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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2023.tde-21082023-123534
Document
Author
Full name
Amir Zeide Charruf
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2023
Supervisor
Committee
Júnior, Ulysses Ribeiro (President)
Bresciani, Claudio Jose Caldas
Castro Junior, Gilberto de
Castro, Osvaldo Antonio Prado
Title in Portuguese
Impacto da quimioterapia perioperatória nos resultados cirúrgicos e patológicos de pacientes com câncer gástrico
Keywords in Portuguese
Complicações pós-operatórias
Gastrectomia
Neoplasias gástricas
Quimioterapia
Terapia neoadjuvante
Abstract in Portuguese
Introdução: o Câncer de Estômago (CG) representa uma das principais causas de mortes por Câncer no mundo. A despeito dos avanços médicos, sua letalidade permanece alta. A Quimioterapia perioperatória (QTPeri) somada à cirurgia padrão, com linfadenectomia adequada, representa uma opção ao tratamento curativo para pacientes com câncer gástrico avançado (CG). Objetivo: avaliar, além de suas características clínicas e os resultados patológicas e cirúrgicos de pacientes com GC que receberam QTPeri, seu impacto na sobrevida. Métodos: trata-se de um estudo retrospectivo do tipo casocontrole, pareado cuja correspondência foi realizada com o uso de um protocolo 1:1 (pareamento simples), sendo escolhido o algoritmo mais próximo. O pareamento foi realizado sem reposição. Resultados: um total de 45 casos com QTPeri foi pareado com 45 pacientes submetidos à gastrectomia inicial para as seguintes características: sexo, idade, tipo de gastrectomia, extensão da linfadenectomia, ASA, tipo histológico, cT e cN. Os grupos QT-Peri e Cirurgia após pareamento, apresentavam características clínico-laboratoriais semelhantes, com exceção para a média da taxa de neutrófilos/linfócitos (4,38 vs. 1,65, p < 0,001), o grupo QT-Peri teve tumores menores (4,9 vs. 6,8 cm p = 0,006), menor taxa de invasão linfático (40% vs. 73,3%, p = 0,001), menor taxa de invasão venosa (17,8% vs. 46,7%, p = 0,003) e menor taxa de invasão perineural (35% vs. 77,8%, p < 0,0001). O grupo QT-Peri apresentou ainda predomínio de pT1/pT2 (44,4% vs. 6,7%, p < 0,001) e predomínio de pN0 (46,7% vs. 15,6%, p = 0,001). O grupo Cirurgia apresentou predomínio de complicações pós-operatórias maiores (grau III/IV e V de Clavien-Dindo) quando comparado ao grupo QT-Peri (24% vs. 6,7%, respectivamente, p = 0,02), bem como maior tempo de internação hospitalar (17 vs. 10,8 dias, p = 0,005). A sobrevida global, em 5 anos, estimada de toda população foi de 51,1%, e os pacientes no grupo QT-Peri apresentaram melhor sobrevida em comparação aos pacientes do grupo Cirurgia (p = 0,022). Conclusão: constatou-se uma influência positiva nos resultados patológicos e cirúrgicos dos pacientes submetidos a tratamento QTPeri, independente do esquema quimioterápico realizado
Title in English
Impact of perioperative chemotherapy on surgical and pathological results of gastric cancer patients
Keywords in English
Drugtherapy
Gastrectomy
Gastric neoplasms
Neoadjuvant therapy
Postoperative complications
Abstract in English
Background: gastric Cancer (CG) represents one of the main causes of cancer deaths in the world. Despite medical advances, its lethality remains high. Perioperative chemotherapy (QTPeri) in addition to standard surgery, with adequate lymphadenectomy, represents an option for curative treatment for patients with advanced CG. OBJECTIVE: To evaluate the clinical-pathological characteristics and surgical results of patients with CG who received QTPeri and its impact on survival. Methods: this is a retrospective case-control study, matching whose correspondence was performed using a 1: 1 correspondence protocol (simple pairing), with the closest algorithm being chosen. Pairing was performed without replacement. A total of 45 QT-Peri cases were matched with 45 patients who underwent initial gastrectomy for the following characteristics: sex, age, type of gastrectomy, extension of lymphadenectomy, ASA, histological type, cT and cN. Results: the QTPeri and Cirurgia groups, after pairing, had similar clinical laboratory characteristics, except for the median neutrophil / lymphocyte rate (4.38 vs. 1.65, P <0.001), the QTPeri group had smaller tumors (4, 9 vs. 6.8 cm P = 0.006), lower rate of lymphatic invasion (40% vs. 73.3%, P = 0.001), lower rate of venous invasion (18% vs 46.7%, P = 0.003) and lower perineural invasion rate (35% vs 77.8%, P <0.0001). There was also a predominance of pT1 / pT2 (44.4% vs. 6.7%, p <0.001) and a predominance of pN0 (46.7% vs. 15.6%, p = 0.001). The Cirurgia group showed a predominance of major postoperative complications (grade III / IV and V of Clavien-Dindo) when compared to the QT-Peri group (24% vs. 6.7%, respectively, P = 0.02), as well as a longer hospital stay (17 vs 10.8 days, P = 0.005). The estimated overall 5-year survival of the entire population was 51.1%, being 62% in the QT-Peri group and 40% in the Cirurgia group, there was a statistically significant difference between the two groups, with p = 0.037. Conclusion: in our study, a positive influence was observed on the pathological and surgical results of patients undergoing treatment with QTPeri, regardless of the chemotherapy regimen performed
 
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Publishing Date
2023-08-29
 
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