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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Densidade linfonodal como fator de pior prognóstico no câncer de laringe / Lymph node density as a predictive factor for worse outcomes in laryngeal cancer

Petrarolha, Silvia Migueis Picado 07 June 2019 (has links)
Introdução: A metástase linfonodal tem impacto significativo não somente no prognóstico do carcinoma espinocelular (CEC) de laringe, como também na sobrevivência. O índice de densidade linfonodal (IDL) combina a análise da extensão e a qualidade do esvaziamento cervical, com a habilidade na análise anatomopatológica. Objetivo: Avaliar o IDL como fator prognóstico no CEC de laringe. Métodos: Foi realizado um estudo retrospectivo com 186 pacientes submetidos a tratamento cirúrgico da laringe com esvaziamento cervical entre janeiro de 2009 a dezembro de 2016. Variáveis clínico-patológicas foram avaliadas, assim como o ponto de corte de IDL para determinar fatores prognósticos. Resultados: Foram calculados dois valores de IDL no estudo: considerando os pacientes N0 (IDL= 0,018) e considerando pN+ (IDL= 0,06). A curva de Kaplan-Meier (log-rank) em relação à sobrevivência acumulada mostrou que tanto os pacientes com IDL > 0,018 quanto considerando o IDL >= 0,06 tiveram maior taxa de mortalidade do que os pacientes com IDL <= 0,018 ou IDL < 0,06, mostrando uma forma mais agressiva da doença, com recidiva mais precoce. Entretanto, apenas o IDL > 0,06 mostrou impacto tanto no intervalo livre de doença quanto na sobrevivência global. Conclusão: O IDL mostrou ser um índice importante na avaliação prognóstica dos pacientes com CEC de laringe, tendo relação direta com recidiva da doença. Pacientes com IDL > 0,060 provavelmente têm doença mais agressiva e devem ser candidatos à terapia adjuvante / Introduction: Lymph node metastasis has a significant impact not only on the prognosis for laryngeal squamous cell carcinoma (SCC), but also on survival. The index of lymph node density (LND) combines the analysis of the extension and quality of the neck dissection with the skill in analyzing the pathology. Objective: To evaluate LND as a prognostic factor in patients with laryngeal SCC. Methods: A retrospective study was carried out with 186 patients submitted to laryngeal surgical treatment with neck dissection between January 2009 and December 2016. Clinical-pathological variables were assessed, as well as the cut-off point for LND, to determine prognostic factors. Results: Two LND values were calculated in the study: one considering N0 patients (LND=0.018) and the other considering pN+ (LND=0.060). The Kaplan-Meier curve (log-rank) related to cumulative survival demonstrated that not only patients with LND > 0.018 but also those with LND >= 0.060 had a higher mortality rate than those with LND <= 0.018 or LND < 0.060, presenting a more aggressive form of the disease, with earlier recurrence. However, only the LND >= 0.060 group had impact on both disease-free survival, and overall survival. Conclusion: The LND proved to be an important index in the prognostic evaluation of larynx SCC patients, having a direct relationship with disease recurrence. Patients with LND >= 0.060 are likely to have a more aggressive form of the disease and should be considered for adjuvant therapy

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