RESUMO
BACKGROUND: Non-small cell lung cancer (NSCLC) is a major cause of brain metastases. Nonetheless, patients with central nervous system (CNS) spread are poorly represented in clinical trials. We sought to evaluate the overall survival (OS) of patients with NSCLC and CNS metastases. METHODS: Patients with NSCLC and CNS metastases treated at A. C. Camargo Cancer Center from January 2007 to December 2017 were selected. The primary endpoint was OS following the diagnosis of CNS metastasis. The Kaplan-Meier method was applied to calculate OS. Prognostic factors were assessed by the Cox Proportional Hazards model. As an exploratory analysis, a survival tree was generated based upon the two most statistically significant variables in the multivariate model and one additional clinically meaningful variable. RESULTS: In total, 311 patients were included. Median OS was 10.3 months (95% CI, 8.7-13.1 months). ECOG performance status 2-4 (HR 2.12; 95% CI, 1.40-3.20; P<0.01) and the absence of a driver mutation (HR 3.30; 95% CI, 1.85-5.90; P<0.01) were strongly associated with worse OS. A Modified Recursive Partitioning Analysis (mRPA) was developed based on the curves generated by the survival tree. mRPA stratified our cohort in four subgroups with significantly different OS (3.1 to 43 months) and it outperformed both RPA and GPA in predicting OS in our population. CONCLUSIONS: OS in our cohort was better than previously reported. However, prognosis is widely variable and is mostly dictated by performance status and the presence of a driver mutation.
RESUMO
Síndromes cromossômicas são raras, porém graves e, em geral, de prognóstico reservado, o que vai ao encontro da necessidade de uma maior investigação a respeito das suas prováveis etiologias. O objetivo desse estudo é comparar os resultados a partir da base de dados do Estudo Colaborativo Latino-Americano de Malformacões Congênitas (ECLAMC) em nascidos vivos (NV) do Complexo Hospitalar da Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA) com aqueles já descritos e, a partir disso, considerar hipóteses causais para essas síndromes. Métodos: Estudo de caso-controle, com dados de obtidos através dos questionários do banco de dados do ECLAMC da maternidade do ISCMPA. Caso foi definido como recém-nascidos RN com qualquer anormalidade morfológica detectada ao nascimento. Todos os casos NV foram pareados com um controle, não malformado e de igual sexo que nasceu no mesmo hospital imediatamente depois do recém-nascido malformado. Resultados: Em um total de 259 RNs malformados (MF), foram encontrados 18 com malformações cromossômicas, sendo 16 com Síndrome de Down, 1 com Síndrome de Turner, e 1 com Síndrome de Pierre Robin. Dentre as variáveis analisadas, observou-se que RN vivos com malformações cromossômicas possuíam peso menor (P=0,002), eram em número maior de meninas (P<<0,01), nasceram com idade gestacional menor (P=0,043), possuíam pais com idade maior (P<<0,01 para mães e P=0,012 para pais) e mães que fumaram (P<<0,01) e beberam mais álcool (P=0,011) mais, que o grupo controle. Conclusão: As variáveis materno-paterno-dependentes parecem influenciar o número de RN que apresentam anomalias cromossômicas.
Although chromosomal syndromes are rare, they are serious and generally of poor prognosis, which meets the need for more research about their probable etiologies. The aim of this study is to compare the results from the database of the Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC) - Latin American Collaborative Study of Congenital Malformations in live-born infants (LBI) of the Hospital Complex of the Santa Casa de Misericordia of Porto Alegre (ISCMPA) with those already described and, from there, consider causal hypotheses for these syndromes. Methods: A case-control study with data obtained from questionnaires of the ECLAMC database in the Maternity Hospital of ISCMPA. A case was defined as a newborn (NB) with any morphological abnormalities detected at birth. All cases were matched with a non-malformed control of the same sex born in the same hospital immediately after the malformed NBs. Results: From a total of 259 malformed (MF) NBs, 18 had chromosomal malformations, 16 of which Down Syndrome, 1 Turner Syndrome, and 1 Pierre Robin Syndrome. Among the variables analyzed, we found that LBI with chromosomal abnormalities had lower weight (p = 0.002), were more likely females (p <<0.01), were born at lower gestational age (p = 0.043), and were born to older parents (p <<0.01 for mothers and p = 0.012 for fathers) and more likely to mothers who smoked (p <<0.01) and drank (p = 0.011) than the control group. Conclusion: The maternal-paternal-dependent variables seem to influence the number of NBs who have chromosomal abnormalities.
