Survival analysis of myasthenia gravis patients at a Referral Center in Pará, Brazil (2005-2020) / Análise de sobrevivência de pacientes com miastenia ravis em um Centro de Referência no Pará, Brasil (2005-2020)

Objective: To evaluate the profile and survival of patients diagnosed with Myasthenia Gravis, by reviewing medical records of neurological consultations at a referral service in the interior of Pará (Brazil), between 2005 and 2020. Methods: a historical, observational and retrospective cohort study. 36 participants were included. Survival analysis methods were used to identify prognostic factors for disease remission at the observation time of 36 months. The correlation between the variables and the death outcome was performed using the chi-square test. Results: Most patients were women (66.6%) and had the generalized form of the disease (86.1%). The most prevalent symptoms were: ophthalmoparesis (97.2%), fatigability (75%) and dysphagia (72.2%). Among the complications, 19.4% had myasthenic crisis. The dosage of antiacetylcholine receptor (AChR) antibody was positive in 58.3% and 69.4% underwent electroneuromyography, and 72% of them had electrodecrement. Most of the patients responded to the staggered standard treatment and achieved remission (83.3%), while 16.6% died. Survival analysis showed through Kaplan-Meier curves and Log-rank test that the variables related to poor control were male gender (p=0.01), thymus disease (p=0.02) and use of cyclosporine (p=0.02). The factors that influenced the death outcome were male gender, cyclosporine and thymectomy. Conclusion: The study showed that the evolution of people with Myasthenia Gravis over 15 years and the poor prognostic factors were equivalent to the international literature.

Objetivo: Avaliar o perfil e a sobrevida de pacientes com diagnóstico de Miastenia Gravis, por meio da revisão de prontuários de consultas neurológicas em um serviço de referência no interior do Pará (Brasil), entre 2005 e 2020. Métodos: estudo de coorte histórico, observacional e retrospectivo. 36 participantes foram incluídos. Métodos de análise de sobrevivência foram utilizados para identificar fatores prognósticos para remissão da doença no período de observação de 36 meses. A correlação entre as variáveis e o desfecho de óbito foi realizada por meio do teste qui-quadrado. Resultados: A maioria dos pacientes eram mulheres (66,6%) e apresentavam a forma generalizada da doença (86,1%). Os sintomas mais prevalentes foram: oftalmoparesia (97,2%), fadiga (75%) e disfagia (72,2%). Dentre as complicações, 19,4% tiveram crise miastênica. A dosagem do anticorpo anti-receptor de acetilcolina (AChR) foi positiva em 58,3% e 69,4% realizaram eletroneuromiografia, sendo que 72% deles apresentaram eletrodecremento. A maioria dos pacientes respondeu ao tratamento padrão escalonado e obteve remissão (83,3%), enquanto 16,6% morreram. A análise de sobrevivência mostrou através de curvas de Kaplan-Meier e teste Log-rank que as variáveis relacionadas ao mau controle foram sexo masculino (p=0,01), doença do timo (p=0,02) e uso de ciclosporina (p=0,02). Os fatores que influenciaram no desfecho óbito foram sexo masculino, ciclosporina e timectomia. Conclusão: O estudo mostrou que a evolução das pessoas com Miastenia Gravis ao longo de 15 anos e os fatores de mau prognóstico foram equivalentes à literatura internacional.

Characteristics of the out-of-hospital cardiac arrest attended by the medical emergency services in Medellín. A population-based retrospective cohort study / Características del paro cardiaco extrahospitalario atendido por operadores de ambulancias en Medellín. Estudio de cohorte retrospectivo de base poblacional

Abstract Introduction: Every year, five million people around the world experience an out-of-hospital cardiac arrest (OHCA) and less than 40 % receive any assistance before the arrival of the Emergency Medical Services (EMS). Ambulance operators (AO) take care of people experiencing an OHCA, stabilize and then transfer them. In Medellín, Colombia, there is a public AO and several private providers, but the information about an OHCA and the operational characteristics during the response to the event are limited. Objective: To estimate the incidence of OHCA and to explore the factors associated with survival after the event in Medellín city. Methods: Retrospective, population-based cohort study. All the medical records of patients experiencing an OHCA who were assessed and treated by ambulance operators, (AO) of the Emergency Medical Services (EMS) and private agencies in Medellin city were reviewed. Descriptive statistics were used for data analysis and the annual incidence of the event standardized for the general population was estimated. Potential survival-associated factors reported as OR with their corresponding 95% CI were explored. Results: A total of 1,447 patient records with OHCA between 2018 and 2019 were analyzed. The event incidence rate for the number of cases assessed was 28.1 (95 % CI 26.0-30.3) and 26.9 (95 % CI 24.929.1) cases per 100,000 inhabitants/year for 2018 and 2019, respectively; the incidence rate of treated OHCA was 2.6 (95 % CI 2.0-3.3) and 3.2 (95 % CI 2.5-4.0) per 100,000 inhabitants/year, for 2018 and 2019. Survival on arrival at hospitals of treated cases was 14.2 % (95 % CI 5.5-22.8) and 15.5 % (95 % CI 7.4-23.5) for 2018 and 2019, respectively. Conclusions: This study portrays the operating and care characteristics of the population experiencing OHCA in Medellín city. The incidence rate of the event and the survival were lower than those reported in the literature.

Resumen Introducción: Cada año, cinco millones de personas en el mundo presentan paro cardiaco prehospitalario (PCEH), de los cuales menos del 40 % reciben ayuda antes de la llegada de los sistemas de emergencia médica (SEM). Los operadores de ambulancias (OA) atienden a los que sufren un PCEH, su estabilización y posterior traslado. En Medellín, Colombia, existe un OA público y agencias privadas, pero la información acerca del PCEH y las características operacionales durante la respuesta a este evento es escasa. Objetivo: Estimar la incidencia del PCEH y explorar factores asociados a la supervivencia del evento en la ciudad de Medellín. Métodos: Estudio de cohorte retrospectivo de base poblacional. Se revisaron todos los registros médicos de pacientes que presentaron un PCEH que fueron evaluados y tratados por OA del SEM y de agencias privadas de Medellín. Se usaron estadísticos descriptivos para los datos y se estimó la incidencia anual del evento estandarizada para la población general. Se exploraron posibles factores asociados a la supervivencia, reportados como OR con su respectivos IC 95 %. Resultados: Se analizaron 1.447 registros de pacientes con PCEH presentados entre 2018 y 2019. La tasa de incidencia del evento para los casos evaluados fue de 28,1 (IC 95 % 26,0-30,3) y 26,9 (IC 95 % 24,9-29,1) casos por 100.000 habitantes/año, para 2018 y 2019, respectivamente; la tasa de incidencia del PCEH tratado fue de 2,6 (IC 95 % 2,0-3,3) y 3,2 (IC 95 % 2,5-4,0) por 100.000 habitantes/año, para 2018 y 2019. La supervivencia a la llegada a los hospitales de los casos tratados fue 14,2 % (IC 95 % 5,5-22,8) y del 15,5 % (IC 95 % 7,4-23,5) para 2018 y 2019, respectivamente. Conclusiones: Se muestra las características operativas y de atención de la población que presenta un PCEH en Medellín. La tasa de incidencia del evento y la supervivencia fueron menores a las reportadas en la literatura.

Recurrence factors in patients with cutaneous melanoma and positive sentinel lymph node treated in a single reference unit in Buenos Aires / Factores de recurrencia en pacientes con melanoma cu táneo y ganglio centinela positivo

Abstract Introduction : Although therapeutic advances have improved results of cutaneous melanoma (CM), senti nel node-positive patients still have substantial risk to develop recurrent disease. We aim to investigate prog nostic indicators associated with disease recurrence in positive-sentinel lymph node biopsy (SLNB) patients in a Latin-American population. Methods : Retrospective analysis of CM patients and positive-SLNB (2010-2020). Patients were divided into two groups: Group A (completion lymph node dissection, CLND), Group B (active surveillance, AS). Association of demographics, tumor data and SLN features with recurrence-free (RFS), distant metastases-free (DMFS) and melanoma specific (MSS) survival was analyzed. Results : Of 205 patients, 45 had a positive SLNB; 27(60%) belonged to Group A and 18(40%) to Group B. With a median follow-up of 36 months, 16 patients (12 in Group A and 4 in Group B) developed recurrent dis ease and estimated 5-yr RFS at any site was 60% (CI95%, 0.39 - 0.77) (44.5% in CLND group vs. 22% in AS group; P = 0.20). Estimated 5-yr DMFS and MSS: 65% (CI 95%, 0.44 - 0.81) and 73% (CI 95%, 0.59 - 0.89) with no differ ences between groups (p = 0.41 and 0.37, respectively). Independent predictors of poorer MSS were extranodal extension (ENE) and MaxSize > 2 mm of melanoma deposit in SLN. Factors independently associated with DMFS: Breslow depth > 2 mm, ENE, number (≥ 2) of posi tive SN and CLND status. Conclusion : Primary tumor and SN features in mela noma provide important prognostic information that help optimize prognosis and clinical management. AS is now the preferred approach for most positive-SLNB CM patients.

Resumen Introducción : Si bien los avances terapéuticos han permitido mejorar los resultados del melanoma cutáneo (MC), los pacientes con ganglio centinela positivo (BGCP) aún tienen riesgo elevado de desarrollar recurrencia de la enfermedad. Nuestro objetivo fue investigar in dicadores pronósticos asociados a dicho evento en una población latinoamericana. Métodos : Análisis retrospectivo de pacientes con MC y BGCP entre 2010-2020. Los pacientes se dividieron en 2 grupos: Grupo A (linfadenectomía terapéutica) y Grupo B (Vigilancia activa, VA). Se analizaron datos demográficos, tumorales y características del GC junto con sobrevida-libre de recurrencia (SLR), libre de metástasis a distancia (SLMD) y específica de melanoma (SEM). Resultados : De 205 pacientes, 45 presentaron BGCP; 27 (60%) perteneció al Grupo A y 18 (40%) al Grupo B. Con una mediana de seguimiento de 36 meses, 16 pa cientes (12 en Grupo A y 4 en Grupo B) desarrollaron enfermedad recurrente con una SLR a 5 años de 60% (IC95%: 0.39-0.77) (44.5% en Grupo B vs. 22% en Grupo A; P = 0.20). Las SLMD y SEM estimadas a 5 años fueron de 65% (CI 95%, 0.44 - 0.81) y 73% (CI 95%, 0.59 - 0.89) sin diferencias entre ambos grupos (p = 0.41 y 0.37, respec tivamente). Los predictores independientes de peor SEM fueron: extensión extranodal (ENE) y MaxSize > 2mm de depósito tumoral en GC. Los factores asociados de forma independiente con SLMD fueron Breslow >2mm, ENE, número (≥ 2) de GC positivos y el status (positividad) de la linfadenectomía. Conclusión : Características del tumor primario y del GC brindan información importante que ayuda a optimi zar el pronóstico y manejo clínico de los pacientes con MC. La VA es actualmente el abordaje de elección para la mayoría de los pacientes con BGCP.

Complicaciones, clínica y tratamiento de pacientes con hepatocarcinoma, posterior a quimioembolización en dos hospitales de Quito / Complications, symptoms and treatment of patients with hepatocellular carcinoma, after chemoembolization in two hospitals in Quito

INTRODUCCIÓN. La quimioembolización transarterial ha demostrado mejorar la tasa de sobrevida en los pacientes con hepatocarcinoma, se ha descrito como tratamiento paliativo; es útil, efectivo y bien tolerado. Esta terapéutica tiene el objetivo de disminuir el volumen tumoral. OBJETIVO. Determinar las complicaciones que presentan los pacientes con diagnóstico de hepatocarcinoma, posterior a la realización de quimioembolización transarterial del servicio de Gastroenterología del Hospital de Especialidades Carlos Andrade Marín y Hospital de Especialidades Eugenio Espejo, durante el período enero 2015 - enero 2020. MATERIALES Y MÉTODOS. Es un estudio retrospectivo observacional transversal; se diseñó un formulario de recolección de información, utilizando media y desvío estándar para variables cuantitativas; frecuencia y porcentaje para cualitativas; en las variables con distribución no paramétrico se recurrió a la mediana, rango intercuartil y sus intervalos, además se utilizó Chi Cuadrado, Índice de Yates y test de U Mann Whitney. Se trabajó en el paquete estadístico SPSS versión 26. RESULTADOS. Se analizaron 97 pacientes, el 60,8% fue de sexo masculino de los cuales el 56.7% presentó alguna comorbilidad; la mayoría de los pacientes no tuvieron complicaciones, sin embargo, la hipertensión arterial se presentó como manifestación clínica post quimioembolización transarterial (10,3%); el choque, el síndrome ascítico ­ edematoso y el dolor abdominal fueron las complicaciones de mayor frecuencia. Los datos estadísticamente significativos fueron los siguientes: los pacientes con hepatocarcinoma y cirrosis hepática con severidad Child Pugh B, tuvieron un porcentaje mayor de complicaciones valor p = 0,01; un tamaño más grande del tumor sobre el número de lesiones, se relacionó con presentar alguna complicación postquimioembolización transarterial valor p = 0,001, lo que significó un aumento en la estancia hospitalaria valor p = 0,006; los pacientes que presentaron complicaciones mayores y menores tuvieron un tiempo de hospitalización más prolongado valor p < 0,05; la asociación entre la mortalidad y las complicaciones post quimioembolización en hospitalización y en UCI tuvieron una tasa general de 3,2% valor p = 0,001. CONCLUSIÓN. Las complicaciones mayores como el síndrome ascítico edematoso y el estado de choque, se mantuvieron sobre la media general. Con una tasa de mortalidad esperada según la tendencia internacional.

INTRODUCTION: Transarterial chemoembolization has been shown to improve the survival rate in patients with hepatocarcinoma, it has been described as palliative treatment; it is useful, effective and well tolerated. This therapy aims to reduce tumor volume, due to its embolic, vascular and cytotoxic effects. OBJECTIVE: To determine the complications presented by patients diagnosed with hepatocarcinoma, after performing transarterial chemoembolization of the Gastroenterology service of the Carlos Andrade Marín Specialty Hospital and Eugenio Espejo Specialty Hospital, during the period January 2015 - January 2020. METHODOLOGY: This cross-sectional observational study was conducted in patients with hepatocarcinoma who underwent transarterial chemoembolization. A form was designed for the collection of information, through a pseudonymized database, which was analyzed using the statistical package SPSS version 26. RESULTS: 97 patients were analyzed, 60.8% were male, of which 56.7% presented some comorbidity; Most of the patients had no complications, however, arterial hypertension presented as a clinical manifestation after transarterial chemoembolization in 10.3%; shock, ascites edema decompensation and abdominal pain were the most frequent complications. The statistically significant data were the following: patients with hepatocellular carcinoma and liver cirrhosis with Child Pugh B severity had a higher percentage of complications valor p = 0,01; a larger tumor size compared to the number of lesions was related to presenting some post-transarterial chemoembolization complication valor p = 0,001, which meant an increase in hospital stay valor p = 0,006; patients who presented major and minor complications had a longer hospitalization time valor p < 0,05, the association between mortality and post chemoembolization complications in hospitalization and in the ICU had an overall rate of 3.2% valor p = 0,001. CONCLUSION. Major complications, such as edematous ascitic syndrome and shock, remained above the general average. With an expected mortality rate according to the international trend.

Stomach Cancer and Postendoscopy Colorectal Cancer: Parallel Lives / Cáncer gástrico y cáncer colorrectal posendoscopia: vidas paralelas

Abstract Background and objectives: The rates of (interval) stomach cancer (SC) or postendoscopy (PECRC) or postcolonoscopy (PCCRC) colorectal cancer (CRC) have been little studied in our setting. Data from overseas studies reported PECRC and PCCRC rates of 7-26%. We aim to determine and compare local PECRC and PCCRC rates and characteristics. Patients and methods: With data from three quaternary-care cancer centers, we ambispectively identified patients diagnosed with SC and CRC between 2012 and 2021, in whom a history of endoscopies or colonoscopies in the previous three years was investigated. Cancers diagnosed between 6 and 36 months after an endoscopic study reported as normal were defined as interval cancers. This study compares the clinical, endoscopic, and survival characteristics of both PECRC and PCCRC cohorts. Results: Of 828 patients diagnosed with SC, 66 had PECRC (rate: 7.3%), while in 919 patients with CRC, 68 had PCCRC (rate: 6.9%). There were no significant differences in age or sex, although males predominated (2:1) in the PECRC (0.09). The finding of premalignant lesions was similar in both groups (p = 0.260). The anatomical location was shown to be more proximal (right colon) in the PCCRC than in the PECRC (cardia/fundus) (p = 0.002). Gastric neoplasms were more poorly differentiated (58%) than colon neoplasms (26%) (p = 0.001). There were no differences in early cancers, but tumor status was more advanced in PECRC (p < 0.01). The Kaplan-Meier showed a worse survival for PCCRC than for detected CRC, with no differences in SC and PECRC, suggesting poor survival. Conclusions: The rate of interval cancers is 7.3% and 6.9%, and differences were found between PECRC and PCCRC, proximal locations of the lesions, degree of differentiation, tumor status, and poor survival for the PCCRC. Establishing measures to achieve the World Endoscopy Organization's goal of <5% is necessary.

Resumen Antecedentes y objetivos: Las tasas de cáncer gástrico (CG) o cáncer colorrectal (CCR) posendoscopia (CGPE) o poscolonoscopia (CCRPC) (de intervalo) han sido poco estudiadas en nuestro medio. Los datos de estudios en el exterior informaron tasas de CGPE y CCRPC de 7%-26%. Nuestro objetivo fue determinar y comparar las tasas y características del CGPE y CCRPC locales. Pacientes y métodos: Con datos de tres centros oncológicos de cuarto nivel se identificaron, de forma ambispectiva, pacientes diagnosticados con CG y CCR entre 2012 y 2021, en quienes se investigó el antecedente de endoscopias o colonoscopias en los tres años previos. Los cánceres diagnosticados entre 6 y 36 meses después de un estudio endoscópico reportado como normal se definieron como cánceres de intervalo. En este estudio se comparan las características clínicas, endoscópicas y de sobrevida entre ambas cohortes de cánceres posendoscopia y poscolonoscopia. Resultados: De 828 pacientes diagnosticados con CG, 66 tuvieron CGPE (tasa: 7,3%), mientras que en 919 pacientes con CCR, 68 pacientes presentaron CCRPC (tasa: 6,9%). No hubo diferencias significativas en la edad o el sexo, aunque predominó el masculino (2:1) en el CGPE (0,09). El hallazgo de lesiones premalignas fue similar en ambos grupos (p = 0,260). La ubicación anatómica mostró ser más proximal (colon derecho) en el CCRPC que en el CGPE (cardias/fondo) (p = 0,002). Las neoplasias gástricas fueron más mal diferenciadas (58%) que las de colon (26%) (p = 0,001). No hubo diferencias en los cánceres tempranos, pero el estado tumoral fue más avanzado en el CGPE (p < 0,01). El Kaplan-Meier mostró una peor sobrevida para el CCRPC que para el CCR detectado, sin diferencias en el CG y el CGPE, que mostraron una pobre sobrevida. Conclusiones: La tasa de cánceres de intervalo es de 7,3% y 6,9%, y se encontraron diferencias entre los CGPE y el CCRPC, ubicaciones proximales de las lesiones, grado de diferenciación, estado del tumor y una pobre sobrevida para el CCRPC. Se hace necesario establecer medidas para lograr la meta de la Organización Mundial de Endoscopia de <5%.

Liver retransplantation: prognostic scores and results in the state of paraná / Retransplante de fígado: escores prognósticos e resultados no estado do paraná

ABSTRACT BACKGROUND: Hepatic retransplantation is associated with higher morbidity and mortality when compared to primary transplantation. Given the scarcity of organs and the need for efficient allocation, evaluating parameters that can predict post-retransplant survival is crucial. AIMS: This study aimed to analyze prognostic scores and outcomes of hepatic retransplantation. METHODS: Data on primary transplants and retransplants carried out in the state of Paraná in 2019 and 2020 were analyzed. The two groups were compared based on 30-day survival and the main prognostic scores of the donor and recipient, namely Model for End-Stage Liver Disease (MELD), MELD-albumin (MELD-a), Donor MELD (D-MELD), Survival Outcomes Following Liver Transplantation (SOFT), Preallocation Score to Predict Survival Outcomes Following Liver Transplantation (P-SOFT), and Balance of Risk (BAR). RESULTS: A total of 425 primary transplants and 30 retransplants were included in the study. The main etiology of hepatopathy in primary transplantation was ethylism (n=140; 31.0%), and the main reasons for retransplantation were primary graft dysfunction (n=10; 33.3%) and hepatic artery thrombosis (n=8; 26.2%). The 30-day survival rate was higher in primary transplants than in retransplants (80.5% vs. 36.7%, p=0.001). Prognostic scores were higher in retransplants than in primary transplants: MELD 30.6 vs. 20.7 (p=0.001); MELD-a 31.5 vs. 23.5 (p=0.001); D-MELD 1234.4 vs. 834.0 (p=0.034); SOFT 22.3 vs. 8.2 (p=0.001); P-SOFT 22.2 vs. 7.8 (p=0.001); and BAR 15.6 vs. 8.3 (p=0.001). No difference was found in terms of Donor Risk Index (DRI). CONCLUSIONS: Retransplants exhibited lower survival rates at 30 days, as predicted by prognostic scores, but unrelated to the donor's condition.

RESUMO RACIONAL: O retransplante hepático está associado a maior morbimortalidade do que o transplante primário. Dada a escassez de órgãos e a necessidade de alocação eficiente, avaliar parâmetros que possam prever a sobrevida pós-retransmissão é crucial. OBJETIVOS: Analisar os resultados dos retransplantes hepáticos em relação aos principais escores prognósticos. MÉTODOS: Foram analisados os transplantes primários e os retransplantes realizados no Estado do Paraná nos anos de 2019 e 2020. Os dois grupos foram comparados em relação à sobrevida em 30 dias e aos principais escores prognósticos do doador e do receptor: Model for End-Stage Liver Disease (MELD), MELD-albumin (MELD-a), Donor MELD (D-MELD), Survival Outcomes Following Liver Transplantation (SOFT), Preallocation Score to Predict Survival Outcomes Following Liver Transplantation (P-SOFT) e Balance of Risk (BAR). RESULTADOS: Foram incluídos 425 transplantes primários e 30 retransplantes. A principal etiologia da hepatopatia no transplante primário dos pacientes retransplantados foi o etilismo (n=140; 31,0%), e os principais motivos para os retransplantes foram o não funcionamento primário do enxerto (n=10; 33,3%) e a trombose da artéria hepática (n=8; 26,2%). A sobrevida em 30 dias foi maior nos transplantes primários em relação aos retransplantes (80,5% vs 36,7%; p=0,001). Os escores prognósticos foram mais elevados nos retransplantes em relação aos transplantes primários: MELD 30,6 vs 20,7 (p=0,001); MELD-a 31,5 vs 23,5 (p=0,001); D-MELD 1234,4 vs 834,0 (p=0,034); SOFT 22,3 vs 8,2 (p=0,001); P-SOFT 22,2 vs 7,8 (p=0,001); e BAR 15,6 vs 8,3 (p=0,001). Não foi observada diferença em relação ao Índice de Risco do Doador. CONCLUSÕES: Os retransplantes apresentam menor sobrevida em 30 dias, prevista nos escores prognósticos, porém sem relação com a qualidade dos doadores.

O Impacto da Cardiopatia Grave nas Causas de Óbito e Sobrevida após Aposentadoria por Invalidez / The Impact of Severe Heart Disease on Causes of Death and Survival after Disability Retirement

Resumo Fundamento: As doenças não comunicáveis são responsáveis por mortes prematuras e limitações. A aposentadoria por invalidez está associada a condições crônicas, especialmente a doenças cardiovasculares. A II Diretriz Brasileira de Cardiopatia Grave definiu critérios para enquadramento das doenças cardiovasculares. Poucos estudos abordam esse tema em instituições federais. Objetivos: Avaliar sobrevida e causas de óbito de servidores aposentados por invalidez na UFRJ, com ênfase no impacto da cardiopatia grave. Métodos: Estudo de coorte retrospectivo baseado nos registros de aposentadorias e óbitos ao longo de 15 anos. As aposentadorias foram divididas em três grupos: integral por cardiopatia grave, integral por outras doenças e proporcional. As causas de óbito foram obtidas a partir das certidões de óbito. Foram avaliadas taxa de mortalidade, sobrevida e a presença de diagnósticos concordantes entre a aposentadoria e o óbito. Foram utilizados testes qui-quadrado, log-rank, modelos de Cox e curvas de Kaplan-Meier. Significância estatística com intervalo de confiança de 95%, considerando p < 0,05. Resultados: Foram 630 aposentadorias, 368 (51,4%) no sexo feminino, com idade média de idade de 52,9 (DP=7,8) anos, e 169 (26,8%) óbitos. A mortalidade foi maior nos professores (37,0%; p=0,113), na faixa etária entre 65 e 70 anos (48,4%; p=0,004), no sexo masculino (34,0%; p=0,001), e nas aposentadorias integrais por cardiopatia grave (41,5%; p < 0,001). Diagnósticos concordantes entre aposentadoria e óbito foram mais frequentes em professores (74,1%; p=0,026) e nas aposentadorias integrais por cardiopatia grave (72,7%; p < 0,001). Conclusões: O diagnóstico de cardiopatia grave confere maior taxa de mortalidade e menor sobrevida aos aposentados por invalidez, e sua presença em maior frequência nos diagnósticos de aposentadoria e óbito ressalta sua importância neste contexto.

Abstract Background: Noncommunicable diseases contribute to premature deaths and limitations. Disability retirement is linked to chronic conditions, particularly cardiovascular diseases. The II Brazilian Guideline for Severe Heart Disease established criteria for cardiovascular disease classification. However, there is a lack of research in this topic within federal institutions. Objectives: Evaluate the survival and causes of death among disabled retirees at UFRJ, focusing on the impact of severe heart disease. Methods: A retrospective cohort study based on retirement and death records over 15 years. Retirements were categorized into three groups: full retirement due to severe heart disease, full retirement due to other diseases and proportional. Causes of death were obtained from death certificates. Mortality rates, survival and the presence of matching diagnoses between retirement and death were evaluated. Chi-square, log-rank, Cox models, Kaplan-Meier curves were utilized. Statistical significance with a 95% confidence interval, considering p<0.05. Results: There were 630 retirements, 368 (51.4%) in females, with an average age of 52.9 (SD=7.8) years, and 169 (26.8%) deaths. Mortality was higher in professors (37.0%; p=0.113), in the age group between 65 and 70 years (48.4%; p=0.004), in males (34.0%; p=0.001), and in full retirements due to severe heart disease (41.5%; p<0.001). Matching diagnoses between retirement and death were more frequent in professors (74.1%; p=0.026) and in full retirements due to severe heart disease (72.7%; p<0.001). Conclusions: Severe heart disease diagnosis is associated with higher mortality and shorter survival in disabled retirees. Its frequent occurrence in retirement and death diagnoses underscores its significance in this context.

Quimioterapia perioperatória, quimioterapia adjuvante e quimiorradioterapia adjuvante no tratamento cirúrgico do câncer gástrico em um hospital do sistema único de saúde brasileiro / Perioperative chemotherapy, adjuvant chemotherapy and adjuvant chemoradiotherapy in the surgical treatment of gastric cancer in a hospital of the brazilian unified health system

ABSTRACT BACKGROUND: Despite the preference for multimodal treatment for gastric cancer, abandonment of chemotherapy treatment as well as the need for upfront surgery in obstructed patients brings negative impacts on the treatment. The difficulty of accessing treatment in specialized centers in the Brazilian Unified National Health System (SUS) scenario is an aggravating factor. AIMS: To identify advantages, prognostic factors, complications, and neoadjuvant and adjuvant therapies survival in gastric cancer treatment in SUS setting. METHODS: The retrospective study included 81 patients with gastric adenocarcinoma who underwent treatment according to INT0116 trial (adjuvant chemoradiotherapy), CLASSIC trial (adjuvant chemotherapy), FLOT4-AIO trial (perioperative chemotherapy), and surgery with curative intention (R0 resection and D2 lymphadenectomy) in a single cancer center between 2015 and 2020. Individuals with other histological types, gastric stump, esophageal cancer, other treatment protocols, and stage Ia or IV were excluded. RESULTS: Patients were grouped into FLOT4-AIO (26 patients), CLASSIC (25 patients), and INT0116 (30 patients). The average age was 61 years old. More than 60% of patients had pathological stage III. The treatment completion rate was 56%. The pathological complete response rate of the FLOT4-AIO group was 7.7%. Among the prognostic factors that impacted overall survival and disease-free survival were alcoholism, early postoperative complications, and anatomopathological status pN2 and pN3. The 3-year overall survival rate was 64.9%, with the CLASSIC subgroup having the best survival (79.8%). CONCLUSIONS: The treatment strategy for gastric cancer varies according to the need for initial surgery. The CLASSIC subgroup had better overall survival and disease-free survival. The INT0116 regimen also protected against mortality, but not with statistical significance. Although FLOT4-AIO is the preferred treatment, the difficulty in carrying out neoadjuvant treatment in SUS scenario had a negative impact on the results due to the criticality of food intake and worse treatment tolerance.

RESUMO RACIONAL: Apesar da preferência pelo tratamento multimodal para o câncer gástrico, o abandono do tratamento quimioterápico bem como a necessidade de cirurgia "upfront" em pacientes obstruídos traz impactos negativos para o tratamento. A dificuldade de acesso ao tratamento em centros especializados no Sistema Único de Saúde (SUS) é um agravante. OBJETIVOS: Identificar vantagens, fatores prognósticos, complicações e sobrevida de terapias neoadjuvantes e adjuvantes no tratamento do câncer gástrico no cenário do SUS. MÉTODOS: Estudo retrospectivo incluindo 81 pacientes com adenocarcinoma gástrico submetidos a tratamento segundo os protocolos INT0116 (quimiorradioterapia adjuvante), CLASSIC (quimioterapia adjuvante), FLOT4-AIO (quimioterapia perioperatória) e cirurgia com intuito curativo (ressecção R0 e linfadenectomia D2) em um único centro oncológico entre 2015 e 2020. Indivíduos com outros tipos histológicos, coto gástrico, câncer de esôfago, outros protocolos de tratamento e estádio Ia ou IV foram excluídos. RESULTADOS: Os pacientes foram distribuídos em: FLOT4-AIO (26 pacientes), CLASSIC (25 pacientes) e INT0116 (30 pacientes). A média de idade foi 61 anos. Mais de 60% dos pacientes apresentaram estádio III patológico. A taxa de completude do tratamento foi 56%. A taxa de resposta patológica completa do grupo FLOT4-AIO foi 7,7%. Dentre os fatores prognósticos que impactaram a sobrevida global e sobrevida livre de doença tivemos etilismo, complicações pós-operatórias precoces, status anatomopatológico pN2 e pN3. A taxa de sobrevida global em 3 anos foi 64,9% sendo o subgrupo CLASSIC com melhor sobrevida (79,8%). CONCLUSÕES: A estratégia de tratamento do câncer gástrico varia de acordo com a necessidade de cirurgia inicial. O subgrupo CLASSIC apresentou melhor sobrevida global e sobrevida livre de doença. O esquema INT0116 também protegeu contra a mortalidade, mas não com significância estatística. Apesar do FLOT4-AIO ser o tratamento de escolha, a dificuldade na realização da neoadjuvância no âmbito do SUS impactou negativamente nos resultados devido à criticidade da ingesta alimentar e à pior tolerância ao tratamento.

Sobrevida por câncer de laringe em pacientes tratados no Sistema Único de Saúde - SUS, 2002-2010 / Survival rate of laryngeal cancer patients treated in Brazil's Unified Health System - SUS, 2002-2010

Resumo O objetivo do artigo foi analisar a sobrevida de cinco anos em pacientes com câncer de laringe tratados no Sistema Único de Saúde no Brasil e regiões entre janeiro de 2002 e junho de 2010. São escassas as informações relativas à magnitude e sobrevida do câncer de laringe no país, o que dificulta a adoção de estratégias específicas para seu controle. Foi realizado um estudo de coorte retrospectiva a partir da Base Nacional em Oncologia. Estimou-se a probabilidade de sobrevida para o câncer de laringe segundo faixa etária, sexo e regiões/estados brasileiros por meio do método de Kaplan-Meier. O teste de log-rank foi aplicado para avaliar as diferenças na sobrevida, considerando-se o nível de significância de 5%. A sobrevida no Brasil foi estimada em 50,8% (IC95%: 49,9-51,8), sendo menor em pacientes do sexo masculino (49,1%; IC95%: 48,10-50,16); com idade entre 50 e 60 anos (48,4%; IC95%: 46,7-50,0); e para moradores da região Norte (45,5%; IC95%: 39,5-51,3). A variação na sobrevida para o câncer de laringe em relação aos estados e às regiões do país aponta disparidades que podem estar relacionadas à desigualdade de acesso ao diagnóstico e/ou tratamento.

Abstract The scope of this article was to analyze the five-year survival rate among patients with laryngeal cancer treated in the Unified Health System in Brazil and its regions between January 2002 and June 2010. There is still scarce information in Brazil regarding the scale and survival rate of laryngeal cancer patients, which makes it difficult to adopt specific strategies for the control of the condition in the country. A retrospective cohort study based on the National Oncology Database was conducted, and the survival probability rate for laryngeal cancer according to age, sex and Brazilian regions/states was estimated using the Kaplan-Meier method. The log-rank test was used to assess the differences observed, considering a 5% significance level. Survival in Brazil was estimated at 50.8% (95%CI: 49.9%-51.8%), being lower among male patients (49.1%; 95%CI: 48.10%-50.16%); between 50 and 60 years of age (48.4%; 95%CI: 46.7%-50.0%); for residents of the Northern region (45.5%; 95%CI: 39.5%-51.3%). The regional variation in the survival rate for laryngeal cancer in Brazil reveals disparities between Brazilian regions/states that may be linked to inequality of access to diagnosis and/or treatment.

Sobrevida post instalación de gastrostomía: experiencia de un centro terciario / Survival post installation of gastrostomy: experience of a tertiary cente

Introduction: Percutaneous Endoscopic Gastrostomy (PEG) is one of the preferred methods for providing enteral feeding to patients whose oral intake nutrition is not feasible. There is limited evidence regarding post- PEG survival. Our primary objective is to evaluate long-term survival and identify main variables in a cohort of patients with PEG. Methodology: A retrospective study of patients who underwent PEG at Sótero del Río Hos- pital between 2013 and 2020 was conducted. Demographic data, indications for PEG, and time from placement to death, in applicable cases, were evaluated. Specific indications were classified into four groups: Neoplasia, Dementia, Stroke (CVA), and Other neurological causes. Kaplan-Meier curves were plotted to represent survival, and log-rank tests were used. Results: 635 patients were included, 53.5% male, with a median age of 69 years (IQR 55-79). Indications included Neoplasia (11.8%), Dementia (9.8%), Stroke (58.4%), and Other neurological causes (20.0%). The overall survival rate was 36%, with rates of 50.23% at one year and 3.94% at five years, and a median survival of 12 months (IQR 4-28). According to the previous diagnosis, the Other neurological causes group had a higher survival rate (p < 0.001), with a median survival of 16 months (IQR 4-35). Conclusions: PEG is an invasive technique where placement is influenced by multiple variables such as previous diagnosis and patient type. Our study demonstrated a survival rate consistent with the literature, where factors such as age and the type of disease that prompted indication are relevant to consider.

Introducción: La gastrostomía endoscópica percutánea (GEP) es uno de los métodos de elección para brindar alimentación enteral a pacientes que ven afectada su capacidad de nutrición por vía oral. Existe escasa evidencia respecto a la sobrevida post GEP, estudios describen un 40% al año, en relación a la gravedad inherente de la enfermedad de base de los pacientes. Nuestro objetivo principal es evaluar la sobrevida a largo plazo y cuáles serían las principales variables que podrían influir, en una cohorte de pacientes con GEP. Metodología: Estudio retrospectivo de pacientes a quienes se les instaló una GEP en el Hospital Sótero del Río, entre los años 2013- 2020. Se evaluaron datos demográficos, indicación de la GEP y tiempo transcurrido desde la instalación hasta el fallecimiento, en los casos correspondientes. Las indicaciones específicas fueron clasificadas en cuatro grandes grupos: Neoplasia, Demencia, Accidente Cerebrovascular (ACV) y Otras causas neurológicas. Se trazaron curvas de Kaplan-Meier para representar la supervivencia y se utilizaron pruebas de log-rank test. En el análisis estadísti- co se utilizó SPSS versión 25. Resultados: Se incluyeron 635 pacientes, 53,5% sexo masculino, con una mediana de edad 69 años (RIQ 55-79). Dentro las indicaciones: Neoplasia (11,8%), Demencia (9,8%), ACV (58,4%) y Otras causas neurológicas (20,0%). La tasa de sobrevida global fue del 36%, siendo al año 50,23 % y a los 5 años 3,94%; con una mediana de sobrevida de 12 meses (RIQ 4-28). Según diagnóstico previo, el grupo Otras causas neurológicos tuvo una mayor sobrevida (p < 0,001), con una mediana de 16 meses (RIQ 4-35). Conclusiones: La GEP es una técnica invasiva donde su instalación responde a múltiples variables como diagnóstico previo y tipo de paciente. Nuestro trabajo demostró una tasa de supervivencia acorde con la literatura, donde los factores como la edad y el tipo de enfermedad que originó indicación son relevantes a considerar.

Retrospective analysis of the efficacy and survival associated with cTACE and DEB-TACE in the palliative treatment of hepatocellular carcinoma: experience of a tertiary care hospital in southern Brazil / Análise retrospectiva da eficácia e sobrevida associadas a cTACE e DEB-TACE no tratamento paliativo do carcinoma hepatocelular: experiência de um hospital de cuidado terciário no sul do Brasil

Abstract Objective: To compare conventional transarterial chemoembolization (cTACE) and drug-eluting bead TACE (DEB-TACE) in terms of efficacy, survival, and adverse effects in patients with hepatocellular carcinoma who are not candidates for curative therapy. Materials and Methods: This was a retrospective study of patients with hepatocellular carcinoma who underwent cTACE or DEB-TACE for palliative treatment between January 2009 and December 2021. The Kaplan-Meier method was used for survival analysis. Values of p < 0.05 were considered statistically significant. Results: We evaluated 268 patients, of whom 70 underwent DEB-TACE and 198 underwent cTACE. There was no significant difference between the groups regarding sex, age, or etiology of cirrhosis. The proportion of patients achieving a complete response on imaging examinations was higher in the cTACE group (31.8% vs. 16.1%), whereas that of patients achieving a partial response was higher in the DEB-TACE group (33.9% vs.19.7%), and the differences were significant (p = 0.014). The mortality rate was similar between the groups. The survival rate in the DEB-TACE and cTACE groups, respectively, was 87.0% and 87.9% at one year, 35.1% and 32.9% at three years, and 20.5% and 18.1% at five years (p = 0.661). There was no significant difference between the DEB-TACE and cTACE groups in terms of the frequency of adverse events (7.1% vs. 17.8%; p = 0.052). The most common complication in both groups was post-embolization syndrome. Conclusion: Although a complete response was more common among the patients who underwent cTACE, there was no difference in survival between the groups and the frequency of adverse events was similar.

Resumo Objetivo: Comparar a eficácia, sobrevida e efeitos adversos entre cTACE e DEB-TACE em pacientes com carcinoma hepatocelular não candidatos a terapia curativa. Materiais e Métodos: Estudo retrospectivo de pacientes com carcinoma hepatocelular submetidos a cTACE ou DEB-TACE para tratamento paliativo entre janeiro de 2009 e dezembro de 2021. Foi utilizado o método Kaplan-Meier para análise de sobrevida. Valor de p < 0,05 foi considerado estatisticamente significante. Resultados: Foram avaliados 268 pacientes, dos quais 70 foram submetidos a DEB-TACE e 198 foram submetidos a cTACE. Não houve diferença em relação ao sexo, idade e etiologia da cirrose. O grupo cTACE apresentou maior porcentual de resposta completa em exames de imagem (31,8% vs. 16,1%) e o grupo DEB-TACE apresentou maior porcentual de resposta parcial (33,9% vs.19,7%), com valor de p = 0,014. A mortalidade foi semelhante. As taxas de sobrevivência para os grupos DEB-TACE e cTACE foram 87,0% e 87,9% em um ano, 35,1% e 32,9% em três anos e 20,5% e 18,1% em cinco anos, respectivamente (p = 0,661). Em relação à frequência de eventos adversos, não houve diferença significativa entre os grupos (7,1% na DEB-TACE vs. 17,8% na cTACE; p = 0,052). A complicação mais comum, em ambos os grupos, foi a síndrome pós-embolização. Conclusão: Embora tenha sido observada maior frequência de resposta completa em pacientes submetidos a cTACE, não houve diferença na sobrevida dos pacientes entre os grupos. A taxa de eventos adversos também foi semelhante.

Mortality trends and sociodemographic factors associated with early death in sickle cell disease patients in the state of São Paulo / Tendência da mortalidade e fatores sociodemográficos associados à morte precoce em pacientes com doença falciforme no estado de São Paulo

ABSTRACT Objective: To estimate trends in mortality rate and average age of death, and identify sociodemographic factors associated with early death in patients with sickle cell disease (SCD). Methods: An ecological and cross-sectional study was conducted using data from the Mortality Information System. All deaths of patients residing in the state of São Paulo from 1996 to 2015 with at least one International Disease Code for SCD in any field of the death certificate were included. Simple linear regression was used to estimate trends. The Log-rank test and multiple Cox regression were used to identify factors associated with early death. Results: The age-standardized mortality rate per million inhabitants increased by 0.080 per year (R2=0.761; p<0.001). When the events were stratified by age at death, the increase was 0.108 per year for those occurring at age 20 years or older, (R2=0.789; p<0.001) and 0.023 per year for those occurring before age 20 years old (R2=0.188; p=0.056). The average age at death increased by 0.617 years (7.4 months) per year (R2=0.835; p<0.001). Sociodemographic factors associated with early death identified were male gender (hazard ratio — HR=1.30), white race (HR=1.16), death occurring in the hospital (HR=1.29), and living in the Greater São Paulo (HR=1.13). Conclusions: The mortality rate and the average age of death in patients with SCD have increased over the last two decades. Sociodemographic factors such as gender, race, place of occurrence, and residence were found to be associated with early death.

RESUMO Objetivo: Estimar as tendências da taxa de mortalidade e da idade média de morte e identificar os fatores sociodemográficos associados ao óbito precoce em pacientes com doença falciforme (DF). Métodos: Estudo ecológico e transversal realizado com dados do Sistema de Informações sobre Mortalidade. Foram incluídos todos os eventos de óbitos de pacientes residentes no estado de São Paulo de 1996 a 2015, que continham pelo menos um Código Internacional de Doenças para DF, em qualquer campo do atestado de óbito. As tendências foram estimadas por meio da regressão linear simples. Para a identificação dos fatores associados ao óbito precoce, foram realizadas análises de sobrevida, por meio da regressão de Cox simples e múltipla. Resultados: A taxa de mortalidade, padronizada pela idade, por milhão de habitantes, aumentou 0,080 ao ano (R²=0,761; p<0,001). Quando os eventos foram estratificados por idade do óbito, naqueles que ocorreram com 20 anos ou mais, o aumento foi de 0,108 ao ano (R²=0,789; p<0,001) e, nos que ocorreram antes de 20 anos, foi de 0,023 ao ano (R²=0,188; p=0,056). A idade média ao morrer aumentou 0,617 ano por ano (R²=0,835; p<0,001). Os fatores associados ao óbito precoce identificados no modelo múltiplo foram: sexo masculino (hazard ratio — HR=1,30), raça branca (HR=1,16), morte dentro do hospital (HR=1,29) e moradia na Grande São Paulo (HR=1,13). Conclusões: Houve aumento da taxa de mortalidade e da idade média de óbito com DF nas duas últimas décadas estudadas. Os fatores sociodemográficos sexo, raça, local de ocorrência e município de residência estiveram associados com a faixa etária do óbito.

Sobrevida del cáncer glótico en estadio inicial en 4 centros hospitalarios de Uruguay / Survival of glottic cancer in the initial stage in 4 hospital centers in Uruguay / Sobrevivência de câncer glótico em estágio inicial em 4 hospitais uruguaios

Introducción: El cáncer de laringe es el tumor maligno de mayor prevalencia en la Otorrinolaringología. La topografía glótica es la más frecuente en Uruguay y suele detectarse en estadios tempranos dada la manifestación precoz y sostenida de disfonía. El objetivo de este estudio es describir la sobrevida libre de enfermedad (SLE) y la sobrevida global (SG) de los pacientes con cáncer de laringe glótico en estadio T1N0M0 en 4 instituciones de Montevideo. Metodología: Se analizó de forma retrospectiva la SG y SLE de 55 pacientes diagnosticados con cáncer de glotis T1 entre los años 2009 y 2019. Para el cálculo de la sobrevida se utilizó el método de Kaplan-Meier. Se estudió además el efecto de variables pronósticas de interés sobre la SG mediante análisis univariado y multivariado. Resultados: En la muestra analizada la SG de los pacientes con cáncer glótico T1N0M0 fue como media de 7.706 años (IC 95% 6.63 - 8.78). A los 5 años, la SG fue de 77.5% (± 7%) y de 62% (± 9.8%) a los 10 años. La SLE para todos los pacientes correspondió al 74.6% (± 7.5%) y 63.1% (± 9.8%), a 5 y 10 años respectivamente. No se alcanzaron las medianas de SG ni de SLE para los grupos. Conclusiones: Los valores de SG y SLE medios obtenidos en nuestro medio son comparables a los valores reportados en la bibliografía internacional. No se alcanzó la mediana de SG ni de SLE, por lo que se puede afirmar que ésta enfermedad tiene, cuando se realiza el tratamiento adecuado, un buen pronóstico vital a los 10 años. Se requiere un seguimiento más largo para determinar las medianas de SG y SLE de los grupos en estudio.

Introduction: Laryngeal cancer is the most prevalent malignant tumor in Otorhinolaryngology. Glottic topography is the most frequent in Uruguay and is usually detected in early stages given the early and sustained manifestation of dysphonia. The objective of this study is to analyze disease-free survival (DFS) and overall survival (OS) of patients with stage T1N0M0 glottic laryngeal cancer at 4 institutions in Montevideo. Methodology: The mean OS and DFS of 55 patients diagnosed with T1 glottic cancer between 2009 and 2019 were retrospectively analyzed. Kaplan-Meier method was used to calculate survival. The prognostic effect of certain variables of interest on OS was also studied using univariate and multivariate analysis. Results: In this study, mean odds survival (OS) for T1N0M0 glottic cancer was 7.706 years (CI 95% 6.63 - 8.78). At 5 years, OS was 77.5% (± 7%) and at 10 years was 62% (± 9.8%). Disease free survival (DFS) was 74.6% ± (7.5%) at 5 years and 63.1% (± 9.8%), at 10 years. Median OS and DFS for the groups were not reached. Conclusions: OS and DFS in our medium is comparable to that reported in the international literature. The median OS and DFS were not reached, so it can be stated that this disease has, when appropriate treatment is performed, a good vital prognosis at 10 years. Longer follow-up is required to determine the median OS and DFS of the study groups.

Introdução: O câncer de laringe é o tumor maligno mais prevalente na Otorrinolaringologia. A topografia glótica é a mais frequente no Uruguai e geralmente é detectada em estágios iniciais devido à manifestação precoce e sustentada da disfonia. O objetivo deste estudo é analisar a sobrevida livre de doença (DFS) e a sobrevida global (OS) de pacientes com câncer de laringe glótico estágio T1N0M0 em 4 instituições em Montevidéu. Metodologia: Foram analisados retrospectivamente o OS e DFS de 55 pacientes diagnosticados com câncer glótico T1 entre 2009 e 2019. O método de Kaplan-Meier foi usado para calcular a sobrevida. Resultados: Na amostra, a sobrevida global (OS) do câncer glótico T1N0M0 foi em média de 7.706 anos (IC 95% 6,63 - 8,78). Aos 5 anos, a OS foi de 77,5% (± 7%) e 62% (± 9,8%) aos 10 anos. A DFS para todos os pacientes correspondeu a 74,6% (± 7,5%) e 63,1% (± 9,8%), aos 5 e 10 anos, respectivamente. As medianas de OS e DFS para os grupos não foram alcançadas. Conclusões: OS e DFS em nosso ambiente é comparável ao relatado na literatura internacional. As medianas de SG e SLD não foram alcançadas, pelo que se pode afirmar que esta doença apresenta, quando realizado tratamento adequado, um bom prognóstico vital aos 10 anos. É necessário um acompanhamento mais longo para determinar a mediana da SG e da SLD dos grupos de estudo.

Individual and contextual factors associated with the survival of patients with severe acute respiratory syndrome by COVID-19 in Brazil / Fatores individuais e contextuais associados à sobrevida de pacientes com síndrome respiratória aguda grave por COVID-19 no Brasil

ABSTRACT Objective: To analyze the influence of individual and contextual factors of the hospital and the municipality of care on the survival of patients with Severe Acute Respiratory Syndrome due to COVID-19. Methods: Hospital cohort study with data from 159,948 adults and elderly with Severe Acute Respiratory Syndrome due to COVID-19 hospitalized from January 1 to December 31, 2022 and reported in the Influenza Epidemiological Surveillance Information System. The contextual variables were related to the structure, professionals and equipment of the hospital establishments and socioeconomic and health indicators of the municipalities. The outcome was hospital survival up to 90 days. Survival tree and Kaplan-Meier curves were used for survival analysis. Results: Hospital lethality was 30.4%. Elderly patients who underwent invasive mechanical ventilation and were hospitalized in cities with low tax collection rates had lower survival rates compared to other groups identified in the survival tree (p<0.001). Conclusion: The study indicated the interaction of contextual factors with the individual ones, and it shows that hospital and municipal characteristics increase the risk of death, highlighting the attention to the organization, operation, and performance of the hospital network.

RESUMO Objetivo: Analisar a influência dos fatores individuais e contextuais do hospital e do município de assistência sobre a sobrevida de pacientes com Síndrome Respiratória Aguda Grave por COVID-19. Métodos: Estudo de coorte hospitalar com dados de 159.948 adultos e idosos com Síndrome Respiratória Aguda Grave por COVID-19 internados de 01 de janeiro a 31 de dezembro de 2022 e notificados no Sistema de Informação de Vigilância Epidemiológica da Influenza. As variáveis contextuais foram relacionadas à estrutura, aos profissionais e equipamentos dos estabelecimentos hospitalares e indicadores socioeconômicos e de saúde dos municípios. O desfecho foi a sobrevida hospitalar em até 90 dias. Árvore de sobrevida e curvas de Kaplan-Meier foram utilizados para analisar a sobrevida. Resultados: A letalidade hospitalar foi de 30,4%. Idosos submetidos à ventilação mecânica invasiva e internados em cidades com baixo percentual de arrecadação de impostos apresentaram menor sobrevida quando comparados aos demais grupos identificados na árvore de sobrevida (p<0,001). Conclusão: O estudo indicou a interação de fatores contextuais com os individuais, e evidencia que características hospitalares e dos municípios aumentam o risco de óbito, destacando a atenção à organização, ao funcionamento e desempenho da rede hospitalar.

Survival analysis of Chagas disease patients, beneficiaries of social security and social assistance in Brazil, 1942-2016 / Análise de sobrevida de portadores da doença de Chagas, beneficiários da previdência e da assistência social no Brasil, 1942-2016

ABSTRACT Objective To analyze the survival of patients with Chagas disease, beneficiaries of social security and social assistance, in Brazil, from 1942 to 2016. Methods This is a retrospective cohort study with data from the Brazilian Ministry of Social Security. The event of interest was death, and the survival functions were estimated by the Kaplan-Meier and Cox regression methods. Results In the period "onset of the disease until death", women (HR=0.54; 95%CI 0.43-0.53) and receiving social security benefits (HR=0.13; 95%CI 0.11-0.23) were associated with longer survival. Lower survival was associated with the cardiac form of the disease (HR=2.64; 95%CI 2.23-3.12), living in a rural area (HR=1.23; 95%CI 1.14-1.21), and manifestation of the disease between the years 2000 and 2016 (HR=5.32; 95%CI 4.74-5.93). Likewise, in the period "work disability until death", women (HR=0.51; 95%CI 0.41-0.52) and receiving social security benefits (HR=0.24; 95%CI 0,14-0.45) were associated with longer survival, as well as the cardiac form of the disease (HR=1.95; 95%CI 1.83-2.13), living in a rural area (HR=1.31; 95%CI 1.21-1.54), and manifestation of the disease between 2000 and 2016 (HR=1.53; 95%CI 1.33-1.71) were associated with lower survival. Conclusion The main predictors of mortality and survival of patients with Chagas disease who receive social security and assistance benefits in Brazil were presented. These findings can guide the definition of priorities for follow-up actions by Primary Health Care, currently recommended for the longitudinal management of the disease.

RESUMO Objetivo Analisar a sobrevida de portadores da doença de Chagas, beneficiários da previdência e da assistência social no Brasil, 1942-2016. Métodos Estudo de coorte retrospectivo com dados do Ministério da Previdência Social. O evento de interesse foi o óbito, e as funções de sobrevida foram estimadas pelos métodos Kaplan-Meier e de regressão de Cox. Resultados No período "início da doença até o óbito", o sexo feminino (HR=0,54; IC95% 0,43-0,53) e recebimento de benefícios previdenciários (HR=0,13; IC95% 0,11-0,23) foram associados a maior sobrevida. A menor sobrevida esteve associada à forma cardíaca da doença (HR=2,64; IC95% 2,23-3,12), residência em zona rural (HR=1,23; IC95% 1,14-1,21) e manifestação da doença entre os anos de 2000 e 2016 (HR=5,32; IC95% 4,74-5,93). Da mesma forma, no período "incapacidade laboral até o óbito", o sexo feminino (HR=0,51; IC95% 0,41-0,52) e o recebimento de benefícios previdenciários (HR=0,24; IC95% 0,14-0,45) foram associados a maior sobrevida, assim como forma cardíaca da doença (HR=1,95; IC95% 1,83-2,13), residência em zona rural (HR=1,31; IC95% 1,21-1,54) e manifestação da doença entre os anos de 2000 e 2016 (HR=1,53; IC95% 1,33-1,71) associaram-se a menor sobrevida. Conclusão Os principais preditores de mortalidade e sobrevida de portadores de doença de Chagas que recebem benefícios previdenciários e assistenciais no Brasil foram apresentados. Estes achados podem nortear a definição de prioridades de ações de acompanhamento pela atenção primária à saúde, preconizada atualmente para o manejo longitudinal da doença.

Características clínico- patológicas y evolución del cáncer de mama en pacientes asistidas en la Unidad de Mastología del Hospital de Clínicas

Introducción: En Uruguay el cáncer de mama (CM) ocupa el primer lugar en incidencia y mortalidad por cáncer en la mujer, se trata de una enfermedad multifactorial que guarda relación con la herencia genética, historial hormonal estrogénico, estilo de vida, factores ambientales y culturales. Objetivos: investigar las características clínico-patológicas de pacientes con CM diagnosticadas en el Hospital de Clínicas y evaluar la sobrevida global total (SVG) y de acuerdo al subtipo biológico. Metodología: se recolectaron datos relacionados con las características clínico-patológicas y la evolución de pacientes tratadas por CM en el período comprendido entre el 1º de enero del 2011 y 31 de diciembre de 2020 asistidas en la Unidad de Mastología del Hospital de Clínicas. Se calculó la SVG para todas las pacientes, globalmente, y según el subtipo biológico. Resultados: se incluyeron 390 pacientes. Las características clínico-patológicas fueron: carcinoma ductal: 83%, estadio: in situ (1.8 %), I (27.7 %), II (29.7 %), III (23.6%), IV (12.6 %). Con respecto al perfil biológico: 235 tumores (60.3%) fueron RRHH+ HER 2−, 88 tumores (22.6%) fueron HER2 +, mientras que otros 41 tumores (10.5%) fueron clasificados como triple negativos (TN). La SVG para la totalidad de las pacientes tuvo una mediana de 92 meses. Las tasas de SVG a 2 y 5 años fueron para las luminales de 92% y 64%; en las TN la tasa de SVG a 24 meses fue de 69%, siendo a 5 años de 53.3% y en las HER2 + 76.6% y 67.3% respectivamente. Conclusiones: La mayoría de los tumores fueron diagnosticados en estadios precoces, siendo estos datos son concordantes con los reportados en estudios realizados a nivel nacional. La frecuencia de tumores RE/RP+ algo inferior a la reportada en estudios previos (70%) a nivel nacional, mientras que la de tumores HER 2 + TN fue similar a la reportada en estudios europeos, norteamericanos y en Latinoamérica donde se la prevalencia encontrada es del 20%

Introduction: In Uruguay, breast cancer (BC) ranks first in incidence and mortality from cancer in women. It is a multifactorial disease that is related to genetic inheritance, estrogenic hormonal history, lifestyle, environmental and cultural factors. Objectives: to investigate the clinicopathological characteristics of patients with BC diagnosed at the Hospital de Clínicas and to evaluate the overall overall survival (SVG) and according to the biological subtype. Metodology: data related to the clinicopathological characteristics and the evolution of patients treated for BC in the period between January 1, 2011 and December 31, 2020 assisted in the Mastology Unit of the Hospital de Clínicas were collected. Overall survival (SVG) was calculated for all patients, globally, and according to biological subtype. Results: 390 patients were included. The clinicopathological characteristics were: ductal carcinoma: 83%, stage: in situ (1.8%), I (27.7%), II (29.7%), III (23.6%), IV (12.6%). Regarding the biological profile: 235 tumors (60.3%) were HR+ HER 2−, 88 tumors (22.6%) were HER2 +, while another 41 tumors (10.5%) were classified as triple negative (TN). The SVG for all the patients had a median of 92 months. SVG rates at 2 and 5 years were 92% and 64% for luminals; in TN the 24-month survival rate was 69%, being 53.3% at 5 years and in HER2 + 76.6% and 67.3% respectively. Conclusions: Most of the tumors were diagnosed in early stages, these data being consistent with those reported in studies carried out at the national level. The frequency of ER/RP+ tumors was somewhat lower than that reported in previous studies (70%) at the national level, while that of HER 2 + TN tumors was similar to that reported in European, North American and Latin American studies where the prevalence found is 20%

Introdução: No Uruguai, o câncer de mama (CM) ocupa o primeiro lugar em incidência e mortalidade por câncer em mulheres. É uma doença multifatorial que está relacionada à herança genética, história hormonal estrogênica, estilo de vida, fatores ambientais e culturais. Objetivos: investigar as características clinicopatológicas dos pacientes com CM diagnosticados no Hospital de Clínicas e avaliar a sobrevida global (OSV) e segundo o subtipo biológico. Material e método: foram coletados dados referentes às características clínico-patológicas e à evolução dos pacientes atendidos por CM no período de 1º de janeiro de 2011 a 31 de dezembro de 2020 atendidos na Unidade de Mastologia do Hospital de Clínicas. A sobrevida global (SVG) foi calculada para todos os pacientes, globalmente e de acordo com o subtipo biológico. Resultados: 390 pacientes foram incluídos. As características clínico-patológicas foram: carcinoma ductal: 83%, estádio: in situ (1,8%), I (27,7%), II (29,7%), III (23,6%), IV (12,6%). Quanto ao perfil biológico: 235 tumores (60,3%) eram HR+ HER 2−, 88 tumores (22,6%) eram HER2+, enquanto outros 41 tumores (10,5%) foram classificados como triplo negativo (TN). O SVG para todos os pacientes teve uma mediana de 92 meses. As taxas de SVG aos 2 e 5 anos foram de 92% e 64% para luminais; em TN a sobrevida em 24 meses foi de 69%, sendo 53,3% em 5 anos e em HER2 + 76,6% e 67,3%, respectivamente. Conclusões: A maioria dos tumores foi diagnosticada em estágios iniciais, sendo esses dados consistentes com os relatados em estudos realizados em nível nacional. A frequência de tumores ER/RP+ foi um pouco menor do que a relatada em estudos anteriores (70%) em nível nacional, enquanto a de tumores HER 2 + TN foi semelhante à relatada em estudos europeus, norte-americanos e latino-americanos, onde a prevalência encontrado é 20%

Desempenho do Escore SHARPEN e do Índice de Comorbidade de Charlson para Predição de Mortalidade durante a Internação Hospitalar e após a Alta na Endocardite Infecciosa / Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis

Resumo Fundamento O SHARPEN foi o primeiro escore desenvolvido especificamente para a predição de mortalidade hospitalar em pacientes com endocardite infecciosa (EI), independentemente da realização de cirurgia cardíaca. Objetivos Analisar a capacidade do escore SHARPEN na predição de mortalidade hospitalar e mortalidade após a alta e compará-la à do Índice de Comorbidade de Charlson (ICC). Métodos Estudo retrospectivo do tipo coorte incluindo internações por EI (segundo os critérios de Duke modificados) entre 2000 e 2016. A área sob a curva ROC (AUC-ROC) foi calculada para avaliar a capacidade preditiva. Curvas de Kaplan-Meier e regressão de Cox foram realizadas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados Estudamos 179 internações hospitalares. A mortalidade hospitalar foi 22,3%; 68 (38,0%) foram submetidos à cirurgia cardíaca. Os escores SHARPEN e ICC (mediana e intervalo interquartil) foram, respectivamente, 9(7-11) e 3(2-6). O escore SHARPEN mostrou melhor predição de mortalidade hospitalar em comparação ao ICC nos pacientes não operados (AUC-ROC 0,77 vs. 0,62, p = 0,003); não foi observada diferença no grupo total (p=0,26) ou nos pacientes operados (p=0,41). Escore SHARPEN >10 na admissão foi associado a uma menor sobrevida hospitalar no grupo total (HR 3,87; p < 0,001), nos pacientes não operados (HR 3,46; p = 0,006) e de pacientes operados (HR 6,86; p < 0,001) patients. ICC > 3 na admissão foi associada a pior sobrevida hospitalar nos grupos total (HR 3,0; p = 0,002), de pacientes operados (HR 5,57; p = 0,005), mas não nos pacientes não operados (HR 2,13; p = 0,119). A sobrevida após a alta foi pior nos pacientes com SHARPEN > 10 (HR 3,11; p < 0,001) e ICC > 3 (HR 2,63; p < 0,001) na internação; contudo, não houve diferença na capacidade preditiva entre esses grupos. Conclusão O SHARPEN escore foi superior ao ICC na predição de mortalidade hospitalar nos pacientes não operados. Não houve diferença entre os escores quanto à mortalidade após a alta.

Abstract Background SHARPEN was the first dedicated score for in-hospital mortality prediction in infective endocarditis (IE) regardless of cardiac surgery. Objectives To analyze the ability of the SHARPEN score to predict in-hospital and post-discharge mortality and compare it with that of the Charlson comorbidity index (CCI). Methods Retrospective cohort study including definite IE (Duke modified criteria) admissions from 2000 to 2016. The area under the ROC curve (AUC-ROC) was calculated to assess predictive ability. Kaplan-Meier curves and Cox regression was performed. P-value < 0.05 was considered statistically significant. Results We studied 179 hospital admissions. In-hospital mortality was 22.3%; 68 (38.0%) had cardiac surgery. Median (interquartile range, IQR) SHARPEN and CCI scores were 9(7-11) and 3(2-6), respectively. SHARPEN had better in-hospital mortality prediction than CCI in non-operated patients (AUC-ROC 0.77 vs. 0.62, p = 0.003); there was no difference in overall (p = 0.26) and in operated patients (p = 0.41). SHARPEN > 10 at admission was associated with decreased in-hospital survival in the overall (HR 3.87; p < 0.001), in non-operated (HR 3.46; p = 0.006) and operated (HR 6.86; p < 0.001) patients. CCI > 3 at admission was associated with worse in-hospital survival in the overall (HR 3.0; p = 0.002), and in operated patients (HR 5.57; p = 0.005), but not in non-operated patients (HR 2.13; p = 0.119). Post-discharge survival was worse in patients with SHARPEN > 10 (HR 3.11; p < 0.001) and CCI > 3 (HR 2.63; p < 0.001) at admission; however, there was no difference in predictive ability between these groups. Conclusion SHARPEN was superior to CCI in predicting in-hospital mortality in non-operated patients. There was no difference between the scores regarding post-discharge mortality.

Factores asociados a mayor sobrevida en pacientes con cáncer de páncreas tratados mediante pancreatoduodenectomía. Estudio de casos y controles

Introducción: El cáncer de páncreas (CP) tiene un pronóstico ominoso a pesar de los avances en técnica quirúrgica y en los cuidados peri/postoperatorios. Nuestro objetivo fue identificar factores asociados a mayor sobrevida en pacientes con CP tratados mediante pancreatoduodenectomía (PD). Material y Método: Estudio de casos y controles de pacientes con CP tratados mediante PD en el Hospital Clínico de la Universidad Católica entre 2002-2015. Se definió como caso al paciente con sobrevida ≥ 3 años y como control a aquel con sobrevida inferior a ese plazo. Se comparó entre casos y controles datos biodemográficos, clínicos, histopatológicos, de morbilidad y mortalidad mediante regresión logística. Resultados: Se analizaron 70 pacientes, con una edad media de 62 ± 11 años; 40 (57%) mujeres. Hubo morbilidad en 26 enfermos (37,1%); Clavien-Dindo ≥ Illa en 8 (11,4%). La mediana (rango) de días de hospitalización fue 12 (7-84). La sobrevida actuarial a 1, 3 y 5 años fue 77%, 32% y 22% respectivamente. Se identificaron 21 casos (30%) y 49 controles (70%). En el análisis univariable, la resección R0, los ganglios regionales negativos, la ausencia de infiltración perineural, los estadios más precoces (IA, IB y IIA) y la ausencia de diabetes mellitus (DM2) al momento del diagnóstico, fueron variables asociadas a sobrevida ≥ 3 años (p 100 U/mL) y los tratamientos complementarios no se asociaron a diferencias significativas en sobrevida. En el análisis multivariable, se identificó la ausencia de DM2 (OR ajustado: 12; IC95% 1,7-84,3), la ausencia de infiltración perineural (OR ajustado: 7; IC95% 1,3-36,3) y los estadios precoces IA, IB y IIA (OR ajustado: 10,3; IC95% 2,1-49,1) como los factores independientes asociados a sobrevida mayor a 3 años. Conclusión: Los pacientes no diabéticos, con etapas precoces del CP sin infiltración perineural, resecados R0 mediante PD pueden obtener una sobrevida mayor a 3 años.

Introduction: Pancreatic cancer (PC) remains one of the most lethal malignancies, despite developments in surgical and non-surgical therapies. Significant improvements in long-term survival have not been achieved. Only radical surgical resection has obtained a moderate extension in survival. We aim to identify factors associated with longer survival in patients with PC treated by pancreatoduodenectomy (PD). Material and Method: We designed a case-control study of patients with PC treated by PD in our center between 2002-2015. We compare patients who survived ≥ 3 years (case) with those not achieving it (control). Bio-demographic, clinical, histopathological, morbidity and mortality data were compared between cases and controls using logistic regression. Results: Seventy patients were analyzed; mean age 62 ± 11 years; 40 (57%) women. Morbidity was found in 26 patients (37.1%); Clavien-Dindo ≥ Illa in 8 (11.4%). The median (range) of hospitalization days was 12 (7-84). The actuarial 1, 3, and 5 years survival was 77%, 32%, and 22%, respectively, for the entire series. Twenty-one cases (30%), and 49 controls (70%) were identified. In the univariate analysis, R0 resection, negative regional lymph nodes, the absence of perineural infiltration, the earliest stages (IA, IB, and IIA) and the absence of diabetes mellitus (DM) at time of diagnosis were variables associated with survival ≥ 3 years (p 100 U / mL), and neo/adjuvant treatments, did not significantly show differences in survival. In the multivariate analysis, no DM at diagnosis (adjusted OR: 12; 95% CI 1.7 - 84.3), no perineural infiltration (adjusted OR: 7; 95% CI 1.3 - 36.3) and early stages IA, IB, and IIA (adjusted OR: 10.3; 95% CI 2.1 - 49.1) were identified as independent factors associated with survival > 3 years. Conclusion: Nondiabetic patients with early stages PC without perineural infiltration, resected R0 by PD can achieve survival over 3 years.

Rehabilitación cardiovascular en pacientes con prótesis valvular mecánica / Cardiovascular rehabilitation in patients with mechanical valvular prosthesis i: en

Introducción: La rehabilitación cardiaca en pacientes con prótesis valvular es esencial para aumentar su sobrevida e incorporarlos óptimamente a la sociedad. Objetivo: Caracterizar a pacientes con prótesis valvular mecánica y rehabilitación cardiovascular. Métodos: Se realizó un estudio observacional, descriptivo, de serie de casos, de 70 pacientes con prótesis valvular mecánica, admitidos en el programa de rehabilitación cardiovascular del Hospital General Universitario Vladimir Ilich Lenin de la provincia de Holguín, desde marzo del 2019 hasta noviembre del 2022. Resultados: Predominaron los pacientes de 55 a 64 años de edad (38,6 %), con prótesis en posición mitral, sin complicaciones. En los sujetos rehabilitados se observó una reducción de la media de hipercolesterolemia (de 250 a 175 mg/dL) y un aumento de la capacidad funcional por la duración del ejercicio, así como de las unidades metabólicas consumidas. La media de la función ventricular izquierda tras la terapia rehabilitadora se incrementó de 52,4 a 58,2 %. Solo 2 afectados necesitaron rehospitalización e incorporar más fármacos a su tratamiento basal y 50 retornaron a sus actividades laborales. El resultado fue satisfactorio en 97,1 % de los integrantes de la serie. Conclusiones: Esta terapia resultó beneficiosa, pues se incrementó la capacidad funcional de los pacientes y fueron pocas las complicaciones. Los factores de riesgo coronarios estuvieron controlados, se redujo la rehospitalización y aumentó la reincorporación laboral.

Introduction: Heart rehabilitation in patients with valvular prosthesis is essential to increase their survival and incorporate them optimally to the society. Objective: To characterize patients with mechanical valvular prosthesis and cardiovascular rehabilitation. Methods: An observational, descriptive, serial cases study of 70 patients with mechanical valvular prosthesis was carried out, who were admitted to the program of cardiovascular rehabilitation of Vladimir Ilich Lenin University General Hospital in Holguín province, from March, 2019 to November, 2022. Results: There was a prevalence of 55 to 64 years patients (38.6%), with prosthesis in mitral position, without complications. In the rehabilitated patients a reduction of the mean in hypercholesterolemia was observed (from 250 to 175 mg/dL) and an increase of the functional capacity due to the duration of exercise, as well as of the consumed metabolic units. There was an increase from 52.4 to 58.2% in the mean of the left ventricular function after the rehabilitative therapy. Only 2 affected patients needed rehospitalization and to incorporate more medication to their basal treatment and 50 returned to their working activities. The result was satisfactory in 97.1% of the series members. Conclusions: This therapy was beneficial, because there was an increase of the functional capacity of patients and complications were not very common. The coronary risk factors were controlled; there was a reduction of rehospitalization and an increase of working reincorporation.

Sobrevida del adenocarcinoma ductal de páncreas

El objetivo de este trabajo es analizar la presentación epidemiológica y la sobrevida de los pacientes con adenocarcinoma ductal de páncreas de acuerdo con su estadío clínico y al tipo de intervención realizada, en una cohorte de pacientes atendidos en una clínica en Lima, Perú. Estudio de cohortes retrospectivas que evaluó desde enero del 2015 a febrero del 2021 a pacientes con diagnóstico de adenocarcinoma ductal de páncreas considerando diversos factores epidemiológicos, radiológicos, estadiaje oncológico, haber recibido quimioterapia neoadyuvante o adyuvante, haber sido sometidos a cirugía y la sobrevida posterior a alguna de las intervenciones realizadas. De los 249 pacientes analizados, se encontró que 75 de ellos requerían cirugía resectiva. Entre los principales resultados obtenidos, se observó que aquellos con un nivel de CA 19-9 menor a 200 U/mL presentaban una media de sobrevida más alta en comparación con aquellos cuyo nivel de CA 19-9 era superior a 200 U/mL (HR: 1,96; IC95%: 0,18-0,53; p≤0,001). Asimismo, al comparar a los pacientes según su etapa, se encontró que aquellos con tumores resecables tenían una media de sobrevida de 37,72 meses, mientras que aquellos con tumores localmente avanzados tenían una media de sobrevida de 13,47 meses y aquellos con tumores metastásicos tenían una media de sobrevida de 7,69 meses (HR: 0,87; IC95%: 0,31-0,25; p≤0,001). Igualmente, se observó que recibir tratamiento neoadyuvante se asociaba con un mejor pronóstico de sobrevida para los pacientes (HR: 0,32; IC95%: 0,19-0,53; p≤0,001). Asimismo, se llevaron a cabo 5 pancreatectomías con resección metastásica en pacientes oligometastásicos tratados con quimioterapia de rescate, y se encontró que la media de sobrevida para estos pacientes fue de 22,51 meses. Conclusión: La cirugía resectiva en un estadío clínico temprano , presentar valores de CA 19-9 por debajo de 200 U/mL y haber recibido quimioterapia neoadyuvante se correlaciona estadísticamente con una mayor esperanza de sobrevida.

The objective of this study is to analyze the epidemiological presentation and survival of patients with pancreatic ductal adenocarcinoma according to their clinical stage and the type of intervention performed, in a cohort of patients treated at a clinic in Lima, Peru. A retrospective cohort study evaluated patients diagnosed with pancreatic ductal adenocarcinoma from January 2015 to February 2021, considering various epidemiological factors, radiological findings, oncological staging, receipt of neoadjuvant or adjuvant chemotherapy, undergoing surgery, and post-intervention survival. Out of the 249 patients analyzed, 75 of them required resective surgery. Among the main findings, it was observed that those with a CA 19-9 level below 200 U/mL had a higher median survival compared to those with a CA 19-9 level above 200 U/mL (HR: 1.96; 95% CI: 0.18-0.53; p≤0.001). Furthermore, when comparing patients according to their stage, those with resectable tumors had a median survival of 37.72 months, while those with locally advanced tumors had a median survival of 13.47 months, and those with metastatic tumors had a median survival of 7.69 months (HR: 0.87; 95% CI: 0.31-0.25; p≤0.001). Additionally, receiving neoadjuvant treatment was associated with a better prognosis of survival for patients (HR: 0.32; 95% CI: 0.19-0.53; p≤0.001). Furthermore, 5 pancreatectomies with metastatic resection were performed in oligometastatic patients treated with salvage chemotherapy, and the median survival for these patients was 22.51 months. Conclusion: Resective surgery at an early clinical stage, CA 19-9 levels below 200 U/mL, and receiving neoadjuvant chemotherapy are statistically correlated with a higher overall survival.