Origem geográfica e estado clínico na admissão de pacientes com doença trofoblástica gestacional em um centro de referência especializado no Estado de São Paulo, Brasil
Carregando...
Arquivos
Data
2020-02-19
Autores
Silva, Valdete Aparecida Ribeiro da
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O estado clínico das pacientes com doença trofoblástica gestacional (DTG) na admissão em centros especializados é consideravelmente influenciado por fatores sociais, econômicos e barreiras aos cuidados de saúde. Isto leva a apresentações em estágios avançados da doença. No Brasil, a estratégia da regionalização das ações de saúde (regiões de saúde político-administrativas) foi instituída a fim de facilitar o acesso aos serviços de saúde. Objetivos: Avaliar a proveniência e as condições clínicas de admissão das pacientes com DTG, encaminhadas para o Centro de Doenças Trofoblásticas de Botucatu, Universidade Estadual Paulista (CDTB/Unesp) e relacioná-las com a Região de Saúde de origem da paciente. Métodos: Estudo observacional transversal que incluiu pacientes com DTG encaminhadas de regiões de saúde que pertencem ao Estado de São Paulo e avaliadas no CDTB/Unesp, no período entre 1990 e 2018. As condições clínicas das pacientes com MH foram avaliadas pelo sistema de escore de risco da gravidez molar segundo Berkowitz et al. (1987) enquanto àquelas com NTG foram avaliadas por meio do sistema de classificação de estadiamento e escore prognóstico FIGO (2002). Foram coletados dados referentes à idade, raça, paridade, nível de escolaridade, estado civil, emprego, conhecimento prévio sobre a DTG. A análise estatística da pontuação de risco e do estado clínico na admissão de pacientes com MH e NTG em função da Região de Saúde de origem foi efetuada a partir do ajuste de modelos de regressão. Resultados: De 470 pacientes com DTG, 366 pacientes foram elegíveis para participar do estudo. As três regiões com maior proporção de encaminhamentos foram VI-Bauru (n=269; 73,5%), XVI-Sorocaba (n=70; 19,1%) e IX-Marília (n=15; 4,1%). Das 335 pacientes diagnosticadas com MH, 197 (58,8%) apresentaram escore de alto risco (≥ 4). Notavelmente, pacientes encaminhadas das regiões IX-Marília e XVI-Sorocaba apresentaram pontuação aumentada em 2,38 e 0,78 pontos respectivamente, quando comparadas àquelas da região VI-Bauru. Pacientes com conhecimento prévio sobre DTG, tiveram pontuação de risco da MH menor em 1,68 pontos (IC 95%: -4,82 – 1,34, p = 0,269). Do total de 31 pacientes com NTG, 22,6% tiveram pontuação de alto risco (≥ 7). Pacientes com NTG da região XVI-Sorocaba tiveram escore de risco FIGO (2002) aumentado em 3,42 pontos, quando comparadas àquelas da região VI-Bauru [β = 3,42, IC 95% (0,96 – 5,89), p = 0,006]. Conclusões: Mais de 25% das pacientes com DTG direcionadas ao CDTB/Unesp são de outras regiões que não a região de saúde VI-Bauru, o que pode indicar a desregulação do sistema de referência para doenças raras. Houve predominância de gravidez molar avançada com escore de risco ≥ 4, particularmente da região de saúde IX-Marília. Chama a atenção a elevada proporção de NTG metastática de alto risco, particularmente na região XVI-Sorocaba.
Background: The clinical status of patients with gestational trophoblastic disease (GTD) upon admission to specialized centers is significantly influenced by social and economic factors, as well as by barriers in access to health care, which are associated with advanced disease at presentation. In Brazil, a regionalization strategy has been adopted in order to facilitate access to healthcare (political-administrative healthcare districts). Objectives: To assess the clinical status upon admission in GTD patients referred to the Botucatu Trophoblastic Diseases Center (BTDC) of São Paulo State University to determine its relationship with the patient’s healthcare district of origin. Methods: This observational study included 366 GTD patients from health districts located across the state of São Paulo, who were referred to and then assessed at BTDC between 1990 and 2018. Patient clinical status upon admission was assessed according to the molar pregnancy risk score system of Berkowitz et al. in cases of MH, and using the FIGO risk/stage score system in cases of GTN. Data collected included age, race, parity, education level, marital status, employment status, previous knowledge of GTD. The statistical analysis of the relationship of risk score and clinical status upon admission with patient’s healthcare district of origin was performed by adjusting regression models. Results: Of 470 patients with GTD, 366 women were eligible to participate in the study. The highest proportion of referrals originated from the districts of Bauru-VI (n = 269; 73.5%), Sorocaba-XVI (n = 70; 19.1%) and Marília-IX (n = 15; 4.1%). Of the 335 patients diagnosed with MH, 197 (58.8%) had a high risk score (≥ 4). Notably, patients referred from the districts of Marília-IX and Sorocaba-XVI had scores increased by 2.38 and 0.78 points, respectively, when compared to those in the Bauru-VI district. Participants with previous knowledge on GTD had a 2-point lower MH risk score [β = - 1.68, 95% CI (-4.82 - 1.34), p = 0.269]. Of the 31 patients with NTG, 22.6% had high risk scores (≥ 7). GTN patients from the Sorocaba-XVI district had a FIGO risk score increased by 3.42 points, when compared to those from the Bauru-VI district [β = 3.42 95% CI (0.96 - 5.89), p = 0.006]. Conclusions: More than 25% of the patients with GDT treated at the CDTB/Unesp originate from regions other than of our center, which may indicate deregulation of the referral system for rare diseases. There was a predominance of advanced molar pregnancy with a risk score ≥ 4, particularly in the-Marília-IX district. The high proportion of high-risk metastatic GTN stands out, particularly in the Sorocaba-XVI district.
Background: The clinical status of patients with gestational trophoblastic disease (GTD) upon admission to specialized centers is significantly influenced by social and economic factors, as well as by barriers in access to health care, which are associated with advanced disease at presentation. In Brazil, a regionalization strategy has been adopted in order to facilitate access to healthcare (political-administrative healthcare districts). Objectives: To assess the clinical status upon admission in GTD patients referred to the Botucatu Trophoblastic Diseases Center (BTDC) of São Paulo State University to determine its relationship with the patient’s healthcare district of origin. Methods: This observational study included 366 GTD patients from health districts located across the state of São Paulo, who were referred to and then assessed at BTDC between 1990 and 2018. Patient clinical status upon admission was assessed according to the molar pregnancy risk score system of Berkowitz et al. in cases of MH, and using the FIGO risk/stage score system in cases of GTN. Data collected included age, race, parity, education level, marital status, employment status, previous knowledge of GTD. The statistical analysis of the relationship of risk score and clinical status upon admission with patient’s healthcare district of origin was performed by adjusting regression models. Results: Of 470 patients with GTD, 366 women were eligible to participate in the study. The highest proportion of referrals originated from the districts of Bauru-VI (n = 269; 73.5%), Sorocaba-XVI (n = 70; 19.1%) and Marília-IX (n = 15; 4.1%). Of the 335 patients diagnosed with MH, 197 (58.8%) had a high risk score (≥ 4). Notably, patients referred from the districts of Marília-IX and Sorocaba-XVI had scores increased by 2.38 and 0.78 points, respectively, when compared to those in the Bauru-VI district. Participants with previous knowledge on GTD had a 2-point lower MH risk score [β = - 1.68, 95% CI (-4.82 - 1.34), p = 0.269]. Of the 31 patients with NTG, 22.6% had high risk scores (≥ 7). GTN patients from the Sorocaba-XVI district had a FIGO risk score increased by 3.42 points, when compared to those from the Bauru-VI district [β = 3.42 95% CI (0.96 - 5.89), p = 0.006]. Conclusions: More than 25% of the patients with GDT treated at the CDTB/Unesp originate from regions other than of our center, which may indicate deregulation of the referral system for rare diseases. There was a predominance of advanced molar pregnancy with a risk score ≥ 4, particularly in the-Marília-IX district. The high proportion of high-risk metastatic GTN stands out, particularly in the Sorocaba-XVI district.
Descrição
Palavras-chave
Doença trofoblástica gestacional, , Referência e consulta, Prognóstico, Neoplasia trofoblástica gestacional, Gestational trophoblastic disease, Reference and consultation, Prognosis, Gestational trophoblastic neoplasia