Silva Ana Maria Fantini, Piva Breno, Nunes Marco Antônio Prado
Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, Sergipe, Brazil.
Department of Medicine (DME), Federal University of Sergipe, Campus Prof. João Cardoso Nascimento, Aracaju, Sergipe, Brazil.
Sci Rep. 2025 Jul 1;15(1):20907. doi: 10.1038/s41598-025-06113-7.
Breast cancer is the leading cause of cancer-related deaths among women globally, including Brazil. This study assesses neoadjuvant treatment patterns, the impact of new therapies, and factors determining palliative care for patients who failed initial treatments. A historical cohort study using secondary data from DATASUS (2008-2017) focused on women aged 18-90 with stages II and III breast cancer who received neoadjuvant treatment. Data on chemotherapy, hormonal therapy, and anti-HER2 treatment were analyzed. The Palliative Treatment Rate (PTR) was calculated by cross-referencing neoadjuvant treatment records with subsequent palliative care records, indicating cases where the initial curative intent was not achieved. The study included 71,181 patients, with a mean age of 51.5 years. Most were diagnosed at Stage III (85%). Anti-HER2 therapy was introduced in 2013, with 10.5% receiving it. The 5-year PTR decreased from 44% (2008-2012) to 36% (2013-2017). The combination of chemotherapy, endocrine therapy, and anti-HER2 therapy had the lowest PTR. Logistic regression identified younger age, higher histological grade, Stage III disease, and compromised lymph nodes as factors increasing the likelihood of needing palliative care, while HER2 positivity and hormonal therapy reduced it. Regional disparities were observed, with patients from the Southeast more likely to receive palliative care. Early diagnosis and access to anti-HER2 therapy significantly reduce palliative care needs. Socio-economic and regional disparities in treatment highlight the need for equitable access to diagnostic tools and therapies to improve survival outcomes in Brazil's public healthcare system.
乳腺癌是全球女性（包括巴西女性）癌症相关死亡的主要原因。本研究评估新辅助治疗模式、新疗法的影响以及决定对初始治疗失败患者进行姑息治疗的因素。一项历史性队列研究使用了来自巴西卫生信息系统（DATASUS，2008 - 2017年）的二手数据，重点关注年龄在18 - 90岁、患有II期和III期乳腺癌且接受新辅助治疗的女性。对化疗、激素治疗和抗HER2治疗的数据进行了分析。姑息治疗率（PTR）通过将新辅助治疗记录与随后的姑息治疗记录交叉对照来计算，以表明初始治愈意图未实现的病例。该研究纳入了71,181名患者，平均年龄为51.5岁。大多数患者在III期被诊断出（85%）。抗HER2疗法于2013年引入，10.5%的患者接受了该疗法。5年姑息治疗率从2008 - 2012年的44%降至2013 - 2017年的36%。化疗、内分泌治疗和抗HER2治疗联合使用时的姑息治疗率最低。逻辑回归分析确定年龄较小、组织学分级较高、III期疾病以及淋巴结受累是增加需要姑息治疗可能性的因素，而HER2阳性和激素治疗则降低了这种可能性。观察到存在地区差异，东南部的患者更有可能接受姑息治疗。早期诊断和获得抗HER2疗法可显著降低对姑息治疗的需求。治疗方面的社会经济和地区差异凸显了在巴西公共医疗系统中公平获得诊断工具和疗法以改善生存结果的必要性。
