Prof. Dr. Luís Carlos Lopes-Júnior

10552 Background: The rising incidence of early-onset (EO) cancers (< 45 years) since the 1990s presents a global public health challenge. In Brazil, Hospital-Based Cancer Registries (HCR) provide essential data for understanding cancer epidemiology, encompassing diagnosis, treatment, and outcomes. This study analyzes temporal trends in EO cancer incidence rates (IR) and clinical data in Brazil from 2000 to 2019. Methods: A retrospective cohort study was conducted using data from the Brazilian HCR system (SIS-RHC). Individuals aged 19–44 years, diagnosed with malignant neoplasms (ICD-10) and treated within Brazil’s oncology network, were included. Temporal trends in cancer incidence (2000–2019) were evaluated using the Mann-Kendall test, and bivariate analyses explored associations between demographic and clinical variables. Results: A total of 701,115 individuals were included (mean age: 35 years, SD: 6.62); the cohort was predominantly female (71.9%), non-white (54%), with basic education (49%), and residing in the southeast region (44%). Family history of cancer was reported by 47%, alcohol use by 28%, and smoking by 29%. The Unified Health System (SUS) referred to 79% of cases. Breast (21%) and cervical (21%) cancers were the most prevalent malignancies, followed by non-melanoma skin cancers (8.8%) and thyroid cancer (7.3%). Colon cancer ranked seventh (2.8%). Most cases were diagnosed at localized stages (51.7%), with 28.3% regional and 19.8% metastatic. Localized diagnoses increased significantly over time. Sex differences were observed across age groups and cancer stages (p < 0.001). Annual cancer cases rose significantly from 93,714 cases (2000 to 2004) to 222,301 cases (2015 to 2019) (p < 0.001). Incidence rates (IR) increased with age and over time, rising from 5.65 (ages 19–24) and 46.80 (ages 40–44) in 2000 to 12.28 and 77.11 in 2019. Peaks in IR were observed in 2014 and 2016, reaching 17.41 (ages 19–24) and 111.42 (ages 40–44). Overall, reported cases increased by 219% during the study period. Conclusions: The incidence of EO cancers in Brazil rose by 219% between 2000 and 2019, with breast cancer as the leading malignancy. These findings emphasize the growing cancer burden among younger populations and the need for enhanced cancer registries to guide targeted EO interventions. Future population-based studies are critical to validate and expand upon these results.

Background Prostate cancer is among the most common malignancies worldwide and a leading cause of premature mortality in men. Although survival rates have improved globally, disparities persist. Here, we aim to analyze the risk factors associated with prostate cancer‐specific mortality among patients in a southeastern Brazilian state. Methods We conducted a retrospective cohort study using data from 10,556 patients diagnosed with prostate cancer between 2000 and 2016. Data were extracted from hospital‐based cancer registries linked to the state Mortality Information System. Patients were followed up for a minimum of 5 years and classified as alive, deceased from prostate cancer, or deceased from other causes. Subdistribution hazard ratios (SHRs) were estimated using Fine–Gray competing‐risks models. Results By the end of 2021, 6388 patients were alive, 1936 had died from prostate cancer, and 2232 had died from other causes. Older age increased prostate cancer‐specific mortality (SHR per 10 year increment = 1.098; 95% CI: 1.024–1.176), while distant metastasis was the strongest clinical predictor (SHR = 5.315; 95% CI: 4.676–6.041). Higher educational attainment remained statistically associated with lower prostate cancer‐specific mortality in the multivariable competing‐risks model (SHR = 0.767; 95% CI: 0.629–0.935), although the protective effect was attenuated after adjustment. Surgery (SHR = 0.382; 95% CI: 0.309–0.471) and radiotherapy (SHR = 0.477; 95% CI: 0.396–0.575) were also associated with lower cancer‐specific mortality, while hormone therapy remained associated with higher mortality, reflecting treatment selection among patients with a more advanced disease rather than a causal treatment effect. Conclusion Age, education, metastatic disease, and treatment modalities were significantly associated with prostate cancer‐specific mortality. These findings reinforce the importance for equitable access to early diagnosis pathways and curative treatment options and highlight the value of competing‐risks methods for accurately estimating prostate cancer outcomes in population‐based settings.

417 Background: The interplay between chronic inflammation and cancer progression is well established. Inflammatory markers—Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocyte-to-Lymphocyte Ratio (MLR), and C-reactive protein (CRP)—are associated with prognosis and poorer quality of life (QoL). Cancer symptom clusters (CSCs) also reflect symptom burden and impact patient well-being. This study examined the longitudinal association between inflammatory biomarkers, CSCs, and QoL in Brazilian women undergoing chemotherapy (CT) for breast cancer (BC). Methods: A prospective cohort study (2022–2024) was conducted at a cancer center in southeastern Brazil. Women ≥18 years with newly diagnosed stage I–III BC receiving outpatient CT were included. Exclusion criteria: palliative care and multiple primary tumors. Data were collected at six 21-day CT cycles, including inflammatory markers (blood tests), CSCs (Memorial Symptom Assessment Scale), and QoL (EQ-5D-3L). Analyses involved descriptive statistics, bivariate tests, and multivariate models. Results: Fifty participants (mean age 53.3±11.4) were equally diagnosed with ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC), in stages I (16%), II (62%), and III (22%). Regimens included neoadjuvant (42%) or adjuvant (58%) CT with Doxorubicin, Cyclophosphamide, and Docetaxel. Inflammatory markers rose across cycles: NLR (Glass’ delta = 0.83; p=0.013), PLR (0.92; p<0.001), MLR (0.59; p=0.001). Significant differences were observed for PLR (CT3, CT4; p=0.042) and NLR (CT5; p=0.050) between DCIS and IDC. Mean QoL was 79.36 (p=0.219). MLR correlated with anxiety/depression (EQ-5D D5, CT3; p=0.028) and decreased usual activities (D3, CT6; p=0.019). CSCs identified included: i) Cluster 1 (emotional): concentration issues, nervousness, insomnia, sadness, worry, irritability (affecting D2, D3, D5; all p<0.001); ii) Cluster 2 (somatic): pain, fatigue, dry mouth (impacting D4, D5; p<0.001); iii) Cluster 4 (gastrointestinal): nausea, appetite loss, taste changes, bloating, weight loss, diarrhea—emerging at CT6—worsened all QoL domains (p<0.001). Conclusions: Progressive inflammation and persistent emotional, somatic, and gastrointestinal CSCs significantly compromised QoL during CT. Monitoring biomarkers and symptom clusters may enable earlier, targeted interventions to improve patient outcomes. Further research is needed to confirm findings and inform supportive care strategies.

e13830 Background: Cancer disparities persist among Indigenous populations due to socio-demographic, cultural, and environmental factors. In Brazil, limited healthcare access contributes to late diagnoses and worse outcomes. While cancer trends have been extensively studied in the general population, evidence on Indigenous adults remains scarce. This study evaluates temporal trends in cancer incidence among Indigenous adults in Brazil from 2000 to 2018, using data from the Brazilian Hospital-based Cancer Registry (HbCR), and compares findings with estimates from the Brazilian Demographic Census. Methods: A retrospective cohort study was conducted using HbCR (SIS-RHC) data. The cohort included Indigenous individuals aged ≥18 years, diagnosed with malignant neoplasms (ICD-10), and treated within the Brazilian Unified Health System (SUS). Temporal trends in cancer incidence were assessed using the Mann-Kendall test, with bivariate analyses evaluating associations between variables. Cumulative incidence rates (CIR) were calculated based on the Brazilian Demographic Census of 2000 and 2010. Results: Among 3,701 Indigenous individuals (mean age: 56.91 years, SD: 16.22), 58.61% were female, 51.44% had elementary education, and 32.14% resided in the Northeast. Family history of cancer was reported by 35.22%; 62.19% did not consume alcohol, and 53% were non-smokers. Multiple primary tumors were absent in 96.93% of cases. The most common cancers were cervical (19.02%) and breast (11.51%), followed by non-melanoma skin (10.81%) and prostate (8.46%) cancer. Most cases were localized (stages I–II, 35.38%), while 33.71% were regional (stage III) and 30.92% metastatic (stage IV). Diagnoses at localized and regional stages (I–III) increased significantly (p < 0.001). Significant differences were observed across sexes and age groups (p < 0.001). Annual cancer case counts rose significantly from 2000 to 2018 (S = 113; p < 0.001), with 337 cases (8.84%) reported from 2000–2004, 982 (26.53%) from 2005–2009, 849 (22.94%) from 2010–2014, and 1,238 (33.45%) from 2015–2018. Overall, cases increased by 378.59% during the study period. The CIR calculated for the period, were as follows: 2000 to 2009: 169.59 cases/100,000 Indigenous individuals; and 2010 to 2018: 188.05 cases/100,000 Indigenous individuals. Conclusions: Cancer incidence among Indigenous adults in Brazil increased substantially from 2000 to 2018, with cervical and breast cancers being the most prevalent. Despite improvements in early detection, a significant proportion of cases remain diagnosed at advanced stages. These findings highlight the need for targeted public health efforts to improve screening, early diagnosis, and access to culturally tailored cancer care. This study provides critical insights to inform future cancer prevention and control efforts tailored to Indigenous populations in Brazil.

e24045 Background: Chronic inflammation and cancer share a complex relationship. Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocyte-to-Lymphocyte Ratio (MLR), and C-reactive protein (CRP) are reliable biomarkers linked to inflammation and cancer prognosis. Elevated levels correlate with poorer quality of life (QoL). Research on cancer symptom clusters (CSC) may elucidate mechanisms and improve symptom management, particularly regarding QoL. This study assessed associations between inflammatory biomarkers, CSCs, and QoL in Brazilian breast cancer (BC) patients under chemotherapy (CT). Methods: A longitudinal study at a southeastern Brazil cancer center (2022-2024) included newly diagnosed women (≥18 years) with stage I-III BC under outpatient CT. Exclusion criteria: palliative care and >1 primary tumor. Data collection occurred before CT-infusion including: blood samples for inflammatory biomarker analysis, CSC data (MSAS), and QoL scores (EQ-5D-3L) were collected across six 21-day CT-cycles. Descriptive, bivariate, and multivariate analyses were held. Results: Fifty BC patients (mean age: 53.3±11.4) were followed. Diagnoses included invasive ductal carcinoma (IDC) (50%) and non-IDC (50%), with stages I (16%), II (62%), and III (22%). Adjuvant therapy regimens for breast cancer included anthracycline in 42% of patients, while 58% received nonanthracycline therapy . Effect sizes (Glass' delta) were large for NLR (0.83 [0.03-1.62]) and PLR (0.92 [0.25-1.57] and moderate for MLR (0.59 [0.22-0.96]). NLR (p=0.013), PLR (p<0.001), and MLR (p=0.001) increased significantly during CT1-CT6 cycles, indicating inflammation and poor prognosis. Differences emerged between IDC and non-IDC for PLR at CT3 (p=0.042) and CT4 (p=0.042), and NLR at CT5 (p=0.05). QoL averaged was 79.36 (p=0.219). MLR impacted D5-Anxiety/Depression at CT3 (p=0.028) and D3-Usual Activities at CT6 (p=0.019). Predominant CSCs during CT1-CT5 included: Cluster-1 (emotional): concentration issues-nervousness-insomnia-sadness-worry-irritability; and Cluster-2 (somatic): pain-fatigue-dry mouth. At CT6, Cluster-2 persisted, joined by Cluster-4 (gastrointestinal): nausea-appetite loss-taste changes-bloating-weight loss-diarrhea. Cluster-1 impacted D2 (p<0.001), D3 (p<0.001), and D5 (p<0.001). Cluster-2 affected D4 (p<0.001) and D5 (p<0.001). Clusters-2 and 4 worsened all QoL domains at CT6 (p<0.001). Conclusions: Emotional, somatic, and gastrointestinal CSCs significantly impaired QoL during CT. Inflammatory biomarkers progressively increased, reflecting poor prognosis and QoL impact. CSC and biomarker research may provide insights into the complex biological networks underpinning cancer symptoms, supporting personalized care, enabling early interventions to manage CT side effects.