Caracterização clínico patológica de pacientes com melanoma e sua associação com desfechos clínicos

Abstract

INTRODUCTION: Melanoma constitutes less than 5% of skin cancers, but is responsible for approximately 75% of deaths due to these neoplasms, with an increasing incidence in recent decades (1,2). In the United States, respectively, the fifth and sixth most frequente cancer in men and women, they constitute one of the most common neoplasms in the population of young people and adolescents(3). In 2012, 67,753 people diagnosed with cutaneous melanoma were diagnosed in the United States, an estimated 100 50 new cases with consecutive cuts out of 202 (1,4,5). In Brazil 2020-2022, the number of estimated cases will be 4,200 in men and new, estimated 250 in women, numbers that are probably underreported (6).(7). Metastatic melanoma has a poor prognosis, with median survival with stage IV melanoma ranging from 8 to 18 months after diagnosis (8). Studies to study the clinical biology of melanoma have led to a new understanding of the disease, with genomic studies identifying several target oncogenes (9). Two therapeutic therapies have improved the survival of patients with advanced melanoma in recent years: immunotherapy with checkpoint inhibitors and targeted therapies. BRAF inhibitors are indicated for patients who are approximately 40 to immune that are approximately 5 and independent of BR status, which are effective therapies in % of BRAF patients (16). However, as targeted therapy and immunotherapy it still has a high cost, at 45,000 reais per month, and it takes effort that can reach an objective response of 70% (10–13,16–19). Identification of patients who will really benefit from such treatments. MATERIAL AND METHODS: Based on records of first consultations at the oncology service of Hospital São Lucas at PUCRS, we carried out a survey of patients treated at the institution. We performed data collection in a structured questionnaire. OBJECTIVES: Main objective: To describe clinicopathological characteristics of patients with melanoma treated at Hospital São Lucas, PUCRS Secondary objectives: to assess overall survival, progression-free survival, in an exploratory way, to identify predictive and/or prognostic markers, to identify other potential prognostic factors in multivariate analysis. RESULTS: We analyzed data from 552 melanoma patients with a mean follow-up of 58 months. Among them, 85.2% were from the public health system, 53% were female, the median age was 57.5 years, 87.2% had no BRAF mutation test. Of the patients tested, 67% had a BRAF mutation and LDH was normal in 87.5% of patients. The mean time from diagnosis to completion of margin and sentinel lymph node enlargement was 2.4 months. The distribution of clinical stages (AJCC 8 edition) was: 7.6% 0, 26.3% IA, 8.3% IB, 10.1 IIA, 7.2% IIB, 10.1% IIC, 2.4 % IIIA, 3.5% IIIB, 9.6% IIIC, 3.9% IIID and 11% IV. The 1-year overall survival rates were 100% for EC I, 98.5% for EC II, 97.8% for EC III, and 85.7% for EC IV. The 5-year overall survival rates were 97.8% for EC I, 93% for EC II, 74.8% for EC III and 68.8% for EC IV. CONCLUSION: To our knowledge, this is the largest cohort of individually analyzed patients with melanoma treated in Brazil, mainly in the public health network. We believe that this information is extremely important for planning strategies to improve care management and clinical outcomes.