Introduction The partnership between the Brazilian Society of Cellular Therapy and Bone Marrow Transplantation (SBTMO) and the Center for International Bone Marrow Transplant Research (CIBMTR) enabled the establishment of the Brazilian Registry of Hematopoietic Cell Transplantation and Cellular Therapy (RBTCH-TC). Although the number of transplant centers participating in the RBTCH-TC has increased over time, consistent and complete reporting of patient follow-up data remains a challenge. Maintaining adequate follow-up is essential for robust clinical research and accurate outcome assessment. Objective To evaluate follow-up data completeness among Brazilian centers in the RBTCH-TC using the Completeness Index Calculation (CIC) and to identify centers with suboptimal follow-up guiding targeted interventions to improve follow up reporting. Methods All allogeneic transplants performed in Brazil between 2012 and 2023 and reported to the RBTCH-TC were included. The RBTCH-TC receives standardized transplant data from Brazilian centers through the CIBMTR Data Back to Center platform. Follow-up completeness was assessed using the CIC, defined as the ratio of observed to potential follow-up time (CIC = 1 for patients followed until the expected period or death; CIC < 1 for incomplete follow-up). Centers with median CIC ≥ 0.90 were considered to have adequate follow-up, following CIBMTR’s Transplant Center Specific Analysis. Each center received their CIC scores from the RBTCH-TC. Centers with adequate follow-up were publicly recognized at the SBTMO Annual Meeting, while those below the adequate threshold were contacted to update their follow-up data. Analyses were performed at two time points to evaluate changes following center outreach. Results As of July 2025, the RBTCH-TC had recorded 6,415 baseline transplant evaluations from 41 centers. Median follow-up for survivors was 24.3 months. Most centers (n=25; 61%) had a median CIC ≥0.90, while 16 centers (39%) had lower CIC values. After targeted outreach, 7 of these 16 centers improved their median CIC to ≥ 0.90, increasing the total number of centers with adequate follow-up from 25 to 32. Median follow-up time for survivors also increased from 24.3 to 28.9 months, and the proportion of completed follow-up forms at each interval improved consistently between July 1 and October 2, 2025 (Figure 1). Conclusion The use of CIC effectively identified RBTCH-TC centers with adequate and inadequate follow-up completeness. Both public recognition of centers achieving high follow-up quality data and direct engagement with those below the threshold led to measurable improvements in completeness across all time points. This initiative demonstrates how systematic monitoring and feedback can optimize registry data quality, enhance research potential, and strengthen understanding of hematopoietic transplantation outcomes in Brazil.
Background Acral cutaneous melanoma (ACM) is an aggressive skin cancer, especially when diagnosed in the advanced stage. The Ki-67 is a rapid tool for proliferation rate analysis. Previous data indicated that its staining pattern is distinct during the several stages of the cell cycle among epithelial cells. Objective To evaluate the prognostic impact of Ki-67 expression pattern classification among advanced acral cutaneous melanoma cases. Methods Two pathologists classified staining nuclear patterns of Ki-67 in the hot spot of scanning slides of advanced ACM (pT4): NP1 (randomly Ki-67 immunopositive fine or coarse granules), NP2 (Ki-67 stained in one or two well defined and centralized nodules), NP3 (Ki-67 seen as granules or nodules occupying most of the nucleus), NP4 (nucleoplasm with intense and homogeneous Ki-67 staining) and NP5 (empty central area with peripheral Ki-67). For analysis, seven cases per group ‒ Alive (Al) and Melanoma-Related Death (De) ‒ were randomly selected. Results This pilot study analyzed 5676 Ki-67 positive nuclei. Means comparison between the two groups revealed differences in nuclear patterns NP1 (p = 0.0014), NP4 (p = 0.038), NP5 (p = 0.0193), and the total number of stained nuclei (p = 0.0258). Study limitations Small number of cases and biased value of 6.35 through the Bland-Altman analysis. Conclusion The present analysis highlights the importance of Ki-67 staining patterns as a potential prognostic marker among ACM. High Ki-67 positive nuclei were associated with worse outcomes (death), particularly in staining patterns before and after mitosis (NP1, NP4, and NP5).
Although ovarian cancer is the most lethal among gynecological cancers, access to massive BRCA testing is still limited. Its cost-effectiveness is still a topic of discussion in several countries. In Brazil, olaparib was recently incorporated into the public health system, access to BRCA testing is still limited. In this article, we aim to review the cost-effectiveness of offering BRCA testing to the at-risk population. A working group composed of 14 specialists in surgical oncology and cancer genetics was established to discuss the cost-effectiveness of population-based BRCA testing for ovarian cancer. The project was divided into five main areas, each with subtopics assigned among the 14 participants. They were: the existing clinical testing guidelines, the current healthcare infrastructure in the Brazilian public health system, cost-effectiveness analysis, challenges in implementing prophylactic surgeries, and family counseling and risk communication. A comprehensive literature review was conducted, followed by a series of meetings among the article's contributors to reach consensus on unresolved issues. These discussions aimed to build recommendations based on the best available scientific evidence. Using as a basis the current structure already existing within the Brazilian public health service (SUS [Sistema Único de Saude]), and based on the testing of the at-risk population chosen by our experts, we estimated savings. The net savings for a population of 100 000 women would range from BRL 7030.30 (US$1255.41) to BRL 1853.92 (US$331.05). And these costs could have an even greater impact when public service PARP inhibitors are incorporated. The working group of the Brazilian Society of Surgical Oncology understands that large-scale BRCA testing is cost-effective, especially when risk-reducing surgery is implemented. Other measures are important, such as training teams of non-specialists to recognize the population at risk, in addition to creating an entire line of care for patients with ovarian cancer in the SUS.
