Sobrevida específica de pacientes com câncer de mama não-metastático submetidas à quimioterapia adjuvante

Abstract

RESUMOOBJETIVO. Analisar a sobrevida específica de cinco anos em mulheres com câncer de mama invasivo não-metastático, e que foram submetidas à cirurgia com intenção curativa e quimioterapia adjuvante. MÉTODOS. Foram selecionadas 428 pacientes a partir de todos os serviços de oncologia da cidade de Juiz de Fora (MG) com diagnóstico da doença efetuado entre janeiro de 1998 e dezembro de 2000. A data do diagnóstico histopatológico da doença foi considerada como início do tempo de sobrevida e a data do óbito pela doença foi considerada como o evento adverso. Foram censuradas as mulheres que permaneceram vivas até dezembro de 2005, data final do seguimento. Para aquelas que interromperam o seguimento, a data da censura foi referente ao último acompanhamento no registro médico. As curvas de sobrevida foram estimadas pelo método de Kaplan-Meier e as diferenças observadas foram avaliadas pelo teste de log-rank. RESULTADOS. A idade média das pacientes foi de 51,2 anos, sendo a maioria das pacientes (72,6%) da raça branca. Os estadios clínicos predominantes foram II (47,4%) e III (38,6%). A função de sobrevida específica para o câncer de mama, no período de cinco anos, foi de 82%. Entre as principais características associadas com uma melhor sobrevida na população de estudo destacaram-se: pré-menopausa (p=0,02), raça branca (p=0,08), tamanho do tumor ≤ 2,0cm (p=0,05), ausência de comprometimento linfonodal (p=0,000), estádios mais precoces da doença (p=0,000), realização de ciclos completos de quimioterapia adjuvante (p=0,03) e uso de hormonioterapia (p=0,05). CONCLUSÃO. Esta pesquisa possibilitou uma melhor caracterização do perfil e da sobrevida de pacientes com câncer de mama que utilizaram terapia quimioterápica adjuvante. Foi constatada a necessidade de ampliação, por parte dos órgãos competentes do setor de saúde local, do rastreamento do câncer de mama, especialmente para o grupo de mulheres considerado como de maior risco, bem como a garantia de tratamento oportuno para todos os casos diagnosticados, o que poderá influenciar positivamente o prognóstico da doença. UNITERMOS: Câncer da mama. Quimioterapia. Fatores prognósticos. Análise de sobrevivência.

Taxa de sobrevida na mulher com câncer de mama: estudo de revisão

“…46 The epidemiological data encountered indicated that the highest incidence for breast cancer is in the age group of 50 and 60 years, followed by the age group 40 to 49. 3,20,39,43 Thus, this reaffirms the necessity of conducting mammography examinations from the age of 50, as established by the International Consensus for the Control of Breast Cancer, 47 and the Brazilian initiative, which instituted mammography for all women from the age of 40 approaching this reality. This initiative was enacted by Law 11.664/08, which made effective healthcare actions that ensure the prevention, detection, treatment and monitoring of the cancers of the cervix and breast, in the context of the Brazilian National Health System (SUS), with this initiative, anticipation mammography for 40 year olds, being contrary to the international consensus.…”

“…50 Considering the size of the tumor, the diagnosis of breast cancer tends to be performed by self-examination with the tumor greater than 2.0 cm, varying between 2.0 and 5.0 cm. 8,14,20,38,43 This result demonstrates the difficulty for the healthcare systems to diagnose breast cancer in the early stages, especially with the absence of metastasis, when the disease is easy to control and potentially curable.…”

“…39 A Brazilian study conducted in the state of Minas Gerais, described the predominance of stage II and III (86%), where among patients with stage III, 27.9% died. 20 In the state of Santa Catarina, only 18.1% of women were diagnosed with stage I, with them having the best overall survival at five years (93.6%), whereas the women diagnosed with stage IV had the worst overall survival at five years (27.3%). The risk of death for women with stage III was 7.18 times that of those with stage I, and those with stage IV at diagnosis were 19.49 times more likely to die.…”

“…The majority of the women presented more than ten compromised lymph nodes. 20 Only early diagnosis can alter this reality and consequently increase the survival rate of women with breast cancer, especially when the screening is associated with the development of effective therapy after the early detection of the disease. The prioritization of the early diagnosis, primarily in the nursing and medical care, with guidance, information and consistent care practices, can significantly alter the sad reality of delayed breast cancer diagnosis, as well as quick access to healthcare services and resolvability from the planning in the diagnostic and therapeutic steps.…”

“…The publications originated from 20 countries: Korea (six studies), [8][9][10][11][12][13] Japan (five studies), [14][15][16][17][18] Brazil (four studies), 3,[19][20][21] Canada (three studies), [22][23][24] United States (three studies), [25][26][27] Italy (three studies), [28][29][30] Switzerland (three studies), [31][32][33] France (two studies), 34,35 China (one study), 36 Singapore and Sweden (one study, study performed in both countries), 37 Scotland (one study), 38 Spain (one study), 39 Finland (one study), 40 India (one study), 41 England (two studies), 42,45 Mexico (one study), 43 Poland (one study), 44 and the Netherlands (one study). 46 From the aim established for this study, the variables to be investigated were defined: the study design, study site/country, number of subjects, age of the subjects, five year survival rate, disease-free five year survival rate, factors that contribute to the increase in survival rates.…”