Sobrevida e fatores prognósticos em pacientes com câncer de mama: um estudo de coorte

Abstract

Introduction: Breast cancer (BC) is the most frequent worldwide and represents an important cause of death among women. The study of survival and prognostic factors in cancer allows a better understanding of the disease, bringing impacts to global public health. Objective: To analyze survival and prognostic factors in patients with breast cancer. Methods: This is a retrospective cohort of 201 patients with anatomopathological diagnosis of breast cancer who met the study inclusion criteria (34 were excluded). The consultations took place between January/2018 and December/2022 at the Regional Hospital of Caxias Dr. Everaldo Ferreira Aragão, located in Caxias (MA). Data collection in the institution's records took place between January/2023 and June/2023. Data were analyzed using the R program, version 4.0.2. Descriptive analysis was performed by calculating the absolute (n) and relative (%) frequencies. The assessment of the prognostic factors was performed using Cox regression (univariate/bivariate and multivariate analysis), with calculation of hazard ratios (HR), unadjusted and adjusted, and their respective 95% confidence intervals (95%CI). The Wald test was used to assess statistical significance, with p-values < 0.05 considered significant. The overall survival (OS) and disease-free survival (DFS) curves were constructed according to the Kaplan-Meier model. Results: There was a predominance of women (98.5%), over 40 years of age (86.1%), with a diagnosis of non-special type invasive carcinoma (94%), G1 or G2 (79.1%), smaller than 5 cm (64.6%), without angiolymphatic (52.7%) and neural (77.6%) invasion, with positivity for estrogen receptors - ER (60.7%) and progesterone - PR (52.2%), with negativity for HER2 (73.6%) and with Ki-67 expression ≤ 30% (63.2%). 85.1% underwent curative surgery, of which 51.4% had no lymph node involvement. 79.1% underwent radiotherapy, 98% chemotherapy and 57.7% hormone therapy. Of the 53 patients with HER2 expression, 54.7% used trastuzumab. 10% had indication of zoledronic acid. 27 (13.4%) had recurrence, mostly systemic (66.7%). 23.9% presented metastasis at diagnosis or due to recurrence, with lungs and bones (47.9%) being the most common sites. At the end of the follow-up, 73.1% were alive without the disease, 22.4% were alive with the disease and 4.5% died due to the disease. The analyzes showed that male gender, larger tumor size and presence of angiolymphatic and neural invasion were associated with a higher risk of death, and only male gender showed worse prognosis by multivariate analysis. Presence of angiolymphatic invasion, triple negative molecular subtype and negativity for ER and PR were associated with a higher risk of relapse. In the multivariate analysis, the presence of angiolymphatic and neural invasion and negativity for ER showed a worse prognosis. The 5-year OS and DFS curves had values of 91.3% and 72.4%, respectively. Conclusion: Male gender, presence of angiolymphatic and neural invasion and negativity for ER were prognostic factors associated with a higher risk of death or recurrence in the multivariate analysis. The 5-year OS and DFS values of the study were 91.3% and 72.4%, respectively.