Trabalhos Científicos

Introduction The insertion of biosimilars as a treatment option for complex diseases has brought a number of benefits, such as cost reduction and increased access to effective therapies. However, it has also raised important and challenging questions, both from a regulatory and clinical standpoint, such as interchangeability. Currently, there is a scarcity of clinical evidence, whether in randomized clinical trials or real-world studies, regarding the effect of this practice in patients with HER2-positive breast cancer. Objective To analysed the effect of interchangeability, involving multiple switches, on the effectiveness and safety of treatment for early-stage HER2-positive breast cancer. Methods This single-center retrospective cohort study included patients treated between 2018 and 2021. Sociodemographic, clinical, therapeutic, and safety data were collected. Logistic regression analyzed the association between interchangeability and pathological complete response (pCR). Disease-free survival (DFS) was assessed at 18 and 30 months using Kaplan-Meier and Log-rank tests between the interchangeability groups. Cox regression evaluated recurrence risk. Safety was assessed by adverse event (AE) occurrence, frequency, and severity. Results The study included 233 women, with 143 in the intervention group (interchangeability) and 90 in the control group (non-interchangeability). pCR rates were 31.5% (29/92) in the intervention group and 44.0% (62/141) in the control group (p=0.059). Median DFS at 18 months was 17.6 months in the intervention group and 17.4 in the control group, with 6 and 8 recurrences (HR 0.46, 95% CI 0.16 – 1.35; p = 0.161), respectively. At 30 months, median DFS was 28.1 months in the intervention group and 27.3 months in the control group, with 17 and 14 recurrences (HR 0.98, 95% CI 0.58–1.67; p=0.951), respectively. There was no statistically significant difference in the occurrence of AEs between the groups (p=0.427). After initiating Trastuzumab, 115 (80.4%) patients in Group 1 and 79 (87.8%) in Group 2 experienced at least one AE. It was found that 34 (23.8%) women in Group 1 and 20 (22.2%) in Group 2 (p=0.784) experienced severe AEs (grade 3 and 4). Cardiac events occurred in 18 (12.6%) patients in Group 1 and 6 (6.7%) in Group 2 (p=0.148). Conclusion Interchangeability did not influence pCR, DFS or safety outcomes in the studied population. Future studies may complement and corroborate these findings.

Background/aim: The combination of atezolizumab-bevacizumab changed the prognosis of unresectable hepatocellular carcinoma (HCC) since 2020. Present study aimed evaluate the outcomes of HCC patients who received this combination in a Cancer Center in Brazil and which factors were associated with prognosis. Patients and methods: This was a retrospective study of first-line patients treated with atezolizumab-bevacizumab from 2020 to 204. Patients’ data were collected retrospectively from patients’ files. Survival curves were calculated with the Kaplan–Meier method and compared by means of the log-rank test stratified by clinical pathological features. Results: Forty patients were included; Most patients had had BCLC C disease (80.0%). Most common hepatitis etiology was NASH (42.5%); viral etiology composed 20%. Twenty-one (52.5%) patients had esophageal varices before treatment. Thirty two patients had Child-Pugh A cirrhosis (80.0%), 22 (55.5%) had ALBI score 1 and macrovascular invasion was present in 23 patients (57.5%). Response evaluation was performed in 34 patients; response rate was 35.3%; disease control rate was 85.3%. In progressive disease, 14 patients had second-line treatment; in 11 of them Lenvatinib was performed. Five patients had variceal bleeding and five had immune-related adverse event (irAE). Median PFS and OS were 7.4 (95% CI: 2.4-12.4) and 19.3 (95% CI: 9.2-29.4) months, respectively. Factors associated with worst prognosis were: Child B, macrovascular invasion and esophageal varices. There was no association between cirrhosis etiology with survival. We found no association between response rate stratified by hepatitis etiology or Child classification. Conclusion: Our data had had comparable prognosis of the pivotal IMBRAVE trial, despite including patients with Child B liver function. Clinical factors like Child B, macrovascular invasion and esophageal varices were associated with worst survival.

Cisplatin-based concurrent chemoradiotherapy (CRT) is the standard of care for locally advanced head and neck cancer (HNC) as a definitive or adjuvant therapy. This approach has been associated with a 6.5% improvement in overall survival (OS) and enhanced locoregional control when compared to radiotherapy (RT) alone. However, Cisplatin and RT carry a significant risk of ototoxicity, with 53% developing grade two (G2) or higher hearing loss through audiometry. Pre-clinical studies have suggested that Flunarizine may offer otoprotective benefits. This is a unicentric, non-comparative, open-label, phase II clinical trial conducted to assess the otoprotective efficacy and safety of Flunarizine in patients undergoing Cisplatin-based CRT (100mg/m2 IV every 21 days), with the aim of reducing G2 or higher ototoxicity by 20%. Patients received Flunarizine for 21 days prior to CRT, continued throughout the course of CRT, and extended up to three months post-CRT. The primary endpoint was acute and late ototoxicity. Secondary endpoints included objective response rate, safety profile, quality of life and OS. Between October 2019 and December 2022, 91 patients were screened, and nine were enrolled. The high screening failure was due to the high prevalence of pre-existing hearing loss (36.3%): 17.6% symptomatic and 18.7% asymptomatic hearing loss (detectable only through audiometry). The median follow-up was 57.5 months. Flunarizine most frequent adverse events were weight loss (88.9% G1, 11.1% G2 e 22.2% G3), xerostomia (44.4% G1, 11,1% G2 e 11.1% G3), decreased appetite (33.3% G1, 33,3% G2 e 11,1% G3) and drowsiness (33.3% G1). At the three-month post-CRT assessment, audiometry was performed on five patients, all of them (5/5) exhibited G2 or higher hearing loss. One patient (14.3%) had G1 hearing loss and one patient (14.3%) had G1 tinnitus. At the six-month post-CRT assessment, seven patients underwent audiometry and five patients (71%) had G2 or higher hearing loss. The objective response rate was 66.67%. All patients achieved complete response. Three patients (33%) had disease progression and died due to cancer. The median OS was not reached, and two-year OS rate was 66.6%. Due to the lack of otoprotective effect observed in the interim analysis, the study was prematurely terminated for futility. This phase II trial demonstrated that Flunarizine did not confer any otoprotective benefit in patients undergoing Cisplatin-based concurrent CRT for locally advanced HNC.

Introduction: Melanoma recurrence rates remain high despite complete resection followed by adjuvant chemotherapy and immunotherapy. Different types of melanoma vaccines have emerged as complementary treatment to reduce recurrence. However, their effectiveness in preventing recurrence and improving survival remains debatable. Objectives: To evaluate the efficacy of different melanoma vaccines (TLPLDC, TLPLDC+G, and TLPO) compared to standard treatment, determine their impact on Disease-Free Survival (DFS) and Overall Survival (OS), and provide quantitative evidence on the effectiveness of these vaccines through a meta-analysis. Methods: We searched in Pubmed, Cochrane, and Embase in April 2024 for studies comparing different types of melanoma vaccines against standard treatment. Inclusion criteria were randomized controlled trials evaluating the effectiveness of tumor lysate, particle-loaded, dendritic cells (TLPLDC), TLPLDC+granulocyte-colony stimulating factor (G), and tumor lysate particle only (TLPO) vaccines against control on the recurrence and survival of patients with completely resected melanoma. Outcomes of interest included DFS and OS. Hazard ratios were pooled using random-effects models in R software version 4.3.2. Risk-of-bias assessment was conducted using RoB 2. Results: We included 7 randomized controlled trials comprising 1,211 patients. At the 3-year follow-up, TLPLDC favored DFS over control (HR=0.66 [0.47,0.93], p=0.02, I²=49%), although the 2-year follow-up was not statistically significant (HR=0.78,CI[0.59,1.03],p=0.07,I²=0%). At 3 years follow-up, TLPLDC+G (HR=1.31,CI[0.93,1.84],p=0.12,I²=0%) and TLPO (HR=0.71, CI[0.44,1.12],p=0.14,I²=74%) were not statistically significant. TLPLDC showed improved OS at both 3-year (HR=0.18, CI[0.07,0.48], p<0.01, I² =0%) and 2-year follow-ups (HR=0.28,CI[0.12,0.67],p<0.01,I²=36%). TLPO at 36-months (HR=0.55,CI[0.29,1.03],p=0.06,I²=35%) was not significant, while at 24-months (HR=0.41, CI[0.21,0.82],p=0.01,I²=0%) it was significant. TLPLDC+G could only be analyzed at the 3-year follow-up, showing no difference (HR=1.04,CI[0.6,1.8],p=0.88,I²=0%). Conclusion: TLPLDC vaccines consistently improved DFS and OS in the 3-year follow-up analysis. Therefore, TLPLDC vaccines could be an effective addition to resectable melanoma treatment.

INTRODUCTION: Representing 80% of all lung cancers, non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related death and encompasses adenocarcinoma and squamous cell carcinoma. Studies indicate that the use of inhibitors of programmed cell death protein 1 (PD-1) and programmed cell death ligand 1 (PD-L1), which are common biomarkers in patients with NSCLC, may be effective in enhancing therapy for various diseases, including NSCLC. By inhibiting the PD-1/PD-L1 binding complex, patients may achieve improved survival. OBJECTIVES: To evaluate the efficacy of PD-L1 inhibitors in the treatment of non-small cell lung cancer and compare the efficacy of PD-L1 inhibitors with other immunotherapies. METHODOLOGY: A systematic review was conducted using PubMed with the descriptors "immune checkpoint inhibitors," "PD-L1 inhibitors," and "carcinoma, non-small-cell lung," combined with Boolean operators AND and OR. Studies in English published between 2019 and 2024 were included. Articles on other checkpoint inhibitors were excluded. Out of 153 articles identified, 16 were selected. RESULTS: Analysis of the studies showed that PD-L1 inhibitor monotherapy significantly improved Overall Survival (OS) as well as Progression-Free Survival (PFS). When used in combination with chemotherapy, there were significant improvements in OS, PFS, Objective Response Rate (ORR), Event-Free Survival (EFS), and PFS. However, there were many grade 3-5 adverse effects both in monotherapy and when combined with chemotherapy, leading to treatment discontinuation. Other therapies, such as PD-1 inhibitors, were associated with better OS, PFS, and safety, as well as lower mortality rates compared to PD-L1 inhibitors, with reduced adverse effects and treatment discontinuation. Comparison of CTLA-4 inhibitors with PD-L1 and PD-1 inhibitors did not yield significant results but suggested that PD-1 and PD-L1 inhibitors have better efficacy. CONCLUSION: There is a consistent relationship between PD-1 and PD-L1 inhibitors and significant improvements in survival-related outcomes, including reduced risk of death and adverse events, with PD-1 inhibitors showing superior results in terms of lower mortality and minimized treatment discontinuation.

INTRODUCTION: Sarcomas are malignant and rare tumors originating from mesenchymal cells with an undefined and multifactorial cause. The Brazilian Society of Oncological Surgery identifies risk factors associated with a higher incidence of sarcomas, including immunosuppressive conditions (such as HIV infection or patients with a history of transplantation), genetic conditions (such as neurofibromatosis), and exposure to arsenic. Objective: To identify regional disparities in the incidence of sarcomas from January 2019 to July 2024. METHODS: This is an epidemiological, retrospective, cross-sectional, and quantitative study conducted through data collection using the SINAN/DATASUS platform, analyzing the incidence of sarcomas by region between 2019 and 2024. RESULTS: During the specified time period, 60,770 new cases of sarcomas were identified in Brazil. The Northeast region had the highest incidence (25,604), followed by the Southeast (18,556) and South (11,595) regions, while the North region had the lowest incidence (1,825), preceded by the Central-West region (3,190). The age groups with the highest incidence in the Northeast and Southeast regions are the same: 70 to 74 years and 80 or older; however, it is notable that the Southeast region has a higher incidence in the 0 to 19 age group (1,066) compared to the Northeast (804) and other regions. CONCLUSION: The incidence of sarcomas in Brazil, with the exception of the Northeast region, aligns with its population distribution. However, the results indicate a significant disparity in the incidence of sarcomas in the Northeast compared to other regions, which deviates from the established trend. This highlights the importance of analyzing and identifying health inequities and tailoring public health policies to regional needs and specificities.

Introduction: Bladder cancer is a malignant neoplasm characterized by the uncontrolled growth of the cells lining the organ, with smoking being the main risk factor. This disease is classified into three main types: transitional cell carcinoma, which represents the majority of cases and begins in the cells of the innermost tissue of the bladder, potentially spreading through the tissue, invading the muscle wall, and metastasizing to nearby organs or lymph nodes; squamous cell carcinoma, which affects thin, flat cells and arises after prolonged infections or irritations; and adenocarcinoma, which begins in glandular cells after a long period of irritation or inflammation. Objectives: To characterize the panorama of bladder cancer in Brazil over the past five years, according to epidemiological indicators, considering the impact on the population. Methodology: A retrospective and ecological study was conducted using the DATASUS database for the period from 2019 to 2023. Morbidity and hospitalizations due to bladder cancer in Brazil were analyzed, using variables such as age group and sex by region. Results: Bladder cancer shows higher morbidity among people aged 60 years or older, with males being the most affected. Within this age group, the prevalence increases significantly among individuals aged 80 years or older. Regionally, the disease is more prevalent in the Southeast region across all age groups analyzed. An interesting observation is that children under one year old are more affected by bladder cancer than the population aged 1 to 29 years, when considering each age group. Hospitalizations are most common in the 20 to 29-year age group, with the highest number of cases recorded in the Southeast region, and are more frequent among women. Conclusion: The data revealed a higher prevalence of bladder cancer in men, particularly those over 60 years old, with an increasing incidence in the 80+ age group. Smoking, the main risk factor, combined with occupational exposure to carcinogenic substances, significantly contributes to these results, especially in the Southeast region where such exposures are more common. The unexpected detection of cases in children under one year old requires further investigation. These findings are essential for guiding public policies focused on reducing smoking and controlling occupational exposures to promote the health of these patients.

Introduction: Leukemias are common neoplasms characterized by non-solid tumors in blood tissue, displaying hallmark features like uncontrolled growth and mutagenic patterns. They are generally categorized by progression speed (acute or chronic) and the type of affected blood cells (myeloid or lymphoid). Symptoms include fatigue, fever, cachexia, and immunodeficiency, among others. Objective: Given the severity and varied presentations of leukemias, understanding the epidemiological profile of affected patients is crucial. This article aims to describe the profiles of leukemia patients from the North and Northeast regions of Brazil, focusing on age, gender, and ethnicity. It also seeks to identify the most common leukemia presentations in these regions to enhance clinical management. Materials and Methods: We analyzed retrospective data on leukemia from the Cancer Information System (SISCAN) and Hospital Morbidity of SUS, available on the TabNet/DATASUS platform. Data collection utilized R software with the "microdatasus" package (R. F. SALDANHA, 2019), including variables like gender, age, place of residence, and specific diagnosis. Data analysis was performed using Excel for better organization. Results: Using R software, we reviewed 883,165 cases of malignant neoplasms from the North and Northeast regions, identifying 23,205 leukemia diagnoses over 10 years, resulting in 135,880 hospitalizations and 8,982 deaths. The majority of cases were either myeloid or lymphoid, with about 1% being monocytic leukemia. Among lymphoid leukemia cases, 50% were under 19 years old, while myeloid leukemia was more prevalent in those over 50 years old. Hospitalizations showed two peaks: one in the under-19 age group and another in those over 50. Gender differences were not statistically significant, but ethnic distribution showed a higher number of cases and mortality among the Asian population, attributed to genetic factors. Conclusion: This study highlighted typical characteristics of oncologic diseases, including age-related risk factors and genetic predispositions, particularly prevalent in Asian populations. Although absolute mortality numbers were low, the high incidence underscores the need for effective population screening. The patient profile is predominantly young (lymphoid leukemia) and elderly (myeloid leukemia), particularly children up to 19 years old and adults over 50.

Introduction: Pancreatic cancer is a well-known disease in oncoendocrinology, being one of the leading causes of death related to endocrine system tumors. Considering this, it becomes necessary to understand the epidemiological profile of the patients most affected by this disease to develop prevention programs and monitor patients at higher risk of developing this tumor. Objective: This study aims to determine the profile of patients with pancreatic cancer in the northeastern region of Brazil, as well as the mortality indicators of this population, to better understand the target group for improved monitoring to prevent deaths. Materials and Methods: We collected data from the morbidity data system for the past 10 years (2014–2024) using Tabnet/Datasus. These data were collected and selected using the R software package “microdatasus” and then exported to “Excel” software for analysis. Results: From the initial screening, 2,153,584 hospitalizations due to neoplasms were identified, with a mortality rate of 6.37%. Among these, hospitalizations for pancreatic neoplasms were 21,760 (1% of cases), with a growing average (a 200% increase in annual cases between 2014 and 2023) and a mortality rate of 21.88%. Regarding the patient profile, no significant prevalence was observed between genders, with women representing 51% of the cases, consistent with the population distribution. Proportionally, the disease affects more white individuals; however, mortality is higher in the black population, with na average patient age of 55 years. Conclusions: Based on the findings, it is concluded that pancreatic neoplasm is na emerging public health problem, with na increase in cases and deaths over the years. It can also be inferred that it affects both female and male populations equally, with na average age of 55 years, and has higher mortality in the black population. Therefore, it suggests the need for more public policies for early diagnosis to achieve a better prognosis for the disease.

INTRODUCTION Prostate cancer represents the second most common tumor among men, second only behind non-melanoma skin tumors. According to the Instituto nacional de Cancer (INCA), age is the primary risk factor for prostate cancer, with higher incidence in men starting from their seventh decade of life. Other risk factors include a family history of prostate cancer before the age of 60 and obesity, particularly for advanced histological types. In the early stages, prostate cancer may not present symptoms, but when it does, common signs include difficulty urinating, hematuria, weak urine stream, frequent urination, and hesitancy. Diagnosis is confirmed through a biopsy, which is recommended when there are alterations in prostate-specific antigen (PSA) levels or abnormalities detected during a rectal examination. Although typically associated with older age groups, prostate cancer diagnoses are not uncommon in younger men. OBJECTIVES This study aims to analyze the prevalence of prostate cancer cases and mortality rates among men aged 20 to 59 in different regions of Brazil between 2019 and 2023. METHODOLOGY The study is an ecological, retrospective, and descriptive epidemiological analysis based on data collected from the Hospital Information System (SIH/SUS) through the Department of Health Information of the Unified Health System (DATASUS) during the specified period. The focus is on the number of hospitalizations and mortality related to prostate cancer. RESULTS Over the past five years, there were a total of 23,875 hospitalizations. The Southeast region was the most affected, accounting for 53.10% of hospitalizations, while the North region had the lowest impact, with only 2.87%. The Southeast also had the highest absolute number of deaths, totaling 530 cases (46.94%), but had the lowest mortality rate (4.18). The highest mortality rate occurred in the North region, reaching 8.4 per 100,000 inhabitants. The age group most affected was 50 to 59 years old, representing the highest absolute number of deaths (1,001 cases, 88%). Interestingly, the age group with the highest mortality rate was 30 to 39 years old, with 8.89 per 100,000 inhabitants. CONCLUSION This study evinces the relevance of prostate cancer even in younger patients. Despite not being the most commonly affected age group, epidemiological data illustrate the importance of early diagnosis and clinical suspicion, given the mortality rates among young men.

Introduction: Brain neoplasia includes tumors that originate in the brain or metastasize there from cancers in other parts of the body. Despite its low incidence, mortality rates are high, with only one-third of patients surviving more than 5 years. No significant risk factors have been identified, making further studies necessary to improve prevention and diagnosis. Objective: This study aims to analyze the epidemiological trends of brain neoplasia in Paraíba compared to the rest of Brazil. Method: An observational, descriptive, cross-sectional study was conducted, evaluating hospitalizations for malignant brain neoplasia in Paraíba and Brazil from 2014 to June 2024. Variables considered included race/ethnicity, sex, age group, type of care, care regime, and year. Data were obtained from the Hospital Information System (SIH) of DATASUS. Results: From 2014 to 2024, there were 5,655,757 hospitalizations for malignant brain neoplasia in Paraíba. The majority of patients were mixed race (77.40%), followed by white (11.22%) and black (0.77%), with 6.22% having no information on race. Female patients accounted for 51.38% of hospitalizations, and male patients accounted for 48.52%. Prevalence increased significantly after the age of 50 (58.04% of cases), with 13.10% in those up to 19 years old and 28.85% in those aged 20 to 49 years. Most hospitalizations were elective (53.42%), and despite 96.28% of care regimes being unspecified, the majority of declared regimes were private (2%), followed by public (1.7%). There was a constant increase in cases, with 1.30% occurring in 2014 and a peak of 21.11% in 2023. Conclusion: The study revealed important epidemiological data on hospitalizations for malignant brain neoplasms in Paraíba, highlighting the predominance of elective admissions, mixed-race patients, and female patients. There was a higher incidence in people over 50 years old and a significant increase in cases from 2014 to 2023. These findings underscore the need for further studies to better understand the factors associated with brain neoplasia and improve prevention and diagnosis strategies.

Introduction: Malignant neoplasms of the bones and articular cartilage of the limbs are rare neoplasms, mainly restricted to the long bones, such as the femur, tibia and humerus, as well as the cartilage that forms the joints. These tumors can be divided into primary and secondary, originating from primary metastases in the bones or secondary metastases in other parts of the body. It is worth noting that joint metastases can affect the patient's ability to move, requiring a multidisciplinary and multimodal approach. Objective: To analyze the rates of malignant neoplasms of the bones and articular cartilage of the limbs by age group in the five regions of the country over half a decade. Methods: Cross-sectional, retrospective and descriptive study, with data collected from the Hospital Information System (SIH/SUS) of the Department of Information Technology of the Unified Health System (DATASUS). Brazilian cases from the International Classification of Diseases 10 - C40: Malignant neoplasm of bone and articular cartilage of limbs from 2019 to 2023 were analyzed. The study variables were: year of medical care, region, age group and gender. Results: In the period studied, the cancer panel for C40 presented 11,809 cases in the country, with a presence in the five major regions. Among them, two stand out with the highest prevalence, the Southeast (4,083) and the Northeast (3,607), making up 65.12% of the total cases in this period. It is also worth highlighting the focus of neoplasia in the 0-19 age group, with a total of 2,679 cases. In the other age groups, considering a standard interval of five years for analysis, there was little variation in prevalence, with an average of approximately 702 cases; except between 55 and 59 years, where there were more than 1,000 cases of C40. It is worth noting that 2019 was the year with the highest number of cases recorded in the country with 3,031 (25.6%). As for gender, there is a higher prevalence in females with 6,065 cases (51.3%), while males have 5,744 cases (48.7%). Conclusion: There is a predominance of C40 in the Southeast region, which can be explained by the high geographical density and greater diagnostic power. In addition, the most prevalent age group is 0-19, with a slight predominance of females. Therefore, early diagnosis is extremely important to increase the chances of cure and patient survival, as well as minimizing functional complications.

Introduction: Non-Hodgkin lymphoma (NHL) comprises a diverse group of malignancies originating from B or T lymphocytes in several subtypes, such as follicular lymphoma and diffuse large B-cell lymphoma (DLBCL). Although understanding the epidemiological profile is crucial for the development of effective public health strategies, it remains insufficiently clear. Aim: To analyze mortality rates between follicular lymphoma and DLBCL in Brazil and identify the most vulnerable groups, focusing on differences by gender, age, and geographic location, providing data to support more effective and targeted public health policies. Methods: This descriptive, observational, cross-sectional study examined the epidemiology of follicular and diffuse non-Hodgkin's lymphoma in Brazil from 2012 to 2022. Data were sourced from the National Cancer Institute (INCA) database, with variables including gender, age group, and geographic region. The study was conducted in accordance with the STROBE Statement guidelines. Results: According to the INCA database, 171,050 cases of NHL were diagnosed between 2012 and 2022, with 69,583 of these cases occurring in women. The crude mortality rate for DLBCL was 0.38 per 100,000 inhabitants, compared to 0.08 per 100,000 for follicular lymphoma. Men exhibited higher mortality rates for both subtypes, with a significant increase among those over 70 years old. Mortality from DLBCL was particularly high in individuals over 80, reaching 2.94 per 100,000 inhabitants. The Southeast region of Brazil reported the highest number of deaths for both follicular lymphoma and DLBCL. These findings underscore the greater lethality of DLBCL, consistent with its more aggressive nature. Men and the elderly, particularly those over 70, are the most vulnerable to DLBCL. Regional disparities in mortality rates suggest that access to healthcare services and socioeconomic conditions play a crucial role in the diagnosis and treatment of these lymphomas. These differences highlight the need for targeted strategies that address local healthcare challenges. Conclusion: These findings highlight DLBCL's significantly higher lethality. Men and the elderly, especially those over 70, are the most vulnerable to DLBCL. The observed regional disparities in mortality rates suggest that access to healthcare and socioeconomic conditions play critical roles in diagnosing and treating these lymphomas, underscoring the need for a more tailored approach to address local challenges.

Introduction: Neoplasia is the abnormal development of cells that can generate tumors. Malignant cortical neoplasms, which include primary and metastatic tumors of the central nervous system, are public health challenges due to their high clinical-surgical complexity and high morbidity and mortality. In Brazil, the analysis of cancer mortality is crucial for health policies. The state of Paraíba, in the Brazilian Northeast region, presents a particular epidemiological profile that reflects socioeconomic conditions and access to health services, highlighting the need for targeted strategies. Objective: To analyze the mortality profile due to cortical malignant neoplasms in the state of Paraíba between 2012 and 2022. Method: Selection and analysis of data obtained by the National Cancer Institute (INCA) regarding mortality due to cortical malignant neoplasms (ICD 10 - C71.0) in Paraíba during the period from 2012 to 2022. Results: 1,884 deaths due to cortical malignant neoplasms were recorded in Paraíba during the study period, resulting in the highest mortality rate in the Northeast region, with 4.31 deaths for every 100,000 inhabitants. On a national level, the state had the fifth highest mortality rate, surpassed only by the states of Rio Grande do Sul, Paraná, Santa Catarina and Rio de Janeiro. Comparing the first and last year analyzed, there was an increase of 17.28% in the rate in Paraíba, 10.73% in the Northeast region and 7% in Brazil. The majority of deaths (70.9%) occurred in individuals over 50 years of age, with emphasis on the age group of 60 to 69 years, which represented 22.9% of cases. Conclusion: The analysis of the epidemiological data allowed us to outline the mortality profile due to cortical neoplasms in Paraíba, highlighting a serious public health problem. The state ranks first in the region and fifth nationally in number of deaths. Therefore, the importance of implementing measures to improve early diagnosis and improve access to treatment for the population of Paraíba is emphasized, especially for the most affected age group, in order to minimize regional disparities in access to healthcare.

INTRODUCTION: Breast cancer accounts for 24.5% of all new cases of cancer in women and 15.5% of all cancer-related mortality annually among Brazilian women. As a strategy for early diagnosis, improving treatment outcomes and mortality, the Ministry of Health recommends annual mammographic screening for women aged 50 to 69 years, through the Unified Health System. OBJECTIVES: To evaluate mammographic coverage in the target population by the Brazilian states in 2022; the availability of mammography machines and the distribution of radiologists; the percentage of BIRADS 0 mammograms and tumors smaller than 2 cm. METHODS: An analysis of public data related to the number of mammograms, lesion sizes, and BIRADS results was conducted using SISMAMA; the number of radiologists was obtained from the Brazilian College of Radiology; the number of women aged 50 to 69 years was sourced from the 2022 Census (IBGE), along with the coverage of private health plans from ANS. The target population considered patients without health insurance and within the established age range for screening. RESULTS: There are 22.360.526 women aged 50-69 years in Brazil, the majority residing in the southeast region, with those lacking health insurance concentrated in the north region. Mammographic coverage of the target population varied between 2% (Amapá) and 22% (Paraná). The northern and northeastern regions have the lowest number of radiologists, with 80% located in the capitals in 10 states. Mammography machines are also less concentrated in the northeastern and northern states. The percentage of inconclusive examinations, tolerable up to 12% (Breast Cancer Surveillance Consortium), was exceeded in states across all Brazilian regions, except for the southern region. Lesions larger than 2 cm were prevalent in half of the states, distributed across all regions of the country. CONCLUSION: Mammographic coverage by SUS for its population is insufficient. The availability of radiologists remains concentrated in capitals and in the Southeast and South states, revealing a clear inequality in the distribution of mammography machines. The rate of inconclusive examinations above the recommended threshold is high in the country. This study demonstrates that integrated database analysis allows for a more precise detailing of the mammographic screening situation by state, aiding in the planning of targeted measures to improve national diagnostic outcomes and, consequently, breast cancer treatment.

Introduction: Colorectal cancer (CRC) is a global health issue. The incidence rate of the disease is strictly linked to the human development index (HDI). Nevertheless, epidemiology, access to treatments and clinical outcomes of CRC is scarcely described in low- and middle-income countries, such as Brazil. Objectives: Evaluate the epidemiology, access to treatments and clinical outcomes of CRC in Brazil Methods: Data from CRC patients registered in the national databases of the Brazilian Unified Health System - SUS (Mortality Information Systems— SIM, Outpatient Information System—SIA/SUS, and Hospital Information System—SIH/SUS) from 1999 to 2015 were obtained. These databases include information from the 26 Brazilian states and the Federal District. Results: A total of 242.465 new cases of colorectal cancer were documented, of which 68,7% were colon cancer and 31,3% rectal cancer. The median age at diagnosis was 58 years. 50,1% were male. Staging information was available for 130.450 patients: 3,2% stage I, 26,9% stage II, 40,4% stage III, and 29,5% stage IV. The first treatment modality was surgery in 63,8%, chemotherapy in 30,6%, and radiotherapy in 5,6% of patients. 76,7% of patients received treatment within 60 days of diagnosis (median 53 days). The longest waiting time for the start of treatment was observed in the northern region (median 68 days), followed by the southeast (median: 59 days), northeast (median: 49 days), central-west (median: 44 days ) and southern (median: 40 days) (p<0.05). Mortality in this cohort was 39%. Overall survival at 1-year, 2-years, 5-years and 10-years was 70%, 66%, 59% and 51% respectively. Colon cancer, male sex, African American ethnic background, and age over 50 years were associated with worse survival. Conclusion: This is the largest Brazilian cohort study of CRC patients with sociodemographic data so far. In agreement with international literature, the majority of patients were diagnosed at later stages. Mortality rate around 40% is in line with SEER data. Colon cancer, male sex, African American ethnic background, and age over 50 years were associated with worse survival. Screening programs must be strengthened throughout the country.

Introduction: The treatment of metastatic castration-sensitive prostate cancer (mCSPC) has evolved over the years. These therapies are guided by current volume (CHAARTED) and risk (LATITUDE) criteria, instituted based on conventional exams. The emergence of new imaging exams like PSMA-PET, with its greater accuracy and early detection of metastatic disease raises questions about the applicability of these criteria in this context for earlier initiation of systemic therapy and its benefit in overall survival (OS). Methods: We conducted a retrospective, single-center study comparing patients staged with PSMA PET between August 2017 and February 2022 and classified as metastatic after curative therapy or de novo metastatic. Patients with stage IVA, i.e., N1, were also included. Patients were stratified into high and low volume and risk, with the aim of comparing these patients with each other, with the primary outcome of OS. Results: A total of 48 patients were selected for analysis, with a median age of 66 years at diagnosis. Of these, 81.3% had a Gleason score between 8 and 10, 57% had a T classification of T3 or higher, and 32% were N1 based on conventional imaging. According to PSMA PET, 40% were de novo metastatic, with disease sites identified as follows: bones (M1b - 52%), non-pelvic lymph nodes (M1a – 21%), pelvic lymph nodes (N1 – 17%), and viscera (M1c – 10%). Applying CHAARTED criteria, 71% of patients were classified as low volume, and applying LATITUDE criteria, 75% were classified as low risk. With a median follow-up time of 37.5 months and a total of 7 deaths, the median OS was not reached. At 36 months, 64.6% of the high volume group were alive compared to 96.6% of the low volume group (p=0.054), and 77.8% of the high risk patients were alive compared to 89.9% of the low risk patients (p=0.739). There was a 67% increase in the detection of distant metastases. When correlated with bone scintigraphy (BS) (n=19), there was a 78.9% discordance in the number and/or location of bone lesions, and in 53.3% of cases, PSMA PET was positive for bone disease while BS was negative at the same time. Conclusion: PSMA PET appears to be prognostic when applied to volume-based curves, despite a p-value of 0.054, which does not hold for risk. It also increases the detection of metastatic disease compared to conventional imaging and is more precise in detecting bone disease compared to BS.

Introduction: High-grade gliomas represent a significant portion of Central Nervous System tumors, with Glioblastoma Multiforme (GBM) being the most common subtype. The median survival for patients treated with standard therapy is 12 months. Within this time period, tumor recurrence is common and the optimal rescue-therapy remains under investigation. The use of metronomic Temozolomide (mTMZ) at the tumor recurrence has been described in studies as a safe and well-tolerated treatment option. Objective: The aim of this study was to assess the efficacy and toxicities of mTMZ in the treatment of high-grade gliomas at a tertiary public university hospital in Brazil. Method: All patients treated at our center between January 2014 and June 2024 were retrospectively reviewed. The main inclusion criteria were initial standard therapy at diagnose with surgery followed by chemoradiotherapy; relapse after the first or subsequent line of therapy and treatment with mTMZ 50 mg/m² continuously. Results: A total of 51 patients were enrolled, 37 men (72%) and 14 women (28%). The median age at diagnosis was 42 years. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was <2 in 32 patients (62%). Total tumor resection surgery was performed in 25 patients (49%), and the number of adjuvant TMZ cycles was <6 in 21 patients (41%). The number of treatment lines was <2 in 48 patients (94%). The number of metronomic TMZ cycles was >6 in 23 patients (45%). Four patients achieved partial response (7%), 11 had stable disease (21%) and 28 experienced disease progression at first revaluation (54%). The median Overall Survival (OS) for GBM patients was 15.5 months. The median Progression-Free Survival (PFS) was 2 months. In univariate analysis, the use of mTMZ after at least 2 months of the end of adjuvant treatment ("Rechalleng") was associated with OS (Hazard Ratio 0.24, Confidence Interval 0.11 to 0.55, p = 0.001). Other factors did not reach statistical significance for PFS or OS. Forty-four patients (86%) experienced light-mild toxicities (grade 1-2). The most common Grade 3 toxicities were hematological (3.8%) and nausea (11.5%). Grade 4 toxicities were not observed in any patient. Treatment was discontinued due to refractory toxicities in 2 patients (3%). Conclusion: mTMZ rechallenge is a viable and well-tolerated treatment modality for recurrent gliomas. It has successfully being able to achieve radiological response and disease control in these patients.

Cancer is defined as a group of diseases characterized by the uncontrolled growth of cells, which can invade tissues and organs. In Brazil, it is estimated that approximately 625,000 new cancer cases will occur between 2020 and 2022, with prostate, lung, breast, colorectal, and stomach cancers being among the most common. Oncology patients are immunosuppressed due to the neoplasm itself and also due to treatments such as chemotherapy, radiotherapy, and surgeries, making them more susceptible to infections compared to the general population. Therefore, it is essential to update the vaccination schedule for oncology patients and their cohabitants. This vaccination guidance should be conducted in collaboration with the attending physician and CRIE, especially during the patient's first consultation, with a plan for updating vaccinations before the start of any immunosuppressive treatment to achieve a better immune response.Objectives:Evaluate the vaccination status of oncology patients who receive or have received treatment through SUS in the city of Campinas. Secondary Objectives:Assess the knowledge about the vaccination status of oncology patients in public clinical oncology outpatient clinics in the city of Campinas. Evaluate the vaccination status of the cohabitants of oncology patients attended in two public services in the city of Campinas, SP. Implement a database on immunization in oncology patients.Materials and Methods:Data collection for this project was carried out during the first semester of 2019. The research is a cross-sectional observational study. A total of 237 individuals from oncology clinics of the SUS in the city of Campinas, SP, were considered. 183 individuals were excluded due to meeting exclusion criteria, leaving 54 patients for final analysis (22.78%). The main exclusion factor was the lack of a vaccination card. A total of 54 individuals were evaluated, with 30 males (55.56%) and 24 females (44.44%). Thirty-seven individuals (68.51%) received vaccination guidance before their cancer diagnosis. The main vaccines advised for administration were influenza, diphtheria/tetanus (dT), and yellow fever. Sixteen individuals (29.62%) received vaccination guidance after their cancer diagnosis.Conclusion:Based on the data from this study, we observed that professionals in the oncology departments of the SUS in the city of Campinas, SP, still need guidance on the vaccination coverage of their oncology patients.

Introduction: Endometrial cancer (EC) has rising rates; Black women face higher mortality due to aggressive tumors, health disparities, and prevalent risk factors like obesity. Objectives: This study aims to evaluate EC incidence and mortality trends among racial groups in Brazil, focusing on clinical and sociodemographic characteristics of Black and White women. It seeks to identify differences in diagnosis and outcomes to highlight contributing factors to disparities. The primary objective is to provide insights so as to reduce racial inequities in healthcare access and treatment. Methods: Data from the Population-Based Cancer Registries (PBCRs), Hospital-Based Cancer Registries (HBCRs), and Mortality Information System (SIM) of Brazil were utilized. Race/skin color was classified according to the Brazilian Institute of Geography and Statistics (IBGE) categorization. The data encompassed clinical and sociodemographic characteristics of women diagnosed and treated for EC between 2000 and 2019. Results: From 2010 to 2015, 32,831 new cases of EC were registered in the 13 participating PBCRs, with 35.7% in Black women. The median age at diagnosis was 63 years, with Black women being diagnosed earlier (62 years) than White women (65 years). Incidence in White women gradually increases with age, while in Black women, it peaks between 60 and 64 years. Black women were diagnosed at more advanced stages and received less efficient and delayed treatment. The incidence rate was 11.8/100,000 for White women and 7.0/100,000 for Black women, with mortality rates at 3.8/100,000 for White women and 2.4/100,000 for Black women. Crude incidence rates increased by 4% annually, higher for Black women (6.7%) than for White women (3.0%). The mortality rate decreased by 1.6% annually, higher for White women (1.2%) than for Black women (0.6%). Conclusion: The racial disparities observed in EC in Brazil underscore the urgent need for targeted interventions to improve access to and quality of healthcare for vulnerable racial groups. A detailed understanding of these disparities is essential for developing effective strategies to ensure equitable outcomes for all women. This study highlights the importance of addressing inequalities in access to healthcare services and the quality of treatment, aiming to reduce disparities in the incidence and mortality of EC among women from different racial groups in Brazil.

Introduction: Cervical cancer is the fourth most common malignancy among women globally, primarily caused by human papillomavirus (HPV) infection. Despite advancements in vaccination and screening, socioeconomic disparities significantly impact cervical cancer rates, particularly in underdeveloped countries. In Brazil, marked variations in incidence and mortality highlight the influence of geographical and socio-demographic factors on healthcare access and outcomes. Objective: To assess how socioeconomic and healthcare factors influence access to prevention and treatment services and cervical cancer mortality in Brazil. Methods: This cross-sectional study analyzed public data on the Brazilian National Institute of Cancer (INCA), the National Institute of Geography and Statistics (IBGE), and the Brazilian Ministry of Health. Data was collected on indicators such as the Human Development Index (HDI), physician density, average household income, HPV vaccine coverage, pap smear screening rates, radiotherapy machine density, and non white population rates by state and macroregion across Brazil. Spearman's rank correlation test and simple linear regression analysis were employed. Results: Cervical cancer mortality rate is statistically lower in women with health insurance, positive self-perception of health, located in states with a higher HDI, per capita household income, density of physicians, and radiotherapy machines per 1,000 inhabitants. In contrast, mortality rates proportionally increase according to poverty levels, as expected, and rates of non-white population. Considering public health, HDI scores significantly affected Pap smear test coverage, the number of radiotherapy machines, and HPV vaccine uptake. The North and the Southeast regions have, respectively, the lowest and the highest socioeconomic indicators, proportional to their mortality rates. No significant correlation was found between mortality rates and HPV vaccine or pap smear coverage. Conclusion: Cervical cancer mortality in Brazil is significantly influenced by socioeconomic and healthcare disparities. This study provides a data-driven basis for public health strategies that address both medical and social determinants of health.

Background: Gastric Cancer (GC) is the fifth most lethal cancer worldwide. It is a heterogeneous disease with different tumor profiles based on histological and molecular factors that remain in some aspects discordant. Pathogenesis underlying GC and genes responsible for the disease is still under investigation. In cutting-edge cancer research, machine learning (ML) received increasing attention in identifying clinically useful biomarkers. Our study aims to explore gene expression patterns associated with Lauren histological classification (LHC) in GC using ML techniques. Methods: Transcriptome data of GC was acquired and normalized using R language from The Cancer Genome Atlas dataset, filtering LHC by intestinal and diffuse types. Our initial model, a logistic regression, used principal component analysis to reduce dimensionality and yielded a recall of 0.67 and a precision of 0.8. However, it lacked individual variable analysis due to pure mathematical grouping. Hence, an Elastic Net (EN) model was employed, using an IHQ of 0,5%, allowing individual gene analysis with a reduced recall of 0.5. Functional enrichment analysis (FEA) was conducted in gProfiler to detect selected enriched terms. Survival analysis was conducted for genes selected by EN, using p<0,05 as the threshold. Results: The dataset included 244 patients, with 64 of the diffuse type. EN analysis selected 42 genes, 17 differentially upregulated (DU) in Intestinal and 25 DU in Diffuse type. In the FEA, the intestinal subtype exhibited DE of endopeptidase and peptidase inhibitor activity and endopeptidase and peptidase regulator activity. Di"use type showed DE of antigen binding and response to stimulus. Worse prognosis-relevant DU genes in di"use type were CHRDL1, ADH1B, NLGN1, and FOXD1. MLXIPL and NEBL correlated with poor prognosis in the intestinal type DU genes, while LHPL3 and UPK3A were more favorable. Conclusions: Given the small dataset and the naturally low proportion of diffuse tumors compared to intestinal ones, these findings should be interpreted with caution. Nonetheless, machine learning represents a promising and reliable tool for evaluating the gene expression profiles in different morphological subtypes of gastric cancer.

Background: Adjuvant chemotherapy for soft tissue sarcomas is controversial as clinical trials had mixed results. Chemotherapy is often offered to patients with high-risk factors or low predicted survival as per the Sarculator tool; however, this nomogram was developed within a European cohort and mostly validated in high-income settings. Objectives: validate the Sarculator prognostic tool in a Brazilian retrospective cohort. Methods: Retrospective study of patients with localized trunk and extremity soft tissue sarcomas from January. 2010 to January. 2023. We collected data on patients age, cancer histology, grade, diameter (in cm), and calculated the 5 and 10-year predicted survival probability (pr-OS) with Sarculator. We evaluated its discrimination with the c-index, and compared Kaplan-Meier landmark survival estimates to mean pr-OS. We further divided patients in high (< 60% 10yr prOs) and low-risk (≥ 60% 10ry prOS) groups to compared survival outcomes. Results: 376 patients were evaluated with a median age of 52 years (IQR 40-62). Median tumor size was 11cm (IQR 7-15), most were high-grade (65%). Peri-operatively, 58% received radiotherapy and 22% chemotherapy. Median follow-up was 47mo (IQR 18-83). The mean 5yr and 10yr prOS were 71.2% and 61.3%, compared to 5yr and 10yr OS of 63.8% (95%CI 58.8-69.3) and 44.9% (95% CI 38.5-52.3). The estimated c-index for the entire cohort was 0.72. Compared to low-risk group (207/376, 55%), high-risk patients (169/376, 45%) had higher tumor size (median 14cm vs 7cm, p<0.001), grade (G3 91% vs 45%, p<0.001), and poorer survival outcomes (5-year OS 43% vs 80%, HR 3.41 95%CI 2.44-4.75). Conclusions: The Sarculator nomogram had moderate to good discriminatory performance, varying across sarcoma subtypes, but over-estimated survival probabilities in this Brazilian cohort. Medical oncologists from developing regions should be aware of possible limitations when using the Sarculator nomogram in clinical practice.

Background Gastric cancer globally ranks as one of the most aggressive tumors, with high mortality rates. Recent studies suggest potential benefits of triple therapies (FLOT protocol) aiming to optimize survival and response rates, especially in metastatic cases. We aimed to compare detailed treatment outcomes between triple therapy versus (vs) Folfox protocol+- Nivolumab in patients with metastatic GEJ and gastric cancer. Materials and Methods Retrospective study carried out at the AC Camargo Cancer Center, São Paulo, Brazil. From January 2017 to July 2023 were collected patients with a metastatic diagnosis of GEJ adenocarcinoma or gastric adenocarcinoma who underwent Folfox +- Nivolumab or FLOT as first-line treatment. The primary outcomes were Overall Survival (OS) and Progression-Free Survival (PFS). Secondary endpoints were point response rate (ORR) and G3/4 toxicity. Cox proportional hazards models were created to adjust for the effects of independent variables on the primary outcomes. Results A total of 82 patients were included, most of them men (n=51; 62.2%), median age of 57.5 years (range 29-86), with ECOG 0 (n=51; 62.1%) and the main location of the primary was the stomach (n=65; 79.2%). Regarding clinical and pathological staging, (n= 37; 46.9%) had only one metastatic site and (n= 17; 19.5%) were represented by the diffuse subtype, followed (n= 56; 68.2%) by intestinal subtype and a total (n=36; 43.9%) of patients had CPS less than 5. After the start of chemotherapy treatment, (n=27; 33%) of patients received FLOT, (n=34; 41 %) received Folfox and (n=21; 26%) received Folfox plus Nivolumab. There were no differences in ORR between chemotherapy treatments. Regarding grade 3/4 adverse effects, 82% of patients using FLOT vs 78% Folfox+-nivolumab (p= 0.13) presented toxicity, but there was no statistical difference. Overall survival with a median follow-up of 36 months showed that first-line treatment with FLOT had a median OS of 23 months (95% confidence interval [CI]15.13-30.86 months) vs 28 months (95% CI 20.48-36.91; p= 0.47) of Folfox +-Nivolumab. PFS showed a median of 8.1 months in the FLOT arm (95% CI 3.45-12.81) vs 9.01 months in the Folfox +- Nivolumab arm (95% CI 6.07-11.96; p= 0.25). In the exploratory analysis of diffuse histology there was no difference between the treatment groups. Conclusion In conclusion, FLOT did not present better response rates or survival data when compared to Folfox +- Nivolumab.

Introduction: Colorectal cancer is a common malignancy affecting the colon or rectum, with approximately 1.9 million new cases worldwide in 2020, being the third most frequent cancer in Brazil’s population, with 40 thousand new cases each year. Surgery is the primary treatment for this disease, with partial colectomy being a common approach, involving removal of the segment of the colon containing the tumor and some surrounding healthy tissue, followed by reconnecting the remaining sections. Partial colectomy can be performed via open surgery or laparoscopically, the latter offering benefits like shorter recovery times and less postoperative pain. Objective: This study aims to forecast the 10-year demand for partial colectomy amongst colon cancer patients in Northeastern Brazil, evaluating the potential necessity for interregional collaboration according to migration trends. Methods: An observational study was conducted using annual estimates of partial colectomies amongst colon cancer patients from DATASUS, from 2013 to 2023 in Northeastern Brazil. Forecasting models regarding number and pricing of authorization for hospital admissions (AIH) by place of residence and hospitalization were made with ARIMA (R programming 4.0) and used to predict annual oncology colectomy for the next ten years (2024-2033). Results: The ARIMA forecast predicted average annual demand of 414 (95% CI: 275,86-552,50) partial colectomies for oncology patients residing in the northeastern region. Similarly, the forecast for in-region hospitalizations is 412 (95% CI: 272,86-552,04) patients per year. By 2033, it is estimated a mean value of R$ 2.201.864,00 (95% CI 1.745.235 -2.658.493) of total expenditure with this procedure, with a cost of R$ 5.424,96 (95% CI 3.616,93 - 7.232,97) per patient in Northeastern region. Meanwhile, the estimate of expenses for hospitalizations is R$ 2.194.325,00 (95% CI: 1.729.299-2.659.352) and R$ 5.429,45 (95% CI: 3.618,06-7.240,84) per patient, which indicates that, possibly, this region has a trend of receiving proper fundings for partial colectomies for the next ten years. Conclusion: Migratory trends weren’t noted over the next 10 years, as expenditure by place of residence and hospitalization are quite similar. However, investment in this procedure is still relevant, considering the demand and its need of maintenance over the next years, as to ensure reliable, cost-effective, and prompt cancer surgeries nationwide.