Cribado de cáncer de pulmón: Supervivencia en un amplio programa de detección precoz en España (I-ELCAP) / Lung Cancer Screening: Survival in an Extensive Early Detection Program in Spain (I-ELCAP)

Introducción y objetivo: El cáncer de pulmón (CP) se diagnostica habitualmente en estadios avanzados con una supervivencia media a cinco años del 12%. Ensayos como el National Lung Screening Trial (NLST) y el NEderlands Leuvens longkanker Screenings ONderzoek (NELSON) demuestran una reducción de la mortalidad que justifican la implantación del cribado en población de riesgo. Nuestro objetivo es presentar los resultados de supervivencia del programa de cribado de CP más amplio de España con tomografía computarizada de baja dosis (TCBD). Métodos: Se analizaron los datos del programa Internacional de Detección Precoz de CP (IELCAP) en Valencia, España. Este programa reclutó fumadores o exfumadores con una edad entre 40- 80 años. Se comparan los resultados con otros programas de similar tamaño. Resultados: Un total de 8.278 participantes fueron reclutados con al menos dos rondas de seguimiento, hasta noviembre de 2020 (62,8% varones), realizando una media de seis rondas de cribado por individuo. Diagnosticamos 239 tumores en 12 años de seguimiento. El adenocarcinoma fue el tumor más frecuente con un 61,3% en estadio I. Las tasas de prevalencia e incidencia fueron de 1,5% y 1,4%, respectivamente, con una tasa de detección anual de 0,17. Las tasas de supervivencia cáncer específica a cinco años fueron del 90 y del 80,1% a 10 años. La adherencia fue de 96,84%. Conclusión: La experiencia del programa más amplio de España demuestra que la supervivencia se mejora cuando se realiza en equipos multidisciplinares con experiencia en CP y es similar a programas similares. (AU)

Introduction: Lung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). Methods: Clinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs. Results: A total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. Conclusion: Largest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs. (AU)

[Translated article] Lung Cancer Screening: Survival in an Extensive Early Detection Program in Spain (I-ELCAP) / Cribado de cáncer de pulmón: supervivencia en un amplio programa de detección precoz en España (I-ELCAP)

Introduction: Lung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). Methods: Clinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs. Results: A total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. Conclusion: Largest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs. (AU)

Introducción y objetivo: El cáncer de pulmón (CP) se diagnostica habitualmente en estadios avanzados con una supervivencia media a cinco años del 12%. Ensayos como el National Lung Screening Trial (NLST) y el NEderlands Leuvens longkanker Screenings ONderzoek (NELSON) demuestran una reducción de la mortalidad que justifican la implantación del cribado en población de riesgo. Nuestro objetivo es presentar los resultados de supervivencia del programa de cribado de CP más amplio de España con tomografía computarizada de baja dosis (TCBD). Métodos: Se analizaron los datos del programa Internacional de Detección Precoz de CP (IELCAP) en Valencia, España. Este programa reclutó fumadores o exfumadores con una edad entre 40- 80 años. Se comparan los resultados con otros programas de similar tamaño. Resultados: Un total de 8.278 participantes fueron reclutados con al menos dos rondas de seguimiento, hasta noviembre de 2020 (62,8% varones), realizando una media de seis rondas de cribado por individuo. Diagnosticamos 239 tumores en 12 años de seguimiento. El adenocarcinoma fue el tumor más frecuente con un 61,3% en estadio I. Las tasas de prevalencia e incidencia fueron de 1,5% y 1,4%, respectivamente, con una tasa de detección anual de 0,17. Las tasas de supervivencia cáncer específica a cinco años fueron del 90 y del 80,1% a 10 años. La adherencia fue de 96,84%. Conclusión: La experiencia del programa más amplio de España demuestra que la supervivencia se mejora cuando se realiza en equipos multidisciplinares con experiencia en CP y es similar a programas similares. (AU)

Lung Cancer Screening: Survival in an Extensive Early Detection Program in Spain (I-ELCAP). / Cribado de cáncer de pulmón: Supervivencia en un amplio programa de detección precoz en España (I-ELCAP).

INTRODUCTION: Lung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). METHODS: Clinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs. RESULTS: A total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. CONCLUSION: Largest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs.

Spanish Lung Cancer Group SCAT trial: surgical audit to lymph node assessment based on IASLC recommendations.

BACKGROUND: The Spanish Customized Adjuvant Therapy (SCAT) trial assessed the role of individualized adjuvant therapy in clinical N0 incidental pN1 and/or N2 non-small cell lung cancer (NSCLC) completely resected. We assessed surgical topics with an in-depth analysis of quality of lymphadenectomy based on International Association for the Study of Lung Cancer (IASLC) recommendations. METHODS: Patients with information about lymphadenectomy available were included (N=451). Prospectively collected data about tumor, type of resection, and postoperative morbidity and quality of lymph node dissection (LND) were retrospectively evaluated. Role of lymph node assessment on survival was analyzed using Kaplan-Meier curves, using regression models to identify prognostic factors. RESULTS: In 33.7%, 17.7% and 49.9% of cases, regions 7, 10 and 11 respectively were not assessed. In 21.1% of patients, less than three lymph node regions were biopsied, while in 19.6% of patients less than six lymph nodes were assessed. In 53,4% of patients only one N1 region was evaluated. From patients with positive N2, 8.9% had no N1 regions biopsied. Twenty-nine percent of patients with at least one N2 lymph node resected shown the highest region involved. Thirty-day postoperative mortality was unknown. Five-year overall survival (OS) was 61.7% (95% CI: 55.4-67.4%), 51.5% (95% CI: 39.2-62.4%) and 42.3% (95% CI: 32.1-52.2%) for patients with N1, N2 and N1+N2 disease, respectively (P<0.01). Both number of lymph nodes resected and number of lymph nodes involved by tumor were significantly related to prognosis. CONCLUSIONS: IASLC recommendations for surgical resections were not followed in a high proportion of surgical procedures. Hilar and mediastinal lymph node assessment and involvement showed to impact prognosis. Surgical issues such as postoperative mortality could not be evaluated owing to trial design.

Diagnóstico precoz del cáncer de pulmón: utilidad de la tomografía computarizada de baja dosis de radiación / Lung Cancer Screening: Use of Low-Dose Computed Tomography

Introducción: El pronóstico del cáncer de pulmón (CP) está relacionado directamente con el estadio de la enfermedad al diagnóstico. Material y métodos: Realizamos TC de baja dosis (TCBD) a personas asintomáticas ≥ 50 años, fumadores o exfumadores de ≥ 10 paquetes-año, sin antecedentes oncológicos. Seguimos un algoritmo de evaluación según el tamaño y la morfología de los nódulos. En los CP diagnosticados se estableció el tratamiento adecuado y el seguimiento fue de 5 años. Resultados: Estudiamos 4.951 personas (65,4% varones) con una media de edad de 56,89 ± 5,26 años; 550 presentaron nódulos. De 3.891 nódulos detectados, 692 (19,57%) fueron considerados positivos, hallando 38 tumores (36 CP). En el estudio anual, 224 sujetos mostraban algún nódulo, siendo 288 (7,91%) positivos (13 CP). En el 80% el control se realizó con TCBD y se indicó biopsia en el 5,8% (basal) y 7,6% (anual) de los nódulos positivos. La prevalencia fue del 0,89 y la incidencia del 0,1%. La sensibilidad, la especificidad, el VPP y el VPN en el estudio basal fueron del 92,31, del 89,54, del 6,55 y del 99,93%, respectivamente, y en el anual, del 76,92, del 95,7, del 4,52 y del 99,94%, respectivamente. Se detectaron 52 tumores (49 CP), 25 (52,08%) en estadio I. La supervivencia global de los CP fue del 58,5% a los 5 años, y la supervivencia cáncer específica, del 67,1% (75,8% en los pacientes quirúrgicos). Conclusiones: La TCBD integrada en un programa elaborado de detección y evaluación de nódulos es una herramienta útil para diagnosticar CP en estadio precoz

Introduction: The prognosis of lung cancer (LC) correlates directly with the stage of the disease at the time of diagnosis. Material and methods: We performed low-dose CT (LDCT) in asymptomatic individuals ≥ 50 years old, smokers or former smokers of ≥ 10 pack-years, with no history of cancer. We followed an evaluation algorithm, according to the size and morphology of the nodules. The appropriate treatment for the LC diagnosis was given and patients were followed up for 5 years. Results: We studied 4,951 individuals (65.4% males) with an average age of 56.89 ± 5.26 years; 550 presented nodules. Of the 3,891 nodules detected, 692 (19.57%) were considered positive, and 38 tumors (36 LC) were identified. In the annual follow-up, nodules were found in 224 subjects, 288 (7.91%) of which were positive (13 LC). In 80%, the study was performed with LDCT, and biopsy was indicated in 5.8% (baseline) and in 7.6% (annual) of the positive nodules. Prevalence was 0.89 and incidence was 0.1%. The sensitivity, specificity, PPV and NPV in the baseline study were 92.31, 89.54, 6.55 and 99.93%, respectively, and in the annual study, they were 76.92, 95.7, 4.52 and 99.94%, respectively. A total of 52 tumors were detected (49 LC), 25 (52.08%) in stage I. The 5-year overall survival rate for LC was 58.5% and cancer-specific survival was 67.1% (75.8% in surgical patients). Conclusion: LDCT integrated into an elaborate nodule detection and evaluation program is a useful tool for diagnosing early-stage LC

Lung Cancer Screening: Use of Low-Dose Computed Tomography. / Diagnóstico precoz del cáncer de pulmón: utilidad de la tomografía computarizada de baja dosis de radiación.

INTRODUCTION: The prognosis of lung cancer (LC) correlates directly with the stage of the disease at the time of diagnosis. MATERIAL AND METHODS: We performed low-dose CT (LDCT) in asymptomatic individuals ≥50years old, smokers or former smokers of ≥10 pack-years, with no history of cancer. We followed an evaluation algorithm, according to the size and morphology of the nodules. The appropriate treatment for the LC diagnosis was given and patients were followed up for 5years. RESULTS: We studied 4,951 individuals (65.4% males) with an average age of 56.89±5.26years; 550 presented nodules. Of the 3,891 nodules detected, 692 (19.57%) were considered positive, and 38 tumors (36LC) were identified. In the annual follow-up, nodules were found in 224 subjects, 288 (7.91%) of which were positive (13LC). In 80%, the study was performed with LDCT, and biopsy was indicated in 5.8% (baseline) and in 7.6% (annual) of the positive nodules. Prevalence was 0.89 and incidence was 0.1%. The sensitivity, specificity, PPV and NPV in the baseline study were 92.31, 89.54, 6.55 and 99.93%, respectively, and in the annual study, they were 76.92, 95.7, 4.52 and 99.94%, respectively. A total of 52 tumors were detected (49LC), 25 (52.08%) in stageI. The 5-year overall survival rate for LC was 58.5% and cancer-specific survival was 67.1% (75.8% in surgical patients). CONCLUSION: LDCT integrated into an elaborate nodule detection and evaluation program is a useful tool for diagnosing early-stage LC.

Mortalidad en carcinoma pulmonar no microcítico resecado, con tamaño máximo de 3 cm y sin afectación ganglionar: análisis de riesgos competitivos / Mortality in early-stage, surgically resected non-small cell lung cancer less than 3 cm of size: Competing risk analysis

Fundamentos y objetivo: Los estudios de supervivencia en el carcinoma pulmonar no microcítico (CPNM) se basan, habitualmente, en el método de Kaplan-Meier. Sin embargo, otros factores, no contemplados por este método, pueden modificar la observación del suceso de interés. Existen modelos de incidencia acumulativa (IA) que, teniendo en cuenta estos riesgos competitivos, permiten estimaciones más precisas de la supervivencia y valorar el riesgo de muerte por otras causas. Nuestro objetivo es evaluar dichos modelos en pacientes operados de CPNM en estadio precoz. Pacientes y método: Estudio de 263 pacientes resecados de un CPNM con un diámetro ≤ 3 cm y sin afectación ganglionar (N0). Se analizaron variables demográfico-clínicas, morfopatológicas, quirúrgicas, clasificación TNM y evolución a largo plazo. Para el análisis de la IA se consideró suceso competitivo la mortalidad por otra causa. Para el análisis univariante se utilizó el método de Gray, y para el multivariante, el de Fine y Gray. Resultados: La mortalidad por CPNM fue del 19,4% a los 5 años y del 14,3% por otra causa. Ambas curvas se cruzaron a los 6,3 años, siendo la probabilidad de muerte por otra causa mayor a partir de este punto. En el análisis multivariante, condicionaron la mortalidad por cáncer la invasión pleural visceral (IPV) (p = 0,001) y la vascular (p = 0,020), mientras que para la mortalidad por otra causa diferente del cáncer lo fueron la edad > 50 años (p = 0,034), el tabaquismo (p = 0,009) y el índice de Charlson ≥ 2 (p = 0,000). Conclusiones: Mediante el método de IA, la IPV y la invasión vascular condicionaron la muerte por cáncer en CPNM > 3 cm y se determinaron cuáles fueron las causas no tumorales de muerte a largo plazo (AU)

Background and objective: Survival studies of non-small cell lung cancer (NSCLC) are usually based on the Kaplan-Meier method. However, other factors not covered by this method may modify the observation of the event of interest. There are models of cumulative incidence (CI), that take into account these competing risks, enabling more accurate survival estimates and evaluation of the risk of death from other causes. We aimed to evaluate these models in resected early-stage NSCLC patients. Patients and method: This study included 263 patients with resected NSCLC whose diameter was ≤ 3 cm without node involvement (N0). Demographic, clinical, morphopathological and surgical variables, TNM classification and long-term evolution were analysed. To analyse CI, death by another cause was considered to be competitive event. For the univariate analysis, Gray's method was used, while Fine and Gray's method was employed for the multivariate analysis. Results: Mortality by NSCLC was 19.4% at 5 years and 14.3% by another cause. Both curves crossed at 6.3 years, and probability of death by another cause became greater from this point. In multivariate analysis, cancer mortality was conditioned by visceral pleural invasion (VPI) (P = .001) and vascular invasion (P = .020), with age > 50 years (P = .034), smoking (P = .009) and the Charlson index ≥ 2 (P = .000) being by no cancer. Conclusions: By the method of CI, VPI and vascular invasion conditioned cancer death in NSCLC > 3 cm, while non-tumor causes of long-term death were determined (AU)

Resultados funcionales del trasplante pulmonar en la enfermedad pulmonar obstructiva crónica / Functional Outcomes After Lung Transplant in Chronic Obstructive Pulmonary Disease

Introducción: El trasplante pulmonar (TP) es una opción terapéutica con resultados controvertidos en la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo es analizar los resultados del trasplante en términos de función pulmonar, así como identificar los factores pronósticos. Método: Se realizó un análisis retrospectivo de 107 pacientes con EPOC trasplantados en el Hospital Universitario La Fe entre 1991 y 2008. Se analizaron variables preoperatorias, estudio funcional pre y post-TP, variables del procedimiento quirúrgico y del seguimiento a largo plazo, expresadas en media o porcentaje según el caso, comparándose los resultados espirométricos antes y después del TP. Para el análisis multivariante se utilizó regresión lineal o logística según la variable. Resultados: Fueron trasplantados 94 hombres (87,9%) y 13 mujeres (12,1%), con una edad media ± desviación estándar de 52,58 ± 8,05 años; el 71% de TP fueron bipulmonares. Los valores espirométricos mejoraron tras el TP: FVC: +1,22 l (+34,9%), FEV1: +1,66 l (+56,7%) y FEF25-75: +1,85 l (+50,8%); p = 0,001, manteniéndose esta mejoría funcional tras 5 años solo en el grupo con puntuación BODE > 7 (p = 0,001). La talla del receptor, el tipo de TP, la utilización de circulación extracorpórea durante el procedimiento quirúrgico, la presencia de síndrome de bronquiolitis obliterante junto con la edad y la causa de muerte del donante influyeron significativamente en la función pulmonar a largo plazo. Conclusiones: El TP mejora la función pulmonar de los pacientes con EPOC. Esta mejoría se mantiene a los 5 años solo en los pacientes con BODE mayor de 7. El trasplante bipulmonar proporciona mejores resultados funcionales que el unipulmonar

Introduction: Lung transplantation (LT) is a therapeutic option with controversial results in chronic obstructive pulmonary disease (COPD). We aimed to analyze the outcomes of transplantation in terms of lung function and to identify prognostic factors. Method: A retrospective analysis of 107 patients with COPD receiving lung transplants in the La Fe Hospital between 1991 and 2008 was performed. Preoperative variables, pulmonary function tests before and after LT, surgical procedure variables and long-term monitoring, expressed as mean or percentage, as applicable, were analyzed. Spirometric results before and after LT were analyzed. Linear or logistic regression were used for multivariate analysis depending on the variable. Results: Ninety-four men (87.9%) and 13 women (12.1%) were transplanted, with a mean age ± standard deviation of 52.58 ± 8.05 years; 71% of LTs were double-lung transplantations. Spirometric values improved after LT: FVC: +1.22 L (+34.9%), FEV1: +1.66 L (+56.7%) and FEF25-75: +1.85 L (+50.8%); P = .001. This functional improvement was maintained after 5 years only in the group with BODE score > 7 (P = .001). Recipient height, type of LT, use of extracorporeal circulation during the surgical procedure, presence of bronchiolitis obliterans syndrome and the age and cause of death of the donor significantly influenced lung function over time. Conclusions: LT improves lung function in COPD patients. This improvement was maintained at 5 years only in patients with BODE > 7. Double lung transplantation provides better functional results than single-lung transplantation

[Mortality in early-stage, surgically resected non-small cell lung cancer less than 3 cm of size: Competing risk analysis]. / Mortalidad en carcinoma pulmonar no microcítico resecado, con tamaño máximo de 3 cm y sin afectación ganglionar: análisis de riesgos competitivos.

BACKGROUND AND OBJECTIVE: Survival studies of non-small cell lung cancer (NSCLC) are usually based on the Kaplan-Meier method. However, other factors not covered by this method may modify the observation of the event of interest. There are models of cumulative incidence (CI), that take into account these competing risks, enabling more accurate survival estimates and evaluation of the risk of death from other causes. We aimed to evaluate these models in resected early-stage NSCLC patients. PATIENTS AND METHOD: This study included 263 patients with resected NSCLC whose diameter was ≤ 3 cm without node involvement (N0). Demographic, clinical, morphopathological and surgical variables, TNM classification and long-term evolution were analysed. To analyse CI, death by another cause was considered to be competitive event. For the univariate analysis, Gray's method was used, while Fine and Gray's method was employed for the multivariate analysis. RESULTS: Mortality by NSCLC was 19.4% at 5 years and 14.3% by another cause. Both curves crossed at 6.3 years, and probability of death by another cause became greater from this point. In multivariate analysis, cancer mortality was conditioned by visceral pleural invasion (VPI) (P=.001) and vascular invasion (P=.020), with age>50 years (P=.034), smoking (P=.009) and the Charlson index ≥ 2 (P=.000) being by no cancer. CONCLUSIONS: By the method of CI, VPI and vascular invasion conditioned cancer death in NSCLC >3 cm, while non-tumor causes of long-term death were determined.

Functional outcomes after lung transplant in chronic obstructive pulmonary disease.

INTRODUCTION: Lung transplantation (LT) is a therapeutic option with controversial results in chronic obstructive pulmonary disease (COPD). We aimed to analyze the outcomes of transplantation in terms of lung function and to identify prognostic factors. METHOD: A retrospective analysis of 107 patients with COPD receiving lung transplants in the La Fe Hospital between 1991 and 2008 was performed. Preoperative variables, pulmonary function tests before and after LT, surgical procedure variables and long-term monitoring, expressed as mean or percentage, as applicable, were analyzed. Spirometric results before and after LT were analyzed. Linear or logistic regression were used for multivariate analysis depending on the variable. RESULTS: Ninety-four men (87.9%) and 13 women (12.1%) were transplanted, with a mean age±standard deviation of 52.58±8.05 years; 71% of LTs were double-lung transplantations. Spirometric values improved after LT: FVC: +1.22L (+34.9%), FEV1: +1.66L (+56.7%) and FEF25-75: +1.85L (+50.8%); P=.001. This functional improvement was maintained after 5 years only in the group with BODE score >7 (P=.001). Recipient height, type of LT, use of extracorporeal circulation during the surgical procedure, presence of bronchiolitis obliterans syndrome and the age and cause of death of the donor significantly influenced lung function over time. CONCLUSIONS: LT improves lung function in COPD patients. This improvement was maintained at 5years only in patients with BODE>7. Double lung transplantation provides better functional results than single-lung transplantation.

Trasplante pulmonar en la linfangioleiomiomatosis esporádica. Estudio de 7 casos / Lung transplantation in sporadic lymphangioleiomyomatosis: Study of 7 cases

Fundamentos y objetivo: La sporadic lymphangioleiomyomatosis (S-LAM, «linfangioleiomiomatosis esporádica») es una enfermedad rara que afecta a la mujer. Se caracteriza por una proliferación anormal de células musculares lisas inmaduras, células LAM, que crecen de una manera aberrante en el pulmón. La enfermedad no tiene tratamiento, evolucionando hacia la insuficiencia respiratoria. El trasplante pulmonar (TP) puede ser una opción terapéutica en este estadio. Nuestro objetivo es el estudio de 7 pacientes sometidas a TP por S-LAM. Material y método: Se estudiaron las características clinicodemográficas, de diagnóstico, y los resultados. Se realizó un análisis descriptivo y se estimó la supervivencia mediante el método de Kaplan-Meier. Resultados: La edad media de aparición de los síntomas, diagnóstico y TP fue de 35, 37 y 38 años, respectivamente. El síntoma más frecuente fue la disnea. La media del volumen espiratorio forzado en el primer segundo fue del 32,7%, y la de difusión del monóxido de carbono, del 29%. La supervivencia fue del 100, 85,7 y 57,1% a uno, 3 y 5 años, respectivamente. Tres pacientes fallecieron por bronquiolitis obliterante y en 2 necropsias realizadas no se observó recidiva de la enfermedad. Conclusiones: El TP es una opción terapéutica en pacientes con S-LAM en insuficiencia respiratoria avanzada (AU)

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Necrosis grasa pericárdica asintomática / Asymptomatic pericardial fat necrosis

La necrosis grasa pericárdica es una entidad poco frecuente, benigna y de causa desconocida. Se suele presentar como un dolor torácico agudo, de características pleuríticas, en personas previamente sanas. Radiológicamente se asocia con un aumento de densidad de localización anterior, a nivel paracardíaco, de contornos bien definidos, en la radiografía de tórax posteroanterior. Con carácter excepcional, constituye un hallazgo incidental. El objetivo de esta nota clínica es presentar un caso de necrosis grasa pericárdica en un varón de 38 años asintomático, hallado intraoperatoriamente durante la resección de un carcinoma pulmonar(AU)

Pericardial fat necrosis is an uncommon benign condition of unknown cause. It presents as acute pleuritic chest pain in previously healthy persons associated with a well-defined anterior paracardiac density on posteroanterior chest radiography. Exceptionally, it constitutes an incidental finding. The objective of this study is to report a clinical case of pericardial fat necrosis in an asymptomatic 38-year-old man, found intraoperatively during a lung carcinoma resection(AU)

[Lung transplantation in sporadic lymphangioleiomyomatosis: study of 7 cases]. / Trasplante pulmonar en la linfangioleiomiomatosis esporádica. Estudio de 7 casos.

BACKGROUND AND OBJECTIVE: Sporadic lymphangioleiomyomatosis (S-LAM) is a rare disease that affects only women. It is characterized by an abnormal proliferation of immature smooth muscle cells (LAM cells) that grow in an aberrant manner in the airway, parenchymal lung lymph and blood vessels, determining the onset of pulmonary cystic lesions. The disease has no treatment, progressing to respiratory failure, and lung transplantation (LT) may be a treatment option at this stage. Our goal was to study 7 patients undergoing LT for S-LAM. MATERIAL AND METHOD: We studied a series of clinical and demographic characteristics, diagnostic modality and post-transplant outcomes. We performed a descriptive analysis of the series. The Kaplan-Meier method was used to estimate survival. RESULTS: The mean age of onset of symptoms was 35 years, the diagnosis of 37 years and that of LT 38 years. The most common symptom was dyspnea. Four patients had a history of pneumothorax and pleural effusion. The mean forced expiratory volume in one second was 32.7% and the diffusing capacity for carbon monoxide was 29%. All patients were subjected to LT and survival was 100, 85.7 and 57.1% at one, 3 and 5 years, respectively. Three died of bronchiolitis obliterans and 2 necropsies did not show evidence of disease recurrence. CONCLUSIONS: LT is a therapeutic option in patients with S-LAM with an advanced respiratory functional impairment.

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.

Complicaciones del trasplante de pulmón en la enfermedad pulmonar obstructiva crónica / Complications after lung transplantation in chronic obstructive pulmonary disease

Fundamento y objetivo: El trasplante de pulmón (TP) en la enfermedad pulmonar obstructiva crónica (EPOC) es un procedimiento con una alta tasa de morbimortalidad. El objetivo del presente trabajo es analizar la tasa de complicaciones, precoces y tardías, del TP en pacientes con EPOC. Pacientes y método: Estudio retrospectivo de 107 pacientes con EPOC trasplantados en el Hospital Universitario La Fe entre 1991 y 2008. Se recogieron variables preoperatorias, así como todas las complicaciones, médicas y quirúrgicas, sucedidas en el seguimiento, expresadas como media o porcentaje, según el caso. Se estableció la mortalidad a 30 días y la supervivencia a largo plazo. Resultados: Se trasplantaron 94 varones (87,9%) y 13 mujeres (12,1%), con una edad media (DE) de 52,58 (8,05) años; un 71% de TP fueron bipulmonares. La puntuación BODE media fue de 7,24 (1,28). La tasa de disfunción primaria del injerto fue del 39,3%. Las complicaciones quirúrgicas más frecuentes fueron: parálisis frénica (16,8%), hemotórax (17,8%) y errame pleural (30,8%). Hubo un elevado número de hospitalizaciones postoperatorias (30%) y de complicaciones médicas, como hipertensión (36%), diabetes mellitus (16,7%) e insuficiencia renal (40%), secundarias al tratamiento inmunodepresor. La mortalidad perioperatoria fue del 14% y al año del 34,5%, siendo las causas más frecuentes las infecciones (34,6%) y el rechazo crónico (17,8%). La supervivencia a 5 años fue de 40,9%, siendo la presencia de bronquiectasias y el consumo de tabaco factores de riesgo. Conclusiones: El TP es un procedimiento de elevada mortalidad precoz, que asocia una alta tasa de complicaciones médicas y quirúrgicas, que condicionan el resultado del mismo (AU)

Background and objective: Lung transplantation (LT) in chronic obstructive pulmonary disease (COPD) is a procedure with a high rate of morbimortality. The aim of this paper is to analyze the early and late rates of complications and mortality in COPD patients undergoing LT. Patients and method: Retrospective study of 107 COPD patients transplanted in the Hospital Universitario La Fe, between 1991 and 2008. Preoperative variables were collected as well as all the complications, medical and surgical, occurred in the follow-up, which are expressed as mean or percentage as appropriate. The 30-day mortality and long term survival were established. Results: A total of 94 men (87.9%) and 13 women (12.1%) were transplanted with a mean age (SD) of 52.58 (8.05) years with 71% of double-lung LT. BODE score was 7.24 (1.28). The rate of primary graft dysfunction was 39.3%. The most common surgical complications were phrenic paralysis (16.8%), hemothorax (17.8%) and pleural effusion (30.8%). There was a high number of postoperative hospitalization (30%) and medical complications such as hypertension (36%), diabetes mellitus (16.7%) and renal failure (40%), secondary to treatment. Perioperative mortality was 14% and 34.5% after a year, being the most frequent causes infections (34.6%) and chronic rejection (BOS) (17.8%). Five-year survival was 40.9% with bronchiectasis and smoking history being the risk factors. Conclusions: LT is a procedure with a high early mortality rate associated with high medical and surgical complications that affect the outcome (AU)

[Complications after lung transplantation in chronic obstructive pulmonary disease]. / Complicaciones del trasplante de pulmón en la enfermedad pulmonar obstructiva crónica.

BACKGROUND AND OBJECTIVE: Lung transplantation (LT) in chronic obstructive pulmonary disease (COPD) is a procedure with a high rate of morbimortality. The aim of this paper is to analyze the early and late rates of complications and mortality in COPD patients undergoing LT. PATIENTS AND METHOD: Retrospective study of 107 COPD patients transplanted in the Hospital Universitario La Fe, between 1991 and 2008. Preoperative variables were collected as well as all the complications, medical and surgical, occurred in the follow-up, which are expressed as mean or percentage as appropriate. The 30-day mortality and long term survival were established. RESULTS: A total of 94 men (87.9%) and 13 women (12.1%) were transplanted with a mean age (SD) of 52.58 (8.05) years with 71% of double-lung LT. BODE score was 7.24 (1.28). The rate of primary graft dysfunction was 39.3%. The most common surgical complications were phrenic paralysis (16.8%), hemothorax (17.8%) and pleural effusion (30.8%). There was a high number of postoperative hospitalization (30%) and medical complications such as hypertension (36%), diabetes mellitus (16.7%) and renal failure (40%), secondary to treatment. Perioperative mortality was 14% and 34.5% after a year, being the most frequent causes infections (34.6%) and chronic rejection (BOS) (17.8%). Five-year survival was 40.9% with bronchiectasis and smoking history being the risk factors. CONCLUSIONS: LT is a procedure with a high early mortality rate associated with high medical and surgical complications that affect the outcome.

Experiencia de un programa de fast-track surgery en resección pulmonar / Experience With Lung Resection in a Fast-Track Surgery Program

Introducción: Este trabajo pretende evaluar la influencia de un programa de fast-track surgery en la estancia hospitalaria y en la morbimortalidad en cirugía de resección pulmonar. Pacientes y métodos Estudio prospectivo de 100 pacientes sometidos a resección pulmonar abierta por afección neoplásica. Se analizaron las variables demográficas y las clínicas, el tipo de resección, la estancia hospitalaria y las complicaciones postoperatorias, ajustándolas a la clasificación establecida en función del tratamiento requerido. Resultados: Setenta y tres pacientes fueron hombres y la media de edad de 60,8 años. El 82% fueron asintomáticos y el 97% tenía historia de tabaquismo. La mayoría presentó comorbilidad asociada y se realizaron 7 neumonectomías, 79 lobectomías, 6 bilobectomías y 8 segmentectomías. La estancia media fue de 5,4±4,2 días (rango, 3-23), variando entre 3,4±0,8 días (rango, 3-6) y de 9,8±5,3 días (rango, 4-23) en función de la ausencia o presencia de complicaciones. La mortalidad asociada fue del 2% y la morbilidad del 31%, siendo las complicaciones más frecuentes la fuga aérea persistente (10%) y la fibrilación auricular (6%). El 51,5% de las complicaciones se clasificaron dentro del grupo de complicaciones de menor grado en función del tratamiento requerido. Cuatro pacientes requirieron reingreso tras el alta hospitalaria. Conclusiones: Los programas de fast-track surgery permiten conseguir una reducción de los tiempos de estancia hospitalaria al planificar una estrategia multidisciplinar del procedimiento quirúrgico, en el que toma parte activa el propio paciente. Igualmente, se hace necesario establecer sistemas de clasificación de las complicaciones postoperatorias que puedan evaluar la calidad de la cirugía(AU)

Introduction: This paper intends to assess the influence of a fast-track surgery program on hospital stay and morbidity/mortality in lung resection surgery. Patients and methods A prospective study was conducted including 100 patients who underwent open lung resection due to neoplastic pathologies. The variables analyzed were demographic, clinical, resection type, length of hospital stay, and postoperative complications, adjusting these to the classification established according to the treatment required. Results: Seventy-three patients were men, and mean age was 60.8. 82% of the subjects were asymptomatic, 97% had a history of smoking and the majority presented associated comorbidities. The resection types included 7 pneumonectomies, 79 lobectomies, 6 bilobectomies, and 8 segmentectomies. Mean hospital stay was 5.4±4.2 days (range, 3–23), varying between 3.4±0.8 days (range, 3–6) and 9.8±5.3 days (range, 4–23) according to the absence or presence of complications. Associated mortality was 2% and morbidity 31%; the most frequent complications were persistent air leak (10%) and atrial fibrillation (6%). 51.5% of the complications were classified within the lower grade complication group, depending on treatment required. Four patients required readmittance after hospital discharge. Conclusions: Fast-track surgery programs are able to reduce hospitalization times by planning a multidisciplinary strategy of the surgical procedure, in which the patient him/herself participates. It is equally necessary to establish systems to classify postoperative complications that can evaluate the quality of the surgery(AU)

Experience with lung resection in a fast-track surgery program.

INTRODUCTION: This paper intends to assess the influence of a fast-track surgery program on hospital stay and morbidity/mortality in lung resection surgery. PATIENTS AND METHODS: A prospective study including 100 patients who underwent open lung resection due to neoplastic pathologies. The variables analyzed were demographic, clinical, resection type, length of hospital stay and postoperative complications, adjusting these to the classification established according to the treatment required. RESULTS: Seventy-three patients were men, and mean age was 60.8. 82% of the subjects were asymptomatic, 97% had a history of smoking and the majority presented associated comorbidities. The resection types included 7 pneumonectomies, 79 lobectomies, 6 bilobectomies and 8 segmentectomies. Mean hospital stay was 5.4±4.2 days (range: 3-23), varying between 3.4±0.8 days (range: 3-6) and 9.8±5.3 days (range: 4-23) according to the absence or presence of complications. Associated mortality was 2% and morbidity 31%; the most frequent complications were persistent air leak (10%) and atrial fibrillation (6%). 51.5% of the complications were classified within the lower grade complication group, depending on treatment required. Four patients required readmittance after hospital discharge. CONCLUSIONS: Fast-track surgery programs are able to reduce hospitalization times by planning a multidisciplinary strategy of the surgical procedure, in which the patient him/herself participates. It is equally necessary to establish systems to classify postoperative complications that can evaluate the quality of the surgery.

Linfangioleiomiomatosis esporádica e hipertensión pulmonar. Estudio clínico-patológico en pacientes receptoras de un trasplante pulmonar / Sporadic lymphangioleiomyomatosis and pulmonary hypertension. Clinical and pathologic study in patients undergoing lung transplantation

Fundamentos y objetivo: La linfangioleiomiomatosis (LAM) es una enfermedad rara que se caracteriza por una proliferación aberrante de células musculares lisas inmaduras, células LAM, en la vía aérea, parénquima, ganglios linfáticos y vasos pulmonares, provocando lesiones quísticas. Afecta predominantemente a la mujer y puede producir hipertensión pulmonar (HP). Nuestro objetivo es el estudio clínico y de los hallazgos morfológicos que expresan HP en los pulmones nativos de pacientes sometidas a trasplante pulmonar (TP) por LAM. Pacientes y método: Se estudió un grupo de variables clínicas en 7 pacientes que presentaban una LAM y que fueron sometidas a TP. Asimismo, utilizando técnicas morfológicas e inmunohistoquímicas, se analizaron las alteraciones histológicas en los pulmones nativos, su nivel de gravedad, la presencia de hemosiderosis en espacios aéreos y el índice de correlación entre el grosor de la media y el diámetro vascular arterial pulmonar, expresión morfológica de HP.Resultados: La edad media fue de 34 años y la disnea, el síntoma predominante. El patrón funcional respiratorio fue mixto con disminución del porcentaje de difusión de monóxido de carbono ajustado a hemoglobina y a volumen alveolar y hemoglobina, hipoxemia grave y normocapnia. Existieron manifestaciones subclínicas de HP en los estudios cardiológicos. La inmunohistoquímica mostró positividad a los marcadores de músculo liso y de expresión melánica, receptores estrogénicos en 6 casos y de progesterona en 4. El índice de correlación vascular mostró criterios de HP en todos. Conclusiones: Este estudio pone de manifiesto la presencia de criterios clínicos y morfológicos de HP en pacientes afectadas de LAM avanzada. Ello justificaría una valoración cardiológica pretrasplante con cateterismo derecho, siendo conveniente comprobar en futuros trabajos si la HP debería ser un criterio de TP en la LAM (AU)

Background and objective: Lymphangioleiomyomatosis (LAM) is a rare disease characterized by an aberrant immature smooth muscle cells proliferation. This excessive growth of LAM cells around airways, parenchyma, lymphatic ganglia and lung vessels, produces cystic damages. LAM affects mainly women and can lead to pulmonary hypertension (PH). The aim of this research is the clinical study, as well as the analysis of the morphological features, expressing PH, of the native lungs from lung transplant (LT) patients. Patients and methods: Several clinical variables were studied in 7 patients who had a LAM and who were subjected to LT. The variables analyzed using morphologic and immunohistochemistry techniques were: histological alterations in native lungs, their severity rate, the presence of haemosiderosis in the air spaces and correlation index between thickness of the middle layer and the pulmonary arterial vascular diameter, morphological expression of HP. Results:The average age was 34 years old and the predominant symptom was dyspnea. The respiratory functional pattern was mixt, with decrease of DLCO% and KCO%, serious hypoxemia and normocapnia. In the cardiological study, subclinical signs of HP were found. The immunohistochemistry was positive for smooth muscle and melanic expression markers, estrogen receptor in 6 cases and progesterone receptor in 4. Vascular correlation index showed HP criteria at all. Conclusions: This research shows the presence of clinical and morphological HP criteria in advanced LAM patients. Therefore, cardiological assessment before LT with right catheterization will be justified. Future research should be addressed to clarify whether the HP should be criteria for LT in LAM patients (AU)