RESUMO
BACKGROUND: The goal of the current study was to assess the effect of pregnancy on the subsequent risk of recurrence after treatment for breast carcinoma, adjusting for established prognostic factors. METHODS: Between 1974 and 1998, 383 patients age < or =35 years were treated for breast carcinoma with adjuvant chemotherapy at The University of Texas M. D. Anderson Cancer Center (Houston, TX). The median follow-up period was 13 years. Of these, 13 patients were excluded from analysis, as no history was available regarding pregnancy; 240 (65%) were >30 years old; 47 (13%) had at least 1 pregnancy after therapy; 32 had full-term pregnancies; 10 had spontaneous or elective abortions; 4 had miscarriages; and 1 had a premature delivery. Estrogen receptor (ER) status, lymph node involvement, and disease stage were evaluated as potential risk factors for recurrence. Information on ER status was unavailable for 123 (33%) patients. RESULTS: Patients who experienced a pregnancy tended to have earlier-stage disease (Stage I/II: 80% vs. 73%), fewer positive lymph nodes (<4: 87% vs. 52%), more ER negativity (68% vs. 58%), and younger age (<30 years: 57% vs. 32%) than patients who did not. The incidence of disease recurrence was 23% for women who experienced a pregnancy and 54% for women who did not. The hazard ratio (using the multivariate Cox proportional hazards model) for disease recurrence in patients with posttreatment pregnancy was 0.71 (P=0.4). CONCLUSIONS: In the current study population, pregnancy was not associated with an increased risk of disease recurrence or poorer survival in patients previously treated for breast carcinoma.
Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Carcinoma/terapia , Recidiva Local de Neoplasia/epidemiologia , Complicações Neoplásicas na Gravidez/epidemiologia , Gravidez de Alto Risco , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/patologia , Carcinoma/patologia , Terapia Combinada , Intervalos de Confiança , Feminino , Humanos , Incidência , Mastectomia Segmentar/métodos , Recidiva Local de Neoplasia/patologia , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Resultado da Gravidez , Probabilidade , Prognóstico , Modelos de Riscos Proporcionais , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Análise de SobrevidaRESUMO
Desde el reporte original (1943), se han descrito 150 casos de la púrpura hiperglobulinnémica de Waldenström. Dicha condición se caracteriza por la recurrencia de lesiones purpúricas en las extremidades inferiores de mujeres jóvenes. Concomitantemente en estos pacientes se encuentra: prolongación sustancial del tiempo de sedimetnación de los hematies, altos niveles de factor reumatoideo, marcado aumento de las inmunoglobulinas , complejos de antigeno-anticuerpo circulantes y pruebas de coagulación sanguínea normales. Se ha descrito una alta coincidencia con las colagenosis. Aquí presentamos nuestra experiencia de 18 años con 7 pacientes con este diagnóstico. Todos los pacientes son mujeres, con comienzo de su mal a una edad joven. Sus pruebas de coagulación fueron normales, la velocidad de sedimentación de hematies fue uniformemente alta, las inmunoglobulinas (especialmente IgG) mostraron aumento significativo y la elevación del factor reumatoideo fue notable en todas. Tres pacientes presentaron enfermedad de Sjögren, y dos lupus sistémico. Si hizo reevaluación en 1988 a cinco pacientes disponibles, la cual reveló: biopsias de piel con vasculitis leucocitoclástica, complejos antigeno-anticuerpo circulantes y positividad para anticuerpos contra SS A en todos los casos. Los estudios de linfocitos T fueron anormales y sugieren un problema en el balance inmunológico de estos pacientes. Se discute la patofisiología y el tratamiento