Your browser doesn't support javascript.
loading
Análise da associação dos aspectos clínicos, histopatológicos e terapêuticos em crianças e adolescentes com osteossarcoma / Analysis of the association of clinical, histopathological e therapeutic aspects, in children and teenagers with osteosarcoma
São Paulo; s.n; 2019. 78 p. ilus, tab, quadros.
Thesis in Pt | Inca | ID: biblio-1017218
Responsible library: BR30.1
Localization: BR30.1
RESUMO

Introdução:

O osteossarcoma é um tumor maligno raro, tipo mais comum de câncer ósseo, com maior frequência em crianças e adolescentes. É um tumor agressivo que evolue rapidamente, porém quando diagnósticado precocemente aumenta as chances de cura e, por conta da evolução das técnicas cirurgicas e de novas drogas quimioterapicas, vem a permitir um tratamento mais especifico.

Objetivo:

Avaliar, no osteossarcoma, a associação entre as caracteristicas sociodemográficas, clínicas-patológicas e terapêuticas em crianças e adolescentes com a evolução da doença.

Metodologia:

Estudo de coorte retrospectivo entre os anos de 2010 a 2017, onde foram incluidos um total de 64 pacientes com osteossarcoma de ambos os sexos com idade ≤ 21 anos. Os dados foram provenientes de prontuários e para a análise estatísticas de associação foram utilizados os testes exato de Fischer e Qui-quadrado, sendo considerado significativo p<0,05. A estimativa do tempo de sobrevida foi realizada pela curva de Kaplan-Meier e teste de Log-rank.

Resultados:

A mediana da idade foi 14 anos, a maioria do sexo masculino (57,8%) e raça não branca (89,1%). No sexo feminino, houve uma maior frequência de tumor no fêmur (66,7%), de localização distal (66,7%) e tamanho menor que 15 cm (85,2%) quando comparado ao grupo masculino (p=0,041; p=0,043; p=0,025, respectivamente). No sexo masculino, houve uma maior frequência de óbito (59,5%; p=0,023). Na faixa etária <13, a quimioterapia metronômica foi realizada em 79,7% dos casos (p<0,0001). No grupo com tamanho tumoral ≥ 15, obteve uma maior frequência de estádio III (94,4%), cirurgias com amputação (72,0%), quimioterapia metronômica (70,8%), metástases e óbitos (72,0%) (p<0,05). O grupo com aparecimento de metástases, verificou-se uma maior frequência de recidiva local (30,0%). A mediana de sobrevida global (SG) foi 4,08 anos dos paciente com o mínimo de 0,15 anos e máximo de 9,55 anos. A mediana de SG no grupo do sexo masculino foi de 2,5 anos com taxa de SG de 50,6%, e no sexo feminino foi de 73,2% (p=0,0188). A mediana de SG no grupo com tumor < 15 cm foi de 1,86 anos com taxa de SG de 83,6% e de 46,6% no grupo com tumores ≥ 15 cm (p=0,0002).

Conclusão:

No osteossarcoma, os principais fatores associados ao prognóstico desfavorável foram ser do sexo masculino e ter tamanho tumoral acima de 15 cm (AU)
ABSTRACT

Introduction:

Osteosarcoma is a rare malignant tumor and the most prevalent bone malignant tumor in children and teenagers. They are agressive and grow rapidly but when diagnosed early, chances of cure raise and, due to appropriate polichemotherapy and surgical management limb salvage is more frequent than amputation.

Objective:

Analize the clinical follow up of pediatric patients with osteosarcoma treated at the Cancer Hospital of Pernambuco.

Methods:

This is a retrospective cohort study where 64 patients with osteosarcoma of both genders were included. Age varied from > 4 to _< 21 years old during the period from 2010 to 2017. All data were collected from patients hospital files and aubmitted to Fischer and Chi Square tests, being considered significative a p<0,05. The overall survival and free disease survival rates were represented by a Kaplan-Meyer curve and compared to the Log Rank. For the analysis of death association, the Hazard ratio was applyed.

Results:

the median age was 14 and the majority of males (57,8%) and non white. Most came from the countryside of Pernambuco and neighbor states (68,8%) and Recife and its metropolitan area (31,3%). Analysing the clinical aspects, the most frequent sympton was a growing mass (40,6%) and intensive pain (34,4%). The histologycal subtype was the osteoblastic (77,1%) and most frequent tumor site was the femur (p=0,041) distally (p=0,043) and size <15cm (p=0,025) all significative and associated to the female gender. In the association survival status and gender, the male one was significative to death (p=0,023). In relation to TNM staging the most prevalent was stage III (73,4%) being significative to tumors <15cm (p=0,040) and Enneking stage most prevalent was IIB (90,5%). Significane was observed in the association of tumors <15cm, limb salvage surgery (p=0,037), metronomic polichemotherapy (p=0,024), overall survival (p=0,004) and metastasis (p=0,004). Follow up with metastasis during treatment was observed in 46,9% of all cases and associated to local recurrence (p=0,005) being the lungs the most frequent site (76,7%). The treatment aplyed was polichemotherapy (95,3%), surgery (96,9%) being 54,9% amputation and radiotherapy 1,6%. Metronomic chemotherapy was used in 79,7% of all patients showing significancy for the age ranging from >4 to <13 (p=0,0001). Local recurrence ocurred in 15,9% of cases and among them 50% died. The overall survival median was of 4,08 years with a minimum of 0,15 years and free overall survival and disease progression was greater for those using methrotexate in high doses.

Conclusion:

It was conclude that tumors < 15cm, female gender and a metronomic polichemotherapy were positive prognostic factors for osteosarcoma and overall survival. The male gender showed to be a negative risk factor leading to death (AU)
Subject(s)
Key words
Full text: 1 Database: Inca Main subject: Bone Neoplasms / Osteosarcoma / Retrospective Studies / Cancer Survivors Limits: Adult / Aged / Aged80 / Female / Humans / Male Language: Pt Year: 2019 Document type: Thesis Country of publication: Brazil
Full text: 1 Database: Inca Main subject: Bone Neoplasms / Osteosarcoma / Retrospective Studies / Cancer Survivors Limits: Adult / Aged / Aged80 / Female / Humans / Male Language: Pt Year: 2019 Document type: Thesis Country of publication: Brazil