Navegando por Palavras-chave "Taxa de sobrevivência"

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    Avaliação do Programa Nacional de Controle do Câncer do Colo do Útero no Estado de Mato Grosso: impacto sobre o perfil da doença
    (Universidade Federal de São Paulo (UNIFESP), 2010-10-28) Nakagawa, Janete Tamami Tomiyoshi [UNIFESP]; Schirmer, Janine [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    In 2002, the State joined the second phase of intensification of the National Program for the Control of Cervical Cancer (PNCCU) as a measure to deal with the high rates of the disease and of death by cervical neoplasia. With the aim of analyzing the main PNCCU results, a two-stage study was carried out. The first phase aimed at presenting the disease profile and the coverage of the screening exam by the PNCCU in the State. The aims of the second phase were to analyze the clinical follow-up of the population that was screened, analyze the different evolutionary characteristics of the disease associated to socio-demographic and clinic factors, as well as analyze the factors associated to death risk and the stratified survival rate by the socio-demographic and clinical variables of women that presented invasive carcinoma. In the first part, the cross-sectional study was used and a cohort study was used in the second phase. The period of study was from 2002 to 2007 and comprised all the municipalities of the State of Mato Grosso. The population studied in the first phase of the study was all the women who had undergone the screening test in 2002. The population used in the second phase of the study was a representative random sample of those that presented cytological alterations in the first phase of the study, a total of 323 women. The source of data used was the official health information system, among them the SISCOLO, SIM, APAC, and also the official data of the State Health Department/MT (SES/MT), data available in the INCA and DATASUS sites and medical records. For the statistical analysis of the data, descriptive and inferential techniques were used. In the descriptive part, tables, graphics and position and dispersion measures were used. In order to evaluate the risk of being sick due to invasive cervical carcinoma, the univariate and multivariate logistic regression analysis was used. The Kaplan-Meier estimator was used to analyze the survival rate and to analyze the prognostic factors, the Cox proportional hazards model was used. Among the main results it is highlighted that in 2002, Mato Grosso presented high incidence rates, above the national average. The data of the clinical follow up showed the different clinical outcomes, among the 323 women, 18 (6,2%) died having as the basic cause of death the cervical cancer. The risk of the disease developing into the invasive carcinoma was analyzed according to the socio-demographic and clinical variables, and the variables: age group, marital status, smoking history, menopause and municipality were those that presented a strong association with the disease in the invasive phase. However, in the survival analysis, the global survival rate in 60 months, estimated by the Kaplan-Meier method, was of 66,7%. In the final Cox proportional hazards model, the variables with higher death risk was the advanced stage of the disease and the race/color. These data lead to a conclusion that the disease in the State of Mato Grosso has a very large social determination, considering the difficulties in the access to the health services by the population affected by racial, socio-economic conditions that arrive in the health services with the disease in an advanced stage, when the survival probability is very small. The conclusion is that for the effective fight against the disease governmental policies such as the PNCCU are necessary, and that the universality of the assistance be guaranteed, mainly to the socially disadvantaged population.
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    Cirurgia mamária em mulheres com câncer de mama metastático. Revisão sistemática Cochrane e metanálise
    (Universidade Federal de São Paulo (UNIFESP), 2018-06-28) Tosello, Giuliano Tavares [UNIFESP]; Riera, Rachel [UNIFESP]; http://lattes.cnpq.br/0591884301805680; Tosello, Giuliano Tavares; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the efficacy of breast surgery in patients with metastatic breast cancer. Methods: A systematic review was conducted according to the Cochrane methodology. The electronic search was performed on February 22, 2016, using the MeSH terms "breast neoplasms", "mastectomy" and "analysis, survival" in the following electronic databases: the Cochrane Breast Cancer Specialized Register, CENTRAL, MEDLINE (by PubMed), EMBASE (by OvidSP), LILACS, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. Hand search on citation reference lists and contact with study authors to identify additional studies completed the search procedures. Randomized clinical trials with women diagnosed with metastatic breast cancer, comparing breast surgery associated with systemic therapy versus systemic therapy, were included. Two independent researchers evaluated the studies obtained in the electronic search regarding the eligibility criteria and the risk of bias. The risk of bias in the included studies was assessed by the Cochrane Risk of Bias tool. The quality of the evidences was evaluated using the GRADE tool. The risk ratio (RR) was used to measure the treatment effect for dichotomous outcomes, mean differences (MD) for continuous outcomes, and risk ratio (HR) for timetoevent outcomes. Confidence intervals of 95% (95% CI) were calculated for these measures. The primary outcome was overall survival and quality of life. Secondary outcomes were progressionfree survival (local and distance control), breast cancerspecific survival and toxicity from local therapy. Results: Two randomized clinical trials involving 624 participants were included. Breast surgery did not improve the overall survival of women with metastatic cancer (HR = 0.83, 95% CI 0.531.31, very lowquality evidence), but the progressionfree survival site was 78% better (HR = 0.22, 95% CI 0.08 0.57, low quality evidence), and metastatic progressionfree survival worsened by 40% (HR 1.42, 95% CI 1.081.86, moderate quality evidence). Conclusion: Based on poor quality evidence from two randomized clinical trials, it is not possible to reach definitive conclusions about the risks and benefits of breast surgery in women with metastatic breast cancer.
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    Retransplante de fígado: validação interna de um modelo matemático preditivo de sobrevida
    (Universidade Federal de São Paulo (UNIFESP), 2009-09-30) Mattos, Rogerio Obregon de [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Summary: The demands for liver transplantation in various countries have greatly supplanted the offer for this vital organ. In general the survival of re-transplantation patients and of the grafts are smaller than in relation to primary transplantation ones. Therefore, it is important to determine still in pre-operative patients who have a low chance to re-transplantation survival. In previous research we developed mathematical early mortality model in re- transplanted patients. Objective: To validate the mathematical surviving model created by Linhares et al. (2006), to predicting early mortality of patients undergoing liver to re-transplant. Method: It was studied prospectively 92 patients undergoing liver re-transplant in the period between September 1999 and December 2008 in Paul Brousse hospital – Villejuif – France. Patient data were obtained from the computerized database service and through consultation of patient records. The following variables were collected from the receiver: age, creatinine, urgency of re-transplant, time between re-transplant and transplantation. Using the ROC curve to dichotomize derivation sample and find a cut point representing the maximum sensitivity and specificity, the value found in this cut-off was 30 (> 30 e <= 30, high and low-risk respectively). With the objective to validating the mathematical model compared to the areas under the ROC curves corresponding to the two independent samples (Sample derivation and validation). 95% Confidence intervals were estimated for the ROC. By the log-rank technique the two survival curves samples were compared when dichotomized in two deciles (high and low-risk). By the same statistical method both curves samples were also compared, when they were dichotomized in tertile according to the cut point of the original model: high-risk (> 32), medium risk (24-32) and low risk (< 24). Results: the results of the second period have showed equal results to the first one, as regards to biological variations. Either age as the creatinine and as regards the time between the transplantation and re-transplantation and the urgency with which patients were enrolled, being comparable survival curves for each of the four variables studied between the samples of derivation and validation. When compared to the areas under the curves ROC derivation (0,733) and validation (0,741) and statistical significance was not noticed (p = 0,915), showing that the sensitivity and specificity relationship between the two curves are similar. Also similarity was noticed in survival curves of Kaplan-Meier of both samples, both at cut-off dichotomized (cut-off point = 30), for tertile distribution (<24, 24-32 and > 32). Conclusion: It has been possible with this study to perform internal mathematical validation of the predictive original survival model, within six months in the liver re-transplantation at a different sample period to those used for the preparation of the initial model.