Fatores prognósticos e sobrevida de pacientes com carcinomas colorretais: uma análise retrospectiva em hospital universitário em tempos de pandemia
Tipo
TCC
Data de publicação
2025-05-29
Periódico
Citações (Scopus)
Autores
Santos, Emily Karoline Araujo Nonato dos
Kawagoe, Rafaela Iria
Kawagoe, Rafaela Iria
Orientador
Mehanna, Samya Hamad
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ISSN da Revista
Título de Volume
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Introdução: O câncer colorretal (CCR) é a segunda malignidade mais incidente no Brasil, quando excluídos casos de câncer de pele não melanoma, e dados recentes evidenciam crescimento na taxa de mortalidade. A importância da detecção precoce desse câncer é destacada, especialmente em indivíduos acima de 50 anos, considerados de médio risco, para os quais a realização de colonoscopias de rastreio é recomendada. Além disso, o prognóstico dos pacientes diagnosticados com CCR é profundamente impactado por fatores clínicos e patológicos, como estágio TNM, grau de diferenciação tumoral e a presença de marcadores moleculares, refletindo a necessidade de abordagens terapêuticas personalizadas e precoces. A pandemia do COVID-19, declarada em março de 2020, impôs significativos desafios para o diagnóstico e acompanhamento do CCR, com a suspensão de programas de rastreamento e a limitação de exames endoscópicos. Como consequência, observou-se uma redução no número de diagnósticos, assim como um aumento de casos detectados em estágios mais avançados, prejudicando o prognóstico dos pacientes e refletindo os impactos adversos da pandemia no manejo da doença. Objetivo: Avaliar a sobrevida e correlacionar fatores clínico-patológicos ao prognóstico de pacientes com câncer colorretal que foram diagnosticados com a doença em meio a pandemia do COVID-19 em um hospital universitário de referência. Métodos: Estudo observacional retrospectivo analítico com tabulação de dados históricos, no qual foram utilizados os dados de prontuários médicos de todos os pacientes submetidos a intervenção cirúrgica por câncer colorretal nos anos de 2020 e 2021. A amostra total foi de 155 pacientes. Resultados: A média de idade ao diagnóstico foi de 63,9 anos, com leve predominância do sexo masculino (53,5%). Tumores do lado esquerdo do cólon representaram 65,8% dos casos, e o tipo histológico mais comum foi o adenocarcinoma intestinal sem outras especificações (73,5%). A maioria dos pacientes foi diagnosticada em estágio III (32,9%) ou IV (27,1%), e 28,4% já apresentavam metástases à distância no diagnóstico, principalmente hepáticas. Tumor budding foi identificado em 64,5% dos casos, e a invasão angiolinfática em 63,2%. A presença de metástases síncronas (HR 2,23; p<0,001), estágio clínico IV (HR 4,01; p=0,004) e invasão angiolinfática (HR 1,65; p=0,036) foram os principais fatores associados à menor sobrevida global e livre de doença. Conclusão: Os achados deste estudo evidenciam o impacto da pandemia da COVID-19 sobre o diagnóstico e evolução do câncer colorretal, resultando em maior frequência de casos avançados e em pior desfecho clínico. O reconhecimento desses efeitos pode orientar estratégias que reduzam danos futuros, reafirmando a importância do diagnóstico precoce no controle das neoplasias malignas. Além disso, reforçam a necessidade da incorporação de variáveis histopatológicas como o tumor budding na estratificação de risco e planejamento terapêutico individualizado, contribuindo para um cuidado personalizado e prognósticos mais favoráveis.
Introduction: Colorectal cancer (CRC) is the second most common malignancy in Brazil, when excluding non-melanoma skin cancer, and recent data indicate a rising mortality rate. The importance of early detection is emphasized, especially in individuals over 50 years of age, considered at medium risk, for whom screening colonoscopies are recommended. Furthermore, the prognosis of patients diagnosed with CRC is deeply influenced by clinical and pathological factors such as TNM staging, tumor differentiation, and the presence of molecular markers, highlighting the need for early and personalized therapeutic approaches. The COVID-19 pandemic, declared in March 2020, posed significant challenges to the diagnosis and follow-up of CRC, with the suspension of screening programs and reduced access to endoscopic procedures. As a result, a decline in the number of diagnoses was observed, as well as an increase in cases detected at more advanced stages, negatively impacting patient prognosis and reflecting the adverse effects of the pandemic on cancer care. Objective: To evaluate survival and correlate clinical and pathological factors with the prognosis of colorectal cancer patients diagnosed during the COVID-19 pandemic in a referral university hospital. Methods: Analytical retrospective observational study with historical data collection, based on medical records of all patients who underwent surgical intervention for colorectal cancer in the years 2020 and 2021. The total sample included 155 patients. Results: The mean age at diagnosis was 63.9 years, with a slight predominance of males (53.5%). Tumors located on the left side of the colon accounted for 65.8% of cases, and the most common histological type was non-specified intestinal adenocarcinoma (73.5%). Most patients were diagnosed at stage III (32.9%) or IV (27.1%), and 28.4% already presented with distant metastases at diagnosis, mainly hepatic. Tumor budding was identified in 64.5% of cases and angiolymphatic invasion in 63.2%. The presence of metastasis at diagnosis (HR 2.23; p<0.001), clinical stage IV (HR 4.01; p=0.004), and angiolymphatic invasion (HR 1.65; p=0.036) were the main factors associated with reduced overall and disease-free survival. Conclusion: The findings of this study highlight the impact of the COVID-19 pandemic on the diagnosis and progression of colorectal cancer, resulting in a higher frequency of advanced cases and worse clinical outcomes. Recognizing these effects may help guide strategies to reduce future harm, reaffirming the importance of early diagnosis in the management of malignant neoplasms. Furthermore, the results reinforce the need of incorporating histopathological variables such as tumor budding into risk stratification and personalized therapeutic planning, contributing to more precise care and improved prognostic outcomes.
Introduction: Colorectal cancer (CRC) is the second most common malignancy in Brazil, when excluding non-melanoma skin cancer, and recent data indicate a rising mortality rate. The importance of early detection is emphasized, especially in individuals over 50 years of age, considered at medium risk, for whom screening colonoscopies are recommended. Furthermore, the prognosis of patients diagnosed with CRC is deeply influenced by clinical and pathological factors such as TNM staging, tumor differentiation, and the presence of molecular markers, highlighting the need for early and personalized therapeutic approaches. The COVID-19 pandemic, declared in March 2020, posed significant challenges to the diagnosis and follow-up of CRC, with the suspension of screening programs and reduced access to endoscopic procedures. As a result, a decline in the number of diagnoses was observed, as well as an increase in cases detected at more advanced stages, negatively impacting patient prognosis and reflecting the adverse effects of the pandemic on cancer care. Objective: To evaluate survival and correlate clinical and pathological factors with the prognosis of colorectal cancer patients diagnosed during the COVID-19 pandemic in a referral university hospital. Methods: Analytical retrospective observational study with historical data collection, based on medical records of all patients who underwent surgical intervention for colorectal cancer in the years 2020 and 2021. The total sample included 155 patients. Results: The mean age at diagnosis was 63.9 years, with a slight predominance of males (53.5%). Tumors located on the left side of the colon accounted for 65.8% of cases, and the most common histological type was non-specified intestinal adenocarcinoma (73.5%). Most patients were diagnosed at stage III (32.9%) or IV (27.1%), and 28.4% already presented with distant metastases at diagnosis, mainly hepatic. Tumor budding was identified in 64.5% of cases and angiolymphatic invasion in 63.2%. The presence of metastasis at diagnosis (HR 2.23; p<0.001), clinical stage IV (HR 4.01; p=0.004), and angiolymphatic invasion (HR 1.65; p=0.036) were the main factors associated with reduced overall and disease-free survival. Conclusion: The findings of this study highlight the impact of the COVID-19 pandemic on the diagnosis and progression of colorectal cancer, resulting in a higher frequency of advanced cases and worse clinical outcomes. Recognizing these effects may help guide strategies to reduce future harm, reaffirming the importance of early diagnosis in the management of malignant neoplasms. Furthermore, the results reinforce the need of incorporating histopathological variables such as tumor budding into risk stratification and personalized therapeutic planning, contributing to more precise care and improved prognostic outcomes.
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Palavras-chave
neoplasias colorretais , prognóstico , sobrevida , colorectal neoplasms , prognosis , survival