O impacto do atendimento especializado em diagnóstico oral no prognóstico de pacientes com câncer de boca: estudo observacional em um centro de assistência de alta complexidade em oncologia
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2023-02-10
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Universidade Federal de Goiás
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Despite advances in the treatment of oral cancer in recent decades, mortality from oral cancer remains stable, with an estimated mortality of 50% after 5 years of follow-up. Delay in diagnosis and treatment has been an important factor associated with higher clinical stages of oral cancer (OC), observed in the first consultation at the High Complexity Oncology Care Center (HCOCC), which negatively impacts the prognosis. Strategies that enable early diagnosis and reduce delays in treatment are important to promote a better prognosis for the patient. In this context, professionals specializing in oral diagnosis, stomatologists, oral pathologists, and head and neck surgeons are expected to be more effective in diagnosing and referring patients to a HCOCC. However, no study has evaluated the prognosis of patients with OC referred by specialists concerning non-specialists. This study aimed to investigate whether patients with OC referred by specialists in the oral diagnosis and treated at a HCOCC have a better prognosis compared to patients referred by non-specialized professionals. A retrospective cohort study was carried out with 282 participants attended at HCOCC - Hospital de Cancer Araujo Jorge in the period 1998-2016. Two groups were formed: group I - participants referred by teams specialized in oral diagnosis (n = 129), and group II: participants referred by non-specialized teams (n = 153). Demographic, clinical, and pathological data, diagnosis, and treatment delay times, treatment modalities, and clinical outcomes were collected from the medical records. Categorical variables were analyzed using the Chi-square test and numeric variables using the Mann-Whitney test. To assess disease-free survival (DFS) and overall survival (OS), Kaplan-Meier curves, log-rank test, and Cox multivariate regression were performed. Multivariate logistic regression was performed to assess the determining factors for surgical treatment, and, to assess the impact of delays on staging, and ordinal and multinomial logistic regression was performed for parameters T and N, respectively. P value < 0.05 was considered statistically significant. The male gender was predominant in the groups, being more prevalent in group II. T staging was significantly lower in group I, with 24% of tumors classified as Tis or T1, while group II recorded 11.8% in these T stages. There was a higher incidence of locoregional metastasis in group II (42.5%) than in group I (28.7%) and more distant metastases in group II (9.2%) than in group I (1.5%). Surgery was performed in 75.2% of group I and 60.8% of group II. Although the delay in diagnosis was longer in group I, the time taken to start treatment and the time taken to return post-radiotherapy in the head and neck department was shorter in this group. Surgical treatment was associated with lower TNM staging. DFS and OS analyses between groups did not show significant differences. Multivariate analysis revealed that T3/T4 tumors, locoregional metastasis (N+), distant metastasis (M1), and tumor recurrence are risk factors, while surgical treatment was a protective factor to impact DFS. T3/T4, N+, and M1 tumors were risk factors for OS. Specialized care positively influenced decision-making regarding surgical treatment in the univariate analysis; however, in the adjusted models, no influence was observed in the indication of the surgical modality or the DFS and OS. In summary, the results found allow us to infer that professionals specialized in oral diagnosis diagnose OC at lower stages, although there is a longer diagnostic delay, and promptly refer them to a HCOCC, enabling the initiation of treatment in less time and with a greater chance of receiving surgical treatment as the first option. This fact impacts the prognosis and survival rates. The insertion of a professional specialized or trained in oral diagnosis in the various levels of health care for the prevention, diagnosis, and treatment of oral cancer is important and has an impact on the patient's prognosis.
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SOUSA NETO, S. S. O impacto do atendimento especializado em diagnóstico oral no prognóstico de pacientes com câncer de boca: estudo observacional em um centro de assistência de alta complexidade em oncologia. 2023. 106 f. Dissertação (Mestrado em Odontologia) - Universidade Federal de Goiás, Goiânia, 2023.