients <40 years old and treatment results. METHODS: In a retrolective study we reviewed the clinical records of 500 patients with laryngeal cancer in the period from 1989 to 2004 and included those patients<40 years of age. RESULTS: We found 15 patients, representing 4.4% of the series. Nine (60%) were men and six (40%) were women, with a 1.5:1 ratio. Average group age was 35 years (range 21-40 and median of 37 months). Average time of evolution at the time of diagnosis was 14.4 months (range 0-36 and median of 12 months); 60% of the patients were smokers and 40% admitted to drinking alcohol; dysphonia was the main symptom found in 87% of the patients. The most frequent location was the glottis in 11 (73%) patients. Well-differentiated tumors represented 53% of the cases. Initial treatment was surgery in four (27%) patients; radiotherapy in five (33%) patients receiving an average of 63.44 Gy; concomitant chemoradiotherapy in one patient (7%) using gemcitabine; four (27%) patients were treated with neoadjuvant chemotherapy followed by radiotherapy; and one patient did not receive treatment. The average time in which the patients relapsed after the first treatment was 19.57 months (range 2-63) and four were classified as persistent. Survival time was 32 months (range 2-106 and median 27 months). Finally, organ preservation rate was obtained in 28.5%. CONCLUSIONS: Squamous cell carcinoma of the larynx is rare in patients<40 years old in our study. Gender relation seems to be equal, although a slight predominance of men does still exist. Classical risk factors were present in 60% of the cases. Prognosis for these patients was determined by the initial clinical stage.