[Analysis of the age-period-cohort effect on mortality from colorectal cancer in Rio de Janeiro State, Brazil, from 1980 to 2014]

Approaches to the problem of nonidentifiability in the age-period-cohort models in the analysis of cancer mortality: a scoping review

Aiming to detect age, period and cohort effects in cancer mortality, age-period-cohort models (APC) can be applied to distinguish these effects. The main difficulty with adjusting an APC model involving age, period and cohort factors is the linear relationship between them, leading to a condition known as the 'nonidentifiability problem'. Many methods have been developed by statisticians to solve it, but there is not a consensus. All these existing methods, with their advantages and disadvantages, create confusion when choosing which one of them should be implemented. In this context, the present scoping review intends not to show all methods developed to avoid the nonidentifiability problem on APC models but to show which of them are, in fact, applied in the literature, especially in the cancer mortality studies. A search strategy was made to identify evidence on MEDLINE (PubMed), Scopus, EMBASE, Science Direct and Web of Science. A total of 46 papers were analyzed. The main methods found were: Holford's method (n = 14; 30%), ntrinsic estimator (n = 10; 22%), Osmond & Gardner method n = 8; 17%), Carstensen (n = 6;13%), Bayesian approach (n = 6;13%) and others (n = 2; 5%). Even with their limitations, all methods have beneficial applications. However, the decision to use one or another method seemed to be more related to an observed geographic pattern.

Stromal scoring in advanced colon and rectal cancer: Stroma-rich tumors and their association with aggressive phenotypes

Background: Our aim was to explore relevance of the proportion between neoplastic cell component and tumor-associated stroma in order to assess its association with confirmed aggressive phenotypes of right/left colon and rectum cancers in a large series of patients. Methods: The quantification of stroma component was performed in patients diagnosed with colorectal adenocarcinoma who underwent surgical resection. The analyzed variables were age, gender, anatomical/pathological features, and tumor-stroma proportion. Tumor-stroma proportion was estimated based on slides used in routine pathology for determination of T status and was described as low, with a stromal percentage ?50% or high, with a stromal percentage >50%. The tumor-stroma proportion was estimated by two observers, and the inter-observer agreement was assessed. Results: The sample included 390 colorectal adenocarcinoma patients. Stroma-rich tumors were observed in 53.3% of cases. Well-differentiated tumors had the lowest stromal proportions (p = 0.028). Stroma-poor tumors showed less depth of invasion (p<0.001). High stromal content was observed in association with tumor budding, perineural, angiolymphatic, and lymph node involvement, and distant metastasis (p?0.001). Colorectal adenocarcinoma without lymph node or distant metastasis involvement had lower stromal proportion, while metastatic ones exhibited high stromal content (p <0.001). The inter-rater reliability (concordance) between the estimations of pathologists for tumor-stroma proportions was high (?=0.746). Conclusion: The tumorstroma proportion in colorectal adenocarcinoma was associated with adverse prognostic factors, reflecting the stage of the disease. Stroma-rich tumors showed a significant correlation with advancement of the disease and its aggressiveness. Due to its availability tumor-stroma proportion evaluation has high application potential and can complement current staging system for colorectal adenocarcinoma.

Characterization of elderly people with an intestinal stoma at a reference center in the state of Bahia

Objective: To characterize the elderly patients with intestinal stoma, enrolled in a Reference Center of the public health network of the state, regarding sociodemographic and clinical aspects. Method: This is a cross-sectional descriptive study with a sample of 33 elderly patients with intestinal stoma who met the inclusion criteria. Data were extracted from the medical record, interview and evaluation of the stoma and surrounding skin, analyzed through descriptive statistics. Results: patients underwent surgery in public and private hospitals, 54.5% were female, 51.6% married or in stable union, mean age was 68.03 (± 7.2) years, 69.7% had cancer as a cause of the stoma, 66.7% were temporary and 81.8% were colostomies. There was a predominance of stomas with a regular and round shape, diameter between 10 and 64 mm and a mean protrusion of 2.79 mm (± 5.1), use of a drainage bag with a cut greater than the stoma, 51.5% for stoma and device care. Conclusion: the study allowed to identify the profile of the elderly with intestinal stoma, which will allow the adjustment of the specialized assistance planning and the provision of collecting equipment and adjuvants in the context of the state.

Caracterização dos idosos com estomia intestinal atendidos em centro de referência do estado da Bahia

Objetivo: Caracterizar, quanto aos aspectos sociodemográficos e clínicos, os pacientes idosos com estomia intestinal cadastrados em um Centro de Referência da rede pública de saúde. Métodos: Trata-se de uma pesquisa descritiva, transversal, com amostra de 33 pacientes idosos com estomia intestinal que atenderam aos critérios de inclusão. Os dados foram extraídos do prontuário, da entrevista e avaliação da estomia e pele ao redor, analisados por meio da estatística descritiva. Resultados: Os pacientes realizaram cirurgia em hospitais públicos e privados, 54,5% eram do sexo feminino, 51,6% casados ou em união estável, média de idade de 68,03 (± 7,2) anos, 69,7% tiveram câncer como causa da estomia, 66,7% eram temporários e 81,8% colostomias. Houve predomínio de estomias de formato regular e redondo, diâmetro entre 10 a 64 mm e protrusão média de 2,79 mm (±5,1), utilização de bolsa drenável com recorte maior que a estomia, 51,5% demandavam auxílio parcial ou completo para os cuidados com estomia e dispositivo. Conclusão: O estudo permitiu identificar o perfil dos idosos com estomia intestinal, o que possibilitará a adequação do planejamento da assistência especializada e da provisão de equipamentos coletores e adjuvantes no contexto do estado.