Panorama do tratamento do câncer gástrico no Brasil: um estudo multicêntrico da Associação Brasileira de Câncer Gástrico
Gastric cancer treatment in Brazil: a multicenter study of the Brazilian Gastric Cancer Association
Marcus Fernando Kodama Pertille Ramos; Marina Alessandra Pereira; Thiago Francischetto Ribeiro; Oddone Braghiroli Neto; Felipe José Fernandez Coimbra; Marco Antônio Gonçalves Rodrigues; Flavio Duarte Sabino; Ulysses Ribeiro Junior; Ronaldo Mafia Cuenca; Felipe Carvalho Victer; Flávio Daniel Saavedra Tomasich; Geraldo Ishak; Antonio Nocchi Kalil; Álvaro Antônio Bandeira Ferraz; Luis Fernando Moreira; Claudemiro Quireze Junior; Nelson Adami Andreollo; Osvaldo Antônio Prado Castro; Fernando Antônio Siqueira Pinheiro; Antônio Carlos Weston
Resumo
Introdução: O câncer gástrico (CG) apresenta características e manejos diferentes de acordo com a região do mundo e o objetivo do nosso estudo foi avaliar como ele está sendo realizado no Brasil.
Métodos: Este é um estudo multicêntrico que envolveu 18 centros de referência oncológicos. Os dados foram coletados usando a plataforma REDCAP e compilados ao final de 1 ano.
Resultados: Todas as regiões brasileiras foram representadas e 635 pacientes foram incluídos. A maioria dos pacientes era das regiões Sudeste (40,6%) e Nordeste (29,6%). A média de idade foi de 62 anos, com predomínio do sexo masculino. A maioria dos pacientes (84,6%) tinha bom desempenho clínico, com ECOG de 1-2. Menos de 10% dos pacientes eram cobertos por seguro médico. Um quarto dos pacientes foi submetido a laparoscopia diagnóstica, mas ultrassonografia endoscópica e PET scans raramente foram realizados. A categoria cT3 foi a mais comum (40,6%), envolvimento de linfonodos foi descrito em 48,9% e metástases à distância em 14,4% dos exames de estadiamento. O estadiamento cTNM final foi III (29,4%), II (26%), I (24,2%) e IV (20,5%). A maioria dos pacientes foi submetida à cirurgia com intenção curativa (74,4%) e via de acesso aberta (82,8%). Quimioterapia pré-operatória foi realizada em 37,2% dos casos e os procedimentos cirúrgicos mais comuns foram gastrectomia subtotal (45,3%) e gastrectomia total (33,1%).
Conclusão: O presente estudo permitiu avaliar o panorama atual do tratamento cirúrgico do CG, representando todas as regiões do Brasil. Tumores com estádio III, distais e difusos continuam predominantes no Brasil e foi observado um uso relevante da laparoscopia diagnóstica, quimioterapia pré-operatória e cirurgia minimamente invasiva.
Palavras-chave
Abstract
Introduction: Gastric cancer (GC) has distinct characteristics and management according to the region of the world, and the objective of our study was to evaluate how it is being managed in Brazil.
Methods: This is a multicenter study that involved 18 oncology referral centers. Data were collected using the REDCap platform and compiled at the end of one year.
Results: All Brazilian regions were represented, and 635 patients were included. Most patients were from the Southeast (40.6%) and Northeast (29.6%) regions. The mean age was 62 years, with a predominance of males. Most patients (84.6%) had good performance status, with an ECOG score of 1-2. Less than 10% of patients were covered by medical insurance. A quarter of the patients underwent diagnostic laparoscopy, but endoscopic ultrasound and PET scans were rarely performed. The cT3 category was the most common (40.6%), lymph node involvement was described in 48.9%, and distant metastases, in 14.4% of the staging exams. The final cTNM staging was III (29.4%), II (26%), I (24.2%) and IV (20.5%). Most patients underwent surgery with curative intent (74.4%) and open access (82.8%). Preoperative chemotherapy was performed in 37.2% of cases, and the most common surgical procedures were subtotal gastrectomy (45.3%) and total gastrectomy (33.1%).
Conclusion: The present study allowed us to evaluate the current panorama of surgical treatment of Gastric Cancer, representing all regions of Brazil. Stage III, distal, and diffuse tumors continue to be prevalent in Brazil, and there has been relevant use of diagnostic laparoscopy, preoperative chemotherapy, and minimally invasive surgery.
Keywords
Referências
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Submetido em:
04/09/2024
Aceito em:
02/03/2025
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