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Introduction: We conducted an extensive, sex-oriented real-world data analysis to explore the impact and safety of non-steroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors (coxibs) on cancer treatment outcomes. This is particularly relevant given the role of the COX-2/PGE2 pathway in tumor cell resistance to chemotherapy and radiotherapy. Methods: The study applied a retrospective cohort design utilizing the TriNetX research database consisting of patients receiving cancer treatment in 2008-2022. The treated cohorts included patients who were prescribed with coxibs, aspirin or ibuprofen, while individuals in the control cohort did not receive these medicines during their cancer treatment. A 1:1 propensity score matching technique was used to balance the baseline characteristics in the treated and control cohorts. Then, Cox proportional hazards regression and logistic regression were applied to assess the mortality and morbidity risks among patient cohorts in a 5-year follow-up period. Results: Use of coxibs (HR, 0.825; 95% CI 0.792-0.859 in females and HR, 0.884; 95% CI 0.848-0.921 in males) and ibuprofen (HR, 0.924; 95% CI 0.903-0.945 in females and HR, 0.940; 95% CI 0.917-0.963 in males) were associated with improved survival. Female cancer patients receiving aspirin presented increased mortality (HR, 1.078; 95% CI 1.060-1.097), while male cancer patients also had improved survival when receiving aspirin (HR, 0.966; 95% CI 0.951-0.980). Cancer subtype specific analysis suggests coxibs and ibuprofen correlated with survival, though ibuprofen and aspirin increased emergency department visits' risk. Secondary analyses, despite limited by small cohort sizes, suggest that COX inhibition post-cancer diagnosis may benefit patients with specific cancer subtypes. Discussion: Selective COX-2 inhibition significantly reduced mortality and emergency department visit rates. Further clinical trials are needed to determine the optimal conditions for indication of coxibs as anti-inflammatory adjuvants in cancer treatment.

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OBJECTIVE: Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María. METHODS: A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed. RESULTS: Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment (P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01). CONCLUSIONS: Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.

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O presente estudo parte de reflexões acerca da sobrevivência ao câncer e da experiência estigmatizante vivenciada por pessoas diagnosticadas com câncer de laringe no Hospital Nacional do Câncer/Instituto Nacional do Câncer, submetidas à cirurgia de Laringectomia Total e participantes do Grupo de Laringec-tomizados Totais. O objetivo foi compreender as mediações de saberes e de informações produzidas pelos participantes do grupo na interface com os profissionais de saúde, considerando a sua dupla condição de estigma: o câncer e a deficiência. Parte-se de uma abordagem socioantropológica de caráter qualitativo e ex-ploratório que empregou os métodos de entrevista narrativa com cinco participantes. A análise foi realizada pelo método hermenêutico-dialético. Nos resultados destacam-se a busca pelo reconhecimento individual e social e a valorização da experiência frente aos saberes oficiais e o quanto as mediações extrapolam o espaço institucional. A mediação de saberes faz emergirem elementos significativos para o enfrentamento de uma cultura informacional dominante.

This study is based on reflections on surviving cancer and the stigmatizing experience of people diagnosed with laryngeal cancer at the Hospital Nacional do Câncer/Instituto Nacional do Câncer, who underwent Total Laryngectomy surgery and participated in the Total Laryngectomy Group. The goal was to understand the mediations of knowledge and information produced by the group participants, in the interface with health professionals, considering their double condition of stigma: cancer and disability. It is based on a socio-anthropological approach, of qualitative and exploratory nature that employed the narrative interview method with five participants. The analysis was carried out through the hermeneutic-dialectic method. The results highlight the search for individual and social recognition and the appreciation of experience in relation to official knowledge, and how the mediations go beyond the institutional space. The mediation of knowledge brings out significant elements to confront a dominant informational culture.

El presente estudio se basa en las reflexiones sobre la supervivencia al cáncer y la experiencia estigmatiza-dora de personas diagnosticadas de cáncer de laringe en el Hospital Nacional do Câncer/Instituto Nacional do Câncer, que se sometieron a una Laringectomía Total y participaron en el Grupo de Laringectomía Total. Objetivo: comprender las mediaciones de conocimiento e información producidas por los participantes del grupo, en la interfaz con los profesionales de salud, considerando su doble estigma: cáncer y discapacidad. Se basa en un abordaje socioantropológico, cualitativo y exploratorio, que utilizó métodos de entrevista narrativa con cinco participantes. El análisis ocurrió a través del método hermenéutico-dialéctico. Los resultados destacan la búsqueda de reconocimiento individual y social y la valorización de la experiencia en relación con el conocimiento oficial y la medida en que las mediaciones van más allá del espacio insti-tucional. La mediación del conocimiento pone de manifiesto elementos significativos sobre una cultura informacional dominante.

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Introduction: Acute promyelocytic leukemia (APL) is a rare myeloid leukemia subtype affecting adult and pediatric populations. APL constitutes 15-20% of all childhood AML in Latin America, compared to 7% in the non-Latino population. This leukemia has unique characteristics, such as its association with chromosomal translocations involving the retinoid acid receptor α (RARA) gene on chromosome 17. In addition, APL is also distinct from other AML subtypes due to its response to all-trans-retinoic acid (ATRA), which induces terminal granulocytic differentiation of blasts. Overall 5-year survival rates are generally reported to be greater than 80%. Materials and methods: A study was conducted from January 2008 to December 2022 applying the IC-APL 2006 treatment protocol. This case series reports the clinical results of 22 children with APL. In all cases, the diagnosis was made by bone marrow aspiration and evaluation of the t(15:17) or t(11:17) transcripts. Results: We identified 22 patients with APL, of whom 10 were female and 12 were male. Twelve patients debuted with coagulation abnormalities. The doses of anthracyclines varied according to the risk, with an average of 496.8 mgm2. The cardiological assessment was performed before and after chemotherapy, finding 2/22 patients with moderate sisto-diastolic dysfunction and one with mild pulmonary insufficiency at the end of treatment. There were 6/22 patients with complications related to ATRA treatment, the most frequent being pseudotumor cerebri. All complications were transitory and treated immediately without complications. In this series of cases, an overall survival of 90.6% and a relapse-free survival of 90.6% were recorded. The follow-up mean was 9.1 ± 3.8 years. Conclusion: APL is a highly curable disease when combined with ATRA and anthracyclines. In this series of cases, good long-term results were observed with the IC-APL 2006 protocol. However, in Latin America, the availability of drugs such as arsenic trioxide as the first line of treatment is an unresolved challenge.

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Testicular cancer (TCa) is a rare malignancy affecting young men worldwide. Sociodemographic factors, especially socioeconomic level (SEL) and healthcare access, seem to impact TCa incidence and outcomes, particularly among Hispanic populations. However, limited research has explored these variables in Hispanic groups. This study aimed to investigate sociodemographic and clinical factors in Mexico and their role in health disparities among Hispanic TCa patients. We retrospectively analyzed 244 Mexican TCa cases between 2007 and 2020 of a representative cohort with diverse social backgrounds from a national reference cancer center. Logistic regression identified risk factors for fatality: non-seminoma histology, advanced stage, and lower education levels. Age showed a significant trend as a risk factor. Patient delay and healthcare distance lacked significant associations. Inadequate treatment response and chemotherapy resistance were more likely in advanced stages, while higher education positively impacted treatment response. Cox regression highlighted non-seminoma histology, below-median SEL, higher education, and advanced-stage survival rates. Survival disparities emerged based on tumor histology and patient SEL. This research underscores the importance of comprehensive approaches that integrate sociodemographic, biological, and environmental factors to address health disparities improving outcomes through personalized interventions in Hispanic individuals with TCa.

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Background: Gastric adenocarcinoma (GA) has changed in recent decades. Cancer estimates are often calculated from population-based cancer registries, which lack valuable information to guide decision-making (clinical outcomes). We describe the trends in clinical practice for GA using a hospital-based cancer registry over a timespan of 15 years. Methods: A retrospective cohort study was conducted. Data were gathered from adults diagnosed and treated for GA at Fundación Valle del Lili (FVL), between 2000 and 2014, from the hospital's own cancer registry and crossed with Cali's Cancer Registry. Additional data were obtained directly from clinical records, pathology reports and the clinical laboratory. Patients younger than 18 years and those for whom limited information was available in the medical history were excluded. A survival analysis was conducted using Kaplan-Meier method. Results: A total of 500 patients met eligibility criteria. Median age was 64 years (IQR: 54-74 years), 39.8% were female, 22.2% were at an early stage, 32.2% had a locally advanced disease, and 29% a metastatic disease, 69% had intestinal subtype, 48.6% had a positive H. pylori test, 85.2% had a distal lesion, 62% underwent gastrectomy, 60.6% lymphadenectomy, and 40.6% received chemotherapy. Survival at 5 years for all cases was 39.9% (CI 95% 35.3-44.5). Survival decreased over time in all groups and was lower in age-groups <39 and 60-79 with either locally advanced or metastatic disease. Prognostic factors that were significant in the Cox proportional-hazards model were late stages of the tumor (locally advanced: HR=2.52; metastatic: HR=4.17), diffuse subtype (HR=1.40), gastrectomy (subtotal: HR=0.42; total: 0.44) and palliative chemotherapy (HR=0.61). Conclusions: The treatment of GA has changed in recent decades. GA survival was associated with clinical staging, diffuse subtype, gastrectomy and palliative chemotherapy. These findings must be interpreted in the context of a hospital-based study.

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Population-based net survival is an important tool for assessing prognostic advances. The unbiased Pohar Perme Estimator (PPE) was suggested in 2012 and soon established itself as the gold standard for estimating net survival. This scoping review aims to know in which context this estimator is being used in the oncology area, what the authors point out as a justification for its use, and the limitations found. We searched PubMed, and the grey literature to answer the question: Have studies involving patients diagnosed with cancer used the PPE to estimate cancer-specific survival? How do they justify the use of the PPE and what are the limitations pointed out? Out of 295 screened, 85 studies were included in this review. The two main characteristics of the PPE mentioned by the studies as justification were the fact that it is an unbiased estimator (83.5%) and that it produces comparable estimates among populations with different mortality rates from causes other than cancer (36.47%). No study pointed to a limitation due to the use of PPE. As a conclusion, the Pohar Perme Estimator is the gold standard for estimating net survival and should be more used in oncology, especially when dealing with population-based studies where the follow-up time is long, making high the probability of death from causes other than cancer.

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Worldwide breast cancer ranks first in mortality and incidence rates in women over 20 years old. Rather than one disease, breast cancer is a heterogeneous group of diseases that express distinct molecular profiles. Neoadjuvant chemotherapy is an important therapeutic strategy for breast cancer patients independently of their molecular subtype, with the drawback of resistance development. In addition, chemotherapy has adverse effects that combined with resistance could contribute to lower overall survival. Although great efforts have been made to find diagnostic and prognostic biomarkers for breast cancer and for response to targeted and immune therapy for this pathology, little has been explored regarding biomarkers of response to anthracyclines and taxanes based neoadjuvant chemotherapy. This work aimed to evaluate the molecular profile of patients who received neoadjuvant chemotherapy to identify differentially expressed genes (DEGs) that could be used as biomarkers of chemotherapy response and overall survival. Breast cancer patients who were candidates for neoadjuvant chemotherapy were enrolled in this study. After treatment and according to their pathological response, they were assigned as sensitive or resistant. To evaluate DEGs, Gene Ontology, Kyoto Encyclopedia Gene and Genome (KEGG), and protein-protein interactions, RNA-seq information from all patients was obtained by next-generation sequencing. A total of 1985 DEGs were found, and KEGG analysis indicated a great number of DEGs in metabolic pathways, pathways in cancer, cytokine-cytokine receptor interactions, and neuroactive ligand-receptor interactions. A selection of 73 DEGs was used further for an analysis of overall survival using the METABRIC study and the ductal carcinoma dataset of The Cancer Genome Atlas (TCGA) database. Nine DEGs correlated with overall survival, of which the subexpression of C1QTNF3, CTF1, OLFML3, PLA2R1, PODN, KRT15, HLA-A, and the overexpression of TUBB and TCP1 were found in resistant patients and related to patients with lower overall survival.

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Introducción: La anemia es un problema grave de salud pública mundial, que incluso podría influir en la supervivencia y en la respuesta al tratamiento del cáncer. Objetivo: Determinar la relación entre anemia y la supervivencia a 5 años en pacientes con cáncer atendidos en el servicio de Oncología del Complejo Hospitalario Luis Nicasio Sáenz en Lima, Perú. Métodos: Estudio observacional, analítico, de cohorte retrospectiva. La población estuvo constituida por pacientes con diagnóstico reciente de cáncer que registraron atenciones en el año 2014, con un seguimiento de los datos registrados hasta el año 2019. Se evaluó el tiempo hasta la ocurrencia del evento muerte, la presencia de anemia y otras variables confusoras. Se elaboraron curvas de supervivencia con el método de Kaplan Meier, y fueron analizados con la prueba del log-rank. Se determinó el riesgo con HR mediante el modelo de regresión de Cox. Resultados: Se incluyeron 72 pacientes, el 79.2% correspondieron a neoplasias sólidas. La anemia estuvo presente al diagnóstico en el 45.8% de pacientes. Se encontraron diferencias estadísticamente significativas en las curvas de supervivencia de las variables anemia, anemia según severidad, edad, y estadio clínico. En el análisis bivariado y multivariado ajustado a la edad mayor de 70, la anemia tuvo una asociación significativa con la supervivencia (HR: 3,03, IC: 95, p <0,05); así mismo en pacientes con neoplasias sólidas, ajustado a la edad y estadio clínico. El 30.3% de los pacientes recibió algún tipo de tratamiento para la anemia. Conclusión: La anemia es un hallazgo frecuente en pacientes oncológicos y está relacionada significativamente con la supervivencia global a 5 años. La anemia severa y la edad mayor de 70 mostraron relación con mayor mortalidad.

Introduction: Anemia is a serious public health. Several studies indicate that anemia status is a factor that might influence survival and response to cancer treatment in patients. Objective: To determine the relationship between anemia and 5-year survival in cancer patients. Methods: Observational, analytical, and retrospective cohort study. The sample population consisted of novel diagnosed cancer patients registered for hospital care with their respective follow up from 2014 until 2019. Time to death, presence of anemia, and other variables were evaluated. Survival was determined using Kaplan Meier curves and analyzed using the log-rank test. Hazard ratio and risk were determined in turn using the Cox regression model. Results: 72 patients were included in the study, 79.2% of which correspond to solid neoplasms. Anemia was present at the time of diagnosis in 45.8% of patients. Statistically significant differences were found on survival curves for anemia, severity graded anemia, age, and clinical stage. Anemia showed a significant relation with survival (HR: 3.03; CI: 95; p <0.05) on the adjusted bivariate and multivariate analysis for age over 70 years. Likewise, on the respective adjusted analysis for age and clinical stage, anemia showed a significant relation with survival on patients with solid neoplasms. Overall, 30.3% of patients received some type of treatment for anemia. Conclusion: Anemia is frequently found in cancer patients and is significantly related to 5-year overall survival. Age over 70 and severe anemias were related to higher mortality of cancer patients

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Background Few in-depth reports on cancer epidemiology in New Mexico or the United States-Mexico border region exist. We aim to quantify cancer incidence and survival in New Mexico and the United States-Mexico border region in New Mexico. Methods Incidence and survival were obtained using SEER*Stat 8.3. The data were divided into either New Mexico, or SEER 18 (comprised of the 17 remaining regions) and then further divided by county in New Mexico and by time period. Incidence rates were age-standardized to the 2000 US census. Five-year survival was calculated for each cancer type. Kaplan-Meier survival plots were produced, and significance was determined using log-rank analysis. Results Analysis demonstrated that cancers in New Mexico are diagnosed at a lower rate with the exception of thyroid, liver, and ovarian. Survival is generally lower in New Mexico with 10 of the 14 cancers having worse survival in New Mexico. Only uterine cancer had improved survival in New Mexico (77.9% vs 74.9%, P < .001). Additionally, breast (82.2%), prostate (83.3%), lung and bronchus (13.7%), colorectal (53.7%), melanoma (80.1%), kidney and renal pelvis (61.2%), uterine (78.5%), and ovarian (41.6%) all had lower survival in the border counties. Conclusion Comparing New Mexico to the other regions in the SEER 18 database, both cancer incidence and survival are consistently lower; these findings could be explained by lower access to healthcare, which can result in underreporting and delays in diagnosis.

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BACKGROUND: Breast cancer has a high incidence and increasing mortality in Southern Brazil. The present study evaluated clinical and sociodemographic characteristics, and their association with overall survival in a private cancer center. METHODS: 1113 breast cancer patients were included in this study. The association between survival and clinicopathological and sociodemographic characteristics was analyzed using Cox regression and Kaplan-Meyer curves. RESULTS: Median age at diagnosis was 52 years (SD 13.5). Most patients were diagnosed in stages 0 and I (62.7%), while only 1.3% had stage IV disease. Five- and 10-year overall survival were 93.5% and 83.8%, respectively. According to multivariate analysis, age at diagnosis (HR 1.05; CI95 1.03-1.06), staging (stage III: HR 4.04; CI95 1.34-12.19; stage IV: HR 9.61; CI95 2.17-42.50), high KI67 (HR 5.46; CI95 1.27-23.32) and distant recurrence (HR 7.28; CI95 4.79-11.06) were significantly associated with survival. Smoking status, years of education, BMI, and tumor biological status were not significantly associated with mortality. CONCLUSIONS: This cohort of Brazilian patients, who received timely and appropriate treatment, achieved outcomes that are comparable to those from high income countries. Breast cancer mortality seems dependent on the quality of health care available to patients.

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Background: Colorectal cancer (CRC) is the third most frequent and the second deadliest cancer worldwide. The ethnic structure of the population has been gaining prominence as a cancer player. The purpose of this study was to determine the genetic ancestry of Brazilian CRC patients. Moreover, we intended to interrogate its impact on patients' clinicopathological features. Methods: Retrospective observational cohort study with 1,002 patients with CRC admitted from 2000 to 2014 at Barretos Cancer Hospital. Following tumor DNA isolation, genetic ancestry was assessed using a specific panel of 46 ancestry informative markers. Survival rates were obtained by the Kaplan-Meier method, and the log-rank test was used to compare the survival curves. Multivariable Cox proportional regression models were used to estimate hazard ratios (HRs). Results: We observed considerable admixture in the genetic composition, with the following average proportions: European 74.2%, African 12.7%, Asian 6.5%, and Amerindian 6.6%. The multivariate analysis for cancer-specific survival showed that clinical stage, lymphovascular invasion, and the presence of recurrence were associated with an increased relative risk of death from cancer (p < 0.05). High African proportion was associated with younger age at diagnosis, while high Amerindian proportion was associated with the mucinous histological subtype. Conclusions: This represents the larger assessment of genetic ancestry in a population of Brazilian patients with CRC. Brazilian CRC patients exhibited similar clinicopathological features as described in Western countries. Impact: Genetic ancestry components corroborated the significant admixture, and importantly, patients with high African proportion develop cancer at a younger age.

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BACKGROUND: Social inequalities in survival after cancer diagnosis have been described in several high-income countries, all cancer sites combined and for several specific cancer sites. The objective of this study was to analyze 5-year net survival after cancer diagnosis in a middle-income country (Costa Rica), according to the characteristics at the district level. METHODS: Costa Rican Cancer Registry is a national population-based registry. All cases diagnosed between January 1, 2011 and December 31, 2015 were included (N = 46,904). Deaths that occurred before December 31, 2018 were identified. An ecological study was implemented. The 477 districts were described using the 2011 Census. Urbanity and wealth was assessed. Socioeconomic inequalities in cancer survival were measured using multivariable flexible parametric models. Life tables by socio-economic status were used. RESULTS: 5-year net survival ranged from 9% for liver cancer to 98 % for in situ cervical cancer. Patients living in socioeconomically disadvantaged districts experienced poorer cancer survival at 5 years, after taking into account the inequalities in survival in the general population (HR = 1.23, p < 0.01). This result was robust and was found at 1, 2 and 5 years, in all-cancer combined, and in low-, medium- and high-lethality cancers. There was no difference according to the area, except for low-lethality cancers at 1 year. DISCUSSION: Despite its universal and solidarity-based health system, Costa Rica is experiencing social inequalities in survival after cancer diagnosis.

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Objectives: To describe the age group, clinical stage at diagnosis, treatment, and survival rates of breast cancer patients treated in a Brazilian specialized Cancer Center. Method: A hospital-based retrospective cohort study is presented herein, on women with breast cancer diagnosed between January 1, 2000 and December 31, 2012. Data were extracted from the Hospital Cancer Registry of the A.C.Camargo Cancer Center. Data on age group, histology of the tumor, TNM classification, clinical stage and treatments were described in absolute and relative frequencies for three periods. Survival curves were estimated with the Kaplan-Meier estimator. Hazard ratio (HR) and 95% confidence interval (95%CI) were calculated for all variables. Results: A total of 5,095 female breast cancer patients were identified, with most stages classified as I and II (60%). The overall survival was 82.7% for the period of 2000­2004, and 89.9% for 2010­2012 (p<0.001). Patients with invasive ductal carcinoma, who were treated with surgery and hormonal therapy, showed a reduction in the risk of death in the most recent period HRadj=0.42 (95%CI 0.34­0.53) (2010­2012). Conclusions: Early stage diagnosis and combined treatment (including HT) are predictive prognostic factors for high survival rates in patients with invasive breast cancer. Specialized cancer centers can provide valuable indications regarding cancer control policies, evaluating overall survival for breast cancer and its associated prognosis.

Objetivos: Descrever as faixas etárias, estadiamento clínico ao diagnóstico, tratamento e sobrevida global das pacientes com câncer de mama tratadas em um centro de câncer brasileiro. Método: Estudo de uma coorte retrospectiva de base hospitalar, com mulheres diagnosticadas de câncer de mama entre 1º de janeiro de 2000 e 31 de dezembro de 2012. Os dados foram extraídos do Registro Hospitalar de Câncer do A. C. Camargo Cancer Center. Faixa etária, tipo histológico, classificação TNM, estadiamento clínico e tratamento foram descritos em frequência absoluta e relativa estratificados em três períodos. As curvas de sobrevida global foram estimadas pelo método de Kaplan-Meier. A Hazard ratio (HR) com intervalo de confiança de 95% foram calculados para todas as variáveis. Resultados: O total de 5.095 pacientes mulheres com câncer de mama foi identificado, a maioria era estágio inicial 60% (I e II). A sobrevida global foi de 82,7% para o período de 2000­2004 e 89,9% para 2010­2012 (p<0,001). Pacientes com carcinoma ductal invasivo que foram tratadas com cirurgia e hormonioterapia, mostraram redução do risco de morte no período mais recente HRaj=0,42 (0,34­0,53 em 2010­2012). Conclusões: Diagnóstico precoce e tratamento combinado (incluindo hormonioterapia) são fatores prognósticos preditivos para altas taxas de sobrevida em pacientes com câncer de mama invasivo. Centros especializados em câncer podem prover informações valiosas sobre as políticas de controle do câncer, avaliando a sobrevida global do câncer de mama e fatores associados ao prognóstico.

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BACKGROUND: Although acute lymphoblastic leukemia (ALL) 5 years survival in minors has reached 90%, socioeconomic differences have been reported among and within countries. Within countries, the difference has been related to the socioeconomic status of the parents, even in the context of public health services with universal coverage. In Mexico, differences in the mortality of children with cancer have been reported among sociodemographic zones. The Instituto Mexicano del Seguro Social (IMSS), the country's main social security institution, has reported socioeconomic differences in life expectancy within its affiliated population. Here, the socioeconomic inequalities in the survival of children (< 15 years old) enrolled in the IMSS were analyzed. METHODS: Five-year survival data were analyzed in cohorts of patients diagnosed with ALL during the period 2007-2009 in the two IMSS networks of medical services that serve 7 states of the central region of Mexico. A Cox proportional risk model was developed and adjusted for the socioeconomic characteristics of family, community of residence and for the clinical characteristics of the children. The slope of socioeconomic inequality of the probability of dying within five years after the diagnosis of ALL was estimated. RESULTS: For the 294 patients studied, the 5 years survival rate was 53.7%; the median survival was 4.06 years (4.9 years for standard-risk diagnosis; 2.5 years for high-risk diagnosis). The attrition rate was 12%. The Cox model showed that children who had been IMSS-insured for less than half their lives had more than double the risk of dying than those who had been insured for their entire lives. CONCLUSIONS: We did not find evidence of socioeconomic inequalities in the survival of children with ALL associated with family income, educational and occupational level of parents. However, we found a relevant gradient related social security protection: the longer children's life insured by social security, the higher their probability of surviving ALL was. These results add evidence of the effectiveness of social security, as a mechanism of wealth redistribution and a promoter of social mobility. Extending these social security benefits to the entire Mexican population could promote better health outcomes.

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BACKGROUND: Martinique has one of the highest incidences of prostate cancer (PCa) worldwide. We analysed overall survival (OS) among patients with PCa in Martinique, using data from a population-based cancer registry between 2005 and 2014. METHODS: The log-rank test was used to assess the statistical differences between survival curves according to age at diagnosis, risk of disease progression including Gleason score, stage at diagnosis and Prostate Specific Antigen (PSA). A multivariable Cox model was constructed to identify independent prognostic factors for OS. RESULTS: A total of 5045 patients were included with a mean age at diagnosis of 68.1±9.0 years [36.0 - 98.0 years]. Clinical stage was analysed in 4999 (99.1% of overall), 19.5% were at low risk, 34.7% intermediate and 36.9% at high risk. In our study, 8.9% of patients with available stage at diagnosis, were regional/metastatic cancers. Median PSA level at diagnosis was 10.4 ng/mL. High-risk PCa was more frequent in patients aged 65-74 and ≥75 years as compared to those aged <65 years (36.6% and 48.8% versus 28.7% respectively; p<0.0001). One-year OS was 96.3%, 5-year OS was 83.4 and 10-year OS was 65.0%. Median survival was not reached in the whole cohort. High-risk PCa (HR=2.32; p<0.0001), regional/metastatic stage (HR= 9.51; p<0.0001) and older age (65-74 and ≥75 years - respectively HR=1.70; and HR=3.38), were independent prognostic factors for OS (p<0.0001). CONCLUSION: This study provides long term data that may be useful in making cancer management decisions for patients with PCa in Martinique.

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Abstract Breast cancer survival in Latin America countries is below Central European countries. Hospital-based breast cancer survival studies in western Amazon, Brazil, are lacking. This article aims to estimate hospital-based breast cancer survival in Rio Branco, Acre, and predictor factors. Hospital-based cohort study of all women diagnosed with breast cancer (2007-2012) was proceeded. Information were obtained from medical reports, and follow-up was until 2013. One-, 2- and 5- years breast cancer specific-survival were estimated by Kaplan-Meier method. Crude and adjusted Harzards Ratios (HR) were estimated by proportional Cox regression model. One-, 2-, and 5-year overall breast cancer survival were 95.5%, 83.7%, and 87.3% respectively. Surgery combined to radiotherapy significantly affected 1-, 2-, and 5-year survival (99%, 94%, and 90.6%, respectively) as compared to other treatments (77%,57.1%, and 37.5%, respectively). Comparing to surgery combined to radiotherapy treatment, surgery alone increased the risk of death, independently of age and stage (HR = 7.23;95%CI:2.29-22.83). In Rio Branco, Acre, 5-year breast cancer survival is similar to more developed areas in Brazil. Surgery combined to radiotherapy was independently associated to a lower risk of death as compared to surgery alone and other treatment.

Resumo Na América Latina, a sobrevida de 5 anos do câncer de mama está abaixo dos países da Europa central. Não há estudos de sobrevida de câncer de mama de base hospitalar no oeste da Amazônia brasileira. O objetivo deste artigo é estimar a sobrevida hospitalar de câncer de mama e fatores associados em Rio Branco, Acre. Estudo de coorte de base hospitalar com todos os casos de câncer de mama diagnosticados em Rio Branco (2007-2012). As informações foram obtidas de prontuários. As sobrevidas específicas para câncer de mama foram estimadas para 1, 2, e 5 anos pelo método de Kaplan Meier. As hazards ratios (HR) brutas e ajustadas foram estimadas pela regressão proporcional de Cox. As sobrevidas globais em 1, 2 e 5 anos foram respectivamente 95,5%, 83,7%e 87,3%. A cirurgia combinada à radioterapia afetou significativamente a sobrevida em 1, 2 e 5 anos (99%, 94% e 90,6%, respectivamente) quando comparadas a outros tratamentos (77%, 57,1% e 37,5%, respectivamente). Comparadas à cirurgia combinada, as mulheres submetidas à cirurgia isolada apresentaram maior risco de óbito, independentemente da idade e estadiamento (HR = 7,23; 95%CI:2,29-22,83). Em Rio Branco, Acre, a sobrevida em 5 anos para câncer de mama foi elevada. A cirurgia combinada à radioterapia foi independentemente associada ao menor risco de óbito.

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La mortalidad por cáncer en niños mexicanos no ha disminuido a los niveles informados en países desarrollados. Una explicación frecuentemente declarada es el alto porcentaje (57.3 %) de pacientes diagnosticados en estadios avanzados (III/IV), atribuible a errores en la sospecha o en la metodología empleada, consideración dudosa si se toma en cuenta que el tiempo de diagnóstico y la proporción de estadios avanzados en México son semejantes a los de países desarrollados. En la mayoría de los niños con cáncer, los días transcurridos desde el primer síntoma a momento del diagnóstico oncológico no correlacionan con el estadio clínico y tampoco con la probabilidad de supervivencia. El éxito en la supervivencia depende en gran medida del tratamiento integral (específico y de la atención a las complicaciones). Esta visión obliga a estrategias dirigidas principalmente a invertir más recursos en opciones terapéuticas eficaces y eficientes, capacitación oncológica integral del equipo de salud (médicos, enfermeras, técnicos), tecnologías diagnósticas, fomento a la colaboración interinstitucional e internacional y apoyo socioeconómico a las familias durante el proceso terapéutico.Cancer mortality in Mexican children has not decreased to the levels reported in developed countries. A commonly proposed explanation is the high percentage (53.7%) of patients diagnosed at advanced stages (III/IV), which is attributed to erroneous assumptions or mistakes in the diagnostic approach ­a questionable consideration taking into account that both time to diagnosis and the proportion of advanced stage cases in Mexico are similar to those in developed countries. In most cancer cases in children, the number of days elapsed from the moment of the first symptom to the cancer diagnosis is not correlated with clinical stage, and neither with the probability of survival. Survival success largely depends on comprehensive treatment (specific and for the care of complications). This view calls for strategies mainly aimed at spending more resources on efficacious and efficient therapeutic strategies, comprehensive oncology training of healthcare personnel (physicians, nurses and technicians), diagnostic technologies, promotion of interinstitutional and international collaboration and socioeconomic support to families during the therapeutic process.

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ABSTRACT A total of 150 women from Grand Bahama Island, The Bahamas, with cancer of the breast were followed up for 10 years post-diagnosis to assess survival rates, not only generally, but also by age and stage of disease at diagnosis, the presence or absence of axillary lymph node metastases, the treatment modalities received, and the diagnostic periods. The patients' medical records and the death registers of the Medical Records Department of Rand Memorial Hospital (RMH), Grand Bahama Island, supplemented with data from the ledgers of the Pathology Department of RMH and from The Bahamas ' national death register, were utilized. By Pearson Chi-square and Kaplan-Meier survival analysis, females who were 40 years old or younger lived significantly longer (71.2% of whom for at least 10 years; mean: 213.8 months) than those who were older than 40 years (42.9% of whom for at least 10 years; mean: 167.9 months). The absence or presence of axillary lymph node metastases also had a bearing on survival, with 71.9% surviving at least 10 years (mean: 243.9 months) versus 32.7% (mean: 108.1 months) respectively. Despite the accepted importance of the diagnostic stage of disease, the small sample size obtained allowed only a limited assessment of the influence of staging on the survival rates. Neither the treatment received nor the diagnostic periods had any significant influence on the survival rates. The establishment of a national cancer registry in The Bahamas would alleviate the problems due to retrieval of information and aid in the better management and follow-up of cancer. Because of a relatively young age at diagnosis, consideration must also be given to beginning mammography screening of Bahamian women at an age below 40 years.

RESUMEN Un total de 150 mujeres con cáncer de mama en Gran Bahama, Bahamas, recibieron un seguimiento de 10 años después del diagnóstico, a fin de evaluar las tasas de supervivencia. La evaluación de las tasas de supervivencia se realizó no sólo de manera general, sino también sobre la base de la edad y etapa de la enfermedad en el momento del diagnóstico, la presencia o ausencia de metástasis en los ganglios axilares, las modalidades de tratamiento recibidas, y los períodos de diagnóstico. A tal fin, se utilizaron las historias clínicas de los pacientes y los registros de defunción existentes en el Departamento de Historias Clínicas del Hospital Rand Memorial (HRM) de Gran Bahama, complementados con datos provenientes de los libros de archivo del Departamento de Patología de HRM y el Registro Nacional de Defunciones de Bahamas. Según el análisis de la supervivencia mediante Pearson Chi-Square y Kaplan-Meier, las mujeres de 40 años o más jóvenes vivieron significativamente más tiempo (71.2% de ellas por lo menos diez años; promedio: 213.8 meses) que las mayores de 40 años (42.9% de ellas por lo menos diez años; promedio: 167.9 meses). La ausencia o presencia de metástasis en los ganglios axilares también tuvo una incidencia en la supervivencia, sobreviviendo el 71.9% por lo menos 10 años (promedio: 243.9 meses) frente a un 32.7% (promedio: 108.1 meses) respectivamente. A pesar de la reconocida importancia de la etapa diagnóstica de la enfermedad, el pequeño tamaño de la muestra obtenida permitió sólo una evaluación limitada de la influencia de la estadificación en las tasas de supervivencia. Ni el tratamiento recibido ni los periodos de diagnóstico tuvieron influencia significativa en las tasas de supervivencia. El establecimiento de un registro nacional del cáncer en las Bahamas aliviaría los problemas relacionados con la recuperación de información y ayudaría a un mejor tratamiento y seguimiento del cáncer. Debido a la edad relativamente joven en que realiza el diagnóstico, debe considerarse también comenzar la investigación de la mamografia de las mujeres de las Bahamas antes de los 40 años.

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PURPOSE: In Trinidad and Tobago (TT), prostate cancer (CaP) is the most commonly diagnosed malignancy and the leading cause of cancer deaths among men. TT currently has one of the highest CaP mortality rates in the world. METHODS: 6,064 incident and 3,704 mortality cases of CaP occurring in TT from January 1995 to 31 December 2009 reported to the Dr. Elizabeth Quamina Cancer population-based cancer registry for TT, were analyzed to examine CaP survival, incidence, and mortality rates and trends by ancestry and geography. RESULTS: The age-standardized CaP incidence and mortality rates (per 100,000) based on the 1960 world-standardized in 2009 were 64.2 and 47.1 per 100,000. The mortality rate in TT increased between 1995 (37.9 per 100,000) and 2009 (79.4 per 100,000), while the rate in the US decreased from 37.3 per 100,000 to 22.1 per 100,000 over the same period. Fewer African ancestry patients received treatment relative to those of Indian and mixed ancestry (45.7%, 60.3%, and 60.9%, respectively). CONCLUSIONS: Notwithstanding the limitations surrounding data quality, our findings highlight the increasing burden of CaP in TT and the need for improved surveillance and standard of care. Our findings highlight the need for optimized models to project cancer rates in developing countries like TT. This study also provides the rationale for targeted screening and optimized treatment for CaP to ameliorate the rates we report.

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