Impact of Pleural Lavage Cytology Positivity on Early Recurrence After Surgery for Non-Small Cell Lung Cancer / Impacto de la positividad de la citología del lavado pleural en la recurrencia temprana después de la cirugía por cáncer de pulmón de células no pequeñas

Objective: The aim of this study was to elucidate the impact of pleural lavage cytology positivity on early recurrence in patients operated on non-small cell lung cancer (NSCLC). Methods: This is a multicentre prospective cohort study of 684 patients undergoing an anatomical lung resection for NSCLC between October 2015 and October 2017 at 12 national centres. A pleural lavage was performed before and after lung resection. The association between the different predictors of early recurrence and PLC positivity was performed using univariate and multivariate logistic regression models. A propensity score analysis was performed by inverse probability weighting (IPSW) using average treatment effect (ATE) estimation to analyse the impact of PLC positivity on early recurrence. Results: Overall PLC positivity was observed in 15 patients (2.2%). After two years, 193 patients (28.2%) relapsed, 182 (27.2%) with a negative PLC and 11 (73.3%) with a positive PLC (p<0.001). Factors associated to early recurrence were adenocarcinoma histology (OR=1.59, 95%CI 1.06–2.38, p=0.025), visceral pleural invasion (OR=1.59, 95%CI 1.04–2.4, p=0.03), lymph node involvement (OR=1.84, 95%CI 1.14–2.96, p=0.013), advanced pathological stage (OR=2.12, 95%CI 1.27–3.54, p=0.004) and PLC positivity (OR=4.14, 95%CI 1.25–16.36, p=0.028). After IPSW, PLC positivity was associated with an increased risk of early recurrence (OR=3.46, 95%CI 2.25–5.36, p<0.001). Conclusions: Positive pleural lavage cytology was found to be the strongest predictor of early recurrence.(AU)

Impact of Pleural Lavage Cytology Positivity on Early Recurrence After Surgery for Non-Small Cell Lung Cancer.

OBJECTIVE: The aim of this study was to elucidate the impact of pleural lavage cytology positivity on early recurrence in patients operated on non-small cell lung cancer (NSCLC). METHODS: This is a multicentre prospective cohort study of 684 patients undergoing an anatomical lung resection for NSCLC between October 2015 and October 2017 at 12 national centres. A pleural lavage was performed before and after lung resection. The association between the different predictors of early recurrence and PLC positivity was performed using univariate and multivariate logistic regression models. A propensity score analysis was performed by inverse probability weighting (IPSW) using average treatment effect (ATE) estimation to analyse the impact of PLC positivity on early recurrence. RESULTS: Overall PLC positivity was observed in 15 patients (2.2%). After two years, 193 patients (28.2%) relapsed, 182 (27.2%) with a negative PLC and 11 (73.3%) with a positive PLC (p<0.001). Factors associated to early recurrence were adenocarcinoma histology (OR=1.59, 95%CI 1.06-2.38, p=0.025), visceral pleural invasion (OR=1.59, 95%CI 1.04-2.4, p=0.03), lymph node involvement (OR=1.84, 95%CI 1.14-2.96, p=0.013), advanced pathological stage (OR=2.12, 95%CI 1.27-3.54, p=0.004) and PLC positivity (OR=4.14, 95%CI 1.25-16.36, p=0.028). After IPSW, PLC positivity was associated with an increased risk of early recurrence (OR=3.46, 95%CI 2.25-5.36, p<0.001). CONCLUSIONS: Positive pleural lavage cytology was found to be the strongest predictor of early recurrence.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didn't find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. / Seudotumor inflamatorio y tumor miofibroblástico inflamatorio. Criterios diagnósticos y diferencias pronósticas.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didnt find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

Torsión lobar superior izquierda tras una lobectomía inferior videoasistida / Left upper lobar torsion after video-assisted thoracoscopic lower lobectomy

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Effect of delays on survival in patients with lung cancer.

BACKGROUND: The effect on survival of delays in the consultation, diagnostic and treatment processes of lung cancer (LC) is still under debate. The objective of our study was to analyse these time delays and their possible effect on survival. METHODS: A retrospective study has been performed on all patients in our health area diagnosed with LC (confirmed by cytohistology) over 3 years. The delay in specialist consultation (time between start of symptoms and the first consultation with a specialist), hospital delay (time between first consultation and start of treatment) and overall delay (the sum of the previous two delays) were analysed. The influence of each of these delays was calculated using Cox regression, adjusted for other factors. RESULTS: A total of 415 patients were included. Of these, 92.5% were male and 75.4% were in stages III-B or IV. The overall delay gave a mean of 123.6 days, the delay in consulting a specialist 82.1 days and the delay in hospitalisation was 41.4 days. A greater overall delay or greater hospital delay was associated with longer survival. No relationship was observed between the specialist consultation delay and survival. CONCLUSIONS: Globally analysing all the cases and all the stages with LC, it is seen that longer delays are associated with longer survival. This probably reflects the fact that patients with more symptoms are treated more rapidly.

Platelet count: association with prognosis in lung cancer.

Lung cancer (LC) is now the leading cause of cancer mortality in the world, therefore it would be useful to identify prognostic factors to determine patient outcome. The objective of this study is to evaluate the usefulness of platelet counts at the time of diagnosis as a prognostic factor. A retrospective study of patients with histological diagnostic evidence of LC was carried in our catchment area over a 3-year period. Survival adjusted for other factors was assessed according to the platelet count at the time of diagnosis. Patients with platelet levels within the reference range (RR) (135000-381000/microl) were divided into two groups, between 135000-258000/microl and 258000-381000/microl. A third group was made up of patients with platelet counts over 381000/microl. Adjusted survival was analysed using Cox regression models. Patients with high platelets have a 37% worse survival than those with a platelet level within the RR, but lower than 258000/microl. When tumour stage is included in the covariates, platelet levels are no longer an independent survival factor. In conclusion, platelet levels at the time of diagnosis could be a useful prognostic factor in LC.

[Impact of hemoglobin level on lung cancer survival]. / Efecto del valor de la hemoglobina en la supervivencia del cáncer de pulmón.

BACKGROUND AND OBJECTIVE: Anemia is commonly observed in lung cancer (LC). Hemoglobin levels at the time of diagnosis could be considered a prognostic indicator in patients with LC. The aim of this trial was to analyze hemoglobin levels at the time of diagnosis as a prognostic factor in patients with LC. PATIENTS AND METHOD: We retrospectively examined all patients with LC (cytologically or histologically confirmed) diagnosed in our health area for a period of 3 years. Correlation between hemoglobin levels and survival was assessed. All patients were divided into 2 groups: patients with low hemoglobin levels (lower than percentile 25 of the distribution), and patients who exceeded that figure. By means of Cox's regression, the influence of hemoglobin levels in survival was calculated and adjusted to other factors. RESULTS: 421 patients were included, 52.2% of them presented anemia at the time of diagnosis. Mean age was 65.8 years and 92.7% were male. The group of patients with hemoglobin levels lower than percentile 25 had a survival rate that was 41% inferior. CONCLUSIONS: Low hemoglobin levels are associated with decreased survival in patients with LC. The evaluation of this parameter could be used for a more accurate prognosis in LC and a better adequacy of therapeutic indications.

Efecto del valor de la hemoglobina en la supervivencia del cáncer de pulmón / Impact of hemoglobin level on lung cancer survival

FUNDAMENTO Y OBJETIVO: La anemia es un hallazgo frecuente en pacientes con cáncer de pulmón(CP). Los valores de hemoglobina en el momento del diagnóstico del CP podrían permitirnosuna más precisa clasificación pronóstica inicial de estos pacientes. El objetivo de nuestro estudioha sido analizar el valor de la hemoglobina en el momento del diagnóstico como factor pronósticoen pacientes con CP.PACIENTES Y MÉTODO: Se ha realizado un estudio retrospectivo de todos los pacientes diagnosticadosde CP (con confirmación citohistológica) durante 3 años en nuestra área sanitaria. Se evaluóla supervivencia en función de la hemoglobina en el momento del diagnóstico, ajustada porotros factores. Según el valor de hemoglobina, los pacientes se clasificaron en 2 grupos: unocon hemoglobina baja (< percentil 25 de la distribución) y otro con pacientes que superabanesta cifra. Mediante regresión de Cox se calculó la influencia en la supervivencia de la hemoglobina.RESULTADOS: Se incluyó finalmente a 421 pacientes, de los que el 52,3% presentaron anemia aldiagnóstico. La edad media fue de 65,8 años y el 92,7% fueron varones. Presentar una hemoglobinainferior al percentil 25 supone una posibilidad de supervivencia un 41% inferior.CONCLUSIONES: La hemoglobina baja se asocia con disminución de la supervivencia. La evaluaciónde este parámetro podría permitir una mayor precisión en el pronóstico del CP y una mejoradecuación de las indicaciones terapéuticas

BACKGROUND AND OBJECTIVE: Anemia is commonly observed in lung cancer (LC). Hemoglobin levelsat the time of diagnosis could be considered a prognostic indicator in patients with LC.The aim of this trial was to analyze hemoglobin levels at the time of diagnosis as a prognosticfactor in patients with LC.PATIENTS AND METHOD: We retrospectively examined all patients with LC (cytologically or histologicallyconfirmed) diagnosed in our health area for a period of 3 years. Correlation between hemoglobinlevels and survival was assessed. All patients were divided into 2 groups: patientswith low hemoglobin levels (lower than percentile 25 of the distribution), and patients who exceededthat figure. By means of Cox’s regression, the influence of hemoglobin levels in survivalwas calculated and adjusted to other factors.Results: 421 patients were included, 52.2% of them presented anemia at the time of diagnosis.Mean age was 65.8 years and 92.7% were male. The group of patients with hemoglobin levelslower than percentile 25 had a survival rate that was 41% inferior.CONCLUSIONS: Low hemoglobin levels are associated with decreased survival in patients with LC.The evaluation of this parameter could be used for a more accurate prognosis in LC and a betteradequacy of therapeutic indications

[Immunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura]. / Inmunohistoquímica y vías de abordaje en el tumor fibroso pleural.

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory.

Inmunohistoquímica y vías de abordaje en el tumor fibroso pleural / Inmunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura

El tumor fibroso pleural (TFP) es una neoplasia benigna poco frecuente, de crecimiento lento, que se origina a partir de las células submesoteliales de la pleura. Habitualmente, la resección del tumor y de las estructuras adyacentes, si están afectadas, suele ser suficiente para su resolución. Actualmente, la videotoracoscopia (VTC) permite un acceso adecuado para el tratamiento de estos tumores. La positividad para CD34 es un rasgo diferencial con el mesotelioma. Se presentan 15 casos de TFP (9 mujeres y 6 varones) intervenidos en nuestro servicio en los últimos 12 años (10 toracotomías, 1 esternotomía y 4 mediante VTC). Sólo 4 casos presentaron síntomas al diagnóstico. Se plantea la VTC como un método diagnóstico y terapéutico, menos invasivo que la toracotomía, que permite un abordaje adecuado para la resección del TFP, en casos seleccionados. El seguimiento a largo plazo es obligado, dado su potencial maligno (AU)

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory (AU)

Carcinoma insular de tiroides. Una neoplasia poco frecuente pero agresiva / Insular carcinoma of the thyroid. An uncommon but aggressive neoplasm

El carcinoma insular de tiroides es una entidad infrecuente, denominada así por Carcangiu et al, en 1984, cuando describió su característica anatomía patológica. Desde un punto de vista morfológico, y también clínico, se le considera en una posición intermedia entre el carcinoma diferenciado de tiroides, papilar o folicular, y el indiferenciado o anaplásico. No obstante, la mayoría de los autores lo consideran una entidad independiente y aparte. Su pronóstico es peor que el del carcinoma tiroideo clásico, y la mayoría de los autores recomienda un tratamiento enérgico, que en algunos casos puede proporcionar supervivencias prolongadas. Presentamos a 2 pacientes que, tras el tratamiento de un tumor primario, sufrieron recidiva, que fue tratada, pero con una evolución diferente (AU)

Insular carcinoma of the thyroid is an infrequent entity, named in 1984 by Carcangiu when he described its characteristic histology. Clinically and morphologically it is considered to be in an intermediate position between well-differen-tiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic carcinoma of the thyroid, and most authors advise aggressive therapy, which in some cases can achieved prolonged survival. We describe 2 patients who experienced recurrence after treatment for the primary tumor. The recurrences were treated but the clinical courses differed (AU)

[Thoracic surgery]. / Cirugía torácica.

Thirty-two patients with shock wave lesions to the chest who did not require invasive ventilatory support were treated. The Injury Severity Score (median 13), the pO2/FiO2 ratio (350) and lung injury severity (Murray score 1.25) were analyzed. Symptoms, mainly chest pain, depended on the severity of barotrauma and respiratory distress. All the lesions developed in the first 24 hours and most patients (75%) presented lung contusion. Although patients with lung contusion had greater intra- and extrathoracic comborbidity, differences in comparison with those without lung contusion were not significant, except in length of hospital stay (13 days vs 5.5 days; p = 0.008). Costal fractures were found in 12 patients (37%), mostly in the first 3 ribs and 60% of the patients had reduction of the upper thoracic contour (traumatic apical thoracoplasty). Outcomes were satisfactory with no mortality.

Cirugía Torácica / Thoracic Surgery

Nuestro servicio trató a 32 pacientes con traumatismo torácico por onda expansiva que no necesitaban soporte ventilatorio invasivo. Se analizan el Injury Severity Score (mediana de 13), la relación presión parcial de oxígeno/fracción inspiratoria de oxígeno (mediana de 350) y la gravedad de la lesión pulmonar observada (mediana de 1,25 en el índice de Murray). La clínica, dominada por el dolor torácico, dependió de la intensidad del barotrauma y del distrés respiratorio. Todas las lesiones aparecieron en las primeras 24 h y la mayoría de los pacientes (75%) presentaban contusión pulmonar. Aunque los pacientes con contusión pulmonar presentan mayor comorbilidad, intra y extratorácica, las diferencias no son significativas respecto a los que no la tienen, salvo en la estancia hospitalaria (13 frente a 5,5 días; p = 0,008). Aparecieron fracturas costales en 12 pacientes (37%), la mayoría en las 3 primeras costillas y en el 60% de los casos con disminución del contorno torácico superior (toracoplastia traumática apical). La evolución ha sido satisfactoria, sin mortalidad (AU)

Thirty-two patients with shock wave lesions to the chest who did not require invasive ventilatory support were treated. The Injury Severity Score (median 13), the pO2/FiO2 ratio (350) and lung injury severity (Murray score 1.25) were analyzed. Symptoms, mainly chest pain, depended on the severity of barotrauma and respiratory distress. All the lesions developed in the first 24 hours and most patients (75%) presented lung contusion. Although patients with lung contusion had greater intra- and extrathoracic comborbidity, differences in comparison with those without lung contusion were not significant, except in length of hospital stay (13 days vs 5.5 days; p = 0.008). Costal fractures were found in 12 patients (37%), mostly in the first 3 ribs and 60% of the patients had reduction of the upper thoracic contour (traumatic apical thoracoplasty). Outcomes were satisfactory with no mortality (AU)

[Insular carcinoma of the thyroid. An uncommon but aggressive neoplasm]. / Carcinoma insular de tiroides. Una neoplasia poco frecuente pero agresiva.

Insular carcinoma of the thyroid is an infrequent entity, named in 1984 by Carcangiu when he described its characteristic histology. Clinically and morphologically it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic carcinoma of the thyroid, and most authors advise aggressive therapy, which in some cases can achieved prolonged survival. We describe 2 patients who experienced recurrence after treatment for the primary tumor. The recurrences were treated but the clinical courses differed.