Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-06-15T11:52:31Z No. of bitstreams: 1 470446 - Texto Completo.pdf: 5542034 bytes, checksum: cb2fd7a5960d4cf7f92d7bee885029f6 (MD5) / Made available in DSpace on 2015-06-15T11:52:31Z (GMT). No. of bitstreams: 1 470446 - Texto Completo.pdf: 5542034 bytes, checksum: cb2fd7a5960d4cf7f92d7bee885029f6 (MD5) Previous issue date: 2015-03-23 / Introduction: New drugs have been developed to treat renal cell carcinoma apparently improving overall survival. Methods: This is an observational study in a retrospective cohort. Five hundred nine patients with renal cell carcinoma treated between 2002 and 2012 in Southern Brazil were divided in two groups: patients receiving public health system care and participants in clinical research protocols. Data collected from medical records were: socio-demographic and clinical characteristics, type of surgery and pathological information. Statistical analysis was performed using Chi-square, Fisher exact, Student's t tests; the survival curve was according to Kaplan-Meier method and Cox regression. Significance was considered at p<0.05. Results: Patients were male (68.6%), Caucasian (94.9%), and had no family history of cancer (91.6%). Most cases were submitted to nephrectomy and the most frequent histological type was clear cell carcinoma (90.7%). Global median survival for all patients was 50.2 (45.0-54.7) months. Global survival was different between patients enrolled in clinical trials [142.1 months (95% CI: 94.1- 152.6)] and those treated in the public health system [44.9 months (95% CI: 39.5 - 49.1)] (p<0.001). The unadjusted hazard ratio was 0.24 (0.15-0.37). After adjustment for gender, age, smoking at the time of diagnosis, body mass index, skin color, patient origin, ECOG score, histology and clinical stage, hazard ratio was 0.26 (0.13-0.55) (p<0.001). Conclusion: Renal cell carcinoma patients treated in clinical research protocols have longer survival when compared to patients managed within the public health care system in Brazil. This finding strongly suggests that, in this setting, participation in clinical research protocols should be encouraged. / Introdu??o: Novas drogas t?m sido desenvolvidas para o tratamento de carcinoma de c?lulas renais, melhorando, aparentemente, a sobreviv?ncia global. M?todos: Este ? um estudo observacional em uma coorte retrospectiva. Quinhentos e nove pacientes com carcinoma de c?lulas renais, tratados entre 2002 e 2012 num hospital Universit?rio do sul do Brasil, foram divididos em dois grupos: aqueles que foram tratados pelo sistema de sa?de p?blica e os participantes em protocolos de pesquisa cl?nica. Os dados coletados a partir dos prontu?rios foram: caracter?sticas s?cio-demogr?ficas e cl?nicas, tipo de cirurgia e informa??es patol?gicas. A an?lise estat?stica foi realizada por meio dos testes Qui-quadrado, exato de Fisher, t de Student; a curva de sobreviv?ncia foi realizada de acordo com o m?todo de Kaplan-Meier e regress?o de Cox. A signific?ncia foi considerada quando p <0,05. Resultados: A maioria dos pacientes era do sexo masculino (68,6%), Caucasianos (94,9%), e n?o tinham hist?rico familiar de c?ncer (91,6%). A maioria dos casos foi submetida ? nefrectomia e o tipo histol?gico mais freq?ente foi o carcinoma de c?lulas claras (90,7%). A sobrevida global mediana para todos os pacientes foi de 50,2 (45,0-54,7) meses. A sobrevida global foi diferente entre os pacientes inclu?dos em ensaios cl?nicos [142,1 meses (IC 95%: 94.1- 152,6)] e aqueles tratados no sistema p?blico de sa?de [44,9 meses (IC 95%: 39,5-49,1)] (p <0,001). A taxa de risco n?o ajustada foi de 0,24 (0,15-0,37); ap?s o ajuste para idade, sexo, tabagismo no momento do diagn?stico, ?ndice de massa corporal, cor da pele, origem do paciente, pontua??o ECOG, histologia e estadiamento cl?nico, a taxa de risco foi de 0,26 (0,13-0,55) (p <0,001). Conclus?o: Pacientes com carcinoma de c?lulas renais tratados em protocolos de pesquisa cl?nica t?m maior sobrevida quando comparados aos pacientes tratados no ?mbito do sistema p?blico de sa?de no Brasil. Esse achado sugere fortemente que, neste cen?rio, a participa??o em protocolos de pesquisa cl?nica deve ser incentivada.