Effectiveness Evaluation of Low-dose Spiral Computed Tomography for Lung Cancer Screening in Minhang District of Shanghai / 中国肺癌杂志

BACKGROUND@#Low-dose spiral computed tomography (LDCT) has been recommended for lung cancer screening in high-risk populations. However, evidence from Chinese populations was limited due to the different criteria for high-risk populations and the short-term follow-up period. This study aimed to evaluate the effectiveness in Chinese adults based on the Lung Cancer Screening Program in Minhang District of Shanghai initiated in 2013.@*METHODS@#A total of 26,124 subjects aged 40 years or above were enrolled in the Lung Cancer Screening Program during the period of 2013 and 2017. Results of LDCT examination, and screen-detected cancer cases in all participants were obtained from the Reporting System of the Lung Cancer Screening Program. The newly-diagnosed cases and their vital status up to December 31, 2020 were identified through a record linkage with the Shanghai Cancer Registry and the Shanghai Vital Statistics. Standardized incidence ratio (SIR) and 95%CI were calculated using the local population at ages of 40 or above as the reference. Proportions of early-stage cancer (stage 0-I), pathological types, and 5-year observed survival rates of lung cancer cases were estimated and compared between the cases derived from the screened and non-screened populations. Cox regression models were applied to evaluate the hazard ratio (HR) and 95%CI of LDCT screening with all-cause death of the lung cancer cases.@*RESULTS@#The crude and age-standardized incidence of lung cancer in screened population were 373.3 (95%CI: 343.1-406.1) and 70.3 per 100,000 person-years, respectively, with an SIR of 1.8 (95%CI: 1.6-1.9), which was observed to decrease with following-up time. The early-stage cancer accounted for 49.4% of all lung cancer cases derived from the screened population, significantly higher than 38.4% in cases from the non-screened population during the same period (P<0.05). The proportion of lung adenocarcinoma (40.7% vs 35.9%) and 5-year survival rate (53.7% vs 41.5%) were also significantly higher in the cases from the screened population (all P<0.05). LDCT screening was associated with 30% (HR=0.7, 95%CI: 0.6-0.8) reduced all-cause deaths of the cases.@*CONCLUSIONS@#The participants of the screening program are at high-risk of lung cancer. LDCT favors the early-detection of lung cancer and improves 5-year survival of the screened cases, indicating a great potential of LDCT in reducing the disease burden of lung cancer in Chinese populations.

Global burden and trends of lung cancer incidence and mortality / 中华医学杂志(英文版)

BACKGROUND@#Lung cancer has been the leading cause of cancer-related deaths worldwide for many years. This study aimed to investigate the global patterns and trends of lung cancer.@*METHODS@#Lung cancer incidence and mortality were derived from the GLOBOCAN 2020 database. Continuous data from Cancer Incidence in Five Continents Time Trends were used to analyze the temporal trends from 2000 to 2012 using Joinpoint regression, and average annual percent changes were calculated. The association between the Human Development Index and lung cancer incidence and mortality was assessed by linear regression.@*RESULTS@#An estimated 2.2 million new lung cancer cases and 1.8 million lung cancer-related deaths occurred in 2020. The age-standardized incidence rate (ASIR) ranged from 36.8 per 100,000 in Demark to 5.9 per 100,000 in Mexico. The age-standardized mortality rate (ASMR) varied from 32.8 per 100,000 in Poland to 4.9 per 100,000 in Mexico. Both ASIR and ASMR were approximately twice higher in men than in women. The ASIR of lung cancer showed a downward trend in the United States of America (USA) between 2000 and 2012, and was more prominent in men. The age-specific incidence rates of lung cancer for ages of 50 to 59 years showed an upward trend in China for both men and women.@*CONCLUSIONS@#The burden of lung cancer is still unsatisfactory, especially in developing countries like China. Considering the effectiveness of tobacco control and screening in developed countries, such as the USA, there is a need to strengthen health education, accelerate the establishment of tobacco control policies and regulations, and improve early cancer screening awareness to reduce the future burden of lung cancer.

Long-term Survival in Hospitalized Patients with Lung Cancer among Peasants in the Coal-producing Area in Eastern Yunnan, China / 中国肺癌杂志

BACKGROUND@#Xuanwei and Fuyuan are rural counties, located in the late Permian coal poly area of eastern Yunnan and western Guizhou, where lung cancer mortality rates are among the highest in the China, with similarity for both men and women, younger age at diagnosis and death, and higher in rural areas than in urban areas. In this paper, long-term follow-up of lung cancer cases in local peasants was conducted to observe their survival prognosis and its influencing factors.@*METHODS@#Data of patients diagnosed with lung cancer from January 2005 to June 2011, who had lived in Xuanwei and Fuyuan counties for many years, were collected from 20 hospitals at the local provincial, municipal and county levels. To estimate survival outcomes, individuals were followed up until the end of 2021. The 5-year, 10-year and 15-year survival rates were estimated using the Kaplan-Meier method. Survival differences were examined with Kaplan-Meier curves and Cox proportional hazards models.@*RESULTS@#A total of 3,017 cases were effectively followed up (2,537 peasants and 480 non-peasants). The median age at diagnosis was 57 years, and the median follow-up time was 122 months. During the follow-up period, 2,493 cases (82.6%) died. The distribution of cases by clinical stage was as follows: stage I (3.7%), stage II (6.7%), stage III (15.8%), stage IV (21.1%) and unknown stage (52.7%). Treatment at the provincial, municipal and county-level hospitals accounted for 32.5%, 22.2% and 45.3%, respectively, and surgical treatment was performed in 23.3% of cases. The median survival time was 15.4 months (95%CI: 13.9-16.1), and the 5-year, 10-year and 15-year overall survival rates were 19.5% (95%CI: 18.0%-21.1%), 7.7% (95%CI: 6.5%-8.8%) and 2.0% (95%CI: 0.8%-3.9%), respectively. Peasants with lung cancer had a lower median age at diagnosis, higher proportion residing in remote rural areas, and higher use of bituminous coal as a household fuel. They also have a lower proportion of early-stage cases, treatment at provincial or municipal hospitals, and surgical treatment, leading to poorer survival outcomes (HR=1.57). Even when considering factors such as gender, age, residential location, clinical stage at diagnosis, histological type, hospital level of service, and surgical intervention, peasants still exhibit a survival disadvantage. Multivariable Cox model analysis comparing peasants and non-peasants reveals that surgical intervention, tumor-node-metastasis (TNM) stage, and hospital level of service are common factors influencing survival prognosis, while the use of bituminous coal as a household fuel, hospital level of service and adenocarcinoma (compared to squamous cell carcinoma) are independent prognostic factors for lung cancer survival among peasants.@*CONCLUSIONS@#The lower lung cancer survival rate among peasants is associated with their lower socioeconomic status, lower proportion of early-stage diagnoses, lower proportion of surgical interventions, and treatment at provincial-level hospitals. Furthermore, the impact of other factors such as high-risk exposure to bituminous coal pollution on survival prognosis requires further investigation.

China National Lung Cancer Screening Guideline with Low-dose Computed Tomography (2023 Version) / 中国肺癌杂志

Lung cancer is the leading cause of cancer-related death in China. The effectiveness of low-dose computed tomography (LDCT) screening has been further validated in recent years, and significant progress has been made in research on identifying high-risk individuals, personalizing screening interval, and management of screen-detected findings. The aim of this study is to revise China national lung cancer screening guideline with LDCT (2018 version). The China Lung Cancer Early Detection and Treatment Expert Group (CLCEDTEG) designated by the China's National Health Commission, and China Lung Oncolgy Group experts, jointly participated in the revision of Chinese lung cancer screening guideline (2023 version). This revision is based on the recent advances in LDCT lung cancer screening at home and abroad, and the epidemiology of lung cancer in China. The following aspects of the guideline were revised: (1) lung cancer risk factors besides smoking were considered for the identification of high risk population; (2) LDCT scan parameters were further classified; (3) longer screening interval is recommended for individuals who had negative LDCT screening results for two consecutive rounds; (4) the follow-up interval for positive nodules was extended from 3 months to 6 months; (5) the role of multi-disciplinary treatment (MDT) in the management of positive nodules, diagnosis and treatment of lung cancer were emphasized. This revision clarifies the screening, intervention and treatment pathways, making the LDCT screening guideline more appropriate for China. Future researches based on emerging technologies, including biomarkers and artificial intelligence, are needed to optimize LDCT screening in China in the future.
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Insomnia Burden among Informal Caregivers of Hospitalized Lung Cancer Patients and Its Influencing Factors / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to reveal the insomnia burden and relevant influencing factors among informal caregivers (ICs) of hospitalized patients with lung cancer.@*METHODS@#A cross-sectional study on ICs of hospitalized patients with lung cancer was conducted from December 31, 2020 to December 31, 2021. ICs' burden was assessed using the Caregiver Reaction Assessment (CRA), Hospital Anxiety and Depression Scale (HADS), and Insomnia Severity Index (ISI). Linear and logistic regression models were used to identify the influencing factors.@*RESULTS@#Among 289 ICs of hospitalized patients with lung cancer, 83 (28.72%), 53 (18.34%), and 14 (4.84%) ICs experienced mild, moderate, and severe insomnia, respectively. The scores concerning self-esteem, lack of family support, financial problems, disturbed schedule, and health problems were 4.32 ± 0.53, 2.24 ± 0.79, 2.84 ± 1.14, 3.63 ± 0.77, and 2.44 ± 0.95, respectively. ICs with higher Activities of Daily Living Scale (ADLS) scores were associated with a lower risk of insomnia, with an odd ratio ( OR) and 95% confidence interval ( CI) of 0.940 (0.898-0.983). Among the ICs, female gender ( OR = 2.597), alcohol consumption ( OR = 3.745), underlying medical conditions ( OR = 11.765), long-term caregiving experience ( OR = 37.037), and higher monthly expenses ( OR = 5.714) were associated with a high risk of insomnia.@*CONCLUSION@#Of the hospitalized patients with lung cancer, 51.9% experienced insomnia. Patients' ADL, ICs gender, alcohol consumption, underlying medical conditions, caregiving duration, and monthly expenses were influencing factors. Therefore, prompt screening and early intervention for ICs of patients with lung cancer is necessary.

Características clínico-patológicas de los pacientes asistidos en el Centro Docente Asociado de Oncología Médica en el Hospital Departamental de Soriano durante su primer año de funcionamiento / Clinical-pathological characteristics of patients assisted at the Associated Teaching Center of Medical Oncology at Soriano Departmental Hospital during its first year of operation / Características clínico-patológicas dos pacientes atendidos no Centro Docente Associado de Oncologia Médica no Hospital Departamental de Soriano durante seu primeiro ano de funcionamento

Introducción: Según el Ministerio de Salud las muertes por cáncer constituyen un cuarto del total de las defunciones registradas en Uruguay cada año. Objetivo: Conocer el perfíl epidemiológico de los pacientes diagnosticados de cáncer asistidos en el Hospital Departamental de Soriano. Material y métodos: Estudio observacional, retrospectivo y descriptivo que incluyó a los pacientes diagnosticados de cáncer asistidos en el Hospital Departamental de Soriano durante el 2022. Se mantuvo el anonimato de los pacientes en el análisis estadístico y se contó con la aprobación del Comité de Ética del Hospital de Clínicas. Resultados: Se incluyeron 113 pacientes nuevos; 53.1% fueron hombres, siendo la mediana de edad al diagnóstico de 69 años. Los 4 tumores más frecuentes para ambos sexos reunidos fueron: mama, próstata, pulmón y colo-recto; la distribución por estadio fue la siguiente: E IV 48.6% pacientes; EIII 22.5%; EII 26.5%; y EI 2.6%. En el 79.6% de las pacientes se contaba con la confirmación del diagnóstico mediante anatomía patológica. El tiempo entre el diagnóstico y el primer tratamiento oncológico fue ≤ 3 meses para el 88.2% de los pacientes. El total de los pacientes con EIV fueron contactados con la Unidad de Cuidados Paliativos. Únicamente el 15% de los casos fueron discutidos en Comité de Tumores. Conclusiones: Los datos analizados permitieron caracterizar el perfil epidemiológico del cáncer de los pacientes procedente de Soriano asistidos en el ámbito público y pueden contribuir a la implementación de políticas públicas orientadas a la prevención y por ende a la mejora en la asistencia pacientes asistidos.

Introduction: According to the Ministry of Health, cancer deaths constitute a quarter of the total deaths registered in Uruguay each year. Objective: To identify the epidemiological profile of patients diagnosed with cancer treated at the Departmental Hospital of Soriano. Materials and Methods: An observational, retrospective and descriptive study that included patients diagnosed with cancer attended at the Departmental Hospital of Soriano during 2022. The anonymity of the patients was maintained in the statistical analysis and approval was obtained from the Ethics Committee of the Hospital de Clínicas. Results: A total of 113 new patients were included; 53.1% were men, with a median age at diagnosis of 69 years old. The four most frequent tumors for both sexes were: breast, prostate, lung and colorectal; the distribution by stage was as follows: Stage IV 48.6% patients; Stage III 22.5%; Stage II 26.5%; and Stage I 2.6%. In 79.6% of the patients the diagnosis was confirmed by pathological anatomy. The time between diagnosis and first oncological treatment was ≤ 3 months for 88.2% of patients. The total number of patients with Stage IV were contacted by the Palliative Care Unit. Only 15% of the cases were discussed in the Tumor Committee. Conclusions: The data analyzed made it possible to characterize the epidemiological profile of cancer in patients from Soriano assisted in the public sector and may contribute to the implementation of public policies aimed at prevention and, therefore, at improving patient care.

Introdução: Segundo o Ministério da Saúde, as mortes por câncer constituem um quarto de todas as mortes registradas no Uruguai a cada ano. Objetivos: Conhecer o perfil epidemiológico dos pacientes diagnosticados com câncer atendidos no Hospital Departamental de Soriano. Material e Métodos: Estudo observacional, retrospectivo e descritivo que incluiu pacientes diagnosticados com câncer atendidos no Hospital Departamental de Soriano durante o ano de 2022. O anonimato dos pacientes foi mantido na análise estatística e foi aprovado pelo Comitê de Ética do Hospital de Clínicas. Resultados: foram incluídos 113 novos pacientes; 53,1% eram homens, com mediana de idade ao diagnóstico de 69 anos. Os 4 tumores mais frequentes para ambos os sexos combinados foram: mama, próstata, pulmão e colorretal; a distribuição por estágio foi a seguinte: E IV 48,6% pacientes; EIII 22,5%; EII 26,5%; EI 2,6%. Em 79,6% dos pacientes houve confirmação do diagnóstico pela patologia. O tempo entre o diagnóstico e o primeiro tratamento oncológico foi ≤ 3 meses para 88,2% dos pacientes. Todos os doentes com DIV foram contactados com a Unidade de Cuidados Paliativos. Apenas 15% dos casos foram discutidos no Comitê de Tumores. Conclusões: Os dados analisados ​​permitiram caracterizar o perfil epidemiológico do câncer em pacientes de Soriano atendidos na esfera pública e podem contribuir para a implementação de políticas públicas voltadas para a prevenção e, consequentemente, para a melhoria na assistência aos pacientes atendidos.

Cáncer pulmonar: caracterización, estadificación y supervivencia en una cohorte de una década en un hospital del sistema público de salud de Chile / Lung cancer at a Chilean public hospital

Background: Lung cancer is the world's leading cause of cancer death. Aim: To describe the clinical, staging and survival characteristics of lung cancer in a public Chilean regional hospital. Material and Methods: Analysis of a prospective database of a thoracic surgery service, retrieving histologically confirmed lung cancer cases from January 2010 to December 2019 and reviewing their medical records. Cases were re-staged by the TNM-8 system and variables were compared between periods 2010-2014 and 2015-2019. Results: We retrieved 551 lung cancer cases, 333 (60 %) men, with a mean age of 65 years. Distant metastases were found in 72% of cases (excluding lymphatic metastases). Of the non-small cell lung cancers (NSCLC), 50 (10%) cases were in stage I, 18 (4%) in stage II, 81 (16%) in stage III and 347 (70%) in stage IV. Global five-year survival was 18%, 20% for NSCLC, 71% for excised NSCLC, 8% for non-excised NSCLC, 88% for stage I and 92% for subgroup IA. Resective surgery was performed in 81 (14%) cases. When comparing 2010-2014 and 2015-2019 periods, the frequency of resective surgery increased from 7% to 20%. Conclusions: The diagnosis of lung cancer was frequently made in advanced stages. There was a significant increase in early diagnosis and frequency of surgeries with curative intent in the second observation period.

Evaluación de nódulos pulmonares mediante el sistema Lung-RADS / Assessment and Follow-up of Pulmonary Nodules in Lung-RADS System

El cáncer de pulmón es la causa de muertes por cáncer por año más importante en Argentina. Según el Instituto Nacional de Cáncer fue responsable en 2019 de 10.662 muertes, lo que significa el 16% de las muertes por esa enfermedad en ambos sexos y el 19,2% del total de varones1-3. En el año 2018, 234.000 personas en Estados Unidos fueron diagnosticadas de cáncer de pulmón y ese mismo año 154.000 murieron a causa de dicho cáncer. La gran mayoría, 85% de los cánceres eran cáncer de pulmón no a células pequeñas, 10 a 15% eran a células pequeñas y menos del 5% eran tumores carcinoides de pulmón

Nivolumab en cáncer de pulmón de células no pequeñas en segundo línea tratamiento / Nivolumab in second-line treatment in non-small cell lung cance

El presente informe es producto del trabajo colaborativo de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC), dependiente del Ministerio de Salud de la Nación y creada por RM N° 623/2018. La CONETEC realiza evaluaciones y emite recomendaciones a la autoridad sanitaria sobre la incorporación, forma de uso, financiamiento y políticas de cobertura de las tecnologías sanitarias desde una perspectiva global del sistema de salud argentino. En sus evaluaciones y recomendaciones, la CONETEC tiene en cuenta criterios de calidad, seguridad, efectividad, eficiencia y equidad, evaluados bajo dimensiones éticas, médicas, económicas y sociales. Sus resultados son consensuados mediante discusiones públicas y ponderados a través de un marco de valor explícito, con la participación de todos los actores involucrados en el proceso de toma de decisiones en salud. Los informes y recomendaciones de esta comisión surgen de este proceso público, transparente y colaborativo, siendo de libre consulta y acceso para toda la sociedad.

Carcinoma Pulmonar: estudio clínico patológico / Pulmonary carcinoma: clinical pathological study

Clasificar los carcinomas de pulmón según criterios establecidos por la OMS 2015 en biopsias de la sección de patología respiratoria del Instituto Anatomopatológico "Dr. José Antonio O`Daly" en el período enero 2006-diciembre 2016. Se realizó estudio descriptivo y retrospectivo, en el que se evaluaron todos los casos de carcinomas pulmonares recibidos entre enero 2006 diciembre 2016. La edad de presentación del carcinoma pulmonar fue 61 ± 11,45 años. Fue más frecuente en el sexo masculino 56,57 %. El tipo histológico más frecuente fue el adenocarcinoma 61,6 %. El adenocarcinoma el patrón predominantemente sólido fue el más constante 57,3 %, seguido de patrón predominantemente acinar 18,2 % y patrones mixtos. El carcinoma de células escamosas fue el segundo tipo más frecuente con 30,3 % de los casos representando el carcinoma de células escamosas poco diferenciado no queratinizante un 40 %. El carcinoma neuroendocrino fue el tercer tipo de carcinoma más común y el carcinoma de células pequeñas representó el 80 % de estos casos. Al menos 10,8 % de los casos fueron carcinomas no clasificables por necrosis o muestra escasa. Los casos previamente diagnosticados como adenocarcinoma poco diferenciado se corresponden con patrón sólido. Es importante el uso de inmunohistoquímica para el diagnóstico definitivo especialmente de adenocarcinoma patrón predominantemente sólido. El uso de la actual clasificación permite definir pronóstico y tratamiento personalizado(AU)

To classify the lung carcinomas according to criteria established by WHO 2015 in the biopsies of the section of respiratory pathology of the Anatomo Pathological Institute "Dr. José Antonio O`Daly" in the period January 2006 December 2016. A study will be carried out descriptive and retrospective, in which all cases of the pulmonary carcinomas received between January 2006 and December 2016 were evaluated. The age of presentation of the lung carcinoma was 61 ± 11.45 years old. It was more frequent in the male sex 56.57 %. The most frequent histological type was the adenocarcinoma 61.6 %. The predominantly solid adenocarcinoma pattern was the most constant 57.3 % followed by predominantly acinar pattern 18.2 % and the mixed patterns. The squamous cell carcinoma was the second most frequent type 30.3 %, and the poorly differentiated and non-keratinizing type was a 40 %. The neuroendocrine carcinoma was the third most common type of it the small cell carcinoma accounted an 80 %. At least 10.8 % of the cases were carcinomas unclassifiable due to necrosis or scarce sample. The cases previously diagnosed as poorly differentiated adenocarcinoma correspond to a solid pattern. The immunohistochemically use is important for the definitive diagnosis, especially for the adenocarcinoma predominantly solid pattern. The use of the current classification allowsdefining the prognosis and the personalized treatment(AU)

Concordância e validade dos diagnósticos de cânceres associados ao asbesto no sistema de informação hospitalar do Sistema Único de Saúde / Agreement and validity of asbestos-related cancers in the hospital information system of the Brazilian Unified Health System

RESUMO: Objetivo: Estimar o grau de concordância e validade dos diagnósticos de neoplasias malignas relacionadas à exposição ao asbesto registrados no Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS), em comparação aos Registros Hospitalares de Câncer do Estado de São Paulo (RHC/SP). Métodos: Óbitos com registros de neoplasias malignas associadas ao asbesto foram identificados e extraídos do SIH/SUS entre 2007 e 2014. Óbitos nos casos de câncer registrados na base do RHC/SP foram extraídos para o mesmo período. Essas bases foram unidas pelos mesmos indivíduos empregando-se o software Link Plus. Um único diagnóstico codificado pela CID-O3 ou CID-10 selecionado de cada sistema foi analisado. A proporção de concordância e a sensibilidade, especificidade e valores preditivos foram estimados. Resultados: Encontraram-se 19.458 pares com registros nas duas bases. A proporção de concordância foi elevada, variando de 92,4% para a localização primária desconhecida a 99,7% para o câncer de pleura. O índice Kappa variou de 0,05 (IC95% 0,04 - 0,07) para o câncer de pleura a 0,85 (IC95% 0,84 - 0,87) para o câncer de pulmão. A menor sensibilidade foi de 0,08 (IC95% 0,01 - 0,25), para o câncer de pleura, e a maior de 0,90 (IC95% 0,90 - 0,91), para o câncer de pulmão. Conclusão: Diagnósticos de neoplasias malignas associadas ao asbesto alcançaram maiores níveis de concordância e validade quando comuns. Os diagnósticos mais raros apresentaram baixa acurácia no SIH/SUS.

ABSTRACT: Objective: To estimate the degree of agreement and validity of diagnoses of asbestos-related malignant neoplasms registered in the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), in comparison to the Hospital Cancer Registries of the State of São Paulo (HCR/SP). Methods: Deaths with records of malignant neoplasms associated with asbestos were identified and extracted from SIH/SUS between 2007 and 2014. Deaths in cases registered in the HCR/SP were extracted for the same period. The databases were linked using software Link Plus. A single ICD-10-coded diagnosis selected from each system was analyzed. The proportion of agreement, and the sensitivity, specificity and predictive values were estimated. Results: 19,458 pairs were found with records in both bases. The proportion of agreement was high, ranging from 92.4% for the unknown primary site, to 99.7% for cancer of the pleura. The Kappa Index ranged from 0.05 (95%CI 0.04 - 0.07) for cancer of the pleura to 0.85 (95%CI 0.84 - 0.87) for lung cancer. Sensitivity varied from 0.08 (95%CI 0.01 - 0.25) for cancer of the pleura, to 0.90 (95%CI 0.90 - 0.91) for lung cancer. Conclusion: Diagnosis of asbestos-related malignancies reached higher levels of agreement and validity when common. Rare diagnoses showed low accuracy in SIH/SUS.

Caracterización de los pacientes operados de cáncer de pulmón de células no pequeñas / Characterization of Patients Operated on for Nonsmall-Cell Lung Cancer

RESUMEN Introducción: El tumor de pulmón de células no pequeñas es un problema de salud pública, y la primera causa de muerte por cáncer a nivel mundial. Objetivo: Describir las características epidemiológicas, clínicas e histológicas en la población de enfermos aquejados de cáncer de pulmón de células no pequeñas, así como de las técnicas de resección pulmonar y de linfadenectomías utilizadas. Métodos: Se realizó un estudio descriptivo y transversal en el Servicio de Cirugía General del Hospital Provincial "Saturnino Lora" de Santiago de Cuba, desde enero de 2009 hasta enero de 2019. La muestra aleatoria fue de 55 pacientes diagnosticados de cáncer de pulmón de células no pequeñas a los que se les realizó resección pulmonar más linfadenectomía mediastinal. Se utilizaron como medidas de resumen para caracterizar las variables, el número absoluto, el porcentaje y la media, así como la prueba de significación Ji al cuadrado de independencia para identificar su posible asociación. Resultados: Predominó el sexo femenino y el grupo etario de 55 a 64 años. El adenocarcinoma fue el tipo histológico más frecuente. El lóbulo superior izquierdo resultó el más afectado. La lobectomía pulmonar con disección ganglionar por muestreo fue la técnica quirúrgica más utilizada. Predominaron los pacientes en estadios IB y IIA de la enfermedad. Conclusión: La linfadenectomía sistemática del mediastino, permite una certera estadificación, lo que determina una mejor evaluación del tratamiento y del pronóstico en estos enfermos(AU)

ABSTRACT Introduction: Non-small cell lung tumor is a public health problem, and the leading cause of cancer death worldwide. Objective: To describe the epidemiological, clinical and histological characteristics in the population of patients suffering from non-small cell lung cancer, as well as the techniques of lung resection and lymphadenectomies used. Methods: A descriptive and cross-sectional study was carried out in the General Surgery Service of the Provincial Hospital "Saturnino Lora" in Santiago de Cuba, from January 2009 to January 2019. The random sample consisted of 55 patients diagnosed with cell lung cancer non-small patients who underwent lung resection plus mediastinal lymphadenectomy. The absolute number, the percentage and the mean were used as summary measures to characterize the variables, as well as the Chi-squared significance test of independence to identify their possible association. Results: The female sex and the age group 55 to 64 years predominated. Adenocarcinoma was the most frequent histological type. The left upper lobe was the most affected. Pulmonary lobectomy with sampling lymph node dissection was the most widely used surgical technique. Patients in stages IB and IIA of the disease predominated. Conclusion: Systematic lymphadenectomy of the mediastinum allows an accurate staging, which determines a better evaluation of treatment and prognosis in these patients(AU)

Tuberculosis and lung cancer / Tuberculosis y cáncer de pulmón

Abstract: Objective: To describe the epidemiological studies about the relationship between lung cancer (LC) and pulmonary tuberculosis (Tb) and its possible molecular mechanisms. Materials and methods: We reviewed research databases in search of publications that included keywords LC and Tb. Results: It has been proposed that chronic inflammation in the lungs due to Tb could cause clastogenic activity in the DNA of bronchial epithelium. Another possibility is lateral gene transfer; since Mycobacterium tuberculosis (MTb) is an intracellular organism, bacterial DNA could integrate to bronchial epithelial cells inducing neoplastic transformation. Conclusions: There are epidemiological reports, particularly from Asian countries, which confirm a relationship between LC and Tb. MTb could play an active role in cellular transformation and it is important to elucidate the mechanism involved.

Resumen: Objetivo: Describir los estudios que documentan la relación entre el cáncer de pulmón (CP) y la tuberculosis pulmonar (Tb) y sus posibles mecanismos moleculares. Material y métodos: Se revisaron bases de datos de publicaciones, usando como palabras clave CP y Tb. Resultados: Se ha propuesto que la inflamación crónica en el pulmón provocada por la Tb podría producir actividad clastogénica. Otra posibilidad es la transferencia lateral de genes; Mycobacterium tuberculosis (MTb) es un organismo intracelular facultativo cuyo DNA podría integrarse al material genético del epitelio bronquial induciendo transformación neoplásica. Conclusión: Existen evidencias epidemiológicas, particularmente en países asiáticos, que documentan la relación entre CP y Tb. MTb podría desempeñar un papel activo en la transformación neoplásica cuyo mecanismo debe de ser elucidado.

Incidencia, mortalidad y costos de la atención por cáncer de pulmón en el Instituto Mexicano del Seguro Social / Incidence, mortality and associated costs of lung cancer in the Mexican Institute of Social Security

Resumen: Objetivo: Analizar la tendencia temporal de la incidencia y la mortalidad del cáncer de pulmón, así como los costos asociados con su atención médica. Material y métodos: Se estimó el número de casos incidentes a partir de los egresos hospitalarios de 276 hospitales del Instituto Mexicano del Seguro Social (IMSS) entre 2006 y 2016. Se calcularon tasas de mortalidad crudas y ajustadas. Los costos del tratamiento ambulatorio y hospitalario se calcularon con base en los costos médico-técnicos de referencia o costos estándar de 2015. Resultados: Tanto la incidencia como la mortalidad muestran tendencia descendente. El costo de la atención médica de los 2 539 pacientes de 2017 fue de 42 millones de dólares americanos, con costo promedio por paciente de 16 527 dólares americanos. El gasto promedio anual de pensiones por invalidez es de 97.2 millones de pesos. Conclusiones: Es probable que la reducción del riesgo de enfermar y morir por cáncer de pulmón en derechohabientes del IMSS se deba a las medidas de control del humo de tabaco. Todavía es necesario establecer estrategias para diagnosticar y tratar a los pacientes en estadios tempranos.

Abstract: Objective: To describe temporal trends in lung cancer incidence, mortality and associated health care costs in the Mexican Institute of Social Security. Materials and methods: Incident cases were estimated from hospital discharges in 276 IMSS hospitals between 2006 and 2016. Crude and adjusted mortality rates were calculated. The costs of outpatient and inpatient treatment were calculated based on the medical-technical costs of reference o standard cost. Results: Both incidence and mortality had a decreased time trend. The cost of medical care for the 2 539 patients in 2017 was 42 million US dollars, with an average cost per patient of 16 537 US dollars. The cost per annum of disability pensions is 97.2 million pesos. Conclusions: It is likely that the reduction of the risk of getting sick and dying from lung cancer in IMSS affiliates is due to the control measures of tobacco smoke. It is still necessary to establish strategies to diagnose and treat patients in early stages.

The descriptive epidemiology of lung cancer and tobacco control: a global overview 2018 / Epidemiología descriptiva del cáncer de pulmón y control de tabaco en 2018: una visión global

Abstract: Objective: To present the most recent national estimates of lung cancer burden globally in 185 countries and tobacco smoking prevalence (%) by sex. Materials and methods: Estimates of lung cancer incidence and mortality for 2018 were extracted from the Globocan database; observed incidence, from the last volume of Cancer Incidence in Five Continents, and tobacco prevalence, from the World Health Observatory/WHO database. Results: In 2018, over two million new lung cancer cases and 1.7 million deaths were estimated to occur worldwide, representing 14% of the new cancer cases and 20% of the cancer deaths. Incidence rates showed marked variation between countries. Stable or decreasing incidence rates were predominant among males, while among females increasing rates were common. Conclusion: The continuing rise in lung cancer among women reinforces the need for strengthening implementation of the preventive actions committed to by governments in the WHO Framework Convention for Tobacco Control.

Resumen: Objetivo: Presentar las estimaciones nacionales más recientes de la carga del cáncer de pulmón a nivel mundial en 185 países y de prevalencia de tabaquismo (%) por sexo. Material y métodos: Las estimaciones de incidencia y mortalidad por cáncer de pulmón para el año 2018 se extrajeron de la base de datos Globocan, la incidencia observada del último volumen de Incidencia de Cáncer en Cinco Continentes y la prevalencia de tabaquismo del Observatorio Mundial de la Salud/OMS. Resultados: En 2018, se estimaron más de dos millones de nuevos casos de cáncer de pulmón y 1.7 millones de muertes a nivel mundial, que representan 14% de los casos nuevos y 20% de las muertes por cáncer. Las tasas de incidencia mostraron grandes variaciones entre países. En hombres, se observaron principalmente tasas de incidencia estables o decrecientes, mientras que en mujeres se observó con frecuencia un incremento. Conclusión: Los resultados en mujeres refuerzan la necesidad de fortalecer las acciones preventivas de los gobiernos en el Convenio Marco de la OMS para el Control del Tabaco.

Comportamiento de las metástasis cerebrales en el cáncer de pulmón en Matanzas / Behavior of brain metastases in lung cancer in Matanzas

RESUMEN Introducción: en las últimas tres décadas, las enfermedades cardiovasculares y las neoplasias malignas han pasado a ser los principales problemas de salud en Cuba como consecuencia de la constante mejoría de los niveles de salud, la prevención de las enfermedades transmisibles, y el incremento de la esperanza de vida al nacer; entre ellas se destaca el cáncer de pulmón como el tumor primario que con mayor incidencia causa compromiso cerebral metastásico. Objetivo: analizar el comportamiento de las metástasis cerebrales en pacientes con cáncer de pulmón. Materiales y métodos: se realizó un estudio descriptivo y retrospectivo en 96 pacientes con diagnóstico cito-histológico de cáncer de pulmón y metástasis cerebral, atendidos en la consulta externa del Centro Oncológico Provincial de Matanzas, entre enero del 2013 y diciembre del 2016. Se obtuvieron los datos clínicos-demográficos a partir de las historias clínicas individuales de los enfermos y el documento de Reporte de Cáncer. Resultados: la mayor incidencia de cáncer de pulmón corresponde a las personas entre 45 y 64 años de edad; comportándose de forma similar para el género masculino como para el femenino, aunque el primero con un mayor número de casos y el color de la piel predominante para ambos sexos fue la blanca. En tanto las metástasis cerebrales son más comunes de la quinta a la séptima década de la vida. Conclusiones: la metástasis cerebral aparece desde edades tempranas hasta la tercera edad y el mayor porcentaje fue diagnosticado a inicio de la enfermedad constituyendo esto un factor de riesgo importante.

ABSTRACT Introduction: in the last three decades, cardiovascular diseases and malignant neoplasms have become the main health problem in Cuba as a consequence of the steady improvement of the health levels, the prevention of the communicable diseases, and the increase of the life expectancy at birth; among them lung cancer stands out as the primary tumor that more frequently causes metastatic brain compromise. Objective: to analyze the behavior of brain metastases in patients with lung cancer. Materials and methods: a retrospective and descriptive study was carried out in 96 patients with cyto-histological diagnosis of lung cancer and brain metastases, who attended the external consultation of the Provincial Oncologic Center of Matanzas, from January 2013 to December 2016. Clinic-demographic data were obtained from the patients´ individual clinical reports and the Cancer Report document. Results: the highest incidence of lung cancer corresponds to people aged 45-64 years; it behaves very similar both in male and in female genders, thought the first one shows more quantity of cases; white color skin predominated in both sexes. As for the brain metastases, they are more common from the fifth to the seventh decade of life. Conclusions: brain metastasis appears from early ages and up to the elder age; the highest percent was diagnosed at the beginning of the disease, being this an important risk factor.

Tendência de mortalidade por câncer de pulmão em diferentes contextos urbanos do Brasil, 2000-2015 / Tendencia de mortalidad por cáncer de pulmón en diferentes contextos urbanos de Brasil, 2000-2015 / Lung cancer mortality trends in different urban settings in Brazil, 2000-2015

Objetivo: analisar a tendência de mortalidade por câncer de pulmão no Brasil, 2000-2015. Métodos: estudo de série temporal; realizou-se correção dos registros de óbito por câncer de pulmão; utilizaram-se modelos lineares autorregressivos para calcular os coeficientes de regressão (β1) e intervalos de confiança de 95% (IC95%) nas análises de tendência, segundo sexo, em maiores de 30 anos, de 19 regiões metropolitanas (RMs) e interior de 14 estados brasileiros; β1 positivo indica tendência crescente, e negativo, decréscimo. Resultados: aumentos foram observados em homens do interior do Norte e Nordeste, destacadamente no Rio Grande do Norte (β1=1,03 - IC95%0,47;1,58); declínio também foi verificado nesse grupo, notadamente na RM Porto Alegre (β 1=-2,55 - IC95%-2,79;-2,31); em mulheres, maior aumento foi observado no interior do Ceará (β 1=0,86 - IC95%0,79;0,92). Conclusão: foram revelados padrões diferenciados segundo localidade e sexo; medidas de controle do câncer devem ser consideradas, principalmente para mulheres e interior do Brasil.

Objetivo: analizar la tendencia de mortalidad por cáncer de pulmón en Brasil, 2000-2015. Métodos: estudio de serie temporal; se realizó la corrección de los registros de defunciones por cáncer de pulmón; en los análisis de tendencia se utilizaron modelos lineales autorregresivos para calcular los coeficientes de regresión (β 1) e intervalo de confianza de 95% (IC95%), según sexo, mayores de 30 años, 19 regiones metropolitanas (RMs) e interior de 14 estados brasileños; β 1 positivo indica tendencia de aumento y negativo, de decrecimiento. Resultados: fueron observados aumentos en hombres, interior del Norte y Nordeste, destacadamente en Rio Grande do Norte (β 1=1,03 - IC95%0,47;1,58); también se observó disminución en este grupo, particularmente en la RM de Porto Alegre (β 1=-2,55 - IC95%-2,79;-2,31); en mujeres, el mayor aumento fue observado en el interior de Ceará (β 1=0,86 - IC95%0,79;0,92). Conclusión: se revelaron patrones diferenciados según localidad y sexo; el control de cáncer debe ser considerado principalmente para mujeres e interior de Brasil.

Objective: to analyze lung cancer mortality trends in Brazil, 2000-2015. Methods: this was a time series study; lung cancer death records were corrected; linear autoregressive models were used to calculate regression coefficients (β1) and 95% confidence intervals (95%CI) in trend analysis according to sex, in the 30 and over age group, for 19 metropolitan areas (MAs) and the interior regions of 14 Brazilian states; positive β1 indicates upward trends while negative β1 indicates downward trends. Results: increases were found in males from interior regions of North and Northeastern Brazilian states, especially in Rio Grande do Norte state (β1=1.03 - 95%CI0.47;1.58); downward trends were also found in males, notably in the Porto Alegre MA (β1=-2.55 - 95%CI-2.79;-2.31); the highest increase in females was found in the interior of Ceará state (β1=0.86 - 95%CI0.79;0.92). Conclusion: differentiated patterns according to location and sex were revealed; cancer control measures should be considered above all for women and the interior regions of Brazil.