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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2021.tde-05042022-103446
Document
Author
Full name
Renata Nobre Moura
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Maluf Filho, Fauze (President)
Takeda, Flavio Roberto
Arantes, Vitor Nunes
Júnior, Ulysses Ribeiro
Title in Portuguese
Resultado do Programa de Rastreamento de Neoplasia de Esôfago em pacientes com câncer de cabeça e pescoço no Instituto do Câncer do Estado de São Paulo (ICESP)
Keywords in Portuguese
Análise de sobrevida
Carcinoma de células escamosas de cabeça e pescoço
Dissecção endoscópica da submucosa
Endoscopia digestiva alta
Neoplasia precoce de esôfago
Programa de rastreamento
Abstract in Portuguese
INTRODUÇÃO: Pacientes com diagnóstico de carcinoma de células escamosas de cabeça e pescoço apresentam maior risco de desenvolver um segundo tumor primário, mais comumente no trato aerodigestivo alto. A principal justificativa para o rastreamento de carcinoma de esôfago nestes pacientes é detectar as displasias assintomáticas e as lesões precoces, para permitir um tratamento curativo e melhorar a sobrevida. Apesar desta recomendação, a efetividade do rastreamento endoscópico permanece incerta. O presente estudo teve como objetivo descrever o resultado do programa de rastreamento quanto a prevalência, fatores de risco associados, sobrevida e tratamento endoscópico da neoplasia precoce de esôfago. MÉTODOS: Análise retrospectiva de banco de dados coletados prospectivamente incluindo os pacientes portadores de CEC-CP submetidos à endoscopia digestiva alta de alta definição associada à cromoscopia no período de 2010 a 2018 em centro acadêmico terciário. RESULTADOS: 1888 pacientes foram incluídos. A prevalência de CEC esôfago foi de 7,9%. A maioria (77,8%) das lesões eram de aspecto superficial à endoscopia. Os fatores de risco associados foram tumores de cavidade oral e orofaringe e presença de displasia de baixo grau. As lesões de esôfago tratadas por dissecção endoscópica da submucosa foram estatisticamente de maior tamanho e tiveram maiores taxas de ressecção em bloco e ressecção curativa (R0), além de maior ocorrência de estenoses. A sobrevida foi mais curta no grupo em que a neoplasia de esôfago foi diagnosticada num estádio avançado. CONCLUSÃO: O rastreamento de câncer superficial de esôfago em pacientes com neoplasia de cabeça e pescoço é efetivo em melhorar a sobrevida e deve ser recomendado especialmente nos pacientes com câncer em orofaringe e cavidade oral, assim como naqueles com displasia de baixo grau no esôfago
Title in English
Results of the Esophageal Neoplasm Screening Program in patients with head and neck cancer at the Sao Paulo Cancer Institute (ICESP)
Keywords in English
Endoscopic submucosal dissection
Endoscopy
Head and neck squamous cell carcinoma
Mass screening
Superficial esophageal neoplasia
Survival Analysis
Abstract in English
INTRODUCTION: Patients with head and neck squamous cell carcinoma (HNSCC) are at risk to develop a second primary tumor, most commonly in the upper aerodigestive tract. The main reason for screening esophageal carcinoma in these patients is to detect asymptomatic dysplasia and early cancer, thus allowing curative treatment and improving survival. Nevertheless, the effectiveness of endoscopic screening remains uncertain. The present study aimed to describe the results of the screening program regarding prevalence, associated risk factors, survival and endoscopic treatment of early esophageal cancer. METHODS: Retrospective analysis of a prospectively collected database including patients with HNSCC who had undergone high-definition endoscopy with chromoscopy between 2010 and 2018 in a tertiary academic center. RESULTS: 1,888 patients were included. The prevalence of esophageal SCC was 7.9%. The majority (77.8%) were superficial lesions. Tumors of the oral cavity and oropharynx and the presence of low-grade dysplasia were significant risk factors. The esophageal lesions treated by endoscopic submucosal dissection were statistically larger in size and had higher en bloc and RO resection rates, in addition to a higher occurrence of strictures. Survival significantly changed in the group in which the esophageal cancer was diagnosed at an advanced stage. CONCLUSION: Endoscopic screening in HNSCC is effective for improving mortality and should be recommended specially for patients with oropharynx and oral cavity cancers and for those with esophageal low-grade dysplasia
 
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RenataNobreMoura.pdf (2.94 Mbytes)
Publishing Date
2022-04-07
 
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