Composite anatomical-clinical-molecular prognostic model in non-small cell lung cancer.

The objective of the present study was to elaborate a survival model that integrates anatomic factors, according to the 2010 seventh edition of the tumour, node and metastasis (TNM) staging system, with clinical and molecular factors. Pathologic TNM descriptors (group A), clinical variables (group B), laboratory parameters (group C) and molecular markers (tissue microarrays; group D) were collected from 512 early-stage nonsmall cell lung cancer (NSCLC) patients with complete resection. A multivariate analysis stepped supervised learning classification algorithm was used. The prognostic performance by groups was: areas under the receiver operating characteristic curve (C-index): 0.67 (group A), 0.65 (Group B), 0.57 (group C) and 0.65 (group D). Considering all variables together selected for each of the four groups (integrated group) the C-index was 0.74 (95% CI 0.70-0.79), with statistically significant differences compared with each isolated group (from p = 0.006 to p < 0.001). Variables with the greatest prognostic discrimination were the presence of another ipsilobar nodule and tumour size > 3 cm, followed by other anatomical and clinical factors, and molecular expressions of phosphorylated mammalian target of rapamycin (phospho-mTOR), Ki67cell proliferation index and phosphorylated acetyl-coenzyme A carboxylase. This study on early-stage NSCLC shows the benefit from integrating pathological TNM, clinical and molecular factors into a composite prognostic model. The model of the integrated group classified patients with significantly higher accuracy compared to the TNM 2010 staging.

[Sequential double-lung transplantation. Technique and results in the first 3 cases. Pulmonary Transplant Group]. / Trasplante bipulmonar secuencial. Técnica y resultados de los tres primeros casos. Grupo de Trasplante Pulmonar.

Patients who suffer advanced lung disease associated to respiratory infection and who are candidates for transplantation must have both lungs replaced. Until recently, this procedure was accomplished by transplanting a heart-lung block, a procedure of questionable merit if the heart is healthy, or by carrying out a double-lung transplant requiring extracorporeal circulation and involving a high percentage of complications the tracheal anastomosis. The year 1990 saw publication of the first descriptions of a simpler procedure, sequential double-lung transplantation. After brief experience with good results in single-lung transplantation, we present the first three cases of sequential double-lung replacement carried out in Spain. We describe the consecutive substitution of both lungs, with no need for extracorporeal circulation in most cases. Sequential bilateral lung transplantation combines the advantages of single-lung transplantation with the use of anterior thoracoesternotomy to provide good access to both pleural cavities, facilitating the procedure when pleural adhesion is present.

[Spontaneous pneumothorax. Apropos 2507 cases]. / Neumotórax espontáneo. A propósito de 2.507 casos.

This retrospective study of 2,507 cases of spontaneous pneumothorax (SP) involves 1,873 patients treated at our hospital over nearly 20 years. Men represented 92.4% and most patients were between 16 and 30 years old (56.2%). Presenting more than one episode were 29.7%. The treatment of choice was placement of a pleural drain whenever SP had led to lung collapse amounting to more than 10% of volume. Thoracotomy was performed when the patient had experienced three or more episodes of SP; when a pleural drain had not resolved the condition 10 days after placement; in hemo-SP with severe hemorrhage; and in 2 cases in which SP was bilateral. A total of 419 thoracotomies were performed on 384 patients (20.7%). All episodes were resolved and complications were few. Six patients died (0.32%), three following thoracotomy. All of these had antecedents of chronic obstructive lung disease and all were over 70, excepting one who was 56.