Residential radon and characteristics of chronic obstructive pulmonary disease.

It is not known whether residential radon exposure may be linked to the development of chronic obstructive pulmonary disease (COPD) and/or have an influence on the functional characteristics or exacerbations of COPD. The aim of this study was therefore to ascertain whether there might be an association between residential radon concentrations and certain characteristics of COPD. We analyzed COPD cases drawn from a case-control study conducted in an area of high radon exposure. Data were collected on spirometric pulmonary function variables, hospital admissions, and smoking. Radon measurements were taken using alpha-track-type CR-39 detectors individually placed in patients' homes. All statistical analyses were performed using the IBM SPSS v22 computer software program. The study included 189 COPD cases (79.4% men; median age 64 years). The median radon concentration was 157 Bq/m3. No differences were found between radon concentration and sex, age or severity of breathing obstruction as measured by FEV1%. It should be noted, however, that 48.1% of patients with FEV1% < 50 had radon concentrations below 100 Bq/m3, as compared to 35.6% with the same severity of obstruction who had over 300 Bq/m3. COPD cases with radon concentrations higher than > 600 Bq/m3 exhibited no different characteristics in lung function. Exposure to radon does not appear to have an influence on the clinical characteristics of smokers and ex-smokers with COPD. As exposure to residential radon increases, there is no trend towards a worsening of FEV1%. Further studies are thus needed to analyze this possible association in never-smokers with COPD.

El neumólogo y su paciente tras la decisión del comité de cáncer de pulmón / The Pulmonologist-Patient Relationship After the Lung Cancer Committee Decision

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Normativa sobre el manejo del nódulo pulmonar solitario / Guideline on Management of Solitary Pulmonary Nodule

Las recomendaciones que se proponen pretenden ser un instrumento que facilite la toma de decisiones en pacientes con nódulo pulmonar solitario (NPS). Para una decisión óptima hay que incorporar la accesibilidad a las distintas técnicas diagnósticas y las preferencias del paciente. La primera valoración, que incluye la tomografía computarizada torácica, separa a un grupo de pacientes con neoplasia extrapulmonar o muy alto riesgo quirúrgico que requieren manejo individualizado. Otros 2 grupos son los pacientes con NPS de hasta 8 mm y los que tienen NPS subsólido, para los que se establecen recomendaciones específicas. Los NPS mayores de 8 mm se clasifican según su probabilidad de malignidad en baja (menor del 5%) donde se recomienda observación, alta (mayor del 65%) que se manejan con el diagnóstico de presunción de carcinoma en estadio localizado, e intermedia, donde la tomografía de emisión de positrones tiene gran rendimiento para reclasificarlos en alta o baja probabilidad. En los casos de probabilidad de malignidad intermedia o alta puede ser una opción la punción o biopsia transbronquial del nódulo. Se recomienda la observación radiológica con tomografía computarizada de baja radiación y sin contraste en el NPS con baja probabilidad de malignidad, y la resección con videotoracoscopia en los casos no diagnosticados y con probabilidad de malignidad intermedia o alta

The aim of the proposed recommendations is to be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated. The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8 mm and those who have a subsolid SPN, for which specific recommendations are established. SPNs larger than 8 mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy

Guideline on management of solitary pulmonary nodule.

The aim of the proposed recommendations is be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated. The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8mm and those who have a subsolid SPN, for which specific recommendations are established. SPN larger than 8mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy.

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

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

Incidencia del carcinoma broncopulmonar en Castilla y León y en Cantabria durante el año 2007. Estudio de la Sociedad Castellano-Leonesa y Cántabra de Patología Respiratoria (SOCALPAR) / Incidence of bronchopulmonary cancer in Castilla y Leon and Cantabria in the year 2007. A study by the Castilla y Leon and Cantabria respiratory diseases society (SOCALPAR)

Introducción Dada la importancia sanitaria del carcinoma broncopulmonar, hemos planteado un estudio para conocer su incidencia y otros aspectos epidemiológicos en los pacientes residentes en Cantabria y en Castilla y León, comparando en esta comunidad los datos actuales con los obtenidos 10 años antes en un estudio similar. Pacientes y métodos Obtención prospectiva y multicéntrica de información (edad, sexo, residencia, tabaquismo e histología) en todos los pacientes diagnosticados a lo largo del año 2007. Resultados Se incluyó a 1.486 pacientes —1.295 varones (87,1%) y 191 mujeres (12,9%)—, de los que 1.145 residían en Castilla y León —1.010 varones (88,2%) y 135 mujeres (11,8%)—, y 341 en Cantabria —285 varones (83,6%) y 56 mujeres (16,4%)—. Las tasas de incidencia por 100.000 habitantes ajustadas a la población mundial estándar han sido significativamente superiores en Cantabria (29,53; varones: 52,9; mujeres: 9,76) que en Castilla y León (21,35; varones: 38,31; mujeres: 5,58). Habían sido fumadores un 90,24% (varones: 96,12%; mujeres: 49,17%). Los principales tipos histológicos fueron los tumores escamosos, un 32,82%, adenocarcinomas un 28,74% y carcinomas de células pequeñas un 18,33%. En Castilla y León, desde 1997 a 2007, el número de varones ha pasado de 920 a 1.010 y el de mujeres de 95 a 135 (incremento de tasas brutas: un 10,5% en varones y un 43% en mujeres), objetivándose un descenso de los tumores escamosos y un aumento de los adenocarcinomas. Conclusiones En 2007 las tasas de incidencia del cáncer broncopulmonar eran en Cantabria significativamente superiores a las de Castilla y León. En esta comunidad las tasas de 2007 han sido superiores a las de 1997, tanto en varones como en mujeres(AU)

Introduction This study sets out to find out the incidence and other epidemiological characteristics of bronchopulmonary cancer in patients living in Cantabria and Castilla y Leon (Spain) and comparing the current data obtained in the last communities with that obtained 10 years ago in a similar study. Patients and methods Prospective, multicentre study using information (age, sex, residence, smoking habits and histology) obtained from all patients diagnosed during the year 2007. Results A total of 1486 patients were included —1295 males (87.1%) and 191 females (12.9%)—, of whom 1145 lived in Castilla y Leon —1010 males (88.2%) and 135 females (11.8%)—, and 341 in Cantabria —285 males (83.6%) y 56 females (16.4%)—. The incidence rates per 100,000 inhabitants adjusted to the world standard population were significantly higher in Cantabria [29.53; (males: 52.9; females: 9.76)] than in Castilla y Leon [21.35; (males: 38.31; females: 5.58)]. A total of 90.24% were smokers (males: 96.12% and women: 49.17%). The main histology types were: squamous, 32, 82%; adenocarcinoma, 28.74%, and small cell carcinomas, 18.33%. In Castilla y Leon, from 1997 to 2007, the numbers went from 920 to 1010 in males and from 95 to 135 in females (a crude rate increase of 10.5% in males and 43% in females), and showed a decrease in squamous tumours and an increase in adenocarcinomas. Conclusions The incidence rates of bronchopulmonary cancer in 2007 were significantly higher in Cantabria than those of Castilla y Leon. The 2007 rates in this community were higher than in 1997 in both males and females(AU)

[Incidence of bronchopulmonary cancer in Castilla y Leon and Cantabria in the year 2007. A study by the Castilla y Leon and Cantabria Respiratory Diseases Society (SOCALPAR)]. / Incidencia del carcinoma broncopulmonar en Castilla y León y en Cantabria durante el año 2007. Estudio de la Sociedad Castellano-Leonesa y Cántabra de Patología Respiratoria (SOCALPAR).

INTRODUCTION: This study sets out to find out the incidence and other epidemiological characteristics of bronchopulmonary cancer in patients living in Cantabria and Castilla y Leon (Spain) and comparing the current data obtained in the last communities with that obtained 10 years ago in a similar study. PATIENTS AND METHODS: Prospective, multicentre study using information (age, sex, residence, smoking habits and histology) obtained from all patients diagnosed during the year 2007. RESULTS: A total of 1486 patients were included--1295 males (87.1%) and 191 females (12.9%)--, of whom 1145 lived in Castilla y Leon--1010 males (88.2%) and 135 females (11.8%)--, and 341 in Cantabria--285 males (83.6%) and 56 females (16.4%)--. The incidence rates per 100,000 inhabitants adjusted to the world standard population were significantly higher in Cantabria [29.53; (males: 52.9; females: 9.76)] than in Castilla y Leon [21.35; (males: 38.31; females: 5.58)]. A total of 90.24% were smokers (males: 96.12% and women: 49.17%). The main histology types were: squamous, 32, 82%; adenocarcinoma, 28.74%, and small cell carcinomas, 18.33%. In Castilla y Leon, from 1997 to 2007, the numbers went from 920 to 1010 in males and from 95 to 135 in females (a crude rate increase of 10.5% in males and 43% in females), and showed a decrease in squamous tumours and an increase in adenocarcinomas. CONCLUSIONS: The incidence rates of bronchopulmonary cancer in 2007 were significantly higher in Cantabria than those of Castilla y Leon. The 2007 rates in this community were higher than in 1997 in both males and females.

El cáncer de pulmón y la enfermedad pulmonar obstructiva crónica estrechan relaciones / No disponible

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Epidemiología del carcinoma broncogénico en España en los comienzos del siglo XXI / Epidemiology of bronchogenic carcinoma in the early XXI century in Spain

In the early 1990s the Spanish lung cancer incidence and mortality rates where clearly lower than European rates. But recently, in 2002, the incidence and mortality rates where 55.8 and 49.2 cases/100 000 respectively in men (similar to the mean of Southern European countries) and 5.4 y 4.7 cases/100 000 in women (very low rates although growing). This tumor is the most frequent in men and responsible of the highest mortality (15 995 deaths in 2002, 26.2% of all tumor deaths). 2 119 women also died (5.8% of tumor derived deaths). The men from Extremadura, Asturias and Cantabria, and the women from País Vasco, Castilla-León and Navarra showed the highest mortality rates among Spanish communities. Absolute survival in five years time is around 8% based on clinical and epidemiological Spanish studies and the age-adjusted relative survival is 12.4% in men and 12.8% in women based in the Eurocare-3 study

A pesar de que a principios de los '90 las tasas ajustadas de incidencia y mortalidad del carcinoma broncogénico se encontraban en España claramente por debajo de las correspondientes a los países de su entorno europeo, en el año 2002 llegaron a 55.8 y 49.2 casos por 100 000, respectivamente, en hombres, similares ya a la media de los países del sur de Europa. En las mujeres alcanzaron 5.4 y 4.7 por 100 000, valores muy bajos en el contexto continental pero que se encuentran en continuo crecimiento actualmente. El carcinoma broncogénico es el tumor diagnosticado con mayor frecuencia en los hombres españoles y el que ocasiona mayor mortalidad (15 995 fallecimientos en 2002; 26.2% de todas las muertes por tumores). Fue también causa de muerte en 2 119 mujeres (5.8% de las causadas por tumores). Por comunidades autónomas, las tasas brutas de mortalidad más altas las presentan los hombres extremeños, asturianos y cántabros, junto con las mujeres del País Vasco, Castilla-León y Navarra. Según estudios clínico-epidemiológicos españoles, la supervivencia absoluta a los 5 años se halla próxima al 8%, pero la supervivencia relativa (ajustada por edad según otras causas de muerte en una población similar) alcanza el 12.4% en hombres y el 12.8% en mujeres, de acuerdo con los resultados del estudio Eurocare-3