RESUMEN
Objective: Neoadjuvant chemotherapy (NACT) has become the standard of care for patients with triple-negative breast cancer (TNBC) with tumors > 1 cm or positive axillary nodes. Pathologic complete response (pCR) has been used as an endpoint to select patients for treatment scaling. This study aimed to examine the benefit of adding adjuvant capecitabine for TNBC patients who did not achieve pCR after standard NACT in a real-world scenario. Methods: This retrospective cohort study included all patients with TNBC who underwent NACT between 2010 and 2020. Clinicopathological data were obtained from the patient records. Univariate and multivariate analyses were conducted at the 5 years follow-up period. Results: We included 153 patients, more than half of whom had stage III (58.2%) and high-grade tumors (60.8%). The overall pCR rate was 34.6%, and 41% of the patients with residual disease received adjuvant capecitabine. Disease-specific survival (DSS) among the patients who achieved pCR was significantly higher (p<0.0001). Residual disease after NACT was associated with detrimental effects on DSS. In this cohort, we did not observe any survival benefit of adding adjuvant capecitabine for patients with TNBC subjected to NACT who did not achieve pCR (p=0.52). Conclusion: Our study failed to demonstrate a survival benefit of extended capecitabine therapy in patients with TNBC with residual disease after NACT. More studies are warranted to better understand the indication of systemic treatment escalation in this scenario.
Asunto(s)
Capecitabina , Terapia Neoadyuvante , Neoplasias de la Mama Triple Negativas , Humanos , Capecitabina/administración & dosificación , Capecitabina/uso terapéutico , Neoplasias de la Mama Triple Negativas/tratamiento farmacológico , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Quimioterapia Adyuvante , Adulto , Antimetabolitos Antineoplásicos/uso terapéutico , Antimetabolitos Antineoplásicos/administración & dosificación , AncianoRESUMEN
Abstract Objective Neoadjuvant chemotherapy (NACT) has become the standard of care for patients with triple-negative breast cancer (TNBC) with tumors > 1 cm or positive axillary nodes. Pathologic complete response (pCR) has been used as an endpoint to select patients for treatment scaling. This study aimed to examine the benefit of adding adjuvant capecitabine for TNBC patients who did not achieve pCR after standard NACT in a real-world scenario. Methods This retrospective cohort study included all patients with TNBC who underwent NACT between 2010 and 2020. Clinicopathological data were obtained from the patient records. Univariate and multivariate analyses were conducted at the 5 years follow-up period. Results We included 153 patients, more than half of whom had stage III (58.2%) and high-grade tumors (60.8%). The overall pCR rate was 34.6%, and 41% of the patients with residual disease received adjuvant capecitabine. Disease-specific survival (DSS) among the patients who achieved pCR was significantly higher (p<0.0001). Residual disease after NACT was associated with detrimental effects on DSS. In this cohort, we did not observe any survival benefit of adding adjuvant capecitabine for patients with TNBC subjected to NACT who did not achieve pCR (p=0.52). Conclusion Our study failed to demonstrate a survival benefit of extended capecitabine therapy in patients with TNBC with residual disease after NACT. More studies are warranted to better understand the indication of systemic treatment escalation in this scenario.
RESUMEN
Introduction: the first COVID-19 case in the state of Rio de Janeiro was registered on march 6 2020 and SARS-Cov-2 has been impacting population's lives on biopsychosocial aspects since, being characterized as a syndemic and overwhelming the Brazilian public Unified Health System. Objectives: describe the COVID-19 pandemic through demographic stratification of deaths occurring from january 2020 to august 2021 and on Rio de Janeiro state's health service regions. Methods: this is an aggregate transversional study, which used data available from the Health Ministry, producing a descriptive epidemiology. Measures of absolute prevalence and standardized mortality ratio (SMR) were calculated; population size used was the one estimated to 2020. Associations between variables were checked by Pearson's test. Results: statistically significant associations were observed between scholarity, sex, age and health service region in relation to COVID-19 deaths and by other causes. About COVID-19 mortality, there was an association between scholarity and sex, highlighting more deaths than expected on higher educated males and on no educated females. The health regions Metropolitana I and II had SMR over 100%, and the other regions had low SMR, specially Baía da Ilha Grande and Baixada Litorânea regions which had less deaths than expected. Conclusions: the results showed demographic, geographic and historic patterns of the pandemic on Rio de Janeiro state, which may represent socioeconomic vulnerabilities, allowing to characterize COVID-19 as a syndemic.
Introdução. O primeiro caso de COVID-19 no Estado do Rio de Janeiro ocorreu em 6 de março de 2020 e o SARS-Cov-2 vem impactando a vida da população nos aspectos biopsicossociais, apresentando características de sindemia, e sobrecarregando o Sistema Único de Saúde. Objetivo: Descrever a pandemia de COVID-19 pela estratificação demográfica dos óbitos ocorridos no período de janeiro de 2020 a agosto de 2021 e nas Regiões de Saúde do Estado do Rio de Janeiro. Metodologia. Trata-se de estudo transversal de agregados, que utilizou dados disponibilizados pelo Ministério da Saúde, visando produzir uma epidemiologia descritiva. Foram calculadas medidas de prevalência absoluta, coeficiente de prevalência e razão padronizada de mortalidade (RPM); foram considerados os tamanhos populacionais estimados para 2020. Foram verificadas associações entre variáveis pelo teste de Pearson. Resultados. Foram observadas associações estatisticamente significativas entre escolaridade, sexo, faixa etária e regiões de saúde em relação aos número de óbitos por COVID-19 e outras causas. Dentre os óbitos por COVID-19, houve associação entre escolaridade e sexo, destacando mais óbitos que o esperado entre pessoas do sexo masculino com ensino superior e do sexo feminino sem escolaridade. As Regiões de Saúde Metropolitana I e II apresentaram RPM acima de 100% e as demais abaixo, destacando as regiões Baía da Ilha Grande e Baixada Litorânea por apresentarem menos óbitos que o esperado. Conclusão. Os resultados mostraram padrões demográficos, geográficos e históricos da pandemia no Estado do Rio de Janeiro, que podem representar vulnerabilidades socioeconômicas, permitindo caracterizar a COVID-19 como sindemia.