La ciudad de Guayaquil se convirtió en el epicentro de la pandemia en el Ecuador, el primer caso reportado oficialmente fue en la ciudad de Guayaquil el 29 de febrero del 2020 y el 11 de marzo del 2020 se declara Estado de Emergencia Sanitaria en el Sistema Nacional de Salud. El virus denominado SARS-CoV-2, responsable de la nueva enfermedad COVID-19 (Corona Virus Disease 19), llegó como un huracán, nadie se imaginó lo que pasaría en marzo y abril del 2020, la incertidumbre, la cuarentena, el bloqueo, sin estudios clínicos controlados para conocer cuál era la mejor opción de tratamiento, pero el sentido común y las experiencias de otros países que estaban pasando por la tormenta que es el COVID-19, nos ayudaron a tener una perspectiva del problema y a plantearnos objetivos a corto y mediano plazo.
Background: Breast cancer is the most common type of neoplasm in women. According to statistics from Globocan 2020, the incidence of breast cancer in Ecuador, as well as worldwide is 47.8 per 100,000 people/year, with a mortality rate of 13.6 per 100,000 people/year. Our health system provides coverage to approximately 60% of the population by the Ministry of Public Health (MSP), 30% by The Ecuadorian social security Institute (IESS), 5% by other entities (ISSFA, ISSPOL, MUNICIPIOS), and < 3% of the population have private medical coverage. Medical care attentions for breast cancer, covered by the MSP was 7,134 consults in 2013, with an increase to 8,767 in 2018. SOLCA Guayaquil, as a national reference Center, provides 24.425 oncologic consults per year, with 38% corresponding to breast cancer. The presentation of breast cancer, at diagnosis, corresponds approximately to 63% in localized stage, 29% as locally advanced, 6% as metastatic disease, with a 5-year overall survival of 99%, 85% and 29% respectively. The proportion of clinical stage IV breast cancer diagnoses varies from 5-10%, with an average of 6% in urban areas, reaching up to 50% in rural areas, so metastatic breast cancer is a public health challenge, especially for countries with emerging economies like ours. Methods: An observational, retrospective, descriptive, single-center study was carried out. All patients with metastatic breast cancer who had been treated at the National Oncology Institute SOLCA Guayaquil, in the period from 2016 to 2020 were included in the analysis. The clinical and pathological characteristics were recorded and their impact on overall survival was calculated by the Kaplan-Meier method and compared by the long-rank test, multivariable adjusted hazard ratios (HR) were estimated by Cox regression models. Results: 3700 patients were identified between January 2016-December 2020. A total of 2587 patients were excluded. Of a total of 1113 remaining patients, 84 debuted as metastatic disease. No male patients where reported with metastatic breast cancer in the past 5 years. Median age at diagnosis was 53,31 years (28-88 years). The most frequent metastatic sites, were: bone 63.86% (N:53), lungs 50.6% (N:42), liver 30,12% (N:25), soft tissue 22.89% (N:19), CNS 16.87% (N:14); A multivariable analysis was performed, all metastatic sites have a higher risk of mortality vs not having any metastasis, but the only significant one is CNS metastases RR 1.31 (1.08-1.61), p< 0.005. A total of 28 patients (33.73%) had 2 metastatic sites at presentation; 21 patients (25.30%) had 3 o more metastatic sites at presentation with a RR 1,22 (0.95-1,57) p:0,011, with overall survival -OS- (36 months vs 15 months) (long Rank 0,001). ECOG 1 was reported in 59 patients (71.08%), ECOG 2 in 18 (21.69%) and ECOG 3 in 5 (6,02%). A multivariable analysis was perform with ECOG 2-3, RR 1.03 (0,43-2-44), p:0,94. Principal reported comorbidities where: hypertension in 28 patients (33,73%), dyslipidemia in 16 (19,28%), obesity 14 (16,87%), Diabetes 8 (9,64%). By grouping 2 or more comorbidities, the RR 1,04 (0,83-1.30), p:0,71. Surgery was classified as done or not, where 33 patients (39,77%) underwent rescue mastectomy. Multivariable analysis shows Not Surgery with a RR 1,88 (1.07-3,3) p:0.02. Median OS was estimated for surgery 44,48 months +/-4,7SD; Not surgery 20,72 months +/-2,8 SD. Conclusions: In our population, metastatic breast cancer occurs in 7.6% (84 patients out of 1113 total), similar to that reported worldwide. Being a neoplasm with multiple immunophenotypes, and therefore, different treatment options, OS depends on multiple clinicopathological variables. This study showed that CNS metastases have a negative impact on OS, it is an independent variable for RR of mortality. ECOG and comorbidities did not show an impact on OS. Ultimately, mastectomy was offered to patients with good clinical response to systemic chemotherapy, and shows positive impact in OS. Citation Format: Elina A. Rodriguez-Melendez, Emiliano Pulla-Cadmilema, Lissette P. Velez Avila, Maria del Mar Sanchez Salazar, Patricia Tamayo Aguilar, Lissette Yagual Bohorquez, Jimmy Martin-Delgado, Glenda Ramos Martinez, Katherine Garcia Matamoros, Mayra Santacruz Maridueña, Ruth Engracia Vivanco, Roberto Escala Cornejo, Felipe Campoverde Merchan, Isabel Delgado Guerrero, Veronica Torres Floril, Diego Garcia Gamboa, Luis Pendola Gomez, Elizabeth Gamarra Cabezas, Juan Carlos Garces Santos, Evelyn Valencia-Espinoza. Impact of baseline ECOG, comorbidities, and surgery treatment election on overall survival [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-64.
Background Metastatic breast cancer, has a heterogeneous presentation and management, therefore its overall survival ranges from 2 to 3 years. Despite advances in breast cancer screening, diagnosis, and treatment, nearly 12-30% of early stage breast cancer patients eventually develop metastatic disease. In Ecuador, breast cancer is the most common malignancy among women, and the leading cause of newly diagnose cancer in the general population (Globocan 2020). This study aims to determine the frequency of metastatic sites and its impact in overall survival. Methods: An observational, retrospective, descriptive, single-center study was carried out. All patients with Metastatic breast cancer who had been treated at the National Oncology Institute SOLCA Guayaquil, in the period from 2016 to 2020 were included in the analysis. All statistical analyses were performed using SPSS for Windows (version 25.0;SPSS). The Kolmogorov-Smirnov test was used to test for the normality of distribution. Correlations were determined with Spearman correlation coefficients. The number of metastatic sites were recorded and their impact on overall survival was calculated by the Kaplan-Meier method and compared by the long-rank test, multivariable adjusted hazard ratios (HR) were estimated by Cox regression models. Results: A total of 1113 patients were included in the analysis, of which 84 patients (7.5%) were metastatic disease. The distribution of metastatic sites at diagnosis were: bone 64% (n=53), lung 51% (n=42), liver 30% (n=25), soft tissues 23% (n=19), and the least frequent were metastases to the central nervous system 17% (n=14), mediastinal lymph node 5% (n=4), peritoneal lymph node 1% (n=1). Regarding metastatic sites, 41% (N: 35) had only 1 metastatic site, 33,7% (N: 28) had 2 metastatic sites, and 25.3% (N:21) has 3 or more sites. A multivariable analysis was performed which takes into account all the metastases in the analysis. All have a higher risk of mortality vs not having any metastasis (all are greater than 1). But the only significant one is CNS with a RR 1,31 (1,08 - 1,61) P=0,005. Three or more sites of metastasis have RR 1,22 (0.95-1.57) p: 0.11. Relative Risk (RR) according to the different sites of metastasis are shown in the table#1. The association between 3 or more sites of metastasis showed a negative impact on overall survival (15 months +/-2.3 SD vs 36 months +/- 3.7 SD) compared to 1 site of metastasis. Conclusions: Approximately half of the women (N:49) with metastatic breast cancer in our population presented 2 or more sites of metastasis, which significantly decreases overall survival. The central nervous system is the site of metastasis with the highest relative risk of mortality, generating functional deterioration, adding morbidity, and only 64% (9 out of 14) of the patients access to radiotherapy as palliative treatment. Thus, better strategies for early diagnosis and adequate treatment of metastatic disease should be developed. Citation Format: Lissette Yagual Bohorquez, Evelyn Valencia-Espinoza, Emiliano Pulla-Cadmilema, Lissette P. Velez Avila, Maria del Mar Sanchez Salazar, Patricia Tamayo Aguilar, Jimmy Martin-Delgado, Glenda Ramos Martinez, Katherine Garcia Matamoros, Felipe Campoverde Merchan, Ruth Engracia Vivanco, Mayra Santacruz Maridueña, Roberto Escala Cornejo, Isabel Delgado Guerrero, Veronica Torres Floril, Diego Garcia Gamboa, Elina A. Rodriguez-Melendez. Impact on overall survival according to sites of metastasis: Real-world data [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-07.
El trasplante de progenitores hematopoyéticos se ha convertido en una opción curativa y de sobrevida libre de enfermedad que las alcanzadas con otras modalidades terapéuticas en ciertas patologías congénitas o tumorales. A inicios del año 2006 se diseñó el proyecto para la creación de la Unidad de Trasplante de progenitores hematopoyéticos del Hospital de SOLCA – Guayaquil. En Junio de 2006, la Unidad de Trasplante de Médula Ósea (UTMO) inicia los primeros trasplantes, uno autólogo y otro alogénico, y a partir de entonces se han realizado 375 trasplantes de progenitores hematopoyéticos, de los cuales 166 han sido de tipo alogénicos, 147 con progenitores hematopoyéticos obtenidos desde la sangre periférica o médula ósea propiamente dicha y 19 con células obtenidas desde la sangre de cordón umbilical, así como 209 trasplantes de tipo autólogo. Atualmente se ha diseñado un proyecto de ampliación que contempla una infraestructura con 20 habitaciones para hospitalización y un área para manipulación celular más amplia con equipamiento complementario, lo cual permitirá incrementar la cartera de servicios, a saber: la opción del trasplante alogénico de tipo haploidéntico y ciertos procedimientos de inmunoterapia adoptiva con células T.
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