Sobrevida de pacientes submetidos a ressecção cirúrgica de metástases cerebrais de câncer de pulmão no Hospital das Clínicas da Faculdade de Medicina de Botucatu
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Data
2023-06-14
Autores
Botta, Fabio Pires
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: metástases cerebrais (MC) estão entre as mais comuns neoplasias intracranianas. Seu foco primário mais comum são canceres de pulmão. Frequentemente são a primeira manifestação de um câncer ainda não diagnosticado. Seu tratamento envolve uma combinação entre ressecção cirúrgica, radioterapia, radiocirurgia, quimioterapia convencional, imunoterapias, terapias alvo e suporte clínico otimizado. Diversas escalas estimam a sobrevida de paciente portadores de MC com crescente importância dada à genética tumoral. Entretanto, dados biomoleculares e tratamentos oncológicos modernos são frequentemente indisponíveis nos países em desenvolvimento, onde a literatura atual internacional pode não representar a sobrevida dos pacientes. Objetivo: determinar a sobrevida dos pacientes operados de MC de câncer de pulmão em um hospital terciário do sistema público de saúde brasileiro, fatores a ela relacionados e comparar às escalas prognósticas. Metodologia: foi elaborada uma coorte retrospectiva dos pacientes operados por MC de câncer de pulmão no HCFMB. Resultados: 55 pacientes operados entre junho de 2012 e dezembro de 2022 foram recrutados. A sobrevida média foi global foi 9,3 ±12 meses, com mediana de 5,8 meses (IIQ: 9,9 meses). O foco primário era desconhecido em 76,4% dos pacientes e sua sobrevida não teve diferença significativa com os demais. Sexo feminino, melhora de KPS após a cirurgia e a classificação de GPA2012 no grupo 3,5 a 4 pontos tiveram significância estatística em análise univariada para sobrevida de 18 meses. Análise multivariada demonstrou significância estatística apenas para melhora de KPS e GPA2012 para sobrevida de 18 meses. A sobrevida estimada pelas escalas de GPA2017 e GPA2022, que lançam mão de dados histológicos e biomoleculares, não se assemelharam à sobrevida observada. Conclusão: a sobrevida mediana dos pacientes operados por MC de câncer de pulmão no HCFMB foi de 5,8 meses (0,2 – 76,5 meses). A melhora de KPS em pós-operatório foi associada a uma maior sobrevida. A sobrevida observada melhor se assemelhou à estimada pela GPA2012.
Introduction: brain metastasis (BM) are among the most common intracranial tumors. Its most frequent primary focus is lung cancer. BM are often the first symptom of an undiagnosed cancer. Its treatment may involve a combination of surgery, radiation therapy, chemotherapy, target and immunotherapy and best supportive care. Published scales attempt to estimate the survival of patients with BM and show growing importance of the genetic pattern of the disease. However, biomolecular testing and modern oncologic treatment are often unavailable in developing countries, where patient survival may differ from literature description. Aims: determine the survival of patients operated on BM from lung cancer at a high complexity hospital within the Brazilian public health system, analyze related variables and compare it to the prognostic scales. Methods: a retrospective cohort was elaborated with patients that received surgical treatment for BM from lung cancer at the HCFMB. Results: 55 patients operated on between June 2012 and December 2022 were recruited. The average survival was 9.3 ±12 months, with median survival of 5.8 months (IQR: 9.9). Primary focus was unknown on 76.4% of patients, and their survival did not differ from those who had been previous diagnosed of their disease. Female sex, improvement on KPS after surgery and GPA2012 scoring between 3.5 and 4 points were statistically associated with increased survival on 18 months. Multivariate analysis showed statistical significance only for improvement on KPS e GPA2012 for greater survival rate on 18 months. The estimated survival by the GPA2017 and GPA2022 scales, which use histological and biomolecular data, did not resemble the observed survival. Conclusions: median survival of patients operated on BM from lung cancer at the HCFMB was 5.8 months (0.2 – 76.5). Improvement on KPS post operatively was associated with longer survival. The observed survival best resembled the estimated survival by the GPA2012.
Introduction: brain metastasis (BM) are among the most common intracranial tumors. Its most frequent primary focus is lung cancer. BM are often the first symptom of an undiagnosed cancer. Its treatment may involve a combination of surgery, radiation therapy, chemotherapy, target and immunotherapy and best supportive care. Published scales attempt to estimate the survival of patients with BM and show growing importance of the genetic pattern of the disease. However, biomolecular testing and modern oncologic treatment are often unavailable in developing countries, where patient survival may differ from literature description. Aims: determine the survival of patients operated on BM from lung cancer at a high complexity hospital within the Brazilian public health system, analyze related variables and compare it to the prognostic scales. Methods: a retrospective cohort was elaborated with patients that received surgical treatment for BM from lung cancer at the HCFMB. Results: 55 patients operated on between June 2012 and December 2022 were recruited. The average survival was 9.3 ±12 months, with median survival of 5.8 months (IQR: 9.9). Primary focus was unknown on 76.4% of patients, and their survival did not differ from those who had been previous diagnosed of their disease. Female sex, improvement on KPS after surgery and GPA2012 scoring between 3.5 and 4 points were statistically associated with increased survival on 18 months. Multivariate analysis showed statistical significance only for improvement on KPS e GPA2012 for greater survival rate on 18 months. The estimated survival by the GPA2017 and GPA2022 scales, which use histological and biomolecular data, did not resemble the observed survival. Conclusions: median survival of patients operated on BM from lung cancer at the HCFMB was 5.8 months (0.2 – 76.5). Improvement on KPS post operatively was associated with longer survival. The observed survival best resembled the estimated survival by the GPA2012.
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Palavras-chave
Metástase, Neurocirurgia, Pulmões Câncer, Pulmões - Câncer - Cirurgia, Sistema nervoso - Cirurgia, Cérebros - Metástase, Neoplasias encefálicas, Taxa de sobrevida