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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-23102019-170254
Document
Author
Full name
Luiz Fernando Girotto Balarezo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Mello, Luane Marques (President)
Franco, Laercio Joel
Miranda, Vanessa da Costa
Peria, Fernanda Maris
Title in Portuguese
Perfil de pacientes com câncer de reto atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto: estudo transversal
Keywords in Portuguese
Adenocarcinoma de reto
Câncer
Câncer colorretal
Diabetes mellitus
Metformina
Neoadjuvância
Resposta patológica completa
Abstract in Portuguese
Os adenocarcinomas retais apresentam uma parcela importante dos canceres incidentes no Brasil, que pode ser explicado pelo envelhecimento da população, mudanças no estilo de vida e pelo o diabetes mellitus. Por outro lado, estudos têm indicado o papel protetor da metformina no risco de incidência para CCR e mortalidade específica. Portanto, vê-se a importância de investigar o papel da metformina como aliada aos tratamentos padrões objetivando um aumento das taxas de sobrevida, redução de recidivas e redução de risco de CCR em pacientes com DM. Trata-se de um estudo transversal que buscou descrever o perfil dos pacientes com adenocarcinoma de reto, através de informações clínicas e epidemiológicas, de acordo com os registros em prontuários dos pacientes do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de 2006 a 2016. Resultados: Do total de 742 inicialmente selecionados, 113 responderam aos critérios de elegibilidade e foram analisados quanto aos dados demográficos epidemiológicos e clínicos. A média de idade da amostra foi próxima entre homens e mulheres, acima de 60 anos, como indica a literatura para prevalência dos canceres de reto. A maioria dos pacientes eram provindos de municípios vizinhos ao do hospital. Do total, 19(16,8%) eram diabéticos, 17(15%) faziam uso de metformina, 10(8,8%) faziam uso de AAS, 48(42,4%) era tabagistas, 44(38,9%) tinham história familiar de câncer, 22(19,4%) apresentaram resposta patológica completa, 87 (77%) apresentavam tumor em reto baixo e 26 (23%) apresentavam tumor em reto médio. Através de regressão logística foi estimada as associações entre essas variáveis e a resposta patológica completa. O modelo estimou que indivíduos sem diabetes mellitus tem maior chance de ter resposta patológica completa, sendo a razão (OR) 2.252 [IC] 95%, 0.113 - 41.051 para pacientes diabéticos, em relação a não diabéticos. O uso da Metformina aparece como um fator protetor, com razão (OR) para pacientes em uso do fármaco de 0.263 [IC] 95%, 0.010-7.286 em relação aos que não faziam uso. Na análise das associações, não obtivemos resultados estatisticamente consistentes na associação da resposta patológica completa com demais variáveis. Porém, as razões de possibilidades encontradas sugerem que possa existir associações. Portanto, novos estudos com diferentes abordagens e métodos, buscando investigar fatores de bom prognóstico para o paciente, devem ser realizados
Title in English
Profile of patients with rectal cancer attended at the Hospital das Clínicas of the Ribeirão Preto Medical School: cross-sectional study
Keywords in English
Cancer
Colorectal cancer
Diabetes mellitus
Metformin
Neoadjuvant
Pathologic complete response
Rectal adenocarcinoma
Abstract in English
Rectal adenocarcinomas present a large number of cancers incident in Brazil, which can be explained by aging populations, lifestyle changes and diabetes mellitus. Other studies showed that metformin has utility for the treatment and may reduce risk of incidence for CRC and mortality. Therefore, it is important to investigate metformin in combination with standard treatments aiming at an increase in survival rates, relapse reduction and risk reduction for CRC in patients with DM. This is a cross-sectional study that described the profile of patients with rectal adenomarcinoma, using clinical and epidemiological information, according to the patient records of the Hospital of Ribeirão Preto Medical School, University of Sao Paulo, from 2006 to 2016. Out of a total of 742 patients, 113 were selected and analyzed for demographic, epidemiological, and clinical data. The mean age of the sample was close between men and women and according to the studies. Most of the patients were from neighboring municipalities to the hospital. Of the total, 19(16.8%) were diabetic, 17(15%) used metformin, 10(8.8%) used AAS, 48(42.4%) were smokers, 44(38.9% ) had a family history of cancer, 22(19,4%) had a complete pathological response, 87(77%) had a low rectal tumor and 26(23%) had a medium rectal tumor. Through logistic regression we estimated the associations between these variables and the complete pathological response. The model estimated that individuals without diabetes mellitus had more chances to have a pathologic complete response, with the odds ratio (OR) 2,252 [IC] 95%, 0.113 - 41.051 for diabetic patients compared to non-diabetic patients. The use of Metformin appears as a protective factor, with odds ratio (OR) for patients in use of the drug of 0.263 [ICI] 95%, 0.010-7.286 compared to those who did not use it. We did not obtain statistically consistent results in the association of pathologic complete response with other variables. However, the odds ratio found suggest that there may be associations. Therefore, new studies with different approaches and methods, seeking to investigate factors of good prognosis for the patient, should be performed
 
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Publishing Date
2020-01-27
 
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