Sobrevida e fatores prognósticos de pacientes com câncer de mama no Estado de São Paulo
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Data
2020-02-19
Autores
Almeida, Raissa Janine
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Universidade Estadual Paulista (Unesp)
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Introdução: O câncer de mama é um problema de saúde pública ao nível mundial, sendo a neoplasia maligna mais frequente na população feminina. Objetivos: A dissertação será apresentada no formato de dois manuscritos, cujos objetivos foram: (i) descrever as características das pacientes com câncer de mama incluídas no Registro Hospitalar de Câncer (RHC) da Fundação Oncocentro de São Paulo (FOSP) e investigar os fatores associados com o estádio clínico ao diagnóstico e (ii) estimar a probabilidade de sobrevida em 5 e 10 anos destas mulheres e investigar os fatores prognósticos para esta neoplasia. Material e métodos: Para os dois manuscritos, foram utilizados os casos de câncer de mama em mulheres incluídos no RHC-FOSP. O Manuscrito 1 foi uma série de casos, que incluiu os casos de câncer de mama diagnosticados entre 2000 e 2014. O evento estudado foi estádio clínico (estádio 0-II versus III-IV). As variáveis explicativas foram idade e nível de escolaridade. Foi realizada análise descritiva e regressão logística. Foram estimados odds ratios (OR) e respectivos intervalos de 95% de confiança (IC95%). O Manuscrito 2 foi uma coorte histórica que incluiu mulheres com câncer de mama diagnosticadas entre 2002 e 2012. O evento estudado foi mortalidade específica por câncer de mama. Casos vivos no final do seguimento (31/12/2017), as perdas de seguimento e aquelas que morreram por outras causas diferentes do câncer de mama foram censurados na data do último contato ou data do óbito. Foi realizada análise descritiva e análise de sobrevida pelo método de Kaplan-Meyer. As curvas de sobrevida foram comparadas usando o teste log-rank. Também foram estimados os hazard ratios (HR) e respectivos IC95% através do modelo de riscos proporcionais de Cox. O estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da Faculdade de Medicina de Botucatu, Unesp. Resultados: Manuscrito 1: O estudo incluiu 84.987 mulheres com câncer de mama in situ e invasivo diagnosticadas entre 2000-2014. A média de idade das mulheres ao diagnóstico foi 56,7 anos. 65% dos casos tinham ensino fundamental completo ou menos e o tipo histológico mais frequente foi o carcinoma ductal (77,2%). Durante o período de estudo, houve pequena diminuição da proporção de tumores em estádios mais avançados, passando de 39,8% em 2000 para 32,6% em 2014. Observou-se uma associação estatisticamente significativa entre idade ao diagnóstico e nível de escolaridade com o estádio clínico agrupado das mulheres. Manuscrito 2: No período entre 2002-2012, foram registrados 53.146 casos de câncer de mama invasivos no RHC-FOSP. A mediana de idade das mulheres ao diagnóstico foi 55,9 anos. Até o final do seguimento, 20.683 pacientes foram a óbito e 71,4% deles foi devido ao câncer de mama. A probabilidade de sobrevida específica para toda a coorte em 5 e 10 anos foi de 76,1% (IC95% 75,7-76,5%) e 64,8% (IC95% 64,2-65,3%), respectivamente. Na análise multivariada, os fatores associados ao prognóstico foram: idade ao diagnóstico, ano de diagnóstico, nível de escolaridade, estádio clínico agrupado e tipo histológico. Conclusão: Esses achados podem contribuir para o desenvolvimento de políticas para identificação de tumores mamários em estádios mais precoces.
Introduction: Breast cancer is a public health problem worldwide, being the most common malignant neoplasm in the female population. Objectives: This Masters Dissertation is structured in the format of two papers. The aims of this research were: (i) to describe the characteristics of breast cancer patients included in the hospital-based cancer registry of the Fundação Oncocentro de São Paulo (FOSP, in Portuguese) and to assess factors associated with the clinical stage at diagnosis, and (ii) to estimate 5- and 10-year breast cancer-specific survival probabilities and to assess the prognostic factors for this neoplasm. Methods: Breast cancer in women included in RHC-FOSP were used in both papers. Manuscript 1 was a case series study, which included breast cancer cases diagnosed between 2000 and 2014. The outcome was clinical stage (stage 0-II versus III-IV). The explanatory variables were age and educational level. Descriptive analysis and logistic regression were performed. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated. Manuscript 2 was a historical cohort study that included women with breast cancer diagnosed between 2002 and 2012. The event of interest was breast cancer-specific mortality. Living cases at the end of follow-up (December 31, 2017), loss to follow-up and death other than that due to breast cancer were considered censored on the date of the last contact or date of death. Descriptive analysis and survival analysis were performed using the Kaplan-Meyer method. Survival curves were compared using the log-rank test. Hazard ratios (HR) and their 95%CI were estimated using Cox's proportional hazards model. The study was approved by the Human Research Ethics Committee of the Botucatu Medical School, São Paulo State University, Brazil. Results: Manuscript 1: The study included 84,987 women with in situ and invasive breast cancer diagnosed between 2000-2014. The average age of cases at diagnosis was 56.7 years (95%CI 56.6 - 56.8 years). Sixty-five percent of cases completed elementary school or less and the most frequent histological type was ductal carcinoma (77.2%). During the study period, there was a slight decrease in the proportion of tumors in more advanced stages, from 39.8% in 2000 to 32.6% in 2014. There was a statistically significant association between age at diagnosis and educational level with the women's grouped clinical stage. Manuscript 2: 53,146 cases of invasive breast cancer were registered at RHC-FOSP between 2002-2012. The median age at diagnosis was 55.9 years. By the end of the follow-up, 20,683 patients died and 71.4% were due to breast cancer. The 5- and 10-year breast cancer-specific survival for the entire cohort was 76.1% (95%CI 75.7-76.5%) and 64.8% (95% CI 64.2-65.3%), respectively. In the multivariate analysis, the factors associated with prognosis were age at diagnosis, year of diagnosis, educational level, grouped clinical stage, and histological type. Conclusion: These findings may contribute to the development of policies for the identification of breast tumors at earlier stages.
Introduction: Breast cancer is a public health problem worldwide, being the most common malignant neoplasm in the female population. Objectives: This Masters Dissertation is structured in the format of two papers. The aims of this research were: (i) to describe the characteristics of breast cancer patients included in the hospital-based cancer registry of the Fundação Oncocentro de São Paulo (FOSP, in Portuguese) and to assess factors associated with the clinical stage at diagnosis, and (ii) to estimate 5- and 10-year breast cancer-specific survival probabilities and to assess the prognostic factors for this neoplasm. Methods: Breast cancer in women included in RHC-FOSP were used in both papers. Manuscript 1 was a case series study, which included breast cancer cases diagnosed between 2000 and 2014. The outcome was clinical stage (stage 0-II versus III-IV). The explanatory variables were age and educational level. Descriptive analysis and logistic regression were performed. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated. Manuscript 2 was a historical cohort study that included women with breast cancer diagnosed between 2002 and 2012. The event of interest was breast cancer-specific mortality. Living cases at the end of follow-up (December 31, 2017), loss to follow-up and death other than that due to breast cancer were considered censored on the date of the last contact or date of death. Descriptive analysis and survival analysis were performed using the Kaplan-Meyer method. Survival curves were compared using the log-rank test. Hazard ratios (HR) and their 95%CI were estimated using Cox's proportional hazards model. The study was approved by the Human Research Ethics Committee of the Botucatu Medical School, São Paulo State University, Brazil. Results: Manuscript 1: The study included 84,987 women with in situ and invasive breast cancer diagnosed between 2000-2014. The average age of cases at diagnosis was 56.7 years (95%CI 56.6 - 56.8 years). Sixty-five percent of cases completed elementary school or less and the most frequent histological type was ductal carcinoma (77.2%). During the study period, there was a slight decrease in the proportion of tumors in more advanced stages, from 39.8% in 2000 to 32.6% in 2014. There was a statistically significant association between age at diagnosis and educational level with the women's grouped clinical stage. Manuscript 2: 53,146 cases of invasive breast cancer were registered at RHC-FOSP between 2002-2012. The median age at diagnosis was 55.9 years. By the end of the follow-up, 20,683 patients died and 71.4% were due to breast cancer. The 5- and 10-year breast cancer-specific survival for the entire cohort was 76.1% (95%CI 75.7-76.5%) and 64.8% (95% CI 64.2-65.3%), respectively. In the multivariate analysis, the factors associated with prognosis were age at diagnosis, year of diagnosis, educational level, grouped clinical stage, and histological type. Conclusion: These findings may contribute to the development of policies for the identification of breast tumors at earlier stages.
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Palavras-chave
Neoplasias da mama, Diagnóstico tardio, Análise de sobrevida, Prognóstico, Breast Neoplasms, Delayed diagnosis, Survivalanalysis, Prognosis