RESUMO RACIONAL: O câncer anal é uma doença relativamente rara com escassas evidências de sobrevida oriundas de países de baixa e média renda. OBJETIVOS: Investigar a sobrevida e os fatores prognósticos de casos de câncer anal atendidos em Centro de Assistência de Alta Complexidade em Oncologia na capital do Rio de Janeiro, Brasil. MÉTODOS: Estudo de coorte retrospectiva desenvolvido com 665 casos de carcinoma escamocelular do ânus/canal anal atendidos no período 2000-2016. Para estimar a probabilidade de sobrevida em cinco anos, global e segundo variáveis selecionadas, aplicaram-se o método de Kaplan-Meier e o teste log-rank. Para identificar fatores associados à sobrevida, o modelo semiparamétrico de riscos proporcionais de Cox, estratificado por estadiamento, estimou hazard ratios (HR). Intervalos de 95% de confiança (IC95%) também foram calculados. RESULTADOS: A probabilidade de sobrevida global foi de 62,20% (IC95% 57,90–66,20). Maior sobrevida foi observada em casos do sexo feminino, com estadiamento não avançado e naqueles tratados com quimiorradioterapia (p<0,001). Entre os casos com estadiamento avançado, o sexo feminino mostrou-se fator de proteção para o óbito (HR=0,52; IC95% 0,28–0,93). Em comparação à quimiorradioterapia, pelo menos um tipo de tratamento mostrou-se fator de risco: quimiorradioterapia+cirurgia entre os casos com estadiamento não avançado (HR=22,65; IC95% 5,65–90,81), radioterapia entre os casos com estadiamento avançado (HR=2,71; IC95% 1,39–5,30) e, entre os casos com estadiamento desconhecido, nenhum (HR=3,36; IC95% 1,73–6,50), radioterapia (HR=2,38; IC95% 1,46–3,88) e radioterapia+cirurgia (HR=3,99; IC95% 1,20–13,27). CONCLUSÕES: Os achados corroboram a superioridade da quimiorradioterapia sobre as demais modalidades terapêuticas contra o câncer anal, determinando maior sobrevida e melhor prognóstico. RACIONAL renda OBJETIVOS Janeiro Brasil MÉTODOS 66 ânuscanal ânus canal 20002016. 20002016 2000 2016. 2016 2000-2016 anos selecionadas aplicaramse aplicaram se KaplanMeier Kaplan Meier logrank. logrank log rank. rank log-rank Cox HR. HR . (HR) 95 IC95 IC calculados RESULTADOS 6220 62 20 62,20 (IC95 57,90–66,20. 57906620 57,90–66,20 57 90 57,90–66,20) p<0,001. p0001 p p<0,001 0 001 (p<0,001) mostrouse mostrou HR=0,52 HR052 52 (HR=0,52 0,28–0,93. 028093 0,28–0,93 28 93 0,28–0,93) risco quimiorradioterapiacirurgia cirurgia HR=22,65 HR2265 22 65 (HR=22,65 5,65–90,81, 5659081 5,65–90,81 , 5 81 5,65–90,81) HR=2,71 HR271 2 71 (HR=2,71 1,39–5,30 139530 1 39 30 desconhecido HR=3,36 HR336 3 36 (HR=3,36 1,73–6,50, 173650 1,73–6,50 73 6 50 1,73–6,50) HR=2,38 HR238 38 (HR=2,38 1,46–3,88 146388 46 88 radioterapiacirurgia HR=3,99 HR399 99 (HR=3,99 1,20–13,27. 1201327 1,20–13,27 13 27 1,20–13,27) CONCLUSÕES prognóstico 2000201 200 201 2000-201 (HR 9 IC9 622 62,2 (IC9 5790662 57,90–66,2 p000 p<0,00 00 (p<0,001 HR=0,5 HR05 (HR=0,5 02809 0,28–0,9 HR=22,6 HR226 (HR=22,6 565908 5,65–90,8 8 HR=2,7 HR27 7 (HR=2,7 1,39–5,3 13953 HR=3,3 HR33 (HR=3,3 17365 1,73–6,5 HR=2,3 HR23 (HR=2,3 1,46–3,8 14638 4 HR=3,9 HR39 (HR=3,9 120132 1,20–13,2 200020 2000-20 62, (IC 579066 57,90–66, p00 p<0,0 (p<0,00 HR=0, HR0 (HR=0, 0280 0,28–0, HR=22, HR22 (HR=22, 56590 5,65–90, HR=2, HR2 (HR=2, 1,39–5, 1395 HR=3, HR3 (HR=3, 1736 1,73–6, 1,46–3, 1463 12013 1,20–13, 20002 2000-2 57906 57,90–66 p0 p<0, (p<0,0 HR=0 (HR=0 028 0,28–0 HR=22 (HR=22 5659 5,65–90 HR=2 (HR=2 1,39–5 139 HR=3 (HR=3 173 1,73–6 1,46–3 146 1201 1,20–13 2000- 5790 57,90–6 p<0 (p<0, HR= (HR= 02 0,28– 565 5,65–9 1,39– 17 1,73– 1,46– 14 120 1,20–1 579 57,90– p< (p<0 0,28 56 5,65– 1,39 1,73 1,46 12 1,20– 57,90 (p< 0,2 5,65 1,3 1,7 1,4 1,20 57,9 (p 0, 5,6 1, 1,2 57, 5,
ABSTRACT BACKGROUND: Anal cancer is a relatively rare disease, and there is a lack of survival data from low- and middle-income countries. AIMS: The aim of this study was to investigate the survival rates and prognostic factors of anal cancer cases treated at a High-Complexity Oncology Care Center in Rio de Janeiro, Brazil. METHODS: A retrospective cohort study was conducted involving 665 cases of squamous cell carcinoma of the anus/anal canal treated from 2000 to 2016. To estimate the 5-year overall survival probability and survival according to selected variables, the Kaplan-Meier method and the log-rank test were applied. To identify factors associated with survival, the Cox proportional hazards model, stratified by staging, was used to estimate hazard ratios (HR). Ninety-five percent confidence intervals (95%CI) were also calculated. RESULTS: The overall survival probability was 62.20% (95%CI 57.90–66.20). Higher survival rates were observed in female cases, those with non-advanced staging, and those treated with chemoradiotherapy (p<0.001). Among cases with advanced staging, being female was a protective factor against death (HR=0.52; 95%CI 0.28–0.93). Compared to chemoradiotherapy, at least one type of treatment was identified as a risk factor: chemoradiotherapy + surgery among cases with non-advanced staging (HR=22.65; 95%CI 5.65–90.81), radiotherapy among cases with advanced staging (HR=2.71; 95%CI 1.39–5.30), and among cases with unknown staging, no treatment (HR=3.36; 95%CI 1.73–6.50), radiotherapy (HR=2.38; 95%CI 1.46–3.88), and radiotherapy + surgery (HR=3.99; 95%CI 1.20–13.27). CONCLUSIONS: The findings support the superiority of chemoradiotherapy over other therapeutic modalities for anal cancer, resulting in increased survival and a better prognosis. BACKGROUND disease low middleincome middle income countries AIMS HighComplexity High Complexity Janeiro Brazil METHODS 66 anusanal anus 200 2016 5year year 5 variables KaplanMeier Kaplan Meier logrank log rank applied model HR. HR . (HR) Ninetyfive Ninety five 95CI CI 95 calculated RESULTS 6220 62 20 62.20 57.90–66.20. 57906620 57.90–66.20 57 90 57.90–66.20) nonadvanced non p<0.001. p0001 p p<0.001 0 001 (p<0.001) HR=0.52 HR052 52 (HR=0.52 0.28–0.93. 028093 0.28–0.93 28 93 0.28–0.93) HR=22.65 HR2265 22 65 (HR=22.65 5.65–90.81, 5659081 5.65–90.81 , 81 5.65–90.81) HR=2.71 HR271 2 71 (HR=2.71 1.39–5.30, 139530 1.39–5.30 1 39 30 1.39–5.30) HR=3.36 HR336 3 36 (HR=3.36 1.73–6.50, 173650 1.73–6.50 73 6 50 1.73–6.50) HR=2.38 HR238 38 (HR=2.38 1.46–3.88, 146388 1.46–3.88 46 88 1.46–3.88) HR=3.99 HR399 99 (HR=3.99 1.20–13.27. 1201327 1.20–13.27 13 27 1.20–13.27) CONCLUSIONS prognosis 201 (HR 9 622 62.2 5790662 57.90–66.2 p000 p<0.00 00 (p<0.001 HR=0.5 HR05 (HR=0.5 02809 0.28–0.9 HR=22.6 HR226 (HR=22.6 565908 5.65–90.8 8 HR=2.7 HR27 7 (HR=2.7 13953 1.39–5.3 HR=3.3 HR33 (HR=3.3 17365 1.73–6.5 HR=2.3 HR23 (HR=2.3 14638 1.46–3.8 4 HR=3.9 HR39 (HR=3.9 120132 1.20–13.2 62. 579066 57.90–66. p00 p<0.0 (p<0.00 HR=0. HR0 (HR=0. 0280 0.28–0. HR=22. HR22 (HR=22. 56590 5.65–90. HR=2. HR2 (HR=2. 1395 1.39–5. HR=3. HR3 (HR=3. 1736 1.73–6. 1463 1.46–3. 12013 1.20–13. 57906 57.90–66 p0 p<0. (p<0.0 HR=0 (HR=0 028 0.28–0 HR=22 (HR=22 5659 5.65–90 HR=2 (HR=2 139 1.39–5 HR=3 (HR=3 173 1.73–6 146 1.46–3 1201 1.20–13 5790 57.90–6 p<0 (p<0. HR= (HR= 02 0.28– 565 5.65–9 1.39– 17 1.73– 14 1.46– 120 1.20–1 579 57.90– p< (p<0 0.28 56 5.65– 1.39 1.73 1.46 12 1.20– 57.90 (p< 0.2 5.65 1.3 1.7 1.4 1.20 57.9 (p 0. 5.6 1. 1.2 57. 5.
