Jesús Hernández

Estudio multicéntrico epidemiológico-clínico de cáncer de pulmón en España (estudio EpicliCP-2003)

Objetivo La mortalidad por cancer de pulmon en Espana aumenta ininterrumpidamente. El objetivo del presente estudio ha sido conocer su incidencia hospitalaria, asi como otros datos de manejo clinico, en varias regiones espanolas. Material y metodos Se ha realizado un estudio prospective observacional de los pacientes diagnosticados de cancer de pulmon en 2003 en 13 centros de 9 comunidades autonomas. Se evaluaron variables epidemiologicas, clinicas, diagnosticas y terapeuticas. Resultados Se han registrado 1.064 varones y 125 mujeres correspondientes a una poblacion total de 2.726.601 habitantes (1.346.483 varones y 1.380.118 mujeres). Las tasas estandarizadas segun poblacion 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% tenia mas de 70 anos. El 97,5% de los varones y el 32% de las mujeres eran fumadores o ex fumadores. Se obtuvo confirmacion citohistologica en el 93,1% de los casos (un 20,8% microciticos y un 79,2% no microciticos). Los sintomas iniciales predominantes fueron tos, dolor toracico y perdida de peso. En el 13,7% el diagnostico se sospecho solo por anormalidad radiologica. La proporcion de estadios TNM clinicos I y II vario entre el 6,3 y el 26,9%. El estadio IV fue el mas comun en todos los centros. La tasa de intervenciones vario entre el 2,5 y el 20,6%; el promedio fue del 14,8% (un 19,9% del total de no microciticos). El 27,0% solo recibio medidas paliativas. Conclusiones Entre los casos de cancer de pulmon aumenta la proporcion de mujeres con respecto a estudios previos, con notables diferencias interregionales. Pese a las mejoras diagnosticas, la tasa de intervenciones, muy variable entre diferentes centros, es muy baja.

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

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.

Normativa sobre el manejo del nódulo pulmonar solitario

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.

The EpicliCP-2003 Study: a Multicenter Epidemiological and Clinical Study of Lung Cancer in Spain

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.

El neumólogo y su paciente tras la decisión del comité de cáncer de pulmón

The role of the pulmonologist in the different stages of diagnosis and staging of lung cancer (LC) in routine clinical practice is well recognized. Clinical data and endoscopic tests provide essential technical information that allows multidisciplinary tumor committees to evaluate the individual situation of each patient. Furthermore, knowledge of the more personal aspects of the patient’s socio-cultural views and their opinions on the various treatment alternatives, etc., in the context of a disease that often challenges one’s perception of life, creates an important bond between the patient and the pulmonologist: the patient comes to consider us as their physician of reference, while we get to know them as an individual person. Is it reasonable, then, that after the committee meeting, at such a transcendental point in that person’s life, we lose all contact with our patient? Are we prepared to maintain the relationship? The contact does continue in some situations. For example, we are responsible for the management of complications from the various treatments or earlier comorbidities. However, we need to reflect more deeply on how to maintain the ties and commitments that we have established with our patients. Our first task after receiving the personalized evaluation of the tumor committee will be to explain the advised course of treatment to our patient. The information to be transmitted is particularly sensitive for individuals with more advanced disease or whose physical conditions do not meet the required criteria for curative treatment. During this visit, we must transmit the specific, up-to-date technical details appropriate to the situation in an appropriately personal manner. Therapeutic advances are occurring very rapidly in different fields, sometimes leading to some degree of disorientation; in this case, the updated information offered by the websites of highly prestigious organizations can be of particular help.1,2 For patients who are candidates for chemotherapy, this may be the time to highlight the potential benefits, which may offer some hope. We should remember that currently about 50% of patients with a diagnosis of advanced non-small cell LC may be suitable candidates for some of

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OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

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OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

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OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

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OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.