Impact of Pleural Lavage Cytology Positivity on Early Recurrence After Surgery for Non-Small Cell Lung Cancer.

OBJECTIVE: The aim of this study was to elucidate the impact of pleural lavage cytology positivity on early recurrence in patients operated on non-small cell lung cancer (NSCLC). METHODS: This is a multicentre prospective cohort study of 684 patients undergoing an anatomical lung resection for NSCLC between October 2015 and October 2017 at 12 national centres. A pleural lavage was performed before and after lung resection. The association between the different predictors of early recurrence and PLC positivity was performed using univariate and multivariate logistic regression models. A propensity score analysis was performed by inverse probability weighting (IPSW) using average treatment effect (ATE) estimation to analyse the impact of PLC positivity on early recurrence. RESULTS: Overall PLC positivity was observed in 15 patients (2.2%). After two years, 193 patients (28.2%) relapsed, 182 (27.2%) with a negative PLC and 11 (73.3%) with a positive PLC (p<0.001). Factors associated to early recurrence were adenocarcinoma histology (OR=1.59, 95%CI 1.06-2.38, p=0.025), visceral pleural invasion (OR=1.59, 95%CI 1.04-2.4, p=0.03), lymph node involvement (OR=1.84, 95%CI 1.14-2.96, p=0.013), advanced pathological stage (OR=2.12, 95%CI 1.27-3.54, p=0.004) and PLC positivity (OR=4.14, 95%CI 1.25-16.36, p=0.028). After IPSW, PLC positivity was associated with an increased risk of early recurrence (OR=3.46, 95%CI 2.25-5.36, p<0.001). CONCLUSIONS: Positive pleural lavage cytology was found to be the strongest predictor of early recurrence.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didn't find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. / Seudotumor inflamatorio y tumor miofibroblástico inflamatorio. Criterios diagnósticos y diferencias pronósticas.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didnt find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

Effect of delays on survival in patients with lung cancer.

BACKGROUND: The effect on survival of delays in the consultation, diagnostic and treatment processes of lung cancer (LC) is still under debate. The objective of our study was to analyse these time delays and their possible effect on survival. METHODS: A retrospective study has been performed on all patients in our health area diagnosed with LC (confirmed by cytohistology) over 3 years. The delay in specialist consultation (time between start of symptoms and the first consultation with a specialist), hospital delay (time between first consultation and start of treatment) and overall delay (the sum of the previous two delays) were analysed. The influence of each of these delays was calculated using Cox regression, adjusted for other factors. RESULTS: A total of 415 patients were included. Of these, 92.5% were male and 75.4% were in stages III-B or IV. The overall delay gave a mean of 123.6 days, the delay in consulting a specialist 82.1 days and the delay in hospitalisation was 41.4 days. A greater overall delay or greater hospital delay was associated with longer survival. No relationship was observed between the specialist consultation delay and survival. CONCLUSIONS: Globally analysing all the cases and all the stages with LC, it is seen that longer delays are associated with longer survival. This probably reflects the fact that patients with more symptoms are treated more rapidly.

Platelet count: association with prognosis in lung cancer.

Lung cancer (LC) is now the leading cause of cancer mortality in the world, therefore it would be useful to identify prognostic factors to determine patient outcome. The objective of this study is to evaluate the usefulness of platelet counts at the time of diagnosis as a prognostic factor. A retrospective study of patients with histological diagnostic evidence of LC was carried in our catchment area over a 3-year period. Survival adjusted for other factors was assessed according to the platelet count at the time of diagnosis. Patients with platelet levels within the reference range (RR) (135000-381000/microl) were divided into two groups, between 135000-258000/microl and 258000-381000/microl. A third group was made up of patients with platelet counts over 381000/microl. Adjusted survival was analysed using Cox regression models. Patients with high platelets have a 37% worse survival than those with a platelet level within the RR, but lower than 258000/microl. When tumour stage is included in the covariates, platelet levels are no longer an independent survival factor. In conclusion, platelet levels at the time of diagnosis could be a useful prognostic factor in LC.

[Impact of hemoglobin level on lung cancer survival]. / Efecto del valor de la hemoglobina en la supervivencia del cáncer de pulmón.

BACKGROUND AND OBJECTIVE: Anemia is commonly observed in lung cancer (LC). Hemoglobin levels at the time of diagnosis could be considered a prognostic indicator in patients with LC. The aim of this trial was to analyze hemoglobin levels at the time of diagnosis as a prognostic factor in patients with LC. PATIENTS AND METHOD: We retrospectively examined all patients with LC (cytologically or histologically confirmed) diagnosed in our health area for a period of 3 years. Correlation between hemoglobin levels and survival was assessed. All patients were divided into 2 groups: patients with low hemoglobin levels (lower than percentile 25 of the distribution), and patients who exceeded that figure. By means of Cox's regression, the influence of hemoglobin levels in survival was calculated and adjusted to other factors. RESULTS: 421 patients were included, 52.2% of them presented anemia at the time of diagnosis. Mean age was 65.8 years and 92.7% were male. The group of patients with hemoglobin levels lower than percentile 25 had a survival rate that was 41% inferior. CONCLUSIONS: Low hemoglobin levels are associated with decreased survival in patients with LC. The evaluation of this parameter could be used for a more accurate prognosis in LC and a better adequacy of therapeutic indications.

[Immunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura]. / Inmunohistoquímica y vías de abordaje en el tumor fibroso pleural.

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory.

[Thoracic surgery]. / Cirugía torácica.

Thirty-two patients with shock wave lesions to the chest who did not require invasive ventilatory support were treated. The Injury Severity Score (median 13), the pO2/FiO2 ratio (350) and lung injury severity (Murray score 1.25) were analyzed. Symptoms, mainly chest pain, depended on the severity of barotrauma and respiratory distress. All the lesions developed in the first 24 hours and most patients (75%) presented lung contusion. Although patients with lung contusion had greater intra- and extrathoracic comborbidity, differences in comparison with those without lung contusion were not significant, except in length of hospital stay (13 days vs 5.5 days; p = 0.008). Costal fractures were found in 12 patients (37%), mostly in the first 3 ribs and 60% of the patients had reduction of the upper thoracic contour (traumatic apical thoracoplasty). Outcomes were satisfactory with no mortality.

[Insular carcinoma of the thyroid. An uncommon but aggressive neoplasm]. / Carcinoma insular de tiroides. Una neoplasia poco frecuente pero agresiva.

Insular carcinoma of the thyroid is an infrequent entity, named in 1984 by Carcangiu when he described its characteristic histology. Clinically and morphologically it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic carcinoma of the thyroid, and most authors advise aggressive therapy, which in some cases can achieved prolonged survival. We describe 2 patients who experienced recurrence after treatment for the primary tumor. The recurrences were treated but the clinical courses differed.