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Introduction: The survival of patients with metastatic renal cell carcinoma (mRCC) has improved dramatically due to novel systemic treatments. However, mRCC mortality continues to rise in Latin America. Methods: A retrospective, multicenter study of patients diagnosed with mRCC between 2010-2018 in Mexico City was conducted. The aim of the study was to evaluate the impact of healthcare insurance on access to treatment and survival in patients with mRCC. Results: Among 924 patients, 55.4%, 42.6%, and 1.9% had no insurance (NI), social security, (SS) and private insurance (PI), respectively. De novo metastatic disease was more common in NI patients (70.9%) compared to SS (47.2%) and PI (55.6%) patients (p<0.001). According to IMDC Prognostic Index, 20.2% were classified as favorable, 49% as intermediate, and 30.8% as poor-risk disease. Access to systemic treatment differed by healthcare insurance: 36.1%, 99.5%, and 100% for the NI, SS, and PI patients, respectively (p<0.001). NI patients received fewer lines of treatment, with 24.8% receiving only one line of treatment (p<0.001). Median overall survival (OS) was 13.9 months for NI, 98.9 months for SS, and 147.6 months for NI patients (p<0.001). In multivariate analysis, NI status, brain metastases, sarcomatoid features, bone metastases, no treatment were significantly associated with worse OS. Conclusion: OS in mRCC was affected by insurance availability in this resource-limited cohort of Mexican patients. These results underscore the need for effective strategies to achieve equitable healthcare access in an era of effective, yet costly systemic treatments.
RESUMO
A model of BALB/c mice was developed to determine the effects of zinc supplements on immune responses during certain stages of ontogeny. The mice received zinc acetate in drinking water concentrations of 500 and 1000 mg/l during the periods of gestation, lactation and postweaning. The sequence employed in this study was: (I) 0/0 (II) 500/500 (III) 1000/1000 (IV) 0/0/0 (V) 500/500/500 and (VI) 1000/1000/1000 with their respective controls. No changes were observed in the general appearance, growth curves, hematocrit or signs of achromotrichia between treated and control animals. Group II and III showed a significant increase in 3H-thymideine-determined splenic lymphoproliferation, while groups V and VI exhibited and important decrease. A significant increase in plaque-forming cell response (IgM) was observed after the period of lactation in groups II and III as well as i groups V and VI. Zinc concentrations determined by atomic absorption in liver and thymus were significantly higher in all treated mice 42 days after bith. Results suggest that for carefully monitored periods and doses, oral zinc supplements might have a beneficial effect over some immune responses in the perinatal stages