Azevedo Pamela Santos, Zuppo Laper Isabella, Oliveira Deborah Marta do Santos, Sabino Adriano de Paula, Garcia Marina Morgado, de Freitas Isabela Cristina Menezes, Prata Wallace Mateus, Cherchiglia Mariângela Leal, Álvares-Teodoro Juliana, Acurcio Francisco de Assis, Júnior Augusto Afonso Guerra
Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Department of Clinical and Toxicological Analyses, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Front Pharmacol. 2025 Jan 10;15:1414244. doi: 10.3389/fphar.2024.1414244. eCollection 2024.
Follicular lymphoma (FL) is a common type of non-Hodgkin lymphoma that is incurable but often follows an indolent course. While survival is improving thanks to advances in diagnosis, supportive care, and new therapies, understanding outcomes and their impact on overall survival is still limited. There are few studies on FL in Brazil, so this study aims to evaluate the patient's profile, morbidity and mortality treated by the Brazilian national health service (SUS) and evaluate risk factors associated with treatment failure.
This is a nationwide 16 years cohort with patients that underwent chemotherapy in the SUS (2000-2015). The Kaplan-Meier method was used to estimate survival until treatment failure, and the Cox proportional hazards model was used to evaluate risk factors.
The cohort included 10,009 patients and survival rates were 73.3%, 45.3%, and 30.7% for the first, fifth and 10th year respectively. The median overall survival was approximately 4.1 years. The most used regimen was CHOP (13%), followed by CVP (9.7%) and R-CHOP (3.3%). Four hundred and ninety-eight patients (4.9%) used rituximab-containing regimens. Univariate analysis indicated worse survival rates for male patients, those over 65 years of age, clinical stage III or IV and those using non-rituximab-containing regimens. The health technology performance assessment related to oncology schemes for FL suggests that rituximab-based regimens has shown best survival probability (0.52 CI 0.39-0.69) in 78 months of follow up with a HR 1.5 times better than other schemes (HR 0.67; CI 0.55-0.81).
In light of the substantial advancements achieved by the SUS, there is a need for CONITEC to expedite decision-making processes in order to enhance patients access to new oncology drugs. This should be done while upholding health technology assessment standards. Timely integration and sufficient funding for oncology services have the potential to save lives, especially when compared to the treatments available within SUS at that time.
滤泡性淋巴瘤（FL）是一种常见的非霍奇金淋巴瘤，无法治愈，但病程通常较为惰性。尽管由于诊断、支持治疗和新疗法的进展，生存率有所提高，但对预后及其对总生存的影响的了解仍然有限。巴西关于FL的研究较少，因此本研究旨在评估巴西国家卫生服务体系（SUS）治疗的患者的特征、发病率和死亡率，并评估与治疗失败相关的危险因素。
这是一项针对在SUS接受化疗的患者的全国性16年队列研究（2000 - 2015年）。采用Kaplan-Meier方法估计直至治疗失败的生存率，并使用Cox比例风险模型评估危险因素。
该队列包括10,009名患者，第1年、第5年和第10年的生存率分别为73.3%、45.3%和30.7%。中位总生存期约为4.1年。最常用的方案是CHOP（13%），其次是CVP（9.7%）和R-CHOP（3.3%）。498名患者（4.9%）使用了含利妥昔单抗的方案。单因素分析表明，男性患者、65岁以上患者、临床分期为III或IV期的患者以及使用不含利妥昔单抗方案的患者生存率较差。与FL肿瘤学方案相关的卫生技术性能评估表明，在78个月的随访中，基于利妥昔单抗的方案显示出最佳的生存概率（0.52，CI 0.39 - 0.69），风险比（HR）比其他方案好1.5倍（HR 0.67；CI 0.55 - 0.81）。
鉴于SUS取得的重大进展，CONITEC需要加快决策过程，以增加患者获得新肿瘤药物的机会。这应在坚持卫生技术评估标准的同时进行。肿瘤学服务的及时整合和充足资金有挽救生命的潜力，特别是与当时SUS提供的治疗相比。
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