Tumores mamários malignos em cadelas : estudo retrospetivo de 30 casos em dois contextos clínicos diferentes
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2023
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Os tumores mamários em cadelas são ainda frequentes em Portugal e noutros países do Sul da Europa. Para este tipo de tumores, as terapêuticas pouco têm evoluído nos últimos anos. A sua caracterização e a influência de diversos fatores clínicos e histopatológicos, na resposta à terapêutica e na sobrevida dos animais, são áreas que justificam mais investigação. O objetivo deste trabalho foi fazer essa caracterização, em dois contextos clínicos distintos e avaliar os fatores de prognóstico, a sobrevida e a evolução da doença, tendo em conta os mesmos. Foi estudada, de forma retrospetiva, uma série de trinta cadelas com tumores mamários malignos. Destas, dezasseis eram provenientes de um hospital universitário e catorze de um hospital pertencente a uma rede internacional. Os animais, foram intervencionados cirurgicamente entre novembro de 2017 e abril de 2022. Os casos provenientes destes dois centros, apresentavam todos ficha clínica e relatório histopatológico, disponíveis para consulta e recolha de dados. Foi organizada uma base de dados a que se aplicaram os métodos estatísticos clássicos, inferencial e a análise de Kaplan-Meier. O tempo médio de permanência no estudo foi de 8,92 meses na população total, de 12,39 meses no HVS e de 5,58 meses no HFMVUL. Globalmente, o tamanho do nódulo superior a 5 cm teve uma correlação negativa (p=0,002) com a sobrevida. O grau histológico de malignidade teve uma correlação negativa com a sobrevida (p=0,001) e positiva com o aparecimento de metástases (p=0,001). No estadiamento TNM, os estádios III, IV e V, tiveram uma menor sobrevida, na margem da significância (p=0,066). A quimioterapia mostrou uma correlação positiva com a sobrevida (p=0,014). Nas amostras provenientes dos dois contextos clínicos, verificou-se que existiam diferenças em algumas características. Quanto à raça, os animais sem raça definida predominaram no HFMVUL (p=0,008). O nódulo mamário, como principal motivo da consulta, foi mais frequente no HFMVUL (p=0,018). Quanto ao tamanho do nódulo, no HVS predominaram os nódulos inferiores a 3 cm (p=0,003). Os exames complementares de estadiamento, foram mais vezes executados no HFMVUL: radiografia torácica (p=0,010) e ecografia abdominal (p=0,001). A escolha da técnica cirúrgica realizada, foi diferente nos dois CAMVs. No HFMVUL foi mais utilizada a mastectomia radical unilateral (68,8%) e no HVS foi a mastectomia regional (42,9%). A excisão completa do tumor foi mais frequente no HVS (p=0,001) e a excisão do gânglio linfático foi mais frequente no HFMVUL (p=0,003). A terapêutica adjuvante com quimioterapia foi feita em sete casos no HVS e em nenhum no HFMVUL. As metástases, quer no gânglio quer à distância, apenas ocorreram no HFMVUL. Estes dados, apontam para uma maior malignidade dos casos do HFMVUL. Foi comparada a percentagem de animais, do HVS e do HFMVUL, que permaneceram no estudo ao longo do tempo. Aos 6 meses, era de respetivamente 57,1% e 18,8% (p=0,029). Aos 12 meses era de 42,9% e 12,5% (p=0,061). Aos 24 meses era de 28,6% e 6,3% (p=0,102). Verifica-se, assim, uma atenuação da diferença entre os dois CAMVs, ao longo do estudo. A curva de sobrevida de Kaplan-Meier não mostrou diferença, entre os dois CAMVs. Este estudo permitiu a caracterização clínica, histopatológica, dos fatores de prognóstico e do tempo de sobrevida nesta população de cadelas com tumor mamário. Verificando-se que o contexto dos animais influencia a abordagem clínica e terapêutica. Palavras-Chave: tumores mamários em cadelas; apresentação clínica; mastectomia; classificação histopatológica; quimioterapia
Canine mammary tumours are a very common neoplasms in south European countries. In veterinary medicine CMT treatment has not evolve in the last years. The clinical and histopathologic factors have influence on the therapeutics response and survival time. Therefore, the continuous investigation on the matter is justifiable. The aim of this study was to characterize thirty cases of CMT, evaluate the prognostic factors and the influence in the survival time and disease progression. The present study evaluated thirty cases of female dogs, all of them have been diagnosed with CMT and have been already operated. This was a retrospective study where all the animals had clinical records and histopathologic report. A database was organized with the information of two veterinary hospitals, fourteen from the HVS and sixteen from the HFMVUL. For the statistical analysis classic and inferential methods were applied, as well the Kaplan-Meier curve. The mean time for the length of stay in the study was 8.92 months in the total population. Animals from the HVS stayed 12.39 months, and from the HFMVUL 5.58 months. Nodule size bigger than 5 cm had a negative correlation (p=0.002). The degree of malignancy had a negative correlation with survival (p=0.001) and a positive correlation with the appearance of metastases (p=0.001). In the TNM staging, stages III, IV and V had a lower survival, at the margin of significance (p=0.066). And a positive correlation with chemotherapy (p=0.014). In the samples from the two clinical, it was found differences in some characteristics. As for race, mixed-breed animals predominated in the HFMVUL (p=0.008). The tumour as the main reason for consultation, was more frequent in the HFMVUL (p=0.018). In the HVS in most cases, the nodules size was smaller than 3 cm (p<0.001), and in the HFMVUL, those equal to or greater than 5 cm were more common (p<0.001). In the HFMVUL, there was a greater number of cases with a higher degree of malignancy (p=0.013). The number of cases with higher TNM stages was also higher in HFMVUL (p=0.003). Image staging tests were performed more often at the HFMVUL thoracic radiography (p=0.010) and abdominal ultrasound (p=0.001). The choice of surgical technique performed was different in the two CAMVs. In the HFMVUL the unilateral radical mastectomy was used more times (68.8%), and in the HVS it was regional mastectomy (42.9%). Complete tumour excision was more frequent in HVS (p=0.001), and lymph node excision was more frequent in HFMVUL (p=0.003). Adjuvant therapy with chemotherapy was performed in seven cases in the HVS and in none in the HFMVUL. Metastases, whether in the ganglion or at a distance, only occurred in the HFMVUL. These data point to a greater malignancy of HFMVUL cases. The percentage of animals, from the HVS and from the HFMVUL, that remained in the study over time was compared. At 6 months, it was respectively 57.1% and 18.8% (p=0.029). At 12 months it was 42.9% and 12.5% (p=0.061). At 24 months it was 28.6% and 6.3% (p=0.102). Thus, there is an attenuation of the difference between the two CAMVs throughout the study. The Kaplan-Meier survival curve showed no difference between the two CAMVs. This study allowed the clinical and histopathological characterization of prognostic factors and survival time in this population with canine mammary tumour. Noting that the context of the animals influences the clinical and therapeutic approach. Key-words: Canine mammary tumours; clinical presentation; mastectomy; histopathological classification; chemotherapy
Canine mammary tumours are a very common neoplasms in south European countries. In veterinary medicine CMT treatment has not evolve in the last years. The clinical and histopathologic factors have influence on the therapeutics response and survival time. Therefore, the continuous investigation on the matter is justifiable. The aim of this study was to characterize thirty cases of CMT, evaluate the prognostic factors and the influence in the survival time and disease progression. The present study evaluated thirty cases of female dogs, all of them have been diagnosed with CMT and have been already operated. This was a retrospective study where all the animals had clinical records and histopathologic report. A database was organized with the information of two veterinary hospitals, fourteen from the HVS and sixteen from the HFMVUL. For the statistical analysis classic and inferential methods were applied, as well the Kaplan-Meier curve. The mean time for the length of stay in the study was 8.92 months in the total population. Animals from the HVS stayed 12.39 months, and from the HFMVUL 5.58 months. Nodule size bigger than 5 cm had a negative correlation (p=0.002). The degree of malignancy had a negative correlation with survival (p=0.001) and a positive correlation with the appearance of metastases (p=0.001). In the TNM staging, stages III, IV and V had a lower survival, at the margin of significance (p=0.066). And a positive correlation with chemotherapy (p=0.014). In the samples from the two clinical, it was found differences in some characteristics. As for race, mixed-breed animals predominated in the HFMVUL (p=0.008). The tumour as the main reason for consultation, was more frequent in the HFMVUL (p=0.018). In the HVS in most cases, the nodules size was smaller than 3 cm (p<0.001), and in the HFMVUL, those equal to or greater than 5 cm were more common (p<0.001). In the HFMVUL, there was a greater number of cases with a higher degree of malignancy (p=0.013). The number of cases with higher TNM stages was also higher in HFMVUL (p=0.003). Image staging tests were performed more often at the HFMVUL thoracic radiography (p=0.010) and abdominal ultrasound (p=0.001). The choice of surgical technique performed was different in the two CAMVs. In the HFMVUL the unilateral radical mastectomy was used more times (68.8%), and in the HVS it was regional mastectomy (42.9%). Complete tumour excision was more frequent in HVS (p=0.001), and lymph node excision was more frequent in HFMVUL (p=0.003). Adjuvant therapy with chemotherapy was performed in seven cases in the HVS and in none in the HFMVUL. Metastases, whether in the ganglion or at a distance, only occurred in the HFMVUL. These data point to a greater malignancy of HFMVUL cases. The percentage of animals, from the HVS and from the HFMVUL, that remained in the study over time was compared. At 6 months, it was respectively 57.1% and 18.8% (p=0.029). At 12 months it was 42.9% and 12.5% (p=0.061). At 24 months it was 28.6% and 6.3% (p=0.102). Thus, there is an attenuation of the difference between the two CAMVs throughout the study. The Kaplan-Meier survival curve showed no difference between the two CAMVs. This study allowed the clinical and histopathological characterization of prognostic factors and survival time in this population with canine mammary tumour. Noting that the context of the animals influences the clinical and therapeutic approach. Key-words: Canine mammary tumours; clinical presentation; mastectomy; histopathological classification; chemotherapy
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VETERINARY MEDICINE, MAMMARY TUMORS, DOGS, MASTECTOMY, HISTOPATHOLOGY, CHEMOTHERAPY, MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, MEDICINA VETERINÁRIA, NEOPLASIAS MAMÁRIAS, CÃES, MASTECTOMIA, HISTOPATOLOGIA, QUIMIOTERAPIA, Mestrado Integrado em Medicina Veterinária