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Purpose: Primary central nervous system (CNS) tumors are the second most common cancer in children and adolescents, leading to premature death and disability. Population-based survival estimates aid decision-making in cancer control, however data on survival for primary CNS tumors in Latin America is lacking. We describe survival rates for children with primary CNS tumors treated in ten Colombian cities. Methods: We analyzed data from children and adolescents newly diagnosed with cancer between 2012 and 2021, participating in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) in ten cities in Colombia. VIGICANCER collects information on clinical outcomes from twenty-seven pediatric oncology units and conducts active follow-up every three months. VIGICANCER does not register craniopharyngiomas; we excluded intracranial germ cell tumors for this report. We used the Kaplan-Meier method to estimate the overall survival probability, stratified by sociodemographic variables, topography, WHO grading, receipt of radiation therapy, and type of surgical resection. We analyzed the prognostic capacity of variables using multivariate proportional Cox's regression, stratified by city and year of diagnosis. Results: During the study period, VIGICANCER included 989 primary CNS tumors in 879 children and 110 adolescents. The cohort median age was 9 years; 53% of patients were males, and 8% were Afro-descendants. Most common tumors were supratentorial astrocytomas (47%), astrocytic tumors (35%), medulloblastomas (20%), ependymomas (11%), and mixed and unspecified gliomas (10%). Five-year overall survival of the entire cohort was 54% (95% CI, 51-58); for supratentorial gliomas, WHO grade I was 77%, II was 62%, III-IV was 27%, respectively, and for medulloblastoma was 61%. The adjusted hazard rate ratio for patients with WHO grade III and IV, for those with subtotal resection, for brainstem location, and for those not receiving radiation therapy was 7.4 (95% CI, 4.7-11.8), 6.4 (95% CI, 4.2-9.8), 2.8 (95% 2.1-3.8), 2.0 (95% CI, 1.3-2.8) and 2.3 (95% CI, 1.7-3.0), respectively. Conclusion: We found that half of Colombia's children and adolescents with primary CNS tumors survive five years, compared to 70% to 80% in high-income countries. In addition to tumor biology and location, gross total resection was crucial for improved survival in this cohort. Systematic monitoring of survival and its determinants provides empirical data for guiding cancer control policies.
RESUMEN
Mediante una aproximación a la noción de sujeto desde una perspectiva psicoanalítica fundamentada en Freud y Lacan, este artículo teórico busca problematizar la dicotomía psicología individual versus psicología social, dicotomía que aún opera en ciertos ámbitos y debates académicos. El énfasis que esta postura psicoanalítica pone en la inscripción simbólica de la subjetividad, así como su introducción de una necesaria distinción conceptual entre el sujeto y el yo, contribuye a la teorización de la subjetividad más allá de todo reduccionismo individualista o socioestructuralista. Asimismo, con el propósito de animar debates interdisciplinarios, se explicitan al final puntos de convergencia y divergencia con algunos discursos psicológicos y sociológicos hegemónicos en la actualidad.
Through an approach to the notion of subject from a psychoanalytic perspective based on Freud and Lacan, this theoretical paper seeks to discuss the dichotomy between individual psychology and social psychology and that operates even in certain academic fields and debates. The emphasis of this psychoanalytic approach on the symbolic inscription of subjectivity, as well as its introduction of a necessary conceptual distinction between the subject and the I, contributes to theorize subjectivity beyond any individualist or socio-structuralist reductionism. In order to encourage interdisciplinary discussions, points of convergence and divergence with some psychological and sociological discourses currently hegemonic are also specified at the end.
Grâce à une approche de la notion de sujet à partir dune perspective psychanalytique fondée sur Freud et Lacan, cet article théorique cherche à mettre en question la dichotomie psychologie individuelle face à la psychologie sociale, dichotomie qui opère encore dans certains milieux et débats académiques. Laccent mis par cette perspective psychanalytique sur linscription symbolique de la subjectivité, ainsi que son introduction dune nécessaire distinction conceptuelle entre le ® sujet ¼ et le ® moi ¼, contribue à la théorisation de la subjectivité, au-delà de tout réductionnisme individualiste ou socio-structuraliste. De même, des points de convergence et de divergence par rapport à certains discours psychologiques et sociologiques hégémoniques daujourdhui sont explicités à la fin, dans l'intention de motiver des débats interdisciplinaires.
