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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2022.tde-08092022-163720
Document
Author
Full name
Anny Alves Pereira Trevisan
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2022
Supervisor
Committee
Peria, Fernanda Maris (President)
Brunaldi, Mariângela Ottoboni
Serrano, Sergio Vicente
Title in Portuguese
Análise da efetividade e toxicidades da quimioterapia adjuvante no adenocarcinoma de pâncreas: estudo de mundo real realizado em um hospital terciário do Sistema Único de Saúde
Keywords in Portuguese
Análise de sobrevida
Carcinoma de pâncreas
Estudo de mundo real
Gencitabina
Quimioterapia adjuvante
Abstract in Portuguese
Introdução: A incidência do adenocarcinoma de pâncreas vem aumentando progressivamente, sobretudo nos países desenvolvidos, sendo atualmente o 14° tumor mais frequente em incidência e o 7° em mortalidade, podendo em 2030 se tornar a 2ª causa de mortalidade câncer-específica. A ressecção cirúrgica é o único tratamento com intenção curativa, porém é indicado em apenas 20% dos pacientes. A associação da quimioterapia adjuvante com gencitabina levou a um aumento da sobrevida global de 20 para apenas 23 meses, segundo o estudo CONKO-001. Outras combinações de quimioterápicos demonstraram ganho de sobrevida global às custas de elevada toxicidade, restringindo esta opção a pacientes jovens, com poucas comorbidades e em ótimo estado geral. Objetivos: Analisar, no cenário de vida real de um hospital público brasileiro, a sobrevida livre de recorrência, sobrevida global e toxicidades dos pacientes com adenocarcinoma de pâncreas que realizaram ressecção cirúrgica com intenção curativa complementada de quimioterapia adjuvante com gencitabina. Resultados: Após avaliação de 66 pacientes com tumor de pâncreas ressecados entre os anos de 2010 e 2017, que foram submetidos ao tratamento adjuvante com gencitabina, encontramos a probabilidade de não progressão em 5 anos de 31% (IC 95% 0,2 a 0,4) e a probabilidade de sobrevida em 5 anos de 40% (IC 95% 0,26 a 0,54). Conclusão: No nosso estudo foi visto que a SLP e a SG foram superiores em relação ao estudo pivotal, mostrando benefício na realização de QT adjuvante para os pacientes ressecados mesmo em um hospital com perfil diferente.
Title in English
Effectiveness and toxicities analysis of adjuvant chemotherapy for pancreatic cancer: real world data from a university hospital of the Brazilian Public Health System
Keywords in English
Adjuvant chemotherapy
Gemcitabine
Pancreatic carcinoma
Real world study
Survival analysis
Abstract in English
Introduction: The incidence of pancreatic cancer has been increasing progressively, especially in developed countries, being currently the 14th most frequent tumor in incidence and the 7th in mortality, and by 2030 it may become the 2nd cause of cancerspecific mortality. Surgical resection is the only treatment with curative intent, but it is indicated in only 20% of patients. The combination of adjuvant chemotherapy with gemcitabine led to an increase in overall survival from 20 to 23 months, according to study CONKO-00. Other combinations of chemotherapeutic drugs have shown a gain in overall survival at the expense of high toxicity, restricting this option to young patients, without comorbidities and in excellent general condition. Objectives: to analyze in the real-life scenario of a Brazilian public hospital the progression free survival, the overall survival and toxicities of patients with pancreatic cancer submitted to surgical resection with curative intent, followed by adjuvant chemotherapy with gemcitabine. Results: after evaluating 66 patients with pancreatic tumor resected between 2010 and 2017, that were submitted to adjuvant treatment with gemcitabine, we found a 5-year probability of non-progression of 31% (95% CI 0.2 to 0 ,4) and a 5- year survival probability of 40% (95% CI 0.26 to 0.54). Conclusion: in our study, it was seen that PFS and OS were superior in relation to the pivotal study, showing benefit in performing adjuvant chemotherapy for resected patients even in a hospital with a different profile.
 
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Publishing Date
2022-11-03
 
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