Tumor size predicts worse prognosis in esophagogastric junction adenocarcinoma.

Adenocarcinoma of the esophagogastric junction (AEGJ) has an increasing incidence and is associated with limited overall survival. Several studies have tried to identify prognostic factors for AEGJ, although few have described relationships between prognosis and the tumor's size or anatomical location. Thus, this retrospective study evaluated 188 patients with resected locally advanced AEGJ. Tumor location was determined using upper endoscopy, and the following groups were created: E&E + EGJ (distal esophagus, esophagogastric junction, and distal esophagus), EGJ (esophagogastric junction), EGJ + G (esophagogastric junction and proximal stomach), G (proximal stomach), and E + EGJ + G (esophagus to the proximal stomach, including the esophagogastric junction). Other variables of interest were tumor size and differentiation, TNM stage, comorbidities, surgery type, and survival outcomes. Among 188 patients included, 163 were men (86.7%), and the mean age was 64.9 years. Forty-eight (25.6%) patients underwent total gastrectomy and distal esophagectomy, while 140 (74.4%) subtotal esophagectomy with proximal gastrectomy. Presence of comorbidities, tumor size, angiolymphatic and perineural invasion, and pTNM status were different between groups according to tumor location. The mean follow-up period was 47.4 months. The disease-free survival (DFS) rates were as follows: 72.7% (G), 68.0% (E&E + EGJ), 63.4% (EGJ), 57.1% (EGJ + G), and 44.4% (E + EGJ + G), while the overall survival (OS) rates were 81.0% (EGJ + G), 78.8% (G), 64.0% (E&E + EGJ), 54.9% (EGJ), and 48.1% (E + EGJ + G). Multivariate analysis revealed that tumor size of < 5 cm, and tumor location G subgroups were associated with better DFS. High histological grade and advanced pT status were independent factors related to worse OS. In conclusion, the prognosis of AEGJ may be preoperatively predicted by a tumor size of ≥ 5 cm and its anatomical location.

Low body mass index is associated with reduced intratumoral CD4+ T-lymphocyte infiltration in laryngeal squamous cell carcinoma patients.

Tumor size, inflammation, and nutritional status may be correlated with the immune response to cancer. Our hypothesis is that there is an interrelationship among tumor size, inflammatory response, and body mass index (BMI), and that these variables could alter T-lymphocyte infiltration in patients with laryngeal squamous cell carcinoma (LSCC). A retrospective cohort of 91 surgical LSCC patients treated at a Brazilian National Cancer Reference Center was followed for 5 years. We collected data regarding BMI, clinical factors, patients' lifestyle, C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). Data were obtained in the medical records within a maximum interval of 7 days before surgery. The stromal and intratumoral CD4+ and CD8+ T-cell infiltrations were obtained by immunohistochemistry. Our results demonstrated a significant correlation among tumor size and BMI, NLR, PLR, and LMR. Similarly, PLR and LMR were significantly correlated with BMI. Tumor size and inflammatory parameters were not associated with changes in T-cell infiltrations. However, patients with low BMIs had a significantly lower density of intratumoral CD4+ T lymphocytes infiltrated when compared with normal/high BMI patients (odds ratio, 0.14; 95% confidence interval, 0.03-0.58; P = .007). CD8+ T-lymphocyte infiltration did not change in low-BMI patients. In conclusion, we observed a correlation among tumor size, inflammation, and BMI. Tumor size/inflammation axis may be responsible for the change in BMI and, therefore, may have influenced the reduction of intratumoral CD4+ T-lymphocyte infiltration in LSCC patients.

Long-term PM2.5 exposure before diagnosis is associated with worse outcome in breast cancer.

PURPOSE: Increasingly epidemiological evidence supports that environmental factors are associated with breast cancer (BC) outcomes after a BC diagnosis. Although evidence suggests that air pollution exposure is associated with higher mortality in women with BC, studies investigating potential mechanisms have been lacking. METHODS: We evaluated women with BC (N = 151) attended at the National Cancer Institute-Mexico from 2012 to 2015. We calculated 1-year average exposures to particulate matter < 2.5 µm (PM2.5) at home address before diagnosis. We used linear and logistic regression models to determine the associations between PM2.5 exposure and BC aggressiveness (tumor size, molecular phenotype). RESULTS: Average annual PM2.5 exposure of this population was 23.0 µg/m3 [standard deviation (SD)]: 1.90 µg/m3]. PM2.5 levels were positively correlated with tumor size at diagnosis (r = 0.22; p = 0.007). Multivariable linear models had a similar inference [risk ratio (RR): 1.32; 95% confidence interval (95% CI): 1.04, 1.674]. We did not observe differences in this association by age or menopause status. Further, women with triple-negative BC (TNBC) had significantly higher PM2.5 levels compared with other phenotypes (p = 0.015). Multivariable-adjusted logistic regression models assessing the association between PM2.5 and tumor size had a similar inference (RR 1.41; 95% CI 1.05, 1.89) overall for all ages and also for women who were ≤ 50 years old at diagnosis (RR 1.63; 95% CI 1.036, 2.57). CONCLUSIONS: Our findings suggest a significant association between long-term PM2.5 exposure and BC aggressiveness based on tumor size and phenotype, as well as a worse outcome.

Real-world assessment of the effect of impact of tumor size on pathological complete response rates in triple negative breast cancer after neoadjuvant chemotherapy.

BACKGROUND: Triple negative breast cancer (TNBC) is characterized rapid tumor growth, and increased metastatic potential compared to other breast cancer subtypes. However, pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) can predict patients with a better prognosis. Clinical predictors of pCR such as tumor size (TS) are controversial. This study aims to evaluate the influence of TS on achieving pCR, and the associated survival outcomes. METHODS: Medical records from 310 TNBC patients treated with NACT between 2010 and 2013 in National Cancer Institute Brazil were screened. The aim study was to examine the impact of TS on pCR. We used descriptive statistics to organize and summarize TS data and all the other variables of interest. Logistic regression has done to assess if any of these variables were associated with pCR. Survival data were extrapolated using Kaplan-Meier analysis and log-rank tests. RESULTS: Thirty-nine (21%) of 187 enrolled patients achieved pCR. Median age was 48 years, 50.27% were postmenopausal, 93.03% T3/T4 and 75.39% axillar clinical node-positive; 92.51% received an anthracycline regimen followed by a taxane. Age >40 years (P=0.04, OR 0.45, 95% CI, 0.20-0.95) and tumor infiltrating lymphocytes (TILs) presence (P<0.01, OR 3.71, 95% CI, 1.60-8.60) were factors significantly associated with increased rates of pCR. Neither the TS (IQR: 4; P=0.22, OR 0.93, 95% CI, 0.83-1.03) nor the other subgroups analysed demonstrated any association with achieving pCR. Median follow-up was 36 months. The 5-year OS and RFS of the study population was 71.20% and 61.10% respectively. CONCLUSIONS: Preoperative TS did not significantly impact pCR rate in our cohort of patients receiving NACT for TNBC. Characteristics associated with higher pCR rate included TILs and age >40 years. In addition, pCR, was indicative of better survival outcomes.

Factors associated with nodal metastasis in 2-centimeter or less non-small cell lung cancer.

OBJECTIVE: Lymph node involvement is an important determinant of treatment and prognosis in non-small cell lung cancer (NSCLC) and must be determined via surgical lymph node (LN) evaluation. However, lymphadenectomy is associated with multiple significant morbidities. Recent studies have suggested LN evaluation can be foregone in some or all patients with NSCLC ≤2.0 cm. Our objective was to identify whether these patients may be safely spared the morbidity of lymphadenectomy. METHODS: We undertook a retrospective study of patients treated for NSCLC ≤2.0 cm at a single institution from 2005 to 2017. We examined patient, demographic, and tumor variables for associations with LN metastases via univariable and multivariable analyses. RESULTS: In total, 555 patients met our inclusion criteria. Our primary independent variables included tumor size, histology, and histologic subtype. Although tumors ≤1 cm were less likely to have LN metastases than 1.1- to 2-cm tumors (6.8% vs 13.3%), there was no statistically significant difference. Histologic type was not associated with LN status. In an adenocarcinoma subgroup analysis, micropapillary predominant tumors were more likely to have LN metastases. All invasive mucinous adenocarcinomas and minimally invasive adenocarcinomas were N0. CONCLUSIONS: LN evaluation may be unnecessary in patients with minimally invasive adenocarcinoma or invasive mucinous adenocarcinomas ≤2.0 cm. However, this information is rarely available pre- or intraoperatively. Thus, we recommend LN evaluation always be performed when possible, even for subcentimeter NSCLC, unless the histology is absolutely certain. To our knowledge, this is the largest dataset published to study patients with NSCLC ≤2.0 cm.

Cáncer de mama T1a y T1b: factores pronósticos de compromiso axilar / Breast cancer T1a y T1b: Prognostic factors of axillary commitment

Objetivos Se analizaron 331 pacientes con tumores de mama de entre 0,1 y 1 cm tratados en la Unidad de Mastologia Clínica Breast, Hospital Italiano de La Plata, en el período de tiempo comprendido entre 2012 y 2017. Se estudiaron factores pronósticos (tamaño tumoral, edad, ivl, grado histológico, tipo y subtipo tumoral y Ki67) y su relación con el compromiso ganglionar, el cual se encontró presente en 42 casos (12,98%). Resultados El subtipo tumoral con mayor afectación axilar fue el tn seguido por los Luminal B. La edad y tamaño tumoral no arrojaron datos relevantes. La ivl y el Ki67 fueron las variables más significativas en relación con el compromiso axilar. Conclusiones Pudimos concluir que nos hallamos dentro de los valores estándares publicados tanto nacional como internacionalmente

Objective We analyzed 331 patients with breast tumors between 0.1 and 1 cm treated in the Breast-Italian Hospital La Plata Clinical Mastology Unit, in the period between 2012 and 2017. We studied prognostic factors (tumor size, age, ivl, histological grade, tumor type and subtype and Ki67) and its relationship with lymph node involvement, which was present in 42 cases (12.98%). Results The tumor subtype with the most axillary involvement was tn followed by Luminal B. Age and tumor size did not yield relevant data. The ivl and the Ki67 were the most significant variables in relation to the axillary commitment. Conclusions We were able to conclude that we are within the standard values published both nationally and internationally

Patterns of Care and Efficacy of Chemotherapy and Radiotherapy in Skin-Involved Breast Cancers of All Sizes.

BACKGROUND: The management of small skin-involved (SI) invasive breast cancers is controversial because although they are considered unresectable, their prognosis is far better than their stage III classification. This study was undertaken to determine how SI lesions are treated in the United States and to discern the benefit of systemic therapy. PATIENTS AND METHODS: Data of patients diagnosed with stage I-III breast cancer in the National Cancer Data Base between 2004 and 2011 were reviewed. Treatment patterns were examined and overall survival assessed. RESULTS: A total of 3485 patients had SI and 456,287 patients had non-SI breast cancers. Chemotherapy was administered to 68.5% of SI and 45.9% of non-SI tumors (P < .001), including 77.2% of SI and 33% of non-SI tumors < 2 cm (P < .001). After adjusting for patient and tumor characteristics, SI patients were 19.4% more likely to receive chemotherapy than non-SI patients. Radiotherapy was provided to 61.1% of SI and 64.3% of non-SI tumors (P < .001), including 65.5% of SI and 66.5% non-SI tumors < 2 cm (P = .711). After adjusting for patient and tumor characteristics, SI patients were 76.6% more likely to receive radiotherapy than non-SI patients. Chemotherapy and radiotherapy provided an overall survival benefit for stage II and III SI and non-SI tumors. CONCLUSION: Despite controversy regarding staging and prognosis of SI tumors, the majority of patients are provided systemic therapy and radiotherapy. Varied patterns of chemotherapy administration for SI tumors suggests that further treatment guidance and standardization are required, especially because chemotherapy and radiotherapy are equally efficacious in SI and non-SI tumors alike.

[High mortality for cervical cancer in young women from the Metropolitan Area of Buenos Aires]. / Elevada mortalidad por cáncer cérvico-uterino en mujeres jóvenes del área Metropolitana de Buenos Aires.

The cervical cancer, which is a reliable indicator of social inequality, remains a major public health issue in Argentina. It is generally accepted that its frequency among young women is low, being the most exposed those over 35 years old. Nevertheless, as gynecologic oncologists, we have been accompanying young patients to their death, mostly women with neither access to screening strategies nor timely or suitable treatment. Such a situation motivated the present analysis of our data on frequency, survival, and demography of cervical cancer collected at the referral cancer hospital of Buenos Aires City. Of 748 cases retrospectively assessed (2007-2011), 84.0% (n = 627) resided in the Metropolitan Area of Buenos Aires; 76.9% (n = 576) were admitted at a locoregionally advanced stage. Regarding tumor size, 53.6% (n = 401) had tumors > 4 cm diameter and 24.2% (n = 181) > 6 cm. The lowest rates of disease-free survival and cause-specific survival were observed for tumor sizes > 6 cm and the age subgroup < 35 years old. Both tumor size and age retained their prognostic value after multivariate analysis adjustment. When focusing in patients under 35 years old, 48% (n = 70) died within 5 years following diagnosis and their probability of surviving 5 years more was < 50%. These figures raise a public health alert on young women with cervical cancer living in the Metropolitan Area of Buenos Aires, which concentrates almost one third of the country population.

Elevada mortalidad por cáncer cérvico-uterino en mujeres jóvenes del área metropolitana de Buenos Aires / High mortality for cervical cancer in young women from the Metropolitan Area of Buenos Aires

El cáncer cérvico-uterino, fiel indicador de inequidad social, sigue siendo un grave problema de salud pública en la República Argentina. Se suele afirmar que su frecuencia en mujeres jóvenes es baja y que las más expuestas son aquellas mayores de 35 años. Sin embargo, como ginecólogos oncólogos, con frecuencia acompañamos a morir a mujeres jóvenes que no han tenido acceso a tamizaje ni a tratamiento oportuno y adecuado del cáncer invasor. Esto ha motivado el presente análisis de frecuencia y supervivencia del cáncer cérvico-uterino en el contexto demográfico de las mujeres asistidas en el hospital de referencia en cáncer ginecológico de Buenos Aires. De los 748 casos analizados retrospectivamente (2007-2011), el 84.0% (n = 627) residía en el Área Metropolitana de Buenos Aires y el 76.9% (n = 576) fue admitido en estadios loco-regionalmente avanzados. El 53.6% (n = 401) presentó un diámetro tumoral > 4 cm y el 24.2% (n = 181) > 6 cm. Las tasas más bajas de supervivencia se observaron en tumores > 6 cm y en el subgrupo etario < 35 años. Tanto el tamaño tumoral como la edad conservaron su valor pronóstico tras ser ajustados en el análisis multivariado. En el subgrupo < 35 años, el 48% (n = 70) murió durante los 5 años siguientes al diagnóstico y la probabilidad de sobrevivir otros 5 años fue < 50%. Estos resultados representan una alerta sanitaria sobre la situación de mujeres jóvenes con cáncer cérvico-uterino en el Área Metropolitana de Buenos Aires, la cual concentra casi un tercio de la población del país.

he cervical cancer, which is a reliable indicator of social inequality, remains a major public health issue in Argentina. It is generally accepted that its frequency among young women is low, being the most exposed those over 35 years old. Nevertheless, as gynecologic oncologists, we have been accompanying young patients to their death, mostly women with neither access to screening strategies nor timely or suitable treatment. Such a situation motivated the present analysis of our data on frequency, survival, and demography of cervical cancer collected at the referral cancer hospital of Buenos Aires City. Of 748 cases retrospectively assessed (2007-2011), 84.0% (n = 627) resided in the Metropolitan Area of Buenos Aires; 76.9% (n = 576) were admitted at a locoregionally advanced stage. Regarding tumor size, 53.6% (n = 401) had tumors > 4 cm diameter and 24.2% (n = 181) > 6 cm. The lowest rates of disease-free survival and cause-specific survival were observed for tumor sizes > 6 cm and the age subgroup < 35 years old. Both tumor size and age retained their prognostic value after multivariate analysis adjustment. When focusing in patients under 35 years old, 48% (n = 70) died within 5 years following diagnosis and their probability of surviving 5 years more was < 50%. These figures raise a public health alert on young women with cervical cancer living in the Metropolitan Area of Buenos Aires, which concentrates almost one third of the country population.

Serum ghrelin levels in papillary thyroid carcinoma

ABSTRACT Objective Ghrelin plays a role in several processes of cancer progression, and numerous cancer types express ghrelin and its receptor. We aimed to investigate serum levels of ghrelin in patients with papillary thyroid carcinoma (PTC) and its association with the prognostic factors in PTC. Materials and methods We enrolled 54 patients with thyroid cancer (7 male, 47 female) and 24 healthy controls (6 male, 18 female) in the study. We compared demographic, anthropometric, and biochemical data, and serum ghrelin levels between the groups. Serum ghrelin levels were measured using as enzyme-linked immunosorbent assay. Results Ghrelin levels were similar between the groups, but plasma ghrelin levels were significantly higher in tumors larger than 1 cm diameter compared with papillary microcarcinomas. Serum ghrelin levels also correlated with tumor size (r = 0.499; p < 0.001). Body mass index, thyroid-stimulating hormone, and HOMA-IR levels were similar between the groups. There were no statistically significant differences regarding average age and other prognostic parameters including lymph node invasion, capsule invasion, multifocality and surgical border invasion between patients with microcarcinoma and tumors larger than 1 cm. Conclusion In our study, no significant difference in serum ghrelin levels was determined between patients with papillary thyroid cancer and healthy controls however, serum ghrelin levels were higher in tumors larger than 1 cm compared to in those with thyroid papillary microcarcinoma.

Multichannel vaginal cylinder brachytherapy-Impact of tumor thickness and location on dose to organs at risk.

PURPOSE: Multichannel vaginal cylinder brachytherapy (MCVCB) has the potential to sculpt dose distribution, although this is typically reserved for lesions <5-mm thick. The aim of this study was to investigate the dosimetric consequences of treating lesions with MCVCB of varying locations, ≥5 mm in thickness. METHODS AND MATERIALS: Patients previously treated with MCVCB were randomly selected to each fill one of six categories based on location (lateral, anterior, or vaginal cuff and/or apex) and size of cylinder (2.5 or 3.0 cm). Based on magnetic resonance image, each patient's target lesion was extended circumferentially into theoretical high-risk clinical target volumes measuring 5, 7, and 10 mm in thickness. Image-based brachytherapy treatment plans for each of the six patients' three target volumes were generated. Total 2 Gy per fraction equivalent dosages (EQD2) were calculated using an external beam radiation therapy dose of 45 Gy in 25 fractions in conjunction with a high-dose-rate brachytherapy dose of 25 Gy in five fractions. RESULTS: Maximum EQD2 vaginal surface doses in gray for 5-, 7-, and 10-mm targets were as follows (location-cylinder size): lateral-3.0 cm: 122/153/210, lateral-2.5 cm: 145/195/301, anterior-3.0 cm: 115/135/197, anterior-2.5 cm: 132/173/283, apex-3.0 cm: 173/241/367, and apex-2.5 cm: 349/461/706. Total rectal EQD2 D 2 cc ranged from 53.9 to 67.2 Gy. Total bladder EQD2 D 2 cc ranged from 51.5 to 71.2 Gy. CONCLUSIONS: The vaginal surface dose seems to be the dose-limiting structure for anterior, lateral, and apical vaginal lesions. Caution should be taken when treating lesions >5 mm in depth, with particular attention to vaginal surface dose, especially for apical lesions and with smaller cylinders. In such cases, interstitial brachytherapy should be given strong consideration.

Estimation of Tumor Size Evolution Using Particle Filters.

Cancer is characterized by the uncontrolled growth of cells with the ability of invading local organs and/or tissues and of spreading to other sites. Several kinds of mathematical models have been proposed in the literature, involving different levels of refinement, for the evolution of tumors and their interactions with chemotherapy drugs. In this article, we present the solution of a state estimation problem for tumor size evolution. A system of nonlinear ordinary differential equations is used as the state evolution model, which involves as state variables the numbers of tumor, normal and angiogenic cells, as well as the masses of the chemotherapy and anti-angiogenic drugs in the body. Measurements of the numbers of tumor and normal cells are considered available for the inverse analysis. Parameters appearing in the formulation of the state evolution model are treated as Gaussian random variables and their uncertainties are taken into account in the estimation of the state variables, by using an algorithm based on the auxiliary sampling importance resampling particle filter. Test cases are examined in the article dealing with a chemotherapy protocol for pancreatic cancer.

Riesgo de malignidad en masas renales sólidas menores a cuatro centímetros / Risk of malignancy in solid renal masses less than four centimeters

El tratamiento de las masas renales sólidas menores de cuatro centímetros constituye un tema de debate. La “vigilancia activa” se ha propuesto como alternativa para su manejo, sin embargo, estudios publicados recientemente, señalan que un porcentaje no despreciable de estos tumores resultan ser malignos, e incluso en un 6 por ciento de los casos pueden producir metástasis. El objetivo del presente estudio consiste en determinar el riesgo de malignidad en masas renales sólidas menores de cuatro centímetros en un grupo de pacientes sometidos a Nefrectomía Parcial Laparoscópica (NPL). Estudio retrospectivo de pacientes sometidos a NPL. Se seleccionaron aquellos que presentaron lesiones renales sólidas menores a 4 cm informadas por TAC y/o RMN. Se crearon intervalos de tamaño (<2 cm, 2-2.9 cm, 3-4 cm). Se realizó un análisis univariado para determinar el riesgo de malignidad de acuerdo al tamaño del tumor, estableciendo el Odds Ratio correspondiente y el intervalo de confianza (95 por ciento). Los datos obtenidos fueron analizados mediante el programa SPSS v17. Se consideró como significativo un p< 0.05. Entre los años 2000 y 2012 se efectuaron 135 nefrectomías parciales laparoscópicas por la presencia de una masa renal sólida. Noventa y dos casos presentaron lesiones menores a cuatro centímetros, los que fueron incluidos en este estudio. Del total de tumores el 9.8% resultó ser benigno en el estudio histopatológico definitivo. No existieron diferencias significativas (p=0,67) con respecto a la media del tamaño (2,2 y 2,57 cm respectivamente) entre los tumores benignos y malignos. El porcentaje de tumores malignos aumentó significativamente (p = 0,025) en las masas mayores de 2 cm, al compararlo con aquellas de menor tamaño (69 por ciento v/s 86.7 por ciento). Mediante el análisis univariado se estableció que el riesgo de malignidad se incrementa 4.9 veces (p=0.027) en aquellas masas renales sólidas mayores de 2 cm...

The treatment of solid renal masses less than four centimeters (cm) is a subject of debate. Active surveillance has been proposed as a management option, however, recently published studies indicate that, in a substantial proportion, these tumors are malignant; and even at 6 percent of the cases can produce metastases. The aim of this study was to determine the malignancy risk in solid renal masses less than four cm in a group of patients undergoing laparoscopic partial nephrectomy (LPN).A retrospective study of patients undergoing LPN was performed. We selected those who had solid renal lesions smaller than 4 cm reported by CT and/or MRI. Size ranges were set (<2 cm, 2-2.9 cm, 3-4 cm). Univariate analysis was performed to determine the risk of malignancy according to tumor size, obtaining the corresponding odds ratio and confidence interval (95 percent). Data were analyzed using SPSS v17. P-value < 0.05 was considered stadistically significant. RESULTS: One hundred and thirty five laparoscopic partial nephrectomies were performed due to a solid renal mass between 2000 and 2012. Of them, ninety-two cases had a lesion less than four cm, which were included in this study. From the total of tumors, 9.8 por ciento were proved benign on final histopathology. No significant difference was found between benign and malignant tumors when mean sizes were compared (2.2 and 2.57 cm, respectively, p =0.67). The percentage of malignant tumors was significantly higher in masses larger than 2 cm, compared with those of smaller size (86.7 percent v/s 69 percent respectively, p=0.025). Univariate analysis established that the malignancy risk is increased 4.9 times in solid renal masses larger than 2 cm (p = 0.027). Our study shows that although the risk of cancer increases significantly in renal masses from the 2 cm there is a considerable percentage of malignancy in masses below this size.

Tamaño del tumor y supervivencia en carcinoma de pulmón, estadio IA / Tumor size and survival in lung cancer, stage IA

El estadio determinado por el sistema TNM (tumor, ganglios, metástasis) sigue siendo el factor predictor de supervivencia más importante en el carcinoma de pulmón. Sin embargo, varios estudios demostraron que el tamaño del tumor tenía valor pronóstico en sí mismo, aunque la relación entre tamaño tumoral y supervivencia dentro del grupo de tumores T1 todavía no es clara. El objetivo del presente estudio fue evaluar el valor del tamaño del tumor como factor pronóstico para la supervivencia en pacientes con carcinoma de pulmón de estadio IA, resecado quirúrgicamente. Se revisaron 79 pacientes con carcinoma de pulmón de células no pequeñas. En 34.4% de los pacientes (n = 28) el tamaño fue igual o menor a 1.5 cm. La mortalidad operatoria fue de 1.3%. Hubo recurrencia de la enfermedad en el 19%. Los pacientes con tumores de hasta 15 mm tuvieron una supervivencia a los 5 años de 95% (IC: 0.05) y con más de 15 mm, de 77%. (IC: 0.07), siendo la diferencia estadísticamente significativa (log-rank test: 0.035). La supervivencia libre de enfermedad fue de 95% en los tumores de hasta 15 mm y de 72% (IC: 0.09) en los de más de 15 mm. El análisis multivariado (Cox) mostró que el mayor determinante del riesgo de mortalidad fue el tamaño mayor de 15 mm (riesgo relativo 25.9, IC: 2.3-292, p = 0.004). Este estudio demuestra la influencia del tamaño del tumor en estadio IA, lo cual puede tener importancia práctica en función de las recientes propuestas de investigación sistemática de pacientes con alto riesgo de cáncer pulmonar.

TNM staging is an important long-term predictor for survival of lung cancer patients. Some studies have shown, however, that tumor size may have intrinsic prognostic value independent of TNM stage. The relationship between tumor size and survival is particularly unclear in T1 tumors. The objective of this study was to assess the prognostic value of tumor size in surgically resected stage I of non-small cell lung cancer (NSCLC). Clinical records of 79 patients with stage IA NSCLC were reviewed. In 34.4% of patients (n = 28) size was ≤ 1.5 cm. Surgical mortality was 1.3%. Disease recurrence was noted in 19%. Patients with tumors ≤ 15 mm had a significantly higher 5-year survival (95% CI:0.05 vs. 77% CI: 0.07 in > 15mm group). Disease-free survival was 95% for tumors less than 15 mm vs. 72% in larger tumors. Using Cox Multivariate analysis, the most determinant factor for higher risk of mortality was size >15 mm (relative risk 25.9, IC: 2.3-292, p = 0.004). The independent influence of tumor size in stage IA NSCLC may have practical implications with regards to proposals for screening asymptomatic individuals at high risk for lung cancer.

GESTRINONE IN THE TREATMENT OF MYOMAS.

In a study involving over 300 women, gestrinone has been found to induce regression of uterine myomas. Gestrinone was given in doses of 2.5-5 mg (orally or by vaginal pessary), two or three times weekly. The treatment regimen depended upon tumor size and tumor age. Patients with small tumors, i.e. uterine volumes of less than 200 cm3 , were treated for 6 months, whereas those with uterine volumes of 200-300 cm3 were treated for 1 year. In severe cases where uterine volumes were greater than 400 cm3 , the patients were treated for 2 years. Large myomas of 300 cm3 or more required higher doses of steroid. During the first 6 months of treatment there was a marked reduction in uterine volume, but subsequently the rate of tumor regression was slower. Following discontinuation of treatment, reactivation of tumor growth was slow in most patients. Gestrinone caused amenorrhea in all patients and in most women it lasted throughout therapy. The abdominal discomfort, dyspareunia and dysuria which resulted from the myoma were progressively alleviated during treatment. Most patients experienced at least some side-effects associated with the mild androgenicity of gestrinone. These included weight gain, seborrhea and acne (which developed in most patients). Hirsutism, hoarseness and increase in libido were less common, affecting 10-20% of patients, depending on the dose and duration of treatment. All side effects were reversible.