Fatores associados à sobrevida global de crianças e adolescentes com câncer no Espírito Santo e sua relação com o índice brasileiro de privação
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Data
2024-06-19
Autores
Rodrigues, Jonathan Grassi
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Universidade Federal do Espírito Santo
Resumo
Background: Childhood cancer (between 0 and 19 years of age) accounts for 1 to 4% of all malignant tumors in most populations. Over the past four decades, there have been substantial advances in the treatment of childhood cancer and, in line with these advances, survival analysis techniques have assumed a pivotal role in recent years, mainly after the development and improvement of statistical methods technology, with several applications, especially into Public Health. Objective: To investigate the occurrence of pediatric malignant neoplasms in the state of Espírito Santo; to assess the quality and completeness of data, overall survival and to identify associated factors as well as their relationship with the Brazilian Deprivation Index (DPI). Methods: This is an analytical observational study. The cohort was comprised by new cases diagnosed with primary malignant neoplasm of any morphology in children and adolescents between 0 and 19 y.o., in a 10-year period (between 2007 and 2015) in Espírito Santo (ES), Brazil. Secondary data were obtained from the Hospital-based Cancer Registry (HCR) of the Nossa Senhora da Glória State Children's Hospital (HEINSG) as well as from the Mortality Information System - SIM/ES. For data analysis the Kaplan-Meier method was used and the Cox proportional hazards model was performed in multivariate analysis. In the final model, variables that presented significance levels below 5% have remained. Statistical analyses were held using the free software RStudio (version 2022.07.2) and R (version 4.1.0). Results: It was found that the variables with the highest incompleteness included race/color (17.24%), level of education (51.40%), TNM (56.88%), disease status at the end of the first treatment (12.09%), family history of cancer (79.12%), history of alcohol consumption (39.25%), history of tobacco consumption (38.32%) and type of admission clinic (10.28%). A significant trend of decreasing completeness was observed for race/color, TNM and history of tobacco consumption. The mean age was 7.85 years; the majority were mixed-race (53.32%), in the age range of 1-4 years (29.47%) (p=0.008). Leukemias, followed by central nervous system tumors and lymphomas were the most frequent in males (p=0.006) with a significant difference between age groups, with a higher occurrence between 5 and 9 years (p=0.007). This historical series have shown a decreasing trend in the number of new cases (p<0.001). At the end of treatment, complete remission of the disease was observed in 30.57% of cases. Five-year overall survival was 76% (95% CI: 0.736−0.790) at 1 year, 69% (95% CI: 0.665−0.724) at 2 years, and 62% (95% CI: 0.587−0.650) at 5 years. Girls had a 28% lower risk of dying from cancer within 5 years compared to boys (HR=0.72; 95% CI: 0.579−0.901; p=0.004). The highest survival rates were found for individuals with Hodgkin lymphoma, neuroblastoma, and ganglioneuroblastoma. The lowest 5-year survival rates were observed for patients with acute myeloid leukemia. The estimated 5-year overall survival was 61% (95% CI: 0.585−0.651; p=0.1) for children from the least disadvantaged city in the state according to the DPI. We observed a significantly increased risk of death among children and adolescents in the most disadvantaged cities (Q5) (HR=2.12; 95% CI: 1.06−4.23; p=0.034). Conclusion: In summary, although most variables maintained excellent completeness, the increasing trend of incompleteness in race/color and the decreasing trend in TNM highlight the importance of reliable and complete HCR for personalized cancer care, public policy planning, and conducting cancer control research. Our findings indicated a gradual decline in the incidence of cancer in children and adolescents over the time series evaluated, with a higher prevalence of leukemia in male children and a higher occurrence of malignant bone tumors and carcinomas in adolescents aged 10 to 14. In this historical series, we found an overall five-year survival rate of 62% for patients diagnosed between 2007 and 2015, which was associated with sex and diagnostic groups and is closely related to the socioeconomic context. Furthermore, the socioeconomic level estimated through the DPI was associated with worse survival among children and adolescents with cancer. Socioeconomically vulnerable children and adolescents may constitute a group of high-risk patients, who should be identified at the time of diagnosis for personalized and timely management. Some approaches can result in better survival rates, such as investing in public education, improved training of health professionals, investing in the detection of childhood cancer, strengthening and access to oncology services, clinical research and international cooperation.
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Neoplasias , Epidemiologia , Análise de sobrevivência