Cribado de cáncer de pulmón: Supervivencia en un amplio programa de detección precoz en España (I-ELCAP) / Lung Cancer Screening: Survival in an Extensive Early Detection Program in Spain (I-ELCAP)

Introducción y objetivo: El cáncer de pulmón (CP) se diagnostica habitualmente en estadios avanzados con una supervivencia media a cinco años del 12%. Ensayos como el National Lung Screening Trial (NLST) y el NEderlands Leuvens longkanker Screenings ONderzoek (NELSON) demuestran una reducción de la mortalidad que justifican la implantación del cribado en población de riesgo. Nuestro objetivo es presentar los resultados de supervivencia del programa de cribado de CP más amplio de España con tomografía computarizada de baja dosis (TCBD). Métodos: Se analizaron los datos del programa Internacional de Detección Precoz de CP (IELCAP) en Valencia, España. Este programa reclutó fumadores o exfumadores con una edad entre 40- 80 años. Se comparan los resultados con otros programas de similar tamaño. Resultados: Un total de 8.278 participantes fueron reclutados con al menos dos rondas de seguimiento, hasta noviembre de 2020 (62,8% varones), realizando una media de seis rondas de cribado por individuo. Diagnosticamos 239 tumores en 12 años de seguimiento. El adenocarcinoma fue el tumor más frecuente con un 61,3% en estadio I. Las tasas de prevalencia e incidencia fueron de 1,5% y 1,4%, respectivamente, con una tasa de detección anual de 0,17. Las tasas de supervivencia cáncer específica a cinco años fueron del 90 y del 80,1% a 10 años. La adherencia fue de 96,84%. Conclusión: La experiencia del programa más amplio de España demuestra que la supervivencia se mejora cuando se realiza en equipos multidisciplinares con experiencia en CP y es similar a programas similares. (AU)

Introduction: Lung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). Methods: Clinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs. Results: A total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. Conclusion: Largest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs. (AU)

[Translated article] Lung Cancer Screening: Survival in an Extensive Early Detection Program in Spain (I-ELCAP) / Cribado de cáncer de pulmón: supervivencia en un amplio programa de detección precoz en España (I-ELCAP)

Introduction: Lung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). Methods: Clinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs. Results: A total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. Conclusion: Largest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs. (AU)

Introducción y objetivo: El cáncer de pulmón (CP) se diagnostica habitualmente en estadios avanzados con una supervivencia media a cinco años del 12%. Ensayos como el National Lung Screening Trial (NLST) y el NEderlands Leuvens longkanker Screenings ONderzoek (NELSON) demuestran una reducción de la mortalidad que justifican la implantación del cribado en población de riesgo. Nuestro objetivo es presentar los resultados de supervivencia del programa de cribado de CP más amplio de España con tomografía computarizada de baja dosis (TCBD). Métodos: Se analizaron los datos del programa Internacional de Detección Precoz de CP (IELCAP) en Valencia, España. Este programa reclutó fumadores o exfumadores con una edad entre 40- 80 años. Se comparan los resultados con otros programas de similar tamaño. Resultados: Un total de 8.278 participantes fueron reclutados con al menos dos rondas de seguimiento, hasta noviembre de 2020 (62,8% varones), realizando una media de seis rondas de cribado por individuo. Diagnosticamos 239 tumores en 12 años de seguimiento. El adenocarcinoma fue el tumor más frecuente con un 61,3% en estadio I. Las tasas de prevalencia e incidencia fueron de 1,5% y 1,4%, respectivamente, con una tasa de detección anual de 0,17. Las tasas de supervivencia cáncer específica a cinco años fueron del 90 y del 80,1% a 10 años. La adherencia fue de 96,84%. Conclusión: La experiencia del programa más amplio de España demuestra que la supervivencia se mejora cuando se realiza en equipos multidisciplinares con experiencia en CP y es similar a programas similares. (AU)

Lung Cancer Screening: Survival in an Extensive Early Detection Program in Spain (I-ELCAP). / Cribado de cáncer de pulmón: Supervivencia en un amplio programa de detección precoz en España (I-ELCAP).

INTRODUCTION: Lung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). METHODS: Clinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs. RESULTS: A total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. CONCLUSION: Largest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs.

Diagnóstico precoz del cáncer de pulmón: utilidad de la tomografía computarizada de baja dosis de radiación / Lung Cancer Screening: Use of Low-Dose Computed Tomography

Introducción: El pronóstico del cáncer de pulmón (CP) está relacionado directamente con el estadio de la enfermedad al diagnóstico. Material y métodos: Realizamos TC de baja dosis (TCBD) a personas asintomáticas ≥ 50 años, fumadores o exfumadores de ≥ 10 paquetes-año, sin antecedentes oncológicos. Seguimos un algoritmo de evaluación según el tamaño y la morfología de los nódulos. En los CP diagnosticados se estableció el tratamiento adecuado y el seguimiento fue de 5 años. Resultados: Estudiamos 4.951 personas (65,4% varones) con una media de edad de 56,89 ± 5,26 años; 550 presentaron nódulos. De 3.891 nódulos detectados, 692 (19,57%) fueron considerados positivos, hallando 38 tumores (36 CP). En el estudio anual, 224 sujetos mostraban algún nódulo, siendo 288 (7,91%) positivos (13 CP). En el 80% el control se realizó con TCBD y se indicó biopsia en el 5,8% (basal) y 7,6% (anual) de los nódulos positivos. La prevalencia fue del 0,89 y la incidencia del 0,1%. La sensibilidad, la especificidad, el VPP y el VPN en el estudio basal fueron del 92,31, del 89,54, del 6,55 y del 99,93%, respectivamente, y en el anual, del 76,92, del 95,7, del 4,52 y del 99,94%, respectivamente. Se detectaron 52 tumores (49 CP), 25 (52,08%) en estadio I. La supervivencia global de los CP fue del 58,5% a los 5 años, y la supervivencia cáncer específica, del 67,1% (75,8% en los pacientes quirúrgicos). Conclusiones: La TCBD integrada en un programa elaborado de detección y evaluación de nódulos es una herramienta útil para diagnosticar CP en estadio precoz

Introduction: The prognosis of lung cancer (LC) correlates directly with the stage of the disease at the time of diagnosis. Material and methods: We performed low-dose CT (LDCT) in asymptomatic individuals ≥ 50 years old, smokers or former smokers of ≥ 10 pack-years, with no history of cancer. We followed an evaluation algorithm, according to the size and morphology of the nodules. The appropriate treatment for the LC diagnosis was given and patients were followed up for 5 years. Results: We studied 4,951 individuals (65.4% males) with an average age of 56.89 ± 5.26 years; 550 presented nodules. Of the 3,891 nodules detected, 692 (19.57%) were considered positive, and 38 tumors (36 LC) were identified. In the annual follow-up, nodules were found in 224 subjects, 288 (7.91%) of which were positive (13 LC). In 80%, the study was performed with LDCT, and biopsy was indicated in 5.8% (baseline) and in 7.6% (annual) of the positive nodules. Prevalence was 0.89 and incidence was 0.1%. The sensitivity, specificity, PPV and NPV in the baseline study were 92.31, 89.54, 6.55 and 99.93%, respectively, and in the annual study, they were 76.92, 95.7, 4.52 and 99.94%, respectively. A total of 52 tumors were detected (49 LC), 25 (52.08%) in stage I. The 5-year overall survival rate for LC was 58.5% and cancer-specific survival was 67.1% (75.8% in surgical patients). Conclusion: LDCT integrated into an elaborate nodule detection and evaluation program is a useful tool for diagnosing early-stage LC

Lung Cancer Screening: Use of Low-Dose Computed Tomography. / Diagnóstico precoz del cáncer de pulmón: utilidad de la tomografía computarizada de baja dosis de radiación.

INTRODUCTION: The prognosis of lung cancer (LC) correlates directly with the stage of the disease at the time of diagnosis. MATERIAL AND METHODS: We performed low-dose CT (LDCT) in asymptomatic individuals ≥50years old, smokers or former smokers of ≥10 pack-years, with no history of cancer. We followed an evaluation algorithm, according to the size and morphology of the nodules. The appropriate treatment for the LC diagnosis was given and patients were followed up for 5years. RESULTS: We studied 4,951 individuals (65.4% males) with an average age of 56.89±5.26years; 550 presented nodules. Of the 3,891 nodules detected, 692 (19.57%) were considered positive, and 38 tumors (36LC) were identified. In the annual follow-up, nodules were found in 224 subjects, 288 (7.91%) of which were positive (13LC). In 80%, the study was performed with LDCT, and biopsy was indicated in 5.8% (baseline) and in 7.6% (annual) of the positive nodules. Prevalence was 0.89 and incidence was 0.1%. The sensitivity, specificity, PPV and NPV in the baseline study were 92.31, 89.54, 6.55 and 99.93%, respectively, and in the annual study, they were 76.92, 95.7, 4.52 and 99.94%, respectively. A total of 52 tumors were detected (49LC), 25 (52.08%) in stageI. The 5-year overall survival rate for LC was 58.5% and cancer-specific survival was 67.1% (75.8% in surgical patients). CONCLUSION: LDCT integrated into an elaborate nodule detection and evaluation program is a useful tool for diagnosing early-stage LC.

Factores pronóstico en el carcinoma bronquial no microcítico menor de 3 centímetros (análisis actuarial, incidencia acumulativa y grupos de riesgo) / Prognostic factors in non-small cell lung cancer less than 3 centimeters: actuarial analysis, accumulative incidence and risk groups

Introducción: En la clasificación TNM, los factores determinantes del factor T en el carcinoma pulmonar no microcítico apenas han variado con el tiempo y todavía se basan únicamente en características anatómicas. Nuestro objetivo fue estudiar la influencia en la supervivencia de estos y otros factores de tipo morfopatológico. Métodos: Se incluyeron 263 pacientes sometidos a resección pulmonar por carcinoma pulmonar no microcítico en estadio I patológico y diámetro ≤ 3 cm. Se realizó un estudio de supervivencia y de estimación del riesgo competitivo observando variables clínicas, quirúrgicas y patológicas, siguiendo los métodos de análisis actuarial y de incidencia acumulativa, respectivamente. Posteriormente, se creó un modelo de riesgo de acuerdo con los resultados. Resultados: La supervivencia fue de 79,8 y 74,3% a los 5 y 10 años, respectivamente. Los factores con mejor pronóstico, estadísticamente significativo según el método actuarial fueron: presencia de síntomas, hábito tabáquico, FEV1 > 60%, número de ganglios resecados > 7, tipo histológico escamoso, ausencia de invasión vascular, ausencia de invasión pleural visceral y presencia de invasión bronquial lobar proximal. La edad < 50 años rozó la significación estadística. En el análisis multivariante entraron en regresión la invasión pleural visceral y la invasión vascular. El estudio de riesgo competitivo mostró una probabilidad de muerte por cáncer de 14,3 y 35,1% en 5 y 10 años, respectivamente. Las variables significativas en los análisis univariante y multivariante fueron similares excepto el FEV1 > 60%. Conclusiones: La presencia de invasión pleural visceral y la invasión vascular determina la supervivencia o el riesgo de muerte por carcinoma pulmonar no microcítico ≤ 3 cm y permiten elaborar un modelo predictivo de riesgo

Introduction: In TNM classification, factors determining the tumor (T) component in non-small cell lung cancer have scarcely changed over time and are still based solely on anatomical features. Our objective was to study the influence of these and other morphopathological factors on survival. Methods: A total of 263 patients undergoing lung resection due to stage I non-small cell lung cancer ≤ 3 cm in diameter were studied. A survival analysis and competing-risk estimate study was made on the basis of clinical, surgical and pathological variables using actuarial analysis and accumulative incidence methods, respectively. A risk model was then generated from the results Results: Survival at 5 and 10 years was 79.8 and 74.3%, respectively. The best prognostic factors were presence of symptoms, smoking habit and FEV1 > 60%, number of resected nodes > 7, squamous histology, absence of vascular invasion, absence of visceral pleural invasion and presence of invasion more proximal than the lobar bronchus. All these were statistically significant according to the actuarial method. The factor 'age < 50 years' was close to the margin of statistical significance. Pleural invasion and vascular invasion were entered in the multivariate analysis. The competing-risk analysis showed a probability of death due to cancer of 14.3 and 35.1% at 5 and 10 years, respectively. Significant variables in the univariate and multivariate analyses were similar, with the exception of FEV1 > 60%. Conclusions: Pleural invasion and vascular invasion determine survival or risk of death due to non-small cell lung cancer ≤ 3 cm and can be used for generating a predictive risk model

Giant primary mediastinal liposarcoma: A rare cause of atrial flutter.

We report the case of a 68-year-old man who presented with atrial flutter and was observed radiologically to have a large mass in the posterior mediastinum. During surgical removal, spontaneous recovery of sinus rhythm occurred. There was no late recurrence of arrhythmia. The diagnosis was mediastinal liposarcoma of mixed type (extremely rare). Supraventricular arrhythmia associated with mediastinal tumors is exceptional. Surgery appears to be the only potentially curative treatment for these tumors. In cases like ours presenting with arrhythmia, surgery is considered essential for control of the arrhythmia.

Prognostic Factors in Non-Small Cell Lung Cancer Less Than 3 Centimeters: Actuarial Analysis, Accumulative Incidence and Risk Groups.

INTRODUCTION: In TNM classification, factors determining the tumor (T) component in non-small cell lung cancer have scarcely changed over time and are still based solely on anatomical features. Our objective was to study the influence of these and other morphopathological factors on survival. METHODS: A total of 263 patients undergoing lung resection due to stage I non-small cell lung cancer ≤3cm in diameter were studied. A survival analysis and competing-risk estimate study was made on the basis of clinical, surgical and pathological variables using actuarial analysis and accumulative incidence methods, respectively. A risk model was then generated from the results. RESULTS: Survival at 5 and 10 years was 79.8 and 74.3%, respectively. The best prognostic factors were presence of symptoms, smoking habit and FEV1>60%, number of resected nodes>7, squamous histology, absence of vascular invasion, absence of visceral pleural invasion and presence of invasion more proximal than the lobar bronchus. All these were statistically significant according to the actuarial method. The factor "age<50 years" was close to the margin of statistical significance. Pleural invasion and vascular invasion were entered in the multivariate analysis. The competing-risk analysis showed a probability of death due to cancer of 14.3 and 35.1% at 5 and 10 years, respectively. Significant variables in the univariate and multivariate analyses were similar, with the exception of FEV1>60%. CONCLUSIONS: Pleural invasion and vascular invasion determine survival or risk of death due to non-small cell lung cancer ≤3cm and can be used for generating a predictive risk model.

Carcinoide tímico asociado a síndrome de neoplasia endocrina múltiple tipo I / Thymic Carcinoid Associated With Multiple Endocrine Neoplasia Syndrome Type I

Los carcinoides tímicos son una entidad poco frecuente que puede asociarse a enfermedades endocrinológicas como el síndrome de Cushing o el síndrome de neoplasia endocrina múltiple tipo I (MEN1). Suponen el 4% de los tumores del mediastino anterior y se caracterizan por tener un comportamiento muy agresivo. Presentamos el caso de un paciente diagnosticado de síndrome MEN1 a quien durante el seguimiento de su enfermedad se detectó una imagen torácica compatible con carcinoide tímico. Tras intervenirle quirúrgicamente mediante timectomía ampliada a grasa peritímica, se confirmó el diagnóstico clínico. A los 14 meses de seguimiento se halló en las pruebas de imagen una lesión sospechosa de recidiva local, motivo por el que fue reintervenido. El informe anatomopatológico de dicha intervención fue de fibrosis rádica. Así mismo, presentamos una revisión del manejo diagnóstico y terapéutico actual en pacientes con síndrome MEN1 diagnosticados de carcinoide tímico(AU)

Thymic carcinoids are a rare entity that may be associated with endocrine diseases like Cushing's syndrome or multiple endocrine neoplasia syndrome type I (MEN1). These tumors represent 4% of anterior mediastinal tumors and are characterized by their very aggressive behavior. We present the case of a patient with a previous MEN 1 diagnosis in whom, during the follow up of his disease, a thoracic image compatible with thymic carcinoid was detected. After an extended thymectomy that included peri-thymic fat resection, the clinical diagnosis was confirmed. A follow-up examination 14 months later revealed a suspicious lesion that suggested local recurrence, therefore the patient was reoperated on. The pathology report of this surgery indicated post-radiation fibrosis. Likewise, we present a review of the current diagnostic and therapeutic management of patients with MEN1 syndrome who are diagnosed with thymic carcinoid(AU)

Thymic carcinoid associated with multiple endocrine neoplasia syndrome type I.

Thymic carcinoids are a rare entity that may be associated with endocrine diseases like Cushing's syndrome or multiple endocrine neoplasia syndrome type I (MEN1). These tumors represent 4% of anterior mediastinal tumors and are characterized by their very aggressive behavior. We present the case of a patient with a previous MEN 1 diagnosis in whom, during the follow up of his disease, a thoracic image compatible with thymic carcinoid was detected. After an extended thymectomy that included peri-thymic fat resection, the clinical diagnosis was confirmed. A follow up examination 14 months later revealed a suspicious lesion that suggested local recurrence, therefore the patient was reoperated on. The pathology report of this surgery indicated post-radiation fibrosis. Likewise, we present a review of the current diagnostic and therapeutic management of patients with MEN1 syndrome who are diagnosed with thymic carcinoid.