HAS THE AGING OF BRAZILIANS IMPACTED THE OCCURRENCE OF OSTEO-CARTILAGINOUS NEOPLASMS?

Cancer cases and survival have increased significantly in recent decades. OBJECTIVE: In this study, we sought to evidence whether bone, joint and cartilage neoplasms are increasing with the aging of the Brazilian population, using the analysis of the DATASUS and IBGE databases, between 1979 and 2020. METHODS: We compared the means and the proportion of death in Brazil, to observe the confidence interval overlaps, separated by region. Comparison between genders, age group, death and specific rate were compared via proportion tests and the trend was investigated via time series analysis. RESULTS: Through the analyses, we can see that there is an increasing trend of cases, about 2.5 times in the period. Separated by region, the Southeast stands out, with a number of deaths about 6 times higher than other regions. CONCLUSION: Metastatic carcinoma is the most common neoplasm treated by orthopedic surgeons, and it is essential to adapt to this future projection, with cases of pathological bone involvement resulting from metastatic carcinomas, increasingly present in the routine of orthopedic surgeons. Level of Evidence IV, Cross-Sectional Observational Study.

Os casos oncológicos e a sobrevida aumentaram expressivamente nas últimas décadas. Objetivo: Investigar se as neoplasias de osso, articulação e cartilagem estão aumentando com o envelhecimento da população brasileira, por meio da análise das bases de dado do Sistema Único de Saúde (DATASUS) e do Instituto Brasileiro de Geografia e Estatística (IBGE), entre os anos de 1979 e 2020. Métodos: Realizamos a comparação de médias e de proporção de morte entre as regiões do Brasil para observar as sobreposições de intervalo de confiança em cada região. A comparação entre sexo, faixa etária, óbito e taxa específica foi feita via testes de proporção, e a tendência foi investigada via análise de séries temporais. Resultados: Foi evidenciada uma tendência crescente dos casos de neoplasia, com um aumento de cerca de 2,5 vezes no período analisado. Entre as regiões do Brasil, destacou-se o Sudeste, com número de mortes cerca de seis vezes maior que outras regiões. Conclusão: O carcinoma metastático é a neoplasia mais comum tratada pelos cirurgiões ortopédicos, e é fundamental nos adequarmos a essa projeção futura, com casos de comprometimento ósseo patológicos decorrentes de carcinomas metastáticos cada vez mais presentes na rotina do cirurgião ortopédico. Nível de Evidência IV, Estudo Observacional Transversal.

EXTRA-ABDOMINAL DESMOID TUMOR: ANALYSIS OF 23 CONSECUTIVE CASES IN A SINGLE INSTITUTION.

OBJECTIVE: Extra-abdominal desmoid tumor (EDT) is a rare condition, caused by proliferation of fibroblasts. Despite being a benign tumor, it is locally aggressive and has unpredictable clinical behavior. The objective of this study is to present the clinical outcomes of patients with EDT treated surgically between 1995 and 2016. METHODS: This is a retrospective series of 23 patients with histopathological diagnosis of EDT that underwent surgery at the orthopedic oncology service of our hospital. The information was obtained from the institute's clinical and pathology reports. RESULTS: A total of 223 medical records with histopathological reports were evaluated. Only 23 cases of EDT were included in the present study. The mean age was 22.5 years. Twelve (52.2%) patients had the tumor on the lower limbs, seven (30.4%) on the upper limbs and four (17.4%) cases were reported on the back. Five (21.7%) patients had tumors measuring less than 5 cm, while eighteen (78.3%) patients had tumors measuring more than 5 cm. All patients underwent surgery as the definitive treatment in our institute. Twelve (52.2%) cases presented negative margins (NM) and eleven (47.8%) cases had positive margins (PM). Local recurrence (LR) occurred in eleven (47.8%) patients. CONCLUSION: Impairment of the surgical margin was the only prognostic factor found for LR of EDT. Level of Evidence IV, Case Series.

OBJETIVO: O tumor desmoide extra-abdominal (TDE) é raro, formado por proliferação de fibroblastos. Apesar de ser um tumor benigno, é localmente agressivo e tem comportamento clínico imprevisível. O objetivo desta pesquisa é apresentar os resultados clínicos obtidos nos pacientes com TDE, tratados cirurgicamente entre 1995 e 2016. MÉTODOS: Trata-se de uma série retrospectiva de 23 pacientes com diagnóstico anatomopatológico de TDE, tratados cirurgicamente no serviço de oncologia ortopédica de nosso hospital. A informação foi obtida dos relatos clínicos e patológicos do instituto. RESULTADOS: Um total de 223 prontuários com relato anatomopatológico foi revisado. Apenas 23 casos de TDE foram incluídos no presente estudo. A média de idade foi de 22,5 anos. Doze (52,2%) casos se localizaram nos membros inferiores, sete (30,4%) casos nos membros superiores e quatro (17,4%) casos se localizaram no dorso. Cinco (21,7%) casos tinham tamanho < 5 cm e 18 (78,3%) casos tinham tamanho > 5 cm. Todos os pacientes receberam tratamento cirúrgico como terapia definitiva no instituto. Doze (52,2%) casos apresentaram margens livres (ML) e onze (47,8%) casos tinham margens comprometidas (MC). A recorrência local (RL) ocorreu em onze (47,8%) pacientes. CONCLUSÃO: O comprometimento da margem cirúrgica foi o único fator de prognóstico encontrado para a RL do TDE. Nível de Evidência IV, Série de Casos.

TIBIAL ADAMANTINOMA: ANALYSIS OF SEVEN CONSECUTIVE CASES IN A SINGLE INSTITUTION.

OBJECTIVE: Adamantinoma accounts for less than 1% of the primary bone neoplasms. The tibia is the most affected bone and it is predominant in male patients between the second and third decades of life. The objective of this study is to obtain epidemiological and clinical information on patients with adamantinoma of the tibia treated surgically between 1989 and 2016. METHODS: Retrospective series of seven patients diagnosed with adamantinoma of the tibia that underwent surgery at the orthopedic oncology service of our hospital. The information was obtained from the medical records and histopathological reports of our institution. RESULTS: A total of 2870 medical records with histological reports were evaluated. Seven cases of adamantinoma of the tibia were included. The mean age was 28.5 (17-49) years. We found a predominance of females (71.4%) and the most affected side was the left one, with four cases (57.1%). The biopsy revealed bone adamantinoma in four (57.1%) patients, while the diagnosis of the other patients was confirmed after the histological examination of the surgical specimen. All the patients underwent surgery as definitive treatment. No positive margins were reported. No local recurrence (LR) was reported and two patients had distant metastasis (DM). CONCLUSION: The prognosis of survival in cases of adamantinoma of the tibia is high. The rates of LR and DM were low. Surgical treatment with extensive tumor resection is the treatment of choice. Level of Evidence IV, Case Series.

OBJETIVO: O adamantinoma representa menos de 1% das neoplasias ósseas primárias. Afeta predominantemente a tíbia, em pacientes do sexo masculino entre a segunda e terceira décadas da vida. O objetivo deste trabalho é obter informação epidemiológica e clínica dos pacientes com adamantinoma da tíbia, tratados mediante cirurgia entre 1989 e 2016. MÉTODOS: Série retrospectiva de sete pacientes com diagnóstico de adamantinoma da tíbia, tratados cirurgicamente no serviço de oncologia ortopédica do nosso hospital. A informação foi obtida dos relatos clínicos e patológicos do instituto. RESULTADOS: Um total de 2870 prontuários com relatos anatomopatológicos foram revisados. Sete casos de pacientes com adamantinoma na tíbia foram encontrados. A média de idade foi de 28,5 anos (17-49). Encontramos predominância do sexo feminino (71,4%). O lado mais afetado foi o esquerdo, com quatro (57,1%) casos. A biópsia diagnosticou adamantinoma em 57,1% dos casos e o diagnóstico dos outros casos foi definido após exame da peça cirúrgica. Todos os pacientes receberam tratamento cirúrgico como terapia definitiva. Não foram reportadas margens comprometidas. Nenhum paciente apresentou recorrência local (RL). Dois pacientes apresentaram metástase à distância (MD). CONCLUSÃO: O prognóstico de sobrevida do adamantinoma da tíbia é alto. Apresenta taxas baixas de RL e MD. A cirurgia com ampla ressecção do tumor é o tratamento de escolha. Nível de Evidência IV, Série de Casos.

Tibial adamantinoma: analysis of seven consecutive cases in a single institution / Adamantinoma da tíbia: análise de sete casos consecutivos em uma única instituição

ABSTRACT Objective: Adamantinoma accounts for less than 1% of the primary bone neoplasms. The tibia is the most affected bone and it is predominant in male patients between the second and third decades of life. The objective of this study is to obtain epidemiological and clinical information on patients with adamantinoma of the tibia treated surgically between 1989 and 2016. Methods: Retrospective series of seven patients diagnosed with adamantinoma of the tibia that underwent surgery at the orthopedic oncology service of our hospital. The information was obtained from the medical records and histopathological reports of our institution. Results: A total of 2870 medical records with histological reports were evaluated. Seven cases of adamantinoma of the tibia were included. The mean age was 28.5 (17-49) years. We found a predominance of females (71.4%) and the most affected side was the left one, with four cases (57.1%). The biopsy revealed bone adamantinoma in four (57.1%) patients, while the diagnosis of the other patients was confirmed after the histological examination of the surgical specimen. All the patients underwent surgery as definitive treatment. No positive margins were reported. No local recurrence (LR) was reported and two patients had distant metastasis (DM). Conclusion: The prognosis of survival in cases of adamantinoma of the tibia is high. The rates of LR and DM were low. Surgical treatment with extensive tumor resection is the treatment of choice. Level of Evidence IV, Case Series.

RESUMO Objetivo: O adamantinoma representa menos de 1% das neoplasias ósseas primárias. Afeta predominantemente a tíbia, em pacientes do sexo masculino entre a segunda e terceira décadas da vida. O objetivo deste trabalho é obter informação epidemiológica e clínica dos pacientes com adamantinoma da tíbia, tratados mediante cirurgia entre 1989 e 2016. Métodos: Série retrospectiva de sete pacientes com diagnóstico de adamantinoma da tíbia, tratados cirurgicamente no serviço de oncologia ortopédica do nosso hospital. A informação foi obtida dos relatos clínicos e patológicos do instituto. Resultados: Um total de 2870 prontuários com relatos anatomopatológicos foram revisados. Sete casos de pacientes com adamantinoma na tíbia foram encontrados. A média de idade foi de 28,5 anos (17-49). Encontramos predominância do sexo feminino (71,4%). O lado mais afetado foi o esquerdo, com quatro (57,1%) casos. A biópsia diagnosticou adamantinoma em 57,1% dos casos e o diagnóstico dos outros casos foi definido após exame da peça cirúrgica. Todos os pacientes receberam tratamento cirúrgico como terapia definitiva. Não foram reportadas margens comprometidas. Nenhum paciente apresentou recorrência local (RL). Dois pacientes apresentaram metástase à distância (MD). Conclusão: O prognóstico de sobrevida do adamantinoma da tíbia é alto. Apresenta taxas baixas de RL e MD. A cirurgia com ampla ressecção do tumor é o tratamento de escolha. Nível de Evidência IV, Série de Casos.

Extra-abdominal desmoid tumor: analysis of 23 consecutive cases in a single institution / Tumor desmoide extra-abdominal: análise de 23 casos consecutivos em uma única instituição

ABSTRACT Objective: Extra-abdominal desmoid tumor (EDT) is a rare condition, caused by proliferation of fibroblasts. Despite being a benign tumor, it is locally aggressive and has unpredictable clinical behavior. The objective of this study is to present the clinical outcomes of patients with EDT treated surgically between 1995 and 2016. Methods: This is a retrospective series of 23 patients with histopathological diagnosis of EDT that underwent surgery at the orthopedic oncology service of our hospital. The information was obtained from the institute's clinical and pathology reports. Results: A total of 223 medical records with histopathological reports were evaluated. Only 23 cases of EDT were included in the present study. The mean age was 22.5 years. Twelve (52.2%) patients had the tumor on the lower limbs, seven (30.4%) on the upper limbs and four (17.4%) cases were reported on the back. Five (21.7%) patients had tumors measuring less than 5 cm, while eighteen (78.3%) patients had tumors measuring more than 5 cm. All patients underwent surgery as the definitive treatment in our institute. Twelve (52.2%) cases presented negative margins (NM) and eleven (47.8%) cases had positive margins (PM). Local recurrence (LR) occurred in eleven (47.8%) patients. Conclusion: Impairment of the surgical margin was the only prognostic factor found for LR of EDT. Level of Evidence IV, Case Series.

RESUMO Objetivo: O tumor desmoide extra-abdominal (TDE) é raro, formado por proliferação de fibroblastos. Apesar de ser um tumor benigno, é localmente agressivo e tem comportamento clínico imprevisível. O objetivo desta pesquisa é apresentar os resultados clínicos obtidos nos pacientes com TDE, tratados cirurgicamente entre 1995 e 2016. Métodos: Trata-se de uma série retrospectiva de 23 pacientes com diagnóstico anatomopatológico de TDE, tratados cirurgicamente no serviço de oncologia ortopédica de nosso hospital. A informação foi obtida dos relatos clínicos e patológicos do instituto. Resultados: Um total de 223 prontuários com relato anatomopatológico foi revisado. Apenas 23 casos de TDE foram incluídos no presente estudo. A média de idade foi de 22,5 anos. Doze (52,2%) casos se localizaram nos membros inferiores, sete (30,4%) casos nos membros superiores e quatro (17,4%) casos se localizaram no dorso. Cinco (21,7%) casos tinham tamanho < 5 cm e 18 (78,3%) casos tinham tamanho > 5 cm. Todos os pacientes receberam tratamento cirúrgico como terapia definitiva no instituto. Doze (52,2%) casos apresentaram margens livres (ML) e onze (47,8%) casos tinham margens comprometidas (MC). A recorrência local (RL) ocorreu em onze (47,8%) pacientes. Conclusão: O comprometimento da margem cirúrgica foi o único fator de prognóstico encontrado para a RL do TDE. Nível de Evidência IV, Série de Casos.

Schooling of the patients and clinical application of questionnaires in osteoarthitis.

OBJECTIVE: To evaluate the consistency of the questionnaires (WOMAC, Lequesne, VAS, SF 36-PCS and SF 36-MCS) when applied in patients with osteoarthritis of the knees (KOA) verifying if age and level of education interfere with the completion of the questionnaires. METHOD: One hundred and two patients with KOA answered WOMAC, LESQUESNE, VAS and SF-36 questionnaires and provided data correlated with age and education. The internal consistency of the WOMAC questionnaire was verified with Cronbach's alpha. Pearson's correlations between the questionnaires, age and educational level was performed. RESULTS: Mean age was 65 years old. Schooling averaged 7.94 years; WOMAC 47.95; VAS 63.57; Lequesne 12.29; PCS and MCS 31.91 43.68. Cronbach's alpha for WOMAC 0.9. Education did not affect WOMAC response (r=-0.182, p = 0.067) and MCS (r=0.021 / p=0.835), but showed weak but significant correlation with VAS (r=-0.264 / p=0.007), Lequesne (r=0.277, p=0.005) and PCS (r=0.309/ p=0.002). Age showed significant direct correlation only with PCS (r=0.205, p=0.039). CONCLUSION: The level of education does not interfere with the completion of WOMAC but may interfere with completing VAS, Lequesne and physical component of SF-36. Level of Evidence II, Retrospective Study.

Schooling of the patients and clinical application of questionnaires in osteoarthitis

Avaliar a consistência dos Questionários WOMAC,LEQUESNE, EVA, SF 36-PCS e SF 36-MCS quando aplicadosem pacientes portadores de osteoartrite dos joelhos (OAJ), verificandose a escolaridade e a idade interferem no preenchimentodos questionários. Método: Cento e dois pacientes comdiagnóstico de OAJ responderam os questionários de WOMAC,LESQUESNE, EVA e SF-36 e forneceram dados correlacionadoscom idade e escolaridade. Foi verificada a consistência internado questionário de WOMAC com uso do alpha de Cronbach, eas correlações de Pearson entre as escalas avaliadas, a idadee a escolaridade. Resultados: A idade média foi de 65 anos, ea escolaridade média de 7,94 anos: WOMAC 47,95; EVA 63,57;Lequesne 12,29; PCS 31,91 e MCS 43,68. Alfa de Crombachpara WOMAC de 0,9. Aleatoriedade do WOMAC segundo escolaridade(correlação – 0,182 / p= 0,067) e baixa correlaçãodas escalas EVA (r =-0,264/p=0,007), Lequesne (r =-0,277/p= 0,005), PCS (r = 0,309/p = 0,002) e MCS (r= 0,021/ p=0,835) com a escolaridade dos pacientes. A idade apresentoucorrelação direta significativa apenas com PCS (r= 0,205/ p=0,039). Conclusão: O grau de escolaridade não interfere nopreenchimento do WOMAC, mas pode interferir no preenchimentodo EVA, Lequesne e componente físico do SF-36. Nível deEvidência II, Estudo Retrospectivo...

Objective: To evaluate the consistency of the questionnaires(WOMAC, Lequesne, VAS, SF 36-PCS and SF 36-MCS)when applied in patients with osteoarthritis of the knees(KOA) verifying if age and level of education interfere withthe completion of the questionnaires. Method: One hundredand two patients with KOA answered WOMAC, LESQUESNE,VAS and SF-36 questionnaires and provided data correlatedwith age and education. The internal consistency of theWOMAC questionnaire was verified with Cronbach’s alpha.Pearson’s correlations between the questionnaires, age andeducational level was performed. Results: Mean age was 65years old. Schooling averaged 7.94 years; WOMAC 47.95;VAS 63.57; Lequesne 12.29; PCS and MCS 31.91 43.68.Cronbach’s alpha for WOMAC 0.9. Education did not affectWOMAC response (r=-0.182, p = 0.067) and MCS (r=0.021/ p=0.835), but showed weak but significant correlation withVAS (r=-0.264 / p=0.007), Lequesne (r=0.277, p=0.005)and PCS (r=0.309/ p=0.002). Age showed significant directcorrelation only with PCS (r=0.205, p=0.039). Conclusion:The level of education does not interfere with the completionof WOMAC but may interfere with completing VAS, Lequesneand physical component of SF-36. Level of Evidence II,Retrospective Study...