José Antônio Figueiredo Pinto

Is there a gender difference in non-small cell lung cancer survival?

BACKGROUND A possible association had previously been noted between gender and prognosis in non-small cell lung cancer (NSCLC), with a better survival rate for women. OBJECTIVE The purpose of the current study was to further clarify the role of gender as a possible prognostic factor in NSCLC. METHODS This retrospective cohort study examined the survival of NSCLC patients who underwent surgical curative treatment at the Hospital Sao Lucas da PUCRS, Porto Alegre, Brazil, between January 1, 1990, and December 31, 2000. Data were analyzed using Kaplan-Meier survival curves. In addition, a Cox proportional hazards regression model was used to adjust for potential confounding factors. RESULTS In the period studied, lung resections were performed in 253 patients with NSCLC, of whom 114 had stage I tumors. Four patients were excluded because of death in the immediate postoperative period, and 1 committed suicide. The 5-year survival rate was 85.5% for women and 46.4% for men (P<0.0001). The median overall survival time was 44.7 months (interquartile range [IQR(25%-75%)], 17.4-72.3 months) and was longer in women than in men: 63.9 months (IQR(25%5%), 35.2-98.7 months) versus 32.3 months (IQR(25%-75%), 11.8-61.5 months), respectively (P<0.0001). Gender effect was still present after adjustment by Cox regression for several factors (age, smoking habits, hemoglobin, forced expiratory volume in 1 second, tumor size, tumor-node-metastasis stage, histology, postoperative complications, and surgery type). The adjusted hazard ratio in women was 0.23 (95% CI, 0.09-0.59; (P<0.0001) when compared with men. CONCLUSION This study confirms previous findings that women live longer than men after surgery for stage I NSCLC. This effect persisted after adjusting for several factors. These results highlight the fact that analyses of long-term survival of NSCLC patients, usually generalized to men and women as a whole, may be an inadequate extrapolation. These results question whether analyses of long-term survival, which commonly group men and women together, provide an adequate prognosis of survival rates in women with NSCLC.

Sobrevida de longo prazo em carcinoma brônquico após tratamento cirúrgico: sexo é fator prognóstico?

INTRODUCAO: A semelhanca de resultados relatados por outros autores, anteriormente haviamos encontrado possivel associacao entre sexo e prognostico em carcinoma bronquico nao-pequenas celulas (CBNPC) em estagio I, com melhores taxas de sobrevida em mulheres. OBJETIVO: O objetivo do presente trabalho foi o de ampliar o estudo dos possiveis fatores prognosticos em CBNPC. METODO: Em estudo de coorte retrospectivo, foi avaliada a sobrevida de 163 pacientes com CBNPC tratados cirurgicamente, com intencao curativa, no Hospital Sao Lucas da Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), entre 1990 e 1997, ate o obito ou o seguimento por cinco anos. Os dados foram analisados atraves de curvas de Kaplan-Meier e pelo teste de Mann-Whitney para comparar os tempos de sobrevida e pelo modelo de regressao de Cox para avaliar possiveis fatores de confusao. RESULTADOS: Foram incluidos 124 (76,07%) homens e 39 (23,93%) mulheres. A sobrevida mediana foi 32,3 e 60,6 meses e a sobrevida em cinco anos de 38,0% e 55,4%, para homens e mulheres, respectivamente (p=0,030). Considerando apenas pacientes em Estagio I, as taxas de sobrevida foram 44,4% e 81,8% para homens e mulheres, respectivamente (p=0,009). O efeito do sexo persistiu apos ajuste para varios fatores (idade, hemoglobina, histologia, tamanho do tumor, extensao da cirurgia e complicacoes pos-operatorias), realizado atraves da regressao de Cox. O risco relativo em mulheres foi 0,09 (IC90%:0,03-0,25, p<0,001) quando comparado com o de homens. CONCLUSAO: Este estudo confirmou achados previos de que as mulheres vivem por mais tempo apos cirurgia para tratamento de CBNPC, quando comparadas aos homens. Esse efeito e observado apenas em estagio precoce e persiste apos ajuste de varios fatores.

Primary tracheobronchial amyloidosis

Tracheobronchial amyloidosis is an uncommon localized form of amyloidosis, characterized by amyloid deposits restricted to the trachea, main bronchi and segmental bronchi. We present the case of a retired 67-year-old man with long-term progressive dyspnea, wheezing and chest pain. A diagnosis of tracheobronchial amyloidosis was made after the third fiberoptic bronchoscopy and histological confirmation through Congo red staining of tissue samples.

[Concordance between clinical and pathological staging in patients with stages I or II non-small cell lung cancer subjected to surgical treatment].

OBJECTIVE To compare clinical and pathological staging in patients with non-small cell lung cancer submitted to surgical treatment, as well as to identify the causes of discordance. METHODS Data related to patients treated at the Department of Thoracic Surgery of the Pontifical Catholic University of Rio Grande do Sul São Lucas Hospital were analyzed retrospectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for clinical stages IA, IB, and IIB. The kappa index was used to determine the concordance between clinical and pathological staging. RESULTS Of the 92 patients studied, 33.7% were classified as clinical stage IA, 50% as IB, and 16.3% as IIB. The concordance between clinical and pathological staging was 67.5% for stage IA, 54.3% for IB, and 66.6% for IIB. The accuracy of the clinical staging was greater for stage IA, and a kappa of 0.74, in this case, confirmed a substantial association with pathological staging. The difficulty in evaluating nodal metastatic disease is responsible for the low concordance in patients with clinical stage IB. CONCLUSIONS The concordance between clinical and pathological staging is low, and patients are frequently understaged (in the present study, only one case was overstaged). Strategies are necessary to improve clinical staging and, consequently, the treatment and prognosis of patients with non-small cell lung cancer.

Amiloidose traqueobrônquica primária

Amyloidosis is a disease characterized by extracellular deposition of fibrillar protein in organs and tissues. Primary tracheal amyloidosis is rare. We report here a case of a 55-year-old man with tracheal amyloidosis hospitalized for acute respiratory insufficiency and with a history of recent episodes of pneumonia. Chest X-ray and chest computed tomography showed tracheal obstruction due to a tumor. A passage was created in order to relieve the symptoms. Histological examination (Congo red staining) revealed amyloid deposits but no evidence of neoplasia. Although this is a rare clinical condition, its importance is discussed regarding the differential diagnosis of tracheal tumors and the repercussions for therapeutic decision-making.

Retrograde Orotracheal Intubation with a Double-Lumen Tube

BACKGROUND AND OBJECTIVES Difficult airway management in thoracic surgeries is a peculiar subject due to the demands of monopulmonary ventilation with double-lumen tubes. Flexible bronchoscopy guidance is extremely important, but it is not always available. The objective of this report was to describe a case of retrograde selective orotracheal intubation in the absence of specific endoscopy equipment for the procedure. CASE REPORT This is a patient with a history of retosigmoidectomy, admitted for a right thoracotomy for a lung lesion. Preoperative anesthetic evaluation did not reveal any clinical and physical exam particularities. After anesthetic induction and ventilation with face mask, two attempts of orotracheal intubation under direct laryngoscopy were ineffective due to difficult visualization of the vocal folds (Cormack-Lehane grade III). Due to the unavailability of specific material for selective endoscopic intubation it was decided to use the retrograde technique using the double-lumen tube. The patient was extubated in the operating room shortly after the end of the surgery without complications secondary to the alternative technique. CONCLUSIONS Retrograde selective orotracheal intubation is a minimally invasive technique, low cost, safe, and extremely useful whenever flexible bronchoscopy is not available.

Intubação orotraqueal com tubo de duplo-lúmen pela via retrógrada

JUSTIFICATIVA Y OBJETIVOS: El manejo de la via aerea dificil en cirugia toracica es un asunto peculiar, debido a las exigencias de la ventilacion monopulmonar con el uso de tubos de doble lumen. El auxilio de la broncoscopia flexible es de enorme importancia, sin embargo no siempre esta disponible. El objetivo de este relato, es describir un caso de intubacion orotraqueal selectiva retrograda en la ausencia de un equipo de endoscopia especifico para el procedimiento. RELATO DEL CASO: Paciente con historial previo de retosigmoidectomia que fue ingresado para el abordaje quirurgico de la lesion pulmonar por toracotomia derecha. La evaluacion anestesica preoperatoria no revelaba particularidades ni en la historia clinica ni en el examen fisico. Despues de la induccion anestesica y ventilacion con mascara facial, en la laringoscopia derecha dos intentos de intubacion orotraqueal no tuvieron el efecto esperado debido a una dificil visualizacion de las cuerdas vocales (Cormack-Lehane grado III). En funcion de la indisponibilidad de un material especifico para la intubacion selectiva endoscopica, se opto por la tecnica retrograda utilizando un tubo de doble lumen. El paciente fue desentubado en quirofano enseguida que termino la operacion y no presento complicaciones provenientes de la tecnica alternativa. CONCLUSIONES: La intubacion orotraqueal selectiva retrograda fue una tecnica alternativa minimamente invasiva de bajo coste, segura e incluso extremadamente util cuando no se cuenta con la ayuda de la broncoscopia flexible.