Intensidade da reação infl amatória cervical como fator de risco para recorrência do carcinoma do colo do útero nos estádios IB e IIA
Palavras-chave:
Neoplasias do colo do útero, Recidiva, Sobrevivência, Inflamação, Metástase linfática, Invasividade neoplásicaResumo
CONTEXTO E OBJETIVO: A intensidade da reação infl amatória é citada como possível fator de risco para recorrência do carcinoma do colo do útero (CCU). Alguns autores observaram aumento do risco com reação infl amatória fraca, enquanto outros descreveram o oposto. Este estudo procurou avaliar os fatores de risco para recorrência do CCU em estádios iniciais (IB e IIA), considerando na análise a reação infl amatória. TIPO DE ESTUDO E LOCAL: Coorte retrospectiva, no Centro de Tratamento e Pesquisa Hospital A. C. Camargo (Hospital do Câncer). MÉTODOS: Estudaram-se 289 pacientes com diagnóstico de CCU (estádios IB e IIA) submetidas à cirurgia radical entre 1980 e 1999. Realizou-se a coleta de dados nos prontuários. Os cortes histológicos dos tumores e dos linfonodos foram revistos em 247 casos. As taxas de sobrevida livre de doença em cinco anos foram calculadas pelo método de Kaplan-Meier e as curvas comparadas pelo teste de log-rank. Para a análise multivariada empregou-se o modelo de riscos proporcionais de Cox. A estimativa do risco de recorrência foi o hazard ratio (HR). RESULTADOS: Registraram-se 43 recorrências. A análise multivariada identifi cou os seguintes fatores de risco independentes para recorrência: número de linfonodos pélvicos metastáticos (1 linfonodo: HR = 3,3 [1,3-8,3]; 2 ou 3 linfonodos: HR = 5,3 [1,5-18,6]; 4 ou mais linfonodos: HR=7,6 [1,7 – 33,2]), profundidade de invasão do tumor (terço profundo: HR = 2,1 [1,1-4,1]) e intensidade da reação infl amatória no colo do útero (ausente ou leve: HR = 2,5 [1,1-5,7]). CONCLUSÃO: Este estudo identifi cou a reação infl amatória ausente ou de intensidade leve como fatores de risco independentes para recorrência. Os outros fatores de risco foram o número de linfonodos pélvicos metastáticos e a invasão do terço profundo do colo do útero.
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