Nueva inmunoterapia y cáncer de pulmón / New Immunotherapy and Lung Cancer

Investigaciones recientes sobre la relación entre el sistema inmune y el cáncer han desvelado los mecanismos moleculares mediante los cuales las células neoplásicas aprovechan algunos receptores de los linfocitos T, con función inhibitoria de la respuesta citotóxica, para defenderse del ataque inmune desarrollado frente a ellas. Estos hallazgos han permitido identificar dianas precisas (receptores de los linfocitos T o ligandos que se acoplan a ellos) frente a los que se han diseñado anticuerpos monoclonales, capaces de desbloquear la respuesta inmunitaria. Estos fármacos (immune check point inhibitors), de eficacia demostrada en el melanoma metastásico o el carcinoma renal, han sido probados con éxito frente al carcinoma de pulmón no microcítico en ensayos recientes. Tras su aprobación e incorporación a la práctica clínica en 2.ª línea después de una pauta inicial de quimioterapia (QT), se han comunicado en el último año resultados positivos en ensayos aleatorizados que los comparaban con QT estándar en 1.ª línea. Se han observado respuestas sorprendentes y duraderas, aunque no superan el 20-25% en pacientes no seleccionados, por lo que es crucial detectar rasgos predictivos de eficacia, como el biomarcador PD-L1, si bien los diferentes métodos para su detección han producido resultados dispares. En esta revisión no sistemática se discuten los resultados de los últimos ensayos, las posibilidades de incorporar estos fármacos en primera línea, los criterios de selección de pacientes, los efectos adversos y las perspectivas de su empleo asociados a modalidades terapéuticas tradicionales como QT, radioterapia o antiangiogénicos (AU)

Recent research on the relationship between the immune system and cancer has revealed the molecular mechanisms by which cancer cells co-opt certain T cell receptors which block the cytotoxic response to defend themselves from the antitumor immune attack. These findings have helped identify specific targets (T cell receptors or their corresponding ligands) for the design of monoclonal antibodies that can unlock the immune response. These drugs, known as immune checkpoint inhibitors, have shown efficacy in metastatic melanoma and kidney cancer, and have been successfully tested in non-small cell lung cancer in recent trials. Immune checkpoint inhibitors were included in clinical practice as a second-line option after an initial chemotherapy (CT) regimen, and in the last year positive results have been reported from randomized trials in which they were compared in first line with standard CT. Responses have been surprising and durable, but less than 20%-25% in unselected patients, so it is essential that factors predicting efficacy be identified. One such biomarker is PD-L1, but the different methods used to detect it have produced mixed results. This non-systematic review discusses the results of the latest trials, the possibilities of incorporating these drugs in first-line regimens, the criteria for patient selection, adverse effects, and the prospects of combinations with conventional treatment modalities, such as CT, radiation therapy, and antiangiogenic agents (AU)

New Immunotherapy and Lung Cancer. / Nueva inmunoterapia y cáncer de pulmón.

Recent research on the relationship between the immune system and cancer has revealed the molecular mechanisms by which cancer cells co-opt certain T cell receptors which block the cytotoxic response to defend themselves from the antitumor immune attack. These findings have helped identify specific targets (T cell receptors or their corresponding ligands) for the design of monoclonal antibodies that can unlock the immune response. These drugs, known as immune checkpoint inhibitors, have shown efficacy in metastatic melanoma and kidney cancer, and have been successfully tested in non-small cell lung cancer in recent trials. Immune checkpoint inhibitors were included in clinical practice as a second-line option after an initial chemotherapy (CT) regimen, and in the last year positive results have been reported from randomized trials in which they were compared in first line with standard CT. Responses have been surprising and durable, but less than 20%-25% in unselected patients, so it is essential that factors predicting efficacy be identified. One such biomarker is PD-L1, but the different methods used to detect it have produced mixed results. This non-systematic review discusses the results of the latest trials, the possibilities of incorporating these drugs in first-line regimens, the criteria for patient selection, adverse effects, and the prospects of combinations with conventional treatment modalities, such as CT, radiation therapy, and antiangiogenic agents.

Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas / Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer

La Sociedad Española de Neumología y Cirugía Torácica (SEPAR), a través de las áreas de Cirugía Torácica y de Oncología Torácica, ha promovido la realización de un manual de recomendaciones para el diagnóstico y el tratamiento del cáncer de pulmón de células no pequeñas. Las elevadas incidencia y mortalidad de esta patología hacen necesaria una constante actualización de las mejores evidencias científicas para su consulta por parte de los profesionales de la salud. Para su confección se ha contado con un amplio grupo de profesionales de distintas especialidades que han elaborado una revisión integral, que se ha concretado en 4 apartados principales. En el primero se ha estudiado la prevención y el cribado de la enfermedad, incluyendo los factores de riesgo, el papel de la deshabituación tabáquica y el diagnóstico precoz mediante programas de cribado. En un segundo apartado se ha analizado la presentación clínica, los estudios de imagen y el riesgo quirúrgico, incluyendo el cardiológico y la evaluación funcional respiratoria. Un tercero trata sobre los estudios de confirmación cito-histológica y de estadificación, con un análisis de las clasificaciones TNM e histológica, métodos no invasivos y mínimamente invasivos, así como las técnicas quirúrgicas para el diagnóstico y estadificación. En un cuarto y último capítulo se han abordado aspectos del tratamiento, como el papel de las técnicas quirúrgicas, la quimioterapia, la radioterapia, el abordaje multidisciplinar por estadios y otros tratamientos dirigidos frente a dianas específicas, terminando con recomendaciones acerca del seguimiento del cáncer de pulmón y los tratamientos paliativos quirúrgicos y endoscópicos en estadios avanzados

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages

Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer. / Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas.

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Recomendaciones SEPAR de diagnostico y tratamiento del cancer de pulmón de celulas no pequeñas / Recommendations of the Spanish Society of Pneumology and Thoracic Surgery on the diagnosis and treatment of non-small-cell lung cancer

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Recidivas y segundos tumores en el cáncer de pulmón de larga supervivencia / Disease Recurrence and Second Tumors in Long-term Survivors of Lung Cancer

Introducción y objetivos: Al mejorar la supervivencia del cáncer, la presencia de tumores múltiples en un paciente es cada vez más frecuente. El objetivo del estudio ha sido analizar la evolución a largo plazo, especialmente las posibles recidivas y segundos tumores primarios, en pacientes con cáncer de pulmón (CP) y supervivencia ≥ 3 años. Material y métodos: Estudio retrospectivo de 1.769 pacientes con CP. Se incluyen 218 (136 tratados con cirugía y 82 con otros tratamientos) con supervivencia global ≥ 3 años, de cualquier estirpe y seguidos durante un período entre 5 y 23 años. Se registró la evolución del CP y las enfermedades intercurrentes. Resultados: Un total de 65 presentaron recidiva del tumor, de los cuales el 60,9% apareció en los 3 primeros años; 26 desarrollaron segundos primarios pulmonares (84,6% después de 5 años) y 24, 2 o más segundos extrapulmonares (66,6% después de 5 años), la mayoría relacionados con el tabaco. La incidencia de segundos primarios fue superior a la incidencia esperable de cáncer en población general de similar edad y género. Conclusión: El efecto carcinogénico múltiple del tabaco persiste y se manifiesta en diversos órganos después de pasados 5 años tras el diagnóstico de CP, incluso en pacientes que han tenido una larga supervivencia. Después de 5 años, un segundo tumor es más probable que una recidiva del primero y el pulmón es el órgano con mayor probabilidad de desarrollar un segundo tumor

Introduction and objectives: As cancer survival improves, the appearance of multiple tumors in a single patient is becoming more common. The aim of this study was to analyze long-term evolution, focusing particularly on disease recurrence and second primary tumors, in patients with lung cancer (LC) and ≥ 3 years overall survival. Material and methods: Retrospective study of 1,769 patients with LC. A total of 218 (136 treated with surgery and 82 with other treatments), followed up for between 5 and 23 years were enrolled. LC progress and intercurrent diseases were recorded. Results: A total of 65 patients presented tumor relapse, of which 60.9% occurred in the first 3 years; 26 patients developed secondary primary tumors (84.6% after 5 years) and 24 developed 2 or more second extrapulmonary tumors (66.6% after 5 years), most of which were smoking-related. The incidence of second primaries was greater than the expected incidence of cancer in the general population matched for age and sex. Conclusion: The multiple carcinogenic effect of smoking persists and manifests in various organs, more than 5 years after the diagnosis of LC, even in patients with long survival. After 5 years, a second tumor is more likely than a relapse of the primary disease, and the lung is the most common site of development of a second tumor

Disease Recurrence and Second Tumors in Long-term Survivors of Lung Cancer.

INTRODUCTION AND OBJECTIVES: As cancer survival improves, the appearance of multiple tumors in a single patient is becoming more common. The aim of this study was to analyze long-term evolution, focusing particularly on disease recurrence and second primary tumors, in patients with lung cancer (LC) and ≥ 3 years overall survival. MATERIAL AND METHODS: Retrospective study of 1,769 patients with LC. A total of 218 (136 treated with surgery and 82 with other treatments), followed up for between 5 and 23 years were enrolled. LC progress and intercurrent diseases were recorded. RESULTS: A total of 65 patients presented tumor relapse, of which 60.9% occurred in the first 3 years; 26 patients developed secondary primary tumors (84.6% after 5 years) and 24 developed 2 or more second extrapulmonary tumors (66.6% after 5 years), most of which were smoking-related. The incidence of second primaries was greater than the expected incidence of cancer in the general population matched for age and sex. CONCLUSION: The multiple carcinogenic effect of smoking persists and manifests in various organs, more than 5 years after the diagnosis of LC, even in patients with long survival. After 5 years, a second tumor is more likely than a relapse of the primary disease, and the lung is the most common site of development of a second tumor.

Cáncer de pulmón en estadio i y factores pronósticos / Prognostic Factors in Stage i Lung Cancer

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Diagnosis and treatment of neuroendocrine lung tumors.

Pulmonary neuroendocrine tumors (PNT) encompass a broad spectrum of tumors including typical carcinoid (TC) and atypical (AC) tumors, large-cell neuroendocrine carcinoma (LCNEC) and small-cell lung cancer (SCLC). Although no variety can be considered benign, AC and TC have a much lower metastatic potential, are usually diagnosed in early stages, and most are candidates for surgical treatment. Several chemotherapy (CT) regimens are available in the case of recurrence or in advanced stages, although scientific evidence is insufficient. LCNEC, which is currently classified alongside large-cell carcinomas, have molecular features, biological behavior and CT sensitivity profile closely resembling SCLC. Pathological diagnosis is often difficult, despite the availability of immunohistochemical techniques, and surgical specimens may be necessary. The diagnostic tests used are similar to those used in other lung tumors, with some differences in the optimal tracer in positron emission tomography. The new TNM classification is useful for staging these tumors. Carcinoid syndrome, very rare in PNT, may cause symptoms that are difficult to control and requires special therapy with somatostatin analogs and other drugs. Overall, with the exception of SCLC, new trials are needed to provide a response to the many questions arising with regard to the best treatment in each lineage and each stage.

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.

Registro del Grupo Cooperativo de Cáncer de Pulmón-II de la Sociedad Española de Neumología y Cirugía Torácica. Estudio descriptivo / The Spanish Society of Pulmonology and Thoracic Surgery Lung Cancer Cooperative Group-II Registry. A Descriptive Study

Introducción y objetivos: La 7.a edición de la clasificación TNM, junto a ventajas indudables, presenta limitaciones. El Comité de Estadificación de la International Association for the Study of Lung Cancer (IASLC) ha diseñado un estudio prospectivo internacional para perfeccionar esa clasificación. En el área de Oncología de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) se constituyó un grupo de cirujanos torácicos y neumólogos que creó un registro de nuevos casos de cáncer de pulmón (CP) para participar en ese proyecto. El objetivo del presente trabajo es describir las características principales de los pacientes incluidos. Material y métodos: Estudio prospectivo, observacional, multicéntrico y multirregional de recogida de datos (epidemiológicos, clínicos, funcionales, terapéuticos y, especialmente, de extensión anatómica), según protocolo de la IASLC, para analizar su valor pronóstico. Resultados: Se incluyen 2.419 (83,6% hombres) pacientes de 28 hospitales. El 96% de los hombres y el 54% de las mujeres eran fumadores o exfumadores. Se practicó TC de tórax/abdomen en más del 90% y PET/TC en el 51,5% de los casos. Entre 1.035 pacientes sometidos a cirugía, el 77% tenían estadios tempranos ( I a hasta II b), y de los tratados con otros medios, el 61,6% tenían estadio IV . La comorbilidad respiratoria fue mayor en hombres (47,9% frente al 21,4%). La estirpe más común fue adenocarcinoma (34%), especialmente en mujeres no fumadoras (69,5%). Conclusiones: La proporción de mujeres y adenocarcinomas aumenta entre los casos de CP en España, así como los resecados en estadio temprano (AU)

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 ( I a to II b), 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 (AU)

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.

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El cáncer de pulmón en España. Epidemiología, supervivencia y tratamiento actuales / Lung Cancer in Spain. Current Epidemiology, Survival, and Treatment

En 2005 fallecieron 19.115 personas por cáncer de pulmón en España. Pese al aumento de las cifras absolutas de mortalidad desde 1950, las tasas ajustadas en varones han disminuido. La incidencia en mujeres, inferior a la de otros países, ha aumentado (1 por cada 8,5 varones). Más del 50% de los pacientes tienen más de 70 años. La proporción de adenocarcinomas ha aumentado en el mundo, aunque en España la estirpe epidermoide es predominante (24 50,5%). Las resecciones quirúrgicas (un 14,8% en España, en 2003) no han aumentado. La mortalidad operatoria es del 6,8%. Un 25 50% de los pacientes recibe sólo medicación paliativa. La supervivencia absoluta global del cáncer de pulmón es menor del 10% en muchos países. Entre pacientes resecados, la supervivencia a los 5 años (estadio IA: 58,3 68,5%; estadio IIIA: 28,3 35,8%) ha aumentado ligeramente(AU)

In 2005, 19 115 people died of lung cancer in Spain. In spite of the increase since 1950 in absolute mortality rates, the adjusted rate for men has declined. The incidence among women is lower in Spain than in other countries but it has increased (with a ratio of 1 woman for every 8.5 men). More than 50% of the patients are over 70 years of age. While the proportion of adenocarcinomas relative to other histological types has increased worldwide, squamous cell carcinoma still predominates in Spain (ranging from 24% 50.5%). The number of patients treated by surgical resection has not increased (14.8% in Spain in 2003).Operative mortality is 6.8%. Between 25% and 50% of patients receive only palliative medication. Absolute overall survival in patients with lung cancer is under 10% in many countries. The 5-year survival rate among patients treated surgically has increased slightly, with stage IA rates ranging from 58.3% to 68.5% and stage IIIA from 28.3% to 35.8%(AU)

Oncología torácica en ARCHIVOS DE BRONCONEUMOLOGÍA 2008 / Thoracic Oncology in ARCHIVOS DE BRONCONEUMOLOGÍA 2008

Se comentan brevemente los artículos sobre oncología torácica publicados en esta revista durante el año2008. En relación con la epidemiología, cabe destacar que se constata el comienzo de un declive en la tasade incidencia estandarizada de cáncer de pulmón en varones y otro trabajo que analiza los vínculos existentesentre 2 enfermedades frecuentes como son la enfermedad pulmonar obstructiva crónica (EPOC) y elcáncer de pulmón. Otros trabajos se centran en aspectos diagnósticos, de estadificación o pronósticos yanalizan el valor de la tomografía de emisión de positrones en la evaluación del nódulo pulmonar solitario,la rentabilidad de la punción transbronquial aspirativa en la estadificación del mediastino o el significadopronóstico de la sobreexpresión y amplificación de c-erbB-2 en pacientes con carcinoma microcítico. Conrespecto al tratamiento, otros autores analizan la supervivencia de pacientes con cáncer de pulmón N2 detectadosdurante o tras la cirugía de resección pulmonar. La nueva técnica terapéutica de ablación por radiofrecuenciade tumores pulmonares en estadios tempranos es objeto de 2 publicaciones que describen sufundamento, indicaciones, contraindicaciones y primeros resultados. Por último, las habilidades de comunicaciónnecesarias para informar a los pacientes, la cirugía de las metástasis pulmonares y la presentaciónde un caso inusual de tumor carcinoide son el motivo de otros trabajos(AU)

The articles on thoracic oncology published in this journal during the year 2008 are briefly commented on.As regards the epidemiology, it is noted that the standardised incidence rate of lung cancer in males isstarting to decline, and there is another study that analysed links between two common diseases, COPDand lung cancer. Other works have focused on aspects such as diagnosis, staging or prognosis, and analysingthe value of positron emission tomography in the assessment of a solitary pulmonary nodule, theeffectiveness of aspiration transbronchial needle aspiration in mediastinal staging, the prognosticsignificance of the over-expression and amplification of c-erbB-2 in patients with small cell carcinoma. Asregards treatment, other authors analysed the survival of patients with N2 lung cancer detected during orafter lung resection surgery. The new therapeutic technique of ablation of lung tumours by radiofrequencyin the early stages is the subject of two publications that describe its basis, indications, contraindicationsand first results. Lastly, the communication skills needed to inform patients, surgery of lung metastases,and the presentation of an unusual case of carcinoid tumour were the subjects of other articles(AU)

[The EpicliCP-2003 study: A multicenter epidemiological and clinical study of lung cancer in Spain]. / Estudio multicéntrico epidemiológico-clínico de cáncer de pulmón en España (estudio EpicliCP-2003).

OBJECTIVE: Mortality due to lung cancer in Spain is increasing continuously. The aim of the present study was to collect information on the hospital incidence of lung cancer, as well as information on clinical management, in different regions of Spain. MATERIAL AND METHODS: A prospective observational study of patients diagnosed with lung cancer in 2003 was carried out in 13 centers in 9 autonomous communities. Epidemiological, clinical, diagnostic, and therapeutic variables were assessed. RESULTS: Of a total population of 2,726,601 inhabitants (1 346 483 men and 1 380 118 women), 1064 male and 125 female lung cancer patients were included. The incidence standardized to the world population varied between 42.4/100,000 and 61.8/100,000 in men and between 1.5/100,000 and 8.6/100,000 in women. Overall, 51% were aged over 70 years, and 97.5% of the men and 32% of the women were smokers or ex-smokers. Cytologic or histologic confirmation was obtained for 93.1% of the cases (20.8% of which were small cell lung cancers and 79.2% were non-small cell lung cancers). The main initial symptoms were cough, chest pain, and weight loss. In 13.7%, lung cancer was suspected because of abnormal chest x-ray. The percentage with clinical TNM stages I and II ranged from 6.3% to 26.9%. The most common stage was stage IV in all centers. The percentage of patients undergoing surgery ranged from 2.5% to 20.6%, with a mean of 14.8% (19.9% of whom were patients with non-small cell lung cancer); 27% received palliative treatment only. CONCLUSIONS: The proportion of women suffering from lung cancer increased with respect to previous studies, with notable differences among regions. Despite diagnostic improvements, the percentage of patients undergoing surgery is low, though interregional variation is considerable.

Estudio multicéntrico epidemiológico-clínico de cáncer de pulmón en España (estudio EpicliCP-2003) / The EpicliCP-2003 Study: a multicenter epidemiological and clinical study of lung cancer in Spain

Objetivo: La mortalidad por cáncer de pulmón en España aumenta ininterrumpidamente. El objetivo del presente estudio ha sido conocer su incidencia hospitalaria, así como otros datos de manejo clínico, en varias regiones españolas. Material y métodos: Se ha realizado un estudio prospectivo observacional de los pacientes diagnosticados de cáncer de pulmón en 2003 en 13 centros de 9 comunidades autónomas. Se evaluaron variables epidemiológicas, clínicas, diagnósticas y terapéuticas. Resultados: Se han registrado 1.064 varones y 125 mujeres correspondientes a una población total de 2.726.601 habitantes (1.346.483 varones y 1.380.118 mujeres). Las tasas estandarizadas según población mundial variaron entre 42,4 y 61,8/100.000 en varones y entre 1,5 y 8,6/100.000 en mujeres. El 51% tenía más de 70 años. El 97,5% de los varones y el 32% de las mujeres eran fumadores o ex fumadores. Se obtuvo confirmación citohistológica en el 93,1% de los casos (un 20,8% microcíticos y un 79,2% no microcíticos). Los síntomas iniciales predominantes fueron tos, dolor torácico y pérdida de peso. En el 13,7% el diagnóstico se sospechó sólo por anormalidad radiológica. La proporción de estadios TNM clínicos I y II varió entre el 6,3 y el 26,9%. El estadio IV fue el más común en todos los centros. La tasa de intervenciones varió entre el 2,5 y el 20,6%; el promedio fue del 14,8% (un 19,9% del total de no microcíticos). El 27,0% sólo recibió medidas paliativas. Conclusiones: Entre los casos de cáncer de pulmón aumenta la proporción de mujeres con respecto a estudios previos, con notables diferencias interregionales. Pese a las mejoras diagnósticas, la tasa de intervenciones, muy variable entre diferentes centros, es muy baja

Objective: Mortality due to lung cancer in Spain is increasing continuously. The aim of the present study was to collect information on the hospital incidence of lung cancer, as well as information on clinical management, in different regions of Spain. Material and methods: A prospective observational study of patients diagnosed with lung cancer in 2003 was carried out in 13 centers in 9 autonomous communities. Epidemiological, clinical, diagnostic, and therapeutic variables were assessed. Results: Of a total population of 2 726 601 inhabitants (1 346 483 men and 1 380 118 women), 1064 male and 125 female lung cancer patients were included. The incidence standardized to the world population varied between 42.4/100 000 and 61.8/100 000 in men and between 1.5/100 000 and 8.6/100 000 in women. Overall, 51% were aged over 70 years, and 97.5% of the men and 32% of the women were smokers or ex-smokers. Cytologic or histologic confirmation was obtained for 93.1% of the cases (20.8% of which were small cell lung cancers and 79.2% were non-small cell lung cancers). The main initial symptoms were cough, chest pain, and weight loss. In 13.7%, lung cancer was suspected because of abnormal chest x-ray. The percentage with clinical TNM stages I and II ranged from 6.3% to 26.9%. The most common stage was stage IV in all centers. The percentage of patients undergoing surgery ranged from 2.5% to 20.6%, with a mean of 14.8% (19.9% of whom were patients with non-small cell lung cancer); 27% received palliative treatment only. Conclusions: The proportion of women suffering from lung cancer increased with respect to previous studies, with notable differences among regions. Despite diagnostic improvements, the percentage of patients undergoing surgery is low, though interregional variation is considerable