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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2023.tde-05012024-164401
Document
Author
Full name
Raphael Camerini Maciel
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2023
Supervisor
Committee
Sankarankutty, Ajith Kumar (President)
Fabbro, Amaury Lelis Dal
Serrano, Sergio Vicente
Title in Portuguese
Análise clínica epidemiológica do câncer esofágico em um hospital de referência no interior do estado de São Paulo
Keywords in Portuguese
Análise de sobrevida
Câncer de esôfago
Epidemiologia
Abstract in Portuguese
Introdução: atualmente o câncer de esôfago (CE) é considerado o 7º câncer mais comum e o 6º câncer que mais causa óbito no mundo, com expectativa de aumento até 2040. Globalmente, o Carcinoma de Células Escamosas (CEC) representa 85% dos casos, no entanto, em 21 países desenvolvidos, o Adenocarcinoma (ACE) é o tipo predominante e vem em aumento progressivo nas últimas décadas. Apresenta-se tardiamente, com mais de 50% dos casos diagnosticados em estágios clínico IIIC e IV. Objetivo e Método: realizou-se uma coorte retrospectiva que avaliou as características clínico epidemiológicas de todos os casos de câncer de esôfago atendidos entre 2014 e 2018 no Hospital das Clínicas de Ribeirão Preto, além da sobrevida dos pacientes portadores de CEC e ACE. Foi utilizado um modelo de riscos proporcionais de Cox e análise de sobrevida pelo método de Kaplan-Meier. Para todas as comparações adotou-se um nível de significância de 5%. Resultados: dos 249 pacientes atendidos, a maioria chegou ao serviço em estágios avançados da doença. Os estágios clínicos (EC) 0, IA e IB, apresentaram respectivamente 4,35 %, 5,31% e 2,9% dos casos. Os ECs IIA e IIB continham 7,25% e 10,63% dos casos, respectivamente. Nos ECs IIIA, IIIB e IIIC, foram identificados 7,73%, 4,35% e 27,05% casos, na mesma ordem. A maioria dos pacientes (30,43%) chega no EC IV. A análise de sobrevida geral resultou em uma média de 17,71 meses (IC95% 15,21 - 20,2). Em cinco anos, a sobrevida geral foi igual a 13% (IC95% 0,08 - 0,17). Pacientes que concluíram tratamento neoadjuvante com quimioterapia e radioterapia tiveram média de sobrevida maior, de 25,02 meses (IC95% 20,38-29,67) e 24,17 meses (IC95% 20,06-28,27), respectivamente, em comparação aos que não concluíram (médias de 15,74 meses [IC95% 9,92-21,56 - logrank 0,03] e 6,57 meses [IC95% 3,52-9,61 - logrank < 0,01]). O mesmo aconteceu com aqueles que passaram por ressecções, com médias de 27,93 meses (IC95% 22,93-32,93) e sobrevida em 5 ano de 0,32 (IC95% 0,19-0,45), em comparação com os que não foram ressecados, com média de 13,93 meses (IC95%11,54-16,32) e sobrevida em 5 anos de 0,08 (IC95% 0,03-0,12 - logrank <0,01). As taxas de complicações cirúrgicas grau III, grau IV e grau V foram de 29,27%, 9,76% e 24,39%, respectivamente. Conclusão: o perfil de paciente atendido permanece semelhante aos de outros países em desenvolvimento, com predominância de Carcinoma de Células Escamosa e não houve redução importante da mortalidade. Além disso, nota-se que a maioria dos pacientes chega ao serviço de referência com doença avançada.
Title in English
Clinical epidemiological analysis of esophageal cancer in a referral hospital in the interior of the state of São Paulo
Keywords in English
Epidemiology
Esophagus cancer
Survival analysis
Abstract in English
Introduction: Currently, esophageal cancer (EC) is considered the 7th most common cancer and the 6th leading cause of death worldwide, with an expected increase by 2040. Globally, Squamous Cell Carcinoma (SCC) accounts for 85% of cases. However, in 21 developed countries, Adenocarcinoma (AC) is the predominant type and has been steadily increasing over the past decades. It is often diagnosed at advanced stages, with over 50% of cases diagnosed at clinical stages IIIC and IV. Objective and Method: A retrospective cohort study was conducted to evaluate the clinical and epidemiological characteristics of all esophageal cancer cases treated between 2014 and 2018 at the Hospital das Clínicas in Ribeirão Preto. The survival of patients with SCC and AC was also analyzed. A proportional hazards Cox model and Kaplan-Meier survival analysis were used. A significance level of 5% was adopted for all comparisons. Results: Among the 249 patients treated, the majority presented at advanced stages of the disease. Clinical stages 0, IA, and IB accounted for 4,35%, 5,31%, and 2.9% of cases, respectively. Stages IIA and IIB comprised 7,25% and 10,63% of cases, respectively. Stages IIIA, IIIB, and IIIC accounted for 7,73%, 4,35%, and 27,05% of cases, respectively. The majority of patients (30,43%) presented at stage IV. The overall survival analysis showed a mean survival of 17,71 months (95% CI 15,21-20,2). At five years, the overall survival rate was 13% (95% CI 0,08-0,17). Patients who completed neoadjuvant treatment with chemotherapy and radiation therapy had a longer mean survival of 25.02 months (95% CI 20,38-29,67) and 24,17 months (95% CI 20,06-28,27), respectively, compared to those who did not complete treatment with mean survival of 15,74 months [95% CI 9,92-21,56 - logrank 0,03] and 6,57 months [95% CI 3,52-9,61 - log-rank <0,01]). The same trend was observed for patients who underwent resections, with mean survival of 27,93 months (95% CI 22,93-32,93) and 5-year survival rate of 0,32 (95% CI 0,19-0,45), compared to those who were not resected (mean survival of 13,93 months [95% CI 11,54-16,32] and 5-year survival rate of 0,08 [95% CI 0,03-0,12 - log-rank <0,01]). The rates of surgical complications of grade III, grade IV, and grade V were 29,27%, 9,76% and 24,39%, respectively. Conclusion: The profile of patients treated remains similar to that of other developing countries, with a predominance of Squamous Cell Carcinoma, and there has been no significant reduction in mortality. Furthermore, the majority of patients arrive at the referral service with advanced disease.
 
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Publishing Date
2024-02-26
 
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