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"Mafra, Allini"
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Impact of COVID-19 Pandemic on Cancer-Related Hospitalizations in Brazil
by
Reis, Rui M.
,
Mafra da Costa, Allini
,
Soerjomataram, Isabelle
in
Brazil - epidemiology
,
Cancer
,
Coronaviruses
2021
Background
Alongside the SARS-CoV-2 (COVID-19) pandemic, Brazil also faces an ongoing rise in cancer burden. In 2020, there were approximately 592 000 new cancer cases and 260 000 cancer deaths. Considering the heterogeneities across Brazil, this study aimed to estimate the impact of the COVID-19 pandemic on cancer-related hospital admissions at a national and regional level.
Methods
The national, regional, and state-specific monthly average of cancer-related hospital admission rates per 100 000 inhabitants and 95% confidence intervals (95% CIs) were calculated from March to July (2019: pre-COVID-19; and 2020: COVID-19 period). Thematic maps were constructed to compare the rates between periods and regions.
Results
Cancer-related hospital admissions were reduced by 26% and 28% for clinical and surgical purposes, respectively. In Brazil, the average hospitalization rates decreased from 13.9 in 2019 to 10.2 in 2020 per 100,000 inhabitants, representing a rate difference of −3.7 (per 100,000 inhabitants; 95% CI: −3.9 to −3.5) for cancer-related (clinical) hospital admissions. Surgical hospital admissions showed a rate decline of −5.8 per 100,000 (95% CI: −6.0 to −5.5). The reduction in cancer-related admissions for the surgical procedure varies across regions ranging between −2.2 and −10.8 per 100 000 inhabitants, with the most significant decrease observed in the south and southeastern Brazil.
Conclusions
We observed a substantial decrease in cancer-related hospital admissions during the COVID-19 pandemic with marked differences across regions. Delays in treatment may negatively impact cancer survival in the future; hence, cancer control strategies to mitigate the impact are needed.
Journal Article
Deterministic linkage for improving follow-up time in a Brazilian population-based cancer registry
by
da Costa, Allini Mafra
,
Pereira, Talita Fernanda
,
Waldvogel, Bernadette Cunha
in
631/67/2324
,
692/4028/67/2324
,
Brazil - epidemiology
2023
Population-based cancer registries (PBCR) are the primary source of cancer incidence and survival statistics. The loss to follow-up of these patients is concerning since it reduces the reliability of any statistical analysis. The linkage techniques have been increasingly used to improve data quality in various information systems. The linkage was performed between the databases of the PBCR-Barretos and the mortality database of the state of São Paulo. To evaluate the improvement in the follow-up time of patients, the comparability of the two databases, pre- and post linkage, was made. Three analyses were performed: a comparative analysis of the absolute number of deaths, a comparative analysis of the follow-up time of patients and the survival analysis. After linkage, there was an increase of 813 deaths. The follow-up time of patients was extended and observed in most types of tumours. The comparability of the survival analyses at both time points also showed a decrease in survival probabilities for all tumour types. Deterministic linkage is effective in updating the vital status of registered patients, improving patient follow-up time, and maintaining good quality data from PBCRs, consequently producing more reliable rates, as seen for the survival analyses.
Journal Article
Overall survival and time trends in breast and cervical cancer incidence and mortality in the Regional Health District (RHD) of Barretos, São Paulo, Brazil
by
Fregnani, José Humberto Tavares Guerreiro
,
da Costa, Allini Mafra
,
Hashim, Dana
in
Adult
,
Aged
,
Biomedical and Life Sciences
2018
Background
Breast and cervical cancers represent a significant cause of morbidity and mortality among women. The purpose of this study was to analyse the survival and time trends in two of the most common female cancers in the Regional Health District (RHD) of Barretos, São Paulo, Brazil.
Methods
From 2000 through 2015, we calculated the breast and cervical cancer incidence and mortality rates per 100,000 women who were age-standardized to the world population. We obtained the time trends using the Joinpoint Regression software. We estimated the overall survival rates using the Kaplan-Meier methods.
Results
The age-standardized rates (ASR) for incidence of breast cancer increased annually, with an average annual percentage change (AAPC) of 4.3 (95% Confidence Interval (CI): 2.4 to 6.3) for invasive breast cancer and 10.2 (95% CI: 6.1 to 14.5) for in situ breast cancer. The mortality rates for invasive breast cancer decreased with an AAPC of 0.2 (95% CI: -1.9 to 2.4). The ASR incidence of invasive cervical cancer showed an AAPC of − 1.9 (95% CI: -4.7 to 0.9). For in situ cases, the ASR showed an AAPC of 9.3 (95% CI: 3.3 to 15.7). The ASR mortality for cervical cancer showed an AAPC of − 5.3 (95% CI: -9.5 to − 0.8). The Kaplan-Meier analysis indicated 5-year overall survival rates of 74.3% for breast cancer and 70.7% for cervical cancer.
Conclusions
The incidence of in situ and invasive breast cancer is increasing, while the mortality rates remain stable. We observed an increase in the incidence of in situ cervical cancer and a decrease in invasive incidence rates during the study period, and we noted that the cervical cancer mortality significantly declined during the study period.
Journal Article
Association of microsatellite instability (MSI) status with the 5-year outcome and genetic ancestry in a large Brazilian cohort of colorectal cancer
by
Scapulatempo-Neto, Cristovam
,
Pereira, Rui
,
Berardinelli, Gustavo Noriz
in
Cancer
,
Colorectal cancer
,
Colorectal carcinoma
2022
Colorectal cancer (CRC) has a high incidence and mortality worldwide. Microsatellite instability (MSI) is crucial in CRC, with distinct molecular and clinicopathological features in patients. Nowadays, it is a predictive marker for immunotherapy. We proposed to evaluate the 5-year outcome of MSI status in 1002 Brazilian CRC, and associate it with genetic ancestry, molecular and clinicopathological features. MSI evaluation was performed using molecular markers. MSI+ tumors were analyzed for alterations in 23 MSI-targeted genes. Genetic ancestry was evaluated using an Ancestry-Informative markers panel. MSI status was analyzed in relation to CRC specific survival and other clinical and genetic variables. MSI+ status was observed in 10.5% of cases. MSI+ status was significantly associated with the anatomic site right colon, mucinous histological type, clinical stage II, histological grade III/undifferentiated, no recurrence of disease, and live cases without cancer. No association of MSI status with genetic ancestry components was observed. MSI-targeted genes analyses showed the most frequently altered genes: ATM, EGFR, MRE11, ROCK1, and TGFBRII. There was a statistically significant difference in cancer-specific survival between cases according to MSI status. This study constitutes the most comprehensive analyses of the MSI impact on the Brazilian CRC. MSI+ frequency in Brazilian CRC agreed with the literature and was associated with several clinicopathological features related with less aggressive tumors, independently of their genetic ancestry.
Journal Article
HPV infection and p53 and p16 expression in esophageal cancer: are they prognostic factors?
by
Fregnani, José Humberto Tavares Guerreiro
,
Neto, Cristovam Scapulatempo
,
Villa, Luisa Lina
in
Biomedical and Life Sciences
,
Biomedicine
,
Cancer
2017
Background
Esophageal squamous cell carcinoma (ESCC) is a highly lethal malignant tumor. Currently, Human papillomavirus (HPV) is suggested as a potential risk factor for esophageal cancer (EC) in addition to the classic risk factors, alcohol and tobacco, but this hypothesis still remains contradictory. We sought to investigate wether HPV and well-known biomarkers (p16 and p53) and patient-related factors that may have impact on survival of ESCC.
Methods
We conducted a prospective cohort study. By using multiplex PCR, we determined the prevalence of high risk HPV in ESCC, and evaluated the immunohistochemical expression of p16 and p53, molecular markers related to esophageal carcinogenesis in order to verify the potential influence of these variables in patients’s survival. Survival rates were estimated using Kaplan-Meier methods. A multivariate confirmatory model was performed using Cox proportional hazards regression.
Results
Twelve (13.8%) of 87 patients were HPV-DNA positive. Positive reactions of p16 and p53 were 10.7% and 68.6%, respectively. Kaplan-Meier analysis indicated that men (
p
= 0.025) had poor specific-cancer survival and a shorter progression-free survival (
p
= 0.050) as compared to women; III or IV clinical stage (
p
< 0.019) had poor specific-cancer survival and a shorter progression-free survival (
p
< 0.001) compared to I and II clinical stage; not submitted to surgery (<0.001) and not submitted to chemoradiotherapy (
p
= 0.039) had a poor specific-cancer survival, as well. The multivariate analysis showed that HPV, p16 and p53 status are not predictive parameters of progression-free and specific-cancer survival.
Conclusion
HPV infection and p53 and p16 expression are not prognostic factors in ESCC.
Journal Article
Incidence and mortality of myeloid malignancies in children, adolescents and Young adults in Brazil: A population-based study
by
Pombo-de-Oliveira, Maria S.
,
da Costa, Allini Mafra
,
Santos, Marceli de Oliveira
in
Acute myeloid leukaemia
,
Adenomatous polyposis coli
,
Adolescent
2019
•Incidence and Mortality rates of Myeloid Malignances in cAYA in Brazil are explored.•Variations in incidence rates of AML/APL are reported regionally inside the country.•Trends in incidence and mortality rates overtime showed mortality decreasing.•Age-dependent association with AML/APL needs investigations of environmental exposures.
Myeloid malignancies (MM) are heterogeneous when it comes to incidence rates and pathogenesis. These variation rates are important to generate hypotheses on causal aetiology. This study aimed to describe incidence and mortality patterns of MM among children, adolescents and young adults (cAYA) in Brazil and to evaluate trends in incidence and mortality rate overtime.
Data were extracted from a dataset of 15 Population-based Cancer Registries located in five Brazilian geographical regions and calculated by age-specific, crude, and age-standardized incidence (ASR) and mortality rates per million persons. Joinpoint regression analyses were performed for trends evaluations, regionally. Annual Percent Change (APC) and Average Annual Percent Change (AAPC) were also estimated.
The overall ASR for incidence and mortality of MM in Brazil was 14.57 and 8.83 per million, respectively. The AML (non-APL AML and APL) incidence rate is 8.18 per million, whereas other MM subtypes altogether have an incidence rate of 2.62 per million, and not otherwise specified (NOS) is 3.70 per million. The analysis of incidence trends (AAPC) showed a significant decline in Manaus (-5.6%) and São Paulo (-4.7%), and a significant increase was observed in Fortaleza (5.8%). Mortality trends steadily declined in all registries, with significant declines occurring in Goiânia (-1.5%), Belo Horizonte (-2.3%), São Paulo (-2.5%), Curitiba (-2.8%) and Porto Alegre (-4.1%).
Our findings showed differences in the incidence and mortality rates of MM in cAYA in Brazil, geographically. Infants-AML have the highest incidence within the cAYA population (17.42 per million). There was a substantial decrease in mortality rate observed, which was interpreted as an improvement in MM recognition and therapeutic approach.
Journal Article
Retrospective analysis of breast cancer prognosis among young and older women in a Brazilian cohort of 738 patients, 1985-2002
by
Fregnani, José Humberto Tavares Guerreiro
,
Scapulatempo-Neto, Cristovam
,
Costa, Allini Mafra da
in
Age groups
,
Brazil
,
Breast cancer
2016
Invasive breast cancer (BC) is infrequent among women aged ≤40 years, however, the disease outlook in these younger patients is generally worse than among older women. The present study aimed to compare socio-demographic, clinical and pathological characteristics, and their association with long-term survival, between two random cohorts of young (≤40 years) and older (50-69 years) Brazilian patients with BC. The cohort comprised of 738 randomly selected women who were diagnosed with BC at Barretos Cancer Hospital, Pio XII Foundation (Barretos, Brazil) between January 1985 and December 2002; the patients included young women (n=376) and older women (n=362). The current analysis suggested that BC in young women is associated with numerous pathological features of aggressiveness. Second cancer and bilateral BC were independent predictors of a poor outcome in the younger group. Furthermore, C-erB-2 was positively correlated with poor outcome in the older group, whereas estrogen receptor status and TNM stage were associated with disease prognosis in both groups. The overall survival rates of the two age groups were similar except when analyzed according the treatment period (1997-2002). Although patients aged ≤40 years harbored tumors with more aggressive clinicopathological characteristics, these characteristics were not independent predictors of overall survival. The present study indicates that medical advances associated with prevention of breast cancer may improve screening programs, which may therefore increase early diagnosis and subsequently lower mortality rates.
Journal Article
Ki-67 and CD100 immunohistochemical expression is associated with local recurrence and poor prognosis in soft tissue sarcomas, respectively
by
CURCELLI, EMÍLIO CARLOS
,
LONGATTO-FILHO, ADHEMAR
,
PENNA, VALTER
in
Angiogenesis
,
Cancer therapies
,
CD100
2013
Soft tissue sarcomas (STSs) are a heterogeneous group of mesenchymal tumors of >50 subtypes. However, STSs represent <1% of types of cancer. Despite this low frequency, the disease is aggressive and treatment, when possible, is based on traditional chemotherapies. A number of cases of resistance to adjuvant therapies have been reported. Metastases are commonly identified in STS patients during diagnosis and the development of effective clinical parameters is crucial for correct management of the disease. The use of biological markers in cancer is a useful tool to determine patient prognosis. Ki-67 is a protein marker for proliferation of somatic cells and is widely used in prognostic studies of various types of tumor, including STSs. Cluster of differentiation 100 (CD100) is a member of the semaphorin family. The family was initially described as axon guidance molecules important for angiogenesis, organogenesis, apoptosis and neoplasia. CD100 was previously utilized as a prognostic factor in tumors and also in STSs. In the present study, protein expression of Ki-67 and CD100 was analyzed by immunohistochemistry in samples of STS patients of the Barretos Cancer Hospital (Barretos, Brazil) to establish prognostic criteria of the disease. Results demonstrate a correlation between CD100 expression and poor prognosis, consistent with a previous study. Moreover, the expression of Ki-67 was identified to correlate with presence of local or locoregional recurrence. To the best of our knowledge, no large casuistic study has revealed this correlation between Ki-67 and local recurrence in STSs. The use of Ki-67 and CD100 as markers in clinical pathological analysis may be suitable as a prognostic criterion in disease progression.
Journal Article
Cancer mortality trends in Luxembourg: A 24-year descriptive study (1998–2021)
2024
Cancer, the second most common cause of death worldwide, is projected to cause 17 million deaths by 2045. Epidemiological studies on cancer play a vital role in understanding cancer burden impact and formulating control plans. This study aimed to analyse the changes in cancer mortality rates within Luxembourg from 1998 to 2021 by sex and age.
Data on cancer-related deaths were extracted from Luxembourg's National Registry of Death Causes (1998–2021), and the corresponding population data were analysed. Age-standardized mortality rates (ASRs) per 100,000 individuals were calculated and adjusted to the European standard population. To identify significant changes in cancer mortality over time, the Average Annual Percentage Changes (AAPC) method was used.
We identified 23,750 cancer-related deaths, resulting in an ASR of 152.86 per 100,000 people per year. Lung cancer was the most common cancer-related case of death in men and in both sexes combined. In women, breast cancer was the most common cancer death. Significant decreases in the ASR over time were observed for both sexes. Sex-specific cancers, such as prostate (AAPC: −2.7) and breast (AAPC: −1.0) cancers, also exhibited significant decreasing trends in mortality. In the evaluation by life stage, stability or significant decreases were observed for women, men and both sexes, however significant increases were observed in late adulthood women in laryngeal and lung cancer (AAPC: 3.9 and 1.8, respectively). The trend patterns observed during 1998–2021 were largely consistent with those seen when excluding the COVID-19 pandemic year of 2020.
Our study provides a comprehensive analysis of mortality trends by cancer type in Luxembourg, contributing to the understanding of cancer epidemiology and informing healthcare policy and planning. This highlights the importance of targeted public health interventions as such early detection and screening programs and continued advancements in cancer treatment.
[Display omitted]
•The study documents 23,750 cancer-related deaths in Luxembourg from 1998 to 2021, with lung cancer being the leading cause of death in both sexes throughout the period. Over 80 % of cancer-related deaths occurred in individuals aged >60 years, underscoring the significant link between age and cancer mortality.•Disparities across different sexes and age groups were highlighted, including a notable shift in the primary cause of cancer mortality among women from breast to lung cancer. Age-standardized mortality rates (ASRs) per 100,000 individuals had a male-to-female ratio of 1.64, indicating a greater burden of cancer mortality in men.•A considerable decrease in the overall cancer mortality rate was observed over the study period, with an average annual percentage change (AAPC) of −2.1 % for both sexes combined. However, increases in mortality rates from laryngeal and lung cancer among women in late adulthood and Hodgkin lymphoma in men were noted, suggesting areas where targeted interventions are needed.•The findings emphasize the impact of environmental and lifestyle factors on cancer mortality trends, supporting the need for targeted public health measures, such as smoking cessation campaigns.•The importance of continuous monitoring and research to inform healthcare policy and planning is highlighted, particularly in light of the aging population and evolving risk factors.
Journal Article
Cancer survival in the northwestern of São Paulo State, Brazil: A population-based study
by
Fregnani, José Humberto Tavares Guerreiro
,
Mafra, Allini
,
Weiderpass, Elisabete
in
Brazil
,
Breast cancer
,
Breast Neoplasms
2023
Population-based cancer registry (PBCR) data provide crucial information for evaluating the effectiveness of cancer services and reflect prospects for cure by estimating population-based cancer survival. This study provides long-term trends in survival among patients diagnosed with cancer in the Barretos region (São Paulo State, Brazil).
In this population-based study, we estimated the one- and five-year age-standardized net survival rates of 13,246 patients diagnosed with 24 different cancer types in Barretos region between 2000 and 2018. The results were presented by sex, time since diagnosis, disease stage, and period of diagnosis.
Marked differences in the one- and five-year age-standardized net survival rates were observed across the cancer sites. Pancreatic cancer had the lowest 5-year net survival (5.5 %, 95 %CI: 2.9–9.4) followed by oesophageal cancer (5.6 %, 95 %CI: 3.0–9.4), while prostate cancer ranked the best (92.1 %, 95 %CI: 87.8–94.9), followed by thyroid cancer (87.4 %, 95 %CI: 69.9–95.1) and female breast cancer (78.3 %, 95 %CI: 74.5–81.6). The survival rates differed substantially according to sex and clinical stage. Comparing the first (2000–2005) and last (2012–2018) periods, cancer survival improved, especially for thyroid, leukemia, and pharyngeal cancers, with differences of 34.4 %, 29.0 %, and 28.7 %, respectively.
To our knowledge, this is the first study to evaluate long-term cancer survival in the Barretos region, showing an overall improvement over the last two decades. Survival varied by site, indicating the need for multiple cancer control actions in the future with a lower burden of cancer.
•Study provided overview of long-term survival trend of cancer cases in Barretos region.•Survival varied by sex, cancer type; partly due to stage differences.•Survival varied within stage groups; e.g. survival of cancer diagnosed at early stages varied across different cancer.•The study provides valuable results on cancer survival, will allow comparisons between other populations.
Journal Article