Fatores prognósticos em pacientes com câncer colorretal: análise de sobrevida global e livre de doença / Prognostic factors in patients with colorectal cancer: analysis of overall and disease-free survival

Objetivos: avaliar o impacto de variáveis clínicas e tumorais sobre a sobrevida global e a sobrevida livre da doença em pacientes com câncer colorretal atendidos em um hospital especializado em oncologia, em Curitiba, Paraná, Brasil. Métodos: estudo de coorte retrospectivo com análise do registro hospitalar de câncer e de prontuários de pacientes com câncer colorretal tratados entre 2015 e 2016, com acompanhamento até janeiro de 2022. A curva de Kaplan-Meier e o modelo de Cox, com apresentação do RR e IC95%, foram empregados nas análises. Resultados: foram incluídos no estudo 235 pacientes, dos quais 126 (53,6%) eram do sexo masculino, 204 (86,8%) tinham idade igual ou superior a 50 anos ao diagnóstico e 125 (53,2%) receberam inicialmente o diagnóstico de tumor de cólon. O risco de morte e de recorrência foram maiores em pacientes com estadiamento IV (RR = 2,77; IC95% = 1,57-3,85 e RR = 3,98; IC95% = 1,15-13,79), tumor no reto (RR = 2,04; IC95% = 1,24-3,38 e RR= 2,25; IC95% = 1,40-3,60) e metástase nos linfonodos regionais (RR = 2,26; IC95% = 1,27-4,03 e RR = 2,15; IC95% = 1,24-3,73). O risco de óbito foi elevado em idosos com Índice de Massa Corporal de baixo peso (RR = 3,5; IC95% = 0,9-75). Conclusões: no momento do diagnóstico, fatores tumorais como estadiamento avançado, tumor no reto e a presença de metástase são importantes preditores de mortalidade e recidiva do câncer colorretal, além disso, indicam o Índice de Massa Corporal como potencial variável de pior prognóstico na população idosa com câncer colorretal

Aims: to evaluate the impact of clinical and tumor variables on overall survival and disease-free survival in patients with colorectal cancer treated at a specialized oncology hospital in Curitiba, Paraná. Methods: a retrospective cohort study was carried out with analysis of the câncer hospital registry and medical records of patients with colorectal cancer treated between 2015 and 2016, with follow-up until January 2022. The Kaplan-Meier curve and the Cox model, with presentation of the Hazard Ratio (HR) and confidence interval 95% (95%CI), were used in the analyses. Results: 235 patients were included in the study, 126 (53.6%) males, 204 (86.8%) aged at diagnosis equal to or greater than 50 years and 125 (53.2%) with the initial diagnosis of tumor of colon. The risk of death and recurrence were higher in patients with stage IV (HR = 2.77; 95%CI = 1.57-3.85 and HR = 3.98; 95%CI = 1.15-13.79), tumor in the rectum (HR = 2.04; 95%CI = 1.24-3.38 and HR = 2.25; 95%CI = 1.40-3.60) and regional lymph node metastasis (HR = 2.26; 95%CI = 1.27-4.03 and HR = 2.15; 95%CI = 1.24-3.73). In addition, the risk of death was high in elderly with low weight Body Mass Index (HR =3.5; 95%CI = 0.9-75). Conclusions: at the time of diagnosis, tumor factors such as advanced staging, tumor in the rectum and the presence of metastasis are important predictors of mortality and recurrence of colorectal cancer, in addition, they indicate Body Mass Index as a potential variable of worse prognosis in the elderly population with colorectal cancer

Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil

Abstract INTRODUCTION: Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS: A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS: Mean age was 57.5 years and 59% were females. Most patients' (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS: This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.