Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire.

INTRODUCTION: Lung cancer (LC) is the first cause of cancer-related mortality worldwide and health-related quality of life (HRQL) is a fundamental outcome for evaluating treatment results. Our objective was to validate the Mexican-Spanish versions of the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life QLQ-LC13 disease-specific questionnaire module in Mexican patients with LC; and to explore the possible prognostic role of HRQL data. METHODS: Translation procedures followed EORTC guidelines. Both instruments were completed by patients with LC. Tests for reliability and validity were performed. A subset of patients was administered HRQL evaluations before and after chemotherapy. HRQL was associated with prognosis in chemotherapy-naïve patients. The protocol was approved by the Institute's Ethics Committee. RESULTS: One hundred fifty three patients (mean age, 60.3 years; 84 females and 69 males) completed both questionnaires. Compliance rates were high, and the questionnaires were well accepted. Nine of 10 multi-item scales of both questionnaires presented Cronbach's alpha coefficients > 0.7. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. Patients with better Karnofsky or Eastern Cooperative Oncology Group (ECOG) performance status reported better functional HRQL scores. Different scales in the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires were accurately related with clinical characteristics. Functional as well as disease-symptom scales improved after chemotherapy, but treatment side-effects scales worsened in test-retest analysis. Better role functioning and absence of thoracic pain scales were associated with longer overall survival (OS) (p = 0.009 and p = 0.035, respectively). CONCLUSION: The Mexican-Spanish versions of the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires are reliable and valid for HRQL measurement in Mexican patients with LC and can be used in clinical trials.

Bronchogenic carcinoma in patients under 50 years old.

INTRODUCTION: Lung cancer in young patients is increasing in frequency. Its clinical course seems to be more aggressive than in the elderly. Our objective is to assess the clinicopathologic characteristics and survival of patients with bronchogenic carcinoma who underwent surgery at our department, comparing people younger than 50 years to older patients. MATERIALS AND METHODS: We present a retrospective study of 610 patients diagnosed with non-small-cell lung cancer operated on between 1997 and 2006. They were classified into two groups: under 50 (n=60) and equal to or over 50 (n=550). RESULTS: The proportion of women, smokers and adenocarcinoma were significantly higher in young patients. There were no significant differences in survival rate between the two groups. CONCLUSIONS: In our series, despite the differences in sex, smoking history and histology, the behaviour of the disease is similar in both age groups.

Lobectomia por carcinoma brônquico: análise das co-morbidades e seu impacto na morbimortalidade pós-operatória / Lobectomy for treating bronchial carcinoma: analysis of comorbidities and their impact on postoperative morbidity and mortality

OBJETIVO: Analisar o impacto das co-morbidades no desempenho pós-operatório de lobectomia por carcinoma brônquico. MÉTODOS: Estudaram-se retrospectivamente 493 pacientes submetidos a lobectomia por carcinoma brônquico e 305 preencheram os critérios de inclusão. A técnica cirúrgica foi sempre semelhante. Analisaram-se as co-morbidades categorizando-se os pacientes nas escalas de Torrington-Henderson e de Charlson, estabelecendo-se grupos de risco para complicações e óbito. RESULTADOS: A mortalidade operatória foi de 2,9 por cento e o índice de complicações de 44 por cento. O escape aéreo prolongado foi a complicação mais freqüente (20,6 por cento). A análise univariada mostrou que sexo, idade, tabagismo, terapia neo-adjuvante e diabetes apresentaram impacto significativo na incidência de complicações. O índice de massa corporal (23,8 ± 4,4 kg/m²), volume expiratório forçado no primeiro segundo (74,1 ± 24 por cento) e relação entre volume expiratório forçado no primeiro segundo e capacidade vital forçada (0,65 ± 0,1) foram fatores preditivos da ocorrência de complicações. As escalas foram eficazes na identificação de grupos de risco e na relação com a morbimortalidade (p = 0,001 e p < 0,001). A análise multivariada identificou que o índice de massa corporal e o índice de Charlson foram os principais determinantes de complicações; o escape aéreo prolongado foi o principal fator envolvido na mortalidade (p = 0,01). CONCLUSÃO: Valores reduzidos de volume expiratório forçado no primeiro segundo, relação entre volume expiratório forçado no primeiro segundo e capacidade vital forçada, índice de massa corporal e graus 3-4 de Charlson e 3 de PORT associaram-se a mais complicações após lobectomias por carcinoma brônquico. O escape aéreo persistente associou-se fortemente à mortalidade.

OBJECTIVE: To analyze the impact that comorbidities have on the postoperative outcomes in patients submitted to lobectomy for the treatment of bronchial carcinoma. METHODS: A retrospective study of 493 patients submitted to lobectomy for the treatment of bronchial carcinoma was conducted, and 305 of those patients met the criteria for inclusion in the final study sample. The surgical technique used was similar in all cases. The Torrington-Henderson scale and the Charlson scale were used to analyze comorbidities and to categorize patients into groups based on degree of risk for postoperative complications or death. RESULTS: The postoperative (30-day) mortality rate was 2.9 percent, and the postoperative complications index was 44 percent. Prolonged air leakage was the most common complication (in 20.6 percent). The univariate analysis revealed that gender, age, smoking, neoadjuvant therapy and diabetes all had a significant impact on the incidence of complications. The factors found to be predictive of complications were body mass index (23.8 ± 4.4), forced expiratory volume in one second (74.1 ± 24 percent) and the ratio between forced expiratory volume in one second and forced vital capacity (0.65 ± 0.1). The scales employed proved efficacious in the identification of the risk groups, as well as in drawing correlations with morbidity and mortality (p = 0.001 and p < 0.001). In the multivariate analysis, body mass index and the Charlson index were found to be the principal determinants of complications. In addition, prolonged air leakage was found to be the principal factor involved in mortality (p = 0.01). CONCLUSION: Reductions in forced expiratory volume in one second, in the ratio between forced expiratory volume in one second and forced vital capacity, and in body mass index, as well as a Charlson score of 3 or 4 and a Torrington-Henderson score of 3, were associated with a greater number of postoperative complications in patients...

Lobectomy for treating bronchial carcinoma: analysis of comorbidities and their impact on postoperative morbidity and mortality.

OBJECTIVE: To analyze the impact that comorbidities have on the postoperative outcomes in patients submitted to lobectomy for the treatment of bronchial carcinoma. METHODS: A retrospective study of 493 patients submitted to lobectomy for the treatment of bronchial carcinoma was conducted, and 305 of those patients met the criteria for inclusion in the final study sample. The surgical technique used was similar in all cases. The Torrington-Henderson scale and the Charlson scale were used to analyze comorbidities and to categorize patients into groups based on degree of risk for postoperative complications or death. RESULTS: The postoperative (30-day) mortality rate was 2.9%, and the postoperative complications index was 44%. Prolonged air leakage was the most common complication (in 20.6%). The univariate analysis revealed that gender, age, smoking, neoadjuvant therapy and diabetes all had a significant impact on the incidence of complications. The factors found to be predictive of complications were body mass index (23.8 +/- 4.4), forced expiratory volume in one second (74.1 +/- 24%) and the ratio between forced expiratory volume in one second and forced vital capacity (0.65 +/- 0.1). The scales employed proved efficacious in the identification of the risk groups, as well as in drawing correlations with morbidity and mortality (p = 0.001 and p < 0.001). In the multivariate analysis, body mass index and the Charlson index were found to be the principal determinants of complications. In addition, prolonged air leakage was found to be the principal factor involved in mortality (p = 0.01). CONCLUSION: Reductions in forced expiratory volume in one second, in the ratio between forced expiratory volume in one second and forced vital capacity, and in body mass index, as well as a Charlson score of 3 or 4 and a Torrington-Henderson score of 3, were associated with a greater number of postoperative complications in patients submitted to lobectomy for the treatment of bronchial carcinoma. Air leakage was found to be strongly associated with mortality.

Estudo comparativo dos fatores prognósticos entre os pacientes com maior e menor sobrevida em portadores de carcinoma broncogênico / Comparative study of prognostic factors among longer and shorter survival patients with bronchogenic carcinoma

Apesar dos avanços no tratamento, há pouca melhora na sobrevida dos pacientes com câncer do pulmão. Atualmente, é importante o conhecimento dos fatores que intervêm na sobrevida. Objetivos: Verificar possíveis diferenças de fatores prognósticos em duas populações de pacientes com câncer de pulmão, uma com pequena sobrevida (menos de seis meses) e outra com maior sobrevida (acima de 24 meses). Métodos: De 1997 a 1999 foram estudados 52 pacientes com diagnóstico histopatológico de carcinoma homogênico, sendo colhidos dados demográficos, clínicos, paramétricos, hábitos tabágicos, índice de Karnofsky, estadiamento da doença e dosagem laboratorial de desidrogenase lática, fosfatase alcalina, antígeno carcinoembrionário e cálcio. Resultados: 29 pacientes tiveram sobrevida menor do que seis meses e 23, superior a 24 meses. Os três fatores mais importantes que influenciaram o tempo curto de sobrevida foram baixo índice de Karnofsky inicial, redução do apetite e alto nível sérico de DHL. Conclusão: Os três componentes do prognóstico são o estado físico atual, o estado físico prévio e o estado atual da doença

Evaluación funcional del paciente para cirugía de resección pulmonar / Preoperative risk evaluation in patients undergoing lung resection

Objetivos: Analizar la información publicada sobre los factores que pueden incidir en la presentación de complicaciones en el postoperatorio de la cirugía de resección pulmonar. Lugar: Hospital Británico de Buenos Aires. Base de datos: Base electrónica Medline e información relevante publicada en la literatura médica. Estrategia de búsqueda: La resección quirúrgica es el procedimiento de elección para el tratamiento del carcinoma broncogénico de pulmón. Los pacientes con carcinoma de pulmón suelen presentar un deterioro concomitante de los aparatos respiratorio y cardiovascular. La resección de parénquima pulmonar puede precipitar complicaciones en el postoperatorio que, en muchos casos, terminan con la vida del paciente. La evaluación preoperatoria pretende determinar la capacidad del paciente de soportar la resección. Numerosos parámetros han sido postulados como factores de riesgo. En este trabajo se analizan los que se han manifestado como relevantes. Se propone un algoritmo de estudio y diagnóstico de operabilidad.

Evaluación funcional del paciente para cirugía de resección pulmonar / Preoperative risk evaluation in patients undergoing lung resection

Objetivos: Analizar la información publicada sobre los factores que pueden incidir en la presentación de complicaciones en el postoperatorio de la cirugía de resección pulmonar. Lugar: Hospital Británico de Buenos Aires. Base de datos: Base electrónica Medline e información relevante publicada en la literatura médica. Estrategia de búsqueda: La resección quirúrgica es el procedimiento de elección para el tratamiento del carcinoma broncogénico de pulmón. Los pacientes con carcinoma de pulmón suelen presentar un deterioro concomitante de los aparatos respiratorio y cardiovascular. La resección de parénquima pulmonar puede precipitar complicaciones en el postoperatorio que, en muchos casos, terminan con la vida del paciente. La evaluación preoperatoria pretende determinar la capacidad del paciente de soportar la resección. Numerosos parámetros han sido postulados como factores de riesgo. En este trabajo se analizan los que se han manifestado como relevantes. Se propone un algoritmo de estudio y diagnóstico de operabilidad. (AU)

[Evolution of resected bronchogenic carcinoma: 5-year survival. Our experience]. / Evolución del carcinoma broncogénico resecado: supervivencia a los 5 años. Nuestra experiencia.

To review the causes of non-small cell bronchogenic carcinoma treated surgically with the intention to cure, in order to determine and analyze the course of disease in our patients, particularly regarding survival after five years, and to compare our outcomes with those reported in the literature. Retrospective study of all patients resected in our unit from September 1984 through December 1990. We also analyze sex, age, and course of disease over a period of 60 months, emphasizing surgically related mortality, TNM stage, type of resection and tissue type. We calculated five year actuarial survival globally and for each variable studied, excluding patients who died as a result of surgery and those who were lost to follow-up. We identified 115 cases (13.62% of all patients under-going surgery during this period). Nine patients (7.82%) died after surgery. Six patients were lost to follow-up and for three patients data were incomplete. Fifty-three patients died within five years of surgery. Forty-four lived at least five years. Overall actuarial survival was 56.05%. Analyzing by TNM stages, 54.9% were stage I, 50% were stage II and 32.09% were stage IIIa. Pneumonectomy was performed on 43.59%, single or double lobectomy on 50.29%, and infralobar resection on 33.33% Histology revealed 54.56% to be epidermoid versus 33.01% for all other tissue types. The outcomes for bronchogenic carcinomas resected in our department are comparable to those in the literature, survival after five postoperative years being similar to the rate reported for other series.

Cáncer Broncogénico: Experiencia de Dos Años en el Hospital Universitario Ramón González Valencia de Bucaramanga / Bronchogenic Cancer: Two Years Experience at the Hospital Universitario Ramón González Valencia

El cáncer broncogénico es hoy en día la cuasa más frecuente de muerte por cáncer entre hombres (34 por ciento) y mujeres (22 por ciento). Hay factores de riesgo que contribuyen a esta enfermedad, siendo el tabaquismo el factor predisponente más importante para su desarrollo. Es de vital importancia reconocer tempranamente esta enfermedad, ya que es la única forma de disminuir la alta mortalidad de este tipo de tumores. En el presente trabajo se revisaron las historias clínicas de todos los pacientes con diagnóstico de cáncer broncogénico que fueron vistos en el Hospital Universitario Ramón González Valencia entre enero de 1995 y diciembre de 1996, correspondientes a pacientes con historia clínica que tenían datos histopatológicos concluyentes para cáncer broncogénico o datos clínicos, imagenológicos y citológicos altamente sugestivos de esta enfermedad. En los resultados obtenidos, se encontraron 95 pacientes registrados con diagnóstico de cáncer broncogénico, en donde sólo 47 tenían datos suficientes para ser inlcuidos en el estudio. El diagnóstico fue mas frecuente en hombres con 33 casos (70.2 por ciento) y 14 en mujeres (29.8) por ciento. Treinta pacientes (63.8 por ciento) tenían antecedentes de tabaquismo, siendo la mayoría (24 pacientes) fumadores de mas de 20 paquetes/año. Los síntomas mas frecuentes fueron tos (75 por ciento), disnea (75.5 por ciento) y pérdida de peso (64.4 por ciento) que se presentaron en 45 pacientes (97.5 por ciento). Los hallazgos radiológicos simples y escanográficos mostraron que el signo de masa pulmonar fue el mas frecuente con 22 (46.8 por ciento) y 19 casos (41.3 por ciento) respectivamente, seguido de adenopatías y derrame pleural. El tipo histológico más frecuentemente reportado fue el escamocelular (37.9 por ciento). La mayoría de tumores se diagnosticaron en estados avanzados III B y IV (92.5 por ciento). La conclusión más importante del estudio fue que en el momento de hacer un diagnóstico la gran mayoría de pacientes de pacientes presentaba estadíos avanzados, donde las probabilidades de intervención médico-quirúrgica para mejorar la sobrevida son prácticamente nulas

Bronchogenic cancer in patients under 40 years old. The experience of a Latin American country.

Lung cancer in young patients is increasing in frequency, as documented by data from the United States, Canada, Japan, and European countries. However, to date and to our knowledge, there have not been any reports from Latin America on this topic. The published reports show that lung cancer in young patients is associated with smoking habit and family history of lung cancer. Its clinical course seems to be more aggressive than in older patients and the histologic type is less often squamous type. We describe 48 patients, aged 40 years or younger, who were diagnosed as having lung cancer in the Instituto Nacional de Cancerología from 1980 to 1990. The patients were equally divided between men and women. Smoking was documented for only 46 percent of the cases. The histologic type most frequently diagnosed was adenocarcinoma (N = 26) followed by squamous cell carcinoma (N = 12). Almost all the cases (46 cases) were staged IV according to the TNM classification. A group of 33 patients older than 40 years (56 to 82 years) were used for comparison. The differences in sex ratio that were higher for men in the elder (m/f, 2.7:1) were family history for cancer in six patients elder; positive smoking habit in all the aged patients (100 percent) compared with only 43.7 percent in the younger group; histologic type (26 adenocarcinomas and 4 squamous in the younger compared with 14 and 12, respectively, in the elder).

Carcinoma broncogénico: estudio patológico clínico de 102 casos

Se revisan los conceptos fundamentales del carcinoma broncogénico desde el punto de vista clínico patológico. Se estudia el comportamiento de los diversos tipos histológicos del carcinoma pulmonar en 102 casos diagnosticados en el Hospital General Universitario Santa Sofía, Manizales, Caldas, Colombia.