Seguimiento a largo plazo de los pacientes operados de cáncer de pulmón / Spanish Society of Thoracic Surgery (SECT) consensus document. Long-term follow-up for operated patients with lung cancer

El tratamiento más efectivo para el cáncer de pulmón es la resección pulmonar completa, si bien las recidivas llegan hasta el 10% y la aparición de segundos primarios, hasta el 6%. Será, por tanto, indispensable el seguimiento de estos pacientes para la detección y tratamiento precoces de estos eventos; sin embargo, no existe una definición de la forma, tiempo y cadencia de estos seguimientos. En el presente documento de consenso, tratamos de definirlos con base en la evidencia científica disponible. Se realiza una revisión crítica de la bibliografía (metaanálisis, revisiones sistemáticas, revisiones, recomendaciones de consenso de sociedades científicas, estudios controlados aleatorizados, estudios controlados no aleatorizados, estudios observacionales y estudios de series de casos) y comunicaciones a los principales congresos de oncología y cirugía torácica en castellano, inglés y francés. Se clasifican las evidencias halladas siguiendo el sistema GRADE. Queda definido, según la evidencia existente, que se debe realizar un seguimiento del paciente resecado por cáncer pulmonar, así como que este seguimiento debe ser estrecho durante los primeros años y con realización de TC (no siendo necesario el seguimiento con tomografía por emisión de positrones-tomografía computarizada [PET-TC], biomarcadores o broncoscopia). Se recomienda también en ese seguimiento el cese del hábito tabáquico (AU)

The most effective treatment for lung cancer is complete lung resection, although recurrences reach up to 10% and the appearance of second neoplasms, up to 6%. Therefore, the follow-up of these patients will be essential for the early detection and treatment of these events; however, there is no definition of the form, time and cadence of these follow-ups. In this consensus document, we try to define them based on the available scientific evidence. A critical review of the literature is carried out (meta-analysis, systematic reviews, reviews, consensus recommendations of scientific societies, randomized controlled studies, non-randomized controlled studies, observational studies and case series studies) and communications to the main congresses on oncology and thoracic surgery in Spanish, English and French. The evidences found are classified following the GRADE system. It is defined according to the existing evidence that the patient resected for lung cancer should be followed up, as well as that this follow-up should be close during the first years and with CT (not being necessary to follow up with PET-CT, biomarkers or bronchoscopy). Cessation of smoking is also recommended in this follow-up (AU)

Clinical significance of epithelial-mesenchymal transition-related markers expression in the micrometastatic sentinel lymph node of NSCLC.

OBJECTIVES: Metastatic lymph node affectation is the main prognostic factor in localised lung cancer. However, the pathological study of lymph nodes reveals tumour relapse for 20% of patients after oncological curative surgery. Recently, EMT (epithelial-mesenchymal transition) has been established as one of the main factors related to lymphatic dissemination and metastasis. This study evaluated the prognostic value of EMT-related gene expression in micrometastatic sentinel lymph nodes (SLN) of non-small cell lung cancer (NSCLC) patients. METHODS: The presence of genes CDH1, CDH2, VIM, TWIST1, SNAI1, SNAI2, ZEB1, and ZEB2 in mRNA was analysed in tumours and in the SLN of NSCLC patients for whom surgery was planned for treatment. The significant association between the expression level of EMT-related markers and patients' clinicopathological characteristics and relapse was assessed. RESULTS: Of the 96 patients, 56 (58.33%) presented molecular micrometastasis in SLN, which showed higher CDH1, CDH2, and VIM expressions than non-micrometastatic ones. An association linking a low CDH1/CDH2 ratio in SLN with molecular micrometastasis, adenocarcinoma, and non-smoking patients was found. The multivariate Cox regression analysis proved the prognostic accuracy of the CDH1/CDH2 ratio in SLN. CONCLUSIONS: The molecular EMT status of SLN could be used as an independent prognosis predictor in early stage NSLCL patients, and as a new tool to better stratify and predict patient outcomes.

Topography of the sentinel node according to the affected lobe in lung cancer

Purpose. The objective of this study is to describe the anatomic location of the sentinel lymph node (SLN) of patients with lung carcinoma and to analyze its relationship with the characteristics of the tumor. Patients and methods. 98 Stage I lung cancer patients were included in the study. SLN was marked just after performing the thoracotomy by injecting peritumorally 0.25 mCi of nanocolloid of albumin (Nanocol1) labeled with Tc-99 m in 0.3 ml, and later, it was resected. For SLN micrometastasis analysis, CEACAM5, BPIFA1, and CK7 gene expression at mRNA level was studied. Possible relation between tumor characteristics and SLN location was analyzed. Results. While most of the SLN were located in hilar area, we find a significantly higher number of SLN located in mediastinal stations when the lesion is in the left upper lobe (LUL). This difference disappears in the group of SLN with a positive result in the micrometastasis study. Regarding tumor size, squamous tumors and tumors located in the left lower lobe (LLL) were found significantly larger. Conclusion. The location of the SLN in patients with stage I lung cancer is predominantly hilar, being less consistent in the left hemithorax. The tumor size or histological type is not variables that affect this distribution. The distribution of SLNs with a positive result in the analysis of micrometastasis suggests further spread to the hilar areas when the lesion is in the LUL and to the mediastinal zones when it is in the LLL (AU)

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Topography of the sentinel node according to the affected lobe in lung cancer.

PURPOSE: The objective of this study is to describe the anatomic location of the sentinel lymph node (SLN) of patients with lung carcinoma and to analyze its relationship with the characteristics of the tumor. PATIENTS AND METHODS: 98 Stage I lung cancer patients were included in the study. SLN was marked just after performing the thoracotomy by injecting peritumorally 0.25 mCi of nanocolloid of albumin (Nanocol1) labeled with Tc-99 m in 0.3 ml, and later, it was resected. For SLN micrometastasis analysis, CEACAM5, BPIFA1, and CK7 gene expression at mRNA level was studied. Possible relation between tumor characteristics and SLN location was analyzed. RESULTS: While most of the SLN were located in hilar area, we find a significantly higher number of SLN located in mediastinal stations when the lesion is in the left upper lobe (LUL). This difference disappears in the group of SLN with a positive result in the micrometastasis study. Regarding tumor size, squamous tumors and tumors located in the left lower lobe (LLL) were found significantly larger. CONCLUSION: The location of the SLN in patients with stage I lung cancer is predominantly hilar, being less consistent in the left hemithorax. The tumor size or histological type is not variables that affect this distribution. The distribution of SLNs with a positive result in the analysis of micrometastasis suggests further spread to the hilar areas when the lesion is in the LUL and to the mediastinal zones when it is in the LLL.

Prognostic value of ERCC1, RRM1, BRCA1 and SETDB1 in early stage of non-small cell lung cancer.

INTRODUCTION: Nowadays, 40 % of early-stage NSCLC patients relapse in the 2 years following resection, suggesting a mis-staging in this group of patients who are not receiving adjuvant chemotherapy. Although different biomarkers, such as ERCC1, RRM1 and BRCA1 have been found to present prognostic value in advanced NSCLC patients, in early-stage NSCLC patients its relevance remains unclear. Moreover, SETDB1 has been recently proposed as a bona fide oncogene in lung tumourigenesis and related with metastasis. The aim of the present study was to analyze the prognostic value of ERCC1, RRM1, BRCA1 and SETDB1 expression levels in NSCLC patients at stage I. PATIENTS AND METHODS: ERCC1, RRM1, BRCA1 and SETDB1 expression at mRNA level was analyzed by real-time quantitative RT-PCR in fresh-frozen tumor and normal adjacent lung tissue samples from 64 stage I NSCLC patients. Later, significant association between gene expression levels, clinicopathological characteristics and patient's disease-free survival was assessed. RESULTS: We did not find any statistically significant correlation between gene expression and gender, age, histological type or smoking status. Univariate followed by multivariate Cox analysis showed that higher levels of BRCA1 and SETDB1 expression were significantly associated with shorter disease-free survival in stage I NSCLC patients. CONCLUSION: Our study finds that ERCC1 and RRM1 are not independent prognostic factors of recurrence in stage I NSCLC patients. By contrast, BRCA1 and SETDB1 stand out as the most significant prognostic markers in this group of patients, appearing as promising tools to predict tumor recurrence in early-stage NSCLC patients.

Study of survival in patients with malignant lung lesions treated with radiofrequency

OBJECTIVE: To report on the survival of a series of patients with primary and metastatic lung tumours treated with radiofrequency (RF). Four years ago we published our preliminary experience with the use of this technique. MATERIALS AND METHODS: For a period of 8 years we have treated 59 patients (by means of a total of 70 procedures) with primary or metastatic pulmonary neoplastic lesions, which fulfilled inclusion criteria to perform the technique. They were in all cases non-surgical lesions that had been either previously treated or not. The technique was performed in the radiology suite, under conscious analgo-sedation. We treated primary pulmonary lesions, neoplastic recurrences, or metastases with curative or palliative intention (pain management). RESULTS: Current global survival rate is 19 patients (32 %) with a mean of 26.61 ± 3.17 months (range: 20.38 ± 32.83) and a median of 16.00 ± 3.57 (range: 8.99-23.00). If we establish the difference between primary and metastatic tumours, mean survival is 27.62 ± 4.12 months in primary tumours (median: 16.00) vs. 24.65 ± 4.47 months in metastatic tumours (median: 16.00). When we studied the survival in those cases with a curative intent, mean survival in primary tumours was 30.97 ± 4.57 months (median: 21.00) vs. 25.14 ± 4.68 (median: 16.00) months in metastatic tumours. CONCLUSIONS: RF ablation of lung lesions is a minimally invasive procedure that is useful in primary tumours (especially in stage I) and metastatic ones. RF has proven its usefulness in the multidisciplinary treatment of this pathology due to the low incidence of serious complications and survival obtained, considering that patients are elderly with significant comorbidity (AU)

Study of survival in patients with malignant lung lesions treated with radiofrequency.

OBJECTIVE: To report on the survival of a series of patients with primary and metastatic lung tumours treated with radiofrequency (RF). Four years ago we published our preliminary experience with the use of this technique. MATERIALS AND METHODS: For a period of 8 years we have treated 59 patients (by means of a total of 70 procedures) with primary or metastatic pulmonary neoplastic lesions, which fulfilled inclusion criteria to perform the technique. They were in all cases non-surgical lesions that had been either previously treated or not. The technique was performed in the radiology suite, under conscious analgo-sedation. We treated primary pulmonary lesions, neoplastic recurrences, or metastases with curative or palliative intention (pain management). RESULTS: Current global survival rate is 19 patients (32 %) with a mean of 26.61 ± 3.17 months (range: 20.38 ± 32.83) and a median of 16.00 ± 3.57 (range: 8.99-23.00). If we establish the difference between primary and metastatic tumours, mean survival is 27.62 ± 4.12 months in primary tumours (median: 16.00) vs. 24.65 ± 4.47 months in metastatic tumours (median: 16.00). When we studied the survival in those cases with a curative intent, mean survival in primary tumours was 30.97 ± 4.57 months (median: 21.00) vs. 25.14 ± 4.68 (median: 16.00) months in metastatic tumours. CONCLUSIONS: RF ablation of lung lesions is a minimally invasive procedure that is useful in primary tumours (especially in stage I) and metastatic ones. RF has proven its usefulness in the multidisciplinary treatment of this pathology due to the low incidence of serious complications and survival obtained, considering that patients are elderly with significant comorbidity.

Linfomas primarios de pulmón / Primary pulmonary lymphoma

Los linfomas de tejido linfoide asociado a mucosas (MALT), aún siendo infrecuentes en la población, han sido considerados como una entidad propia que puede afectar a distintas topografías del organismo. Presentamos 3 casos de linfomas primarios pulmonares MALT diagnosticados entre 1995 y 2009. La determinación se realizó tras cirugía y estudio patológico. La forma de presentación fue como nódulo/masa, con diagnóstico definitivo tras la extirpación (AU)

Mucosa-associated lymphoid tissue (MALT) lymphomas, although rare in the population, are considered an entity per se, that may affect different topographies of the body. We present 3 cases of primary pulmonary MALT lymphomas diagnosed between 1995 and 2009. The diagnosis was made after surgery and pathology study. The presentation form was a nodule/mass, with definitive diagnosis after excision (AU)

Gastrotórax hipertensivo estrangulado tras herida por arma blanca / Strangulated hypertensive gastrothorax after knife wound

Resumen. La rotura diafragmática es una lesión poco frecuente, presente en el 5-7% de los politraumatizados y en el 10-15% de las lesiones penetrantes en la región torácica inferior. El diagnóstico precoz es fundamental, puesto que su demora conlleva una elevada morbimortalidad. Sin embargo éste se obtiene en menos del 50% de los casos. Presentamos el caso clínico de un paciente que debutó con hernia diafragmática estrangulada como consecuencia de herida por arma blanca un año antes. Asimismo, analizamos el controvertido manejo diagnóstico-terapéutico de las lesiones diafragmáticas (AU)

Summary. Diaphragmatic injury is a slightly frequent pathology, which is present in 5-7 % of polytraumatized pacients and 10-15 % of low thoracic penetrating injuries. An early diagnosis is fundamental, since a delay it’s associated with a high morbimortality. Nevertheless this one is obtained in less than 50 % of the cases. We present the case of a patient with a strangulated diaphragmatic hernia as a consequence of a stab wound one year before. We also analyze the controversial diagnostic and therapeutic management of diaphragmatic injuries (AU)

Sospecha radiológica de rotura diafragmática / No disponible

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Fístula broncoesofágica congénita de diagnóstico tardío / Congenital bronchoesophageal fistula of late diagnosis

Presentamos el caso de una mujer de 52 años con el antecedente de infecciones respiratorias de repetición desde la infancia, que presenta una fístula broncoesofágica (FBE) congénita diagnosticada de forma incidental a raíz de la aparición de disfagia en los últimos meses. Los estudios radiológicos y manométricos demuestran la asociación con megaesófago y acalasia. Se confirmó el diagnóstico de FBE en bronquio principal izqdo. gracias a un tránsito con gastrografín, esofagoscopia y fibrobroncoscopia. El tratamiento fue quirúrgico mediante toracotomía posterolateral izquierda, procediendo a la resección del trayecto fistuloso e invaginación del muñón con sutura de muscularis esofágica (AU)

We report the case of a 52-year-old woman with a history of recurrent respiratory infections, which presents a congenitalbronchoesophageal fistula (BEF) incidentally diagnosed after the appearance of dysphagia in the last months. Theradiological and manometric studies demonstrate the association with megaesophagus and achalasia. Diagnosis of BEFm in the left main bronchus was confirmed thanks to an esophagogram, esophagoscopy and fiberoptic bronchoscopy. The surgical treatment was carried out through a left posterolateral thoracotomy, proceeding to resection of the fistula and invagination of the stump with suture of esophageal muscularis (AU)