Jefferson Luiz Gross

O envelhecimento e o aumento da sobrevida de pacientes com doenças reumatológicas aumentam o risco de doenças crônico-degenerativas, incluindo o câncer. Fatores como inflamação crônica, imunossupressão e terapias biológicas podem elevar em cerca de 20% a mortalidade por neoplasias nessa população. Diante da ausência de diretrizes específicas, o objetivo deste artigo é revisar a literatura sobre o risco de câncer em pacientes reumatológicos e analisar as recomendações vigentes de rastreamento populacional aplicáveis. Realizamos uma análise crítica de dados epidemiológicos e diretrizes de rastreamento para tumores de maior impacto (próstata, mama, colorretal, colo uterino e pulmão), bem como as bases que estabelecem associação entre doenças reumatológicas e tipos específico de câncer. Existem descrições de associação epidemiológica entre doenças reumatológicas e neoplasias malignas, destacando-se o risco de linfoma na síndrome de Sjögren, doenças linfoproliferativas associadas ao metotrexato na artrite reumatoide, além de tumores de pulmão e pele. Para o rastreamento, o Ministério da Saúde/Instituto Nacional de Câncer preconiza mamografia bianual (50-69 anos) para câncer de mama e citopatologia/teste molecular para câncer do colo uterino. O rastreamento colorretal é recomendado via pesquisa de sangue oculto ou colonoscopia (50-75 anos), enquanto para pulmão indica-se tomografia de baixa dose individualizada para tabagistas ou ex-tabagistas entre 50 e 80 anos. O rastreamento de próstata deve ser baseado em decisão compartilhada em homens a partir dos 50 anos. Embora faltem diretrizes específicas para a população reumatológica, o reumatologista exerce papel central na aplicação rigorosa das diretrizes de prevenção secundária vigentes. A vigilância deve ser intensificada para subtipos tumorais específicos associados a cada doença autoimune e ao tipo de tratamento reumatológico que o paciente recebe.

Objectives: To evaluate if the use of robotic technique (RATS) was able to achieve a better lymph node staging when compared with video-assisted (VATS) and open techniques for lung resections for treatment of non-small cell lung cancer. Methods: We used data from the Brazilian Lung Cancer Registry to retrospectively analyse 1376 patients submitted to lung resections for non-small cell lung cancer with curative intention. A propensity score matching analysis was performed to create groups with comparable baseline characteristics in a pairwise fashion (open vs RATS and VATS vs RATS). The primary endpoint was nodal upstaging. Results: After propensity score matching, 165 patients in the open group were compared with 165 in the RATS group. The rate of overall upstaging was higher in the open but not statistically significant when compared with RATS (open 22.4% vs RATS 15.2%; P = .09). Total lymph node count was similar for both groups (open 10; interquartile range [IQR] 5-17 vs RATS 11; IQR 8-17), P = .054). In the other comparison, 279 patients in the VATS group were compared with 279 patients in the RATS group. The rate of overall upstaging was the same in both groups (VATS 11.1% vs RATS 11.1%; P = 1). RATS had a higher number of lymph nodes harvested (VATS 9; IQR 6-13 vs RATS 10; IQR 7-15, P < .001). Conclusions: RATS had a similar upstaging rate when compared with both VATS and open techniques.

Neoplastic pleural effusion is one in which malignant neoplastic cells are detected in the pleural fluid or in the parietal pleura. When secondary, it confirms disseminated neoplastic disease and suggests a reduced life expectancy and low quality of life. This review was described by a group of physician members of the Brazilian Society of Oncological Surgery regarding the treatment of neoplastic pleural effusion, developed to guide surgeons, palliative care physicians and clinical oncologists in their clinical practice to assess patients indicated for pleurodesis based on survival scores.

This document presents guidelines to assist surgeons in the diagnosis and management of this condition, emphasizing a multidisciplinary approach. Recommendations described by a group of physicians members of the Brazilian Society of Oncological Surgery regarding the treatment of neoplastic pericardial effusion, developed to guide oncological surgeons, cardiothoracic surgeons and general surgeons in their clinical practice. Members of the Thoracic Neoplasms Committee carried out a literature review and discussion among expert peers to create a guideline that would help in managing this very serious clinical condition in our oncology practice: Neoplastic pericardial effusion.

Objective: The purpose of this study was to assess performance in the Brazilian Lung Cancer Registry Database by using the parsimonious EuroLung risk models for morbidity and mortality. Methods: The EuroLung1 and EuroLung2 models were tested and evaluated through calibration (calibration plot, Brier score, and the Hosmer-Lemeshow test) and discrimination (ROC AUCs), in a national multicenter registry of 1,031 patients undergoing anatomic lung resection. Results: The evaluation of performance in Brazilian health care facilities utilizing risk-adjustment models, specifically EuroLung1 and EuroLung2, revealed substantial miscalibration, as evidenced by calibration plots and Hosmer-Lemeshow tests in both models. In terms of calibration, EuroLung1 exhibited a calibration plot with overlapping points, characterized by a slope of 1.11 and a Brier score of 0.15; the Hosmer-Lemeshow test yielded a statistically significant p-value of 0.015; and the corresponding ROC AUC was 0.678 (95% CI: 0.636-0.721). The EuroLung2 model displayed better calibration, featuring fewer overlapping points in the calibration plot, with a slope of 1.22, with acceptable discrimination, as indicated by a ROC AUC of 0.756 (95% CI: 0.670-0.842). Both models failed to accurately predict morbidity and mortality outcomes in this specific health care context. Conclusions: Discrepancies between the EuroLung model predictions and outcomes in Brazil underscore the need for model refinement and for a probe into inefficiencies in the Brazilian health care system. (Plataforma Brasil identifier: 16424413.2.1001.0065. [https://plataformabrasil.saude.gov.br/])

Category: Thoracic Oncology Introduction: Despite the proven survival benefits of adjuvant systemic therapy (AT) in resected non-small-cell lung cancer (NSCLC), its underutilization remains a concern.(–) Objecitve: This study aims to explore the extent to which socioeconomic disparities influence AT underutilization. Methods: Data from the Brazilian Registry of Lung Cancer (2009-2023), was queried for patients with complete surgical resected stage IB-III and stratified based on AT delivery. Demographic, clinical, and pathological variables were evaluated. Logistic regression model was performed. The model’s

Category: Thoracic Oncology Introduction: The prognostic evaluation of early-stage non-small cell lung cancer (NSCLC) remains critical for optimizing treatment strategies and improving patient outcomes.(–) Objective: This study aims to delineate the pivotal predictors affecting survival rates among early-stage NSCLC patients, leveraging data from the Brazilian Lung Cancer Registry. Methods: This study retrospectively analyzed data from the Brazilian Lung Cancer Registry, encompassing 2,045 patients who underwent surgical treatment for lung cancer across 14 institutions in five Brazilian states. The registry is

Objetivo: Avaliar a taxa de sucesso diagnóstico e complicações da biópsia percutânea por fragmentos guiada por tomografia computadorizada (TC) em nódulos pulmonares menores que 10 mm.

Objective: To assess the diagnostic success rate and complications of computed tomography (CT)-guided percutaneous biopsy in pulmonary nodules < 10 mm in diameter.