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Doctoral Thesis
Full name
Antonio Vitor Martins Priante
Knowledge Area
Date of Defense
São Paulo, 2010
Kowalski, Luiz Paulo (President)
Kanda, Jossi Ledo
Lehn, Carlos Neutzling
Michaluart Junior, Pedro
Vartanian, José Guilherme
Title in Portuguese
A importância da tríplice endoscopia no diagnóstico de neoplasias primárias múltiplas em pacientes com carcinoma epidermóide de vias aerodigestivas superiores
Keywords in Portuguese
Carcinoma de células escamosas/diagnóstico
Estadiamento de neoplasias
Neoplasias de cabeça e pescoço
Neoplasias primárias múltiplas/diagnóstico
Abstract in Portuguese
INTRODUÇÃO: Pacientes com carcinomas das vias aerodigestivas superiores (VADS) apresentam um alto risco de desenvolver outros cânceres tanto simultaneamente quanto subsequentemente. A maioria destes tumores ocorre nas VADS, pulmões ou esôfago. A tríplice endoscopia (laringoscopia, endoscopia digestiva alta e broncoscopia) possibilita o diagnostico de lesões precursoras e de tumores invasivos. No entanto, a maioria dos estudos limita-se a descrever a frequência de diagnósticos, mas não os resultados do tratamento e o impacto na sobrevida. OBJETIVOS: Avaliar a importância da tríplice endoscopia para o diagnóstico de neoplasias primárias múltiplas e as diferenças no estadiamento e nas taxas de sobrevida de pacientes com carcinoma epidermóide de VADS. Caracterizar o perfil e analisar fatores de risco para neoplasias primárias múltiplas. MÉTODOS: Trata-se de estudo caso-controle retrospectivo em que foram incluídos pacientes com carcinoma epidermóide de VADS, submetidos à tríplice endoscopia antes do início do tratamento (grupo tríplice endoscopia), pareados, por sexo, idade e localização, estádio clínico e tratamento do tumor primário, com pacientes não submetidos à tríplice endoscopia na avaliação inicial (grupo controle). RESULTADOS: Foram incluídos 135 pacientes em cada grupo. No grupo tríplice endoscopia ocorreram mais diagnósticos de segundo tumor primário (STP), 34 (17 simultâneos e 17 metacrônicos), do que no grupo controle, 20 (1 simultâneo e 19 metacrônicos). Não foi identificada diferença significativa entre o estadiamento dos tumores de grupo tríplice endoscopia e do grupo controle. As curvas de sobrevida global, específica por câncer, livre de doença e pós-STP foram semelhantes nos dois grupos. A sobrevida livre de STP foi maior no grupo controle. Na análise multivariada foram identificados como fatores prognósticos independentes para a sobrevida, o sexo (feminino, RR 0,51, IC 0,30 0,88), a idade (maior que 57 anos, RR 1,73, IC 1,29 2,31), a localização do tumor primário (laringe, RR 0,60, IC 0,39 0,93), o estádio N (N2 e N3, RR 1,78, IC 1,26 2,51) e o estádio clínico do tumor primário (III e IV, RR 2,75, IC 1,69 4,46). As variáveis independentes relacionadas ao diagnóstico e à ocorrência de STP foram a realização de tríplice endoscopia (RR 1,93; IC 95% 1,02 - 3,65), o tipo de tratamento do tumor primário (cirurgia exclusiva, RR 3,14; IC 95% 1,11 - 8,85) e o tempo de seguimento (maior que 24 meses, RR 3,69; IC 95% 1,19 - 11,47). CONCLUSÃO: Não ocorreu diferença no estádio clínico dos STP e nas sobrevidas global, específica por câncer, livre de doença e pós-STP entre o grupo tríplice endoscopia e o grupo controle. Foram identificados como fatores independentes relacionados ao diagnóstico e a ocorrência de STP o tratamento realizado (cirurgia exclusiva), o tempo de seguimento (maior que 24 meses) e a realização da tríplice endoscopia.
Title in English
Importance of triple endoscopy in the diagnosis of multiple primary tumors in patients with upper aerodigestive tract squamous cell carcinoma
Keywords in English
Carcinoma squamous cell/diagnosis
Head and neck neoplasms
Neoplasm staging
Neoplasms multiple primary/diagnosis
Survivorship (Public health)
Abstract in English
INTRODUCTION: Patients with upper aerodigestive tract (UADT) carcinomas have a high risk of developing others cancers simultaneously or subsequently. Most of these tumors occur in UADT, lungs or esophagus. Triple endoscopy (laryngoscopy, endoscopy and bronchoscopy) enables the diagnosis of premalignant and invasive tumors. However, most of the studies describe only the frequency of the diagnosis, but not the results of treatment and its impact on survival. OBJECTIVES: To evaluate the importance of triple endoscopy for the diagnosis of multiple primary tumors and the differences in clinical stage and survival rates of patients with squamous cell carcinoma of the UADT. To characterize and to analyze the risk factors for multiple primary tumors. METHODS: This is a case-control study that included patients with squamous cell carcinoma of the UADT, that were submitted to a triple endoscopy before the first treatment (triple endoscopy group), matched by sex, age and location, clinical stage and treatment of primary tumor, with patients not undergoing triple endoscopy in the initial evaluation (control group). RESULTS: One hundred and thirty five patients were included in each group. The diagnosis of second primary tumor (SPT) was more frequent in the triple endoscopy group than in the control group, 34 (17 simultaneous and 17 metachronous) and 20 cases (1 simultaneous and 19 metachronous), respectively. No significant difference was found between the clinical stage of triple endoscopy group and the control group. The curves of overall survival, cancer specific, disease-free and after SPT were similar in both groups. The SPT free survival was higher in the control group. In the multivariate analysis were identified as independent prognostic factors for survival, sex (women, RR 0.51, CI 0.30 - 0.88), age (older than 57 years, RR 1.73, CI 1.29 - 2.31), the primary tumor site (larynx, RR 0.60, CI 0.39 - 0.93), N stage (N2 and N3, RR 1.78, CI 1.26 - 2.51) and the clinical stage of primary tumor (III and IV, RR 2.75, CI 1.69 - 4.46). The independent variables related to the diagnosis and the occurrence of SPT were triple endoscopy (RR 1.93, 95% CI 1.02 - 3.65), the primary tumor treatment (surgery alone, RR 3.14, 95% CI 1.11 - 8.85) and follow-up (greater than 24 months, RR 3.69, 95% CI 1.19 - 11.47). CONCLUSION: There was no difference in the clinical stage of the SPT and overall survival, cancer specific, disease-free and post SPT between the triple endoscopy group and control group. As independent predictors for the diagnosis and the occurrence of SPT were treatment performed (just surgery), follow-up time (greater than 24 months) and triple endoscopy.
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