Sobrevida dos pacientes com câncer de laringe tratados no Sistema Único de Saúde (SUS), 2002-2010

Abstract

Laryngeal cancer (LC) occupies the third position among the most recurrent head and neck tumors and still has an unfavorable prognosis. In Brazil, information on the magnitude and survival of this disease is scarce, making it difficult to adopt strategies for its control and management. This study aimed to analyze the five-year survival and prognostic factors in patients with CL treated at the Sistema Único de Saúde (SUS) in Brazil, in large regions and Brazilian states, between January 2002 and June 2010. Data were obtained from a retrospective cohort from the National Base in Oncology (Base Onco). Two subpopulations were analyzed: the initial study population, called Population 1, in which survival by CL was evaluated according to sex, age and geographic distribution; and the portion of the population on which information on staging was available, called Population 2, which enabled the evaluation of prognostic factors for CL. Thus, specific survival was estimated for CL and, in addition to sociodemographic aspects and staging, other variables were considered as potential prognostic factors, such as number of hospitalizations, treatment combinations and presence of comorbidities. Survival probabilities were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the observed differences, considering a 5% significance level. In turn, the analysis of prognostic factors was performed using the Cox proportional hazards model. In Population 1, we observed a majority of male patients (22,163; 84.54%), a ratio of 5 men: 1 woman. Survival in Brazil was estimated at 50.8 (95%CI: 49.9-51.8), being worse in male patients (49.1; 95%CI: 48.10-50.16), aged between 50 and 60 years (48.4; 95%CI: 46.7-50.0), and those living in the North Region (45.5; 95%CI: 39.5-51.3). In Population 2, survival was better in patients with stage I (68.50; 95%CI: 65.32-71.45), with single hospitalization (49.84; 95%CI: 47.36-52.27), and who underwent combined surgery and radiotherapy (57.15; 95%CI: 35.72-40.65). The factors associated with worse prognosis were similar to those pointed out in the scientific literature. The variation in survival for CL in relation to the different states and regions of the country points to disparities, with worse results for the North Region, which may be linked to regional inequality of access to diagnosis and/or treatment.