[The prognosis of mediastinal lymph node infiltration (N2) in patients with non-small-cell lung carcinoma (NSCLC) who have undergone curative treatment]. / Pronóstico de la infiltración ganglionar mediastínica (N2) en pacientes con carcinoma de pulmón de células no microcelulares (CPCNM) intervenidos con intenciones curativas.

In this prospective study of 148 surgically treated patients with non-small cell carcinoma of the lung (NSCLC) who were followed for 5 to 7 years, we analyzed the prognostic value of mediastinal lymph node invasion (N2) and survival after 5 years depending on different characteristics. Forty-two (28.4%) patients were N2. Survival in this sample was 9%. Twenty-seven T2N2 patients (among whom survival was 13%) were selected from this group and classified according to whether lymph node invasion was intranodal (survival 39%) or extracapsular (survival 5%) (p < or = 0.05). We also evaluated the prognostic value of different ganglionic areas in accordance to the maps suggested by the American Thoracic Society (ATS). There were no survivors for areas 2, 8 and 9, and no patient with invasion of more than two areas lived more than 18 months. Significant differences in survival were found among patients with invasion of areas 10 and 11. We conclude a) that global analysis of N2 is of such little value in predicting survival that surgery is not justified unless screening criteria are applied; b) that extracapsular invasion rules out surgical treatment; c) that the prognostic value of ganglionic areas is not entirely clear, although the prognosis seems to be poorer for invasion of areas 2, 8 and 9 or invasion of more than 2 areas, and d) that invasion of area 10 would appear to be better classified as N2 than as N1.

[The role of computed tomography (CT) of the thorax in defining the anatomical extent in bronchogenic carcinoma (BC)]. / Papel de la tomografía computarizada (TC) de tórax en la definición de la extensión anatómica en el carcinoma broncogénico (CB).

A series of 129 carriers of non-small cell bronchogenic carcinoma (BC), in whom computed tomography (CT) of the thorax was performed as part of the preoperative study, are presented. The results of CT were compared with those of thoracotomy in terms of sensitivity (SEN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV). Thoracic wall (prevalence 0.18): SEN, SP, PPV and NPV were 0.65, 0.92, 0.63 and 0.92, respectively. In peripheral tumors these values were 0.85, 0.90, 0.69 and 0.96, respectively. CT demonstrating invasion of the thoracic wall thus requires confirmation for the purpose of surgical staging. If CT reveals an intact wall, however, surgery may take place immediately. Malignant mediastinal lymph nodes: (prevalence 0.36): SEN, SP, PPV, and NPV were 0.70, 0.89, 0.78 and 0.84, respectively. For peripheral tumors these values were 0.78, 0.93, 0.82 and 0.91, respectively. CT demonstrating malignant mediastinal lymph nodes should be confirmed by mediastinoscopy. If mediastinal malignancy is not observed by CT, thoracotomy may be performed in peripherally located tumors; in centrally located tumors, however, the absence of adenopathy should be confirmed by mediastinoscopy.

[A multivariate prospective study of prognostic factors in non-small-cell lung carcinoma (NSCLC): the results at 5 years]. / Estudio prospectivo multivariante sobre factores pronósticos en el carcinoma de pulmón no microcelular (CPNM): resultados a 5 años.

We present the results of a 5-year prospective study of 153 patients with a diagnosis of bronchogenic carcinoma (BC) who underwent curative surgery. Clinical and anatomical variables were analyzed by multiple regression analysis for prediction of death. Among the anatomical variables, the most significant were the following: stages of anatomical spread (p < or = 0.00000), ganglionic state (p < or = 0.00000), type for surgery (curative or non-curative) (p < or = 0.00000) and state of tumor (p = 0.00012). Significant clinical variables were clinical stage by Feinstein's classification (p = 0.00037), functional capacity (ECOG scale) (p = 0.01196) and tumor size measured conventionally (p = 0.01196). These variables were entered into a multivariate model for prognostic prediction in order to determine the patient's relative risk over time. The best combination of anatomical variables was obtained by associating the stages of spread and ganglionic state (chi 2 = 34.24; p = < 0.00000); the best combination of clinical variables was clinical stage and tumor size (chi 2 = 17.37; p = 0.00023). Thus, although the anatomical variables are more important than clinical ones, the latter have independent prognostic value, are easy to obtain and are available before surgery. They therefore represent an alternative to prognosis based on anatomical spread.

Condrosarcoma de pared torácica secundario a condroma de larga evolución / Chondrosarcoma of the thoracic wall secondary to long course chondroma

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