Cancer inpatients with COVID-19: A report from the Brazilian National Cancer Institute.

OBJECTIVE: This study aimed to describe the demographic and clinical characteristics of cancer inpatients with COVID-19 exploring clinical outcomes. METHODS: A retrospective search in the electronic medical records of cancer inpatients admitted to the Brazilian National Cancer Institute from April 30, 2020 to May 26, 2020 granted identification of 181 patients with COVID-19 confirmed by RT-PCR. RESULTS: The mean age was 55.3 years (SD ± 21.1). Comorbidities were present in 110 (60.8%) cases. The most prevalent solid tumors were breast (40 [22.1%]), gastrointestinal (24 [13.3%]), and gynecological (22 [12.2%]). Among hematological malignancies, lymphoma (20 [11%]) and leukemia (10 [5.5%]) predominated. Metastatic disease accounted for 90 (49.7%) cases. In total, 63 (34.8%) had recently received cytotoxic chemotherapy. The most common complications were respiratory failure (70 [38.7%]), septic shock (40 [22.1%]) and acute kidney injury (33 [18.2%]). A total of 60 (33.1%) patients died due to COVID-19 complications. For solid tumors, the COVID-19-specific mortality rate was 37.7% (52 out of 138 patients) and for hematological malignancies, 23.5% (8 out of 34). According to the univariate analysis COVID-19-specific mortality was significantly associated with age over 75 years (P = .002), metastatic cancer (p <0.001), two or more sites of metastases (P < .001), the presence of lung (P < .001) or bone metastases (P = .001), non-curative treatment or best supportive care intent (P < .001), higher C-reactive protein levels (P = .002), admission due to COVID-19 (P = .009), and antibiotics use (P = .02). After multivariate analysis, cases with admission due to symptoms of COVID-19 (P = .027) and with two or more metastatic sites (P < .001) showed a higher risk of COVID-19-specific death. CONCLUSION: This is the first Brazilian cohort of cancer patients with COVID-19. The rates of complications and COVID-19-specific death were significantly high.

Acral melanoma: a retrospective cohort from the Brazilian National Cancer Institute (INCA).

Acral melanoma (AM) is a rare subtype of melanoma arising on the palms, soles and subungual areas. In the Brazilian and Latin American populations, the sociodemographic and clinical-pathologic features of AM are unclear. AM tends to be more advanced at presentation because of delayed diagnoses, with poor survival. This study reports on a retrospective AM cohort from the Brazilian National Cancer Institute. We reviewed a database of 529 patients presenting with AM from 1997 to 2014 and analysed the sociodemographic and clinical-pathologic features of AM associated with overall survival and relapse-free survival. All patients were Brazilian, ranging in age from 19 to 101 years (mean 65.4; median 67.0). Two hundred and ninety-four (55.8%) patients were women. The Breslow primary lesion thicknesses ranged from 0.0 to 65.0 mm (mean 8.3 mm; median 5.0 mm). Of these patients, 43.3% had the acral lentiginous histologic subtype. Plantar was the most frequently involved site (68.5%), and ulcers and mitosis were present in 79.0 and 86.4% of these cases, respectively. Multivariate analysis results found that Breslow thickness of 1.03 (95% confidence interval: 1.01-1.05; P=0.01) and ulceration of 2.70 (95% confidence interval: 1.00-7.06; P=0.05) were poor prognostic indicators of overall survival. AM tumours were thick on diagnostic tests and were associated with poorer survival outcomes. Unfavourable prognosis likely derives from the delayed diagnosis compared with other melanoma subtypes.

Socioeconomic status as a predictor of melanoma survival in a series of 1083 cases from Brazil: just a marker of health services accessibility?

Melanoma survival is determined by disease-related and patient-related factors; there is a growing body of evidence that other issues may play a role in this disease. In this study, the role of socioeconomic factors in the evolution of melanoma was evaluated. This was a retrospective study with incident cases of melanoma treated in an oncology center in Rio de Janeiro, Brazil, during the period of 1997-2004. The socioeconomic variable of choice was education (9 years or more vs. 8 years or less of school attendance). In this period, there were 1083 patients with primary melanoma of the skin, 58.1% with low school attendance. No difference was found in relation to the year of diagnosis with respect to overall survival. Five-year survival for the entire group was 67.0%. Men had worse survival [hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.54-2.35]; a protective effect was found for whites (HR 0.64, 95% CI 0.49-0.84), higher educational level (HR 0.55, 95% CI 0.44-0.69), and upper limb lesions (HR 0.61, 95% CI 0.38-0.98). A higher risk of death was observed for patients with nodular melanoma (HR 1.96, 95% CI 1.49-2.58), acrolentiginous melanoma (HR 2.68, 95% CI 2.09-3.44), lesions in the soles and palms (HR 1.78, 95% CI 1.22-2.6), and increasing age (HR 1.02 for each year, 95% CI 1.01-1.02). In the multivariate analysis, after controlling for stage, age, sex, ethnicity, and clinical type, education remained a protective factor both for overall survival (HR 0.76, 95% CI 0.61-0.94) and for relapse-free survival (HR 0.76, 95% CI 0.61-0.94). In conclusion, socioeconomic status as measured by educational level represented an important factor related to melanoma clinical evolution in the cohort studied.