[Evolution of the incidence and survival of bronchogenic carcinoma in the province of Castellón (Spain) from 2004 to 2017.] / Evolución de la incidencia y supervivencia del carcinoma broncogénico en la provincia de Castellón en el periodo de tiempo 2004-2017.

OBJECTIVE: Bronchogenic carcinoma (BC) is the second most frequent worldwide and the most lethal tumour in both sexes. Its incidence varies not only among countries but also among different areas of the same country. So, the aim of this work was to analyse the evolution of its incidence and survival in the province of Castellón from 2004 to 2017 and to compare them with those of de rest of the country. METHODS: A retrospective observational study was carried out from patients diagnosed with BC and registered in the Castellón Tumour Register from 2004 to 2017. Survival was estimated using the Kaplan-Meier method whereas to estimate the relationship among different variables both the chi-square and ANOVA test were used. RESULTS: 4,346 cases were diagnosed, whose mean age was 67.5±11.3 years, 85.2% men, the most frequent histological types were adenocarcinoma (28.3%) and epidermoid carcinoma (25.1%). The gross global incidence was 53.4 cases/105 inhabitants, 90.9 cases/105 men and 15.7 cases/105 women. Median global survival at five years was 12.7%, 12% in men and 18.4% in women. CONCLUSIONS: The global incidence of BC in Castellón is lower than the national one, having remained stable in men while it is double in women. Global survival at five years is less than 15%, being higher in women than in men, nevertheless it increases compared to that of previous studies.

OBJETIVO: El carcinoma broncogénico (CB) es el segundo tumor más frecuente a nivel mundial y el más letal en ambos sexos. Su incidencia varía, no sólo entre países, sino también entre diferentes zonas de un mismo país. Por tanto, el objetivo de este trabajo fue analizar la evolución de su incidencia y la supervivencia en la provincia de Castellón desde 2004 hasta 2017, y compararlas con las del resto del país. METODOS: Se realizó un estudio observacional retrospectivo en pacientes diagnosticados de CB e inscritos en el Registro de Tumores de Castellón desde 2004 hasta 2017. La supervivencia se estimó mediante el método de Kaplan-Meier, mientras que para estimar la relación entre distintas variables se utilizaron los test Chi-cuadrado y ANOVA. RESULTADOS: Se diagnosticaron 4.346 casos, con una edad media de 67,5±11,3 años, el 85,2% eran hombres, los tipos histológicos más frecuentes fueron adenocarcinoma (28,3%) y carcinoma epidermoide (25,1%). La incidencia global bruta fue de 53,4 casos/105 habitantes, con 90,9 casos/105 de hombres y 15,7 casos/105 de mujeres. La mediana de supervivencia global a los cinco años fue del 12,7%, siendo del 12% en hombres y del 18,4% en mujeres. CONCLUSIONES: La incidencia global de CB en Castellón es inferior a la nacional, habiéndose mantenido estable en hombres mientras que se duplica en mujeres. La supervivencia global a los cinco años es inferior al 15%, siendo mayor en mujeres que en hombres; no obstante, aumenta respecto a la reportada en estudios previos.

Outbreak of multidrug-resistant tuberculosis in two secondary schools.

OBJECTIVES: To describe an outbreak of multidrug-resistant tuberculosis (MDR-TB) in two schools METHODS: This was a prospective, observational study of an outbreak of MDR-TB in 2 schools located in the towns of Onda and Nules, in the Spanish province of Castellon, from the moment of detection in November 2008 until November 2014, including patient follow-up and contact tracing. RESULTS: Five cases of MDR-TB were diagnosed. Overall attack rate was 0.9%, and among the contacts traced, 66 had latent tuberculous infection, with an infection rate of 14.4%. Molecular characterization of the 5M. tuberculosis isolates was performed by restriction fragment length polymorphism (RFLP) analysis of the IS6110 sequence. In all 5 patients, cultures were negative at 4-month follow-up, showing the efficacy of the treatment given. No recurrence has been reported to date. CONCLUSIONS: In the context of globalization and the increased prevalence of MDR-TB, outbreaks such as the one presented here are only to be expected. Contact tracing, strict follow-up of confirmed cases, the availability of fast diagnostic techniques to avoid treatment delay, and chemoprophylaxis, together with the molecular characterization of strains, are still essential.

Tumor, node and metastasis classification of lung cancer--M1a versus M1b--analysis of M descriptors and other prognostic factors.

INTRODUCTION: The current edition of the tumor, node and metastasis (TNM) classification of lung cancer (LC) divides the presence of metastasis (M1) into two categories: M1a and M1b, depending on its anatomical location. To assess this new classification, the survival and the M descriptors of LC patients with metastatic disease registered by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery II (GCCB-S-II), were analyzed. METHODS: Non-small cell lung cancer (NSCLC) patients, with M1a or M1b disease, included in the GCCB-S-II, from April 2009 to December 2010, staged in accordance with the prospective staging project protocol of the International Association for the Study of Lung Cancer (IASLC), and with complete TNM staging and follow-up data, were studied. The overall survival associated with each M1 category and each M descriptor, besides other prognostic factors (sex, age, performance status [PS] and others) were analyzed by univariate and multivariate models. RESULTS: 640 NSCLC patients (195 M1a and 445 M1b) were included. M1b tumors had significantly worse survival than M1a tumors (p < 0.001). The prognostic value of M1 category was independent from other prognostic variables such as PS, weight loss, and others. The number of metastatic sites (isolated versus multiple) and the number of lesions (single versus multiple) in patients with isolated metastasis showed prognostic value, especially in those with brain metastasis. CONCLUSION: The current division of the M1 category into two subsets (M1a and M1b) is warranted by their prognostic significance. The number of metastatic sites and the number of lesions in patients with isolated metastasis should be taken into account, because they also have prognostic relevance.

The Spanish Society of Pulmonology and Thoracic Surgery Lung Cancer Cooperative Group-II registry. A descriptive study.

INTRODUCTION AND OBJECTIVES: The seventh edition of the TNM classification, together with undeniable advantages, has limitations. The International Association for the Study of Lung Cancer (IASLC) Staging Committee has designed an international prospective study to improve this classification. A group of thoracic surgeons and pulmonologists was established in the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) Oncology area, and created a registry of new lung cancer (LC) cases to participate in this project. The aim of this paper is to describe the main characteristics of the patients included. MATERIALS AND METHODS: Prospective, observational, multicentre, multiregional data collection (epidemiological, clinical, therapeutic and, especially, anatomical extension) study, according to the IASLC protocol, to analyse its prognostic value. RESULTS: Two thousand, four hundred and nineteen patients (83.6% men) from 28 hospitals were included. Ninety-six percent of the men and 54% of the women were smokers or ex-smokers. Chest/abdominal computed tomography (CT) scanning was performed in over 90% and positron emission tomography (PET)/CT scanning in 51.5% of cases. Among the 1035 patients who underwent surgery, 77% had early stages (ia to iib), and 61.6% of those treated using other methods had stage iv. Respiratory comorbidity was higher in men (47.9% versus 21.4%). The most common histological subtype was adenocarcinoma (34%), especially in non-smoking women (69.5%). CONCLUSIONS: The proportion of women and adenocarcinomas, as well as those resected at an early stage, increased among LC cases in Spain.

[The EpicliCP-2003 study: A multicenter epidemiological and clinical study of lung cancer in Spain]. / Estudio multicéntrico epidemiológico-clínico de cáncer de pulmón en España (estudio EpicliCP-2003).

OBJECTIVE: Mortality due to lung cancer in Spain is increasing continuously. The aim of the present study was to collect information on the hospital incidence of lung cancer, as well as information on clinical management, in different regions of Spain. MATERIAL AND METHODS: A prospective observational study of patients diagnosed with lung cancer in 2003 was carried out in 13 centers in 9 autonomous communities. Epidemiological, clinical, diagnostic, and therapeutic variables were assessed. RESULTS: Of a total population of 2,726,601 inhabitants (1 346 483 men and 1 380 118 women), 1064 male and 125 female lung cancer patients were included. The incidence standardized to the world population varied between 42.4/100,000 and 61.8/100,000 in men and between 1.5/100,000 and 8.6/100,000 in women. Overall, 51% were aged over 70 years, and 97.5% of the men and 32% of the women were smokers or ex-smokers. Cytologic or histologic confirmation was obtained for 93.1% of the cases (20.8% of which were small cell lung cancers and 79.2% were non-small cell lung cancers). The main initial symptoms were cough, chest pain, and weight loss. In 13.7%, lung cancer was suspected because of abnormal chest x-ray. The percentage with clinical TNM stages I and II ranged from 6.3% to 26.9%. The most common stage was stage IV in all centers. The percentage of patients undergoing surgery ranged from 2.5% to 20.6%, with a mean of 14.8% (19.9% of whom were patients with non-small cell lung cancer); 27% received palliative treatment only. CONCLUSIONS: The proportion of women suffering from lung cancer increased with respect to previous studies, with notable differences among regions. Despite diagnostic improvements, the percentage of patients undergoing surgery is low, though interregional variation is considerable.